BAKER CHIROPRACTIC , PA

"Putting Patients First"

The Anatomy of Back Pain

		Sunday, 01 July 07 - 03:06 PM (GMT) By Dr. John Raymond Baker in General

There is a reason many days are lost from back pain every year.

One is that there are many potential sources of back pain. One very common one is the intervertebral disc. It used to be thought that the disc itself had no nerve supply, but since then, we have discovered that there is a sinuvertebral nerve supplying the outsiode of the disk than can cause considerable pain.

A herniated disc or protruding disc, can, depending on its size and position, press on the nerve root, spinal cord, or both. It can decrease the space for the nerve between the bones (the foraminal size, a decrease is stenosis of the foraminal opening or foraminal stenosis). This can serious problems that can even end up being permanent if one does not get prompt attention and/or surgical intervention.

Another source of pain is the zygapophyseal joints. These joints are also called "facet joints". Inflammed and damaged cervical zygapophyseal joints have, in the past few years, been found to be a great source of pain in folks injured in so-called "whiplash injuries" (a longer term is hyperextension / hyperflexion injuries resulting from hyperacceleration/hyperdeceleration forces).

An interesting article about these joints as a nocigenerative or pain causing element, is found at:

BMC Musculoskeletal Disorders 2004, 5:15     doi:10.1186/1471-2474-5-15

Of course , torn muscles can be sources of pain as well, even without these more serious sources.

Swelling in the tissues around the nerves in or near the foraminal openings, can cause a relative increase in partial pressures exrerted on the nerve root, and can cause altered function, the results of which can include pain. This swelling can happen as a result of inflammation, but also, as a result of the paraspinal and deep muscles going into spasm after trauma, and locking the low back down, preventing the normal flexion, extension, and torsion, which helps to move fluids in and out of the area.

These are just a few of the pain causing factors in the low back, and in most of these, the answer is not a narcotic pain reliever, but using ice to reduce pain and spasms, stretching lumbar muscles, using digital pressure over the belly of the muscle to induce stretching, electrical muscle stimulation to fatigue muscles in spasm, intervertebral traction / intersegmental traction to stretch paraspinal muscles and to introduce added segmental motion in the axial plane. And, if it is not contraindicated by other factors, Chiropractic manipulation to increase movement and proper positioning of the osseous elements of the spinal joints.

What is the deal with companies in China putting poison into supplies we use in our homes?

		Tuesday, 19 June 07 - 11:53 PM (GMT) By Dr. John Raymond Baker in General

First, it was pets being killed from eating pet food that was coming from China. It took a while, but it was discovered that apparently, a poisonous compound named Melamene was being added to pet food in China, ostensibly because the high nitrogen content of Melamene would trick the tests that monitored the food to make it look like it had higher protein content.

Now, the alleged "intellectual property" issues with China (production of knockoffs, trademark violations, copyright violations,etc) have come together with these addition of potentially poisonous chemicals in the finding of counterfeit COLGATE toothpaste in dollar stores, that, as I understand, has the chemical from antifreeze in it.

http://www.reuters.com/article/healthNews/idUSPEK21554220070615
" BEIJING (Reuters) - A Chinese firm accused of manufacturing tainted toothpaste said it has stopped using a chemical found in antifreeze, Xinhua news agency reported on Friday amid a row about the safety of Chinese products.

Shanghai White Cat Shareholding Co. Ltd, maker of "MAXAM" toothpaste, said in a statement the company stopped using diethylene glycol, or DEG, in all products on May 21.

The statement said DEG, a thickening agent used in antifreeze, was commonly used in toothpaste.

"Tests indicate that a low level of DEG does not threaten health," the company was quoted as saying.

China's quality control watchdog said on Thursday it hoped Hong Kong would allow three brands of home-made toothpastes -- MAXAM Toothpaste with Fluoride, SANQI and Tianqi -- back on to supermarket shelves.

Hong Kong's ban was the latest in a slate of recalls and warnings linked to Chinese toothpaste. The United States, New Zealand, Singapore, Panama and several other Latin American and Caribbean countries have taken similar action.

Panama says at least 100 people died after taking cough syrup which contained DEG rather than the glycerine which was supposed to have been used.

China blamed the media last week for stoking fears about the safety of its food and drugs, but senior officials acknowledged that it was not realistic to expect a 100 percent quality guarantee.

They were reacting to a series of scandals that have plagued Chinese products, from the poisoned cough syrup in Panama to tainted pet food in the United States, and shaken global confidence in the made-in-China label."
=========SNIP================
Look, I believe we should BOYCOTT any and all food items, toiletries, pet food, etc,, made in China. We have good food and hygeine products being made here in the United States, and we have abandoned purchase of so many US made items that now, it has adversely affected our economy. We need to make some good choices for a change. Say NO to Chinese made foods and toiletries.

CHIROPRACTIC DOCTOR, DR. ERIC BREVARD, DIED IN AUTOMOBILE CRASH ON FRIDAY, 15 JUNE 2007

		Tuesday, 19 June 07 - 11:49 PM (GMT) By Dr. John Raymond Baker in General

CMS: Seven Private Fee-for-Service Plans to Suspend Marketing

		Saturday, 16 June 07 - 06:20 PM (GMT) By Dr. John Raymond Baker in General

http://public.cq.com/docs/hb/hbnews110-000002533208.html

"

The Centers for Medicare and Medicaid Services announced late Friday that seven insurers with the lion’s share of the Medicare private fee-for-service plan market have agreed to suspend marketing of the plans. The announcement follows hundreds of complaints by Medicare beneficiaries that they were duped or strong-armed by sales agents into joining the plans without understanding how they worked or the restrictions involved. CMS said the plans will be able to resume marketing when the agency certifies they have controls in place to prevent deceptive marketing.

State insurance regulators joined Senate Aging Committee Chairman Herb Kohl , D-Wis., at a May 16 hearing in saying Medicare officials have failed to properly oversee the marketing of private plans in Medicare, with Kohl revealing the results of a congressional investigation he said turned up “countless” cases of seniors being preyed upon by unscrupulous insurance agents. Cases cited at the hearing primarily involved private fee-for-service plans, which were added to Medicare as an alternative to HMOs and other managed care plans that critics feared would increasingly ration care to the elderly (See related story, CQ HealthBeat, May 16, 2007)

CMS described the agreement as “voluntary” on the part of the seven insurers, and said they will be permitted to continue enrolling members during the marketing suspension. House Ways and Means Health Subcommittee Chairman Pete Stark , D-Calif., termed the agency’s response to marketing abuses by private fee-for-service plans as “pathetic.”

The seven insurers are Humana, United Healthcare, Wellcare, Universal American Financial Corporation, Coventry, Sterling, and Blue Cross/Blue Shield of Tennessee. A total of 1.5 million Medicare beneficiaries are enrolled in private fee-for-service plans, 200,000 of which signed up as a part of company or union retirement health benefit plans. The other 1.3 million are in the individual, “non-group” market — in other words, they signed up on their own. The marketing suspension applies only to the non-group market. The seven insurers have 90 percent of the non-group market, CMS said.

Abby Block, director of the CMS Center for Beneficiary Choices, told reporters in an afternoon telephone briefing that CMS received 2,700 complaints between December 2006 and April 2007 about plans in the private health plan side of Medicare, known as Medicare Advantage. The majority of the complaints were about private fee-for-service plans, she said. Other types of Medicare Advantage plans include HMOs and PPOs.

Block didn’t blame the companies themselves for the marketing practices, but rather a relative handful of “rogue sales agents” selling their products. Wisconsin Insurance Commissioner Sean Dilweg told the Senate Aging Committee hearing in May that “seniors are being told that they can go to any provider without being told that they may only go to a provider that accepts Medicare, and also a provider that has agreed to accept the plan’s payments.”

To have the suspension lifted, a plan must provide a complete list of sales representatives if requested to do so by CMS and must authorize the agency — if it seeks to do so — to make the list available to state insurance departments. Plans must make calls to new enrollees to make sure they understand the plan rules and want to enroll. Sales reps will have to pass a written test showing their familiarity with Medicare and the product they are selling. Lists of planned sales events provided to CMS must include “delegated” brokers and agents as well as those sponsored by the plan.

Stark was unimpressed. “The administration’s response is to allow private companies to determine which crimes they’ll plead to and which sentences they’ll serve,” the California Democrat said in a statement. “This will do virtually nothing to protect Medicare beneficiaries and is a pathetic attempt to pre-empt congressional action.” Stark added that the plans are receiving excessively high payments that, as long as they continue, will lead to huge sales commissions that continue to fuel marketing abuses. Stark is widely expected to propose legislation cutting Medicare payments to private fee-for-service plans.

Senate Finance Chairman Max Baucus , D-Mont., offered milder criticism. “I applaud plans for volunteering a suspension,” he said. “I’d like to see CMS spend less time promoting private coverage and more time figuring out how to regulate the actions of insurers who sell directly to seniors.”

Karen Ignagni, president of America’s Health Insurance Plans, said the insurance industry is “moving immediately” to put additional protections in place. She said AHIP has asked CMS and the National Association of Insurance Commissioners to develop a uniform reporting mechanism allowing plans to clearly identify brokers and agents selling on behalf of Medicare Advantage plans. “Secondly, we have urged the development of clear guidelines for health plans to report serious broker-agent misconduct to CMS and the states,” she said.

Others pointed a finger at the growing private health plan presence in Medicare. “This is a clear acknowledgment that there are health plan abuses throughout the country that are causing many seniors to be enrolled in plans that are unresponsive to their needs,” said Ron Pollack, Executive Director of Families USA."

Court Weighs Autism-Vaccine Link

		Wednesday, 13 June 07 - 12:52 PM (GMT) By Dr. John Raymond Baker in General

Parents have sued the federal government over the perceived link between vaccines and the increase of autism in the United States.

WebMD reports the case, but as expected, pooh-poohs the notion that an ingredianet of vaccines, thimerosal is to blame.
http://www.webmd.com/news/20070611/court-weighs-autism-vaccine-link

" Is Thimerosal to Blame?

In years past, experts believed autism affected four to five out of every 10,000 children. But a new CDC report released earlier this year showed about one in 150 8-year-old children had autism. Since that study involved just 14 states, it’s unclear if those numbers reflect national statistics.

If there is indeed a rise, what could be fueling this increase? The question is whether this possible rise is due to doctors doing a better job at identifying kids with autism or to some other reason.

What could that reason be? One theory is children’s vaccines. The MMR vaccine – measles, mumps, and rubella -- has gotten the most attention, mainly linked to the mercury-based preservative thimerosal.

Experts Say 'No'

Several medical studies have shown no link between autism and the MMR vaccine. And several premier medical organizations have concluded that there is no link between autism and thimerosal.

The CDC says there is no evidence to suggest a link. The Institute of Medicine, a nonprofit, nongovernment organization, takes it one step further and says the MMR vaccine absolutely does not cause autism.

Since 1999, when the American Academy of Pediatrics recommended that thimerosal be taken out of vaccines as a precautionary measure, kids’ exposure to the preservative has dropped significantly.

Thimerosal has been removed from or reduced to trace amounts in all vaccines routinely recommended for children 6 years of age and younger. The exception is the flu vaccine. A preservative-free version of the flu vaccine (contains trace amounts of thimerosal) is available in limited supply for infants, children, and pregnant women.

Some vaccines, such as the tetanus-diphtheria booster for older children and adults, are also available in formulations that are free of thimerosal or contain only trace amounts.

If Not Thimerosal, Then What Causes Autism?

The exact cause of autism is not known, but research has pointed to several possible factors, including genetics, certain types of infections, and problems occurring at birth.

Recent studies strongly suggest that some people have a genetic predisposition to autism, meaning that a susceptibility to develop the condition may be passed on from parents to children.

Researchers are looking for clues about which genes contribute to this increased vulnerability. In some children, environmental factors may also play a role. Studies of people with autism have found abnormalities in several regions of the brain, which suggest that autism results from a disruption of early brain development while still in utero."

-------snip----------
To say that genetics if the reason, as a wastebasket explanation, really doesn't cut the mustard, because, unless autistic prone males are seeking out autistic prone females and mating (assuming that the tendency to become autistic is a recessive trait) and producing very autistic prone children, their theory is useless. And, if the above were the case, why would there suddenly be such an increase of such matings and such reproductions? It makes not sense.

More news on the topic :
http://www.cbc.ca/canada/toronto/story/2007/02/02/ontario-lawsuit.html

" Parents sue Ontario for autism treatment

BAKER CHIROPRACTIC,PA and Dr. John Raymond Baker,DC now on Texas True Choice insurance for Longview City Workers

		Tuesday, 12 June 07 - 12:25 PM (GMT) By Dr. John Raymond Baker in General

BAKER CHIROPRACTIC,PA and Dr. John Raymond Baker,DC are now on the list of providers for Texas True Choice, the insurance for city workers of the City of Longview Texas. This includes police, firemen, city utility workers, and everypone covered by the health insurance offered by the city of Longview Texas, Gregg County.

If you need Chiropractic care, conveniently located within the city of Longview, please call for an appointment today at 903-753-5400.

Have a great day!

DIAGNOSTIC X-RAYS ARE SAFE...DON'T LET FEARMONGERS FOOL YOU.

		Tuesday, 05 June 07 - 07:55 PM (GMT) By Dr. John Raymond Baker in General

ARE DIAGNOSTIC X-RAYS SAFE ?

There are some fearmongers out there who are trying
to say that you should not use diagnostic x-rays unless in
extremely limited, "dire emergency" conditions.

"FEARMONGER (DEFINITION) -one inclined to raise or excite alarms
especially needlessly". Synonym- "scaremonger" From Merriam Webster Dictionary
http://www.m-w.com/dictionary/scaremonger

Look, I take x-rays, maintain a safe x-ray unit, and
probably, over the past 18 years, have gotten exposed more
than most people, because I am not afraid to take x-rays of
myself when I feel they are warranted.

These fearmongers and organizations that hire these
fearmongers, are doing a disservice to patients.

Firstly, please read a paper I did, which quotes reputable
sources such as the National Cancer Institute, and other
very scientific sources. That paper is at:
http://www.bakerchiropractic.net/radiationexposure.pdf .

That paper ALONE will reassure you that the fearmongers
are just frothing at the mouth over nothing. For God's sake,
you expose yourself to "ionizing radiation" (as the fearmongers
love to put it) every time you go out into the sunshine.

But, don't just take my paper alone as your only reassuring
source. Look at the following link :
http://medinfo.ufl.edu/medinfos/vrm/rads.html

"

Explaining radiation dose to a patient using the BERT concept

Answering your patient's question about the amount of radiation would be easy if you knew the effective dose. However, it is unlikely the patient would be satisfied if your answer was "the mammogram will give you an effective dose of about 1 millisievert (mSv)." She probably would understand if you converted the effective dose into the amount of time it would take her to accumulate the same effective dose from background radiation. Since the average background rate in the U.S. is about 3 mSv per year, the answer in this case would be about four months. It is likely that she would understand and be satisfied with your answer.

This method of explaining radiation is called Background Equivalent Radiation Time or BERT.2,3 The idea is to convert the effective dose from the exposure to the time in days, weeks, months or years to obtain the same effective dose from background. This method has also been recommended by the U.S. National Council for Radiation Protection and Measurement (NCRP).4 To calculate BERT, I recommend using the average background in the U.S. including contributions to the lung from radon progeny. This is assumed to be 3 mSv/y (300 mrem/y). The background in different parts of the U.S. varies about +/- 50% from this value. This uncertainty is unimportant for explaining radiation to patients. The effective dose from common diagnostic x-ray procedures are typically less than the amount of radiation you receive >from nature in two years. (See Table 1.) Giving the answer in terms of background radiation has three advantages:

1. It does not imply any risk - it is just a comparison
2. It emphasizes that radiation is natural
3. The answer is understandable to the patient

Radiologists should help educate patients about background radiation

It is natural that some patients will confuse x-rays with radiation from radioactivity. They may mistakenly think that man-made radiation is more dangerous than an equal amount of natural radiation. Most patients are unaware that most of their background radiation comes from radioactivity in their own body. Radiologists should explain to them that we are all radioactive. A typical adult has over 9,000 radioactive disintegrations in their body each second - over a half million per minute. The resulting radiation strikes billions of our cells each hour. The idea that radiation to one cell can initiate cancer is illogical - it assumes that the body has no defense or repair mechanisms. The body has several defense mechanisms to protect itself from doses up to about 200 mGy.1

Radiographers should be trained to answer patients questions in terms of BERT

Most patients never get to see the radiologist. Questions about radiation are often asked of the radiographer. Radiographers are generally not prepared to answer a patient's question about radiation dose. However, if tables of effective dose and BERT are available at each x-ray unit, any radiographer can answer the patient's question about radiation dose. If the patient desires further information the radiographer should recommend a basic book, such as Understanding Radiation.6

Scientific quantities for radiation protection

There are two scientific quantities for radiation protection: equivalent dose and effective dose. Neither of these quantities can be directly measured.Effective dose, E was defined by the International Commission for Radiological Protection (ICRP)7 and adopted by the U.S. National Council for Radiation Protection and Measurement (NCRP).8 The concept of effective dose is appealing but unattainable - E was intended to equate the relative risk of inducing a fatal cancer from a partial body dose (such as radon progeny in the lungs) to the whole body dose that would have the same the risk of inducing a fatal cancer.

The effective dose cannot be measured and it is difficult to calculate.9 Physicists use computer simulation programs to estimate the organ doses in a standard patient from typical exposure conditions for various projections. The results of these simulations can be used to estimate E for various patient exposures. Once a table of effective doses is constructed for a particular x-ray unit, it is a simple matter to calculate the BERT - the time to get the same effective dose from background. Typical effective doses and BERT values for some common x-ray projections are given in Table I.

Entrance skin dose (ESD) is not a good indicator of the dose to the patient

Effective dose should not be confused with the entrance skin dose (ESD), which was commonly used for describing patient radiation up until about 20 years ago. The ESD is easy to measure, but it is not a good measure for the amount of radiation to the patient. For example, the ESD for a dental intra-oral x-ray (e.g., a bitewing) is about fifty times greater than the ESD for a chest radiograph, yet the effective dose from the dental exposure is usually lower than from a chest radiograph.

Fluoroscopic radiation should be measured with a dose-area product (DAP) meter

During fluoroscopy the beam size, the organs exposed and the dose rate change. This makes it impractical to determine the effective dose. However, the fluoroscopic dose is very easy to measure with a transmission ion chamber covering the exit of the collimator. All of the radiation striking the patient must pass through the ion chamber. The ion current collected is a measure of the exposure-area product (EAP). The reading can easily be converted to the dose-area product (DAP). A meter for this purpose has been available for more than 30 years. Fluoroscopic procedures typically give larger doses to the patient than a roentgenogram. The reading from a DAP-meter is approximately proportional to the energy deposited in the patient-the imparted energy. If the kVp and HVL are known the DAP meter reading in Gy m2 can be converted to the imparted energy in joules (J) deposited in the patient.5 DAP meters, or their predecessor, exposure-area product meters, are little known or used in the U.S. In the UK and Germany they are required on all medical fluoroscopes. I think the NCRP should recommend that all medical fluoroscopes should include such an instrument and that fluoroscopes used for interventional radiology must have such a meter.

There is no risk from normal diagnostic x-ray doses

To reassure the patient about the lack of risk from low doses of radiation it is useful to explain that no studies of radiation to humans have demonstrated an increase in cancer at the doses used in diagnostic radiology. A number of studies described below indicate that low to moderate doses may improve the health and even reduce cancer.

A-bomb survivors are living longer on the average than unexposed Japanese

A-bomb survivors who had large doses - greater than the equivalent of 150 years of background - had a slight increase in cancer. In the last 50 years there was an average of fewer than 10 radiation induced cancer deaths per year in about 100,000 A-bomb survivors. A-bomb survivors who received a dose less than the equivalent of 60 years of background showed no increase in the incidence of cancer. Survivors in that dose range tended to be healthier than the unexposed Japanese. That is, their death from all causes was lower than for the unexposed Japanese. The improved health of those with low doses more than compensated for the radiation induced cancer deaths so that A-bomb survivors as a group are living longer on the average than the unexposed Japanese controls.

Nuclear shipyard workers were much healthier than non-nuclear shipyard workers

Evidence for health benefits from low dose rate radiation comes from the nuclear shipyard workers study (NSWS) a decade ago.10 This DOE sponsored study found that 29,000 nuclear shipyard workers with the highest cumulative doses had slightly less cancer than 33,000 job matched and age matched controls. The decreased cancer among nuclear workers was not statistically significant. However, the low death rate from all causes for the nuclear workers was statistically very significant. Nuclear workers had a death rate 24% (16 standard deviations) lower than the unexposed control group. If the nuclear workers had a death rate 24% higher than the controls, it would have made the world news in 1988.

Areas with high natural background have less cancer

Humans receive ionizing radiation from several natural sources - radioactivity inside their body, radioactivity outside their body and cosmic rays. The amount of radiation from these various sources varies with the geographical location and the material used in the buildings where you work and live. In addition, the contribution from radon varies depending on the construction of your home and the amount of uranium in the soil beneath it.

If ionizing radiation is a significant cause of cancer we would expect the millions of people who live in areas with high natural levels of radiation to have more cancer. However, that is not the case. The seven western U.S. states with the highest background radiation - about twice the average for the country (excluding radon contributions) - have 15% lower cancer death rate than the average for the country.11

Radon in mines increases lung cancer; radon in homes reduces lung cancer

Uranium miners had a higher incidence of lung cancer from the high concentrations of radon in underground mines. This was the basis for the Environmental Protection Agency (EPA) to estimate that high levels of radon in homes cause thousands of lung cancer deaths each year in the U.S. However, a study of lung cancer death rates in 1600 U.S. counties representing over 90% of the U.S. population shows that counties with the highest radon levels (> 5 pCi/l) have 40% lower lung cancer death rates than the counties with lowest radon levels (< 0.05 pCi/l).12 It appears that radiation from radon progeny actually prevents some cancers caused by smoking!

Summary and recommendations

Radiologists contribute most of the man-made radiation to the public. The benefits of this radiation are tremendous. There are no data to suggest a risk from such low doses. Radiologists have a responsibility to help educate their patients and others who ask them about radiation. You have a choice. You can increase the patient's fear of radiation by explaining the "official" policy of the NCRP and the American College of Radiology that even the smallest amount of radiation may cause cancer. Based on this assumption, a recent ACR publication13 shows that the risk of inducing a fatal cancer from a chest x-ray is ten times greater than the risk of dying in a commercial airline flight. The same table shows that a CT scan of the kidneys has a greater risk of inducing a fatal cancer than a cigarette smoker has of dying from lung cancer.

I strongly recommend that each clinical x-ray unit have a table of the effective dose for various projections and patient size. A separate column should give the BERT - the time to obtain the same effective dose from background. The radiographers should be taught how to answer the patient's questions using the BERT method. The BERT concept does not suggest any risk and is understandable to the patient.

References

1. Feinendegen LE, Bond VP, Sonhaus CA: Low level radiation may protect against cancer. Physics and Society News (In press) 1998
2. Cameron JR: A radiation unit for the public. Physics and Society News 20:2, 1991.
3. Cameron JR: How to explain x-ray exposure to your patient (30 min. video). Medical Physics Publishing, Madison, WI, 1993.
4. NCRP Report 117: Research needs for radiation protection, p. 51. National Council on Radiation Protection and Measurement, Bethesda, MD, 1993.
5. IPSM Report No. 53: Patient dosimetry techniques in diagnostic radiology, p. 53 and Table A7, p. 117. Institute of Physics and Engineering in Medicine, York, UK, 1988.
6. Wahlstrom B: Understanding radiation. Medical Physics Publishing, Madison, WI. 1996.
7. ICRP Publication 60 Recommendations of the International Commission of Radiological Protection, 1991.
8. NCRP Report 116: Limitation of exposure to ionizing radiation. National Council on Radiation Protection and Measurement, Bethesda, MD, 1993.
9. NCRP Report 100: Exposure of the U.S. population from diagnostic radiation, pp. 73-74. National Council on Radiation Protection and Measurement, Bethesda, MD, 1989.
10. Matanoski GM: Health effects of low-level radiation in shipyard workers final report. Baltimore, MD, DOE DE-AC02-79 EV10095, 1991.
11. Fremlin JH: Power production: What are the risks? 2nd ed. Bristol, UK: Adam Hilger, pg. 58, 1989.
12. Cohen BL: Test of the linear no-threshold theory of radiation carcinogenesis in the low dose, low dose rate region. Health Physics 68:157-217, 1995.
13. ACR Radiation Risk: A Primer. American College of Radiology, Reston, VA, p. 6, 1996. "

Not convinced? Check out emedicinehealth.com
http://www.emedicinehealth.com/understanding_x-rays/article_em.htm

" Are X-rays Safe?

Diagnostic x-rays are safe. But who hasn’t wondered about them when undergoing a chest x-ray, mammogram, routine dental x-rays, or an x-ray for a broken bone?

No scientific data indicate any danger. In fact, there is evidence that low doses may actually reduce the chance of cancer. The question about the amount of radiation you receive is difficult for x-ray technicians and doctors to answer because very few x-ray units have an instrument to measure the radiation to the patient.

You may have heard that even the smallest amount of radiation may cause cancer. Based on this unscientific assumption, the risk of causing a fatal cancer from a chest x-ray is 10 times greater than the risk of dying in a commercial airline flight. Or a CT scan of the kidneys has a greater risk of inducing a fatal cancer than a cigarette smoker has of dying from any cancer. These statements produce unnecessary worry. There is no data to show any risk from diagnostic x-rays.

• A radiologist is the doctor trained to read your x-ray. A medical physicist is the best-trained person to explain your dose risk. But most people having x-rays never get to see the medical physicist or the radiologist. Questions about radiation are often asked of the radiographer. This is the trained technician who positions you for an x-ray and makes the exposure. This person is usually not able to respond to your questions about radiation.
  
   
• If you ask, and are told a dose, you may not understand what a dose of 1 millisievert (mSv) might mean. But if this effective dose is converted into the amount of time it would take you to accumulate the same effective dose from background radiation, you could make a comparison. For example, the average background rate of radiation you get just living in the United States is about 3 mSv per year. So a mammogram of 1 mSv would translate into the amount of radiation you would get by just living in the US about 4 months.
  
   
• This method of explaining radiation is called Background Equivalent Radiation Time or BERT. The idea is to convert the effective dose from the exposure to the time in days, weeks, months, or years to obtain the same effective dose from background. This method has also been recommended by the US National Council for Radiation Protection and Measurement (NCRP).
  
   
• To calculate BERT, one good way is to use the average background in the US including contributions to the lung from radon progeny. This is assumed to be 3 mSv/y (300 mrem/y). The background in different parts of the US varies about half of this value, either more or less. This uncertainty is unimportant for understanding radiation exposure. The effective dose from common diagnostic x-ray procedures is typically less than the amount of radiation you receive from nature in 2 years. "

Now, let me repeat a sentence in the quote from above...."No scientific data indicate any danger. "

What part of that sentence is unclear to the fearmongers and obfuscaters out there that are trying to tell doctors they should not be using diagnostic x-rays? To me, it is VERY clear.

Have you, as the reader, gotten the idea that there is a developing consensus on the safety (or, for the scaredy cats..."relative safety") of diagnostic x-rays?

From a British site, that has a PDF on X-ray safety, (located at the link below)

http://www.hpa.org.uk/radiation/publications/misc_publications/x-ray_safety_leaflet.pdf

" The radiation risks for simple X-ray examinations of the teeth, chest or limbs, can be seen to fall into this negligible risk category (less than 1 in 1,000,000 risk). More complicated examinations carry a minimal to low risk. Higher dose examinations such as barium enemas, CT body scans or  isotope bone scans fall into the low risk category (1 in 10,000 to in 1,000 risk). As we all have a 1 in 3 chance of getting cancer even if we never have an X-ray, these higher dose examinations still represent very small addition to this underlying cancer risk from all causes.

As long as it is clearly necessary to help make the patient, the benefits from any X-ray examination outweigh these small radiation risks. It should be examinations are normally used to diagnose more benefit to the patient is to be expected."

I consider that site to be more conservative and cautionary than most, and even THEY downplay ANY
possible danger of exposure from diagnostic x-rays.

Hey, how about the Mayo Clinic ? Reckon THEY know anything about the safety of X-rays?

http://www.mayoclinic.com/health/x-ray/FL00064
"One of the oldest forms of medical imaging, X-ray is a painless medical test that can help your doctor in diagnosis and treatment — even in emergency situations. It's a fast, easy and safe way for your doctor to view and assess conditions ranging from broken bones to pneumonia to cancer. Many different types of X-rays, such as bone or chest X-rays, exist. The type your doctor uses depends on what part of your body is being examined and for what purpose.

X-rays are safe and effective for people of all ages, even young children. X-rays are particularly useful for examining the chest, bones, joints and abdomen. Your doctor may recommend an X-ray for many different reasons."

I bet that quote upsets the fearmongers out there who claim ANY x-ray exposure is "injuring" patients. In fact, I bet all my following sources upset the people who are trying to scare you.
Why? Because they are SCIENTIFIC AND AUTHORITATIVE sources on the safety of diagnostic x-rays.

Now the question arises, is there any benefit for these fearmongers who want to try to scare you into not getting diagnostic x-rays?

Interestingly enough, the British Journal of Radiology  has an article on just that kind of question.
http://bjr.birjournals.org/cgi/content/full/77/919/545
From British Journal of Radiology (2004) 77, 545-546
"

Is there a benefit in promoting the concept of radiation risk?

J Williams, MSc, FIPEM

Department of Medical Physics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK

We live in a risk averse society. The public is prepared to believe scare stories regarding the risks associated with many manufactured devices and materials whether they relate to genetically modified crops, mobile phone masts, or the measles, mumps and rubella vaccine. Attitude towards risk is tempered by the degree of imposition and by the perceived benefit — "my mobile phone is safe, your transmitter is dangerous".

In this climate we should ask whether it is to the benefit of the radiological community, or indeed to patients, to promote an awareness of the potential harm from X-rays when the risks are, as discussed below, negligible in most circumstances. A typical scenario is for the benefits of MRI to be promoted on the basis of the absence of risk from ionizing radiation. This is frequently stated when trying to fund a new scanner. It is surely more important to promote the benefits of MRI: high quality 3-dimensional images providing clinical information that cannot be obtained from any other diagnostic tool. Radiology does itself a disservice when it talks up the risk from imaging modalities that have an essential role in clinical diagnosis.

Radiation risk is promoted in several ways. For example the first part of a radiologist's specialist training in the UK is concerned with the requirement of the Ionising Radiation (Medical Exposure) Regulations 2000, IR(ME)R, to have had adequate training, specified in the legislation as being principally concerned with the physics of ionizing radiations and radiation protection. The implication is clear: X-ray and radionuclide imaging modalities are associated with significant hazards whereas ultrasound and MRI are not. This implication is reinforced by the possible requirement to notify the IR(ME)R Inspectorate of certain incidents involving an overexposure of a patient, for example the injection of the incorrect radiopharmaceutical, when there is no such requirement for non-ionizing radiations.

Medical imaging is a field of endeavour in which artificial energy sources are used to penetrate the body. It has been said that if X-ray examinations with present day techniques and equipment had been the first and only significant exposure of humans to ionizing radiation, then we would have no doubt that they were safe. But this was not the case. The early uses of diagnostic X-ray equipment inflicted massive doses of radiation on both operator and patient, and other uses (and abuses) of ionizing radiations have firmly established that ionizing radiations cause cancer. This fact, recognised since early in the last century, has promoted the simplistic view: non-ionizing radiation – good; ionizing radiation – bad. The view is reinforced by the layers of regulation concerning the use of these radiations with no comparable legislation governing the use of ultrasound or MRI. The introduction of ultrasound and MRI was not without concerns about their safety. These concerns have not been fully resolved but the extensive use of these modalities and the lack of any evidence of harm at the exposure levels used for imaging is taken as sufficient demonstration that any risk that there may be is negligible, particularly in the context of the proven clinical benefits.

Diagnostic radiology contributes approximately 14% of the average annual dose received by the UK population [1]. Other artificial sources in the UK contribute less than 0.4% with just 0.012% arising from the disposal of radioactive waste. The patient protection legislation in Europe is attributed to the public concern over the impact of artificial sources in the environment. The argument runs that if the public demand stringent action to minimize the dose from one particular source, then there should be concerted action to ensure that the population dose from the much greater source of radiation (i.e. medical exposure) is subject to equally rigorous standards.

In discussions of radiation hazards, one factor often neglected is that risk is proportional to dose. This is the received wisdom, promoted by the International Commission on Radiological Protection, the so called linear no-threshold theory (LNT). LNT has many challengers but it is not the purpose of this paper to debate that issue. LNT is the basis of our legislation and is required to be the basis on which we seek to minimize risk. In dealing with risk we accept that there is a 1 in 20 000 chance of developing fatal cancer following irradiation to an effective dose of 1 mSv. Legislation does not permit us to act as though the risk is any less, but at the same time we should not suggest that the risk might be any greater.

The range of doses in diagnostic radiology spans almost 5 orders of magnitude and the resultant risks vary to the same extent. A CT scan of the abdomen and pelvis gives a dose of about 10 mSv with an associated fatal cancer risk of 1 in 2000 (approximately equal to the annual death rate from all causes for people in their mid-20s). An X-ray of the hand gives a dose no greater than 0.2 µSv with a fatal cancer risk of 1 in 100 million (approximately one-tenth of the annual risk of being killed by lightning).

In recent years the contribution of CT scanning to the collective dose has been a major concern. Following publication of the UK survey on CT doses, the National Radiological Protection Board (NRPB) [2] reported that, whereas CT represented only 2% of all imaging involving X-rays, its contribution to the collective dose was approximately 23%. More recently it has been noted that the frequency of examinations has increased to about 4% and the contribution to collective dose has probably increased to 40% [3]. Such evidence, that a few examinations contribute disproportionately to the collective dose, is used to inform decisions on investment in alternative imaging modalities or in other investigation techniques. However, we can look at this information in another way. The typical dose for a chest X-ray is 17 µSv, for an X-ray of the extremities the dose per radiograph lies between 0.2 µSv and 3 µSv [4], and for dental radiology it is 4 µSv and 7 µSv, respectively, for two bitewing films using E-speed film and for a panoramic radiograph [5]. These very low dose examinations represent about 70% of all medical and dental exposures, but they contribute (on average) individual doses no greater than 3 µSv per year, that is less than 1% of the dose arising from all medical exposures. The average annual dose from air travel is 20 µSv, nearly 7 times greater [1].

IR(ME)R is concerned with all medical exposures and there is no de minimis dose below which the regulations do not apply. IR(ME)R requires the justification of individual medical exposures on the basis of the balance between risk and benefit. In applying the regulations it is important to recognise that when risk is extremely low then the benefit need only be proportionate to that risk and as has been discussed above, for the majority of X-ray examinations that risk is negligible (defined in my dictionary as "such as may be ignored because very little or very unimportant").

An NRPB leaflet containing information for patients [6] poses the question "X-rays: how safe are they?" and concludes that even for high dose examinations the dose "represents a very small addition to the underlying cancer risk from all sources". For those examinations with effective doses of 20 µSv or less (70% of the total) the risk is described as negligible. In every day language we might conclude that the majority of X-ray examinations are indeed safe.

In general the balance between risk and benefit is not judged by a simple mathematical calculation but let us try an example. It might be acceptable to advocate chest radiography (1 in 1 000 000 risk) in particular clinical circumstances even if 99 out of 100 films were expected to have no abnormal finding. The ratio of winners to losers would still be 10 000 to 1, a very substantial benefit to risk ratio. This may not be practicable as a general approach to justification, but a mathematical approach is taken in breast screening to provide the reassurance that the potential harm, i.e. numbers of cancers induced, is very much less than the numbers detected that can be successfully treated as a result. ^{"
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Now, to be honest, I could go on and on and on with sources reassuring patients AND doctors on the need not to be overly concerned about any imagined danger from diagnostic x-rays. The list of articles would soon become prohibitively long, because , let's face it, the authorities assure you that diagnostic x-rays offer no real concern for the intelligent, thinking person. The fearmongers cannot convince the intelligent person who researches the issue. They try to convince people that know no better. Unfortunately, some companies acting as specialty health networks, are extremely guilty of promoting nonsense and poppycock fearmongering, and deny doctors who use diagnostic x-rays appropriately, from joining their networks. The shame is that any doctor who, in order to get into their little network, changes his or her diagnostic protocol to AVOID proper use of diagnostic x-rays to rule out contraindications to treatment or to evaluate for fractures or focal bone pathology, are putting themselves at serious risk for medical malpractice in my opinion, and furthermore, putting their patients at risk for failure to properly diagnose.}

BAKER CHIROPRACTIC , PA launches new website.

		Tuesday, 05 June 07 - 01:25 AM (GMT) in General

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