REPLY TO REPLY MED VS PHYS

["ZAPP, NEAL (JSC-SD)" <neal.zapp1@jsc.nasa.gov>]

"I wish things (in medical practice) were the way you seem to think 
they are but that's not the current reality.  Isn't it possible that 
medical practice decisions could be improved with input (risk 
estimates and procedural improvement) from physicists?"


I think the point you make is very valid, and indeed correct for the most
part.  Providing safety input is in fact the reason that physiscists are in
general employed in conjunction with a comprehensive imaging facility at
health care centers.  And I would also have to agree that most MD's (please
don't tell the flight surgeons I deal with that I said this) would not be
able to in any general way quantitate a risk corresponding to a given
exposure, so that this information should come from the physicist.  In fact,
in reading this last posting, I only have one point of contention:  neither
the existence of financial incentives inherent in the health care industry
associated with the overuse of diagnostic imaging , nor the fact that
physicians lack education in the basics of radiation risk analysis as it
pertains to imaging exposure, is the fault of the medical physics community.
It is not the responsibility of the medical physicist to question the orders
for diagnostic images coming from a physician.  That is a medical decision,
and I think we can all agree on that fairly quickly.  If the medical
community looks within and sees that there is overexposure of patients
stemming from over-ordering of diagnostic images, then it would seem that it
is the responsibility of the medical community to correct the situation,
either by educating physicians on the basics of radiation risk (which it
seems could be done fairly painlessly), or by asking the physicist.
Anything else puts the physicist in the place of making a medical decision,
and as a physicist, I'm not comfortable with that.  I can't imagine a
reality wherein every film ordered by every physician in every hospital in
every town must be accompanied by a medical justification, to be approved or
rejected by a physicist.  In reality, when an order for a panel (of whatever
image type) comes in to radiology, then those shots are the shots that the
doctor says he or she needs to make a medical decision.  That's implicit in
the order.  If that's not reality, then I agree, there's a problem, but I
disagree that it is the place of the physics community to "fix" the medical
community.  In any case, risk estimates exist, and in my world procedural
improvements are a constant effort, so I agree that these are necessary
pieces of progress.  Since we've traded a couple now, I suggest that if you
wish to continue this particular line of discussion, we should do it
off-list.

Of course only my personal opinion,

Neal Zapp
NASA/JSC, Radiation Biology
Bldg. 37, Rm. 1118
(281) 483-2244 (O)
(713) 765-2193 (P)



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