ICRP 2023 Satellite Event (organized by JART & JSRT)
Date and Time: 12 November (Sun) 2023, 14:00 – 17:00
Location: B1 Floor, Grand Nikko Tokyo Daiba
Organizers: Japan Association of Radiological Technologists (JART)
Japanese Society of Radiological Technology (JSRT)
Opening Remarks 14:00 – 14:05
1. Keynote Lecture (English) 14:05 – 15:00
Chair: Kosuke Matsubara (Kanazawa University, Japan)
Title:
Ethical values, tolerability and reasonableness in the aspects of gonadal shielding in radiology
Speaker:Marie Claire Cantone (University of Milan, Italy)--- Break 15:00 – 15:10 --2. Symposium (English) 15:10 – 16:55
Chairs: Hironobu Tomita (Teikyo University, Japan)
Takayuki Igarashi (International University of Health and Welfare Narita
Hospital, Japan)
Theme:Gonadal shielding in radiology: How do we make decisions while understanding ethical issues?
Titles and Speakers:
1) Perspectives on the unnecessity of gonadal protection from the history of radiation healtheffects
Yoshiaki Hirofuji (Fukushima Medical University, Japan)
2) Guidance on using gonad shielding on patient for diagnostic radiology from Japanese Societyof Radiological Technology
Yasutaka Takei (Kawasaki University of Medical Welfare, Japan)
3) The issues of discontinuing gonadal shielding from the perspective of facilities optimizing
medical exposure dose
Yoshiaki Suzuki (Bellland General Hospital, Japan)
4) Can gonadal shielding be abolished response in the medical fieldTakeshi Sasaki (Ageo Central General Hospital, Japan)
Closing Remarks 16:55 – 17:00

Ethical values, tolerability and reasonableness in the aspects of gonadal shielding in radiology
Marie Claire Cantone1, Kimberly Applegate2, Sébastien Baechler3, François Bochud4, Reinhard
Loose5
1 University of Milan, Italy
2 University of Kentucky COM, USA
3 Federal Office of Public Health, Switzerland
4 IRA CHUV, Switzerland
5 Hospital Nuremberg, Germany
Historically, a practice was introduced in radiology to reduce exposure to particularly sensitive
areas, as for gonads, by placing lead gonad contact shielding (GCS). The use of GCS direct on
the surface of the patient during the diagnostic imaging procedure became a common practice inradiology from 1950s. In consideration of the ongoing scientific and technological evolution,evidence emerged that GCS is not effective in reducing the internal scatter, thus allowing artefacts
to be a disadvantage leading to degradation of image quality. Due to innovation in imaging
technology that resulted in marked dose reduction to the patient, and dose reduction practices
using the principle of optimisation, the use of patient contact shielding is no longer recommended.
However, the recommended cessation of the widespread practice of applying patient contact
shielding requires a major cultural, policy change and good communication in outlook regarding
radiation safety and practice amongst medical professionals, educators, regulators, and the publicalike.
An effective and balanced education and training programme in the ethical issues related toradiological protection enables health professionals to help patients, families, and carers tounderstand the process. As evidenced by ICRP TG109 an understanding of the basic principlesof RP is an absolute pre-requisite; it is necessary, but not sufficient without ethical training, forall health professionals working with radiation for the purpose of diagnosis or treatment. In theclinical setting, situations arise where the health professionals are required to make an ethicaljudgement with regards to their own practice. This can be both challenging and complex andrequires a knowledge foundation and updated knowledge, providing the basis from which toevaluate a clinical situation and to then act appropriately. A clear understanding of ethical values,
together with the principles of RP, can help address issues of potential conflicts in decision
making processes.
Justification and optimisation of radiation exposures in medicine are linked to tolerability andreasonableness. The ICRP TG114 has explored these relationships. For patient exposure,tolerability may be associated with the principle of justification. If a medical procedure is justified
the benefits outweigh the risks. The patient, and family, are part of the shared decision-making toensure there is a clear understanding regarding benefit/risk. The concept of reasonableness is
closely linked to the principle of optimisation, considering that optimization in medical exposures
does not necessarily mean the reduction of patient doses. Indeed, the dose to the patient isdetermined by the medical needs and cannot be reduced indefinitely without prejudicing theintended outcome. In addition, contact may cause artefacts that reduce image quality. If image
quality is inappropriate for the clinical purpose, the radiation provides no clinical benefit.
Considering the goal of RP for medical exposures of patients, the conceptual framework oftolerability and reasonableness could be based on three dimensions: Appropriateness/Justification,
Radiation safety of patient/Optimisation, Patient-centredness.
Following ethical values, together with a tolerable exposure level considering the reasonablenessof the procedure is a basis towards the best possible benefit at the lowest possible risk.