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X-ray Safety: Are You Getting More Than the Picture?
By James Wasco, M.D.

In most cases the risk of harm from an individual X-ray is less than the risk involved in not having a needed test. Still, the effects of X-rays are cumulative, so it makes sense to have as few as possible. The following information will help you decide whether an X-ray is in order for a particular problem and also give you some general safety guidelines.

X-ray Checklist

Abdominal and Back X-Rays. To be avoided unless absolutely necessary since the radiation exposure to the sexual organs is several hundred times that of a chest X-ray. Abdominal X-rays are needed only to evaluate unexplained pain, distension or masses. Back X-rays should be done only for severe persistent pain or symptoms that radiate into the extremities.

Barium Studies. The most common of these tests are the upper GI series and the barium enema, which help in evaluating a suspected peptic ulcer, hiatus hernia, colitis, diverticulitis, polyps, tumors and other conditions. Therapy, however, should usually be tried before these tests are ordered. Even if testing is necessary, techniques such as ultrasound and endoscopy, neither of which uses radiation, may be even more valuable.

Cat Scan. Less radiation than a simple X-ray but still should be reserved for serious medical or surgical problems that require quick, accurate diagnosis.

Chest X-Ray. No longer recommended as part of a physical for healthy people and certainly not necessary to evaluate every chest cold. A chest X-ray may be ordered, however, as a screening test before general anesthesia for heavy smokers, and those exposed to certain chemicals or industrial pollutants, as well as to evaluate chest pain, shortness of breath and persistent cough.

Dental X-Rays. Necessary for good dental care, but X-rays shouldn't be taken at every visit. Experts suggest a full set of films no more than every three to five years, with a smaller series of bitewing films in the interim to follow any troublesome problems.

Mammography. The one X-ray screening test for cancer that makes sense, especially because new technology limits radiation exposure. [Edit. note: We do not agree with routine mammography; the FDA position is not to use routine mammography under the age of 50]

Skull X-Rays. One of the most abused and overused X-rays. They should be done only if the physician thinks there is a significant risk of fracture. For evaluation of confusion, headache, instability and other alterations in behavior, a CAT scan is much more valuable.

Important Precautions

  • Never refuse a needed X-ray, but do limit exposure.
  • Don't insist on an X-ray if your physician doesn't think it's necessary. Many doctors will give in and order one because they fear legal liability.
  • Ask your doctor for an explanation if you don't understand why an X-ray is being ordered. Inquire about the possibility of using an alternative non-radiating technique such as ultrasound.
  • Keep a record of every medical and dental X-ray you have, including the date, type of exam and where it was done. This is particularly important if you travel or move frequently. Make this information available to your doctor. Often such information can be used instead of a new X-ray.
  • Make sure your doctor knows if you are pregnant, or even if you think you might be. Whenever possible, postpone non-urgent or elective X-rays to the ten days following your period, when pregnancy risk is lowest.
  • If you or your children (male or female) are going to have an X-ray of the back, abdomen or anywhere near the genital area, ask if a gonad shield can be used. This is particularly important for anyone who might be getting pregnant in the future. [Ed. Note: This is because the X-rays affects the seed.]
  • When an X-ray is being taken, follow the technicians's advice carefully to avoid the need for retakes.
  • Do not have X-rays taken in offices where you suspect the equipment is old or the staff is poorly trained.

When Does an Injury Require an X-ray?

Doctors don't automatically order an X-ray for many injuries these days. But even the most experienced physician cannot always diagnose a broken bone with certainty. As an emergency physician, I treat people with traumatic injuries every day. And I can think of several times I found fractures I wasn't expecting and not found them when I was.

Here is when you should expect an X-ray:

  • A limb is deformed or unstable after an injury.
  • You have marked pain or swelling that prevents or severely restricts using the injured area.
  • There is extensive bleeding or bruising under the skin at the site of the injury.
  • A limb becomes cold, blue or numb from the injured area outward toward the tip.
  • You have suffered trauma from a motor vehicle or any moving object that strikes with great force or velocity. Blunt objects are particularly dangerous.
  • An injury that at first appeared to be minor is still painful 48 hours afterward.
  • An injury is accompanied by generalized sweating, pallor, dizziness or excessive thirst. Such symptoms are early signs of shock. Injuries to the thigh, chest, abdomen and pelvis most often fit into this category.

Reprinted from Woman's Day. Dr. Wasco is a specialist in emergency medicine in the Boston area.

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