Reducing radiation exposure in x-rays for children: the Image Gently program
I’ve been doing this blog for three years, and by far the post that has provoked the most interest is this one, about the safety of x-rays. The comments, now at 102, keep steadily coming. Google tells me that the most common search string that brings folks here is some variant of the question: “how safe are x-rays?” Recent studies, such as this one, have highlighted the issue of CT scans.
The important thing to understand is that nobody wants to stop doing x-rays and CT scans. The latter in particular represent a quantum leap in our diagnostic ability, and appropriate x-ray studies improve and even save children’s lives. What we want is to strike a balance between doing too few and too many. The question always to consider is this: what is the risk of doing the x-ray or CT (still very, very tiny) versus the risk of not doing the study, of not getting the information the study provides. If the study is needed to rule out the possibility of a serious condition, then the risk/benefit calculation virtually always favors doing the test.
There is another consideration, one highlighted recently by the Alliance for Radiation Safety in Pediatric Imaging, an initiative led by pediatric radiologists — the Image Gently initiative. The concept is simple: use only as much radiation as you need to get a good picture. In the past, CT scanners in particular often used radiation doses more appropriate for adults than children. Using that dose causes risk without adding benefit.
If my child needed a CT scan, I would ask the doctor to lay out the risk/benefit ratio — the risk of doing versus not doing the scan. If the scan is needed, I’d then ask if the radiologist will use the minimum dose required to get a good picture.
This site, from the International Atomic Energy Agency, has lots of useful information about protecting patients from unnecessary radiation.
Here’s a useful short post by a pediatric radiologist about all this.