Research has long suggested that routine patient shielding during digital radiography provides negligible benefits to patients – and, in fact, that it presents substantial risks, as shielding can lead to patient motion or artifacts, thus necessitating repeat exams. For these reasons, the American Association of Physicists in Medicine (AAPM) as well as other professional societies have recommended that technologists should no longer routinely use patient shields.
Rigsby
"In October 2020, our institution implemented the recommendation of the AAPM and other professional societies to eliminate the routine use of patient shields for radiography," said Cynthia K. Rigsby, MD, pediatric radiologist and chair of medical imaging at Ann & Robert H. Lurie Children's Hospital of Chicago.
Dr. Rigsby and her fellow researcher, Jan Pachon, MS, medical physicist at Ann & Robert H. Lurie Children's Hospital of Chicago, conducted a study to assess how this change in practice impacted clinical repeat rates and speed of service of pediatric digital radiography at their institution.
The goal of this work was to determine whether risk of repeat exposures had significantly decreased without patient shields as hypothesized, and if implementing this practice had created delays in speed of service through questions related to shielding.
Discontinuing Routine Shielding and Gathering Data
Over the course of 19 months, the researchers documented clinical repeat rates (RRs) and reasons for repeating pediatric digital radiographs. Routine patient shielding was used for the first 12 months, but not for the last seven months.
To help facilitate this change, a public awareness campaign was created using social media, posters, flyers and other means to educate patients and staff about the rationale for discontinuing shielding.
The researchers documented shielding-related repeats as artifacts or patient motion whenever a shield negatively affected exam quality. They compared the RRs of these reasons for repeat radiographs with and without the use of routine shielding for pelvis and abdomen exams.
Dr. Rigsby and Pachon also assessed the time elapsed between the exam time stamped into the radiology information system and the time when the image became available on the picture archiving and communication system during the 12 months when patient shielding was routinely used and seven months after the discontinuation of patient shields.
Analyzing Results
The average RR of digital radiographs due to patient motion with routine shielding was 10.06% and 7.7% due to artifacts. After discontinuing shielding, the average patient motion-related RR was 7.43% and 5.84% from artifacts.
"We found the overall repeat rate without routine patient shielding to be significantly lower (p <0.05) than when shielding was routinely used," Pachon said. "This is particularly true for abdomen and pelvis exams where patient motion can cause the shield to move and obscure anatomy."
A comparison of repeat rate (RR) for abdomen and pelvis exams shows a decrease in motion related repeats of ~9% and ~1.8% for abdomen and pelvis exams, respectively, after the discontinuation of shielding. There were no statistical differences in artifact related repeat rate when shielding was not used (p>0.05).
The researchers found only negligible differences when they assessed speed of service before and after discontinuation of shielding.
"These results demonstrate that with a well-thought-out awareness campaign, an age-old practice can be changed, and quality and patient safety can be improved," Pachon said.
The poster presentation, "Impact of Patient Shielding Discontinuation on Repeat Rates and Speed of Service in Pediatric Digital Radiography," (PD05-A2) will take place on Thursday, Dec. 2 at 12:15 p.m. Visit the Learning Center or access the poster at Meeting.RSNA.org
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