RE: Mammography Doses

["Barry Siegel" <siegelb@mirlink.wustl.edu>]

After reading much of this chatter today, I've decided that someone has to
stand up for the use of diagnostic radiation exposure in the practice of
medicine.  The benefit-to-risk ratio for most such exposures is sufficiently
high that long discussions about dose with patients simply are not worth the
time it would take for technologists and most radiologists to memorize the
numbers for each examination.  Moreover, the discussion of stochastic radiation
effects with most patients will lead either to bewilderment or unnecessary fear
(this audience, in particular, knows just how much trouble most people have
understanding relative risks), and will consume large amounts of technologist
and/or radiologist time for which insurance companies have no intention of
paying. [How much extra would these patients be willing to pay out of pocket
for this extra information, if there were a charge for providing it?]  I am not
surprised that most technologists cannot cite the radiation dose ranges for
particular examinations, but would be surprised if most radiologists could not
FIND (find, but not recall directly from memory) the information if it were
requested.

At what dose level should a patient refuse a clinically indicated diagnostic
examination because of the concern about radiation exposure?  [With regard to
the patient mentioned below, I would have given him information regarding
expected radiation exposure from his chest radiograph, but would have asked him
to seek his medical care elsewhere before I would have provided a film badge
for this diagnostic study.]  I wonder if these same individuals ask for
detailed risk analyses each time they are given a prescription or undergo a
laboratory test (e.g., what is the probability that a false-positive result
will lead to the wrong treatment which win turn will cause a fatal adverse
reaction?  

Barry A. Siegel, M.D.
Mallinckrodt Institute of Radiology
_______________________________________________________________________________
From: radsafe@romulus.ehs.uiuc.edu on 7 Nov 1994 17:34
Subject: Re: Mammography Doses
To: Multiple recipients of list

I am also curious about whether men get different handling from the 
technologists if the question about dose is asked by a man.
     
Looking forward to my further education,
     
Sue Dupre/Health Physicist/Princeton University


     Sue,  Regarding your question above on the dose from obviously 
     gender-specific mammography, males do run into similar problems.  
     Some years ago, a male friend of mine refused to take a chest 
     x-ray for TB (a requirement for State employment).  He said 
     unless he knew the dose to be delivered, he preferred a skin 
     test.  Rather than argue (or acquiesce), the radiology folks 
     eventually allowed him to wear a film badge during the x-ray so 
     he'd have an idea of the dose.  This process took days to iron 
     out and made for some hard feelings, but the radiology people 
     never were able to really say much about the expected exposure 
     until after the film was developed. 


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From: "GOLDIN, ERIC" <goldinem@songs.sce.com>
To: Multiple recipients of list <radsafe@romulus.ehs.uiuc.edu>
Subject: Re: Mammography Doses
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