X-ray Safety: What You Need to Know

X-ray imaging is a crucial diagnostic tool that provides valuable insights into a wide range of medical conditions. Because X-rays use ionizing radiation, however, it’s important to consider the possible health risks of X-ray procedures, including CT and fluoroscopy exams. In this article, we’ll discuss factors that influence X-ray safety, questions to ask your health care providers, and tips for minimizing risk.

What risks are involved with X-ray exams?

There are two main sources of risk in X-ray exams: ionizing radiation and contrast material.

Ionizing Radiation

Ionizing radiation, which is indispensable in X-ray imaging, carries enough energy to alter matter at the atomic level. With sufficient exposure, this can result in damage to human cells and DNA, increasing the risk of cancer development and potentially causing injury to tissues. Any potential increase in cancer risk from common medical imaging techniques is thought to be very small, and tissue effects such as skin irritation, hair loss, and cataracts are uncommon. The FDA advises, however, that these tissue effects may occur in longer, more complex interventional fluoroscopy procedures that deliver much higher radiation doses than typical X-ray or CT exams.

Contrast Material

Some X-ray exams use contrast dye to create clearer pictures. Some patients may experience allergic reactions to these dyes. Mild reactions might cause symptoms like itching or a skin rash, but severe reactions could result in anaphylaxis. During procedures that utilize contrast, patients are monitored for signs of allergic reaction. If a patient has a known allergy to contrast dye, they may be prescribed medication to head off a reaction, or their doctor may prescribe a different type of contrast or order an exam that doesn’t use contrast material.

Additionally, some patients may be at increased risk from contrast dyes due to pre-existing medical conditions, such as kidney damage or thyroid dysfunction, or medications that they’re taking. Because of this, it’s important to communicate fully with your providers about your medical history.

How do medical providers limit imaging risk?

Whether and to what extent the low doses of radiation typically used in X-ray imaging increase a person’s cancer risk is a matter of debate in the scientific community. As a precaution, however, medical professionals rely on the principle of ALARA, which stands for “as low as reasonably achievable,” to guide their decisions about when and how to utilize X-ray imaging.

The ALARA principle demands that

• X-ray procedures are performed only when medically necessary.
• The medical benefit the X-ray procedure provides outweighs the risk associated with the radiation exposure involved.
• X-ray equipment is properly maintained.
• Machine settings and imaging protocols are selected to create high quality images while minimizing radiation exposure.

An individual’s susceptibility to developing cancer after radiation exposure depends on not only the dose of radiation received but also their age, sex, and the area of the body that is exposed to the radiation. Patients exposed to radiation at a younger age experience a greater increase in lifetime cancer risk than those exposed later in life, and females have a greater lifetime cancer risk than males who receive similar radiation exposures.

What steps can patients take to limit their risk?

While medical professionals take many steps to make X-ray imaging as safe as possible, there are also some things patients can do to protect themselves from unnecessary radiation exposure.

Ask questions.

Self-advocacy is an important part of safeguarding your health. You have a right to understand your medical procedures, the reasons for conducting them, and the benefit they’re expected to provide. Don’t be afraid to ask questions about exams that your doctor orders and the facility that performs them. For example,

• How will the procedure help to evaluate my condition or contribute to my treatment?
• Could another exam that doesn’t deliver ionizing radiation provide the information needed?
• What steps will be taken to limit the radiation dose?
• Will the procedure use contrast material, and if so, what type will be used and how will it be delivered?
• What accreditations has the facility earned?

The (ACR) College of Radiology awards accreditations to facilities that they determine provide the highest level of imaging quality and safety based on meeting specific requirements for equipment, medical personnel and quality assurance. These include general accreditations as well as special recognition for excellence in specific types of imaging, such as comprehensive breast imaging, pediatric CT, lung cancer screening, and more.

Fully communicate your medical history.

If you see a variety of medical professionals, keeping track of all your medical information can be challenging. However, the more complete picture you’re able to communicate to your health care providers, the better they can safeguard your health. Keep a complete list of medications and health conditions, and communicate these to your imaging provider. Additionally, keep a record of all medical imaging you undergo. This can help prevent unnecessary exams as well as keep your providers informed about radiation that you’ve already been exposed to. Finally, always inform your provider if there is a chance that you may be pregnant. If pregnancy is confirmed, they may choose a different type of imaging or postpone the exam until you are no longer pregnant.

At Iowa Radiology, your health and comfort are important to us. All our facilities are ACR accredited, and all our radiologists are board certified. We’re always happy to explain procedures scheduled at our offices and answer any questions you may have. Learn more about our services, or subscribe to our blog for regular updates on important health topics.

Resources

American Cancer Society. Understanding Radiation Risk from Imaging Tests. Cancer.org. Updated August 3, 2018. Accessed June 25, 2024. https://www.cancer.org/cancer/diagnosis-staging/tests/imaging-tests/understanding-radiation-risk-from-imaging-tests.html.

Crease RP. How sound is the model used to establish safe radiation levels? Physics World. Published October 17, 2023. Accessed June 25, 2024. https://physicsworld.com/a/how-sound-is-the-model-used-to-establish-safe-radiation-levels/

U.S. Environmental Protection Agency. Frequent Questions: Radiation in Medicine. EPA.gov. Updated June 6, 2024. Accessed June 25, 2024. https://www.epa.gov/radiation/frequent-questions-radiation-medicine - fluoroscopy.

U.S. Food & Drug Administration. Medical X-ray Imaging. FDA.gov. Updated February 21, 2023. Accessed June 25, 2024. https://www.fda.gov/radiation-emitting-products/medical-imaging/medical-x-ray-imaging.