RADIATION SAFETY OF MEDICAL STAFF,

WORKING WITH SOURCES OF IONIZING

RADIATION
 виды излучений
Types of radiation

ионизирующее
Ionizing неионизирующее
Nonionizing

квантовое
Quantum, корпускулярное
Corpuscular, тепловое
Thermal Resonance
состоящее of
consisting из состоящее из
consisting of инфракрасное
radiation, резонансное
radiation
фотонов
photons частиц
particles infrared
radiation

γ-излучениеand
-radiation α,β-частицы
тормозное
deceleration пучки
- particles, ультразвуковые волны
Ultrasonic waves
(рентгенов-
radiation (X- протонов,
-particles
ское)
ray emission) электронов
 Ionizing radiation
 Ionizing radiation - any radiation, whose interaction
with the environment leads to the formation of the
electric charges of opposite signs.

Kinds of radiation

γ
neutron
radiation

α
β
 Alpha particles
 A cluster of 2 protons and 2 neutrons (the nucleus of a
helium atom)
 Travel extremely short paths (at most 10 cm in air) – the
lowest penetration ability
 Readily stopped by a piece of paper, the top, dead layer
of the skin, film of water, rubber gloves and regular
clothes.
 If they are kept outside the body - little damage results.
 Possess great ionsing power – the highest ionizing
capability (the ionization density).
 Hazardous only when taken into the body
(oral, inhalation - internal irradiation) –
The most dangerous type of radiation during
the internal exposure.
 Beta-particles
 A flow of electrons or positrons.
 Ionizing capability is lower than that of α-
particles.
 The penetration ability is greater than that of
α-particles – 15 cm – 18 m in air.
 Depending on their energy, they can be
stopped by:
low atomic number - aluminum, glass, plastic.
high energy – steel, iron, zinc , aluminum.
Gamma-rays and X-rays emission
 A flow of photons that do not have a charge.
 The lowest ionization capability.
 Present the most external radiation exposure
hazard.
 The higher penetration power - hundreds meters
in air (they penetrate several centimeters of
steel).
 To reduce radiation the shielding materials are
used: lead, copper, iron, cast iron, steel, zinc,
concrete, reinforced concrete, barytic beton).
 X rays
 X rays are produced by electron bombardment of
target materials. They are commonly used to produce
shadow pictures (roentgenograms) of dense portions
of objects.
The penetration of different kinds of
radiation
 Basic terms and definitions

 Irradiation - the human exposure to ionizing

radiation.

 Medical irradiation – the exposure of patients as a

result of the medical examination or treatment.

 Professional irradiation - the exposure of personnel

in the process of working with man-made sources of
ionizing radiation.
 Sources of radiation

Natural sources
83%

Sources that
are used in
Other sources medicine
1% 16%
 The source of ionizing radiation

The source of ionizing radiation - radioactive material or a

device that emits or has the capability of emitting ionizing
radiation.
 Closed source don’t emits radionuclides in the environment
for intended use.
Examples: cesium powder for gamma-therapy, radioactive
powder in a lead container, capsule with radioactive powder,
needle with soldered radioactive substance.
It is possible only external irradiation (when
source of radiation is out of human body; under
fluoroscopy for example).
  The source of ionizing radiation

 The open source emits radionuclides in the

environment for intended use.
Examples: flacons or ampoule with radioactive solutions
to introduce into a patient body.
External and internal irradiation is possible.
Internal irradiation – when source of radiation is in the
human body; under inhalation, ingestion, penetrate
through skin, administration of radioactive
solutions or capsules with radioactive
substance.
The most important medical procedures are diagnostic
radiological and radionuclide study.
The contribution of the IR sources used for medical purposes
in the total load of the population is not too large (it is
basically therapy of malignant neoplasms).
The main proportion accounted for diagnostic X-ray
examinations, among which stand out:
 roentgenoscopy (63%)
 fluorography (23%)
 roentgenography (14%)
 Kinds of diagnostic X-ray examinations

 Roentgenography - the production of a shadow image

of the internal structure, that is recorded permanently
on film or paper.
 Tomoghraphy – the production of a view of “slice”
through the object under examination.

 Roentgenoscopy - the production of a dynamic multi-

view image on the fluorescent screen or monitor.

 Fluoroscopy - the production of a photograph of a

shadow image, that is presented temporarily on a
fluorescent screen.
The safest for the patient kind of medical examination.
 Thus, the widespread use of ionizing radiation and
radioactive isotopes in medicine creates the risk of
radiation damage, both for health professionals and
for the general population.
In this context, the protection of medical personnel
radiology rooms and departments, as well as
reduction of radiation exposure to the patient is an
important task of Radiation Hygiene.
 The postulates of the distribution of
ionizing radiation and the nature of its
interaction with matter
 external radiation dose is directly proportional to
the intensity and time of exposure;
 the intensity of radiation from a point source is
proportional to the number of photons or
particles produced in them per unit of time, and
inversely proportional to the square of the
distance;
 the intensity of radiation can be reduced by the
screens.
 Protection by medical staff
against external radiation

 Control of exposure time (all medical operations

need to perform as quickly as possible)
 Control of distance (perform all operations on
the largest distance, for example, to use a long
needle for administering radioactive solution)
 Control of exposure dose (to reduce as possible
the resulting radiation dose)
 Shielding
 Types of protective screens

 Сontainers, in which radioactive drugs are placed for

storage. They are made from different materials
depending on the type of radiation: plastics and aluminum
(for α-and β-emitters), lead, iron, steel (for γ-emitters),
paraffin, boron (first layer) and lead, iron, steel (second
layer) - for neutron sources.

 Protective screens for equipment (all working

equipment completely surround by screen, when
radioactive source is in the operating position).
 Types of protective screens

 Mobile screens to protect working place. There are movable screens for
various applications, particularly in X-ray cabinets.
 Protective screens mounted as part of building structures (powerful
walls, floors, special doors, concrete partitions, labyrinthine input)
designed to protect the placement when the staff always is and the
surrounding area.
 The screens of personal protective equipment (plate of
plexiglas, sight glass, lead impregnated glove, aprons)
Protection by medical staff against
internal exposure

 rational (three-zone system) planning of the

working place;
 sanitation device for removal and deactivation
of liquid, solid and gaseous radioactive waste;
 maximum mechanization and automation of
working operations;
 the use of personal protective equipment.
The mechanism of biological action
of ionizing radiation
 The absorption of radiation energy by
tissue;
 Redistribution of the excess energy with
excitation and ionization of atoms and
the formation chemically active
products: ions and free radicals;
 The interaction of ions and free radicals
with each other and with other
molecules → cell damage (mutations,
death, malignancy, etc.)
 The effects of irradiation

 The effects of irradiation on living systems:

- effects on the living cells
- changes in biochemical reactions
- disease
- changes in life or normal growth
 The effects of irradiation

 The effect of ionizing radiation on living

tissue is due to the ionization process,
which destroys the capacity of
reproduction or division in some cells
and causes mutation in others.
 The effects of irradiation

 There are some classifications of

irradiation effects on the body:
1) Stochastic and Deterministic and
effects
 Stochastic effects
Stochastic (probability) effects are those for which
the probability of an effect occurring, rather than its
severity, is regarded as a function of dose, without
threshold.
The probability of occurrence of which is proportional
to dose, and the severity of which is not dependent on
dose (carcinogenesis, leukemia, hereditary diseases).
Occur under the influence of small doses of IR, which is
most often used in medical
radiological procedures.
 Deterministic effects

Non-stochastic (deterministic) effects are those for

which the severity of the effect varies with the dose, and for
which threshold may therefore occur.
For all these changes, the severity of the effect depends on the
magnitude of the dose received, and there is likely to be a clear
threshold of dose below which no detrimental effects are seen.
Example, radiation sickness, radiation burns, trophic disorders,
radiation cataract of the lens, gonadal cell damage - radiation
infertility, fetal anomalies, cell depletion in the bone-marrow –
haematological deficiencies. Occur under the influence
of sufficiently high doses
of IR.
 The effects of irradiation

2) the somatic effects the hereditary effects

(become manifest in the (affect his descendants)
exposed individual
himself)
radiation sickness, fetal anomalies, hereditary
radiation burns, radiation diseases
cataract, malignant tumor,
leukemia, radiation
infertility
 The effects of irradiation

 The degree of injury inflicted on an

individual by radiation exposure
depends on such factors as the total
dose, exposure route, the kind of
radiation, and the body part exposed to
radiation.
Features of the effects of ionizing
radiation on the body

 The absence of selectivity

 Amount of absorbed energy of radiation
at which a noticeable biological effects
is negligible
 Sense organs do not feel the ionizing
radiation
 Features of the effects of ionizing
radiation on the body

 The most sensitive populations to the effects of

radiation:
women, the elderly and children.
 Factors that enhance the effect of ionizing
radiation:
high air temperature,
noise and vibration
chemicals
 The effects of irradiation

 Sensitivity of tissues to radiation is

directly proportional to the intensity of cellular
metabolism
in inverse proportion to the degree of differentiation of
cells and tissues

Tissues such as the bone marrow, where blood cells are

produced, the lining of the digestive tract are more
sensitive to radiation than cells of bone, muscle, and
nerve.
 Radiation safety - a complex of measures
(administrative, organizational, technical,
sanitary, etc.), limiting exposure and
radioactive contamination of the
environment, persons of the staff and
population to lower values, ​attained by
means acceptable to the society.
 PRINCIPLES OF RADIATION
PROTECTION

The aim of radiation protection should be to prevent

detrimental non-stochastic effects and to limit the
probability of stochastic effects to level deemed to
be acceptable.

1. The principle of normalization –

The dose to individuals (from all sources of ionizing
radiation) shall not be exceed the limits
recommended for the appropriate circumstances.
Permissible limits of individual doses

are intended to prevent non-stochastic effects and

to limit the occurrence of stochastic effects to an
acceptable level.
 Radiation Safety Standards (RSR-99) SR 2.6.1.758-
99 Russian Ministry of Health. 1999.
 International Commission on Radiological
Protection (ICRP)
 Group of medical staff:
 Group A - persons who always work with
artificial sources of radiation.
Personal of roentgenological/ radiological
department.
 Group B - persons who are in the area of the
impact of sources of ionizing radiation under
the terms of work (work with sources from
time to time)
Other specialists – surgeon, dentist,
traumatologist, etc.
 Basic dose-equivalent limits
Dose limits, mSv
Norms Staff
Group А Group В Members
of the
public
Dose-equivalent limit in a year to all
tissues except lens 50,0 12,5 5,0
Dose-equivalent limit in a year to lens 150,0 38,5 15,0
Dose-equivalent limit in a year to skin 500,0 125,0 50,0
Dose-equivalent limit in a year to hand 500,0 125,0 50,0
and foot
Dose-equivalent limit in a month to the
surface of the abdominal bottom of -
women aged 45 years 1,0 0,25
 It has seemed correct, on an international level, to
avoid linking individual dose limits with the social
context in which the optimization analysis takes
place; and therefore it seems right to set limit that
apply to any individual, in any country, for any
practice. The individual persons nay accept
individual doses and risks without expecting for
themselves adequately compensatory benefit,
considering instead the general benefits deriving
from the fact of belonging to the society for which
the practice is recognized as justified.
 PRINCIPLES OF RADIATION
PROTECTION

2. The justification principle –

The activity should produce total benefits greater
than the total costs, including those deriving from
the biological risk.
 The implementation of the principle:

 priority to the use of alternative (non-radiation) diagnostic

methods;
 research only when clinically indicated;
 selection of the most benign methods of radiological studies;
 risk of refusal from the radiology studies should certainly
exceed the risk from radiation during its implementation;
 use of a method of treatment only in cases where the
expected effectiveness of the treatment including the
preservation of the functions of vital organs exceeds the
efficiency of alternative (non-radiation) methods.
 PRINCIPLES OF RADIATION
PROTECTION
3. The principle of optimization –
All exposure shall be kept as low as reasonably achievable,
economic and social factors being taken into account.
The aim is to make sure that the practice considered is carried out
at on exposure level sufficiently low, so that any further
reduction in exposure – in terms of collective dose – would not
be considered such as to justify the extra cost to be incurred in
achieving it.
The implications of this - a full set of measures to protect staff
and patients from the ionizing radiation.
 Ways of ensuring radiation safety
 restriction of access to the work with radiation sources for
age, sex, health status, level of previous exposure and other
factors;
 knowledge of and compliance with the rules of the sources
of radiation;
 adequacy of protective barriers, screens, and the distance
from the radiation source, and the time limit of radiation
sources;
 the creation of conditions that meet the requirements of
НРБ-99 and OСПОРБ-99;
Ways of ensuring radiation safety

 the use of personal protective equipment;

 compliance with established control levels;
 organization of radiation monitoring;
 organization of information about the radiation
environment;
 implement effective measures to protect workers
from the exposure in the event of threats and
emergency.
 Control of Radiation Safety

Individual control
 radiometric control contamination of skin and personal
protective equipment;
 control the nature, dynamics and levels of radioactive
substances into the body using the methods of direct or
indirect radiometry;
 doses of external control β-, γ-and X-ray radiation using
personal dosimeters or calculation methods.

Taken into account effective and equivalent dose, effective

dose for consecutive 5 years, the total dose for the entire
professional career.
 The dosimeters

 Dosimeters for the overall radiation control. Measure

the exposition, the absorbed, equivalent dose and dose
rate.
They include fixed and portable radiation monitors and
dosimeters-radiometers, which measure the dose
characteristics as well as the particle flux density
 Personal dosimeters - measure the external radiation
dose of personnel. It is applied ionization, photo,
thermoluminescent dosimeters.
 Medical radiation safety

Contra-indications for persons working with sources of radiation

(diseases with which do not take on the job) :
 persistent expressed changes of peripheral blood;
 obliterating diseases of the arteries, vasoconstriction of the
peripheral vessels;
 premalignant disease, malignant tumors;
 benign tumors and diseases that prevent wearing of protective
clothing;
 radiation sickness I - ІҮ severity;
 chronic suppurative diseases of the paranasal sinuses, chronic
otitis media;
 chronic fungal disease.
 Medical radiation safety
Frequency of periodic medical examinations is
determined by the degree of radiation hazard in the
workplace.
In carrying out inspections to take part:
therapist, neurologist, ophthalmologist,
otolaryngologist, dermatologist.
It is conducted laboratory and functional studies:
blood, ECG, lung function tests and x-rays of the
lungs.
Health physics
technician monitoring
protective clothing
after removal of outer
protective suit. Survey
meter has a dual
plastic scintillator to
detect alpha-, beta-,
and gamma-
radioactivity.
 Control of Radiation Safety

 dose rate measurements of X-ray and γ-radiation

in the workplace, in the adjacent rooms, on the
territory of the organization;
 measurement of levels of radioactive
contamination of work surfaces, equipment,
vehicles, personal protective equipment, skin
and clothing of personnel;
 determination of the volume activity of gases
and aerosols in the air of working premises.
A health physics technician wearing a
thermoluminescence detector attached to a
neck strap and an electronic alarming dosimeter
on his right shirt pocket.
Use of a hand-and-
shoe monitor for
final radiological
checkout.