208 CARE OF PATIENT IN DIAGNOSTIC RADIOGRAPHY

clearly an efficient means of reducing radiation (Lead rubber

dosage.
should not be used without a previous check to ensure that it will protect

against the primary beam.) In most abdominal X-ray examinations, if

the subject is a male, the scrotum may be shielded without likelihood of
obscuring features of diagnostic significance. However, if the patient is a
woman there are relatively few examinations involving irradiation of the
pelvis and abdomen in which shielding of the ovaries would not be detri
mental to the radiograph. In these circumstances it is necessary to rely on
other methods of protection.
In the case of a child, gonad shielding may be inadvisable in practice,
though theoretically possible. For example, in X-ray examinations made
to detect the presence of congenital dislocations of the hip, the area of
diagnostic importance is adjacent radiographically to both the testis and
the ovary but sufficiently removed from them to permit their shielding —
provided such protection can be accurately placed.
This will be recognized as a simple statement which covers
sundry
difficulties, the major one being that even if correctly
placed in the first
instance the appropriate lead shield is scarcely likely to remain at its post,
when the subject is an active child expressing uninhibited disapproval of
the entire procedure. The attempt to use such protection may well entail
a higher dose to the patient than would have been the case had a gonad
shield not been used in the first instance.
In some cases it would be desirable to protect the gonads for subsequent
examinations, though not for the initial survey. This is true, for example,
of accident cases involving the possibility of fractures of the pelvis.
Clinical indications may suggest a particular site of bone involvement,
but it is unwise to take radiographs only of a strictly localized area. In
this type of case the exploratory examination should be made reasonably
extensive. Later radiographs of a proven lesion are a different matter and
here only the immediate area should be included, unless there are definite
indications to the contrary.
There are in common use a number of devices which will protect the
gonads from radiation. These most usually take the form of a lead strip,
sometimes mounted on a T-shaped or triangular perspex base, which is
placed on the patient in an appropriate position over the thighs or lower
abdomen. A variant of this is essentially a mask placed at the X-ray beam's
exit port from the tube-head; this must operate in conjunction with a
light beam collimator or diaphragm which visually delineates on the
subject the area covered by the protector.