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Jan
02-06-2015, 05:32 PM
Hi,
I have concern about the multiple XRays that young girls are having to be exposed to during their scoliosis journeys. Would it be possible to use lead apron to protect the ovaries?
Please see below a copy of a reply to a thread started last week (surgery) which I wonder if you could respond to?
Many thanks,
Jan

Hi Tracy,
Thanks for that information, you've raised an important issue that has also been on my mind. I am glad that other people are also worried about the effects of radiation from multiple XRays. Especially with young girls as they are maturing. It could be a risk to their fertility in the future.
My daughter had posterior fusion T4 to L3 6 months ago.
Every time that she has had to have an XRay I have asked the radiographer if she could wear a lead apron to protect her ovaries / uterus, but every time, they say that they cannot do that as it would block the view of the spine.
In actual fact, if you look at the anatomy, the ovaries and uterus actually sit quite low in the pelvis, such that, you could still use lead to cover them and then still get a good view of the spine right down to the sacrum. Maybe it is just an assumption that you can't get the full view of the spine if pelvic region is protected with lead apron, maybe there is no apron the right shape or size? At least they could test it out to see if a lead apron could be used and if you could still get a good view of the spine.
I think this is an issue that should be brought out a bit more, if the ovaries can be protected from multiple XRays, then we should be trying to do this if it is possible.
I think I'll send this message to Dr Scoliosis and see what he says.
Cheers,
Jan

Dr Scoliosis
04-06-2015, 04:22 PM
Dear Jan,

Thanks for your question. X-rays are an essential investigation in the assessment of spinal deformities. However, they should only be done when absolutely necessary. In some cases, that could mean up to 2 - 3 times a year, such as in young children, whose curves can worsen rapidly. In teenagers, the frequency of X-rays also depends on a number of factors. In general, the following guidelines are reasonable:

1. When a child or teenager is first seen for scoliosis, a standing (erect) X-ray is taken “PA and lateral”. This gives a good view of the spine from the back and the side. In many cases, no more lateral (side) views are needed.

2. On subsequent visits, X-rays are not always needed. They could be done as infrequently as once a year, or two in someone whose curve seems stable. They might be needed every six months if treatment such as a brace is being used. If surgery is being planned, special “bending” X-rays are often done.

X-rays should not be done without good reason. There is certainly no scientific reason to have one regularly as part of chiropractic treatment.

3. Spine X-rays should be taken “PA” - that is, with the person's back to the radiation source (the tube) with the film cassette in front. The reason for this is that a lot of the X-rays “bounce” or scatter off the outer layers of body without passing straight through. The most sensitive tissues to radiation in the field of a spine X-ray are not the ovaries or testes, but breast and thyroid. An X-ray taken PA reduces the radiation dose to those tissues by up to 6 times, compared to an AP (front to back) film. You should make sure your child has X-rays taken in this manner.

4. Ovaries tend to sit low in the pelvis and are usually out of the field of the x ray beam. Most spine X-rays only need to see the upper part of the pelvis, above the ovaries. Therefore, shielding is usually not necessary.

5. For most girls and boys with an adolescent idiopathic scoliosis only a few X-rays over number of years are ever needed. That is because most people with scoliosis need no treatment for it. Only 1 : 100 of those with a curve will be facing brace or surgical treatment. It is that group, with progressive curves, that will usually need the most X-rays. Even then, the doses are relatively low (and reducing, due to better technology). The risk of a cancer or other damage forming due to a series of spinal X-rays over a few years is extremely low. However, as noted above, there should always be a good reason to take an X-ray.

6. X-rays, like photographs, can be taken in different ways. The exposure/dose can be reduced but the quality of the picture may be not as good. Some X-ray practices are very good at lowering the dose for children's X-rays but still getting a good image. If your city has an EOS scanner and your child is likely to need a number of X-rays, due to a progressive scoliosis, it might be worth the effort to go to that centre. Ask your doctor.

Some notes on X-rays:

We are exposed to x rays (ionising radiation) every day of our lives. In Australia, the average yearly exposure is 2 - 3 milliSieverts (mSv). One third comes from cosmic radiation, 2/3 from sources on earth, such as some foods, mineral water, rocks such as granite and so on. In some parts of the world, the levels are much higher (Sweden 6msV, France 5mSv, Kerala, India 50mSv). Cancer rates in these countries is no higher than in places with lower exposures. Air travel exposes us to more radiation, as it increases with altitude. A return flight from Sydney to Perth gives more radiation than a chest X-ray.

Medical radiation sources (X-rays and CT scans) give varying radiation ‘doses’, depending on the type of scan being done. A chest X-ray uses little radiation (0.03mSv) as the chest is mainly air. A spine X-ray (depending on views taken) gives a dose between 1.5 and 2.5mSv. That dose represents about 6 to 9 months background radiation.

EOS scanners, present at some major centres, use far less radiation than standard machines.

CT scanners use higher energy X-rays and in some circumstances, can give doses equivalent to several years background radiation.

I hope this has been helpful.

Dr S

Jan
05-06-2015, 08:44 AM
Thanks you Dr S,
that is really helpful and reassuring.
Jan