Severe radiation burns and possible cancers arising from the increasing use of sophisticated X-rays have become new examples in the continuing saga of medical neglect and ignorance.
More and more, doctors are using special X-rays for diagnosis or to guide their medical procedures. But they are often insufficiently trained to monitor the amounts of radiation they give their patients.
While experts say the benefits of X-ray procedures still outweigh their risk, one example of what can happen after excessive radiation exposure is a rash and then a hole in the flesh. These radiation injuries can be quite disfiguring and painful.
Only recently has there been some heightened attention at medical conferences and in the medical literature about this health threat, which has been building for at least a decade.
Only Recently Getting Attention
The Food and Drug Administration is about to propose new guidelines for a type of machine implicated in causing these radiation burns.
"It has taken a long time, but more health professionals are beginning to wake up to this issue because it is getting harder to ignore the type of data that is becoming available," said radiation expert Louis Wagner of the Houston Medical School of the University of Texas. "But there is still a lot of catching up to do."
In July, a paper co-authored by Wagner will be published in a major medical journal. It will provide details of 73 cases of severe skin injuries, such as large, deep holes and burns caused by medical radiation.
In all these cases, the X-ray-emitting procedure used was fluoroscopy and often involved cardiologists who cleared out plaque from clogged arteries, a technique known as angioplasty.
Rather than cut open a patient to do angioplasty, doctors insert their miniaturized medical instruments through fine tubes, or catheters, threaded up to the heart through a patient's blood vessels. Doctors monitor where the blockage is using the X-ray pictures produced by fluoroscopy, which are converted into visible light images that can be revealed by a television camera and then exhibited on a TV monitor. Depending upon the complexity of the blockage, these procedures can take several hours, potentially exposing a patient to a lot of radiation.
It is the doctor's job to control the X-ray beam by stepping on a pedal.
Besides cardiologists, gastroenterologists, surgeons and other medical specialists are increasing their use of fluoroscopy methods in their practice.
Physicians Aware of the Issue
Cardiologists and radiologists acknowledge that radiation burns can be a problem.
Some cardiologists performing angioplasties today may not have had training in radiation exposure, but the next generation will, says Dr. John W. Hirsfeld Jr., chairman of the cardiac catheterization and interventional committee of the American College of Cardiology.
Radiologists have worked with the FDA to develop the new guidelines for fluoroscopy machines, says Dr. Anne Roberts, past president of the Society of Cardiovascular and Interventional Radiology.
Wagner says that as more doctors use fluoroscopy, he is learning of more injuries. He now knows of an additional 25 cases of fluoroscopy-related skin injury.
Those are not large numbers, considering that about 700,000 fluoroscopy-guided angioplasties are done every year in this country and that they often save lives.
Government Getting Involved