the late harmful effects of radiation doses of hundreds of roentgens become apparent. Yet in spite of the overwhelming evidence which is available in medical literature, a user of the nasopharyngeal applicator stated that after 24 years during which many thousands of patients had been treated not a single instance of burn or other complication due to the use of radium had been observed. “* * * Claiming that there are no ill effects from large radiation doses is `meaningless, as we state again and again, unless the same group of patients is followed up for many years. Dr. L. A. Schall, radiologist of Boston, commenting on the radium applicator, said, "To state that "I have used the method for 17 years (or longer) and have never seen a bad result” raises a doubt as to one's powers of observation as well as to the thoroughness of the examination.' "Drs. M. D. Schulz and L. L. Robbins, of the Massachusetts General Hospital -and the Collins P. Huntington Memorial Hospital in Boston, have made many followup studies of the effects of radium treatment given at these hospitals for 30 years. In a paper published in 1949 they conclude: ""The effect of overtreatment [of benign lesions with radium] *** may be marked by an apparent immediate cure or marked improvement, and the serious injuries may never be known to the doctor who administered the radium unless he had the facilities for a careful followup of each patient over a period of many years. Even today the exact effect and the final result of X-ray or radium irradation cannot actually be foretold.' "In 1949, in the professional journal, Laryngoscope, the same authors wrote: "[Physicians] have become nervously aware of the growing tendency to give larger and larger doses and to incorporate the method as a routine part of tonsillectomy. That radiation of any sort should become a routine is unwise. *** Lack of an immediate reaction should not lull to rest the fears for possible latent reaction. Decision to treat a benign condition with so potent an agent as X-rays, radium, or any other radioactive material should be made only after careful consideration of each given case and after weighing the known beneficial results against the unknown dangers which may not appear for as long a time as 10, 20, or more years. "The use of diagnostic X-rays in pediatric practice presents a very disturbing picture. Let us start the story with the report of H. M. Parker, physicist now in charge of radiation safety at the Hanford atomic energy works, and Dr. Franz Buschke, radiologist, of Seattle. In 1941, they presented a joint paper on Possible Hazards of Repeated Fluoroscopies in Infants' to a meeting of pediatricians, the substance of which was later published for the profession in the Journal of Pediatrics in 1942. They pointed out that some pediatricians give monthly fluoroscopy to infants the first 6 months of life, and that some continue through the first and second years. The potential hazard of fluoroscopic examination to infants is very high, particularly in view of the large dosage delivered. This hazard is increased because 'even many specialized radiologists do not know the actual output per minute of their diagnostic machine.' In referring to a report which revealed the inadequacies of protection by even some specially trained doctors, the authors state that 'we can hardly expect a greater appreciation of these potential dangers where equipment used in office practice by physicians not specializing in radiology is concerned.' **** In order to check the potential hazards, Buschke and Parker measured the actual amount of radiation delivered during fluoroscopic examination of infants. They investigated seven machines selected at random and used in offices of reputable pediatricians. Not all the seven pediatricians did routine or even regular repeated fluoroscopies, but Buschke and Parker found that all seven had one thing in common-none of them knew how many roentgens their machines were delivering. "Here are the facts: The average dose given by all the machines was 25 roentgens per minute. Assuming that the average rapid fluoroscopy by an experienced examiner takes about 20 seconds, this means an average of 8.3 roentgens, or 100 roentgens in the first year of life (if routine monthly fluoroscopies are done). However, Buschke and Parker state that 'we know from experience that some of the fluoroscopies last considerably longer*** They found one machine delivered radiation at the rate of 200 roentgens a minute a dose rate high enough to cause death from radiation within a month following a 10-minute continuous exposure. Buschke and Parker's paper appeared in 1942. Did it have any effect on the overuse of fluoroscopy? A survey has recently been made by Drs. Valaer and Zavon of the College of Medicine of the University of Cincinnati. Writing in the Journal of the American Medical Association for October 1956, Dr. Zavon gave a preview of their findings: 'What is most disquieting is that the situation described in 1955 is virtually unchanged from that described by Buschke and Parker in 1942.' "There is no need to comment on the clearly expressed statements made above. Additional evidence of overuse of the fluoroscope in pediatric practice is that of Dr. Sonnenblick and associates of the Newark Beth Israel Hospital in New Jersey. They checked the radiation doses delivered by 63 fluoroscopic units located in large cities in New Jersey. These units were located in hospitals and doctors' offices. In brief, they found that the pediatricians' fluoroscopes were delivering from 3 to 46 roentgens per minute and in one pediatrician's office the dose delivered to older children was 116 roentgens per minute. A return visit 3 months later showed about the same readings. According to Dr. Sonnenblick, the doses mentioned are minimum doses. Again, none of the physicians knew the roentgen output of his machine. "These results were so disquieting to Dr. Sonnenblick that he studied the roentgen doses given by 54 more fluoroscopes in two States. Again he found that the machines delivered minimum doses of from 2 to 118 roentgens or more per minute. Twenty-one percent of the machines delivered more than 30 roentgens per minute. He concluded: "Almost all physicians concerned are completely unaware of the X-ray output of their instruments and few realize the necessity for calibration. Whether a high or low dose is received by the patient seems merely fortuitous.' "Examples of nonmedical carelessness “*** One such use of X-rays remains etched in our memory: We recall that on February 25, 1956, Hildegarde, the singer, bared her heart to the fluoroscope for the benefit of the Chicago Heart Fund. She stood in the window of the Chicago Federal Saving & Loan Association while Leo Wenger, a sculptor, ob served her heart through a fluoroscope and sculpted his impression of it. This was labeled 'Art for Heart' and was part of a promotion stunt to remind Chicagoans of the heart fund drive. "Nor can we forget the television program 'Omnibus,' which one Sunday in 1952 displayed a fluoroscopic study of a girl as she daintily daubed her lips with lipstick. The event was notable enough to be reproduced in Life. A single "A more serious radiation hazard is presented by the use of the fluoroscope in prisons and industrial establishments. Known as the 'Inspectoscope, it is used to detect concealed weapons, instruments, or pilfered items. exposure of 6 seconds gives 0.1 roentgen but higher and longer exposures occur to say nothing of repeated exposures on the same person. The operators of these machines, according to a survey made in Michigan, receive about 0.1 roentgen per day for each 50 visitors inspected. This is about twice the permissible daily allowance. According to an article in This Week magazine for May 1, 1953, the operator of the Inspectoscope at San Quentin Prison scans the insides of between 40,000 and 50,000 visitors a year. Remember, this is whole body radiation. Many people are exposed 50 or more times a year to the Inspectoscope. In the entire article not one mention was made of the potential hazards of such radiation exposure. **** Fluoroscopes and X-ray units are widely used in post offices for examining packages, and in conservation departments to aid in identifying banded animals. In connection with the latter, the head of the Michigan Department of Health was surprised to find, when making a survey of X-ray equipment used in the State, that in one wildlife research project workers held banded ducks while they were being X-rayed. These men were X-rayed as many as 400 times a day. chiropractors, and veterinarians. The literature is full of descriptions of in"There are roughly 15,000 X-ray and fluoroscopic units used by osteopaths, juries suffered by these men and some of their human patients. It would be ind teresting to survey the output of these machines and the amount of scattered any more carefully than those operated by physicians and hospitals.” [NOTE. Subsequently several surveys of veterinarian radiological practices have appeared and many careless practices found. For example, see May 1957 issue of the New York State Department of Labor Monthly Review, Division of Industrial Hygiene.] "*** The most inexcusable situation, however, is the giving of excess doses of radiation to children simply in the course of routine examinations or for a trivial and unnecessary item like shoe fitting. Let us first look into the shoefitting business. "According to U.S. Public Health Service reports, there are approximately 10,000 X-ray shoe-fitting machines in use in the United States. Besides the thousands of children who are exposed to these machines, we must include 40,000 salespeople as well. The State of New York has at least 750 shoe fluoroscopes as of 1956, and there are well over 500 in use in Michigan. In Zurich, Switzerland, some shoeshops have as many as five machines in constant use on busy days. Some clerks deny that these shoe machines are X-ray devices but say that they are 'Pedoscopes'-the trade name. Obviously it is important to know precisely the radiation doses received by the children as well as by clerks and other persons in the vicinity. "The Michigan Department of Health has investigated the operation of more than half the shoe-fitting machines in the State. The results of the investigation can be taken as a good index of the state of affairs applying to the country as a whole. Here are some of the findings reported in 1951: 85 percent of the machines were found to be unsatisfactory in one way or another; the X-ray beam was too strong in 51 percent (some gave as much as 65 roentgens a minute); the timing device was unsatisfactory in 60 percent (meaning overlong exposure); and in 50 percent there was a great deal of scattered radiation which in one instance exposed nearby people to as much as 0.7 roentgen per hour. RECOMMENDATIONS The final chapter of the book, "Radiation," written by Dr. Ralph E. Lapp and myself and published in 1957 by the Viking Press, gives specific recommendations on the control of radiation hazards and the types of legislation required. Many of the activities we suggested are applicable directly to the FRC. Along with the recommendations made in our book I also support, in general, the specific recommendations made by Dr. Lapp in his supplemental statement. Therefore, it would be redundant for me to tabulate similar material. I would like to reemphasize, however, that the successful functioning of the FRC requires adherence to at least two factors. One factor is that of granting enforcement powers with compulsory features to the FRC. The other involves procedures for choosing advisory personnel. The FRC should avoid the pitfalls associated with selfappointed, self-perpetuating committees of scientists and to choose advisers for their scientific and professional competence and not because of their organizational connections alone. The Federal Radiation Council should take pains to include competent critics of past and present policies on radiation hazard evaluation and in this way to strengthen not only the political impact of their decisions but to strengthen the scientific integrity as well. (Thereupon at 4:35 p.m., a recess was taken until Thursday, June 2, 1960, at 10 a.m.) ROTECTION CRITERIA AND STANDARDS: THEIR BASIS AND USE THURSDAY, JUNE 2, 1960 CONGRESS OF THE UNITED STATES, JOINT COMMITTEE ON ATOMIC ENERGY, Washington, D.C. tee met, pursuant to recess, at 10:05 a.m., in room Hon. Chet Holifield, chairman of the subcommit sentatives Holifield, Van Zandt, and Hosmer. ames T. Ramey, executive director; Carey Brewer, d_Richard T. Lunger, professional staff members; James E. Turner, technical consultants. HOLIFIELD. The committee will be in order. tee will continue its study of radiation protection dards. Our topic this morning is organizational, id legislative relationships and problems. Our first ing will be Mr. Elmer B. Staats, Deputy Director of Budget. ELMER B. STAATS,1 DEPUTY DIRECTOR, BUREAU \ET; ACCOMPANIED BY GORDON OSBORN AND ER, BUREAU OF THE BUDGET STAFF r. Chairman, it is my understanding that it is the nittee to have us return here this morning to respond ints which have been raised during the course of the latter of assistance to the committee, and to expedite this from our point of view, it occurred to us that be well for us to list some of these points in the ent, which we have done. It may be that there are ou would like to address to us in the light of these ; agreeable, I will read this statement, which is rela HOLIFIELD. You may proceed. r. Chairman and members of the committee, I am his opportunity of returning to testify concerning onal issues raised during the course of the commitadiation standards. ›n p. 86. 441 |