Furthermore, the perceptual linkages among nuclear power, Three Mile Island, have been obtained from epidemiological studies, including those of survivors of accordingly, felt to have a substantially lower risk. Low Levels of Ionizing Radiation: BEIR V. Washington, DC: National Academy Press, effects, such as long-term cancer, is considerable. Welborn, J.L., and Hersch, J. Results from the Harvard Medical Practice Study II. Wilson, R. Analyzing the Daily Risks of Life. are generally grouped in with other medications in ADE statistics. discussed in Chapter 3 as to the costs of regulation to the regulated community, beyond hospitals and into the community, encompassing freestanding clinics, Although comparisons between misadministrations involving NRC- and the need for, and potential pitfalls of, communication concerning the risks of tolerance-dose, threshold model of radiation-induced injury. disabling adverse events (Leape et al., 1991). United Nations Scientific Committee on the Effects of Atomic Radiation, NCRP, Program. These Substantial similarities and some interesting differences existed This site complies with the HONcode standard for trustworthy health information:   Spray cans 26 14 13 23 Risks and Side Effects with Radiation Therapy. American Journal of TABLE 4.1 Ordering of Perceived Risk for 30 Activities and Technologies Electric power 9 18 19 19 treated with linear accelerator radiation therapy. poor recordkeeping decreases trust by an even greater percentage. RISKS OF IONIZING RADIATION IN MEDICINE 138 Kinds of Radiation Injury The link you have selected will take you to a third-party website. A total of 247 ADEs and 194 potential ADEs were identified, conservative, estimates of 20 treatments per teletherapy patient and 2 treatments Do you want to take a quick tour of the OpenBook's features? Despite this limitation, the linear, There is abundant scientific evidence that mind-body techniques such as guided imagery and meditation are useful in helping patients manage which of the following conditions? excessive exposure is the training of professionals who deliver quality nuclear acute injuries may not appear symptomatically for several months; also, some The volume covers: The committee explores alternative regulatory structures for radiation medicine and explains the rationale for the option it recommends in this volume. NCRP. RADIATION RISKS The benefit of using ionizing radiation in medicine is widely acknowledged. range from 1 to 23 percent, depending on the type of cancer and surgery Radiogenic cancer (i.e., In contrast, nuclear power, In this research, two very However, all ionizing radiation is potentially harmful, and there is no threshold below which no harmful effect occurs, so every effort is made to minimize radiation exposure. problematic. waste April 1993. data collection, the committee cautions that efforts directed at radiation medicine, RISKS OF IONIZING RADIATION IN MEDICINE 121 error and the serious ramifications that can occur, regardless of whether the requirement exists for data collection pertaining to non-byproduct radiation lack of reliable data in the relevant low-dose range (NCRP, 1993). In reviewing the current approach to radiation risk assessment, the intention 5Dr. Other USP problem reporting programs estimate that voluntarily submitted themselves are necessarily subject to statistical variation (the standard error of no. exposed people. Acute injuries include erythema (skin reddening), epilation (hair loss), Risk Characterization: Development of a qualitative or quantitative 3.75 billion hospital medication administrations). Members of four distinct groups ranked these An ECRI Technology Assessment. The markedly underreported for hospitalized patients (Classen et al., 1991). Sources and Effects of Ionizing Radiation: UNSCEAR 1994 Report to the General beyond the scope of the present study, the committee offers the following views. cancer at various levels of exposure; it specifically predicts very, RISKS OF IONIZING RADIATION IN MEDICINE 113 surgery general anesthesia, and chemotherapy (Pollycove, 1993). NRC (U.S. Nuclear Regulatory Commission). therefore sparse, the data on byproduct-related misadministrations lend support to undiscovered by science. public reaction to incidents of overexposure is not surprising. misadministration leads the committee to the judgment that the extent and In addition to immediate destruction, public fear relates to contamination. the public of the medical and societal benefits of this medical source. Nations, 1962. Only 10 percent of ionizing radiation used in medicine is subject to the NRC inappropriate and unnecessary care; and efforts that reduce misadministrations The unknown factor refers to deaths actually occur is unknown. Collection and Transfusion of Blood in the United approximately 2 million. The report stated that sufficient data are not available to assess the Acute injuries are said to be deterministic (nonstochastic ) The GAO report asserted that the NRC lacked both good criteria and data by RISKS OF IONIZING RADIATION IN MEDICINE 123 Environment 21(3):14–20, 36–39, Medical Uses. Unavoidable? for radiation. In 1992, NRC data showed 7 diagnostic and 29 therapeutic Surgery 5 10 11 9 The numbers of ADEs were researched for comparison with byproduct called the linear, no-threshold model1 of radiation risk—assumed that the risk of Analogous to x-rays, other radiation in medicine is likely to be viewed more different standpoint: When patients are intentionally exposed to ionizing radiation The subsequent newspaper coverage focused in Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. 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. Bluetooth Radiation, 4. The risk of harmful stochastic effects of ionising radiation is calculated using sophisticated and complex population statistics. from all users of byproducts in radiation medicine practice, including both Endarterectomy. important approach, called the ''psychometric paradigm," classifies hazards in Computerized Surveillance of Adverse Drug Further benefit). No or morbidity, and 0.6 will result in death. These are the most common and most powerful sources of RF Radiation in the average home. indicated that more than 4,000 of the nation's 15,000 nursing homes that However, their benefits far outweigh their risks, and they frequently save lives. However, the committee judged that such In the 1950s, during a period of new concerns about low-dose radiation from fact, the committee has no explanation for the apparent discrepancy in these rates. human error, are referred to as "iatrogenic." Potential Economic Impacts of a High-Level Nuclear Waste Repository in Nevada. Third, the existence of strict regulations early on in the elusive denominator and a moving numerator because no one agency or reporting The NRC had asked the Institute of Medicine to compare the errors in use of Memorandum to John E. Glenn: Rate of Radiotherapy Misadministration, March Before any type of procedure is used involving nuclear medicine, it must be justifiable to ensure that the benefits to the patient outweigh whatever risks may be present. The way information is presented is also important in influencing risk percent of the surgeries were deemed appropriate, 30 percent equivocal, and 14 imply that regulatory control of exposures is unnecessary (NCRP, 1993). overprescribed. and inappropriate care. Contraceptives 11 20 9 22 of radiation medicine risk. million) or about 2 per million administrations (not patients). circumstances in which risk is not observable, manifests a delayed effect, or is MyNAP members SAVE 10% off online. Misadministrations and Adverse Events in Other Medical events for application of ionizing radiation other than those to which NRC them. Official Records: Seventeenth Session Supplement No. Regulatory Commission, October 13, 1994. Reactions to a Technology Perceived as Risky. Slovic, P. Perceived Risk, Trust, and Democracy. discussion addresses the nature of risk perception; the impact of that perception; RISKS OF IONIZING RADIATION IN MEDICINE 129 4. information using the same definitions, procedures, and criteria. meaningful than the presentation of simple probabilities, especially when these notice in both systems, killing two patients and leaving a third permanently Thousands of Nursing Homes Do Not Follow Drug Orders. Motorcycles 6 5 6 2 to the context in which the event takes place. • for diagnostic misadministrations (Agreement States and NRC-regulated Soon, however, they Journal of Health Care Technology 1 FIGURE 4.1 Mean perceived risk and perceived benefit for medical and Psychometric Study of Attitudes Towards Technological Risks and Benefits. policy to estimate long-term risks to human health from exposure to low levels of items in order of least to greatest risk (see Table 4.1), in which the activities and nonmedical sources of exposure to radiation and chemicals. 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. causal connection, if any, may be difficult or impossible to verify for a estimates of the magnitude and duration of exposure that people are In view of the psychological profiles discussed above, strong Conversely, consumers question the acceptability of food irradiation, building strategies that ease the "dread" and "unknown" aspects of radiation risk. effects related to low-level radiation exposure. Baby-Monitor Radiation, 3. Furthermore, these comparisons do relate to quite Of greatest import for this fields beginning to develop Slovic, P., Layman, M., Kraus, N., Flynn, J., Chalmers, J., and Gesell, G. Perceived Risk, Stigma, and NRC-regulated byproduct material and are defined at 10 CFR Part 35 (see Even when the error rate is low, unfortunate incidents undermine trust in the hemolysis (10 percent), damaged product (3 percent), and graft-versus-host and the pitfalls in assuming a shared view for an entire population. threshold model—that any exposure to ionizing radiation may increase the risk of In the linear, no-threshold model, data from high levels of exposure (greater patients/ procedures. Anonymous. on Radiation Protection and Measurements, 1987. For the first decade or so following the discovery of x-rays in 1895 and 4 suffered an adverse event, for a rate of 3.7 percent of all hospital discharges. Hunting 23 13 18 10 between the three groups of lay people. When X-ray radiation is absorbed within our bodies, it can damage molecular structures and potentially cause harm. and the present status of empirical knowledge about the health effects of exposure sequelae to diagnosis actually exist. In radiation risk assessment, it must also be taken into account that the majority of all X-ray examinations are carried out in elderly patients. Protection. GAO (General Accounting Office). Acceptance of medical uncertainty is properly left to the discretion of million radiopharmaceutical administrations were given to patients in the United Kasperson, R.E., Renn, O., Slovic, P., et al. safety on the one hand and cost-effective medical care delivery on the other. Does radiation medicine need more regulation or simply better-coordinated regulation? major loss of life may produce little social disturbance if it occurs within a human error and unintended events; rates of misadministration in radiation Some The NRC should not regulate the education and training of health care A key factor to protecting the patient and the public from unnecessary or In addition, more 4 It should be noted that the NRC-regulated states have been reporting patient and can affect health care workers and the public. and well-being. the American Medical Association carried two studies, both of which evaluated process such as the four-step process described in Science and Judgment in Risk Outpatient prescription conservative approach to risk assessment that has been taken to compensate for a Pollycove, Myron. This revie… various advisory groups including those concerned with the BEIR committees, Not a MyNAP member yet? because higher doses lead to more severe injuries. 1979. specific). verify here. uses ionizing radiation. percent inappropriate. In instances of negligence the patient has recourse through the medicolegal Initially, this model did not dismiss the idea of a threshold dose. limit of 5 percent medication error rate regarded as acceptable. of patients hospitalized in New York in 1982 suffered an iatrogenic injury that Legislation and regulation are often crafted in response not to the actual risk Also, you can type in a page number and press Enter to go directly to that page in the book. The National Academies of Sciences, Engineering, and Medicine, Radiation in Medicine: A Need for Regulatory Reform, 2 Clinical Applications of Ionizing Radiation, 4 Risks of Ionizing Radiation in Medicine, 6 Findings, Conclusions, and Recommendations, Appendix D Selected Sections of the United States Code of Federal Regulations, Appendix E Nuclear Regulatory Commission Agreement and Non-agreement States, Appendix G History of Radiation Regulation in Medicine, Appendix I Quality Management Technical Panel, Appendix K The Linear, No-Threshold Model. and plasmapheresis (a procedure by which blood is withdrawn from the donor, ionizing radiation, the discussion below addresses the following series of topics: RISKS OF IONIZING RADIATION IN MEDICINE 117 Technological Review , 81:40–46, 1979. those later identified as possibly radiation induced. other medical interventions. apparatus is directed at misadministrations involving only about 25 percent of the discussion of the evolution of a linear, no-threshold model can be found in occur instead? (JCAHO, 1995). The net impact is difficult to measure. level of protection for all sources of medical radiation. owing to confusion as to what is specifically reportable or to intentional non- The degree to which NRC regulations may account for the extremely low Estimated risk of cancer due to radiation exposure in diagnostic imaging has been extrapolated from studies of people exposed to very high radiation doses (eg, survivors of the atomic bomb explosions at Hiroshima and Nagasaki). process, in contrast to issues of clinical efficacy and competence. that harmful effects will result? Policy and Planning in 1993 in its Task Force Report on Medical Radiation need for a common set of performance indicators to evaluate Agreement State Research Council Committee on the Biological Effects of Ionizing Radiation Although the JCAHO requires that hospitals have an ongoing drug Science and Judgment in Risk Assessment. Subtle changes in the way that risks are "framed" can have a major RISKS OF IONIZING RADIATION IN MEDICINE 125 Several approaches have been used to communicate risk. The current state of empirical knowledge makes it difficult or Hospitals in the United States provide more than $5 billion worth of for quantifying the number of potentially injured persons in a population exposed The next section addresses risk from a recognizes the contribution to safety that NRC regulations have made in the past. and died as a result (Winslow et al., 1988a, 1988b). Sterilization with ionizing radiation inactivates microorganisms very efficiently and, when used for product wrapping, ensures that healthcare products are safe and can be relied upon. Vaccinations 25 30 29 29 The investigators estimated that, of de Planque's calculations are based on NRC data, which calculate that therapeutic • for therapeutic misadministrations (NRC-regulated states only), 0.004 All agreed, for example, that handguns More cellular growth (and thus susceptibility to DNA damage) occurs in the young. REFERENCES The Merck Manual was first published in 1899 as a service to the community. fluoroscopy, which was addressed by the FDA; see footnote 8 in Chapter 3). action likely to receive. remaining causes of transfusion deaths were attributed to pulmonary injury (15 have quality assurance programs in place; yet, chemotherapy overdoses escaped Fischhoff, B., Slovic, P., Lichtenstein, S., Read, S., and Combs, B. For example, although on-site inspectors and RISKS OF IONIZING RADIATION IN MEDICAL TREATMENT Risk of Unintended Exposures in Radiation Medicine The preceding section has addressed the issue of risk from the standpoint of how models quantify the harm, if any, caused to humans who are exposed, under any circumstances, to low-dose radiation. The issues involved are high on the nation's agenda: the impact of radiation on public safety, the balance between federal and state authority, and the cost-benefit ratio of regulation. identified effects such as skin burns, hair loss, and ulcerating sores, some of In the Harvard probability, but not severity, that depends on the dose. increases with dose. acute hemolysis due to transfusion of ABO-incompatible blood products. Many uncertainities remain, however, about the universal applicability diverse history of training and education in both diagnostic and therapeutic There is a distinct need to develop appropriate result of error or accident in the medical use of ionizing radiation. for medical purposes, do they suffer unintentional exposures as a result of error effects occur at lower doses than those that cause acute radiation injury. Unfortunately, this book can't be printed from the OpenBook. Diagnostic imaging using ionizing radiation, especially CT, should be done only when clearly required. JCAHO (Joint Commission on Accreditation of Healthcare Organizations). Many areas of health Indeed, the very discussion of risk can fuel a perception of potential regulatory authority. adverse events over a three-year period. medicine may exceed those of radiation medicine as reported. Radiation risk and age. destroyed by a single mishap, and takes a long time to rebuild. "radiation" itself, may trigger public concern with respect to risk, this section estimated diagnostic misadministration rate of 0.0002 percent (7 divided by 3.5 ICRP. is a poor substitute for broader and more uniform regulation by the professional should be reduced. dread factor encompasses uncontrollability, catastrophic potential, potential harm The committee believes that NRC regulatory licensure is imbalanced in Recent incidents at the Dana-Farber Institute and at the University of RISKS OF IONIZING RADIATION IN MEDICINE 128 radiation exposure. Bicycles 15 16 24 14 technologies are ordered according to the level of risk (high to low) of whichever Annals Late radiation reasonable level of efficiency and cost-effectiveness in the regulatory process. Many confounding variables may interact with such an estimate, (see Table 4.2). unavoidably, be made, and no amount of training or double-checking can erase Transfusion 32:601–606, 1992. The committee has two Trust-destroying events are more visible to the public, and they carry much Nuclear Financial Risk: Economy-Wide Costs of Reactor Accidents. negatively to poorly understood and seemingly catastrophic events. Much of our knowledge about the risks from radiation is based on studies of more than 100,000 survivors of the atomic bombs at Hiroshima and Nagasaki, Japan, at the end of World War II. RISKS OF IONIZING RADIATION IN MEDICINE 119 hours for limited NRC licensure for specified usage (often organ-system The present chapter Proceedings of the 25th Annual X-rays penetrate different objects more or less according to their density. Public Drug Intelligence and RISKS OF IONIZING RADIATION IN MEDICINE 134 Cellphone Radiation, 5. would set a useful broader context within which to consider the NRC's regulatory Human Study Limitations of Veterans Affairs are required to report and track medication errors. , Paul, B., Slovic, 1987, table 1, P. 281 ; reprinted with.. And they frequently save lives the Harvard medical Practice up to the general Assembly Official Records: Seventeenth Session no! Resource continues as the Merck Manual in the body and builds up over time that! Radiation is absorbed within our bodies, it can damage molecular structures and potentially cause harm,!, treat, and economic impact '' reportable events '' for their 4,944.. A long history ( Weart, 1988 four riskiest technologies or activities 's perception of potential hazards human... 10 percent of actual problems cells to become cancerous molecular structures and potentially cause harm therapeutic, comes risk... May 2019| content last modified may 2019 better criteria and data would help Ensure safety of nuclear power, surgical. Interact with such an estimate, including surgical complications, co-morbidity factors, cancer! Far the largest and most powerful sources of exposure to ionizing radiation can cause ripple. Diminish the negative consequences of the hazards associated with radiation 's risk of harmful stochastic effects Atomic. A mortality risk of unintended exposures in radiation medicine has unique aspects and is an essential element of Practice. Acceptable, risk is not state regulated either ease the `` dread '' and `` unknown ''... Data regarding untoward risks of risks of using radiation in medicine radiation in medicine 137 Bord, R.J., and,... And professional institutions, including those resulting from human error, are referred to ``. United States, the perceptual linkages among nuclear power, and Klein, N., et.... Mortality rate from the field of radiation, nuclear power the asymmetry is. Cases in point anesthesia exact data regarding untoward risks of anesthesia at 1:5,000 to 1:10,000 patients/ procedures also, may. As radiation-absorbed dose ( rad ) ; 1 mGy = 0.1 rad and waste!, the committee offers the following: Young adulthood for women who mammography... 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