MEDICAL ADVANCEMENT

Do no harm: Revisiting medical radiation

There are concerns over the increase of unnecessary medical examinations and also the cumulative dose to individuals

In Summary

•It is worth to note that the danger from radiation is a quantitative issue, and thus it must be considered quantitatively.

•The historical background to the discovery of x-rays, its applications, and previously documented safety issues bears a strong significance on how we should address the role of x-rays and its value in our current society. 

A patient undergoes a CT scan at a hospital.
A patient undergoes a CT scan at a hospital.
Image: JANE CHEROTICH

It is no doubt that one of the most startling medical technologies is the invention of x-rays, 124 years ago, today.

The story is quite interesting because, Willem Conrad Roentgen, a professor of physics at Würzburg University in Germany, was working in the laboratory on his usual experiments when he noticed that a photographic paper on one end of the lab benches was changing color.

He then came to the conclusion that there must be certain invincible form of light that is making these photographic papers change. Since he did not know the name of the invincible form of light, he called them x-rays. To date, we still call them x-rays.

All this happened without anyone ever thinking of the possibility of dangers associated with the invincible light, until 1896 and 1898, when Henri Becquerel, Pierre and Marie Curie respectively undertook studies separately that brought a deeper understanding of the different properties and functions of the “invincible lights”.

In a nut shell, it was astounding how one could see inside the human body without having an operation. Other discoveries have since followed; like the CT scanner, MR scanner and Ultrasound which has the ability to demonstrate the structures inside the human body in three dimensions.

As the excitement on the various applications of x-rays were being mooted, studies were also being conducted separately to understand the dangers of these form of invincible but powerful rays.

One case that has been highlighted and changed the occupational safety of industrial workers was the story of “radium girls”. The radium girls worked in a watch factory where they smeared watches to make them luminous in the dark. According to several reports and investigations, it was discovered that the women in each facility had been told the paint was harmless, and subsequently ingested deadly amounts of radium after being instructed to "point" their brushes on their lips in order to give them a fine point; some also painted their fingernails, face and teeth with the glowing substance.

The women were instructed to point their brushes because using rags, or a water rinse, caused them to waste too much time and waste too much of the material made from powdered radium, gum arabic and water. Many of the women later began to suffer from anemia, bone fractures and necrosis of the jaw, a condition now known as radium jaw.

In fact, there is a movie Radium Girls 2018 Directed by Lydia Dean Pilcher, Virginia Mohler that is based on true events of the late 1920s. In the words of Mara Webster “Radium Girls is a celebration of everyday women finding their strength in the unlikeliest of circumstances. This film explores what it takes to piece together the small elements of wrongdoing in order to understand the scope of a larger injustice and, ultimately, fight against the system, when life's odds are stacked against you”.

The historical background to the discovery of x-rays, its applications, and previously documented safety issues bears a strong significance on how we should address the role of x-rays and its value in our current society.

However, these very useful form of invincible light has catastrophic effects if managed or used wrongly. One of the most highlighted danger is the likelihood that it can cause cancer. The application of radiation in medicine has received praise and criticism in equal measure.

The author, Mamati Antony Barasa.
The author, Mamati Antony Barasa.

The praise is based on the extraordinary abilities that it has brought to the medical world, and the criticism is associated with its dangers. Even as we celebrate the 124th year after discovery of x-rays we need to be cognizant of the following: It is important to appreciate that the public views radiation as something quite new, highly mysterious, and extremely dangerous; and to acknowledge, perhaps surprisingly, the fact that radiation is a natural part of our environment and none of us can avoid being exposed to radiation.

We are exposed to it all the time, everywhere we go and as such, exposure to radiation is a daily occurrence. It is worth to note that the danger from radiation is a quantitative issue, and thus it must be considered quantitatively. This means that, radiation doses can be measured and any risk can be statistically calculated and a very extensive basis be made available for estimating the risks of radiation exposure.

It is worthy to appreciate that as much as radiation exposure is a risk, the risk from radiation compared to some of the daily activities that we do turns out riskier. In most situations, people don't bother with these things. Rather, they recognize that life is full of risks.

For instance, every time you take a bite of food, it may have a chemical that will initiate cancer, but still, people go on eating, every ride or walk we take could end in a fatal accident, but that doesn't keep us from riding or walking.

Patient safety from the effects of ionizing radiation during diagnostic or therapeutic procedures is a priority area for healthcare professionals in radiation medicine industry. Globally, there has been a notable increase in the medical exposures from 2.4 billion exposures to 3.6 billion exposures. In addition, there are concerns over the increase of unnecessary medical examinations and also the cumulative dose to individuals from medical exposure.

It is also important to acknowledge that patients are always first, not right, because, sometimes the healthcare professional shall perform uncomfortable procedures to make you safe. For instance, an injection is never a pleasant feeling, in fact very few people enjoy having a needle break through their skin during hospital visits. However, it is a small inconvenience to make you feel better.

In order to secure and continually improve radiation protection standards in the field of medical X-ray, it is advised that each individual examination be properly justified and that any procedure undertaken be optimized.

The ancient, though still operational precautionary philosophy in healthcare service training and delivery circles; “Primum non nocere”, translated to mean “first do no harm”. Healthcare professional working in radiation medicine facilities have no option but to ensure that before any procedure is undertaken, the safety of the patient, the public and the professional are put into consideration before any other variable.

For all the procedures that we request let us weigh the benefits of each must carefully. Secondly for economic reasons. The additional cost incurred by undergoing a procedure that has no additional benefit towards a patients’ management, and third, acknowledging that healthcare service is scarce (that is urgent) and when we consume that which we do not need we deny someone a chance to consume it. Let’s us all celebrate the great inventions by affirming that the safety of patients is our priority

The author is a founder member of  Afrosafe-Rad, and the immediate former president of the Society of Radiography in Kenya. He is also secretary of Africa Radiography Forum.