Here’s The Husband. There is no ghost-writing, I promise. I’ve kept my hands tied behind my back for the past few days.
The Husband is a pediatric radiologist. He works at Children’s. He’s passionate about reducing the amount of radiation a child receives when they have any imaging. In the medical world, “imaging” includes x-rays, CT scans (“cat” scans), bone scans, MRI studies, ultrasound, and procedures like “swallow studies” and VCUGs. He’s real smart and has taught me why to reduce the number of x-rays and CT scans I obtain in my own clinic.
Our tale began when we met the first day of medical school. I went up to the physician lecturer and made a comment after a lecture on gun violence. Jonathan stood right behind me. He said, “Ditto to everything she said.” I don’t think he’s ever said ditto again. Darn.
Read his guest post. You’ll learn ways to reduce radiation exposure for your children. I say, “Ditto to everything he said.”
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Let me begin by saying that I live in awe of Mama Doc’s efficiency. In the time that I put this short post together, Mama Doc has posted 3 blogs including the Disaster preparedness video. Mind blowing. To those of you who are thinking about taking up this blogging thing and who do not have Mama Doc’s alien-like efficiency, let me say this very slowly…keep your day jobs.
Potential topics I considered for my guest blog entry.
- How the success of this blog somehow explains or redeems the fact that my family members bypass me for medical advice and go straight to Mama Doc. Example conversation, “Hey bro…” Me, “Yeah Wendy’s here…yeah…no, I understand.” “WENDY, my brother is on the phone…he wants to ask you something about medicine.”
- The eerie parallel between this blog and the plant from Little Shop of Horrors. Think “Feed me!”
- The risk of medical radiation, especially in children. How parents can reduce the risks for their children.
Alas, I chose option #3. No wonder my family members ask for Mama Doc when they call.
When my mom was a child, she would go to the shoe store, try on shoes and then go to the handy-dandy in-store x-ray machine to see if the shoes fit. Foot in, foot out. X-ray on, x-ray off. Every time she checked, she received radiation. No one told her that the radiation might be bad for her.
Fast forward sixty years. Sorry to date you, Mom. A study in 2007 suggested that only 13% of parents of children in medical settings understood that there is a theoretical risk that the radiation associated with CT scan might increase the risk of cancer.
We can do better than that. Since 100% of people should know this:
- To be safe, assume low doses of radiation may cause harm. Any radiation for a baby, child or adolescent carries risk as their bodies are still developing. However, a typical chest x-ray provides no more radiation than you get while flying in an airplane from New York to Seattle.
- A head CT scan provides the equivalent amount of radiation to between 100 and 250 chest x-rays.
- The amount of radiation a CT scanner emits is adjustable. For example, an adult head requires more radiation than that of a child to get quality images. Therefore, when a child gets a head CT scan, the radiation can, and should be, dialed down.
So here is the deal – There is no conclusive evidence in scientific literature that radiation from one simple X-rays causes cancer. However, some studies of large populations exposed to radiation have demonstrated slight increases in cancer risk even at low levels of radiation exposure, particularly in children.
Do everything in your power to minimize risks from radiation for your children going forward, especially if they have underlying medical problems and get repeated CT scans. However, if your child has had numerous CT scans, don’t freak out. CT scans provide a tremendous amount of information and often the benefits truly outweigh the associated risks.
Much, if not all, of this information is available at www.imagegently.org , a web site set up by the Society of Pediatric Radiology.
- Go to the Image Gently and look for the “Parents” tab under What Can I do? Here you will find excellent resources about the medical risk of radiation, CT scans, and interventional radiology.
- Print out the Medical Radiation Record (found on the Image Gently parent page). It is like a Vaccine record. But different. The idea is that by tracking each and every study that your child has had, it is less likely that a study will be repeated unnecessarily. Also, your child’s doc will have a better idea of how much radiation your child may have received already.
- Be proactive. Tell your pediatrician about the Image Gently website. It’s ok to tell your pediatrician what you know. They work to protect your child, too. Direct them to the section for pediatricians. Some doctors image more than others. If you think your child is going to get an x-ray or CT scan it’s always okay to ask them about alternatives (like an MRI or ultrasound that don’t provide radiation). If your child’s doctor or an ER doctor orders a CT scan for your child, ask if another study without radiation would answer the question they are looking to solve.
- If your child is about to have a CT scan in any hospital, ER or clinic, mention the Image Gently program. If the CT technologist is not aware of it, have them google it and look at resources on reducing radiation to your child before they scan your child. If nothing else, it may remind a technologist who is used to scanning adults to use a lower dose with your child.
- Get a digital copy (on a CD) of your child’s studies (CT scans, x-rays, MRIs) and bring them with you if your child gets referred to another doctor or hospital. This too will decrease the likelihood of a repeat study. It is often easier and faster for a doctor to repeat a CT scan than it is to track down the images from a CT scan from an outside hospital. Don’t give them the choice! Bring them the study yourself.
Medical imaging is amazing. Often, the benefits of imaging and CT scans far outweigh the risks of radiation because of what we learn and how we can treat and cure disease. But, like most amazing scientific advances, there are associated risks. Use these resources to inform yourself, your pediatrician, and the imaging center where your child is cared for so that your child gets the best care, the right answers, and the least amount of radiation.
And, if your child never needs an x-ray or CT scan, may good fortune continue to shine on them for the rest of their lives.
–The Husband, aka Dr Jonathan Swanson
Kate Wolfe says
is this “image gently” thing something that all the radiologists at Seattle Children’s already know about and are well-versed in? I ask because we’ll be spending a lot of time there, and I want to know if it’s something I need to be proactive about there.
Wendy Sue Swanson, MD says
Dr Husband is here. He says:
“You do not need to worry at Children’s. We spend a large part of our day, every day, making sure that we are avoiding radiation for our patients or using the lowest dose possible for the images we need. We often call the ordering doctor to discuss if we have ideas about studies with lower radiation that can get to the same answer.”
I say:
This is just another reason to have your child cared for in a pediatric facility rather than one that treats all ages.
Jane says
I’m wondering about the effects of dental x-rays. I think they do them 1x a year at my children’s dentist. Is that necessary? Is there anything different about the dental xray that makes it safer?
Thanks for the info!
Marna Fasteland says
Thank you Drs. Swanson for this excellent and informative information. And timely too as my 17 year old visited her physician yesterday and the result was a possible “scan” as the next step (waiting for results of the blood work up first). I now feel much better prepared to discusss options.
Amanda Walsh says
I’m so glad that you think about things like this. I actually decided not to stay at Lake Stevens Everett Clinic when the doctor recommended a swallow study be done on my 1 month old baby rather than waiting to see if an acid reflux medicine worked for him first. I’m anti-testing if the test isn’t necessary to the diagnosis. My sister and her kiddos see a non-pediatrician and I’m so glad that I see you! Thanks to “The Husband” for the thoughtful post, though I thought ideas #1 and 2 were great too. 🙂
Wendy Sue Swanson, MD says
I’m glad to help inform you on how to think about testing, too. We all have to think about weighing risks and benefits–for our own health care and those that are dependent on our decisions (our children, parents, etc). Often there is more than one right answer on how to investigate or work-up a problem. Talking with your doc about concerns you have with a plan is always the right thing to do. It’s always ok to ask!
Kris Brauns says
Dr. Swanson, thank you for that information. My 11 year old son Brandon recently passed away from his brain tumor he has been fighting since 2003. He was treated by Dr. Geyer and Cory. This information is so valuable. We knew secondary cancers were possible. Brandon had more Pet, CT and MR scans than I could count. Had I been given this info I would have surely spent more time on planning his scans.
Thank you, I hope others will read this!
Kris
Wendy Sue Swanson, MD says
Jane, from what we can find, dental x-rays (the panoramic kind) provide about the same amount of radiation of a chest x-ray. So about the same amount of radiation you receive flying in an airplane across country. This is thought to be very low risk.
hope smith says
Thanks for bring this out.
I had neve thought of it before.
Dentist Los Angeles says
As a dentist, I think dental x-rays for children are necessary only when we are suspicious there is a dental problem. However, the new digital x-rays have far less radiation than the traditional ones and are much safer.
Bend or Dentists says
Radiation causes cancer, that we know, even low doses increase the risk tremendously but aside from the medical radiation a person gets there are even more in our modern world to warrant staying away from electrical equipment that emits radiation.
Mesa Family Dentist says
I would love to be a patient of this Dentist then. Few clinics are really that modern and 100% sanitized.
Ruby at Summer Camps In Missouri says
I try to limit the amount of radiation that my child receives in any case. I’m glad there are professionals in the field with the same belief. If I can, I try to avoid even those airport scanners.
Periodontal Treatment Expert says
My mom was diagnosed with cervical cancer. She had it for almost 4 years. And she undergone a lot of treatment including what they called radiation or emission of a certain beam to kill cancer cells.
I was just wondering, why some doctors are still advising cancer patients to undergo such method even if it’s harmful since it uses radiation. Now my mom still have such illness and I think it’s not effective and the cancer is even recurring.
Thanks for this article that you shared. I actually learned a lot from it.
radtech says
This is an excellent initiative and at least in theory should be fairly easy to establish as a standard protocol for CT techs. The elephant in the corner is the many MD’s who use CT as a defensive medicine tool or substitute it for physical exams. In many cases, and I have seen a few, MD’s (other than radiologists) simply don’t realize how much radiation is involved with cat scan.
Jonathan T. says
As a parent I protect my child. I just assume that dentist and medical professionals are experts at how much radiation should be used on a child safely. Now with the Image Gently website information it is necessary in my mind to have the conversation with my sons dentist.
mike the murrieta dentist says
This is very helpful information that many patients are not aware of when going in for a treatment. I think the radiation levels that we get exposed to at a dental or medical clinic should be more open and accessible to everyone.
aiza@familydentist says
I’m concern also on how much radiation my child gets. But I think their is nothing to worry about. I trust you professionals on that.
Matt - x-ray supplies says
I was shocked to read this post below about the amount of radiation exposure we receive from a CT scan.
The results of the study, presented in May at the annual conference of the Society for Academic Emergency Medicine, were disturbing: the average patient had received 45 millisieverts (mSv) of radiation. (The typical chest X-ray dispatches 0.02 mSv of radiation.) And 12% of patients had gotten more than twice that amount — 100 mSv or more.
Read more: https://www.time.com/time/health/article/0,8599,1818520,00.html#ixzz1STrucVqU
Bend Family Dentist says
Digital dental x-rays have significantly reduced the amount of radiation exposure for patients. A Digital pano has less radiation offload than a standard chest xray.
Jade says
There was a recent study (Berkeley, Oct. 2010) about only 1-3 xrays (not CT’s, regular xrays, not dental xrays) increasing leukemia risk in children. It has scared me to death- I have two kids who have had plenty of xrays that were medically necessary. What do I do with this information besides freak out?? Is there any reassurance out there or not??? If children live at sea level and takes no flights, does that cancel out some of this risk? I am so scared and in tears when I read this study… I trusted the doctors when they said it was perfectly safe to get these xrays. I understand that no one knows for sure but that’s not acceptable to me.
Jade says
Oh, and I forgot to add that assuming there is damage done to children’s bodies, is it reversible? With healthy diet, low/no esposure to BPA/pesticides, organic food, etc.? I read another study (got to stop reading these studies, I am a parent, not a doctor!!!) that breastfeeding REDUCES the incident of leukemia (and other childhood cancers). So, I breastfed both my children for a year…does that reduce their risk from any xrays they received?? And, altitude of where we live. I live at sea level, John Doe’s children live at a very high altitude…his kids no xrays, mine a few, but we don’t have as much background radiation per day. Are they at the same risk? In fact, I read (imagine that) another study that showed people living in high altitues with higher radiation have LOWER risk of cancer. Wonder if this is assuming these people live there throughout childhood? I am so confused, scared, and worried. I don’t want to worry the rest of my children’s childhood about this…they are beautiful and healthy girls and I want to enjoy it. This wakes me up in the middle of the night! Thanks for the vent & the information 🙂
Jonathan Swanson, MD says
Jade,
I certainly understand how frightening these studies/articles can be. Terrifying, no doubt.
In your case, I think much of your fear is unwarranted. Although I don’t know the exact number of studies that your children have had, it is very unlikely that your children’s necessary diagnostic studies should increase their risk of leukemia in a significant way.
The estimation of radiation risk is not an exact science. Many assumptions go into a calculation of risk. One important reminder – there is no example of a patient who developed a cancer directly related to undergoing diagnostic radiology studies.
Although I don’t know of any data regarding reversal of cellular damage caused by radiation, feeding your children a healthy diet and limiting exposures to pesticides seems like a good idea regardless.
Cay Hart says
At nine weeks, my son entered the hospital because he wouldn’t eat, was running a fever, and had (oddly) a bit of a runny nose. The doctor ran many tests (blood, urine, spinal tap) and took one x-ray with a small portable unit. The doctor said that the film did not show anything but that the film quality wasn’t very good, so he ordered two more x-rays the next day on the huge hospital x-ray machine. At the time, I was distraught about my 8.5lb 9-week-old baby and didn’t think to question the subsequent x-rays which I later felt were made to cover the doctor’s liability vs. being warranted by my baby’s improved health.
Once home, I started reading about x-rays: dosage should be adjusted for size, scope needs to be scaled down to hit chest only, and babies under three months old are affected more greatly by radiation. I spoke to my child’s regular pediatrician, who agreed that x-rays weren’t ideal at his age, shrugged her shoulders when I asked about the necessity of three total, and then contacted the radiology department to get an answer to my question: how much radiation was my child exposed to? The responding radiologist was terse and would only tell my doctor that the smaller machine emitted less radiation and that “all the machines were calibrated to the industry standard.”
I understand the urgency when dealing with babies to figure out what’s causing their ailment. While I think only one front view on the large machine would have been sufficient, I can rationalize that there’s no reason to mess around with a young baby. That said, I feel that the head radiologist of a hospital should be able to definitively answer what dosage my son received. The reply I got was at best condescending but at worst a cover-up of ignorance regarding the details of the procedures performed on my son during the two x-ray sessions.
At 18 months of age, my son was seen by a physician’s assistant at urgent care (since I wanted him looked at after normal business hours). His symptoms: bearing down when coughing and more congestion at night. He did not have a fever, his breaths per minute were normal, his heart beats per minute were normal, and his lungs sounded clear with the exception of “a little congestion” on one side. Then the physician’s assistant looking at him decides that he needs a chest x-ray because his oxygen saturation, as shown by their reader, was 94%.
Now every single time I’ve gone to an appointment at that medical group, the people taking the oxygen saturation level had a hard time getting a reading. They’d use different attachments, different units, and different people to try until someone could get a reading of 98% or higher saturation. Now 94% is a bit lower, but on normal check-ups he’s read 96%. I told this medical person that he’s already had three x-rays and I wasn’t keen on more. He stressed his “concern” over the saturation level and stated that he and the doctor on call were “debating” releasing us or sending us to the hospital. To make a long story a bit shorter, he wanted two x-rays. The technician proceeded to tell me that one x-ray is equal to ONE YEAR of normal exposure. I subsequently read that a chest x-ray, for an adult, is equivalent to 10 days of normal exposure to radiation, so now I’m wondering what dose she gave him and if there’s any way for me to find out based on data saved with the x-ray.
I’ve since found another medical group. His new pediatrician said that five x-rays at his age was a lot. She also said that his symptoms would not have prompted her to x-ray.
Please reply with an estimate for what exposure my son has received for five x-rays and any recommendation for how I can find out definitively–that is, what wording do I use when following up with the medical group and hospital radiologists regarding dosage received and finding out how they ensure that all their technicians are trained to adjust settings for small babies? Please also reply with any other thoughts.
This medical group seems to favor liability coverage over a child’s long-term health. After all, they can’t be liable if a person develops cancer years after x-rays they ordered. And in the meantime they get some extra money.
Elizabeth Daher says
My child has abdominal pain and an abdominal film was ordered to rule out any mass etc. She did seem to have some stool in the descending colon. Can an ultrasound or MRI give similar information?
Erica says
Mr. or Mrs. Doc Swanson,
Do you know if Swedish Hospital in Ballard has a reputation for reducing radiation in CT Scans on infants? My newborn had a CT Scan at 3-weeks-old to check for damage due to blunt trauma. I wasn’t offered an MRI, and I wish I had been wise enough to take my baby to Children’s Hospital instead. I will never make that mistake again. I have been weeping ever since…
Same question for Cedars-Sinai in Los Angeles. My 6-month-old was given a CT Scan after the shopping cart tipped over. I have no idea if the scanner was adjusted for babies at the time of incident. One of the country’s best hospitals; they should know to reduce the radiation, right?
1 in 500 gives me plenty of reason to worry.
Annie Stayson says
I know this is really late from this post but first thank you for the post it was very informative. We is my I am also terrified of the number of X-rays my daughter had had. Beginning at 14 days old they performed an xrays hips for displaysiA. Many several follow ups for that, again at 20 months two weeks apart for pain and sudden refusal to walk in same leg they thought could be related or fracture. Foot X-ray for injury, cheat X-ray for breathing problem and now orthodontist do two panoramic a in a row because first was blurry (they didn’t ask if could repeat). I am terrified of how many that has been. Everything says one is very safe. But all those?
Jonathan Swanson, MD says
Annie,
Thanks for your question.
The x-rays your daughter has had represent excellent examples of responsible uses of radiation: following hip dysplasia after 4 months of age, evaluating for toddler fractures, evaluating for early signs of pneumonia in the lungs, and mapping the teeth for orthodontic planning.
Additionally, the doses needed for these studies (even the two panoramic dental exams) are small compared to the average radiation that we all receive from normal background radiation in our environments.
So I think your daughter has enjoyed all the benefits of radiology with minimal radiation exposure. Good work!
Annie Stayson says
Thank you for your reply. You are very kind to take the time.