As a Patient Safety and Quality of Care Researcher at Columbia University Medical Center, one of the orthopedic doctors I worked for noticed that the shielding in the X-Rays of his patients was inconsistent. This is one of the first red flags when it comes to quality of care research, and he asked me to investigate.

After reviewing the literature on ideal shielding techniques and conducting a systematic review of the 100 most recent patient X-rays, it became clear that the optimal gonadal shielding was not present for females.

I decided to visit the radiology department to find out why. During my visit it became clear that no shield existed to protect the female patients because of the unique needs of our office: radiology was under immense pressure to get a large number of X-Rays done in many ways for many departments, radiology was using a new advanced scanning technology that allowed them to X-Ray a patient’s entire spine in excellent quality, and Orthopedics required very specific views of the spine, including much of the pelvic region. Traditional circular shields would obstruct critical views for the doctors in order to provide treatment, but this meant that female patients were not receiving the same level of shielding for the gonadal region as their male counterparts.

After observing the radiology technicians, interviewing them about how they place shields, and taking time to note how their technology operated, I set out to invent a new kind of female X-Ray shield that would provide ideal protection to patients with scoliosis. It was particularly important to create a shield for this group, as the majority of our patients were female, pediatric, and would need repeat scanning every 3-6 months, thus meaning their ovaries’ risk of radiation exposure was worthy of attention. ‍

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Based on my literature review and interviews with the Orthopedic doctors and radiologists, I needed to construct a shield that

• Provided a clear view of the spine while protecting the lower pelvic region and hips.
• Could be rapidly placed on a patient using landmarks on the skin in such a way that it wouldn’t later be found to have obstructed the internal view of the spine.
• Would provide protection and visibility from both head on and sideways views.
  

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Prototyping

I began by determining an ideal X-Ray silhouette and creating some mock X-Rays with mock levels of user variation and brought these to doctors for their opinion. After gathering their feedback, I realized I could add extra protection in some areas and should cut back on protecting in others. Next, I brought the mock X-Rays to radiology and asked their opinion. They let me know the silhouettes were good for their purposes.

Then, knowing the importance of involving your users in the design process, I asked the radiologist if there were any prominent landmarks on the body in the area that they like to use when placing shields. They said the Iliac Crest is usually quite prominent on patients and is a good landmark. After learning this, I went back to the lab with X-Ray shielding material provided by radiology and hand constructed a X-Ray shield intended to meet the specifications requested by the doctors and the ease of use from the radiologists.

With the design slightly tweaked to work with the desired landmark, I returned to radiology for testing. We first tested the shield by placing objects like our cellphones under it and compared it to current standard of care shields. It passed, and with the informed consent of a patient and her parent, I then gave it to a radiologist to test. Indeed, the image came back perfect, just as the mock silhouettes had intended. I then taught three other radiologists how to use it and asked them to test it over the next few days. Again, the results came out better than I could have hoped. Their only request — that I make two additional sizes for patients who were larger and smaller. I did so, and within two weeks the entire team had been trained and my shields were formally adopted as the new standard of care at the Columbia University Medical Center Children’s Hospital of New York. When I visited two years later
in 2016, I was pleased to see the shields were still in regular use.

As a young designer, this project taught me that you can create seemingly simple interventions that can have an important impact on the equity and safety challenges present in our world.

Long-Term Results

As of 2022, 8 years on, the shields remain the new standard of care at Children’s Hospital of New York/Columbia University Medical Center. Orthopedics and Radiology continue to enjoy the high reliability and ease of use built into this design. Many thousands of patients with ovaries, predominantly young women, have received the benefit of ovarian radiation protection they otherwise would have lacked.