Living Well For years, I've warned readers about how doctors casually use X-rays with ionizing radiation in medicine. And recently, a reader e-mailed in to let us know about a provoking new study...
R.M. wrote to us about the uselessness of lead aprons, which are supposed to shield you from unnecessary radiation during an X-ray:
Doc, you've written in the past about the danger of excessive X-ray radiation and its impact on our DNA. I came across this article that supports your position, if only unwittingly... The spin of the article is to suggest that we don't need to worry about dental X-rays. It says the apron is "not needed" and in fact provides mainly just psychological benefit. It also says, "The internal scatter that exposes the organs below the jaw cannot be prevented with an apron." How's that for an understatement!... The only way to truly limit the danger is to avoid exposure as much as possible. Your thoughts?
Thanks for writing in, R.M.
This is not the first time that the usefulness of lead aprons has been called into question. Four years ago, the American Association of Physicists in Medicine suggested X-ray shielding on unborn babies and people's sex organs be discontinued because it can block aspects of an issue from being detected – like the root cause of the disease, for instance – and cause the person to require more imaging and further radiation exposure.
I agree, we should be avoiding radiation as much as possible. Many studies show that exposure to X-ray radiation increases the likelihood of developing cancer. Even if that increased risk is very small with low doses of radiation (dental X-rays are typically very low doses), it is still an increase nonetheless.
However, sometimes X-ray imaging is a necessary evil. There are certain situations where an X-ray is the only way to understand the full scope of an issue.
So, make sure you're only getting an X-ray when it really counts. Here are my five tips for assuring an X-ray is worth the risk...
1. Don't ask for X-rays.
According to a lead apron and radiation study, your dentist should be asking themselves the following questions before determining that an X-ray is warranted, on a case-by-case basis:
- Will imaging provide answers to my questions about diagnosing a particular issue?
- Which imaging techniques will minimize the amount of radiation exposure, while also providing enough information to make a diagnosis?
- Do the benefits of imaging greatly outweigh the risks associated with exposure to radiation?
If a medical professional isn't recommending an X-ray, you probably don't need it. If you still think you need an X-ray and the doctor has misunderstood your complaint, take steps to make sure you're communicating the issue clearly.
2. Make sure the X-rays are necessary.
Sometimes medical professionals are thinking about cash flow when it comes to recommending X-rays. A 2018 study found that in a group of Scottish dentists, those who switched from being salaried to being on a fee-for-service payment model were 6% more likely to give an X-ray after the switch.
Before agreeing to an X-ray, the U.S. Centers for Disease Control and Prevention suggests asking your dentist – or other medical provider – these two questions:
- Do any of my recent tests provide the needed images or information?
- Are there other tests – without radiation – that could give you the answers you're looking for?
And if your dentist insists on giving you X-rays every year without a specific reason or diagnosis, it's probably time to switch dentists.
3. Ask for digital X-rays, as opposed to film X-rays.
According to the U.S. Department of Health and Human Services, digital X-rays expose you to far less radiation than film X-rays. And if they are using film X-rays, a faster film speed – E or F as opposed to D – also exposes you to less radiation, without any added costs to the doctor. Ask your dentist which they use and see where you can go to get the best option possible.
4. Limit the region exposed to the X-ray.
Some machines have a more direct focus than others, meaning they only cover a small area of your body. Ask your provider about using a different machine with a smaller, more direct beam of radiation for your specific issue.
5. Keep a historical log of your X-rays.
Get a little notebook and each time you have an X-ray (or other radiation imaging procedure), write down the following information:
- Date
- Type of exam
- Reason for exam
- Referring physician
- Contact information for the place where your images being stored
Then, use this log to show your doctors when they mention a need for imaging. They'll be able to tell if they can get the information they need without unnecessary image duplication.
While we may not be able to avoid X-ray radiation entirely, there are certainly things we can do to limit our amount of exposure to instances that are completely necessary. And when it comes to taking care of your teeth, do what I do and start by brushing well and flossing every single day.
What We're Reading...
- Here's the article R.M. wrote to us about: Lead aprons offer little protection during X-rays.
- Something different: Defend your right to sexual expression using your health care power of attorney.
Here's to our health, wealth, and a great retirement,
Dr. David Eifrig and the Health & Wealth Bulletin Research Team
December 7, 2023