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. 2023 Jan;24(1):e13842.
doi: 10.1002/acm2.13842. Epub 2022 Nov 10.

Unique approaches for testicular shielding during total-body irradiation for pediatric patients

Mohit Shiv Agarwal  1 , Kathryn Bales Kelly  1 , Panos Papanikolaou  1 , Neil Kirby  1 , Chul Soo Ha  1
Affiliations

Unique approaches for testicular shielding during total-body irradiation for pediatric patients

Mohit Shiv Agarwal et al. J Appl Clin Med Phys. 2023 Jan.

Abstract

Total-body irradiation (TBI) has been used as a part of the conditioning regimen for patients undergoing hematopoietic stem cell transplantation for certain nonmalignant conditions such as sickle cell disease. Although effective, TBI can cause lasting side effects for pediatric patients. One of these potential side effects includes oligospermia or even permanent azoospermia. Although many investigators have studied ways to shield the testicles during the TBI for nonmalignant conditions, there is no set standard. We describe the technical aspects of effective techniques to shield the testicles of male pediatric patients undergoing TBI. We verified that our techniques reduced the testicular dose by approximately 80%-85% of the TBI prescription dose in four male pediatric patients, keeping the dose well below the documented doses that can cause permanent infertility and hypogonadism.

Keywords: Total-body irradiation (TBI); gonadal shielding; pediatric; testicular shielding.

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Conflict of interest statement

Mohit Shiv Agarwal: conflicts of interest: none.

Kathryn Bales Kelly: conflicts of interest: none.

Panos Papanikolaou: conflicts of interest: none.

Neil Kirby: conflicts of interest: none.

Chul Soo Ha: Protectum Oncology Founder and Chief Medical Officer.

Figures

FIGURE 1
FIGURE 1
Testicular shielding block (arrow head) screwed into acrylic tray. Block placed by visual inspection of the shadow from the field light
FIGURE 2
FIGURE 2
Projection of the posterior–anterior (PA) block on posterior skin surface. Block was contoured to project on desired area to be shielded, which has been defined in the patient's anterior skin surface.
FIGURE 3
FIGURE 3
Surface rendering from Figure 2 was used to aid in the positioning of the posterior–anterior (PA) gonadal block during patient's setup.
See this image and copyright information in PMC

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