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« Not Hoping For Good News | Main | Healing Touch »

August 18, 2009

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DocSwill

Wendy, you bring up a very good point here. As you might recall, I'm a head and neck cancer patient that had tongue cancer. Stage 4 squamous carcinoma of the left lateral tongue that matastasized to the neck lympth nodes.

I received 60 grays of radiation to the left side of my mouth. Do you know if this guard you speak of is something that should be requested for a patient such as myself or is it too close to the radiation field to matter?

Thank you for the subject.

Peace
Brian

Wendy S. Harpham, MD

Dear Brian,
Good question, as many of my readers have had XRT (radiation therapy.)

I think you are wise to ask for a thyroid guard if the xray was ordered to get a better look at a part of your body not covered by the guard.

If the scans were ordered to help your doctors "see" (with xrays) any part of your body that lies under the guard, the benefits of the views outweigh the risk of additional x-ray exposure to your thyroid.

My concern about radiation to my neck is greater than my concern about radiation to other parts of my body, because my neck/thyroid have already received a hefty dose of radiation therapy (which is a much, much higher dose than that used in diagnostic studies.)

"Only a Click Away" explains why I want to avoid unnecessary radiation exposure but am willing to undergo additional x-rays if it will help my doctors keep me as well as possible: http://tinyurl.com/OnlyAC

Let me know if this helps. With hope, Wendy

B

Do you think radiation techs will be annoyed, though, if I bother them to ask for the guard or to get me one more thing? I just dont want to be a bother them..

Wendy S. Harpham, MD

Dear B,
Your worry is legitimate. Feeling vulnerable, you don't want to annoy or anger people on whom you depend for the test to go well.

One approach is to be upfront: "I don't want to cause you any trouble, but I've been told to ask if I may have a thyroid guard for this x-ray. Will it interfere with the test, or is it okay?" And then, of course, thank the tech.

I often say, "Sorry for the extra trouble. I've had a lot of radiation to my neck. I'm trying to minimize additional x-ray exposure when possible."

Requests that are both respectful and explanatory go a long way in working together with the techs. Does this help?

With hope, Wendy

B

Yes - thank you so much.

DocSwill

Wendy, One more question about this topic. Is is prudent to ask for this when getting a standard chest x-ray?

Peace Brian

Wendy S. Harpham, MD

Dear Brian,

An easy and effective approach is to ask the technician and/or radiologist, "Will a thyroid guard interfere with this x-ray in any way? If not, may I have one, please?"

It might not be wise to use a thyroid guard if doing so covers the upper edges of lung tissue.

Going back to the mammogram question, many mammographers do not use thyroid shields when doing so would make it difficult to get axillary tissue (tail end of breast, near arm pit) on the oblique view and/or tissue deep on the craniocaudal view.

Healthy Survivors keep perspective on this matter. The ability of state-of-the-art equipment to direct a low dose of radiation to the breast means that the only radiation is scatter (and a very low dose, at that), and not a direct hit.

Fluoroscopy (real-time x-ray studies to evaluate the esophagus, stomach and heart) and CT scans and are another story: They expose the thyroid to quite a bit of x-ray.

The last thing Healthy Survivors want to do is hinder their care in their efforts to help their care.

As with just about everything in Healthy Survivorship, there is no one simple answer. But there is a best answer for each of you at each juncture in your survivorship. Open, respectful communication with every member of your healthcare team helps you maximize the benefits and minimize the risks every step of the way.

Let me know if this helps. With hope, Wendy


Trudy Kennedy

I had no idea... thank you for taking this topic seriously and helping all of us learn how to advocate for ourselves gracefully.
Sincerely,
Trudy

Cindy Paschall

Can you tell me if there are any ongoing studies out there about people who avoid x-ray (radiation) exposure as much as possible and the average population? Is x-ray exposure linked to increased cancers in general? Should we avoid preventive heath care X-rays? It is after all, the cumulative effect and the more we are exposed to x-rays on a daily basis ,I would think, there is a higher risk of tissue damage. In the 1900's, do we know what the average persons radiation exposer was a month? What is that exposure today? "Bourquin says radiation is all around us, all the time. It's even inside our bodies and to a certain degree, that is perfectly normal and perfectly safe. To illustrate radioactivity in every day life, Newschannel 9 got a hold of a geiger counter, which tests radiation. The meter immediately showed background radiation, just standing outside." AS far as I am concerned what is "normal" today does not mean "SAFE" We need to be careful in balancing the risk with the benefits. I have thyroid cancer and I look back on the exposure to x-rays and radiation and that not once was I diagnosed with something d/t the results. If I could go back in time I would never have had one X-ray for preventive care treatment. The medical community should develope and have blood tests screenings instead. Thank you for the information on the thyroid guard. I can forward this information onto my relatives.
Cindy

Wendy S. Harpham, M.D.

Dear Cindy,

You asked the million-dollar question: How does someone balance the risks and benefits of diagnostic radiation exposure?

Brief answer: Ask what the risks are of bypassing the xray. In the case of an evaluation for pain, you may miss diagnosing a cancer when it is still early and curable. In the case of routine dental evaluations, you may miss root disease when it is still treatable without losing the tooth.

Make a case-by-case assessment with your healthcare professionals. Unfortunately many doctors and dentists are too blase, as evidenced by how rarely women are offered thyroid guards when having routine mammography.

I'll go more in depth in a forthcoming new blog posts.

Until then, thank you for asking. With hope, Wendy

Martha B. Mainiero, MD

I recommend viewing the recommendations of the Society of Breast Imaging and The American College of Radiology on this matter which recommend AGAINST the use of thyroid shields during mammography
http://www.mammographysaveslives.org/Documents/ACR-SBI%20Thyroid%20CA%20Statement.pdf
You can obtain this link through the American College of Radiology website

Wendy S. Harpham, M.D.

Dear Martha,
Thank you for your comment and the link, providing additional perspective on an emotionally charged topic. I'll address specifically in a future post.
With hope, Wendy

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