Re[4]: A question of ethics

[BRZGV@ccmail.ceco.com]

     thanks for the feedback.  As far as nuclear workers and the "perceived 
     benefit" received; it is generally accepted that the high paying jobs 
     we have are benefit enough to offset the small exposures we receive.  
     We are also supplying lots of wonderfully environmentally clean power 
     to benefit all of society.
     
     Sorry about the Tl-201 mistake.  You are indeed correct.
     
     
     Sincerely,
     Glen


______________________________ Reply Separator _________________________________
Subject: Re: Re[2]: A question of ethics
Author:  radsafe@romulus.ehs.uiuc.edu at INTERNET
Date:    6/25/96 1:36 PM


BRZGV@ccmail.ceco.com wrote:
> 
>      I think it would not be too unreasonable to say that the health care
>      community just doesn't care or is ignorant and doesn't care.  Wouldn't 
>      it be easy to charge each patient another $500.00 for an Excel
>      spreadsheet dose calculation.  Maybe they're afraid the relatively 
>      large amounts of dose will scare people?  Something else to be sued 
>      for?
> 
>      Patients also get terrible information on clearance rates from
>      doctors.  We frequently get personnel who have received information 
>      stating the activity would be gone in 2 or 3 days, while they still
>      alarm our whole-body monitors (~30 nCi) for three weeks or so.  TL-208 
>      administrations are what we see most.
> 
>      Remember doctors are people too and are no more caring or honest than 
>      you, I, or anyone else.
> 
>      Glen Vickers
>_______________________________________________________
     
1) Lumping all members of the health care community into one bunch of 
people that "don't care" is similar to calling all radiation exposure 
"deadly" or lumping all members of an ethnic group into one basket.
     
The members of the medical community that deal with radioactivity are 
indeed aware of the potential effects of radiation exposure.  And not 
only because the NRC keeps tabs on us, just as they do you.  
     
All Radiology, Radiation Therapy, and Nuclear Medicine residents and 
technologists must go through radiation and radiobiology training.  
Those that are interested in the subject pursue it further; those that 
receive the take-home message that low doses are probably nothing to be 
concerned about (sound familiar, HPS members?) know that they are using 
ionizing radiation, but don't bother with remembering all the specifics 
because the specifics don't affect the way they take care of patients.
     
When a patient has a question or a specific concern about radiation 
exposure that the technologist or doctor can not recall from their 
training 5 years earlier, they should be referred to those that are 
more familiar with the subject.  The same as being referred to any other 
specialist.  How many personnel at a nuke plant know health physics?  
They may deal with public opinion and radioactivity daily, but they may 
know nothing about dosimetry, other than the fact that they and the 
public around the plant are not exposed to levels of concern.  If they 
are asked a more detailed question, they refer to the HPs.
     
2) As I mentioned before, conveying dosimetry data is not the difficult 
task.  It is discussing the importance of the numbers.  Yes, we often 
deal with exposures much higher than those seen in nuke plants.  Why 
does it seem that our exposures are dismissed while the smaller 
exposures at a nuke plant are jumped all over?  Because we intentionally 
expose patients to radiation for a perceived benefit, while any 
exposures at a nukes plant are not directly associated with a benefit to 
that individual.  If a plant exposes someone, it is difficult to 
identify a direct beneficial effect of that exposure to that individual, 
hence, a "mistake" was made.  For almost any exposure.
     
The fact that you have to package and dispose of levels of activity at a 
cost of thousands of dollars per 55 gal drum, while I can scrape a 
higher level of activity out of my fireplace and toss it in the trash is 
one of the wonders of the regulatory system that the medical community 
is not responsible for.  The problem there is not that I throw too much 
activity into my trash, but that you have to pay so much to get rid of 
yours.
     
Subsequently, it has been beaten into you that you must account for every 
itty bitty decay, and you have become very good at it.  So it seems 
difficult to understand why we (medical) can be so flippant about telling 
someone injected with an isotope with a half-life of 73 hours that it is 
"all gone" in 2 or 3 days.  We are not ignorant of the remaining 
activity.  Rather, we are cognizant of the relative importance of that 
amount of remaining activity.  Just when it seems, from your perspective, 
that the NRC is out of their minds, they do something like acknowledge 
that a radioactive person with a small amount of activity in them does 
not need to be put in a 55 gal drum for 10 half-lives.
     
3) It is most likely you are seeing Tl-201 administrations, not Tl-208. 
Tl-208 has gammas higher than we can use, and the half-life is a bit 
short.  Not to mention, I haven't the foggiest of how we could obtain 
such a beast.
     
Kevin Donohoe, M.D.
kjd@nucmed.bih.harvard.edu