Radiation protection of the ovaries in young scoliosis patients

Concerns in clinical practice arose over the amount of ovarian irradiation received from X-ray examinations in females with scoliosis. This study was instigated to assess the adequancy of ovarian protection in this young and genetically vulnerable group of patients. A total of 283 plain films in 20 patients with scoliosis were reviewed. If the area immediately adjacent to the medial wall of the acetabulum was clearly seen, then this was taken as indicative of ovarian irradiation. In a separate study, the radiation dose in the centre of the X-ray field on the surface of a tissue- equivalent anthropomorphic phantom was measured using thermoluminescent dosimeters. Standard conditions for scoliosis X-ray examination were used. The average age of patients was 21.5 years. The mean number of single X-ray exposures per patient was 14.1 over a mean of 44 months. The mean measured entrance dose to the skin in the 20 patients was 0.08 mGy (equivalent dose = 0.08 mSv). The mean percentage of examinations without lead protection was 18% per patient (range 0-40%). This would have resulted in a mean equivalent dose to the surface of the abdomen of 0.1 mSv per year per patient from the unprotected examinations. The maximum dose received in 1 year was 0.6 mSv. The maximum dose to the unprotected ovary was estimated to be 0.05 mSv from a single examination. The mean total cumulative ovarian dose was calculated as 180 μSv per patient (range 45-355 μSv) over the time period studied. The findings of this study indicate that ovarian protection should be improved. Reasons for this and suggestions for improvement are discussed.