[ RadSafe ] In utero dose

Wed Apr 19 05:17:18 CDT 2006

COMMENT:

1) "For diagnostic and therapeutic medical radiation exposures, the
key would be optimization"

No - The keys words would be justification and optimization
IAEA BSS page 45 -

JUSTIFICATION OF MEDICAL EXPOSURES

II.4. Medical exposures should be justified by weighing the diagnostic or
therapeutic benefits
they produce against the radiation detriment they might cause, taking into
account the benefits
and risks of available alternative techniques that do not involve medical
exposure.

11.5. In justifying each type of diagnostic examination by radiography,
fluoroscopy or nuclear medicine, relevant guidelines will be taken into
account, such
as those established by the WHO (a,b)

a)  WORLD HEALTH ORGANIZATION, A Rational Approach to Radiodiagnostic
Investigations,
Technical Report Series No. 689, WHO, Geneva (1983).  WORLD HEALTH
ORGANIZATION,
 Effective Choices for Diagnostic Imaging in Clinical Practices, Technical
Report Series No. 795, WHO, Geneva (1990).

b)   WORLD HEALTH ORGANIZATION, Effective Choices for Diagnostic Imaging in
Clinical Practices,
Technical Report Series No. 795, WHO, Geneva (1990).

2) About Limit (IAEA BSS page 91)

II-1. The dose limits specified in Schedule II apply to exposures
attributable to practices,
with the exceptions of medical exposures and of exposures from natural
sources that
 cannot reasonably be regarded as being under the responsibility of any
principal party of the Standards.

Dose limitation for comforters and visitors of patients (page 93)
II-9. The dose limits set out in this part shall not apply to comforters of
patients, i.e.,
to individuals knowingly exposed while voluntarily helping (other than in
their employment
or occupation) in the care, support and comfort of patients undergoing
medical diagnosis
 or treatment, or to visitors of such patients. However, the dose of any
such comforter or visitor
of patients shall be constrained so that it is unlikely that his or her dose
will exceed 5 mSv during
the period of a patient's diagnostic examination or treatment. The dose to
children visiting patients
 who have ingested radioactive materials should be similarly constrained to
less than 1 mSv.

3) "(I believe there is an ICRP publication on optimization)"
There is a draft report that those interest can download at
 http://www.icrp.org/docs/Optimisation_web_cons_draft_42_105_05.pdf

Jose Julio Rozental
joseroze at netvision.net.il
Israel

----- Original Message -----
From: "Cindy Bloom" <radbloom at comcast.net>
To: "Michael Bohan" <mike.bohan at yale.edu>; <radsafe at radlab.nl>
Sent: Wednesday, April 19, 2006 11:32 AM
Subject: RE: [ RadSafe ] In utero dose

> My sense is that ALARA applies to regulated workers' exposures to
> radiation.  For diagnostic and therapeutic medical radiation exposures,
the
> key would be optimization of the risks, benefits and costs (I believe
there
> is an ICRP publication on optimization).  In emergency-type situations,
the
> costs are probably given little thought and the focus is on the benefits
of
> obtaining  information (or perhaps reducing swelling, in the case of a
> brain tumor, etc.).  It would make sense if generic planning for
> emergencies considered the risks, benefits and costs.  I would guess
> professional organizations routinely provide guidance on these matters and
> that most radiology programs consider these matters at least informally
> (and would be well advised to consider these issues formally).  As noted
by
> others, life-saving, as well as preservation of quality of life (lives),
is
> of greatest importance, and in most instances it will be very unlikely
that
> the risks of radiation exposure outweigh the benefit of obtaining
> diagnostic information that allows more rapid treatment of the emergency.
>
> I think the balancing of image quality and radiation exposure is more a
> matter of optimization than ALARA, but perhaps the semantics are best left
> for discussion in a casual setting.
>
> Cindy
>
> At 06:13 PM 4/18/2006 -0400, Michael Bohan wrote:
> >Hello Floyd and RadSafer's:
> >
> >In medicine, the conservative approach (of ALARA for radiation) is
usually
> >NOT advisable.  ALARA is specifically an industrial hygiene practice that
> >has been bastardized by some to apply to realms it was never intended
for.
> >
> >If there is a pregnant mother, who's been in a serious car accident, the
> >risk of having an undiagnosed condition that results in immediate death
to
> >the mother and/or fetus, is real.   The theoretical risk of even a 10 rad
> >dose to her and the fetus are a very small concern in comparison.  Even
> >with a dose of 10 rad, the theoretical risk to the fetus is about 1 in a
> >thousand, and it might only be expressed many years later.  However, the
> >mortality of mothers and fetuses from serious car accidents and
> >undiagnosed trauma, is immediate and probably would lead to 10's if not
> >100's of deaths/thousand, if modern diagnostic tests are withheld due to
> >radiophobia.  It should be remembered that ALARA is meant to keep
> >occupational workers well away from any risk at all, even theoretical
> >ones.  When reality strikes, we need to use a different set of standards.
> >
> >ALARA does have a place in medicine.  Medical Physicists spend a lot of
> >time and energy making sure that all hospital equipment provides the best
> >diagnostic information for the smallest necessary dose.   However, ALARA
> >should never be used to deny a patient a necessary diagnostic procedure.
> >
> >Regards,
> >
> >Mike Bohan, RSO
> >Yale-New Haven Hospital
> >Radiological Physics
> >20 York St. - WWW 204
> >New Haven, CT 06510
> >Tele: (203) 688-2950
> >Fax: (203) 688-8682
> >Email: mike.bohan at yale.edu
> >
> >This message originates from Yale New Haven Health System. The
information
> >contained in this message may be privileged and confidential. If you are
> >the intended recipient, you must maintain this message in a secure and
> >confidential manner. If you are not the intended recipient, please notify
> >the sender immediately and destroy this message. Thank you.
> >
> >On Apr 18, 2006, at 2:32 PM, radsafe-request at radlab.nl wrote:
> >
> >>I realize this. But taking the conservative approach is always
> >>advisable. Hence ALARA. The lack of set limits is an issue which should
> >>be addressed. We cannot continue to let the medical world self-police.
> >>They have proven time and time again that they are prone to leaning to
> >>one extreme or the other. The limit should mirror occupational dose
> >>except, of course in the case of limits hindering treatment. All of this
> >>falls into the principals of ALARA in one way or another.
> >
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