[ RadSafe ] In utero dose

[Michael Bohan]

Hello Jerry and RadSafer's,

My apologies, I didn't mean to disparage Industrial Hygienist's by my 
comment.  ALARA is a construct to keep workers who are already well 
protected by the 5 rem/yr limit (in the US), even more protected by a 
"radiation" hygiene philosophy to minimize needless exposures when it 
is reasonable.

Applying ALARA to emergency medicine, without considering the real 
risks of trauma is dangerous.  The problem with ALARA in this medical 
context,  along with LNT,  is they are used by people who do not 
understand the true magnitude of risks at low levels.  Most medical 
schools have no standard training about radiation risks, so many 
non-radiology physicians (and even some radiology physicians!) believe 
that the risks of radiation in pregnancy are far higher than reality.  
They make the initial determination to order a radiological procedure 
and if they are biased against radiological procedures because they 
believe that small doses of radiation have significant risks, then 
patient care will suffer.

If you want to see some examples where the ignorance of radiation risks 
in medicine has deleterious effects, please read these references:

Joerg, N.E., "A Personal Story About Pregnancy Radiation Risk 
Counseling", Teratology, 59:314-315 (1999)

Brent, R.L., "Clinical Teratology Counseling and Consultation Case 
Report: Exposure to Diagnostic Radiation Early in Pregnancy", 
Teratology, 46:31-33 (1992)

Brent, R.L., "Radiation Teratogenesis", Teratology, 21:281-298 (1980)

Although these examples do not address the emergency medicine issues 
directly, it does illustrate that many medical practitioners make life 
and death decisions about radiation risks, without adequate 
understanding.   Unfortunately, the misuse of the ALARA and LNT 
concepts contribute to this sad state of affairs.  After reading some 
of these case studies, I wonder how many people were never born because 
of the  misapplication of the ALARA and LNT concepts.   If you really 
think about it, the concepts of ALARA and LNT may have killed more 
people than they ever saved!

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

(Proud survivor of x-ray pelvimetry (1955), estimated fetal dose 
(pre-intensification screens) approximately 2-5 rad)

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