Do you need an x-ray?

X-rays are often used by physicians to diagnose and treat broken bones and other orthopedic conditions in children, such as knock knees, bowed legs, or scoliosis.  The x-rays provide physicians with a detailed view of bone structure, beyond what can be done on physical exam alone, and are an essential part of orthopedic care.

A common concern, however, is that small doses of radiation are needed to create the images. Improvements to modern day x-ray machines continue to minimize the dose needed, but often parents worry about the risks.

Dr. David Roberts, a pediatric orthopedic surgeon with Advocate NorthShore Pediatric Partners in Illinois, says that the risks of x-rays of the arms and legs is generally negligible, even if children need more than one x-ray through the course of treatment, such as for a broken arm or leg.

“Concerns from parents about the risks of getting x-rays for children are common, given that hypothetically, exposure to radiation could slightly increase the risk of getting cancer at some point later in life. However, fortunately most films of the arms and legs have such low exposure that risks are considered negligible with modern equipment,” says Dr. Roberts. “However, x-rays for scoliosis have to include the breasts, thyroid, and gonads in the image, and so have more hypothetical concerns.”

While Dr. Roberts understands parent concerns, he says it’s important to give parents context about radiation exposure.

“Radiation is scary. However, we are all are exposed to a certain amount of radiation each day, from natural sources such as cosmic rays, radioactive elements in the earth’s crust, brick and concrete buildings, and even from isotopes in our own bodies. The additional exposure due to x-rays is generally relatively low in comparison,” says Dr. Roberts.

Even with continued improvements to x-ray technology and techniques, the goal remains to minimize radiation exposure as much as possible. This is especially important when monitoring kids with scoliosis, which may require repeated x-rays over several years of childhood and adolescence.

“Patients with mild scoliosis who are in screening programs have only one to two x-rays per year, so their risk are still very low, not much more than baseline,” says Dr. Roberts. “However, scoliosis patients being treated with a brace or surgery may require more frequent monitoring.”

In an effort to minimize exposure for these and other patients, Advocate Children’s Hospital is the only comprehensive children’s hospital in the Chicago area now using EOS imaging, a new ultra-low dose imaging system for scoliosis monitoring. EOS provides 2D and 3D full-body radiographic images, but has a special technology that reduces the radiation dose used by 50-85% compared to standard digital radiographs.

Parents worried about x-rays should consult their child’s physician about ways to minimize radiation exposure. These may include skipping x-rays for patients who can be evaluated with a reliable physical exam, spacing out appointments when x-rays are needed, or incorporating new technology like ultra-low dose EOS imaging as an alternative to standard x-rays.