Ethics

[Kent Lambert <lambert@allegheny.edu>]

If this message has been posted already, sorry, but I keep getting error messages 
(e.g., undeliverable mail, you dummy).

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.  And I'm sure that 
many other "proud CHP's" have done much 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@allegheny.edu

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