Thursday, February 24, 2005

Medical News

Federal agency adds x-rays to carcinogen warning list

Ionizing radiation has been listed for the first time as a known human carcinogen in a report prepared by the National Toxicology Program, an interagency group coordinated by the U.S. Department of Health and Human Services. The report has been published every two years for more than two decades.
According to the "Report on Carcinogens, Eleventh Edition" released on Jan. 28, studies show that exposure to x-rays and gamma rays causes many types of cancer. Childhood exposure is linked to an increased risk for leukemia and thyroid cancer, while exposure during reproductive years increases the risk for breast cancer. Exposure later in life increases risk for lung cancer.
The report cites evidence that exposure to ionizing radiation is linked to cancer of the salivary glands, stomach, colon, bladder, ovaries, central nervous system, and skin.
The American College of Radiology will petition the NTP to have ionizing radiation removed from the list. The ACR fears that patients will be inappropriately alarmed.

The U.S. National Toxicology Program has added ionizing radiation to its list of known carcinogens. Do you believe this step will deter patients from getting needed x-ray and CT exams, or that it is a legitimate warning against overuse of radiological procedures?

From-
www.diagnosticimaging.com

2 comments:

Anonymous said...

As with any intervention with a patient in medicine explanation of risks and benefits are important. Every CBC you order should be justified in your mind and in theory even to the patient. This prevents unneccessary tests that cost the system and patients money, that cost time and personel power and save the patient undue grief. If you don't need it, don't order it! Every needle that touches skin is associated with risk to the patient. Threatening LPs for instance on terrified crying kids often gets their equally terrified parents asking if it is really needed so we tend to explain things better, talking about the risk of missing meningitis and the benefit of diagnosing it. Now that radiation risks are identified and known to the public, much like any other area of medicine (surgery especially) we will have to discuss risk/benefits with patients. The worry of missing that pneumonia because of avoiding a CXR for a minute cancer risk can easily be explained to the patient so that they can decide on their own. Most I'd imagine will go for the test, just like the surgery when the pages of risks are recited and just like the LP on those "rule out sepsis" kids.

It is important I think to explain risk in a way the patient understands, not just these "1/10000" things. You should quote everyday things and associated risks like driving in the car, flying on a plane or getting hit by lightning to really hit the message home about these radiation risks.

Of course we should also realize we are causing a few kids to get cancer after so many chest x-rays and be thinking about that, again justifying each one to the best of our ability. That doesn't mean don't order CXRs we just need to accept causing a possibly bad outcome in process of trying to help an individual as well as the entire patient base.

Having said all that, I believe that this "consent" approach to radiology should be a team approach, with the radiologists personally being at the head of the table in these discussions with patients, something that in the current set up the system is not going to occur adequately unfortunately. Like the anesthiologist explaining their intervention's risk or the internist their medication's side effects, it is the radiologist's responsibility.

MC

Anonymous said...

agreed that once explained the risks.. patient usually wud go for the investigation anyhow and it is better for the patient that he is informed bout the risks of radiation.. sumer sethi

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