Re: Ethics

[Kent Lambert <lambert@allegheny.edu>]

TED S. BOHN wrote:
>
> Isn't it amazing how with the blessing of the Medical field (Dentistry,
> Internal medicine, Cancer treatments etc.) the use of radioactivity is
> often never questioned and is readily accepted ("A SPOON FULL OF SUGAR
> MAKES THE MEDICINE GO DOWN"..Ref. Mary Poppins), where as the nuclear
> power industry is looked down on with disdain by the general public and
> activists work hard to shut them down.  Are Medical facilities ever picketed
> for their adminitration of radioisotopes?  Where is most radiation doses
> picked up by the public, in the field of Medicine or Industry?

Maybe Medicine has provided a clear and unambiguous benefit for the risk from the
radiation exposure that cannot be demonstrated by Industry.  The perception is that a
radiation exposure from industrial sources is caused by accidents and incompetence
rather than the deliberate and considered administration of radiation to determine if
one has a malignancy, kidney stones, cysts, etc.  An environmental release of
radioactive material at a nuclear power plant never lit a lightbulb.
 
William G. Nabor writes:

>          2) My OPINION is that a technician that cannot calculate a dose and
> explain it to a patient is the equivlent of a mechanic who doesn't know how
> much oil he put in your crankcase.  I think it unprofessional.  It should be
> a mandatory part of their certification requirements.  It is allowed to
> exist because only health physicists ask such questions.  It's a matter of
> patient training.

I disagree.  Using your analogy, it is the equivalent of a mechanic who doesn't know the
content (i.e., the additives) in the motor oil.  The technician that cannot tell you the
technique factors used to generate the radiographic image is the same as the mechanic
who does not know how much oil was put in your car.  You are asking a technician with 2
years of post high school education to answer questions which are, as Mike Bohan
indicates, time consuming and in some cases difficult for a highly trained medical
physicist to answer.  Can you tell me what the TEDE is for an extremity exposure which
involves the elbow and parts of the ulna, radius and humorus if the skin entrance
exposure is 15 mR at 60 kVp?  What about the TEDE for a lower GI fluoroscopic procedure
at 80 kVp for 5 minutes at 2 R/minute skin entrance exposure where the area under the
fluoroscope is moved, but there is no record of its time exposing any single area?  And 
what good is this information if one cannot discuss comparative risks?  

With all due respect to Alex Zapantis, the professionals on this listserver 
ARE constantly at odds with one another about the risks from radiation at exposure 
levels in the range of diagnostic imaging.  LNT is a model for radiation protection not 
for risk.  How many additional cancers have been seen from all those people who have 
received nuclear medicine procedures?  Who out there believes that a system as complex 
as the human body and its interaction with any assult, especially the complex 
interaction of ionizing radiation with tissue, behaves with a simple linear 
relationship? 

I agree that a patient has the right to be informed of the risks associated with
healthcare.  I disagree that the radiological technician is the right person to discuss
these risks.  Why is it that the HP patients are afraid to ask his/her physician?  Would
you ask the operating room nurse or the person transporting you into the operating room 
'Which is more risky, Procedure A or Procedure B?'?  I don' think so.  The problem, 
however, is that the physician does not know the answer any better than the technician. 
 I was once told by a dentist that he informed his patients that a dental x-ray was the 
same exposure as a day on the beach.  I guess we need leaded bathing suits (now there's 
a real risk).

Although I agree with Mike Bohan's comments, I think HP's share in the blame.  How hard
have we (through the HPS) lobbied to get radiation protection into the medical school
curriculum and on certification board tests?  If our goal is to reduce collective doses, 
and medical exposures are the largest man-made contributer to collective dose, then 
wouldn't our efforts educating the physicians prescribing these tests be well placed?

Merritt, Kim D 7714 M <KDMERRI@sandia.gov> wrote:

> Why aren't those proud CHP's out there interacting with the community to educate them?

This CHP has given lectures to high school students, set up booths at science fairs and 
career days (back when the Newsletter had ads in the back), and participated at exhibits 
for science teachers, given lectures to medical dosimetrists, taught radiation physics 
to radiological technologists and taught radiation protection to industial hygienists on 
an undergraduate and graduate level.  I'm sure that other proud CHP's have done more of 
this than I have.  So be careful of generalizations.

And now, I'll let someone else use the soapbox.

Kent Lambert, CHP
lambert@hal.hahnemann.edu

All opinions are well reasoned and insightful.
Needless to say, they are not [necessarily] the
opinions of my employer. - paraphrased from Michael Feldman


--
Kent Lambert, CHP
lambert@hal.hahnemann.edu

All opinions are well reasoned and insightful.
Needless to say, they are not [necessarily] the
opinions of my employer. - paraphrased from Michael Feldman