Are X-rays, CT scans ignoring patient safety?

By M H Ahssan

Before prescribing an xray, does your physician ask you when you last underwent a radio-diagnostic test? Is he willing to accept test reports done at the suggestion of other doctors? If your answer to both questions is no, you may be among the growing number of Indians who get unnecessarily exposed to harmful radiation emitted by diagnostic machines.

According to guesstimates by industry insiders, demand for x-rays and CT scans have gone up by 50% in the past five years. This poses a clear danger of radiation over-exposure, especially for the seriously ill who are often asked to repeat diagnostic tests each time they consult a new expert. The absence of a watchdog or set treatment protocols only makes matters worse.

What’s worse, doctors often may not have a clue about the dangers of exposure. According to a study done by AIIMS in Delhi in 2006-07, 80% of physicians were found to be ignorant about the levels of radiation exposure in radio-diagnostic tests. “When awareness is so little, over-prescribing is inevitable. X-rays are the most over-prescribed tests. It is estimated that nearly 100 million x-rays are performed each year in India,’’ said Dr Pratik Kumar, assistant professor, medical physics, AIIMS, who conducted the study.

For a person, 1 milli Sievert (mSv) per year radiation exposure is considered within permissible limits. Limited x-ray exposure is considered “safe’’ as each test results in a 0.02 mSv exposure. “It is safe but should be judiciously prescribed,’’ said Dr Kumar.

According to the Radiation Protection Act, 2004, all x-ray machines have to be registered with the Atomic Energy Regulatory Board (AERB). CT scan machines, too, should have an AERB licence. Nearly five years after the Act was revised, AERB is still in the process of registering equipment and says that those bought before 2004 are “very difficult to trace’’. S P Aggarwal, director, radiology safety division, AERB, admitted that x-rays and CT scans are being overprescribed. “But, it is not our job to monitor this. Doctors have to be cautious,” he said.

Dr Omprakash Tavri, who formerly headed the Indian Radiological and Imaging Association, said it was difficult to estimate if x-rays were being over-prescribed. “It depends on what a patient is suffering from. There is an accepted radiation dose per person per year and patients should see that they don’t exceed that.’’

The Medical Council of India (MCI) says it’s not possible to monitor overuse as there are no standard treatment guidelines. The health ministry had tabled the Clinical Establishments (Registration and Regulation Bill) in the Lok Sabha in 2007 to bring all clinical facilities under one umbrella. Legislatures of four states (Arunachal, Himachal, Mizoram and Sikkim) have started the move by passing resolutions requesting Parliament to enact a comprehensive law to regulate both government and private sector medical services. “The Centre can’t force states to adopt this Bill as health is a state subject. We need stringent laws to stop the misuse of these diagnostic facilities,’’ said Dr C M Gulhati, editor, Monthly Index of Medical Specialities (MIMS-India).

But the MCI says it is difficult to monitor over-prescription of these tests. “There is no set rule or guidelines to diagnose a disease. It has to be left to the physicians to decide how many tests are needed,’’ said Dr Ketan Desai, president, MCI.

Doctors privately admit that many physicians have “arrangements’’ with diagnostic centres that give them a commission for every referral.

The advent of sophisticated machines has popularized CT scans, too. “Earlier, it used to take nearly 30 minutes, but now it is done in a few minutes. People think that less time under the machine means less exposure, but that’s not true,’’ said Dr Kumar. “The demand for CT scans has gone up drastically. Today, doctors don’t want to take a chance and are writing CT scans even for headaches.,’’ said a radiologist.

Said Dr Veena Choudhary, HOD, radiology, GB Pant hospital, “These tests tell you the real picture and no doctor wants to take a chance. In court, evidence counts and these tests are hard evidence.’’