During a triathlon, paramedics responded to a scene with multiple patients involved in a serious bicycle accident. B.R., a 20-year-old woman, lost control of her bike while descending a hill at approximately 40 mph. As she fell, two other cyclists collided with her, sending all three crashing to the ground.

At the scene, B.R. complained of pain in her head, back, chest, and leg. She also had numbness and tingling in her legs and feet. Other injuries included a cut on her face and on her right arm and an obvious deformity to both her shoulder and knee. She had slight difficulty breathing.

The paramedic did a rapid cephalocaudal assessment and immobilized B.R.'s neck in a cervical collar. She was secured on a backboard and given oxygen. After her bleeding was controlled and her injured extremities were immobilized, she was transported to the nearest emergency department.

During transport, the paramedic in charge radioed ahead to provide a prehospital report to the charge nurse. His report included the following information: occipital and frontal head pain; laceration to right temple, superior and anterior to right ear; lumbar pain; bilateral thoracic pain on inspiration at midclavicular line on right and midaxillary line on the left; dull aching pain of the posterior proximal right thigh; bilateral paresthesia (numbness and tingling) of distal lower legs circumferentially; varus (knock-knee) adduction deformity of left knee; and posterior displacement deformity of left shoulder.

At the hospital, the emergency department physician ordered radiographs for B.R. Before the procedure, the radiology technologist positioned a lead gonadal shield centered on the midsagittal line above B.R.'s symphysis pubis to protect her ovaries from unnecessary irradiation by the primary beam. The technologist knew that gonadal shielding is important for female patients undergoing imaging of the lumbar spine, sacroiliac joints, acetabula, pelvis, and kidneys. Shields should not be used for any examination in which an acute abdominal condition is suspected.

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