Is it time to put restraints on veterinary radiography?

By Julia Bitan, RVT

When Dr. Debrah Berman, a Thornhill veterinarian with over 30 years of experience felt a lump in her tongue, she didn’t think much of it.

Up until that point, her health had been excellent and she was following all current radiology safety regulations such as monitoring her dosimeter values and using all protective equipment.

The diagnosis of Mucoepidermoid Carcinoma of the salivary gland (a type of cancer often associated with excess radiation exposure) came as a shock and made her start questioning the safety of today’s veterinary radiography.

“Since the 1990s, numerous jurisdictions in North America, and worldwide, have strengthened their regulations and best practice guidelines to actively move away from holding patients, in recognition that exposure to scatter radiation poses a risk.”

Outdated regulations

Although there are several provincial and federal laws in place to protect radiation workers in Ontario, the clauses specifically concerning veterinary workers have not been updated since 1990.

According to a veterinary radiography survey conducted in partnership with the Ontario Association of Veterinary

Technicians (OAVT) in April of 2016, 8 out of 10 RVTs still hold their patients during x-rays most of the time, while 7 out of 10 respondents choose to sometimes forgo the use of gloves and other protective equipment simply due to inconvenience.  

Our human radiology counterparts in Ontario are rarely present in the room when x-rays are taken because regulations state that no person should regularly perform manual restraining for x-rays.

Technicians commonly request parents hold their own children if x- rays are required.

Since the 1990s, numerous jurisdictions in North America and worldwide have strengthened their regulations and best practice guidelines to actively move away from holding patients, in recognition that every x-ray taken increases the overall risk of cancer.

Because we don’t see regular reports of veterinary workers dying of radiation exposure, we may naively assume that modern science has overcome the dangers with newer machine design and intensive research.

In reality, current occupational exposure limits are derived from decades-old research and we know that the risk of getting cancer increases with every exposure.

Recent findings do show that extended exposure to a low level of radiation increases the risk of developing leukemia, while radiation-induced cataracts are observed at a much lower radiation dose than previously believed. In veterinary medicine, the damage caused by ionizing radiation is simply too low to be felt right away and the ALARA principle (As Low As Reasonably Achievable) is much too ambiguous in the context of our profession.

Change is happening

A small number of veterinary clinics in Ontario, including Toronto Veterinary Emergency Hospital and Referral Center (TVEH), began enforcing a strict no-hold, out-of-the-room x-ray policy to keep their veterinarians and RVTs away from ionizing radiation emitted by the x-ray machines.

TVEH started enforcing the 100% -out-of-the- room radiography six years ago.

RVT Ashley Jenner, head of radiology at TVEH, has developed a number of tools and techniques to make out-of-room x-rays possible.  

“Non-manual veterinary radiography is much easier and faster than most people believe,” Jenner says. “All it takes is proper techniques and some extra tools.”

Jenner uses positioning devices alone on 75% of her cases (non-sedated patients), and sedation on the remainder.

Dr. Debrah Berman is now “cancer-free” and back to practicing veterinary medicine. She now endeavors to obtain all her x-rays using positioning/restraining devices or sedation.

“Radiation exposure is cumulative,” says Berman. “You may not realize until 20 or 30 years down the road that you have received too much. It may take a little more effort, but had I known that I would need to have a quarter of my tongue removed because of cancer and that I'd have permanent nerve damage and varying degrees of chronic pain, I wouldn't hesitate. And, I am one of the lucky ones. We need to protect ourselves”.

Transitioning to non-manual radiography is not always an easy task.

Change is rarely welcomed in our profession and as long as the minimum standards are followed, there is little reason or incentive to change.

We do, however, know there are risks involved with radiation, and alternatives do exist.

A program was created to guide clinics through transitioning to non-manual radiography using different tools and techniques.

The Hands-Free X-Rays Initiative aims to promote awareness and encourage change to current veterinary radiography.

For more information about the program, visit our website - www.handsfreexrays.com.

For comments, feedback or help to bring change to your clinic, please contact us at:

email: info@handsfreexrays.com

Phone - +1 (647) 502-4843.

Written by By Julia Bitan, RVT