For some reason, this advice strikes me the same way as the advice (also in this newspaper) not to rinse off raw chicken before cooking. The advice *may* be true, but I'm not going to comply with the advice. I still wash off the fresh chicken before I cook, and I am still going to use the lead aprons.
5
Arguments based on “aprons don’t really protect areas of the body incidental to the part being imaged” are worth attending to. Arguments stating that the people performing xrays may put the apron on incorrectly so that it does not provide the designed protection, or so that it blocks accurate imaging are.... terrible, terrible arguments. There are folks in this discussion pointing out how incredibly long and intense their education is in order to do this imaging. So why is their error in placing protection any reason to get rid of the protection? Better training, better designed aprons. Or significant proof they serve no purpose, not better marketing jingles.
5
First issue, please use correct terminology. "Technicians" work on the equipment, just as a technician works on your car and Radiologic Technologists create x-rays. How did you miss that?!?!?
4
@Kelli
I know...this is a pet peeve for me.
Seems to me that if the techs still need shielding the rest of us do too. a lifetime of exposure is just that. Does medical history change the likelihood of developing cancer? Would that change the need for shielding? Lots of questions are unanswered here.
5
A patient is in say, a CT room for only their exam. A tech goes behind a leaded barrier because they perform hundreds of CT scans per year. A tech should be exposed to hundreds of doses?
3
Not a good assumption. Patient is being exposed to radiation for medical purposes (to get a good picture). X ray texhnlgy has changed a lot in the past 30 years. With newer technology, the lead shield is useless (doesn’t actually decrease radiation to the shielded area because the radiation to the shielded area is already near nothing), AND the shields can actually be harmful (with new technology, the shields can actually make the image worse while simultaneously INCREASING radiation dose).
Times change. Practice needs to change with it.
1
Less exposure the better, constantly telling my dentist I do not need xrays every 6 months....ok, please sign this waiver....
I changed dentist
12
Well, my brother-in-law, a radio therapist died several years ago, and so did his partner who failed to shield themselves adequately, when conducting an experiment over a period of time.
And, as far as dentists over using dental x-rays for to charge additional fees, I do concur that they don't need to use them for every dental appointment, unless explained and warranted.
And not every dentist has the latest x-ray equipment, and many use older equipment which emits greater radiation.
So, I believe that those professionals, medical and dental should provide adequate information and comfort to the patient, before insisting that it be done without reasoned explanation, with concurrence by the patient.
5
It always amuses me when Medics claim for years that everything they do is infallibly 'Evidence Based' and falsely claim this haughtily separates them from other modalities, then suddenly they declare a previous 'Evidence Based' method or procedure is no longer to be employed. The reason? Evidence Based!.....do they not realise this new 'Evidence Based' procedure by simple deduction is resting on a bed of sand? Trust me I'm a Doctor? Abbott and Costello made more sense.
5
@T.Burgess
Oh TB...you're falling for the false idea that science and its research is all set in stone like a fossil. By its very nature, science is always in flux...as today we know more then yesterday, but less then tomorrow! Get with it.
Should we still be bleeding people, because that was the "high science"of the day, therefore infallible for all time.
You're being a science denier - and that's a denial we all can't,should not tolerate!
3
How would a thyroid shield interfere with an x-ray of my knee or my hand?
In ancient days, a doctor "burned out" my adenoids by leaving a long radioactive rod against them for an hour (a nurse had slid it down my throat through my nose somehow). The process was supposed to take only a few minutes, but she forgot about me ("You were so quiet and good!").
I'll never forget the danger sign on the canister she drew that thing out of. And I'll never stop wanting a thyroid shield when I have an x-ray.
15
You’re totally correct. A thyroid shield will not interfere with an X-ray of your hand. BUT it won’t do you any good either. That’s the point of this entire push by the AAPM- in many cases (like the example you used), the shield is pointless- no harm but no benefit. In other cases, the shield is actually harmful (either making the image worse by blocking parts of the image or actually increasing the radiation dose to the patient).
X ray technology has changed. Time for shielding practices to change with the times as well. As evidenced by the article itself AND the comments for this article, there is a need to educate the public about why shielding isn’t necessary, and this change isn’t going to be accepted overnight.
1
@MLChadwick
@MLChadwick
I think they were assuming readers would read between the lines and assume that this is about the xrays that are in the light field. Exams that could be done table-top or those best manually, not AEC, aren’t included from what I’m getting. Also, again from what I’m getting from the article, is that the restrictions currently in place will simply be lifted and shielding will be left to the hospitals to require it, radiologist preference technologist or case by case basis.
Of course, I could be wrong.
It’s true, in fact, that machines today are exposing patients at a fraction of the dose of the machines used in the 1950s.
What’s never mentioned is the astronomical increase in the use of ionizing radiation exams since the 1950’s. Yes, machines are more efficient. Humans are also receiving multiples of the amounts of imaging exams now compared to decades ago.
Radiation exposure is cumulative and that has not changed or been negated. So, of course there “isn’t evidence of gonadal harm from X-ray use since the 1950s” BECAUSE SHIELDS HAVE BEEN USED DURING THAT TIME. You cannot substantiate the removal of shields with data acquired when shields were used!
Can we not focus one of the main reasons for this removal of shielding is due to shields being placed improperly, especially for automatic exposures? We’d seriously rather pursue the removal of shields instead of education in radiation safety? Never mind the current battle with dose creep... I just cannot believe this is the conversation.
Dr. Stewart Bushong, please help your colleagues either find news ways to support this cause or convince them that they are incorrect.
17
@Allison Dr. Bushong published an editorial on this last fall. I'll see if I can find it. He is against the "no shielding" notion.
1
The article, as written, leads the reader to conflate the practice of shielding reproductive organs and fetuses with shielding of other parts of the body during X-ray diagnosis, such as the thyroid. The distinction is missing in the fourth paragraph. Dr. Frush serves with Image Gently Alliance. Its website says while it endorses Dr. Marsh's proposal, it specifically advocates USING thyroid shields during dental x-rays.
Still, provide the references for the "no harm" claims made concerning X-ray effects on fetuses and gonad tissue. Better, briefly detail their design strengths, sample size and conclusions. Too often current "absence of evidence" is little more than "the studies are pretty poor up to this point." Human studies have little power to reveal harm even if it does exist. Better studies require harsh experimentation, and thankfully we don't do that to people, and less and less often, with animals. Maybe studies have been or can be done to evaluate the X rays effects on the health of mammalian cells in culture.
Until that evidence is laid out for me in convincing manner, I will subscribe to the precautionary principle.
Such a policy could increase the use of unneeded X-rays. It creates a "look, no worries-a shield isn't even needed" vibe leading to patient compliance. It distracts the patient from thoughts of whether the X-rays is medically necessary and whether there are equally good or better diagnostic imaging alternatives.
7
@will There's much supporting evidence you requested at these two web sites.
x-lnt.org
radiationeffects.org
1
I recently had a 3D mammogram and a lead shield was draped around my waist. I am post menopause by 5 years, so I was wonder what the shield was shielding. But figured it could hurt. Reading this article makes me wonder if I should refuse the sheik next time.
depends what he's offering..... just sayin'
@EOL I think the facility where I get mammograms also do 3 D, and no shield for any part of the body has ever been offered for any type of mamogram (there have been several generations of ever-better equipment). Now I am wondering about the thyroid area, and whatever you were being shielded for. Annual mammograms must rival dental xrays for frequency.
2
And I have seen multiple stories blaming dental X-rays and mammograms being blamed for increase in thyroid cancer instructing patients to demand shielding.
6
"Lead shields are difficult to position accurately, so they often miss the target area they are supposed to protect."
So how does this translate into not using them?
Really makes u wonder why any x-ray/shield would not capture the area desired. Perhaps the techs are in a hurry? Train the techs better.
10
There are a few reasons the lead shield might actually make the images worse-
-x-ray technology has changed in the past 20 years, akin to film versus digital photography. While shielding was thought to be best practice 30 years ago, with digital x-ray it is not. If the shield is in the image, the x-ray machine tries to use MORE radiation to compensate for the shield being in the way.
-it’s harder to properly position shields than one might think! For example, when an x-ray is taken portably in the patient’s room instead of the radiology department, the patient often has tubes and machines attached to them, making it hard to position bodies for the x-ray, or even to see a atomic landmarks for positioning.
1
A comment to all of the "radiologic technologists" writing in.
Whatever you wish to call yourselves, you are, at best, technicians. A technician is "an expert in the practical application of a science; a person skilled in the technique of an art or craft; someone who has knowledge and training in a technical process."
The fact is, you are still technicians. You may be experts in how to operate certain equipment, but you have no expertise in the fundamental science of it's design or effect on the human body. That requires a doctoral degree or two (MD and PhD).
6
@Eugene Actually, all of us technologists are very well trained on the effects of radiation, it's design and application to include the production of radiation and biological effects on the human body. It takes anywhere from 2-4 years to complete a radiology program which is very extensive and requires a national registry from the American Registry of Radiological Technologists upon graduation. Please educate yourself before making such ill-informed comments.
24
@Amanda
It takes more than ten years to earn an MD and PhD - plus original research.
2
@Eugene
Was it really necessary to make this comment? It's mean-spirited and demeaning.
6
I can appreciate the thought behind this article, particularly with the digital equipment and improvements in technology. However, there are major concerns that conflict with what I was taught in training. First and foremost, this should never apply to the pediatric population; particularly with orthopedic issues that require serial x-rays for several years during development. Scoliosis, DDH, osteotomies for lengthening just to name a few. This babies and children can require multiple exams annually over consecutive years. This all contributes to an accumulative lifetime dose. The same would apply to individuals who suffer from other diseases that require serial studies. Shielding should utilized until a study proves otherwise.
9
There is no study cited in this article, that I saw, that would prove that shielding has no benefit. I didn't see proof that a greater dose of radiation would occur due to shielding either. I can't imagine there is any way to test that theory and have that proof. I started in the field of x-ray in 1978 and there has been a great reduction in the dosage used with improved equipment. Most in the field recognize that patients can be scared by the thought of any radiation and that alone is reason to shield. I do believe that there is so little radiation used that it makes very little difference whether we shield or don't, depending on the age and area of exposure. We are professionals who know where to place a shield to keep the area of interest free from a lead shield if it is used. This sounds like a change that has little merit.
5
I'm a dentist and "newer 3d xrays" are not routinely indicated for dental patients. For typical dental radiographs, there is virtually no downside to lead shielding, and I certainly would prefer it given dental radiation's documented effect on thyroid cancer risk.
23
Is there any effort to replace X-ray diagnoses with sonogram or terahertz imagery in cases where it's appropriate?
5
The reason there is no evidence of harm from medical-rays is that the NRC has never done follow-up studies,
8
As a non-medical member of society, I would still like some assurance that the X-ray is being deployed correctly.
I recall that when x-ray scanners were deployed at airports, some agents were given badges that indicated exposure level.
If parts of my body no longer need to be shielded due to claims that there is little risk, can I get some of those badges to put there and reassure myself that there is actual proof?
Several years ago I recall reading that some people were inadvertently being exposed to much more radiation than prescribed for their conditions, leading to such interesting developments as a line of hairlessness on the head - I can't remember the details but it may have been reported in this newspaper.
How does the non-use of a shield protect me from a malfunctioning machine, or someone who sets the device incorrectly? Remember, I am completely unqualified to determine the skill of the people setting up and running the machinery.
10
@Margo
Let me turn your final question around. How does the use of a shield protect you from a malfunctioning machine, or someone who sets the device incorrectly?
6
@jim Assuming there was a purpose to the lead shield in the first place, I would have to consider that it effectively protected parts of the body which were more vulnerable to x-rays.
When the persons maintaining and operating the equipment get it wrong, surely being partially shielded is better than no protection.
9
@Margo The point of the change in practice is that there is no evidence that the parts of the body we were trying to shield are vulnerable at all, and the use of the shields themselves can cause issues and repeat exams.
3
I’m sorry but I’d disagree. I remember a study conducted in a Medical Physics class that looked at the radiation levels within the exam room when a shot was done. Even if the beam is strictly collimated, the radiation exposure is still unacceptable. I’ll stick with the shield.
10
@News User How long ago was that? With the advent of digital capture of ther x-rays the dose delivered is very small. With film, yes you got as big dose. With digital, a much smaller dose. And with digital imaging the software can really give you very crisp x-rays. Sharp clear pictures. You can even "tune" the grey scale to your advantage digitally to get even better pics.
5
@Per Axel
Perhaps. But even if the does today is smaller, there is still a dose. As I understand it, pilots and those who work in granite filled buildings have a measurably higher incidence of radiation damage.
5
I can understand the lack of shied use in most diagnostic x-rays, as collimation and overall decrease in radiation need is sufficient. But the article suggesting a heavy amount of radiation to a fetus has little to no impact? I dont buy it. It's no secret that, biologically, the cells which proliferate often and have a short life span are the most likely to be affected by radiation. Leading to denaturing and cancer or cell death.
8
I perform Radiographic exams to include X-Ray and CT using Ionizing Radiation and am NOT a Technician- I am a Radiographer or a Radiologic Technologist.
I attended and completed a college-based Degree program, sat for a professional board, hold a license, am subject to a professional code of ethics and complete annual professional continuing education. To call me a technician is like calling an RN an aide, a Paramedic an EMT or a Journalist a blogger. I would expect that the New York Times would know that the term X-Ray Technician is outdated and describes people who performed this role in a different time with different schooling and professional development.
Now we can discuss the issue of shielding patients when performing these exams.
31
@David Gregory Thank you for speaking up for us highly educated and registered TECHNOLOGISTS!
When these position statements and news reports come out and what to discuss our profession they first need to get the terminology/professional titles correct.
6
@Rebecca
Technicians rotate your tires and change your oil.
We are the first line in patient safety as we are the ones who perform the exams, have direct contact with patients, review them for quality and forward them to Radiologists who often never see a patient and many times are on another campus or different floor of the hospital.
4
Thank you for saying that!
3
It has always appeared to me that the frequency of dental x-rays is driven more by economics and insurance reimbursement than a patient's well being. Facts like some x-rays are now one twentieth of the exposures used in the 1950s, totally misses the point of what amount of radiation and, more important, what lifetime exposure to radiation is harmful. I've had a tooth abscess that was detected by an x-ray. It was no fun, but I pretty easily survived it. Despite that, I'm extremely uncomfortable with the common practice of routine x-rays when there is no indication of a need for the exposure. Rather than studying the need for shields, I think we would be better off with an evaluation, from the patient's perspective, of the need for the common practice of routine x-rays.
46
@Jim. Have no cavities for 20 years. Still my dentist demands to take about 6 exposures twice a year, plus a panoramic xray every few years. They earn good money that way.
It's interesting that today, experts advocate less testing for prostate cancer and maybe breast cancer, but the dentists go right on.
Also: all the problems mentioned in the article are about procedure and equipment, which should be improved before the lead apron is given up.
Finally: In all the years, no dentist has ever offered me a lead collar, only the apron. Why?
5
@99Percent You can refuse dental x-rays. I have. Also, my long time dentist seems to be in the process of retiring, and I am very leery of the new folks who have appeared in the office. They wanted to begin with a "set" of xrays. I said no. Now they mail me notices that haven't seen me in a while. I will probably be looking for a different dental practice. Look up The Truth About Dentistry, The Atlantic.
4
Disclosure: I am in the nuclear industry.
The problem from my perspective is public perception. The mantra is, and the discussion of how it came to be is too tedious to have yet again, "Nuculur Is Bad".
This is well ingrained into the public psyche to the point where a rational discussion of nuclear technology, its applications, uses and abuses, is well nigh impossible.
We are rationalizing animals, not rational animals. Logic and facts cannot overcome fear and emotion, especially if the audience actively refuses to listen.
I know these lead aprons are useless. But, that is what I know, and what I know does not matter. When I go in for an x-ray I go along with the lead apron not because it provides any benefit (it doesn't, in my opinion) but because it makes the life of the x-ray technician easier if I don't fight her on the issue.
A hundred years ago people would plug up unused electrical outlets because everybody knew that if you didn't, the electricity would seep out at night and suffocate you. Guaranteed.
We have the same level of misinformation concerning medical x-rays and shielding. But once again, logic and data cannot and will not prevail against fear and emotion.
15
@Alternate Identity I totally agree. But as a OR nurse who has worked in neurosurgery for 45 years there is 1 area I think that needs to be worked on. And that is after craniotomy, brain surgery where we take a piece of your skull out and replace it when we are finished, is that for a very long time these patients were CT scanned each and every day to see what was going on inside your head. Those each and every day scans deliver you a huge amount of radiation. Thank God we mostly use MRI now. That 4 mSv each day adds up.
4
@Alternate Identity Interesting that you are “in the industry” and believe lead aprons are a waste. My father was a nuclear engineer with a PhD and a career in nuclear and other high level waste. He insisted we always have a lead apron when being x-rayed, and refused to allow us as children to have any routine xrays. Radiation risk is based on lifetime exposure, not a single exposure. Also many folks in the medical industry point out the lowered levels of radiation per dose, but they do not take into account those of us who are older were exposed to the larger doses in the past.
I am willing to do further research on this issue to investigate the conclusions of this fuzzily written article, as technology does indeed change. Meanwhile, I remain pro-nuclear power, anti-routine xrays and will wear a lead apron protection until more substantial info is established.
1
The arguments offered against this practice aren't backed up by evidence.
Aside from that, the problems anecdotally mentioned here seem to stem from operator misuse of the equipment.
If there is evidence to show that the practice actually does provide shielding, then the onus is on this trade association to explain why professionals are not being trained properly.
5
@Sequel This is not a technical journal, and the gist of the article doesn't require a lengthy "proof". Would you believe it anyway? Perhaps, however, the NYTimes should annotate articles like this with references to scientific journals/articles.
2
I haven't read the whole thing anyway, but I won't trust the decision people who aren't completely qualified to make those decisions. What has the Radiographers/Medical Imaging Scientists in that area said about this?
And no, I'm not asking of the opinion of "technicians"
4
@PhanDira
"X-Ray Technicians" is an obsolete term and has been for many years. It dates from a time when people could be trained in many states on the job or in hospital-based vocational programs.
A Radiologic Technologist or Radiographer - which I happen to be - is a professional. We are a College trained- commonly doing 40 hours a week from our 2nd through 4th year of training, unlike most undergraduates. The time not spent in the classroom is spent in hands-on training under the direct supervision of Trained and Licensed Radiographers.
Our training includes radiation biology and we are the person with the most responsibility for the safe application of ionizing radiation and the highest image quality for your exam. We have our hands and eyes on the patient - not the Radiologist or other practitioner interpreting the exam and if we do not perform these exams correctly they can seriously mislead a Physician.
Excepting interventional procedures and fluoroscopic exams, the Radiologist rarely sees the patient and has no direct control of any aspect of the exam.
13
@PhanDira The article is literally almost entirely about what the medical imaging scientists have to say about this...
1
@PhanDira The article actually quotes medical physicists on the matter. Having a medical physicist is as qualified as you’re ever going to get. Physicists practically built these scanners.
1
I am concerned that this article takes this ‘evolution’ in the radiology industry as justified and presents the industry’s new party line about less protection for patients as an article of faith. Having had the misfortune to suffer various surgeries, ongoing required chiropractic care, cardiac issues and significant dental care staring ten years ago, I received so much exposure that I became concerned enough to start recording it. I have had literally hundreds of exposures – all by medical personnel who had not a care in the world about my exposure risk. People just keep snapping away with radiation at my body. This is a concern because as of late researchers are finding that repeated exposure to ionizing radiation from medical imaging can accumulate over time to cancer-causing doses. Supposedly some are now recommending weighing the benefits of imaging against the risks. How interesting that in the face of this new found concern about too much exposure to radiation that the medical-industrial complex and its lobbying groups now want to convince us to take less protective action. Coincidence?
12
Radiation exposure has always been a risk vs benefit exercise. The change in this recommendation acknowledges that shielding doesn’t reduce the risk, and in some situations may increase it. It doesn’t suggest increasing the number of exams. The best way to reduce radiation dose is to ensure exams are justified (for example, x-rays for lower back pain frequently don’t improve patient outcomes). This change is backed by physicists and about ten years of peer reviewed research.
12
@Helen Smith With respect, I must reply that to say that radiation exposure has always been a risk vs benefit exercise is living in an idealized world. Individual practitioners are snapping away images with no thought as to the amount of exposure to the individual, as often re-enforced by the insurance arm of the medical-industrial complex (and perhaps the practitioners practice of defensive medicine in litigious America). The article is badly lacking. What is the relevance of the article’s statement that “[t]he amount of radiation needed for an X-ray is about one-twentieth of what it was in the 1950s” if out in the trenches images are taken almost willy-nilly without regard to an individual’s overall exposure. I’m not anti-science, so tell me, where are the years of peer reviewed research regarding the best way to reduce radiation dose by ensuring exams are really justified in an industry where there is no tracking of overall exposure inflicted on the patient? Perhaps after that we could discuss lessening protection (and what’s really going on with all those ovaries…)
3
@Trailwalker, I would make the argument that the chiropractic field is the most likely to overexpose a patient with their relatively indiscriminate use of spinal (read: high high energy) radiographs only to prove that you have some pseudomedical condition (spinal subluxation). Exposing someone to ionizing radiation to "diagnose" a condition that doesn't exist is the pinnacle of unethical behavior. talk about cost/benefit; get a whopper x-ray/get no benefit from it.
6
Sorry, but I guess I am cynical to wonder which lobbying group spent the most to get this change and who stands to benefit financially from any change.
21
Where is there a financial benefit? It’s a change in how things are done, not what is done.
11
@Jason That would be the “Don’t spend money on lead aprons” lobbying group. I’d be more concerned about hypothetical groups that encouraged expenditures.
@Jason How about the ‘patient care and safety professional lobby group’? And the benefit would be that of the patient, by having a longer healthier life (because of this improved practice).
I'd be interested to see what criteria they used for measuring possible harm to female patients' ovaries. Presumably radiation at any age between a female patient's ovarian development in utero and her death could affect her ovarian reserve, function, and health. Were her periods normal? Did she have a hard time getting or staying pregnant? Were her children born without congenital abnormalities? Did she go through menopause significantly earlier than average? Did she develop ovarian cancer? That's a lot of longitudinal data to collect and analyze for each female patient, potentially over an entire lifespan. Since the amount of radiation needed for most tests is vastly lower than it once was, but many more tests involving radiation are performed on many of us than was once the case, AND we are living longer, how do we even control the dosage variable? I'd feel a lot better about dispensing with lead aprons if there was a way for patients to be monitored with dosimetry badges over their ovaries during all radiation imaging, when flying, visiting Chernobyl, leaning up against their granite countertops, etc.
12
Interesting. I recently had x-rays and no shield was provided, which surprised me.
1
@Ann
Shielding is being reviewed and if incorrectly applied can actually increase the dose to the patient. This is especially true with CT exams.
The best protection you as a patient can have is knowing that your exam is performed by a Registered Radiologic Technologist that has passed the ARRT Exam and is currently registered and in good standing with that organization. Ask the person performing your exam if they are, as in some states there are people with far less training performing these examinations. Studies have shown that exams in clinics with significant variations in radiation dose to the patient- as in a much larger dose.
The reproductive organs are not the only tissues highly sensitive to radiation. The lens of the eye, for example, is also very sensitive. The beam should be collimated as closely as appropriate for the exam and differential diagnosis. The exposure factors- unseen to the patient - also have a significant impact on not only image quality and diagnostic value, but the radiation dose to the patient.
Every exam using ionizing radiation increases cancer risk to the patient and it is your health. Know who is performing these exams- in some places the regulations are lax and there are people performing these exams I would not be comfortable with performing them. If they will not show you their certification and registry, they probably do not have it.
Know who is passing radiation through your body.
5
We are frequently reminded that "modern" medicine is imperfect. Concepts regarded as facts turn out to be just errors. Experts turn out to be foolish in retrospect.
Unfortunately we do not have anything better to guide us until science advances. Nonetheless, it is the best we have. Do not abandon the best practices of the present (I.E. VACCINES) unless facts support changing the guidelines.
5
Another part of our de facto criminal pre ACA health care system, ie protect the billionaire HMO/big Phrama execs at the expense of the average patient.
Let's take a million X-rays to run up the bill and the shield will protect you.
You have the extremes on both sides ie the anti vac. nuts who say all vacs. are wrong and the other side the hypos/pro medical cult fanatics who never met a dubious procedure, drug or test they did not like, like the one mentioned here.
3
Whoa! After all these years of having the lead apron used on me, I am furious after reading this article.
3
@BSR You should be happy. It’s like someone came and told you: Hi. Made the car you’re driving, and now I can tell you that you don’t need to wear an airbag vest to drive your car. It already has one in it.
No evidence that a fetus is harmed by a CAT scan of the abdomen? What exactly is the “no evidence”? Have they followed the children all the way to old age, where cancer rates due to mutations over a lifetime rise? This statement does not strike me as valid.
19
@Barry You have it right, in that "no evidence for" doesn't necessarily mean "strong evidence against." Do journalists all know that?
I imagine the " National Council on Radiation Protection and Measurements" is aware of that, but you're right in principle.
5
@Barry
"No evidence for harm caused"....
You are doctors. Your mission is to heal. You are changing it to see how much you can get away with without causing harm. Perhaps this is why 35 countries are healthier than we are.
This reminds me of the 1914 so called "bleached bread" Supreme Court decision that it was OK to poison bread as long as it appeared no harm was done.
@Barry This is a very, very important point. It is one that the technicians who are commenting here, who apply the X-rays, who get paid well to do so, would do well reading up on. It requires very sophisticated thinking and training (much of which you can study up on yourself). It includes statistics, experimental design and knowing the concept of statistical power, or the ability of an experiment to reject the null hypothesis when it is in fact incorrect. A lot of bad actors have hidden behind this "there is no evidence" nonsense. They are the ones who work hard to prevent effective study on the effects of the material or procedure in question. Often the bad actors "do the research", but do not release it if it contains a smoking gun (which is legal in most situations, although certainly not ethical). Look at the history of the tobacco industry's stone-walling for a start. There are many more case studies.
1
This is an interesting discussion. I hope this doesn't make people assume that standing near a patient getting X-rays is also safe and not necessary to use shielding. As far as I know that has not changed. Also, technologists need to practice good collimation of the primary beam to safeguard the patient from unnecessary radiation and decreased image quality.
I would like to point out one incorrect use of terminology. I am a radiologic technologist for the past 23+ years. We are licensed after board registry exam and 3+ years of schooling. The term "technician" is incorrect. We are technologist which denotes a person who uses scientific knowledge to solve practical problems. Most personnel working in hospitals and clinics are technologists.
12
The reasoning behind the proposed elimination of X-ray shields is the absence of evidence of harm. In medicine, there is an old saying: "Absence of evidence is not evidence of absence." The failure to find a certain phenomenon may only reflective of an observation bias, not of the truth. To obtain a more scientific basis for this, double blind studies would need to be done to examine the health effects, short AND long term of differential radiation exposures. Anything short of this is mythology.
22
@Samantha Of course there’s evidence and plenty of it: https://www.ajronline.org/doi/full/10.2214/AJR.18.20508
Why not just get an MRI or CT of the lead aprons obscure parts of the body.
1
@Jacquie Because x-rays are diagnostic enough in many cases, so a CT or MRI is not needed. Also, a CT is anywhere from 100-1,000x the dose of an x-ray, so it would be absolutely absurd to send patients to get a CT, when a low dose x-ray is sufficient for that particular patient. CT's and MRI's are definitely needed in many cases, but not to replace x-rays. Those modalities are also a lot more time consuming, more expensive, and come with more risks.
5
@Jacquie
CT exams use ionizing radiation and use doses significantly greater than an x-ray. CT exams are also performed in a way that makes beam limitation less flexible than a conventional x-ray.
MRI exams do not use ionizing radiation but have serious limitations and considerations beyond the expense and greater time needed for the exam. Patients with many kinds of implanted medical devices cannot safely have an MRI to include pacemakers, insulin pumps, IVC filters and certain catheters. There are other considerations beyond those listed here.
An X-ray can be performed bedside or in the operating room- to include fluoroscopic exams that are live. This is not the case with MRI. CT is available in the OR in some institutions but is not very common.
As to shielding everything, improper shielding can actually increase the dose to a patient.
3
@Anonymous And an MRI is NOT an xray. A catscan is. MRIs may have their own problems/limitations but they are as different from xrays as a cat is from a dog.
The only know causes of meningioma are genetics and high doses of radiation to the head. My mother had a large meningioma diagnosed 20 years after a panoramic dental x ray.
3
Your mother is the exact demographic who most commonly gets meningiomas, older women. She was going to get that benign meningioma regardless of the panoramic dental X-ray.
15
@Aaron Elliott A pano X-ray produces somewhere between 14-24 micro Severts of radiation. You get 200 times that amount of radiation in a year just by walking outside and around doing nothing.
http://hps.org/hpspublications/articles/dentaldoses.html
1
Given that today's x-rays are 1/20th of the radiation than those in the 50s, it's still radiation. Can it "hurt" to keep using patient aprons? Rather than abrogating standards and regulations wholesale, the authorities should simply make it a patient's choice. At least this way, the shields will still be available to a 71-year old, as I am, whose had more than enough films taken for multiple surgeries during my life.
13
The majority of dose is coming from internal scatter. By using a lead shield, you are are actually creating a barrier and not allowing those particles to exit the body. Because those particles are unable to exit, they continue to bounce around internally and actually cause more cellular damage.
8
@RMW
Not trying to be rude at all but at 71 you really don't need to be worried about the radiation. The possible negative effects take decades to show up in most cases.
8
@JJ
Hah! I am older then 71 years of age ,they say the very same thing to me about a PSA prostate exam...but in my instance ,I am certain that I will live to 116 years of age:-)
3