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Thread: Repeated x-rays

  1. #1
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    Default Repeated x-rays

    Hi everyone,
    Is that time of the year again and my Jessie will be having yet another x-ray of her spine.
    My question is, do they cover your child's neck to protect his/her thyroid glands and your child's reproductive organs during his/her x-ray? Also are the x-rays AP or PA?
    I had this discussion here before whether to have AP or PA x-ray and I still believe that PA (postero-anterior) x-rays are less harmful to your child's glands (breast, thyroid) than AP.
    Please read this article and let me know what you think. I know that we are constantly reassured that one x-ray once in a while is not harmful at all but I believe that this does not apply to frequent x-rays plus any additional CT scans a child might need. I was told many times that to orthopaedics it doesn't matter whether the x-ray is done PA or AP so why the standard of x-rays is AP rather than PA if it could reduce the risk of cancer in the future? Please see below.
    All the best,
    Stana

    "Reducing Radiation Dose
    One effective way to reduce radiation exposure in scoliotic patients is to obtain the spinal x-rays from the rear of the body (called PA or postero-anterior) instead of from the front (called AP or antero-posterior). This will reduce the risk of developing cancer from one-half to three-quarters (3).

    Other recommendations to reduce the radiation dose include limiting the number of x-rays to one PA view, properly aiming the x-ray beam to the target (a process called collimation), shielding the patient with a lead apron (to the extent possible), and reducing repeat x-rays due to poor image quality.

    Some investigators have proposed the use of a specially designed MRI for the purpose of scoliosis follow-up (4); however this technique may be too expensive"


    http://www.spineuniverse.com/exams-t...scoliosis-cobb

  2. #2
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    Default Re: Repeated x-rays

    Hi Stana

    I have been told on a number of times when I asked "Why are you not doing an xray?" that Katie has had far too many for a child of her years!

    Now, when she does have an xray, her ovaries get covered by a protective cover! And she always had the xrays front to back, (I have to say I have never even thought which way would be better. I presume that we trust in our Radiologists which way is best)!!

    Love Claire xx

  3. #3
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    Default Re: Repeated x-rays

    My 14 year old daughter has been x-rayed for the past 2 years from the back. I was told that this protects the breasts from radiation. She also has a lead plate pulled up to cover the ovaries area. It's never pulled up as far as I would like, but they need to see the whole spine, so it's the best they can do.
    I guess as a concerned parent I'm never going to be entirely happy

    Liz

  4. #4
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    Default Re: Repeated x-rays

    My surgeon always orders X-rays PA to protect the breast tissue ... not that I have any!
    Me, a Mod? Nah ... I'll always be a rocker

  5. #5
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    Default Re: Repeated x-rays

    At a rheumatology clinic recently (for my hypermobility syndrome and osteo-arthritis) I had to have xrays of some joints, and asked the radiologist about this. Her take was that PA requires significantly more radiation to achieve a suitable image because the spine is then so far from the plate, so she didn't see it being useful. However, there is of course the study showing the relative risks to be reduced for women especially and less so for men having PA versus AP xrays.

    One thing which is for sure - there is no massive cancer epidemic in the women and men who are members of revision surgery forums and mailing lists, despite the fact that many of them had large numbers of xrays over several years as children, with each of those xrays being far higher dosage than a modern xray is. That is not to say that there is no risk - of course any excess exposure to radiation carries a certain risk with it, but I do find it reassuring that there do not seem to be big problems among the older age group who had their treatment 30+ years ago
    Diagnosed at 15 with 50 curve, but probably juvenile IS. Fused in kyphosis (by non-specialised ortho) with a/p surgery T10-L2 @ 21, posterior only revision surgery to correct kyphosis @ 29. Now 38 with further revision surgery and extension of fusion to sacrum required to correct residual kyphosis, restore lordosis and address spinal stenosis.

  6. #6
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    Default Re: Repeated x-rays

    To give some more context, apparently the average dose for a spine xray is 1.5mSv (and I presume will be lower than this for children because of their small size. http://www.radiologyinfo.org/en/safe...m?pg=sfty_xray). This is equated to roughly 6 months natural exposure, however, there's plenty of places which have much higher levels than this. For example, Cornwall has an average annual exposure of 7.8mSv, so for people living there, the spinal xray would be equivalent to just 10 weeks of exposure. Frequent flying clocks up up to another 0.5mSv per year.
    Diagnosed at 15 with 50 curve, but probably juvenile IS. Fused in kyphosis (by non-specialised ortho) with a/p surgery T10-L2 @ 21, posterior only revision surgery to correct kyphosis @ 29. Now 38 with further revision surgery and extension of fusion to sacrum required to correct residual kyphosis, restore lordosis and address spinal stenosis.

  7. #7
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    Default Re: Repeated x-rays

    Hi everyone
    My daughter is just begining the whole diagnosis and treatment procedure with her first appointment on Monday. I am hoping she will have x-rays during this appointment but I haven't given any thought to the views on the possible damage in the long term from them. She has already had several taken this year for a suspected heart problem but I don't know what the protection procedure was as I didn't go in with her. Do I need to ask for x-rays taken from the back or will it be done automatically as she is 14 years old?

  8. #8
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    Default Re: Repeated x-rays

    Quote Originally Posted by Lizz View Post
    My 14 year old daughter has been x-rayed for the past 2 years from the back. I was told that this protects the breasts from radiation. She also has a lead plate pulled up to cover the ovaries area. It's never pulled up as far as I would like, but they need to see the whole spine, so it's the best they can do.
    I guess as a concerned parent I'm never going to be entirely happy

    Liz
    Dear Liz,
    I am glad that they actually try to protect your daughter's reproductive organs by pulling the plate up. The last x-ray my daughter had was so wide that it took picture of her entire reproductive organs, legs and arms. I am definitely going to make sure they only take x-ray of the smallest area possible.
    From the answers to my question, it seems that every hospital has a different policy as some do x-ray from the back, some from the front, some cover reproductive organs, some don't etc.
    Thank you,
    Stana

  9. #9
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    Default Re: Repeated x-rays

    Quote Originally Posted by AlisonW View Post
    Hi everyone
    My daughter is just begining the whole diagnosis and treatment procedure with her first appointment on Monday. I am hoping she will have x-rays during this appointment but I haven't given any thought to the views on the possible damage in the long term from them. She has already had several taken this year for a suspected heart problem but I don't know what the protection procedure was as I didn't go in with her. Do I need to ask for x-rays taken from the back or will it be done automatically as she is 14 years old?
    Hi AlisonW,

    My daugter also had many x-rays in the past plus few CT scans which use radiation beams, MIBG scans which use intravenous liquid radiation and PET scan which again uses radioactive substance so naturally I am also concerned about the amount if radiation she has already been exposed to, not even mentioning background radiation we are exposed to every day.

    I know that x-ray radiation is obviously much lower than the radiation used in all of the scans I mentioned above but why not to even reduce the exposure further if it's at all possible.

    The problem is that every hospital has different procedure, some hospitals do PA (from the back x-rays), some AP (from the front) and some cover some organs and some don't.

    However, I do always ask! Unfortunately, with a different radiologist comes a different answer ;-)

    Some tell you PA x-rays don't make any difference as the child is exposed to the radiation anyway since the radation beams go through the whole of the body, some actually agree with PA x-rays as they believe the further the child's thyroid and breast tissues are from the radiation, the less radiation it absorbs.

    None of them so far were willing to cover my daughter's reproductive organs, apparently because the surgeon wants a full picture of the whole of her spine despite her curve being in thoracic area.

    My daughter has x-ray due on Friday so again I will be asking probably a different radiologist at GOSH about AP, PA, covering etc.
    I will post the outcome here so you can get some more idea about what to ask before your daughter's app. on Monday.

    All the best,
    Stana

    PS: I did watch a program on BBC last week, unfortunately I cannot remember what it was called but they actually compared cells under a microscope before and after x-ray and the difference was remarkable with some cells dying off after x-ray exposure.
    Last edited by stana29; 12th October 2011 at 12:57 PM. Reason: Adding info

  10. #10
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    Default Re: Repeated x-rays

    Quote Originally Posted by titch View Post
    To give some more context, apparently the average dose for a spine xray is 1.5mSv (and I presume will be lower than this for children because of their small size. http://www.radiologyinfo.org/en/safe...m?pg=sfty_xray). This is equated to roughly 6 months natural exposure, however, there's plenty of places which have much higher levels than this. For example, Cornwall has an average annual exposure of 7.8mSv, so for people living there, the spinal xray would be equivalent to just 10 weeks of exposure. Frequent flying clocks up up to another 0.5mSv per year.
    Hi Titch,
    Thank you for this, it's very interesting. The fact, that they do actually acknowledge that there is a risk of developing cancer whether is very low, low, moderate etc. says it all really.
    Stana x

  11. #11
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    Default Re: Repeated x-rays

    Quote Originally Posted by titch View Post
    I had to have xrays of some joints, and asked the radiologist about this. Her take was that PA requires significantly more radiation to achieve a suitable image because the spine is then so far from the plate, so she didn't see it being useful.
    Hi Titch,
    I will ask about this on Friday as I never heard of this before.
    Thank you for pointing this out.
    Stana

  12. #12
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    Default Re: Repeated x-rays

    I know it doesn't help much (and when I think of all the xrays and CT scans I've had as well as a bone scan it helps less ) but the thing to remember about low, moderate, doubled, tripled etc is that they are relative measurements of risk. The absolute measurement is likely to remain extremely low - a really good example of this disparity, and the disproportion of fear, is the worry over blood clots from certain kinds of contraceptive pill back in the mid 90s.

    The fear came from a relative risk which was stated - something like you had double the chance of a fatal blood clot if taking x, y or z contraceptive pill than if you were taking others. The absolute risk remained extremely low, far lower in fact than the risk of pregnancy and abortion, so the actual result of the fear generated by the announcement was a whole load of pregnancies that wouldn't have otherwise happened, a whole load of abortions that wouldn't have been required, and several deaths which would have been avoided had the women stayed on the pill.

    Of course I understand that this is a different situation, but the one above is good for illustrating the problem with being given relative risk rather than absolute. It is however definitely worth questioning the imagine staff about things. Certainly my xrays at QMC once they went fully over to digital xrays were much narrower than the traditional plates, so I would definitely question the need for wide xrays.

    I do also tend to feel that there is a problem with a lot of radiolographers being inadequately informed about scoliosis - I have a friend who is a radiographer and it eventually occurred to me (no idea why it took so long to occur ) to ask her about what her training covered regarding scoliosis. She remembered there being very little, it was more or less mentioned in passing - however, what she at least was taught was that you do not maul the patient around to get them to some artificial ideal of "straight", because then you don't see the curve in it's natural state.

    It's certainly notable that when I had my first xray at just turned 16, my curve measured 51 degrees after they had finished pushing and pulling me to make me stand with one knee bent, one arm raised out slightly to the side etc in order to level my hips and shoulders, and just 4 months later even though I was supposedly fully grown, an xray where I was not mauled around had a measurement of 58 degrees. It's certainly possible it had progressed in that time, although my clothes suggested not, but I suspect at least some of the difference came from the fact I was allowed to stand naturally for the second one, and the curve remained in its natural state.
    Diagnosed at 15 with 50 curve, but probably juvenile IS. Fused in kyphosis (by non-specialised ortho) with a/p surgery T10-L2 @ 21, posterior only revision surgery to correct kyphosis @ 29. Now 38 with further revision surgery and extension of fusion to sacrum required to correct residual kyphosis, restore lordosis and address spinal stenosis.

  13. #13
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    Default Re: Repeated x-rays

    Hi folks,

    This is a very useful comparison of different sources of radiation.

    http://xkcd.com/radiation/


    chele
    c.June 2005: Curves as follows: Right thoracic curve approx. 155 degree; Left lumber curve approx. 78 degree.

    Surgery July 2006: Fused T3-L5. Right thoracic curve to approx. 86 degrees.
    Surgery March 2008: Fusion extended to sacrum. Now fused T3-S1.

  14. #14
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    Default Re: Repeated x-rays

    Whow what a chart!!!
    So one chest CT scan is around 7 mSv and max yearly dose permitted for US radiation workers is 50 mSv and lowest one year dose clearly linked to increased risk of cancer is 100 mSv!!!
    So far this year my Jessie had 2 CT scans of chest and spine, 4 x-rays I think and one MIBG scan. Not sure how much radiation MIBG scan uses though as it's in an intravenous liquid form.
    Well, I guess not much I can do about this now.
    Thanks for the chart.
    Stana

  15. #15
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    Default Re: Repeated x-rays

    Quote Originally Posted by stana29 View Post
    Whow what a chart!!!
    So one chest CT scan is around 7 mSv and max yearly dose permitted for US radiation workers is 50 mSv and lowest one year dose clearly linked to increased risk of cancer is 100 mSv!!!
    So far this year my Jessie had 2 CT scans of chest and spine, 4 x-rays I think and one MIBG scan. Not sure how much radiation MIBG scan uses though as it's in an intravenous liquid form.
    Well, I guess not much I can do about this now.
    Thanks for the chart.
    Stana
    Glad it's of use.

    A very good friend passed this to me, figuring it could be of help to you.
    c.June 2005: Curves as follows: Right thoracic curve approx. 155 degree; Left lumber curve approx. 78 degree.

    Surgery July 2006: Fused T3-L5. Right thoracic curve to approx. 86 degrees.
    Surgery March 2008: Fusion extended to sacrum. Now fused T3-S1.

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