News

 

As published by the BBC on 3 December 2012 By Michelle Roberts Health editor, BBC News online

Dentists have been warned against using a hand-held X-ray machine on patients as it poses a significant health risk.

The cheap imported machine, known as the Tianjie Dental Falcon, exposes users and patients to 10 times the normal level of radiation, increasing their risks of cancer and organ damage.

The Medicines and Healthcare Regulatory Agency is asking NHS and private dentists to dispose of these devices.

It is not known how many patients may have been put at risk.

So far, 13 of the machines - sold on internet sites including eBay by a Chinese manufacturer - have been seized at a distribution centre.

 “I certainly wouldn't want someone to use this piece of equipment to take an X-ray of me”

Scientist Donald Emerton

At least one dental surgery has been found using the device.

Emergency testing of the product by the Health Protection Agency and scientists at King's College Hospital in London revealed that it has insufficient lead shielding inside it to protect dentists and patients from excessive radiation.

The machine's X-ray beam is also too wide, which means a patient's whole skull and brain is exposed to radiation rather than just their mouth.

And the device poses an electrical hazard because it comes with a European plug and a travel adapter that are not earthed or fused for the UK mains supply. As well as being a fire hazard, it could cause a serious electric shock (50,000 volts) to the dentist or patients.

Scientist Donald Emerton, who tested the device, said: "Over time someone operating this machine, such as a dental assistant, would be exposed to unacceptable levels of accumulated radiation and this would have an increased risk to their health.

"I certainly wouldn't want someone to use this piece of equipment to take an X-ray of me."

The MHRA believes it has shut down the UK's only distributor but says investigations are ongoing to ensure no more can be sold and used here. The problem first came to light in June 2012.

It is not yet known how many of the devices are already in circulation.

The manufacturer - Zhengzhou Tianjie Electronic Equipment Co - is currently unavailable to contact.

The Tianjie Dental Falcon was priced at about £200, a fraction of the cost of other dental hand-held X-ray sets available for sale in the UK, which can be over £4,000.

Bruce Petrie, of the MHRA's Medical Devices Enforcement Team, said: "It's vital that dentists and dental staff do not buy these dental X-ray machines from eBay or other websites because they are not approved and not safe for dentists or patients.

"We are working with eBay and other governments to ensure dentists and patients are protected."

He said anyone who had bought one of these machines should the MHRA's hotline on 020 3080 6701 or at counterfeit@mhra.gsi.gov.uk.

Barry Cockcroft, chief dental officer for England said: "It is vitally important that when buying equipment, dentists make sure it is appropriate and safe for use.

"I would urge all dental professionals to be cautious of seemingly cheap devices which may not be fit for purpose and potentially dangerous."

Richard Paynter, deputy director of the Health Protection Agency's Centre for Radiation, Chemical and Environmental Hazards, said: "We're delighted that MHRA is now taking such positive steps to ensure public and occupational protection from unnecessary radiation exposure."

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Dentists warned over x-ray machine amid radiation fears (Guardian online 3rd December)

Tianjie Dental Falcon x-ray machine exposes patients to 10 times recommended dose of radiation, say health officials.

Dentists have been warned not to buy a handheld x-ray machine which exposes patients to 10 times the recommended dose of radiation.

The cheap imported devices could also pose a significant risk to dentists and nurses, health officials said.

The Tianjie Dental Falcon scanners can be purchased on eBay for as little as £205, compared with about £4,000 for a safe model.

Officials have confirmed that one UK-based dental practice purchased one of the dangerous machines, and several others have expressed interest in buying one.

Any dental practices that have purchased the machines have been urged to contact the Medicines and Healthcare products Regulatory Agency (MHRA).

Bruce Petrie, of the MHRA's medical devices enforcement team, said: "It's vital that dentists and dental staff do not buy these dental x-ray machines from eBay or other websites because they are not approved and not safe for dentists or patients.

"We have seized 13 of these x-ray machines from the distributor and we are working with eBay and other governments to ensure dentists and patients are protected. We urge anyone who has bought one of these machines to contact us."

Barry Cockcroft, chief dental officer for England and the government's principal dental adviser, added: "It is vitally important that when buying equipment dentists make sure it is appropriate and safe for use. I would urge all dental professionals to be cautious of seemingly cheap devices which may not be fit for purpose, and potentially dangerous."

Clinical evaluator Donald Emerton, who examined the seized devices at King's College hospital, added: "When we tested the x-ray machine we found it did not properly protect either a potential patient, nor the person operating it.

"Over time someone operating this machine, such as a dental assistant, would be exposed to unacceptable levels of accumulated radiation and this would have an increased risk to their health. I certainly wouldn't want someone to use this piece of equipment to take an x-ray of me."

 

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Routine chest X-rays in the ICU: a bad hospital habit finally being broken

 

 

By Pamela Fayerman

 

Patients have long been given daily, routine chest X-rays in hospital intensive care units around the developed world,  for no good medical reasons. Just because of decades of habit.

 

But recent studies have shown they are a waste of time and resources, not to mention being potentially hazardous because of the repeated radiation.

 

Such X-rays don’t detect more problems, don’t alter mortality rates, the length of stay in ICU, or the number of days patients are hooked up to breathing machines, recent studies have shown.

 

So when doctors at St. Paul’s Hospital in downtown Vancouver decided to instigate a stop to the practice, they managed to find cost savings of  $40,000 annually by ordering 70-per-cent fewer routine X-rays. Each X-ray test costs about $40.

 

In the process, they spared patients from X-ray radiation and freed up staff time more more proven interventions.

 

“Not to sound stupid, but it was one of those things we were used to doing out of tradition, because of thinking it was the right thing to do. But it was one of those things for which there was no evidence of benefit,” said intensive care specialist Dr. Peter Dodek. He led a study of the practice as a scientist with the Centre for Health Evaluation and Outcome Sciences at St. Paul’s and the University of B.C.

 

“All I can say is sometimes, habits are deeply ingrained and there are things we do in medicine which don’t really add to our diagnostics,” he added.

The American College of Radiology used to recommend daily chest X-rays for patients on ventilators. But the recommendation has now changed because of evidence that such routine tests are not necessary.

Frequent chest X-rays are, however, still necessary for patients with symptoms of heart and lung distress or those freshly hooked up to tubes and catheters that could pose complications.

St. Paul’s began to rethink its policy a few years ago when five residents in internal medicine read about a comprehensive study in France showing that daily chest X-rays of ICU patients were unnecessary. As part of their postgraduate medical training and a project on patient care quality improvement, they decided to launch their own study.

“Our intention was not to eliminate chest X-rays because some patients do need them. After all, we are talking about patients who are intubated, and often on mechanical ventilation. They’re at risk of acquiring pneumonia in hospital so that’s why daily chest X-rays were thought to be useful, to check for those signs,” Dodek said.

But there are other ways and means to look for signs of pneumonia — fever, white blood cell counts and oxygen levels. Doing a chest X-ray on an ICU patient means radiology technicians have to wheel portable X-ray machines to the bedside, nurses have to lift and reposition seriously ill patients, and clear tubes and catheters out of the way of the X-ray beam. Repositioning patients can result in catheters and tubes coming loose.

Once the patient is readied for the scan, nurses and other health professionals must stand back so they’re not exposed to the radiation.

The St. Paul’s project team drew up a list of conditions that still require routine chest X-rays and worked with computer programmers to change the electronic order-entry system so that all requisitions include at least one of the required indicators. They spread the word by putting up posters and giving educational sessions. They also hope to have their work published in a medical journal.

By eliminating the electronic, automatic orders for daily chest X-rays, St. Paul’s reduced the number of tests by 25 per cent. The most dramatic drop has been in routine tests while there’s been a slight increase (10 per cent) in orders for X-rays done on patients with suspicious symptoms.

The changes at St. Paul’s have spilled over to some hospitals in the Lower Mainland but not all.

“The ICU at Vancouver General Hospital adopted the same practices as St. Paul’s starting several months ago,” said spokesman Gavin Wilson.

“Recognizing that not every patient needs a daily chest X-ray, ICU physicians decide during rounds whether or not (it’s) required, depending on the patient’s clinical picture. If a patient’s condition changes during a shift, staff may request a chest X-ray.”

Dr. Sean Keenan, a critical care medicine leader at the Fraser Health Authority, said daily, routine chest X-rays are still the norm at that authority’s hospitals, but change is coming.

“At this time, daily routine chest X-rays continue to be performed throughout all our acute care sites, particularly at the tertiary level.

“We are, however, planning to transition to the practice currently followed by VGH and St. Paul’s whereby ICU physicians decide on a case-by-case basis the need for an X-ray.”