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To the Editor: I am concerned about 2 possible confounding factors in the study by Dr Hujoel and colleagues.¹ First, in December 2000 the Washington State Department of Health alerted state health departments throughout the United States to the discovery of lead oxide powder in shielded boxes used to store radiographic films in dental offices. Subsequent testing demonstrated the possibility of the transfer of substantial amounts of lead to patients' mouths from contaminated film and the technicians' hands.² Because maternal lead exposure has been associated with low birth weight (LBW), and because the study population was located in Washington state, the possibility that lead exposure was contributory to LBW in this study cannot be excluded.

Second, radiation doses delivered to the thyroid gland remain unknown, despite the authors' careful attempts to estimate them retrospectively. This is due in part to lack of documentation about the use of thyroid shielding, which . . . [Full Text of this Article]

Robert E. Reiman, MD
reima001@mc.duke.edu
Radiation Safety Division
Duke University Medical Center
Durham, NC

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