Ethics - Whose?

["Mike Bohan" <mike.bohan@yale.edu>]

        Reply to:   Ethics - Whose?

Hi Radsafers:

The problem as I see it is that most (but not all) X-ray technologists and
physicians do not have the appropriate understanding of the dosimetry and risk
benefit issues to give a patient a legitmate answer in the first place.  This is
not because of ethics, at least by the individuals involved, but because of
ignorance.  

Most medical students never receive any radiation science training through their
4 year medical education.   However once they get their M.D., they are licensed
to prescribe x-rays.  Even physicians who go on to radiology residencies,
sometimes receive inadequate information on radiation dosimetry and protection
issues.  Especially concerning the issues of radiation and pregnancy.  

The Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) a
few years ago put in a requirement that each x-ray facility should be able to
quote dosages to patients, based on actual machine measurements.  However, many
institutions, especially smaller ones do not have the appropriate physics staff
to provide this information.  They may hire a physicist to do the measurements
but usually don't know what the information means on how to use it once they get
it.  

The caveat to all this is, quoting a number to a patient without explanation. 
Granted that most on this list, would know what it means, but the public in
general would have nothing to compare it with.  In CT, which started this
thread, explaining the dosimetry can get relatively complicated.  Do you quote
entrance exposure, central dose, CTDI, MSAD?  Have you ever tried explaining the
dosimetry of a fluoroscopic special procedure to a patient, which includes cine
runs and multiple exposures with different field sizes and anatomical sites?  

In my experience, when a patient has a question such as this which gets referred
to me, it takes more than a few minutes to explain what the numbers and the
radiation risks mean.  For some a simple explanation is enough, however I have
had radiophobia cases where no explanation will ever be enough.

The problem underlying all of this is fundamental ignorance.  The public is
understandable, but why is radiation science not a requirement in most medical
and science graduate schools.  For that matter, how do people go through a B.S.,
M.S, and possibly a Ph.D. in biology or other science which utilizes radioactive
materials for research purposes without course work in radiochemistry and
physics.  Then the poor RSO's out there are expected to provide the necessary
training in a  few hour course and set them free to be P.I.'s?

So to wrap up this soap box, the real ethical problem is in the professional
educational system.  We all cry about the public ignorance about radiation
issues, but how can the professional educational system allow this to slip
through the cracks?

Just my $0.02 worth, well maybe two bits!

Mike Bohan
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Michael J. Bohan, RSO   |  e-mail: mike.bohan@yale.edu
Yale-New Haven Hospital |    Tele: (203) 785-2950
Radiological Physics    |     FAX: (203) 737-4252
20 York St. - WWW 204   |    As usual, everything I say may be plausibly
New Haven, CT    06504  |    denied at my employer's convenience ...
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