X-ray examination of the child

introduction

The X-ray examination of a child means taking an X-ray image using X-rays to diagnose specific diseases.
X-rays are particularly suitable for assessing bony structures. Soft tissues such as organs can be better seen through an ultrasound scan or an MRI. However, there are a few things to consider in children that are different from x-rays in adults.

Indications

The indications, therefore, indications for an X-ray examination in a child should be made more stringent than in an adult.

This is particularly related to radiation exposure, as children are still growing and their tissue is therefore more sensitive to radiation. Cells that divide frequently are at greater risk of genetic changes from exposure to radiation.

For this reason, the urgency of imaging to identify or assess a disease must be considered. On the one hand, the severity of the disease must be taken into account, i.e. whether the effects in the absence of imaging or treatment delay are superior to the radiation risk. On the other hand, it has to be considered whether other radiation-free diagnostic procedures are available, such as ultrasound or MRI.

Examples of indications for an X-ray examination in children are broken bones, suspected skeletal malformations or lung diseases such as pneumonia. Since bones can best be seen in the X-ray, those bone diseases are among the main indications.

Read more on this topic:

• Forearm fracture in the child
• Pneumonia in the child

Preparation for the X-ray examination in the child

Depending on the age and the reason for the X-ray examination in the child, the preparation also differs.
With CT images of the abdomen, which are also part of the X-ray procedures, the child may have to be fasted. This means that no food should be consumed at least 6 hours before the examination and no water should be consumed 2 hours beforehand. It is best to ask your doctor about this.
For x-ray examinations that take place on an outpatient basis, it is also important to have the referral slip and insurance card with you.

If your child is old enough to understand the circumstances, it may be helpful to explain in advance what will be done in the examination, to reassure them and to convey that it is important to remain calm during the admission.

procedure

In pediatric radiology departments there are specially trained assistants who are familiar with radiation protection regulations and who make the examination as pleasant as possible by dealing with children on a daily basis.
As a rule, the parents are informed beforehand about the course of the respective X-ray examination. Depending on the body part affected, the procedure takes place sitting or lying down. There are special holding devices, especially for babies and toddlers, as the child must remain still during this time. In most cases, the parents can stay with their child during this time.

For some x-rays, a contrast agent must be given beforehand for a better assessment. Fortunately, x-rays do not cause pain.

evaluation

The evaluation of the X-ray image in children does not differ from the evaluation in adults. This is usually done by radiologists, although there are also specialized pediatric radiologists.
In order to make a diagnosis with the help of the image, the image is systematically examined and attention is paid to pathological changes. These include fracture lines, deformations or changes in X-ray density in the bones.
The X-ray findings are not always so clear that a disease can be directly assigned to them. Rather, the interplay of the clinical picture, further laboratory tests and imaging is relevant to inferring a disease by means of an exclusion procedure or to establish a normal healthy result.

You might also be interested in this topic: Chest x-ray

Risks

The risks involved in an X-ray examination of a child are in principle the same as with adults, with the difference that children are more sensitive to radiation and therefore have an overall increased risk of consequential damage.
Damage to the DNA by radiation can cause changes in the genes and, in rare cases, cancer. This affects the actively dividing tissues and organs such as the skin, the bone marrow and the germ cells. This can reduce fertility.

Radiation protection therefore plays a major role in both adults and children.
The radiation risk is reduced by legally stipulated regulations. In addition to the strict indication, this also includes a reduction in the radiation dose, a reduction in the size of the irradiated area and a shorter examination time.Even gonadal protection, i.e. covering the testicle with a lead capsule, leads to a reduction in the radiation to the germ cells.

How high is the risk of cancer to be assessed?

It cannot be said in general by which factor the cancer risk is increased by X-ray examinations in children. On the one hand, the radiation dose differs depending on the examined body part and the question. On the other hand, the frequency with which X-ray images are made plays a role.
However, it can be said that the risk correlates with the number of X-ray examinations and that children are more at risk of developing cancer from radiation than older people. In addition to the sensitivity of the child's tissue, the long time it takes to develop a radiation-induced malignancy is also important, since children have a longer life ahead of them.
Even if the genetic material is damaged, cancer is not necessarily the result, as the body has many of its own repair mechanisms and severely damaged cells perish on their own without dividing any further and forming a tumor. Cancer can only develop when these mechanisms are overloaded or weakened by existing previous illnesses.
However, by complying with radiation protection, the risk is reduced as much as possible, so that the risk of cancer can largely be neglected for a given medical indication. Overall, the occurrence of X-ray associated cancer is very rare in the modern world.

What are the alternatives?

Alternative imaging methods are primarily ultrasound and MRI. However, both are more suitable for examining soft tissues such as the organs rather than for assessing the bones. In very young children, however, a large part of the skeleton is not yet ossified and still consists of cartilage. This means that x-rays can be replaced to a certain extent by ultrasound.

With an MRI, you have to lie completely still for at least a few minutes in order to create a suitable image. This is a problem with restless children. For this reason, X-ray examinations such as CT are often carried out with the lowest possible radiation dose.

Also read: Radiation exposure in computed tomography