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Eric Horton
Assignment: Essay 4 Draft
Professor: Dr. Skutar
English 2089
25th of March 2015
Are we over radiating our patients across the nation?
Good evening ladies and gentleman, it is a great honor to have the opportunity to speak this evening regarding this sensitive, but yet controversial issue regarding over exposure to xrays and radiation in our medical facilities. My name is Eric Horton. I am a registered
Radiologic Technologist and a representative of the American College of Radiology and the
American Society of Radiologic Technologist. What is radiation? The Merriam-Webster
Medical dictionary defines it as “the process of emitting radiant energy in the forms of waves and particles.” (Merriam- Webster 694) Radiation and x-rays are harmful so why do medical professionals continue to over expose our patients to this type of electromagnetic energy?
Before we begin our discussion on the over exposure of radiation and x-rays to our patients I want to first discuss a brief history lesson as to how x-rays were discovered and to also further your knowledge and define what x-rays are. Morphine and Oxycodone are a tightly controlled and regulated substance that is very toxic to our society. Why are x-rays not treated as such across our great nation?
On the 8 th of November 1895 the day was coming to an end and it was about time to call it a day once again in Doctor Wilhelm Conrad Roentgen’s laboratory at the Polytechnic
Institute in Zurich, Germany. As he was ending his day, Doctor Roentgen got the room ready

Horton 2 so he could continue his work for the following day. (Fauber 2) Before he left for the day he decided to conduct just one more experiment. Doctor Roentgen dimmed the lights in his lab so he could once again observe the warm glow of the electrified vacuumed tube which at the time was called a Crooks tube. Doctor Roentgen covered his specialized vacuumed tube with a piece of black cardboard and then energized the tube once again with electricity. Off in the distance he noticed that a piece of paper coated with barium platinocyanide, began to produce light and fluoresce. This is where he Doctor Roentgen began to realize that there was a specific type of energy that was being emitted from the tube and projected in the path of the coated paper.
This energy is what we know as x-rays. (Fauber 3-4)
How harmful is radiation exposure? In the mathematical equation X-5=7 what does the letter x stand for? The letter x represents the unknown variable in this simple mathematical equation. The letter x in x-ray is the unknown ray. (Fauber 6) In the evolving stages of x-ray development in 1898 there was another detrimental finding of what this type of energy could cause. This type of energy that was produced from these vacuumed tubes caused skin reddening and burning of the skin. Once a patient was exposed to too many x-rays the dose of the x-rays/radiation creates significant biological damage, malignant tumors as well as the alteration to chromosomes and the tissues of humans. Extreme levels of radiation can become very detrimental to patients. X-rays are a form of electromagnetic radiation that behaves like particles and waves. (Fauber 6) Vlietstra also explains how serious the biological damage can become to human anatomy. He explains that over the years, radiologist and others working in

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the field of x-rays/radiation have suffered from severe dermatitis and skin degeneration on the hands of these individual’s. The severe dermatitis and skin degeneration occurs because of the repeat exposure from the x-rays and by placing their hands in the primary field of the radiation when the tube is energized. What is really scary that Vlietstra explains is that sometimes the damage is so severe to the worker that amputations of the fingers were necessary due to the damage from the ionizing radiation. I can see how people that work around the radiation all of the time can become complacent and not really worry about the dangers that truly exists around us. (Vlietstra 132) Like a prescription drug, if an individual takes too much medication then it can make them sick or perhaps kill an individual. Prescription drugs can be harmful unless their use is supervised by a licensed practitioner. (Acosta 4) X-rays at just the right dose can be therapeutic just like pharmaceuticals. Too many x-rays can be detrimental to one’s health. The destruction of something so tiny in our molecular make up can yet impact us in a large way.
I want to shift focus a little and I want everyone to try and imagine radiation levels on a much bigger scale. What comes to most everyone’s mind about a nuclear bomb? I would say the majority of us would say mass destruction. Can I please see a number of hands? What about the extreme radiation levels from nuclear disasters or perhaps war?
How dangerous is radiation to the human population? “Death, of course is the most devastating human response to radiation exposure.” (Bushong 517) When x-rays were still in the development stage of discovery the individuals who studied x-rays died from the late

Horton 4 effects of radiation dosages. (Fauber 6) Stewart Bushong explains that the sequences of events that occur once a human is bombarded with an extreme amount of radiation that there is a chain of events that occur. With acute radiation syndrome the following events happen in precedence which are as followed; hematologic death, gastrointestinal death and death of the central nervous system. In other words an individual that has received a tremendous amount of radiation and has been diagnosed with gastrointestinal death would also have hematological death. An individual that has been diagnosed with Central Nervous System Syndrome will have all three syndromes which are hematological syndrome as well as gastrointestinal syndrome and central nervous system syndrome. (Bushong 517)
What is hematological syndrome? This is caused by the radiation destroying and the reduction of platelets, white blood cells and red blood cells. Hematologic syndrome occurs at a radiation dosage of 200 to 1000 radiation absorbed dose also known as rads. An interesting fact about how sensitive our blood cells are is according to Bushong at 25 rads of radiation an individual can be affected by depressed blood cells in there system. Some of the signs and symptoms for hematologic death are nausea, vomiting, diarrhea, anemia, hemorrhage, fever and infection. (Bushong 518)
The next devastating syndrome from radiation that humans can receive is called
Gastrointestinal Syndrome. This is when an individual receives 1,000 to 5,000 rads. What is so devastating about type of syndrome is the radiation actually destroys the lining of the intestines. When the cells are destroyed in the intestines this allows fluids to pass by and there

Horton 5 is no longer absorption and the functions of the cells are lost. (Bushong 519) Without the absorption functions of our intestines how will our body be able to sustain life?
The final syndrome that is the most serious out of all of the radiation sickness is central nervous system syndrome. This occurs once an individual is exposed to 5,000 rads of radiation.
In other words this is a tremendous amount of radiation that is received all at once. Levels of this intensity, death can occur within hours. During the initial exposure to radiation of this magnitude Bushong explains that the victims become extremely nervous, confused and the radiated victim complains that their skin burns. A loss of vision and consciousness can also happen once the body receives this tremendous amount of radiation exposure. The ultimate cause of death regarding this syndrome is fluid in the brain. (Bushong 519)
Let’s do a recap of what we have learned so far. We have now touched on some of the history of radiology. We have discussed some of the dangers from x-rays and radiation and we have also learned what radiation can do in the form of bombs and nuclear war. Are there any questions? I will answer a few before I proceed.
To answer the question are we over radiating our patients across the nation? The answer is yes! There are numerous CT scans that are ordered, plain radiographs as well as interventional and cardiovascular procedures. According to Vlietstra, “cardiologist are very often unaware that excess focal exposure to x-rays can produce radiation injuries which are a delayed erythema” (Vlietstra 145) According to Vlietstra when patients receive an absorbed dose of approximately 6 Gy’s to a local area of skin tissue then it is possible that deep necrotic ulcers can form due to tissue death from the extreme doses of radiation from the procedure.

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As the dose increases on the skin there will be more drastic effects that the patient can suffer in the localized area where the skin was radiated. (Vlietstra 145)
On a molecular level our cells are constantly dying and regenerating to make new cells.
When radiation destroys the building blocks, which is DNA, to make these new cells then no more cells will be able to regenerate. (Bushong 504) If a tornado comes and wipes out a dodge factory that makes Challengers then there will no longer be a plant to make Dodge Challengers for example.
Everyone here is probably asking the question to themselves as to how in the world would we know how much dosage our patients receive when a fluoroscopic intervention takes place during a procedure or intervention? The information is displayed on the monitor as the interventionalist is using the equipment to treat the individual. What is displayed on the monitor is called RAK and KAP. (Weinberg 38)
The acronym RAK stands for air kerma at a reference. KAP is air kerma area product.
RAK is the measure of the energy that is deposited per unit volume of the air to the reference point in the radiation field. The computer generates this information by taking into account the field of view that is being used, technical factors, the angulation of the tube and how long the machine has been operating. This information is a requirement for all fluoroscopic devices sold in the United States since 2006. (Weinberg 39) Weinberg describes understanding RAK by comparing it to the dashboard on a vehicle. The RAK rate is the dose or the analogy of speed which the vehicle is traveling. The cumulative RAK rate is the odometer. How far the vehicle traveled in this case is how much radiation was given to our patient. KAP however is the

Horton 7 measure of the total radiation beam while the machine is energized. Weinberg explains that
KAP is the best way to determine overall measurement of total patient dosage and risk for DNA damage and future cancer. (Weinberg 40)
In the Journal of Interventional Cardiology the statement is made that “cardiologist are at the forefront when it comes to using x-ray fluoroscopy” (Vlietstra 131) Cardiologist are now becoming more aware of the dangers of fluoroscopy. A radiologist and x-ray technologist have more of an extensive background in radiation physics training as opposed to cardiologist. The article informs us that in our world today the majority of radiation skin burns follow interventional procedures such as percutaneous transluminal coronary interventions also known as PTCA. This is a fancy way of saying a stent was placed in a blood vessel. From my personal experience as a radiologic technologist working in the field of cardiac medicine, patients can receive a tremendous amount of radiation trying to save their life from heart attacks and preventing people from having their legs amputated.
Another interesting fact that the Vlietstra mentions is the legal aspect to over radiating our patients. Hospitals and cardiologist themselves can be held accountable and sued for damages that patients can get from radiation burns. Radiation burns can become severely painful as well as disfiguring. Again looking at the history of x-rays the reason why there is such a delay in seeing the damage that is left behind from the electromagnetic radiation.
“Approximate entrance dose thresholds have been determined for various skin changes.” (Vlietstra 132) On average if a patient receives a dose of 2Gy’s then it is possible that within a few hours there can be a reddening of the skin where the x-ray beam entered the

Horton 8 patient. In a catherization lab 99 percent of the time, the x-ray beam comes from the bottom of the table. By a show of hands how many people look at their backs? Since I do not have any eyes back there it is difficult to see my own back unless someone else looks at it. The x-ray beam is directed through the patients back so if there are any reddening of the skin it will be hard to see. This can take several weeks to appear on an individual because of the nature of this energy. At an energy level of 6 Gy’s there is more erythema present on the skin. This is due to the inflammatory process of human physiology and the destruction of the basal cells in the epidermis. As dose increases more issues arise in the skin such as blisters, swelling and ischemia to the area that has been radiated.
Here is another interesting fact to mention about skin injuries. “Skin injuries are often mistaken for other causes. Because radiation burns develop weeks after the procedure their association with a coronary intervention procedure can be the last thing that people really think about what causes the burn. Sometimes the skin reddening can be confused with monitors and lead placements on the skin. What is really disturbing is that the deep pain that is associated with radiation burns can lead to extensive chest and abdominal evaluations as well as in appropriate surgeries. (Vlietstra 133)
A big thing that still continues to plaque our medical facilities is the lack of communication. A big part of this is during patient transfers. How many times have you seen a lack of communication at our medical facilities when a patient is transferred from a different facility? Sometimes what can occur are missing documentation or CD’s that contain

Horton 9 radiographic images that were previously done and are sometimes repeated due to a knowledge deficit of miscommunication?
An example that I can relate to about communication from my personal experience is one afternoon working as a student technologist I can remember receiving an x-ray order for a bone survey. The technologist and I went to pick up our patient and take him to the x-ray room to begin the examination. He was upset because he had to get more x-rays. His first comment was that he refused and he was not going to have any more x-rays done because he has had enough x-rays to demonstrate what was wrong with him. After the technologist talked to him and explained the importance as to why he needed these x-rays he then the patient complied and we did what we were told by the physician. That was to obtain the x-rays. Looking back at this situation if we would of talked to his family member we may of found out that these x-rays may have been taken a week ago at another medical facility. The gentleman may have not had too lie on the cold hard table and be zapped over and over with the x-ray energy applied through his body. We now over exposed our patient with radiation that may have been preventable.
Another interesting issue regarding patient overexposure to radiation can also be in the form of anxiety from the patient receiving the test. According to Heyer he states “Furthermore, many patients reported a number of additional anxiety triggers including poor information, possibility of tumor diagnosis, radiation exposure, and application of contrast media.” (Heyer
105). In other words patients were not given enough information about what their

Horton 10 expectations were regarding the CT scan as well as the individual factor of being concerned that the technologist may find something growing inside of their body. Better communication by the technologist could improve the image quality just by having a conversation with a person.
In conclusion as healthcare professionals we need to be more proactive by reducing the amount of radiation patients receive. Now that we have a brief understanding of the history of radiology, Now that we have an understanding of what nuclear war can cause, We are now armed with new knowledge to apply in our practice to reduce radiation to our patients. I urge everyone of you to take this knowledge and use it to your advantage to help people. This will help generate new pathways and ideologies for better guidelines and practices. Thank you ladies and gentleman for attending, have a safe drive home and good night.

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Annotated Bibliography
Acosta, Renee. Pharmacology for Health Professionals 2nd ed. Philadelphia: Lippincott
Williams & Wilkins, 2013. Print.
Balter, Stephen. Miller, Donald. et al. “Radiation Dose Measurements and Monitoring for
Fluoroscopically Guided Interventional Procedures.” American College of Radiology. May 2012.
595-597. National Center for Biotechnology Center. 12th March 2015
Bushong, Stewart. Radiologic Science for Technologist; Physics, Biology and Protection 4th ed.
St. Louis, Elsevier Mosby, 2004: Print.
Fauber, Terri. Radiographic Imaging and Exposure 2nd ed. St. Louis, Mosby, 2004: Print
Heyer, Christopher MD; Thuring, Johannas MD. et al. “Anxiety of Patients Undergoing CT
Imaging- An Underestimated Problem” Academic Radiology (2015): 105-112. UC online
Library. 10 March 2015.
Mahesh, Mahadevappa. Detorie, Nicholas. “The New Joint Commission Sentinel Event
Pertaining to Prolonged Fluoroscopy” American College of Radiology. March 2007. 497-500.
National Center for Biotechnology Center. March 12th 2015.
Merrium-Webster Incorporated. Merrium Websters Medical Desk Dictionary. Springfield:
2002, print.
Miller, Donald. Hollington, Lu. Et al. “Radiation Doses in Interventional Radiology Procedures:
The RAD-IR Study” Journal of Vascular and Interventional Radiology (2003): 977-990. National
Center for Biotechnology Center. 12 March 2015.
Vlietstra, Ronald; Wagner, Louis. “Radiation Burns as a Severe Complication of Fluoroscopically
Guided Cardiological Interventions” Journal of Interventional Cardiology. Vol 17, 3, (2004) 131-
141. National Center for Biotechnology Center. 12th March 2015.
Vlietstra, Ronald; Wagner, Louis. “X-ray Burns – Painful, Protracted and Preventable.” Clinical
Cardiology. 31, 4. (2008) 145-147. National Center for Biotechnology Center. 12th March 2015.
Weinberg, Brent MD; Guild, Jeffery; et al. “Understanding and Using Fluoroscopic Dose Display
Information.” Current Problems in Diagnostic Radiology (2015): 38-46. UC online Library. 10
March 2015.