X-rays what patients need to know?

X-rays are a form of apparent wave that can penetrate or pass through the human body, making shadow-like images of bones and some organs. They can reveal signs of disease as well as injury; fluoroscopy, which allows observation of motion within the body and certain diagnostic and treatment procedures.

The person’s body absorbs some but not all of the x-rays’ energy. The very low radiation doses absorbed during imaging procedures generally produce no adverse effects, but it is still recommended to reduce those numbers as much possible. We use quite large amounts of radiation in oncology or therapy to stop cancer cells from multiplying.

» What are X rays and what do they do?

Adverse effects from radiation dose absorbed in diagnostic practice are rare. For example, chest X rays, skull X rays and simple hand or foot X rays each expose the patient to a radiation dose of less than 1000 mSv; the annual exposure due to natural sources is ~1000 mSv.

Even at these low levels of radiation exposure, you can’t entirely rule out that there could be genetic effects or cancer-causing side effects. Currently there is no evidence to show such effects from medical procedures like this one, but this isn’t because they haven’t been studied. The theoretical possibility cannot be ruled out–in fact it’s quite likely–and it will take more extensive studies to find these results.

» How safe are X rays?

CT and interventional procedures such as angiography, cardiac catheterisation and implantolog are associated with a lot of radiation. CT and angiography is about 100 to 1000 times more than chest X rays.

» Which procedures are associated with higher radiations doses?

Some procedures, such as the one used in diagnostic X rays and nuclear medicine exams, could lead to adverse effects. Procedures with higher doses, such as CT and interventional procedures, could lead to biological effects in some cases. A higher absorbed dose means a higher risk for an adverse effect – the relationship is almost linear.

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Adverse effects could include skin redness, infertility, cataracts, and hair loss. There are no reports of radiation exposure from diagnostic and interventional procedures causing infertility or cataracts.

Patients undergoing interventional procedures that require fluoroscopy that last more than one hour could experience radiation induced injuries if other factors are present (this only happens very rarely). Diagnostic X rays and nuclear medicine exams have a slightly increased risk of developing cancer. This risk increases with the magnitude of the dose and with the number of treatments.

» What are the possible effects of radiation on my health?

Radiation can be an important tool in the fight against cancer. As with every other medical procedure, radiation should only be used when it is appropriate for a patient and will have minimal risk.

International organizations have established guidelines and recommendations based on scientific data which allow providers to implement measures designed to reduce dose exposure for patients.

» How much radiation is acceptable?

X rays are powerful machines that need to be maintained and tested regularly by qualified staff. As with any technology, radiation safety is a serious concern. There are some organizations that accredit facilities of high quality.

» How do I know if the X ray facility is safe to perform the procedure?

More often than not, medical tests or procedures should be justified. Benefits and risks of the evaluation or procedure should be factored in, and the possibility of using other methods that do not involve radiation exposure should be explored. The principle of justification allows for the exam being performed with minimal radiation dose, which requires achieving adequate image quality while keeping the exposure as low as reasonably achievable.

The principle of optimization means keeping risk low by comparison with regional, national, or international reference levels that indicate approximate dose levels for different procedures;Repeat examinations are sometimes needed to monitor progression, particularly with cancer treatment.

» How will I know if I am getting the radiation dose that is needed and no more?

By helping your doctor decide what to do next and when a previous exam took place, you can avoid unnecessary repeat investigations. Sometimes, these re-investigations are needed to determine what’s most effective treatment in your case.

» Can I avoid unnecessary repeat investigations?

Medical professionals take all available data into account when conducting their exams, especially radiation exposure. They prefer to use tests that are alternative, non-ionizing or in other ways reduce radiation exposure.

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» How does my doctor select the most appropriate investigation/procedure?

Ultrasound and magnetic resonance imaging (MRI) are two types of imaging that do not use X rays or radioactivity. Ultrasound can be used for examining the pelvis and abdomen, particularly during pregnancy, and it’s also helpful for checking in on things like the breast, testes, scrotum and parts of the neck and limbs. When available, MRI is often used for scanning whole-body areas like the head, spine and joints.

» What alternative investigations are available that do not use X rays or radioactivity?

When diagnostic investigation exposes the patient to radiation, it usually falls within a small range, similar to what is received from radiographs.

» How do doses and risk from nuclear medicine compare to X rays?

When it comes to exposure, an unborn child is considered to be much more sensitive than adults or even children. It is necessary that any X ray examination of the head (including dental X rays) be conducted with extreme caution due to the unplanned radiological effects which can be dangerous for an unborn child.

For many procedures such as these, the radiation dose would likely be low since the pelvic region of a pregnant patient will not come in contact with the x-ray beam itself.

Prenatal procedures, however, are considered a last resort and doctors may take special actions to keep exposure levels low such as shielding the pregnant subject during the procedure. Trust us, including a pregnant individual in an x-ray study is better than being radiated while pregnant!

» Can I undergo X ray investigations while I am pregnant?

The goal is to keep an unborn child’s exposure to radiation as low as possible. An unborn child is considered to be more sensitive than adults or children to potential adverse radiation effects.

For many investigations such as X ray exams of the head (including dental X rays), the dose to an unborn child would be very low because the pelvic region is not exposed to the X ray beam.

Doctors may consider delaying procedures that would place the pelvic region and the unborn child in direct path of the X ray beam, particularly fluoroscopy or CT investigations. If a procedure is essential for a mother’s health, doctors take special steps to keep the dose for her baby as low as possible.

They can shield her pelvic region during procedures before starting and throughout, or they can turn off other imaging equipment entirely when she enters an MRI machine.

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