Peripheral dose to the testes: the design and clinical use of a practical and effective gonadal shield.

A simple and practical gonadal shield has been developed for use near megavoltage radiation fields. The lead shield encloses only the testes, allowing its use with nearly any radiation field that does not include the testes. The dose to the testes with and without the shield has been measured extensively both in phantoms and on patients. The gonadal shield allows a 3 to 10-fold reduction in dose to the testes depending primarily on the distance from the field edge to the gonads. When the shield is used, the gonadal dose is always less than 1% of the patient's prescription dose. Based on our patient studies of testicular injury following conventionally-fractionated irradiation, a dose of less than 50 cGy (1% of a typical 5000 cGy treatment regimen) should preserve normal testicular function.