X-Ray Hesitancy: Patients’ Radiophobic Concerns Over Medical X-rays

Abstract

All too often the family physician, orthopedic surgeon, dentist or chiropractor is met with radiophobic concerns about X-ray imaging in the clinical setting. These concerns, however, are unwarranted fears based on common but ill-informed and perpetuated ideology versus current understanding of the effects of low-dose radiation exposures. Themes of X-ray hesitancy come in 3 forms: 1. All radiation exposures are harmful (i.e. carcinogenic); 2. Radiation exposures are cumulative; 3. Children are more susceptible to radiation. Herein we address these concerns and find that low-dose radiation activates the body’s adaptive responses and leads to reduced cancers. Low-dose radiation is not cumulative as long as enough time (e.g. 24 hrs) passes prior to a repeated exposure, and any damage is repaired, removed, or eliminated. Children have more active immune systems; the literature shows children are no more affected than adults by radiation exposures. Medical X-rays present a small, insignificant addition to background radiation exposure that is not likely to cause harm. Doctors and patients alike should be better informed of the lack of risks from diagnostic radiation and the decision to image should rely on the best evidence, unique needs of the patient, and the expertise of the physician—not radiophobia.

X-Ray Hesitancy: Potential Concerns

“…It is written in the abstract by Drs. Oakley and Harrison: “Medical X-rays present a small, insignificant addition to background radiation.” 1 The estimated global average exposure from natural radiation sources is 2.4 mSv. The U.S. annual individual effective dose from diagnostic and interventional medical procedures was estimated to have been 2.9 mSv in 2006 and 2.3 mSv in 2016.…”

“…Some aspects of the Chernobyl accident are elucidated incompletely. 1 Even conservative appraisals do not exclude the possibility of radiogenic thyroid cancer after Chernobyl. 5 The statement “Regarding the Chernobyl accident, it must also be noted that…doses to the thyroid were 3 to 4 orders of magnitude greater than to other body organs” 1 is given with the reference.…”

“… 1 Even conservative appraisals do not exclude the possibility of radiogenic thyroid cancer after Chernobyl. 5 The statement “Regarding the Chernobyl accident, it must also be noted that…doses to the thyroid were 3 to 4 orders of magnitude greater than to other body organs” 1 is given with the reference. 6 It is written in the cited article: “The thyroid has a unique ability to concentrate and bind radioactive iodine, so that it receives a dose 500-1000 times higher than the rest of the body,” 6 which is not the same.…”

“…The following statement is written without references: “Thus, repeated medical imaging, as long as it is in the low-dose range (<100-200 mGy), will not result in an actual accumulation of radiation-induced DNA damage as long as the repeat imaging is done after a lag period (i.e. 24-hour).” 1 In this way, up to 200×365=73,000 mGy can be accumulated in a year. Indeed, mutations can be repaired, but they can also accumulate.…”

“…Indeed, mutations can be repaired, but they can also accumulate. Furthermore, the supposition that “children are not more susceptible to radiation effects” 1 is questionable as the cells undergoing mitosis and hence growing tissues are supposed to be more susceptible to mutagenic stimuli. This is a topic for a separate review.…”