I'm sure many of you are aware but recently there was an article published by the AJR discussing discontinuation of patient shielding. When I first read the article, I kind of brushed it off.. but now I'm reading that the AAPM released a statement insisting that patient and fetal gonadal shielding should be discontinued. The ACR has also endorsed this statement.

"several clinical studies have shown that gonadal shields are often positioned incorrectly, obscuring relevant anatomy and increasing repeat rates"

"If a lead shield, which is meant to protect the patient, enters the imaging FOV, the radio-graphic system will drastically increase the tube output to try to penetrate the shield."

Improper shield placement isn't a reason to discontinue the practice all together. Why not provide in-service training to correct the problem instead of abandoning the practice all together?

"For anatomy outside the imaging FOV, radiation exposure results almost entirely from internal scatter generated within a patient".

I can follow that. But what about off focus radiation? Not an internal form of scatter, provides additional patient dose, and never helpful to our image.

I get that the doses we're talking about here can be considered pretty insignificant and the risk is low but stating that patient shielding should be abandoned all together seems pretty impetuous. Anyone who has read the article or been following this, thoughts?