Gonad shielding in pelvic radiography: modern optimised X-ray systems might allow its discontinuation

OBJECTIVE

As gonad shielding is currently under debate, this study evaluates the practice, from its introduction in about 1905 until today.

METHODS

The literature was searched for developments in shielding and insights into the effects of ionising radiation on gonads. Based on own pre-1927 dose reconstructions, reported doses after 1927, a 2015-report from the European Union and recent own measurements, the effects of technological evolution and optimisation on radiation dose and hereditary risk were assessed.

RESULTS

In the 1900s, gonad shielding was first applied to prevent male sterility, but was discontinued when instrumental developments led to reduced radiation doses. In the 1950s, concerns about hereditary risks intensified and gonad shielding was recommended again, becoming routine worldwide. Imaging-chain improvements over time were considerable: in 2018, the absorbed dose was 0.5% of its 1905 value for the testes and 2% for the ovaries, our optimised effective dose a factor five lower than the value corresponding to the current EU diagnostic reference level, and the reduction in detriment-adjusted risk by shielding less than 1 × 10-6 for women and 5 × 10-6 for men.

CONCLUSIONS

Assessment of pelvic doses revealed a large reduction in radiation risks facilitated by technological developments. Optimisation likewise contributed, but unfortunately, its potential was never adequately exploited. Today, using a modern and optimised X-ray system, gonad shielding can be safely discontinued for women. For men, there might be a marginal benefit, but potential negative side-effects may well dominate. Discontinuation of gonad shielding seems therefore justifiable.

The skin dose of pelvic radiographs since 1896

OBJECTIVES

To derive conversions of antiquated exposure data into modern equivalents and to apply these in the assessment of the skin dose of pelvic radiographs since 1896.

METHODS

The literature 1896-2018 was searched for implicit and explicit dose information. The early implicit dose data contained now obsolete descriptions of radiation quality and quantity for long since disappeared X-ray systems of limited efficiency. Converting the old information into modern specifications was achieved using contemporary data and computer simulations. Final dose calculations were done with modern software. Explicit radiation doses of later date reported in old quantities and units were adapted according to current recommendations.

RESULTS

For the period before 1927 conversion algorithms for spark gap data and penetrometer hardnesses to high voltage could be derived. Electrical and X-ray efficiencies of several old röntgen systems were determined. Together they allowed reconstruction of 53 doses. After 1927 doses were generally explicitly specified; 114 were retrieved. Although an enormous spread was observed, the average skin dose was reduced by a factor of about 400.

CONCLUSIONS

Antiquated exposure data were successfully used for dose reconstruction. Extreme dose variability was a constant. Efforts to cut down doses were effective as skin doses went down from sub-erythema values to about one milligray.

Early X-ray workers: an effort to assess their numbers, risk, and most common (skin) affliction

Objective

To assess quantitatively the number of early X-ray workers, their risk of becoming a radiation victim, and their most common radiation-induced (skin) disease.

Methods

Information on professional life and occupational disease was retrieved from the Ehrenbuch, a book of honour containing biographies of 404 radiation victims, as well as member and congress lists of the German and US radiological societies, obituaries, books, articles, and the Internet.

Results

The estimated numbers of X-ray users in a medical setting in the US increased from about 300 to 600 in 1900–1903, in Germany from about 700 to 1200 during 1905–1908. The risk for a beginning user eventually to die from radiation was 1–2 % in these years, but up to 10–25 % in 1896. Data on 198 victims of fatal radiation-induced skin disease were collected. The incidence of the various stages of skin afflictions with a fatal outcome was characterized by very wide distributions.

Conclusions

After 1896, the radiation risk decreased very fast at first and more slowly thereafter to nearly zero in 1935. Many victims became quite old, partly because of the slower progress of tissue reactions at lower radiation doses, partly because of the success of often multiple surgical interventions.

Main messages

US and German X-ray users amounted to several hundreds to thousand in 1900–1908.

The risk eventually to die from radiation was about 1–2 % during 1900–1908.

After 1896, this risk decreased from >10 % to nearly zero in 1935.

The incidence of subsequent stages of skin harm varied strongly in time.

X-ray victims could become quite old, dependent on radiation dose and surgery.

Electronic supplementary material

The online version of this article (doi:10.1007/s13244-015-0457-2) contains supplementary material, which is available to authorized users.

[Quality assurance in roentgen diagnosis. Comparison of constancy test methods according to DIN and IEC and practical consequences in Germany]

Since 1987 constancy tests for X-ray imaging equipment are required by the German Röntgenordinance and are performed according to the DIN 6868 standards. On an international level, standards for these tests have been developed by the IEC (International Electrotechnical Commission, IEC 1223 series); however, these standards have so far not been applied in nation-wide quality programmes in any country. Typical aspects of both, DIN and IEC standards, are demonstrated for direct radiography and indirect radioscopy and indirect radiography as examples. DIN standards optimise test procedures for minimum effort and cost efficiency designed for execution even in small hospitals and practices by the users. For each type of x-ray equipment tests are performed with only one universal test device, which is precisely specified and independent of local conditions. Oplimisation is misation is missing for IEC test procedures; they are designed for more performance characteristics and need for each x-ray equipment more individual test devices, which are mostly open for local choice and need a considerably higher effort in respect of time consumption and test films compared to DIN. Adoption of the IEC standards for the constancy tests in Germany would involve considerable financial and organisational effort which is probably not counterbalanced by an increased benefit.

[Image quality assurance in x-ray diagnostic units. Information on DIN 6868 standard series]

The Working Group for Standardisation justifies and comments on the establishment of a standard series for image quality assurance in X-ray diagnostic services (DIN 6868). In order to promote compliance with these standards, the users are given some background information on the structure of the standard series and on the recommended procedures to be followed. The definitions for the various hierarchically arranged tests, such as constancy test, status test, acceptance test as well as a definition for the term "base-line image quality" are explained.