A patient X-rayed by a dentist or doctor in Virginia stands a significant chance of receiving an excessive dose of radiation, according to state health records and officials.
Medical and dental personnel in the state operate X-ray machines virtually free of government regulation. There are no required inspections of X-ray equipment, no required inspections of X-ray equipment, no limits on patient exposure levels, no standardized operating procedures and no required training or licensing of operators.
State health records show:
In a 1977 survey of dental X-ray machines in Washington's Virginia suburbs, 251 of 420 machines emitted excessive radiation. Some machines exceeded the federal radiation standard by five times; one Fairfax dentist's machine was radiating patients at 10 times the standard.
Another statewide inspection of new X-ray machines-the ones least likely to emit excessive radiation-found 146 faulty units of 273 examined.
None of the 975 X-ray units in the state's hospitals have been inspected for the last three years. Units in five Northern Virginia hospitals have not been checked since 1970.
Federal radiation experts say that the excessive doses in many cases are not attributable to old or inadequate equipment but to the X-ray technicians.
John Villforth, director of the U.S. Food and Drug Administrations bureau of radiological health, says, "The longer you expose the patient, the faster you can develop the film. That saves you time in the darkroom, and time is money to a dentist."
As a result, he says, "The patient gets zapped."
Says one state official, "You need a license to X-ray a boiler or a tree, but not a person."
Although the state Bureau of Radiological Health's budget increased 50 percent last year, much of the new money went toward monitoring radiation at nuclear power plants, which officials say poses much less of a public health threat than improper X-rays.
"We can't say exactly how many (X-ray) machines are being faultily operated," said bureau supervisor Charles Price. "But it's fair to say, based on our dental X-ray survey and on the inspections we've done, that at the very least thousands of people are getting more radiation than they should."
The Virginia experience is not unusual, according to Villforth of the FDA. He said surveys throughout the country have shown dentists routinely exposing patients to two to three times the necessary radiation levels.
The FDA estimates that X-rays account for 90 percent of the radiation, beyond natural background levels, that the average person is exposed to during a lifetime. Experts say that while X-rays can be an important medical tool, any excessive exposure is potentially hazardous and increases the risk of birth defects and cancer.
Dental groups, including the Virginia Dental Association, have cooperated with the dental X-ray survey program, but compliance is strictly voluntary.
State law authorizes the Virginia Board of Health to establish radiation regulations and to use legal sanctions to enforce them. But health officials say the regulations adopted in 1972 lack specific data on how X-ray units should be operated, and officials in the past did not encourage enforcement.
"Under the former health commissioner (Dr. Mack I. Shanholtz, who retired in 1976), we were told-not by him but by people close to him-that radiation control should be a voluntary program," said Price. "That ended the question of enforcement right there."
Lack of support also extended to the bureau's budget. "It was the only state budget that had actually gone down over the years," said Dr. Robert Jackson, assistant health commissioner, who has been instrumental in increasing the bureau's finding. "Frankly, until recent years there was no high priority for it."
Officials discovered how widespread excess radiation was three years ago when the bureau, in cooperation with the FDA, began surveying the state's estimated 4,200 dental X-ray units. X-ray exposure cards with radiation meters attached were sent to dentists, who were asked to expose the cards and mail them back.
Of 99 machines tested in Alexandria, 65 emitted excessive radiation, state records show. In Arlington, 53 of 101 exposures were excessive, and in Fairfax City, 23 of 36. In most cases, officials say, the excesses were linked to poor X-ray development techniques.
Inspectors say the highest radiation level the survey has uncovered so far was in August, 1977, on a machine belonging to Dr. Marbury M. Hutchison of Fairfax City. According to bureau records, the unit's emissions averaged nearly 10 times federal guidelines.
Hutchinson said in an interview last week that all problems were corrected after a state inspector tested the machine and advised him on improvements.
While health officials believe the voluntary program helps reduce exposure, they haven't followed up to make sure. In Hutchinson's case, inspectors haven't revisited the office in nearly two years to reexamine his equipment.
Hospitals are required to have annual private inspections of X-ray units in order to maintain accreditation with the Joint Commission on Accreditation, an industry group. But the consultants who do the inspections are not state-licensed, nor are there state requirements on the thoroughness of inspections.
State health officials say hospitals, which are likely to have at least some personnel trained in X-ray use, are less of a problem than dentists' or physicians' offices where older, faulty equipment and untrained staff are often found.
The state bureau has proposed a set of more stringent radiation regulations to the state Board of Health. But radiology experts both in and out of state government expect a battle from doctors who are leery of any increased state regulation.
Health officials also hope to find a legislator to propose a law at next year's General Assembly session requiring training of X-ray technicians. For now, only technicians using radioactive substances such as Cobalt-60, widely used in industrial radiography, are required to be licensed by the federal Nuclear Regulatory Commission.
Nine states presently require licensing, said FDA analyst Lois Miller. The FDA has not taken an official stand on state licensing, but officials there clearly favor it.
"If you don't have some control over who's pushing the X-ray button, you can have the equipment in tip-top shape and still be overexposing patients," said Miller.
For now, state health officials said, patients in Virginia have no way of determining if their dentist or physician is properly operating his X-ray equipment. CAPTION: Picture 1, Virginia residents may be exposed doses of X-ray radiation. By Douglas Chevalier-The Washington Post; Picture 2, Dental and medical X-ray equipment, operated without regulation, may be emitting excessive radiation. By Tom Allen-The Washington Post