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Dr Goldenring takes issue with several of the methods used in our preemployment medical examination. He comments that neither the cost nor radiation exposure justify the routine chest x-ray film. Radiation exposure from a single posteroanterior film is negligible. At our institution, a single posteroanterior chest film provides three millirad of radiation. For comparison, background radiation exposure in New York City averages 40 to 50 millirad per year. Whether a routine chest film, performed at four- to five-year intervals, provides sufficient baseline medical information, must be based on the population at risk. In view of the high risk of morbidity and the low rate of compliance with preventive programs among house staff, baseline screening for this group seems justified.Dr Goldenring consistently confuses charges with costs. Charges for single tests may be less than charges for an automated screen. However, it often costs far less to perform an
Lewy R. Occupational Health Programs for House Staff Physicians-Reply. JAMA. 1982;247(10):1405–1406. doi:10.1001/jama.1982.03320350019009
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