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Some Physicians Fear Airport Scanner Radiation, Despite Evidence

In preparation of Internal Medicine 2011 in San Diego this week, the unavoidable choice to make isn’t which sessions to attend, but even before arriving: Will you pass through the airport’s security scanners, or opt for the pat down?

Physicians themselves are split on the issue, with some physicians opting out of repeat scanning in favor of the pat down search.

“I do whatever I can to avoid the scanner,” one physician told CNN. Other physicians interviewed were split on the issue one way or another. But as a frequent flier, this doctor was concerned about the cumulative effect. “This is a total body scan–not a dental or chest X-ray. Total body radiation is not something I find very comforting based on my medical knowledge.”

The Archives of Internal Medicine looks at the safety of the scanners, which haven’t been independently examined outside of the government’s own analysis of their safety. They apply radiation, specifically for the backscatter scanners, the more common ones used in the United States, which use ionizing radiation. Low doses cause biological damage, but cells repair it quickly. Backscatter X-ray scans use exceedingly low doses, the report said, “… so low that it is really not known whether there is any potential for causing harm.”

But, 750 million air passengers a year, even a small risk per person could potentially become a significant number of cancers.

Ionizing radiation occurs naturally, and is widely used in industry and medicine, the article points out. The National Council on Radiation Protection and Measurements reports that common sources of exposure are medical procedures and ubiquitous background radiation from the sun and cosmic rays, and from radon released from the earth. Backscatter X-ray scanners expose people to the equivalent of 3 to 9 minutes of what they’d get anyway from daily living.

Those who fly are exposed to more radiation anyway, but backscatter X-ray machines still equal only the radiation exposure that occurs for 1 to 3 minutes of flight time, or an increase of less than 1% for a cross-country flight.

The article points out that it takes 50 airport scans to equal the exposure of a single dental radiograph, 1,000 to equal a chest radiograph, 4,000 to equal the exposure of a mammogram, and 200,000 to equal an abdominal and pelvic CT scan.

“Based on what is known about the scanners, passengers should not fear going through the scans for health reasons, as the risks are truly trivial,” the authors concluded. “If individuals feel vulnerable and are worried about the radiation emitted by the scans, they might reconsider flying altogether since most of the small, but real, radiation risk they will receive will come from the flight and not from the exceedingly small exposures from the scans.”

*This blog post was originally published at ACP Internist*


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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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