The risk of receiving multiple spinal x-rays during treatment of scoliosis: analysis based on 2025 standards.
DOI:
https://doi.org/10.71332/yvk3pq91Keywords:
Scoliosis, Diagnostic Imaging, Risk ReductionAbstract
Scoliosis is a deformity of the spine in all three planes. The most common types emerge in otherwise healthy children during adolescent growth. Spine imaging is required for diagnosis and surveillance to determine whether the deformity is progressing. Epidemiologic studies that looked at the long-term effects of receiving multiple spine x-rays in childhood showed a concerning increase in adult malignancy. However, many of those studies were based on exposure from x-ray equipment 50 or more years ago. This paper examines the current risk of receiving necessary spinal x-rays using modern equipment and up to date exposure recommendations from the leading medical organizations. Using example treatment scenarios, children are receiving x-ray exposure that is well below the safe limits. Results show that cumulative radiation doses in adolescents with typical AIS range from 2.04 – 12.21 mSv, a safe cumulative dosage, while the most extreme cases would reach up to 28.45 mSv, a slight increase in risk.
References
1. Scherl, SA, Hasley, BP (2025a). Adolescent idiopathic scoliosis: Clinical features, evaluation, and diagnosis. UpToDate. Connor RF (Ed), Wolters Kluwer. Accessed on June 9, 2025 from https://www.uptodate.com/contents/adolescent-idiopathic-scoliosis-clinical-features-evaluation-and-diagnosis?search=scoliosis
2. Weinstein SL. Adolescent idiopathic scoliosis: prevalence and natural history. Instr Course Lect. 1989;38:115-128.
3. Kenner P, McGrath S, Woodland P. What Factors Influence Delayed Referral to Spinal Surgeon in Adolescent Idiopathic Scoliosis?. Spine (Phila Pa 1976). 2019;44(22):1578-1584. doi:10.1097/BRS.0000000000003146
4. Bunnell WP. Selective screening for scoliosis. Clin Orthop Relat Res. 2005;(434):40-45. doi:10.1097/01.blo.0000163242.92733.66
5. Lonstein JE, Winter RB. The Milwaukee brace for the treatment of adolescent idiopathic scoliosis. A review of one thousand and twenty patients. J Bone Joint Surg Am. 1994;76(8):1207-1221. doi:10.2106/00004623-199408000-00011
6. Lonstein JE, Carlson JM. The prediction of curve progression in untreated idiopathic scoliosis during growth. J Bone Joint Surg Am. 1984;66(7):1061-1071.
7. Ronckers CM, Land CE, Miller JS, Stovall M, Lonstein JE, Doody MM. Cancer mortality among women frequently exposed to radiographic examinations for spinal disorders. Radiat Res. 2010;174(1):83-90. doi:10.1667/RR2022.1
8. Higingbotham, H. (2022, September 19). From the annals of NIH history. National Institutes of Health. https://irp.nih.gov/catalyst/30/5/from-the-annals-of-nih-history
9. Thorne MC. Principles of the International Commission on Radiological Protection system of dose limitation. Br J Radiol. 1987;60(709):32-38. doi:10.1259/0007-1285-60-709-32
10. Smith-Bindman R, Alber SA, Kwan ML, et al. Medical Imaging and Pediatric and Adolescent Hematologic Cancer Risk. N Engl J Med. 2025;393(13):1269-1278. doi:10.1056/NEJMoa2502098
11. Brenner DJ, Doll R, Goodhead DT, et al. Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. Proc Natl Acad Sci U S A. 2003;100(24):13761-13766. doi:10.1073/pnas.2235592100
12. Kutanzi KR, Lumen A, Koturbash I, Miousse IR. Pediatric Exposures to Ionizing Radiation: Carcinogenic Considerations. Int J Environ Res Public Health. 2016;13(11):1057. Published 2016 Oct 28. doi:10.3390/ijerph13111057
13. Ron E, Modan B, Preston D, Alfandary E, Stovall M, Boice JD Jr. Thyroid neoplasia following low-dose radiation in childhood. Radiat Res. 1989;120(3):516-531.
14. Nash CL Jr, Gregg EC, Brown RH, Pillai K. Risks of exposure to X-rays in patients undergoing long-term treatment for scoliosis. J Bone Joint Surg Am. 1979;61(3):371-374.
15. Doses in our daily lives. NRC Web. April 26, 2022. Accessed June 22, 2025. https://www.nrc.gov/about-nrc/radiation/around-us/doses-daily-lives.html.
16. Guidelines for ALARA – as low as reasonably achievable. Centers for Disease Control and Prevention. February 26, 2024. Accessed July 22, 2025. https://www.cdc.gov/radiation-health/safety/alara.html.
17. Center for Devices and Radiological Health. Pediatric X-ray imaging. U.S. Food and Drug Administration. March 20, 2023. Accessed July 22, 2025. https://www.fda.gov/radiation-emitting-products/medical-imaging/pediatric-x-ray-imaging
18. Amis ES Jr, Butler PF; American College of Radiology. ACR white paper on radiation dose in medicine: three years later. J Am Coll Radiol. 2010;7(11):865-870. doi:10.1016/j.jacr.2010.04.006
19. What Parents Should Know about Medical Radiation Safety. Image Gently. Accessed July 22, 2025. https://www.imagegently.org/Portals/6/Parents/Image_Gently_8.5x11_Brochure.pdf.
20. Ionizing radiation and health effects. World Health Organization. July 27, 2023. Accessed July 23, 2025. https://www.who.int/news-room/fact-sheets/detail/ionizing-radiation-and-health-effects.
21. Dose limits. ICRPaedia. June 20, 2019. Accessed July 23, 2025. https://icrpaedia.org/Dose_limits.
22. Ionizing radiation - overview. Occupational Safety and Health Administration. Accessed July 23, 2025. https://www.osha.gov/ionizing-radiation.
23. Pacult MA, Walker CT, Godzik J, Turner JD, Uribe JS. Emerging Technologies in Spinal Surgery: Ultra-Low Radiation Imaging Platforms. Oper Neurosurg (Hagerstown). 2021;21(Suppl 1):S39-S45. doi:10.1093/ons/opaa324
24. Rose LD, Williams R, Ajayi B, et al. Reducing radiation exposure and cancer risk for children with scoliosis: EOS the new gold standard. Spine Deform. 2023;11(4):847-851. doi:10.1007/s43390-023-00653-6
25. Presciutti SM, Karukanda T, Lee M. Management decisions for adolescent idiopathic scoliosis significantly affect patient radiation exposure. Spine J. 2014;14(9):1984-1990. doi:10.1016/j.spinee.2013.11.055
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