radiation by girlbanks


									                                           Radiation exposures during medical
                                                             x-ray procedures
Background                                                                                 image quality diagnostic film possible. Good image quality ensures that any
There is some radiation exposure during medical x-ray procedures; however,                 pathology will be distinguishable on the x-ray film. This aids the doctor in
it is prevalently believed that the medical benefits of having an x-ray for a              making the proper medical diagnosis.
patient presenting some medical symptom (broken bones, stomach pain,
etc...) far outweighs the risk of the potential harm that may be caused by an              Status and Trends
x-ray.                                                                                     With advancing medical technology, there has been an increase in the amount
                                                                                           of radiation to which the public is exposed. The chart below shows the
X-rays are known as ionizing radiation; this means that the radiation is of                estimated change in radiation exposure in the US. In 1980, the total exposure
high enough energy to break chemical bonds. This ability to break chemi-                   was 360 millirems (mrem), of which medical exposure accounted for about 55
cal bonds is the component of x-rays that has the potential to be harmful to               mrem. In 2006, it is estimated that the total exposure increased to about 600
living organisms; when these bonds are broken, there is the potential to                   mrem, with medical exposure comprising approximately 310 mrem, most of
cause damage to cell nuclei. However, this same component makes x-rays                     which can be attributed to the increased use of computed tomography (CT) and
effective as a cancer treatment in the form of radiation therapy. In addition              nuclear medicine procedures.
to this beneficial effect, x-rays also give physicians the ability to image
internal organs and bone structure to evaluate bone
and organ health without performing invasive surgery.
Fortunately, the frequency of this occurrence is
believed to be low and harmful effects are directly
proportional to the amount or dose the patient
receives, and in recent years, technological improve-
ments have resulted in significant reductions in these

Within the Department, the Bureau of Radiological
Health (BRH) is tasked with protecting the public and
radiation workers from unnecessary exposure to
ionizing radiation from machine sources and reducing
medical misdiagnosis caused by faulty x-ray equip-
ment and operator error. BRH regulations are de-
signed to ensure that the x-ray equipment is working
as the manufacturer designed it to work and require
that people who take medical x-rays are properly
educated, trained and licensed. In addition, quality
assurance regulations ensure that the users of
medical x-rays evaluate their x-ray system (including
the film developing system) to ensure that they are
using the least dose possible to obtain the best
                                                                                                Radiation exposures during medical x-ray procedures
                                                                                                                 Page 1- Updated 9/2008
                                                                Environmental Trends Report, NJDEP, Division of Science, Research & Technology, http://www.state.nj.us/dep/dsr/trends2005/
Because of this growing trend, in January 2001, New Jersey enacted                                                                        The second chart shows that radiation exposure for lumbar spine x-rays
mandatory quality assurance (QA) programs applying to medical x-ray                                                                       (Entrance Skin Exposure-ESE) has decreased from 2000 baseline values since
procedures and equipment. Since then, facilities performing medical                                                                       the implementation of the QA program in 2001, while the average image quality
diagnostic x-rays in New Jersey have reduced patients’ radiation exposure 33                                                              score (IQ) has improved each year from 2001-2005 with a slight decrease in
to 63 percent. In addition, medical x-ray image quality improved 21 percent                                                               image quality in 2006. This data includes all hospitals, medical facilities and
during the same time period. These improvements benefit New Jersey patients                                                               chiropractors performing x-ray studies of the lumbosacrial spine. The dotted
by reducing their risks from exposure to ionizing radiation and by providing                                                              black line represents the national average radiation exposure level for
physicians with better diagnostic images for identifying and treating disease.                                                            lumbosacrial spine, which is equal to 388 mrem. New Jersey has decreased its
(See Image Quality Distribution by Year and Lumbar Spine ESE and Image                                                                    average radiation exposure for this frequently performed procedure below the
Quality below). The first chart shows the steady improvement in diagnostic                                                                national average.
image quality scores over a five-year period. The percentage of facilities having
good or excellent image quality scores increased from 53 percent of all
                                                                                                                                                                                      Lumbar Spine
facilities in 2001 to 88 percent of all facilities in 2006. Poor image scores
                                                                                                                                                                                   ESE and Image Quality
decreased from 11 percent of all facilities in 2001 to 1 percent of facilities in
2006.                                                                                                                                                      600                                                           70

                                                                                                                                                           500                                                           60

                                         Imag e Quality Distribution by Year                                                                               400

                                                                                                                                                ESE (mR)

                                                                                                                                                                                                                              IQ Score
                   45%                                                                                                                                                                                                   40
                                             M ea n IQ
                   40%                                                                                                                                                                                                   30
                                            Yr 1   5 1.3
                   35%                                                                                                                                     200
                                            Yr 2   6 0.6                                                                                                                                                                 20
                   30%                      Yr 3   6 2.0
 % of Facilities

                                            Yr 4   6 3.2                                                                                                                                                                 10
                                            Yr 5   6 1.9
                   20%                                                                                                                                       0                                                           0
                                                                                                                                                                 Baseline   yr 1       yr 2       yr 3     yr 4   yr 5
                                                                                                                                                                                        Avg ESE   Ave IQ


                         0-9   10-19    20-29      30-39   40-49    50-59    60-69        70-79     80-89    90-100
                                                       Im age Qu ality S core
                                                Yr 1     Yr 2    Yr 3       Yr 4         Yr 5
                                                                                                                                                More Information
                                                                                                                                                Material in this section was made available by the Division of Radiation
                                                                                                                                                Protection and Release Prevention. For more information, visit

                                                                       Radiation exposures during medical x-ray procedures
                                                                                        Page 2- Updated 9/2008
                                       Environmental Trends Report, NJDEP, Division of Science, Research & Technology, http://www.state.nj.us/dep/dsr/trends2005/

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