Having worked in radiology (x-ray) for more than 9 years, I always hear patients, physicians, and staff in many departments, including radiology, interventional cardiology, and surgery worry about radiation safety during different x-ray procedures.
Always the main question will having an x-ray or being in the procedure room cause cancer and how safe is it in general towards the human body.
I have also had some students wonder if it was wise to pursue a degree in radiography because they fear radiation involved.
Now let’s educate ourselves in this article. I will try to answer commonly asked questions about radiation safety.
I write this article relying on three things.
⚫As an experienced diagnostic radiation who works in almost all areas that use radiation.
⚫Am also a radiation protection supervisor in the hospital where I work.
⚫Lastly, I will rely on medical protocols and studies about radiation protection.
Happy reading!😃
Have any questions, remarks, or experience to share? Feel free to use the comments section at the end of the article!🙏
Last updated: Dec 2024. Written by Juliet Semakula, diagnostic radiographer.
Disclaimer: no affiliate links
Summary: Radiation protection aims to reduce unnecessary radiation exposure with a goal to minimize the harmful effects of ionizing radiation to every procedure done.
▶️What are x-rays and what do they do?
X rays are a form of electromagnetic radiation that can penetrate or pass through your body and produce shadow-like images of bones and some organs.
The images can reveal signs of disease and injury that help doctors to understand your illness.
From this they may be able to treat your condition or rule out certain diseases that are projected on an x-ray.
▶️What procedures do we use for X rays in radiography?
There are several problems that can be detected during an x-ray or scan.
The table below will break them down for you.
| X Ray modality | X-ray or scan procedures |
| X-ray or plain imaging | ♦️Bone fractures or breaks. ♦️Bone abnormal deformities such as spine curvatures, scoliosis, osteogenesis imperfecta ♦️Lung problems such as pneumonia, cancer, bone tumours |
| CT scan (computer tomography) more detailed still imaging | ♦️Most body organs disease such as normal and abnormal tumours, growth, heart failure. |
| Fluoroscopy x-ray imaging enables observation of motion within the body | ♦️Used when checking swallowing problems, using video & barium swallows |
| Breast or mammography imaging | ♦️Breast cancer and other abnormalities |
| Interventional imaging | ♦️Such as angiography, cardiac & non-invasive procedures such as nephrostomy insertions, gastrostomy |
| Dental imaging | ♦️Dental abscesses |
| Nuclear medicine | ♦️Uses radioactive tracers (radiopharmaceuticals) to assess bodily functions and to diagnose and treat disease |
What modalities in radiology that do not use x-rays at all.
| MRI no radiation but there are others MRI mental conditions | ♦️Used to investigate or diagnose conditions that affect soft tissue, such as: Tumours, including cancer. Soft tissue injuries such as damaged ligaments. Joint injury or disease. |
| Ultrasound scans no radiation | ♦️Sometimes called a sonogram, is a procedure that uses high-frequency sound waves to create an image of part of the inside of the bod |
▶️What are the 3 basic radiation protection principles we follow during x-ray procedures.
Radiographers need to think about the dose if the benefit outweighs the risks before starting any examination.
According to the Ionising radiation (Medical Exposure Regulations (IR(ME)R) in the United Kingdom.
As radiographers we follow a set out responsibilities and duty for radiation protection and we do follow basic safety standards.
Under the radiation protection principle, we use the principle of As Low as Reasonably Achievable (ALARA).
1️⃣Justification involves an appreciation for the benefits and risks of using radiation for procedures or treatments
2️⃣Optimization diagnostic does to keep them ‘as low as reasonably practicable’ for their intended use
3️⃣Dose limitation by avoiding excessive or incorrect medical exposures.
▶️How safe are x-rays
Most patients I see are often concerned about being exposed to radiation during an X-ray.
For some reassurance when you are having an x-ray for example x-ray of the hand, very low radiation for a fraction of a second will only be exposed to that particle body part.
The amount of radiation you get is equivalent to a few days or years of natural radiation from the environment
Usually procedures that are medically necessary, and thus the benefits outweigh the risks. The As Low as Reasonably Achievable (ALARA) principle.
Radiographers are trained to understand and know the amount of radiation to set for each body part.
And most x-ray equipment is auto set to only give a minimum required.
All x-ray equipment used in most hospitals have been made safe by following regulations and protocols established to help limit and cut off the amount of radiation given.
Being exposed to x-rays according to studies, does carry a possible risk of causing cancer many years or decades later, but this risk is thought to be very small, and this can affect prolonged radiation therapy exposure.
More research is needed to show more evidence on the possible risks. There was limited actual research on the findings of people who claim to have had cancer because of radiation exposure.
▶️How much radiation is acceptable for different body parts and modalities?
This table gives typical average doses, effective doses, equivalent periods of natural background radiation and lifetime fatal cancer risks from diagnostic medical exposures.
▶️What are impossible effects of radiation on your health?
It is very difficult to predict what radiation side effects you will get after an examination.
Importantly and surprisingly, the level of radiation exposure is relatively low for medical diagnostic imaging amongst both the medical professionals, patients and the public, based on accumulating lines of evidence in different scientific studies (Luan,2021)
X-rays provide such a low dose of radiation that they are not believed to cause any immediate health problems.
While x-rays are linked to a slightly increased risk of cancer, there is an extremely low risk term side effect.
⏭️Possible Risks
🟢You may have tissue effects such as cataracts, skin reddening, and hair loss, which occur at relatively high levels of radiation exposure and are rare for many types of imaging exams.
🟢A small increase in the possibility that a person exposed to X-rays will develop cancer later in life, but this has not largely proven.
Even though a single imaging for one patient might not be so harmful, the volume might be tremendous for cumulative radiation exposure over one patient with multiple times of imaging (Luan,2021)
Having looked at the average dose given to different body parts and the possible lifetime risks, having an x-ray should not scare you off because it also has its benefits.
⏭️Benefits of having an x-ray procedure.
🟢Non-invasive procedure that helps diagnose a medical issue or monitor treatment progression without the need to physically examine the patient.
🟢 Guiding doctors as they insert catheters stents and nephrostomy tubes
🟢 Unexpected findings such as pathologies such as infection in the bones, gas or fluid
One of the commonly asked radiation questions from patients.
▶️Can I undergo x-ray investigations when pregnant?
Yes, you can have an x-ray when pregnant. I have x-rayed so many pregnant women over my years of working as a radiographer.
Some patients wonder why ultrasonography or magnetic resonance imaging (MRI) are not the imaging modalities of choice that can be used because they do not use radiation.
These two modalities can only be used if they could answer a relevant clinical question and would be beneficial to you.
Usually, when the doctor decides for you to have for example a chest x-ray while you are pregnant, just know it is the best option for your diagnosis.
Most of the time it’s to rule out any infection or other complications that could then be harmful to you or the baby you are carrying.
Always the benefit outweighs the radiation risk, which in actual sense will focus on the body part.
The radiographer taking the x-ray is trained to collimate and minimise the amount of radiation given.
However, with any kind of prolonged therapeutic radiation exposure purposes such as treating cancers. There could be a possibility of side effects.
For pregnant women undergoing therapeutic radiation exposure some studies identify some of the side affects you or your baby could have.
🟡It can lead to acute radiation sickness.
🟡Multi-system syndromes.
🟡Genetic abnormalities at the cellular level.
For some reassurance, radiographers make sure your safety and the safety of your baby are priority by making a mutual effort to minimize radiation exposure during the procedure.
▶️How can you protect me from radiation during an x-ray procedure? Both patients and staff.
As a radiographer we are trained to follow the following three basic radiation protections rules which are justification, optimisation and compliance with limits.
Also, we follow some of these guidelines.
🟡Using lead protection when appropriate.
🟡Minimise the amount of radiation exposure based on the body part being examined.
🟡Tight collimation and minimise radiation beam distance only focusing on the part being exposed.
▶️Here are some of the radiation protection devices we use in radiology
For staff members who are present in the x-ray room during procedures.
We have radiation protection gowns, hand rings and dose badges that are provided for you to wear in every procedure.
For patients we also provide radiation gowns to cover some sensitive body parts during some procedures
These badges and gowns are monthly monitored and exchanged to check for how much radiation you are being exposed to during the procedure.
I have been involved in the audit and sending off these badges in my place of work, but we rarely receive any negative feedback on all our dose badges.
By this I mean they always come back with 0 doses registered on them. Which shows that you are always protected when you wear these radiation protection devices properly.
Images of radiation gowns
These are finger ring dosimeters, head eyes dosimeters and dose badges.
Most of the time you will be given a dose badge only if you are just going to be in the room.
For radiologists and doctors, they are given dose badges, finger ring dosimeters and eye head bands because they are doing the procedure and most of the time, they are closer to the x-ray radiation beam.
I have had some people wonder why not all the body parts are protected such as the hands, face and legs.
These gowns only protect the major body parts such as the thyroid, chest, groins and abdomen. These parts hold body organs such as the liver, kidney and heart that can be more sensitive to radiation effects.
Take home messages for patients.
There is no number of x-rays that is safe a month, just as there is no number that is definitely dangerous.
Every x-ray can involve some tiny risk however If the x-ray is needed to find out about a medical problem, then that small risk is certainly worth taking.
Take home message for all healthcare workers that work around radiation (theatres, fluoroscopy and interventional labs)
You should make sure you are fully protected by wearing your radiation gowns and dose badges to help effective dose monitoring and protection.
We have come to the end of this article and I hope I have answered most of your radiation fear questions.
Any questions ,let’s meet in the comments section.
Source:📚
Frane N, Bitterman A. Radiation Safety and Protection. [Updated 2023 May 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557499/
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Luan FJ, Zhang J, Mak KC, Liu ZH, Wang HQ. Low Radiation X-rays: Benefiting People Globally by Reducing Cancer Risks. Int J Med Sci. 2021 Jan 1;18(1):73-80. doi: 10.7150/ijms.48050. PMID: 33390775; PMCID: PMC7738971.
Puckett Y, Al-Naser YA, Nappe TM. Ionizing Radiation. 2023 Dec 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 30480970.