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Risks of Radiation in Medical Imaging

By

Mehmet Kocak

, MD, Rush University Medical Center

Last full review/revision Jun 2019| Content last modified Jul 2019
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NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
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Imaging tests that use radiation, usually x-rays, are a valuable tool in diagnosis, but exposure to radiation has some risks (see also Radiation Injury).

Different diagnostic tests require different amounts of radiation (see table Comparing Radiation Doses), but most of them use low doses that are generally considered safe. For example, the radiation dose from one chest x-ray is more than 100 times lower than the average yearly dose of radiation from the environment (background radiation). However, exposure to radiation is cumulative, regardless of the interval between tests. This means that if people have many diagnostic tests that use low doses or several tests that use high doses, they may be exposed to a relatively large amount of radiation. The greater the cumulative dose, the greater the risk of cancer and sometimes tissue damage.

Did You Know...

  • Exposure to radiation is cumulative, regardless of the interval between tests.

Imaging tests are only one source of exposure to radiation. Exposure to radiation in the environment (from cosmic radiation and natural isotopes—see Radiation Injury) can be relatively high, particularly at high altitudes. When traveling by airplane, exposure to environmental radiation is increased.

When planning diagnostic tests, doctors consider a person’s total (lifetime) exposure to radiation—the person’s total radiation dose. However, the benefit of a diagnostic test often outweighs the potential risks.

Table
icon

Comparing Radiation Doses For Different Tests*

Imaging Test

Number of Chest X-Rays Needed to Get the Same Dose

Approximate Environmental Exposure Equivalent to the Dose †

Single view chest x-ray (from back to front)

1

2.4 days

20

48 days

An x-ray series of the lumbar spine

75

180 days

CT of the head

100

243 days

CT of the abdomen

300–400

2–2.7 years

Coronary artery angiography during cardiac catheterization

350–750

2.3–4.9 years

* These doses account for how much radiation is delivered and how susceptible the body part exposed to radiation is to radiation damage.

† People are exposed constantly to low levels of naturally occurring radiation but the amount varies in different locations.

CT = computed tomography.

In the United States, about 15% of all imaging tests are computed tomography (CT), but up to 70% of radiation exposure from imaging tests comes from CT. The radiation dose for CT can be hundreds of times the dose for most plain x-rays. However, with newer techniques, doses for most CT scans can be much lower than they have been with older techniques.

Still, even when CT is done using older techniques, the risk is low for adults, and health is unlikely to be affected.

However, the risk due to radiation exposure is higher in certain situations:

  • During infancy

  • During early childhood

  • During pregnancy (particularly early)

  • For certain tissues, such as lymphoid tissues (part of the immune system), bone marrow, blood, the testes, the ovaries, and the intestines

To minimize risks, doctors do the following:

  • Use tests that do not require radiation, such as ultrasonography or MRI, when possible

  • Recommend diagnostic tests that use radiation, particularly high doses (as in CT) and particularly in young children, only when such tests are necessary

  • Take precautions to limit radiation exposure during tests (for example, shielding vulnerable parts of the body, such as the thyroid gland or a pregnant woman’s abdomen) when possible

Modern techniques and equipment have significantly lowered the radiation doses used in imaging tests.

Radiation risk during infancy and early childhood

The risks from radiation are higher in infants and young children because children live longer, giving cancers more time to develop. Also in children, cells are dividing more rapidly, and rapidly dividing cells are more susceptible to damage by radiation.

The risk of cancer resulting from radiation is difficult to determine. Some experts estimate that about 18 of every 10,000 1-year-olds who have a CT scan of the abdomen eventually develop cancer caused by the radiation. This scan uses one of the highest doses of radiation in medical imaging. Also, one study suggested that for every 10,000 CT scans of the head done in children under 10 years old, the radiation exposure would cause one case of leukemia and one brain tumor during the decade after that CT scan.

When children require diagnostic tests, parents should talk to the doctor about the risks and about possible use of tests that do not require radiation. If tests that use radiation are necessary, parents can help minimize the risks by asking about the following:

  • Using the lowest possible dose to make the diagnosis (for example, sometimes low-resolution scans, which use less radiation, can be used)

  • Limiting exposure to the smallest possible area of the body

  • Limiting the number of scans done

Radiation risk during pregnancy

Pregnant women should be aware that radiation from imaging tests has risks for the fetus. If women need to have an imaging test, they should tell their doctor whether they are or may be pregnant. Doctors also consider whether the woman may be pregnant and not know it. However, x-rays, if necessary, can be done in pregnant women. During diagnostic tests, the examiner protects the fetus from exposure to radiation by covering the woman’s abdomen with a lead apron.

The risk to the fetus depends on

  • When during the pregnancy a test is done

  • Which part of the mother’s body is x-rayed

During pregnancy, the time when risk is greatest is when organs are being formed, during the 5th to 10th weeks of pregnancy. At this time, radiation can cause birth defects. Earlier during pregnancy, the most likely problem to develop is a miscarriage. After the 10th week, miscarriages and significant birth defects are less likely.

X-rays of parts of the mother's body that are far away from the fetus, such as the wrists and ankles, expose the fetus to less radiation than x-rays of closer parts, such as the lower back. Also, x-rays of smaller body parts, such as fingers and toes, require less x-ray energy than x-rays of larger body parts, such as the back and pelvis. Because of these facts, plain x-rays that do not involve the abdomen have little risk, regardless of when they are done, particularly if a lead shield is worn over the uterus. Thus, if x-rays are necessary (for example, to evaluate a broken bone), the benefit usually outweighs the risk.

NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
Click here for the Professional Version
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