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Toward safer scoliosis screening.

Due in part to increased school screening programs for scoliosis, an estimated 120,000 U.S. adolescents now are being monitored with X-rays for a lateral curvature of the spine -- creating concern among health experts over the long-lasting effects of radiation exposure.

For several years, cancer researchers have suspected a link between early use of X-rays and later development of breast cancer (SN: 12/5/81, p. 359). Because scoliosis assessment may depend on repeated X-rays of the spine, and because two-thirds of the patients are young females, the Food and Drug Administration (FDA) is urging physicians to carefully evaluate their X-ray methods.

According to Charles Showalter, a director in FDA's Center for Devices and Radiological Health, at each scoliosis exam the average patient receives radiation exposure eight times that of a chest X-ray, and individual exposures may greatly exceed that. In addition, some patients may be X-rayed every three to six months for several years, from adolescence to skeletal maturity.

Speaking at an FDA seminar last week, Showalter and health physicist Alvin Thomas agreed that the actual increased risk of breast cancer due to scoliosis monitoring may be small, but they emphasized that it is an "avoidable risk." Thomas said breast tissue is "bearing full force of the X-ray beams" in commonly used techniques, but a recent FDA study at the Bethesda (Md.) Naval Hospital proved exposure could be reduced 10- to 360-fold. Citing that study, Showalter said that, for no more than $1,000, radiologists could "virtually decrease exposure to zero," depending on how many of the FDA's recommended methods are used:

* Turn the patient around so the chest faces away from the X-ray beam (gives a fuzzier but adequate image).

* Use faster rare-earth film/screen systems to shorten exposure time.

* Add gradient filters or shadow shields onto X-ray equipment to decrease or stop radiation to areas of the upper chest.

* Give patients specially designed vests with attenuating materials sewn over the breast area.
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Author:Edwards, Diane D.
Publication:Science News
Date:Oct 26, 1985
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