07.08.11 How new policies work in their favor
Radiation is kind of like the boogey-man. You can't see it. You don't know when it's going to get you, but you know it's there and it's scary...really scary. Ever since the earthquake hit Japan, people have been terrified that excess radiation could damage their health. The silver lining of our current radiation fear is that it's brought people into an international conversation about how much radiation is too much. The answer: We don't exactly know. We do know, however, that we don't want to be exposed to any more of it than absolutely necessary. Why not? Because radiation changes normal structures like healthy cells, into abnormal structures, like genetic mutations and cancers. There's not much we can do individually to avoid ambient radiation from natural disasters, but there's quite a lot we can do to protect ourselves from too much medical radiation. In fact, in the past few years, doctors all over the world have hopped on board new radiology guidelines called the ALARA Concept: As Low As (is) Reasonably Allowable. That means they're trying to quit doing so many radiologic tests like x-rays and CT scans. This is particularly important for children. That's why a coalition of health care organizations formed The Alliance for Radiation Safety in Pediatric Imaging and created the Image Gently campaign to raise awareness, educate patients and providers and reduce children's exposure to radiation. Doctors and hospitals aren't always aware of how much unnecessary radiation they're exposing children to. Until recently, if a kid had a sinus infection, bad cough or sports injury, their doctor might order a CT scan or x-ray, "just in case." These tests provide such quick, convenient peeks inside the body that many doctors overused them. An awful lot of "just in case" radiology tests were ordered for medical conditions that just didn't warrant them and didn't change treatment plans enough to justify the radiation exposure. Radiation doses in individual x-rays are pretty small, but they add up over a lifetime. If kids are exposed early and often, especially to high-radiation tests like CT scans, their lifetime exposure can build to unsafe levels at relatively young ages. Until recently, most doctors and hospitals didn't keep track of how much a child received over time. Many radiology departments didn't calibrate radiation machines and doses to accommodate children's smaller bodies. In short, too many kids got way too much radiation. Pregnant women who need an x-ray don't have much to worry about. They're abdomen is shielded with a lead apron that protects their baby from receiving radiation. Even if Mom needs an x-ray directly to her abdomen (I once had a patient who broke her pelvis in a car accident), the dose is tiny and the baby is probably safe. Once that baby is born, however, he/she doesn't necessarily get the same level of protection it did in the uterus. The New York Times wrote about how children are exposed to way too much radiation while in the hospital. Babies in the NICU can be exposed to multiple x-rays over a short period of time as doctors diagnose their health problems and determine that IV lines and breathing tubes are properly placed. NICUs can be chaotic and crazy. When a sick newborn gets admitted, there's an all-hands-on-deck-save-the-baby attitude. Lots of tests are ordered including x-rays. Instead of taking a newborn to the x-ray department, portable x-ray machines are usually brought to the NICU. When x-rays are needed in one heck of a hurry babies aren't always adequately shielded from excess radiation. They don't always get the lead apron and might get total-body irradiation instead. Even if a baby is shielded properly, the other babies in the NICU probably aren't and they could potentially be exposed to radiation scatter. Newborns are at especially high risk for problems related to radiation (like cancer, infertility and more) and these problems might show up years later. What can parents do? First of all, do whatever you can to keep your baby out of the NICU. Since that's not always possible, however, do a little research before you go into labor: - Read up on the Image Gently campaign. - Interview pediatricians and ask them about how their practices support the ALARA concept. - Find out if your delivering hospital and NICU have adapted ALARA guidelines. If your baby has to go to the NICU, go with him. Pediatricians always have their patients' well-being in mind, but when things get frantic in the NICU, they'll be more aware of what they're doing if a parent is standing there. When a well-informed parent asks, "Hey, didn't you just take an x-ray a couple hours ago? Does my baby really need a CT scan?" their doctor might say, "You know what? You're right. Let's back off a little here." If, however, your pediatrician says, "I really need to see what's going on in there," don't micromanage. Sometimes a picture (or x-ray) really is worth a thousand words. That's what radiation is for. Radiation isn't always the boogeyman. Sometimes it's a lifesaver. Jeanne Faulkner, R.N., lives in Portland, Oregon with her husband and five children. Got a question for Jeanne? E-mail it to firstname.lastname@example.org and it may be answered in a future blog post. This Fit Pregnancy blog is intended for educational purposes only. It is not intended to replace medical advice from your physician. Before initiating any exercise program, diet or treatment provided by Fit Pregnancy, you should seek medical advice from your primary caregiver.