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Re: Age determination by x-ray examinations
First of all apologize to comment this subject only now, I couldn’t do it
last week.
Medical practices as Bone densitometer using radioactive source as Am-241
and I-125, and very
low-dose X-ray beams to scan areas of a patient's body, especially cases of
Osteoporosis, were justified and approved by Regulatory Authority, case of
Brazil, for instance. That time the justification was made take into account
the ICRP 27 and the IAEA Basic Safety Standards, Safety Series, 9
However, to this subject, it is my point of view that Sandy is correct, and
his argument is founded in the first
principle of radiation protection, the principle of justification of the
practice, now, as
stated in the ICRP 60, page 29, 4.3.1 (115):
"Decisions concerning the adoption and continuation of any human activity
involve a choice between possible options and are often carried out in two
stages. The first stage is the examinations of each option separately in
order to identify those options, which can be expected to do more good than
harm. This provides a "short list" from which the preferred option can be
selected. The second stage, the final selection, will often involve the
replacement of one existing practice to another. The net benefit of the
change will then be the relevant feature rather than the net benefit of each
option separately. The ICRP recommends that, when practices involving
exposure, or potential exposure, to radiation are being considered, the
radiation detriment should be explicit included in the process of choice"
However, also the ICRP state: "To search for the best of all available
options is usually a task beyond the responsibility of radiological
protection agencies"
The IAEA Basic Safety Standards, Safety Series 115, page 45 (II.4) states:
Medical exposures should be justified by weighing the diagnostic 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.
II.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 (1,2)
1 - WHO - A Rational approach to Radiodiagnostic Investigations, TRS 689,
WHO, 1983
2 - WHO - A Rational Use of Diagnostic Imaging in Pediatrics, TRS 757,
WHO, 1987
My question on this topic is: Was this specific medical practice justified
and approved by the Regulatory Authority?
Jose Julio Rozental
joseroze@netvision.net.il
Israel
----- Original Message -----
From: Chris Alston <alstonc@odrge.odr.georgetown.edu>
To: Multiple recipients of list <radsafe@romulus.ehs.uiuc.edu>
Sent: Monday, January 08, 2001 8:05 PM
Subject: Re: Age determination by x-ray examinations
Sandy
There's nothing wrong with these studies. In fact, I can't think right off
of a study of comparable importance in which as much information is
obtained, at the cost of such a low EDE. Perhaps another Radsafer can
suggest one.
Are we all aware that what's being done, typically, is a radiograph of the
hands (including wrists), and a panoramic dental view? The idea is to
determine when the patient has reached physical maturity (ceased growing),
which is defined by the fusion of the wrist bones, and the appearance of
wisdom teeth. Many centers do these routinely, for, e.g., children who've
had BMT's, since they are usually small for their ages. What methods or
"applications" would you recommend, to get this information?
Cheers
cja
At 12:01 PM 1/7/01 -0800, you wrote:
>I am not a physician, but will provide my own personal opinions.
>
>This practice is akin to many other practices over the decades,
>whereby individuals were exposed to ionizing radiation, all in the
>name of research and for various other socio reasons. In recent
>years, many of these practices have come to the forefront in the
>media, and in the US, into the political arena. These issues, every
>time they are raised, and public attention is raised, only causes
>our profession, health and medical physicists, to be looked upon in
>disdain.
>
>My opinion is that unless there is a significant medical benefit,
>where no other procedure may be used instead of, then the use of
>ionizing radiation, be it from x-ray generating machines, or, from
>nuclear medicine procedures, should not be conducted. How
>different is age determination from the very old practice of proper
>shoe fitting, using fluroscopic machines? Were there other
>methods available? Of course. Are there other applications
>available to determine age? Of course.
>
>When are we going to learn?
>---------------------------------------------------------------------------
-------
>Sandy Perle Tel:(714) 545-0100 / (800)
>548-5100
>Director, Technical Extension 2306
>ICN Worldwide Dosimetry Service Fax:(714) 668-3149
>ICN Pharmaceuticals, Inc. E-Mail:
sandyfl@earthlink.net
>ICN Plaza, 3300 Hyland Avenue E-Mail: sperle@icnpharm.com
>Costa Mesa, CA 92626
>
>Personal Website: http://sandyfl.nukeworker.net
>ICN Worldwide Dosimetry Website: http://www.dosimetry.com
>
>~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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