title: Gonad Shielding during Pelvic Radiography: A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  Gonad shielding has been extensively advocated during pelvic radiography at or below reproductive ages. The popular practice of gonad shielding is placement of a lead shield in the midline of the pelvis. The aim of this study was to address the prevalence of gonad shielding and find out whether the current practice of gonad shielding can be considered as an effective method to reduce radiation exposure in patients undergoing pelvic radiography.
  
  
  METHODS
  National and international electronic databases, including PubMed, MEDLIN, EMBASE, and Google-Scholar, were searched up to January 2016. The database searches were supplemented with manual searches of reference lists. Two authors independently assessed the eligibility of all studies and extracted data.
  
  
  RESULTS
  The searches yielded a total of 243 publications. After assessing each identified study against specific inclusion exclusion criteria, 18 studies were deemed as relevant for this review. The total prevalence rate of gonad shielding was estimated at 58% (95% CI: 40 to 74%). It was estimated that only 34% (95% CI: 25 to 44%) of the radiographs had correct positioning of the shield. Also, incorrect positioning of the shield was statistically significantly higher in females than males (85% vs. 52 %; P-value < 0.001).
  
  
  CONCLUSIONS
  Our study demonstrates that the current practice of gonad shielding during female pelvic radiography should be no longer considered as an effective method to reduce radiation exposure. Training the best qualified radiographers is the key to accurate positioning of the shield in male subjects.
authors.affiliation: Department of Medical Physics, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
authors.forename: Vahid
authors.initials: V
authors.lastname: Karami
authors.affiliation: 2)Department of Medical Physics, Student Research Committee, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. 3)Department of Clinical Oncology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz.
authors.forename: Mansour
authors.initials: M
authors.lastname: Zabihzadeh
authors.affiliation: Department of Oral and Maxillofacial Radiology, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
authors.forename: Nasim
authors.initials: N
authors.lastname: Shams
authors.affiliation: Department of Biostatistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
authors.forename: Amal
authors.initials: A
authors.lastname: Saki Malehi
mesh_terms: D005260:Female; D006066:Gonads / Q000528:radiation effects*; D006801:Humans; D008297:Male; D010388:Pelvis / Q000000981:diagnostic imaging*; D011835:Radiation Protection / Q000592:standards*; D011859:Radiography / Q000009:adverse effects*