Do Two-Year-Olds Need Lead Shields During Chest X-Rays?

X-ray for a two-year-old child?

When a 2-year-old child undergoes a chest X-ray, is it necessary to use a lead apron to shield the lower abdomen? I have been to National Taiwan University Hospital, and they always provide shielding, but at another medical center, the radiologic technologist said it was not necessary.
Why is there such a significant difference in practice between medical centers? What is your opinion, doctor? Is it really unnecessary? The child is inherently weak and often suffers from colds and pneumonia, requiring X-rays.
The child has also undergone multiple X-rays and other radiological examinations since birth due to illness.
Will long-term exposure have any effects on the body or ovaries? Thank you, doctor.

Yu Yu, 30~39 year old female. Ask Date: 2023/08/24

Dr. Wang Yifen reply Radiology

Hello, considering the advancements in technology and the current evidence regarding radiation exposure risks, the American Association of Physicists in Medicine (AAPM) issued a position statement on April 2, 2019, recommending the discontinuation of the use of gonadal and fetal shielding in routine X-ray diagnostic imaging.
This is because such shielding may obscure organ structures or interfere with the automatic exposure control of imaging systems, potentially increasing the patient's radiation dose.
Therefore, with current imaging technology, the use of shields is not recommended.

For children, whose organs are still developing and who have a longer lifespan, they are more sensitive to radiation than adults.
It is advisable to document the child's history of X-ray radiation exposure and discuss the necessity of the examination with the physician before proceeding with X-ray imaging, ensuring that the benefits of the examination outweigh the risks.
Additionally, do not avoid examinations out of fear of radiation, as this may lead to missed opportunities for disease treatment.
Please take this into consideration, and I wish you safety and health.

Reply Date: 2023/08/24

More Info

When it comes to performing chest X-rays on young children, such as a two-year-old, the question of whether to use lead shields to protect the lower abdomen is a topic of ongoing debate among medical professionals. The American Association of Physicists in Medicine (AAPM) has stated that the use of lead shielding for patients undergoing routine X-ray examinations is no longer recommended. This is primarily due to advancements in imaging technology and the understanding that lead shielding can sometimes obscure important anatomical structures or interfere with automatic exposure control systems, potentially leading to increased radiation doses.

In practice, the decision to use lead shielding can vary between medical facilities and practitioners. Some hospitals, like the one you mentioned (Taipei Medical University Hospital), may still adhere to traditional practices of using lead shields, while others may follow the latest guidelines that suggest they are unnecessary for certain types of imaging. The inconsistency in practice can be attributed to differences in training, protocols, and interpretations of the latest research among radiology staff.

For children, who are more sensitive to radiation due to their developing bodies, it is crucial to weigh the risks and benefits of any imaging procedure. While it is understandable to be concerned about the cumulative effects of radiation exposure, especially in a child who has had multiple X-rays due to health issues, it is important to note that diagnostic X-rays are considered low-dose radiation. The radiation dose from a typical chest X-ray is relatively small, and the risk of significant long-term effects, such as cancer or reproductive issues, is very low when the procedures are performed judiciously.

Regarding your concern about the potential impact on your child's health, including the ovaries, it is essential to keep a record of all X-ray exposures and discuss them with your child's healthcare provider. They can help assess whether the benefits of each X-ray outweigh the risks based on your child's medical history and current health status. It is also worth noting that the background radiation exposure from natural sources is approximately 1.6 mSv per year, which provides a context for understanding the doses received from medical imaging.

In summary, while the use of lead shields during chest X-rays for young children is not universally required according to current guidelines, it is essential to have open communication with healthcare providers about any concerns regarding radiation exposure. They can provide reassurance and guidance tailored to your child's specific medical needs. Ultimately, avoiding unnecessary imaging is important, but when imaging is necessary for diagnosis or treatment, the benefits typically outweigh the risks.

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