I have been frequently heard to say that among the things you are never supposed to debate with your friends and family are sex, money, religion, and Radiation Hazards!! It is a very controversial subject with social, theoretical, and political consequences. There are 2 sides of the fence: 1. every bit of radiation should be avoided or 2. radiation is actually good for you. I will not be so bold as to ask which side of the fence is your side.
With the proliferation of radiation producing equipment into all areas of inpatient and outpatient care, the practice of applying radiation procedures for diagnosis left the hands of those with specific training to protect the patient from deleterious effects. As equipment transitioned from analog to digital, radiation dose creep became an everyday event. As the hazards increased with dose, reports of severe overexposure began to surface, first as anecdotal at medical meetings and eventually as documented medical cases. In early 1990’s the FDA had documented 40 cases of radiation burns from fluoro procedures and in 1994 issued the first hazard advisory. Pictures of actual radiation burns began to fly around the internet and documented side effects such as hair loss. Wait a minute! Documented hair loss? That is only supposed to happen in radiation oncology. But, soon Informed Consent Forms for some radiologic procedures were listing reddening of the skin and hair loss as a common side effect of several diagnostic procedures.
This phenomenon is complicated by the referral patterns to specialists doing radiologic procedures in facilities or cities far removed from the patient’s home base. A second complication is patient travel between settings or facilities where different physicians order more procedures or repeat the procedures already performed. No tracking of radiation dose is accomplished and the effects continue to build. Disaster is in the making. Reports of overexposure to children and adults began to get wide coverage in the media.
In November 2014 Federal Guidance Report 14 was issued with recommendations for radiation protection for patients and personnel. Currently 9 states (Alaska, California, Colorado, Iowa, Massachusetts, Minnesota, Oregon, Pennsylvania, and Texas) have developed regulations for personnel who use fluoroscopy to have documented training for equipment operation and safety. The Joint Commission required training implementation for radiology personnel for CT and fluoroscopy along with a requirement for safety training on an annual basis this year. New proposed language from The Joint Commission is changing the words in the Standards to include all individuals who operate or supervise the operation of fluoroscopy or CT equipment. The Cardiology Associations have issued a new joint expert consensus document providing best practices for radiation safety.
Finally, the tide is turning. Maybe.