Gonad Shielding during Pelvic Radiography: A Systematic Review and Meta-analysis.

BACKGROUND Gonad shielding has been extensively advocated during pelvic radiography at or below reproductive ages. The popular practice of gonad shielding is placement of a lead shield in the midline of the pelvis. The aim of this study was to address the prevalence of gonad shielding and find out whether the current practice of gonad shielding can be considered as an effective method to reduce radiation exposure in patients undergoing pelvic radiography. METHODS National and international electronic databases, including PubMed, MEDLIN, EMBASE, and Google-Scholar, were searched up to January 2016. The database searches were supplemented with manual searches of reference lists. Two authors independently assessed the eligibility of all studies and extracted data. RESULTS The searches yielded a total of 243 publications. After assessing each identified study against specific inclusion exclusion criteria, 18 studies were deemed as relevant for this review. The total prevalence rate of gonad shielding was estimated at 58% (95% CI: 40 to 74%). It was estimated that only 34% (95% CI: 25 to 44%) of the radiographs had correct positioning of the shield. Also, incorrect positioning of the shield was statistically significantly higher in females than males (85% vs. 52 %; P-value < 0.001). CONCLUSIONS Our study demonstrates that the current practice of gonad shielding during female pelvic radiography should be no longer considered as an effective method to reduce radiation exposure. Training the best qualified radiographers is the key to accurate positioning of the shield in male subjects.