Most urgent care centers offer X-rays. But simply having access to X-ray equipment is not the same as having access to the best medical care.
Without pediatric clinical expertise, many physicians overuse X-rays and other imaging, with potential long-term consequences for your child’s health and very immediate consequences for your wallet.
This is what every parent needs to know.
What is an X-ray?
X-rays (radiography), computed tomography (CT), and fluoroscopy all use electromagnetic radiation to create images of internal parts of the human body. Forms of radiation similar to X-rays include visible light, radio waves, and microwaves.
A standard X-ray is a single image. A CT scan takes three-dimensional images by rotating around the body. Fluoroscopy uses a dye to allow for real-time visualization of an internal system. CT scans and fluoroscopic scans require referral to a hospital or specialized medical center.
For each imaging process, an X-ray beam passes through the body. Parts of the X-ray are absorbed by internal structures, while others pass through, exposing the film or digital detector and creating an image. Denser parts of the body—like bone—absorb more of the beam and generate a lighter color on the film.
The radiation absorbed by the body from a scan becomes the “radiation dose” to the patient. A standard chest X-ray yields a radiation dose comparable to roughly 10 days in the natural environment—a very small amount. However, a CT scan can generate up to 200 times that amount, or as much as three years of exposure in the natural environment.
In pediatric medicine, physicians most often use X-rays to diagnose bone fractures and lung ailments, such as pneumonia. They may also check for an object ingested by a child or whether a piece of glass or metal remains in a wound. X-rays have advanced medicine from an earlier era when, without imaging, exploratory surgery was the only option.
Reading pediatric X-rays accurately requires specialized training and experience, as the growing bones and organs of pediatric patients make diagnosis more challenging for general practitioners and radiologists. Detecting subtle fractures requires a full understanding of the order of ossification (the natural process of bone formation) in growing children and teens.
X-rays and Imaging Safety
Put simply, parents shouldn’t request an X-ray—or refuse one recommended by their health-care professional.
While all radiation exposure increases the risk of developing cancer, medical imaging poses a small risk. (Estimates suggest that every 10,000 CT scans lead to one additional case of cancer.) Still, electromagnetic imaging should be used only when necessary. Children are 2–10 times more sensitive to radiation exposure compared to adults.
This makes pediatric diagnostic skills vital. They allow physicians to diagnosis and treat illness and injury without imaging, when possible. Specialized pediatric care also ensures use of appropriate settings on imaging equipment. In general hospitals, X-rays or CT scanners often are not calibrated for the size of the child, despite the fact that 90% of pediatric imaging occurs in this setting.
At KidMed, we take X-rays in a child-centered environment and interpret them with decades of pediatric experience. Equally important, we have the clinical expertise to avoid the risks and costs of unnecessary imaging.
–Dr. Mark Flanzenbaum, KidMed
Because radiation exposure accumulates over time, tracking the exposure of your child to X-rays can help physicians assess the risk or benefit of additional imaging.
The Growth of Medical Imaging
The average radiation dose per person from medical X-rays has grown nearly 500% since the early 1980s, when it accounted for about 11% of all exposure to radiation. Today, it makes up nearly 35%. Growth has been led by increased use of CT scans, not radiography, according to the National Council on Radiation Protection and Measurements.
An International Atomic Energy Agency (IAEA) study found that up to 50% of all medical imaging was unnecessary, citing multiple reasons:
- Parents requesting imaging for a more “thorough” investigation
- Financial conflict-of-interest for the physician, medical practice, or hospital
- “Defensive medicine” to protect physicians from malpractice lawsuits
- Media overemphasis on rare “missed” diagnoses
- Overuse of new imaging technology before cost-benefit studies determine appropriate use
- Retaking existing imaging for convenient access
The average child now receives seven scans before the age of 18. Pediatricians attribute the rise to a decline in clinical skills as well as the convenience of instant diagnosis.
One study of minor pediatric head injuries showed that 4–6 hours of observation in the emergency department was equally effective as a CT scan, with no negative impact on patient safety. A further deterrent is the cost of a CT scan, which can range from $437 to $2,239.
These statistics highlight the importance of expert pediatric care that limits unnecessary imaging. X-rays are an essential diagnostic tool—but they should not replace a thorough clinical exam and patient history. Regardless of where your child receives care, the Food and Drug Administration (FDA), which regulates imaging devices, recommends that parents:
- Log their child’s medical-imaging history
- Ask their physician about the benefits and risks of imaging
- Ask whether alternative exams are equally as valuable
- Ask if the imaging facility adjusts settings for children
- Confirm whether additional steps, such as use of a dye or sedative, are part of the process
What to Expect
X-rays are painless. Your child will not feel anything during imaging. Still, there are ways to make the experience more comfortable. Remove any metal jewelry prior to arriving at the medical facility and have your child wear loose-fitting clothing.
For very small children unable to stay still, a number of light restraint methods help ensure a clear image. Experience with these restraint methods—and managing pediatric patients’ anxiety—avoids repeated imaging and unnecessary radiation exposure. A National Institutes of Health study cites winning a child’s trust and cooperation as a primary factor in successful pediatric imaging.