Schürmann Till, Lang Friederike, Jakobi Annika, Rau Alexander, Weiss Jakob, Mueller-Peltzer Katharina, Goller-Bruchmann Kristin, Uller Wibke, Schlett Christopher L, Bamberg Fabian, Fiebich Martin, Stein Thomas
Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany.
Eur Radiol. 2025 Sep 18. doi: 10.1007/s00330-025-12006-0.
Despite recommendations and guidelines on patient contact shielding in X-ray imaging, substantial uncertainties remain in clinical practice, particularly concerning computed tomography (CT) examinations and vulnerable groups such as pediatric and pregnant patients. This study identifies gaps in existing recommendations and offers a comprehensive statement of the actual risks and benefits associated with patient shielding.
A systematic literature search was conducted using Google Scholar and PubMed, alongside current national and international guidelines. Our special report focused on patient shielding in projection radiography, interventional radiology, and CT, with special emphasis on vulnerable patient groups sensitive to radiation exposure.
Current research lacks robust, evidence-based data comparing the benefits and risks of patient shielding, especially in CT. In projection radiography and interventional radiology, patient shielding offers minimal benefits and may inadvertently increase radiation exposure due to interference with automatic exposure control or necessitate repeated examinations. This issue is particularly addressed in pediatric and pregnant patients. In CT, the benefits and risks are more complex, with substantial research gaps hindering informed decision-making.
Traditional and generalized recommendations for patient contact shielding do not adequately account for technological advancements and individual patient needs. The use of patient shielding should be reconsidered on a case-by-case basis, guided by evidence-based research. There is an urgent need for clinical studies to assess the benefits, and in particular the risks in real-world settings, facilitating the development of precise patient-specific guidelines.
Question While patient shielding can increase radiation dose due to interference with automatic exposure controls, uncertainties persist regarding patient shielding in X-ray imaging practices. Findings There is marginal evidence of the clinical risks of patient shielding, and urgent needs exist for patient-specific evidence-based shielding guidelines. Clinical relevance By critically evaluating the ambiguous guidelines on patient shielding and highlighting the lack of evidence-based risks of patient shielding, this study argues for individualized, evidence-based practices to improve patient safety in clinical radiology.
尽管有关于X射线成像中患者接触防护的建议和指南，但临床实践中仍存在很大的不确定性，尤其是在计算机断层扫描（CT）检查以及儿科和孕妇等弱势群体方面。本研究找出了现有建议中的差距，并全面阐述了与患者防护相关的实际风险和益处。
利用谷歌学术和PubMed进行了系统的文献检索，并参考了当前的国家和国际指南。我们的特别报告聚焦于投影放射成像、介入放射学和CT中的患者防护，特别强调了对辐射暴露敏感的弱势群体。
目前的研究缺乏有力的、基于证据的数据来比较患者防护的益处和风险，尤其是在CT方面。在投影放射成像和介入放射学中，患者防护的益处微乎其微，而且由于干扰自动曝光控制或需要重复检查，可能会无意中增加辐射暴露。这个问题在儿科和孕妇患者中尤为突出。在CT中，益处和风险更为复杂，大量的研究空白阻碍了明智的决策。
传统的、通用的患者接触防护建议没有充分考虑技术进步和个体患者需求。应根据具体情况重新考虑患者防护的使用，并以循证研究为指导。迫切需要进行临床研究，以评估其益处，尤其是在实际环境中的风险，从而促进制定精确的针对患者个体的指南。
问题虽然患者防护可能因干扰自动曝光控制而增加辐射剂量，但X射线成像实践中患者防护仍存在不确定性。发现几乎没有证据表明患者防护存在临床风险，迫切需要针对患者个体的循证防护指南。临床相关性通过批判性地评估关于患者防护的模糊指南，并强调缺乏基于证据的患者防护风险，本研究主张采用个体化的、基于证据的做法，以提高临床放射学中的患者安全性。
