Doctors rely solely on X-ray or scan to diagnose ailments:

How safe are private X-ray centres?

By Kurulu Kariyakarawana

Radiography and scanning are key features in the modern medical world, to diagnose an illness or identify a defect in a body part. Unlike in the good old days doctors now rely solely on an X-ray or a scan result to diagnose one's ailment and prescribe medication.

Getting an X-ray is simple nowadays which can be obtained at any state or private hospital in the country or in most medical centres in a town that has such facilities.

It has grown to be a lucrative domestic business in the outstation where centres are set up in houses in the absence of proper medical centres or due to the scarcity of hospitals in villages.

Anybody who has an X-ray machine and an atom of skill in radiology could simply open an X-ray centre almost anywhere, even in a room in a house or in a roadside boutique. One could easily get an X-ray done in any of these centres just for Rs.400, within minutes. But, how appropriate and safe is it to get an X-ray at these places and what is the quality of the radiography, are important questions.

There are guidelines set to carry out a proper X-ray centre authorised by a licence issued by the relevant authorities. The licence is issued only if proper standards of the trade are maintained, and if not, it is an unauthorised X-ray centre which is not only illegal but also hazardous to health.

The competent authority in charge of licensing X-ray machines or centres is the Atomic Energy Authority. It is responsible for the constant monitoring of X-ray machines or scanners used by hospitals, medical centres and even domestic X-ray parlours to determine the safety of the public who use it.

Chairman Atomic Energy Authority (AEA) Dr. Ranjith Wijeyawardena told the Sunday Observer that a special licence has to be obtained to operate, possess or import a General Radiography Machine or an X-ray machine.

There are four modalities of machines that require a licence to operate in Sri Lanka, namely, General Radiography Machine Computed Tomography Scanner (CT scanner), Mammography Scanner, Dental X-ray Machine and Fluoroscopy Machine.

According to the Atomic Energy Authority Act No 19 of 1969, it is a punishable offence to operate or carry out an X-ray centre without a licence. A heavy fine or a prison sentence can be imposed on offenders who run unauthorised X-ray centres.

Deputy Director (Medical Applications) Radiation Protection and Regulations T H S Shantha said a licence is issued for a two year period. Before issuing a licence the AEA conducts a field study of the building and environment of the place where the machine will be set up.

They will first check whether the chamber meets the Radiation Protection Requirements such as whether the walls are thick enough and the doors and door frames are shielded with lead sheets to prevent radiation penetrating through them. It would be more suitable if the room does not have any windows or ventilation grids.

Then, they check the performance of the machine to ascertain whether it meets the required standards. Old and damaged machines could not only leak radiation but also generate a radiograph with poor picture quality which would not give the correct defect of a body part for a correct diagnosis.

Thirdly, the qualification of the person who operates it will be checked, to ensure whether he is a professional radiographer or a newly qualified university graduate with the necessary qualifications.

The AEA maintains a database of X-ray licence holders including state and private centres. If it is a big hospital a single licence is issued to the head of the institute regardless of the number of X-ray machines they have. For example, the National Hospital Colombo has about 40 X-ray machines but the licence is issued to its Director.

At present there are about 400 registered licence holders and over 800 X-ray machines being used in Sri Lanka. However, these figures could differ as there are non registered unauthorised X-ray machines being operated at the same time.

The AEA could make surprise visits to these centres from time to time to check their functioning. Specially trained Inspectors carry out quality tests even at the time of the renewal of licence. They would check for any hazardous radiation leaks in the centre and the quality of the picture. If there are any problems the licence would not be renewed and action will be taken against them.

With the issuance of the licence a special certificate is given to be displayed in the form of a notice at the entrance of the specific X-ray centre, which is a guarantee by the AEA that it is an authorised centre, safe to obtain an X-ray.

All authorised centres managed by hospitals, private medical centres and even domestic parlours display this certificate.

Dr. Wijeyawardena said it is the responsibility of the public to check for the certificate before they obtain an X-ray from a private or domestic centre to ensure that it is a safe place. Especially in rural areas one can find many X-ray centres set up in houses as a domestic business. There has been a number of instances reported about centres operating without a licence.

If a centre operates without a licence it means it is not guaranteed as a safe place to obtain an X-ray. In other words it is a hazardous place for the humans, that has radiation leaks.

The chairman said, "bad images could affect the doctor's diagnosis on an illness. An incident was reported where an X-ray was ordered to be taken for a stomach ailment. But the image showed nothing unusual about the patient's stomach, although the pain persisted. The doctor then ordered to take another X-ray at a different place, which showed a defect in the patient's stomach. Hence, the poor picture quality of the unauthorised centre gave a wrong report."

The Chairman advised doctors to use X-ray as a last option to diagnose a patient's illness. Some doctors, even without having a proper examination ask the patient to obtain an X-ray. Even a few seconds of exposure to radiation is a risk.

Taking many X-rays could badly damage the health of a person causing long term illnesses such as cancer, he said.

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X-ray

X-ray or X-radiation is a form of electromagnetic radiation discovered by a German physics professor Wilhelm Conrad Rontgen in 1895. He found that although an X-ray could pass through the human tissue, it cannot pass through bone or metal.

X-ray photons carry enough energy to ionise atoms and disrupt molecular bonds. This makes it a type of ionising radiation and thereby harmful to living tissue.

A very high radiation dose over a short period of time causes radiation sickness, while lower doses can give an increased risk of radiation-induced cancer. In medical imaging this increased cancer risk is generally greatly outweighed by the benefits of the examination.

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