3 Ways to Protect Yourself from Radiation from Spinal Imaging

Understanding the potential risks can help you make more informed medical decisions

Written by S. Samuel Bederman, MD, PhD, FRCSC

Of all the diagnostic tools spine specialists have at their disposal, few are as helpful as imaging scans. These tests, which include x-rays and computed tomography (CT) scans, illuminate your spinal structures to help your doctor see the root of the problem. But, these tests bear radiation risks—and a published survey shows many patients don’t clearly understand them.

Discussing risks and benefits with your doctor shouldn’t only be about treatment—the conversation is also important during the diagnostic process. To help you be a more informed patient, this article shares three ways to reduce your radiation exposure from spinal imaging scans.


Patients Don’t Understand Radiation Risk: A Look at Survey Findings
Many patients don’t understand the radiation risks of spinal imaging—this was the overarching message from survey findings published in the March 2017 issue of The Spine Journal. The survey included 100 patients who were surveyed during an appointment with their spine surgeon. The patients were asked to estimate how many chest x-rays worth of radiation equaled the radiation emitted during common spinal imaging tests in the neck (cervical spine) and low back (lumbar spine).

While the patients’ estimates of cervical x-ray radiation were somewhat accurate, the patients significantly underestimated the radiation dose associated with cervical spine CT scans, lumbar spine x-rays, and lumbar spine CT scans. Also, most patients mistakenly thought magnetic resonance imaging (MRI) was associated with radiation, but MRI bears no radiation exposure risk.

3 Ways to Protect Yourself from Radiation from Spinal Imaging
Most spinal imaging tests, including x-rays, image-guided procedures (eg, spinal injection), CT scans, nuclear medicine tests, and bone density scans, carry some radiation risks. Use the three steps below to protect yourself when undergoing radiation-emitting spinal imaging.

Step 1: Ask questions
If your doctor recommends spinal imaging, ask him or her the following questions to better understand the radiation risks:

  1. How much radiation is emitted from the test?
  2. What is the chance that the test will be inadequate and need to be repeated with double the radiation dose?

Here’s an example of when a re-test could occur: If you first undergo a plain CT scan but later need a CT myelogram, you may end up with double the dose of radiation. Plain CT scans may not adequately show neural structures, such as the spinal cord and spinal nerve roots. On the other hand, CT myelography (which involves injecting contrast medium into the spinal fluid followed by a CT scan) provides much more detail with the same amount of radiation as a CT scan.

Another example is if a CT scan’s images don’t have enough detail, which may require another exam with finer cuts for better imaging. This will increase your radiation dose.

Step 2: Keep copies of your imaging scans
Another way to protect yourself from radiation exposure is by keeping copies of all your imaging scans (you may request your records from your doctor). This is particularly important if you’re interested in getting a second opinion on treatment recommendations. Failing to provide copies of your imaging scans to your second opinion physician may result in having to undergo the same scans twice.

Step 3: Request a limited imaging field
If you are to undergo spinal imaging, you may ask your doctor to request a limited imaging field to reduce unnecessary exposure. For example: If your doctor is interested in viewing your lumbar spine up to the lower part of your thoracic spine (mid-back) and orders a CT scan of both areas, the thoracic CT scan can be limited to include only the lower portion rather than all the way up to the base of the neck.

Being More Informed Today Leads to Better Health Tomorrow
Understanding the risks and benefits of diagnostic spinal imaging tests, such as x-rays and CT scans, will not only reduce wasteful testing but also help prevent potential long-term damage of radiation exposure. Spinal imaging is incredibly beneficial to identifying the source of your spine pain, but it does have risks. Having transparent discussions with your doctor about these risks will empower you as a patient and allow you to move forward with confidence.

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