K.S.Parthasarathy
Date:05/06/2008 URL: http://www.thehindu.com/thehindu/seta/2008/06/05/
stories/2008060550081400.htm
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Dismal state of medical X-ray safety
A study supported by the International Atomic Energy Agency (IAEA) in 12 developing countries (not including India) showed that the fraction of the medical X-ray images rated as poor was as high as 53 per cent (American Journal of Roentgenology, June 2008). This leads to unnecessary radiation doses to patients due to repeat examinations. The conditions in the 45 hospitals in 12 countries improved as the hospitals started implementing quality assurance programmes. The Atomic Energy Regulatory Board (AERB) has complete information on the status of medical X-ray safety nation-wide. However, in the implementation of X-ray safety measures in each installation, India has miles to go.
Analysis of dark room techniques in 175 X-ray departments in India revealed that 12 per cent of these installations were exposing patients to excessive doses of more than 200 per cent because of improper techniques. The use of automatic film developing equipment may help in improving the condition.
Needlessly exposed
A more recent survey of 30 mammography clinics in Mumbai revealed that patients are needlessly exposed to high radiation doses.
Researchers in an AERB project measured skin doses in 12 different examinations. For all types of examinations except skull, the skin doses were mostly within the reference levels published in the Basic Safety Standards for Protection against Ionizing Radiation and the Safety of Radiation Sources.
The ratio of maximum to minimum dose was five for chest X-ray; lumbar spine, eight, thoracic spine (lateral) 8.5 etc. If the doses are too high, it is not good practice as the patient does not receive optimized protection.
There is no justification for exposing patients to such a wide range of doses to get the same clinical benefits.
In 1994, AERB found that nearly 30 per cent of over 30,000 X-ray units it studied were over 15 years old. Older equipment may deliver higher doses. The user of the equipment must evaluate the safety features of each old unit; there are ways to remedy their deficiencies.
There are over 2,500 CT units in the country. The progress in carrying out quality assurance tests of these is very slow.
An AERB supported coordinated research programme covered 785 X-ray units in 495 hospitals. About forty per cent of the 1,15,000 examinations studied were on the reproductive sections of the population; 20 per cent of examinations were on children under 15. Physicians must be extra vigilant in X-raying children as their tissues are growing and as such more sensitive to radiation.
Surveys at 71 CT Units in India revealed that on an average 8.9 per cent of CT procedures were on children; paediatric protocols were not used in 32 of the 71 installations. These centres are exposing children to unjustifiably high radiation doses (The Hindu, March 6, 2008).
India has about 45,000 x-ray units; many of them are very old; about 1500 units are added every year. Each unit must be inspected periodically. Large scale introduction of CT scan units and interventional radiology units calls for greater caution. Enforcing the X-ray safety provisions in the Atomic Energy (Radiation Protection) Rules 2004, is the only way forward to ensure safe use of this potentially powerful tool .
Proactive promotion of X-ray safety is not a substitute for effective implementation of regulations. In 1986, an AERB task group chaired by Dr Arcot Gajraj, an eminent radiologist, recommended decentralization of radiation surveillance programmes for X rays by setting up five Regional Enforcement Directorates.
The suggestion to set up regional directorates came up repeatedly at least once every ten years since 1971! AERB has been persuading the State Governments for the past several years.
State health authorities who are responsible for enforcing AERB provisions in probably the majority of hospitals in each State must get a wake up call.
K.S. PARTHASARATHY
FORMER SECRETARY, AERB
ksparth@yahoo.co.uk
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