Evaluation of Gonadal Exposure Dose in Long Bone Plain Radiography for Radiation Protection

Document Type : Original Paper


1 Department of Bio-Convergence Engineering, Korea University, Seoul, Republic of Korea

2 Department of Radiological Sciences, Gachon University, Incheon, Republic of Korea


Introduction: Long bone examination in standing position, as one of the diagnostic methods in plain radiography, is most commonly used in the field of medical diagnosis, especially leg length discrepancy. However, with regard to this examination, reproductive organs are exposed to radiation as they are placed in the adjacent area to the long bone. Due to the sensitivity of gonads to radiation, their exposure must be kept as minimal as possible to the extent to which proper diagnosis is feasible in order to reduce tumor growth in lower extremity examination. The purpose of this study was to optimize the radiation dose in the long bone examination in standing position.
Material and Methods: This experimental study was conducted to evaluate the radiation exposure dose to a phantom and estimate effective doses and organ-specific doses (i.e., testes and ovaries) among patients using PC-based Monte Carlo program. 
Results: A phantom examination in the posterior-anterior (PA) configuration produced a radiation dose nine and three times smaller than those in the anterior-posterior (AP) and AP with shielding configurations, respectively. In a patient study (PA configuration), the testes, ovaries and effective doses were estimated at 15, 1.2, and 2 times smaller than those in the AP configuration, respectively.
Conclusion: This study demonstrated that examinations in the PA configuration produce a smaller radiation dose than those in the AP configuration.


Main Subjects


    1. Walsh M, Connolly P, Jenkinson A, O'Brien T. Leg length discrepancy—an experimental study of compensatory changes in three dimensions using gait analysis. Gait Posture. 2000; 12(2): 156-61.
    2. Gurney B. Leg length discrepancy. Gait Posture. 2002; 15(2): 195-206.
    3. Giles L, Taylor J. Low-back pain associated with leg length inequality. Spine. 1981; 6(5): 510-21.
    4. Murrell P, Cornwall MW, Doucet SK. Leg-length discrepancy: effect on the amplitude of postural sway. Arch Phys Med Rehabil. 1991; 72(9): 646-8.
    5. Brunet ME, Cook SD, Brinker M, Dickinson J. A survey of running injuries in 1505 competitive and recreational runners. J Sports Med Phys Fitness. 1990; 30(3): 307-15.
    6. Aaron A, Weinstein D, Thickman D, Eilert R. Comparison of orthoroentgenography and computed tomography in the measurement of limb-length discrepancy. JBJS. 1992; 74(6): 897-902.
    7. Terjesen T, Benum P, Rossvoll I, Svenningsen S, Isern AEF, Nordbø T. Leg-length discrepancy measured by ultrasonography. Acta Orthop Scand. 1991; 62(2): 121-4.
    8. Altongy JF, Harcke HT, Bowen JR. Measurement of leg length inequalities by Micro-Dose digital radiographs. J Pediatr Orthop. 1986; 7(3): 311-6.
    9. Zarghani H, Bahreyni Toossi MT. Evaluation of Organ and Effective Doses to Patients Arising From Some Common X-Ray Examinations by PCXMC Program in Sabzevar, Iran. IJMP. 2015; 12(4): 284-91.
    10. Protection R. ICRP publication 103. Ann ICRP. 2007; 37(2.4): 2.
    11. Harrison R. Ionising radiation safety in diagnostic radiology. IMAGING-OXFORD. 1997; 9: 3-14.
    12. Mazonakis M, Kokona G, Varveris H, Damilakis J, Gourtsoyiannis N. Data required for testicular dose calculation during radiotherapy of seminoma. Med Phys. 2006; 33(7Part1): 2391-5.
    13. Matsumoto Y, Umezu Y, Fujibuchi T, Noguchi Y, Fukunaga J, Kimura T, et al. Verification of the protective effect of a testicular shield in postoperative radiotherapy for seminoma. Nihon Hoshasen Gijutsu Gakkai Zasshi. 2014; 70(9): 883-7.
    14. Singhal MK, Kapoor A, Singh D, Bagri PK, Narayan S, Nirban RK, et al. Scattered radiation to gonads: role of testicular shielding for para-aortic and homolateral illiac nodal radiotherapy. J Egypt Natl Canc Inst. 2014; 26(2): 99-101.
    15. Teunen D. The European Directive on health protection of individuals against the dangers of ionising radiation in relation to medical exposures (97/43/EURATOM). J Radiol Prot. 1998; 18(2): 133.
    16. Sharp C, Shrimpton J, Bury R. Diagnostic medical exposures. Advice on exposure to ionising radiation during pregnancy. 1998.
    17. Liakos P, Schoenecker PL, Lyons D, Gordon JE. Evaluation of the efficacy of pelvic shielding in preadolescent girls. J Pediatr Orthop. 2001; 21(4): 433-5.
    18. Davey E, England A. AP versus PA positioning in lumbar spine computed radiography: Image quality and individual organ doses. Radiography. 2015; 21(2): 188-96.
    19. Ben-Shlomo A, Bartal G, Shabat S, Mosseri M. Effective dose and breast dose reduction in paediatric scoliosis X-ray radiography by an optimal positioning. Radiat Prot Dosimetry. 2013; 156(1): 30-6.
    20. Ben-Shlomo A, Bartal G, Mosseri M, Avraham B, Leitner Y, Shabat S. Effective dose reduction in spine radiographic imaging by choosing the less radiation-sensitive side of the body. Spine J. 2016; 16(4): 558-63.
    21. Chaparian A, Kanani A, Baghbanian M. Reduction of radiation risks in patients undergoing some X-ray examinations by using optimal projections: a Monte Carlo program-based mathematical calculation. J Med Phys. 2014; 39(1): 32.
    22. Sikand M, Stinchcombe S, Livesley P. Study on the use of gonadal protection shields during paediatric pelvic X-rays. Ann R Coll Surg Engl. 2003; 85(6): 422.
    23. Le Huec J, Saddiki R, Franke J, Rigal J, Aunoble S. Equilibrium of the human body and the gravity line: the basics. Eur Spine J. 2011; 20(5): 558.
    24. Hart D, Wall BF. UK population dose from medical x-ray examinations. European Journal Radiology. 2004; 50: 285-91.
    25. Moey SF, Shazli ZA, Sayed I. Dose Evaluation for Common Digital Radiographic Examinations in Selected Hospitals in Pahang Malaysia. Iran J Med Phys. 2017; 14: 155-61.