What are the implications of an X-ray (X-ray) near the testis (testicle)?

From the Guidelines

X-rays near the testis should be avoided whenever possible due to the risk of radiation exposure to sensitive reproductive tissues, and alternative imaging methods like ultrasound are preferred for examining the testicles directly as they don't use ionizing radiation. The testes are particularly sensitive to radiation because they contain rapidly dividing cells for sperm production, and radiation damage could potentially affect fertility or increase cancer risk 1. If an X-ray of the pelvic area is medically necessary, a protective lead shield should be placed over the testicles to minimize radiation exposure.

According to the most recent guidelines, high-frequency (>10 MHz) testicular US should be used to confirm the presence of a testicular mass, as it can detect whether a mass is intratesticular or extratesticular, the size of the lesion, multifocal disease, and the characteristics of the contralateral testicle 1. The European Association of Urology guidelines on testicular cancer also recommend the use of testicular US as the primary imaging modality for diagnosing testicular cancer, with MRI being limited to distinguishing between intra- and extra-testicular masses when necessary 1.

The use of X-rays near the testis is not recommended for diagnosing testicular cancer, and instead, serum tumor markers such as alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH) should be drawn and measured prior to any treatment, including orchiectomy 1. Ultrasound is typically the first-line imaging choice for examining the testicles, offering excellent visualization of soft tissue without radiation risks, and it is essential to inform the technologist about any concerns regarding radiation exposure to ensure proper shielding is provided 1.

Key points to consider:

• Avoid X-rays near the testis whenever possible due to radiation risks
• Use alternative imaging methods like ultrasound for examining the testicles
• High-frequency testicular US is the preferred imaging modality for diagnosing testicular cancer
• Serum tumor markers should be drawn and measured prior to any treatment
• Inform the technologist about concerns regarding radiation exposure to ensure proper shielding is provided.

From the Research

Implications of X-ray Near the Testis

• The testis is one of the most radiosensitive tissues, and exposure to X-rays can cause impaired spermatogenesis, a known testicular toxicity of radiation 2.
• The threshold for spermatogonial injury and subsequent impairment in spermatogenesis is ~ 0.1 Gy, and the severity of gonadal injury is highly dose-dependent 2.
• Total doses < 4 Gy may allow for recovery of spermatogenesis and fertility potential, but with larger doses, recovery may be protracted or impossible 2.
• Radiation-induced damage to interstitial stromal cells in the testis can cause dynamic changes, including upregulation of certain factors that may support spermatogenesis recovery after high-dose radiation 3.
• The use of diagnostic imaging, particularly computed tomography (CT), in patients with testicular cancer can result in high cumulative effective doses (CED) of radiation, with 77.5% of patients receiving high CED (>75 mSv) 4.
• Strategies to minimize radiation exposure to the testes, such as additional shielding, can be effective in reducing the dose received by the gonads 5.
• The development and incorporation of alternative, lower-risk imaging techniques is essential to minimize the risks associated with radiation exposure in patients with testicular cancer 6.