Although the American Association of Physicists in Medicine no longer supports the use of lead shielding for most patients undergoing routine x-ray imaging, the practice is still widespread. Elsa Pearson, a senior policy analyst at Boston University School of Public Health, explores the issue in an editorial for STAT.

Radiation is a very real fear for many people, partly because of past disasters. Chernobyl, Hiroshima, and Fukushima are very public demonstrations of the power of radiation gone wrong. In the clinical setting, the fear of radiation is also likely due to a lack of education and understanding of exposure and risk.

A survey of patients in an emergency department found that most do not accurately understand the radiation dose associated with various imaging studies: Standard X-rays use a negligible amount of radiation; CT scans and nuclear imaging use the most. Only 14% of those surveyed said that CT scans use more radiation than chest X-rays. Less than one-quarter accurately said that MRIs do not use radiation at all. A separate survey found that even medical providers do not always fully understand radiation exposure and risk.

Another reason it is hard to move away from shielding is that it is a deeply engrained practice for both patients and providers. “Provider education has always been based on the ALARA principle — as low as reasonably achievable — using time, distance, and shielding to minimize the radiation dose,” says [Jennifer O’Riorden, director of health physics and radiation safety officer at Lahey Medical Center in Burlington, Mass.] Patients have come to expect it, too.

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