Are x-rays completely safe?

October 5, 2007  |  General

Doctors do a lot of x-rays on children. Is there a risk to that, or are x-rays completely safe? The answer, for chest, bone, and abdominal x-rays, is that they are very, very, very safe, but not totally risk-free. All of us are constantly exposed to radiation similar to x-rays. It comes primarily from naturally-occurring radioactive things around us, such as radon gas seeping up through the ground, or from outer space in the form of cosmic rays. People living at higher altitudes receive higher doses of such background radiation, amounting to about half again as much for someone living on the Colorado plateau compared with someone at sea level. To put things in perspective, the radiation dose in a single chest x-ray, on average, is similar to the background radiation most of us receive during a ten day time span living our normal lives.

There are several important things to remember about radiation risks. High radiation doses definitely cause death and disease (primarily cancer); the atomic bomb and the disaster at Chernobyl clearly showed this. A second key point is that radiation risk is cumulative over a lifetime. This is an important consideration for children, since they have most of their life ahead of them. Children are also more sensitive to the effects of x-rays than are adults. Still, it is logical to think of routine chest, arm and leg, and abdominal x-rays as being virtually without risk unless the child has already gotten for some reason a large radiation dose in the past.

Computed tomographic scans, CT scans, are another form of x-rays. We most commonly use CT scans to look at a child’s head, chest, or abdomen. The technology produces good images of the organs inside those body regions, and CT scanning has revolutionized how medicine and surgery are practiced. But CT must be used judiciously, particularly in children, because it subjects the child to much more radiation than does a simple chest or abdomen x-ray–200 to 300 times more, depending upon the particular technique used. So if a chest x-ray is the equivalent of ten days of background radiation exposure, a child getting a CT scan receives the same radiation dose as anywhere from five to ten years of normal living. I’ve written more about CT scan risk here.

The future cancer risk to a child from a single CT scan is still vanishingly small, and the benefits of getting the information the CT provides nearly always outweigh this tiny risk. However, this may not be the case for children who get many CT scans or have been exposed to other radiation in the past. Fortunately, this represents a relatively small number of children. There are ways of using reduced radiation doses in children, compared to the doses adults receive for CT. If you are concerned about this issue, ask your child’s doctor about it, or you can read more about it here.

I’ve also posted here about what medical risk means.

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104 Comments


  1. my son had an abdominal xray at 2 weeks for pain, then 2 skull xrays at 5 weeks and a ckull ct at 16 weeks for craniosynostosis, which required surgery. What is the risk from radiation.

  2. Hi Andrea:

    The risks of the abdominal and skull x-rays are next to nothing. CT scans do carry a somewhat higher risk. I wrote a post about them here. The link in that post is to a good discussion about it, particularly how doctors probably do too many of them. A CT uses several hundred times the radiation of a plain x-ray, the equivalent of the radiation one gets during several years of normal life, although during the last few years radiologists have been working to reduce the radiation exposure needed.

    As I’ve said to several folks upthread, the bottom line is always if the risk of NOT doing the scan is greater than the risk of doing it. Regarding your son, a child with craniosynostosis usually needs at least one CT to make sure he is getting the best care. What I always tell parents to do is ask the doctor what specific, important information the scan will give.

    I realize that may sound a little vague, but I’m not aware of any hard and fast numbers we can put on what the risk to a specific child of an individual head CT scan is. I do know that, for a single scan, it is still a very, very small number.

  3. the ct scan was done at the childrens hospital by one of the leading craniofacial experts in australia, so I trust that the scan was needed. I just do not want to be thinking “what if he gets cancer from it”. It is very draining worrying about the possibility

  4. Andrea:

    I understand. But I think the best way to think about it is that life, even for a child, is full of risks, large and small. Having a CT scan does carry a tiny increased risk, but it truly is tiny in comparison to the other risks we take with our children and think nothing about it — driving in a car, flying in a plane, sending them off across town on the bus by themselves for the first time. My message parents about CT scans is just make sure they are really needed, which, as you say, I’m sure was the case with your son.

    Good luck

  5. dr christopher
    my son had to do an elbow x ray while i was about 8 weeks pregnant with the second one.i told them at the radiology deptt., & stood outside the room.but my son wouldn’t go in alone so the tech,called me into the room thrice to assure him. i would assume the x ray machine wouldn’t be turned on at that time. finally he yelled thru the x ray as he took it alone,while i sttod outside the entry of the room,without a view into it. i think they did 2 x-rays on him,becoz the sign ‘ xray in use ‘was aglow twice.
    i’m worried sick since for the fetus,becoz of all the internet articles abt x rays being harmful from 8- 25 weeks,also abt radiation scatter as i stood outside 3 rooms taking sperate x rays each.PLZ REPLY..THNX IN ADVANCE

  6. Priya:

    Don’t worry about it — really. The x-ray rooms have shielded walls and doors so you didn’t get any exposure at all.

  7. thnx a ton for the prompt reply,u almost lifted a big burden off my chest, however i’m worried abt the 3 times i entered the x ray to calm him down & make him sit in place.although i didn’t stay in long,but was close to the equipment,which i believe was not turned(coz i think the room needs to be closed for it to be on).is that the case
    also what is the amt.of radiation in rads used for an elbow x ray?
    i hope u can understand my being worried as the second one is coming along after a long time & very rough patch of time & losing someone very close…..we just wouldn’t want anything to go wrong .

  8. Again, don’t worry — I’m sure the radiation source was turned off when you were in there comforting him so you weren’t exposed to any.

    Regarding your other question, an x-ray of an arm or a leg delivers roughly the same amount of radiation as your son gets from the background radiation from just a normal day of life. (We get background radiation constantly from outer space and from the earth beneath us.) So that’s nothing to worry about, either.

    Here’s a listing of the radiation exposure of many common x-rays from a reliable source:

    http://www.radiologyinfo.org/en/pdf/sfty_xray.pdf

    And congratulations on your pregnancy!

  9. thnx again..i wish all that u say turns out true,& the baby comes along fine..THANKS

  10. Dr. Chris,
    My son had a pain on his upper left thigh. They gave him pelvic x rays without a shield to the reproductive organs. they got two images that were clear but they had taken two images before that had to be taken again. Also they did two side images of the left leg that were also taken before twice. They had to be redone because they were too dark. i was told I couldnt stay in the room and I realized that the shield was not used afterwards. I am worried sick, blame myself for it and can not even think of anything else. My son is 7. Will this affect him in his future? I don’t know what to do. Please help.

  11. Dr.Chris,
    I also want to add that this facility was not a pediatric doctor
    orthopedic but an adult doctor orthopedic. Was the x ray strength used appropriate for my seven year old son? I am worried sick, I can’t even sleep. I am so upset with myself for letting them perform the x ray. I can’t think straight of why I let them but I was worried sick that something else might have been wrong because the doctor had mentioned hip problems and I just didn’t think right at that moment. If I could take it all back I would. I’d rather be putting myself under such a situation than my child and I feel that I did the wrong thing. I feel terrible, anxious and upset. Why did I let them take this x-ray?

  12. Hi Debby:

    Don’t worry about the x-ray — really. Don’t worry. First off, I’m sure the settings on the x-ray machine were the correct ones for a child. The doctor actually doesn’t order those exact settings — they are set by the technician taking the film, and x-ray technicians know what settings to use. This is not only a matter of safety; if you use the wrong settings, such as those appropriate for a larger person, you won’t get a good picture of the bones. The total radiation used in these films is also quite small — the equivalent of just a day or two of normal life. You can see my link to a list of what radiation doses are found in various kinds of x-rays in my answer to Priya upthread a few comments.

    Also don’t worry about the shield issue. Yes, we should use them whenever possible. Seven-year-old boys, however, don’t have any sperm yet in their testes, so there’s nothing there for the x-ray beam to affect. (This makes boys a bit different from girls — a girl’s supply of eggs is already made and waiting in her ovaries.)

    I hope this helps you.

  13. Doctor Christopher,
    Thank you so much for your prompt reply.
    I feel so much better right now!
    I spend the whole day worrying. Even my kids were telling me not to. Thank you again!

    Best Regards,
    Debby

  14. Hello doctor I just wanted to say thanks for all your answers. I have a 5 yr old son who broke both his legs about 4 months ago and has had 7 sets of x-ray (about 4-5 xrays in each set) and i was worried about the risk but your answers have been very helpfull but i do have one more question. I live in Mexico and my sister in the US says that her 1yr old had xrays and the doctor covered his private parts (penis) with something and she asked the nurse and the nurse said it was just safer but with my 5yr old son in mexico they have never covered his private parts and he has had alot of xrays. does all these xrays have any effect on his privates. I was very worried but your answers to others have been very helpfull. thank you

  15. Hi Estaban:

    We do generally cover the genital area with a shield if possible. For a five-year-old this is more important for girls than for boys, since boys are generally is not making sperm yet but a girl’s eggs are already made. I think your son will be fine with that number of films, but I would ask that his genital area be shielded in the future.

  16. What is the earliest a baby can get an x-ray?

  17. Hi Morgan:

    Sometimes we need to get x-rays immediately after a baby is born. A newborn baby with any breathing problems, for example, usually needs a chest x-ray.

  18. Hi

    I am worried about the side effects from the number of xrays and tests my daughter has had. This started when she was 3 weeks old when she was admitted to the ED of our local hospital because of an unknown infection (turned out to be Strep B) but at the time to diagnose her they took abdominal xrays. Then 6 months later she also had to have a follow us Renal Cortex scan to check her kidneys (due to a urinary tract infection she also had when she had the Strep B) then ontop of all this, she was also diagnosed with Hip Displasia. She has had up to 6 xrays of her pelvis due to this already and she is only 18 months old. Then to add to my growing concerns, last week she broke her leg so had yet another set of xrays (5 xrays) for this and no doubt will need more to follow up on her leg. None of her xrays have had anything to shield her ovaries so I am concerned about her future fertility and even more concerned about cancer risk. She is only 18 months old. Thank you.

  19. I understand your concern about cancer risk, and x-rays do increase the lifetime chances of getting cancer. But — and it’s an important but — that increase is very, very small — infinitesimally so. As I mentioned in a comment above, plain x-rays of the bones carry about the same increased radiation as the normal background radiation of an extra day of normal life. That’s not zero, but it is tiny.

    For another example, I live at over 7,000 feet in altitude. Along with everybody else in town, that fact increases the background radiation I experience over that which people get at sea level. Put another way, I and my neighbors receive the equivalent amount of radiation as a plain x-ray every couple of days or so. (CT scans are another matter.)

    The key notion is that of relative risk. A child with group B strep needs a chest x-ray to receive good care, as do children with congenital dislocation of the hips and broken legs. The risk of not getting those films (and getting poorer management of their problem) far, far outweighs the tiny risk of getting them. Nothing we do is risk-free. It’s all about choices.

    My own daughter received nearly a hundred chest x-rays as an infant. She needed them at the time. I wish she didn’t have to have them, but I don’t worry about it now.

    It’s a tough question, and telling a parent not to worry never works. But still, if I were you I wouldn’t worry about it.

  20. Hello doctor
    My 13month old son just had a chest x ray, they thought he may possibly have pneumonia, but it turned out only to be a chest infection.
    I knew in my heart he was ok and now I am very worried that he had an unneccessary x ray. I have just read on another website that just one x ray can cause the dna of cells damage and cause cancer and that babies should never have x rays.
    I am sick with worry, I had many ultrasound scans throughout pregnancy from early on – I know this is not ionizing radiation bit it seems there is some argument over whether they are safe, he also had a difficult birth. I am so so worried about the effect that all this may have on him, i am bfinding it difficult to sleep and worry all the time. I wish i hadnt agreed to the xray.
    Do you think he is at risk of cancer?
    Many thanks

  21. Hi Sophie:

    Your question is one that many parents have, and quite a few have asked me what you’ve asked back up the blog comments trail. I think if you read their questions and my answers to them you’ll find your question answered, too.

  22. Very sorry – I wrote it without reding the rest as I was in a rush and a panic! Many thanks.

  23. I have had one CT scan of my head and two CT scans of my abdomen in the past month. I have had tingling in my head and body as well as mono. I begin having pain under my left rib and went to the ER worried it was my spleen. They did a CT scan. Spleen was fine. Then I begin having pain under my right rib and my Dr. said it could be my liver, gallbladdar, bowels. So she ordered another CT scan of my abdomen. I told her that I had already had one. She said that it would be ok, but I have been worried sick since I began reading about CT scans on the Internet. Everything turned out to be fine. They did find sludge around my gallbladdar and a cyst on an ovary. I am 29 and have a 2 yr. old. I can’t go through my daily routine without constantly worrying that I might get sick down the road from these scans.

  24. I forgot to add in the earlier post. Will my chances of getting pregnant again be slimmed due to the scans in my adominal area?

  25. Hi Christy:

    It sounds to me as if you needed the scans — without them, your doctors wouldn’t have known what to do. I wouldn’t worry about it. They also should have no effect on your future fertility. As always, the key thing to ask about when considering CT scans is: what is the risk of NOT doing it, of not getting the information the scan provides.

    If you’re really worried, though, I’d talk to your doctor about it. That’s usually the best way to straighten things out and avoid misunderstandings.

  26. Hi Doctor
    One question that has always baffled me is – if a chest x ray is the equivalent to a long haul flight in cosmic radiation exposure, why do they say it is safe for pregnant women to fly, especially during the first trimester, yet would not give an x ray at this time due to increased risk of chldhood luekaemia?
    I am very worried as I flew long haul twice throughout my pregnancy and am now very worried if my baby daughter needed an x ray, that she would have been exposed to too much radiation, so I would have to think very carefully and be very worried abou the risks.
    I wonder if yu can help me with this issue?
    Thank you

  27. Hi Becca:

    You ask a good question. I don’t take care of pregnant women, but it seems to me that the logically consistent thing to do would be to tell women about the very tiny (but still not zero) increased risk of flying, since we do that with x-rays.

    Overall, though, the risk remains tiny. I can’t find the citation, but there have been studies of airline pilots and cancer risk. I believe the largest of these comes from Scandinavia — no increased risk for cancer was found, in spite of all the air miles these pilots had. Of course that’s a somewhat different question than pregnant women, but it was reassuring that the pilots had no increased incidence of cancer.

  28. Dear Doctor,

    I have 22 month old daughter how has Congenital TTP. When she was born she had pnemonia so they did a lot of chest x rays on her for that and they did a CT scan on her brian. Since then we have had to x ray her port three times and her kidneys three times. I’m worried about her exposure to radiation, do I have reason to worry?

    Thank you for your time,

    Shari

  29. Hi Shari:

    Here’s the way I would look at it. Your daughter has received radiation that, statistically speaking, may raise her risk of future cancer by a very, very tiny amount over what her risk would have been without the x-rays. BUT — and it’s a key but — TTP, as you know, is a serious, complicated and potentially severe illness. Her TTP is far, far more likely to cause her future trouble than the radiation from the x-rays. So I would say the best way to proceed is to get whatever studies her doctors need to manage her TTP in the best way. Of course it is always a good idea when doctors want to do an x-ray to ask just what important information the x-ray will give them and why they need it to give her the best care at that moment.

  30. Dear Doctor,
    From previous posts, I’m assuming my son’s situation is similar to others but I wanted to check. When he was 11 months old, the pediatrician ordered a chest x-ray to rule out pneumonia. As most 11 months are, he was difficult to stay still, even with me holding him. They had to try five times to get a clear image. I am assuming the technician wouldn’t make as many x-ray attempts if it was unsafe, but I wanted to check with you. Thanks!

  31. Thanks for your article on safety of x-ray on children.
    I read your comments above on high altitude radiation risks and I happen to live in Denver. I would like to read more on this. Can you please point me to any links that has more info on this.
    Thanks again!

  32. Lisa:

    You’re correct about that

  33. Ram:

    I’m traveling just now and away from my home computer. I’ll post some links next week.

  34. Here’s a good link about the relationship between radiation and altitude:
    http://www.radiologyinfo.org/en/pdf/sfty_xray.pdf

  35. Hi Dr,
    When you say an x ray increases the risk for cancer can I just clarify what you mean by this for children? Do you mean it increases the risk of childhood cancer or getting cancer earlier in life or the liklihood of them getting it when theyre older?
    I had a ct scan when 23 weeks pregnant to check for a blood clot, my dr is now talking about a chest x ray for my one year old to rule out asthma, im concerned about this exposure to him but am cofused as what this risk actually means re my point above. Ive also read that a small exposure to radiation can help repair any dna damage – would you know anything about this?
    Thank you

  36. Hi Janie:

    The risk refers to getting cancer anytime in life, not just childhood.

    I wouldn’t worry at all about the risk of an ordinary chest x-ray — it’s vanishingly small, nearly zero. If you read the rest of the comment trail to this post you’ll see I’ve answered a lot a questions similar to yours.

  37. Dear Dr
    My son was born prematurely at 30 weeks and is now in the SCBU, he is now doing well at 35 weeks. He seems to be having an awful lot of chest x rays and I do not wish to question the staff about this as they are doing such a wonderful job,and I am just grateful he is alive, but in the back of my mind I cant hep worrying about the number of x rays he is having – sometimes 2 a day at first. Is there any more risk to a premature baby than a full term one or older child? I guess I am worried about this as you mentioned other forms of risk, but when you drive a car, for example, you know the risk is over once the car has stopped. It is unnerving to think you may have to wait thirty years for the ‘risk’ of x rays to be seen.
    I am glad a friend pointed me to this site, it seems very relevant to me and my wife and we shall be reading it with great interest in the future.
    Best Wishes
    Mike

  38. Hi Michael:

    It is true that x-rays add risk. But the thing is, as I’ve written in various places in the comment trail for this post, you need to weigh that risk appropriately. The increased cancer risk that even a bunch of chest x-rays — say 50 or so — brings is a tiny, tiny number. It is real, but it is tiny. What you have to do is to weigh that real, but tiny risk against the risk of not getting the information that the x-ray gives. Premature infants with lung problems often need quite a few chest x-rays to get them the best care, especially if they are on a ventilator, a breathing machine. In that case the chest x-ray is still the only way we have of evaluating key aspects of what’s going on in the lungs. So not getting the x-ray brings a much higher risk than getting the x-ray. In medicine we have to weigh relative risk like this all the time — the risk of doing something versus the risk of not doing it.

    On the other hand, there is absolutely nothing wrong with a parent asking the doctor what specific information a particular x-ray will give, and what the risk would be at the moment of not doing it. I always encourage parents to ask questions like that.

    Thanks for stopping by.

  39. My two year old son was crying and had cough, we took him to emergency room as he had difficulty in breathing. We suspected it to be wheezing. The doctor requested for X-RAY and we took him to the xray room. My son was placed in a plastic shielded stool kind of a thing with his hands raised. I was holding him and she took two xrays one sideways and one direct chest. All the while I was standing holding him and they never provided any cover/gown to wear. Is it not harmful for my son and me as I did not have any cover. Any information on this will be helpful.

  40. Hi Suri:

    Many folks have the question you do, and I’ve answered in a couple of places in the comment trail. The short answer is this: there is essentially no increased risk to either you or your son from two x-rays like that (it’s so close to zero as to be essentially zero). I have several links in the comment thread that will take you to some exact figures about what the exposure of such chest x-rays is — about 10 days of the radiation we experience in normal life per film.

  41. Christopher;

    We are considering Chiropractic care for my wife with a doctor who specializes in “Subluxation”. He wants to include a packaged deal for the family which involves my 10yr old son. Given that my son has never suffered a neck injury and rarely plays a sport involving “helmet wearning”, I can’t imagine why he would have subluxation. What is the risk-vs-gain of exposing him to an x-ray from the chest up?

    thanks
    michael

  42. Hi Michael:

    You ask a good and practical question. In this case, though, it’s also a contentious one — even a partly political one. Any chiropractors (or their patients) who read this will probably strongly dispute my opinion. And I don’t want this blog to be a forum for a debate over chiropractic — the Internet has many of those, and some of the debates on them get quite heated. In some ways they really resemble religious debates.

    The bottom line for me is that I agree with virtually all physicians that the chiropractic theory of minute subluxations of the vertebrae (the spinal bones) as a cause of systemic disease is simply not true. No independent scientific research (which is to say research not done by chiropractors or their supporters) has ever shown it to be true, although you will find many chiropractic publications that assume the theory is correct. The theory derives from the late 19th century, a time when we knew little about the functioning of the nervous system. I think it continues to thrive because many persons don’t trust traditional medical care, distrust which in many ways is the fault of us physicians because we don’t explain things as well as we should and tend to think we’re smarter than everybody else, even when we’re not.

    There are times when I think chiropractic care is useful, such as following muscular injuries and for simple back pain. In those situations, however, I think it functions much as good physical therapy does. At least one large study showed that chiropractic manipulation was at least as effective as other forms of therapy for low back pain, and much cheaper and less riskier than some of the alternatives, particularly surgery. But I think the wilder claims of benefits for chiropractic care as a treatment of asthma, allergies, and a host of other ailments are at best unhelpful, at worst bogus.

    So what about your specific question? The risk of spinal x-rays is very tiny. The radiation exposure is greater than for chest x-rays, but far, far less than for CT scans. But my question is this: why would one take a risk, even a tiny, tiny one, if the potential benefit is zero? That’s how I would regard your situation. I have no objections to you taking your son to a chiropractor if you wish to. But I would never do an x-ray if a patient has no symptoms suggesting that the x-ray would be helpful. You are then taking on risk for no benefit.

    Thanks again for stopping by.

  43. Dr. Johnson,

    I had an MRI of my head a month ago because they thought that I might have MS from limited leg and arm movements at the beginning of May. Since I had the MRI I have had eye pain and blurry vision and my legs have been burning. As far as I know I do not have any kidney problems but have been reading a bit about NSF, a condition some kidney patients get from the dye used in MRI’s. Have you known anyone to have such side effects from an MRI?

  44. Hi Jodi:

    No, I haven’t seen the symptoms you describe following an MRI scan. I should add, though, that although I order a fair number of MRI scans on my patients, I’m not particularly expert in the tissue effects of them. A neurologist would be much more knowledgeable about your question.

    Good luck in any event

  45. My son got a lung x-ray for “possible” pneumonia. It was the weekend so the clinic was closed and the Dr suggested one even though he had no shortness of breath, oxygen level was perfect, no phlegm or coughing. He had a high fever and vomiting and that was it. I understand being safe than sorry, so I agreed. But had they asked for a blood tests for some type of blood infection I would have agreed since it would have been more likely than pneumonia. But they didn’t, they jumped to an x-ray. But then when I got to the room there was this contraption they wanted me to shove my son in to and I refused. a “pigg-o-stat”. He was screaming and clinging to me and shaking and I couldn’t do it. I got guilted in to it with “well IF he has pneumonia he needs special treatment or he can die”. Which I understand, and I understand they are just trying to do what might be in his best interests… I’m his mother, no one cares more about his best interests than me. His father shoved him in the contraption and I waited outside of the door listening to him scream.

    But now I’m a bit upset over it. His legs have a little bruise on the side because his legs are chubby and I told them he was too big for that contraption. I mean he’s fine, he is not hurt but he was pretty traumatized and I even had to take him in to the bathroom with me because he feared that if he was not with me they would take him back and put him in again. I am also upset that it was just something not totally needed. To traumatize him and expose him to radiation.

    And I asked then if he had to use the contraption and they insisted it was the only way… Why, when the rest of us don’t need a pigg-o-stat for x-rays? And what are the risks? I mean I’ve heard about internal organs being “cooked”… Why exactly is radiation safe enough to be used on our children?

    Thanks.
    Christy

  46. Hi Christy:

    A couple of things:

    Many other parents have your question and we’ve talked about it quite a bit in the comment trail for the post. Here’s the bottom line. The radiation from a single chest x-ray is vanishingly small. It works out the same as getting the normal background radiation, that radiation coming from the earth and from outer space (cosmic rays) of living about 10 days of normal life at sea level. If you live at higher altitude, say on the Colorado Plateau like I do, a chest x-ray has the same radiation as 7 days or so of normal life. So really, don’t worry about the radiation of a chest x-ray.

    I have no idea what that contraption for holding a child is. For a chest x-ray we generally just have the mother put on a shielding apron and help the x-ray technician hold the child’s arms up above the chest while the picture is taken. Getting a child to hold still for a second can be a challange, but generally tying them down just makes them fearful.

  47. dear Dr.Christopher … my daughter is 2.5 months old , she has hip and knee click since she was born and the bones from the knees till her foots are bent a little bit , the doctor is recommending X-rays …. are there any risks for my baby from the radiation ? is it better to use ultra sound instead of X-ray in her age ?

  48. Hi Hayman:

    I can’t really give you specific medical advice about what is best for your child on an internet blog — only your child’s doctor can do that. But I can tell you that the radiation dose of hip x-rays is very small. Ultrasound is helpful for hip clicks, but not so much for the rest of the leg.

  49. Dr. Johnson,

    My daughter was diagnosed with a hip dysplasia at birth. She had hip ultrasounds, and then we did the Pavlick harness. The pediatric orthopedist monitored her progress and felt that the harness worked in correcting her hip. However, we had visits at 6 months old, and then at one year to make sure that the dysplasia was corrected.

    At her one year visit a hip x-ray was taken to confirm that the hips were now fine. I protested a bit, but my husband was adamant that we should do the x-ray as recommended. At the time, I didn’t do any internet research, and so did not see the concern about the ovaries being radiated (which was not raised as a concern to us either).

    Today I am feeling worried for my daughter, and very very guilty about the x-ray. (They did not put any shields over the ovaries). My sister-in-law had hip dysplasia that was discovered as a toddler — she had 2-3 x-rays, and she has not been able to get pregnant as an adult (ivf, treatments, nothing have worked for her. after a decade of trying). OF course I know that there is not necessarily a connection, but the thought is worrying me.

    I was hoping you might be able to offer comfort, or a reasoned assessment of the risk, for myself and other parents of baby girls with hip dysplasia who had these x-rays at such young ages.

    thank you so much.

  50. Hi Vivian:

    You’ve obviously thought about and researched this issue. There really are two issues here: the radiation dose of the hip x-rays as a future cancer risk, and the risk of the radiation to future fertility in your daughter. The first issue is easily dealt with — the effect on future cancer risk is not zero, but it is infinitesimally small. Regarding future fertility, as far as I know the answer is unknown. However, we do know a few things that are helpful in understanding the risk. The main reason we shield girls and women when we x-ray them is the concern that they may be in the early weeks of pregnancy at the time and not know it. The effects of radiation on the developing embryo are potentially substantial. In the case of an infant or toddler girl, her eggs are all in a dormant state. This does not mean that they are completely immune from all radiation harm, but it does mean that they are far more resistant to harm than is a developing embryo, and the radiation dose of plain x-rays like she received is quite modest. If she were my daughter, I really wouldn’t worry about it.

    The larger question, as always, is weighing the risk of doing a test against the risk of not doing it. That’s the way a doctor should explain it, and that’s the way a parent should frame the question to the doctor: “what’s the risk of not doing it, of not getting the information?” A related question is: “can we get the information any other way besides an x-ray?” For example, could we get the information just by waiting a bit and seeing how things turn out, or would that be too risky. And, if it is too risky, why? Those are the sorts of conversations I have with the parents of my patients.

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