Most people in the U.S. undergo radiologic scans such as X-rays or CT scans at some point in their lives. Many people know that these exams involve radiation, which can potentially cause damage in the short-term or, more likely, in the long-term (such as in increased life-time risk of cancer). So what should you know about radiation exposure, and what should you ask and think about when your doctor suggests an X-ray or CT scan for your child?
1. First of all, know the relative amount of radiation. A CT scan provides more than 200 times the amount of radiation of a typical X-ray. This is one main reason that doctors often start with X-rays first. If we can figure out the problem and how to fix it with an X-ray, we’re exposing the patient to much less radiation than if we start with a CT scan.
2. Age and size matter. The same amount of radiation is more concerning in a younger, smaller child who is still growing and developing and whose body is more vulnerable to radiation. While doctors weigh the pros and cons of radiologic testing for each patient, we think especially hard about the risks and benefits of a CT scan in a very small child for whom it may have more serious long-term consequences.
3. How necessary is the test? Generally if your doctor is recommending it, it’s because it’s really important, but it’s worth asking the question. For example, often in the emergency department I will see a patient with an injury where I think the risk of a broken bone is small, but possible. I will generally explain to the parents and patient the advantages (convenience, earlier treatment) and disadvantages (radiation exposure, risk, fear in a very young child) of X-raying then versus waiting and X-raying later if it doesn’t get better on its own (which most injuries do!). So if the doctor suggests an X-ray, you may want to ask him or her to go through that thought process with you to help you make a good decision.
As above, CT scans are much more of a concern because of the larger amount of radiation, but unfortunately are often less negotiable because they are being used to rule out a more serious problem. However, there are sometimes alternatives (such as ultrasound instead of an abdominal CT) that may be possible in a given situation, so don’t be afraid to ask. A good example of times that a CT scan may be avoided is ater a head injury. Often-times, a CT is done to evaluate for possible bleeding in the brain, but this may potentially be avoidable if the doctor is able to get a very thorough history, do a complete physical exam, and possibly observe your child in a medical setting for awhile. Again, it doesn’t hurt to ask if this is possible!
The important thing to remember is that radiologic imaging is often necessary for good medical care. If your doctor feels strongly your child needs the test, it’s probably necessary and not worth the chance of missing an important problem. However, you should always feel comfortable bringing up any concerns you have, such as potential risks of the procedure, or whether the technician has any pediatric experience. Have a conversation with the doctor about the risks and benefits of the test. Don’t ever hesitate to ask and express your concerns and questions!