Radiation Exposures and Doses

[VERNIG.PETER@forum.va.gov]

There has been some confusion regarding dose and exposure.
We were first discussing Average glandular dose for mammography.
Some of the responses seemed to blur the destinction between
dose and exposure and also there has been some argument about
measuring exact doses for a given individual proceedure.  Rahter
I should say arguments against that.  I'm not sure anybody has
argued for it.  I think what many are saying what I would say is
that JCAHO in the case of mammography requires average glandular
doses be calculated and in the case of other normal proceedures
requires that entrance skin doses (ESEs be calculated and these
should be cheerfully provided to any patient that asks.  That is
that the closest appropriate ESE or Glandular dose for mammography
be given and if available a brochure describing the risk benefit
of general proceedures or specific ones given.
 
Dr. Broga indicated he didn't think laymen would be able to use the
information.  I would say that many can't and the point that a low
number isn't the whole story is well taken.  That could be part of
a good brochure.  But I do not go along with the idea that ACR
Acreditation and or State Inspection or FDA approval is all that should
be asked for.  ACR accreditation does not prohibbit the use of
either xeromammography or the use of modified general purpose
tungsten anode mammography units which both deliver significantly higher
doses without any corresponding bendfit.  I frequently ask for the
package insert when a new drug is prescribed for myself or a member of
my family.  We also have had a Physicians Desk Reference and now have
a more layman oriented and less expensive drug reference book.  We
always read carefully about any drug prescribed by our family doctor
that we are not familiar with.  It's not that we don't trust him, if
we didn't he wouldn't be our doctor, but this it is important and
may affect our health.  On occassion we will call him to discuss a
drug new to us.  I take the attitude that he is our medical consultant
we pay fo his advice and usually follow it but are at liberty to
ask for more information.
 
These are my opinions and not necessarilly those of Denver VA Medical 
Center, Dept. of Veterans Affairs or the U.S. Government.