ASSESSMENT OF THE USE OF GONAD SHIELD AMONG RADIOGRAPHY CENTRES IN ENUGU METROPOLIS

ABSTRACT                                                                            During pelvic radiography, gonad shield is one of the most important protective measures in use to protect the gonad which is very sensitive to radiation. This is a study on assessment of the use of gonad shield among radiography centres in Enugu metropolis. The study is aimed at investigating adherence to use of gonad shield, determining level of radiographers’ knowledge on the guidelines for use of gonad shield, and ascertaining whether other radiation protecting measures are used often than gonad shield. This research was carried out between April and May 2013 in the UNTH, NOHE, ESUTH, HANSA CLINIC and ST. MICHAEL CENTRE. A selected population of 34 radiographers practicing in government-owned hospitals and private centres in Enugu metropolis were used for the study. Also, 65 patients were selected for the study using a convenient random sampling. A prospective cross-sectional survey method was employed in selecting the sample sizes with questionnaires. Observation sheets were used to confirm the responses from questionnaires.  Data collected were presented descriptively with aid of tables and charts and Chi Square. The result revealed inconsistency in the use of gonad shield and high percentage of unavailability of gonad shield in various hospitals and private centres studied. The relationship is not significant at 0.05 significant level because X2Cal (6.893) < X2table (7.81). It also revealed that many of the radiographers have good knowledge on the use of gonad shield as recommended by ICRP, although, there was unavailability of gonad shield in various hospitals studied. The study recommends that every radiation worker should strictly adhere to the guidelines on the use of gonad shields. Radiation Protection officers should checkmate all radiation workers on the use of gonad shields in all radiography centres, and the purchase of different sizes of gonad shields. To make utmost and proper use of gonad shield, radiation workers should bear in mind always that gonads are hypersensitive to ionizing radiation and its genetic effect should also be considered. 
TABLE OF CONTENTS Title Page ........................................................................................   i Dedication..........................................................................................ii Approval Page....................................................................................iii    Certification......................................................................................... iv    Acknowledgement.................................................................................v Table of Contents...................................................................................vi     List of tables...........................................................................................viii List of figures..........................................................................................viii  Abstract....................................................................................................ix CHAPTER ONE: INTRODUCTION 1.0 Background of Study.......................................................................................1 1.1 Statement of the Problem................................................................................3 1.2 Objectives of the Study.....................................................................................3 1.3 Significance of the Study..................................................................................4 1.4 Scope of the Study...........................................................................................4 1.5 Review of related literature........................................................................4 CHAPTER TWO: THEORETICAL BACKGROUND  2.1.1 Anatomy of the pelvis.....................................................................................11 2.1.2 Plain Film Radiograph of the Pelvis..............................................................14 2.1.3 Merits of Gonad Shield...............................................................................15 2.1.4 Different Designs and Sizes of Gonad Shield.............................................16 2.2 Guidelines for the Utilization of Gonad Shield in Radiodiagnosis................18  2.3 Major Factors Influencing the application of Gonad Shields during Pelvic  2.3.1 Radiodiagnosis..........................................................................................20                                                                       2.4 The Use of Gonad Shields and Patients’ Dose Minimization  .......................25 CHAPTER THREE: RESEARCH METHODOLOGY 3.1 Research Design...........................................................................................29 3.2 Target Population........................................................................................29 3.3 Sample Size and Sampling Technique.............................................................29 3.4 Tool for Data Collection..................................................................................29 3.5 Method of Data Collection..............................................................................30 3.6 Method of Data Analysis.................................................................................30 CHAPTER FOUR: DATA PRESENTATION AND ANALYSIS 4.1 Data presentation and Analysis......................................................................31 CHAPTER FIVE: DISCUSSIONS, SUMMARY OF FINDINGS, CONCLUSION, RECOMMENDATIONS, LIMITATIONS AND AREAS OF FURTHER STUDY 5.1 Discussions........................................................................................................42 5.2 Summary of findings...................................................................................44                          5.3 Conclusion...................................................................................................45 5.4 Recommendations........................................................................................46 5.5 Limitations of the Study...............................................................................46 5.6 Areas of Further Research..........................................................................47 References............................................48 Appendix 1............................................56  Appendix 2....................................................59 Appendix 3...................................................61
LIST OF TABLES Table 1: Sex and Age Distribution of the Radiographers……………………….32 Table 2: Radiography centres responses on knowledge and consistency use of gonad shield and other radiation protection measures 34 Table 3: Distribution on availability of gonad shields and consistency of their utilization..........................35 Table 4: Radiographers responses on gonad shield…………………………….37 Table 5: Responses on use of gonad shield from patients for first and subsequent pelvic radiography………………………………………………………………..39                                                                                                                            LIST OF FIGURES Fig: 1: Front view of the Pelvis.........................................................................12   Fig: 2: Radiograph of Anteroposterior (AP) View of Pelvis...............................14 Fig: 3: A female pelvis and a male pelvis with gonad shields in position..........15 Fig: 4: Flat Contact Gonad Shields...................................................................16 Fig: 5: Female gonad shields for ovaries..........................................................17 Fig: 6: Male gonad shields………………………………………………………..17 Fig: 7: Radiographers years of working experience…………………………….33 Fig: 8: Patients sex and age distribution ...........................................................38                                INTRODUCTION  Gonad shielding during radiography procedures is an effective utilization of gonad shield to reduce radiation dose to patients’ reproductive organs and reduce the risk of genetic effects in future generations. Protection of the gonads against diagnostic X-rays gained ground in the 1950s1-4. Higher cancer incidence in the atomic bomb survivors are supposed to be induced without a threshold dose5,6. Due to the biological hazard of radiation and radiation doses, the use of gonad shield has been recommended for patients undergoing pelvic radiography before and within the reproductive years involving males and females that have not reached menopause7.       As radiation exposure entails inherent risks of radiation effects, no decision to expose an individual can be undertaken without weighing benefits of exposure against potential risks. National8,9 and international bodies7,10 recommend the use of gonad shielding when applicable. The effectiveness of gonad shielding is dependent on the correct use of the shield11,12. Though there is need for gonad information which helps clinician in appropriate patients care. Because of radiation induced conditions, many patients present with an exaggerated sense of risk associated with X-ray and expect radiographers to protect them from this perceived life threats. The use of gonad shield is required with respect to gender as suitable in plain film radiography of the pelvis. This is done when the diagnostic information needed is not obscured. ALARA principle notices that patients are exposed to ionizing radiation in radiological procedures but also recognizes that these exposures can be minimized13. The gonads should be shielded when, if necessity, they are directly in the X-ray beam or within 5cm of it, unless such shielding excludes or degrades important diagnostic information7. The use of gonad shielding should be adopted only when the clinical objectives of examination would not be compromised. Gonad shielding can be used without concealing visualization of adjacent structures in the majority of radiography examination14.      Judicious choice of investigations can significantly avoid not only radiation exposures but increase both the diagnostic accuracy and working efficiency of a radiology department. Appropriately, gonad protection has been proposed and should be done during all radiographic examinations whenever possible15. The objective is to assess if the guidelines regarding the use of gonad shield is adhered to by radiology staff and consistency use of gonad shield in protecting patients from the perceived life threats of radiation.