Radiation safety in Kerala: Are we still in the red?

KOCHI: Imagine yourself as a patient with a complaint of left flank pain reporting to the casualty department of a busy hospital. The medical officer after examining you, asks for a CT scan of the abdomen and pelvis to rule out a kidney stone. This is where radiation protection first steps in - Is the scan really necessary?  A simple X-ray of the kidney, ureter and bladder would have confirmed the presence of stone or even an ultrasound scan of the area would have done the job. The first rule in protection demands justification of radiation exposure.

Now that you have been asked to undergo a procedure involving radiation, are you sure that the equipment being used for the investigation, the CT scanner, is genuine and is properly calibrated to deliver the optimum radiation dose to give the correct image? This is the second part of protection namely, optimisation.

Are the personnel operating the machines qualified? Is the machine installed in the hospital away from the Paediatric ward? While performing the investigation, the dose delivered to the patient and the public should be As Low As Reasonably Achievable- the principle of ALARA. This forms the third part, called dose limitation.

In order to ensure radiation safety, the Atomic Energy Regulatory Board (AERB) was constituted on November 15, 1983, by the then President of India by exercising the powers conferred by the Atomic Energy Act, 1962. The mission of the AERB is to ensure the use of radiation and nuclear energy in India does not cause undue risk to the health of people and the environment. The Radiation Protection Rules (RPR) of the Act state that the probability for stochastic effects like cancer, leukemia and genetic disorders increase with radiation. In order to enforce safety in the country, AERB decided to start Radiation Safety Directorates in all the states of India. The Directorate of Radiation Safety (DRS) Kerala, was thus formed under the Health & Family Welfare Department with a Memorandum of Understanding (MoU) between AERB and the Government of Kerala in 1996.

Before starting DRS, the radiation safety scenario was deplorable in the state. X-ray and CT machines were installed without any safety precautions along with a number of refurbished and poor quality machines. DRS Kerala started inspection of all X-ray equipment and layout of installations and recommended these for registration with AERB.

The Supreme court was impressed by the working of the Directorate and guided AERB to implement the Kerala model in all the states. Subsequently, AERB introduced e-LORA, an online registration system. The move was welcomed, but permission now could be obtained without a physical inspection or verification of the site and equipment.

Any institution wanting to install an X-ray unit can now do so by just registering in e-LORA. AERB has given a direction to DRS Kerala to stop all radiation safety regulatory activities for want of an appropriate MoU between them and the Government of Kerala. AERB unilaterally removed certain important clauses from it which made DRS irrelevant. AERB does not have the wherewithal to inspect and grant licenses to all the X-ray units along the length and breadth of India. A DRS, if available in every state, can only enhance the regulatory role of AERB effectively rather than work against it.

Incidentally, around 4000 X-ray units including CT, Cathlab are now functioning without AERB registration in Kerala. The present online e-LORA registration system is granting permissions to many illegal units thereby creating grave radiation health hazards. It would be appropriate if the Government takes the initiative to call AERB for a detailed discussion and solve this impasse at the earliest. An appropriate MoU between the Government of Kerala and AERB for delegating a few regulatory clauses to DRS will go a long way and retain its as a role model for the whole country.  

Ask these questions before undergoing  radiation tests
Is the exposure absolutely necessary or justified? Is the equipment properly calibrated to deliver the optimum dose? Are the personnel qualified?

Dr Raghuram K Nair is a former professor and head of Radiation Physics Division at Regional Cancer Centre, Thiruvananthapuram.

(The views expressed by the author are his own)