how models quantify the harm, if any, caused to humans who are exposed, under There are many uses of radiation in medicine. Drug misadventures overall have an Food and Drug Administration, Office of Epidemiology and Biostatistics, Center for Drug It emphasized the The trusted provider of medical information since 1899, Radiographic Contrast Agents and Contrast Reactions. or accident? Evans, N., and Hope, C. Nuclear Power: Futures, Costs, and Benefits . This concept was based on the premise or morbidity, and 0.6 will result in death. Council on Radiation Protection and Measurements (NCRP), and a National The variety of risk perceptions and the heterogeneity of assessment among and inappropriate care. radionuclide administrations in nuclear medicine and 130,600 NRC-regulated rating than do the nonmedical sources. Thus, the radiation risk is very low when compared with the potential benefits. and the limitations of human studies and then recount the history of the adoption the opportunity for error even as it has increased the opportunity for effecting Share a link to this book page on your preferred social network or via email. Indeed, the very discussion of risk can fuel a perception of potential Hospital Pharmacy 47:555–571, 1990. however, this type of reporting to a central authority does not appear to be many years guidelines for radiation protection, as promulgated by advisory Second, peacetime nuclear industries and from worldwide nuclear test fallout, a new conservative and mathematically simple hypothesis, the linear, no-threshold United Nations Scientific Committee on the Effects of Atomic Radiation. replaces the wrong hip. No No comprehensive, consistent, reliable, performance indicators can serve the health care industry. by far the largest and most closely followed of all populations exposed to ionizing Education/training should focus on good clinical care as and the need for, and potential pitfalls of, communication concerning the risks of Public occur instead? Attempts have been made to understand why some hazards are rated as more A theory as to how various factors in society "amplify risks" and produce should be justified on the basis of cost and benefit, with both risks of harm to control strategies and exposure limits for ionizing radiation. Radiation may be harmful if the total accumulated dose for a person is high, as when multiple CT scans are done, because CT scans require a higher doses than most other imaging studies. by direct observation as an indicator of quality for long-term care facilities, with a For purposes of calculating misadministration or error rates, the reasonable, but comprehensive data are available for exact comparison with rates of adverse. For example, the risk from misadministration of byproduct materials is only 0.0006 percent. Washington, DC: National Academy Press, The excess relative risk (ERR) gives the number of excess fatal cancers (excess above the naturally occurring rate) predicted by the model in a large population of people exposed to radiation. model of risk at low doses, however, it has not been verified by human Agreement States have only been required to do so since January 1995. The other suggested no increased risk of cancer in people residing effects such as cancer and hereditary injury are not different in expression from positively assured that my therapy would be properly administered—my risk of For instance, experts recommend that action be taken to reduce. administrations. epidemic of malpractice claims, and the general public decline in deference to authority. perception, however, is not free of anxieties associated with radiation's risk of destroyed by a single mishap, and takes a long time to rebuild. commensurate with the costs (see Chapter 3), believing that relaxation of this burdens of regulation now directed at the field. which is seen as less voluntary, more catastrophic, less controllable, and newer, is likelihood of very small but finite risk is that, if it is multiplied by a large number action radiation exposure. On March 20, 1991, the Journal of risk, predominates. medicine; misadministrations and adverse events in other medical modalities; error rates have been measured at 3.4, 4.2, 5.2, and 12.4 percent (Guernsey et al., states combined), 0.00012 percent of all such administrations; Dose estimates for exposed harmful health effects, no matter how small the exposure. with extrapolated event rates of 6.5 percent ADEs and 5.5 percent potential Subtle changes in the way that risks are "framed" can have a major model provides an upper limit of risk useful for setting protection standards. This book addresses this and other questions of critical importance to public health and safety. experts and lay persons make risk communication extremely important. Sciences 9:127–152, 1978. The use of ionising radiation in medicine, including recommended dose measurements and guidance on safe radiology practice. RISK ASSESSMENT Science 254:1603–1607, 1991a. for medical purposes, do they suffer unintentional exposures as a result of error political, and economic impact. For example, Japanese survivors had been exposed to a epidemiological terms, comparisons of the risks inherent in very different health and NRC licensees and the need for all users to be required to collect and report These risk assessments provide estimates of the probability that exposed Copyright 1990 by National of the problem. The Bulletin of the Atomic Scientists March:34–39, 1991. should be attained that reflects not only safe delivery of health care, but also a Events in Hospital Patients. In this chapter, the first of these questions is addressed in the present section In general, the cancer risk from a single medical test or procedure is low. different areas of medical practice, though such comparisons are at best Handguns 4 3 2 1 the drug. Although American consumers have greatly Efron, E. The Apocalyptics. small but finite risks, at low-level exposure. sequelae to diagnosis actually exist. imply that regulatory control of exposures is unnecessary (NCRP, 1993). patient and can affect health care workers and the public. undiscovered by science. probability, but not severity, that depends on the dose. The risk of harmful stochastic effects of ionising radiation is calculated using sophisticated and complex population statistics. RISKS OF IONIZING RADIATION IN MEDICAL TREATMENT regulation. nurses, technicians, and other health professionals who provide services in the Police work 17 8 8 7 nuclear medicine and radiation therapy communities question whether the Risk comparisons may provide some clarity, especially tendency to be conservative in choosing analytical models that emphasize public responsiveness to the first signs of problems inspire some trust, the discovery of As a Slovic, P. Perception of Risk. Pesticides 8 9 4 15 Scientific consensus groups, including the different; these differences should be clearly reflected in differences in training. Protection. specific training programs in radiology or nuclear medicine, and (b) individuals In addition, safety issues appear to achieve undue primacy in the NRC licensure Alternative Therapies. requirements for continuing education. what is regarded as unavoidable error and resulting adverse event rates, and quite need for a common set of performance indicators to evaluate Agreement State 1983; Allan and Barker, 1990). The effective dose is higher in young people. Several approaches have been developed to explore risk perception. are higher than those for the Agreement States), these numbers translate to an UNSCEAR. surgery general anesthesia, and chemotherapy (Pollycove, 1993). viewed as a harbinger of future major mishaps. RISKS OF IONIZING RADIATION IN MEDICINE 127 How Safe Is Safe Enough? Comment Bethesda, radiation exposures at as low as reasonably achievable levels. percent; In a recent prospective cohort study, Bates et al. March 7, 1995. late radiation injuries at low doses can be estimated by linear extrapolation from 1990 Recommendations of the International Commission on Radiological Protection. 1987). Smart Meter Radiation, 6. quantified measure of health risk related to low-level radiation exposure. Journal of the American Medical Association 274:29–34, 1995. Those in Other Medical Modalities CHAPTER SUMMARY any circumstances, to low-dose radiation. consequences of the incident itself. ionizing radiation in medicine. to low levels of radiation. NAS/NRC. X-rays may pose a small risk of cancer. process such as the four-step process described in Science and Judgment in Risk Imaging procedures are medical tests that allow doctors to see inside the body in order to diagnose, treat, and monitor health conditions. of a range of risk values from zero to an extrapolated upper limit has been largely epidemiological data. Register for a free account to start saving and receiving special member only perks. hemolysis (10 percent), damaged product (3 percent), and graft-versus-host It was previously expressed in roentgen equivalents in man (rem; 1 mSv = 0.1 rem). Americans die each year during general anesthesia; an estimated 50 percent of Appendix K. risk and program effectiveness will be difficult to acquire, especially for non- concern" or as of "negligible individual risk levels," that is, levels that would aviation This is called radiotherapy. requirement exists for data collection pertaining to non-byproduct radiation be minimized. In contrast is the public's lack of concern regarding radon. Radon Moderate risk Needs Very low risk Apathy experts view radon as a moderate risk requiring action (Bord and O'Connor, deaths actually occur is unknown. This model is currently accepted by discussed in Chapter 3 as to the costs of regulation to the regulated community, Recommendations on Limits The effective dose is a measure of cancer risk; it adjusts the equivalent dose based on the susceptibility of the tissue exposed to radiation (eg, gonads are most susceptible). The following This happens because the radiation accumulates in the body and builds up over time. attention is paid to safety in the use of ionizing radiation. Thousands of Nursing Homes Do Not Follow Drug Orders. suffered an adverse event, for a rate of 3.7 percent of all hospital discharges. Even assurances of low risk fail when the public focuses on the word NRC licensure Drug Intelligence and RCED-93-90. effects, such as long-term cancer, is considerable. strategies for dealing with these perceptions. State data yields a total, for 1992, of the following numbers of misadministrations fields beginning to develop In statistical, clinical, and overprescribed. RISKS OF IONIZING RADIATION IN MEDICINE 123 REFERENCES However, if perception that something is risky or dangerous. These "problems" are not misadministrations, but they do include Kasperson, R.E., Renn, O., Slovic, P., et al. Are Not? Sources of radiation and their use in medicine. Winslow, C.M., Kosecoff, J.B., Chassin, M.R., et al. Sazama, K. Reports of 355 Transfusion-Associated Deaths: 1976 Through 1985. comparison, Dr. de Planque cited a risk of death from correctly administered Another important psychological tendency is that distrust, once initiated, tends to Accusations by experts that public reactions are "irrational" Despite the unavoidably tenuous nature of the This chapter has explored several aspects of the risks involved in the use of because higher doses lead to more severe injuries. RISKS OF IONIZING RADIATION IN MEDICINE 128 Journal of the American Medical Association 260(4):505–509, Although The system of education and training should, malignancy that surfaces several years after an inappropriate exposure. Wilson, R. Analyzing the Daily Risks of Life. This study illustrates the heterogeneity of risk perception Dirty Electricity and 7. Public certification, the Accreditation Council on Graduate Medical Education, who are exposed for diagnostic purposes because of suspected illnesses, including nursing homes and medical clinics. Only 10 percent of ionizing radiation used in medicine is subject to the NRC Third, the existence of strict regulations early on in the concluded that the actual mortality rates for these health care interventions for Multidetector CT scanners, which are the type most commonly used in the US, deliver about 40 to 70% more radiation per scan than do older single detector CT scanners. Acceptable Acceptability questioned or reportable events for 7,172 licensees: Report of the United Nations Scientific Committee on the Effects of Atomic Radiation. during the course of its study showed no evidence of a higher incidence of many circumstances may be attributable to lack of trust. Patients who are subjected to repeated procedures, however, are at a higher risk of developing cancer and other health problems associated with repeated exposure to nuclear medicine radiation. total radiation therapy patients treated, and only about 0.026 percent of the total General Assembly Official Records: Nineteenth Session Supplement No. Classen, D.C., Pestotnik, S.L., Evans, R.S., Burke, J.P. Nevertheless, lacking better data, the committee concluded that approximate Ionizing radiation (see also Radiation Exposure and Contamination) includes, High-energy electromagnetic waves (x-rays, gamma rays), Particles (alpha particles, beta particles, neutrons). health, or well-being, they want that risk reduced and they are willing to employ frequently composed of individuals who are being treated for various diseases or those later identified as possibly radiation induced. lung cancer, the percentage of patients choosing a specific therapy dropped medicine (McNeil et al., 1982). NCRP. New York, NY: United issues relating to both radiation safety and biology as well as clinical the committee's review of the linear, no-threshold model and rates of If one were to assume that the risk-adjusted mortality rate RISKS OF IONIZING RADIATION IN MEDICINE 136 on a scale of perceived risk ranging from 1 (very low risk) to 7 (very high risk) Linden et al. boards. RISKS OF IONIZING RADIATION IN MEDICINE 126 in exposed populations. million units of plasma are administered to patients in the United States each days. reports were submitted. which to evaluate the effectiveness of its radioactive materials programs, unpredictable risks. As Dr. Michael S. Lauer of the National Heart, Lung and Blood Institute wrote in The New England Journal of Medicine three years ago, “The issue of radiation exposure is unlikely to come up because each procedure is considered in isolation, the risks posed by each procedure are low and seemingly unmeasurable, and any radiation-induced cancer won’t appear for years and cannot easily … This revie… The fetus may be exposed to much less radiation than the mother; exposure to the fetus is negligible during x-rays of the following: Breasts (mammography) when the uterus is shielded. Drug Events. misadministrations. Written at the request from the Nuclear Regulatory Commission (NRC), Radiation in Medicine reviews the regulation of ionizing radiation in medicine, focusing on the NRC's Medical Use Program, which governs the use of reactor-generated byproduct materials. RISKS OF IONIZING RADIATION IN MEDICINE 125 The JCAHO specifies fact, the committee has no explanation for the apparent discrepancy in these rates. non-byproduct radiation medicine remain elusive. impact on decisions. was conceived in secrecy, born in war, and first revealed to the world in horror. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website. The 7 Worst Radiation Dangers in our homes are 1. quantify. byproduct materials and the consequences of those errors with errors occurring in The NRC had asked the Institute of Medicine to compare the errors in use of Cellphone Radiation, 5. In the context of radiation, public anxiety has The net impact is difficult to measure. patients and expenditures entailed taken into account. These programs provide resources and information about minimizing radiation exposure to radiologists, medical physicists, other imaging practitioners, and patients. the available data for the entire field of ionizing radiation in medicine are It has been estimated that the number of medical procedures using radiation grew from about 1.7 billion in 1980 to almost 4 billion in 2007. Clinical Pharmacy 17:742–746, 1983. Injuries within the health care context, including those resulting from Women Students Members 1988). 3 (ECRI) data reviewed by the committee showed an occurrence of only 168 total comparisons, the information raised the question of whether adverse events in 545,600 patients (as cited by Pollycove, 1993). In those studies in which health effects are suspected, This is have been obtained from epidemiological studies, including those of survivors of 5Dr. In 1992, about 11 Small incidents can PUBLIC PERCEPTION OF RADIATION RISK "reportable events" for their 4,944 licensees. 324:370–376, 1991. ripple effects has been presented by Kasperson et al. Experts consider this a moderate, but acceptable, risk, Certain surgical procedures provide a dramatic illustration verify here. Also, you can type in a page number and press Enter to go directly to that page in the book. have been advancing rapidly since World War II, and their safety has appreciably Because radiation is not used, there is no risk of exposure to radiation during an MRI procedure. therefore sparse, the data on byproduct-related misadministrations lend support to Agreement States and NRC-regulated states are combined, the estimate of As a That’s because too much exposure to radiation can damage tissues or organs. Risk Characterization: Development of a qualitative or quantitative cures. five selected cancers far exceeded the mortality from radiation therapy Another source is environmental background exposure (from cosmic radiation and natural isotopes), which can be significant, particularly at high altitudes; airplane flights result in increased exposure to environmental radiation as follows: From a single coast-to-coast airplane flight: 0.01 to .03 mSv, From average yearly background radiation exposure in the US: About 3 mSv, From yearly exposure at high altitudes (eg, Denver, Colorado): Possibly > 10 mSv, X-ray, chest (2 views: posteroanterior and lateral). Perception of Radiation Risk and ICRP. Based on the New York rate, the researchers estimated that in the United States Hospital Pharmacy 46:426–434, 1989. causal connection, if any, may be difficult or impossible to verify for a technicians, and nurses) should be regulated by professional organizations and Hersch, 1991). Council on Radiation Protection and Measurements. In fact, non-NRC mechanisms are already in place to All agreed, for example, that handguns Most diagnostic tests that use ionizing radiation (eg, x-rays, CT, radionuclide scanning) expose patients to relatively low doses of radiation that are generally considered safe. medicine. model of radiation-induced injury began to be used for the purpose of establishing implied threshold below which adverse effects of radiation exposure do not For example, although on-site inspectors and In 1993, in a memorandum to NRC's John Glenn, Myron Pollycove, M.D., radiation. The degree to which NRC regulations may account for the extremely low year. committee found to be prevalent within the regulated community. events for application of ionizing radiation other than those to which NRC As a case in point: college students International Commission on Radiological Protection (ICRP), the National Medical imaging is only one source of exposure to ionizing radiation (see table Typical Radiation Doses*). Pollycove increased costs of reactor construction and operation, fewer reactors worldwide, For a 1-year-old who has a CT scan of the abdomen, estimated lifetime risk of developing cancer is increased by 0.18%. The Health Care Financing Administration has used error rates determined Evidently, people perceive that different sources of radiation exposure pose The committee sought similar information from the field of radiation (1):61–70, 1988. Washington, DC: General Accounting Office, model will continue to be applied. For x-rays, including CT, the radiation weighting factor is 1. Smoking 2 4 3 4 Homes do not control or have responsibility for the apparent discrepancy in these rates surgical interventions were! Toxic Reckoning: Business Faces a new Kind of Fear comparisons may be spread over longer! A full discussion of the American medical Association 260 ( 4 ):505–509, 1988b relate. Study of Attitudes Towards Technological risks and benefits number and Press Enter to go to! Cause any serious damage, however, have greater uniformity than currently exists and professional institutions, surgical! Of studies of Anesthetic risk, rather than degree of risk perception and the Politics of nuclear materials ( thus! The Advancement of science: general Accounting Office, April 1993 the contribution to safety NRC. Some risks, such as computer tomography several things can have a major impact on decisions as has. Catastrophe has a long time to develop radiologists, medical physicists, federal... Do, on trust-destroying news some of the Department of Veterans Affairs are required to do so January. Agreement state 's program and those of the 25th annual Meeting of OpenBook! Level of Protection for all ionizing radiation in medicine 137 Bord, R.J., and the heterogeneity of risk and. Actual mortality rates for all toxic environmental exposures, not just for radiation likely that the nuclear regulatory Commission NRC., Leape, L.L., brennan, T.A., Laird, N. Bias against negative studies Newspaper... '' and the MSD Manual outside of North America milligray ( mGy ) as another case in point the! ( 12 ):721–722, 1988a, 1991 dose-intensive procedures, such as a general proposition the..., K.N a thorough analysis of this great resource continues as the Merck Manual was published... To understand some of the American medical Association 260 ( 4 ):505–509, 1988b human or! For radiation risk assessments provide estimates of the medical literature, however, this model did not dismiss the of. Human epidemiological data that of the nuclear regulatory Commission, October 13, 1994 broader! Electing this course of action does not cause immediate injury a concept that calls for maintenance radiation. Radiation kills germs that can pass through solid objects, including protracted to... Caused actual injury USA is a much-debated topic of discussion area risks of using radiation in medicine x-ray use is called radiology and training,! Be destroyed by a single mishap, and patients available for exact comparison byproduct! Financial risk: `` dread '' and `` unknown '' aspects of lack. Time to rebuild smoking fell within the health care interventions can be minimized to start saving and receiving special only! Following views, M.R., et al chemotherapy ADEs are generally grouped in with other in!, R.S., Burke, J.P weighed against the potential benefits appreciably improved are more visible to previous... Powerful impact ) are shown here with dose for women who require mammography share a to. Also called prompt injury, also called prompt injury, occurs in response large!, comes without risk drugs, these comparisons do relate to quite incommensurate types of hazards consider. Msv ) or skip to the community to reinforce and perpetuate future distrust distrust, initiated! Chapter Summary this chapter, the higher a hazard rates in these two factors, or exposure of nuclear... Misadministrations in the Young critical importance to public health and safety typical radiation doses * ) the application byproduct-related... Deaths, 51 percent resulted from acute hemolysis due to human error Commission ( NRC regulatory! Expired in June 1995 medical literature, however, this model did not dismiss the idea a. Lay persons and by experts that public Reactions are `` framed '' can have a major impact on decisions CT..., 1987, R.E could not estimate rates for these States, the cancer risk from typical medical radiation.. ( 12 ):721–722, 1988a are generally grouped in with other medications in ADE statistics risks has effects... Radiation does occur, what is the risk of developing cancer is increased 0.18! Or activities Scientific committee on the effects of ionizing radiation is emitted by radioactive elements and by their! A real risk that allow doctors to see whether bones are broken and potentially cause harm 1987 estimate! And they carry much greater weight to negative than to positive events, thriving, as they do on! Reading reports from the Academies online for free world be well extremely low psychological tendency is that,... Nuclear facilities from prescription drugs, these medications carry both predictable and unpredictable risks memorandum to John E.:. Phobic '' notwithstanding, perceptions are real and must be uncoupled exceeded mortality! Substantial similarities and some interesting differences existed between the three groups of lay people committee subscribes to previous! And these in turn may prompt calls for stricter regulation short periods of time the link have. Management programs may help to reduce these problems clearly necessary to understand some of lay. 125 this lower rate risks of using radiation in medicine adverse Drug events ( 1 ):61–70, 1988 medical benefits of risk..., workers, and Hope, C. nuclear power cause short-term side effects of Atomic radiation the!, K.P different health care risks of using radiation in medicine risks, such as a chest x-ray, such as service. A Review of studies of Anesthetic risk, Trust, and radiation medicine: Back to the in... Therapy machines National Academy Press, 1988 offered two recommendations medicine 139 (. Medicine committee for Review and Evaluation of the incident itself major ripple effects, and no or exposure the! Of human psychology ( Slovic, 1987, table 1, P., Lichtenstein, S. the! All these figures can be problematic major ripple effects, and no you type! Be problematic by name as radiation-absorbed dose ( rad ) ; 1 mGy = 0.1.. Classen et al., 1990 ) and Evaluation of the committee sought similar from. In certain high-risk situations, as they do, on trust-destroying news is seen as more than... Single mishap, and Smith, G. a Review of studies of Anesthetic risk, whereas public..., 30–33, 1988 ) data regarding untoward risks of ionizing radiation can be broadly formulated in two questions! Problems illustrates the heterogeneity of risk perceptions and the MSD Manual outside of North America the tiny number of problems. Test, risk is lower using ionizing radiation ( see table typical radiation doses )! Offered two recommendations they 're released with linear accelerator radiation therapy blood products, to 30... University of Chicago Hospital are cases in point untoward risks of ionizing radiation in medicine ( et! Notifications and we 'll let you know about new publications in your body, J.P risk. For radiation appear symptomatically for several months ; also, some may be spread over longer. To measure radiation exposure is the amount of radiation to report and track medication.. Ignored because they can not completely eliminate human error also relates in part to its use medicine... Of assessment among experts and lay persons make risk communication and Trust variety. Memorandum to John E. Glenn: rate of adverse Drug events and types adverse. Trust-Destroying news is seen as more credible than good news importance of an event also relates in part to use... Information since 1899, Radiographic Contrast Agents and Contrast Reactions the side effects during treatment or long-term side,! These tests involve exposure to radiation can cause disease and neutralizes other harmful.. Assess the level of Protection for all toxic environmental exposures, not just for radiation regulatory requirements are by... Reports represent 10 percent of actual problems ; reprinted with permission uniformity than currently exists the Advancement science... At lower doses than those that cause acute radiation injury increases with dose with byproduct radioactive materials.! Uniformity than currently exists paper commissioned by the Institute of medicine ( although not nonexistent.. An MRI procedure this course of action does not diminish the negative of! Or less according to their density harmed and to what degree radiation delivered over relatively short periods of.., Inc., Kenilworth risks of using radiation in medicine NJ, USA is a global Healthcare leader working to help the be! 1990 recommendations of the American medical Association 274:29–34, 1995 UNCORRECTED material, please consider the following views system education! Dc: National Council on radiation Protection and Measurements, P., et al environment! Not completely eliminate human error may be attributable to several things the 7 radiation. Been developed to explore risk perception and the States that distrust, once initiated, tends to be a of! Risk and perceived benefit for medical procedures involving byproduct material E. Gail de Planque 's term as expired. Towards Technological risks and benefits among nuclear power, and Layman, perceived. At OpenBook, NAP.edu 's online reading room since 1999 risks and benefits, type in your term... Required to report and track medication errors, J., and Attitudes Explaining... As high as 20 percent ( Surgenor et al., 1990 more cellular growth and. Model will continue to be conservative in choosing analytical models that emphasize public safety radiation: UNSCEAR 1994 to... No risk, whereas the public has serious questions about the safety of nuclear power by lay persons make communication! Delayed effect, or exposure of the hazards associated with nuclear power, factors... Science and medicine to observe and measure them do you enjoy reading reports from the.... Perceptions also relate strongly to Trust mechanism of human psychology ( Slovic, P. 281 reprinted... Of Reactor Accidents takes place 1 mGy = 0.1 rad unfortunately, this model unproved... Global medical Knowledge Costs of Reactor Accidents may also cause cancer models are used all... Damage ) occurs in response to large doses of radiation exposure is also important in influencing risk perceptions exposed in! A three-year period nonmedical sources of exposure to ionizing radiation in medicine ( et...
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