More than just a ‘button pusher’
R.K. Vanlaldinpuia, CHC, Chawngte
We may have heard this meaningful quote, “Nothing in the world is more dangerous than sincere ignorance and conscientious stupidity.” – Martin Luther King Jr. And at the same time, there is another quote by anonymous, ‘Ignorance is bliss’ is this actually true in today’s time ? In actual sense, ignorance isn’t really a bliss but a curse we have to realise this, why ? lets read on.
We are not in the early 90’s anymore, but in the 21st century, the information age. We can travel around the world on our palm, while we defecate, yes that’s the disgusting truth for many of us but we do that very often. In today’s world, posting things on social media with half information or wrong information can go a long way in creating unnecessary chaos. Not just on social media; the information we read and gossips we read and spread can also be counted. Those small gossips and friendly talks gave rise to this particular word, “Button Pusher”. They are mostly referred in our local community as X-ray technicians and in abroad radiographers or technologists. Let us try to debunk who and why this particular name has been given to one of the vital pillars of Medical Setup.
From the reports taken from February 2017 to August 2017 there has been 9956 x-rays done and 1956 CT scans done in Civil Hospital Aizawl alone. From the numbers we can see that they have pushed the button one too many times this year itself. So what does these button pushers do anyways? The patient comes in and then they push the Exposure button right? Lets try to find out more.
Who is an X-ray technician/Radiographer?
We’ve been referring to them as button pushers so lets just continue with that until we find out why they are called so. To be that person who pushes the button inside the Radiology Dept. or Lab. One has to go through a series of painstaking Academic and Practical Examination. And yet they would actually start learning after they graduate.
To be a button pusher in India there are 2 years Diploma and a full fledge Bachelors Degree. The entry qualification for Bsc is +12 with Physics, Chemistry & Maths/Physics, Chemistry and Biology in their subjects.
These are some of the Syallabuses a button pusher studies during his academic life as an undergraduate student in UGC recognized colleges. Before, I’ve mentioned that the real learning starts only after their graduation, and so they start learning to handle machines on their own, knowing that they have within their grasp a lethal weapon(radiation) that they need to wield to diagnose the patient, yet if any negligence involve the outcome, a disastrous one. (sorry for the dramatic comment there, I just couldn’t help myself). During their internship they’ve been asked to mop the floor, run errands along with practical learnings like hands on study. But now, in their Labs or in their work stations their theoretical knowledges need to be put in to good use. The Patient Care and management class, the Radiation protection class and The anatomy class all of that comes into play to produce an image exposed with the least radiation dose but achieving the best possible image for better diagnosis.
So what is X-Ray?
Before learning what is x-ray let us know who discovered it and how he discovered it?
X-rays were discovered by Sir Wilhelm Cornard R¨ontgen in 1895. He received Nobel prize in Physics for this in 1901 (the very first Nobel prize!!!). R¨ontgen was working on investigating cathode rays (electron beam in an evacuated tube called Crookes tube) and a fluorescent screen painted with Barium accidently left near the tube glowed green even though the tube was covered with a black screen. He investigated this effect further and showed that the radiation could pass through matter, including human skin and named these mysterious rays X-rays. We now know that X-rays are part of the Electromagnetic (EM) spectrum. Visible radiation(Visible light) are also part of the EM spectrum but only occupy a tiny range.
To put it in simple terms X-Ray is nothing but a part of so many rays that are present in the Universe i.e. The Electromagnetic Spectrum, and it was accidentally discovered hence the X. (remeber in maths we use to write let x be the so and so… Yes, this was the unknown ray so he called it ‘x’)
X-rays are a part of the electro magnetic spectrum. All electromagnetic radiation have the same velocity i.e 3×10^8 m/s however they all differ greatly in wavelength and frequency. Before I confuse you with all these jargons of details let me keep this aside and explain what is Electromagnetic Radiation and its related terms. But before that, please do study the figure given here of the elctromagnetic spectrum.
The electromagnetic spectrum. Frequency and photon energy are directly related; frequency and photon energy are inversely related to wavelength.
- What is electromagnetic radiation?
Electromagnetism is a branch of physics involving the study of electro magnetic force, a type of physical interaction that occurs between electicrally charged particles. The electromagnetic force usually exhibits electro magnetic fields such as electric fields, magnetic fields and light is one of the four fundamental interactions in nature.
(i) Fundamental interaction:
In physics the fundamental interactions also known as fundamental forces, are the interactions that do not appear to be reducible to more basic interactions. There are four fundamental interactions known to exist; the gravitational and electromagnetic interaction, which produces significant long range forces and whose effects can be seen directly in everyday life and the strong and weak interactions, which produce forces at miniscule subatomic distances and nuclear interactions.
In physics radiation is the emission of transmission of energy in the form of waves or particles through a material medium. This includes electromagnetic radiation such as radiation waves, micro waves, visible ligt, x-rays and gamma radiation.
Ok ! So, does all these happen inside that huge machine kept in Civil Hospital??
Yes, all these interactions and actions we’ve just learnt happen inside that huge machine. No, not on the table but the x-ray tube that the button pusher moves around. Let me tell you how it actually works inside the x-ray tube.
The x-ray tube consists of a cathode and anode. The cathode acts as the source of electrons which are accelerated and strike the anode (for safety issues the anode is grounded and the cathode is maintained at a high negative potential with respect to the anode) which acts as the source for producing X-rays. Most of the energy of the incoming electrons get converted to heat (X-ray production is a highly inefficient process. Typically 1% of the electrons get converted to X-rays). In more simple meaning, the cathode is heated with a high kiloVoltage of energy thus producing electrons from the cathode(-ve) directing towards the anode(+ve) opposite charges attract.. Thus, x-ray production is also due to thermionic emission. And so, cooling water is flowed through the anode for heat extraction. X-rays are produced in all directions and come out of the tube through the Beryllium window while the rest are blocked by the metal shielding. The emission of X-rays depends on the energy of the electrons striking the anode target, which in turn depends on the applied voltage.
All these happens within seconds when the button pusher pushes the button.
(So, we’ve reached to the point where a button is being pushed. Sounds easy right?)
Ok, we’ve now figured out why they are called “button pusher” and learnt what X-rays are. But are they safe? Being on the harmful side of visible light from
Is this safe?
Yes, it is, if it is handled by a trained professional. And No, if some button pusher barges in and considers it a piece of cake.
This is why a certified technician is needed to operate radiation. Without the knowledge of Radiation Hazards and its Risks no one should be made to handle any radiation emiting machines.
We should know that humans have always been exposed to ionizing radiation. Some ionizing radiations (such as those emitted by uranium) occur naturally in the earth’s crust and in its atmosphere (from the sun and cosmic reactions in space). These radiations are present in the structures in which we live and in the food we consume; radioactive gas is present in the air that we breathe, and there are traces of radioactive materials in our bodies. These radiations are referred to as natural background (environmental) radiation. The levels of natural background radiation vary greatly from one geographic location to another. The greatest portions of our exposure to background radiation comes from naturally occurring sources such as these. In addition to natural background radiation, we are also exposed to sources of radiation created by humans. Artificial or man-made background radiation sources include such as medical and dental x-rays, nuclear testing fallout, and radiation associated with nuclear power plants. Figure 1.4 illustrates the approximate quantity of radiation received from natural and artificial sources. The population’s exposure to various sources of ionizing radiation. Natural background radiations (the earth, the sun, building materials) compose the majority of our exposure. Medical radiation is the largest portion of our exposure to artificial sources of radiation. Occupational radiation, nuclear energy, and fallout are responsible for only a minute portion of our total exposure.
However, since 65% to 80% of the body is composed of water, most interactions between ionizing radiation(X-rays)and body cells will involve radiolysis(molecular disintegration resulting from radiation) of water rather than direct interaction with DNA. The majority (approximately 90%) of cell damage is repairable. However, subsequent or multiple “hits” to the same cell are more likely to leave permanent damage. Diagnostic x-rays are considered low LET(Amount of Energy produced) radiation; the approximate LET of diagnostic x-rays is 3 keV/μm.
And we should know that Each member of the world’s population bears a particular genetic dose of radiation. Its sources include environmental exposure, radiation received for medical and dental purposes, and occupational exposures. The quantity of exposure to each individual depends on that individual’s geographical location (environmental radiation and elevation of terrain). Overall general health, the accessibility of health care, and occupational workers are suppose to abide to radiation protection guidelines. Generally speaking, the genetic dose to an individual is very small. Some individuals may receive no genetic dose in a given year, some individuals are past their reproductive years, and some individuals will not or cannot bear children. Even if some individuals receive larger quantities of radiation exposure, its impact is “diluted” by the total number of populations. This concept is referred to as genetically significant dose, defined as the average annual gonadal(reproductive organs) dose to the population of childbearing age, and estimated to be 20 mrem.
Knowing all these is vital, because with knowledge comes power. And with power comes great responsibilities. Therefore, your local friend who is a technician is responsible for protecting you from unwanted radiation exposure, at the same time he/she is helping Doctors diagnose your disease process.
How can I protect myself?
Health care professionals involved in prescribing and delivering radiologic examinations i. e. X-ray technician/Radiographers, have an obligation to keep nonproductive radiation exposure to all individuals as low as possible. Possible abusive overuse of radiologic (and other diagnostic) examinations is currently being scrutinized by many health care facilities as part of a continuous quality improvement program. Some formerly routine examinations are now considered excessive and unnecessary. For example, routine chest x-ray on admission to the hospitals, are no longer performed unless the patient is admitted as pulmonary medicine or surgical service; preemployment chest and/or lumbar spine examinations are frequently considered to have little benefit. In states having no licensure requirements for radiographers, physicians and hospitals often assume the responsibility of hiring only credentialed radiographers. Participation in quality assurance ensures that imaging equipment is functioning optimally and that image quality is up to expected standards. Radiographers must consider patient’s dose when selecting exposure factors. One component of a radiographer’s professionalism. As stated in the principles of the AERB Code of Ethics, it is to consistently employ every means possible to decrease radiation exposure to the population. Radiographers must follow the ALARA principle (keeping exposure As Low As Reasonably Achievable) as they carry out their required tasks. The radiologic facility must undergo appropriate radiation surveys. Staff must be properly oriented and regular inservice reviews of radiation safety must take place. Proper radiation monitoring and review of monthly radiation reports is essential.
Apart from these, there are few equipments and techniques a radiographer can protect the patient and himself/herself are as follows –
- Exposure Factors.
- Image Receptors.
- Grid and Air Gap techniques.
And most importantly ALARA.
In India we have AERB (Atomic Energy Regulatory Board) regulating all the facilities and machines and performing quality assurance program (through an ongoing preventive maintenance program and appropriate inservice education) that assures proper equipment function and compliance with established standards. We (Mizoram) are the second state in India to have RSA(Radiation Safety Agency) headed by Dr. Khamsuanpau. So we are in great hands in the Radiation Safety Department.
Let me share a small excerpt from ISRT(Indian society of Radiographers and Technologist) monthly magazine shared by Dr. Madhu Sharma leading radiologist in Mizoram and the HoD BRIT, Ripans about Radiation Safety.
“A chef should know how to manage fire so that it doesn’t become a menace. Similarly we have to know how to manage radiation” Dr. Madhu Sharma, HoD BRIT, Ripans.
Rightly so, Radiation should be managed to produce the least possible radiation at the same time using it to the fullest potential. Radiation as a profession will not be going out of business in the near future nor will it go out of fashion for the foreseeable future. From the First World War the likes of Madame Marie Curie using her portable x-rays kept in ambulances made a lot of difference in the war fronts and till today Radiation has saved many lives including our own family members.
Apart from the normal x-ray there are Interventional Radiology done with X-rays, CT Scan and MRI under the Radiology Department.
Interventional Radiology can be divided into two Vascular and Non Vascular. In vascular we have IVU, HSG(Hystero Salpinography) and Non Vaschlar interventions like Barium Meal, Barium Swallow, etc.
CT scans are a whole new topic which needs another fresh article for itself. Likewise MRI is also another topic but relating to magnets.
We’ve debunked the word “Button pusher” and got an idea of what X-rays are and what it can do. And Apart from debunking we’ve learnt a whole lot about Radiation and its association with our everday lives. So now, it’s our decision whether we want to uphold the profession as a “Button pushers job” or “Someone who protects me from unwanted radiation. In our present world of Sickness and Pot holes, we might face a time when we need to be diagnosed with any one of the modalities or an X-ray due to any kind of accidents or unwanted illness. All in all, each team of a medical setup has their own importance so, let us not be the one to cause disharmony amongst them.