Risks & Benefits
Radiation effects from general radiography procedures are discussed. Studies evaluating the safety and impact on patients and current analysis on x-ray safety as it relates to general radiography are provided. Discussion of various methods in minimizing radiation exposure.
Articles discussing risk of radiography low dose radiation:
The Scoliosis Quandary: Are Radiation Exposures From Repeated X-Rays Harmful?
Loyola University Health System - 2015
In recent years, there has been widespread media coverage of studies purporting to show that radiation from X-rays, CT scans and other medical imaging causes cancer. But such studies have serious flaws, including their reliance on an unproven statistical model, according to a recent article in the journal Technology in Cancer Research & Treatment. Corresponding author is Loyola University Medical Center radiation oncologist James Welsh, MS, MD.
"Although radiation is known to cause cancer at high doses and high-dose rates, no data have ever unequivocally demonstrated the induction of cancer following exposure to low doses and dose rates," Dr. Welsh and co-author Jeffry Siegel, PhD, write.
J. A. Siegel, J. S. Welsh. Does Imaging Technology Cause Cancer? Debunking the Linear No-Threshold Model of Radiation Carcinogenesis. Technology in Cancer Research & Treatment, 2015; DOI: 10.1177/1533034615578011
American Journal of Clinical Oncology
No Proof that Radiation from X-Rays and CT Scans Causes Cancer Radiation fears based on unproven theoretical model- Feb 3rd, 2016
The widespread belief that radiation from X rays, CT scans and other medical imaging can cause cancer is based on an unproven, decades-old theoretical model, according to a study published in the American Journal of Clinical Oncology.
The model, known as linear no-threshold (LNT), is used to estimate cancer risks from low-dose radiation such as medical imaging. But risk estimates based on this model "are only theoretical and, as yet, have never been conclusively demonstrated by empirical evidence," corresponding author James Welsh, MD and colleagues write. Use of the LNT model drives unfounded fears and "excessive expenditures on putative but unneeded and wasteful safety measures."
LOW DOSE RADIATION
NO REASON TO FEAR LOW DOSE RADIATION
Jerry Cuttler, Ph.D. Nuclear Sciences and Engineering, past president of Canadian Nuclear Society. Is it safe to be exposed to low-level radiation? You can go to two different places for answers: 1) If you go to the radiation protection people, whose job it is to protect everyone from any exposure to radiation (human-made), you'll find there’s a higher risk of cancer. 2) But, if you go out into the real world, who do you know that’s ever been harmed by low-level radiation? There’s just no evidence of that. There are beneficial effects of low radiation from medical practitioners ~1900 to ~1960, to eliminate metastases or slow cancer growth, accelerate healing of wounds, stop infections: gas gangrene, carbuncles and boils, sinus, inner ear, pneumonia, and treat arthritis and other inflammatory conditions.
Related items
- Exaggerated dangers of medical imaging (William Doss, Jeffrey Siegel) USofA
- The good rays, let them shine (Poul Hoilund-Carlsen) Denmark
- Summary of 2018 ANS - HPS Joint Conference on Low Dose Radiation and LNT (Alan Waltar) USofA
- Radiobiology and radiation hormesis (Charles Sanders) USofA
- Nuclear Science and Technology (Vagisha Nidhi, Mody University) India
- Does Imaging Technology Cause Cancer? Debunking the Linear No-Threshold Model of Radiation Carcinogenesis
X-Ray Basics Safety
| Article # | Article Title | Author & Journal | Authors Conclusion | Radiographic Considerations / Key Points |
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| Molecular biology, epidemiology, and the demise of the linear no-threshold (LNT) hypothesis. | Pollycove M1, Feinendegen LE.; Comptes Rendus de I'Academie des sciences,C R Acad Sci III. 1999 Feb-Mar;322(2-3):197-204. | The biologic effect of radiation is not determined by the number of mutations it creates, but by its effect on the biosystem that controls the relentless enormous burden of oxidative DNA damage. At low doses, radiation stimulates this biosystem with consequent significant decrease of metabolic mutations. Low-dose stimulation of the immune system may not only prevent cancer by increasing removal of premalignant or malignant cells with persistent DNA damage, but used in human radioimmunotherapy may also completely remove malignant tumors with metastases. The reduction of gene mutations in response to low-dose radiation provides a biological explanation of the statistically significant observations of mortality and cancer mortality risk decrements, and contradicts the biophysical concept of the basic mechanisms upon which, ultimately, the NCRPs confidence in the LNT hypothesis is based. | 2Q “The argument that Low dose radiation can induce a genomic instability, which can in turn induce a cancer is not based on convincing data” No significant correlation between sensitivity to radiation-induced genomic instability and cancer induction. Doses of less than 100 mSv, cancer excess is not seen. However it doesn’t rule out the possibility of a smaller effect inducing cancer. Atomic bomb data does not provide solid arguments for the LNT model. Among humans there is no carcinogenic effects for acute irradiation at doses less than 100mSv and for protracted Irradiation at doses less than 500mSv. Fears associated with LNT at any dose lack scientific justification. If the carcogenic risk exists, it is so small that it is without clinical importance |
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| Does Imaging Technology Cause Cancer? Debunking the Linear No-Threshold Model of Radiation Carcinogenesis. | Siegel JA, Welsh JS; Technology in cancer research and treatment,Technol Cancer Res Treat. 2016 Apr;15(2):249-56. doi: 10.1177/1533034615578011. Epub 2015 Mar 30. | The risk:benefit ratio models used to calculate the hazards of radiological imaging studies may be grossly inaccurate if the linear no-threshold hypothesis is wrong. Here, we review the myriad inadequacies of the linear no-threshold model and cast doubt on the various studies based on this overly simplistic model. | The current model of radiation carcinogenesis is based on linear transgression of high-dose radiation exposure. Low-dose radiation exposure (<100-200 mSv) is what the medical and chiropractic fields operate in, and are not comparable to the conclusions from high-dose studies. The authors further state that low-dose radiation exposure is likely beneficial when the healing function of the boy is considered. |
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| It Is Time to Move Beyond the Linear No-Threshold Theory for Low-Dose Radiation Protection. | Cardarelli JJ 2nd, Ulsh BA.; ,Dose Response. 2018 Jul-Sep; 16(3): 1559325818779651. Published online 2018 Jul 1. doi: 10.1177/1559325818779651 | Currently, the USEPA uses the linear no-threshold (LNT) model to estimate cancer risks and determine cleanup levels in radiologically contaminated environments. The LNT model implies that there is no safe dose of ionizing radiation; however, adverse effects from low dose, low-dose rate (LDDR) exposures are not detectable. This article (1) provides the scientific basis for discontinuing use of the LNT model in LDDR radiation environments, (2) shows that there is no scientific consensus for using the LNT model, (3) identifies USEPA reliance on outdated scientific information, and (4) identifies regulatory reliance on incomplete evaluations of recent data contradicting the LNT. | This study shows low dose radiation in X-rays are not as dangerous as previously thought |
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| Diagnostic pediatric computed tomographic scans of the head: actual dosage versus estimated risk. | Jaffurs D, Denny A; Plast Reconstr Surg. 2009 Oct;124(4):1254-60. doi: 10.1097/PRS.0b013e3181b59d2d. | The authors suggest that published experimental evidence does not support the linear no-threshold model at low linear energy transfer levels similar to the exposure of their patients undergoing computed tomographic scans of the head. In addition, no convincing epidemiologic data exist demonstrating an increase in cancer incidence for doses below 100 mSv. | This study shows low dose radiation in X-rays are not as dangerous as previously thought |
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| Regarding the Credibility of Data Showing an Alleged Association of Cancer with Radiation from CT Scans. | Socol Y1, Welsh JS;Technol Cancer Res Treat. 2016 Feb;15(1):159-62. doi: 10.1177/1533034614566923. Epub 2015 Jan 23. | Computed tomography (CT) scans are of high clinical value as a diagnostic technique, and new applications continue to be identified. However, their application is challenged by emerging concerns regarding carcinogenesis from their radiation. Recent articles made a significant contribution to the above-mentioned concerns by reporting evidence for direct association of the radiation from CT scans with cancer. Such interpretation of the data has already been criticized; there is the possibility of reverse causation due to confounding factors. Nevertheless, such work has had a high impact, with one article being cited more than 300 times from the Web of Science Core Collection within 2 years. However, the data points on cancer relative risk versus CT dose in that article fit straight lines corresponding to the linear no-threshold hypothesis suspiciously well. Here, by applying rigorous statistical analysis, it is shown that the probability of the fit truly being that good or better is only 2%. The results of such studies therefore appear "too good to be true" and the credibility of their conclusions must be questioned. | This study discusses CT scans and cancer risk. It states previous studies cite the same study that was statistically suspicious. This study re-analysis this study and shows that probability of the CT-Cancer study being accurate is 2%. |
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| Risk of radiation-induced malignancies from CT scanning in children who underwent shunt treatment before 6 years of age: a retrospective cohort study with a minimum 10-year follow-up. | White IK1, Shaikh KA, Moore RJ, Bullis CL, Sami MT, Gianaris TJ, Fulkerson DH; J Neurosurg Pediatr. 2014 May;13(5):514-9. doi: 10.3171/2014.2.PEDS12508. Epub 2014 Mar 14. | Previously published models predict a significant number of future cancers directly caused by CT scanning. However, there are very few published clinical data. In the authors' study, zero future radiation-induced malignancies were detected after routine CT scanning in a high-risk group. While the authors do not consider their single-institution study adequate to define the actual risk, their data suggest that the overall risk is low. The authors hope this study encourages future collaborative efforts to define the actual risk to patients. | This study shows that after routine CT scans in a high-risk group of children, no cases of radiation-induced malignancies were observed after 10 year follow up. |
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| Imaging strategies for low-back pain: systematic review and meta-analysis | Lancet. 2009 Feb 7;373(9662):463-72. doi: 10.1016/S0140-6736(09)60172-0. Chou R1, Fu R, Carrino JA, Deyo RA. | Lumbar imaging for low-back pain without indications of serious underlying conditions does not improve clinical outcomes. Therefore, clinicians should refrain from routine, immediate lumbar imaging in patients with acute or subacute low-back pain and without features suggesting a serious underlying condition. | Many clinicians do routine low back pain x-rays without "Red flags". Research fails to discuss tha physical presentation of no pain does not equal to no need for xrays and the need for x-rays for chiropractic technique analysis. Additionally, the term "Usual Care" is used as the comparison standard. Defined as care given through and MD, with or without bed rest and exercise. Funding is from the "American Pain Society" | |
| Radiophobia: 7 Reasons Why Radiography Used in Spine and Posture Rehabilitation Should Not Be Feared or Avoided. | Oakley PA1, Harrison DE2; Dose Response. 2018 Apr-Jun; 16(2): 1559325818781445. Published online 2018 Jun 27. doi: 10.1177/1559325818781445 | Radiography is a safe imaging method for routine use in patient assessment, screening, diagnosis, and biomechanical analysis and for monitoring treatment progress in daily clinical practice. | (This article relates best to Question number 2) Exposure to radiation does not directly correlate to the linear effect on the body as previously founded in research that looked at exposure to the atomic bomb over time. There is a Hormesis effect to radiation that increases and decreases throughout the exposure. 2i- Radiographs are the best clinical affordable option to spinal correction. Especially in determining force vectors through manual manipulation. | |
| Subjecting Radiologic Imaging to the Linear No-Threshold Hypothesis: A Non Sequitur of Non-Trivial Proportion. | J Nucl Med. 2017 Jan;58(1):1-6. doi: 10.2967/jnumed.116.180182. Epub 2016 Aug 4. Siegel JA1, Pennington CW2, Sacks B3. | The present work calls for ending the radiophobia caused by those asserting the need for dose optimization in imaging: the low-dose radiation of medical imaging has no documented pathway to harm, whereas the LNTH and ALARA most assuredly do. | The linear no-threshold hypothesis (LNTH) has dominated the medical community for decades with no evidence of increased cancer risk in doses under 100mGy used in medical imaging. We are exposed to anywhere from 1-260 mSv from our environment depending on where we live on the planet. Adverse events cannot be found in the literature associated with this regular exposure. The scientific literature actually shows that low-dose exposure increases a protective biological response which repairs DNA above and beyond the initial insult, whereas the high dose can overwhelm this protective response and increase damage. ALARA (as low as reasonably achievable) precedence is simply not based on sound science. This rampant radiophobia not only leads to reduced quality of imaging, but also reduces the likelihood of finding a potential contraindication or adaptation to care in the chiropractic office. | |
| A survey of general practitioners opinions on the role of radiology in patients with low back pain. | Owens JP, Ruth G, Keir MJ, Spencer H, Richardson D, Richardson A, et al. Br J Gen Pract 1990;40:98-101. | Ninety general practitioners responded to a questionnaire about the role of radiology in patients with low back pain. Their clinical indications for requesting radiographs were mostly in agreement with the opinions of radiologists, but nearly 80% requested investigations for their own or patients' reassurance. Understanding of the terms used by radiologists was good, although 25% thought that acute disc prolapse could be demonstrated on plain films. Previous training in radiology did not seem to influence knowledge. When general practitioners understood radiological terms they had clear therapeutic and specialist referral preferences. Poorly understood terms and those with which they were familiar but unclear about the implications for management were also identified. | ||
| Regarding the Credibility of Data Showing an Alleged Association of Cancer with Radiation from CT Scans. | Socol Y1, Welsh JS;Technol Cancer Res Treat. 2016 Feb;15(1):159-62. doi: 10.1177/1533034614566923. Epub 2015 Jan 23. | Computed tomography (CT) scans are of high clinical value as a diagnostic technique, and new applications continue to be identified. However, their application is challenged by emerging concerns regarding carcinogenesis from their radiation. Recent articles made a significant contribution to the above-mentioned concerns by reporting evidence for direct association of the radiation from CT scans with cancer. Such interpretation of the data has already been criticized; there is the possibility of reverse causation due to confounding factors. Nevertheless, such work has had a high impact, with one article being cited more than 300 times from the Web of Science Core Collection within 2 years. However, the data points on cancer relative risk versus CT dose in that article fit straight lines corresponding to the linear no-threshold hypothesis suspiciously well. Here, by applying rigorous statistical analysis, it is shown that the probability of the fit truly being that good or better is only 2%. The results of such studies therefore appear "too good to be true" and the credibility of their conclusions must be questioned. | This is a critique of Pearce et al study conclusion there is a statistically significant dependence of relative risk of leukemia and brain tumors from CT scans in childhood. It hypothesizes the conclusions a not consistent with the body of evidence regarding this topic. It also criticized the study for possible faulty mathematical interpretation, it was to good to be true. | |
| Risk of radiation-induced malignancies from CT scanning in children who underwent shunt treatment before 6 years of age: a retrospective cohort study with a minimum 10-year follow-up. | White IK1, Shaikh KA, Moore RJ, Bullis CL, Sami MT, Gianaris TJ, Fulkerson DH; J Neurosurg Pediatr. 2014 May;13(5):514-9. doi: 10.3171/2014.2.PEDS12508. Epub 2014 Mar 14. | Previously published models predict a significant number of future cancers directly caused by CT scanning. However, there are very few published clinical data. In the authors' study, zero future radiation-induced malignancies were detected after routine CT scanning in a high-risk group. While the authors do not consider their single-institution study adequate to define the actual risk, their data suggest that the overall risk is low. The authors hope this study encourages future collaborative efforts to define the actual risk to patients. | CT scanning has a low risk for developing cancer/tumors, but more powerful studies are necessary. Presently assumptions of cancer risk are extrapolated from data related to exposures after Hiroshima and Nagasaki, therapeutic radiation treatment and nuclear facility employment. | |
| Answers to Common Questions About the Use and Safety of CT Scans. | Mayo Clin Proc. 2015 Oct;90(10):1380-92. doi: 10.1016/j.mayocp.2015.07.011. McCollough CH1, Bushberg JT2, Fletcher JG3, Eckel LJ3. | Articles in the scientific literature and lay press over the past several years have implied that computed tomography (CT) may cause cancer and that physicians and patients must exercise caution in its use. Although there is broad agreement on the latter point--unnecessary medical tests of any type should always be avoided--there is considerable controversy surrounding the question of whether, or to what extent, CT scans can lead to future cancers. Although the doses used in CT are higher than those used in conventional radiographic examinations, they are still 10 to 100 times lower than the dose levels that have been reported to increase the risk of cancer. Despite the fact that at the low doses associated with a CT scan the risk either is too low to be convincingly demonstrated or does not exist, the magnitude of the concern among patients and some medical professionals that CT scans increase cancer risk remains unreasonably high. In this article, common questions about CT scanning and radiation are answered to provide physicians with accurate information on which to base their medical decisions and respond to patient questions. | Limitations of epidemiological research in assessing cancer risk of CT scans are discussed. There is no conclusive evidence that radiation absorbed doses under about 150 mGy at one exposure will cause cancer. An average effective dosage from CT is between 1 and 10 mSv while average U.S.background environmental exposure is 3 mSv. In conclusion it is recommended to order CT if it will give you the best information. | |
| Are plain radiographs of the spine necessary during evaluation after blunt trauma? Accuracy of screening torso computed tomography in thoracic/lumbar spine fracture diagnosis. | Berry GE, Adams S, Harris MB, Boles CA, McKernan MG, Collinson F, Hoth JJ, Meredith JW, Chang MC, Miller PR. J Trauma 2005;59:1410-3. | Admission CAP CT obtained as part of the routine trauma evaluation in these high-risk patients is more sensitive than plain radiographs for evaluation of the TL spine after blunt trauma. In addition, CAP CT can be performed faster. Omission of plain radiographs will expedite accurate evaluation allowing earlier treatment and mobilization. | ||
| Risk of malignancy associated with head and neck CT in children: a systematic review. | Otolaryngol Head Neck Surg. 2014 Oct;151(4):554-66. doi: 10.1177/0194599814542588. Epub 2014 Jul 22. Chen JX1, Kachniarz B1, Gilani S1, Shin JJ2. | Cohort data suggest that 1 excess brain malignancy occurred after 4000 brain CTs (40 mSv per scan) and that the estimated risk in the 10 years following CT exposure was 1 brain tumor per 10,000 patients exposed to a 10 mGy scan at less than 10 years of age. | The risk of malignancy asociated with radiation exposure from a CT scan of the head and neck has shown to be very low. "Cohort data suggest that 1 excess brain malignancy occurred after 4000 brain CTs (40 mSv per scan) and that the estimated risk in the 10 years following CT exposure was 1 brain tumor per 10,000 patients exposed to a 10 mGy scan at less than 10 years of age." A CT scan is roughly 7 times more radiation exposure than from a typical low-dose exposure film study done in a chiropractic setting. | |
| Radiographic examination of the lumbar spine in a community hospital: an audit of current practice | Halpin SF, Yeoman L, Dundas DD. BMJ 1991;303:813-5. | There is a need to inform doctors of the efficacy of radiological examinations. An awareness of the college's guidelines among general practitioners should be actively promoted by radiologists. | This is a retrospective study primarily focused on risk and appropriate use of Lumbar Spine Xray | |
| REDUCING THORACIC HYPERKYPHOSIS SUBLUXATION DEFORMITY: A SYSTEMATIC REVIEW OF CHIROPRACTIC BIOPHYSICS® METHODS EMPLOYED IN ITS STRUCTURAL IMPROVEMEN | Oakley, Paul & Harrison, Deed. (2018). 1. 59-66. | Non-operative correction of flat back syndrome using lumbar extension traction: a CBP® case series of two | A well cited article on CBP and its effectiveness on hyperkyphosis of the thoracic spine. No new direct findings relative to radiography mentioned. Most facts related to radiology were mentioned as conclusions from previous studies. Although the article did clearly outline the benefits of radiography and its safety and cited other articles well. | |
| National Emergency X-Radiography Utilisation Study Group. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. | Hoffman JR, Mower WR, Wolfson AB, Tood KH, Zucker M, N Engl J Med 2000;343:94-9 | A simple decision instrument based on clinical criteria can help physicians to identify reliably the patients who need radiography of the cervical spine after blunt trauma. Application of this instrument could reduce the use of imaging in such patients. | A set of criteria to rule out serious pathology to dictate when and when not to image trauma patients in the cervical spine. Proper use is supposed to decrease | |
| Impact of imaging guidelines on X-ray use among American provider network chiropractors: interrupted time series analysis. (assess for clinical outcome differences, biases in research such as backed by insurance company, number of visits/cost between two groups, patient understanding of injury) | Spine J. 2014 Aug 1;14(8):1501-9. doi: 10.1016/j.spinee.2013.08.051. Epub 2013 Oct 4. Bussières AE1, Sales AE2, Ramsay T3, Hilles SM4, Grimshaw JM5. | Web-based guideline dissemination was associated with an immediate reduction in spine X-ray imaging claims. Sensitivity analysis suggests our results are robust. This passive strategy is likely cost-effective in a chiropractic network setting. | One of the flaws in the paper is that it is using data from chiropractors in a managed care group. There are multiple other factors, including reimbursement rates that account for his findings. Beyond that, the paper is based off of the Choosing Wisely paradigm and assumption. Bussières is a chiropractor : no x-ray should be taken if not absolutely necessary | |
| Identifying factors likely to influence compliance with diagnostic imaging guideline recommendations for spine disorders among chiropractors in North America: a focus group study using the Theoretical Domains Framework. | Implement Sci. 2012 Aug 31;7:82. Bussières AE1, Patey AM, Francis JJ, Sales AE, Grimshaw JM; Canada PRIme Plus Team, Brouwers M, Godin G, Hux J, Johnston M, Lemyre L, Pomey MP, | Chiropractors' use of diagnostic imaging appears to be influenced by a number of factors. Five key domains may be important considering the presence of conflicting beliefs, evidence of strong beliefs likely to impact the behavior of interest, and high frequency of beliefs. The results will inform the development of a theory-based survey to help identify potential targets for behavioral-change strategies. | The study starts with the assumption that x-rays that are not following Choosing Wisely guidelines are doing so incorrectly, then goes on to find out the belief systems behind those clinical choices. The first 4 citations are the same articles used in choosing wisely where it is a GP interaction with low back pain. Also very low number of participants in the survey | |
| Imaging studies in patients with spinal pain: Practice audit evaluation of Choosing Wisely Canada recommendations. | Can Fam Physician. 2016 Mar;62(3):e129-37. Ferrari R. | In the evaluation of nonspecific spinal pain and symptoms, setting and following an a priori threshold for ordering MRI, CT, or bone scans in the spirit of the current Choosing Wisely Canada recommendations has a very low risk of missing a case of a serious cause of back pain. | Primary Care setting, following imaging and low back pain within the PCP model. In support of Choosing Wisely Canada, no advanced imaging without "red Flags" being the threshold | |
| Historical influence on the practice of chiropractic radiology: part II - thematic analysis on the opinions of diplomates of the American Chiropractic College of Radiology about the future. | Chiropr Man Therap. 2017 May 8;25:15. doi: 10.1186/s12998-017-0145-z. eCollection 2017. Young KJ1. | The increasing necessity of demonstrating evidence for diagnostic and therapeutic procedures in healthcare makes it likely that chiropractic radiologists and the wider chiropractic profession will need to take a more active position on evidence-based practice. Re-evaluation of guidelines and legislation as well as enforcement policies and practices will be necessary. The consequences of failing to do so may include increased marginalisation and reduced viability as a profession. | Relatively low number of respondents (73/190). The opinions were fairly split, and it would be disingenuous to say there was a consensus amongst those that responded. | |
| Awareness of radiographic guidelines for low back pain: a survey of Australian chiropractors. | Chiropr Man Therap. 2016 Oct 5;24:39. eCollection 2016. Jenkins HJ1. | Only 50 % of Australian chiropractors report awareness of current radiographic guidelines for low back pain. A poorer awareness of guidelines is associated with an increase in the reported likelihood of use, and the perceived usefulness of radiographs for low back pain, in clinical situations that fall outside of current guidelines. Therefore, education strategies may help to increase guideline knowledge and compliance. | The first citation is based on radiography for low back pain in a primary care (medical) office. The guidelines are based on "usual Care" within that setting. The studies and recomendations cited are not within a chiropractic office context of care. | |
| Radiation Hormesis: The Good, The Bad, The Ugly | D. Luckey, Lawrence, KS. Dose-Response 4(3):169–190, 2006 Formerly Nonlinearity in Biology, Toxicology, and Medicine | Three aspects of hormesis with low doses of ionizing radiation are presented: the good, the bad, and the ugly. | Three aspects of hormesis with low doses of ionizing radiation are presented: the good, the bad, and the ugly. The good is acceptance by France, Japan, and China of the thousands of studies showing stimulation and/or benefit, with no harm, from low dose irradiation. This includes thousands of people who live in good health with high background radiation. The bad is the nonacceptance of radiation hormesis by the U. S. and most other governments; their linear no threshold (LNT) concept promulgates fear of all radiation and produces laws which have no basis in mammalian physiology. The LNT concept leads to poor health, unreasonable medicine and oppressed industries. The ugly is decades of deception by medical and radiation committees which refuse to consider valid evidence of radiation hormesis in cancer, other diseases, and health. Specific examples are provided for the good, the bad, and the ugly in radiation hormesis. | |
| Imaging in the Diagnosis and Monitoring of Children with Idiopathic Scoliosis | Shu-Yan Ng* and Josette Bettany-Saltikov The Open Orthopaedics Journal, 2017, 11, (Suppl-9, M5) 1500-1520 | Radiography, however, enables diagnosis and monitoring of the adolescent idiopathic scoliosis (AIS). It is thus the gold standard in the evaluation and management of scoliosis curves. | Within the chiropractic profession, vertebral rotation has been discussed for decades as a disruptor of good health. In this study, it is stated that knowing the extent of vertebral rotation is important clinically. Clinically as apical lumbar vertebral rotation in excess of 33% has been shown to be associated with an increased incidence of low back pain. However, there needs to be research to evaluate stress and increased risk of injury and degeneration to facet joints as well as intervertebral discs with various degrees of rotation over time. This study also discusses increased rates of cancer associated with Adolescent Idiopathic Scoliosis. They attribute this to X-ray utilization without accounting for variables like medications use in surgery at a young age, potential genetic factors, decreased exercise compared to controls. There are too many variables, including a small sample size in comparison to the entire populous, that are not accounted for to confidently conclude the increased rate of cancer to low dose radiation utilization. | |
| Low doses of very low-dose-rate low-LET radiation suppress radiation-induced neoplastic transformation in vitro and induce an adaptive response. | Radiat Res. 2008 Mar;169(3):311-8. doi: 10.1667/RR1199.1. Elmore E1, Lao XY, Kapadia R, Giedzinski E, Limoli C, Redpath JL. | It is concluded that doses of less than 100 mGy delivered at very low dose rates in the range 1 to 4 mGy/day can induce an adaptive response against neoplastic transformation in vitro. When the dose rate drops below approximately 1 mGy/day, this suppression is apparently lost, suggesting a possible dose-rate-dependent threshold for this process. | ||
| Modeling of the sagittal cervical spine as a method to discriminate hypolordosis: results of elliptical and circular modeling in 72 asymptomatic subjects, 52 acute neck pain subjects, and 70 chronic neck pain subjects. | Harrison DD, Harrison DE, Janik TJ, Cailliet R, Ferrantelli JR, Haas JW, et al. Spine 2004; 29:2485-92. | In the normal group, a family of ellipses was found to closely approximate the posterior body margins of C2-C7 with a least squares error of less than 1 mm per vertebral body point. The only ellipse/circle found to include T1, with a least squares error of less than 1 mm, was a circle. Compared with the normal group, the pain group's mean radiographic angles were reduced and the radius of curvature was larger. For normal, acute, and chronic pain groups, the mean angles between posterior tangents on C2-C7 were 34.5 degrees, 28.6 degrees, and 22.0 degrees, C2-C7 Cobb angles were 26.8 degrees, 16.5 degrees, and 12.7 degrees, and radius of curvature were r = 132.8 mm, r = 179 mm, and r = 245.4 mm, respectively. | ||
| Relation between low back pain syndrome and x-ray findings. | Magora A: Scand J Rehab Med 1978; 10:135-145. | No direct relation between sacralization, partial or complete, and LBP was found; this was based on interrelation of the LBP and control groups, with or without sacralization, to age, ethnic community, occupation, number of changes of occupation or place of employment, duration of LBP, and physical occupational requirements (sitting, standing, bending, sudden maximal effort). There is some evidence that LBP, when associated with sacralization, may be more severe. | ||
| Low-dose radiation risk extrapolation fallacy associated with the linear-no-threshold model. | Hum Exp Toxicol. 2008 Feb;27(2):163-8. doi: 10.1177/0960327107083410. Scott BR1. | Here, indirect evidence is provided that the excess cancer risk calculated at very low doses of low-LET radiation (e.g., around 1 mGy), based on extrapolating from high dose data for an irradiated human population using the LNT model, is likely a phantom excess risk. Indirect evidence is provided, suggesting that for brief exposures to low-LET radiation doses on the order of 1 mGy, that a decrease below the spontaneous level is many orders of magnitude more probable than for any increase in risk as would be predicted by extrapolating from high to low doses using the LNT model. | ||
| Molecular biology, epidemiology, and the demise of the linear no-threshold (LNT) hypothesis. | Pollycove M1, Feinendegen LE.; Comptes Rendus de I'Academie des sciences,C R Acad Sci III. 1999 Feb-Mar;322(2-3):197-204. | The biologic effect of radiation is not determined by the number of mutations it creates, but by its effect on the biosystem that controls the relentless enormous burden of oxidative DNA damage. At low doses, radiation stimulates this biosystem with consequent significant decrease of metabolic mutations. Low-dose stimulation of the immune system may not only prevent cancer by increasing removal of premalignant or malignant cells with persistent DNA damage, but used in human radioimmunotherapy may also completely remove malignant tumors with metastases. The reduction of gene mutations in response to low-dose radiation provides a biological explanation of the statistically significant observations of mortality and cancer mortality risk decrements, and contradicts the biophysical concept of the basic mechanisms upon which, ultimately, the NCRPs confidence in the LNT hypothesis is based. | 2Q “The argument that Low dose radiation can induce a genomic instability, which can in turn induce a cancer is not based on convincing data” No significant correlation between sensitivity to radiation-induced genomic instability and cancer induction. Doses of less than 100 mSv, cancer excess is not seen. However it doesn’t rule out the possibility of a smaller effect inducing cancer. Atomic bomb data does not provide solid arguments for the LNT model. Among humans there is no carcinogenic effects for acute irradiation at doses less than 100mSv and for protracted Irradiation at doses less than 500mSv. Fears associated with LNT at any dose lack scientific justification. If the carcogenic risk exists, it is so small that it is without clinical importance. |
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| Prospective evaluation of criteria for obtaining thoracolumbar radiographs in trauma patients. | Holmes JF, Panacek EA, Miller PQ, Lapdis AD, Mower WR. J Emerg Med 2003;24:1-7. | A total of 2404 patients were enrolled. TL spine injuries were identified in 152 patients. Of these 152 patients with spine injuries, all 152 (100%, 95% confidence interval 98-100%) were considered high risk by having at least one of the high-risk criteria. These criteria have a specificity of 3.9%, a positive predictive value of 6.6%, and a negative predictive value of 100%. All of the high-risk criteria but intoxication with ethanol or drugs were important as sole predictors of TL spine injury. The use of high-risk clinical screening criteria identified virtually all blunt trauma patients with acute TL spine injuries. These criteria, however, have poor specificity and positive predictive value. | ||
| Lumbar Spine X-Ray as a Standard Investigation for all Low back Pain in Ghana: Is It Evidence Based? | Ghana Med J. 2017 Mar;51(1):24-29. Tannor AY1. | There is strong evidence indicating very little benefit from routine lumbar spine x-rays for all LBP. The GSTG needs to be revised considering the increased risks of radiation exposure and the x-ray costs. | The article is a brief comparison of 4 different guidelines established by different medical groups. A wide net search was cast through multiple databases, most reputable, and Google was included as well. Although the exclusion criteria were not elaborated, the 4 guidelines selected served the purposes of the author(s). It is worth noting, however, that some of the guidelines are informed by studies that have small populations, but those populations were followed up within 1 year or more frequently in other cases. Other guidelines were informed by more robust studies. | |
| It Is Time to Move Beyond the Linear No-Threshold Theory for Low-Dose Radiation Protection. | Cardarelli JJ 2nd, Ulsh BA.; ,Dose Response. 2018 Jul-Sep; 16(3): 1559325818779651. Published online 2018 Jul 1. doi: 10.1177/1559325818779651 | Currently, the USEPA uses the linear no-threshold (LNT) model to estimate cancer risks and determine cleanup levels in radiologically contaminated environments. The LNT model implies that there is no safe dose of ionizing radiation; however, adverse effects from low dose, low-dose rate (LDDR) exposures are not detectable. This article (1) provides the scientific basis for discontinuing use of the LNT model in LDDR radiation environments, (2) shows that there is no scientific consensus for using the LNT model, (3) identifies USEPA reliance on outdated scientific information, and (4) identifies regulatory reliance on incomplete evaluations of recent data contradicting the LNT. | Linear nothreshold modèle (LNT) should not be used anymore to determine health risks because it creates a society fearful of radiations and carcinogenicity of low radiation doses like thoses associated with medical imaging examinations has not been demonstrated . | |
| The relationship between head posture and severity and disability of patients with neck pain. | Yip CH1, Chiu TT, Poon AT. Man Ther. 2008 May;13(2):148-54. Epub 2007 Mar 23. | The CV angle in subjects with neck pain is significantly smaller than that in normal subjects. There is moderate negative correlation between CV angle and neck disability. Patients with small CV angle have a greater forward head posture, and the greater the forward head posture, the greater the disability. | Measuring CV angle has high inter examiner reliablility and would be useful to monitor head posture. Small CV angle => forward head posture => neck pain and increased likelyhood of disability. | |
| Sagittal alignment in lumbosacral fusion: relations between radiological parameters and pain. | Eur Spine J. 2000 Feb;9(1):47-55. Lazennec JY1, Ramaré S, Arafati N, Laudet CG, Gorin M, Roger B, Hansen S, Saillant G, Maurs L, Trabelsi R. | Appropriate position of the fused vertebrae is also of paramount importance to minimize muscle work during posture maintenance. The main risk is failing to correct or to causing excessive pelvic retroversion with a vertical sacrum leading to a sagittal alignment that replicates the sitting position. This situation is often accompanied by loss of lumbar lordosis and adversely affects stiff or degenerative hips. | Connection is that the use of x-ray to evaluate sacral base angle and lumbar lordosis is important to understand the correlation to pain levels with the musculature supporting normal posture.] | |
| Sagittal lumbar and pelvic alignment in the standing and sitting positions. (USE THIS STUDY TO POINT OUT THAT SITTING FURTHER INCREASES SPINAL STRESS WITH ABNORMAL CURVATURES AND HOW IMPROTANT PROPER SPINAL ALIGNMENT IS FOR PEOPLE WHO SIT A LOT FOR WORK( | J Orthop Sci. 2012 Nov;17(6):682-6. doi: 10.1007/s00776-012-0281-1. Epub 2012 Aug 23. Endo K1, Suzuki H, Nishimura H, Tanaka H, Shishido T, Yamamoto K. | This study showed that LLA decreased by approximately 50 % and PT increased by approximately 25 % in the sitting position compared with the standing position. No significant gender differences were observed for LLA, SS, and PT in the standing position. In the sitting position, however, LLA and SS were markedly larger for women. | Use of xray to determine the difference in lumbar lordosis and sacral base angle in a standing and sitting position. Connection is the use of xray to accurately determine these changes was necesary. | |
| Imaging studies in patients with spinal pain: Practice audit evaluation of Choosing Wisely Canada recommendations. | Can Fam Physician. 2016 Mar;62(3):e129-37. Ferrari R. | In the evaluation of nonspecific spinal pain and symptoms, setting and following an a priori threshold for ordering MRI, CT, or bone scans in the spirit of the current Choosing Wisely Canada recommendations has a very low risk of missing a case of a serious cause of back pain. | Primary Care setting, following imaging and low back pain within the PCP model. In support of Choosing Wisely Canada, no advanced imaging without "red Flags" being the threshold. Using red flags as the threshold for ordering advanced imaging yields a very low risk of missing any serious cases of spinal pain. | |
| Practice patterns in spine radiograph utilization among doctors of chiropractic enrolled in a provider network offering complementary care in the United States.(Chiropractic schools teach different approaches to xrays) | J Manipulative Physiol Ther. 2013 Mar-Apr;36(3):127-42. doi: 10.1016/j.jmpt.2013.04.002. Epub 2013 May 8. Bussières AE1, Sales AE, Ramsay T, Hilles S, Grimshaw JM. | Chiropractic school attended and practice location were the most influential predictors of spine radiograph utilization among network chiropractors. This information may help to inform the development and evaluation of a tailored intervention to address overuse of radiograph utilization. | ||
| Do chiropractors adhere to guidelines for back radiographs? A study of chiropractic teaching clinics in Canada. | PMID:18090093) Ammendolia C, Côté P, Hogg-Johnson S, Bombardier C. Spine (Phila Pa 1976) [2007] | The results suggest a strong adherence to radiography guidelines for patients with a new episode of low back pain who presented to chiropractic teaching clinics. Although a high proportion of patients had red flags, radiography utilization was lower than rates reported in previous studies suggesting that adherence to guidelines may help prevent unnecessary radiography. | There is a high adherence to clincical guidelines recommending the use of radiography for the assessment and management of acute low back pain that is being taught at Canadian Chiropractic college. Despite the occurance of red flags, radiographic evaluation was obtained in only a minor percentage of cases and a trial of conservative care was first utlized. This, however, appears to differ from the higher utilization of radiographic assessments by community chiropractors, who may be more cautious when it comes to the presentation of red flags, have fears about malpractice, or who may not be up to date with the current practice guidelines. | |
| Current evidence for spinal X-ray use in the chiropractic profession: a narrative review. | Jenkins, H.J., Downie, A.S., Moore, C.S. et al. Chiropr Man Therap 26, 48 (2018) doi:10.1186/s12998-018-0217-8 | In most cases the potential benefits from routine imaging, including spinal X-rays, do not outweigh the potential harms. The use of spinal X-rays should not be routinely performed in chiropractic practice, and should be guided by clinical guidelines and clinician judgement. | ||
| General practice and chiropractic in Norway: how well do they communicate and what do GPs want to know?(STANDARDIZING X-RAYS AND PROVING WHAT WE DO FROM A POSTURE STANDPOINT MAY HELP GPs UNDERSTAND WHAT WE DO AND RECOMMEND CHIROPRACTORS MORE FOR SPINAL COMPLAINTS) | J Manipulative Physiol Ther. 2001 Nov-Dec;24(9):576-81. Langworthy JM1, Birkelid J. | In general, communications between GPs and chiropractors in Norway are not ideal, particularly with regard to frequency and written quality. However, this is not unique to Norway. With increasing emphasis on multidisciplinary health care, greater understanding and better communication is needed to optimize the benefits of such an approach to patient management. Relevant, timely, consistent reporting on a reciprocal basis, together with a shared vocabulary, should help this process. | Interdisciplinary collaboration is not only possible, but encouraged. The strongest factor in successful relationships amongst physicians is communication, both in terminology and timely updates | |
| Lumbosacral spine imaging: physioanatomic method. | Curr Probl Diagn Radiol. 1992 Sep-Oct;21(5):151-213. Luers PR1. | In a minority of patients the findings on noninvasive imaging either will not correlate with the patient's symptoms or will demonstrate multiple abnormalities that could account for the patient's symptoms. In these patients, invasive techniques are extremely helpful in defining a pain generator or pain generators.(ABSTRACT TRUNCATED AT 400 WORDS). | ||
| Current Evidence for Spinal X-ray use in the chiropractic profession: A Narrative Review | Chiropr Man Therap. 2018 Nov 21;26:48. doi: 10.1186/s12998-018-0217-8. eCollection 2018. Jenkins HJ1, Downie AS1, Moore CS2, French SD1,3. | There is strong evidence indicating very little benefit from routine lumbar spine x-rays for all LBP. The GSTG needs to be revised considering the increased risks of radiation exposure and the x-ray costs. | In most cases the potential benefits from routine imaging, including spinal X-rays, do not outweigh the potential harms. The use of spinal X-rays should not be routinely performed in chiropractic practice, and should be guided by clinical guidelines and clinician judgement. | |
| Primary prevention in chiropractic practice: a systematic review. (Utilization in X-rays can improve preventative measures via postural analysis, which can explain preventative measures.) | Chiropr Man Therap. 2017; 25: 9. Published online 2017 Mar 20. doi: 10.1186/s12998-017-0140-4 Guillaume Goncalves,corresponding author1,2,3 Christine Le Scanff,1,2 and Charlotte Leboeuf-Yde1,2,3 | More research efforts have been put into wellness than into prevention of musculoskeletal disorders or public health-related disorders. It therefore seems that parts of the chiropractic profession are in search of an understanding of various aspects of clinical practice over and above its traditional musculoskeletal role. Interestingly, only a small proportion of chiropractic patients consult for PP, despite the readiness of the profession to offer such services. | Not relivant to this Lit Review | |
| Interventional therapies for chronic low back pain (lack of posture and chiropractic which can be alleviated by posture/chiropractic understanding, hence the need for chiropractic standardization in xray analysis) | Neuromodulation. 2014 Oct;17 Suppl 2:31-45. doi: 10.1111/ner.12250. Veizi E1, Hayek S | Implementation of interventional pain procedures in the treatment framework of LBP has resulted in improvement of pain intensity in at least the short and medium terms, but equivocal results have been observed in functional improvement. | This article is mostly about interventional therapies... namely various types of inections, dry needlings, and epidurals. Most of the therapies are short term relief, and do not offer long term solutions to CLBP |