Concerns About Multiple X-Ray Exposures in Young Children

Multiple radiographic examinations within a short period?

Hello Doctor, my son is six years old.
Since January, he has undergone various X-ray and CT scans for different reasons.
1.
He had chest X-rays in January and February (suspected pneumonia).
2.
In March, he had about three dental X-rays (not a full mouth).
3.
In July, he had a hand X-ray to assess bone age.
4.
In August, after hitting his head and showing significant neurological vomiting, the doctor requested a CT scan of the head (without contrast).
An X-ray of the head was taken in the emergency room (before any vomiting response).
5.
Before turning six, he had very few X-rays, only two or three for bone age.
Given that children are said to be more sensitive to radiation, along with the fact that 1.
he flies from Taiwan to the East Coast of the U.S.
once or twice a year for long-haul flights, and 2.
he flies back and forth to East Asian countries once a year for medium-haul flights, and 3.
he lives in a country at approximately 40 degrees latitude, I would like to ask: 1.
Will having so many X-rays in a short period increase his risk of developing cancer in the future? 2.
If he continues to have one bone age X-ray each year, will that have any implications? Can he still have dental X-rays annually? 3.
I have seen responses stating that radiation does not accumulate in the body after passing through, but I have also seen mentions of biological effects of radiation that need to be considered.
What is the difference between these two statements? Thank you for your response from a very concerned mother.

Juan, 0~9 year old female. Ask Date: 2020/08/27

Dr. Wang Yifen reply Radiology

Hello,
1.
Multiple exposures to radiation can indeed increase the risk of developing additional cancers.
The purpose of imaging examinations is to assist physicians in diagnosing and identifying the underlying causes of diseases, enabling appropriate interventions so that patients can recover their health as soon as possible.
It is recommended to discuss the necessity of X-ray examinations with your physician, and to assess whether the benefits of the examination outweigh the risks before proceeding with the X-ray.
Do not avoid examinations out of fear of radiation, as this may result in missing critical treatment opportunities for diseases.
2.
The need for X-ray imaging should be evaluated and determined by a clinical physician; it is not necessary to have X-rays taken every year.
3.
It is important to emphasize that X-ray radiation does not accumulate in the body after the examination, to prevent the public from mistakenly believing that there is a risk of "radiation contamination" from X-rays.
"Radiation contamination" refers to the inhalation of radioactive materials or the adherence of radioactive substances to the surface of the body.
Individuals or objects that have undergone X-ray examinations do not possess "radiation contamination." "Radiation biological effects" refer to the impact of energetic ionizing radiation on human tissues, where the energy from the radiation is transferred to cells.
After absorbing high-energy radiation, cells may undergo ionization or excitation, potentially leading to the breaking of molecular chemical bonds and impairing cellular function.
According to the International Commission on Radiological Protection (ICRP) report 103, doses below 100 millisieverts (including single or multiple exposures) do not cause clinical functional damage.
For more in-depth information about radiation, you can refer to the website of the Atomic Energy Council at https://www.aec.gov.tw/.

Please take this information into consideration, and I wish you safety and good health.

Reply Date: 2020/08/27

More Info

Dear concerned mother,
Thank you for reaching out with your questions regarding your son's multiple X-ray exposures. It's completely understandable to be worried about the potential health impacts of radiation, especially in young children. Let's address your concerns systematically.

1. Cancer Risk from Multiple X-Ray Exposures: The cumulative effect of radiation exposure is a valid concern. However, it's important to note that the radiation doses from diagnostic X-rays are relatively low. For instance, a typical chest X-ray exposes a person to about 0.1 mSv (millisieverts), while a CT scan of the head can be around 1-2 mSv. The International Commission on Radiological Protection (ICRP) suggests that doses below 100 mSv are unlikely to cause any significant health effects, including cancer. Given your son's history of X-rays, even if he had several in a short period, the total dose is likely still below levels that would significantly increase his cancer risk.
2. Annual Bone Age X-Rays: If your son requires annual bone age assessments, it's essential to discuss this with his pediatrician. While repeated X-rays can contribute to cumulative exposure, the doses from bone age X-rays are generally low. If the need for these assessments is medically justified, the benefits often outweigh the risks. As for dental X-rays, they are also low in radiation, and with proper shielding (like lead aprons), they can be safely performed annually if necessary.

3. Radiation Accumulation vs. Biological Effects: It's crucial to differentiate between the concepts of radiation accumulation and biological effects. While radiation does not "accumulate" in the body in the way some substances do, the biological effects of radiation exposure can be cumulative over time. This means that while each individual exposure may not pose a significant risk, repeated exposures can increase the likelihood of potential effects, such as DNA damage, which could lead to cancer. This is why medical professionals emphasize the ALARA principle (As Low As Reasonably Achievable) in radiological practices, ensuring that any necessary imaging is performed with the lowest possible radiation dose.

4. Air Travel and Background Radiation: It's also worth noting that flying exposes individuals to higher levels of cosmic radiation due to increased altitude. However, the radiation dose from a long-haul flight is still relatively low compared to medical imaging. For example, a round-trip flight from the U.S. to Asia might expose a person to about 0.03 to 0.1 mSv, which is comparable to a single chest X-ray.
In conclusion, while it is wise to be cautious about radiation exposure, the doses from the X-rays your son has received are generally considered safe, especially when weighed against the medical necessity of the imaging. It is always best to maintain open communication with your child's healthcare providers regarding the need for any future imaging and to discuss any concerns you may have about radiation exposure.

If you have further questions or need clarification, please do not hesitate to ask. Your child's health and well-being are paramount, and it's essential to stay informed and proactive.

Best wishes for your son's health and your peace of mind.

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