NCRP Patient Shielding Guidelines: What This Means for Interventional Healthcare Workers
- Feb 4
- 4 min read
If you work in interventional fluoroscopy, you may have heard about the National Council on Radiation Protection and Measurements (NCRP) issuing new guidance on patient shielding. Some facilities have stopped using lead aprons and gonadal shields on patients during certain imaging procedures. This has understandably raised questions:
Does this mean we should stop wearing our protective equipment too?
The answer is an unequivocal no. The NCRP guidance on patient shielding does not change occupational radiation protection requirements for healthcare workers. Your protective equipment remains just as critical as ever. Here's what you need to know.
What Changed: NCRP Statement No. 13
In January 2021, the NCRP issued Statement No. 13, recommending that healthcare facilities discontinue routine gonadal shielding during abdominal and pelvic radiography for patients. This was a significant departure from decades of standard practice.
The scientific rationale behind this change includes several key findings:
Lower genetic risk than previously thought: The risks of heritable genetic effects from radiation exposure are now considered much less than estimates from the 1950s when patient shielding was first recommended.
Technological advances: Improvements in imaging technology since the 1950s have resulted in up to a 95% reduction in absorbed dose to patients.
Shield positioning challenges: Studies have shown significant variation in gonad position among patients, making accurate shield placement difficult without imaging assistance.
Unintended consequences: Patient shields can interfere with automatic exposure control systems, potentially increasing overall exposure, and may obscure important diagnostic information.
This recommendation has been endorsed by the American Association of Physicists in Medicine (AAPM), American College of Radiology (ACR), Health Physics Society (HPS), and the Conference of Radiation Control Program Directors (CRCPD). Many states have begun revising their regulations accordingly.
What Has NOT Changed: Occupational Radiation Protection
Here's the critical distinction that every interventional healthcare worker must understand: the recommendations about patient shielding do not apply to occupational radiation protection.
The AAPM's CARES (Communicating Advances in Radiation Education for Shielding) initiative, which helped develop the patient shielding guidance, explicitly addresses this point. Their FAQ document states unequivocally:
"If you are working in an area with potential exposure to radiation (such as in an imaging exam room) occupational safety standards and regulations require that radiation workers take appropriate action to limit their occupational exposures. These actions include minimizing the time you are exposed to a radiation source, maximizing the distance between you and the radiation source, and placing shielding between yourself and the radiation source... These universally accepted methods to control occupational radiation exposures are not impacted in any way by recommendations" about patient shielding.
The fundamental principles of occupational radiation protection remain unchanged:
Time: Minimize the duration of your radiation exposure
Distance: Maximize your distance from the radiation source
Shielding: Use protective barriers between yourself and the radiation source
Why the Difference?
The rationale for patient shielding and occupational shielding are fundamentally different:
For patients: The original concern was primarily about heritable genetic effects from gonadal exposure during a limited number of imaging exams. Modern science shows this risk was significantly overestimated, and for many patients, the shields provided negligible benefit while introducing potential harms (obscured anatomy, increased exposure from AEC interference).
For healthcare workers: The concern is cumulative career-long exposure. Interventional fluoroscopy workers are among the highest exposed radiation workers worldwide, often receiving higher annual doses than nuclear power plant workers. This cumulative exposure over years or decades of practice carries different risks, including elevated rates of cataracts, brain and neck tumors, and other radiation-related health effects documented in research.
The ALARA principle—keeping radiation exposure As Low As Reasonably Achievable—remains the guiding standard for occupational protection. For workers in interventional environments, this means continuing to use:
Lead aprons (minimum 0.25-0.50 mm lead equivalent)
Thyroid collars
Protective eyewear (the lens of the eye has a particularly low dose threshold)
Table-mounted and ceiling-suspended shields
Portable protective barriers
The Bottom Line
The NCRP's patient shielding recommendations represent important science-based refinements to clinical practice. But they should not be misinterpreted or misapplied to occupational radiation protection.
If anyone in your facility suggests that the patient shielding changes mean workers no longer need to wear protective equipment, this is incorrect. Federal OSHA regulations, state radiation control programs, and every major professional society continue to require occupational radiation protection measures.
You have the right to work in an environment where your radiation exposure is kept as low as reasonably achievable. You have the right to appropriate protective equipment provided at no cost to you. And you have the right to accurate information about the risks you face.
Patient safety and worker safety are not in conflict—they are complementary. The science evolves, our practices should evolve with it, but the commitment to protecting healthcare workers must remain constant.
Resources & Original Sources
For those who want to explore this topic further, here are the key source documents:
NCRP Statement No. 13 (January 2021) – The official recommendation for ending routine gonadal shielding during abdominal and pelvic radiography:
AAPM CARES FAQs on Patient Shielding – Comprehensive FAQ document that specifically addresses occupational protection (see Question A9):
NCRP Patient Shielding in Medical Imaging Project Page – Information on the ongoing comprehensive review of patient shielding practices:
ARRT Statement on Gonadal and Fetal Shielding – Position from the American Registry of Radiologic Technologists:
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