Answer to Question #10975 Submitted to "Ask the Experts"

Is there a regulatory body in a state that monitors procedures and has an exact amount of radiation that is "over the limit"? I was told that in hospitals and doctors’ offices it is at the discretion of the physician, but I thought that there was some agency that could regulate and say that x-amount of radiation was too much. I also know that there are physicists who check equipment and monitor the radiation, so are there guidelines that they make the doctors aware of? There seems to be a large amount of radiation in surgery, and the use of the C-arm, while beneficial, can lead to other problems further down the road. I just wanted to know if there are any laws, agencies, charts, etc., that regulators go by during these procedures.

The answer to your first question is that there are no radiation regulations nor any regulatory bodies limiting diagnostic or therapeutic medical radiation doses to patients. The physicians are educated in radiation biology, radiation protection, and the use of radiation in imaging and therapy and use only the amount necessary to diagnose or treat disease. Since each patient presents a unique set of circumstances to the physician, the use of radiation must be adjusted for each patient, so setting radiation limits is neither feasible nor in the best interest of patient medical care.

There are guidelines established by international and national authorities for ranges of radiation dose with something called a reference level established for some diagnostic imaging procedures. The reference levels are set at the amount of radiation dose 75 percent of the patient population might receive from that particular procedure. But a difficult or exceptionally large patient might need a radiation dose in excess of that reference level in order to get images of appropriate diagnostics quality so the physician can properly assess the patient’s medical condition. The reference level is NOT a limit, but a guideline.

In the hospital environment, the diagnostic medical physicists work with staff and physicians to evaluate the performance of the equipment to ensure that it is working properly, and conduct training with staff and physicians on the reference levels. 

Where did you get the idea that there is “use of a large amount of radiation in surgery, and the C-arm?” As a diagnostic imaging physicist for 21 years, I monitored patient radiation doses and the use of the C-arms, and at no time was an excessive or a large amount of radiation used. The physicians only use the C-arms to “see” what they are doing in the most noninvasive way, which reduces the risk of invasive surgical procedures, thus limiting the risk of complications from surgery and enables the patient to recover more quickly. There are select groups of physicians who use fluoroscopy procedures to visualize small vessels in the brain, heart, and arterial systems, and those procedures need more radiation for proper visualization. They are performed in specialty labs, such as the neurological, vascular, and cardiac suites.

Jean Gresick-Schugsta, DABR