Background The problem of inaccurate placement of gonad shields in children has been highlighted by several publications nationally and internationally.³

A written departmental protocol for the correct use of gonad protection, with regular audit, will:

• Avoid confusion over when and where gonad protection is required

• Help new staff and locum staff to adapt readily and easily to local policy

• Reduce gonad dose without significant loss of radiographic information

Objectives

• The aim of the study is to make sure that children’s gonads are protected from the unnecessary harmful radiations caused by x-rays that can affect them in the long term

• Gonad protection should be used according to the local policy in all cases.^{1 2} (The guidelines of the paediatric radiology department at BRI)

• Initial Hip/Pelvic x-ray doesn’t require gonad shield to avoid obscuring the sacrum in females or symphysis pubis in males.

• Gonad shield should be used and positioned accurately in all subsequent images.

Methods

• PACS system was used to search for 2 views Hip/Pelvic X-ray in patients <16 years old at BRI hospital.

• Retrospective study (Audit: September 2017 – April 2018)

(Re-audit April 2017 – August 2018)

- Each image was assessed to determine the presence or absence of gonad protection and whether the protection was placed correctly or not.

Results

• The results were discussed at the radiological clinical governance meeting.

• The superintendent radiographer has sent a reminder e-mail to all the radiographers discussing the importance of not only using the gonad shield but also placing it correctly.

• Reminder posters to use the gonad shield were put in every x-ray room.

• A course has been conducted for the new radiographers by a senior radiographer about when and how to use the gonad shield.

• The local guidelines have been reviewed and simplified to make it easier to follow.

• Gonad shields have been used in the correct position in 60% of patients after implementing the changes compared to 33% only in the first cycle.

Conclusions It was noticed that the percentage of the well-positioned shields has improved dramatically from 33% to 60% after implementing the previous changes.