[ RadSafe ] CT scans dangerous? -ALARA

Sat Nov 17 22:23:27 CST 2007

Speaking of John Villforth, we met at the local
Baltimore-Washingtion Chapter-HPS meeting this week.
He said that the value of 30% of x-ray exposures were
"unnecessary" was made up.  He had no data that
supported that value, except that usually 30% of
anything was probably too much.  

I assume that there were concerns in the 1970s, as
there are today, that x-ray exam are over prescibed. 
This lead to John speaking out on the issue, and
trying to put a value to it.

--- "Brennan, Mike  (DOH)" <Mike.Brennan at DOH.WA.GOV>
wrote:

> "There is NO other source of excess useless
> radiation exposure to the US
> public than what Dr. Villforth cites."
> 
> Except radon.  While I completely agree that
> unnecessary medical
> exposures should be discouraged, there is at least
> (usually) some
> potential benefit, even if only to rule out
> something.  With radon
> exposure there is no demonstrated benefit (Yes, I
> know there are some
> hormesis fans out there, but I think you still have
> a ways to go to
> prove your case).  I suspect that if one looked at
> the costs of
> increased regulation to decrease medical dose vs.
> programs to reduce
> radon dose you would find the radon programs more
> productive on a $ per
> rem avoided rate. If you included costs avoided by
> not having the
> procedure then reducing medical dose might be more
> cost effective. 
> 
> -----Original Message-----
> From: radsafe-bounces at radlab.nl
> [mailto:radsafe-bounces at radlab.nl] On
> Behalf Of stewart farber
> Sent: Thursday, November 08, 2007 9:55 AM
> To: John Jacobus; radsafe at radlab.nl
> Subject: Re: [ RadSafe ] CT scans dangerous? -ALARA
> 
> Hi all,
> 
> I have not been following this thread carefully, and
> do not know if my
> point below has been made in some manner. 
> 
> While ALARA, per se is not applied to the dose
> delivered in a given
> radiation diagnostic procedure, there is a real
> issue if there is
> significant total excess dose delivered to the US
> public due to the
> issue raised below.
> 
> In 1979, Dr.. John Villforth, then head of the FDA
> Bureau of
> Radiological Health [BRH], testified before Congress
> that by the FDA BRH
> estimate one-third of all medical radiation exposure
> was "unnecessary".
> Dr. Villforth was considering the problem with
> retakes due to use of
> improper technique, tests being ordered without
> proper indications for a
> given procedure,  etc., etc. 
> 
> If Dr. Villforth's rough estimate still holds, fully
> one-third of all
> medical diagnostic radiation integrated dose yields
> no useful diagnostic
> information. This sum amounts to very approximately
> 2 million person-rem
> per year of "unnecessary" radiation dose in the US
> alone. 
> 
> Does anyone have any information that Dr.
> Villforth's one-third
> "unnecessary" diagnostic radiation exposure is no
> longer applicable??
> 
> There is NO other source of excess useless radiation
> exposure to the US
> public than what Dr. Villforth cites. Is this excess
> radiation dose due
> to poor practice in medical applications in a broad
> sense ALARA? Should
> something be done or set as a goal to reduce
> "unneccessary" radiation
> exposure in diagnostic radiology?
> 
> As a simple comparison, the TMI accident caused
> about 1,000 person-rem
> of total integrated population exposure. Thus the
> excess wasted dose in
> routine medical testing per year cited by Dr.
> Villforth is equal to
> 2,000 TMI scale accidents per year in the US --year
> in year out. 
> 
> Stewart Farber, MS Public Health
> 
> Farber Medical Solutions, LLC
> Linac & Medical Instrumentation Brokerage
> 1285 Wood Ave.
> Bridgeport, CT 06604
> [203] 441-8433 [Office]
> [203] 522-2817 [Cell]
> [203] 367-0791 [Fax]
> email: radproject at sbcglobal.net
> website: http://www.farber-medical.com
>           
> ====================================
> 
> 
> 
> 
> ----- Original Message -----
> From: "John Jacobus" <crispy_bird at yahoo.com>
> To: <radsafe at radlab.nl>
> Sent: Thursday, November 01, 2007 9:09 PM
> Subject: RE: [ RadSafe ] CT scans dangerous?
> 
> 
> > Ward,
> > ALARA does not and should not apply to medical
> > exposures. ALARA principles are used to reduce the
> > risk of harmful effects associated with radiation
> > exposures.  In medicine, the patient is frequently
> > already at risk from harm due to disease or
> injury. 
> > Radiation, surgery, prescribed drugs, etc., all
> have
> > the potential to improve the patents' health and
> > quality of life.  
> > 
> > While physicians are probably not trained in the
> risks
> > of radiation exposure, drug interactions, etc.
> they
> > assume total responsibility for the patient under
> > their care.  
> > 
> > 
> > --- "Brunkow, Ward" <ward.brunkow at wipp.ws> wrote:
> > 
> >> 
> >> Good issue to bring up. I think the answer is as
> it
> >> has been for
> >> decades:
> >> >ALARA principal is not observed well within the
> >> medical community
> >> >Dr.s aren't trained well in radiation safety and
> >> therefore prescribe
> >> diagnostic use freely
> >> >I think the older CT scanners were giving 12 -20
> >> Rem  acute exposure at
> >> times, especially upper and lower GI
> >> >Not enough consideration given to rapidly
> dividing
> >> cells, young people
> >> >$$$$$$$$$$$$$$$$$$$$$$$$$$$, money driven yet,
> not
> >> ethical to give
> >> someone this exposure if there isn't significant
> >> benefit, especially
> >> younger person, but have to keep those bucks
> coming
> >> in
> >> >Too much "cook book" diagnosis in medical
> community
> >> yet, diagnostic
> >> (therapeutic for that matter also) radiation
> >> exposure used too freely.
> >> The Prescribe and move on to the next one....
> >> premise....
> >> 
> >> 
> >> 
> >> W. G. (Ward) Brunkow
> >> DOE Contractor (former Medical School RSO)
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+++++++++++++++++++
"If you guard your toothbrushes and diamonds with equal zeal, you'll probably lose fewer toothbrushes and more diamonds."
- Former national security advised McGeorge Bundy
-- John
John Jacobus, MS
Certified Health Physicist
e-mail:  crispy_bird at yahoo.com

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