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Depiction of a scene from
Voltaire's Candide (1759) |
After
the reactors in Fukushima exploded in March 2011, residents of the affected
areas were advised to keep a journal recording, as best as they could remember,
their movements and diet over the weeks just after the disaster. This would
help them in the future if they developed health problems or wanted to make
claims for compensation. This was an onerous task, but it was no doubt a
necessary and excellent idea. In fact, it turns out that it might be a good
idea for everyone to maintain such a journal over their lifetime.
Everyone
alive today is getting exposed to radiation above what was once natural
background – a term which may not mean what it used to because “natural” radon
levels are confounded with the radon put into the air because of industrial
activities. We live in the fallout from weapons testing and nuclear accidents,
live near weapons factories and nuclear fuel processing sites, we spend long
hours in airplanes, we get x-rays and other radiological medical procedures,
and we face higher exposures to all of these if we are one of thousands of
people classified as “radiation workers.”
Dr. Kristen Shrader-Frechette
has made the case in a scientific journal for a national radiation dose
registry (RDR) for American radiation workers. The number of workers classified
as such would surprise most people:
“In
Canada, whose population is one tenth that of the United States, there are more
than 550,000 radiation workers in more than 80 occupations. These include not
only nuclear workers (those employed in commercial nuclear-power generation or
by those who build and test nuclear weapons) but also radiation workers who are
employed in academic research, food processing, industrial imaging, weld-defect
inspection, leak tracing, automobile-steel testing, mineral-deposits discovery,
and so on. In Switzerland, radiation workers number 60,000; in South Korea, 65,000.
In the United States, 1.5 million radiation workers are occupationally exposed
to ionizing radiation each year. Of this number, 300,000 nuclear workers are
employed in the commercial nuclear industry.” She adds further in her paper, “…
no nation routinely measures cumulative radiation dose and risk from all sources
and all exposure classes, even for high-exposure workers.”
Shrader-Frechette’s
paper points out the deficiencies of present practices meant to control and
track exposures only on the job, and only in limited time frames. A nuclear plant
worker who is close to his annual limit for workplace exposure faces a dilemma
if his doctor tells him he needs to have a whole-body computed tomography (CT)
scan, with an exposure that might add 10 mSv to his workplace exposure. His
health might be endangered, and this will put him over the limit, but as far as
his employer is concerned, he can still work because the medical exposure is
not counted. Incidental and unknown exposures will also not be counted. Not
counted is time spent in airplanes at 30,000 feet, time spent in basements with
high radon levels, time spent sitting beside people who have recently had
radiation therapy, or the cumulative lifetime exposure from x-rays and medical
scans.
This
concern may sound alarmist and exaggerated, but considering the millions of
people affected on and off the job, it would seem wise to apply the
precautionary principle. No one can prove that radiation has not contributed to the increasing rates
of cancer and endocrine and neurological disorders; whereas there are plenty of
research findings that suggest it has been a factor. On both sides of this
controversy there is no debate that radiation damages DNA, proteins and cell
structures.
It
is strange that Shrader-Frechette’s paper includes so many occupations as radiation
workers but excludes medical personnel. In recent years, there have been
numerous reports
of radiological negligence by medical equipment manufacturers and
technicians. Medical experts are also sounding the alarm about complacency and
sloppiness in radiological treatments within medical institutions. It is common
for insufficiently trained staff to be exposed without being aware of the
hazards around them. (Supporting sources, with cited text have been placed at
the end of this article).
Someone who begins a nursing career today
might want to keep one of those Fukushima journals, or even a dosimeter badge,
in order to know twenty years later what her long-term exposure was.
This
is not far-fetched because Shrader-Frechette concludes that the Radiation Dose
Registry should be extended to “… include medical and occupational radiation
exposures for the entire US population. At a fourth stage, all fallout,
accident, consumer-product, and other exposures for the US population might be
added.”
Such
is the state of radiation risk management in developed nations. In other parts of
the world, radiation risks are often higher, but public awareness is
non-existent and controls are utterly lacking. The French NGO CRIIAD (Commission de Recherche et
d'Information Indépendantes sur la Radioactivité) reports this month on the
appalling situation in Niger where French uranium mines have failed to stop
radioactive scrap metals from being sold throughout the country or shipped
overseas. The report states:
“The
scrap metal is contaminated with heavy metal isotopes associated with uranium,
such as uranium 238, thorium 230, radium 226, lead 210, and polonium 210. This
results in an external irradiation of the population and a risk of internal
contamination, depending on how the recycled scrap is used (domestic use is a
possibility). Certain of these substances are particularly radiotoxic when
ingested or inhaled. The contamination is long-term, considering the long
half-life of uranium 238 (4.5 billion years) and radium 226 (1,600 years). The
bad practices of Areva’s affiliated companies thus leads to an increased health
risk to the population, and beyond to other groups in the event of sales to
foreign countries.”
These
uranium mines in Niger have had a long, difficult relationship with the locals.
When Tom Zoellner was writing his book Uranium,
his first attempt to visit the mines was stopped by an attempted attack on the
bus he was on. It was then that he learned about the local rebel groups and
their resentment about the pollution from the mines and their failure to bring
economic development. Yet the French are utterly dependent on the mines for
their energy supplies, just as they have other vital interests in Algeria and
Mali that that they are being forced to protect quite robustly this year. If
Voltaire were alive today he would say, “C’est à ce prix que vous vous chauffez
de l’électricité en Europe.”
This
scrap metal being resold overseas is a fitting illustration of reaping the
whirlwind. The people in Niger handling this scrap may be much more deserving
of a proper Radiation Dose Registry, but their dilemma also means that the
scrap will go, for example, from Niger to China to your tissue containers or your child’s bicycle basket.
And
it’s worse than just a couple isolated cases
A
Scripps Howard News Service investigation looked at NRC records and
the current state of reporting on radioactive materials, turning up numerous
flaws in the U.S.'s current system, and finding a wide range of cases in
which radioactive materials and products were brought to the U.S.
NRC records show 18,740 documented cases involving radioactive materials in
consumer products, in metal intended for consumer products or other public
exposure to radioactive material. The U.S. Government Accountability Office
estimates there are some 500,000 unaccounted for radioactively contaminated
metal objects in the U.S., and the NRC estimates that figure is around is 20
million pounds of contaminated waste. [emphasis added]
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All the more reason for everyone
to start wondering about their lifetime cumulative dose of radiation.
Radiological Hazards for Patients
and Medical Professionals
“For
patients, unnecessary procedures (usually imaging procedures) and radiation
dosing errors represent the bulk of risk from medical radiation, whereas
incidental, unintended radiation exposure is the primary concern for nurses
and other health care workers…
Radiotherapeutic
advances like intensity-modulated radiation therapy (IMRT), for example,
allow escalated radiation dose delivery to tumors while minimizing
irradiation of a patient’s healthy, nontarget tissue. However, these advances have come with increased risks
when targeting errors occur, such as those caused by patient movement or
improper patient setup. IMRT
also requires complex three-dimensional (3-D) computed tomography (CT)
planning examinations that may frequently involve unnecessarily high
radiation doses. Combined
with an upward trend in patient radiation doses over recent decades, and
improved cancer patient survival times, such considerations raise troubling
questions about medically unjustified radiation doses and secondary tumor
risks…. Medically unnecessary
CT scans are prescribed for up to 20 million American adults and 1 million
children each year. A 2007 analysis concluded that up to 2% of
cancers diagnosed in the United States may be attributable to CT
examinations. The justification of any radiological imaging must always
be scrutinized, particularly in pediatric cancer patients, for whom any
radiation poses a larger lifetime risk for secondary cancer than for older
cancer patients. The availability and sufficiency of alternative imaging
modalities that do not involve ionizing radiation, such as magnetic resonance
imaging (MRI), should always be considered. Despite numerous calls for
electronic medical records (EMRs) to include cumulative radiation dose
information, only a handful of US hospitals and medical groups have adopted
such systems to date.”
About
the author: RN, Director of Invasive Services, Baptist Cardiac & Vascular
Institute, Miami, Florida; Program Director, Innovations in Cardiac and
Vascular Care: Advanced Interventions for Nurses and Technologists, The
International Symposium on Endovascular Therapy (ISET):
“One of the root causes of excessive radiation
exposure arises from the fact that many in the healthcare field who work with
radiation have received only rudimentary radiation training. Whereas
interventional radiologists are trained in the safe use of radiation,
interventional cardiologists and vascular surgeons, for instance, typically
receive minimal radiation training. Because they typically are
unfamiliar with all of the sources of radiation exposure, they may know
little about risk-reduction and safety strategies. Compounding
the problem is that, while a radiologist’s key team member is a radiologic
technologist (who also has received radiation safety training), an
interventional cardiologist or vascular surgeon’s key team member may be a
nurse, who likely has received little to no radiation safety training. That’s
not to say that all radiologists employ best radiation safety practices, either. Despite
their training, many of them have become complacent.
Additionally, we often use far more radiation than
necessary. In the United States, there is an increased emphasis
on ensuring the highest quality images, which means more radiation. That’s
not the case in Europe and Japan, where safety is more highly valued. The
ideal dose is the least amount of radiation possible to produce an acceptable
image. A good operator knows how to produce good images without
excess radiation.”
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Sources:
C'est à ce prix que vous mangez du
sucre en Europe.
It is at this price that you eat
sugar in Europe.
Words of
the black slave of Suriname in Voltaire’s Candide,
chapter 19. 1759.
