New research shows that obese patients require higher radiation exposure during radiology exams leading to cancer risks associated with radiation exposure.

A new study from England’s University of Exeter and Musgrove Park Hospital this month highlights Radiology’s conundrum of the obese patient. The practical and social difficulties associated with medical imaging of obese patients are increasingly common problems.  It is no surprise to radiology personnel working in patient care that obese patients require more radiation to complete an exam. The fact that the patient themselves create some of the additional exposure from secondary radiation, which is beyond our control, contributes to the problem.

Obesity is a global health issue and in the United States 39.6 percent of adults were considered obese in 2015-2016. Information from surveys discovered that the eating habits of Americans were contributing to the recorded obesity statistics from multiple states with the South leading the way.

“Fat” is becoming the new normal in America. According to the most recent data from the Centers for Disease Control and Prevention, more than 7 in 10 American adults aged 20 and older are either overweight or obese.

So prevalent is America’s obesity problem that the weight-loss industry has expanded and in 2017 valued at $66 billion. Yes, that’s billion with a “b”.  In comparison, the United States has an annual health care bill of $200 billion related to obesity. Hospitals have made some adaptation to accommodate obese patients. For instance, more health care facilities are purchasing larger operating tables, recliners, CT scanning tables, wheelchairs and other technology that makes caring for obese to severely obese patients safer and easier.  Some hospitals have redesigned physical spaces to better suit the needs of the obese patients.

Some increasing investments made by hospitals for heavier patient include:

• Furniture reinforced with wrought iron
• Wheelchairs and beds designed to held more weight
• Floor mounted and larger toilets
• Wider doorways
• Longer needles to penetrate ticker arms
• Power operated high/low exam tables
• Extra-large blood pressure cuffs
• Patient lifts either portable or fixed
• Waiting room furniture designed for bariatric patients

In radiology, imaging equipment with larger diameters and weight limits have become commercially available.  This equipment is more expensive and is sometimes only found in major health centers. For surgical procedures done with mobile or fixed radiographic equipment there is a recommendation/rule that the x-ray source be at least 12 inches from the skin. Many brands of radiographic fluoroscopy equipment have spacers between the patient’s skin and the x-ray tube. If the spacers are removed, the distance is 8 inches which is allowed only for “special surgical procedures.’ Some states allow the removal and other cite facilities that are not using them or have them available.

The question begs an answer, Fluoroscopy spacers? Yes or No?

There is much debate happening in radiology now about the effects of radiation dose and should be still be shielding patients. The physicists who are touting the removal of all shielding and are not concerned about how close the tube is to the patient, believe only certain radiology exams should trigger concerns.

Currently, there are no guidelines written to minimize radiation doses in obese patients. Those that are grossly obese with BMI’s over 30 are subject to the increased effects of radiation exposure which include cancer risk.

Researchers are calling for more studies to investigate the results of increased radiation dose in overweight and obese patients.  The recent study was published in the Journal pf Radiological Protection. It concluded that the overall risk of cancer caused by extra radiation was more than double (153%) that of normal weight people undergoing x-ray.