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The Dangers of Medical Radiation
It is one of the ironies of medicine that radiation, as in x‐rays, CT scans, radiation therapy and nuclear medicine can cause cancer yet can be used to detect and treat cancer. Perhaps because of this irony, most of us know very little about radiation dangers. Often we simply trust our doctors and caregivers to do what is right. In the majority of cases, this mutual trust system works well. However, what happens when the system fails? A recent study suggests that 15,000 people are projected to die within the coming years from the radiation they received from x‐ray procedures! How can we protect ourselves? There have been reports of patients experiencing serious radiation overdose causing reddening of the skin, hair loss, cataract formation, or burns that cannot heal. A lack of knowledge will not protect you! Radiation cannot be seen, felt, tasted or heard and organ and tissue damage from radiation, and radiation‐induced cancer, may take years or even decades to manifest. However, the dangers are real! Last year 3000 patients were treated for serious radiation burns at a wound care facility. Read how to protect yourself from medical radiation!
P.O. Box 1644 New York N.Y. 10150 http://www.dlitepress.com The author does not guarantee and assumes no responsibility on the accuracy of any websites, links or other contacts contained in this book. The dangers of Medical Radiation All rights reserved. DLite Press/ published by arrangement with the author PRINTING HISTORY DLite Press/ December 2010 Copyright © 2010 by Olive Peart Cover design and digital illustration Copyright © 2010 by Olive Peart All right reserved. No part of this book may be used or reproduced by any means, graphic, electronic, or mechanical, including scanning, photocopying, recording, taping or by any information storage retrieval system without the written permission of the publisher except in the case of brief quotations embodied in critical articles and reviews. Please do not encourage piracy or plagiarization of copyrighted material in violation of the author’s rights. Purchase only authorized editions. For purchase information contact: Peltrovijan Publishing firstname.lastname@example.org P.O. Box 13 Shrub Oak NY 10588 ISBN: 978‐0‐9829774‐1‐5 Printed in the United States of America
The Dangers of Medical Radiation Olive Peart .
She is also the author of two young adult novels The Intruders & Linked. . and Mammography and Breast Imaging‐Just the Facts. Her published works include: Spanish for Professionals in Radiology. Lange Mammography Examination. About The Author Olive Peart has taught radiography students for over ten years. She writes regular columns for radiologic journals and newsmagazines.
...........TABLE OF CONTENTS INTRODUCTION........................................................... 6 ..................................................................... 9 MIRACULOUS IMAGING OF THE HUMAN BODY . 8 7 RADIATION CONTROL/STATE LICENSURE OFFICES: .................................................................. 0 ........................................................................................ 1 ................................................................................................. 7 STATE STATUS . 7 6 ORGANIZATIONS MONITORING RADIATION SAFETY ................................................................................................................................ 2 1 WHY IS RADIATION DANGEROUS? ............................... 2 7 REFERENCES ........................... 6 WHAT CAN THE GENERAL PUBLIC DO? ........ 2 WHAT ARE SOME SOURCES OF RADIATION? ......................................... 9 5 INITIATIVES UNDERWAY TO REDUCE RADIATION DANGERS ................. 5 1 EFFECTIVE DOSE LIMIT RECOMMENDATIONS ............................. 8 2 WHY ARE WE AT RISK FROM MEDICAL RADIATION? ................. 4 ...................................................................... 6 7 GLOSSARY OF TERMS ..................................................... 7 WHAT IS RADIATION? . 3 9 .................................................................. 9 1 POSSIBLE RADIATION EFFECTS .... 2 HOW IS RADIATION USED IN MEDICINE? ....................................................................................... 0 5 HOW IS MEDICAL RADIATION MONITORED? .
Olive Peart 6 .
000 people are projected to die within the coming years from the radiation they received from x‐ ray procedures! There have been reports of patients experiencing acute radiation effects including reddening of the skin. can cause cancer yet can be used to treat cancer. all resulting from the overuse of medical radiation. Many required hyperbaric oxygen chambers to promote healing. CT scan (CAT scan). Organ and tissue damage from radiation and radiation‐induced cancer may take years. Perhaps because of this irony.7 The Dangers of Medical Radiation INTRODUCTION It is one of the ironies of medicine that radiation. Often we simply trust our doctors and care givers to do what is right. but what happens when the system fails. in 2009 the nation’s largest wound care company treated 3000 patients with serious radiation burns. A recent study suggests that 15. nuclear . The problem is that in many states the people who operate radiation‐producing equipment do not need a license. as in x‐rays. That means the person taking your x‐ray. The amount of radiation patients are exposed to have dramatically increased over the past twenty years. It is therefore seldom that a radiation mistake will result in a law suit. In the majority of cases this mutual trust system works well. Yet. to manifest. even decades. hair loss or cataract formation. A new study by the National Council on Radiation Protection and Measurement (NCRP) concluded that Americans were exposed to seven times more radiation from medical procedures in 2006 than in the 1980s. most of us know very little about radiation dangers.
Fortunately. radiation dose never goes away.Olive Peart 8 medicine scan or giving you radiation therapy has little or no training. . Even worse. We worry about radiation dose at airport security systems. Americans are getting the most medical radiation in the world. The US accounts for half of the most advance procedures that use radiation. This child is now a cancer risk! It’s hard for us to conceive of the danger of something we cannot see. the effects are real and unfortunately. However. has no license or no certification. Many states do not require the reporting of errors and even if an error is reported the penalty is nonexistent or not enforced. For a patient age seventy this may not be a significant factor but think of the 2‐ year‐old or even the 10‐year‐old. We worry about electromagnetic radiation from power lines and cell phones yet we are willing to tolerate the massive doses of radiation given to us by our health care providers. feel or hear. The effects of radiation will simply accumulate in their bodies showing up years later as radiation induced cancer. A report documents a New Hampshire teen who was about to get a CT scan to check for kidney stones. The American College of Radiology notes that only about 20 percent of radiotherapy units in the country are accredited. who is responsible for calibrating the radiation emitting equipment. the radiologist discovered the child had already had 14 CT scans for previous checks of kidney stones. often the doctor or physician is unaware of the dangers of radiation and the medical physicist.
capable of penetrating the body. three other scientists Henri Becquerel (1852–1908). These new rays were termed Röntgen rays. Within a few years of the discovery of x‐rays. After spending weeks trying to determine exactly what he had discovered. Professor Röntgen brought his wife into his lab. the property of certain elements to spontaneously . and scientist and the public soon recognized the potential of these new rays.9 The Dangers of Medical Radiation WHAT IS RADIATION? X‐radiation was first discovered in 1895 by Wilhelm Conrad Röntgen (1845–1923). Further experiments lead to the discovery of radioactivity. He asked her to place her hand on a photographic plate and after turning on his new machine. he aimed it at her hand. In 1895 while conducting experiments with electric currents passed through a vacuum tube. unusual ray. Röntgen One of the first x‐ray images. later called x‐rays. He later developed the plate and produce the first know radiograph. Pierre Currie (1859– 1906) and Marie Curie (1867–1934) were able to isolate radium from uranium allowing the use of even higher energy radiation to kill cancer cells. Anna recognized that the tube was Bertha Röntgen's hand emitting a strange and Source: wikipedia:en. Röntgen noted that a nearby fluorescent screen glowed when the current was being passed. When the current was switched off the screen stopped glowing.
Olive Peart 10 emit rays or subatomic particles from matter. With slightly higher photon energy. These are called radiofrequency (RF) waves. Other long wavelength rays are microwaves and infrared waves. green. Objects subjected to infrared light will increase in temperature. orange. Despite the variety of rays at this end . low energy end of the spectrum are radio and TV waves. Electromagnetic Spectrum Source: There are many types of http://upload. blue. The Electromagnetic Spectrum X‐rays are electromagnetic radiation. They are commonly used in magnetic resonance imaging (MRI) and to broadcast signals to and from television and radio stations. and violet). infrared light is given off by the sun. these high‐ energy rays are used in radiation therapy to kill or treat cancer. Visible light is the smallest part of the spectrum and the only portion that we can see.png electromagnetic radiation and they can be grouped together to make what is called the electromagnetic spectrum. yellow. highway speed monitoring and in food preparation. At the long wavelength. All electromagnetic radiation travels at the speed of light although they are photons with various energy levels.org/wikipedia/common s/8/8a/Electromagnetic‐Spectrum. In the middle of the spectrum is visible light (red. Today.wikimedia. Microwaves are used in cellular telephone communication.
The name given to these high‐energy radiation photons is ionizing radiation. This has the potential to cause harm to living tissue. X and gamma rays have the power to disrupt or ionize matter by interacting with electrons and atoms. After visible light. x‐ray and gamma‐ rays. it is responsible for sunburns and can cause skin cancer. Ultraviolet light is also given off by the sun and because of its interaction with molecules. X‐rays have short wavelengths in the range of 0.01 to 10 nanometers and energies in the range 120 electron volts (eV) to 120 kilo electron volts (keV). The machines used to take x‐ray images can produce x‐rays with energies as high as 120. there is ultraviolet light. X‐rays are emitted by electrons outside the nucleus of an atom. The most basic of all matter is the atom and in the center of the atom is the nucleus. The basic difference between these two types of photons is their origin. The x‐rays used for cancer treatment are much more powerful. with energies of between 2 million and 20 million electron volts. .000 electron volts. as the wavelengths get smaller the phonon energy of the rays increase and there is a resulting increase in danger.11 The Dangers of Medical Radiation of the spectrum. However. while gamma rays are emitted by the nucleus of the atom and are associated with alpha or beta particle emission. if they are carefully used theses rays are all relatively safe.
Experimenters soon found that the new rays could penetrate wood. the human heart…you name it. many people did not recognize that these new rays were dangerous. Doctors began photographing their brains. . even as scientists continued to document eyes and skin ailments. the fascination with radiation continued to drive the abuse. although scientists could no longer explain away the hair loss and skin burns of varying severity. Some department stores even had ‘bone portraits’ where customers could get a printed image of their bones.Olive Peart 12 MIRACULOUS IMAGING OF THE HUMAN BODY In the early years after the discovery of x‐rays. Yet. For the people at that time this was an amazing discovery and for his work. shoe stores even had fluoroscopy x‐ ray machines (See Chapter: How is Radiation Used in Medicine) to help customers fit shoes. Everyone assumed that these new rays were a form of light. the consequences to individuals became even more apparent. Many of the early symptoms of radiation burns were dismissed. Very soon. and it was photographed. By 1897. the recreation and medical use of x‐radiation continued to expand. were attributed to the electrical currents being used or were thought to be from the patient’s oversensitive nature. and wealthy individuals had x‐ray units in their homes to entertain guests by imaging their skeleton. Wilhelm Röntgen received the first Noble prize in Physics. the new rays were being used to find bullets in humans. paper and flesh and could expose the bones of the human body. As time progressed. Such was the expansion that by 1908 circuses were using the rays to guess the content of women’s bags. The rays were also used in a number of unproven and unscientific treatments. photograph broken bones and image mummies.
Radiation therapy technologists. tasted. The patients are monitored by closed‐ circuit television and the technologist stays in an adjacent room. . It was difficult for the public to understand the dangers. all personnel working with radiation are required to wear monitoring devices that tracks their lifetime radiation dose. and technologists working with x‐rays are totally safe standing behind the lead walls. a Philadelphia hospital gave the wrong radiation doses to more than 90 patients with prostate cancer and did not report it. Radiation cannot pass easily though lead. All x‐ray rooms are now lined with lead. Other protective devices used by technologists and radiologists are lead glasses to protect the eyes and thyroid shields to protect the thyroid. but what about the patients? In 2009. smelled or heard. are extremely radiosensitive–they are easily damaged by radiation–so the use of lead shielding is important to keeping them safe. they will stand behind a lead glass or lead lined control area or wear a lead apron. If the technologist must stay in the room during an x‐ray procedure. located near the front of the neck. it was the discovery that blood disorders such as aplastic anemia and leukemia were occurring at an alarming rate among radiologists that led to efforts geared mainly toward protecting first radiologists and then later all those who worked with x‐rays. The human eyes and the thyroid glands. All these restrictions are in place to protect workers using x‐ray equipment. do not remain in the room during the treatment of patients. touched. Not until well into the 1950s did the many harmful practices finally cease.13 The Dangers of Medical Radiation The problem was that these rays could not be seen. In another safety measure. Even then. who are working with even higher doses of radiation.
a Florida Hospital reported that 77 brain cancer patients had received 50% more radiation than prescribed because the linear accelerator of the radiation therapy machine had been programmed incorrectly for nearly a year.Olive Peart 14 In 2005. .
Over time. When the photons interact with the atoms of an object. these molecules cease to function or function erratically. This energy causes the molecules of our tissues to change or become ionized. The most significant scatter produced is Compton scatter. If the object is thinner or less dense (such as air in the lungs). Unfortunately. such as in genetic mutations or death. The higher the original energy. The DNA molecules interact with each other in the form of chromosomes. there is another problem. The result is breakage of the molecule or relocation of the atom within the molecule. The dangerous effects of radiation therefore take place at the cellular level in our bodies. If an object is very dense (such as bone). which contains the genetic information for each cell. As they pass through the human body. it can induce chromosome aberrations. they will lose power because they are interacting with the atoms in our bodies and depositing energy in the tissue. Cells and tissue can recover from radiation injury but sometimes the changes are irreversible. This energy is set by the technologist . The scatter produced can and will go in any direction and can include high.15 The Dangers of Medical Radiation WHY IS RADIATION DANGEROUS? X‐ray photons diverge or spread out as they leave the x‐ray producing tube. medium and low energy photons. They are also absorbed by anything in their path. it will interact with. stop or attenuate less photons. The photon electrons leaving a source will continue to bounce off objects in its path until it loses most of its energy or is fully absorbed. it will interact with. If radiation damages our DNA. The amount of scatter depends on the energy of the original photons leaving the x‐ray tube. scatter radiation is produced. stop or attenuate more photons. The most important molecule in the human body is DNA. the more scatter will be produced.
Stem cells are the most radiosensitive. This means that if you have to stay in the x‐ray room with a son or daughter be sure to stay as far from the x‐ray tube as possible and never stay in the direct path of the x‐ray beam. It is an inverse relationship governed by the inverse square law. Other radiosensitive organs. Other conditions such as the areas or actual size of the x‐ray field. the fetus (especially between 8–15 weeks gestation when the rate of growth in the brain is the highest). The production of scatter is the reason why we need to wear protective lead shielding. Scientists also found that some organs and tissues are more radiosensitive than others. The least radiosensitive cells were muscle. blood cells such as bone marrow and the cells in the mucosal lining of the intestinal tract are also more radiosensitive. regardless of whether we are the patient or not.Olive Peart 16 and used to produce the image. and infants and children. The farther we stand from the source of the x‐ray beam. especially covering over our reproductive organs. the less powerful the beam will be. . The intensity or strength of the beam is reduced by one quarter every time the distance is doubled. if we stay in the x‐ray room during an x‐ ray exposure we should wear some form of lead protective shielding. the thickness of the patient and even the room design can affect the scatter produced. heart and nerve cells because these cells undergo less cell renewal. Cells that undergoing high metabolic activity level or rapid and continued regrowth such as the reproductive cells. while mature cells are more resistant to radiation. tissues or cells include: younger tissues and organs in the developing embryo. In fact. regardless of where we stand in the x‐ray room during an x‐ray exposure. Pregnant patients should therefore take precautions before any x‐ray examination and should consult their doctor to discuss the possible benefits versus risks before any x‐ray procedure. cells in the thyroid.
2. Both the SI units and the older units will be described here. Table 2. which measures the amount of energy deposited in living tissue or any medium as ionizing radiation passes through it.000001 nano n 1000−3 10−9 0. The roentgen will not indicate the actual exposure to an individual and it has no SI equivalent because the exposure can be express in units of coulombs per kilograms. Radiation can be measured by the ionization effects in air as a result of exposure to x‐ray or gamma rays.1 centi c 1000−2/3 10−2 0. These units have been accepted by just about all countries except the United States.17 The Dangers of Medical Radiation How is Radiation Measured? The International Commission on Radiation Units and Measurements (ICRU) have adopted standard radiation units based on an international system called Le Système International d’Unités (SI units).000000001 There are four common methods of measuring radiation: 1. Standard Scientific Prefixes Prefix Symbol 1000m 10n Decimal mega M 10002 106 1000000 kilo k 10001 103 1000 hecto h 10002/3 102 100 deca da 10001/3 101 10 10000 100 1 deci d 1000−1/3 10−1 0. The output of x‐ray imaging equipment is usually specified in milliroentgens (mR). The absorbed dose does not take into account the type of organ or . Radiation can be express as the radiation absorbed dose.001 micro μ 1000−2 10−6 0. The unit used is the roentgen.01 milli m 1000−1 10−3 0.
This is needed because tissues and organs have different radiosensitivity and not all types of radiation will produce the same response in living tissue. The quality factor for x‐rays is one therefore: 1 rad x 1 = 1 rem Effective dose is measured in sievert (Sv). The main unit used to measure absorbed dose is the gray (Gy) the older unit is the rad. Many studies estimate that the dose received by patients during actual examinations is even higher than that reported.Olive Peart 18 tissue absorbing the radiation nor does it consider the radiosensitivity of the organ or tissue. inspectors . This is the unit most often used when describing the quantity of radiation received by a patient. The quality factor estimates the radiosensitive of the specific tissue or organ as adopted by the International Council on Radiation Protection and can vary depending on the type and energy of radiation being used. (100 rad = 1Gy). also referred to as the dose equivalent or occupational exposure. The effective dose is used most often to express the quantity of radiation received by radiation workers and the population in general. The effective dose is the absorbed dose multiplied by a quality factor. One reason is that reporting agencies will request documentation of the protocols used during the imaging but in reality. The becquerel (Bq) is the unit of activity. This is referred to as the activity. The unit of activity is used mostly in nuclear medicine and radiotherapy. Radiation can also be a measure of the rate at which radionuclides decay. Another method of measuring radiation attempts to give the biological effect of the radiation by measuring the dose effect on the specific tissues or organs. 4. An accurate measure of the biologic response is the effective dose. The old unit is the rem (100 rem = 1Sv). which have absorbed the radiation. The older unit is the curie (Ci). 3.
Moreover.5 rem (5 mSv) per year for infrequent exposure.1 rem (100 mrem) 0. Table 1 lists the effective dose limits as recommended by the National Council on Radiation Protection and Measurements (NCRP) for radiation workers (occupational exposure) and the general public.5 mSv 5 rem (5000 mrem) 1 rem x age 15 rem (15000 mrem) 50 rem (50000 mrem) 0.19 The Dangers of Medical Radiation do not measure the dose used during the actual study. hands and feet 50 mSv Embryo‐Fetus Exposures (monthly) Equivalent dose limit 0. hands and feet 500 mSv Public Exposures (Annual) Effective Dose Limits Continuous or frequent exposure 1 mSv Infrequent exposure 5 mSv Equivalent Dose Limits for Tissues and Organs Lens of eye 15 mSv Skin. Table 1. Effective Dose Limit Recommendations The effective dose limit for the general public is 0.05 rem (50 mrem) . Effective dose Limits Recommendations Population and area of body irradiated SI unit Occupational Exposures Dose Limits Old unit Effective Dose Limits Annual 50 mSv Cumulative lifetime 10 mSv x age Equivalent Dose Annual Limits for Tissues and Organs Lens of eyes 150 mSv Skin.5 rem (1500 mrem) 5 rem (5000 mrem) 0.1 rem (1 millisievert or 1 mSv) per year for continuous or frequent exposure and 0. actual studies found wide fluctuations in the radiation dose amounts listed for eleven most common CT scans.5 rem (500 mrem) 1.
This is the latent period. this period does not last very long or may not appear at all. This is the prodromal period where the symptoms can include nausea. Radiation can also causes acute symptoms in what is known as the prodromal period which can occur within hours of exposure and continue for a few days after which the person appears to recover in what is known as the latent period. vomiting. which follows. At low doses. diarrhea and reduced white blood cells. The result is reduction in white cells. Death. which can lead to leukopenia. the latent period can extend to four or more weeks. the body will continue to lose cells leading to infections. the body appears to recover and shows no sign of radiation sickness. the person can recover within 2–4 weeks. red cells and platelets. Hematologic Syndrome Radiation doses between 200 and 1000 rad (2–10 Gy) will produce hematologic syndrome. After the latent period. After the prodromal period.Olive Peart 20 POSSIBLE RADIATION EFFECTS Total Body Exposure There are three syndromes related to radiation dose to the entire body: Hematologic death. If the dose is not lethal. the body can again show manifest illness or one of the following syndromes. electrolyte imbalance and dehydration. they will immediately show signs of radiation sickness. is usually due to infections. If the dose is severe. depending on the dose received. Prodromal & Latent Period If a person receives over 100 rad (1 Gy) of radiation to the entire body. Gastrointestinal Syndrome . gastrointestinal (GI) death and central nervous system (CNS) death. hemorrhage and dehydration. At high dose of radiation.
other damage can include peeling and ulceration of the skin. loss of balance (ataxia) and lethargy will follow. A single dose of 300 to 1000 rad (3–10 Gy) can cause erythema.21 The Dangers of Medical Radiation Radiation doses between 1000 and 5000 rad (10–50 Gy) will result in nausea. vomiting and diarrhea followed by confusion. Partial Body Exposure Radiation effects on blood cells can be immediate which is acute. vomiting and diarrhea. The severity of these effects is determined by the amount of radiation exposure received and any effect will be concentrated in the organs receiving the highest doses. In addition. epilation or hair loss. However. ear pain. a burning sensation on the skin and they may lose vision. Most acute effects are a result of accidental exposure such as during therapeutic radiation therapy. the person becomes comatose and dies. swelling of the tongue. Disorientated. For example. the result is tooth decay and infection. depending on where the radiation is directed. Central Nervous System Syndrome A dose of over 5000 rad (50 Gy) can lead to death within hours or days. and loss of vision. If left untreated death can occur within 4–10 days of exposure due to persistent diarrhea as the intestinal cells cease to function resulting in bloody stools. dry mouth. an overdose of radiation can result in a . nausea. The person may experience nausea. Often the first sign of radiation damage is erythema. difficulty breathing. In the final stage. If saliva stops flowing. electrolyte balance and uncontrolled diarrhea. a high dose of radiation to the face can damage the salivary glands. loss of muscle coordination. difficulty swallowing. alveolar damage and fibrosis in the lungs. or chronic which is usually long‐term. loss of taste. sunburn like reddening of the skin. seizures. Radiation can also cause bone weakness and bone destruction.
about 400–500 which become available at puberty. depriving the skin and soft tissue of nourishment. Since spermatozoa are being constantly produced. Doses over 500 rad (5 Gy) can lead to permanent sterility. lead to delayed menstruation. Females are born with their total number of ova. Another problem is that scientists have not yet determined the level or threshold radiation dose that is required to cause chronic . This will reduce the effects of irradiation although nothing can reverse any possible genetic mutation due to the irradiation. can reduce their size. Chronic radiation effects are actually of more danger to the public. after radiation dose to the testes males should refrain from sexual activity for 2–4 months until all the exposed cells have disappeared. Doses to the testes in males can lead to atrophy or reduction in the number of sperm cells. where the ova are produced. This makes it especially hard for the public to accept the dangers of radiation. A dose of 200 rad (2 Gy) can cause temporary infertility. the development of the spermatozoa takes about 3−5 weeks. Radiation to the ovaries. The effects can begin as slight cellular changes that eventually become radiation‐induced cancer or leukemia. Doses over 500 rad (5 Gy) can produce permanent sterility. The appearance of chronic effects can be random and the severity is often unrelated to the dose level received. Doses as low as 10 rad (100 mGy) can lead to delayed or suppression of menstruation. A dose of 200 rad (2 Gy) can produce temporary infertility. and suppression of menstruation or cell death. A dose of 10 rad (100 mGy) can reduce the number of spermatozoa. which can last up to a year.Olive Peart 22 wound that does not heal because the radiation damages the cell’s lining and small blood vessels. Chronic effects are the result of long‐term low doses of radiation and can take 5−25 years to appear. In males.
Time required to deliver the typical threshold dose at the specified dose rate (Hours of Fluoroscopic "On Time" to Reach Threshold) at: Actual Effect Typical Usual Fluoro.2 radiation Dose (Gy)* (2 rad/min) Gy/min (20 episode to rad/min) observed effect Early transient 2 1. 275018. 275019.83 4 week desquamation Invasive fibrosis 10 8.7 1.25 3 week epilation Main erythema 6 5. Report Nos. The longer you are exposed to ionizing radiation the more danger there is.23 The Dangers of Medical Radiation effects.02 Gy/min of 0. 298419.50 >10 week Secondary 20 16.67 >6 week ulceration * The unit for absorbed dose is the gray (Gy) in the International System of units.0 1.17 hours erythema Temporary 3 2. However.2 0.8 0. Radiation stats The more radiation you receive the more harmful it can be. 487999.25 6−10 week Dermal necrosis 18 15. Table 3. One Gy is equivalent to 100 rad in the traditional system of radiation units.00 >52 week Moist 15 12.7 0.92 >14 week Telangiectasis 12 10. 241641.0 0.3 0. Source: Food and Drug Administration Mandatory Device Reporting System.0 1. A patient’s cumulative risk of radiation‐induced cancer is believed to increase with increasing cumulative radiation .5 1. High‐Level Time after a Threshold Dose Rate of Dose Rate single Absorbed 0.5 0. it has been noted that a patient can recover from an acute effect only to develop a chronic effect later in life.58 3 week epilation Dry 10 8.25 4 week desquamation Late erythema 15 12.50 10 day Permanent 7 5.83 Dermal atrophy 11 9. 298423.3 0.5 1.
05 percent) over a persons’ life.000 mrem or 25 rem) of radiation. examinations that give high radiation doses such as Barium Enemas. If we are exposed to 250 mSv (25. gonads and breast. These organs are repeatedly exposed to radiation whenever we subject our bodies to common procedures in the x‐ray department. therefore. thyroid.Olive Peart 24 dose. for any diagnostic study involving radiation. The level of risk is also higher for young patients and higher for women more so than men. The most radiosensitive organs in the body are the eyes. A fetus exposed to radiation during brain development has an increased risk of damage to the central nervous system (CNS). which can cause a small excess risk of cancer (0. The frequent use of CT scans on younger and younger patients is especially harmful because the lifetime effects of radiation dose are not fully understood. pelvic or abdominal CTs should be done only within the first 10 days of menstruation when the patient is least likely to be pregnant unless the doctor determines that the benefits of the test will outweigh the risks. and the risk of induced fatal childhood malignancy from exposure during gestation is calculated at 28 cases per 1000 per sievert. The sievert is the unit that attempts to gives the biological effects of radiation. A typical CT scan can deliver a dose of 5−10 mSv (millisievert) or 0.0 rem. the human body shows signs of impairment. . Pregnant patients should try to limit radiation examinations of the abdominal or pelvic area. There is no single level or threshold after which radiation damage will occur. The risks are 30 IQ points reduction for every sievert. The result is increased incidence of Down syndrome and reduction in IQ. For female patient of reproductive age.5−1. the potential risk must be balance against the expected clinical benefits of the diagnostic study.
25 The Dangers of Medical Radiation If a person receives more than 3.000 mrem) is approximately equivalent to the dose received from 113 chest x‐rays or from three years of natural occurring background radiation. . 10 mSv (1 rem or 1.000 mSv (300.000 mrem or 300 rem) of ionizing radiation in one occurrence there is a 50% chance of mortality.
The radiation from the atmosphere and soil is referred to as background radiation.1 mSv (10 mrem) from cooking with natural gas or from radon gas in the natural gas supply. such as cathode‐ray tubes and smoke detectors. This radiation comes from outer space as cosmic radiation and from naturally occurring radioactive material in the ground such as uranium or radon.Olive Peart 26 WHAT ARE SOME SOURCES OF RADIATION? Radiation is found in our atmospheres and in our soil. . The nuclear industry also contributes to our background radiation from aboveground nuclear weapons testing. We also get radiation from medical test. We get less than 0. In additional to background radiation we also get radiation from a few consumer products. accidents at nuclear power stations and from the disposal of by‐products from nuclear power plants.03 mSv (3 mrem) of radiation.3 rem) per year of naturally occurring radiation. We get about 0.1 mSv (10 mrem or 10 millirem) per year from smoke detectors. In the 1986. Radon gas in the home is the largest source of background radiation. which have radioactive elements. We inhale 2 mSv (200 mrem or 0. A round trip coast‐to‐coast airplane flight across the United States can give an average person 0.9 mSv (90 mrem) annually from TVs and about 0. Chernobyl nuclear accident 30 people received a high dose of radiation causing acute radiation syndrome and death. Radiation can also be inhaled or ingested through food or water.2 rem) of radiation annually from radon in the atmosphere. (See Chapter: How is Radiation Used in Medicine?) What is Background Radiation? The average person in North America receives about 3 mSv (0.
8 mR at 12 feet from the tube 31. Exposure levels based on factors set by technologists Exam Chest x‐ray (AP chest) C‐spine x‐ table (neck x‐ ray) kV 90 80 mAs 4 32 Exposure 19. She later died. a worker died after being exposed to radioactive material at a scrap metal shop. This relationship is shown in Table 4.15 mR at 12 feet from the tube 142 mR 9 feet 6 inches 90 80 .5 mR at 6 feet from the tube 124. Table 4.6 mR at 6 feet from the tube 1113 mR 3feet 6 inches Exposure 4. the further you are from the source of the radiation the lower will be your dose. During radiation therapy. In India. In any radiation exposure. He was one of seven people exposed to high level of radiation from obsolete medical equipment hidden in abandoned equipment. a 14‐year‐old girl received double her prescribed dose for 10 radiation therapy treatments because the facility made faulty calculations and did not follow its policy to verify the dose. another patient received 10 times the prescribed radiation in 1 spot and 1/10 of her dose in another.27 The Dangers of Medical Radiation How Much Radiation Is Too Much? In a summary of radiation accidents published in The New York Times.
and radionuclide used in nuclear imaging. Typical radiation doses for common studies Type of study Abdomen. The skin dose is 800 mrad (8 mGy) 150 mrad (1. It is simply to emphasize that radiation is a natural part of everyday life on .4 mGy) 400 mrad (4 mGy): female 175 mrad (1. gamma rays used in radiation therapy.3 mGy) 40 mrad (0.Olive Peart 28 HOW IS RADIATION USED IN MEDICINE? In radiology departments the use of x‐rays are vital for both diagnostic and therapeutic purposes. kidneys. and CT scanning.5 mGy): female 300 mrad (3mGy): male Mammogram Breast Pelvic imaging Gonadal dose The Background Equivalent Radiation Time or BERT can be used to explain radiation. Consider the following: The effective dose from mammography is approximately 1 millisievert The average background radiation rate in the United States is approximately 3 millisievert per year. Table 5 shows some typical radiation dose for common x‐ray procedures. There are three types of medical radiation: x‐rays used in general x‐rays imaging and in dental imaging. it would take approximately four months for the patient to accumulate the same effective dose of radiation as given in a mammogram. By using this conversion.3 mGy) 30 mrad (0. mobile imaging. Table 5. This does not imply any risks.75 mGy):male– because the male gonads are not in direct path of the x‐rays 300 mrad (3 mGy) per image. fluoroscopy imaging. ureters or bladder x‐ray Hip lumbar sacral spine x‐ray (AP) lumbar spine x‐ray (AP) Organ Fetal dose Fetal dose Fetal dose Gonadal dose Dose 30 mrad (0.
The technologist taking the image has the ability to adjust the energy or kilovoltage (kV) of the photons. The quantity or number of electrons needed to create the image is modified by adjusting the milli‐ amperage (mA) and the time setting. Voltage applied to the filament produces electrons. Table 6.08 mSv (8 mrem) 1 mSv (100 mrem) 3 mSv (300 mrem) 10 mSv (1000 mrem) BERT (time to get the same dose from nature) 10 days 4 months 1 year 3. The same principle can be applied to other x‐ray studies as seen in Table 6. is position under the x‐ray tube. the x‐ray tube is mounted on tracks or suspended from the ceiling. The higher the kV . The duration of the x‐ray exposure is a function of the milli‐seconds of the applied radiation. Radiation Doses Made Easy X‐ray study Chest x‐ray Mammogram Lumbar spine CT of the abdomen Effective dose 0. The patient lies below the tube on the x‐ray table or sits beside the x‐ray table and the specific body part.29 The Dangers of Medical Radiation earth.3 years X‐rays or X‐radiation Explained X‐rays are created when thousands of volts of electricity are applied to a filament in a vacuum tube. which move rapidly across the tube to strike a target at the opposite end. for example the hand. The energy level of the radiation produced is determined by the voltage and current used. In radiology departments. The energy conversion produces heat and x‐rays.
performed on patients after a serious accident.Olive Peart 30 applied. however because any beam of x‐ray created is never homogenous there will always be relatively weak photons regardless of the kV setting used. medium and strong photons. . portable radiography was actually done using a hand held portable machine. The mobile x‐ray unit has the same features as x‐ray units in the large x‐ray departments. At the higher kV levels. They will be stronger which will determine their penetrating ability. Some mobile units use digital technology. the term stuck. mobile. Although the machines are now mobile. In hospitals. the beam will have weak. The mobile unit is a large. portable or trauma radiography are often used interchangeable. It can be plugged in for recharging when not in use and if fully discharged can take up to eight hours to charge. In such cases. battery operated radiographic equipment. Mobile radiography is also often trauma radiography. the more powerful these electrons will be. self‐ propelled. Mobile Imaging Explained In the past. The technologist using the mobile unit should always wear a lead apron during the procedure and should stand at least six feet (2 meters) from the x‐ray tube. a mobile x‐ray unit can be taken to the patient’s room. The three terms. which allows rapid viewing of the image. sometimes a patient is just too sick to be brought to the x‐ray department.
infections and bone loss due to cysts or other abnormalities. Dental Imaging Explained Dental imaging takes x‐rays of the teeth. Pregnant patients and other patients of reproductive age who are adjacent to the patient getting the mobile x‐ray should also get some form of lead protection. and soft tissues around the mouth. Hospital should monitor and log the number of mobile images taken on each patient. Patient Protection during Mobile Imaging The patient should always get a lead protective shield during the mobile exposure. The radiation from multiple mobile images can add up. bones. Dental x‐rays can show cavities. equal to 725 chest x‐rays–during an average hospital admission. Staff working in areas where mobile imaging in being performed should be more than six feet (2 meters) from the x‐ray tube and should not be in the path of the direct beam. acute heart attack patients received an average radiation dose that is 30% of the recommended annual limit. abscesses. hidden problems such as impacted wisdom teeth.31 The Dangers of Medical Radiation According the American Heart Association. . which will show the entire jaws and teeth on a single image. The two most common dental x‐rays are bitewing x‐rays to show each individual tooth and panoramic x‐rays.
and after years of experimentation. patients undergoing a dental x‐ray should wear lead protective shielding. He died in 1904 after suffering from severe radiation burns and the amputation of both arms. Radiologists wore special red‐light goggles to allow their eyes to adjust to the . Fluoroscopy Imaging Explained Fluoroscopy is a method of real time imaging of moving internal organs and structures in the body. however. The shielding should cover the extremely radiosensitive thyroid glands and the gonads. it is difficult to see the image in normal room lightening. The original fluorescent material used by Edison was barium platinocynide. Fluoroscopic images are much fainter than radiographs.03 mSv (2 or 3 mrem). the procedure was performed in a darkened room to allow the radiologist to view the image directly on the fluoroscopy screen. Nevertheless. A typical dental x‐ ray image exposes you to only about 0. Edison stopped his research in fluoroscopy shortly before the death of his assistant and friend Clarence Dally. therefore. Dally was the first person to die from radiation overdose in the United States. As with general x‐ray imaging. he later settled on zinc cadmium sulfide and calcium tungstate. the radiation passing through the patient’s body is used to generate the image.02 or 0. Fluoroscopy was developed in 1898 by Thomas Edison. The effect is similar to watching a movie of the internal organs. In the early days of fluoroscopy.Olive Peart 32 Patient Protection during Dental Imaging Dental imaging uses very low x‐ray dosages. in fluoroscopy the image is then projected on a television monitor.
The x‐ray tube is positioned under the x‐ray table.000 times brighter than the input image. This arrangement allows an output image that is approximately 5000 to 30. The image intensifier is a complex system that received the image formed by the x‐ray beam and converts it into a high intensity visible image. it sends x‐rays leaving the patient to a phosphor. During the procedure. In modern fluoroscopy units. cesium iodide (CsI) which converts the x‐ray energy to visible light.33 The Dangers of Medical Radiation darkness. Some fluoroscopy procedures take place in the x‐ray department while others are surgical or operating room procedures that need very strict . Technically. The image is transmitted directly to a television camera tube capable of converting the output from the phosphor of the image intensifier into an electrical signal that can be sent to the television screen. In today’s imaging world. fluoroscopy imaging uses digital technology. with the intensifier unit above the x‐ray table. Even more advance technology sends the image directly to a flat panel detector allowing further reduction in radiation dose to the patient. These goggles became obsolete in the 1950s with the invention of the image intensifier. It works by amplifying the fluoroscopic image. There is another advantage of using the image intensifier. The device not only allows the image on the screen to be visible under normal lighting conditions. the patient will lie on the x‐ray table while the radiologist moves the fluoroscopy unit over the patient to capture the radiation exiting the patients’ body. it provides the option of recording the image with a conventional camera or sending the image to a television monitor. allowing the production of thousands of light photons for each x‐ray photon. the cesium iodide is bounded to a photocathode. Often fluoroscopy imaging is done after the patient drinks or is injected with a radiographic contrast or dye.
Fluoroscopy procedures in the operating room are performed using a mobile fluoroscopy unit called a C‐arm. There are federal standards. General Fluoroscopy Procedures Esophagram Studies. which sets the unit of exposure rate of fluoroscopy units at 10 rem per minute (100 mSv or 10. patients can often avoid the more risky surgical procedure. Two monitors are used to allow “active display” of the image on one monitor and a reference image or “last image “or “image hold” on the other. Other advantages of interventional radiology include less pain and a quicker recovery time when compared to open surgery. Another category of fluoroscopic procedures is called Interventional Fluoroscopy. The total time of any fluoroscopy examination will determine the radiation exposure that the patient will receive. Procedures performed in the general radiology department utilize a stationary fluoroscopy unit. the C‐arm. The C‐arm unit is generally used with TV monitors and a control cart. however. Interventional radiology offers minimal invasive. These can be performed in radiology departments. the mobile fluoroscopy unit. is used. Upper Gastrointestinal Studies (UGI)–an examination of the stomach. .Olive Peart 34 surgical aseptic techniques. These procedures included cardiac intervention and vascular intervention. By using x‐ray fluoroscopy procedures. targeted treatment. The ‘C’ in C‐arm describes a unit that has an x‐ray tube at one end and an image intensifier at the other. the technique used is similar to surgical techniques and because of the need for flexibility.000 mrem per minute).
. Thrombolytic and fibrinolytic procedures–to clear blocked arteries especially for stroke victims.’ High Radiation Fluoroscopy Procedure These are interventional fluoroscopy procedures and these procedures can result in a high skin dose. Pacemaker insertion and placement. Internal fixation of orthopedic fractures–an operating room procedure used to place nails or rods at facture sites to keep the bones together. Chemotherapy administration. The port is sometimes called a ‘port‐a‐cath. These are surgical procedures used to place semi‐permanent ports or venous catheters in a patient to allow quick access to a patient’s veins for long‐term therapy such as chemotherapy.35 The Dangers of Medical Radiation Small Bowel Examination Series–an examination of the intestines. Endoscopic retrograde cholangiopancreatography (ERCP)– combines endoscopy and fluoroscopy to diagnose and treat problems of the biliary or pancreatic ductal system. Angioplasty & Angiography (of the coronary or other vessels). Percutaneous transhepatic cholangiography–to visualize the anatomy or manage obstruction of the biliary track. Barium Enemas–an examination of the colon. Stent of the carotid artery and vena cava filter placement. Used to correct blockage of the cardiac or other vessels. Periperipherally inserted central catheter (PICC line placement) and central venous access. Percutaneous nephrostomy−renal obstruction management Radiofrequency cardiac catheter ablation−used to correct a disturbance in heart rhythm (cardiac arrhythmias).
Risks of Fluoroscopy Procedures The radiation dose received during a fluoroscopy procedure depends on the size of the patient and the length of the examination. the x‐ray energy needed to produce the images can be relatively high because of the need to penetrate the barium. radiation‐burns due to the high radiation dose to the skin. Interventional fluoroscopy procedures often use an iodine based contrast agent and here the risk is associated with the extended time needed for these procedures. Even in low risk fluoroscopy procedures such as the barium fluoroscopy.000−5. with typical skin dose rates quoted as 2. The troubling fact is that recent trends toward more involved fluoroscopy procedure have led to serious. At least a third of the interventional imaging studies performed each year are cardiovascular procedure. Vascular embolization–to block blood flow to diseased or malfunctional organs. Urinary/gall bladder /biliary stone removal or drainage. Even typical dose rates can result in skin injury after less than one hour of fluoroscopy time. Researchers analyzed the average cumulative radiation dose for patients hospitalized for .000 mrad/min (20–50 mGy/min). Longer procedures will therefore result in higher the radiation dose to the patients.Olive Peart 36 Transjugular intrahepatic portosystemic shunt–placement of a tubular device called a stent in the liver to allow blood flow to bypass the liver.
) Procedure Radiofrequency cardiac catheter ablation Catheter placement for chemotherapy Transjugular interhepatic portosystemic shunt Coronary angioplasty Multiple hepatic/biliary procedures(angioplasty.S. Studies show that this is due to nonuse of radiation protection for the face and head during interventional procedures. tracking 64. These included chest x‐rays. biopsy.45 rem). Cardiac interventional procedures can potentially expose a patient to high radiation doses because patients often undergo repeated cardiac interventional procedures. One hour of fluoroscopy time can result in skin doses to the patient. cardiac catheterization and percutaneous coronary intervention. academic hospitals.680 men) who were hospitalized in 49 U.074 patients (23.5 year span a total of 276.37 The Dangers of Medical Radiation an acute heart attack. etc Renal angioplasty Percutaneous cholangiogram followed by multiple embolizations Number of Injuries Reported 12 1 3 4 3 2 1 . Some injuries occurred prior to 1992.651 procedures involving radiation were performed on these patients. CT scans. equivalent of sunburn. stress tests. the cumulative radiation dose during a heart attack patient’s hospitalization was approximately 14. Reports Received by FDA of Skin Injury from Fluoroscopy (between January 1992 and October 1995. On average. Radiation workers have an annual limit of 50 mSv (5 rem). During a 3.394 women and 40.5 mSv (1. to more serious burns. which can include mild erythema. stent placement. Table 7. Interventional cardiology personnel in Malaysia developed cataracts five times more often than a control group.
make sure to ask if the inspection was performed by a medical physicist. All equipment should have safety features such as ‘pulse’ rather than constant radiation output and ‘last image hold’ a feature. Find out if the facility keeps a record of patients’ skin dose for each fluoroscopy procedure. however. In order to help reduce the skin dose to patients the distance from the x‐ray . find out if she/he has had radiation protection training. Source: FDA personnel conducting the procedure. especially the radiologist. A radiologist must undergo radiation protection training as a part of his or her studies. Sample of Radiation burn from Find out the qualifications of all fluoroscopy. cardiologist and the technologist. Also. Find out the radiation dose rates for the specific fluoroscopic unit. All fluoroscopic equipment should undergo regular checks by a medical physicist. There should be a timer. which can freeze the last image. avoiding the need constantly irradiate the patient. If a cardiologist or surgeon is performing the procedure. which should be set before the start of all procedures and can be used to record the total fluoroscopy time. Know which fluoroscopy procedure carries a high risk for radiation burns. Find out the last inspection date of the fluoroscopy unit. Find out if the facility records the total fluoroscopy time for each procedure. there are no similar requirements for the cardiologist or surgeon.Olive Peart 38 Patient Protection during Fluoroscopy Find out if the facility is accredited.
CT (CAT) Scans Explained Computerized tomography or CT scanning (sometimes incorrectly referred to as CAT scanning) uses a narrow beam of radiation to take multiply images of the body simultaneous. If the bread is sliced. you can literally pick out any slice.39 The Dangers of Medical Radiation tube to the patient must not be less than 15 inches (38. The radiologist or cardiologist performing the procedure and the technologist should all have training specific to the equipment and any training should include radiation protection courses. A CT image of the body works on the same principle. The computer will compare the relative density of the various body structures and display the results on a monitor. recorded and analyzed by a computer.5 cm) on mobile fluoroscopy units. The imaging creates slices of the body (cross sectional images) that can be viewed individually or remain a part of the whole. Think of a loaf of bread. The facility should keep a record of fluoroscopy procedures with an estimation of absorbed dose to the patients’ skin during high‐ risk fluoroscopic procedures or a record of the total fluoroscopy time. dense body structures will reduce the intensity of the beam while less dense structures such as air in the lungs will allow the passage of the x‐ray beam at nearly full strength. look at the slice then return it to its position. The technique is called cross sectional imaging.1 cm) on stationary fluoroscopy units and not less than 12 inches (30. The varying energy levels leaving the body are measured. . As the x‐ray beam passes through the body.
and other pathology. Modern day CT scanners can be used to image the entire body and the newer 64‐slice CT scanners can complete an examination in less than 10 minutes. bladder. Checks of the liver. slice by slice. and tumors. For his role in discovering computed tomography (CT). viewed as full 3‐dimensional structures or viewed as a 2‐dimensional image.Olive Peart 40 With the ability to create a large volume of data. The system also allows viewing of the images from many different angles. surgeons and radiologist the ability to virtually recreate the body’s’ anatomy. Checks of the urinary system including the kidneys. Because of its ability to show cross‐section images and to create a 3‐dimensional image of the different parts of the body. the CT scan has a definite advantage over routine x‐ray imaging. subdural hematomas. . The first commercial CT scanner was invented by an English electrical engineer. Early CT scanners could only take images of the brain and the actual process took over two hours. Sir Godfrey Hounsfield (1919–2004) and the first CT scan was a brain scan done in October 1971. pancreas and spleen. Checks of the lungs for cancer. The information is more detailed and digital technology allows the creation of 3‐dimensional images giving doctors. such as aneurysms. CT allows the user to manipulate the final image of the anatomy of the body’s structures and organs. Housfield later shared the 1979 Nobel Prize for Physiology or Medicine with Allan McLeod Cormack. These images can be rotated. Uses of CT Imaging: Checks of the brain for brain bleed.
This means the using typical dose values and standard risks estimation. the rapid CT scanning that is available today allows detailed 3‐dimentional imaging but is responsible for much of the increased radiation dose in medical imaging. Over half of the patients had undergone 10 or more CT scan in the previous eight years. Radiation Dose during a CT Scan Typically. to a maximum of 70 scans. stomach. The radiation dose and skin dose.000 people were projected to eventually die from the radiation they received from CT scans given in just a single year. abdomen or pelvis. esophagus. Of 500 patients in a study presented at RSNA in 2009 over half or 52. A recent study found that 15. St. during a CT scan can be 100−500 times higher than the dose used during a regular x‐ray examination. The risk of radiation damage to the body accumulates over a lifetime. half the group had accrued additional radiation‐induced cancer risks above baseline. Although the errors . colon (large intestine). followed 130 patients who had at least three emergency department visits within one year in which they had a CT scan of the neck. The patients received over eight times the normal dose. Over 300 patients in four hospitals in California were over‐ radiated by CT scans used to detect strokes. greater than 1 in 110 and up to a maximum of 1 in 17. small intestines. A study at Bridgman and Women’s Hospital. Boston and Washington University School of Medicine. chest. Louis Mo.41 The Dangers of Medical Radiation Examines the entire digestive track including the mouth. The dangers are particular dangerous to children who are more susceptible to radiation and more likely to develop cancer from it.5% received un‐indicated (unnecessary) CT exam..
occurred over an 18‐month period, they were not discovered until the patients lost their hair. The Food and Drug Administration in the US says that more than 250 patients at Cedars‐Sinai Medical Center in Los Angeles mistakenly received eight times the normal radiation dose during CT brain perfusion scans. Some patient indicated that they have suffered hair loss or reddened skin after scanning.
At Mad River Community Hospital in Arcata, a technologist activated the CT scan over 100 times on a 2‐year‐old boy. The examination, which should have taken just a few minutes, lasted over an hour. Since the effects of radiation can take years to develop the child’s prognosis is uncertain however, the prediction is that he will develop cataracts within three to five years.
Patient Protection during CT Scanning
Find out if the facility is accredited. Find out if the facility keeps a record of all patients’ skin dose−for each procedure. Find out if the facility records the total exposure used for the CT scan. Find out the qualifications of all personnel conducting the procedure, especially the CT technologist. Find out if the facility keeps track of patients undergoing CT scans and has a means of monitoring how often each patient has a CT scan. Find out if the facility modifies the exposure dose for small patients and children. Find out if the facility uses radiation protection shielding on the patient during each scan.
The Dangers of Medical Radiation
Table 8. Comparison of Doses from Typical X‐ray Procedures
Natural background radiation Dental radiography Lateral chest radiography Mammography Adult abdominal CT Barium enema Neonatal abdominal CT Chest or Abdomen CT
Organ receiving the most radiation
Whole body Brain Lung Breast Stomach Colon Stomach Chest, abdomen
2 mSv (200 mrem) 0.005 mSv (0.5 mrem) 0.15 mSv (15 mrem) 3.0 mSv (300 mrem) 10.0 mSv (1000 mrem) 15.0 mSv (1500 mrem) 20.0 mSv (2000 mrem) 10−20 mSv (1000−2000 mrem)
Patient Preparation for Interventional and CT Imaging
Patients for any Interventional or CT imaging will often have to modify their diet on the day before or the day of the study. This usually requires the patient to fast for six or more hours before the imaging. CT imaging can require the patient to drink a special x‐ray dye or contrast agent that allows easy visualization of the internal organs. Patients for both CT and Interventional imaging may get an injectable contrast agent, especially when the focus is the blood vessels. Although it is not as common today, there are still some patients who may be allergic to the contrast agent used. Many patients, even those with a history of allergic reactions, can be safety imaged after receiving drugs called steroids, prior to the imaging. However, patients with kidney or liver problems can be prone to complications from the injectable contrast agent and should be carefully monitored. Diabetic patients will often require special treatment and often they will need to modify their medication before or after imaging. Patients with diabetes should consult their doctors for specific instructions to avoid damage to their kidneys.
During at CT scan the patient will lie on a table, which moves into the CT scanner. For interventional procedures, the patients generally lie still on the x‐ray table while the equipment moves over and around them.
Radiation Therapy Explained
Radiotherapy or radiation oncology is primarily used to kill cancer cells. The main type of treatment used is referred to as external beam radiation. During radiation therapy treatments, the radiation can be directed to the entire body as in Total Body Radiation (TBR) or to a single site on the body. Total Body Radiation (TBR) can be given to patients undergoing treatment for cancers such as multiple myeloma. The patient can receive a dose of 10– 12 Gy to the whole body during treatment. These high doses can result in significant side effects such as hair loss, skin irritation, nausea, vomiting, diarrhea, and mouth sores. Long‐term problems can include damage to the lungs or other organs, infertility, cataracts and there is a risk of leukemia or other cancers several years after initial TBI treatment. External beam radiation can also be directed to a single site and can involve 40−45 days of treatment where the patient gets 15– 20 minutes of treatment each business day. This form of treatment can last up to eight weeks. During any radiation treatment, the patient has to lie motionless on the therapy table. Because of the high radiation doses used, the technologist never stays in the room and the patient is monitored by closed circuit television.
In a third method of radiation treatment the radiation is placed directly inside the patient. Immobilization is important because treatment involves directing high‐energy radiation to the cancer site. Many leading medical societies are now calling for oversight and enhanced safety measure in administering medical radiation. This technology is complex and faulty programming of the units or poor training of the imaging professionals can lead to errors. which are use to precisely shape and modulate the radiation beam. Also. Internal beam radiation allows a high dose of radiation to be delivered to the exact site of the cancer while minimizing the damage to normal tissue. . The radiation beam can be focus to the 3‐dimentions contours of even irregular shaped lesions. immobilization devices are always used to minimize any patient movement. A common usage of this technology is the insertion of 40−100 radioactive ‘seeds’ (iodine‐125 or palladium‐103) directly into the prostate glands.45 The Dangers of Medical Radiation During the treatment. which can last eight to nine weeks some methods of the internal beam treatments can be completed in seven to nine days. New radiation therapy uses a technology called Intensity Modulated Radiation Therapy (IMRT). The seeds are never removed because they become biologically inert after a few months. The linear accelerator used in many radiation oncology departments often exposes both normal and cancerous tissue because it is difficult to reduce the size of the radiation field to the exact size of the cancerous lesion. Often ultrasound technology is used to guide the placement of the seeds. This technology is referred to as internal beam radiotherapy or brachytherapy. compared to external radiation. Any movement would direct these deadly rays on normal tissue. IMRT is a new linear accelerator with 120‐complex‐ computer controlled metal leaves or collimators.
In June 2009.Olive Peart 46 Another method of internal beam radiation involves the insertion of hollow needles into the organ. In this method. In 2005. . Patients received the wrong dose of radiation while undergoing radioactive seed implants for prostate cancer at Philadelphia’s VA hospital. The needles are filled with a radioactive material for 5−15 minutes of treatment delivered each day for seven to nine days. The errors gave the patients 50 times their normal radiation dose and were due to a miss‐calibration of their new equipment. A hospital in Missouri reported that it had over‐radiated 76 patients during a five‐year period because their radiation therapy equipment was incorrectly programmed. a Florida hospital disclosed that 77 brain cancer patients had reviewed 50 percent more radiation than prescribed because one of the most powerful–and supposedly precise linear accelerators had been programmed incorrectly for nearly a year. protective brief are available. most oncologists suggest that patient avoid contact with small children or pregnant women for the first two months following the procedure. The radioactive material used in internal beam radiation does not pose a danger because the radiation emitted travels only a short distance. For patients worried about radiation leakage that could harm friends and family. If the seeds are permanently implanted. the radioactive material does not remain in the patient. Studies have also shown that small amounts of radiation can escape from the body in urine. The New York Times reports that a Philadelphia hospital gave the wrong radiation dose to more than 90 patients with prostate cancer−and did not report the error.
radioisotopes or tracers. Because of its ability to visualize cellular function. Nuclear Medicine Explained Nuclear medicine utilizes unsealed radioactive sources to diagnose or treat medical conditions. A 31‐year‐old vaginal cancer patient was over‐radiated more than 80 percent more than the normal by an inexperience radiotherapy team. all because the hospital did not test a piece of equipment after repairs. The radioactive source in nuclear imaging is called radiopharmaceutical. Nuclear medicine can often give functional details of organs in the body whereas CT scans and general x‐ray imaging give details of the patient’s anatomy. These radioisotopes emit gamma rays. All nuclear medicine testing will require either the patient to ingest the radioisotope or the isotope is introduced to the patient’s body via an intravenous injection. a 32‐year‐old breast cancer patient was given radiation overdose of three times her prescribed dose for 27 days before the error was detected. The cause: a linear accelerator was missing a filter.47 The Dangers of Medical Radiation A prostate cancer patient was radiated in the wrong spot on 32 of 38 treatments. She ended up with a hole in her chest that left a gaping weeping and painful wound. In New York. a passage between her rectum and vagina. Once inside the . nuclear imaging is sometimes referred to as molecular imaging. She later died. while another prostate patient at the same institution receive 19 misguided treatments. causing her to develop a fistula.
colon. intestines. the Nuclear Regulatory Commission dropped a requirement that forced patients to be hospitalized after treatment. kidneys. If they stay at a hotel. which will be collected. They can get on a bus or train exposing others to harmful radiation. particular those involving the use of radioactive isotopes which are injected into the breast before . During the nuclear medicine test the radioactive isotopes travels through the body and will expose all organs such as the bladder. Some specialized nuclear medicine studies such as Positron Emission Tomography (PET) imaging can require the patient to fast prior to the study. these patients can put their contaminated trash in regular garbage. again contamination the environment and putting others at risks. After leaving the hospitals. gallbladder. It has been estimated that the levels of unintentional radiation received by the public who have been exposed by patients may well exceed international safe levels established for pregnant women and children.Olive Peart 48 body special gamma cameras are used to detect the distribution of the radioisotope in the patient. In addition. the patient must sit quietly or lie on a table while the gamma camera scans the area of interest or scans the entire body. Nuclear medicine tests. In any nuclear imaging study. they are exposing the hotel staff to unnecessary radiation doses. The distribution of the radioisotopes is analyzed by a computer and used to create 2‐dimentional and 3‐ dimentional images of the body. patients who have ingested a radioisotope can and have vomited radioactive material. ovaries and uterus to radiation. exposing sanitation workers to radiation and contamination public dumpsites. Now patients can leave the hospital when they are highly radioactive. In 1997.
49 The Dangers of Medical Radiation the actual test. can expose the patient to far higher doses of radiation than a regular mammogram. and the lifetime risk of a single P. The BSGI exam was therefore estimated to involve a lifetime risk 20−30 times greater in women aged 40.M) examination exposes the patient to a risk of radiation‐induced cancer that is comparable to the risk from an entire lifetime of yearly mammograms starting at age 40. Physicist estimate that a single breast‐specific gamma image (BSGI) or a positron emission mammography (P. The mammogram is equivalent to about 4 months of natural background radiation.E. A digital mammogram has an average lifetime risk of inducing 1. at exposure.E.000 women aged 40.3 fatal breast cancers per 100. . was 23 times greater.M.
This does not take into account the patient’s medical condition. thereby reducing radiation dose to the patient. even someone with absolutely no knowledge of radiation safety can take your x‐rays. in some states anyone. Another concern is that the current level of training for radiation workers is not enough.Olive Peart 50 WHY ARE WE AT RISK FROM MEDICAL RADIATION? Lack of Knowledge Although a majority of states has specific training for all personnel working with radiation. In fact. many do not. preset setting are usually designed for the average patient. Only knowledge of the principle of radiation‐generating equipment will allow the technologist of make changes and adjust preset settings based on patient size or disease. patient abilities. practicing on the unaware patient. patient functions and the nature of the examination. size. CT scans and even administer therapeutic radiation therapy. The technologist must also have a detailed knowledge of positioning skills. . The untrained or unlicensed technologist will often learn on the job. age or weight. Many modern x‐ray departments have computerized preset settings on all x‐ray units. Using preset settings makes life easier for the technologists however. The radiologic technologist must have the knowledge and clinical skills to make adjustment or change the protocols according to patient size. There has been a rapid advance in technology just within the last few years and education and training of technologists and therapists have not keep pace with this evolution.
The knowledge of the radiologist can therefore determine how effective your imaging will be. radiologists could decide that during a routine imaging of the ankle joint the technologist will take two or three images. In some cases. The facility where you get your imaging often sets the protocols. They use a one‐size‐fits‐ all approach. there are hidden dangers. In a recent survey of radiologist and emergency room physicians. it is assumed that the information gained by the CT scan will offset the risks of radiation‐induced cancer. Even these small doses can potentially involve increased future risk of cancer. about 75 percent of the entire group significantly underestimated the radiation dose from a CT scan and 53 percent of the radiologist and 91 percent of the emergency‐room physicians did not believe that CT scans increased the lifetime risk of cancer. A CT examination gives the patient a very high amount of ionizing radiation. There are compelling medical benefits of these new procedures however. In fact. If the CT examination is used to diagnose a potentially deadly medical condition. additional scanning and increase payment are directly related. . A typical CT examination delivers a dose of 5−10 mSv. many institutions have no CT protocol tailored specifically for small adults or children. For example. The technology is more complex and often imaging personnel will trust the computer software without crosschecking service manuals.51 The Dangers of Medical Radiation CT imaging–often referred to by its old name CAT scan–has grown rapidly within the past few years. they currently have no way to know or estimate any given patient’s cumulative dose. Many medical physicists are over‐relying on computer programs without checking their equipment or using common sense. The imaging field is also facing a lack of knowledge on the part of the doctors referring patients for CT scans. Despite these dangers.
Eight percent of the junior doctors in an Irish study believed ultrasound involves the use of ionizing radiation. even worse. a patient entering a hospital or medical facility is immediately at the mercy of the personnel performing the examination. Eight states allow therapists to perform medical imaging other than mammography with no credentials or educational requirements. the technologist taking your x‐rays has to have completed a minimum of two years training and pass the American Registry of Radiologic Technologist (ARRT). only 30% of their junior doctors correctly estimated the effective radiation dose from a CT scan of the brain. and 55% said patients never asked them about the risks involved. which is a national registry examination. 60% of these doctors never explained to patients about the risks versus the benefits of radiation exposure. Unfortunately. . some states have strict licensure laws for therapist and x‐ray technologist. Lack of Training The next critical area is a lack of training on the part of the technicians and technologists performing the CT scan. and 27% thought MRI involves radiation. with 48% underestimating the effective dose from brain CT scans and 50% underestimating the dose from a CT scan of the abdomen and pelvis. in seventeen states the technician or a therapist who operate the radiotherapy machine does not have to be licensed. However. In many states. In New York State. Furthermore. Yet many of these individuals are unregulated. In a recent Irish study. Fortunately.Olive Peart 52 The lack of knowledge of radiation danger is not unique to United States. the medical personnel working with radiation devices are not keeping up with changes in complexity of the machines.
Repeats will only result in an additional unnecessary radiation dose to the patient. This means that anyone. Radiologic technologists could play an important role in limiting radiation exposure by carefully checking the dose and correlating it to the size of their patient before imaging. the patient. the radiation dose for each x‐ray examination should be tailored to the type of study being performed and the size of the patient. North Carolina and New Hampshire plus the District of Columbia have no basic competency. patients can be at the mercy of technicians who have had no training or only a two weeks training course. South Dakota. Fourteen states have no oversight. the patient. Repeats are sometimes unavoidable but will increase with poor skills and lack training on the part of the imaging professionals. Technologists should always verity the validity of the request even if means contacting the referring physician’s office or the . resulting from the imaging of the wrong part or wrong patient. Ideally. In these states. Georgia.53 The Dangers of Medical Radiation That is not the case in many other states. also lead to unnecessary radiation dose to the patients. Alaska. Errors. Idaho. no certification and no educational requirement. Responsible technologists should also check that the patient’s request to prevent duplication or errors and to verify the patient’s identity before imaging. can take you into a room a deliver a lethal dose of radiation to you. Another factor is the need to reduce the number of repeats during an imaging study. anyone. can take you into a room a deliver a lethal dose of radiation to you. Fourteen states. Michigan. Thirteen states allow unlicensed and untrained personnel to expose the public to dangerous levels of radiation. even someone off the street. Nevada. Alabama. Duplicate imaging is wasteful and also results in unnecessary radiation dose to the patient. even someone off the street. Missouri. Wisconsin. Oklahoma.
are not radiologists. California. Kentucky. Nevada. Montana. South Dakota. Many hospitals recognize the importance of having qualified personnel working with radiation emitting devices and accredited hospitals often employ technologists in good standing with the ARRT. The result has been a dramatic increase in the number of radiation burns within the last few years. Washington. Wisconsin. Many of these burns could have been easily prevented by careful monitoring of the fluoroscopy time during the interventional or surgical procedure. Maine. New York and Texas have licensure requirement for physicists. Maryland. Verifying the patient’s identify reduces the chance of imaging the wrong patient an exposing the patient to unnecessary radiation. Tennessee. The American Association of Physicist in Medicine report that in the following states no information is available on physicist qualifications or they require neither licensure nor registration to practice: Alaska. Louisiana. The main agency that provided examination testing for technologist performing x‐ray or CT examinations is the American Registry of Radiologic Technologist (ARRT). . Vermont. Often these doctors have no knowledge of radiation safety or radiation dangers. Wyoming. In many hospitals the doctors performing high radiation studies such as angioplasty and surgical procedures such as stent placement. Oklahoma. The knowledge and education of cardiologists and surgeons often does not include specific education courses on how to monitor. Idaho. Pennsylvania. Hawaii. Cardiologists and surgeons are moving into the field of interventional radiology.Olive Peart 54 radiologist. Connecticut. Only the states of Florida. Georgia. District of Columbia. North Dakota. manage or reduce the radiation dose to patients.
55 The Dangers of Medical Radiation In 2009. called a phantom that mimicked the human neck and head. a beam‐modifying device used to filter the radiation. In documentation of radiation errors researchers found that on 284 occasions. The resulting error exposed his entire neck. The New York Times recently reported the death of a 43‐year‐old patient. The multileaf collimator on the linear accelerator of an IMRT unit was left open during his treatment. her skin started peeling and the hospital decided to investigate the reason for her injury. she was dead. only 33 States required radiation therapists to be licensed by a State accrediting board. radiation missed all or part of its intended target or treated the wrong body part entirely. Another patient with stomach cancer was treated for prostate cancer. After her 28th treatment. or even close. Another patient developed a sore on her chest during radiation treatment. including one brain cancer patient who received radiation intended for breast cancer. A year later. Fifty patients received radiation intended for someone else. radioactive seeds intended for a man’s cancerous prostate were instead implanted in the base of his penis. In a radiation oncology study nearly 30% of hospital seeking admission into the National Cancer Institute trial had failed to accurately irradiate an object. The overdose resulted in a wound that would not heal. He died after receiving a huge overdose–seven times his prescribed dose−on three separate occasions during radiation therapy treatment. Doctors even tried reconstruction using muscle from her back and skin from her legs. In one case. from the base of his skull to the larynx to seven times the prescribed dose. . the patient received three and a half times the prescribed radiation dose during each treatment. Without the wedge. They discovered that the linear accelerator was missing a wedge.
heart attack patients are getting the equivalent of 850 chest x‐ rays within the first few day of hospital admission. It is true that tests are often a requirement. MRI or nuclear medicine testing. the general public often demands tests based on ‘It can’t hurt!’ or ‘More is better!’ We need to stop the automatic request for tests when visiting the doctor. Also.. A test is a quick way for doctors to give the perception of doing something. x‐ray. Physician. Researchers estimate the within a few decades two percent of cancers in the United States will be due to medical radiation. In fact. Unnecessary Tests The natural background radiation that we all receive is about 3 millisieverts per year. Imaging performed only by qualified personnel will not eliminate radiation errors but it can significantly reduce the patient’s risk of unnecessary radiation exposure if the individual performing the imaging is properly qualified and trained in medical radiation and understands the danger that radiation poses. The trend is that imaging is being used for triage purposes and in many of these cases that imaging is unnecessary. often find it easier to order diagnostic testing versus properly examining their patients. Often when we go to the doctor the first step the doctor takes is to order an imaging study.S. Another study showed that in the U. however. whether it is CT scan. stressed and overworked. typically an . A big study last year found that 4 million American were actually getting more than 20 millisieverts a year from medical imaging. in general we feel that we have not been fully examined until the doctor orders a test. Many new physicians do not know clinical smyptomatology and cannot perform a good clinical exam of the patient.Olive Peart 56 Patients should request qualified personnel during any radiation imaging or therapeutic study. A few people were getting 20–50 millisieverts per year.
Our medical system is sophisticated and high‐tech but a big disadvantage is the ingrained instinct to try all possible tests. reduce their liability and satisfying the patient. the number of tests is unnecessary. These are often legitimate tests needed to diagnosis a problem but in many instances. Another area of unnecessary tests can occur by self‐referrals where the doctor will refer a patient for testing at a facility where the doctor has a financial interest. Patients do need to be more educated about their medical needs. there is no incentive for the doctor to reduce diagnostic testing. The biggest challenge facing individuals is figuring out when to say no. including x‐rays. A number of government experts have been warning about the risks of routinely using powerful CT (CAT) scans to screen patients for colon cancer. There is another factor at play. .57 The Dangers of Medical Radiation emergency room doctor who orders a CT scan and other complex test on the patient will increase revenue for the hospital. lung cancer and other cancers. Navigating the debate can be difficult because doctors. patient advocacy groups and manufactures often endorse positions that are in their economic self‐interest. A typical example occurs when a patient goes to the doctor’s office for pain and ends up having all testing. Instead of a CT scan screen for colon cancer. the American College of Gastroenterology recommend the doctor use a flexible tube (colonoscopy) to view the insides of the colon. In this win‐win situation. Doctors will sometime order unnecessary tests on patients in a concept called ‘practicing defensive medicine’–meaning that the doctor will order a test solely because the patient requests the particular test and the doctor is afraid of a future lawsuit. taken at the office.
it used to just 16. An estimated 70 million CT scans are performed in the United States every year.5%.Olive Peart 58 The average lifetime dose of diagnostic radiation has increased sevenfold since 1980. That means that 20 million adults and more than one million children get CT scans that are needless and are putting themselves at risks. . medical radiation now accounts for more than 50% of the populations total exposure. A single CT scan can deliver the equivalent of 400 chest x‐rays. up from three million in the early 1980s. The top sources of radiation used to be normal background radiation from things like radon in the soil and cosmic energy from the sun. Studies suggest that about 33 percent of all diagnostic tests are unnecessary. In United States today.
In many states. Radiation therapists are not regulated in seventeen states. Until the public becomes agitated enough to request protection from unsafe radiation doses and until the public begins demanding licensed technologists. we will continue to experience an unprecedented levels of unnecessary radiation during imaging procedures. accidents are rarely if ever reported. Fortunately. Manufacturer use this information in their effort to get the radiologist the best possible image of the patients’ internal structures. The basic problem is getting facilities. . the advanced technology in use today comes at the expense of patient dose. real‐time monitoring of the skin dose during fluoroscopy procedures is possible but the technology is unavailable on many fluoroscopic units. doctors and manufactures to use it. For example. x‐ray technologists are not licensed. In eight states. there are many different tools available to lower dose. and medical physicists have no oversight in thirty‐one states. There is a definite reluctance to spend money on safety improvements when the fact is that the image obtained is perfect. There are also no state licenses for medical dosimetrists. There is no single agency overseeing medial radiation and no central clearinghouse of medical error reporting in the United States. board certified radiologist and licensed physicist. because the concentration has always been on getting the most detailed image. However. One of the benefits of self‐regulation is that there is now a pool of data available to manufactures and facilities.59 The Dangers of Medical Radiation HOW IS MEDICAL RADIATION MONITORED? The radiology industry has very little government oversight and much of the industry is self‐regulatory.
Often a public outcry only occurs after the news media or an individual patient has publicized serious radiation injuries. However.Olive Peart 60 States also have different rules. Modest improvement on an existing medical device does not need clinical trial or additional federal approval to prove their safety and efficacy. . In some states radiation accidents do not have to be reported. this has lead to the approval of many radiologic medical devices with minimal oversight. This means that in general. Severe radiation accidents are often underreported because these injuries can take years to show. doctors are allowed to use approved medical devices as they see fit.
The ACR accredits facilities in Breast ultrasound. Patient choosing to go to an ACR accredited facility will know that these facilities have completed a rigorous review process and meets nationally accepted standards. stereotactic breast biopsy. nuclear medicine. positron emission tomography (PET). which will include quality control procedures to test and evaluation the equipment on a regular basis. which means that the technologist performing your examination is competent and has completed an approved education program. The ACR program also ensures that there is a quality assurance program in place. computed tomography (CT). All imaging and procedures must be conducted by board‐certified radiologists (doctors who read x‐rays and CT scans or administers radiation therapy treatments).61 The Dangers of Medical Radiation INITIATIVES UNDERWAY TO REDUCE RADIATION DANGERS Accreditation The American College of Radiology (ACR) accredits facilities such as hospitals or medical centers. ultrasound and radiation oncology. One of the goals of the ACR is to make radiation‐ imaging safe. The accreditation program also evaluates the qualification of the imaging or therapeutic personnel. magnetic resonance imaging (MRI). Accreditation is a voluntary public service. An ACR accredited facility practices high standards and undergo a rigorous peer‐review evaluation of their practice. California CT Oversight The governor of California recently signed new legislation that will require all hospital and clinic CT scanners in the state of . mammography. effective and accessible to those who need it.
asrt. The ASRT believes that the best way to ensure the quality and safety of medical radiation procedures is to establish national education and certification standards for the technical personnel who perform them. In many states radiation accidents involving CT scans. Central Database The American Society of Radiation Oncology called for a central database for reporting errors involving linear accelerators. fluoroscopy equipment and radiation therapy devices do not need to be reported. Hitachi. forging alliances and assessing potential opposition. Equipment Safeguards CT manufactures GE. CARE Bill The ASRT has sponsored a Consistency Accuracy. The society is also focused on drafting bills. to documentation any radiation over exposure of 20 percent over normal exposure.Olive Peart 62 California to be accredited by January 1. 2013. 2012 also requires hospitals and clinics to record radiation doses for CT scans in the patients’ medical records. to document repeated exams except when ordered by a physician. Siemens and Toshiba will add “dose check” safeguards to their scanner starting 2010. radiation therapy and nuclear medicine. which takes effect on July 1. their physician and the California state health department.org. More information on the CARE Bill can be found at www. Responsibility and Excellence (CARE) bill in congress. building grassroots network. and to report exams of an incorrect body part to the patient. all aimed at state legislative efforts to enact licensure for radiography (x‐ray and CT imaging). Philips. This feature will let the scanner operator know when the . The law.
over 49 other medical associations worldwide have joined the alliance.63 The Dangers of Medical Radiation recommended radiation dose for the various CT exams has been exceeded. has pioneered a new concept in CT imaging. Technologists can download program that will help them reduce the radiation doses. especially when imaging children. a manufacture of CT units. The campaign was started in 2007 by the Alliance for Radiation Safety in Pediatric Imaging. a reconstruction technique reprocesses the raw CT data enabling an 80% dose reduction while maintaining diagnostic quality images. founded by the American Society of Radiologic Technologist (ASRT).imagegently. After any CT image.org) and download educational brochures on CT imaging of children in easy to understand language. the American Association of Physicists in medicine and the Society for Pediatric radiology. Even before the start of the scan. The idea here is to integrate dose information into a national dose registry that tracks radiation exposure to patients. another feature will let the operators know that a dangerously high radiation level has been set. Manufactures are also working with professional organizations. iDose Philips. American College of Radiology (ACR). regulatory agencies and clinicians to establish radiation reference doses for CT exams and to develop standardized method of recording CT dose. Since its inception. . The site also has information for facilities. Parents and patients can visit the image gentle website (www. In the concept call iDose. Image Gently Campaign This is an initiative underway to educate parents about radiation and its effects on children. the raw data is compiled in a reconstruction process to create high quality diagnostic images.
The agency is pushing the industry and doctors to set standards for common test. Suggestions include method of displaying. vendors. government agencies. referring physicians and patients. The aim is to expand the principles and education of the Image Gently campaign to cover CT imaging of adult‐size patients. the American Society of Radiologic Technologist (ASRT). educational institutions. Image Wisely seeks to raise increase awareness of opportunities to eliminate unnecessary imaging examinations and to lower radiation in necessary imaging examinations to only what is needed to acquire appropriate medical images. The intent is to target manufactures of CT and fluoroscopic devices urging them to incorporate safeguards into the design of their machines. They are also considering record‐keeping requirement to track patient doses and the technical parameters used during the imaging exam. recording and reporting the radiation dose to the operator. particularly CT scans. Initially the campaign will focus on CT imagine but will broaden to include nuclear medicine. The focus is to provide education resources for radiologists. and optimization of the radiation dose used during each procedure. and to educate health care organizations.Olive Peart 64 Image Wisely This campaign was launched by four partners: The American College of Radiology (ACR). medical physicists and technologists. Industry Standards The FDA has stared and initiative to reduce unnecessary radiation exposure from medical imaging. the Radiological Society of North America (RSNA) and the American Association of Physicists in Medicine. fluoroscopy and radiography. sounding an alarm and stopping the scan if the patient would be burned by . methods of alerting the users when dose exceeds a diagnostic reference level. They have adopted two principles of radiation protection: appropriate justification of the radiation procedure.
or develop cataracts. The FDA encourages patients to visit their web site where they plan to develop a patient medical imaging history card. Many manufactures have agreed to implement these initiatives within the next few years. the FDA and the Centers for Medicare & Medicaid Services are collaborating to improve the oversight of medical imaging facilities by incorporating key quality assurance practices into mandatory accreditation and also setting conditions of participating. the equipment would shut down if it does not detect that the treatment plan has been checked or that beam‐modifying devices were correctly placed and the patient properly positioned. Under new proposals. which will allow patients to track their own . most equipment now leaves the quality assurance checks to the discretion of the user. Oversight of Medical Imaging In the hope of promoting the safe use of advanced imaging technologies. The updates also call for the installation of patient‐ positioning confirmation that would require the therapist to compare an image of the patient in the correct treatment position with the actual patient at the time of treatment. and training users to capture and transmit radiation dose information to a patient’s electronic medical record and to national dose registries.65 The Dangers of Medical Radiation the radiation. Manufacture Updates Two associations representing some of the biggest manufacturers of radiotherapy equipment plan to install software that would include fail‐safe features to help reduce harmful radiation overdoses and other mistakes. In addition. treatment would be blocked unless quality assurance verification is performed on all initial or modified treatment plans. suffer hair loss. Under the plan.
increasing the patient’s risks for radiation induced cancer.Olive Peart 66 medical imaging history and share it with their physicians. The most frequent problem sited was computer software issues resulting in radiation errors. Most of the radiation overdose problems stemmed from problems with the linear accelerators on computer‐controlled machines such as the IMRT units. .gov. Patients can access the site at: www. The doctors is then able to refer to the chart before ordering any test involving radiation and carefully weigh the risks and benefits of each test or even take an alternative approach. the agency has now recognized that this process is flawed. Radiation Tracking A few doctors and hospital have begun charting their patient’s radiation exposure. In practice. Strengthening the Approval Process The FDA is also strengthening the agency’s approval process for new radiotherapy equipment and will no longer allow new radiotherapy equipment to enter the market via the streamlined approval process that could involve outside reviewers. The streamlined approval process was initiated in the 1990s to speed the approval procedure and reduce the agency’s workload.fda. However. often one doctor does not know what another doctor has ordered in the past so tests are repeated.
Calculate your risks Patients can calculate and track their estimated radiation exposure using the calculator on the website. you should be given a lead apron and lead gloves if your hand will be exposed to the direct x‐ray beam. The site allows patients to create their own medical imaging record and generate an x‐ ray ‘risk report’ with information about cancer risk. http://xrayrisk. A knowledgeable technologist will be aware of the difference in radiation dose needed to image an adult versus a child and even the variation in radiation dose for a small or large adult.5 mm lead equivalent. Get lead protection during any x‐ray procedure If you are asked to hold your son/daughter during an x‐ray procedure. . It was created by Mike Hanley and is available as a free education resource. The technologist should be adjusting or modifying their protocol for children and small adults.com. Protective lead aprons should be at least 0. The site also points out that there are no studies proving any direct causality between medical imaging and increased cancer risks. These will stop approximately 90% of the radiation leaving the x‐ray tube at energies of 75‐peak kilovoltage (kVp).67 The Dangers of Medical Radiation WHAT CAN THE GENERAL PUBLIC DO? Appropriate Dose Find out if the dose selected for your imaging is appropriate.
The industry standard states that the gonads should be shielded with lead if the gonad will be closer than 5 cm or 2 inches from the primary x‐ray field during and exposure and if the shielding of the gonads will not affect the imaging. Gonad shields with a minimum of 1 mm lead equivalent can absorb 95−99 percent of primary rays when using energies of 50−100 kilovoltage. the shield must cover the area of the ovaries. In x‐ ray imaging. For females. For males. A PA or AP chest x‐ray on adult gives a skin entrance exposure of 12−26 mR Rules for gonad shielding During any x‐ray examination. this is particularly importing when imaging children and females of reproductive age. uterine tubes and uterus. . the importance of protecting the radiosensitive organs of the body cannot be overemphasized. the shielding should be placed to cover the testes and scrotum. The shielding should cover your front and back below the waist. giving maximum protection to your reproductive organs. Body specific protection Chest x‐ray: Request wrap around shielding to protect your gonads.Olive Peart 68 An AP chest x‐ray on infants gives a skin entrance exposure of 5 mR.
the embryonic and fetal doses should be limited to 5 mSv or 500 mrem (0.5mSv per month (0. Scoliosis Imaging Breast and gonad shielding should always be provided. the x‐ray beam should NEVER be directed at the breast. The monthly equivalent dose to the embryo or fetus should not exceed 0. Extremity Imaging: This includes any x‐ray of the shoulder to the finger & from the hips to the toes. can lead to breast cancer later in life. Studies have shown that directing x‐rays at the breast. especially during the early years of breast development. Gonad shielding should always be provided. or even the equipment in front of you. Also. Scattered radiation is produced after radiation passes through your body.05 rem or 50 mrem per month). Patients should stand with their backs to the x‐ray tube. Over the course of a pregnancy.5 rem).69 The Dangers of Medical Radiation Radiation comes from the x‐ray tube that is usually position behind you for the routine chest x‐ray but radiation also comes from the front in the form of ‘scattered’ radiation. As the radiation strikes tissues and other body areas. The cellular effects of radiation include DNA damage and cell death. Guidelines for Pregnant Patients Ionizing radiation to the uterus from medial test should be avoided if at all possible until after the 15th week of pregnancy. it diverts from its straight path and can bounce in any direction. .
(You should also ask to see the qualification of the technologist performing non‐radiation tests such as MRI and ultrasound). Sacrum and coccyx.Olive Peart 70 The following x‐ray examination require careful consideration during pregnancy because of the high radiation dose to the fetus and embryo: Lumbar spine. Track the type and number of exams and the location where the images are performed. By documenting imaging information patients can help prevent repetitive exams. Many patients do not even think about this. but the unqualified personnel will often repeat the x‐ray because of poor positioning or other factors that the person is not educated enough to know. is always wise to ask for the credentials of the person performing your x‐ray. CT imaging. which promotes high standards of patient care . Each ‘picture’ means another dose of radiation to you. CT or radiation therapy test. Know the Qualification of the Imaging or Therapeutic Personnel With the proliferation of unlicensed and unqualified personnel in radiology. The American Registry of Radiologic technologist (ARRT) is a national agency. especially when changing doctors or moving from one facility to another. Pelvic imaging. Intravenous Urogram (IVU). The basic principle that should always be followed in any radiology department is the principle of ALARA (As Low As Reasonable Achievable) Keep a Medical Image Record Card Keep a diary of any diagnostic test especially those involving radiation. Fluoroscopic procedures. Upper leg (femur).
. which should show the current year’s seal or valid date. Find out if there is an alternative test that does not involve radiation or uses a lower level of radiation.71 The Dangers of Medical Radiation by recognizing qualified individuals in medical imaging. Find out what specific methods are used to ensure that you are getting the lowest possible radiation dose Find out the specific risks of any test ordered. These individuals will be issued an ARRT certificate. Check List–Summary of Questions to Ask (before any procedure involving radiation) Always check the accreditation of the facility and the qualifications of the doctor and technologist. Ask to see the ARRT card of the technologist performing your examination. Individuals who are ARRT qualified must complete a clinical and academic training program and pass a qualifying examination. Always ask for lead protection/shielding. also the risks of not doing the test. Find out if the facility keeps track of the radiation dose given to their patients. interventional procedures and radiation therapy. Find out if the test was ordered solely for screening or was it ordered to diagnose a problem (CT scans for screening is not recommended) Find out how many x‐ray images will be taken and why.
and enforces ethics requirements for all technologists and therapists. advocacy and research. administers continuing education courses. radiation oncologists. . The goal of this agency is to enhance the quality of patient care through education. improve patient care services. and provide accessible service to those in need. The organization offers test and certification for technologists. medical physicists. interventional radiologists and nuclear medicine physicians. interventional procedures and radiation therapy. ARRT seeks to ensure high‐quality patient care services by recognizing qualified individuals in medical imaging. This is a private agency whose goal is to promote radiology imaging. ASRT American Society of Radiologic Technologists (ASRT) is one of the largest organizations of medical imaging and radiation therapy professions.Olive Peart 72 ORGANIZATIONS MONITORING RADIATION SAFETY ACR The American College of Radiology includes radiologists. ARRT The American Registry of Radiologic Technologists (ARRT) is the largest credentialing organization in the United States. influence the social‐economic wellbeing of doctors and allied health professions. and therapists.
73 The Dangers of Medical Radiation FDA The Food and Drug Administration (FDA or USFDA) is a federal agency of the United States. The agency has been active in radiation protection and measurements since 1929. . National Council on Radiation Protection and Measurement The National Council on Radiation Protection and Measurements (NCRP) is a private agency that seeks to provide information and guidance on radiation protection and measurements. The agency is responsible for protecting and promoting public health through regulations and supervision.
M. RT Image Magazine. Rabin. February 1. New York Times. June 10. P57. March 2010. 10.D. 11. Radiology Today. A19. Martino S. RT Image Magazine...C. April/May 2010p. Spread the Word about Image Gently. 4..J. P12 12. New York Times.H. February/March 2010. http://www.R. Wolohan D. et al. August 24.org/ Accessed September. and Fluoroscopy. FDA Targets Radiation Exposure in CT. P21 13. Balancing Benefits and Risks–Managing Patient Dose in CT Brain Perfusion Scans. New Scan. Calculating Risk. April/May 2010. P28. ASRT Scanner. P38 . Urso R. ASRT Scanner. ASRT position statement. Bogdanich W. D5. Brusin J.P8 16. Chain Reaction. ACR American College of Radiology (ACR). 14. Radiology Today. American Roentgen Ray Society (ARRS). As Low as Reasonable Achievable. July 5. 8.D.M. Mackie T. Immerso V. 2010. 2010. 17. 2010. ASRT Scanner. 2. April/May 2010 6.D.54‐55. 2010.acr.J. ASRT Scanner. Lung C.Olive Peart 74 REFERENCES 1. January 4. Focus shifts to strengthening state licensure. Helical IMRT: New Treatments Taking Shape for Multiple Myeloma.org/ Accessed September 2010. 9. Radiation Protection. Assmus A. Early History of X Rays 7.arrs. Going in Circles: Looking for Safety in Radiation Exposure. ASRT Scanner. Safety Features Planed for Radiation Machines. Image Gently–A Campaign Everyone Can Get Behind. Congressional Hearing. April 2010. ASRT Scanner. Radiologic Technology 78:378‐392 2007 5. Yahnke C. RT Image Magazine. 2010. February/March 2009. R. Woloham D. 3. Marotta M. April/May 2010. Radiation and Risks are Focus of Study. Nuc Med. CARE Bill Front and Center at Congressional Hearing. 15. P 8. 2010. http://www.
Shope T. 21. The New York Times. PA14. . Louis. Medical Group Urges New Safety Rules on Radiation. 2010. 9th Ed. Radiologic Science for Technologists. Tolekidis G. At Hearing on radiation. Office of Science and Technology.75 The Dangers of Medical Radiation 18. A15. 19. Center for Devices and Radiological Health. January 19. February 2007. ASRT Scanner.com/article/20100614/NEWS/10 0619836. D. Beware of too much medical radiation. Radiologic Technology 78:378‐392.htm 26. 2010. 25.P. Mobsy Elsvier. March 29.nytimes. Calls for Better Oversight. 2010. 24. Marchione M.com/2010/01/24/health/24radiation. Scientist Say FDA Ignored Warning on Radiation Exposure. Diagnostic Imaging. Missouri. http://www. 2010.greeleytribune. Bushong S. June 14.#5. 23. Brusin J. Vol39. The New York Times. http://www. Radiation‐induced Skin Injuries from Fluoroscopy. Ph. 22..C. October/November 2010.ht ml?_r=1&ref=radiation_boom 27. and Ways to Do Harm. 2010. 2008. February 27. 2010. Saturday. accessed: September 2010.fda.H. The New York Times. Food and Drug Administration.gov/Radiation‐ EmittingProducts/RadiationEmittingProductsandProcedures/ MedicalImaging/MedicalX‐Rays/ucm116682. February 5. Bogdanich W. Bogdanich W. Radiation Protection. Published: January 23. Harris G. Robb M.46‐47. A12. 2007. Am I in Danger? ASRT Scanner. http://www. Ward P. Monday. Radiation Offers New Cures. St. Irish Study Reveals Widespread Ignorance of Radiation Risks. Bogdanich W.P14‐15. 28.B. Image Wisely Focuses on Dose Reduction in Adults. 20.
Texas. Washington. Illinois. Pennsylvania. West Virginia (podiatry only). New Jersey. Florida. Delaware. Certification or Recognition Standards by Discipline. Kansas. Indiana.org/Content/GovernmentRelations/TallyofStateLicensure. Florida. New Mexico. Connecticut. Maryland. Oregon. Delaware. California. Minnesota.Olive Peart 76 STATE STATUS ASRT Tally of State Licensure. Wisconsin. Limited X‐ray Machine Operators. Wisconsin. Ohio. Wyoming. Rhode Island. Kentucky. Ohio. Nebraska. New Jersey. Wisconsin. Iowa (must pass hospital fluoro exam). Colorado. Maine. Vermont.asrt. 31 States–Not permitted to perform fluoroscopy Arizona. Nuclear Medicine Technology. Iowa. Florida (fluoro under direct MD supervision).aspx Radiography. Montana. Maryland. Arkansas. New Mexico. Colorado. Illinois. Wyoming. Arkansas. Nebraska. Radiation Therapy. South Carolina. Delaware. Arkansas. Washington. Maine. Tennessee. Texas. Illinois. Minnesota. . Maryland. Louisiana. New York. California. Florida. Pennsylvania. North Dakota. Mississippi. Arkansas. 39 States: Arizona. Pennsylvania. Delaware. Iowa. Wyoming. Virginia. Maine. California. Illinois. Virginia. Oregon. Connecticut. Utah. Hawaii. Rhode Island. Massachusetts. 33 States Arizona. Ohio. Kansas. Hawaii. Indiana. Montana. Massachusetts. New Hampshire. Massachusetts. 27 states Arizona. Iowa. West Virginia. Louisiana. Vermont. Vermont. North Dakota. Kentucky. Tennessee. Louisiana. West Virginia. Tennessee. South Carolina. South Carolina. New Jersey. Utah. Texas. Washington. Oregon. Rhode Island. Hawaii. Mississippi. California. Utah. New Mexico. Kansas. Colorado. Source: https://www. Maine. New York.
Nevada. California. 3 states New Mexico. North Carolina. Oregon. Massachusetts. Washington. Sonography. New Jersey. Pennsylvania. Virginia. Iowa. Ohio Oregon. Idaho. Washington. Missouri.77 The Dangers of Medical Radiation Mississippi. Minnesota. South Carolina. Oregon. Cardiovascular Technologists (RCIS) Arkansas. Texas. 11 States Arizona. Utah. 5 States Alabama. South Dakota. New York. West Virginia. New Mexico. South Carolina. 28 states Arizona. West Virginia. 2 states New Mexico. District of Columbia. Delaware. Arizona. Washington Fluoroscopy. California. Fusion Imaging. West Virginia. Oregon. Computed Tomography. 1 state Alaska . Vermont. Iowa. Oklahoma. Radiologist Assistant. Florida. Colorado. Mississippi. Colorado. Louisiana. New Jersey. Michigan. Arkansas. Vermont. Ohio. Ohio. Minnesota. Georgia. New York. 3 states Colorado. Maryland. Montana. Illinois. Texas. New Mexico. New Mexico. Maryland. Oregon. Wyoming. Wisconsin. Florida. Wyoming. Ohio. Vermont. Rhode Island. No Standards. Mammography. Kentucky. Magnetic Resonance. Tennessee. Connecticut. Rhode Island. Pennsylvania.
The term comes from apasia meaning defective development or congenital defect. The acronym means ‘As Low As Reasonable Achievable. The technique requires the threading of a thin tubing called a catheter through the blood vessel to the narrowed part or disease portion of the vessel. Often angiography is performed to check the vessels of the heart. This technique is commonly used to treat atherosclerosis and other heart related conditions. It is at these cells called alveoli that air exchange will take place when we breathe in oxygen and let out carbon dioxide. The technique involves the injection of a contrast agent into the blood vessel and fluoroscopy to track the contrast agent as it flows though the blood vessels. Angioplasty is an interventional technique used to widen a narrowed or obstructed blood vessel. Angiography or arteriography is an interventional technique used to visualize the lumen or inside space or blood vessels within the body. Alveolar cells are tiny air sacs in the lungs.’ The idea here is that all radiation workers should keep the public and their co‐workers safe from the harmful effects of radiation by using the lowest possible radiation dose when utilize radiation for diagnostic or therapeutic purposes.Olive Peart 78 GLOSSARY OF TERMS ALARA represents the guiding principal of radiation protection. In . Aplastic anemia is a generalized term describing a condition where the bone marrow does not produce sufficient new blood cells to replace the old or dying ones. The catheter generally has a balloon at the end that can be inflated to widen the artery or it could have a wire cage that can be expanded and left in place to keep the blood vessel open.
called an ion. Ataxia describes a lack of coordination while performing voluntary movements such as walking. Closed‐circuit television (CCTV) is the use of a video camera to transmit a signal to a specific place. One Bq is defined as the activity of a quantity of radioactive material in which one nucleus decays per second. It may appear as clumsiness. symbol: Ci. Atoms can unite or bound to each other to form a molecule. if they have more electrons. The smaller the collimated x‐ray beam. The atom can also be neutral if the protons equal the electrons. Atom is a basic unit of all matter and can only be view with specialized microscopes. Becquerel (symbol: Bq) is named for Henri Becquerel. The atom consists of a central dense nucleus surrounded by negatively charged electrons. The nucleus has positively charged protons and electrically neutral neutrons. They are positively charged ions if there are more protons. Collimation is a method of making the x‐ray field size or area smaller. inaccuracy. the patient will have low red blood cells. This will also reduce scatter .79 The Dangers of Medical Radiation aplastic anemia. who shared a Nobel Prize with Pierre and Marie Curie for their work in discovering radioactivity. Patients are monitored via CCTV. or instability. the smaller the area that radiation will expose. Atoms can be a negatively charged. The technology is used in radiation therapy because no one can remain in the therapy room while a patient is undergoing radiation therapy treatment. The older unit is the Curie. low white blood cells and a low platelet count. The becquerel measures the amount of radioactivity emitted from a radioactive source and is mainly used in nuclear medicine. This signal differs from broadcast signals in that they are not openly transmitted. Movements are not smooth and may appear disjointed or jerky.
or the object. Computed Tomography (CT) imaging (often called CAT scan by the public) uses x‐ray to create a cross‐section anatomy of the human body. placed in the colon (as in barium enemas) or injected into veins. magnetic resonance imaging (MRI). The phenomena will occur when x‐rays and gamma rays leaves a source. It is called a closed system because blood never leaves the network of arteries. position emission tomography (PET).Olive Peart 80 thereby improving the image contrast and reducing patient dose by minimizing unnecessary radiation to nearby organs outside the area of interest. because there is no way to determine the path of these scattered photons anyone in an x‐ ray room can be at risk and should wear lead projection. and ultrasound will use different contrast agents. The incident x‐ray photon is deflected from its original path by an interaction with an electron. In addition. They are substances used to improve the visibility of the internal structures of the body during diagnostic testing. Compton scatter is the scattering of x‐ray photons that occurs when an x‐ray beam passes through your body or any object. nuclear medicine. Different modalities such as Computed Tomography (CT). Cardiovascular System refers the heart and blood vessels used to pump blood though the closed circulatory system and supply nutrients throughout the body. Contrast agents or contrast mediums are often referred to as ‘dyes’ by the public. veins and capillaries. through your body. The contrast agents can be swallowed. CT imaging also allows the creation of 3‐ dimentional images and will generally create images of the body . The electron is ejected from its orbital position and the x‐ray photon loses energy but will continue to travel along a different path.
Other modalities that are referred to as diagnostic include ultrasonography. The Curie measures the amount of radioactivity emitted from a radioactive source and is mainly used in used in nuclear medicine. It can be the accumulated dose to the whole body. The only cells with no DNA containing nucleus are red blood cells.81 The Dangers of Medical Radiation that are more detailed that that produced using general x‐ray imaging. Curie (symbol: Ci) was named in honor of the French physicist Marie Curie. The SI unit is the Becquerel. a specific area of the body or could represent radiation exposure over a given period of time. The DNA also has instructions needed to construct other components of cells such as proteins. symbol: Bq. magnetic resonance imaging (MRI) and positron emission tomography (PET) imaging. DNA or Deoxyribonucleic Molecules are located within cells. nuclear medicine. Diagnostic Radiography is the use of ionizing electromagnetic radiation such as x‐rays. DNA is organized into long structures called chromosomes. to image the human body in order to identify problems or diseases. The dose equivalent is the absorbed dose of specific types of radiation multiplied by a "quality factor. Cumulative Dose is the total dose to an individual resulting from a single or repeated exposure of ionizing radiation to an individual. and other molecules such as RNA molecules. Dose Equivalent attempts to relate the absorbed dose to the biological effect of that dose." When an individual is exposed to x‐ or Gamma . DNA contains the genetic instructions for all living organisms except some viruses.
the quality factor is one. In humans. hands. feet. in the region where radiation first strikes the body. that is. Entrance Skin Dose or entrance skin exposure refers to the dose given to the skin surface. after the fertilization of the egg cell by the sperm. The condition is named after John Langdon Down a British physician who described the syndrome in 1866. At this stage the heart. 1 rem equals 0. it will diverge. symbol: Sv.01 Sv. Field size refers to the distribution of the x‐rays from its source. Dye−see contrast agent. Fetus refers to development after the fertilization of the egg cell by the sperm. brain and other organs are present but will have only minimal operation. the result is called an embryo until about eight weeks after the fertilization. The SI unit is the sievert. Down Syndrome is a chromosomal disorder. The baby is born with an extra pair of chromosome. . As x‐rays leaves the x‐ray tube. Epilation or hair loss is the removal of all hair. The unit of dose equivalent is the rem. Embryo is the multicellular organism in its earliest stage of development. Down syndrome is associated with some impairment of mental ability (cognitive skills) and specific facial characteristics. like light.Olive Peart 82 radiation. The geometric relationship is shown in the diagram. Erythema is sunburn like appearance or reddening of the skin. The fetal stage begins at about the ninth week after fertilization.
The gamma ray is a form of ionization radiation and can cause serious damage if its use is abused. Fluoroscopy often images the body in motion and utilizes a contrast agent that can be swallowed or injected. the main distinction between x‐ray and gamma rays was based on energy. Gamma radiation or gamma rays are electromagnetic radiation with very high frequency therefore short wavelength. A clearer definition of gamma rays is now based on its origin. During a fluoroscopy procedure. X‐rays are emitted by . with gamma rays considered a higher‐energy then x‐rays. One hertz is equal to 1 cycle per second. Frequency is the rate of rise and fall of a wave. However. the radiologist is able to view the body’s internal structures on a television monitor or liquid crystal display (LCD) monitor or electronic display because images created by the x‐rays are sent to an intensifying tube that is connected to a closed‐circuit television system. It is usually expressed in cycles per second and the unit of measurement is the hertz (Hz). The frequency of a wave would be the bump of the crests or the number of valleys to pass a certain point in a specific time. In the past.83 The Dangers of Medical Radiation Fluoroscopy is the use of x‐ray to visualize the internal organs of the body. modern linear accelerators used in radiation therapy can produce very high energy x‐rays.
VIR or CIR) is a sub‐ specialty of radiology where minimal invasive techniques are used to diagnose or correct diseases or pathology. vascular interventional radiology or cardiac interventional radiology (IR. It begins when a fertilized zygote implants in the female's uterus and ends once it leaves the uterus.g. the second trimester is from the 14th to 27th week. Gestation in mammals describes the length of the pregnancy. The gestation period is counted from the last menstrual period (LMP) and can be divided into three trimesters. It is designed to assess intelligence and can be used to predict educational achievement or special needs. The older unit is the Radiation Absorbed Dose. symbol: rad. body tissue). each three months long. The biological effects of radiation will vary by the type and energy of the radiation and the organism and tissues involved. it is the ovaries located in the pelvic cavity (lower abdomen). The rad is still the standard used in United States and is based on the old English system. Gonad is the organ that makes sperm cells for the males and egg cells for the females. Interventional Radiology. IQ or intelligence quotient is a score derived from one of several different standardized tests. it is the testes (singular testicle) located in the scrotum sac and in females. The first trimester is from the last period to the 13th week. Gray (symbol: Gy) is the SI unit measuring the amount of radiation energy absorbed in a medium (e.Olive Peart 84 electrons while gamma rays are emitted by the nucleus or from particle decays. The zygote is the initial cells formed when the sperm from the male fertilizes the ovum from the female. Most other countries use the metric system. and the third trimester is from the 28th week through the 40th week. The . In males.
Examples of VIR or CIR procedures are angiograms or angioplasty. Ionization is the process by which an atom or molecule gains either a positive or negative charge. Joint Commission (The Joint Commission) is an independent. Lead shielding can include lead barriers. If it is positively charged. Lead shielding refers to the use of devices made of lead to shield or protect people from radiation. The charged particle is called an ion because the total number of electrons is not equal to the total number of protons. lead aprons and breast shielding. such as hospitals. thyroid shielding. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality patient care and requires organizations to follow specific standards that demonstrates the commission’s commitment to providing safe and effective high quality care. Leukemia is cancer of the blood or bone marrow characterized by an abnormal increase of blood cells. usually leukocytes which are the white blood cells. gonad shielding. not‐for‐profit organization that accredits and certifies many health care organizations. The types of leukemia are named after the specific blood cell that becomes cancerous.85 The Dangers of Medical Radiation technique is also called Guided Surgery or Surgical Radiology and is usually helpful in that patients can avoid expensive and dangerous surgical procedures. in the United States. Lead is used because lead has a high atomic number or density and can effectively stop radiation at certain energy levels. .5 mm lead or equivalent. A typical lead shielding can have 0. the correct term is cations and a negatively charged ion is an anion. lead gloves.
as in the oxygen molecules O2 or the molecule can be made up of different elements. Catabolism breaks down organic matter. The atoms in a molecule can be the same element. Metabolism is usually divided into two categories. Nuclear imaging includes Positron Emission Tomography (PET) imaging and Breast Specific Gamma Imaging (BSGI). These radioisotopes will‐ have an affinity to a particular tissue or organ and can be used . catabolism and anabolism. MRI testing does not use x‐radiation and can often show problems that cannot be seen with other imaging modalities. It can also give very good soft tissue detail of the human body for example details of joint articulations. also called a radiopharmaceutical or radioisotopes. Molecules are small particles in all living and non‐living things that cannot be seen with the naked eye.Olive Peart 86 Metabolic Activity or Metabolism describes the different chemical processes that happen in living organisms to maintain life. The technology is often considered molecular imaging because it can demonstrate the function of organs where other modality imaging shows only anatomy. MRI examinations are noisy and can take up to 45 minutes. They are groups of more than one atom. maintain their structures. Often the examination involves the injection of a contrast agent into an arm vein. and respond to their environments. A single molecule can have millions of atoms. These processes allow organisms to grow and reproduce. whereas anabolism uses energy to construct components of cells. Nuclear Medicine can involve diagnostic or therapeutic procedures. All nuclear imaging requires the injection of a radionuclide. as in the water molecule H20. Magnetic Resonance Imaging (MRI) is a diagnostic imaging modality that uses powerful magnetic fields and radiofrequency signals to visualize detailed anatomy of the internal structures of the human body.
which will determine how much radiation a patient can be given. They check the calibration of radiation therapy and x‐ray machines and ensure that these machines will deliver the correct dose of radiation based on the factors set by the technologists. therapy department the medical physicist will also create a treatment plan. Moreover. liver or gallbladder. Ovum (plural ova) is the female reproductive cell located in the ovaries.87 The Dangers of Medical Radiation to deliver high dose of radiation to the specific tissue or specific organ. Nuclear medicine can be used treat tumors for example in the thyroid glands.01 Gy. symbol: Gy. In today’s imaging world many treatment plans will be generated by a computer but initial input and organization of information has to be handled by a human. Different materials receiving the same exposure may not absorb the same . Rad (Radiation Absorbed Dose. Ovaries are the female reproductive organs. One rad is equivalent to 0. body tissue). The biological effects of radiation will vary by the type and energy of the radiation and the organs and tissues involved. Physicist or Medical Physicist can often play an important role in patient safety. In the radiation. Most other countries use the metric system using the SI units. the egg cells for females.g. Studies have found that physicist who over rely on computer programs tend to result in more mistakes. the medical physicist must review all treatment plans. The rad is still used in the United States and is based on the old English system. Within the ovaries are the ova. Oncologist−see radiotherapist. symbol: rad) measures the amount of radiation energy absorbed in a medium (e. or to display the function of organs such as the heart. The SI unit of radiation absorbed dose is the gray.
pathology or condition.Olive Peart 88 amount of radiation. . it can also be used to image soft tissue area of the body such as the abdomen. Radiology can refer to two general areas. Radiography describes the use of x‐ray imaging to diagnose a disease. Therapeutic radiology uses ionizing radiation to treat a disease or pathology. In human tissue. Radiographer or technologist is a trained professional licensed to operate x‐ray equipment and to care for patients during radiological examinations or x‐ray treatment. Radiographers who operate equipment used for taking x‐ray images are known as diagnostic radiographers and those who operate equipment used for treatment are known as therapy radiographers. one Roentgen of gamma radiation exposure results in about one rad of absorbed dose. Radiography is particularly important in imaging trauma patient and finding bony fractures however. and nuclear imaging. Radiologist is a qualified doctor who is licensed to interpret x‐ ray images and performing certain types of investigation and treatment that rely on the use of ionization radiation or diagnostic imaging techniques. diagnostic and therapeutic. Diagnostic radiology uses an imaging modality to find out about a disease or pathology. ultrasound. magnetic resonance image (MRI). Another major sub‐specialty is interventional radiology. There are many sub‐ specialties of diagnostic radiology including: computed tomography (CT).
cells in the gonad and cells in the gastrointestinal tract (especially the small intestine) are particularly radiosensitive. it can be destroyed by radiation.89 The Dangers of Medical Radiation Radiotherapist or a clinical oncologist is doctor who specializes in the treatment of disease using x‐rays to kill cells. If a tumor is particular radiosensitive to radiation. The dose equivalent is a measure of the radiation dose to tissues whereas the absorbed dose measures the physical effects of radiation.01 Sv. such as bone marrow cell. This is the measure made by a survey meter. . cells in the thyroid.’ The rem attempts to gives the biological effects of radiation. in the body. One rem equals 0. The unit is named after the German physicist Wilhelm Röntgen. is the ‘roentgen equivalent in man. Cells that are regularly undergoing active division. Radiation monitoring are methods of checking the level of radiation exposure received by an individual. There is no SI unit for this measurement because it can be express in units of coulomb/kilogram (C/kg). Rem (symbol: rem). in particular cancer cell. It can also determine how effective radiation treatment can be. symbol: Sv. Persons working in radiation are risk to radiation exposure during the course of a day’s work–referred to as occupational exposure–and should limit their radiation dose to 50 mSv (5 rem) in a single year. The SI unit is the sievert. Roentgen (symbol: R) measures the strength of a radiation field at some point in air or is a measurement for exposure to radiation. It gives the dose equivalent or occupational exposure as opposed to the absorbed dose. A special device called a dosimeter can be used to measure the quantity of radiation the user has been exposed to over a period of time. Radiosensitivity can determine how cells and tissues will be damaged by radiation.
because there is no way to determine the path of these scattered photons anyone in an x‐ray room can be at risk and should wear lead projection.Olive Peart 90 Scatter Radiation is the scattering of x‐ray photons that occurs when in incident x‐ray photon is deflected from its original path by an interaction with an electron. generally during the first four to five days. symbol: rem. muscle or bone. The electron is ejected from its orbital position and the x‐ray photon loses energy but will continue to travel through the material along a different path. blood vessels. The dose equivalent is a measure of the radiation dose to tissues whereas the absorbed dose measures the physical effects of radiation. bone marrow. which are formed in the earliest stage of fetal development. SI denotes the International System of Units. It is named after Rolf Sievert. Moreover. The system has been accepted through the world with the exception of Myanmar. Sievert (symbol: Sv) is the SI unit that attempts to gives the biological effects of radiation. Liberia and United States. which is the modern system of measurement used in science. skeletal muscles. Stem cells are cells that have not become specialized and can therefore develop into different tissues or organs such as skin. a Swedish medical physicist famous for work on radiation dosage measurement and research into the biological effects of radiation. Some stem cells are also found in adults in areas such as the brain. The most common type of stem cell is embryonic stem cells.01 Sv. It gives the dose equivalent or occupational exposure as opposed to the absorbed dose. The acronym is an abbreviation from the French words Le Système International d'Unités. SI units were developed in 1960. skin and . The phenomena occur when x‐rays and gamma rays leaves a source. One rem is equivalent to 0. The older unit is the ‘roentgen equivalent in man’.
A technician often has minimal training and will work in a state where there are limited or no licensing requirement for persons operating x‐ray equipment. technician The main difference between a technologist and a technician is the educational level of the individual. imaging can be used as a diagnostic test–related to finding out about a disease or pathology−or therapeutic. The American Registry of Radiologic Technologist (ARRT) is a national recognized certifying agency that monitors the ethics and professionalism of radiologic technologist. There is still uncertainly on exactly what this low‐dose level is. Threshold in radiology relates to the effects of a minimum level of radiation dose on the human body. anatomy and physiology and technical details of their imaging modality. Thyroid gland is an endocrine gland located in the front of the neck. Adult stem cells are less able to regenerate into a new organ than embryonic stem cells. Endocrine glands secrete hormones. and the point below which there cannot be any health implications from radiation. In radiology departments. you could be in danger of over radiation or worse. Shielding−see lead shielding Sonography−see ultrasound Technologist vs. Often a technologist will need a professional certification or license to practice in their field. A technologist’s course of study will often include subjects such as radiation protection. The main therapeutic modality in radiology is radiation therapy also called radiation oncology where high doses of radiation are used to destroy cancer cells. If you find that a technician is performing your x‐ray examination. which are necessary .91 The Dangers of Medical Radiation liver. Therapeutic refers to the treatment of a disease.
The thyroid gland makes thyroid hormones. The quality of the ultrasound is dependent on the skills of the ultrasonographer. which functions to regulate the body’s metabolism and has an effect of nearly all tissues of the body. although ultrasonic energy has the potential to enhance inflammatory response and heat soft tissue. The thyroid gland is extremely radiosensitive. sonography or ultrasonography can be used as a diagnostic procedure to visualize internal organs especially soft tissues structures such as the abdomen and fetus. Wavelength refers to the distance from one crest to another or from one valley to another in a wave. Medical ultrasound used high‐frequency sound waves and is generally considered a safe test.Olive Peart 92 for life. Ultrasound. .
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RADIATION CONTROL/STATE LICENSURE OFFICES:
Source: www.asrt.org ALABAMA Kirk Watley, Director. Office of Radiation Control. State Dept. of Public Health. 201 Monroe St/PO Box 303017. Montgomery, AL 36130‐3017. 334‐206‐5391. email@example.com . Beverly Jo Carswell. X‐ray Compliance. State Department of Public Health. PO Box 303017. Montgomery, AL 36130‐3017. 334‐206‐ 5391. firstname.lastname@example.org . www.adph.org. Licensing: does not license personnel. ALASKA Clyde Pearce, Chief. Radiologic Health Program. 4500 Boniface Parkway. Anchorage, AK 99507‐1270. 907‐334‐2107. email@example.com . www.hss.state.ak.us Licensing: does not license personnel. ARIZONA Aubrey Godwin, Director. Arizona Radiation Regulatory Agency. 4814 South 40th St. Phoenix, AZ 85040‐2940. 602‐255‐4845 Ext. 222. firstname.lastname@example.org . Licensure: Shanna Farish, Program Manager. Medical Radiologic Technology Board of Examiners. 602‐255‐4845, Ext. 241. email@example.com ARKANSAS Valerie Brown, Agency Program Coordinator. Radiologic Technology Licensure Program. Arkansas Department of Health. Radiation Control Section. 4815 W. Markham St., Slot H‐30. Little Rock, AR 72205‐3867. Phone: 501‐661‐2301. firstname.lastname@example.org. www.healthyarkansas.com/rtl
CALIFORNIA Gary Butner, Branch Chief. Radiologic Health Branch. Division of Food & Radiation Safety. PO Box 997414, MS‐7610. Sacramento, CA 95899‐7414. 916‐ 440‐7899. email@example.com. http://www.cdph.ca.gov COLORADO Joyce Goldsboro, BA, RTR (M). X‐Ray & Mammography Compliance. Registration & Certification. 4300 Cherry Creek Drive South. Denver, CO 80246‐1530. 303‐692‐3446. firstname.lastname@example.org. www.cdphe.state.co.us/lr/lrhom.asp CONNECTICUT Edward Wilds, Ph.D., Director. Dept. of Public Health. Division of Radiation. 79 Elm Street. Hartford, CT 06106‐5127. 860‐424‐ 3029. email@example.com. http://www.dep.state.ct.us DELAWARE Frieda Fisher‐Tyler, Administrator. Office of Radiation Control. Division of Public Health. 417 Federal Street. Dover, DE 19903. 302‐744‐4546. frieda.fisher‐firstname.lastname@example.org . www.delaware.gov DISTRICT OF COLUMBIA Gregory B. Talley, Program Manager. Department of Health. HRLA/Radiation Protection Div. 717 14th Street NW, Room 639. Washington, DC 20005. 202‐724‐8800. email@example.com FLORIDA William A. Passetti, Chief. Dept. of Health/Bureau of Radiation Control. 4052 Bald Cypress Way, Bin C21. Tallahassee, FL 32399‐ 1741. 850‐245‐4266. firstname.lastname@example.org . Licensing: James A. Futch, Administrator. Radiologic Technology Program. 4052 Bald Cypress Way. Tallahassee, FL 32399‐1741.
The Dangers of Medical Radiation
850‐245‐4540. email@example.com . www.doh.state.fl.us/environment/radiation GEORGIA Jenella Forrester, Team Leader. Diagnostic Services X‐Ray Program. Department of Human Resources. 2 Peachtree Street NW, 33rd Floor. Atlanta, GA 30303‐3142. 404‐657‐5400. firstname.lastname@example.org. www.gaepd.org/document/rmprogram1.html. Licensing: No licensing of personnel HAWAII Russell S. Takata, Program Manager. Dept. of Health. /Noise & Radiation Branch. 591 Ala Moana Blvd. Honolulu, HI 96813‐ 4921. 808‐586‐4700. email@example.com. Licensing: Jeffery M. Eckerd, Supervisor. Radiation Section. Radiological Response/Radiologic. Technology/Mammography. 808‐586‐ 4700. firstname.lastname@example.org; www.state.hi.us IDAHO David Eisentrager, Manager. Dept. of Health & Welfare. Idaho Bureau of Laboratories. 2220 Old Penitentiary Rd. Boise, ID 83712‐8299. 208‐334‐2235 ext.245. email@example.com Licensing: Does not license personnel. www.state.id.us ILLINOIS Joseph Klinger, Asst. Director. IL Emergency Management Agency. Division of Nuclear Safety. 1035 Outer Park Dr. Springfield, IL 62704. 217‐785‐9868. firstname.lastname@example.org. Licensing: Steve Collins. Registration and Certification Section. 217‐785‐6982/Fax 217‐785‐9946. email@example.com . www.iema.illinois.gov INDIANA John H. Ruyack, Director. State Department of Health. Epidemiology Resource Center/. Indoor and Radiological health.
http://www.us . 504‐ 838‐5231. jeff. PO Box 4312. LA 70821.3693. Cabinet for Health & Family Services. dewey.ky.gov .gov. 502‐564‐ 3700 ext.htm Licensing: Vanessa Breeding.gov/radiation . Ext. 3695. Emergency & Radiologic Services Div. IA 50309‐ 4611. firstname.lastname@example.org. KANSAS Tom Conley. www.gov.la. IN 46204‐3003. 785‐296‐3680 KENTUCKY Dewey Crawford.louisiana.us . Administrator. Suite 310. 321 E. 12th St. 5th Fl. Radiation Control Program.gov. 785‐296‐1565. IN 46219. Manager. 502‐564‐3700 Ext.ia. Chief. Medical Radiology Services. www.kdheks. Coordinator./publichealth/radiation.chs. Des Moines.gov/ IOWA Melanie Resmusson.us/ . 515‐281‐3478. E3.state. 225‐219‐3041.meyers@la. 317‐ 351‐7190. Indianapolis.us. vanessa. dhopper@isdh. Radiation Section.ia. Licensing: Darleen Hopper. 2 North Meridan Street. Bureau of Radiological Health. Radiation Control Branch. Topeka.state. Lucas State Office Bldg. Licensing: Charlene Craig. Licensing: Kansas Board of Healing Arts.email@example.com Licensing: Radiological Technologist Board of Examiners.isdh.gov. 317‐ 233‐7565. 5F.state.in.ia. 257. ccraig@idph. 515‐281‐0415. KY 40621‐0001. KS 66612‐1366.gov LOUISIANA Jeffery Meyers.state. http://www.Olive Peart 96 2525 North Shadeland Avenue. Training and Operator Credentialing.in. Chief. HS1C‐A. Baton Rouge. mrasmuss@idph. Operator Certification Program. 275 East Main Street. www. www. 1000 SW Jackson St.. Indianapolis.deq.breeding@ky. Frankfort.
ma.org. Suite 750. ME 04333‐0035.mbp. Schrafft Center. Department of Public Health. P.. Suite 1M2A. MI 48909. MI Dept. of Community Health. MA 02129. ME 04333.state. 410‐537‐3300. of Health Facilities & Services. 286 Water Street.state. Lansing.health. 410‐764‐4777. Division of Environmental Health. 529 Main Street. Augusta. MN 55164‐0975.97 The Dangers of Medical Radiation MAINE Jay Hyland Manager. Manager.michigan.us MASSACHUSETTS Robert Walker. State House Station #35. Bureau of Health Systems. Augusta.us . Manager. bmatko@michigan. Section of Indoor Environments. Department of Health. 517‐241‐ 1993. Telephone: 207‐287‐5677. www.hyland@maine.Dale.mn. 651‐201‐4545. firstname.lastname@example.org/rss MINNESOTA Dale Dorschner. & Radiation. Charlestown.us/xray .md. Paul. Radiation Safety Section.Dorschner@state. www. MD 21230‐1724. Baltimore. 4th Floor. Licensing: Maryland Board of Physicians.state. Radiation Control Program. PO Box 30664.us.us .O.gov/dph/rcp MICHIGAN Bruce Matkovich. www.md. Radiologic Health Program. 617‐242‐3035. jay. bob. Div.gov .mass.gov. Director. St.walker@state. Maryland Dept of the Environment.mn. Division of Environmental Health. 625 Robert Street N. 1800 Washington Blvd. 207‐624‐8603 MARYLAND Roland Fletcher. Box 64975.maineradiationcontrol. www. www. Licensing: Radiological Technology Board. Radiation Control Program.
Suite 300.state. Bureau of Health Protection Services. NE 68509‐ 5026. of Public Health and Human Services. 402‐471‐0528.gov/radprotection/ Licensing: no personnel licensing MONTANA Roy Kemp.gov/rad NEVADA Karen K.health. Jefferson City. Licensure Bureau.S. P. Beckley.gov.ms.state.Olive Peart 98 MISSISSIPPI B. Manager.mo.us. 573‐751‐6083. Dept. Jackson. Box 202953. Helena. P. bjsmith@msdh. Box 95026.gov.gov . 4510 Technology Way. www. Health Services Regulation. Radiological Health Section. M. Radioactive Materials Director. Office of Radiological Health. MT 59620‐2953.com/dli/bsd NEBRASKA. 406‐444‐2868.dhss. 3091 South Park 4th Floor. Radiological Health Program. O. Helena. 775‐687‐7540..langston@dhss. J.ms. Montana Dept. Telephone: 601/987‐6893. Carson City. Nevada State Health Division. www. john. X‐Ray Branch. Julia A. M. Health Physicist Administrative.ne. Licensing: Board of Radiologic Technologists. www.nv. MT 59620. Licensing: Jimmy Carson. of Health & Human Services.ms. MT Dept. kbeckley@health. Lincoln.A. O. Schmitt. 601‐987‐6893. jcarson@msdh. Program Manager. MS 39215‐1700.state.us MISSOURI John Langston.nv. julia. Division of Radiological Health.gov.discoveringmontana. www. NV 89706. of Public Health. Division of Regulation and Licensure. Medical Radiation Control Program. State Department of Health. Healthcare Regulatory Supervisor.P.dhhs.mo.schmitt@nebraska. MO 65102‐0570. 3150 Lawson Street. 406‐841‐2385. PO Box 570. Smith.us/health . www.
Mammography Technologic Certification. 609‐984‐5356.us .99 The Dangers of Medical Radiation NEW HAMPSHIRE Dennis P.dhhs. P. Licensing. 609‐984‐5636. Supervisor.html NEW YORK Gene Miskin. 547 River St. NY 10007. New York.nj.state.htm .us . Radiological Health Section. for Radiation Protection Programs &.nmenv. www.us . www.nyc.us/dhhs/brh NEW JERSEY Paul Baldauf.balduaf@dep. Licensing: Ramona Chambus. 603‐271‐ 4585. Concord.us/dep/rpp/index.nm. Santa Fe.state. of Environmental Protection.us . Administrator. NM 87502‐0110.gov . NJ 08625‐ 0415. Bureau of Envir.sanchez@ state. Radiologic Technologist Cert. Dept. email@example.com. Director. NEW MEXICO Stephen Sanchez. Room 530. Francis Drive.nm.nj.health. 1190 St.state. Troy. NH 03301‐6504. 11th Floor. O'Dowd. stephen. www.nj. of Health and Human Services.nh. gmiskin@health. NY 12180‐2216. 518‐402‐7580/Fax 518‐402‐7575. Program. Administrator. O.state.state. 29 Hazen Drive. Ramona. www.state.ny. paul. New Mexico Environment Department. www.state.htm .nj. Release Prevention Element.firstname.lastname@example.org. Dept. Assistant Director. 2 Lafayette Street. Radiation Protection.us/nmrcb/home.us .us/dep/rpp/index. 505‐476‐3264.nh. dodowd@dhhs. 212‐676‐1550. Box 415. NYSDOH. Office of Radiologic Health.state. Division of Public Health Services. Trenton.us .
gov .odh. Bismarck.us OKLAHOMA Ted Evans.net . 503‐ 7 31‐ 4088 x21 .or. www. Bureau of Radiation Protection. www.gov. Consumer Protection Services. 919‐571‐ 4141. Oregon Health Services. 405‐271‐5243.gov . State Department of Health.email@example.com. Radiation Protection Services. Acting Director. Licensing: Oregon Board of Radiologic Technology.gov/aq/rad OHIO Roger E. OR 97232‐ 2162. Licensing: does not license personnel OREGON Terry D. Division of Air Quality.odh. Lindsey. 918 E. Columbus.lindsey@state. North Carolina Radiation Protection Section. Chief. Owen. 246 North High Street. of Health. Department of Human Services. Ohio Dept.Olive Peart 100 NORTH CAROLINA Walter Cox. OK 73117‐1299.gov.d. Licensing: no licensing of personnel NORTH DAKOTA Terry O’Clair. robert. North Dakota Dept. 800 NE Oregon Street.ncradiation. james.shtml.232. Raleigh. NC 27609‐7221. Portland.firstname.lastname@example.org. terry.ohio. lee.cox@ncdenr. Divide Avenue. OH 43215. 971‐673‐0499. Castle. Oklahoma City.oregon. Ext. Radiologic Technology Section (X‐Ray). www. toclair@nd. Suite 640.ohio. General Inquiries: bradiation@odh. 3825 Barrett Drive. of Health. www. Licensing: James O. www. 701‐328‐5188. ND 58501‐ 1947.gov/DHS/ph/rps/about_us. 614‐644‐2727. Director. Program Director. 1000 Northeast Tenth Street. 614‐644‐2727.ohio.ohio. Administrator.ndhealth.state. Director.us.
Pierre.pa. email@example.com RHODE ISLAND Marie Stoeckel. O. 787‐274‐7802. www.com .us. Providence.horibin@health. Rachel Carson State Office Bldg. X‐Ray Program. rhernandez@salud. Bureau of Radiation Protection.gov . djallard@state. scrqsa@capconsc. Dept.us PUERTO RICO Raul Hernandez.net Licensing.org SOUTH DAKOTA.state. Allard. 615 East 4th St. Office of Facilities Regulation. Chief.gov.stahl@state. SC 29201.php SOUTH CAROLINA Aaron Gantt. SD 57501‐ 1700. Director.O.dep. Box 8469. Licensing: Carol Horibin.us. Licensure: Gary Kaus. 401‐222‐7761.us.ri.pa.scdhec.gov. 401‐222‐ 4520. carol. Division of Environmental and Health Services. Administrator.ri. 605‐ . 803‐545‐4420. Equip. Columbia. www. 717‐787‐2480. 803‐771‐6141/fax 803‐771‐8048. Office of Health Care Facilities. Director. P.ri. RI 02908‐5097. www. Department of Health.ri.gov/state_agencies.state.sd. South Carolina Radiation Quality Standards Association. PA 17105‐8469.stoeckel@health. P. CHP. San Juan. bob. Box 70184. Radiological Health Division. Harrisburg. of Health & Environment Control. marie. Licensing: Pennsylvania Department of Health. Radiological Health Specialist. sd. www.scrqsa. 605‐773‐3356. Chief of Operations. 3 Capitol Hill.state.us. http://www. Bureau of Radiological Health.pa. webmaster@health. PR 00936‐ 8184.gov/hsr/professions/rad_tech. Licensure and Certification.101 The Dangers of Medical Radiation PENNSYLVANIA David J.sc. Room 206. Bob Stahl. 2600 Bull Street.aspx.
Licensure.gov. Medical Radiologic Technologist Certification Program. Licensing. PE. Richard Sanborn.us. (Mammography Contact). 801‐530‐6403 .Olive Peart 102 642‐6010. UT 84114‐6741. LMP. gary.us.state. Director.johnson@state. of Radiation Control. chuck. 2245. Licensing: does not license personnel TENNESSEE Chuck Johnson. TX 78714‐9347. Austin. Tennessee Board of Medical Examiners. Salt Lake City.sd. 426 Fifth Ave.htm UTAH Dane Finerfrock.radiationcontrol. Telephone: 865/594‐ 5577.state.us. Cordell Hall Bldg.tx. richard.state. UT 84114‐4850. Health Physicist. PO Box 14937. Ext. 168 North 1950 West. Radiation Program Officer. www. 801‐536‐4268.tn. PO Box 144850.tn.state. TX 78756.tx. Pam.us. PO Box firstname.lastname@example.org. Division of Radiological Health.utah. TN 37921.kaus@state. N.state. 1100 West 49th St. rsanborn@utah. 801‐ 536‐4257. www. Licensing: Occupational and Prof. www.us/environment/rad/. 512‐834‐6688. Salt Lake City.us/radiation . Cathy Fontaine.Kaderka@dshs.gov. dfinerfrock@utah. 512‐834‐6688. cathy. Licensing: Pam Kaderka.sd. Texas Department of State Health Services.dshs.gov.tx.us/hcqs/plc/mrt. http://www.tdh. www. TN 37247‐1010. Health Related Board. 512‐834‐6679. Nashville. 1‐800‐778‐4123 TEXAS Richard Ratliff. Div.email@example.com. Austin.state. 37911 Middlebrook Pike. State Dept of Health Services. Bureau of Radiation Control. 1st Floor. Knoxville. Chief. Mammography Certification.
109 Governor Street. 804‐ 662‐9908. Department of Health. Suite 200.virginia.us.dhp. Office of Environmental.foldesi@vdh. 1 Davis Square. Department of Health. Sc. Foldesi. 108 Cherry Street.wa. Gary. Radiological Health Program. Board of Medicine for Radiologic Technology. Director.state.aspx. WV 25301‐1798. 360‐236‐3232. WA 98504‐7827. stan. .wa.D.gov/ehp/rp. 802‐865‐7730. Richmond. 304‐558‐ 6721.vt. Room 730. VA 23219. 5th Floor. Chief. 360‐236‐3210. Charleston.vt. Office of Radiologic Health. scott.htm WASHINGTON Gary L.firstname.lastname@example.org. Assistant Director. X‐Ray Section. 804‐864‐8170.state. 802‐862‐8171.gov. PO Box 70.gov/enviro/rad/rad_health. Sr. www.virginia.robertson@doh. Department of Health.. (Mammography Contact).doh.us VIRGINIA Leslie P. www.103 The Dangers of Medical Radiation VERMONT William Irwin. Stan Orchel. Burlington.orchel@vdh. Licensing. healthvermont.vdh. 804‐864‐8151. 6603 West Broad Street. Carla White.c. VT 05402. CHP. (Mammography Contact). Division of Radiological Health. randy. Olympia. les. DHHR Bureau for Public Health.org/rtia. James Madison Bldg.gov WEST VIRGINIA Randy Curtis. cwhite@vdh. Health Services.curtis@wv. CHP. Director.us/medicine/default. (Mammography Contact).gov.wa. Radiological Health Specialist.virginia. wirwin@vdh. Office of Radiation Protection.gov. PO Box 47827.wvdhhr. Office of Radiological Health. Director. Scott Mantyla. Robertson. X‐Ray Registration and Certification. www. Richmond. VA 23230‐1712.state. www.
plboards.htm WYOMING Dewey Long. paul. Cheyenne. WY 82002.T. Cheyenne.wy. dhfs. gradymbowyer@suddenlink. Executive Director. 6101 Yellowstone Road. Suite 201. (R). Madison. Licensing: Wyoming Board of Radiologic. R.Olive Peart 104 Licensing: Grady M. MS. Bowyer.org WISCONSIN Paul Schmidt.gov/dph_beh/RadiatioP/Index.long@health. 304‐546 ‐4642. 608‐267‐4792. Technologist Examiners. Office of Healthcare Licensing. 307‐777‐3507. www. WI 53701‐ 2659. 307‐777‐5244. WV Radiologic Technology Board of Examiners. dewey.wvrtboard. WY 82002.state.gov.wyo.us/radiology . Radiation Protection Section. PO Box 2659. 2020 Carey Ave. Suite #400. of Health and Family Services.schmidt@wisconsin. Dept. Department of Health.net.wisconsin. Mammography Program.gov. First Bank Plaza. Manager.
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