risk factors involved in utilizing uncertified individuals to perform diagnostic and therapeutic applications involving radiation" (ASRT).

One individual believed that the key risk associated with the medical use of byproduct material is unretrieved brachytherapy sources. Texas and Illinois indicated that accelerators and diagnostic x-ray are unregulated at the federal level. They are not covered under misadministration requirements or in training standards for users. Kansas observed that the rules pertaining to cobalt-60 teletherapy and accelerators are very different despite the fact that both are capable of delivering doses that could cause serious acute injuries.

Question 5 (N = 19)

Are your patients informed about the potential risks associated with medical procedures involving ionizing radiation? If yes, how? If not, why not?

In response to this question we received 19 replies: 15 from professional associations, societies, and industry; 2 from states; and 2 from miscellaneous sources. There was widespread consensus that patients are informed verbally and via a written consent form (requiring their signature) regarding radiation hazards of therapy procedures by the physician and/or other personnel. The same is true in some cases regarding ionic contrast medicine. Regarding diagnostic procedures, patients are often informed verbally by the technologist or physician. "In some institutions, the patient is not informed about potential risks for diagnostic procedures as the risk is judged to be too small" (ABNM, AAPM), "and the anticipated medical benefit is so large as to make such discussion unnecessary and potentially counterproductive" (NYH-CMC). However, particular attention is paid to women of childbearing age who might be pregnant or lactating. Signs about potential risks to the fetus are posted and efforts are made to ascertain a woman's pregnancy status.

A few respondents indicated concerns regarding inadequate information. "In general patients are getting limited and sometimes inadequate information to understand the potential risk of radiation" (ARRS). "[We have] no direct patient contact; amount of information provided regarding risk is dependent on medical facility. Our members indicate that patients may not be [getting] adequate information for a variety of reasons that include lack of knowledge that is available. Our philosophy is that all patients deserve to be informed of all risks for any procedure performed on them" (ASRT).

Note: Florida stated that its regulations do not require that all patients be informed about the potential risks associated with medical procedures involving ionizing radiation. Information is provided as requested by patients in most cases.

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