When it comes to safety regulations for radiation, the
experts, radiologists, have got it covered. But the same
can't be said for other specialists, such as orthopedic
surgeons, cardiologists and urologists, who increasingly
use radiation-emitting machines as part of routine procedures.
And this lack of comprehensive guidelines is putting the
doctors at risk, says Normand Laberge, CEO of the Canadian
Association of Radiologists (CAR).
Mr Laberge says he's seen cardiology
units using fluoroscopy equipment but not practising
proper radiation precautions. Sometimes even the most
basic steps, like recording the dose and length of exposure
in a logbook, weren't being followed. "Physicians are
largely unaware of ...dose exposure of the ionizing
exams they prescribe and/or perform daily," found a
study in the September 2005 International Journal
of Cardiology.
There have always been worries
about patient safety with procedures like fluoroscopy.
An explosion of studies in the last couple of years
shows that fears about effects on doctors are growing
apace.
DEADLY
DIAGNOSTIC?
Fluoroscopy uses ionizing radiation and its high dose
(typical skin dose rates range from 20-50 mGy/min) and
the length of procedures increase the risks for certain
cancers and other effects of radiation like mild erythema
or serious burns. Physicians aren't exposed to the same
levels as patients and were believed to be safe. But
recent studies have shown that the doses are higher
than previously thought.
A study in the September 2005
Journal of Urology, for example, found that radiation
exposure during fluoroscopic screening is only 2% less
than permissible annual limits. Actual radiation exposure
risk to surgeons' hands is higher than reported, according
to a study in the June 2005 issue of Archives of
Orthopedic Trauma Surgery. The authors of that study
also note that "scattered reports of complications [affecting
surgeons] such as acute radiodermatitis of fingers,
basal cell carcinoma and even multiple amputations of
digits have been published."
Despite these findings, there aren't
any policies in place to protect doctors outside the
field of radiology. "The rules that apply to radiologists
should be applied to all departments," states Mr Laberge
emphatically.
SAFE
REALITY
Michelle Cottreau, a medical physicist in PEI and radiation
protection officer for the province, says the issue
of radiation protection for other specialties has been
raised in the medical physics community. "I don't know
why it's taken so long, it's still haphazard," she says.
In most jurisdictions in Canada, physicians are legally
allowed to press the button on an x-ray machine. "No
training or credentials are required," she says. The
reality is a little different though. Every institution
she's worked at during her 15-year career required that
an x-ray technician be present to control the conditions
of the machine. In her experience most cardiac cath
suites have standard precautions like leaded walls and
protective gear for staff. The problem, she says, is
when mobile x-ray units are pulled into operating rooms.
"That's when it becomes trickier to monitor," she says.
REGULATION
GAP
Health Canada develops national standards on radiation
safety and disseminates them to the provinces, which
regulate how equipment is used. The equipment itself
is a federal jurisdiction.
Originally, Health Canada's stringent
guidelines were only for radiologists because they were
the only doctors using this type of equipment, says
Mr Laberge. But the rise in radiological diagnostics
means that other specialties are falling through the
cracks.
Many in the radiology field believe
it's time all physicians learned how to properly use
this type of equipment. "It's about changing attitudes,
and changing attitudes is done through education," says
Mr Laberge. He'd like to see medical schools and hospitals
implement radiation-protection courses to non-radiology
staff members and students.
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