X-Ray Question

[2kids]

My daughter got her second Cheneau brace two weeks ago. She is scheduled for an in-brace x-ray at Children's Hospital at the end of this month. Each time she has been x-rayed, the technician has not put on the protective apron over her pelvis area. I inquired about this and was told the x-ray needs to see her entire spine and pelvis. The apron would cover that area. Although that makes sense, isn't it dangerous? Is this normal and to be expected to check her spine. So far she has been x-rayed about 5-6 times since her diagnosis in the fall of 2007.

Thanks!
Brenda

[Snoopy]

For my daughter, they've always used shields. They cover just what is necessary.

Mary Lou

[mamandcrm]

Hi 2kids,

We also go to the location you go to I think. I asked exactly your question at our last appointment and was told that in order to see everything the doctor needs (growth plates, etc.), they don't shield, at least at this age. Very unsatisfactory, I know, but that's the answer I got. I asked about the risks to her future health, and the doctor didn't think it was a concern with modern xray technology. But of course it's a concern if your the parent...

mamandcrm

[2kids]

Hi mamandcrm,

Yes, my daughter is seen in Fairfax by probably the same doctor as your child. I emailed my concerns to the doctor this week. He explained to me that they try to minimize the number of x-rays but attempts to use a pelvic shield often lead to obscuring the iliac crest or lower spine and a second x-ray then increases the exposure. It makes sense, but very worrisome.

I was amazed by the correction your daughter is getting in her Cheneau brace. My daughter had some correction in her first brace, but I hope it is greater in this new brace. Her in-brace x-ray is in two weeks.

Brenda

[leahdragonfly]

ovarian shielding

Hi,

My 6 y/o daughter had multiple x-rays during the past year (in brace/out of brace, bending), at Shriners Philadelphia, Shriners Portland, and at a private pediatric spine specialist's office in Portland. At Shriners they always would tape a small lead shield to my daughter's back, then had her face away from the x-ray beam to take the x-ray (PA). When we went to the private ortho's office they taped a shield on her tummy then took the x-ray the same way. I later realized this was wrong (see previous thread on gonadal shielding). When I called the office they told me they place the shield on the front to protect from the scatter, rather than the main beam.

Everything I have read says that the gonads must be shielded from the main beam, so at our appointment last month I insisted on shielding front and back. The rad tech questioned me and rolled her eyes, and I just told her my reasons and told her to just consider me a paranoid parent. BTW, all these x-rays came out just fine and show all the bony structures that are required.

I think there is pressure in the x-ray dept (and some sloppiness) to do the x-rays as quickly as possible. I know I will be insisting on front and back shielding from now on. It works fine, with a small shield taped in place.

Don't be afraid to stand up and advocate for your child! I would be inclined to call ahead to the x-ray department before your next appt and explain your concerns and tell them you want your daughter shielded, period. It IS possible and it should be mandatory.

Good luck,

[bas2101]

My daughter also wears a Cheneau brace and recently had an in-brace x-ray. They shielded her pelvis area with 2 round plates that just covered that area (albeit it was a rather lame attempt to cover her). Her pelvic bones are still mostly visible in the x-ray. However, I have been to another hospital that did not covered her at all. Refuse the x-ray if they do not cover her to your expectations.

[mamandcrm]

Hi 2kids,

We were stunned at her correction. I'm guessing if your daughter is in a cheneau then she sees Luke at Orthotic Solutions. If anyone can get a better correction for her it's Luke. He also got a terrific correction for our daughter when she was in a Providence. But she's also 7 and VERY flexible. You're in good hands though I think. We have different doctors, as mine is not a "he" but they probably have a policy in the xray department. I got no sense that if I pushed I could have my way on the shielding. Maybe I'll ask the doctor again next time...

[mamandcrm]

Question for Gayle

Hi Gayle,

Do you ask for breast shielding for Leah as well or is that not as big a concern until the breast tissue starts growing? The more I think about it I realize you are right and I need to insist on the shielding. She has so many years of xrays ahead of her. If they won't comply then we need to consider finding another practice (which I don't really want to do) as I think the "no shielding" is driven by the doctor more than the x-ray department in our case.

[leahdragonfly]

Hi Chris,

I asked about breat shielding when Leah had her original diagnostic X-rays last January. These were taken at a general practice clinic's radiology department. I was told then that they used some sort of screen attached or built-in to the X-ray machine that helps shield the breast tissue. I have not yet inquired about it at our current ortho because I considered it most important to get the gonadal shielding the way I wanted it. I will check in to the breast shielding before our summer appointment. I am an RN and work with radiation and rad techs daily, so I have asked around eXtensively about proper shielding techniques. I am told that radiation is most damaging to rapidly developing tissues such as pubertal/developing breast tissue, which is why I fought to get the proper ovarian shielding first. Remember, our daughters have all the eggs they will ever have in their ovaries at birth, so in essence those are our future grandkids in there getting X-rayed, too. You can never be too cautious!

The doctor may be refusing to use shielding for convenience (to make sure nothing is obscured inadvertently and to avoid repeat X-rays). But Gillian is your child and you have the right to insist and have her shielded properly--she needs you as her advocate. I don't know if her X-rays are taken in the doctor's office or in a separate radiology department. This will determine how to proceed. I will tell you what worked for us, maybe it will help.

After the appointment where Leah was shielded improperly, I called the ortho's office and was connected to the rad tech, who told me in a very breezy way "don't worry, your daughter has millions of cells that die each day, it won't hurt her to lose a few more." I found this outrageous, so I called back and was put through to the nurse. I eXplained my concerns to her, and told her I got an unsatisfactory response from the rad tech. I asked her to check with the doctor, which she did and she called back. She told me the doctor had no opinion on how to shield Leah properly (!?) and said he had referred the matter to the office manager. The nurse told me the office manager said I could have Leah shielded however I wanted. The nurse made the order out for the neXt X-ray with shielding front and back (they wanted to shield front only). She instructed me to let her know if the rad techs refused to cooperate. When we were called in for the X-ray, they asked me why I wanted shielding front and back. I told the RT that I believed Leah should be shielded from the primary bean AND from scatter, and that I had called around to every radiology department in Portland and learned there is some controversy about shielding front or back. I told her since apparently no one can agree, I wanted both sides shielded. She did not argue, I think because I was prepared and had a good reason. Leah was shielded on both sides and the X-ray came out just fine.

So you may not receive support from the doctor for proper shielding (which I find disturbing), but you can take steps to ensure the proper shielding is applied. You just may have to go up the chain of command a little higher.

Take care,

[Snoopy]

But Gillian is your child and you have the right to insist and have her shielded properly--she needs you as her advocate.

This is wonderful advice. You are your daughter's best advocate. Trust your instincts and push for what you feel is best. If they insist that they need x-rays without shields to see the pelvis, for example, ask if they can do it every other time, for example. At least she would be getting less x-rays without the shield.

You might get a lot of resistance, but who cares! I once refused to have my daughter x-rayed and you'd have thought I threatened to physically hurt someone. The nurse called Jamie for her x-rays and I told her she didn't need x-rays today and went on to explain that she hadn't worn her brace enough to have any improvement in her back, so therefore, why do an x-ray? She was dumbfounded. She told me she never had a parent refuse an x-ray before. She then told me she'd have to ask the doctor if it was okay to not do an x-ray. I told her I was the parent and Jamie would not be getting an x-ray that day. I kept my cool and also told her I would take full responsibility and explain to the doctor why I refused. She asked the doctor anyway and he agreed with me. I didn't make a friend with the nurse that day, but I didn't needlessly expose Jamie to any extra x-rays.

Mary Lou

[txmarinemom]

For formerly braced adults ...

Gayle ...

Just a question for another "old school" Boston wearer ... were you shielded? I wasn't.

Not only was I constantly x-rayed for scoli, I had a VP shunt placed at age 10. That's actually where most of my A/P baseline x-rays of my curve were accessed in later life.

I guess I kind of have to question the importance of shielding when I had soooooo many x-rays/CT scans as a juvenile/adolescent. Even now, I'm not shielded with digi-films ... of course I do NOT plan to reproduce again (laff ... I have learned my lesson!).

(just random musings ... we ARE the generation that chased the mosquito truck, shot Roman candles/bottles rockets - the real ones - AT each other, and ran with scissors ... ;-)

Today, we feed our kids irradiated food (presumably safe), and chickens that are in the 1/3rd who've survived a diet pumped full of Alimet (a growth hormone feed additive) who's hearts don't explode at the accelerated growth.

I realize it's all about acceptable risk, but are x-rays today really as dangerous (even a FRACTION as dangerous) as what we were exposed to?

Pam

[leahdragonfly]

Hi Pam,

Yes, I was shielded consistently through my AIS treatment. I remember because I was absolutely mortified at age 13-14 to have breast shields and ovarian shields taped on me, I found it all so embarassing.

Today's X-ray technology is WAY safer and a much lower dose of radiation than we received, especially with the newer digital equipment. I reviewed my records that my mom kept all these years, and I was X-rayed every 3-4 months for several years. In my case I had a PA and a lateral each time, to monitor the scoli and the spondylolisthesis. And so far I have no apparent health consequences from it, at age 41, although that doesn't mean you or I won't encounter a serious problem later (cancer and leukemia are the biggest risks). BUT, that said, we should never allow ourselves to become complacent about radiation and protective shielding. I am currently studying for a work-related credentialing eXam, and here is a quote about radiation safety:

"No known level of ionizing radiation is a permissible dose or absolutely safe. The less eXposure, the less chance of absorbed energy biologic interaction. Radiation eXposure is cumulative. There is no washout phenomenon."

Pretty scary stuff, radiation, unfortunately, so very necessary to monitor scoliosis.

Regards,

[Snoopy]

Pam,

Have you every heard of Three Mile Island (TMI)? This is the nuclear power plant in Pennsylvania that had a meltdown in 1979. Yeah, I live about 5 miles from those reactors. Do I worry about the radiation we were exposed to? Not really. What can I do? What's done is done. I've wondered for years if the amount of cancer patients in my town has anything to do with TMI. Did this worry stop me from living my life, which includes having kids? No.

Do I worry about my girls being exposed to excess radiation from x-rays? Yes. Jamie has always been shielded with her x-rays and I never had to ask for the shields. Why do I worry so much about protecting my girls? My mom battled ovarian cancer and is possibly having a reacurrence as I write this. I guess I worry more because of my mom. But it is nice to know that Jamie has been shielded in hopes of protecting her in some small way, since she has a family history of ovarian cancer.

I try not to worry about things that I have no power over, but I refuse to sit back and do nothing.

Mary Lou

[mamandcrm]

The way I am looking at it is that it may be right that modern x-rays present no dangerous long-term health effects for patients but I don't see any definitive, long-term studies that show that. Rather I see diasagreement. So why take a chance with my daughter's health when there is no down-side to taking a more conservative approach and shielding her? Apparently, it can be done with a minumum of effort and done so that it does not interfere with the diagnostic value of the x-ray.

In addition, I wonder (and will ask at the next appointment) why it is necessary to see everything on every x-ray when my daughter is only 7 and her curve is not in the lower lumbar area. I understand the need to see the growth plates in a pre-teen, but obviously my daughter is several years away from being done growing. Maybe there are reasons I do not know of, but it's certainly a question for me.

On a slightly different subject, does anyone know anything about the BioSpace EOS imager? I have read there is one installed at the Spine Group in NJ, but I read in various places that it is only FDA-approved for 16 and up although that might be for some component of the machine that is not necessary for just producing an x-ray. I have inquired with the NJ site about whether they do imaging for those who are not otherwise patients. I am wondering if the images are considered satisfactory quality.

Chris

[christine2]

I also worry about x ray exposure. St Justines hospital (Dr Rivards in Canada) is using a new machine (Q Scan I think it is called) that supposeably cuts down on exposure dramatically. They do use pelvis sheilds. I wish they could use breast protection however I can see where they would get in the way. X ray exposure is one of Dr Rivards reasons for not doing out of brace x rays untill needed.

MaryLou I am sorry about your mom, I hope she is OK.