X-Rays Not Always Necessary for Kids

Chest X rays rarely produced information that affected treatment in children

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Why take a risk when it's not necessary? X-rays produce small amounts of radiation and can be expensive. And, in many cases, chest X-rays may not provide information that affects the way doctors treat kids.

A new study revealed that many children received chest X-rays when they weren't needed. Doctors can often treat kids effectively without using X-rays, the authors of this study found.

Thomas Seman, MD, a pediatrician at North Shore Pediatrics in Danvers, MA, can understand why parents want their doctor to take an x-ray.

“Seeing a sick child, it seems more compelling to do everything possible to get the quickest and most accurate testing and diagnosis available. With the technologies becoming more anatomically accurate, it is very tempting to get the imaging, but like everything else, this too may have a side effect," said Dr. Seman, who was not involved in this study.

"Ionizing radiation that is found in X-rays is dangerous and can cause cancer. Unfortunately, the younger the child, the greater the risk. This is why we need to limit these tests," he told dailyRx News. "Parents do not always recognize these risks and will often ask the doctor if an X-ray can be taken. It takes a while to convince these parents on why we do not need to always image the child.”

X-rays can be useful tools for doctors to diagnose health problems in children, but the radiation they produce is not completely harmless — so it may be best to avoid X-rays unless a doctor says they're necessary, the authors of this study said.

"Chest X-rays can be a valuable exam when ordered for the correct indications," said Ann Packard, MD, a radiologist at the Mayo Clinic in Rochester, MN, in a press release. "However, there are several indications where pediatric chest X-rays offer no benefit and likely should not be performed to decrease radiation dose and cost."

Dr. Packard conducted the study with Kristen B. Thomas, MD, also of the Mayo Clinic.

These researchers reviewed chest X-rays for children from birth to 17 years of age in the Mayo outpatient and inpatient clinics and emergency room from 2008 to 2014. They studied 637 children's chest X-rays.

Of the chest X-rays, most (377) were ordered because the child had chest pain. But in other cases, the child had fainted (98 cases), was feeling unwell (21), or had a low blood pressure when he or she got up from sitting or lying down (37). In 185 cases, a chest X-ray was ordered when a child had been dizzy, and one child had a chest X-ray due to vomiting.

Drs. Packard and Thomas found that doctors didn't learn anything that affected treatment from the X-rays taken for 560 of the 637 children.

Some X-rays, however, did help doctors treat the children. When doctors saw in an X-ray that the child had pneumonia, for instance, they could prescribe antibiotics that would treat the infection. When the doctors did not see anything unusual on the X-ray, they did not learn anything that helped them treat the patient.

Forty-five of the chest X-rays ordered for chest pain were positive — meaning there was something identified that could help with treatment. Of these cases, 17 had pneumonia, 12 had airways that were inflamed, and four had part or all of a lung that had collapsed. Two children had experienced trauma, and four others had chest X-rays for other reasons, such as having breathed in a foreign object like a coin or marble.

When X-rays were done for reasons other than chest pain, the X-ray never revealed information that changed how a child was treated, Drs. Packard and Thomas found.

Dr. Seman said parents need to be educated about the risks and the benefits of X-rays. “If you feel comfortable with your child’s pediatrician taking care of your child, then please try and trust him” when he opts to not order imaging, he said.

Children who don't absolutely need an X-ray should not have one, these researchers wrote. In addition to reducing the amount of radiation children are exposed to, limiting X-rays could also reduce health care costs, they noted. Parents should talk to their children's doctors about the best medical care for their children.

"I would like this research to help guide clinicians and deter them from ordering unnecessary exams which offer no clinical benefit to the patient," Dr. Packard said.

This study was presented Dec. 3 at the annual meeting of the Radiological Society of North America in Chicago. Research presented at conferences may not have been peer-reviewed.

Funding sources and conflict of interest disclosures were not available at the time of publication.

Review Date: 
December 2, 2014
Last Updated:
December 9, 2014