The use of gonad shielding in paediatric hip and pelvis radiographs.

The problem of inaccurate placement of gonad shields in children has been highlighted by several publications nationally and internationally over the past decade and more. Here, we review the literature and present the results of a regional audit designed to assess the use and accuracy of placement of gonad shields for hip and pelvis radiographs in children. 100 consecutive anteroposterior hip or pelvis radiographs in patients under the age of 16 years were reviewed in each of 9 centres. We also included the most recent and all previously available relevant radiographs. A total of 2405 radiographs were reviewed with regard to the presence of a shield and to the accuracy of any shield placement with respect to gonad protection and visualization of orthopaedic landmarks. It is recommended that gonad shields are used in all follow-up paediatric pelvis radiographs. Our results show they were only used in 70% of such cases. When placed, only 38% of all shields were considered to be positioned accurately. For cases where shielding was indicated, an accurately placed shield was present in just 26% of radiographs. Formal written departmental guidelines for shield use were only available in two centres. We conclude that clear guidelines need to be formulated which, together with shield redesign, improved training and audit, should increase effective gonad protection for children.