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Deadly Exposure
Crisis at National Hospital as radiation threat closes cath labs of Cardiology Unit. Kumudini Hettiarachchi reports
Four 'unrelated' patients. A retired nurse who has died of thyroid cancer; a minor staffer whose bladder has been removed due to cancer and now wears a urine bag; a senior radiographer who has just undergone surgery for thyroid cancer and a consultant cardiologist who is suffering from a malignant brain tumour.

One common factor - all have worked or are working with radiation at the Cardiology Unit of the National Hospital of Colombo. They are also the latest victims in this hidden problem, the effects and damage of which are felt many years later.

Radiation seemingly being the link, even to any unqualified person, immediate measures are essential to overcome the dangers posed to hospital staff by radiation exposure while providing all facilities to the three victims who have given more than what is expected of them in their line of duty.

The Atomic Energy Authority called in to conduct a full investigation at the Cardiology Unit has found that the protective gear crucial for all health staff is defective. "Our officers went there on November 3 and then again on November 9, did a thorough check and found that the protective shields or safety equipment were defective. We have submitted a full report to the Health Minister, Health Secretary and the National Hospital Director," Acting Chairman of the Atomic Energy Authority Dr. Shanthi Wilson told The Sunday Times.

Presently cardiac catheter laboratories -- where radiation is a vital tool in diagnosis -- remain closed, except for emergencies, as the staff feels unnecessarily exposed to ionising radiation due to lack of proper protective gear. The staff only had a few aprons lined with lead and torn and damaged thyroid shield.

One "cath lab" with basic facilities was to be opened on Friday while the full range of protective gear is to be imported and supplied immediately at a cost of Rs. 15 million, The Sunday Times learns. That seems to be the right way to handle the crisis as "radiation workers" are providing a service while facing a risk and they deserve the best possible protection.

"We appreciate the urgent action taken by the Minister, the Director-General of Health Services and the hospital Director. A meeting was summoned on Monday to review the situation where all the top officials were present. Prompt action has been taken to rectify this situation not only at the National Hospital but also in all state hospitals," says Christie Fernando, Superintendent Radiographer of the National Hospital.

Radiation or X-rays are essential for diagnosis as well as treatment of different diseases. (see graphic). When an X-ray is being taken, the machine is directed at a specific spot after the patient has been positioned and the radiographer makes an exposure within a safety environment. But screening done under fluoroscopy is a different matter.

"The patient may have to undergo screening once or sometimes on a few occasions for his/her diagnosis and treatment, whereas the team involved gets exposed to radiation with every patient during routine work everyday," says Mr. Fernando.

"The X-ray spot film does not allow the medical team to see the functioning of organs. However, fluoroscopy, an advanced system does. Under this technique, an image intensifier is used to see the interior of a patient on a TV monitor and is commonly used for the diagnosis of any vascular or heart disease," explains Mr. Fernando.

Fluoroscopy is carried out at the "cath labs" of the Cardiology Unit, the Neurosurgical Unit, the orthopaedic operating theatre, the neurosurgical theatres and the general theatres.

Rays of the primary beam from the X-ray tube, after contact with an object penetrates it while others get absorbed. "The rest get scattered. This causes exposure to the team handling fluoroscopy as it is essential for them to be right there in the room by the side of the patient," explains Mr. Fernando.

In the case of heart patients, usually, the medical team consists of the Consultant Cardiologist, a few other doctors assisting him, one or two nurses, the radiographer, the ECG technician (cardiographer) and a minor staff member. Fluoroscopy is used in coronary angiograms and when inserting stents or pacemakers, to name a few.

Therefore, the team that goes into the "cath lab" and stays there the whole day -- considering the lives of patients as their priority, with scant regard for their own health -- needs the highest protection. The Sunday Times understands that in the three "cath labs" around 25 procedures are performed daily.

"Radiation is harmful. Any dose is harmful to the body. The golden principle in diagnostic radiology is that nothing is safe. Not even the minimal dose," explains Mr. Fernando, adding that protection applies not only to the medical team but also to the patient.

Protection from radiation comes in the form of aprons with a lead shield for the body, thyroid shields for the thyroid glands, lead gloves for the hands and lead spectacles for the eyes.

While the state health sector arms itself with protective gear to face the dangers of radiation, the authorities need to act on other crucial issues with regard to private sector health facilities in this life and death matter. In the light of these developments some pertinent questions would be: Is the radiation equipment in the private sector being checked regularly? What of the patients' protection? Do qualified radiographers and radiation workers handle these dangerous rays? Do they follow international radiation protection requirements and the guidelines set by the Atomic Energy Authority?

An urgent answer and action are the immediate requirements, for someone maybe getting exposed to avoidable radiation just this minute.

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