Learning About X-rays with Lula and Ethan

April 4, 2016

Educating patients about radiation is more important than ever.

In 1982, a night no different than many other nights, my father came home and trained my dog, Jocko, in the concrete floored basement of our split-level, ranch-style suburban home. At the time, the stairs that led to the basement were open to the view of the basement from an unenclosed stair rail. As a 5-year-old, however, this was not a stair rail at all; it was a gymnastics paradise to display my ninjutsu expertise-plus a bonus view of my personal dog trainer and new puppy. It does not get much better for a 5-year-old, except for the frequent chastising I would receive for using the rail for that very purpose.

"You will fall and hurt yourself,” was the usual caveat. On this particular night, that warning would go unheeded and my grip would betray me. Gravity was there to teach me a lesson. I fell head-first and landed on the concrete. Now much of what happened later is recalled from a post-traumatic memory and what my parents later told me, but to make a long story short, I remember waiting a very long time in an unfamiliar emergency room.

Because my father was a neuroradiologist and the chairman of the department of radiology at the more familiar hospital and because the more familiar hospital only provided plain film radiography, he insisted upon going to the hospital that could perform a CT scan of my head.  I eventually received a CT scan and a diagnosis of a concussion. Subsequently, my father was able to convince his hospital board to allow him to use his personal finances to help purchase a CT scan for the hospital where he was employed.

Recently, my 8-year-old nephew suffered a similar experience – a head injury while playing.  I realized after talking with his parents that the responsibility should also lie with the parents to understand their available options in similar circumstances. Hence the reason my company, Viewbox Holdings, LLC, and I decided to create our second (and most unlikely) product, a children's book.[[{"type":"media","view_mode":"media_crop","fid":"47299","attributes":{"alt":"Luther B. Adair, II, MD","class":"media-image media-image-right","id":"media_crop_9390219033418","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5553","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 216px; width: 200px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Luther B. Adair, II, MD","typeof":"foaf:Image"}}]]

According to one study, the use of CT has increased fivefold over the last decade. For the first time, the National Cancer Institute and Institute of Health have noticed an increased risk of leukemia and brain tumors as a result of this overuse. In addition, there have been other controversial reports regarding the overuse of CT scans ordered by emergency departments over the last six years. What could cause this overuse? Some argue that the legal system is causing doctors to practice defensive medicine. Others argue that the training of emergency personnel promotes a flippant approach to the use of diagnostic imaging.

The book, Learning about X-rays with Lula and Ethan, is loosely based on my nephew's experience and it attempts to educate the pediatric population about possible concerns around radiation exposure, but also explains its necessity in certain situations. It reinforces the questions that are suggested by the Image Gently Campaign for concerned parents to ask the doctor, and suggests that children can play a role in this discussion as well. For example, ask for the lowest dose of radiation possible, avoid multiple scans, or ask for an ultrasound instead of a CT, which has no radiation at all. 

Most importantly, and aligning with the ACR’s Heart of Radiology campaign to educate the public about our role as radiologists, this book introduces readers, both parents and children, to one of their key health care providers-the radiologist.  This book was written for ages 7+ and features two children eating lunch and discussing one child’s experience of getting an X-ray.  Obviously, it is our desire that parents would never need such a resource, but given the trend of increased diagnostic imaging in the emergency setting, as well as the large numbers of allied providers joining the health care force over the next few years, we believe this resource will help families and providers. 

It is our hope that any provider that treats the pediatric population has access to this resource for their patients (even radiologists in the outpatient or emergency waiting rooms). The book will be available through Amazon, Barnes and Noble, and in the Apple iTunes Store where you can also find our iPad application for radiology trainees, Viewbox. Because the information and message in Learning about X-rays with Lula and Ethan aligns with the Image Gently Campaign, this non-profit organization has also agreed to endorse the book by placing it on their website: www.imagegently.org

During the editing process, we received guidance and amazing support from the Chair of the Image Gently Campaign, Dr. Donald Frush, as well as my sister, Dr. Candace Adair, who is a Child and Adolescent Board-Certified Psychiatrist. If you have any questions or comments please feel free to email me directly at luther.adair@viewbox.net.