Opinion: Will The Joint Commission’s New Standards Keep You Safe from Unnecessary Medical Imaging? | mHealthWatch

Opinion: Will The Joint Commission’s New Standards Keep You Safe from Unnecessary Medical Imaging? | mHealthWatch.

Mature doctor talking to his patient who is about to receive an MRI Scan.url=http://www.istockphoto.com/search/lightbox/9786662][img]http://dl.dropbox.com/u/40117171/medicine.jpg[/img][/url]

From the 14 July 2015 mHealth post

The following is a guest contributed post by Karen Holzberger, Vice President and General Manager for Diagnostics at Nuance.

The Joint Commission standards for diagnostic imaging, which recently went into effect, are designed to help prevent duplicate and unnecessary medical imaging of patients, and reduce potentially harmful exposure to radiation when patients need CT scans, MRI or a combination of these and other diagnostic tests. Beginning July 1, 2015, these standards require protocols, documentation and data collection, staff education and other criteria that raise the bar for quality and safety at ambulatory imaging sites, critical access hospitals and accredited hospitals.  What do these standards really mean to the patient?

The new imaging standards focus primarily on the radiation dose index. There are a number of uncertainties tied to the long-term impact of imaging on patients, but researchers agree it impact patients differently depending upon sensitivities to radiation, age, body parts being tested, absorption rates and other factors and these are still being studied. In the meantime, to prevent undue risk, The Joint Commission has put a stake in the ground with these specific standards to help improve patient safety.  The Joint Commission joins other accredited healthcare organizations, such as the American College of Radiology (ACR) and other clinical associations that are releasing new quality-focused recommendations,enhanced education tools and technologies to make it easier for healthcare teams to keep you safe from unintended risks while you receive diagnostic imaging that could shed light on serious health conditions.

…

Environmental Causes of Breast Cancer and Radiation From Medical Imaging

 

From the article abstract at Archives of Internal Medicine (9 July 2012)

[Full text is free at above link]

Susan G. Komen for the Cure asked the Institute of Medicine (IOM) to perform a comprehensive review of environmental causes and risk factors for breast cancer. Interestingly, none of the consumer products (ie, bisphenol A, phthalates), industrial chemicals (ie, benzene, ethylene oxide), or pesticides (ie, DDT/DDE) considered could be conclusively linked to an increased risk of breast cancer, although the IOM acknowledged that the available evidence was insufficient to draw firm conclusions for many of these exposures, calling for more research in these areas. The IOM found sufficient evidence to conclude that the 2 environmental factors most strongly associated with breast cancer were exposure to ionizing radiation and to combined postmenopausal hormone therapy. The IOM’s conclusion of a causal relation between radiation exposure and cancer is consistent with a large and varied literature showing that exposure to radiation in the same range as used for computed tomography will increase the risk of cancer. It is the responsibility of individual health care providers who order medical imaging to understand and weigh the risk of any medical procedures against the expected benefit.

Susan G. Komen for the Cure, the largest grassroots network of breast cancer survivors and activists in the United States, asked the Institute of Medicine (IOM) to perform a comprehensive and evidence-based review of environmental causes and risk factors for breast cancer, with a focus on identifying evidence-based actions that women can take to reduce their risk.¹ Environmental exposures were defined broadly to include all factors not genetically inherited, and the IOM committee appointed to write this report included academicians and chairs from departments of environmental health, toxicology, cancer epidemiology, preventive medicine, and biostatistics in addition to advocates for patients with breast cancer. Committee members conducted their own reviews of the peer-reviewed epidemiological and basic science literature, commissioned several papers specifically for their report, and drew on evidence-based reviews already completed by organizations such as the Agency for Research on Cancer and the World Cancer Research Fund International. The publication Breast Cancer and the Environment: A Life Course Approach was released online in December 2011.¹

Related articles

• Breast Cancer Risk Can Be Lowered by Avoiding Unnecessary Medical Imaging (sott.net)
• Breast cancer risk can be lowered by avoiding unnecessary medical imaging (eurekalert.org)
• Breast Cancer Radiation Therapy, Treatment & Side Effects (cancercenter.com)
• Susan G Komen for the Cure breast cancer charity ‘misleading screening benefits’ (telegraph.co.uk)
• US cancer body oversells mammograms: experts (engineeringevil.com)
• Cut breast cancer risk by avoiding scans (upi.com)
• Komen overstating mammogram benefit? (cnn.com)

 

Depleted Uranium Weapons – A Short Introduction on the Adverse Health Effects to Soldiers and Others

Last week my “cousin” [actually it is more complicated than that] asked me for information about the effects of depleted uranium weapons.
She had read about a soldier who died from uranium poisoning.
Here is a portion of the email she sent me

There was an obit in our local newspaper,  2/4/12  of a young man who died, and had some Tiffin connection.

Here I quote from his obit:

“Travis Carson, age 25, died Feb. 2, 2012 of uranium poisoning lung cancer….Travis was serving active duty in the U.S.Army from 2006 until his death. He had served one tour of duty I Iraq.” (he is survived by his wife and four children.)

Image via Wikipedia

My cousin also asked me to look up information on depleted uranium which could be used to present to members at her local (Tiffin, OH)  Pax Christi meeting. (I am also a member of Pax Christi here in Toledo, OH)

This is what I sent her. It is a bit sketchy, I admit. But I hope it does give one an idea of what DU can do not only to our military members, but civilians and the environment in general.

I find it distressing that time and time again war materials are used without due regard to long term effects to people (military and civilians alike) and the environment. Agent Orange is another example.

Sites in Kosovo and southern Central Serbia where NATO aviation used forbidden munition with depleted uranium during 1999 bombing.

                                                   

   

Depleted Uranium (DU)  Weapons- A  Short Introduction 

What is DU and where does it come from ? Depleted Uranium (DU) is nuclear waste that is a product of uranium processing. Uranium found in nature occurs in different isotopes: U234, U235, and U238. Each isotope has a different number of neutrons, but the same number of electrons.

Image from http://www.world-nuclear.org/eduation.uran.htm (What is Uranium, How Does It Work- World Nuclear Association)This Web site also has great basic information on uranium and how reactor fuel is extracted from uranium ore

When uranium ore is processed for nuclear fuel, the product is usually pellets made containing the isotopes U-238 and U-235. Most of the fuel is made of the stable isotope U-238 which is barely radioactive.  U-238 is also called a “fertile” fuel; it is acted upon by the U-235 isotope to create energy. The U-235 isotope is much more volatile, radioactive, and “fissile”. When neutrons are fired at it, it produces a self-sustaining series of nuclear reactions, releasing huge amounts of energy. The U-238 atoms can capture neutrons shot off during the U-235 nuclear reactions, and split to become unstable plutonium atoms which also emit energy.

All this energy is converted to steam to produce electricity.   U-235 is one of the waste products of nuclear reactors (as Davis Bessie). Nuclear waste products can be processed for disposal at storage sites or reused as a fuel component or in manufacturing (as weapons).

[For a fuller detailed descriptions, please go to http://www.world-nuclear.org/education.uran.htm and http://www.world-nuclear.org/education/wast.htm]

 What are DU weapons and why are they used?   Depleted Uranium itself is a chemically toxic and radioactive compound, which is used in armour piercing munitions because of its very high density. It is 1.7 times denser than lead, giving DU weapons increased range and penetrative power. They belong to a class of weapons called kinetic energy penetrators. The part of the weapon that is made of DU is called a penetrator: this is a long dart weighing more than four kilograms in the largest examples: it is neither a tip nor a coating. The penetrator is usually an alloy of DU and a small amount of another metal such as titanium and molybdenum. These give it extra strength and resistance to corrosion.

In addition to armour-piercing penetrators, DU is used as armour in US M1A1 and M1A2 battle tanks and in small amounts in some types of landmines (M86 PDM and ADAM), both types contain 0.101g of DU in the resin cases of the individual mines. 432 ADAM antipersonnel landmine howitzer shells were used on the Kuwaiti battlefields during the 1991 Gulf War. Both M86 PDM and ADAM mines remain in U.S. stockpiles.

Where have DU weapons been used?    Governments have often initially denied using DU because of public health concerns. It is now clear that DU was used on a large scale by the US and the UK in the Gulf War in 1991, then in Bosnia, Serbia and Kosovo, and again in the war in Iraq by the US and the UK in 2003. It is suspected that the US also used DU in Afghanistan in 2001, although both the US and UK governments have denied using it there.

While we have a reasonable idea how much DU was used in the Balkans (12,700kg) and the 1991 Gulf War (290,300kg), there is little data on the extent of its use following the 2003 invasion in Iraq. One estimate put the total at 140,000kg by early 2004; with far more being used in urban areas than in 1991. This was chiefly a product of a move towards asymmetric warfare but also an increasingly casual approach to DU’s use. The US consistently refused to release data on the locations of DU strikes to UNEP and post-conflict instability has made assessing the true extent of contamination virtually impossible.

How does the DU in weapons get into the body?   The DU oxide dust produced when DU munitions burn has no natural or historical analogue. This toxic and radioactive dust , which can travel many kilometres when “kicked up” in arid climates, are readily inhaled and retained in the lungs by civilians and the military alike. From the lungs they travel to and are deposited in the lymph nodes, bones, brain and testes.

It is thought that DU is the cause of a sharp increase in the incidence rates of some cancers, such as breast cancer and lymphoma, in areas of Iraq following 1991 and 2003. It has also been implicated in a rise in birth defects from areas adjacent to the main Gulf War battlefields. A Balkan focused UNEP reported that these corroding penetrators were likely to contaminate groundwater and drinking water supplies and should be removed.

What are the radioactive hazards of uranium weapon? Radiation has three basic forms, all are emitted when DU “burns” as in munitions being fired

Alpha -fast moving atoms that are slowed by a few inches of air or piece of paper because of their relatively large size

Beta – fast moving electrons with higher energy than alpha because they are lighter and faster, can go through several feet of air or thin metal

Gamma- most damaging radiation, made of photons (much like light), their high energy can penetrate up to several inches of lead
The chief radiological hazard from uranium 238 is alpha radiation. When inhaled or ingested, alpha radiation is the most damaging form of ionising radiation. However, as U238 decays into its daughter products thorium and protactinium, both beta and gamma radiation are released, increasing the radiation burden further. Therefore DU particles must be considered as a dynamic mixture of radioactive isotopes.

Inside the body alpha radiation is incredibly disruptive. The heavy, highly charged particles leave a trail of ionised free radicals in their wake, disrupting finely tuned cellular processes. In one day, one microgram, (one millionth of a gram), of pure DU can release 1000 alpha particles. Each particle is charged with more than four million electron volts of energy; this goes directly into whichever organ or tissue it is lodged in. Ionizing radiation is a human carcinogen at every dose-level, not just at high doses; there is no threshold dose and any alpha particle can cause irreparable genetic damage.

What are the chemical toxicity hazards of uranium weapons?  While many studies have only investigated the possibility of kidney damage, since 1991, and triggered by concerns over DU, dozens of papers have highlighted other, more worrying effects of uranium toxicity. Repeated cellular and animal studies have shown that uranium is a kidney toxin, neurotoxin, immunotoxin, mutagen, carcinogen and teratogen. Compared to the uranium naturally present in the environment and the ore in mine workings, DU dust is a concentrated form of uranium. Uranium has been shown to cause oxidative damage to DNA. Recent studies in hamsters found that uranium formed uranium-DNA adducts (bonds),these make it more likely that the DNA will be repaired incorrectly. If this occurs, adducts can lead to genetic mutations that may be replicated leading to carcinogensis.  In 2007 DU compounds were shown to damage experimental human lung cells and disrupt DNA repair.

Are there any organizations addressing DU health and environment concerns?

The International Coalition to Ban Uranium Weapons [http://www.world-nuclear.org/education/wast.htm] has information on current legal status, their campaign (news, events, timeline, projects), how to take action, and resources. They have a social media presence via YouTube, Twitter, and Facebook. Most of the information on this page came from this organization.

 

Related Resource

• Uranium (ToxTown – summaries of environmental concerns and toxic chemicals where you work, live, and play)

              Excerpts

Military personnel may be exposed to uranium if they work on a ship or submarine, or handle ammunition or nuclear weapons. They can be exposed through shrapnel that contains depleted uranium or dust from ammunition. Personnel may be exposed if their armored vehicle is penetrated by uranium munitions, or if they salvage vehicles that have been in contact with uranium munitions. When a depleted uranium projectile hits a vehicle, the projectile forms particles of varying sizes. Personnel in or near such vehicles may breathe or swallow depleted uranium, or have tiny uranium fragments in their bodies.

 

How can uranium affect my health?
The health effects of natural and depleted uranium are caused by its chemical properties as a heavy metal and not by radiation.

Eating or breathing very high levels of uranium can cause acute kidney failure and death. Exposure to high levels of uranium may lead to increased cancer risk, liver damage, and internal irradiation. Exposure to uranium can damage the kidneys and respiratory tract, and cause dermatitis and blood changes.

The National Institute for Occupational Safety and Health considers uranium compounds to be potential occupational carcinogens. Uranium is not listed as a known or anticipated carcinogen in the Twelfth Report on Carcinogens published by the National Toxicology Program.

Radon is listed as a human carcinogen in the Twelfth Report on Carcinogens because it causes lung cancer. Exposure to high levels of radon can cause other lung diseases such as emphysema and thickening of lung tissues. Simultaneous exposure to radon and cigarette smoking can increase the incidence of lung cancer and lung disease.

Related articles
(these articles are for informational purposes only, they have not been evaluated fully. So little has    been published by vetted sources that it was decided to include all found articles via a WordPress option)

• Depleted Uranium a Soldiers Death Sentence! (disclose.tv)
• The U.s. Still Uses Uranium Deplet in Afghanistan (socyberty.com)
• Depleted Uranium and the Boeing 747 airplane program (enformable.com)
• Horrors of depleted uranium threaten the world (libyaagainstsuperpowermedia.com)
• Opinion: Depleted Uranium Weapons – a new area of Liberal Democrat policy? (libdemvoice.org)
• Canadian Soldier’s Struggle to Have DU Poisoning Acknowledged (stevebeckow.com)
• Depleted Uranium – the dangerous enemy – A death sentence (powersthatbeat.wordpress.com)
• Quebec ex-soldier plans hunger strike (cbc.ca)
• US and Client States Used Weapons of Mass Destruction on Libya (libyaagainstsuperpowermedia.com)
• Depleted uranium has wreaked havoc on health in Iraq (disclose.tv)
• Fallujah babies: Under a new kind of siege (alhittin.com)
• Poisoned soldier plans hunger strike in bid for care (ctv.ca)
• US uranium to blame for deformed babies in Fallujah? (rt.com)
• ‘Poisoned’ Bosnia veteran begins hunger strike (ctv.ca)
• Veteran who claims poisoning starts hunger strike outside minister’s office (theglobeandmail.com)
• ‘Poisoned’ veteran begins hunger strike outside minister’s office (thestar.com)
• Ex-soldier ends hunger strike (cbc.ca)
• Hunger striking vet to meet Veterans Affairs minister (ctv.ca)
• Vet who went on hunger strike worried about treatment (ctv.ca)