The Risks Associated with Ionising Radiation in Medical Imaging Practice - Assignment Example

?INTRODUCTION:- The medical imaging is a technique that is used in medical to capture the images of the human body for the clinical purposes and usedin the medical sciences such as anatomy and physiology. . Its wide usage in the world can be seen by this studied that until 2010, 5 billion medical imaging studies were conducted worldwide. Doubling every 2-4 years, right after the 1960 the interventional procedures using radiation has substantially increased (Takeyama 1997). The medical imaging technology includes the following subjects under its heading:- 1) Radiography 2) Magnetic resonance imaging 3) Nuclear medicine 4) Photo acoustic imaging 5) Breast thermography 6) Tomography 7) Ultrasound The new techniques and procedures in the medical imaging are posing high radiation doses to the patients as well as the staff (Wilde et al 2001). Due to the in effective training and inadequate awareness given to the staff as well as the patients they are exposed to more unnecessary radiation (Koenig et al 2001). Ionizing radiation is used in applications such as medical imaging in the hospitals and to perform diagnostic imaging. In the medical imaging, the most common forms of the ionizing radiations are the gamma rays and the x-rays. These medical imaging practices are important in the medical field because of the determination of the diseases and different injuries in the human body. However, aside from these benefits and life saving tool, these ionizing radiations has certain limits and conditions to be applied on the patients and people. The reason for this is due to the fact that high doses of these ionizing radiations are responsible for the formation of cancers. The ionizing radiation in the medical imaging is found to be one of the most important discoveries of the medical science. Even with the use of the new technology, the equipments are highly capable of posing high radiation doses if the treatment procedure is not well maintained and followed (ICRP 2000). Whereas there is a strong debate going that the usage of these ionizing radiations may cause genetic mutations and cancers. As it is well known that there is no such dose below which there is no risk of any harm to the exposed one or a zero risk (ICRP 1990). So it is important to avoid the exposure to these ionizing radiations but how can this be possible. Of course someone that needs medical attention and for different diagnosis, one has to go through these treatments, but on the first hand the primary cure is to improve the life styles and the determinants that may cause the health damage to be improved. Below is the typical effective dose from x-ray radiation. Exam Effective Dose mSv (mrem)1 Chest (LAT) 0.04 (4) Chest (AP) 0.02 (2) Skull (AP) 0.03 (3) Skull (Lat) 0.01 (1) Pelvis (AP) 0.7 (70) Thoracic Spine (AP) 0.4 (40) Lumbar Spine (AP) 0.7 (70) Exam Effective Dose mSv (mrem)2 Mammogram (four views) 0.7 (70) Dental (lateral) 0.02 (2) Dental (panoramic) 0.09 (9) DEXA (whole body) 0.0004 (0.04) Hip 0.8 (80) Hand or Foot 0.005 (0.5) Abdomen 1.2 (120) By improving our health status and also improving our physical mental and social states, we can avoid these threats even at the first place to be exposed by such ionizing radiations even for the diagnosis. However the main concern regarding the ionizing radiation is the induced cancer among the young children from the CT scans. As the young children are more susceptible to get the cancer as compared to the elders, so the more controlled experiments and discoveries are to be made in order to avoid this risk of more cancer due to these ionizing radiations. But another debate that why the need for these medical imaging are increasing day by day even with the more sophisticated technology and new era of research, does that means that science failed to improve the health status of the world’s population even with the advancement. The answer could be controversial as the health is comprehensive phenomena and does not depend on one facto but many. So there is a need to improve the health status of the individual and try to improve all the determinants of the health in the first place, as in the human rights the health is also included, so it is also an important determinants of the country’s economy, prosperity and development. The different forms of the ionizing radiation has different levels of effect in the human body depending upon their intensity and their duration of exposure, the medium present and the area of the exposure, all these parameters are responsible for the damage a body can get from the exposure. The following figure shows the data for the entire examination of the patient. Complete Exams Effective Dose mSv (mrem) 1 Intravenous Pyelogram (kidneys, 6 films) 2.5 (250) Barium Swallow (24 images, 106 sec. fluoroscopy) 1.5 (150) Barium Enema (10 images, 137 sec. fluoroscopy) 7.0 (700) CT Head 2.0 (200) CT Chest 8.0 (800) CT Abdomen 10.0 (1,000) CT Pelvis 10.0 (1,000) Angioplasty (heart study) 7.5 (750) - 57.0 (5,700)3 Coronary Angiogram 4.6 (460) - 15.8 (1,580)3 SAFETY FOR PATIENTS AND STAFF:- The safety from the ionizing radiation is also a very important issue as these radiations can pose more harmful effects on the human health rather than the treatment and diagnosis of an injury or disease, if the amount of the radiated dose is not controlled and leveled according to the limits. For the monitoring of the radiation doses, the facilities must have fluoroscopy times, parameters, statement on radiographic images, air kerma rates, skin sites for each procedures etc (ICRP 2000). Whereas, the effective technique used and patient cooperation is helpful in lowering the dose (Ashleigh et al 2000). The patient cooperation is very important as the behavior and attitude of the patients varies significantly. They must be taught and guided that the procedure is not a routine work in life and the doses can affect significantly if their cooperation with the staff is not satisfying or they are not taking the matter seriously. It is important that the staff and the patients should be advised properly about the effects of the radiation and the proper procedure about how to get the administered dose. There safety is at the first place besides all the things and this could only be done by the proper education, precautions and safety measures adopted. Mostly the patient’s safeties are of more importance because they are mostly exposed by these ionizing radiations in the form of diagnostic tool. The biological effects of these radiations could be harmful that is the reason because it is strictly advised to get all the precautionary measures so as to avoid these harmful effects. The effects that are harmful and caused by the ionizing radiations are:- 1) Cell damage 2) DNA damage 3) Cancer 4) Effect on the immune system 5) More susceptibility of cancer in the children especially under the age of 15. 6) Deterministic effects such as cell killing. 7) Cataracts. 8) Stochastic effects such as mutations 9) Acute radiation sickness. 10) Radiation induced malformations during the pregnancy. 11) Hereditary effects. 12) The effects of low efficiency of organs and incapability to work properly. These effects are mostly long term symptoms that appears after certain time period and the safety and precautions to avoid these diseases are both important not only for the health of patients but also the staff and the physicians. THE STAFF:- The staff is exposed mostly with the scattered radiation. There are many reports for interventionists for having cataracts (Vano et al 1998). The safety of staff and workers comes under the term called as occupational radiation protection. The lead apron which has 0.35mm lead gives the staff a good protection from the radiations (Marshall et al 1992). The staff needs to be an expert regarding the safety issues, are in actual they are the care takers of the premises and the patient is only the entity to be exposed from the radiation. So the safety of the staff is important in a context because if they know and understand that how to be more careful only then they can take the safety of the patient into regard. And their life and health is as important just like the patients health, otherwise lacking in the safety and precautionary measures, they will soon be the next patient just like the other patients. Regarding the precautions for the staff, the following steps are necessary. 1) Complete knowledge of the associated radiation risks. 2) Should never perform medical imaging while directly in proximity to the patient. 3) Should stand behind the protective wall that is made in order to avoid the risk of exposure for the involved staff. 4) Only the expert of the medical imaging service should perform the diagnosis. 5) In the smaller settings, the staff must use the protective shielding apron and gloves that are provided by the hospital or should be present with them in any case. 6) In order to safeguard for the health of the technician, there must be regular monitoring and evaluation of the performance of operation of the staff for the medical imaging, and any gaps regarding safety should be discussed with the staff and doctors. 7) The staff must follow the radiation safety instructions. THE PATIENTS:- The patient’s protection for the ionizing radiation comes under the medical radiation protection. The exposure type, government regulations and legal exposure limits varies. The safety precautions for the patients are:- 1) The patients must follow the radiation safety instructions properly. 2) Room selection and preparation, e.g. lead lined to reduce exposure in hallways and patients to adjacent rooms. 3) Cover entire floor area with absorbent bench paper to minimize room cleanup at the end. 4) Patients should be provided scrubs to wear for the period of isolation. 5) Disposable personal grooming items are used. 6) After the dose, all room items of patients are disposed of as radioactive waste or allowed to decay for at least 90 days. 7) Enquire current state of health of patient before medical imaging. 8) If blood or urine specimens are required to be collected, collection should occur before the radionuclide is administered. 9) All female patients of child bearing age must go through pregnancy test before medical imaging. 10) Patient exposure rate measurements should be done after the diagnosis. 11) Reducing time reduces effective dose proportionally. 12) Increase in the distance reduces dose because of inverse square law. 13) Biological shielding is done so as to reduce the level of ionizing radiation up to the suitable level. CONCLUSION:- The use of medical imaging is an effective technique that has helped millions of the patients to recover because of the early identification of the diseases or injuries. The simple procedures that are followed accurately and proper equipment measures are responsible for reducing the patient and the staff dose (Vano et al 1998). It is an effective technology that is proved to be fruitful and opening new dimensions to the field of medical sciences. However, the low to moderate risks of different diseases and cancer still is the matter of debate due to these exposed radiations mainly the ionizing radiation used in the medical imaging technique. But at the same time with the precautionary measures by all the people, it is still proved to be beneficial because these doses of ionizing radiation are not the habit of any patient, and it is suggested in the cases only where there is a need for the medical imaging. By improving our health status and lifestyle, our heath conditions and mental, physical states, we could avoid being exposed to such risk only by taking care of our health to the extreme levels of care. Special care is needed while performing all the radiology procedures and even a minute dose must be kept into the consideration, not neglecting it only because of its minimum exposure and less frequent. As medical science is moving towards more technological advancements, so does the risks due to these upcoming new technologies are maybe higher and we need to identify these risks and control them. A better way to sort out the problem is more and more research as well as the eradication of the problem arising from the source. REFERENCE:- “Be Informed About the Safe Use of Ionizing Radiation in Medicine,” International Atomic Energy Agency, accessed May 15, 2011, http://rpop.iaea.org/RPOP/RPoP/Content/index.htm. International Commission on Radiological Protection, 1990. “Recommendations of the International Commission on Radiological Protection”. ICRP Publication 60. Ann ICRP 1991;21:1—3. Wilde P, Pitcher EM and Slack K. “Radiation hazards for the patient in cardiological procedures”. Heart 2001;85:127—30. Koenig TR, Wolff D, Mettler FA and Wagner LK. “Skin injuries from fluoroscopically guided procedures”: part 1. Characteristics of radiation injury. AJR Am J Roentgenol 2001;177:3—11. Koenig TR, Mettler FA andWagner LK. “Skin injuries from fluoroscopically guided procedures”: part 2. Review of 73 cases and recommendations for minimizing dose delivered to patient. AJR Am J Roentgenol 2001;177:13—20. International Commission on Radiological Protection. “Avoidance of radiation injuries from medical interventional procedures”. ICRP Publication 85. Ann ICRP 2000;30:2. 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