- Email: [email protected]
Re: “Patient radiation ID cards”
LETTERS TO THE EDITOR Re: “Patient Radiation ID Cards” In the June issue of JACR, Drs. Morin and Payne [1] provided guidance on an important aspect of radionuclide therapy: patients’ radiation safety handling after administration. These guidelines will be helpful as changes in patient release criteria are implemented. Guidelines for equally important aspects of radiation safety practices involving radionuclide therapy patients must be considered. Frequently, patients with diagnoses of thyroid disease have multiple medical, physical, social, or mental problems. Some are institutionalized. Nursing an infant is addressed in the cited article, but incontinence, incarceration, special-needs bedside care, and low learning capability are not addressed. For such patients, a selection of the 0.25 “fractional exposure factor” for the most highly exposed member of the general public must be evaluated for its validity. If indicated, a greater factor should be chosen, resulting in a lower body burden of 131I on patient release. In some cases, more than a single individual may be involved in postadministration care of, or contact with, patients. In a few instances, no other individual is associated with a patient on release. Consideration should be given for all individuals involved in patients’ care. What guidelines should we use to evaluate the practical selection of the “factor” used? Patient compliance is a factor in the change in release criteria. The competent assessment of patientspecific criteria (not addressed in the cited article) is a critical portion of the patient release evaluation. What guidelines should be used to evaluate a patient’s status and capability for compliance? What home conditions and family situations should be evaluated? Should a pa-
tient be released to go to a hotel or motel? The use of radionuclide labeled monoclonal antibody therapy has received acceptance and could be expected to substantially increase in usage in community hospitals. Will the model guidance [2] cited in the article be suitable for the new drug therapies? Indeed, will the current regulations be suitable for a large increase in use? If not, is there a more universal approach? Also noted: the US Nuclear Regulatory Commission has precluded the issuance of instructions identifiable to specific patients. What guidelines should be used to deal with Health Insurance Portability and Accountability Act considerations, yet cover legitimate safety, regulatory, and liability concerns in the issuance of instructions? A more complete discussion of the issues cited above would contribute to authorized users’ general understanding, acceptance, and uniform use of the new criteria. David William Switzer, MS, Northern Rockies Radiation Oncology Center, 1041 North 29th Street, Billings, Montana 59101; email:[email protected] REFERENCES 1. Morin RL, Payne JT. Patient radiation ID cards. J Am Coll Radiol 2004;1:427-9. 2. US Nuclear Regulatory Commission. Regulatory guide 1556, 9(8):75-8. DOI 10.1016/j.jacr.2004.09.020 ● S1546-1440(04)00427-2
Re: “Mammography and the Risks of Engagement” I enjoyed Dr. Michael Pentecost’s [1] column in the November 2004 issue of JACR on mammography and the risks of engagement, but I must disagree with his concluding comment that “if mammography didn’t exist,
© 2005 American College of Radiology 0091-2182/05/$30.00 ● DOI 10.1016/j.jacr.2004.09.020
organized radiology would be spending a fortune to invent it.” I can’t imagine that organized radiology would focus its resources on developing a technique that would prove to be the most risk-laden, anxiety-producing, and trouble-ridden part of diagnostic imaging. The falsepositive and false-negative rates quoted by Dr. Pentecost are distressing enough, but even more important to the population of women and the radiologists who read their mammograms is that the benefits of mammography are modest, at best. Even the most optimistic estimates place the mortality reduction from breast cancer in a screened population at 30%, which means that for 70% of women diagnosed with this disease, their mortality rate will be unchanged. Because the average-risk American woman has a 3% lifetime risk of dying of breast cancer (a number that is routinely overestimated by an order of magnitude in surveys of women), under the best of circumstances, screening mammography as it is currently practiced will reduce that risk to about 2%. The general public has been repeatedly encouraged by the medical profession to undergo mammography in an attempt to bring mammography’s benefits to all women. As an unintended consequence of this encouragement, the popular expectation now is that mammography is perfect. Reading radiologists are now held to a de facto standard of perfection rather than the standard of care rendered by an average, similarly trained and similarly qualified radiologist. In addition, breast cancer has become more than a disease in our society: it has moved into the realm of being a political cause and therefore into the legal and societal arenas, where radiologists have limited influence. (Why is there a mandate for radiologists to inform women who have 93
tient be released to go to a hotel or motel? The use of radionuclide labeled monoclonal antibody therapy has received acceptance and could be expected to substantially increase in usage in community hospitals. Will the model guidance [2] cited in the article be suitable for the new drug therapies? Indeed, will the current regulations be suitable for a large increase in use? If not, is there a more universal approach? Also noted: the US Nuclear Regulatory Commission has precluded the issuance of instructions identifiable to specific patients. What guidelines should be used to deal with Health Insurance Portability and Accountability Act considerations, yet cover legitimate safety, regulatory, and liability concerns in the issuance of instructions? A more complete discussion of the issues cited above would contribute to authorized users’ general understanding, acceptance, and uniform use of the new criteria. David William Switzer, MS, Northern Rockies Radiation Oncology Center, 1041 North 29th Street, Billings, Montana 59101; email:[email protected] REFERENCES 1. Morin RL, Payne JT. Patient radiation ID cards. J Am Coll Radiol 2004;1:427-9. 2. US Nuclear Regulatory Commission. Regulatory guide 1556, 9(8):75-8. DOI 10.1016/j.jacr.2004.09.020 ● S1546-1440(04)00427-2
Re: “Mammography and the Risks of Engagement” I enjoyed Dr. Michael Pentecost’s [1] column in the November 2004 issue of JACR on mammography and the risks of engagement, but I must disagree with his concluding comment that “if mammography didn’t exist,
© 2005 American College of Radiology 0091-2182/05/$30.00 ● DOI 10.1016/j.jacr.2004.09.020
organized radiology would be spending a fortune to invent it.” I can’t imagine that organized radiology would focus its resources on developing a technique that would prove to be the most risk-laden, anxiety-producing, and trouble-ridden part of diagnostic imaging. The falsepositive and false-negative rates quoted by Dr. Pentecost are distressing enough, but even more important to the population of women and the radiologists who read their mammograms is that the benefits of mammography are modest, at best. Even the most optimistic estimates place the mortality reduction from breast cancer in a screened population at 30%, which means that for 70% of women diagnosed with this disease, their mortality rate will be unchanged. Because the average-risk American woman has a 3% lifetime risk of dying of breast cancer (a number that is routinely overestimated by an order of magnitude in surveys of women), under the best of circumstances, screening mammography as it is currently practiced will reduce that risk to about 2%. The general public has been repeatedly encouraged by the medical profession to undergo mammography in an attempt to bring mammography’s benefits to all women. As an unintended consequence of this encouragement, the popular expectation now is that mammography is perfect. Reading radiologists are now held to a de facto standard of perfection rather than the standard of care rendered by an average, similarly trained and similarly qualified radiologist. In addition, breast cancer has become more than a disease in our society: it has moved into the realm of being a political cause and therefore into the legal and societal arenas, where radiologists have limited influence. (Why is there a mandate for radiologists to inform women who have 93