After the question of “Can I get an x-ray,” the next most common question I get (which should be the first) regarding x-rays is “Do I need this x-ray?” The answer is not just based on the presence or absence of a medical indication but the medical indication relative to the risk. I’ll provide examples of that consideration shortly. The point of this Straight, No Chaser is to get you to more frequently think of the risks of irradiating your body parts. After all, inappropriate doses of radiation have a much greater chance of contributing to cancer than turning you into a superhero.
Let’s start by getting this off the table: x-rays are safe when used appropriately and with care during each case. Radiologists and x-ray technologists are trained to toe the line between inadequate production of x-rays and overexposure such that patients are placed at risk. Additionally, your physicians consider the risk-benefit ratio with each study ordered. This is why instances exist when your physician (especially emergency physicians) may advise against having x-rays done.
What exactly are the risks of x-rays and other medical imaging studies?
It’s about the risks of radiation and the potential contribution to cancer. You accept these risks everyday. Some of you tan, play golf, surf and otherwise expose yourself to the sun. It’s the cumulative exposure that poses risks, and these risks are miniscule. That said, there are circumstances in which the risks become pronounced, such as irradiation during pregnancy, in children or due to dye materials (called contrast media) such as barium or iodine used to enhance development of the film during special x-ray studies.
In some people, the injection of a contrast medium can cause the following side effects:
- A feeling of warmth or flushing
- A metallic taste in the mouth
- Hives
- Itching
- Lightheadedness
- Nausea
- Severely low blood pressure and shock (anaphylaxis, due to an allergic reaction)
- Cardiac arrest
How much radiation is involved in these studies?
The radiation exposure from one chest x-ray is roughly equivalent to the amount of radiation exposure you obtain from natural surroundings in 10 days.
Aren’t x-rays dangerous during pregnancy?
One of the rules of emergency medicine is we don’t focus on potential side effects when confronted with a defined life threat. The issue of the effect of x-rays on an unborn fetus is secondary to the need to treat the mother. In other words, the best way to protect the fetus is to protect the mother. Even so, the theoretical risk exists, and your physician will take steps to minimize the risk if possible. This may occur by choosing another test (such as an ultrasound) that doesn’t involve radiation. The vast majority of medical x-rays do not pose a critical risk to a developing child. In fact, x-rays of the head, arms, legs and chest do not usually expose the baby directly to radiation.
Regarding standard x-ray examinations of the abdomen, they are not likely to pose a serious risk to the child. Some abdominal and pelvic studies such as CT, nuclear medicine scans and interventional radiologic studies deliver greater amounts of radiation to a developing pregnancy.
What can I do to minimize risks?
I’ll offer two simple recommendations that will help reduce your risk. In both of these instances, alternative evaluation and treatment options might be available that can provide the desired level of care.
- Work with your physician in obtaining x-rays. The instances when you receive x-rays when your physician suggests they are not necessary are not in your best interest.
- Inform the radiologist that you are or might be pregnant.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
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