Illinois had dose limits for common projections & a std.-Reply

[Kathleen Kaufman <KKAUFMAN@dhs.co.la.ca.us>]

Illinois does have entrance skin exposure(ESE) limits. I believe other
states may have such limits- I'm pretty sure Washington also has them. I
believe such limits ARE appropriate & necessary, so long as they are
reasonable. Although the averge ESE for an AP lumbar spine is on the
order of 300 mrems, we still have facilities where it will be over 3,000.
There is ALWAYS some poor practice in these situations, including the
use of intensifying screens that over 30 years old, auto developer temps
at 70 degrees (when they should be 95 degrees), etc. etc. Film quality is
almost always very poor at these facilities also, so the patient is getting a
double whammy of high dose & poor diagnostic info. Remember that
there are a lot of private practitioners out there using x-ray in their
practices. ESE limits could play an important role in improving their
standard of practice, & patients, who can't possibly have any idea that
they may be getting a dose that is 10 times higher than necessary,
deserve our having the ability to require such improvements! Although
we make recommendations, without the enforcement ability they are
OFTEN not implemented.

kkaufman@dhs.co.la.ca.us