Blacks have historically received higher radiation doses


In a practice the authors called “racial adjustment”, guidelines used in the first half of the 20th century for performing radiological examinations on black patients consistently recommended using higher kVp settings than for other people due to the false belief that it was more difficult for X-rays to penetrate the tissues of black patients. For example, a 1905 journal article incorrectly claimed that darker skin offered more resistance to X-rays.

This belief — that black people have denser bones or thicker skin — permeated medical textbooks and clinical practice guidelines for much of the 20th century. This has led radiologists to increase radiation dose levels for a single X-ray by up to 60% in black patients.

X-ray classification map from 1957 showing recommended radiation doses for different types of patients. Image reproduced with the kind permission of New England Journal of Medicine.

The practice prevailed until 1968, when it was discontinued, largely due to the impact of an expose by consumer advocate Ralph Nader, the authors wrote. And even then, the change was resisted by professional societies like the American College of Radiology (ACR) and the American Dental Association (ADA), wrote science historians Itai Bavli, PhD, and Dr. David Jones, PhD, from Harvard University in Cambridge. , MY.

Analysis of how and why this particular institutionalization occurred in the 1960s can provide insights applicable to the calculation and reassessments of health care disparities occurring today, they added.

The practice of giving larger X-ray doses to black patients came to national attention when the US Senate held hearings on the Radiation Health and Safety Control Act of 1968. laxity of existing regulations.

During the hearings, Nader testified that technologists exposed black patients to higher X-ray doses than white patients due to “widespread intuition or folklore”.

That claim led to broader debate among Nader, senators and health officials, and drew objections and denials from the ACR and ADA, according to Bavli and Jones. They quoted William Stronach, executive director of the ACR, who wrote in a letter dated May 29, 1968, that Nader’s allegation was “a combination of misunderstandings and half-truths that need to be sorted out.”

Nader countered that the ACR only sought to protect its autonomy to set professional standards, a desire that led the group to deny a practice that radiologists could simply have recognized and reassessed, the authors wrote.

Ultimately, Nader’s testimony prompted the Senate to seek more information, with the U.S. National Center for Radiological Health issuing an official statement on June 18 advising against using race to adjust radiation exposure. X for diagnostic imaging.

“X-ray technologies, which see through the skin to the deeper structures below, might have been expected to be unaffected by racialization. They were not,” Bavli and Jones.

To its credit, RAC was one of the first medical societies to address racial injustice following the May 2020 murder of George Floyd, the authors noted.

Ultimately, the percentage of X-rays taken on Black Americans who used increased exposures is unknown, as is the number of people potentially injured, the authors wrote.

Lessons to be learned include that superficial social and medical beliefs can become embedded in medical practices and institutions. Race adjustments for x-rays were introduced even though no convincing evidence had been published to justify them. In fact, racial adjustment is still used uncritically with black patients in many areas of American medicine, the authors wrote.

Second, the easy racialization of X-rays highlights the danger of widespread use of racial categories, the authors suggest. Even where specific use of racial categories and racial adjustment could benefit patients, physicians must heed the lessons of history and proceed with caution, questioning evidence, possible biases that influence decisions about diagnosis and treatment, and possible harmful effects, they wrote. .

“The history of radiology provides another example of how the institutionalization of racial categories – the translation of beliefs about race into formal recommendations, policies and practices – can perpetuate health inequities and harm marginalized groups. “, concluded Bavli and Jones.

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