Editorial Comment on: Prevalence of Protective Shielding Utilization for Radiation Dose Reduction in Adult Patients Undergoing Body Scanning Using Computed Tomography by Safiullah et al .

In the article by Safiullah and colleagues, the authors highlight an important oversight in many radiology departments, a lack of shielding during CT imaging. CT imaging is an essential component in the management of many urologic conditions including stone disease. In this questionnaire review, the authors have determined that only one-third of participating hospitals employed shielding during abdominal and pelvic CT imaging, and of these, none applied shielding of gonads for male patients despite clear evidence for its effectiveness (ref. 15). Certainly, as the authors point out, like many surveys, this study suffers from a modest complete response rate of 18%. However, it is possible that the centers that did respond were more concerned with shielding and subsequently more likely to employ shielding. Therefore, it is possible that the true percentage of U.S. hospitals employing routine shielding for CT may be even lower than reported.

In order for routine shielding during CT imaging to be embraced by the radiologic community, it is important that this shielding does not degrade or lessen the image quality of these studies. As the authors have clearly presented, there are two general categories of shielding during CT imaging, that is, “in-plane” and “out-of-plane” shielding. In-plane shielding is more controversial as the shield density in the plane of the study may degrade the image quality and increase noise, although several studies have shown no impact upon image quality (refs. 31, 33, and 34 in the article). It will be important to study in-plane shielding in greater detail to ensure that it does not conflict with other new methods to reduce radiation exposure and that it does not degrade image quality. Out-of-plane shielding is less controversial and has no significant effect upon image quality in the area of interest and can significantly reduce the radiation exposure to the patient in areas of the body not being studied.

This article does an excellent job of highlighting the need for further efforts to increase the use of shielding during CT imaging. We congratulate the authors for identifying this shortcoming and for continuing to seek out ways to reduce radiation exposure and increase the safety of imaging for our patients.