[ RadSafe ] Re: Harm vs Benefit in pelvimetry at delivery

[Keith Welch]

Howard,

I agree.  I am asking these questions because I'm engaged in a 
discussion with some folks outside the medical and HP professions and 
I'm having a hard time communicating to them that "common practice" is 
mostly applicable to "common" situations, and may not at all be 
appropriate in individual cases that have individual sets of 
circumstances.  Overall, it seems to me that in the absence of a staff 
expert, physicians may tend to attempt to apply "standard" protections 
in extremely non-standard cases.  My gut feel is that to the extent that 
this happens, risk communication is very poor and actual radiation risk 
may be overstated in many cases (and becomes an extremely murky mess 
when weighing that risk against others).  I get the feeling most 
physicians are not nearly as knowledgable in this as they perhaps should 
be (but I'd be happy if someone would correct me on this and help ease 
my concern).

I'm not arguing for more rules, just more information in the hands of 
those who need it.

K. Welch


howard long wrote:

> 50 years ago, I took x-rays of a woman in labor in my office, 45 min 
> from a hospital.
> The pelvimetry showed the head well engaged and passing (with 
> surprising squash of the head), so I delivered her there on the Bucky 
> x-ray table 20 min later, of an Apgar 8
> vigorous 7 lb infant. The radiation dose to the infant was less than 
> background for a year (although high rate as Luan would be quick to 
> point out), and likely saved delivery in a car (no ambulance within 15 
> min), with associated risks of aspiration, bleeding, sepsis, etc.
>  
>  "Sound medical judgement?"  "Standard of Care?"
> I would want the same for my own child. Variation greatly exceeds the 
> standard error.
> Better deregulation, than more rules and guidelines.
>  
> Howard Long
>
> */jjcohen at prodigy.net/* wrote:
>
>     >From the questions posed by Keith Welch it would seem that the
>     attending
>     physician might be oblivious to the potential dangers of radiation
>     exposure
>     and that perhaps we need definitive rules and guidelines that
>     cover all
>     possible situations. What ever happened to sound medical judgment?
>
>
>     ----- Original Message -----
>     From: "Flanigan, Floyd"
>     To: "Keith Welch" ;
>     Sent: Tuesday, April 18, 2006 7:44 AM
>     Subject: RE: [ RadSafe ] In utero dose
>
>
>     There should be an HP on site at most hospitals. The general rule of
>     thumb for In Utero Dose is 500 millirem for the term of the pregnancy,
>     but of course all exposure should be kept ALARA. 10CFR20 has
>     additional
>     federal limits.
>
>     Floyd W. Flanigan B.S.Nuc.H.P.
>
>     -----Original Message-----
>     From: radsafe-bounces at radlab.nl [mailto:radsafe-bounces at radlab.nl] On
>     Behalf Of Keith Welch
>     Sent: Tuesday, April 18, 2006 8:49 AM
>     To: radsafe at radlab.nl
>     Subject: [ RadSafe ] In utero dose
>
>     I have some questions for you medical experts. I'm curious what
>     guidelines are used when there is a case requiring x-rays of a
>     pregnant
>     female. Let me give you a hypothetical case. Let's say a woman is
>     injured in an auto accidedent, has some internal injuries and broken
>     bones. She's 12 weeks pregnant. To treat her injuries, she needs
>     surgery and a series of radiographs. Are there generally accepted and
>     well known standards that physicians refer to in order to advise
>     patients and determine a course of treatment? ARe there risk-based
>     guidelines in place and widely known to general surgeons and
>     practicioners? How common is it for a surgeon to seek the advice of an
>     HP or MP to assess the risks of such procedures? My impression of the
>     handling of "routine" x-rays is that if a woman is pregnant,
>     x-rays are
>     always postponed, just to be conservative. But in a case where
>     there is
>
>     a pressing need to preserve health, how is the decision to conduct the
>     x-rays arrived at? How are these risks weighed? What is the typical
>     "standard of care"? Is there an agreed dose at which the patient is
>     advised to terminate the pregnancy?
>
>     Thanks.
>     Keith Welch
>
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