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Radiation Concerns With Radiology Tests

The very word, often accompanied by that familiar radiation logo, evokes alarm. You can't see it, smell it, or feel it; yet it can do you harm. Most of the harm will come from an increased chance of developing cancer sometime in the lifespan of the radiated patient from having the encounter. In the vast majority of the cases, the risks are exceedingly low but in other situations, the risk is high enough that caution is advised. How safe is an upper GI series, an x-ray of the lower back, a chest x-ray?

Because of refinements in technology, in general, you may assume that if everything is working okay, the radiation will be confined to the patient and to the persons working with the patient when the exposure is made. If you are walking through the halls or in the x-ray waiting room, you have nothing to fear. Generally the persons working most closely with the patient are the technologists and the radiologist. These individuals protect their radiation sensitive torsos with aprons made with a lead lining to keep the rays out.

Now and then you may see someone wear a small ring of lead around the neck to protect the thyroid which is very sensitive to radiation. Personnel who work with radiation (e.g., angiograms) for long periods of time may also elect to wear eyeglasses composed partly of a material that helps keep the x-rays from reaching the delicate cornea of the eye.

For a very detailed discussion of x-ray risks, check out, X-rays: Health Effects of Common Exams, by John W. Gofman, M.D., Ph.D., and Egan O'Connor (Sierra Club, 1985). The book is an exhaustive survey and includes many charts that enable readers to calculate risks of common x-ray exams, including routine films, fluoroscopy, mammography, angiography, and CT.

A few of the basic points the authors make in the book include the following:

• One should always consider the risks versus benefits of x-ray exams. If the clinical situation warrants, proceed with caution. If not, look for alternatives.
• The amount of risk depends on many factors including sex, age, and type of examination. Children toward the end of their first decades and fetuses seem most vulnerable. The elderly are much less vulnerable.
• The part of the body that is most vulnerable is the torso, so exams that deal with structures in that section are more risky than exams that involve the extremities.
• The clearest way to evaluate risk is to determine the increased chance of getting cancer as a result of the examination. For example, the risk to a 50-year-old man of getting cancer in his lifetime from having an IVP is 1 chance in 11,000.
• A few of the risks from Gofman and O'Connor's book include: The risk for a newborn infant to develop cancer some time in its life as a result of having a chest x-ray is 1 chance in 3,500 for males and 1 in 1,800 for females. Barium enema, age 50, 1 in 13,500 for both males and females. Chest x-ray (2 views), age 40, 1 in 58,820 in males and 1 in 27,700 for females. Hip x-rays, age 55, 1 chance in 210,000 for males and 1 in 190,000 for females. UGI series, age 40, about 1 chance in 1,500 for both males and females. (The reader should keep in mind that the figures in the charts are somewhat dated. The equipment has improved dramatically and doses have decreased in the past few years.)

Technological improvements in equipment allow radiologists to decrease the radiation dose of common examinations. To get a good clear picture, radiologists can either give a higher dose or, better, use the lower dose exposure and do everything in their power to improve the image after the fact. So nowadays we get much more bang from our buck. Consider what happened with screening mammography. In some institutions, screening mammography programs were begun as far back as the early 1970s. There were many critics of these programs because the radiation dose was relatively high and the discovery rate of early breast cancers relatively low. Screening mammography almost vanished. Then the technology began to improve dramatically. The cathode ray tubes that generated the x-rays were further developed as well as the films and the cassettes that held them. As a result, the pictures became clearer, and more early cancers were detected. At the same time, the dose diminished to a point that swung the risk-benefit ratio over to instituting screening programs around the country.

Though caution is still very much in order, fear is unjustified by the facts. If equipment is working properly and technologists are properly trained and licensed, there should be no problem at all. For children at or around ten, or pregnant women, it is wise to exercise particular caution. If you a woman of childbearing age, extra caution is also called for. It is all about risk versus benefit, and if you need x-rays, you shouldn't be afraid to have them. Make the interaction as gentle as possible with as little radiation as possible, but get it done and go from there and get well.

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