CHAPTER 35

HEALTH PHYSICS

• The first American fatality that resulted from radiation exposure was
Answer: Clarence Dally

• Simplified rules designed to ensure safety in radiation areas for occupational workers
Answer: Cardinal principles for radiation protection

• In what year the first dose-limiting recommendations were made?

Answer: 1931

• Continuously reviews the recommended dose limits

Answer: National Council on Radiation Protection and Measurements (NCRP)

• The practice of health physics

Answer: Providing radiation protection for workers and the public is the

• Design equipment, calculate and construct barriers, and develop administrative protocols to maintain radiation exposures as
low as reasonably achievable (ALARA)
Answer: Health physicists

• Concerned with providing occupational radiation protection and minimizing radiation dose to the public.
Answer: Health physics

• The term health physics was coined during the early days of the Manhattan Project, the secret wartime
effort undertaken to develop the atomic bomb

• A radiation scientist who is concerned with the research, teaching, or operational aspects of radiation
safety
Answer: Health physicist

• Three cardinal principles of radiation

Answer: STD
• Time
• Distance
• Shielding

• When the three cardinal principles are observed, radiation exposure can be _____
Answer: minimized

• Cardinal principles of radiation

Answer:
• Keep the time of exposure to radiation as short as possible
• Maintain as large a distance as possible between the source of radiation and the exposed person
• Insert shielding material between the radiation source and the exposed person

• The dose to an individual is ____ related to the duration of radiation exposure

Answer: directly

• If the time during which one is exposed to radiation is doubled, the exposure will be _____
Answer: doubled
 • Time
Exposure = Exposure rate × Exposure time

• A radiation worker is exposed to 2.3 mGya/hr (230 mR/hr) from a radiation source. If the worker
remains in that position for 36 minutes, what will be the total occupational exposure?
Answer:

• The parent of a patient is asked to remain next to the patient during fluoroscopy, where the radiation
exposure level is 6 mGya/hr (600 mR/hr). If the allowable daily exposure is 0.5 Gya, how long may the
parent remain? (Figure 35-2)
Answer:
Time = Exposure ÷ Exposure rate
= 0.5 mGya ÷6mGya
= 1/12 hours
= 5 minutes

• During radiography, the time of exposure is kept to a minimum to reduce _____

Answer: motion blur

• During fluoroscopy, the time of exposure also should be kept to a minimum to reduce _____
Answer: Patient and personnel radiation exposure

• This is an area of radiation protection that is not directly controlled by the radiologic technologist

• _____ are trained to depress the fluoroscopic foot switch in an alternating fashion, sequencing on-off
rather than continuous on during the course of the examination
Answer: Radiologists

• A repeated up-and-down motion on the fluoroscopic foot switch permits a high-quality examination to
be performed with considerably reduced _____ to the patient
Answer: Exposure

• The use of pulse-progressive fluoroscopy can reduce _____ considerably

Answer: patient dose

• The _____ on all fluoroscopes reminds the radiologist that a considerable amount of fluoroscopic time
has elapsed
Answer: 5-minute reset timer

• The timer records the amount of _____ on time

Answer: x-ray beam

• Most fluoroscopic examinations take less than _____ minutes

Answer: 5 minutes

• Only during difficult _____ procedures should it be necessary to exceed 5 minutes of exposure time
Answer: interventional radiology
 • A particular _____ lies in the use of mobile image intensifiers in surgical suites where some physicians
are less radiation conscious.
Answer: lies

• A fluoroscope emits 42 mGya/min (4.2 R/min) at the tabletop for every milliampere of operation. What
is the patient exposure in a barium enema examination that is conducted at 1.8 mA and requires 2.5
minutes of fluoroscopic x-ray exposure time?

• As the distance between the source of radiation and the person increases, radiation exposure _____
rapidly
Answer: decreases

• The decrease in exposure is calculated using the _____ law

Answer: Inverse square law

• Most radiation sources are _____ sources

Answer: point

• If the distance from the source exceeds _____ times the source diameter, it can be treated as a point
source
Answer: 5 times

• Point source of radiation

Answer: X-ray tube target

• The scattered radiation generated in a patient appears to come not from a point source but rather from an
_____ source
Answer: extended area

• As a rule of thumb, even an extended source can be considered a _____ source at sufficient distance
Answer: point source

• When the square law was used to calculate exposure in radiographic technique, the following formula
may have been used:
New exposure New distance squared In this case, the exposure from the source (the x-ray
= tube) was varied so that the optical density of the
film
Old exposure Old distance squared (OD) would remain constant

• When the inverse square law is used in calculations for radiation protection, it is usual to calculate the
dose received at a point with the radiation from the tube as the constant.
Thus the above formula becomes
New exposure Old distance squared
=
Old exposure New distance squared

• An x-ray tube has an output intensity of26 mGya/mAs (2.6 mR/mAs) at 100-cm source-to-image
receptor distance (SID) when operated at 70 kVp. What would be the radiation exposure 350 cm from
 the target?

• Lines that represent positions of equal radiation exposure in the fluoroscopy room
Answer: Isoexposure lines

• At the normal position for a radiologist or a radiologic technologist, the exposure rate is approximately
_____
Answer: 3 mGya/hr (300 mR/hr)

• During fluoroscopy, the radiologic technologist should remain as far from the ____ as practicable.
Answer: patient

• During portions of the fluoroscopic examination, when it is not necessary for the radiologic technologist
to remain close to the patient, the technologist should step back. Two steps back, the exposure rate is
only
approximately_____
Answer: 50 μGya/hr (5 mR/hr)

• The reduction in exposure does not follow the inverse square law because during fluoroscopy, the patient
is an _____ source of radiation because of scattered x-rays generated within the body
Answer: extended

• What is the approximate occupational exposure of a radiologic technologist at a position where the
exposure rate is 3 mGya/hr, and farther back where the exposure rate is 0.2 mGya, during a fluoroscopic
examination that lasts 4 minutes, 15 seconds?
Answer:
Occupational exposure equals
First position: (3 mGya /hr) (4.25 min)
(1 hr/60 min) = 0.21mGya
Second position: (0.2 mGya /hr) (4.25 min)
(1 hr/60 min) = 14 μGya

• Better yet, after two steps back to take advantage of “maximize distance,” take one step to the side and
get behind the radiologist! This move results in additional shielding

• Positioning shielding between the radiation source and exposed persons greatly reduces the level of
_____
Answer: radiation exposure

• Used in diagnostic radiology usuallyconsists of lead, although conventional building materials also are
used
Answer: Shielding

• The amount that a protective barrier reduces radiation intensity can be estimated if the _____ or_____ of
the barrier material is known
Answer: half-value layer (HVL) or the tenth-value layer (TVL)
 • The TVL is similarly defined as follows:
_____ is the thickness of absorber that reduces the radiation intensity to one-tenth its original value.
Answer: One TVL

• Approximate Half-Value and Tenth- Value Layers of Lead and Concrete at Various Tube Potentials
HVL TVL
Tube Lead Concrete Lead Concrete
Potential (mm) (cm) (mm) (cm)
40 kVp 0.03 0.33 0.06 1.0
60 kVp 0.11 0.64 0.34 2.2
80 kVp 0.19 1.1 0.64 3.6
100 kVp 0.24 1.5 0.80 5.1
125 kVp 0.27 2.0 0.90 6.4
150 kVp 0.28 2.2 0.95 7.1

• When operated at 80 kVp, an x-ray imaging system emits 36 μGya/mAs at an SID of 100 cm. How
much shielding (concrete or lead) would be required to reduce the intensity to less than 2.5 μGya/mAs?
Answer:
The amount of shielding in the first or second column of the following data will reduce the beam intensity to the
value in the third column. The last row is the answer.

Pb (mm) Concrete (cm) Beam intensity (μGya/mAs)

0 0 36
0.19 1.1 18
0.38 2.1 9.0
0.57 3.2 4.5
0.76 4.3 2.3

• An x-ray imaging system is used strictly for chest radiography at 125 kVp. The useful beam is always
directed to a wall that contains 0.8 mm Pb shielding. How much additional shielding will be required if
the workload doubles?
Answer:
When the workload doubles, so does the exposure on the other side of the wall. From one HVL, or 0.27 mm Pb,
is necessary to reduce exposure to its original level

• Protective aprons usually contain _____ mm Pb

Answer: 0.5 mm Pb

• 0.5 mm Pb approximately equivalent to 2 HVLs, which should reduce occupational exposure to _____%
Answer: 25%

• Actual measurements show that such protective aprons reduce exposure to approximately _____%
because scattered x-rays are incident on the apron at an oblique angle
Answer: 10%

• The kVp of a radiographic imaging system rarely exceeds 100 kVp. The output intensity is 46 μGya/
 mAs at 100-cm SID. The distance to a desk on the other side of the wall to which the x-ray beam is
directed is 200 cm. The wall contains 0.96 mm Pb, and 300 mAs is anticipated daily. If the exposure is
to be restricted to 20 μGya/wk, how long each day may the desk be occupied?
Answer:

• Suppose an analysis shows that if an administrator remains at her desk for longer than 24 minutes each
week, the occupational dose limit will be exceeded. How much additional protective lead would be
required?
Answer:
Full occupancy is 4 hr 6 min/hr 2400 min

That is, 2 TVLs or an additional 1.6 mm Pb

• _____ are based on total body radiation exposure

Answer: Radiation risk coefficients

• In medical x-ray imaging, the risk of a stochastic radiation response is not proportional to the tissue dose
but rather to the _____
Answer: effective dose (E)

• It is the equivalent whole-body dose

Answer: Effective dose

E = Σ D i Wt

• _____is the weighted average of the radiation dose to various organs and tissues
Answer: equivalent whole-body dose

• The National Committee on Radiation Protection (NCRP) has identified various tissues and organs and
the relative radiosensitivity of each

Tissue Tissue Weighting Factor (Wt)

Gonad 0.20
Active bone marrow 0.12
Colon 0.12
Lung 0.12
Stomach 0.12
Bladder 0.05
Breast 0.05
Esophagus 0.05
Liver 0.05
Thyroid 0.05
Bone surface 0.01
Skin 0.01
 • Computed tomography of the abdomen and pelvis results in a tissue dose of 20 mGyt (2000 mrad). What
is the effective dose?

• A PA chest radiograph results in an entrance skin dose of 0.1 mGyt, an exit dose of 0.001 mGyt (1
μGyt), and an average tissue dose of 0.05 mGya (50 μGya). What is the effective dose?

• Radiologic technologists receive essentially all of occupational radiation exposure during _____
Answer: fluoroscopy

• During radiography and mammography, the radiographer is positioned behind a protective barrier,
resulting in ____ occupational radiation exposure
Answer: zero

• Effective dose for occupational radiation exposure is based on the _____

Answer: occupational radiation monitor

• During fluoroscopy, we position our occupational radiation monitor at the ____ to estimate dose to the
tissues of the head and neck
Answer: collar

• The tissues of the trunk of the body receive essentially ____ dose; the protective apron does what it is
designed to do
Answer: zero

• An occupational radiation monitor records a dose of 1 mSv. What is the effective dose if the
occupational dose is received during fluoroscopy when a protective apron is worn?

• We assume the occupational effective dose to be ____% of the monitor dose

Answer: 10%

• In actual fact, it is something less than 10%.

• Effective dose that should be used for _____

Answer: radiation risk estimation

Individuals who must make the first decisions and take the first steps in the early stages of emergency response
to a radiologic incident conducted by terrorists
Answer: Emergency responders
 • The first emergency responders are likely to be police, fire, or emergency medical personnel

• In the setting of a health care facility, _____ may likely be the first emergency responders
Answer: radiologic technologists

• _____ and _____ should be attended to before radiologic concerns are addressed
Answer: Rescue and medical emergencies

The first task of emergency responders

Answer: Prevent injury and death and to attend to the medical needs of victims

• Such immediate responses include limiting acute, high-intensity radiation exposure and limiting low-
intensity radiation exposure that could result in late stochastic effects.
• This is an ALARA exercise and will involve the application of the cardinal principles of radiation
protection:
• Reduce time of exposure
• Increase distance from the source
• Impose shielding between the source and the victim

• The malevolent use of radiologic material by terrorists can be described as one of three devices:
Answer:
• Radiation exposure device (RED)
• Radiologic dispersal device (RDD)
• Improvised nuclear device (IND)

• Being exposed to radiation does not make an individual _____

Answer: radioactive

• A sealed source of radioactive material that directly exposes people

Answer: Radiation exposure device (RED)

• An RED will not disperse radioactive material; therefore, decontamination of an RED is not required.

• A bomb that when exploded disperses radioactive contamination over a wide area
Answer: Radiologic dispersal device (RDD)

• Although the contamination can be particularly troublesome, it is not usually life threatening

• RDD may not be explosive, but rather, _____ material

Answer: radioactive

• RDD may be dispersed by hand in the form of _____

Answer:
• Powder
• Mist
• Gas into a water supply or ventilation system

• Contains nuclear material that can produce a nuclear explosion

Answer: Improvised nuclear device (IND)

• An IND is indeed a _____ weapon; therefore, it is unlikely to be the form of attack used by a terrorist
Answer: nuclear

• However, should an IND be employed, the death and devastation would be extreme.

• Protection against exposure to external radiation, exposure from photon and particle radiation, and
internal radioactive contamination transferred from surface radioactive contamination must be
considered. This is accomplished by establishing boundaries for known levels of _____ and _____
Answer: radiation exposure and radioactive contamination

• With the use of radiation monitoring instruments, an inner boundary is established at an exposure rate of
_____
Answer: 100 mGya/hr (10 R/hr)

• Inside of this boundary, one should assume that levels of radioactive contamination are high, until it is
proved otherwise.

• An _____ boundary should be established when exposure exceeds 100 μGya/hr (10 mR/hr) or when
radioactive contamination is detectable
Answer: Outer boundary

• _____ contamination is rarely life threatening

Answer: Radioactive

• _____ equipment with specific capacity should be readily available to the first responder
Answer: Radiation detection

• It is recommended that radiation detection equipment be stored in the _____ and identified to all
technologists and radiologists who might be pressed into emergency response
Answer: nuclear medicine laboratory

• Radiologic terrorism can be addressed safely with an emergency responder’s _____

Answer: equipment kit

• Radiation detection apparatus should be capable of measuring radiation exposure levels to _____
Answer: 500 m Gya/hr (50 R/hr)

• It is recommended that radiation detection instruments should emit unambiguous alarms at _____
Answer:
• 100 μGya/hr (10 mR/hr)
• 100 mGya/hr (10 R/hr)
• 500 mGya/hr (50 R/hr)

• An additional instrument should be available that can be used to clearly detect the presence ______ and
_____ radioactive contamination
Answer: alpha and beta radioactive contamination

• Emergency responders should have available standard _____ and _____ to protect against radioactive
contamination of the responder
Answer: protective coveralls and shoe covers

• Devices may be needed in the case of aerosol radioactive contamination

Answer: Protective respiratory
 • Decontamination of victims may be necessary, and an area should be cordoned off for such activity, so
that a contaminated-to clean step-off pad is provided.
• Officer of a hospital should assign an individual to be responsible for establishing the emergency
response equipment store and for seeing that adequate continuing education is provided for those who
might be called upon to perform as emergency responders
Answer: Radiation Safety Officer