Before prescribing an x-ray, 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 as much as 50% in the past five years alone (though in the absence of a centralized registry, no concrete figure is available).
This poses a clear danger of radiation over-exposure, especially for seriously ill people who are often asked to repeat all diagnostic tests each time they consult a new expert. The absence of a watchdog or set treatment protocols only makes matters worse. And, believe it or not, doctors often may not have a clue about dangers of exposure.
According to a study done by AIIMS in 2006-07 in Delhi, 80% of physicians were found to be more or less ignorant about the levels of radiation exposure in various radio-diagnostic tests. "When awareness is so little, over-prescribing is inevitable. X-rays are the most over-prescribed test. 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" since each test results in a 0.02 mSv exposure. "It is safe but should be judiciously prescribed. Any amount of radiation exposure is hazardous though it might not result in cancer or skin burn," said Dr Kumar.
As per the Radiation Protection Act, 2004, all x-ray machines have to be registered with the Atomic Energy Regulatory Board. 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 those bought before 2004 are "very difficult to trace". "We have registered more than 35,000 x-ray machines and over 1,000 CT-scan units registered. We will complete the process soon," said S P Aggarwal, director, Radiology Safety Division, AERB. Aggarwal too admits that x-rays and CT-scans are being over-prescribed. "But it is not our job to monitor this aspect. It is an ethical issue and doctors have to be cautious," he said. Medical Council of India (MCI), which has all medical practitioners in India registered with it, says it's not possible to monitor overuse as there are no standard guidelines for treatment of a medical condition.
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 government and private sector medical services. "The Centre can't force state governments to adopt this Bill, as health is a state subject. We need stringent laws to stop the misuse of these diagnostic facilities. Today, any registered doctor is free to run a pathological laboratory or a radio diagnostic service. There is no minimum requirement imposed by MCI," said Dr C M Gulhati, editor, Monthly Index of Medical Specialities (MIMS-India). But MCI says that it is difficult to monitor over-prescription of these tests. "There is no set rule or guidelines to diagnosis a disease. It has to be left to the physicians to decide how many tests are needed. And the fear of litigation has spoiled the relationship between doctor and patient. Doctors are also human beings and to err is human," said Dr Ketan Desai, president, MCI.
कोई भी मूल्य एवं संस्कृति तब तक जीवित नहीं रह सकती जब तक वह आचरण में नहीं है.