The Race Correction and the X-ray Machine – The Controversy Over Increasing Doses of Radiation to Black Americans in 1968

The discovery of X-rays in 1895 revolutionized medicine. It allowed doctors to more easily diagnose and treat many medical problems.22 The ability to photograph teeth has also transformed dental care. However, with the development of X-ray technology in the early 20th century, misconceptions about the biological differences between blacks and whites affected how physicians used this technology.

Ideas about racial differences in bone and skin density emerged in the nineteenth century and remained prevalent throughout the twentieth century.5 Theodore Waitz 1863 Introduction to Anthropology He asserted, for example, that “the skeleton of the negro is heavier, and the bones are thicker.”23 These claims reflect both beliefs about behaviors attributed to blacks (for example, violence)23,24 And the interests of white scholars and slave owners who justified slavery.16,19

The ideas persisted even as contexts changed. Almost a century later, in 1959, Atlas of normal radiographic anatomy The skull bones of blacks have been described as “thicker and denser” than those of white people.25 Researchers continued to report racial differences in bone density throughout the 20th century.26 However, when the National Center for Radiological Health of the US Health Services (NCRH) revised this question in 1968, it cast doubt on the claims (eg, “unproven”, “credibility questionable”), and noted that the differences reported About them may have environmental reasons (eg, nutrition and exercise), and he stressed the existence of significant differences within the so-called races.27,28

The belief that blacks had denser bones, more muscle, or thicker skin led radiologists and technicians to use radiation exposure more frequently during X-ray procedures. As a physician asserted in 1896 that “black is completely opaque”, black leather “provides some resistance to cathode rays”.5 A 1905 review explained how “negro skin offers more resistance to X-rays than non-pigmented skin.” This resistance made it difficult to “get a good skate vertebra for the negro’s spine”: “The large exposed surface (belly and back) has so much pigment that it loses a great deal of X-ray energy.”4 New York evening world He described a famous black boxer with a skull that was “almost impregnable”: it required “the utmost skill of Josef Klopper, famous electrician and radiator Roentgen, to get a picture of the cabin’s work.”5,29

Formal teaching about race modification for X-rays appears to have begun later. Clifton Dummett, a prominent black American dentist, described his education in the 1940s to increase the X-ray exposure times of the teeth and jaws of black patients because their oral tissues were more resistant to X-rays.30

Patient classification, 1957.

Reprinted with permission from the American Society of Radiological Technologists.32

General considerations of the body, 1964.

Reprinted from Jacoby and Paris.35

In the 1950s and 1960s, X-ray technologists were required to use higher radiation doses to penetrate black bodies. Roentgen signs in clinical diagnosis, published in 1956, described a radiographic examination of a black person’s skull as a “technical problem” that required modified technology. The author suggested increasing exposure by 10 kV (increase from 12.5 to 21%).31 1957 article in X-ray technician “Eggs” are classified as “normal”. For ‘black or brown’ patients, adjustment is recommended for better radiograph (eg, use higher than normal 4 kV dose – 9.5 to 25% increase) (shape 1).32 Race modifications have appeared in many other textbooks as well.33 Second edition (1960) of Jacobi and Hagen X-ray technology He added the unjustified recommendation that black patients be exposed to 40 to 60% higher than that given to white patients. This directive remained in the third edition (1964) (Figure 2).34, 35

General Electric (GE), then the largest manufacturer of diagnostic X-ray equipment, made its race-based recommendations. In the 1961 and 1963 editions of her pamphlet “How to Prepare a Technical X-ray Scheme,” she advised that black patients needed increased exposure to radiation.28 In 1968, General Electric spokesman Robert Molitor explained that the recommendation reflected “current medical thinking” among radiologists.27

Blacks weren’t alone in receiving more radiation. Guidelines and textbooks also recommend higher doses for people who are “morbidly obese” or “muscular.” In patients with sclerosis, osteomyelitis, or Paget’s disease. And in patients who wear a cast. Meanwhile, thin patients, children, elderly patients, and those with osteoporosis were given lower doses (Figure 2).35 It is not clear which modifications were based on intuition or anecdotal experiences and which, if any, were based on careful consideration.

Several estimates provide a sense of the prevalence of dose adjustment based on race. Surveys of X-ray technicians in the San Francisco Bay Area in 1968 found that 75 of 90 technicians “habitually increased their X-ray doses of Negroes”.36 They said they did it because “”[Black people’s] Their bones are harder and denser, their skin is darker, and their flesh is harder.27 A sample of senior X-ray technicians in New York also found that black patients were receiving increased radiation doses. As Goldman explained, “It appears that a ‘significant proportion’ of X-ray technicians in the state routinely exposed Negroes to higher radiation doses than whites.1

We do not know what percentage of X-rays taken of black Americans used increased exposure. Nor do we know how many people are likely to be harmed. The radiation received during a chest x-ray is equivalent to a normal 10-day exposure.37 Increasing radiation from 40 to 60% of single X-rays would have little effect on a person’s life risk (the increase used with blacks was less than that used for people who are muscular or obese). However, the cumulative effect can be significant for people who have had multiple exposures. The Advisory Committee on Human Radiation Experiments examined this issue of the harm of low-risk radiation exposure.38 Although most of these Cold War experiments probably caused minimal physiological harm, the subjects of the research experienced other harms (for example, their use of research without consent). The situation is similar to race-adjusted X-rays: many people were at increased risk (even if it was small), probably unknowingly, due to unfounded beliefs based on racist science.

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