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FDA Cracking Down On X-ray Exposure For Kids

samzenpus posted more than 2 years ago | from the won't-someone-please-think-of-the-children dept.

Government 138

ericjones12398 writes "The Food and Drug Administration is proposing that manufacturers of X-ray machines and CT scanners do more to protect children from radiation exposure. If companies don't take steps to limit X-ray doses, the agency may require a label on their new equipment recommending it not be used on children. X-rays and CT scans can provide doctors with lots of useful information. But the radiation that creates the helpful images also increases a person's risk for cancer. There's been an explosion in the use of imaging tests. And rising radiation doses, particularly from CT scans, have drawn concern. The cancer risk increases with the dose of X-rays received during a person's lifetime, so kids' exposure is particularly important. It's also the case that children are more sensitive to X-ray damage. The FDA is also telling parents to speak up. If a doctor orders a test or procedure that uses X-rays, parents shouldn't be afraid to ask if it's really necessary. Also, it doesn't hurt to ask if there's an acceptable alternative, such as ultrasound or MRI, that doesn't rely on X-rays."

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Growth (4, Informative)

Hatta (162192) | more than 2 years ago | (#39960739)

Radiation will be especially bad for children, since any mutation their cells acquire will be passed on to all daughter cells. For a growing child that will be a lot more cells than for adults who are only replacing their cells.

Re:Growth (1, Offtopic)

LifesABeach (234436) | more than 2 years ago | (#39960803)

The TSA is trully becoming a sinister group of people. How can one even pity the TSA's logic?

Re:Growth (0)

Anonymous Coward | more than 2 years ago | (#39961619)

Becoming? When were they not myopic?

They irradiate you then they grope you (3, Insightful)

Taco Cowboy (5327) | more than 2 years ago | (#39962053)

And that what TSA is all about

It's not about terrorism, it's not about security, it's about numbing the public through excessive harassment

Can we please... (5, Insightful)

dgatwood (11270) | more than 2 years ago | (#39960745)

...insist on these rules also applying to the TSA?

Re:Can we please... (2)

LifesABeach (234436) | more than 2 years ago | (#39960795)

I'm at odds on this acknowledgement. Irradiating childtren; or Adults, at will, groping them. Which is the lessor of the 2 evils?

Re:Can we please... (5, Informative)

Anonymous Coward | more than 2 years ago | (#39960893)

Perhaps the fact that the TSA scanners are NOT regulated by the FDA, not certified by them, nor do they license their operators, might change your mind.

Re:Can we please... (1)

sjames (1099) | more than 2 years ago | (#39963511)

And they lied about them being certified for human use.

Re:Can we please... (5, Interesting)

dgatwood (11270) | more than 2 years ago | (#39960905)

I'm not conflicted at all. Forcing kids to experience pat-downs just might anger the public enough to force our government to eliminate the bulls**t.

Re:Can we please... (4, Insightful)

jimmy_dean (463322) | more than 2 years ago | (#39960979)

I'm not conflicted at all. Forcing kids to experience pat-downs just might anger the public enough to force our government to eliminate the bulls**t.

I couldn't agree more. The TSA costs way too much money, violates far too many freedoms, and produces nothing more than FUD. I would seriously like to see the TSA removed and each airport and airline worry about their own security.

Re:Can we please... (2, Informative)

Obfuscant (592200) | more than 2 years ago | (#39961389)

I would seriously like to see the TSA removed and each airport and airline worry about their own security.

If it wasn't trivial to move about after passing the security screening, I might agree. Since someone who flys airline X can freely mingle with someone who flies on Y, if X has lax security then so do, effectively, Y. Same for the issue of mixing people between airports. If airport X has no security and Y does, the first plane to land at Y that came from X means Y also has no security.

Much worse was the kind of issue created when England temporarily enacted really draconian security policy. If you weren't aware of the nutiness, you could get on an airplane going there and then not be able to carry your stuff back out. My boss was stuck like that. He carried his laptop in but couldn't leave with it. If airlines were each responsible for their own, you could start a trip with a really nice laptop and expensive electronic gadgets, only to have them confiscated when you were trying to make your connection on a different airline. Trying to make a 45 minute connection at a distant airport is the worst time to find out that you can neither carry on that electronic device nor check it.

Not saying that TSA is not a problem, just that the solution is not a mishmash of mix and match systems. There needs to be national standards and a national implementation.

Re:Can we please... (1)

cheekyjohnson (1873388) | more than 2 years ago | (#39961863)

There needs to be national standards and a national implementation.

I fear we'd just end up with something like the TSA all over again...

Re:Can we please... (1)

sjames (1099) | more than 2 years ago | (#39963561)

I would be fine with removing the lot of it. If enough people are scared enough and sufficiently lacking in personal boundaries, let individual airlines implement security areas at their gates complete with the 100 rad X-ray and mandatory cavity search up to the elbow. Let the market decide.

Re:Can we please... (3, Insightful)

houstonbofh (602064) | more than 2 years ago | (#39961473)

Then support this... http://www.politico.com/news/stories/0512/75896.html [politico.com]

I know... Oh, those crazy Pauls... Always coming up with those crazy political ideas. I mean just crazy, like this one. Eliminate the TSA... That's just crazy! I mean what would we... I mean, what... Uh... OK, they may not be that crazy after all.

Re:Can we please... (5, Insightful)

wvmarle (1070040) | more than 2 years ago | (#39962503)

But but but.... that would mean you're supporting a REPUBLICAN? Do I see that correctly? You must be a Republican. Or how could any Democrat in their right mind support a Republican, even when their ideas make sense for a change?

OK I'm not an American but that's my view of America's super-partisan "as long as it's one of us" politics. Switch Republican and Democrat at will. And it's also why I don't think this TSA-abolishment will happen any time soon, because if one side wants it the other side is automatically against.

Re:Can we please... (0)

Anonymous Coward | more than 2 years ago | (#39963327)

Unfortunately it's also breeding a generation of children who think getting groped by the government is normal.

Re:Can we please... (1)

sjames (1099) | more than 2 years ago | (#39963517)

Double bonus points if schools review 'bad touch' and yelling for help just before vacation time.

Re:Can we please... (1)

jd (1658) | more than 2 years ago | (#39961047)

The TSA is a cult to Dread Cthulhu. What makes you think there's a lesser evil?

Re:Can we please... (1)

X0563511 (793323) | more than 2 years ago | (#39961107)

Groping.

Cancer can kill you. Your personal space being violated can not.

Re:Can we please... (3, Insightful)

Keith111 (1862190) | more than 2 years ago | (#39961149)

I'm pretty sure that suicide or other maligned conditions affect people who have been exposed to molestation as a child more often than it does those who have not. In the future it's probably going to be easier to cure cancer than it is to repair a totally screwed childhood.

Re:Can we please... (3, Insightful)

KhabaLox (1906148) | more than 2 years ago | (#39961233)

I'm pretty sure that suicide or other maligned conditions affect people who have been exposed to molestation as a child more often than it does those who have not.
In the future it's probably going to be easier to cure cancer than it is to repair a totally screwed childhood.

Are you seriously comparing full-on, bare genital contact, sexual molestation with over the clothes pat-downs performed in public spaces within sight of a parent?

I'm no fan of the TSA or their security procedures, but this kind of hyperbole doesn't help your argument. I'd much rather my children get the pat down, though each time they've flown through LAX they get sent to the old style metal detectors, while I got sent through the backscatter* (or mm-wave or whatever it is).

*Next time, I'm asking for the pat-down.

Re:Can we please... (1)

houstonbofh (602064) | more than 2 years ago | (#39961501)

Are you seriously comparing full-on, bare genital contact, sexual molestation with over the clothes pat-downs performed in public spaces within sight of a parent?

I'm no fan of the TSA or their security procedures, but this kind of hyperbole doesn't help your argument. I'd much rather my children get the pat down, though each time they've flown through LAX they get sent to the old style metal detectors, while I got sent through the backscatter* (or mm-wave or whatever it is).

*Next time, I'm asking for the pat-down.

When you do not have the ability to say no, it is rape. Your argument is like saying some rape is not as bad because he used mouthwash... Irrelevant. Rape is about power, and being raped in full public view in front of your parents sounds very damaging to me.

Re:Can we please... (2)

X0563511 (793323) | more than 2 years ago | (#39962375)

I'm sorry, a pat-down search is not rape.

Rape requires a sexual act.

Re:Can we please... (5, Insightful)

houstonbofh (602064) | more than 2 years ago | (#39962419)

If I can go to prison for doing it to a high school girl, it is rape.

Re:Can we please... (1)

element-o.p. (939033) | more than 2 years ago | (#39961639)

Now tell me that the "over the clothes pat-downs performed in public spaces" isn't traumatic to a rape or molestation survivor, particularly when performed by someone with the sensitivity (or lack thereof) of your average TSO. There may very well have been some hyperbole in the GPP, but the point is still valid. Even clothed, in public, *NO ONE* should be routinely touching my children (or me or my wife, for that matter) in that manner without a really fricken' good reason -- and just to be clear, purchasing an airline ticket is NOT "a really good reason."

Re:Can we please... (1)

wvmarle (1070040) | more than 2 years ago | (#39962531)

[TSA]You buying an air ticket means you may very well be a terrorist bound to blow up the plane, traveling with wife and children for decoy. So that's a "really good reason" to search you extra.[/TSA]

Re:Can we please... (4, Interesting)

element-o.p. (939033) | more than 2 years ago | (#39963209)

I call B.S. on that logic. If we assume that all 631,939,829 passengers who flew in 2010 [quora.com] is a fair average for how many people fly per year (and according to the Bureau of Transportation Statistics [bts.gov] it seems to be accurate for 2011 and the projected 2012 stats), then that's over 7,000,000,000 passengers since 9/11. On 9/11, there were what, fifteen hijackers? We've seen two underwear bombers and one shoe bomber since then. Am I missing any other would-be terrorists? If not, that makes a grand total of...


Wait for it...


18 out of over seven billion passengers who are (were) terrorists. In other words, stopping and searching every airline passenger gives you a one in 388 million chance of actually catching a terrorist. Pick any other crime and tell the public that you'll have a one in 388 million chance of catching a bad guy if they would just allow the cops to stop and search people at random, and there would be torches and pitchforks marching towards D.C. Yet we think that's "reasonable" when we want to get on an airplane?!?!

Re:Can we please... (1)

dgatwood (11270) | more than 2 years ago | (#39963311)

In other words, stopping and searching every airline passenger gives you a one in 388 million chance of actually catching a terrorist.

Not quite. Stopping and searching every passenger failed to stop any of those terrorists. What you mean to say is that if the TSA were absolutely perfect at its job, then it would catch at most one terrorist per 388 million passengers screened. Given that 100% detection is impossible in practice, however, and given that they are not, in fact, catching an average of two terrorists per year, I think it is safe to say that the odds are probably much, much lower, and probably orders of magnitude lower on the average.

Re:Can we please... (1)

wvmarle (1070040) | more than 2 years ago | (#39963659)

You took me far more serious than intended.

That said, the underwear bomber and shoe bomber that got on a plane, were not screened by TSA as they did not board in USA. IIRC the father of the underwear bomber already warned US intelligence about the man having this kind of ideas - so that's an intelligence failure even.

The second underwear bomber you refer to the one just uncovered? That bomb didn't even reach an airport, much less a plane, and again wouldn't have been screened by TSA but by some Middle East airport.

Anyway since the increased security after 9/11 two people actually managed to smuggle bombs on planes (and subsequently failed to set them off), while no would-be bombers were stopped by airport security (they would have reported it big time; and I haven't heard any such news over the past decade). That's a 100% failure rate on airport security.

Re:Can we please... (1)

sjames (1099) | more than 2 years ago | (#39963775)

Meanwhile, the TSA is 0 for 2 after a decade.

Re:Can we please... (1)

sjames (1099) | more than 2 years ago | (#39963715)

Are you seriously comparing full-on, bare genital contact, sexual molestation with over the clothes pat-downs performed in public spaces within sight of a parent (who desperately wants to comfort the child but cowers ineffectually against the authority of the touchy feelie strangers)?

FTFY. It's probably not AS damaging, but it's probably not exactly good either.

Re:Can we please... (4, Interesting)

Xenkar (580240) | more than 2 years ago | (#39961291)

Actually sir, I have two genetic disorders, Hemophilia and Osteochondroma.

The Hemophilia basically means my blood clotting proteins are ineffective and thus it takes me longer to stop bleeding and then to heal.

The Osteochrondoma causes a variety of non-cancerous bone tumors to grow near joints during the bone growth phase. They can be in many different shapes and sizes.

The groping/padding down can cause a bone tumor to break, which can cause me to bleed to death if it manages to puncture an artery. Chances are I'll be dead before they get me to a hospital.

The radiation from the scanners can cause my bone tumors to become cancerous. If this happens, I'm pretty much sentenced to a long and painful death.

Re:Can we please... (0)

Shavano (2541114) | more than 2 years ago | (#39962949)

Actually sir, I have two genetic disorders, Hemophilia and Osteochondroma.

The Hemophilia basically means my blood clotting proteins are ineffective and thus it takes me longer to stop bleeding and then to heal.

The Osteochrondoma causes a variety of non-cancerous bone tumors to grow near joints during the bone growth phase. They can be in many different shapes and sizes.

The groping/padding down can cause a bone tumor to break, which can cause me to bleed to death if it manages to puncture an artery. Chances are I'll be dead before they get me to a hospital.

The radiation from the scanners can cause my bone tumors to become cancerous. If this happens, I'm pretty much sentenced to a long and painful death.

No, you can still get the pat-down.

Dose from CT scans is vastly larger... (4, Informative)

JayBat (617968) | more than 2 years ago | (#39961073)

The radiation dose from a properly functioning backscatter xray full-body scanner is about 0.6 Sv. The dose from a properly functioning chest CT scan is about 7mSv, 10000x larger.

(Doesn't change my opinion that all full-body airport scanners are a waste of money, and xray backscatter scanners in particular should be banned.)

But the FDA is right to focus on over-prescribed medical xray procedures.

Re:Dose from CT scans is vastly larger... (3, Informative)

JayBat (617968) | more than 2 years ago | (#39961111)

Heh, Slashdot silently swallowed my carefully crafted "mu". That should be 0.6e-06 Sv.

Re:Dose from CT scans is vastly larger... (1)

dgatwood (11270) | more than 2 years ago | (#39963331)

Yeah. I was going to say.... 0.6 grays is something like an eighth of the LD50.... :-D

Re:Dose from CT scans is vastly larger... (4, Insightful)

houstonbofh (602064) | more than 2 years ago | (#39961529)

The radiation dose from a properly functioning backscatter xray full-body scanner is about 0.6 Sv. The dose from a properly functioning chest CT scan is about 7mSv, 10000x larger.

Assuming that it is working properly. And the FDA mandates frequent testing for their machines. How about the TSA? And do they actually do it?

Re:Dose from CT scans is vastly larger... (1)

SuricouRaven (1897204) | more than 2 years ago | (#39963605)

If they found a machine had a dodgy resistor and was over-irradiating people, I suspect this discovery would be classified secret for 'national security' reasons. You'd never hear about it. Maybe it already happened.

Re:Dose from CT scans is vastly larger... (4, Insightful)

profplump (309017) | more than 2 years ago | (#39962339)

And when the TSA starts preforming regular testing of their machines by an independent contractor, installing "x-ray on" indicators, training staff on the dangers of ionizing radiation, providing staff with personal safety equipment, and otherwise taking all the other basic precautions that every other industry using ionizing radiation already take, then we can talk about the relative danger, and compare it to the benefit.

Until then we can only assume that the TSA is operating death-rays, because the machines they're running are inherently dangerous and they can't be bothered to install basic safeguards.

Re:Dose from CT scans is vastly larger... (1)

wvmarle (1070040) | more than 2 years ago | (#39962561)

Now how many chest CT scans does an average person receive in their life?

Compared to xray backscatter?

And then indeed we have to assume they "work properly" which I will happily assume for the CT scanner (specialised medical grade device; highly trained operators; relatively high dose making radiation safety more of an issue) vs. the airport scanners (non-medical; used 24/7; low dose so low assumed risk; operators with limited training; too low dose will result in no image so such a malfunction is easily detected, too high dose will work just fine from the operator's pov).

Re:Dose from CT scans is vastly larger... (1)

sjames (1099) | more than 2 years ago | (#39963873)

Too bad the TSA machines have no certification at all. Then they are operated by people who haven't the slightest clue how they work and who have none of the training required to use any other sort of x-ray device on a human being.

Re:Can we please... (2)

miknix (1047580) | more than 2 years ago | (#39961101)

What can possibly go wrong? I hang my balls everyday in front of a CRT monitor connected to a megavolt power supply, in fact its a pretty good contraceptive :P

Re:Can we please... (4, Funny)

Obfuscant (592200) | more than 2 years ago | (#39961451)

What can possibly go wrong? I hang my balls everyday in front of a CRT monitor connected to a megavolt power supply, in fact its a pretty good contraceptive :P

And it works even better on the days you forget to retrieve them and take them home with you, right? I can hear it now, in the car on the way home, "Damn, I've got an itch and no place to scratch."

Or, can we please... (1)

BenJCarter (902199) | more than 2 years ago | (#39962957)

..get hot TSA agents?

I'll bet complaints would drop off.

That's nice. (0)

Anonymous Coward | more than 2 years ago | (#39960747)

What about those machines the TSA is using?

TSA (0)

Anonymous Coward | more than 2 years ago | (#39960755)

TSA will be involved ?

Parents? (1)

girlintraining (1395911) | more than 2 years ago | (#39960801)

Why the hell should the parents have to request a less invasive and safer alternative? If the doctor doesn't need to do an x-ray, then performing one is negligent. If this is a question of cost (ultrasounds may cost more money), then the problem is the insurance companies... and we should pass a law at once telling them to eat a bag of dicks and that patient safety comes first.

and then... (2)

englishknnigits (1568303) | more than 2 years ago | (#39960901)

see your monthly premiums go up in response. There are always trade offs and safety is a frequent one in pretty much every aspect of people's lives. If this is the type of thing where 1 in a million kids might get cancer because of x-rays over more expensive alternatives then it may not be worth switching. Money spent treating the 999,999 kids that are unaffected with the more expensive option could possibly be put to better uses. I am not saying whether or not it is worth it in this case because I have absolutely no idea. I don't know what the chances of problems arising are or the comparative costs of the safer alternatives. What I am saying is that it isn't just a matter of "always use the safer method."

Re:and then... (2, Insightful)

girlintraining (1395911) | more than 2 years ago | (#39960925)

see your monthly premiums go up in response.

They'd go up anyway. They've been rising at about 1,200% of the inflation rate since... well, the day they went into business. And it has nothing to do with the costs of medicine and more to do with shitty management and administration.

Re:and then... (1)

englishknnigits (1568303) | more than 2 years ago | (#39962829)

Well...that is true...but forcing them to use more expensive treatments would make it go up even more. That doesn't mean it isn't worth it but we do actually have to ask the question of whether or not it is worth it and not automatically switch to it just because it is safer.

Re:and then... (3, Insightful)

girlintraining (1395911) | more than 2 years ago | (#39963229)

Well...that is true...but forcing them to use more expensive treatments would make it go up even more.

Not true. Every law that has increased your safety came on the cries of "It'll ruin us!" by the businesses who were tasked with improving safety. Air bags, antilock brakes, refridgeration of food, OSHA... every last one of them had a business using that argument. I have yet to see a case of an industry winking out of existance because the government demanded a more stringent safety standard.

Re:and then... (1)

englishknnigits (1568303) | more than 2 years ago | (#39963547)

Step 1, read this wikipedia page: http://en.wikipedia.org/wiki/Straw_man [wikipedia.org]
Step 2, re-read my posts.
Step 3, read this post.
I never said more stringent safety standards has, or would, destroy any industry (this is where that wikipedia page I linked comes in).

My argument really boils down to these 4 points:
#1 Getting x-rays can be dangerous
#2 There are safer but more expensive alternatives
#3 Not all increased safety is worth the cost
#4 We should evaluate if this is a case where the increased safety is worth the cost

An illustration of #3: we could limit cars to 5mph and make them out of air bags to reduce deaths in the US alone by 35,000 per year but we are unwilling to take on that cost to our prosperity and way of life. This is an enormous increase of safety that we are unwilling to go with because of the cost.

That is all, I am not making any other points. Feel free to disagree with any of those 4 points, don't disagree with other points because I am not making any other points.

Re:and then... (1)

profplump (309017) | more than 2 years ago | (#39962357)

Statistically X in 1 million kids will get cancer because of x-rays, not might get cancer. There's a well established link between ionizing radiation and cancer. The risk in any single exposure is statistically small, but if you're the unlucky one that gets cancer from the procedure the low population risk probably won't be much comfort.

Re:and then... (1)

englishknnigits (1568303) | more than 2 years ago | (#39962901)

I'm not trying to belittle the effects of x-rays on cancer rates or how horrible it is for people who get cancer. I'm just saying it needs to be looked at from a cost/benefit angle just like everything else. It certainly does sound morbid and callous to put it that way but that is just a fact of life. If we really wan't to be as safe as possible, the speed limit would be 5 mph and we would all drive cars made of air bags. Is that the case? Not even close. We always choose to weigh costs with benefits, even when lives are concerned and that isn't the way it should be, that is the way it has to be.

Again, maybe they should switch to the safer methods. However, they should not switch automatically just because it is safer. They need to look at how much safer it is and how much more expensive it is.

Re:and then... (1)

sjames (1099) | more than 2 years ago | (#39963919)

There is a risk/benefit calculation to be done, so let's do the math: Given, radiation exposure carries at least a tiny risk, so we'll just say risk=non-zero. Meanwhile, the TSA has NEVER caught a terrorist, so benefit=0. so non-zero/zero = infinite risk per unit of benefit. Translation: it's all down side.

Re:Parents? (1)

lavagolemking (1352431) | more than 2 years ago | (#39960911)

Because some doctors are, as you said negligent, it is the responsibility of the parents to ensure their children are getting proper health care. Rather than legislate/litigate, the FDA is trying to raise awareness, so parents will actively participate in their children's health care, and use their "free market power" to demand proper health care with minimal X-rays.

Re:Parents? (5, Insightful)

mpoulton (689851) | more than 2 years ago | (#39961067)

If the doctor doesn't need to do an x-ray, then performing one is negligent.

It's nowhere near that simple. Like most medical procedures, imaging has costs (in a medical sense) and benefits. The medical "cost" of performing a few radiographs of a potentially broken limb are very low, but the diagnostic benefit is very high. The medical "cost" of doing a thoracic CT is significant enough that every radiologist thinks it over in some detail before ordering one - the radiation dose is several orders of magnitude higher than a single peripheral radiograph. However, the diagnostic benefit in many circumstances is so thoroughly outweighed by the tiny risk of cancer that the CT is often worthwhile. There are many borderline circumstances though, where it's simply a judgment call as to whether the radiation dose is worthwhile to obtain the image. What about a person who loses consciousness and falls, doesn't remember whether he hit is head, but shows no signs of brain injury? Is a head CT worthwhile? Most ER docs say yes, but some would wait and see if any neurological symptoms appear. The increased cancer risk from radio-imaging in children has to be balanced against the increased sensitivity of children to injury, the difficulty of using other (more subjective) non-imaging diagnostic approaches with children, and the increased impact on quality of life of a missed diagnosis in a child. Bottom line: There is no clear answer as to whether radiological imaging is worth the risk in some cases. I tend to believe that radiation exposure is less harmful than most people make it out to be, and that the established limits for exposure are already extremely cautious, and there's little reason to avoid most imaging procedures. At the same time, I am reluctant to get repeated abdominal CT's for my kidney stones because I know that if the procedure is repeated every time I have a problem my cumulative exposure will eventually be very substantial.

Re:Parents? (2)

ColdWetDog (752185) | more than 2 years ago | (#39962387)

Here is a classic problem: Right lower quadrant pain and fever in a child or adolescent. The diagnosis that comes to mind is appendicitis, but not every case of right lower quadrant pain and fever is appendicitis. You don't want to miss this diagnosis - if the appendix ruptures it spills bacteria all throughout the abdomen causing a significant amount of morbidity and possibly mortality.

The classic diagnostic method was history, physical examination and a couple of lab tests. In most cases, this worked out pretty well. The missed appendicitis rate was pretty low but the false positive rate - the number of times you operated on somebody who didn't have appendicitis was about 10%. Not the end of the world - it's a simple surgery and the vast majority of times it is uncomplicated but in the best possible world, you would not operate on somebody unless you really needed to.

A CT scan decreases the false positive rate to something like 1 - 2 % and the false negative rate to about the same. Significantly better than before, BUT with the caveat of additional radiation and in the case of women, radiation to the gonadal structures. Ultrasound (no radiation) is another way to do the test but it's results are often quite variable, depending on the skill of the operator and the size of the patient.

And, experience in Europe seems to indicate that a significant number of patients can be treated successfully with just antibiotics and no surgery.

So, the decision on how to proceed in a patient whom you suspect has appendicitis is not simple indeed. What the FDA is doing is waving the radiation flag around and saying 'look at me - look at me carefully'.

Re:Parents? (1)

Shavano (2541114) | more than 2 years ago | (#39962959)

Often, x-rays are unnecessary because the doctor is going to prescribe the same course of treatment regardless of what the X-ray tells him. So as a medical consumer, it's always in your interest to ask the doctor what he is looking for, how likely it is that he will find it, how much the diagnostic test will cost and how having the test results will affect the course of treatment.

You owe it to yourself (and if you're insured, to the insurance company) to know these things before you consent to the test.

Re:Parents? (1)

Michael Woodhams (112247) | more than 2 years ago | (#39963019)

In these judgement calls, I expect there is another piece to the equation, at least in the USA.

If you don't order a scan, and there was something bad which the scan might have picked up, you get sued.

If you do order a scan, find nothing, but scan results in the patient getting cancer 15 years from now, you don't get sued, as there is no way to know that it was your scan which triggered the cancer.

Re:Parents? (1)

Anonymous Coward | more than 2 years ago | (#39963103)

"If the doctor doesn't need to do an x-ray, then performing one is negligent."

WHAT!?

Negligent: adjective 1: guilty of or characterized by neglect, as of duty, 2: lazily careless; offhand. (Lat. negligentia, from neglegere, to neglect, literally "not to pick up something") is a failure to exercise the care that a reasonably prudent person would exercise in like circumstances.

Extra imaging is, by definition, the opposite of negligence.

Also, I highly doubt that a law requiring insurance companies to "eat a bag of dicks" would do much good.

Insurance companies are easy to blame, lord knows I want to go postal on mine some days, but they are not the root of the problem. Lawyers are the root of the problem.

Re:Parents? (1)

SuricouRaven (1897204) | more than 2 years ago | (#39963679)

I don't know about ultraounds, but MRI does cost more. A lot more.

Focus on TSA too (4, Insightful)

lavagolemking (1352431) | more than 2 years ago | (#39960809)

I realize this may not be possible because they'd be costing Chertoff ^W^W sympathizing with terrorists, but the FDA should work on TSA body scanners too while they're at it. In medicine, doctors are at least remotely concerned about how much radiation people are exposed to. The TSA is only concerned with keeping people in line, maintaining a security theater, and spending/receiving lots of public money. Limiting children's exposure to X-rays is a respectable, important cause, and not all children will travel by air, but it will all be wasted if the kids run through too many body scanners with traveling parents. Plus, parents will probably not know anything about body scanners, and will believe the TSA agents when they say the scanners are "perfectly safe".

Sorry... (5, Funny)

R3d M3rcury (871886) | more than 2 years ago | (#39960825)

Also, it doesn't hurt to ask if there's an acceptable alternative, such as ultrasound or MRI, that doesn't rely on X-rays.

"There is, but it is not covered by your health insurance."

Re:Sorry... (0)

Anonymous Coward | more than 2 years ago | (#39960853)

The sad, sad reality of living in the Corporate States...

Re:Sorry... (2)

KhabaLox (1906148) | more than 2 years ago | (#39961255)

Why is this modded Funny and not Insightful?

Re:Sorry... (1)

wvmarle (1070040) | more than 2 years ago | (#39962603)

Because there is no "sad but true" mod option available.

Re:Sorry... (0)

Anonymous Coward | more than 2 years ago | (#39961507)

Also, it doesn't hurt to ask if there's an acceptable alternative, such as ultrasound or MRI, that doesn't rely on X-rays.

"There is, but it is not covered by your health insurance."

Ultrasounds are definitely covered by most major insurance plans - they're not cheap, but holy hell are PET/CT scans expensive. Ultrasounds are measured in $100s. I just got a PET/CT bill for a hair over $16,000. So its like, 1-2 orders of magnitude higher. (It was high enough that the insurance company personally called me to check that I had actually gotten the scan, and this wasn't fraud.)

Keep in mind that insurance companies are aware that if you get cancer from the X rays, they'll be on the hook for chemo, surgery, and rad therapy which can easily run into the $250,000+ range. It's a math problem they're aware of...

Re:Sorry... (2)

R3d M3rcury (871886) | more than 2 years ago | (#39961971)

Keep in mind that insurance companies are aware that if you get cancer from the X rays, they'll be on the hook for chemo, surgery, and rad therapy which can easily run into the $250,000+ range [...]

But by the time you get cancer (remember, it's not one X-Ray, it's lots of X-Rays), you'll have a different company by then. Or they'll come up with some other excuse to drop you...

Re:Sorry... (1)

profplump (309017) | more than 2 years ago | (#39962389)

No, it's one x-ray. The chance from any single x-ray is very small, but ultimately it's exactly one x-ray energy photon that flips your cell from "normal" to "cancer", and that one photon will come from any single exposure. There are often contributing factors to that change; generally speaking a single DNA transcription error/etc. by itself is not enough to cause cancer, but even so there's a discrete change from "non-canerous" to "cancerous" and that change can easily be caused by a single ionization event.

Re:Sorry... (1)

jafac (1449) | more than 2 years ago | (#39963477)

exactly true.

I have a doctor friend, in his surgical specialty, he does a type of flouroscopy imaging, to allow him to see, in great detail, the bone structure of his patient, as he moves his laproscopic instruments. He takes a great deal of precaution to limit exposure as much as possible, but he's exposed much more than say, your average radiologist. A few years ago, he developed a rare form of leukemia. (now in remission, after bone marrow transplant, and treatment). Nobody can conclude that it was his professional exposure to x-ray radiation. But he believes there's a strong likelihood. There's a correlation among doctors who use his tools and methods, and a higher instance of cancers, but no scientific study was ever done. It's mostly anecdotal, from his professional association.

In the end, it could have been a single photon, mutating a single, critical DNA strand somewhere, that began the chain of events that started the disease.

But his lifelong, high exposure increased the probability that that one photon was going to be in the wrong place at the wrong time.

Re:Sorry... (0)

Anonymous Coward | more than 2 years ago | (#39962273)

PET: Positron emission tomography

It has the word "positron" in it, it's going to be expensive :p

Wiki: [...]it emits a positron, an antiparticle of the electron with opposite charge

Interesting problem (3, Insightful)

jd (1658) | more than 2 years ago | (#39960871)

The "ideal" would be to add a stipulation that no provider (be they medical or otherwise) is permitted to cause the person to exceed the stipulated yearly dose without informed consent, with total dosage accumulated to that point being recorded by the provider before and after a scan.

What I do not see is any way you could possibly achieve this, without being incredibly invasive and/or potentially causing worse side-effects.

Nonetheless, the goal should be to not merely ensure individual scans are given responsibly but that the cumulation of scans is also being done responsibly. That's much harder to do, since human memory isn't reliable and patients can't possibly know what they've been exposed to up to that point (especially in the case of TSA scans). It doesn't matter if individual scans are relatively harmless, it's the dosage per unit time that matters.

Re:Interesting problem (2)

XFire35 (1519315) | more than 2 years ago | (#39961485)

This is where the US is somewhat 'backwards' compared to other countries in regards to ionising radiation (IR) legislation. In the UK the Ionising Radiation (Medical Exposure) Regulations 2000 and its amendments legally requires (when at all possible) that non-ionising imaging modalities be used. There may also be (not entirely certain) a legal requirement to monitor dose given to patients during an examination (however, this is complicated in CT examinations due to how the machine operates and the numerous ways in which dose can be operated) which is performed normally by imputing the dose on the same computer system as the other patient's information. Additionally, there is legal obligation for those who carry out the examination (the operator) to have sufficient knowledge of what they are doing to deem the exam justifiable or not; the operator may include Radiographers (in the case of Radiographers, most of whom are going to be performing the CT, X-ray, MR or US exam they may refer to a Radiologist if they are uncertain to whether it should be performed or not). Another part of justification is viewing the patient's exam history; now because hospitals are linked electronically, it's relatively trivial to transmit images via a PACS system to another hospital, so if the patient had a CT head three weeks ago, the exam need not be repeated and really ought not to be unless the patient's condition has dramatically changed or if it is an acute case. Once again, the information can be stored on a computer and retrieved easily time and time again preventing the patient from being over-exposed. Then there are the ALARA and ALARP principles regarding dose and exams - "as low as reasonably achievable" and "as low as reasonably practicable" which basically are self-explanatory. It's not as simple as saying that there should be a dose limit for patients and that should not be exceeded. What if there is an obese patient, who will not fit in an MR machine, thus a CT machine must be used has cancer? From the staging and monitoring of the cancer his dose is likely to exceed the limit very rapidly. Patients in theatre or a Cath lab having an operation or pace-maker inserted can have doses in excess of 1000cGy due to complications of the exam or difficulty due to patient. So having a limit for people who may need repeated exposure to monitor and track pathological changes isn't entirely sensible (nor is it not without merit either). Again considering patients: with an MR scan the child has to be as still as possible - if it's a small child or an uncooperative one (let's face it a child being caged in the MR coil, fed through the bore and lying around in an environment which has incredibly loud knocking noises ongoing for 20+ mins isn't great if you're a child) moves even slightly it can corrupt the entire scan sequence being undertaken due to how the images are obtained (k-space filling); whereas a CT can reasonably scan the entire body in a few seconds. Additionally, MR, nor US can be used to image the lungs so if the child (or patient) has lung pathologies it can't be demonstrated, therefore an ionising modality has to be used. Once again, the referring clinician should be considering these things when requesting the exam and other doctors (Radiologists) or Radiographers should be vetting these to ensure that they are deemed suitable Quite frankly, the machines for the most part shouldn't be protecting the child in question - the operator of the machine should have sufficient knowledge to know how to use the machine (especially in the plain-film role) that they shouldn't be exposing if they do not; this again is in addition to other healthcare professionals doing what they ought to be doing. It's not as easy as saying ionising radiation = evil. Any doctor requesting the exam should be aware of the dangers of what they are wanting to put the patient through and the risk-benefit should be determined. Other measures such as operators having to justify the exam; exams being vetted and protocoled by a Radiologist prior to the exam commencing; and application of rather basic radiation protection measures can protect a lot of people without having to instigate hard-limits into the machines; hell most of the manufactures are constantly working to curb exposure (especially in the case of CT machines or technological developments - shift from conventional radiography to computed to digital allows for lower exposures as the detecting medium is far more sensitive) without legal imperatives.

Re:Interesting problem (1)

XFire35 (1519315) | more than 2 years ago | (#39961499)

For some reason all of my paragraph breaks disappeared...

Re:Interesting problem (0)

Anonymous Coward | more than 2 years ago | (#39961723)

You have to actually use html tags for paragraphs or line breaks.

Image Gently (5, Informative)

Nemo137 (1207298) | more than 2 years ago | (#39960895)

It's worth noting that the Society for Pediatric Radiology has had a campaign (http://www.pedrad.org/associations/5364/ig/) called Image Gently for a couple years now to raise awareness of this in the radiology community, and in general the trend us towards doing more with MRIs, especially with children.

Re:Image Gently (3, Funny)

Kaenneth (82978) | more than 2 years ago | (#39961433)

After my daughter swallowed some magnets, the stupid doctors refused to do an MRI instead of X-Rays.

Also: Vaccinations Bad!

Re:Image Gently (0)

Anonymous Coward | more than 2 years ago | (#39962013)

The risks of performing an MRI are generally far higher than an x-ray for a child of the age who swallows foreign bodies. MRIs in young children typically require sedation, which has far more consequences than a typical 1-2 view x-ray.

Re:Image Gently (0)

Anonymous Coward | more than 2 years ago | (#39962237)

You can't put a patient who swallowed magnets in an MR machine. You'll tear the magnets right out of his abdomen!

FDA? (1)

craigminah (1885846) | more than 2 years ago | (#39960935)

Last time I checked neither x-ray machines nor CT scanners are considered food or drug so why is the FDA involved? I could see the FCC or OSHA but not FDA.

Re:FDA? (2)

Tackhead (54550) | more than 2 years ago | (#39961059)

Last time I checked neither x-ray machines nor CT scanners are considered food or drug so why is the FDA involved? I could see the FCC or OSHA but not FDA.

In addition to drugs, the FDA is also responsible for clearing medical products and devices [fda.gov] .

Here's this year's list [fda.gov] of newly-approved devices so far. If you're going to stick it in your coronary artery [fda.gov] , your cardiologist probably wants to know that people smarter than him have spent a lot of time asking a lot of hard questions about it.

Not every device gets the full treatment. But even if you're coming up with a minor tweak to something that's comparatively low risk, it must be cleared under section 510(k): last month's cleared devices [fda.gov] . The paperwork's simple compared to a new device approval, but even the 510(k) clearance process means that something as simple as "STERILE LUBRICATING JELLY" is sterile, biocompatible, made in a factory that follows good manufacturing processes, etc.

If it sounds like a horrendous amount of paperwork, well, it is. But the alternative - random uncleared devices without even the practicioner knowing what's in them - is far, far worse. There's a reason that both prescription and over-the-counter medications have standard packaging and labeling requirements, undergo multiyear-long clinical studies, and take the better part of a billion dollars and a decade to bring to market, and why quack 'supplements' advertised on TV and in your email's spam filter have a big disclaimer that "this product is not intended for the diagnosis and treatment of any disease".

If it sounds like TSA used the loophole of "these backscatter X-ray machines aren't intended for the diagnosis and treatment of any disease" in order to circumvent FDA scrutiny, well, I'd have to agree with you there, too. But what's more important: the health of the traveling public, or securing cushy careers for HomeSec bureaucrats?

Re:FDA? (1)

houstonbofh (602064) | more than 2 years ago | (#39961557)

If you're going to stick it in your coronary artery [fda.gov] , your cardiologist probably wants to know that people smarter than him have spent a lot of time asking a lot of hard questions about it.

We are talking about a government agency here... Or were you going for the +5 funny?

Re:FDA? (0)

Anonymous Coward | more than 2 years ago | (#39961079)

FDA regulates all medical devices.

Re:FDA? (1)

tibit (1762298) | more than 2 years ago | (#39961103)

FDA regulates medical devices, too. Their name is just that: a name. It could be Wakalix Agency for all I care. Your name hanged-upness is silly.

Re:FDA? (1)

nedlohs (1335013) | more than 2 years ago | (#39961159)

Maybe look up what the FDA does and you'll educate yourself a little?

The FDA also regulates medical devices, radiation-emitting devices, cosmetics, vaccines, biologics, tobacco products, veterinary products, interstate travel sanitation, and probably a bunch of other things. All of which is mind numbingly obvious within 10 seconds of looking up the FDA.

Re:FDA? (0)

Anonymous Coward | more than 2 years ago | (#39961241)

Be honest, you didn't check anything, you are just making up stuff. If you had checked you would know that the "drug" in fda includes pretty much anything medical.

Re:The last time you checked was? (0)

Anonymous Coward | more than 2 years ago | (#39961319)

Apparently last time you checked was prior to 1983?

The FD&C Act [wikipedia.org] was passed in 1883. It defines medical devices and gives FDA authority over their approval and use.

Read any good book covers lately?

FDA is going to cause more harm than good (2)

russotto (537200) | more than 2 years ago | (#39961093)

The FDA can regulate medical equipment, but it can't regulate the practice of medicine. So if these rules are too onerous, medical equipment manufactures will just label the machines as not for use on children (and likely take out any canned child-specific protocols), and doctors will continue to use the machines on children. In the middle ground, if the rules aren't too hard for the manufacturers to follow, but they cause the images to be poor, doctors and technologists will modify the protocols or use adult protocols on children. And if they're no different than what is done now, what's the point?

If there's really a problem with the protocols being such that the dose to children is higher than necessary to make good images, both manufacturers AND radiologists have to be involved in the solution.

Re:FDA is going to cause more harm than good (0)

Anonymous Coward | more than 2 years ago | (#39962807)

Disclosure: I work for a medical equipment manufacturer. We make medical imaging software, a variety of other software used in clinical contexts, and a bevy of imaging modalities. Other than having assisted in the development of some of this software, I am by no means an expert on medical imaging, a radiologist, or an expert on medical device regulation, so take the following observations with a big pile of salt.

1. Go do a web search for the words "low dose imaging" and poke around. This is very much a hot topic among manufacturers.
2. Radiology workflow solutions are starting to advertise dose monitoring as a major feature, so that radiologists will be notified if their patients are in danger of excessive expsoure.
3. I really, really can't see manufacturers labeling all their devices as not for pediatric use. It's not totally out of the question - "intended use" is a very well defined area in this line of business for exactly this reason. But it's more likely that a manufacturer would word the intended use in such a way to exclude excessive dosage.

X-Ray Film stock versus Digital Imager (0)

Anonymous Coward | more than 2 years ago | (#39961145)

What are the dose differences between older machines that need to develop film versus those that use a CCD or such instant imager?

Well (0)

Anonymous Coward | more than 2 years ago | (#39961195)

Every time a doctor/hospital/clinic orders a scan of any type, they can bill you or your insurance company a huge fee. The more advanced the scanning equipment, the more they can bill. (hence the popularity of CT scans when a plain old X-ray would be fine)

It does not matter if they find out what they already knew from a physical exam with the scan. (aka if they find nothing broken or nothing they didn't already know)

It does not really even matter if it's a duplicate scan for a known injury, they can bill for it anyway.

It doesn't matter if the scan was even medically justified, since said justifications can easily be papered up by the people filling out the claim forms.

Since each scan is just money in the pockets of whoever is doing it, they're going to order them as often as they possibly can.

I look forward to (1)

oDDmON oUT (231200) | more than 2 years ago | (#39961335)

The FDA regulating the TSA.

Those full body scanners've got to go.

Increases Dependence on Radioactive Spider Bites (1)

retroworks (652802) | more than 2 years ago | (#39961449)

Law of supply and demand dictates we need superheroes. Artificially reducing the number of X-Ray superheroes will upset the unnatural balance.

Does this include the TSA? (1)

bryan1945 (301828) | more than 2 years ago | (#39961897)

N/T

On the other hand... (2, Insightful)

Anonymous Coward | more than 2 years ago | (#39962775)

As a trauma ER nurse who just last night treated a 3 year-old who fell 35 feet out of her apartment window, I agree with the sentiment of the effort without agreeing with the implementation.

Sometimes, the extended waiting and confusion caused by more red tape can destroy a child's life sooner and with more pain than the possibility of radiation exposure.

If we had to produce written statements, warnings, and consents instead of a verbal okay from the parents last night before that girl's CT and head to toe X-rays, the case may have turned out with a funeral this weekend.

You know what can cause lifelong problems in the development of a child? An undiagnosed femur or C-spine fracture with a delay in assessment of an abdominal bleed.

My kid... damn doctors (0)

Anonymous Coward | more than 2 years ago | (#39962891)

So some newb doctor (I can look back and say that now) decided my few month old kid needed some major CT scan because he had a flat spot on the back of his skull (from difficult childbirth) that was slow to round out. I think it was either that or his head was slightly larger than average, or both things. Never mind he's half white and half Asian... no that wouldn't possibly change the average shape and size of the head now would it?!?!?! (I can look at my nephew, 100% Japanese, and realize that my kids head was similar to his with some Caucasian influence).

So anyway, it was all a load of complete CRAP that my kid would need some huge doses of Xrays to prove that he's completely fine. Better than that, my kid (much older now) is smarter than all the kids in his fucking class, thank you very much, you God damned medical idiot.

I swear, the older I get the less impressed I am by the average medical doctor I run into. And looking back, all the people I knew in college who went into medicine were just memorizing junkies who couldn't think themselves out of a mouse maze. I had a Dr. in the not so distant past that used a handheld to look up symptoms and another who just plain admits when I know more about him because I just researched it for 2 days before I went in to see him. At least they aren't afraid to admit it... there is no harm in not knowing everything... I sure don't know it all, so how can I expect them to?

Anyway, what's a parent to do? You hope the Dr. halfway knows what they are talking about... you hope the risk for a scan isn't too large if it can find some curable problem. But really, the Dr.'s just love bullshit tests so they get more $$$. It's easy for them too, they just send you on your way and look at the results while sipping coffee and dreaming about memorizing facts that are more accurately found on a computer.

I hope my kid doesn't get cancer at age 25... because if he does I'm blaming the medical idiots for it....

The Dentist (0)

Anonymous Coward | more than 2 years ago | (#39963045)

Anyone who visits their dentist every 6 months to a year for x-rays is a fucking idiot who must secretly lust for cancer to ravage their body and leave them as a statistic.

Take care of your teeth and gums and eat right, and you shouldn't need to allow someone to blast you with x-rays so frequently.

I'm now starting to notice cancer warning signs outside of dentist offices and inside/outside some fast food places, this is simply sick.

What? (0)

Anonymous Coward | more than 2 years ago | (#39963067)

I don't understand this at all.

In my experience doctors don't just order tests or imagery because it's fun. They do it because they need it, or because you present with symptoms that could be something serious. If a kid is getting repeated X-Rays, in most cases it's time to call CPS, not accuse the doctor of excessive use of imagery.

A doctor doesn't want to tell you it's stomach flu and send you home only to find out that you have abdominal cancer (as happened to a member of my family) and then turn around and sue them (did not occur with a member of my family, she died). That's the main reason for unneeded tests; they're a CYA to protect against ambulance chasing attorneys.

From a doctors point of view, this is like an NEO. It's a very low probability event, but it's catastrophic when/if it occurs. Missing a diagnosis these days could cost you your practice and every penny you and your family have, all because you didn't order that CT scan and the patient/family got a good lawyer.

In short, if the feds want to regulate something to death, how about the trial attorneys?

What the fuck is ct? (0)

Anonymous Coward | more than 2 years ago | (#39963519)

What the fuck is ct?

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