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Sunday, 01 July 07 - 04:19 PM (GMT)
By Dr. John Raymond Baker , DC in General
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There is a reason many days are lost from back pain every year.
One is that there are many potential sources of back pain. One very common one is the intervertebral disc. It used to be thought that the disc itself had no nerve supply, but since then, we have discovered that there is a sinuvertebral nerve supplying the outsiode of the disk than can cause considerable pain.
A herniated disc or protruding disc, can, depending on its size and position, press on the nerve root, spinal cord, or both. It can decrease the space for the nerve between the bones (the foraminal size, a decrease is stenosis of the foraminal opening or foraminal stenosis). This can serious problems that can even end up being permanent if one does not get prompt attention and/or surgical intervention.
Another source of pain is the zygapophyseal joints. These joints are also called "facet joints". Inflammed and damaged cervical zygapophyseal joints have, in the past few years, been found to be a great source of pain in folks injured in so-called "whiplash injuries" (a longer term is hyperextension / hyperflexion injuries resulting from hyperacceleration/hyperdeceleration forces).
An interesting article about these joints as a nocigenerative or pain causing element, is found at:
BMC Musculoskeletal Disorders 2004, 5:15 doi:10.1186/1471-2474-5-15
Of course , torn muscles can be sources of pain as well, even without these more serious sources.
Swelling in the tissues around the nerves in or near the foraminal openings, can cause a relative increase in partial pressures exrerted on the nerve root, and can cause altered function, the results of which can include pain. This swelling can happen as a result of inflammation, but also, as a result of the paraspinal and deep muscles going into spasm after trauma, and locking the low back down, preventing the normal flexion, extension, and torsion, which helps to move fluids in and out of the area.
These are just a few of the pain causing factors in the low back, and in most of these, the answer is not a narcotic pain reliever, but using ice to reduce pain and spasms, stretching lumbar muscles, using digital pressure over the belly of the muscle to induce stretching, electrical muscle stimulation to fatigue muscles in spasm, intervertebral traction / intersegmental traction to stretch paraspinal muscles and to introduce added segmental motion in the axial plane. And, if it is not contraindicated by other factors, Chiropractic manipulation to increase movement and proper positioning of the osseous elements of the spinal joints.
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Wednesday, 13 June 07 - 01:46 PM (GMT)
By Dr. John Raymond Baker , DC in General
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Parents have sued the federal government over the perceived link between vaccines and the increase of autism in the United States.
WebMD reports the case, but as expected, pooh-poohs the notion that an ingredianet of vaccines, thimerosal is to blame.
http://www.webmd.com/news/20070611/court-weighs-autism-vaccine-link
" Is Thimerosal to Blame?
In years past, experts believed autism affected four to five out of every 10,000 children. But a new CDC report released earlier this year showed about one in 150 8-year-old children had autism. Since that study involved just 14 states, it’s unclear if those numbers reflect national statistics.
If there is indeed a rise, what could be fueling this increase? The question is whether this possible rise is due to doctors doing a better job at identifying kids with autism or to some other reason.
What could that reason be? One theory is children’s vaccines. The MMR vaccine – measles, mumps, and rubella -- has gotten the most attention, mainly linked to the mercury-based preservative thimerosal.
Experts Say 'No'
Several medical studies have shown no link between autism and the MMR vaccine. And several premier medical organizations have concluded that there is no link between autism and thimerosal.
The CDC says there is no evidence to suggest a link. The Institute of Medicine, a nonprofit, nongovernment organization, takes it one step further and says the MMR vaccine absolutely does not cause autism.
Since 1999, when the American Academy of Pediatrics recommended that thimerosal be taken out of vaccines as a precautionary measure, kids’ exposure to the preservative has dropped significantly.
Thimerosal has been removed from or reduced to trace amounts in all vaccines routinely recommended for children 6 years of age and younger. The exception is the flu vaccine. A preservative-free version of the flu vaccine (contains trace amounts of thimerosal) is available in limited supply for infants, children, and pregnant women.
Some vaccines, such as the tetanus-diphtheria booster for older children and adults, are also available in formulations that are free of thimerosal or contain only trace amounts.
If Not Thimerosal, Then What Causes Autism?
The exact cause of autism is not known, but research has pointed to several possible factors, including genetics, certain types of infections, and problems occurring at birth.
Recent studies strongly suggest that some people have a genetic predisposition to autism, meaning that a susceptibility to develop the condition may be passed on from parents to children.
Researchers are looking for clues about which genes contribute to this increased vulnerability. In some children, environmental factors may also play a role. Studies of people with autism have found abnormalities in several regions of the brain, which suggest that autism results from a disruption of early brain development while still in utero."
-------snip----------
To say that genetics if the reason, as a wastebasket explanation, really doesn't cut the mustard, because, unless autistic prone males are seeking out autistic prone females and mating (assuming that the tendency to become autistic is a recessive trait) and producing very autistic prone children, their theory is useless. And, if the above were the case, why would there suddenly be such an increase of such matings and such reproductions? It makes not sense.
More news on the topic :
http://www.cbc.ca/canada/toronto/story/2007/02/02/ontario-lawsuit.html
" Parents sue Ontario for autism treatment
Last Updated: Friday, February 2, 2007 | 1:28 PM ET
Parents of autistic children are appearing in a Toronto court Friday to try force the Ontario government to pay for their children's treatment.
The parents are currently being forced to pay for the therapy out of their own pockets, often at a cost of thousands of dollars.
Five families are part of the group that launched a $1.25-billion lawsuit. They claim that seven school boards and the government have discriminated against their children and denied them a public education by failing to provide access to specialized treatment in school.
David Baker, a lawyer representing the families, argued in court Thursday that families are being forced to choose between sending their autistic children to school or paying for costly intensive behavioural intervention therapy.
Private therapy costs between $30,000 and $80,000 a year for one child.
'Just another Band-Aid solution': parent
The lawsuit marks the latest battle between parents of autistic children and the province.
Last July, the Ontario Court of Appeal ruled the province does not have to pay for costly specialized autism treatment for children ages six and older.
Since the ruling, the government has said it will provide funding to treat autistic children over six years of age if an assessment shows they are in need.
Two weeks ago, Ontario promised to boost spending on a program to provide therapy by $13 million, increasing total spending on autism to $115 million a year."
"A Costly Education
Mary Ellen Egan 04.09.07
The recent spike in autism diagnoses has school districts spending ever more time and money fending off special ed disputes.
Steven Wyner spends the bulk of his days sitting behind his 14-foot-long custom-made desk fielding calls from anxious parents. Twelve years earlier he left his lucrative career as a tax attorney to practice special education law. He had grown attracted to the specialty after fighting for his learning-disabled child. He worked out of his home for a couple of years, but as he won case after case against southern California school districts, he could afford to move out of his home office and partner with another lawyer.
Two years ago Wyner hit the jackpot. He'd represented a grade-school autistic student who sued the Manhattan Beach Unified School District and the California Department of Education for failing to provide him with an appropriate education, including extra reading instruction. In August 2005, after six years of legal wrangling, the parties agreed to a $6.7 million settlement, including $2.4 million for a family trust. Wyner's firm took home $1.6 million. He now has a partner, two lawyers and three paralegals and says he has more business than he can handle.
The number of kids diagnosed as autistic has risen from 1 in 2,500 in the 1980s to 1 in 150 now. Why? Various environmental influences have been offered up as possible causes, but the evidence for these theories is thin. Dr. Edward Ritvo, professor emeritus at UCLA's medical school and one of the psychiatrists who wrote the original definition of autism for the Diagnostic and Statistical Manual of Mental Disorders, explains the phenomenon in a very different way. "Two things have happened," he says. "We've broadened the definition of autism, and we have a whole cadre of people looking for these kids." The broader definition includes kids with Asperger's syndrome, which means they are socially maladroit. The narrower definition has the ones unable to function in jobs or school at all.
Whatever the cause, the explosion in autism diagnoses has been a boon to lawyers who represent parents dissatisfied with the level of education their autistic kids are getting. Usually well-off, these parents don't hesitate to hire a lawyer to seek extra services or private school tuition. New York City's education department hired ten additional lawyers to focus on disputes over special ed, including the education of autistic students. In Los Angeles, which has seen a sixfold increase in autistic children in the last three years, the bill to reimburse parents' attorneys came to $3.3 million last year.
Little wonder that lawyers are moving into the field. "It's one of the fastest-growing segments of the law," says Diane Pappas, associate general counsel for the Los Angeles school district. "In the late 1990s we had only about 10 or 12 firms that dealt with special education, and now it's over 70."
The suits arise out of a 1975 federal law declaring that every child is entitled to a "free, appropriate education," regardless of ability. That means that kids with learning problems such as dyslexia, speech difficulties or autism are entitled to have their public school systems pay for special services.
So, what's "appropriate"? With help from a lawyer, a school district might be persuaded to pay for one-on-one behavioral therapy, afterschool programs, an individual classroom aide or even horseback riding. And if the public schools aren't doing enough, the parents might send a child to a private school and send the bill to the school district. In New York, sending a child to a private school for autistic children can cost up to $100,000 per year.
In 2004 the autistic daughter of Marvin and Suzette Josif, then 4 years old, was accepted at the New York Child Learning Institute, a private school in Queens, N.Y. "They only take 25 students, and they can stay in the school until they are 21 years old, so it was like winning the lottery," says Suzette Josif.
It was rather like that. After initially insisting that the Josifs' daughter would get an appropriate education in a city special-ed class, the New York City Department of Education and the state were persuaded to cough up the $50,000 in annual tuition for the private school. The private, but not the public, school provides an intense form of therapy known as applied behavior analysis. "It cost us a fortune and a tremendous amount of time to fight this," says Suzette Josif. "But I knew that with the right program and the right teachers, she will succeed."
Steven Wyner's client, Deborah Porter, asked the Manhattan Beach district (south of Santa Monica) to give her fourth-grade son extra reading instruction and work on his socializing skills. (He would later be diagnosed with autism.) She won an administrative ruling requiring the district to provide them. But a year later, after the district failed to act, she sued Manhattan Beach in federal court. Five years later Porter, the district and the California Department of Education settled the case for $6.7 million. "No amount of money can compensate for the school district's deliberate failure to provide an appropriate education at a crucial point in our son's life," she says.
Parents can make their own cases for special treatment but usually hire lawyers if they are going after a big-ticket item like private school tuition. A typical fee is $3,000 for a case settled prior to a hearing and between $5,000 and $15,000 if it goes to a hearing. In New York City the number of hearing requests for all special-education disputes (autism cases are not separately tabulated) has jumped by a third since 2000, to 4,794 in 2006. Under the federal law parents can recover attorney fees from their school district if they win hearings, but not if they settle.
"When you have more kids diagnosed with certain disabilities, you see more suits," says Neal McCluskey, an education analyst with the Cato (nyse: CTR - news - people ) Institute, a think tank. McCluskey likens the recent rise in autism cases to the spike in attention deficit disorder ten years ago. "Better-off parents are savvy enough to learn how to work the system. They find the doctors to make these diagnoses, and they can afford to hire attorneys to challenge the districts," he says.
The Josifs hired Neal Rosenberg, a Manhattan lawyer. Another of his clients is Thomas Freston, founder of MTV, who received $60 million in severance when he left the network last year. Freston is contesting a federal law that says that a child has to attend a public school first before a parent can sue for private school tuition reimbursement. New York City paid for part of two years at a private school for Freston's son, who is learning disabled. Freston is seeking full payment for three years of partial tuition, at $25,000 each. Freston won a federal appeals court decision, and now the city is appealing to the Supreme Court. "This isn't a financial issue, it's a moral one," says Rosenberg."
Autism Families Keep Close Watch As First Test Case Goes To Vaccine Court
WASHINGTON, June 4 /PRNewswire-USNewswire/ -- The first test case of approximately 4800 claims that vaccines caused autism goes to federal court June 11th. Cedillo v. HHS will be heard by three special masters, part of the U.S. Court of Federal Claims, established under the National Vaccine Injury Compensation Program (NVICP).
Parents filed the claims after their children regressed into a diagnosis of autism following multiple rounds of vaccines, many of which were preserved with amounts of mercury that exceeded EPA guidelines.
Thimerosal's inclusion as a vaccine component increased in the early 90's, its rise mirroring the alarming rise in autism. Parents note their children's symptoms of autism mimic mercury poisoning and many autistic children are now being successfully treated for mercury poisoning and damaged immune systems.
Earlier today, Ann Brasher, Board Member of the National Autism Association (NAA) stated, "I believe that NVICP will not provide the specialized medical care necessary for autistic children despite a favorable ruling for the plaintiffs. But the overwhelming evidence needs to be explored. The public deserves to know all the facts and the truth behind them." Parents cite fatal flaws in the NVICP including:
- Families are forced to sue the government, which has no incentive to settle and can drag out cases for years while children go untreated. - Unlike civil court, there is no right to discovery in vaccine court and no jury trial. - The master denied access to vaccine company documents and CDC/HMO vaccine database records that would be routinely available in civil court. - Tax payers end up paying for pharmaceutical mistakes. No other industry is allowed unparalleled protection in a "Free Market" economy. - The massively profitable vaccine industry is not held liable, therefore has no incentive to create safe vaccines.
Several families who have waited years for justice and are willing to share stories of their children's regression will be available for interviews during the hearings. For contact information, please write to naa@nationalautism.org. "
and last source:
http://www.boston.com/news/globe/ideas/articles/2007/06/03/at_risk_vaccines/
"No single medical advance has had a greater impact on human health than vaccines. Before vaccines, Americans could expect that every year measles would infect four million children and kill 3,000; diphtheria would kill 15,000 people, mostly teenagers; rubella (German measles) would cause 20,000 babies to be born blind, deaf, or mentally retarded; pertussis would kill 8,000 children, most of whom were less than one year old; and polio would paralyze 15,000 children and kill 1,000.
Because of vaccines all of these diseases have been completely or virtually eliminated from the United States. Smallpox -- a disease estimated to have killed 500 million people -- was eradicated from the face of the earth by vaccines. And we're not finished; vaccines stand as our only chance to prevent pandemic influenza, AIDS, and bioterror, and our best chance to prevent certain cancers.
Now, massive litigation could force companies to leave the vaccine business, threatening the future of one of medicine's greatest achievements. On June 11, in an unprecedented action before a federal claims court, lawyers for 4,800 autistic children will argue that vaccines caused autism. If successful, these claims could exhaust the pool of money currently set aside to compensate children who have been hurt by vaccines. Further, lawyers will likely take their claims that vaccines cause autism to civil court, where awards could be enormous.
"I don't want to see the drug companies go out of business," said David Kirby, author of the book "Evidence of Harm," speaking on Imus in the Morning in April 2005. But "we are looking at trillions and trillions of dollars of care for these people."
Predictions of massive awards, and dire warnings about the fate of vaccines, may seem over-dramatic. But vaccines were the first medical product that came close to being eliminated by lawsuits.
In 1974 a British researcher named John Wilson published a paper claiming that the whooping cough (pertussis) vaccine caused permanent brain damage. Wilson reported the stories of 22 children who suffered from epilepsy or mental retardation following vaccination. The British media hailed Wilson's report as fact and the percentage of children immunized dropped from 80 to 30. During the next few years, 300,000 children in England were hospitalized and 70 killed by pertussis.
By the late 1970s fears of pertussis vaccine had spread to the United States. Before jurors persuaded more by emotional appeals than by science, lawyers successfully claimed that the pertussis vaccine caused sudden infant death syndrome (later found to be associated with sleep position), Reye's syndrome (later found to be associated with aspirin), unexplained coma, paralysis, mental retardation, and epilepsy.
Seven companies stopped making the vaccine; within a few years only one, Lederle Laboratories, remained. Lederle was punished for its persistence. In 1986 a jury awarded $1.13 million to parents claiming that Lederle's pertussis vaccine had paralyzed their son -- an award that was more than half of the annual sales of the vaccine. Subsequent studies of hundreds of thousands of children showed that the risk of permanent brain damage was the same in children who had not received the vaccine as in those who had
Facing further litigation, vaccine makers were poised to leave the business. To save vaccines, the federal government stepped in, creating in 1986 the National Childhood Vaccine Injury Act. Designed to put an end to unfounded lawsuits, the act included the Vaccine Injury Compensation Program. Now, if parents want to sue for damages caused by vaccines, they first have to go through a federal claims court.
This "vaccine court" established a list of compensable injuries and lessened frivolous litigation. Children actually hurt by vaccines -- such as those paralyzed by the oral polio vaccine or those with severe allergic reactions to egg proteins in the influenza vaccine -- were compensated quickly, generously, and fairly. On the other hand, people whose claims had been disproved by epidemiological evidence -- such as those claiming that the hepatitis B vaccine caused multiple sclerosis -- weren't compensated. The bleeding stopped.
Unfortunately, the legacy of the pertussis litigation remains. Many pharmaceutical companies that abandoned vaccines never came back. At the beginning of the 1980s, 18 companies made vaccines; by the end of the decade, only four were left.
The infrastructure to make vaccines became tenuous, and vaccine shortages became commonplace. For example, in 1998, the tetanus vaccine was in such short supply that its use was restricted to emergency rooms. Beginning in 2000, a pneumococcal vaccine for children -- designed to prevent bloodstream infections, meningitis, and a common cause of pneumonia -- was available only intermittently; parents could only hope that their children weren't among the thousands permanently harmed or killed every year by pneumococcus.
Between 2003 and 2004 an influenza epidemic created a demand that dramatically exceeded supply; more than 150 children died that year from influenza. Since 1996 severe shortages have occurred for 10 of the 16 vaccines routinely given to children and adolescents. All of these shortages resulted in a delay in getting vaccines, and some children never got the vaccines they had missed.
Now, vaccine makers are again threatened. Lawyers will argue that either the measles-mumps-rubella (MMR) vaccine or a mercury-containing preservative (thimerosal) in vaccines or the combination of the two can cause autism. This theory has been advanced on television shows such as 60 Minutes, in popular magazines like Time and Newsweek, and on national radio programs such as Imus in the Morning. Most prominently, the mercury-causes-autism theory has been advanced by a parents advocacy group called Safe Minds -- a group now at the center of the litigation.
Certainly there is plenty of evidence to refute the notion that vaccines cause autism. Fourteen epidemiological studies have shown that the risk of autism is the same whether children received the MMR vaccine or not, and five have shown that thimerosal-containing vaccines also do not cause autism. Further, although large quantities of mercury are clearly toxic to the brain, autism isn't a consequence of mercury poisoning; large, single-source mercury exposures in Minamata Bay and Iraq have caused seizures, mental retardation, and speech delay, but not autism.
Finally, vaccine makers removed thimerosal from vaccines routinely given to young infants about six years ago; if thimerosal were a cause, the incidence of autism should have declined. Instead, the numbers have continued to increase. All of this evidence should have caused a quick dismissal of these cases. But it didn't, and now the courthas turned into a circus. The federal and civil litigation will likely take years to sort out.
-----------snip--------------------
(Note, the above article is by)" Paul A. Offit, MD, is the chief of infectious diseases at the Children's Hospital of Philadelphia, the co-inventor of the rotavirus vaccine currently licensed in the United States, and the author of "Vaccinated: One Man's Quest to Defeat the World's Deadliest Diseases"
We cannot miss an important aspect of this whole mess. The allopathic medical establishment is not just a neutral party in this debate. When asked what good the allopathic approach has done, one of the first things they usually throw out is how the polio vaccine has ridded us of the scourge of polio, or how the smallpox vaccine has protected millions of children from smallpox. The use of injectable and oral medications and interventionistic chemical preparations is the bread and butter of the modern MD, and the AMA will fight tooth and nail to paint the proposition that vaccines, or any component of the vaccines administered to innocent children, most often as a result of governmental imposition of laws which mandate children be forced to take the vaccines, is unfounded or silly. Another obvious entity with a "dog in this fight", because of the lawsuit, is the federal government.
Any time you get the vast resources of the medical government linked with the significant political and financial resources of the American Medical Association, COMBINED with the pharmaceutical lobbyists and lawyers, you have a formidable opponent.
But, remember, David did slay Goliath. All you need is the right stone, or, in the case of the lawsuit, the right set of facts.
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Tuesday, 12 June 07 - 12:32 PM (GMT)
By Dr. John Raymond Baker , DC in General
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BAKER CHIROPRACTIC,PA and Dr. John Raymond Baker,DC are now on the list of providers for Texas True Choice, the insurance for city workers of the City of Longview Texas. This includes police, firemen, city utility workers, and everypone covered by the health insurance offered by the city of Longview Texas, Gregg County.
If you need Chiropractic care, conveniently located within the city of Longview, please call for an appointment today at 903-753-5400.
Have a great day!
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Tuesday, 05 June 07 - 07:42 PM (GMT)
By Dr. John Raymond Baker , DC in General
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ARE DIAGNOSTIC X-RAYS SAFE ?
There are some fearmongers out there who are trying
to say that you should not use diagnostic x-rays unless in
extremely limited, "dire emergency" conditions.
"FEARMONGER (DEFINITION) -one inclined to raise or excite alarms
especially needlessly". Synonym- "scaremonger" From Merriam Webster Dictionary
http://www.m-w.com/dictionary/scaremonger
Look, I take x-rays, maintain a safe x-ray unit, and
probably, over the past 18 years, have gotten exposed more
than most people, because I am not afraid to take x-rays of
myself when I feel they are warranted.
These fearmongers and organizations that hire these
fearmongers, are doing a disservice to patients.
Firstly, please read a paper I did, which quotes reputable
sources such as the National Cancer Institute, and other
very scientific sources. That paper is at:
http://www.bakerchiropractic.net/radiationexposure.pdf .
That paper ALONE will reassure you that the fearmongers
are just frothing at the mouth over nothing. For God's sake,
you expose yourself to "ionizing radiation" (as the fearmongers
love to put it) every time you go out into the sunshine.
But, don't just take my paper alone as your only reassuring
source. Look at the following link :
http://medinfo.ufl.edu/medinfos/vrm/rads.html
"
Answering your patient's question about the amount of radiation would be easy if you knew the effective dose. However, it is unlikely the patient would be satisfied if your answer was "the mammogram will give you an effective dose of about 1 millisievert (mSv)." She probably would understand if you converted the effective dose into the amount of time it would take her to accumulate the same effective dose from background radiation. Since the average background rate in the U.S. is about 3 mSv per year, the answer in this case would be about four months. It is likely that she would understand and be satisfied with your answer.
This method of explaining radiation is called Background Equivalent Radiation Time or BERT.2,3 The idea is to convert the effective dose from the exposure to the time in days, weeks, months or years to obtain the same effective dose from background. This method has also been recommended by the U.S. National Council for Radiation Protection and Measurement (NCRP).4 To calculate BERT, I recommend using the average background in the U.S. including contributions to the lung from radon progeny. This is assumed to be 3 mSv/y (300 mrem/y). The background in different parts of the U.S. varies about +/- 50% from this value. This uncertainty is unimportant for explaining radiation to patients. The effective dose from common diagnostic x-ray procedures are typically less than the amount of radiation you receive >from nature in two years. (See Table 1.) Giving the answer in terms of background radiation has three advantages:
- It does not imply any risk - it is just a comparison
- It emphasizes that radiation is natural
- The answer is understandable to the patient
It is natural that some patients will confuse x-rays with radiation from radioactivity. They may mistakenly think that man-made radiation is more dangerous than an equal amount of natural radiation. Most patients are unaware that most of their background radiation comes from radioactivity in their own body. Radiologists should explain to them that we are all radioactive. A typical adult has over 9,000 radioactive disintegrations in their body each second - over a half million per minute. The resulting radiation strikes billions of our cells each hour. The idea that radiation to one cell can initiate cancer is illogical - it assumes that the body has no defense or repair mechanisms. The body has several defense mechanisms to protect itself from doses up to about 200 mGy.1
Typical Effective Doses And Bert Values For Some Common X-Ray Studies To An Adult (Adapted From Ipsm Report 53) 5
| X-ray Study |
Effective Dose (mSv) |
BERT (time to get same dose from nature) |
| Dental, intra-oral |
0.06 |
1 week |
| Chest x-ray |
0.08 |
10 days |
| Thoracic spine |
1.5 |
6 months |
| Lumbar spine |
3 |
1 year |
| Upper GI series |
4.5 |
1.5 years |
| Lower GI series |
6 |
2 years |
Most patients never get to see the radiologist. Questions about radiation are often asked of the radiographer. Radiographers are generally not prepared to answer a patient's question about radiation dose. However, if tables of effective dose and BERT are available at each x-ray unit, any radiographer can answer the patient's question about radiation dose. If the patient desires further information the radiographer should recommend a basic book, such as Understanding Radiation.6
There are two scientific quantities for radiation protection: equivalent dose and effective dose. Neither of these quantities can be directly measured.Effective dose, E was defined by the International Commission for Radiological Protection (ICRP)7 and adopted by the U.S. National Council for Radiation Protection and Measurement (NCRP).8 The concept of effective dose is appealing but unattainable - E was intended to equate the relative risk of inducing a fatal cancer from a partial body dose (such as radon progeny in the lungs) to the whole body dose that would have the same the risk of inducing a fatal cancer.
The effective dose cannot be measured and it is difficult to calculate.9 Physicists use computer simulation programs to estimate the organ doses in a standard patient from typical exposure conditions for various projections. The results of these simulations can be used to estimate E for various patient exposures. Once a table of effective doses is constructed for a particular x-ray unit, it is a simple matter to calculate the BERT - the time to get the same effective dose from background. Typical effective doses and BERT values for some common x-ray projections are given in Table I.
Effective dose should not be confused with the entrance skin dose (ESD), which was commonly used for describing patient radiation up until about 20 years ago. The ESD is easy to measure, but it is not a good measure for the amount of radiation to the patient. For example, the ESD for a dental intra-oral x-ray (e.g., a bitewing) is about fifty times greater than the ESD for a chest radiograph, yet the effective dose from the dental exposure is usually lower than from a chest radiograph.
During fluoroscopy the beam size, the organs exposed and the dose rate change. This makes it impractical to determine the effective dose. However, the fluoroscopic dose is very easy to measure with a transmission ion chamber covering the exit of the collimator. All of the radiation striking the patient must pass through the ion chamber. The ion current collected is a measure of the exposure-area product (EAP). The reading can easily be converted to the dose-area product (DAP). A meter for this purpose has been available for more than 30 years. Fluoroscopic procedures typically give larger doses to the patient than a roentgenogram. The reading from a DAP-meter is approximately proportional to the energy deposited in the patient-the imparted energy. If the kVp and HVL are known the DAP meter reading in Gy m2 can be converted to the imparted energy in joules (J) deposited in the patient.5 DAP meters, or their predecessor, exposure-area product meters, are little known or used in the U.S. In the UK and Germany they are required on all medical fluoroscopes. I think the NCRP should recommend that all medical fluoroscopes should include such an instrument and that fluoroscopes used for interventional radiology must have such a meter.
To reassure the patient about the lack of risk from low doses of radiation it is useful to explain that no studies of radiation to humans have demonstrated an increase in cancer at the doses used in diagnostic radiology. A number of studies described below indicate that low to moderate doses may improve the health and even reduce cancer.
A-bomb survivors who had large doses - greater than the equivalent of 150 years of background - had a slight increase in cancer. In the last 50 years there was an average of fewer than 10 radiation induced cancer deaths per year in about 100,000 A-bomb survivors. A-bomb survivors who received a dose less than the equivalent of 60 years of background showed no increase in the incidence of cancer. Survivors in that dose range tended to be healthier than the unexposed Japanese. That is, their death from all causes was lower than for the unexposed Japanese. The improved health of those with low doses more than compensated for the radiation induced cancer deaths so that A-bomb survivors as a group are living longer on the average than the unexposed Japanese controls.
Evidence for health benefits from low dose rate radiation comes from the nuclear shipyard workers study (NSWS) a decade ago.10 This DOE sponsored study found that 29,000 nuclear shipyard workers with the highest cumulative doses had slightly less cancer than 33,000 job matched and age matched controls. The decreased cancer among nuclear workers was not statistically significant. However, the low death rate from all causes for the nuclear workers was statistically very significant. Nuclear workers had a death rate 24% (16 standard deviations) lower than the unexposed control group. If the nuclear workers had a death rate 24% higher than the controls, it would have made the world news in 1988.
Humans receive ionizing radiation from several natural sources - radioactivity inside their body, radioactivity outside their body and cosmic rays. The amount of radiation from these various sources varies with the geographical location and the material used in the buildings where you work and live. In addition, the contribution from radon varies depending on the construction of your home and the amount of uranium in the soil beneath it.
If ionizing radiation is a significant cause of cancer we would expect the millions of people who live in areas with high natural levels of radiation to have more cancer. However, that is not the case. The seven western U.S. states with the highest background radiation - about twice the average for the country (excluding radon contributions) - have 15% lower cancer death rate than the average for the country.11
Uranium miners had a higher incidence of lung cancer from the high concentrations of radon in underground mines. This was the basis for the Environmental Protection Agency (EPA) to estimate that high levels of radon in homes cause thousands of lung cancer deaths each year in the U.S. However, a study of lung cancer death rates in 1600 U.S. counties representing over 90% of the U.S. population shows that counties with the highest radon levels (> 5 pCi/l) have 40% lower lung cancer death rates than the counties with lowest radon levels (< 0.05 pCi/l).12 It appears that radiation from radon progeny actually prevents some cancers caused by smoking!
Radiologists contribute most of the man-made radiation to the public. The benefits of this radiation are tremendous. There are no data to suggest a risk from such low doses. Radiologists have a responsibility to help educate their patients and others who ask them about radiation. You have a choice. You can increase the patient's fear of radiation by explaining the "official" policy of the NCRP and the American College of Radiology that even the smallest amount of radiation may cause cancer. Based on this assumption, a recent ACR publication13 shows that the risk of inducing a fatal cancer from a chest x-ray is ten times greater than the risk of dying in a commercial airline flight. The same table shows that a CT scan of the kidneys has a greater risk of inducing a fatal cancer than a cigarette smoker has of dying from lung cancer.
I strongly recommend that each clinical x-ray unit have a table of the effective dose for various projections and patient size. A separate column should give the BERT - the time to obtain the same effective dose from background. The radiographers should be taught how to answer the patient's questions using the BERT method. The BERT concept does not suggest any risk and is understandable to the patient.
- Feinendegen LE, Bond VP, Sonhaus CA: Low level radiation may protect against cancer. Physics and Society News (In press) 1998
- Cameron JR: A radiation unit for the public. Physics and Society News 20:2, 1991.
- Cameron JR: How to explain x-ray exposure to your patient (30 min. video). Medical Physics Publishing, Madison, WI, 1993.
- NCRP Report 117: Research needs for radiation protection, p. 51. National Council on Radiation Protection and Measurement, Bethesda, MD, 1993.
- IPSM Report No. 53: Patient dosimetry techniques in diagnostic radiology, p. 53 and Table A7, p. 117. Institute of Physics and Engineering in Medicine, York, UK, 1988.
- Wahlstrom B: Understanding radiation. Medical Physics Publishing, Madison, WI. 1996.
- ICRP Publication 60 Recommendations of the International Commission of Radiological Protection, 1991.
- NCRP Report 116: Limitation of exposure to ionizing radiation. National Council on Radiation Protection and Measurement, Bethesda, MD, 1993.
- NCRP Report 100: Exposure of the U.S. population from diagnostic radiation, pp. 73-74. National Council on Radiation Protection and Measurement, Bethesda, MD, 1989.
- Matanoski GM: Health effects of low-level radiation in shipyard workers final report. Baltimore, MD, DOE DE-AC02-79 EV10095, 1991.
- Fremlin JH: Power production: What are the risks? 2nd ed. Bristol, UK: Adam Hilger, pg. 58, 1989.
- Cohen BL: Test of the linear no-threshold theory of radiation carcinogenesis in the low dose, low dose rate region. Health Physics 68:157-217, 1995.
- ACR Radiation Risk: A Primer. American College of Radiology, Reston, VA, p. 6, 1996. "
Not convinced? Check out emedicinehealth.com
http://www.emedicinehealth.com/understanding_x-rays/article_em.htm
" Are X-rays Safe?
Diagnostic x-rays are safe. But who hasn’t wondered about them when undergoing a chest x-ray, mammogram, routine dental x-rays, or an x-ray for a broken bone?
No scientific data indicate any danger. In fact, there is evidence that low doses may actually reduce the chance of cancer. The question about the amount of radiation you receive is difficult for x-ray technicians and doctors to answer because very few x-ray units have an instrument to measure the radiation to the patient.
You may have heard that even the smallest amount of radiation may cause cancer. Based on this unscientific assumption, the risk of causing a fatal cancer from a chest x-ray is 10 times greater than the risk of dying in a commercial airline flight. Or a CT scan of the kidneys has a greater risk of inducing a fatal cancer than a cigarette smoker has of dying from any cancer. These statements produce unnecessary worry. There is no data to show any risk from diagnostic x-rays.
- A radiologist is the doctor trained to read your x-ray. A medical physicist is the best-trained person to explain your dose risk. But most people having x-rays never get to see the medical physicist or the radiologist. Questions about radiation are often asked of the radiographer. This is the trained technician who positions you for an x-ray and makes the exposure. This person is usually not able to respond to your questions about radiation.
- If you ask, and are told a dose, you may not understand what a dose of 1 millisievert (mSv) might mean. But if this effective dose is converted into the amount of time it would take you to accumulate the same effective dose from background radiation, you could make a comparison. For example, the average background rate of radiation you get just living in the United States is about 3 mSv per year. So a mammogram of 1 mSv would translate into the amount of radiation you would get by just living in the US about 4 months.
- This method of explaining radiation is called Background Equivalent Radiation Time or BERT. The idea is to convert the effective dose from the exposure to the time in days, weeks, months, or years to obtain the same effective dose from background. This method has also been recommended by the US National Council for Radiation Protection and Measurement (NCRP).
- To calculate BERT, one good way is to use the average background in the US including contributions to the lung from radon progeny. This is assumed to be 3 mSv/y (300 mrem/y). The background in different parts of the US varies about half of this value, either more or less. This uncertainty is unimportant for understanding radiation exposure. The effective dose from common diagnostic x-ray procedures is typically less than the amount of radiation you receive from nature in 2 years. "
Now, let me repeat a sentence in the quote from above...."No scientific data indicate any danger. "
What part of that sentence is unclear to the fearmongers and obfuscaters out there that are trying to tell doctors they should not be using diagnostic x-rays? To me, it is VERY clear.
Have you, as the reader, gotten the idea that there is a developing consensus on the safety (or, for the scaredy cats..."relative safety") of diagnostic x-rays?
From a British site, that has a PDF on X-ray safety, (located at the link below)
http://www.hpa.org.uk/radiation/publications/misc_publications/x-ray_safety_leaflet.pdf
" The radiation risks for simple X-ray examinations of the teeth, chest or limbs, can be seen to fall into this negligible risk category (less than 1 in 1,000,000 risk). More complicated examinations carry a minimal to low risk. Higher dose examinations such as barium enemas, CT body scans or isotope bone scans fall into the low risk category (1 in 10,000 to in 1,000 risk). As we all have a 1 in 3 chance of getting cancer even if we never have an X-ray, these higher dose examinations still represent very small addition to this underlying cancer risk from all causes.
As long as it is clearly necessary to help make the patient, the benefits from any X-ray examination outweigh these small radiation risks. It should be examinations are normally used to diagnose more benefit to the patient is to be expected."
I consider that site to be more conservative and cautionary than most, and even THEY downplay ANY
possible danger of exposure from diagnostic x-rays.
Hey, how about the Mayo Clinic ? Reckon THEY know anything about the safety of X-rays?
http://www.mayoclinic.com/health/x-ray/FL00064
"One of the oldest forms of medical imaging, X-ray is a painless medical test that can help your doctor in diagnosis and treatment — even in emergency situations. It's a fast, easy and safe way for your doctor to view and assess conditions ranging from broken bones to pneumonia to cancer. Many different types of X-rays, such as bone or chest X-rays, exist. The type your doctor uses depends on what part of your body is being examined and for what purpose.
X-rays are safe and effective for people of all ages, even young children. X-rays are particularly useful for examining the chest, bones, joints and abdomen. Your doctor may recommend an X-ray for many different reasons."
I bet that quote upsets the fearmongers out there who claim ANY x-ray exposure is "injuring" patients. In fact, I bet all my following sources upset the people who are trying to scare you.
Why? Because they are SCIENTIFIC AND AUTHORITATIVE sources on the safety of diagnostic x-rays.
Now the question arises, is there any benefit for these fearmongers who want to try to scare you into not getting diagnostic x-rays?
Interestingly enough, the British Journal of Radiology has an article on just that kind of question.
http://bjr.birjournals.org/cgi/content/full/77/919/545
From British Journal of Radiology (2004) 77, 545-546
"
Is there a benefit in promoting the concept of radiation risk?
J Williams, MSc, FIPEM
Department of Medical Physics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK
We live in a risk averse society. The public is prepared to believe scare stories regarding the risks associated with many manufactured devices and materials whether they relate to genetically modified crops, mobile phone masts, or the measles, mumps and rubella vaccine. Attitude towards risk is tempered by the degree of imposition and by the perceived benefit — "my mobile phone is safe, your transmitter is dangerous".
In this climate we should ask whether it is to the benefit of the radiological community, or indeed to patients, to promote an awareness of the potential harm from X-rays when the risks are, as discussed below, negligible in most circumstances. A typical scenario is for the benefits of MRI to be promoted on the basis of the absence of risk from ionizing radiation. This is frequently stated when trying to fund a new scanner. It is surely more important to promote the benefits of MRI: high quality 3-dimensional images providing clinical information that cannot be obtained from any other diagnostic tool. Radiology does itself a disservice when it talks up the risk from imaging modalities that have an essential role in clinical diagnosis.
Radiation risk is promoted in several ways. For example the first part of a radiologist's specialist training in the UK is concerned with the requirement of the Ionising Radiation (Medical Exposure) Regulations 2000, IR(ME)R, to have had adequate training, specified in the legislation as being principally concerned with the physics of ionizing radiations and radiation protection. The implication is clear: X-ray and radionuclide imaging modalities are associated with significant hazards whereas ultrasound and MRI are not. This implication is reinforced by the possible requirement to notify the IR(ME)R Inspectorate of certain incidents involving an overexposure of a patient, for example the injection of the incorrect radiopharmaceutical, when there is no such requirement for non-ionizing radiations.
Medical imaging is a field of endeavour in which artificial energy sources are used to penetrate the body. It has been said that if X-ray examinations with present day techniques and equipment had been the first and only significant exposure of humans to ionizing radiation, then we would have no doubt that they were safe. But this was not the case. The early uses of diagnostic X-ray equipment inflicted massive doses of radiation on both operator and patient, and other uses (and abuses) of ionizing radiations have firmly established that ionizing radiations cause cancer. This fact, recognised since early in the last century, has promoted the simplistic view: non-ionizing radiation – good; ionizing radiation – bad. The view is reinforced by the layers of regulation concerning the use of these radiations with no comparable legislation governing the use of ultrasound or MRI. The introduction of ultrasound and MRI was not without concerns about their safety. These concerns have not been fully resolved but the extensive use of these modalities and the lack of any evidence of harm at the exposure levels used for imaging is taken as sufficient demonstration that any risk that there may be is negligible, particularly in the context of the proven clinical benefits.
Diagnostic radiology contributes approximately 14% of the average annual dose received by the UK population [1]. Other artificial sources in the UK contribute less than 0.4% with just 0.012% arising from the disposal of radioactive waste. The patient protection legislation in Europe is attributed to the public concern over the impact of artificial sources in the environment. The argument runs that if the public demand stringent action to minimize the dose from one particular source, then there should be concerted action to ensure that the population dose from the much greater source of radiation (i.e. medical exposure) is subject to equally rigorous standards.
In discussions of radiation hazards, one factor often neglected is that risk is proportional to dose. This is the received wisdom, promoted by the International Commission on Radiological Protection, the so called linear no-threshold theory (LNT). LNT has many challengers but it is not the purpose of this paper to debate that issue. LNT is the basis of our legislation and is required to be the basis on which we seek to minimize risk. In dealing with risk we accept that there is a 1 in 20 000 chance of developing fatal cancer following irradiation to an effective dose of 1 mSv. Legislation does not permit us to act as though the risk is any less, but at the same time we should not suggest that the risk might be any greater.
The range of doses in diagnostic radiology spans almost 5 orders of magnitude and the resultant risks vary to the same extent. A CT scan of the abdomen and pelvis gives a dose of about 10 mSv with an associated fatal cancer risk of 1 in 2000 (approximately equal to the annual death rate from all causes for people in their mid-20s). An X-ray of the hand gives a dose no greater than 0.2 µSv with a fatal cancer risk of 1 in 100 million (approximately one-tenth of the annual risk of being killed by lightning).
In recent years the contribution of CT scanning to the collective dose has been a major concern. Following publication of the UK survey on CT doses, the National Radiological Protection Board (NRPB) [2] reported that, whereas CT represented only 2% of all imaging involving X-rays, its contribution to the collective dose was approximately 23%. More recently it has been noted that the frequency of examinations has increased to about 4% and the contribution to collective dose has probably increased to 40% [3]. Such evidence, that a few examinations contribute disproportionately to the collective dose, is used to inform decisions on investment in alternative imaging modalities or in other investigation techniques. However, we can look at this information in another way. The typical dose for a chest X-ray is 17 µSv, for an X-ray of the extremities the dose per radiograph lies between 0.2 µSv and 3 µSv [4], and for dental radiology it is 4 µSv and 7 µSv, respectively, for two bitewing films using E-speed film and for a panoramic radiograph [5]. These very low dose examinations represent about 70% of all medical and dental exposures, but they contribute (on average) individual doses no greater than 3 µSv per year, that is less than 1% of the dose arising from all medical exposures. The average annual dose from air travel is 20 µSv, nearly 7 times greater [1].
IR(ME)R is concerned with all medical exposures and there is no de minimis dose below which the regulations do not apply. IR(ME)R requires the justification of individual medical exposures on the basis of the balance between risk and benefit. In applying the regulations it is important to recognise that when risk is extremely low then the benefit need only be proportionate to that risk and as has been discussed above, for the majority of X-ray examinations that risk is negligible (defined in my dictionary as "such as may be ignored because very little or very unimportant").
An NRPB leaflet containing information for patients [6] poses the question "X-rays: how safe are they?" and concludes that even for high dose examinations the dose "represents a very small addition to the underlying cancer risk from all sources". For those examinations with effective doses of 20 µSv or less (70% of the total) the risk is described as negligible. In every day language we might conclude that the majority of X-ray examinations are indeed safe.
In general the balance between risk and benefit is not judged by a simple mathematical calculation but let us try an example. It might be acceptable to advocate chest radiography (1 in 1 000 000 risk) in particular clinical circumstances even if 99 out of 100 films were expected to have no abnormal finding. The ratio of winners to losers would still be 10 000 to 1, a very substantial benefit to risk ratio. This may not be practicable as a general approach to justification, but a mathematical approach is taken in breast screening to provide the reassurance that the potential harm, i.e. numbers of cancers induced, is very much less than the numbers detected that can be successfully treated as a result. "
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Now, to be honest, I could go on and on and on with sources reassuring patients AND doctors on the need not to be overly concerned about any imagined danger from diagnostic x-rays. The list of articles would soon become prohibitively long, because , let's face it, the authorities assure you that diagnostic x-rays offer no real concern for the intelligent, thinking person. The fearmongers cannot convince the intelligent person who researches the issue. They try to convince people that know no better. Unfortunately, some companies acting as specialty health networks, are extremely guilty of promoting nonsense and poppycock fearmongering, and deny doctors who use diagnostic x-rays appropriately, from joining their networks. The shame is that any doctor who, in order to get into their little network, changes his or her diagnostic protocol to AVOID proper use of diagnostic x-rays to rule out contraindications to treatment or to evaluate for fractures or focal bone pathology, are putting themselves at serious risk for medical malpractice in my opinion, and furthermore, putting their patients at risk for failure to properly diagnose.
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Tuesday, 05 June 07 - 04:19 PM (GMT)
in General
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