Physicians and Radiation

Projected first-year radiation dose from the Fukushima accident

This last April I traveled with two colleagues to Japan to help train physicians from the Tokushukai Medical Assistance Team (TMAT) - we gave a total of 8 lectures to over 1200 physicians and emergency responders during our visit, discussing how to safely care for patients who might have been exposed to radiation or who might be contaminated with radioactivity. A major reason that we were there was that the physicians simply were unfamiliar with the risks that the radiation posed to their patients or to them.

I thought it was a shame that so many Japanese physicians lacked what is really a fairly basic understanding of how radiation can affect a person. But it turns out that this lack of understanding is far more prevalent than this single incident in Japan. I helped to teach some medical school classes in the earliest years of this century and I was amazed to find that not only did my students not understand the effects of the medical radiation they were prescribing but they didn’t seem to care much. And when I asked for an hour of students’ time to teach them I was told by the medical school administration that there just wasn’t the time in the four-year curriculum to squeeze this in. Going further, surveys of radiologists in Australia, the United States and Great Britain  indicate that a majority of physicians do not understand the risks of the diagnostic radiation that they prescribe. Going a little further, there is anecdotal evidence (reported in the BBC Horizons documentary Nuclear Nightmares) that Soviet and European physicians advised over 100,000 women to have therapeutic abortions in the aftermath of the Chernobyl accident in spite of the fact that radiation dose to the fetus was insufficient to cause birth defects or other problems. The bottom line is that the majority of physicians – including radiologists and nuclear medicine physicians – are simply ill-informed about the medical and reproductive impact of radiation, be it from diagnostic procedures or from radiological and nuclear emergencies. This means that, in the event of a nuclear or radiological emergency in the United States, we can expect physicians to be similarly unable to offer competent medical advice or to perform competent medical triage in cases involving radiation exposure. This, in turn, has led (and can be expected to continue to lead) physicians to make unwise recommendations to their patients exposed to radiation.

Take one example – a physician confronted by a patient who is radioactively contaminated. In exercises (and in surveys) physicians tend to insist that such patients be decontaminated before even admitting them to the emergency room, in spite of the fact that experience is clear that such contamination poses no threat to medical caregivers – and in spite of the fact that delaying treatment can prove fatal to patients with life-threatening injuries. Returning briefly to reproductive effects – I have provided consultations to a few score of physicians whose pregnant patients received diagnostic radiation and who were wavering about recommending therapeutic abortions – in no cases was this called for. Unfortunately, physicians just don’t know much about the health effects of radiation – this causes problems today when pregnant women are exposed to diagnostic radiation and, if there is a radiological emergency, this can cause even more problems.

The apparent remedy for this would be to find a way to help train physicians – the way that my colleagues and I did in Japan a month and a half after the Fukushima reactor accident. Such training could not only help physicians to respond appropriately (and to provide proper medical advice) to their patients in the event of an accident or a terrorist attack, but could also help physicians today to better understand the impact of the radiation they prescribe and to give better advice to their patients who are exposed to radiation today.

One further comment – people tend to trust their physicians when it comes to health-related matters. Helping to educate physicians on the health effects of radiation exposure can also help to indirectly educate the general public about the health effects of radiation exposure under both routine and extraordinary circumstances – educating physicians might be a good way to help the public to better understand the reality (as opposed to the myths) of radiation’s health effects. This, in turn, could have a very real impact today as well as in the event of a radiological or nuclear emergency at some point in the future.

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Dr. Y is a certified health physicist, trained in nuclear power plant design and operations, with experience in nuclear power, environmental science, and planning for radiological and nuclear emergencies. He has 30 years of experience in the areas of nuclear and radiation safety.

 

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