X-ray procedures and Black people

This is done pushing. I'm going to be talking today with Dennis Lawrence who does the program's untitled Science Report here on KPFA and with Chester Aaron who is Chief Technologist of the X-ray department at all to Bates Hospital in Berkeley. We're going to be talking about the use of X-rays for Negro patients and I'd like to ask Denis Lawrence for us to start out by explaining a little bit of what the problem is. What seems that Mr. Aron discovered about five years or so ago that X-ray technicians routinely give negroes heavier X-ray exposures because they have been victims of some theory about thicker skins. And Mr. Aron feels that this is probably not such a good idea could you explain Highness here. Yes. The Before I explain why let me say that. Many of the people who approached me on this that I understand four or five years ago you discovered this. Actually it was more than four or five years ago it was almost 10 years ago almost 10 years and

at that time the x ray technicians in the East Bay organized an independent union an association of X-ray technicians to do the bargaining for the X-ray technicians in the bay. And at that time I had heard about this strange phenomenon and I requested along with the questionnaire which went out to all the technicians asking them various questions not just about their union sympathies or antipathy so I suggested the various other questions be put in one of them being do you give extra radiation to Negros. Yes or no if yes why. And at that time there were 60 technicians in the organization who were being who had received the question questionnaire. And out of the 60 technicians 53

returned the questionnaire saying yes they get extra radiation and the reasons varied from because they have darker skin because they have thicker skin because they have thicker bones because they have harder bones because their tissue is denser or variations of combinations of these. And that was 10 years ago and since then although I have tried to get this information to the officials that I thought would be responsible for acting on I've been successful in getting it to them but I've not been successful in getting and act on one. Whenever I get an X-ray a chest X-ray they put a big lead apron around my waist and all the technicians go off and hide in another room. So I've always had the impression that X-rays probably aren't good for you as some other things Secretary.

Well ideally of course no one should get no X-rays during his lifetime. But there is no question no doubt about it that the as a diagnostic tool the X-ray picture or the X-ray machine is by far one of the most important ever to be device designed or invented. And the contribution to medical knowledge to patient care to the improvement of health is enormous. But there is no denying the fact that in many instances X-rays are absolutely necessary in some instances. It might be argued by one radiologist or another that the X-ray is not as necessary as the referring to things that might be. And even among radiologists they'll very often disagree as to not only how

necessary the X-ray is but how involved it should be and as to the technicians running. You're very right there. There is a very real awareness on the part of the X-ray technicians of the potential hazards or what are the potential hazards. Well let me let me say first that throughout this interview I'm going to be very careful not to become pretentious to the point of where I tread where I sound like a physicist or I sound like a like a doctor I'm neither. And I don't want to pretend to be. But there is a fairly common agreement among medical people people in health physics and so forth that the hazards can vary depending upon the patient and the state of health in which the patient is when you get X-rays. For instance recently in Time

magazine about a year ago in Time magazine Carl Morgan who is a health physicist at Oak Ridge Ridge I think Oak Ridge National rate of negotiation said that there was a well he gave very real figures something on the on the order of. Approximately thirty thousand I think is 30000 deaths a year which could be attributed to radiation excessive radiation. Now a lot of health physicists dispute this and a lot of health physicists and radiologists rose up in great wrath both That is stating it and that the publicity the time gave it. And I have spoken to health physicists here in the area and I have asked them you know what they thought of Dr. Morgan's figures and

they said well you know he's a he's an old curmudgeon he's a provocative and. He's done a lot of good but he's also done a lot of harm. Well I've had a fairly lengthy correspondence with Dr. Markham and one of the things that I've discovered is that he is intensely interested in what many of us in X-ray are intensely interested in and that is not in eliminating x ray as a diagnostic tool but in cutting down work ever it is possible the amount of radiation the patient receives. And there are many many ways to go about it. He recommended in various appearances before various committees he recommended many. I have my own ideas about how these could be cut. And I think that the important thing really to stress is to

try not to frighten. It is the attempt to keep from frightening patients from getting x rays. Unfortunately you almost have to. You are at the mercy of your physician who says you need an X-ray because very few people can dispute their physician who. And if your physician says you need a chest x ray or you need a G.I. series or you know lumbar spine X-ray you have no choice but to have that done. And if you work for the state you periodically have to go and get a chest X-ray I think writing for this. Right. That's right. Once a year I'm assured with the state regulations are I know that teachers for instance will come in for a periodic chest X-ray. It's not a chest x rays really that that concern most people who are involved in this area although the great preponderance of X-ray examinations

are chest x rays chest x rays account for a very small percentage of the so called total genetic dose because the dosage for a chest X-ray is minimal compared say to the dosage for a number of spine X-ray and lumbar spine x rays one of the. Examination for instance that technician should be most concerned about because it's a usually a series. Oh anywhere from four to seven or eight or nine ten films depending upon which hospital you might be X-rayed or which private office. And most of those X-rays are concentrated on the abdomen and if you are a person is saying the childbearing age virtually all the dosage of almost all the films is accumulated in the donor hands or in the canal area. This is

true even when they put a lead belt or a crane over your. It's true because you see one of the unfortunate facts about an examination like a lumbar spine x ray is that you have to get an X-ray of the lumbar spine and the lumbar spine extends down to the cock six and the cock sixes uncertain views right behind the bladder or right behind the testes. And it's a very rare technician who will protect the gonads in say all seven in view of a number of spine series. Wow. We try in our hospital I have tried to devise ways in which it can be done. But it it's it's chancy because very often the kind of protection that is required for instance a lead sort of jock strap type arrangement over their own hands.

If the patient is still just four or five degrees one way or another the lead jockstrap might cover the fourth or fifth lumbar vertebra which means then that you have to repeat the film so you defeat the purpose for which you originally intended. The who hurt somebody more do such things. But each time you repeat your That's right it's cumulative radiation of human and. You know there are all kinds of. The reason I say that I hesitate in going into the physics of the thing or the health the medical anything is because even very learned and very reputable physicists differ about what is a so-called maximum safe dose or what you ask me for instance what it does differ as to what it is. One may argue that on a patient who has a potential leukemia for instance a long series of X-rays might trigger the whole disease into action whereas another might say no you know it was going to be triggered in action anyway regardless of whether it was exposed to x

rays and the these are things that are so intangible. That and well people like Carl Morgan for instance and various health physicists around the country have been trying to find a fairly constant for years and they haven't so I can't pretend to say that I know but one would think that it would be preferable to err on the side of caution. That's right. And one would think that. So this brings us back to that these negroes who are getting you to tell me double good normal goes. Well you see once again this will vary depending upon whom you ask and what time of the day you ask it whether the moon is full the answer is really so bizarre that when we first started talking about 10 years ago. No one really gave much credence to my statements that you know here is a whole group of people a whole group of people within our country who is

receiving consciously receiving I mean unconsciously receiving consciously being given extra radiation. And when I then began to discuss it with knowledgeable technicians and physicians and health assistance and so forth they thought I was some sort of a kook because when they would first they would say oh come on you know it's not possible. Why would they do this. And I'd give the reason which I gave at the beginning of this interview and they said well that's you know that's incredible. I say I agree. It's incredible but these are the reasons I give. Don't you think something should be done about it. Oh it's you know it's just a crackpot idea and they'd walk away. Well in the last three four years Negroes have become much more militant and much more demanding. The bizarre quality remains the kind of mythology

that on which they technicians base their exploration the mythology remains. But now the radiologists radiation physicists public health officials and so forth take a different attitude. And the last two or three years I've known a real acceptance of the fact what I stated. But now they're afraid. Several times in the last year from long before the thing was publicized in the various newspapers about Ralph Nader's appearance before the Senate Commerce Committee long before that apparently the word gotten around that you know not only I was concerned about this other people were concerned that other organizations were sort of undercover investigating just in case. And well one illustration I went to a radiologist in the area and I said look I'm going to appear in Sacramento and I'm going to appear before a committee

that's investigating a state licensure bill. And I think you should know that I'm going to say. This I'm going to say that Negroes are receiving more radiation and many areas by many technicians. I'm going to say it because I think this statement will undercut the efforts of the California Medical Association to defeat our licensure bill for which we've been struggling for your licensing of X-ray technician expert takes the X-ray technicians are not licensed as they are now actually technique morticians aren't beauticians arm and nurses are laboratory techs are but not X-ray tech and only one state in the union has state licensure. And that's New York. They've had it for about four years and we have been struggling to get state licensure for about 12 years and we've been appearing in Sacramento first through the assembly then through the Senate and then the following year through the Senate and then through the assembly and every year we've been defeated by the California Medical Association. And I almost say collusion I have been to the California

Radiological Society and a part of this this really gets back to the answer to the question if you ask me about the need. When I recently said to this radiologist. These things he was astonished that I didn't know it. So I contacted several technicians in his own department and they said yes they did. In his own department yes. And he didn't know actually. Now then a day or two after that I talked to a man who is responsible for radiation safety to the public and Northern California. I said look this is what's happening. Oh that's fantastic. That's incredible it's not true couldn't be I've been in radiation work for 35 years I never heard of it. I said all right but you recognize the name Saul Harris that you also heroes have to be I forget his official title I

think it's something like Chief of radiological health of the state of New York. And they said yes and I said well I saw Harris disputed my statistics in a survey that I conducted and disputed my charges and I suggested that he go to any hospital of his choosing stop any of the first 10 or 20 or 30 technicians he chose Nason. And he later wrote me a letter in which he said Mister your statistics are confirmed in New York. So it's not just a California oh no it's national national pro-national. And so I told this public servant this thing and I said now all right. There it is and what are you on about. He said I wouldn't touch it. I know it is very complicated partly politics partly personal hesitation fear. The whole it could explode into a racial thing. Would he be responsible.

You're always on the verge of being charged with melodrama and it's and this and I had I have been charged many times with trying to dramatize and I'm dramatize a BL situation. Well he said I wouldn't touch it. And that is the sort of attitude really that is very representative of the kind of thing which we have been fighting for years now I've been fighting it on the basis of the Negro thing. Many technicians in the area have been struggling for well over 10 years for state licensure technicians want to license the technicians want the license and it's a medical social enterprise and I should be the other way round this is look you're right. You know what reasons does the California Medical Association give for being opposed to lists. Well there is a a man who was in charge of the California Medical Lobby

ad in Sacramento. And the his name is Dan Kilroy. He's Chairman Committee on legislation California Medical Association. And let me just read a letter sent to him on June 7th of 67 I want to mention the other people's names but I think his name can be mentioned because he's known as the chairman of the Committee on legislation. Dear Mr. Santa this is in reply to your letter of May 30 first one hundred sixty seven in which you enlist the assistance of the California Medical Association in support of Senate bill 7 5 1. I am somewhat surprised that you do not apparently realize the position of the California Medical Association in relation to this bill. Our position is that of opposition. May I point out that the physicians of the state including one can ologists have I believe a closer and better informed sense of responsibility for the health of the people of this state then do non-medical individuals whose total responsibility and function is to carry out the technical procedures. Taking X-rays frankly and to be quite honest I do not believe

that it is the responsibility of your organization to develop any type of standard for radiological safety. I say this because I do not believe that you have either the education or the experience to properly place you in such a position of medical advice. It will be the continued position of the California Medical Association to oppose legislation such as Senate bill 751 because of the many defects contained. Now it was written by an M.D.. And he replied to that. A man who is a technician in this area who teaches at Merritt College and who was the first really the first technician practically in the United States to try to get a state licensure bill. Many of the years that he first started he stood alone with almost no one to help him. And slowly over the years as the interest grew and the sort of awareness of technicians grew he began to get help in our

so-called professional society state and national fought him tooth and nail for a few years as a professional. The professional X-ray technician says I found him three years and finally the preponderant boy urge of the technicians was for state license here and the societies could no longer ignore it. And in the last two years they've sort of joined forces with us and. He I will not read the entire letter but his reply more or less states my feelings. He says that if for argument's sake in reply to Dr Q write your position regarding licensure and the technologists competence should be correct. Certain conclusions must be drawn. You are indicting the medical profession in its continued employment of incompetence in an area of profound potential hazard to the patient to the patient had been deluded into a false sense of security regarding the capabilities of

para medical personnel employed by physicians and hospital. Technologists cannot be incompetent poorly trained and yet responsible at the same time. The California society of Radiologic technologists has attempted for some eight years to solicit effective assistance from the CMA in correcting the quote many defects contained in that bill. If such defects remain It can only be because the CMA does not wish to correct them. You provide by your letter. Perhaps the most urgent reason for licensure of the technology. And that more or less capsulizes the feelings that I have about the role of the CMA and state licensure my feeling Wesley licensure is that. Such problems as we've run up against in the over radiation for instance over radiation to Negros would be taken care of very well if there were a very rigid state licensure program controlling the

training and testing and certification certify of X-ray technicians to misstate the technicians must pick these ideas up somewhere and they'd get a training to get it in training. It's it's such a if you'll excuse a non-technical word mishmosh that it's difficult for me to say you know where to begin I have an I have a theory about where it began and I can't really prove it but my guess is this that somewhere along the line you know shortly after 1895 when the whole x ray when in the US a white man say of my size weight my whole bone structure came in for a say an X-ray of the arm. And the exposure at that time was probably 10 minutes and the X-ray was probably not too good a quality but it was an X-ray of the humerus.

Some time later the Negro patient came and my high sigh. Wait so what general body structure again. Ted Well if this young man me required a ten minute exposure I surely that man I think required a 10 minute exposure so they gave him an exposure and lo and behold the there was hardly any image of the bone of the humerus. Oh they thought negroes require more penetration. Well ninety nine and nine tenths chance time chances out of 100 that a young negro man or middle aged negro man had been a worker had been in labor laboring probably for years. His muscles were much much denser and thicker harder and so forth. And of course he required more radiation and who had not done manual labor for one fifth of my life. And I think this is the way the myth began. Now

I I trained at a university hospital where we had patients from all over the world. And never did we increase radiation on the basis of the color of the skin. Only in the shape and size and formation of the body and the density of the of the body tissue. Now when you say how much of a did the Rose receive extra. It will vary some technicians will give a force more some will give a half more. The average in all the surveys that Nader has done that I have done indicate anywhere between a 4 to have more dosage per an exposure to each patient. And the average generally of the technicians surveyed is approximately three fourths of all surveyed respond yes they have and their dosages afford to have

more. Now Nader surveyed 90 in California and I think his figures. I go by the figures here I think it was on like 72 out of 90. Is 80 percent right. And then he also did a survey which I think he said compared in Kansas. And so Harris did a survey in New York which proved my figures correct. And I did a survey in California so we have three fairly representative locations California Kansas New York. I have been the conventions all over the country and talk to technicians who come from all parts of the country. And these figures generally no matter whom I ask were the same. So the technicians you talk to try to defend us. I don't know. No. Up until now I don't know how willing they are they will be

to give out the information now. But up until now. Oh yes they they said sure. You have to but now because it's become such an issue and you know sort of the tension. Politically dangerous an issue many technicians I suspect will be very reluctant to get involved even Enter now for instance when I was in Sacramento a couple weeks ago to appear before the committee and investigating the laser will the California State Society of X-ray technologists knew that I was going to oppose the bill. Now I've been a supporter of the bill ever since I've been a technician. But I was going to oppose this bill by Congresswoman Brathwaite from Mom what's I think. I was going to oppose this bill because there was a very very dangerous clause in that bill I'll describe it later but first I'll tell you what

happened. This is I knew that I was going to oppose this bill. Now as I say for the first time in years this is I've been active in getting state licensure and there's a reason for that. So they asked me to meet with their officers before I appeared before the committee and I did and they said that the bill was going to be changed from the one that I had read and that that clause which I was very concerned about was going to be eliminated. And they showed me a copy of a bill which Congressman Brathwaite was going to deliver on the floor before the committee. And sure enough on their copy of the bill which they said was the one breath way that this clause was eliminated. And I said you know this is twice that this has been done to me and I don't. I've just had the last time and I don't trust you. I don't trust the congresswoman. I don't

believe that she's not going to resent this. But they said yes she is. I promise I promise. They said all right I won't protest the bill. But I am going to use this occasion because I knew the CMA lobby was going to be there and are in the information was that he was going to protest the bill. And I thought to undercut the CMA lobby to prove that we need licensure and to get this whole damn thing out into the open. This would be for Nader make this statement. I was going to make a statement here in Sacramento of exposure to negress. And every technician in the rooms groaned and said you know you can't do it it's not true. It's just not true. And I turned to them and said You mean you don't give extra radiation to the grass. And one of them said well only to the skull. And then another one said yeah you know and oh only a few cavy

extra. And then another one said Well you know on and I have actual radiation of the pelvis and then a few others began to say a little bit more but by that time we had to move. This has been the sort of general reaction is that whenever it comes up. Well there had been a negro technician there from Long Beach or San Diego who questioned the sort of political tactics or logic involved in bringing this up before a committee on which so many negroes sat thinking that it would be a sort of you know publicity ploy and might turn against us. And he said in any way he didn't believe it before these technicians began to make comments. And after we walked out of the room. He. And I sat in the chamber. He came mishap aside me and he said man I couldn't

believe it. I just couldn't believe it. I thought you know you were lying. I've never heard it. And this man happens to be a special procedures technician special procedures concentrates probably 80 percent of the work on the skull. And here's a man who has special procedures technician in a veteran's hospital who does skull radiography 80 percent of his time. He does not increase his dosage to Negro skull. But these people did. Even though the United at first more than defined he testified. Oh well that turned into a fiasco because well I said you know I didn't trust the state society I didn't trust Congresswoman Brathwaite and they said oh yes she's going to give us a she didn't eliminate that clause and we sat and so I thought I don't I won't testify.

We walked in and Congress and there were about 10 other bills to be heard and we waited and waited waited and finally Congresswoman Brathwaite with came out with her bill and I got a she didn't read the bill which I had come there to protest her. And I by that time were nowhere near the table I couldn't get near the thing and Willie Brown chairman of the committee and I just couldn't stand it. At a certain point they were laughing about the hazards of radiation and kidding each other you know they were squeaking in high voices and I thought it was absolutely disgusting. They hadn't been so facetious or love as about the previous bills that were you know concerning with the wind industry and real estate and so forth. And I finally wrote stood up I said look I have to protest this I want to say something really Brown said or you introduce myself. Well he knew who I was because I had written him a letter requesting his information to appear as his witness. And I said the reason I'm protesting this bill

is because it does not cover the secretary's receptionist typists nurses and private physicians offices. They are not covered by the licensor bill they are permitted to take X-rays even though they are not trained. And over 75 percent of the X-ray equipment in the state of California is in the hands of private physicians. Therefore what you're doing Mr. Brown. Is protecting only 20 percent of the public. And he said well 20 percent is better than none none of it is sort of all oppose the all are all I would propose no the ayes have it passed. And there I was you know with. The whole thing over my face. When you mention that you had written to the been writing here as a Public Health Service about this.

You tell something that I've been writing to public health and health education and welfare. I also at various conventions which I attended would speak with the officials back at the University of Maryland about two years ago where there was a national conference. I spoke with people from National Public Health. I have spoken to people here in Berkeley countless times. People from Sacramento. Mentioning of the very specific thing two three four years ago I mentioned the survey I had taken and things that were happening and absolutely nothing. Not even a reaction not even a request to me I see your surveys. And then the about a week. I don't know about two days after Ralph Nader's article appeared in The Chronicle. I received a phone call from an official in the state public health and said Mr. Chester I think you're going to get a lot of calls and requests to appear on television

and radio and so forth. You've got to direct all those calls through us. OK. If I can be facetious I gather this is your answer to him. Oh well this is my answer them except that you see I I'm very reluctant to get involved in a lot of appears in various TV radio things because it's extremely time consuming. Now I have other interests and I'm really it's the Unfortunately I'm not the man to do this yob the people who should be doing this job are the public health officials. The California Medical Association officials the Health Education and Welfare people. And I would be very happy you know if there was any indication that there was something being done for instance after all the letters that I've written to these people talks I've had with them. Copies of surveys that I've done. I have yet to receive a single letter telling me that something is being

looked into all the time thing is actually some programs actually being organized. We had been before Nader's before Nader's article. I had gone to our radiologist said out of Bates and I said Look guy you know this is a situation I feel very strongly about it. I don't think it's necessarily racist when technicians do this because many of them have been trained to do it. They believe it's justified. They don't even question the sort of you know more reality of the thing. But. Once they know about it and once a CNA knows once the public health knows about it and they don't do anything then I think it's racist. It's sounds I get and and still you know no indication except for this little article I was talking about. I think public health finding a one of their texts

recommending extra radiation to Nikos and then taking the text at a circulation but what else is being done in the training of technicians for instance U.S.. No one knows that the training of technicians is controlled. Virtually controlled by the radiologists and a Medical Association. And if anyone is responsible. For this being in existence is those people. And if anyone is responsible for changing it it has to be those people. None of those people have been have done anything about so far as I know. Well the. Person that arose in my mind one of the one of the extras taken and you said you had to find out what dosage is given to different people you simply had to go ask the technicians is there any requirement that the dosage be written down in some form or other to be kept track of in some way. No there is no requirement.

And some hospitals are mostly training hospitals where students are involved. There might be a requirement that the so-called technique be written on the onload on a film alone. But I've worked in several hospitals and private offices. And only in the hospital which I trained. Was this not required it was suggested. Now for instance it would be very helpful on this one of the things that that I would recommend that you know that there be a a place on the on the envelope for this. And I actually tried to initiate this very program in our department I finally just threw up my hands and gave up because there are so few technicians so few. And among those so few technicians there are so few good technicians. And the depart actually departments are incredibly

understand and overworked that the technicians in part justifiably balk at taking any more time at writing down the field because there are already so many little things that they have to do. And yet this is a legitimate request. Well Mr. Aron I work out the radiation live in Livermore and whenever I so much as go get a dental X-ray they give me film badges to put in my pockets and stuff. These are little pieces of film that covered with various types of shielding and then I go back and give in to him they develop them and I presume add them all up and you know I mean other people don't do this you know. Then you see you just said you presume you know the enemy and you don't know. Well I know people who are more interested in or concerned about than I am going to ask them and find out their totals and stuff so I hope they do. Will you see one of the strange things that happened in this whole area is no one really knows. Now for instance here are in California

there are approximately fifteen or sixteen thousand actually technicians and this includes everyone. Everyone who takes it free. I don't mean just train register technicians but people who are taking X-rays routinely as a as a job and out of those 15 16000 less than 3000 are registered I mean that they took a test given by the. And I use these in quotes always so-called professional society. Now just because they took the test and passed it they can put an RTA after their name registered technician. But in interviewing technicians from all over the country I have found the arty to be absolutely meaningless. Now these people will take some of these people will take your X-ray. These films they are the techniques used to produce US films are determined by

technicians. But no radiologist anywhere in the room. The radiologist sees the finished film. He doesn't see the patient. He doesn't see the procedures through which the technician goes to take those pictures. Very often there are repeats which he doesn't know about bad films which he doesn't see now you're bad for instance might indicate that you picked up a total and say a lumbar spine if you had a lumbar spine. First of all they would let you have pockets. I don't know where you're going for your bad I know you already do that but these so you have seven exposures. OK and say they permit you to put a badge in our right next to a body here right next to your body here. Now first of all that badge doesn't measure the radiation that your body is picking up. All that badge is measuring is the radiation that strikes that badge at the table level. OK.

So there's no real qualify. Maidment of 100 radiation is your body to let your tissue bounce over the target. Then that technician takes seven picture now seven pictures. I have found that normally one out of 300 or 400 films 400 films that are taken in a day. There are approximately 25 to 50 I mean films not studies are not patient but films 25 to 50 that are repeated. So one of two of your seven is not certain to be repeated but a fairly fairly good probability is going to be repeated. Now you pick up a certain amount of radiation that you should not have picked up if that technician had been a really well-trained technician and if that equipment had been appropriately designed. Now part of the blame I want to say you know is not just a technician Although the great bulk of the responsibilities of technicians in terms of what he does the ultimate responsibility is the medical association and the Radiological Society

trains he who is responsible for training the technicians but much of the X-ray equipment is pretty posthumously and accurate and reliable. And I mean that you could add equipment to give out different doses of radiation when it's at the same. That's right. Oh that's right. So you're proposing some sort of standardized check on the equipment as well not only a standardized check of the equipment but I think that you know when you consider the kinds of fantastic technological developments that have occurred and. Scientific equipment all over the world a simple little X-ray unit certainly ought to be able to be controlled and monitored so that there is a constant in terms of dosage to a patient who may Zhorzh a certain number of centimeters who is of a certain density

so that the number of repeats can be cut down. Let me give you an example for instance at one of the important ways to control dosage to a patient is by what is referred to as collimation. You actually shape your bean so that if you want to X-ray a certain part say the gallbladder. You can shape your beam so that the beam becomes smaller and smaller and smaller until it's just around the area of the gallbladder. Well there are I don't know 10 20 different kinds of commentators existence. Maybe more. Some of them are. So badly designed that technicians cannot rely on them and they just open them up to the full 0 0 or actually Sunday radiation and all the French press they don't naturally because they cannot rely on the collimation rather than take a second gallbladder exam.

They'll just open up the column. Now this is partly the technicians fault but it's also partly the fault of the designers of X-ray equipment and the government so far as I know. I at least I haven't seen anything that the government is not. If it's investigating the design of it and the production of X-ray equipment. I don't I don't know but certainly I think in terms of public welfare This is a government responsibility. And they sound like it. It sounds like niggers are the only ones who have a thing to worry about here. No now. Let me stress again you know anyone who might be listening to this program is going to say my God I'm not going to get an X-ray I'm just not going to do it. But the doctors legitimately say that you have to weigh the hazards of the exposure against the kind of information of the BBC and most of the time the information received really is of such vital importance that it's very very necessary for you to have the x rays emanate in

effect you're. Saying a chance of something going wrong with the x ray and something more likely to go wrong if you don't get it. That's right I know what's wrong with you. That's right. Yeah I want to I want to stress that because a lot of the articles that I've read. Are so terrifying and so sensational that they really have I'm sure because a lot of people to cancel trade nominations and unfortunately probably many of those people are the very ones who should really have had the X-rays and a mission to find out why they are real. And now they might not know what they might know too late. I just hate to see people putting out sort of predicting there are you know the stories of that. Mr Innes something I've long wondered it's about chest x rays are they as intense X-ray as say a series of lumbar vertebrae or a G.I. series. Well you see once again we were talking about

something that can vary from not only from one state to another but one colleague to another from one hospital to another. Now if you were to come to a hospital where I work and a reader were to receive an examination of the stomach which is what a G.I. series is you would be first scoped by the radiologist. He would take about a total of six eight pictures. Then the technician would take three or four more pictures. You would have been through our scope approximately two minutes. You would have been in the other room with the technician approximately five minutes. But only a fraction of a second of that time would you have been receiving radiation for instance on a G.I. series each shot for that one view will be approximately a twentieth to a fourth of a second time to take an awful lot of them.

They why now you would in at out a base that's a procedure the 6 or 8 spot film the 4 3 or 4 Barfield with 2 to 4 exposures on each film in that by the radiologist then 3 or 4 films by the technician. Now at another hospital in the area you will have received. 6 or 8 spot films with 2 to 4 exposure on each of the spot filmed by the radiologist and then when you win in the get the feel for the technician you might receive 10 to 12 pictures in another hospital. You might receive only one spot film with four exposures and two filmed by the technician. There's absolutely no pattern to the thing at all. And this is true of every examination. A lumbar spine in one hospital might be seven films another film hospital might be four films in our hospital. We might use a certain kind of film which is a fast film a certain kind of

screen within the film holder which reduces the required radiation. He might go to another hospital. They use a slow film which means you get more radiation. They use what are called par speed screens which means even more radiation. They might be able to. They might. The radiologist might like a certain kind of density in his film Black white contrast. So it means that you get a lower a lower killable each is used on your film which means then that the time of exposure is greater. In our hospital almost always a very high IQ level which is used and it extremely short exposure. And the high IQ level each has less. Bodily absorbed radiation than the local body. So you see all these things that there is such a variation that it is impossible to learn how to give the panel what they have done about chest x rays as I

gather that's a check for tuberculosis that the state requires for state employees and teachers and whatnot. Right. Well I I'm not sure what the state requirement is I know that this is one of the reason it was started to your go around to the mobo chest x ray that comes around every now and again and me to get a chest x where you don't get an x I write checks right. We see not just TV. There are all kinds of other other diseases and so for that are picked up and routine chest x rays it's not just TV. For instance the incidence of TB has gone way down over the last few years thanks to bionics and new treatments and so new ways of treatment so far but very often in these minute films which is just a sort of scan actually of the public very often in these small films the surveys the patient will be discovered who has some sort of mass or tumor or lesion or scar that normally would have been picked up at all.

And then they were discovered and out of this incidental survey. He goes on to an more intensive examination and if caught in time he can be held. Who are these these x rays and still a good idea. A state requirement there I don't know. Yeah there's a lot of the lot of argument about whether or not they are good and whether or not they should continue. And I you know my own feeling is that you know you'd I'd have to see a lot of other statistics on the subject to see for instance if there are other studies that might be able to be performed other than x ray that could offer the same information that the survey ship offers and I don't know about enough about the medical end to know that but I'm sure that there you know there should be investigations to see whether or not they are sufficient to be done. You mentioned earlier the chest x rays was only were only a small part of the problem is that because

of. It doesn't take as much radiation to take an effective picture of the Internet and its what is one of the variables here are the thickness of what's in between the thickness of the bowls rush is that right. You see chess is primarily lung also primarily air and in the kind of chest X-ray that you get routinely There are two exposures and in a chest x ray the amount of radiation O is so minimal that I give you a fairly approximate fairly good approximation of the kind of hazard involved for instance people working and actually technicians so-called maximum safe dosage of 300 mil or rent can be months.

MILLIRON All right it's now a thousandth of a rocket 300 1000 some prank and now a chest X-ray. Normally in this as I say will vary from one hospital to another depending on which film leave you what screen to use what equipment to use phase and the phase of the glass for how a normal chest X-ray in the average hospital and this is just a guess because I don't think there's any survey that that is really reliable. But a an average just X-ray would take probably one. 50 of that 300 Miller and get another word one. Fifteen hundred of them or I can so that you say you could take many many many many chest x rays to even approach what is the so-called safe dosage. So that doesn't sound like something they worry about much.

No it's not but it's you know in the total picture it's something else. You mention that the technicians are using this column and are radiation out of our bladder for example they open it up why couldn't they make a screen light screen or something that would shield all the rest of you. Are they headed yet. Yes they could and in many places they did resist one eye X-ray. A patient who was well if I if a patient gallbladder Now remember certain things go into play here. First of all these examinations occur around 8:00 or 9:00 morning. There is a long line of patients and there's a long line of patients that are in the morning in almost every X-ray department in the country and you have an you have a patient on the table who is gallbladder to be X-rayed. He would like to be able to rely on that column meter cone down so that just the area of the gallbladder is exposed. If you could do

that you could take the picture help the patient and get the patient out of the department and get the next patient to help him. You can't do that. So then the next best thing to do is open up the column meter a little bit more than what is required. You make sure you don't cut out the area of the gallbladder and have to repeat it and you lay lead strips over the rest of the patient's body. That might pick up the scatter secondary radiation. Well if you start laying strips over every patient This means that the patients who are waiting are backed up backed up like that now and I'm sure a few other patients gallbladders being examined in your 28 or 29 years old do you think you know that all those faces are back to THE LEAD over my body. But there is a tremendous sense of urgency and push and the X-ray technician just want to get that basin out of the room and get the exam over and so they rely on the collar meter alone. Now they should have no doubt about that.

Well I think we've heard quite a comprehensive look at the x rays and only partially the problem of how the negroes are getting increased those switches. Is there anything else that you'd like to say before when I was a. Let me let me if I may just take a minute or two to stress the importance of the licensure Bill and I want to say that first of all the Senate the Brathwaite bill which I just heard today is being altered so that typists secretaries nurses and so forth and for the private physicians offices will now be covered by the licensor bill if it's past its best if it's passed. Now Senator Bayh listen

in order to beat the deadline for the introduction of new legislation put it got a bill into the hopper which was a dummy bill but he wanted to have one there just so he could have them on. Now from what I understand today the. The bill that Senator Benson has introduced is also apparently the same bill which the CMA is putting into the into the assembly into the Senate. And apparently it's a it's the Senate bill 9 3 5. Now it's a licensure bill and extremely important and people should write their congressman saying that it's important that the licensure bill be passed however one of the things that concerns me even about Senator Bayh on this bill is that I'm afraid that it's a

ploy by the CMA. Because the board which is put into existence by the bill. Consists of the following. This board will regulate the certification in the state of California. If the bill is passed and since the CMA is supporting it I suspect it will be passed. But a many many technicians and for instance organizations like the IOW to which the technicians in the local area here belong and many technicians throughout the state are very concerned about this bill for this specific reason. The board which will regulate the certification consists of. Five physicians and surgeons licensed to practice medicine in the state. Three of whom shall be certified in radiology. One person deemed by the governor to be an expert in radiation safety

who may or may not be a physician one radiologic physicist certified by the American Board of Radiology in physics and one X-ray technologist. So it sounds like the physicists have a clear majority for their physicians it's a good course. Course now if the CMA UC which is opposed licensure in 12 years. Successfully opposed it is now coming across with a bill that has a board which they completely control. You can imagine how much improvement is going to be. Yeah so this is this is why I'm very concerned about this bill and I'm not even I'm not even sure whether or not it's it's a good deal. You know it's it's something to start with. But I when we were in Sacramento I was talking to any dental technician who had whose board had been organizing their licensure bill about 40 years ago and for the last 40 years they have been trying to amend that deal so that the dental technicians

were in a majority on the board. And finally in 1068 after 40 years of effort they succeeded. And I just hope it doesn't take us 40. Well thanks very much. Yes to both of you. You've been listening to a conversation between Douglas Lawrence who is well-known to KPFA listeners as the producer and writer and reader of the program Science Report and with Chester Aaron who is Chief Technologist of the X-ray department at all to Bates Hospital in Berkeley. Thanks very much.