292 RADIATION STANDARDS, INCLUDING FALLOUT highly educated specialists, is being conducted in approximately 15 colleges and universities, leading to master’s or doctor’s degrees in the field. These men will greatly influence all types of radiation control, including medical aspects, and their highly skilled abilities should assist future educational as well as regulatory measures. 3. PERSPECTIVE AND PROSPECTS OF MEDICAL EXPOSURES It is of interest to assess the extent of radiation exposure from medical uses and to relate it to that from other sources and to potential hazards which accompany all human radiation exposures. It is far more important to see that we are bee meee ae De oe (c) Research measures The 66 years since the discovery of X-rays have seen tremendous strides in using technical advances which produce more information from less radiation. The development of intensifying screens, very fast film emulsions and filnorescent screens, higher energy and Wore greatly filtered beams have all had great impact. Precision apparatus and precision processing put the radiation where it is desired and insure the best results from the amount of radiation that is used. But we have far from exhausted the potentialities of modern technology. Only in the past few years have applications of television and electronic systems reached practical stages in medical radiology. In the past 2 years imageamplified fluoroscopes have come into wide use in departments that can afford the large initial financial outlay and quick obsolescence associated with complex apparatus undergoing rapid improvement and modification. In the better forms, radiation dosage can be reduced to one-tenth or even to one-hundredth of former values while obtaining. the same or greater diagnostic information than before. Television, cine recording, and magnetic tape storage enhance the potential of these developments in present apparatus and offer great future promise. New developments in intensifying screen materials seem highly promising in dose reductions of the order of one-fourth or more as applied to regular radiography. Constant improvements are also being made in the speed of X-ray films, the design of beam collimators and shields, and in the reliability and production control of film exposures and development. These researches and developments should be vigorously supported not only for their effect on dose reduction, but more importantly for the great benefits to be achived in improved medical diagnosis. Though the cost is tremendous, few medical developments have more promise. ‘ctebeeranclbnetateoe teesebapse AE TE ORR at WR (b) Regulatory measures The States, largely through their departments of health, have increasingly promoted regulatory codes relating to radiation and most of these have provisions affecting minimal standards for equipment, features which can be inspected, such as filtration and shielding. Most of these codes have been based on the recommendations of the National Committee on Radiation Protection and Measurements. In transferring from recommendations to codes with legal force, some difficuities arise in relation to medical uses. For example, in most usual diagnostic X-ray examinations there is no need to use beams with filtration of less than 2 millimeters of aluminum half value layer, and the NCRP recommendation is to this effect. In certain special examinations, however, such as X-ray diagnostic studies for cancer of the breast, a very serious medical problem, the technique requires much lower filtration. Codes such as have been adopted in some States have the effect of making these examinations illegal, though such was not the intent of the NCRP, nor did the State agencies purposely intend to so interfere with a potential lifesaving procedure. The need for caution, highly skilled interpretation, and reappraisal in the promulgation and enforcement of regulatory codes is, nevertheless, apparent. Most of the impact of the moderate measures embodied in the better regulatory codes has been favorable, however. Much of the good has been indirectly achieved by the byproduct educational activities of inspectors in the course of their duties and the educational effects of registration requirements. In many instances, local medical and dental societies have been highly cooperative and have augmented the official program with voluntary campaigns of their own. <A notable example of this has occurred in Philadelphia. In New York City, Dr. Hanson Blatz, director of the Office of Radiation Control of the City of New York, estimates that his department has been instrumental, during the last 3 years, in reducing radiation exposures 25 percent. (Exhibit E in the appendix is a copy of a letter from Dr. Blatz.)