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Security screening
Will my assistive aids be packed down by the security screening staff
so that it does not have to be done several times due to securityrules?
If you have booked disability assistance, an assistant from Falck will packdown your assistive aids.
May I bring medicine in my carry-on baggage, and are there anyquantity limits?
You are allowed to bring medicine for use during your entire journey, and
there are no quantity limits. However, you may be asked to show a proof of the genuineness of the products, for instance that the medicine is inoriginal, unbroken packaging, or a prescription or receipt from thepharmacy. It is a good idea to bring a travel letter from your own physicianor hospital in Danish and English from which it appears which types of medicine you are bringing.
Should I take any precautions if I have a pacemaker?
No, you do not need to take any special precautions to go through security
screening if you have a pacemaker. If you do not feel comfortable aboutgoing through a metal detector, you can ask not to go through it and insteadhave a manual body search afterwards. You just have to inform thescreening staff that you have a pacemaker and would prefer not to gothrough the detector frame and would like to have a manual body search.
Can I bring my guide dog through security?
Yes, you are allowed to bring along your guide dog. You must have a validticket for your guide dog.
Can I bring my electric wheelchair through security?
Electric wheelchairs and other battery-powered aids must be approved bythe airline you will be travelling on. The wheelchair will also be securityscreened. The wheelchair will be packed down at the gate when you checkin there and be transported in the aircraft hold during the flight.
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Can I be screened by a security screener of the same gender?
Yes, you can always ask to be screened by a security screener of the samegender.
Can I ask to be screened in a separate room if I have to be subjectedto additional screening?
Yes, you can ask to be screened in a security room specially designated for that kind of purpose.
Is there any kind of equipment that could be damaged by the X-rayequipment used for security screening?
No, the equipment will not be damaged by being X-rayed.
Is there any kind of equipment which I am not allowed to bring on theflight?
Some special equipment may require a permit either from your airline or theaviation authorities. If you are in doubt, it is always a good idea to contactyour airline well before departure.
Can I get help to go through security, and do I have to take off my belt
or braces, even if I cannot put them back on?
If you have booked disability assistance, the assistant from Falck will helpyou with these things.
Pregnancy and Security Screening
I have a concern about the full-body scanners that are popping up atairports everywhere. I'm concerned about the kind where you plantyour feet and raise your arms above your body for about five seconds.
I'm newly pregnant with my first child and am trying to find some solidresearch on these things. I can find a decent amount of literature interms of general health safety, but hardly anything trustworthy aboutthe potential effects on a pregnancy (at any stage).
I admit to being hormonal right now, but I started to cry today when I
realized I went through a full-body scanner at an airport early this
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month without even a second thought. Pregnancy message boardsonline are filled with paranoid women, I realize, but reading throughthem made me scared that I might have unknowingly/unnecessarilycaused harm to my unborn child.
Should I have opted for a pat-down? Or should I opt for pat-downs inthe future? I would love to see some information on your site aboutthese new machines with regard to pregnancy, especially since I willbe flying quite a few more times before giving birth. The technologyseems relatively new, which makes me even more uncertain aboutwhich advice to follow. Has there even been time to do significantstudies on the effects to a fetus during pregnancy?
There are two kinds of scanners. The radiofrequency scanner does not useionizing radiation, so neither you nor your unborn child would be exposed toany radiation that is hazardous.
The "full-body" x-ray scanner uses a very low-energy and low-intensityradiation, so that the unborn child is not exposed to any radiation that couldpossibly increase the developmental risks of radiation to the embryo.
The energy of the x-ray beam is so low that it does not penetrate the skinand just makes a picture of the outline of your external torso. Your internal
organs receive almost no dose.
For more information on these devices, see "Safety for Security ScreeningUsing Devices That Expose Individuals to Ionizing Radiation."
Remember that radiation is all around us. These very low exposuresrepresent no increased risk to the unborn child. If you are healthy and haveno personal or family history of reproductive or developmental problems,then you began your pregnancy with a 3 percent risk for birth defects and a15 percent risk for miscarriage. These are background risks which allpregnant women face.
I am pregnant and operate an x-ray machine at a courthouse, the typethat scans items people carry in with them. Should I have anyconcerns? Should I continue working?
Baggage x-ray machines emit x rays just like medical x-ray machinesexcept at much, much lower levels. The location of the operator is very wellshielded and, really, exposes no one. It is safe to continue working while
you're pregnant.
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As a pregnant woman, does passing through airport security pose arisk to my baby?
Passing through an airport security portal does not pose a risk to apregnant woman or her unborn child. The metal detector is not known topose any health risk to individuals. The devices used to scan your carry-onsare very well shielded so there is no risk from passing by those, either.
I reached into an airport x-ray screener that is used to see in to our carry-on items. How much radiation exposure did I get?
There is nothing for you to worry about. Airport x-ray machines and similar x-ray machines used by federal and state agencies to screen briefcasesand packages give much lower doses than x-ray machines in hospitals andmedical clinics-almost immeasurable. They are designed this way becausethey do not have to see as much detail, are not designed for looking intovery large objects, and are usually looking for things that really "stand out"on images (like metal).
In all likelihood, your hand was not in the actual beam, which would havemade your exposure much lower. Furthermore, the hands and feet are veryradiation tolerant relative to the rest of the body.
Does radiation from a security screening device, like those used inairports, affect the items that pass through them such as baby bottles,food items, plants, electronic devices (cell phone), or drug products(like injectable nitroglycerin for a heart condition)?
The radiation exposure from these devices is too low to affect any itemspassing through (other than certain types of camera film which can darken),even from repeated exposures. Additionally, in case you were wondering,there isn't any residual radiation in exposed materials after the exposure iscomplete either.
Does radiation from a security screening device, like those used inairports, affect clothing if it passes through the screening a lot? I havea Gore-Tex ® jacket that gets screened quite a bit.
The amount of radiation to which the clothing, even the Gore-Tex® jacket, isexposed is too small to degrade the materials. The manufacturers of thesescanners indicate the radiation exposure to an item from one scan is about
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one-tenth the exposure we receive every day from naturally occurringradiation (commonly called background radiation).
I travel a lot (at least once or twice a week) and will continue to do so
in the foreseeable future. Obviously, I have to go through the metaldetector at least twice for each trip. What effect does this radiationexposure have on me in the long run?
The metal detector does not expose you to ionizing radiation, e.g., x rays;neither do the wands that are used for individual screening. Metal detectorsoperate by generating a low-intensity magnetic field that passes from oneside of the detector to the other. If metal objects pass through that field, themagnetic field will induce a second field in the metal object. Since thatsecond field is a disruption of the first field, the detector senses the changeand sets off an alarm. Magnetic fields are a form of radiation, but they arecalled "nonionizing" radiation. This means that magnetic fields do notgenerate additional, damaging radiation the way that ionizing radiation(such as x rays) does. Magnetic fields below a certain intensity areconsidered to be safe in that they will not cause any biological damage toan individual. As a reference, MRI (magnetic resonance imaging) isconsidered safe and uses much higher magnetic field intensity than a metaldetector. In summary, because of its nonionizing properties, the magneticfield generated in a metal detector will not cause harm to persons even with
routine and/or repeated scanning.
Pregnancy & Prolonged Exposure to Metal Detectors
If you are pregnant and your work or travel exposes you to frequent metal
detector radiation, you are likely worried about the possible long term
effects of exposure on your baby. Most metal detectors used on people in
airports and courthouses only give off safer, non-ionizing radiation and long
term exposure to them does not increase the risk of birth defects,miscarriage, or fetal abnormalities. According to the Health Physics Society,
the radiation you get from traveling on a flight from New York to Los
Angeles is in excess of the radiation you get from going through the metal
detectors in the airport and both are at low levels.
Function
According to the Health Physics Society in "Pregnancy and Security
Screening" metal detectors emit a type of safe non-ionizing radiation that
bounces its beams off of objects to see their outline. The radiation used in
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hand held metal detectors and in walk through security screeners is
considered safe for pregnant women. X-rays in the baggage handler
machine do give off ionizing radiation, but the devices are well shielded
from employees and others who work closely with them.
Considerations
Radiation is present in the background every day so levels are usually
matched up against what they would be as a result of day to day living.
According to the Health Physics Society the radiation given off when you
pass through an airport screener is safe, and even accidental one-time
exposure to the rays inside the baggage handler is unlikely to do much
harm. There are no long term effects on food, medicine, baby bottles or
clothing that pass through a metal detector, even for those items that are
packed frequently.
Significance
Ionizing radiation that is sometimes used in medical equipment can
increase the risks of birth defects, miscarriage and other reproductive harm,
but the level given off from metal detectors is much lower. According to the
Health Physics Society, radiation is measured in units called rad, rem or
roentgen, or in the international equivalent called the gray and sievert.
Limits
According to the Office of Radiation Safety, pregnant women should not be
exposed to more than 500 millirems, or 0.5 rem, during their entire
pregnancy or less than 50 mrem (0.05 rem) in a single month. A round-trip
flight from New York to Los Angeles can expose a woman to 5 mrem (0.005
rem), while the effect of metal detectors is considered negligible. Some
medical x-rays may expose a woman to 60 mrem of radiation, but they maystill be done in cases where the benefits clearly outweigh the risks to the
the mother and fetus.
Prevention/Solution
Although long term metal detector exposure is not believed to harm the
fetus, be prudent if you work around such equipment every day. Try to stay
farther away from the radiation source, and make sure that the device is
blocked or shielded. Have someone measure the radiation exposure
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frequently to make sure that the level does not rise. If you are still
concerned about long term exposure, consider wearing a badge that
measures the radiation levels that you confront. Wash your hands with soap
and water if you feel they have come into contact with radiation.
The Pregnant Traveler
If you are pregnant and considering international travel, you should
evaluate the availability of quality care during travel and at your destination.
You should also investigate issues of insurance exclusions, medical
evacuation costs, etc with your medical insurance carrier and have
assurances in writing. This is of special importance if traveling to developingcountries.
If your pregnancy is complicated for any reason, whether it be high blood
pressure, diabetes, anemia or specific obstetrical issues you need to obtain
permission from your OB/GYN physician.
The second trimester of pregnancy (weeks 18-24) is the safest for travel.
Any special precautions to take for air travel?
Avoid air travel:
From 32 weeks of gestation onward for multiple pregnancies (twins or
more)
From 36 weeks of gestation onward for single pregnancy
Within 7 days of delivery
With complicated pregnancy
Prevent blood clots by frequently exercising the feet and legs, by walking in
the cabin of the aircraft, and bending/straightening your feet and knees for 2
minutes every 10 minutes. Properly fitted graduated compression stockings
may be appropriate for some. Pregnancy increases the risk of blood clots
and preventive measure are crucial. Go to our economy class syndrome
section for further details.
Avoid dehydration by drinking plenty of water or juice. Drink plenty and you
will have to exercise the legs by going to the bathroom!!!
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Wear seat belts at all times while seated, keep them at the level of your
pelvis for a measure of comfort.
Any special advice for vaccinations during pregnancy?
Live bacterial and live viral vaccines are contra-indicated during pregnancy.
These are: Bacille-Calamette-Guerin, Live Intra Nasal Influenza, Mumps-
measles-rubella, oral typhoid –Ty 21a, Oral polio, Varicella and Yellow
Fever.
In general, avoid vaccinations in the first trimester of pregnancy
The following vaccine preparations can be used form the 2nd trimester
onward.
Immune globulin
Hepatitis B
Inactivated Influenza
Pneumovacc
Inactivated Polio
Rabies
Typhoid Vi
Data on safety in pregnancy is not available for Hepatitis – A and Japanese
Encephalitis
Which antibiotics are safer during pregnancy?
Traveler’s diarrhea: Azithromycin (Zithromax) and Cefixime (Suprax)
are safe
Malaria prophylaxis: Mefloquine (Larium) and Atovaquone/Proguanil
(Malarone) are CDC recommended after the 1st trimester.
Chloroquine is safe, but should only be used in areas where Malaria
parasite is known to be sensitive to it.
Avoid
Doxycycline
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Primaquine
Pyremethamine
Trimethoprim-Sulfamethoxazole
Erythromycin
Quinolone class of antibiotics like Ciprofloxacin, Levofloxacin,
Gatifloxacin and antifungal agents like fluconazole, itraconazole.
What do I do about water safety during my pregnancy and travel?
Boiling water for 3 minutes is the most safe and effective method to assure
clean water.
Bottled juices, soft drinks and bottled water should be safe, make sure the
cap is sealed when you buy it.
Avoid iodine tablets and iodine based water purification tablets due to
risk of goiter in the fetus.
Since water filters do not filter viruses and one cannot use iodine to kill
viruses, water filters are not of much use.
Brush your teeth with safe water.
Avoid ice.
See our water safety section for more details.
What do I do about food safety during pregnanacy and travel?
Always wash hands with soap and safe water
Strictly avoid all milk and dairy products. In the developing worldpasteurization is not reliable. Risk of listeria, brucella etc are too great
without this precaution
Avoid raw or undercooked meats, eggs and fish. Risk of Toxoplasmosis,
salmonella etc are too great without this precaution.
Avoid salads, pre-cut vegetables and fruits for reasons of contamination.
If you must have a fruit, make sure the skin is undamaged and you peel the
skin off yourself.
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See our food safety section for more details.
What do I do if I develop traveler’s diarrhea while pregnant?
Dehydration can decrease placental blood flow; therefore one should
aggressively drink fluids. Hot tea, 7-up, Ginger ale, Sports drinks or oral
rehydration packets mixed in safe water are recommended.
Azithromycin(Zithromax) 500 mg once a day for 3 days or Cefixime(Suprax)
400 mg once a day for 3 days are safe antibiotics to use in pregnancy.
Combinations of Kaolin-Pectin and Imodium are safe if needed for symptom
relief.
Avoid Pepto-Bismol or Bismuth salicylate products due to risk of birthdefects and bleeding in the fetus.
See our traveler’s diarrhea section for more details.
What about malaria prevention while traveling and pregnant?
Wear long sleeve shirts and long pants.
Avoid outdoor activities at dusk and dawn.
Stay in accommodations with screens, fans or air-conditioning.
Use mosquito nets tucked into the mattress.
Use repellant containing DEET; use it directly onto clothing and only
sparingly on skin exposed beyond long sleeve clothing.
Medications:
Mefloquine(Larium) is CDC recommended after the 1st trimester
Atovaquone/Proguanil is also considered safe after the 1st trimester
Chloroquine is safe, but ONLY use for areas where malaria parasites
are known to be sensitive to it.
Avoid Doxycycline, Primaquine, Pyremethamine.
What do I do for motion sickness while pregnant?
Meclizine (Antivert) 25 mg three times a day is considered safe
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Dimenhydrinate(Dramamine) 50 mg four times a day as needed is
considered safe
What can I do about nausea while pregnant?
Promethazine (Phenergan) 25 mg three times a day as needed is
considered safe
What can I take for pain while pregnant?
Acetaminophen (Tylenol) as directed is the safest Avoid Aspirin and Non-
steroidal agents like Ibuprofen
Security ScreeningIs it true that some walk-through scanners actually use x rays to screen
people?
Yes, some of these are now being used in large international airports, such
as Heathrow in London. There is very little radiation dose for a person
passing through the scanner because they are not trying to see the detail of
our "soft" tissues as is done in medicine. They are looking for items that will
stand out pretty easily. According to the American National Standards Institute, in its standard
N43.17-2002 "Radiation Safety for Personnel Security Screening Systems
Using X-rays," the maximum effective dose an individual could receive
when walking through this scanner is 0.01 millirem (a unit of radiation dose
commonly abbreviated mrem). For some perspective on the level of this
dose, the annual effective dose each of us receives from background
radiation is about 360 mrem; the effective dose from one chest x ray is
about 10 mrem.
Is it safe for someone with a medical implant to go through the airport (or
office building) metal detectors?
There are two papers published in literature that discuss this. The more
recent article published by Niehaus, et al., in 2001discusses pacemakers
and states: "In 103 patients who were monitored as they passed through
typical metal detectors, security alarms invariably were activated. In none of
the patients was the pacemaker function affected. It is therefore acceptedpractice to advise patients that while airport screening devices may detect
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the pacemaker, the device will not be adversely affected. Patients should
carry their device identification card for the purpose of obtaining security
clearance."
According to the articles' conclusions, patients can go through metal
detectors without causing a pacemaker or cardioverter-defibrillator
malfunction. For other types of implants, it may be best to ask your
physician.
References
Niehaus M, Tebbenhohanns J. Electromagnetic interference in patients with
implanted pacemakers or cardioverter-defibrillators. Heart 86: 246-248;
2001.
Copperman Y, Zarfati D, Laniado S. The effect of metal detector gates on
implanted permanent pacemakers. Pacing Clin Electrophysiol. 11: 1386-
1387; 1988.
I travel a lot (at least once or twice a week) and will continue to do so
in the foreseeable future. Obviously, I have to go through the metaldetector at least twice for each trip. What effect does this radiation
exposure have on me in the long run?
The metal detector does not expose you to ionizing radiation, e.g., x rays;
neither do the wands that are used for individual screening. Metal detectors
operate by generating a low-intensity magnetic field that passes from one
side of the detector to the other. If metal objects pass through that field, the
magnetic field will induce a second field in the metal object. Since that
second field is a disruption of the first field, the detector senses the change
and sets off an alarm. Magnetic fields are a form of radiation, but they are
called "nonionizing" radiation. This means that magnetic fields do not
generate additional, damaging radiation the way that ionizing radiation
(such as x rays) does. Magnetic fields below a certain intensity are
considered to be safe in that they will not cause any biological damage to
an individual. As a reference, MRI (magnetic resonance imaging) is
considered safe and uses much higher magnetic field intensity than a metal
detector. In summary, because of its nonionizing properties, the magnetic
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field generated in a metal detector will not cause harm to persons even with
routine and/or repeated scanning.
I work for a major airline and will be required to spend eight hours a
day near the new baggage x-ray machines (the big ones that I thinkare CT machines) that TSA (Transportation Security Administration)
uses. We have been given a handout saying that TSA has determined
that the machines are not dangerous and that we do not need film
badges. How can anyone say working near radiation is not dangerous
if it is not monitored in any way?
Some of the newer x-ray machines used to scan checked luggage use
computerized tomography (CT) technology—just like those used in
medicine. The main difference between the two types of use (security at
airports and medical diagnosis) is that the machines used in airports have
more shielding to stop the scattered radiation—nearly the entire luggage
belt is shielded where, in medicine, the patient table is not shielded—and
they subject the baggage to lower doses because the image does not need
to be as clear as it does for a patient.
Someone standing next to the unit in airports would receive little, if any,
radiation exposure. Radiation emitted around a piece of equipment when itis operating is determined at the manufacturer and, sometimes, checked by
the purchaser. A manufacturer must assure the equipment is operating
within Federal regulations that govern x-ray equipment which in this case is
0.5 mR/h at 5 cm from the unit (mR or milliroentgen is a unit of radiation
exposure) though performance studies of the equipment indicate that the
average exposure rate was about 0.08 mR (microroentgen, one-one
thousandth of a milliroentgen) per scan (NCRP Report 95). Purchasers can
use the manufacturer's assurance and/or can perform their own surveys on
the equipment. The dose to the luggage is very low and there is no
detectable radiation outside the machines according to one manufacturer.
What does it mean when my employer says the machines are safe
because no "leakage" was found? What is leakage? I work about
those big checked luggage scanners, so what does leakage mean to
me in terms of radiation exposure?
When we say "leakage," that simply means when the x-ray beam is on, the
tube housing has some radiation coming through it. Actually, it always does
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and x-ray machine regulations limit the amount that can come through. So,
in this case, "leakage" means someone was able to detect radiation being
emitted through the tube housing at levels higher than what the regulations
allow.
With that in mind, though, it does not mean that radiation was coming
through the shielding around the unit. The scanners have shielding around
them to make sure the x-ray beam cannot escape and expose people to
unnecessary radiation. So, even if radiation was leaking through the tube
housing when the unit was on, it is unlikely it also went through the unit's
shielding.
There are a couple of ways to find out if a machine is "leaking" when peopleare not wearing radiation dosimeters. One way is the recognition that the
images are not of the same quality as they should be. If the images are
deteriorating significantly, it could mean many things—one of which is that
not all of the radiation is getting to the luggage. Additionally, the
manufacturer or contracted workers will do regular preventive maintenance
on the unit and if they work on the x-ray production portion of the unit, new
surveys around the unit must be done to show that radiation protection
controls still provide the necessary protection.
Would you recommend the frequency of radiation leakage
measurement surveys in an airport environment for the screening
equipment?
Every two to three years would be adequate if the machine is not opened
for repair. After it is serviced, a radiation survey is a must to ensure
shielding and barriers have been repositioned correctly.
What type of instrument can I purchase to do radiation leakage checks
on baggage x-ray screening machines?
It is likely you will need two types of equipment to do a leakage survey. The
first is a Geiger-Mueller probe with a mica window (i.e., a pancake probe)
because it would be the most sensitive to actually find the leakage radiation
if there is any. The second is an x-ray calibrated (calibrated for the energy
emitted by the baggage-screening equipment) ion chamber to measure
actual dose or dose rate. In the United States, the Food and Drug Administration has regulatory authority over the manufacturers of radiation-
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producing equipment and have specified a leakage limit of 0.5 mR/h at a
distance of 5 cm from the surface of the equipment (mR, or milliroentgen, is
a unit of radiation exposure).
With an airport baggage-screening machine, is it safe to line up bagsin a continuous row which doesn't allow the lead protection to be
completely down when a bag is in the x-ray beam?
Judging by the experience of those who have measured radiation
exposures around modern narrow scanning beam baggage security
screening systems while they are continuously in operation, there is very
little scatter from the piece of baggage being screened, so little, if any,
radiation even makes it to the lead protection barrier.
I am pregnant and operate an x-ray machine at a courthouse—the type
that scans items people carry in with them. Should I have any
concerns? Should I continue working?
Baggage x-ray machines emit x rays just like medical x-ray machines
except at much, much lower levels. The location of the operator is very well
shielded and, really, exposes no one. It is safe to continue working while
you're pregnant.
As a pregnant woman, does passing through airport security pose a
risk to my baby?
Passing through an airport security portal does not pose a risk to a
pregnant woman or her unborn child. The metal detector is not known to
pose any health risk to individuals. The devices used to scan your carry-ons
are very well shielded so there is no risk from passing by those, either.
I reached into an airport x-ray screener that is used to see in to our
carry-on items. How much radiation exposure did I get?
There is nothing for you to worry about. Airport x-ray machines and similar
x-ray machines used by federal and state agencies to screen briefcases
and packages give much lower doses than x-ray machines in hospitals and
medical clinics—almost immeasurable. They are designed this way
because they do not have to see as much detail, are not designed for
looking into very large objects, and are usually looking for things that really
"stand out" on images (like metal).
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In all likelihood, your hand was not in the actual beam, making your
exposure much lower. Furthermore, the hands and feet are very radiation
Does radiation from a security screening device, like those used in
airports, affect the items that pass through them such as baby bottles,food items, plants, electronic devices (cell phone), or drug products
(like injectable nitroglycerin for a heart condition)?
The radiation exposure from these devices is too low to affect any items
passing through (other than certain types of camera film which can darken)
even from repeated exposures. Additionally, in case you were wondering,
there isn't any residual radiation in exposed materials after the exposure is
complete either.
Does airport security x-ray screening have any effect for my pet?
The radiation exposure from these devices is too low to affect cats, dogs,
birds, or other animals that need to be security-screened. If it is just the pet
carrier that needs to be screened, you can put the carrier on the conveyor
belt and walk or carry your pet through the metal detector portal instead of
having the animal go through the x-ray unit.Does radiation from a security screening device, like those used in
airports, affect clothing if it passes through the screening a lot? I have
a Gore-Tex jacket that gets screened quite a bit.
The amount of radiation to which the clothing, even the Gore Tex jacket, is
exposed is too small to degrade the materials. The manufacturers of these
scanners indicate the radiation exposure to an item from one scan is about
one-tenth the exposure we receive every day from naturally occurring
radiation (commonly called background radiation).
Can I put my hand inside a screening x-ray machine to get an x ray to
look for injury?
No, absolutely not. These systems are not designed for medical diagnosis
and will not provide appropriate image detail or contract. I would suspect
that in most States, this would be illegal. X rays of people should only be
done with a doctor's order to do so.
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If the airport security screener stops the conveyor to observe the x-
ray image for a longer time, does that mean the item on the conveyer
gets more radiation?
The scanners used for hand luggage at most airports take short single-shotimages of items. The radiation is turned on for the same fixed amount of
time for each item. The images are digital and held on the screen until the
next coat, purse, or other item is processed. Thus, if the screeners choose
to look at the images for an extended visual analysis, no additional radiation
is used. If the item is removed from the scanner and put back onto the belt
for a second time, however, it will then receive additional irradiation. In
other words, these x-ray scanners are not "fluoroscopic" in nature like the
old machines from the mid-20th
century which were used to fit shoes, nor are they like angiographic or surgical x-ray machines. They are more similar
to simple chest x rays, only performed using less radiation.
Effects and Security Screening
I reached into an airport x-ray screener that is used to see in to our
carry-on items. How much radiation exposure did I get?
There is nothing for you to worry about. Airport x-ray machines and similar
x-ray machines used by federal and state agencies to screen briefcases
and packages give much lower doses than x-ray machines in hospitals and
medical clinics—almost immeasurable. They are designed this way
because they do not have to see as much detail, are not designed for
looking into very large objects, and are usually looking for things that really
"stand out" on images (like metal).
In all likelihood, your hand was not in the actual beam, making your
exposure much lower. Furthermore, the hands and feet are very radiation
tolerant relative to the rest of the body.
Does radiation from a security screening device, like those used in
airports, affect the items that pass through them such as baby bottles,
food items, plants, electronic devices (cell phone), or drug products
(like injectable nitroglycerin for a heart condition)?
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The radiation exposure from these devices is too low to affect any items
passing through (other than certain types of camera film which can darken)
even from repeated exposures. Additionally, in case you were wondering,
there isn't any residual radiation in exposed materials after the exposure is
complete either.
Does airport security x-ray screening have any effect for my pet?
The radiation exposure from these devices is too low to affect cats, dogs,
birds, or other animals that need to be security screened. If it is just the pet
carrier that needs to be screened, you can put the carrier on the conveyor
belt and walk or carry your pet through the metal detector portal instead of
having the animal go through the x-ray unit if that would make you more
comfortable.
Does radiation from a security screening device, like those used in
airports, affect clothing if it passes through the screening a lot? I have
a Gore-Tex ® jacket that gets screened quite a bit.
The amount of radiation to which the clothing, even the Gore-Tex® jacket, is
exposed is too small to degrade the materials. The manufacturers of these
scanners indicate the radiation exposure to an item from one scan is about
one-tenth the exposure we receive every day from naturally occurringradiation (commonly called background radiation).
Can I put my hand inside a screening x-ray machine to get an x ray to
look for injury?
No, absolutely not. These systems are not designed for medical diagnosis
and will not provide appropriate image detail or contrast. I would suspect
that in most states, this would be illegal. X rays of people should only be
done with a doctor's order to do so.
If the airport security screener stops the conveyer to observe the x-ray
image for a longer time, does that mean the item on the conveyer gets
more radiation?
The scanners used for hand luggage at most airports take short single-shot
images of items. The radiation is turned on for the same fixed amount of
time for each item. The images are digital and held on the screen until the
next coat, purse, or other item is processed. Thus, if the screeners choose
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to look at the images for an extended visual analysis, no additional radiation
is used. If the item is removed from the scanner and put back onto the belt
for a second time, however, it will then receive additional irradiation. In
other words, these x-ray scanners are not "fluoroscopic" in nature like the
old machines from the mid-20th century which were used to fit shoes, nor
are they like angiographic or surgical x-ray machines. The scans are more
similar to simple chest x rays, only performed using less radiation.
Is it true that some walk-through scanners actually use x rays to
screen people?
Yes, some of these are now being used in large international airports, such
as Heathrow in London. There is very little radiation dose for a person
passing through the scanner because they are not trying to see the detail of
our "soft" tissues as is done in medicine. They are looking for items that will
stand out pretty easily.
According to the American National Standards Institute, in its standard
N43.17-2002 "Radiation Safety for Personnel Security Screening Systems
Using X-Rays," the maximum effective dose an individual could receive
when walking through this scanner is 0.01 millirem (a unit of radiation dose
commonly abbreviated mrem). For some perspective on the level of thisdose, the annual effective dose each of us receives from background
radiation is about 360 mrem; the effective dose from one chest x ray is
about 10 mrem.
I travel a lot (at least once or twice a week) and will continue to do so
in the foreseeable future. Obviously, I have to go through the metal
detector at least twice for each trip. What effect does this radiation
exposure have on me in the long run?
The metal detector does not expose you to ionizing radiation, e.g., x rays;
neither do the wands that are used for individual screening. Metal detectors
operate by generating a low-intensity magnetic field that passes from one
side of the detector to the other. If metal objects pass through that field, the
magnetic field will induce a second field in the metal object. Since that
second field is a disruption of the first field, the detector senses the change
and sets off an alarm. Magnetic fields are a form of radiation, but they are
called "nonionizing" radiation. This means that magnetic fields do not
generate additional, damaging radiation the way that ionizing radiation
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(such as x rays) does. Magnetic fields below a certain intensity are
considered to be safe in that they will not cause any biological damage to
an individual. As a reference, MRI (magnetic resonance imaging) is
considered safe and uses much higher magnetic field intensity than a metal
detector. In summary, because of its nonionizing properties, the magnetic
field generated in a metal detector will not cause harm to persons even with
routine and/or repeated scanning.
I work for a major airline and will be required to spend eight hours a
day near the new baggage x-ray machines (the big ones that I think
are CT machines) that TSA (Transportation Security Administration)
uses. We have been given a handout saying that TSA has determined
that the machines are not dangerous and that we do not need filmbadges. How can anyone say working near radiation is not dangerous
if it is not monitored in any way?
Some of the newer x-ray machines used to scan checked luggage use
computerized tomography (CT) technology—just like those used in
medicine. The main difference between the two types of use (security at
airports and medical diagnosis) is that the machines used in airports have
more shielding to stop the scattered radiation—nearly the entire luggage
belt is shielded where, in medicine, the patient table is not shielded—andthey subject the baggage to lower doses because the image does not need
to be as clear as it does for a patient.
Someone standing next to the unit in airports would receive little, if any,
radiation exposure. Radiation emitted around a piece of equipment when it
is operating is determined at the manufacturer and, sometimes, checked by
the purchaser. A manufacturer must assure the equipment is operating
within federal regulations that govern x-ray equipment, which in this case is
0.5 mR/h at 5 cm from the unit (mR or milliroentgen is a unit of radiation
exposure) though performance studies of the equipment indicate that the
average exposure rate was about 0.08 μR (microroentgen, one-one
thousandth of a milliroentgen) per scan (NCRP Report 95). Purchasers can
use the manufacturer's assurance and/or can perform their own surveys on
the equipment. The dose to the luggage is very low and there is no
detectable radiation outside the machines according to one manufacturer.
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Workers and Security Screening
I work for a major airline and will be required to spend eight hours a
day near the new baggage x-ray machines (the big ones that I thinkare CT machines) that TSA (Transportation Security Administration)
uses. We have been given a handout saying that TSA has determined
that the machines are not dangerous and that we do not need film
badges. How can anyone say working near radiation is not dangerous
if it is not monitored in any way?
Some of the newer x-ray machines used to scan checked luggage use
computerized tomography (CT) technology—just like those used in
medicine. The main difference between the two types of use (security atairports and medical diagnosis) is that the machines used in airports have
more shielding to stop the scattered radiation—nearly the entire luggage
belt is shielded—where, in medicine, the patient table is not shielded and
they subject the baggage to lower doses because the image does not need
to be as clear as it does for a patient.
Someone standing next to the unit in airports would receive little, if any,
radiation exposure. Radiation emitted around a piece of equipment when it
is operating is determined at the manufacturer and, sometimes, checked by
the purchaser. A manufacturer must assure the equipment is operating
within federal regulations that govern x-ray equipment, which in this case is
0.5 mR/h at 5 cm from the unit (mR or milliroentgen is a unit of radiation
exposure) though performance studies of the equipment indicate that the
average exposure rate was about 0.08 μR (microroentgen, one-one
thousandth of a milliroentgen) per scan (NCRP Report 95). Purchasers can
use the manufacturer's assurance and/or can perform their own surveys on
the equipment. The dose to the luggage is very low and there is nodetectable radiation outside the machines according to one manufacturer.
What does it mean when my employer says the machines are safe
because no "leakage" was found? What is leakage? I work about
those big checked luggage scanners, so what does leakage mean to
me in terms of radiation exposure?
When we say "leakage," that simply means when the x-ray beam is on, the
tube housing has some radiation coming through it. Actually, it always does
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and x-ray machine regulations limit the amount that can come through. So,
in this case, "leakage" means someone was able to detect radiation being
emitted through the tube housing at levels higher than what the regulations
allow.
With that in mind, though, it does not mean that radiation was coming
through the shielding around the unit. The scanners have shielding around
them to make sure the x-ray beam cannot escape and expose people to
unnecessary radiation. So, even if radiation was leaking through the tube
housing when the unit was on, it is unlikely it also went through the unit's
shielding.
There are a couple of ways to find out if a machine is "leaking" when peopleare not wearing radiation dosimeters. One way is the recognition that the
images are not of the same quality as they should be. If the images are
deteriorating significantly, it could mean many things—one of which is that
not all of the radiation is getting to the luggage. Additionally, the
manufacturer or contracted workers will do regular preventive maintenance
on the unit and if they work on the x-ray production portion of the unit, new
surveys around the unit must be done to show that radiation protection
controls still provide the necessary protection.
Would you recommend the frequency of radiation leakage
measurement surveys in an airport environment for the screening
equipment?
Every two to three years would be adequate if the machine is not opened
for repair. After it is serviced, a radiation survey is a must to ensure
shielding and barriers have been repositioned correctly.
What type of instrument can I purchase to do radiation leakage checks
on baggage x-ray screening machines?
It is likely you will need two types of equipment to do a leakage survey. The
first is a Geiger-Mueller probe with a mica window (i.e., a pancake probe)
because it would be the most sensitive to actually find the leakage radiation
if there is any. The second is an x-ray calibrated (calibrated for the energy
emitted by the baggage-screening equipment) ion chamber to measure
actual dose or dose rate. In the United States, the Food and Drug Administration has regulatory authority over the manufacturers of radiation-
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producing equipment and have specified a leakage limit of 0.5 mR/h at a
distance of 5 cm from the surface of the equipment (mR, or milliroentgen, is
a unit of radiation exposure).
With an airport baggage-screening machine, is it safe to line up bagsin a continuous row which doesn't allow the lead protection to be
completely down when a bag is in the x-ray beam?
Judging by the experience of those who have measured radiation
exposures around modern narrow scanning beam baggage security
screening systems while they are continuously in operation, there is very
little scatter from the piece of baggage being screened so little, if any,
radiation even makes it to the lead protection barrier.
I am pregnant and operate an x-ray machine at a courthouse—the type
that scans items people carry in with them. Should I have any
concerns? Should I continue working?
Baggage x-ray machines emit x rays just like medical x-ray machines
except at much, much lower levels. The location of the operator is very well
shielded and, really, exposes no one. It is safe to continue working while
you're pregnant.
Can I put my hand inside a screening x-ray machine to get an x ray to
look for injury?
No, absolutely not. These systems are not designed for medical diagnosis
and will not provide appropriate image detail or contrast. I would suspect
that in most states, this would be illegal. X rays of people should only be
done with a doctor's order to do so.
Is it safe for someone with a medical implant to go through the airport
(or office building) metal detectors?
There are two papers published in literature that discuss this. The more
recent article published by Niehaus, et al., in 2001discusses pacemakers
and states: "In 103 patients who were monitored as they passed through
typical metal detectors, security alarms invariably were activated. In none of
the patients was the pacemaker function affected. It is therefore accepted
practice to advise patients that while airport screening devices may detect
the pacemaker, the device will not be adversely affected. Patients should
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carry their device identification card for the purpose of obtaining security
clearance."
According to the articles' conclusions, patients can go through metal
detectors without causing a pacemaker or cardioverter-defibrillator
malfunction. For other types of implants, it may be best to ask your
physician.
References
Niehaus M, Tebbenhohanns J. Electromagnetic interference in patients with
implanted pacemakers or cardioverter-defibrillators. Heart 86: 246-248;
2001.
Copperman Y, Zarfati D, Laniado S. The effect of metal detector gates on
implanted permanent pacemakers. Pacing Clin Electrophysiol. 11: 1386-
1387; 1988.
Safety for Security Screening Using
Devices That Expose Individuals toIonizing Radiation
What are these devices? Does this include the general walk-through
magnetic screeners?
What this FAQ refers to are the devices often seen in airports or
courthouses that expose people to ionizing radiation (x rays) when a person
walks through them. These x-ray-emitting devices are more commonly
called "backscatter screeners," although they have been called "people
scanners" and "security screeners."
We won't be talking about the magnetic screening units or another type of
device called a millimeter wave unit—those use nonionizing forms of
radiation.
To how much radiation am I being exposed? Is this something I need
to be concerned about as a frequent flier (I fly twice a month)?
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There is an American National Standards Institute/Health Physics Society
(ANSI/HPS) consensus standard (listed in the reference information at the
end of this document) stating that people-scanning devices should expose
an individual to no more than 0.25 microsievert per screening (one
screening procedure generally consists of two scans). The two primary
companies who sell people screeners say that their devices expose people
to half that amount of radiation.
For perspective, 0.25 microsievert is also received by flying about a minute
and a half (cosmic radiation during commercial flight exposes fliers to about
10 microsievert per hour). It is also received by living for 40 minutes (natural
background radiation exposes people to about 0.35 microsievert per hour).
Frequent fliers will be exposed to more radiation because they will go
through the people scanners more often, plus they will be receiving more
cosmic radiation while they are flying. The consensus standard took into
account extra scans for frequent fliers and put a recommended limitation on
the total radiation dose from this activity. That limit is 250 microsieverts per
year, which would be 1,000 scans per year if the scanner is operating at the
per scan limit.
Is it safe to take my children through this device? What if I ampregnant?
The American National Standards Institute/Health Physics Society
(ANSI/HPS) consensus standard took into account the varying sensitivity of
different groups of people who might be scanned. The authors first looked
at a number of reports and published studies on the health effects of
radiation. They then chose the 0.25 microsievert dose level to ensure that
children and pregnant individuals can be safely scanned with these devices.
The x-ray scanner uses a very low-energy and low-intensity radiation, so
that an embryo/fetus is not exposed to any radiation that could possibly
increase the developmental risks of radiation to the embryo.
Who decided that it is okay to use radiation on so many people?
The final decision was made by the Department of Homeland Security
(DHS). This was made, however, only after experts gave their input on the
safety of the devices. DHS needed to weigh the potential risk of exposing
people to ionizing radiation versus the overall societal benefit of detecting
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terrorist threats. Because the amount of radiation someone receives from
being screened is so low, the benefit was determined to far outweigh the
risk (if any).
What about concerns that people have raised regarding the skin dosefrom these devices? Some have said that the skin dose must be high
if most of the x rays only come in contact with the skin.
The American National Standards Institute/Health Physics Society
(ANSI/HPS) consensus standard addresses this issue. The 0.25
microsievert limit is an overall whole-body effective dose. To calculate that
dose, measurements of the entrance exposure at the skin was taken first.
The standard indicates that the associated skin absorbed dose is even less
than the overall whole-body effective dose.
What about concerns people have raised about the possible radiation
dose to organs that sit just under the skin—like the thyroid? Or what
about the eyes?
Some organs do get a radiation dose—a higher dose if they are close to the
skin and a lower dose if they are deeper inside the body. They won't,
however, get a dose higher than the skin dose because the x rays all come
in contact with the skin while only a few penetrate deeper into the body. Asa result of that, even the organs that are close to the skin surface receive
less than 0.087 microgray. This is a dose that is considered to have
negligible risk for harmful effects.
Aren't all radiation doses cumulative—doesn't all this radiation add
up?
It isn't as simple as saying we can add up all of the radiation to which we've
been exposed in our lifetime to determine what the effect might be. Whenradiation interacts with a cell in the body, several things can occur:
The cell might have some minor damage that is repaired.
The cell might have some minor damage that remains inactive until
another agent interacts with the cell again.
The cell might have damage that causes it to become cancerous.
The cell may simply stop functioning.
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The cell may die.
So, radiation doses aren't necessarily cumulative.
Who measured these doses, anyway? How do they really know that is
the dose to a person?
The radiation measurements from these devices were performed by some
independent researchers along with the manufacturers. The American
National Standards Institute/Health Physics Society (ANSI/HPS) standard
indicates how these measurements are to be performed, with what types of
measuring instruments, and from the resulting data, how the dose is to be
determined.
The following questions was answered by an expert in the
appropriate field:
If I place my breakfast, lunc h, snacks , and water into t he x-
ray screening machine at work , is this s afe when I wi l l need
to do th is f ive t imes a week, t imes 52 weeks a year, for the
next 25 years? What long -term effects could th is have?
Thank you for your question. Sending food items through ascreening machine, whether at the airport or in your workplace,
will not do anything to the food and the food will not contain
radioactivity after it passes through the x rays. There are no short-
term or long-term effects on the food or for you.
I wo rk at a job that makes us x ray all i tems that we have (food, water, cloth ing, keys) on a dai ly basis. There are no
maintenance records or any cal ibrat ion of these machines.
Are any health r isks associated w i th this ty pe of daily use?
Thank you for your question. Your use of anything (e.g., clothing)
that has gone through the scanner or your intake of anything (e.g.,
food, water) that has gone through the scanner is not associated
with any health risks.
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The items being scanned are exposed to a very low level of
radiation that won't do anything to the clothing or food items and
the items do not stay radioactive. Thus, there are no health risks
from using or eating/drinking these items.
There is an x-ray screener at work and recent ly after a
superior 's order we're being forced to int ro duce even our
lunch totes into the machine. It wouldn' t be wo rr isome i f it
happened every now and then, but w e have to do i t on a
weekly basis. I was jus t wondering if doing it for an extended period of t ime would be harmful , consider ing the heal th r isks
of radiat ion exposure?
There is no harm to you from handling the tote or eating the food
after it has gone through an x-ray screening unit.
There are two reasons for this answer. The first is that the amount
of radiation to which the food and tote are being exposed, even on
a daily basis, isn't enough to cause those items to be changed in
any way that would be harmful if you touched them or ate the
food.
Second, there is no radiation "left over," so neither the tote nor the
food is radioactive after being through the scanner, so you won't
be exposed to any radiation as a result.
Kelly Classic
Certified Medical Health Physicist
What do I need to do if I have an electric/battery-powered wheelchair?
You must state that you use a wheelchair when you book your ticket. In
addition, you must state the weight and size of your wheelchair when you
book your ticket. Electric wheelchairs are not allowed in the cabin and must
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therefore be checked in with the rest of your baggage and be carried in the
aircraft hold. In order to reduce the risk of damage, we recommend that you
remove all loose parts from your wheelchair before leaving it with your
airline.
Wheelchairs with dry batteries and gel batteries are approved for air
transport. However, the battery cables must be removable and must be
joined in order to avoid short circuiting. You can sit in your own wheelchair
right up to the gate, and help to prepare the chair for loading onto the
aircraft. Falck will be at your assistance.
Who assembles my wheelchair?
When your wheelchair is re-assembled, it is important that you give clear
instructions on how this should be done. If the assembly is complicated, you
must arrange in advance for the assistance you need.
Will I be separated from my helper from check-in to the gate?
You will be accompanied by your helper if at all possible, but you may be
separated for a short period of time for various reasons.
Is it possible to get assistance for instance for duty- and tax-free
shopping? No, that is not included in the service.
Is there any kind of equipment which I am not allowed to bring on the
flight?
The airlines may have different rules on what you are allowed to bring. We
therefore recommend that you check this with your airline.
Is there any kind of equipment that could be damaged by the pressure
in the cabin?
We recommend that you check this with the supplier of your equipment
before departure.
Can a person who is unable to read get help to find the right gate?
Yes, an assistant will be available if this service has been booked via Falck.
Otherwise, you can always ask at the airport’s service information desks.
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What can I do if the announcements on the loudspeakers etc. are too
fast and not clear enough for me to understand what they say?
If you have booked assistance, Falck will help you. Otherwise, you can
always ask at the airport’s service information desks.
What should I do if I hear my name on the loudspeaker and do not
understand why?
Ask Falck or at one of the airport’s service information desks.
Can I be accompanied by a social worker/helper all the way to the gate
even if the person will not be accompanying me on the flight?
A companion would need to have a valid ticket to be allowed to accompanyyou all the way to the gate. Falck will assist you all the way to the gate if
you have pre-booked disability assistance.
Can I get help to go through security, and do I have to take off belt and
braces, even if I cannot put them back on?
If you have booked assistance with Falck, you will get help for this as well.
I am going to bring a guide dog. What should I do?
It is important that you state that you will be travelling with a guide dog
already when you book your flight. The rules on accompanying dogs differ
from airline to airline. However, in most cases, a guide dog will be allowed
to accompany you in the cabin and does not have to be in a cage. Normally
there is no extra charge for bringing a guide dog. And the guide dog usually
does not count as part of your baggage allowance.
As for all other animal transport, it is the owner’s responsibility to check
which rules apply in the country of destination. In addition, you must checkin advance which vaccinations the dog must have and what quarantine
rules apply in the relevant countries. Passengers with an accompanying
dog will usually be allowed to board before the other passengers.
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Medical Devices - Defibrillators and
pacemakers
What is the most appropriate approach to go through airport security?
If you have an implanted cardiac defibrillator or pacemaker it is
prudent to carry a pacemaker or medical device ID card that
documents the presence, make and model of your defibrillator or
pacemaker and the telephone number for the manufacturer.
Inform the airport security officer that you have an implanted medical
device and give them the pacemaker or medical device ID card.
Request a pat - down inspection rather than walking through the
arched metal detector. Do not have the hand held security wand used
to screen you, since it can interfere with the workings of your medical
device.
Will my defibrillator or pacemaker set off the metal detector?
Yes, implanted cardiac defibrillators and pacemakers can trigger the alarm
of metal detectors.
Will metal detectors harm my defibrillator or pacemaker?
Hand held security wands can interfere with implanted cardiac defibrillators.
Travelers should carry a letter from your physician and request a physical
pat down. Walk through metal detectors will not interfere with your device
but will set off an alarm.
What else should I consider?
You should also carry a copy of your EKG with you, so physicians who are
not familiar with you can compare EKG’s if an emergency situation
developed while traveling. You should also consider having your
cardiologist’s contact information (telephone/fax/email) with you for others
to communicate with them.
For any questions regarding your defibrillator, pacemaker or stent please
consult your cardiologist or the company that manufactured it.
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Medical Devices - Artificial Joints and
other Orthopedic Issues
Will artificial joints set off the walk through metal detector?
Yes, artificial joints will set off the alarm in walk through metal detectors. As
a general experience total hip joints set off alarms 100% of the time, total
knee joints 90% of the time, plates and screw 25 % of the time, spinal
implants 14 % of the time.
Artificial shoulders, wrists, screws, wires and rods by themselves may not
set off alarms depending on how sensitive the machines are.
Does having a Medical Device Patient Travel Card, Doctor’s letter or X-
ray make it easier to go through airport screening?
NO it does not, these documents can obviously be forged and cannot be
relied upon by airport security officers as a substitute for individual
screening.
What is the most appropriate approach to go through airport security
screening?
You can inform the security officer that you have an artificial joint,
prosthetic device or plates & screws; they may tell you to walk
through anyway or screen you privately with a hand wand.
If you walk through the metal detector and the alarm goes off, let the
officer know that you have an artificial joint, prosthetic device or plates
& screws etc.
You will be taken to a private area and screened with a hand wand to
confirm the presence of your artificial joint, prosthesis or other device.
At this point a Medical Device Patient Travel Card may help to confirm
the location of your device and correlate to where the hand wand
should alarm.
What about Prosthesis, Braces and Casts?
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Security officers will need to see, touch and perhaps do explosive trace
sampling on your artificial limb, brace or cast. These do not need to be
removed for screening.
What about canes, crutches and walkers?
Canes, crutches and walkers must undergo x-ray screening. If they do not
fit the machine, a manual inspection and explosive trace sampling may be
conducted.
What about TENS units, Bone growth stimulators, Orthopedic shoes
etc?
Inform the security officer of your device and its location. You should
request a private screening with pat down and visual inspection as the
calibration of devices will be interfered with by x-ray screening equipment.
Medical Devices - Cardiac stents and
metal heart valves
Will a stent in my heart set off metal detectors?
A single metal stent will not set off alarms, however if you have multiple
stents the metal detector could possibly be set off. At approximately 3-4
weeks after stents have been placed, tissue builds up around them and it
should no longer set off metal detector alarms.
If alarms go off and you feel it is due to your stents, show security officers
your medical device ID card and request a physical pat – down screen.
Will my artificial metal heart valve or ring set off metal detectors?
As a general rule it should not, since the amount of metal in a valve or valve
ring is small. However if the sensitivity of the machines are set extremely
high it is a possibility.
If alarms go off and you feel it is due to your valve or valve ring, show
security officers your medical device ID card and request a physical pat –
down screen.
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Medical Devices - CPAP
Travelers with Obstructive Sleep Apnea who use CPAP at night can travel
by air these days without many hassles with their CPAP machines. Thisability to transport and use the devices at their vacation or business
destinations ensures their well being and health.
What is the most appropriate approach to go through airport security?
Have the CPAP machine in its original bag if possible, with bubble
wrap for protection.
International plug adaptor kit and electric current converter or surge
protector if needed for your device.
Bring a copy of your CPAP prescription and statement of need by
your physician.
Bring a copy of TSA’a statement on CPAP devices, in case the
screeners are not familiar with procedures; available at
www.tsa.gov/travelers/airtravel/specialneeds/index.shtm
Should I have the CPAP machine in my carry-on or check it?
Ideally you should have the CPAP machine in your carry-on luggage to
assure that it does not get lost or damaged. CPAP machines cost $1000’s
while checked luggage is only insured for $200, replacement will be
expensive.
Will I be allowed to take the CPAP machine in my carry-on?
Theoretically, you should be able to take the CPAP machine in your carry-on luggage according to the Department of Transportation and Security
Administration (TSA) guidelines and most TSA screeners are familiar with
these devices. The machines obviously have to go through x-ray screening,
explosive and chemical tests prior to being allowed to board.
So what is the catch?
According to reports from CPAP users, your ability to take the machine in
your carry-on is not guaranteed and many are forced to check it in because
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they did not “pass” the x-ray test. TSA guidelines come with an exception;
respiratory equipment that the Security officers are not able to clear by
inspection will not be allowed on board in your carry-on luggage.
If you are not allowed to take it in your carry-on; be polite, patient,understanding and check it. Wrap it well in bubble wrap to avoid any
damage. Bon voyage!
Can I use the CPAP machine onboard the airplane?
You should be able to use the CPAP machine on board if your seat has a
power port to connect the CPAP machine. You can carry a power port to 12
V adapter and connect the CPAP via its own 12 V adapter cable.
Alternatively carry an inverter that will attach to the airplane power port andhook up the CPAP with its power cord to the inverter.
Seats in first and business class usually come with a power port, check with
seatguru.com to see if your seat comes with a power port.
If you don’t want to mess with cables and power ports, there are battery
powered CPAP machines with a battery life of approximately 11 hrs that
can be used.
How can I use the CPAP machine overseas?
First of all, carry a copy of your prescription and certificate of need from
your physician to clear customs smoothly.
Newer CPAP machines have universal power supplies and adjust for
different voltages (120 or 240) automatically without worrying about
damaging the unit. Older machines may have a switch that you need to flip
or may have to carry a converter or surge protector; check out the
specifications of your machine.
However as electric surges occur in some developing countries surge
protection is vital even if a converter is built in. Wall outlets will be varied
and so it is prudent to carry a multipack international plug adapter kit.
Don’t forget to carry an extension cord, to assure that you actually get to
sleep on the bed and not by the lamp or door.
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Medical Devices
Diabetes medications, equipment &supplies
What is the most appropriate approach to go through security
screening? Pack your insulin and all diabetes testing supplies in a clear separate
pouch or bag.
Medications and supplies are safe to go through x-ray testing and youcan place them on the x-ray machine.
However, if you prefer a visual inspection, inform the security officer
that you have diabetes, have your medications & supplies with you
and request a visual inspection. They may do this as a courtesy but
make the request early before you go through regular screening.
If you have an insulin pump, notify the security officer that you have
an insulin pump and that it cannot be removed; since it is attachedwith a needle under the skin. Ask the officer for a physical pat – down
and visual inspection of the pump.
What all diabetes medications and supplies are allowed to be carried
in your carry on luggage?
Insulin and insulin loaded syringes that are clearly marked as such.
Unlimited number of unused syringes if accompanied by insulin.
Unlimited number of used syringes if they are in sharps disposal
containers.
Blood glucose meters, lancets, test strips, alcohol swabs & meter
testing solutions.
Insulin pumps and pump supplies like cleaning agents, batteries,
catheter, needles, tubing, infusion kit etc, when accompanied by
insulin.
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Glucagon emergency kit.
Medications and SuppliesWhat is the most appropriate approach to go through security
screening?
Pack all your medications and supplies in a separate pouch or bag
from the rest of your belongings to quickly give to security officers.
Medications and supplies are safe to go through x-ray testing and are
normally screened this way.
If you wish to have your medications and supplies inspected visually
rather than through x-ray testing, you maybe granted this wish but you
need to request it prior to going through screening.
If any of the medications or supplies cannot be adequately screened
visually, it will have to go through x-ray screening.
What medications and supplies are allowed to be carried in your carry
on luggage?
As a general statement the Transportation Security Agency states
that all medications and supplies are allowed as long they pass
screening.
These include: Pills and liquids like insulin, inhalers and their refills,
atropens, epipens, insulin syringes, pre-loaded syringes, jet injectiors,
infusers etc.
Medications in pill form need not be labeled, however liquids like
insulin need to be clearly identifiable with labels.
Medications in pill boxes (daily dosage containers) are allowed.
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Oxygen
Do I need supplemental oxygen when I fly?
If you are currently on oxygen treatment at home, you will need
supplemental oxygen during your flight and you will most likely need to
increase the flow rate by 1-2 L/min more than your usual requirements.
Consult with your physician.
If you are currently not on oxygen, you may still need supplemental oxygen
during flight:
If your blood oxygen level at rest while breathing room air is less than
70mmHg. Blood oxygen level is measured by obtaining blood fromyour arm - arterial blood gas test. This is the best test to determine
need for supplemental oxygen during flight.
If your blood oxygen saturation at rest while breathing room air is less
than 92% or if it drops below 85% by walking 150 feet . This is done
non-invasively by placing a probe on your fingertip – pulse oximeter
test. This is the second best test to determine need for supplemental
oxygen during flight.
if you are unable to walk 150 feet or climb a flight of 15 steps without
becoming severely short of breath. Please consult your physician to
determine need for supplemental oxygen
There are other sophisticated tests including placement in an altitude
chamber, breathing mixed nitrogen/oxygen etc to determine need for
supplemental oxygen. However, these tests are cumbersome and not
readily available everywhere.
Should I consult with my doctor before flying?
Individuals with chronic respiratory conditions like asthma, bronchitis and
emphysema, congestive heart failure, angina, sickle cell disease, severe
anemia etc. should consult with their physician regarding supplemental
oxygen during flight.
If you are unable to walk 150 feet or climb a flight of 15 steps without
becoming short of breath you need to consult your physician prior to flying.
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When should I tell the airline regarding my need for oxygen?
You should notify the airline regarding your need for in-flight oxygen as far
in advance as possible, preferably when you make the booking, but a
minimum of 48 hours prior to flying.
Can I carry my own oxygen equipment onto the airplane?
NO airline will not allow you to take your own compressed or liquid oxygen.
The Airline Oxygen Council of America has helped pass legislation now
requiring all airlines to allow Department of Transportation (DOT)
approved Portable Oxygen Concentrators (POC) on flights in the
United States. However not all foreign airlines abide by this legislation;
please check with the airline you are flying.
The DOT approved portable oxygen concentrators are as follows – AirSep
Freestyle, AirSep Lifestyle, Inogen One, Respironics EverGo, SeQual
Eclipse.
What about oxygen at the terminal and during layovers?
You are solely responsible for arranging your oxygen while on the ground in
the terminals, during layovers and during transport at arrival and departure.Use your home oxygen company, friends and relatives etc for this. The
passenger is also responsible for arranging the removal of oxygen canisters
from the gate area upon your departure.
The airline is only responsible for oxygen while you are on the airplane.
You should never forget to make separate arrangements for oxygen at your
destination as well; the airline will not do this for you.
Well, who can arrange all this?
Your home oxygen supplier should be able to help you make these
arrangements. If you are not currently on oxygen, contact your medical
insurance company for a list of contracted home oxygen providers. Your
physician should be able to guide you on this as well.
You can also visit www.homeoxygen.org for assistance in these matters.
What is the most appropriate approach to go through security
screening?
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Inform the security officer that you or the person you are escorting is
on oxygen therapy.
If it is safe to be disconnected from your oxygen and respiratory
equipment, do so and have yourself and the oxygen equipmentscreened separately.
If your doctor has indicated that you cannot be disconnected from
your oxygen and respiratory equipment, inform the security officer and
ask for an alternative method of screening (physical pat – down,
inspection and explosive trace detection etc.)
What equipment is allowed to go through security?
Oxygen canisters, nebulizers, respirators and concentrators are all allowed
into the terminals once they have been screened by security officers.
However again, your own oxygen cannisters will not be allowed on the
airplane - only POC (portable oxygen concentrators).
Elderly Traveler
The elderly are more prone to effects of jet lag, temperature change,
motion sickness and dehydration. To minimize these symptoms:
Get plenty of rest prior to travel.
Carry extra layers of clothing to keep warm on the plane and while on
the ground during layovers or transfers.
Drink plenty of fluids.
Carry extra snacks for unforeseen delays.
Plan ahead and always allow extra time:
To get to the airport, transfer to different terminals, counters and
baggage claim areas.
Make use of available help by asking for wheelchairs and carts.
Should I avoid travel at this time?
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Contraindications to air travel include but are not limited to:
Chest pain that is new, occurs at rest or with minimal effort
Had a heart attack in the past 6 weeks
Uncontrolled high blood pressure
Uncontrolled heart failure – breathless at rest
Had a collapsed lung in the past 3 weeks
Uncontrolled Asthma/COPD – breathless at rest
Active infection of the ear, nose, & throat
Surgery within the past 2 weeks
Had a stroke in the past 2 weeks
Been diving in the past 24 hours
Consult with your physician for your specific situation and any other contra-
indications to air travel.
What if I have a chronic medical illness?
If you have chronic medical conditions like diabetes, asthma or heart
disease, there is specific advice for each illness, please go to any or all of
those sections as needed with this link: traveler with diabetes, traveler with
asthma and traveler with heart disease.
Will I need oxygen for flying?
Lists of conditions requiring supplemental oxygen while flying include, but
not limited to, are:
You are currently on oxygen at home
Your blood oxygen level while breathing room air is less than 70
mmHg
Your finger probe oxygen saturation is less than 92% while at rest or
less than 85% with exertion
if you are unable to walk 150 feet or climb a flight of 15 steps withoutbecoming severely short of breath.
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Consult with your physician regarding whether you require oxygen during
flight.
What is the risk of blood clots from travel or flying?
Factors that increase the risk of blood clots include but are not limited to:
Age > 75,
Previous history of blood clots,
Cancer,
Kidney failure,
Immobility,
Recent surgery,
Genetic susceptibility to clotting,
Prolonged air travel (> than 4 hours) etc.
Consult with your physician regarding your specific risk for developing blood
clots.
Simple measures to prevent blood clots include but are not limited to:
Avoid dehydration by drinking plenty of fluids
Wear loose fitting clothes
Exercise in your seat by bending and straightening your feet and
knees 15 times every 15 minutes.
Walk around the cabin every 30 minutes if safe and feasible
Wear properly fitted graduated compression stockings.
Consult your physician to see if you require medications to prevent
blood clots.
Please go to our section on economy class syndrome for further details.
What about medical devices/records/drugs/supplies?
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If you have implanted medical devices like defibrillators, medication infusion
pumps, pace makers or artificial joints carry a letter and your medical
device ID card from your physician to ease matters with security clearance.
Please go to our section on traveling with medical devices.
Carry a copy of your EKG and a legible list of all your medical problems and
medications with you in your carry on baggage or wallet/purse.
Carry all your medications, supplies and any blood sugar testing kits etc.
with you in your carry on baggage. DO NOT put them in your checked
luggage. If you are gone for a prolonged length of time, consider carrying a
set of new prescriptions with you in your wallet or purse, in case you loose
your luggage, so that you can have them refilled without problems.
How about travel vaccines and antibiotics?
Make sure you have received appropriate travel related and booster
vaccines for the country you are traveling to and have necessary antibiotics
for the prevention of malaria and treatment of diarrhea.
Be aware of the potential for newly prescribed medications like antibiotics,
motion sickness pills etc to interact with your usual daily medications.
Check with your physician or pharmacist about the need to adjust doses or alternatives.
If possible take a dose or two of the new medications prior to departure to
make sure it will not cause any problems.
Should I wear a medical alert bracelet?
Wear a medical alert bracelet if you have diabetes, asthma, heart problems,
seizures or psychiatric problems.
Travel with Children
If children are traveling without their parents, the accompanying responsible
adult or guardian should carry a notarized letter authorizing their travel,
permission for any and all necessary medical treatment for them and
evacuation if needed.
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If children are traveling with a solo parent, a signed letter by the non-
traveling parent, while not absolutely necessary, may speed up health care
and services in countries with a legalistic bend.
Children with chronic heart, lung, blood or ear, nose and throat problemsshould be evaluated by their pediatrician prior to air travel.
Are there any special immunization requirements for children prior
to travel?
Update all recommended age appropriate vaccinations.
Accelerated vaccine administration schedules are available for special
travel circumstances if the child is younger than recommended age, check
with your pediatrician
Children should have at least 3 doses of tetanus toxoid and pertussis
vaccine prior to travel.
Mumps-measles-rubella vaccine or monovalent measles vaccine (if the
child is less than 12 months old) should also be given prior to travel.
Check with your pediatrician for specific recommendations for the country
you are traveling to. Your child may need vaccines for Hepatitis A, HepatitisB, Japanese encephalitis, Meningococcus, Rabies, Typhoid, and Yellow
fever etc.
What should be done for malaria prevention in children during travel?
Stay in accommodations with screened windows and doors.
Use permethrin impregnated mosquito nets.
Avoid outdoor activities at dawn or dusk when mosquitoes are most active.Wear long sleeve clothing.
Apply DEET (N, N-diethylmeta-toluamide) repellant on exposed skin and
clothing as directed on the label for children.
Check with your pediatrician for specific weight based recommendation for
medications like Atovaquone-proguanil, chloroquine, mefloquine etc.
See our malaria prevention section for further details.
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How do I treat traveler’s diarrhea in children?
Follow general food safety and water safety recommendations.
Prepare formulas with safe water only.
Use oral rehydration solutions aggressively. If you are unable to find them
or don’t have it, just mix 6 teaspoons of sugar and 1 teaspoon of salt in 1
liter of bottled, boiled or purified water.
Children should avoid lomotil, Pepto-Bismol or other anti-diarrhea
medications, which could potentially cause blockage.
Take appropriate weight based antibiotics as directed by your pediatrician.
Traveler on Dialysis
Dialysispatients no longer need to be hooked to their hometowns. You
can withsome advance planning and preparation enjoy vacations, out of
townbusiness or pleasure engagements and even go on cruises or
wildernessadventures.
Who should consider travel?
Any hemodialysis or peritoneal dialysis patients who are medically stable
and on a stable dialysis regimen can travel.
Who should avoid travel?
Youshould avoid travel if you are new to dialysis, your regimen
andfrequency are still being determined or your medical condition
isunstable.
How should a hemodialysis patient start planning for a trip?
Oneshould start planning at least 6-8 weeks in advance, perhaps longer
forpopular vacation destinations or during holidays. Discuss your planswith
your kidney specialist (nephrologist) and obtain his approval from amedical
standpoint.
Your local dialysis centers will sometimehave a social worker or nurse who
is familiar with arranging dialysisaway from your home town and can assist
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you in finding a localhemodialysis center in the town you are visiting(travel
dialysiscenter).
If your center is not able to do this, find out whichnational company is
involved in your dialysis care and call their tollfree number. The 2largest companies are: DaVita(1-800-244-0680 ordavita.com) and
Fresenius(1-866-889-6019 or fresinius.com). Theycan help you find a
dialysis center in the town you are visiting.
You can also go to www.globaldialysis.com to find local dialysis centers all
over the world.
What if one has to travel in an emergency or short notice?
Mostdialysis centers will be sympathetic and try to accommodate
yourneeds. Use your dialysis center staff, the above phone numbers
andwebsites to make arrangements.
What adjustments will have to be made?
Youmay not always get into your first choice for dialysis center, you
mayhave to drive a bit longer or take a different shift than you are usedto. If
you plan ahead none of the above may be an issue, but be preparedto be
flexible, especially if on short notice.
What information will be needed at the travel dialysis center?
Youwill need to provide them with your name, address, contact
information,your hometown dialysis center contact number, the dates you
needdialysis, your vascular access type and dialysis prescription.
Inaddition they will need a copy of your medical history & physical,list of
medications, laboratory results, EKG, CXR, 4-6 recent treatmentrecords
and any special dialysis requirements.
They will also needyour insurance information, along with the name and
contact number ofyour physician. Give them the address and local
telephone number for theplace you are staying at.
Are there extra costs out of my pocket for this?
Medicarewill pay for 80% of the costs within the United States and
itsterritories, but the patient is responsible for 20%. Your
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secondaryinsurance may cover this 20%, but travel dialysis centers may
requireyou to pay this upfront and bill your insurance later.
Medicaid by and large will not pay for treatment outside your home state
and you will be responsible for the costs.
Ifyou have private insurance, it is best to have a letter in writing thatthey will
pay for your treatment at the travel dialysis center.
Always inquire if the physician fee is your own responsibility or billed to the
insurance.
What about peritoneal dialysis and travel?
Travelis usually quite a bit simpler since you don’t need a fixedappointment,but make sure to call the peritoneal dialysis center atyour destination and
see if they would be able to assist you if problemsarose. Provide them with
a copy of your pertinent medical records:history & physical, labs, EKG,
CXR, dialysis prescription, list ofmedications etc.
You should carry enough supplies for the entire trip and some extra in case
of problems.
Ifyou are traveling for a prolonged period of time, have suppliesdelivered toyour destination and make sure they have arrived prior todeparture.
What if I get sick while traveling?
Thetravel dialysis center at your destination will be able to handle
yourneeds through their physicians. Carry a complete legible copy of
yourpertinent medical records including medical problems, surgeries
done,list of allergies, list of medications and contact information for
yourphysician and family.
What about home hemodialysis and travel?
Mosthome hemodialysis patients get dialyzed in a local travel dialysiscenter
at their destination, however some do travel in motor homes or goto
campsites with electrical hook ups and are able to performhemodialysis.
Information can be found at travelingdialysisRVassociation.com.
What if I am on a transplant list?
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Ifyou are on a transplant list kindly inform your transplant coordinatorabout
your travel plans and give contact information. If you wish to be“on hold”
during the trip, please do so if you cannot get back in areasonable amount
of time.