Procedure
In pediatric radiology departments there are specially trained assistants who are familiar with the radiation protection regulations and make the examination as pleasant as possible by dealing with children on a daily basis. As a rule, parents are informed in advance about the course of the respective X-ray examination. Depending on the part of the body affected, the procedure takes place in a sitting or lying position.
There are special holding devices especially for infants and toddlers, as the child must remain still during the procedure. In most cases the parents can stay with their child during this time. For some X-rays, a contrast medium must be given beforehand for better evaluation. Fortunately, an X-ray examination does not cause pain.
Evaluation
The evaluation of the X-ray image in the child does not differ from the evaluation in the adult. This is usually done by radiologists, although there are also specialized pediatric radiologists. In order to make a diagnosis using the image, the image is systematically examined and attention is paid to pathological changes.
In the case of bones, these include fracture lines, deformations or changes in X-ray density. X-ray findings are not always so clear that a disease can be directly attributed to it. Rather, the interplay between the clinical picture, further laboratory tests and imaging is more relevant in order to draw conclusions about a disease or to establish a healthy normal finding by means of exclusion procedures.
Risks
The risks involved in an X-ray examination of a child are basically the same as for adults, with the difference that children react more sensitively to radiation and therefore have an overall increased risk of consequential damage. Damage to the DNA through radiation can cause changes in the genes and thus, in rare cases, cancer. The tissues and organs that are active in division, such as the skin, bone marrow and germ cells, are affected.
The reproductive ability can be reduced. Radiation protection therefore plays an important role for both adults and children.The radiation risk is reduced by legally stipulated regulations. In addition to strict indication, these include a reduction in the radiation dose, a reduction in the irradiated area and a shortened examination time.
Gonad protection, i.e. covering the testicles with a lead capsule, also leads to a reduction of radiation at the germ cells. It is not possible to say in general by what factor the risk of cancer is increased by X-ray examinations of children. On the one hand, the radiation dose differs depending on the part of the body being examined and the problem being addressed.
On the other hand, the frequency with which x-rays are taken 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 of development of a radiation-induced malignoma is also important, since children still have a longer lifespan ahead of them.
Even if the genetic material is damaged, cancer is not a compulsive consequence, since the body has many of its own repair mechanisms and severely damaged cells perish on their own without further division and formation of a tumor. Only when these mechanisms are overloaded or weakened by existing previous diseases, cancer can develop. By adhering to radiation protection, however, the risk is reduced as much as possible, so that the risk of cancer is largely negligible for a given medical indication. Overall, the occurrence of cancer associated with X-rays is very rare in the modern world.