1975, British Journal of Radiology, 48, 877
VOLUME 48 NUMBER 575
N O V E M B E R 1975
The British Journal of Radiology Radiology now Which? on radiation The April issue of Which? (magazine of the Consumers Association) contained an article on "Radiation" under the heading "Public Safety". In it the sources, effects and hazards of radiation are described clearly and briefly. The need for gonadal shielding during irradiation, for limitation of the diagnostic beam, and the importance of the "ten-day rule" are explained. What has caused particular comment is that the article includes the results of a survey of 838 CA members, male and female, who had recently been X-rayed. About two-thirds said that they had been given no lead shielding during their X-rays. Of 71 women who had abdominal X-rays, half were not asked about possible pregnancy and of these two-thirds were in fact X-rayed outside the "ten-day" period. And even among those who had been asked about the timing of their periods half were still examined outside the recommended period. A further point which emerged was that 40 per cent of the sample had X-rays requested when the same examination had already been carried out at another hospital. A third had not been asked about previous X-rays, and many others were asked too late for the earlier films +o be obtained in time to affect the requested studies. It is of course possible to question the validity of some of the figures here. For example, would everyone having an X-ray—particularly the chest—be aware when gonadal shielding was employed? Can one be sure that none of the referring clinicians had been told about the films taken elsewhere and had still decided that a fresh examination was needed? Nonetheless, there is little point in being defensive about the report. The Code of Practice was published three years ago (H.M.S.O., 1972) and in spite of the urgings of Ardran and Kemp (1972), Kemp (1973) and Warrick (1973) progress in implementing the "ten-day rule" or alternative procedures has been slow. It is true that the onus of providing details of menstrual history lies with the patient and the clinician, but the responsibility for educating his colleagues and insisting upon the application of the "ten-day rule" is the radiologist's. Again, the radi-
ologist must accept that it is up to him to point out to other colleagues the importance of reviewing any earlier films which may be available. As to gonadal shielding and beam limitation, these are questions entirely for the radiologist and radiographer. The Which? report shows that in all these areas there is considerable room for improvement in many X-ray departments. None of these problems can be solved by crisp, once-for-all action. Each requires a campaign of education, indoctrination and continuous vigilance. A greater public understanding would help, and it is a pity that the restrained and sensible comments of the Which? report will only reach a small proportion of the population. The main responsibility must remain with radiologists and radiographers, and those who have not yet applied the "ten-day rule" in their departments will be glad to know that a paper on the subject prepared by Dr. J. W. Laws is to be circulated by the Royal College of Radiologists. This deals with the practical problems of implementation and can be adapted for circulation to clinical colleagues. One of its suggestions is that notices should be put up in out-patient waiting rooms to remind patients to mention their menstrual history to the doctor who is about to see them. A similar notice might be used to urge patients to mention any previous X-ray examinations they may have undergone. Changing habits of work is a slow and difficult business and all of us need to be stimulated to look again at the way we do things. Which? has done a service in reminding us to think what needs to be done to improve our service to patients. H. M. SAXTON.
REFERENCES Code of Practice for the Protection of Persons against Ionising Radiation arising front Medical and Dental use. 1972
(H.M.S.O., London). ARDRAN, G. M., and KEMP, F. H., 1972. Radiography of
potentially pregnant females. British Medical Journal, 4, 422-423. KEMP, F. H., 1973, Irradiation of the fetus. British Medical
Journal, 3, 497. WARRICK, C. K., 1973. The "ten-day rule". British Journal
877
of Radiology, 46, 933-934.
VOLUME 48 NUMBER 575
N O V E M B E R 1975
The British Journal of Radiology Radiology now Which? on radiation The April issue of Which? (magazine of the Consumers Association) contained an article on "Radiation" under the heading "Public Safety". In it the sources, effects and hazards of radiation are described clearly and briefly. The need for gonadal shielding during irradiation, for limitation of the diagnostic beam, and the importance of the "ten-day rule" are explained. What has caused particular comment is that the article includes the results of a survey of 838 CA members, male and female, who had recently been X-rayed. About two-thirds said that they had been given no lead shielding during their X-rays. Of 71 women who had abdominal X-rays, half were not asked about possible pregnancy and of these two-thirds were in fact X-rayed outside the "ten-day" period. And even among those who had been asked about the timing of their periods half were still examined outside the recommended period. A further point which emerged was that 40 per cent of the sample had X-rays requested when the same examination had already been carried out at another hospital. A third had not been asked about previous X-rays, and many others were asked too late for the earlier films +o be obtained in time to affect the requested studies. It is of course possible to question the validity of some of the figures here. For example, would everyone having an X-ray—particularly the chest—be aware when gonadal shielding was employed? Can one be sure that none of the referring clinicians had been told about the films taken elsewhere and had still decided that a fresh examination was needed? Nonetheless, there is little point in being defensive about the report. The Code of Practice was published three years ago (H.M.S.O., 1972) and in spite of the urgings of Ardran and Kemp (1972), Kemp (1973) and Warrick (1973) progress in implementing the "ten-day rule" or alternative procedures has been slow. It is true that the onus of providing details of menstrual history lies with the patient and the clinician, but the responsibility for educating his colleagues and insisting upon the application of the "ten-day rule" is the radiologist's. Again, the radi-
ologist must accept that it is up to him to point out to other colleagues the importance of reviewing any earlier films which may be available. As to gonadal shielding and beam limitation, these are questions entirely for the radiologist and radiographer. The Which? report shows that in all these areas there is considerable room for improvement in many X-ray departments. None of these problems can be solved by crisp, once-for-all action. Each requires a campaign of education, indoctrination and continuous vigilance. A greater public understanding would help, and it is a pity that the restrained and sensible comments of the Which? report will only reach a small proportion of the population. The main responsibility must remain with radiologists and radiographers, and those who have not yet applied the "ten-day rule" in their departments will be glad to know that a paper on the subject prepared by Dr. J. W. Laws is to be circulated by the Royal College of Radiologists. This deals with the practical problems of implementation and can be adapted for circulation to clinical colleagues. One of its suggestions is that notices should be put up in out-patient waiting rooms to remind patients to mention their menstrual history to the doctor who is about to see them. A similar notice might be used to urge patients to mention any previous X-ray examinations they may have undergone. Changing habits of work is a slow and difficult business and all of us need to be stimulated to look again at the way we do things. Which? has done a service in reminding us to think what needs to be done to improve our service to patients. H. M. SAXTON.
REFERENCES Code of Practice for the Protection of Persons against Ionising Radiation arising front Medical and Dental use. 1972
(H.M.S.O., London). ARDRAN, G. M., and KEMP, F. H., 1972. Radiography of
potentially pregnant females. British Medical Journal, 4, 422-423. KEMP, F. H., 1973, Irradiation of the fetus. British Medical
Journal, 3, 497. WARRICK, C. K., 1973. The "ten-day rule". British Journal
877
of Radiology, 46, 933-934.
