(1) Gonadal shielding is a deeply entrenched practice. Most patients have an expectation that shielding will be used. Most technologists continue to train in shielding techniques at schools today.
(2) State regulatory bodies enforce regulations mandating the use of gonadal shielding
Overcoming the challenges listed above is daunting unless a team is equipped with some of the knowledge and resources below. These information has been developed, or is currently under development, by CARES.
The procedure to discontinue gonadal shielding will vary based on each facility. The two common elements are the need for education and communication tailored for the intended audience, such as technologists, patients and caregivers, clinicians, and hospital administrators.
- Ensure consistent messaging.
- Provide clear guidelines for staff, and technologists in particular, regarding the expected clinical practice
- Use multiple forms of communication to reach the intended audience such as seminars, printed information, departmental signage, and talking points.
- Create an open dialogue between health care professionals and patients to foster a sense of trust.
- Include key messages or talking points for healthcare professionals to use if a patient or family member asks for shielding to be used, including how deviations from the policy should be documented.
When creating a policy for healthcare professionals, it may be prudent for a technologist to provide gonadal shielding to a patient. Technologists should be given some flexibility with guidance from the facility’s policy.
(1) If a parent refuses to allow his or her child to have a medically indicated imaging study unless gonadal shielding is used, the best care for that patient may include gonadal shielding.
(2) If an extremity view is performed on the patient’s abdomen due to limitations in their range of motion.
Regulatory Communication Strategies
State regulations support expectations by both practitioners and patients/caregivers for general gonadal shielding. The CRCPD currently provides a Suggested State Regulation (SSR) stating that the gonadal region shall be shielded when in the primary x-ray beam except when it would interfere with the diagnostic procedure.
A review all of the State, District of Columbia, and New York City regulations found that at least 46 of 52 include the exception provided in the SSR.
While there is an expectation that states will no longer require gonadal shielding in the future, the process to codify and update regulations is lengthy. An alternative to changing a regulation may be for a state to universally apply an exception, or no longer enforce the regulations pertaining to gonadal shielding.
- FAQ for patients, caregivers and clinical staff [1 of 8 pages in Fig. 2]
- Library of Supporting Literature [Fig. 3 & Fig. 4]
- Example Policy Language [ Fig. 5 & Fig. 6 ]