The "Adrian X-Ray Shoe Fitter" and Musings on Radiation

The Adrian fluoroscope was a popular device in shoe stores from the 1920's to the 1960's. They were used in the UK into the '70's! About 10,000 machines were in use in the US. It was a cabinet about 4 feet tall. You would put your kids foot into an opening in the base and look into a view port in the top. There was often 3 ports- one each for the child, the parent and the salesman.  As the x-rays poured through, you could clearly see the child's toe bones wiggle inside the new shoe. The exposure time was adjustable, usually about 20 seconds.

The dangers of x-rays were known much earlier. One of Thomas Edison's glassblowers, who made the tubes, would test the tubes on his hands. He developed such a tenacious cancer that his arms were amputated and he eventually died. Edison subsequently completely abandoned x-ray research in 1903.

Apparently the shoe fluoroscopes did not result in widespread public health problems. But in a worst case scenario (trying on multiple shoes, maybe damaged shielding in an old machine) a high enough dosage to result in radiation sickness could have resulted from a single visit. Several cancers were reported- salesmen who would test machines on their hands, even a shoe model whose legs had to be amputated. This silly technology was eventually banned.

Now this month we have the stoopid study from the American Cancer Society that resulted in stooopid headlines like "dental X-rays give you brain tumors." The study has resulted in widespread accusations of junk science. It was based on sick old people trying to recall how many dental x-rays they had in childhood. Dr. Nancy Snyderman's report on NBC was especially bad. I hope the x-rays they showed in the background were hers. They were a monument to poor decision making- multiple molars with root canals and no crown, root canal on a wisdom tooth. I think the radiation is going to be the least of that patients problems.

More stoopidity- the American Dental Association has come up with this gem of a guideline in regard to radiation- "As Low as Reasonably Achievable." I can easily achieve zero exposure- don't take any! How's that! This is how I believe that you should decide how many x-rays to get- have a discussion with your dentist about the benefits and risks. Of course we should all limit the amount of radiation we receive. A  dental x-ray dose is about the amount the average US resident gets from living for 2 days. This comes from outer space, from materials in the earth and materials in our food. A coast to coast flight is 3 times higher, a hip x-ray about 65 times more, a shoe fitting fluoroscope about 85 times higher.  The benefits of dental x-rays is to find problems when they're small. Yesterday I saw the Director of one of the largest insurance programs in the state. He hasn't had an x-ray lately and a cavity progressed to the point that he needs a root canal and a crown. It will cost over $2,000. An x-ray and a small filling would have cost less than $200 and insurance would have covered over 80% of that. Not everyone should get the same amount of x-rays. It might be a good idea for someone who has recently had cavities to get x-rays more than once a year- even though insurance might not cover it. Someone who hasn't had a cavity in a long time might want to go 18 months- even though insurance would pay yearly.

The bottom line is to make smart decisions. Life is often harder for those who make stoopid ones.