The effect of breast shielding during lumbar spine radiography

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Background. The aim of the study was to determine the influence of lead shielding on the dose to female breasts in conventional x-ray lumbar spine imaging. The correlation between the body mass index and the dose received by the breast was also investigated.

Materials and methods. Breast surface dose was measured by thermoluminescent dosimeters (TLD). In the first phase measurements of breast dose with and without shielding from lumbar spine imaging in two projections were conducted on an anthropomorphic phantom. In the second stage measurements were performed on 100 female patients, randomly divided into two groups of 50, with breast shielding only used in one group.

Results. On average, breast exposure dose in lumbar spine imaging in both projections (anteroposterior (AP) and lateral) was found reduced by approximately 80% (p < 0,001) when shielding with 0.5 mm lead equivalent was used (from 0.45±0.25 mGy to 0.09±0.07 mGy on the right and from 0.26±0.14 mGy to 0.06±0.04 mGy on the left breast). No correlation between the body mass index (BMI) and the breast surface radiation dose was observed.

Conclusions. Although during the lumbar spine imaging breasts receive low-dose exposure even when shielding is not used, the dose can be reduced up to 80% by breast shielding with no influence on the image quality.

1. Valentin J, editor. The 2007 recommendations of the InternationalCommission on Radiological Protection. Orlando: Elsevier, published for the International Commission on Radiological Protection; 2007.

2. European Commission. European Guidelines on Quality Criteria forDiagnosticRadiographicImages(EUR16260EN). Luxembourg: OfficeforOfficial Publications of the European Communities; 2007.

3. Bontrager KL. Textbook of radiographic positioning and related anatomy. 3rd edition. St. Louis (etc.): Mosby Year Book; 1993. p. 243-65.

4. Swallow RA, Naylor E, eds. Clark’s positioning in radiography. 11th edition. London (etc.): Butterworth Heinemann; 1996. p. 166-73.

5. Lipovec V. Rentgenske slikovne metode in protokoli. Ljubljana: Visoka šola za zdravstvo; 2005. p. 257-80.

6. Frank ED, Long BW, Smith BJ. Merrill’s atlas of radiographic positioning& procedures. 11th edition. St. Louis: Mosby/Elsevier; 2007. p. 373-87, 424-35.

7. Fordham LA, Brown ED, Washburn D, Clark RL. Efficacy and feasibility of breast shielding during abdominal fluoroscopic examinations. Acad Radiol 1997; 4: 639-43.

8. Beaconsfield T, Nicholson R, Thornton A, Al-Kutoubi A. Would thyroid and breast shielding be beneficial in CT of the head? Eur Radiol 1998; 8: 664-7.

9. Brnić Z, Vekić B, Hebrang A, Anić P. Efficacy of breast shielding during CT of the head. Eur Radiol 2003; 13: 2436-40.

10. Hohl C, Mahnken AH, Klotz E, Das M, Stargardt A, Mühlenbruch G et al. Radiation dose reduction to the male gonads during MDCT: the effectiveness of a lead shield. Am J Roentgenol 2005; 184: 128-30.

11. Jackson G, Brennan PC. Radio-protective aprons during radiological examinations of the thorax: an optimum strategy. Radiat Prot Dosimetry 2006; 121: 391-94.

12. Clancy CL, O’Reilly G, Brennan PC, McEntee MF. The effect of patient shield position on gonad dose during lumbar spine radiography. Radiography 2010; 16: 131-5.

13. Botros M, Chang K, Miller R, Krishnan S, Iott M. Recurrent invasive lobular carcinoma presenting as a ruptured breast implant. Radiol Oncol 2012; 46: 23-7.

14. Marolt Mušič M, Hertl K, Kadivec M, Podkrajšek M, Jereb S. Rentgenska in ultrazvočna anatomija dojke. Radiol Oncol 2004; 38: S51-S7.

15. Foley SJ, McEntee MF, Achenbach S, Brennan PC, Rainford LS, Dodd JD. Breast Surface Radiation Dose During Coronary CT Angiography: Reduction by Breast displacement and Lead Shielding. Am J Roentgenol 2011; 197: 367-73.

16. Brennan PC, Madigan E. Lumbar spine radiology: Analysis of the posteroanterior projection. Eur Radiol 2000; 10: 1197-201.

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