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Lee Kirksey, MD  
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Cleveland , OH

Specialties: Peripheral Arterial Disease, PAD

Interests: vascular, specialist, treatment options
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Will your next xray lead to Cancer?

Aug 30, 2009 - 16 comments
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Cancer

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X ray

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cardiac cath

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stress test

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Breast Cancer

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mammogram

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Chest Pain

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xray

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dose




A new article published in the New England Journal of Medicine suggests that physicians may be overusing xray tests. The cumulative exposure to radiation that patients experience may be harmful and cause long term problems such as cancer. Unfortunately, there has been very little discussion with patients regarding the potentially harmful consequences of commonly ordered xray tests. Furthermore, physicians and patients will need to become more vigilant in determining that the benefits of x ray exams outweigh the detriment going forward. Question: has your doctor ever discussed the potential harm before you underwent and x ray??

Atlanta, GA - Medical imaging procedures expose many nonelderly patients to substantial doses of ionizing radiation, according to the results of a new study [1]. Myocardial perfusion imaging alone accounts for 22% of the radiation dose from all study procedures, while computed-tomography (CT) scans of the abdomen, pelvis, and chest account for nearly 38%, report investigators.

"Our findings that in some patients worrisome radiation doses from imaging procedures can accumulate over time underscores the need to improve their use," write lead investigator Dr Reza Fazel (Emory University School of Medicine, Atlanta, GA) and colleagues. "Unlike the exposure of workers in healthcare and the nuclear industry, which can be regulated, the exposure of patients cannot be restricted, largely because of the inherent difficulty in balancing the immediate clinical need for these procedures, which is frequently substantial, against the stochastic risks of cancer that would not be evident for years, if at all."

The analysis, which studied 952 420 adults aged 18 to 64 years in five US cities, is published in the August 27, 2009 issue of the New England Journal of Medicine.

During the study period, which ran from 2005 to 2007, 655 613 adults underwent at least one imaging procedure associated with radiation exposure. The mean effective dose was 2.4 mSv per person per year, although a wide distribution was noted. Moreover, the proportion of subjects undergoing procedures and their mean doses varied according to age, sex, and city. For example, approximately 50% of adults aged 18 to 34 years underwent a medical imaging procedure requiring radiation, whereas 86% of adults 60 to 64 years of age were sent for similar testing. Women also underwent imaging procedures significantly more often than men.



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by ChitChatNine, Aug 30, 2009
Yes,my family and I have been quite fortunate our doctor's & even docs in the E.R.  have been conservative and only ordered tests as needed .. especially CT Scans.  Even for me who suffers from ongoing kidney stones, we only do a CT Scan if absolutely necessary ... the doctors with my kids have been especially good about talking about the risks and the benefits of x-rays, CT Scans, etc. vs. the injury or what they are looking to rule in and out and together we decide if it's a good idea, etc.

When you go to the dentist make SURE your THYROID area is covered, too, with the lead blanket -- it's real important.

Great article!

C~
Co-CL Thyroid Disorders

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by AnnieBrooke, Aug 30, 2009
Is there a time after which having had a bunch of X-rays becomes less significant, or does it build up your whole life?

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by April2, Aug 30, 2009
I wish I had known this sooner. I had a bunch of Cat Scans and different tests all within the last few years. The doctor had wanted to keep an eye on a mass I had in my small intestine and so I had a Cat Scan every month for a year to see if it had grown. That coupled with a couple of x-rays and nuclear stress test.
How much radiation does it take to be at risk?

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by rcarver, Aug 31, 2009
AnnieBrooke,

Ionizing radiation builds up over your entire life.  As an x ray tech, we have to monitor our exposure and there is a certain level we try to stay below to avoid meeting our max lifetime exposure.  Although, this is occupational exposure as we do not monitor our exposure for any x ray exams we have as patients.  Also, the amount of radiation a patient absorbs can vary depending on their size.  The larger the patient, the more x rays are used to penetrate the tissue....that also means more exposure to the tech/radiologist because it scatters off the patient and hits us.  CT scans and live flouroscopy (Upper GI, barium swallows, etc also the use of a C-arm during injections or surgery) will provide longer intervals of radiation exposure, thus making them more harmful if exposed unecessarily.  I hope this was helpful to your question.  

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by Jaquta, Sep 01, 2009
In my experience no one has spoken of the potential risk of having x-rays.  (Except my dentist who held off taking films due to recent radiotherapy).
It will be interesting to see if secondary cancer, from exposure, will become an issue for me during my life span.
I feel like a ticking time bomb (at least while I think about this).

I've found this blog and other members comments helpful.  At least with information, we as patients are able to make more informed decisions.

Thanks.
J

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by April2, Sep 01, 2009
I've had a total of 3 barium swallows in three years and about a dozen Cat Scans (they were monitoring a mass I had in my small intestine to see if it would grow and need to be removed, which it did eventually), 3 mammograms,  1 nuclear stress test and a couple of x-rays. Like I mentioned earlier, I wish I'd been warned about too much radiation. Do I have good reason to be concerned?

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by seroma, Sep 02, 2009
I would say yes! Did you have the lump removed from your intestine? Why didn't they just remove the lump and save you a year of radiation exposure that could have caused the tumor to grow?John Hopkins recently came out with new helpful information on Cancer, cancer treatment and prevention. If you really want an education on Nutrition and cancer prevention watch/buy the documentary "Food Inc". Very important to see. For your health. Let thy food be thy medicine. Real food, real nutrition. It can't come out of a box and doctors, bless their hearts can't heal you. KISS (keep It Simple Stupid) :-) no white sugar no white flour, no preservatives, no meats from animals fed with hormones, or antibiotics. If we are what we eat, do you want to eat some poor chicken that has been fattened up with hormones and antibiotics and has been forced to live in a. Box with no light and unable to move its whole life until it is slaughtered for human consumption? If that is the life force we r eating how good could that be? If we really are just made up biologically with no life force it maybe be fine but is that really all we are as a species? Or are we more than that? If so shouldn't the chicken we eat have a healthy life and vital life force first before we eat it? I truly believe it should for us to really receive all the nutritional benefits and life goes on....

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by gb36, Sep 02, 2009
I too have had several barium swallows and upper gi series throughout my life... as well as a couple of nuclear stress tests and many CT scans.  Most of these might have been my fault for being a bit of a hypochondriac most my life.. ironically now from my being that way might cause me to becoming actually ill

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by April2, Sep 02, 2009
Why on earth would doctors have ordered all these knowing how much radiation I would be exposed to? They would know better than I the dangers involved. Or do they just not care?
Seroma, good point about the mass. They originally found it when I had an emergency appendectomy. They wanted to go back in and do exploratory surgery and see what it was. I told them no because I didn't relish the idea of surgery again and I asked if we couldn't just keep an eye on it because they told me it could just be a benign mass that I've had all my life and if it wasn't bothering me not to worry about it. I was fine for 2 years then started experiencing pain because it did grow a little, so they finally took it out 2 years after first discovering it. Meanwhile, I had a year of CT Scans. In hind site, I wish they hadn't done all that. Still, they should have known better than me what was safe since they're the doctors.

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by Mom2four85, Sep 02, 2009
Great article thanks :)  I was concerned about this very thing last week in the hospital.  

Wednesday I had a tilt table test, followed by Xrays of the chest; then EPS & Ablation
Thursday - Xrays of the chest & Cardiac MRI
Friday Cardiac Cath followed by Pacemaker/ICD implant
Saturday Xrays of the chest

HOW much is too much?  I was surprised I had to be shocked during ablation with paddles.  I have no burns, marks or bruising.  What type of current do those paddles use for shocking you back to life?

They told me that many tests in such a short period of time was OK, but it still concerned me, any thoughts?

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by ZeeIn, Sep 03, 2009
I didn't see where the study actually mentioned the statistics of developing Cancer from all the xrays, CTs, etc.
If anyone is at risk, I'm definitely on the list. Just this year alone, I have had countless MRI's w/wo Contrast (nuclear)
on my brain, back and abdomin due to different issues.  I have had several CT scans, a couple of Nuclear Stress Tests and countless Xrays due to back problems. Also each time I have an Epidural, an Xray machine is part of the procedure.  That is only this year.  I've had PET scans, Barrium Swollow, etc etc last year.  I have been really sick for the past 7 years with multiple problems after a lifetime of never getting sick and not even keeping Aspirin in my house.    

I keep getting Polyps now in my Esophagus and Colon, which was never an issue before.  Could that be a result of all this "glow" therapy or just part of the rest of my lowsy health issues?  They all biopsy benign, but I had one Endoscopy last month due to some medical issues, received treatment and had some Polyps removed. Less than one month later, I had another Endoscopy to verify the treatment was affective and complete and she found another Polyp.  I was shocked. I go to see her in a couple of weeks, but is it possible for them to grow that fast.  I'm presuming this last one was benign as well since her office only called me to reschedule my appt later.  I'm hoping it was just one that she missed the previous time.

Anyway, available statistics would be nice to follow these people who were tracked to find out how many actually contracted some form on non-hereditary Cancer.  It's like telling me my cellphone emits radiation, but there are no studies proving that one way or another.    

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by Citizen T, Sep 03, 2009
One of the biggest considerations is when did you have all this radiation exposure,  at what age.  The longer  you are alive, the longer the radiation has a chance of causing cancer.   I am 31, and in the last 5 years I have had waay too many CT scans,  I think that I am at a fairly high risk  after about 8 head CT's,  an abdominal/pelvic,  nuclear stress test,  two GI series,   and a coronary CT as well as a pulmonary CTA later (both whoppers).    I guess we will have to see.

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by Corvin, Sep 04, 2009
I'm happy this subject was brought up, it's something I've been debating in my treatment. My doctors have told me that they don't like to do a bunch of CT's if they don't need to, and that it can be dangerous. I'm being monitored for pulmonary fibrosis due to Sarcoidosis. I've had two head CT's when I was in my twenties, and recently one chest/ab/pelvis CT, and two more chest CT's all within three months of each other this year. I won't have needed three chest CT's but the first two were botched because they didn't time the contrast correctly or didn't use enough or whatever the case because the contrast didn't show up on the first two. Then I went to a bigger hospital, and had the third one, and it turned out excellent. But take a wild guess who still had to pay for the first two, and get the extra radiation besides.

Yesterday they just scheduled another Chest CT in December. I'm considering just monitoring my lung function with PFT's, and regular radiographs, and forgetting about CT's. Or at least cut down on how many I have. If I wouldn't have already had three this year I wouldn't be concerned about having another in December, but I think it's getting excessive now, plus the expense.

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by caregiver222, Sep 04, 2009
All well and good, except it is virtually impossible to refuse unnecessary x-rays, even when a patient knows they are unnecessary. The pressure placed upon the patient is impossible to resist. If you even ask for a lead blanket you are considered a "nut".

A few years ago I was involved taking x-rays. Out of curiosity, I took a piece of lead and taped it to a dental x-ray. I did the same with a hundred other dental x-rays and placed them in various measured locations in the x-ray room. At the end of the week all were fogged. So much for the theory that the x-rays only cover the little area where the film is.

Then I had a fight with the hospital administrator, who was a member of Greenpeace, bicycled to work, ate tofo and Ben and Jerry's ice-cream,  believed Al Gore invented the Internet and between saving the whales had time to write out a "mandatory energy saving policy" for the facility.

In the x-ray area was a room with developing machines we used to soup the film  And there were lights in the room. Of course, we used to leave the lights on 24/7. The hospital administrator, wandering around, discovered this and went nuts.

Doctors using oxycontin. Drunk nurses. Sex in the morgue. All meant nothing.

Our determined adminstrator decided that saving the planet through energy conservation was the prime problem. He was on a mission from God.

The problem was the same switch that controlled the overhead lights controlled the developing apparatus. The outlet was wired to the overhead lights. Don't ask me why this was done. Perhaps the electricians had Alzheimers. Perhaps we were being sabotaged by space aliens.

In any event, film development is heavily influenced by a chemical process and strict control of that proecc is absolutely necessary to optimize the image. As the solution becomes used up, I would soup the film a bit longer, for example. But the critical control was temperature. Our modern machine had a temperature sensor. When the optimal development tenperature became too high or low, the solution would be chilled or heated.

This brilliant idea was nullified by turning off the sensor/heater/cooler whenever we left the room. Instead of remaining at an optimal temperature, the solution was therafter invariably too hot or too cold.

And the resultant quality of the images were not to my liking.

As a matter of fact, sometimes they had to be re-shot.

Did numerous notes, telephone calls, e-mails,  change the protocol?

Nope.

Was I backed up by others?

Nope.

The last I heard, the hospital administrator was banning coca-colas and candy bars in the hospital vending machines, writing letters to the U.N. about the coming rise in the oceans, and ocasionally calling Art Bell on the radio to describe the first time he saw a flying saucer.

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by ZeeIn, Sep 09, 2009
I would say that surprises me, but can't.  Whenever I have my xrays, CT's, Mammo's or MRI's done at our local hospital, I cringe.  7 times out of 10, they are no good and I have to do them over.  Or, the next time I have one done, they amazingly find something (like hot spots on my lungs) that put me through a series of PET scans and sleepless nights, only to find out the CT's done by the hospital in the past were not accurate, but luckilly I had one prior to those and the nodules were there 5 years before.  Whew... terrified and relieved.  I'm not saying this is true for every hospital, but I have heard stories from people I know and that scares me.  I had a Heart Cath and the doctor doing the procedure was so concerned about getting out of there so he could go to his beach home for some time off.  As he was chatting away, I felt myself slipping in and out of conciousness.  I then heard someone ask me if I was ok and I couldn't talk. I then heard the person in the control room yell out that my blood pressure was dropping rapidly.  My heart was in a massive spasm and the other tech yelled at the doctor to put nitro into my heart immediately.  At the end of the procedure, I asked him what the heck happened and he said nothing.  It was all quite normal and told my sister and daughter the procedure was fine and left.  

It was later written up an an uneventful Heart Catherization.  Unbelievable.  I had the Nurse Practitioner show me the film and I saw exactly when the catheder hit the wall of my heart, very carelessly as he was running his mouth.  That is what is wrong with health care today.  Most of them just don't care.  My cardiologist and I have argued several times about the sloppy things that happen in his office and by his staff.

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by teakwood, Sep 23, 2009
My dentist, top in his field in our town, has been pushing xrays for years especially on older people.  Yesterday I had my thrice yearly appointment for a tooth cleaning and was told I must have an xray every six months -- it was the law.  Need to find another dentist but they all seem to be in cahoots about expanding procedures of all kinds.  Seems like time for a clinic to open that does only teeth cleaning.

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