Jeukens Cécile R L P N, Kütterer Gerhard, Kicken Pierre J, Frantzen Marij J, van Engelshoven Jos M A, Wildberger Joachim E, Kemerink Gerrit J
Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, P. Debijelaan 25, 6229 HX, Maastricht, The Netherlands.
Insights Imaging. 2020 Feb 7;11(1):15. doi: 10.1186/s13244-019-0828-1.
As gonad shielding is currently under debate, this study evaluates the practice, from its introduction in about 1905 until today.
The literature was searched for developments in shielding and insights into the effects of ionising radiation on gonads. Based on own pre-1927 dose reconstructions, reported doses after 1927, a 2015-report from the European Union and recent own measurements, the effects of technological evolution and optimisation on radiation dose and hereditary risk were assessed.
In the 1900s, gonad shielding was first applied to prevent male sterility, but was discontinued when instrumental developments led to reduced radiation doses. In the 1950s, concerns about hereditary risks intensified and gonad shielding was recommended again, becoming routine worldwide. Imaging-chain improvements over time were considerable: in 2018, the absorbed dose was 0.5% of its 1905 value for the testes and 2% for the ovaries, our optimised effective dose a factor five lower than the value corresponding to the current EU diagnostic reference level, and the reduction in detriment-adjusted risk by shielding less than 1 × 10 for women and 5 × 10 for men.
Assessment of pelvic doses revealed a large reduction in radiation risks facilitated by technological developments. Optimisation likewise contributed, but unfortunately, its potential was never adequately exploited. Today, using a modern and optimised X-ray system, gonad shielding can be safely discontinued for women. For men, there might be a marginal benefit, but potential negative side-effects may well dominate. Discontinuation of gonad shielding seems therefore justifiable.
由于目前性腺屏蔽存在争议，本研究评估了其从1905年左右引入至今的应用情况。
检索文献以了解屏蔽技术的发展以及对电离辐射对性腺影响的认识。基于1927年以前自己的剂量重建、1927年以后报告的剂量、欧盟2015年的一份报告以及近期自己的测量结果，评估技术演变和优化对辐射剂量及遗传风险的影响。
在20世纪初，性腺屏蔽最初用于预防男性不育，但随着仪器设备的发展导致辐射剂量降低，该方法被停用。20世纪50年代，对遗传风险的担忧加剧，性腺屏蔽再次被推荐并在全球范围内成为常规操作。随着时间的推移，成像链有了显著改进：2018年，睾丸的吸收剂量是1905年值的0.5%，卵巢的吸收剂量是1905年值的2%，我们优化后的有效剂量比当前欧盟诊断参考水平对应的剂量低五倍，屏蔽对女性有害调整风险的降低小于1×10，对男性则小于5×10。
盆腔剂量评估显示，技术发展极大地降低了辐射风险。优化也起到了作用，但遗憾的是，其潜力从未得到充分发挥。如今，使用现代优化的X射线系统，女性可以安全地停止性腺屏蔽。对于男性，可能有微小益处，但潜在的负面副作用可能占主导。因此，停止性腺屏蔽似乎是合理的。
