X-ray radiation can add up, along with risk: When not to ask for an X-ray

by James Hubbard, M.D., M.P.H.

Have you ever had an X-ray?  Probably so.  What would modern medicine be without them?  I can’t count the times I’ve seen a kid with a hurt wrist thinking it was a sprain but I ordered an X-ray just in case and surprise, surprise.  There’s a little fracture.

But sometimes we might depend on them a little too much.  The FDA wants to remind us that X-rays can increase our risk of cancer, however minimally, and the exposure is accumulative. You have an X-ray at six years old and the radiation is still in you at 70.  You have another one at 16 and now you have twice as much in your body.

Am I advising against X-rays?  Not at all.  I’m just saying don’t always insist on them.

For instance, back X-rays.  Studies continue to crop up showing it’s very rare to find anything significant in an under-55-year-old with acute, nontraumatic back pain.  If the doctor examines you, just finds muscle tenderness and wants to wait a little while on the X-rays or CT scan, consider not insisting.


HOW MUCH RADIATION DO WE GET?

The FDA says medical radiation exposure has increased by 500 percent since the 1980s.  We still get most of our radiation from the natural environment (50 percent).  But radiation from medical X-rays  has gone from 11 percent in the ’80s to 35 percent today.  A lot of that increase has come from CTs (CAT scans).

Used to, when someone was knocked unconscious, you did a physical exam.  If it showed hints of a bleed inside the head, you referred the person to the neurosurgeon.  Even if the exam was normal the patient was hospitalized with neurological checks every hour or so.

Now, if you get a bump, you’re likely to get a CT, which can tell right away if there’s a bleed.  CTs are fantastic.  So much so they tend to be overused.

Here are some examples of radiation exposure amounts.  The dosage is in millisiervent (mSv), which is just a measurement unit of radiation.  To give you an example, you get about 3 mSv natural radiation per year at sea level (up to 4.5 at mile-high living).  This includes an average of 2 mSv from radon in the average home of “safe range.”

  • CTs
    Body: 10 mSv, Abdomen: 10 mSv,  Chest: 8 mSv, Head: 2 mSv, Sinuses: 0.6 mSv
  • Plain X-rays
    Spine: 1.5 mSv, Chest: 0.1 mSv, Extremity: 0.001
  • Bone density test
    0.01mSv
  • Mammography
    0.7 mSv
  • A coast-to-coast plane trip
    0.03 mSv

Bottom line, X-rays can be life savers, but you may not want to insist on them every time you see a doctor.

What are your thoughts?  Have you ever been in a situation in which you asked for X-rays or refused them?

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29 Responses to “X-ray radiation can add up, along with risk: When not to ask for an X-ray”

  1. Judy Rodman Says:

    Eh… that sure makes me a little nervous about my hospital stay 30 years ago where they did X-rays every day for about two months. I’m probably glowing :<

    This is really a great warning “heads up”, Dr. Hubbard. We take so much for granted. I have been avoiding X-rays since then. A little voice ( or maybe a ray) in the back of my head whispers “you have had your quota”!

    Judy Rodmans last blog post..Singing In Color vs Black & White

  2. Dr. J Says:

    Totally in support of your message, Dr. Hubbard! Being in the field, I’ve learned to be very careful around X-ray radiation. I remember in my family medicine rotation, being at an older physician’s office, and he still had a fluoroscope! I stood behind him for the one time he used it while I was there!

    Dr. Js last blog post..Warming up helps surgeons improve performance

  3. Sagan Says:

    I’ve only ever had a couple x-rays but I worked at a vet clinic that had an x-ray machine so I used to have to hide around the corner every time they took x-rays of the animals. It was a pain because it would interrupt my work, but definitely worth it to avoid radiation!

    Sagans last blog post..Two Hundred Crunches!

  4. Steve Parker, M.D. Says:

    You found another good issue to bring up, Dr. Hubbard.

    I work as a hospitalist and have much interaction with the Emergency Room.

    It seems nowadays almost everyone coming to the ER with a headache or abdominal pain gets a CT scan. Many fewer of these were done 10-15 years ago. They can provide life-saving information, no doubt. But I suspect what generates at least of few of the scans are 1) defensive medicine, and 2) there are many more CT scanners, and they must be paid for. “Defensive medicine,” which is something done to protect the physician from claims of malpractice, is huge.

    I bet office-based physicians are ordering more of these scans, too.

    I’m not saying the “old days” were better, but certainly different.

    -Steve

    Steve Parker, M.D.s last blog post..Why Does the U.S. Rank Poorly on Global Health Measures?

  5. cathy Says:

    UGH. My 2 yr old daughter has already had 2 chest x-rays and 1 CT scan. I think that they were all merited (maybe), but this article will definitely make me question whether future x-rays are absolutely necessary or not. It’s a wonderful tool for a doctor to have, but it’s clear that parents and patients need to make sure that it isn’t overused.

    Great post. Thanks for keeping us informed!

  6. James Hubbard, M.D., M.P.H. Says:

    Judy, I can understand that. Just don’t avoid the necessary ones.

  7. James Hubbard, M.D., M.P.H. Says:

    Dr. J, you are so right. We have to be careful.

  8. James Hubbard, M.D., M.P.H. Says:

    Sagan, fortunately most x-ray machines these days don’t scatter radiation much. But I would get as far away as possible. Getting behind walls don’t help much unless they have lead in them.

  9. James Hubbard, M.D., M.P.H. Says:

    Dr. Parker I totally agree. A lot goes into the decision for CT’s not least of the malpractice issue.

  10. James Hubbard, M.D., M.P.H. Says:

    Cathy, x-rays can be great tools. Most of the time the benefits definitely outweigh the risks.

  11. Tom Rooney Says:

    Dr. Hubbard,
    I can’t agree or disagree since you would be the expert here, but we still need to use the x-ray in moderation for diagnostics. How do you go in the other direction when a doctor says he needs this to see there is something wrong? Do you ask, is there another way for you to find out without the radiation?

    Tom Rooneys last blog post..Secrets of a Successful Weight Loss Diet

  12. James Hubbard, M.D., M.P.H. Says:

    It never hurts to ask. The Dr. needs to explain why it is needed. It’s the CT’s that have so much radiation and often they are necessary. However, an MRI uses magnetic resonance and does not expose you to x-rays. Their downside is they are more expensive.

  13. FatFighterTV Says:

    Wow – that really puts it in perspective! Thanks! I guess I never even thought about how we are exposed to radiation at home, etc.

    FatFighterTVs last blog post..Weight Loss WooHoo! to Roni (Roni’s Weigh)

  14. FatFighterTV Says:

    Wow – that really puts it in perspective! Thanks! I guess I never even thought about how we are exposed to radiation at home, etc.

  15. James Hubbard, M.D., M.P.H. Says:

    Yeah FatFighter.

    The sun exposes us to radiation and some of the earth’s minerals.

    Thanks

  16. Kim Says:

    Great point! X-ray safety is a good thing to think about especially for patients who are constantly in and out of the hospital.

  17. James Hubbard, M.D., M.P.H. Says:

    Hi Kim.

    I agree, and almost every time they are subject to x-rays. Of course most are essential, but some are repetitive.

  18. James Hubbard’s My Family Doctor Blog » Blog Archive » X-Rays, Radiation and Children: What to ask your imaging center before the scan Says:

    [...] Hubbard recently wrote about X-ray radiation—how it can add up. Today, we’re featuring a guest post from board-certified radiologist Helene Pavlov, M.D., [...]

  19. Bill McLaughlin Says:

    How do I find out if I have been exposed to too many x-rays? In 2004 I attempted suicide with a .22cal.long rifle bullet in my mouth. The bullet is still lodged in my 1st cervical(fractured) vertebrae 1mm from my spinal cord. I have in my posession a stack of x-rays over 1 1/4″ thick and 1 CD of a CT scan. A radiological office has at least that many in their office and the hospital where I spent 3 weeks in their trauma unit has at least that many.

    I’ve been bothered with severe head and neck pain almost constantly now for about 15 mos. Docs don’t seem to know what’s wrong.

    Would you help me please?

  20. Bill McLaughlin Says:

    On my comment left above about, “How do I find out if I’ve been exposed to too many x-rays.” Would you please email me you answer?

    Thank you Dr.Hubbard.

    Very Truly Yours,
    Bill McLaughlin
    email

  21. Lucy Lorenz Says:

    Dr Hubbard,

    How do other medical tests and treatments figure into total radiation exposure? I was treated with 131I for Graves Disease and have had a lower GI, along with years of mammograms, dexa scans, CT scan, lung Xrays for pneumonia, xrays for arthritis and broken bones, etc. And now I fight with my dentist every six months about xrays.

  22. James Hubbard, M.D. Says:

    Lucy,

    Thanks for the questions. There’s no definite answer to how much specific risk accumulative radiation from tests and treatment adds to health risks to an individual, but we’d all like to keep it as low as possible.

    Emory University ( http://whsc.emory.edu/home/news/releases/2009/08/medical-imaging-cummulative-radiation-exposure.html ) says yearly doses over 50 mSV increase cancer risks. (mSV is just a unit measurement of radiation.) That’s a pretty high dose. I think the uncertainty and concern is how much those smaller doses hurt you. This is still up in the air but, in general, we don’t want any exposure not medically necessary.

    I couldn’t find specific figures on how much actual radiation your body is exposed to from radioactive treatment for Graves disease; however, most is absorbed by the thyroid and the other excreted in the kidneys and GI tract.

    The DEXA scan you refer to is the bone density test listed in the blog (0.01 mSV.

    As for dental X-rays, the FDA recommends you make sure they use the “E or F” speed film which costs more but exposes you less. The regular “D” film is apparently slower and exposes you to more. The FDA has recommendations at http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm095505.htm. Dental X-ray exposure is around 0.15 mSV, which is higher than a chest X-ray. You’ll have to keep fighting.

    Bottom line is it’s extremely hard in science to completely rule out any risk. It’s much easier to find proof some exposure causes something. The best we can say now is ask your health care provider if the procedure is really necessary and what are the risks in not getting it. In the end, it’s your call.

    Thanks,

    James Hubbard, M.D.
    Family Doctor and Publisher, http://www.MyFamilyDoctorMag.com

    See disclaimer here: http://www.familydoctormag.com/disclaimer.html

  23. Anonymous Says:

    This is a fair point but the doctors should sometimes let the parents insist upon an x-ray. I know this is a situation that is not likely to happen but my cousin was complaining about really bad back pain. They took him to the doctors but the doctor kept making reasons for the back pain. It turned out that he had a really rare form of cancer. He was only 13 and died as a result of the cancer. If he had an x-ray they would have caught it sooner. I don’t blame the doctors but I think that in cases where really bad back pain continues then an x-ray is probably a good idea.

  24. Erica Says:

    My 5 week old daughter had a ct scan of her head. She was exposed to a DLP of 276.54 exposing her to 1.7 mSv. I did not think she needed it but the ER dr said I think we should. I should have stuck with what I felt was right but being a first time mom I assumed he would NEVER do that to a newborn if it wasn’t needed. Turns out I was right. I am mortified that she will be hurt from this radiation

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