RADIATION

PROTECTION
 OUTLINE
• HEALTH PHYSICS
• GOAL OF RADIATION PROTECTION
• PRINCIPLES OF RADIATION PROTECTION
• RADIATION QUANTITIES AND UNITS
• ADVISORY GROUPS AND REGULATORY
AGENCIES
• RADIOGRAPHIC PROTECTION FEATURES
• FLUOROSCOPIC PROTECTION FEATURES
 OUTLINE
• PERSONNEL PROTECTION
• PATIENT PROTECTION
• PREGNANT RT AND PATIENT PROTECTION
• DESIGN OF PROTECTIVE BARRIER
• SOURCES OF OCCUPATIONAL RADIATION
EXPOSURE
• RADIATION DETECTION AND
MEASUREMENT
 HEALTH PHYSICS
• Concerned with providing occupational
radiation protection & minimizing radiation
dose to the public
▫ Rationale:
 Known biological effects of exposure to ionizing
radiation
 To limit stochastic effects (e.g. cancer & genetic
effects)
 To limit deterministic effects (e.g. cataracts, skin
erythema, sterility)
GOAL OF RADIATION PROTECTION

• To prevent occurrence of deterministic effects or

non stochastic effects.
• To reduce the likelihood of occurrence of
stochastic effects such as somatic and genetic
effects.
 ICRP SYSTEMS OF DOSE LIMITATION

• PRINCIPLES OF OPTIMIZATION
• PRINCIPLES OF JUSTIFICATION
• PRINCIPLES OF DOSE LIMITS
 PRINCIPLE OF OPTIMIZATION
• The exposure from a justified application of
radiation must be kept As Low As Reasonably
Achievable (ALARA)
• Achieved By: application of basic principles of
radiation protection
• Must be applied to prevent the stochastic effects
of radiation exposure (e.g. cancer, leukemia &
genetic effects)
 PRINCIPLE OF JUSTIFICATION

• No radiological practice shall be done unless its

introduction produces a positive net benefit.
 DOSE LIMITS
• Old Name: maximum permissible dose
• Current Name:
▫ Dose equivalent limits
▫ Cumulative effective dose equivalent
• No individual exposure shall exceed the dose
limit set by the Commission.
• Exposure should be within the prescribed dose
limit
 DOSE LIMITS
• Upper boundary dose that can be absorbed,
either in a single exposure or annually, with a
negligible risk of somatic or genetic damage to
the individual
• Specified for
▫ Whole body exposure
▫ Certain tissues and organs exposure
 DOSE LIMITS
• Radiation Worker: 50 mSv/yr (5 rem/yr )
• General Public:
▫ 5 mSv/yr (0.5 rem/yr )
 For infrequent exposure
 1/10 DL for radiation worker
▫ 1 mSv/yr (0.1 rem/yr)
 For continuous exposure
 1/50 DL for radiation worker
 EFFECTIVE DOSE LIMIT RECOMMENDATION
OCCUPATIONAL EXPOSURES
- Effective Dose Limits
Annual 50 mSv (5 rem)
Cumulative 10 mSv x age (1 rem x age)
Tissues & Organs Annual Dose Limits
Lens of eye 150 mSv (15 rem)
Skin, hands & feet 500 mSv (50 rem)
PUBLIC EXPOSURES
Types of Exposure Annual Dose Limit
Continuous/Frequent Exposure 1 mSv (0.1 rem)
Infrequent Exposure 5 mSv (0.5 rem)
 EFFECTIVE DOSE LIMIT RECOMMENDATION
EDUCATION AND TRAINING EXPOSURES
- Dose Limit
Annual 1 mSv (0.1 rem)
Tissue & Organs Dose Limit
Lens of eye 15 mSv (1.5 rem)
Skin, hands & feet 50 mSv (5 rem)
EMBRYO-FETUS/PREGNANCY EXPOSURES
Monthly Dose Limit 0.5 mSv (0.05 rem)
Entire Gestational Period 5 mSv (0.5 rem)
 RADIATION QUANTITIES AND UNITS
• EXPOSURE
▫ Roentgen (R)
• ABSORBED DOSE
▫ Radiation Absorbed Dose (rad)
• EFFECTIVE DOSE
▫ Radiation Equivalent Man (rem)
• RADIOACTIVITY
▫ Curie (Ci)
 ROENTGEN (R)
• A unit of exposure in air
• Quantity of x-rays or gamma rays required to
produced a given amount of ionization (charge)
in a unit mass of air
• Not applicable to particulate radiation
• 1 R:
▫ 2.08 x 109 ip/cm3
▫ 2.58 x 10-4 C/kg (exposure)
 RAD

• A unit of absorbed energy or dose

• 1 rad =
▫ 100 ergs/g
▫ 10 mGyt
 REM
• The conventional unit of equivalent dose
• Equivalent Dose (HT):
▫ Based on the average absorbed dose in the tissue
or organ
▫ Absorbed dose x WR (Quality Factor)
• 1 rem = 10 mSv
 EFFECTIVE DOSE (E)
• Used to estimate radiation risk to the patient or
the radiologic technologist
• The equivalent whole-body dose
• The weighted average dose to each tissue
• Formula: E = ∑DtWRWt
▫ Dt = tissue dose
▫ WR = radiation weighting factor
▫ Wt = tissue weighting factor
 CURIE

• The unit of activity

▫ Quantity of radioactive material
▫ The number of radioactive atoms that undergo
decay per unit time
• 1 Ci = 3.73 x 1010 dps
 CLASSIFICATION OF EXPOSED
INDIVIDUALS
• Radiation workers
▫ Occupationally exposed workers
▫ Occasionally exposed workers
• Members of general public
▫ Individuals not classified as radiation workers
• Note: they should receive instruction and
training regarding hazards of radiation
exposures and radiation protection practices
 ADVISORY GROUPS AND REGULATORY
AGENCIES

• Involve in development of standards for

radiation protection
• Establish regulations for the protection against
the hazard from the use of ionizing radiation
 ADVISORY GROUPS
• International Commission on Radiological
Protection (ICRP)
• National Council on Radiation Protection and
Measurement (NCRP)
• National Academy of Sciences/National
Research Council Committee on the Biological
Effects of Ionizing Radiation (NAS/NRC-BEIR)
• United Nations Scientific Committee on the
Effects of Atomic Radiation (UNSCEAR)
 ICRP
• Publishes international radiation protection
guidelines
• Conducts research
• Provides recommendations on radiation
protection
 NCRP
• Publishes radiation protection guidelines for the
United States
• Recommendations on radiation protection and
measurements in the United States
• Collects, analyzes, develops and disseminates
information and recommendation about
radiation protection
 NCRP Report #49

• Makes recommendation on the design of

structural shielding for x-ray imaging facilities

www.ncrp.com
 NCRP Report #54

• Makes recommendation on the medical

exposure of pregnant and potentially pregnant
women

www.ncrp.com
 NCRP Report #102

• Makes recommendation on equipment design

and protection regarding lead shielding and
fluoroscopic and mobile exposure rates

www.ncrp.com
 NCRP Report #116

• Makes recommendation on limits of exposure

ionizing radiation (Dose Limits)

www.ncrp.com
 NAS/NRC-BEIR AND UNSCEAR

• Two additional advisory group

• Study and report on the risks from exposure to
ionizing radiation
 REGULATORY AGENCIES
• Responsible for protecting the public and
occupationally exposed individuals from the
effects of ionizing radiation
• Carry the force of law
• Inspect facilities
• Issue fines
• Revoke radiation use authorization
 REGULATORY AGENCIES

• NUCLEAR REGULATORY COMMISSION

(NRC)
• FOOD AND DRUG ADMINISTRATION (FDA)
 NRC

• One of the primary sources of radiation

protection standards in the U.S.
• Enforces radiation protection standards relating
to radioactive material
• Implements the standard for occupational dose
limits for adults
 OCCUPATIONAL DOSE LIMIT FOR
ADULTS
(NRC REGULATIONS)
WHOLE BODY
Head, trunk, gonads, arms above elbow, legs above knee
DEFINITION
EXTREMITIES Arms, elbows and below
DEFINITION Legs, knees and below
500 mSv/yr (any organ)
(50 rem/yr)
WHOLE BODY LIMIT
50 mSv/yr (whole body)
(50 rem/yr)
150 mSv/yr
LENS OF THE EYE
(15 rem/yr)
SKIN (WHOLE 500 mSv/yr
BODY) (50 rem/yr)
500 mSv/yr
EXTREMITIES
(50 rem/yr)
5 mSv/term
EMBRYO/FETUS/PR
(0.5 rem/term)(500 mrem/term)
EGNANCY
 FDA
• Regulates radiopharmaceuticals
• Regulates the performance and radiation safety
requirements of commercial x-ray equipment
 TWO NATIONAL REGULATORY
AUTHORITIES IN THE PHILIPPINES

• BUREAU OF HEALTH DEVICES AND

TECHNOLOGY (BHDT) – DOH
• CENTER FOR DEVICE REGULATION ,
RADIATION HEALTH AND RESEARCH
(CDRRHR)- BFAD-DOH (UPDATED)
• PHILIPPINE NUCLEAR RESEARCH
INSTITUTE (PNRI) – DOST
 CDRRHR

Regulates the use of radiation emitting devices in

the Philippines.
 PNRI

Responsible for the regulation, licensing and

safeguards of radioactive materials and atomic
energy facilities
 PROTECTIVE X-RAY TUBE HOUSING

• X-ray tube must be contained within protective

housing
• Reduces leakage radiation
 CONTROL PANEL
• Must indicate the condition of exposure
• Must positively indicate when the x-ray tube is
energized
• Must indicate when the x-ray beam is energized
(visible or audible signals)
• Use of kVp & mA indicators
 SOURCE-TO-IMAGE RECEPTOR
DISTANCE INDICATOR

• Must be provided
• A tape measure attached to the tube housing or
as advance as lasers
 COLLIMATION

• Light-localized, variable-aperture rectangular

collimators should be provided
• Cones & Diaphragms: for special
examination
POSITIVE-BEAM LIMITATION (PBL)
• Automatic, light-localized, variable-aperture
collimators
• It must be adjusted
▫ Rationale: so that the collimator shutters
automatically provide an x-ray beam equal to
image receptor
 BEAM ALIGNMENT

• Each radiographic tube should be provided with

a mechanism to ensure proper alignment of the
x-ray beam & the IR
 FILTRATION
• Total Filtration:
▫ 2.5 mm Al – operated above 70 kVp
▫ 1.5 mm Al – operated b/n 50-70 kVp
▫ 0.5 mm Al – operated below 50 kVp
• HVL: it measures filtration
• Mammography
▫ Total Filtration: 30 μm Mo or 60 μm Rh
 REPRODUCIBILITY

• For any radiographic technique, the output

radiation intensity should be constant form one
exposure to another
 LINEARITY
• Ability of a radiographic unit to produce
constant radiation output for various
combinations of mA & exposure time
• Radiation Intensity: mR/mAs
 LINEARITY

mA Time mAs
100 0.1 s 10
200 0.05 s 10
Note: the mAs is constant, the output intensity should remain constant
 OPERATOR SHIELD
• Fixed Protective Barrier (Console Booth):
RT stands behind this barrier during the
exposure
• Protective Apparel: must be worn when the
RT is in the exposure room during exposure
• Note: exposure control must be fixed to the
operating console and not a long cord
 MOBILE X-RAY IMAGING SYSTEM

• Lead Apron: should be assigned with 0.25 mm

Pb equivalent thickness.
• Exposure Switch: at least 2 m from x-ray tube
during exposure
• Useful Beam: must be directed away from the
RT
 BEAM-ON MODE

• Use intermittent fluoroscopy as opposed to

constant beam-on condition
• Pulse fluoroscopy or low-dose modes should be
used
▫ To achieve ALARA objectives
SOURCE-TO-SKIN DISTANCE (SSD)
• Source-to-tabletop distance
• Increased SSD: reduces entrance skin
exposure (ESE)
• Stationary/Fixed Fluoroscopes:
▫ Not less than 38 cm or 15 in.
• Mobile/Portable Fluoroscopes:
▫ Less than 30 cm or 12 in.
▫ Preferred: 15 in.
 PRIMARY PROTECTIVE BARRIER
• Fluoroscopic IR Assembly: serves as a
primary protective barrier
▫ 2 mm Pb equivalent
▫ Coupled with the x-ray tube & interlocked
• RT should stand on the II side of the C-arm
during lateral or oblique projections
 EXPOSURE CONTROL
• Should be of the dead man type
▫ If the operator should drop dead or just release
the pressure, the exposure would be terminated
• Exposure Controls:
▫ Conventional foot pedal
▫ Pressure switch
 BUCKY SLOT COVER
• Bucky Tray: moved at the end of the table
during fluoroscopy
▫ Result: leaving an opening in the side of the table
approximately 5 cm wide at gonadal level
• Opening: should be covered with at least 0.25
mm Pb equivalent
 PROTECTIVE CURTAIN/PANEL

• Should be position
between fluoroscopist
& patient
• Equivalent: at least
0.25 mm Pb equivalent
 FLUOROSCOPIC TIMER
• Cumulative timer
• Sounds alarm after 5 mins (300 secs) of beam-
on time
▫ Designed to ensure that the radiologist is aware of
the relative beam-on time during each procedure
• Should not be reset before alarm goes off
 DOSE AREA PRODUCT
• The total air kerma striking the surface of the patient
• A quantity that reflects not only the dose but also the
volume of tissue irradiated
• Measured By: DAP meter on the fluoroscopy monitor
• Expressed in: R-cm2 or cGy-cm2 or mGy-cm2
• Better indicator of risk than dose
• Increased Field Size: higher DAP & risk
 EXPOSURE RATE
• Table Top: not exceed 2.1 R/min (21
mGya/min)
▫ For each mA operation at 80 kVp
• No Optional High-Level Control: not
exceed 10 R/min (100 mGyax//min )
• With Optional High-Level Control: 20
R/min (200 mGya/min)
• o Cineradiography/Videography: no limit
on x-ray intensity
 LONG EXPOSURE TIME
• Greater than 30 minutes
▫ Can lead to skin effects
• The patient should be informed of the possibility
of skin injury
▫ Erythema
▫ Epilation
• Fluoroscopy time should be recorded
 LAST IMAGE HOLD (LIH)

• Provides for keeping the most recently acquired

fluoroscopic image displayed on the monitor
without continued radiation exposure to the
patient
 SOURCES OF RADIATION EXPOSURE
• Scattered radiation from the primary beam
▫ Produced by Compton interaction
• Leakage radiation from the x-ray tube
• Scatter Intensity: 1/1000 of the primary beam
▫ At 90-degree angle
▫ At a distance of 1 m from the patient
• Reduction:
▫ Use of collimation
▫ Use of high-speed image receptors
SOURCES OF RADIATION EXPOSURE

• Most Common:
▫ Fluoroscopy
▫ Mobile or portable radiography
▫ Interventional procedures
▫ Cardiac catheterization
▫ Surgical radiography
 LIMITING RADIATION EXPOSURE
• RT should be behind protective barriers
• RT should ascertain whether their presence is
needed during the procedure
• RT should not be involved in holding patients
who are unable to cooperate during an x-ray
exposure
• RT should remain as far from the patient as
practicable during fluoroscopy
CARDINAL PRINCIPLES OF RADIATION
PROTECTION

• Simplified rules designed to ensure safety in

radiation areas for occupational workers
• STD:
▫ SHIELDING
▫ TIME
▫ DISTANCE
 MINIMIZE TIME
• Reduce the amount of time spent in the vicinity
of the radiation source while it is operating
• The time of exposure should be kept to a
minimum
▫ Radiography: to reduce motion blur
▫ Fluoroscopy: to reduce patient & personnel
exposure
• 5-minute Reset Timer:
▫ Reminds the radiologist that a considerable
amount of fluoroscopic time has elapsed
 MAXIMIZE DISTANCE
• Increase the distance between the radiation and
the individual protected
▫ Effective method to reduce exposure to radiation
• Inverse Square Law: radiation dose is
inversely related to the distance between the
source & the patient
 ISOEXPOSURE
LINES
• Lines that represent
positions of equal
radiation exposure in
the fluoroscopy room
• Exposure Rate in
Normal Position:
300 mR/hr (3
mGya/hr)
 MAXIMIZE
DISTANCE

• Two steps back

• Exposure Rate: 5
mR/hr (50 μGya/hr)
• Behind the
radiologist
• Zero exposure
 USE SHIELDING

• Insert shielding material between the radiation

source and the exposed person
• Greatly reduces the level of radiation exposure
• Composition: lead and concrete
 USE SHIELDING
• HVL & TVL: estimate the amount that a
protective barrier reduces radiation intensity
▫ 1 TLV = 3.3 HVL
• Protective Apron: 0.5 mm Pb
▫ Equivalent to 2 HVLs
▫ Reduce occupational exposure to 25% (actual =
10% only)
• Note: structural shielding for x-ray imaging
facilities are designed in accordance to NCRP
Report No. 49
 PROTECTIVE BARRIERS
• Help ensure that the exposure is within the
recommended equivalent dose limits
• Classification:
▫ Primary barrier
▫ Secondary barrier
• Composition:
▫ Lead sheet
▫ Concrete
▫ Lead glass
 PROTECTIVE DEVICES
• Use when a personnel is not possible to remain
behind a protective barrier
• Thickness:
▫ 0.25-1.00 mm Pb
▫ 0.5 mm Pb
 Provides a balance between protection and weight
• Examples:
▫ Lead apron
▫ Lead gloves
▫ Thyroid shield
▫ Lead glasses
▫ Mobile shields
 UNNECESSARY EXAMINATION

• Routine examination should not be performed

when there is no precise medical indication
 HOSPITAL ADMISSION

• Chest x-ray examinations should not be

performed for routine hospital admission when
no clinical indication of disease is found
 PREEMPLOYMENT PHYSICAL
EXAMINATION

• Chest & lower back x-ray examination as part of

a preemployment physical examination are not
justified
PERIODIC HEALTH EXAMINATIONS

• X-ray examinations should not be conducted on

an asymptomatic patient, especially fluoroscopic
examination
 EMERGENCY DEPARTMENTS

• Overutilization of CT examination must be

controlled
WHOLE-BODY MULTISLICE SPIRAL CT
SCREENING

• This should not be done because the radiation

dose is too high
 REPEAT EXAMINATION
• Repeat Rate:
▫ All examination – 10%
▫ Busy Hospital – should not exceed 5%
• Highest Repeat Rate Examination: lumbar
& thoracic spine, chest & abdomen
• Caused By:
▫ Radiologic technologist error
 Most common
▫ Equipment malfunction
 RESPONSIBLE FOR REPEAT
EXAMINATION
• Poor radiographic technique (primary)
• Motion
• Improper collimation
• Dirty screens
• Use of improperly loaded cassettes
• Light leaks
• Chemical fog
• Artifacts
• Wrong projection
• Improper patient preparation
• Grid errors
• Multiple exposures
 PROPER TECHNIQUE SELECTION

• High kVp/low mAs technique must be utilized

• Note: increasing kVp alone does not reduce the
patient dose
 PROPER COLLIMATION
• Essential to good radiographic technique
• X-ray beam should always be restricted to the
area of clinical interest
• X-ray beam should never exceed the size of the
IR
• Advantages:
▫ Reduced effective dose
▫ Improved image quality
▫ Enhance contrast resolution
 FILTRATION
• Absorb low-energy (low frequency/long
wavelength) photons
• Directly proportional to technical factors
• Composition: aluminum
• Minimum Total Filtration:
▫ 2.5 mm Al for >70 kVp
▫ 1.5 mm Al for b/n 50-70 kVp
▫ 0.5 mm Al for <50 kVp
• Note: the overall dose to the patient is decreased
despite the need to increase factors
 SHADOW SHIELD
• Shield that is suspended over the region of
interest
• Casts a shadow over the patient’s reproductive
organs
• More acceptable for use with adult patients
• Improper positioning:
▫ Repeat examinations
▫ Increased patient dose
• Useful in surgery
▫ Requires sterile procedure
 IMAGE RECEPTOR
• The fastest speed–screen-film combination
consistent with the nature of the examination
should be used
• Rare earth and other fast screens should be used
when possible
• General Radiography: 400-speed system
• Digital Radiography: uses faster IR than
screen-film
 PATIENT POSITIONING
• Patient scheduled for upper extremity or breast
examination should be placed in lateral position
(seated) with a protective apron
▫ Rati0nale: so that the useful beam should not
intercept the gonads
• PA Projection: less radiation dose to the lens
of the eyes or breast
• AP Projection: less radiation dose to the
ovaries
 GONADAL SHIELDING
• Used to protect gonads from unnecessary
radiation exposure.
• Used whenever they do not obstruct the area of
clinical interest
• Reduce female gonad dose by up to 50%
• Reduce male gonad dose by up to 95%
• Indicated when a particularly sensitive tissue or
organ is in or near (4-5 cm) the useful beam
▫ Lens of the eye
▫ Breast
▫ Gonads
 GONADAL SHIELDING

• Three Types:
▫ Flat contact shield
▫ Shaped contact shield
▫ Shadow shield
 FLAT CONTACT SHIELD

• Placed between the patient’s gonads and the

source of radiation
• Need to be secured in place
• Made of lead-impregnated vinyl
 CONTACT SHIELD
• Cup-shaped shield designed to enclose the male
gonads
• Provides maximum protection
• Shapes: hearts, diamonds, triangles & squares
• Examples:
▫ Lens shield
▫ Gonads shield
▫ Breast shield
 During scoliosis examination
FLAT AND SHAPED CONTACT SHIELDS
 SHADOW SHIELD
• Shield that is suspended over the region of
interest
• Casts a shadow over the patient’s reproductive
organs
• More acceptable for use with adult patients
• Improper positioning:
▫ Repeat examinations
▫ Increased patient dose
• Useful in surgery
▫ Requires sterile procedure
 GRIDS
• The lowest possible grid ratio should be utilized
▫ Rationale: to keep patient dose ALARA
• 8:1 to 10:1 Grid: used in general-purpose x-ray
imaging system
• 4:1 to 5:1 Grid:
▫ Specially designed grids
▫ Used for mammography
• 5:1 Grid: reduces approximately 85% of the
scatter radiation
• 16:1 Grid: reduces approximately 97% of the
scatter radiation
 PATIENT PROTECTION
• Beam limitation
• High kVp/low mAs techniques
• Filtration
• Lowest possible grid ratio
• Gonadal shielding
• Appropriate projections
• Minimize repeat exposures
 RADIOBIOLOGIC CONSIDERATIONS
• The severity of radiation response in utero is
both
▫ Time dependence/related
▫ Dose dependence/related
• Before Birth: the most radiosensitive to
radiation exposure
• Early Pregnancy: fetus is more radiosensitive
• Late Pregnancy: fetus is more radioresistant
 RADIOBIOLOGIC CONSIDERATIONS

• Fetus: radiosensitive during 8-15 weeks

postconception
• <5 rad: negligible risk for fetal exposure
• >15 rad: increased risk of malformation
• No Response: <25 rad (250 mGyt)
 TIME DEPENDENCE
• 0-14 days (1st two weeks):
▫ Least hazardous
 Rationale: because pregnancies fail during this period
▫ Biologic Responses:
 Resorption of the embryo
 No pregnancy
 Spontaneous abortion
 25% natural incidence
 0.1% increase/100 mGyt
 TIME DEPENDENCE
• 2nd-10th weeks:
▫ Period of major organogenesis
 The major organ systems of the fetus are developing
▫ Biologic Response:
 Congenital malformation
 5% natural incidence
 1% increase/100 mGyt
 Early Organogenesis: skeletal deformities
 Late Organogenesis: neurologic
deficiencies
 TIME DEPENDENCE
• 2nd & 3rd Trimester:
▫ Biological Response:
 Malignant disease during childhood
 Principal response
 Requires a very high radiation dose
 No response in <250 mGyt (25 rad)
 No cell depletion in <0.50 Gyt (50 rad)
 DOSE DEPENDENCE
• 200 rad (2 Gyt):
▫ Previously noted effects will occur
• <25 rad (0.25 Gyt):
▫ Spontaneous abortion is unlikely
 During 1st two weeks
• 10 rad (100 mGyt) fetal dose:
▫ 0.1% of all conceptions would be resorbed
▫ 1% increase in congenital abnormalities
 PREGNANT RT
• Should notify her supervisor
• Should be provided with a second personnel
monitoring device positioned under the
protective apron
▫ Red: collar badge
 Above the protective apron
▫ Yellow: waist level
 Under the protective apron
 Indicates exposure to the fetus
 PREGNANT RT
• Should not be terminated or given an
involuntary leave of absence
• Should be reassigned to areas where exposure is
likely to be lower
▫ Disadvantage: places additional radiation
exposure burden on fellow workers
• Should not be advised to participate in
brachytherapy applications
 PREGNANT RT
• Should be provided with a wrap-around aprons
▫ 0.5 mm Pb
▫ 90% attenuation at 75kVp
• Additional or thicker lead aprons normally are
not required
 PREGNANT RT

• Should handle only small quantities of

radioactive material
• Should not elute radioisotope generators or
inject millicurie quantities of radioactive
material
• Should be provided with a radiation monitor
during pregnancy
 PREGNANT RT

• Maternal Tissues: reduces fetal dose to

approximately 30% of the abdominal skin dose
(30 µSv or 3 mrem)
• Some RT: received >5 mSv/yr
• Most RT: received <1 mSv/yr (100 mrem/yr)
 NOTE
• Back problems during pregnancy constitute a
greater hazard than radiation exposure
• The dose at waist level under a protective apron
is less than 10% of the collar dose
• The DL during pregnancy refers to the fetus not
to the radiologic technologist
DOSE LIMIT FOR EMBRYO

ENTIRE GESTATIONAL PERIOD

EVERY MONTH
(9-MONTH PERIOD)
0.5 mSv 5 mSv
0.05 rem 0.5 rem
50 mrem 500 rem
 PREGNANT PATIENT
• The potential pregnancy status of all female
patients of childbearing age should always be
determined
• He/she should not be examined unless a
documented decision to do so has been made
• Examination should be done with precisely
collimated beams & use high-kVp
technique
• Examination should be done with properly
positioned protective shields
 ADMINISTRATIVE PROTOCOLS

• Used to ensure that we do not irradiate pregnant

patients
• Types:
▫ Elective booking
▫ Patient questionnaires
▫ Posting
 ELECTIVE BOOKING
• 10-day rule
• A guideline used to minimize the possible
exposure to an embryo in the earliest days of a
pregnancy
• The practice of waiting 10 days after the women’s
menstrual flow to conduct a x-ray examination
• Considered obsolete
▫ Rationale:
 Because the egg for the next cycle reaches maximum
sensitivity during the 10-day period
 The application of this has always proven difficult
 ELECTIVE BOOKING
• The most direct way to ensure against
irradiation of an unsuspected pregnancy
• Requires that clinician, radiologist or radiologic
technologist determine the time of the patient’s
previous menstrual cycle
 INFORMATION FORM

• Must be completed before undergoing

examination
• Example: x-ray consent
 POSTING
• Posting signs of caution in the waiting room
“Are you pregnant or could you be? If so, inform the
radiologic technologist,” or “Warning—special precautions
are necessary if you are pregnant,” or “Caution—if there is
any possibility that you are pregnant, it is very important
that you inform the radiologic technologist before you
have an x-ray examination.”
 TYPES OF RADIATION

• Primary Radiation
• Secondary Radiation
▫ Scatter
▫ Leakage
 PRIMARY RADIATION

• The useful beam

• The most intense,
hazardous & difficult
to shield
 PRIMARY BARRIER
• Any wall to which the
useful beam can be
directed
• 1⁄16-inch lead equivalent
• Located where primary
beam may strike the wall
or floor
• Height: 7 feet from the
floor
 PRIMARY BARRIER

• Materials: concrete,
concrete block or brick
▫ May be used instead of
lead
• Note: primary barrier
requirements are always
much less for fluoroscopic
x-ray beams than for
radiographic x-ray beams
 SECONDARY RADIATION
• Scatter Radiation:
▫ Results when the useful beam
intercepts any objects causing
some x-rays to be scattered
• Leakage Radiation:
▫ Radiation emitted from the x-
ray tube housing in all
directions other than that of
the useful beam
• Limit: 1 mGya/hr (100
mR/hr) at 1 m
 SECONDARY BARRIER

• Consist of 1⁄32-inch lead

equivalent
• Designed to shield areas
from secondary radiation
• Less thick than primary
radiation
 SECONDARY BARRIER

• Located wherever leakage

or scatter radiation may
strike
• Composition: gypsum
board, glass or lead acrylic
• Example:
▫ Operating console barrier
▫ Lead window = 1.5 mm Pb
equivalent
 FACTORS THAT AFFECT BARRIER
THICKNESS
• DISTANCE
• OCCUPANCY
▫ CONTROLLED AREA
▫ UNCONTROLLED AREA
• WORKLOAD
• USE FACTOR & KVP
 DISTANCE
• Depends on the distance between the source of radiation
& the barrier
• The distance to the adjacent room not to the inside of the
wall of the x-ray room
• Walls near the x-ray imaging system
▫ Requires more shielding
• Other walls of the room
▫ Requires less shielding
• X-ray Imaging System: must be position in the
middle of the room
 OCCUPANCY
• The use of the area that is being protected
• Often Occupied:
▫ 40 hours per week
▫ More shielding is required
▫ Examples: office & laboratory
• Rarely Occupied:
▫ Less shielding is required
▫ Examples: storeroom & closet
• Time Occupancy Factor (T): length of time
that the area being protected is used
 OCCUPANCY

• Who occupies a given area

• Types:
▫ Uncontrolled area
▫ Controlled area
 UNCONTROLLED AREA
• An area that can be occupied by anyone
• General public areas where personnel are not
provided radiation exposure monitors
(dosimeters) or radiation safety training should be
shielded
• DL: <20 μSv/week (2 mrem/week )
▫ Based on the annual recommended dose limit for
the public of 100 mrem/yr or 1 mSv/yr
▫ Protective Barrier: it should ensure that no
individual will receive more than 2.5 mrem/hr or
25 µSv/hr
 CONTROLLED AREA

• An area occupied primarily by radiology

personnel & patients
• Occupied by persons trained in radiation safety
and wearing personnel monitoring devices
• DL: <1 mSv/week (100 mrem/week)
▫ Based on the annual recommended occupational
dose limit of 5000 mrem/yr or 50 mSv/yr
 WORKLOAD (W)
• The level of radiation activity in the room
• Product of the maximum mA & the number of x-
ray examinations performed per week
• Expressed in: mAmin/week
• Greater number of examination per week
▫ Requires thicker shielding
• Busy, General Purpose X-ray Room: 500
mAmin/week
• Private Office: <100 mAmin/week
 USE FACTOR (U)
• The percentage of time during which the x-ray
beam is on & directed toward a particular
protective barrier
• Walls: ¼
• Floor: 1
• Room for Chest Radiography: 1
• Others: 0
 kVp

• Used as the measure of penetrability

• General Radiography: 100 kVp
• Mammography: 30 kVp
• Modern X-ray Imaging System: 150 kVp
• Most Examination: 75 kVp
PERSONNELS WHO ARE REQUIRED TO
WEAR AN OCCUPATIONAL RADIATION
MONITOR
• Radiologic technologist
• Anyone who is required to immobilize or hold
patients
• Personnel who regularly operate C-arm
fluoroscope
• Personnel who regularly in the immediate
vicinity of C-arm fluoroscope
 RADIOLOGIC PERSONNEL

• Recommended Dose Limit:

▫ 50 mSv/yr (5000 mrem/yr)
• Occupational Exposure in General X-ray
Activity:
▫ Should not exceed 1 mSv/yr
 FLUOROSCOPY
• Contributes to the highest occupational exposure
of diagnostic x-ray personnel
• Personnel exposure is related directly to the x-
ray beam-on time
• X-ray Tube Over The Table
▫ Advantage: better image quality
▫ Disadvantage: higher personnel exposures
 Rationale: higher levels of scatter & leakage
radiation
 REMOTE FLUOROSCOPY

• Results in low personnel exposures

▫ Rationale: personnel are not in the x-ray
examination with the patient
• Note: it is best to position the x-ray tube under
the patient during mobile & C-arm fluoroscopy
INTERVENTIONAL RADIOLOGY
• Personnel receive higher exposures
▫ Longer fluoroscopic x-ray beam-on time
▫ Frequent absence of a protective curtain on the
image-intensifier tower
▫ Use of cineradiography
• Dose Limit: 500 mSv/yr (50 rem/yr)
 MAMMOGRAPHY
• Personnel exposures are low
▫ Rationale: less scatter radiation due to low kVp
operation
• Personnel Protection:
▫ Long exposure cord
▫ Conventional or window wall
• Does not require protective shielding
▫ Rationale: mammographic x-ray units have
personnel protective barriers
 COMPUTED TOMOGRAPHY

• Personnel exposures are low

▫ Rationale:
 CT x-ray beam is finely collimated
 Only secondary radiation is present in the
examination room
 SURGERY

• Occupational exposure for nursing personnel &

other working in the operating room & intensive
care unit is near zero
▫ Not necessary to provide occupational radiation
monitors for such personnel
 MOBILE RADIOLOGY
• Contributes to the highest occupational exposure
of diagnostic x-ray personnel
• Dose Limit: 50 mSv/yr (5000 mrem/yr)
• Smaller Hospitals, Emergency Centers &
Private Clinics: rarely exceeds 5 mSv/yr (500
mrem/yr)
• Average Exposures: <1 mSv/yr (100
mrem/yr)
▫ In most facilities
 GUIDELINES FOR REDUCING
OCCUPATIONAL EXPOSURE
• During Fluoroscopy:
▫ Minimize x-ray beam-on time
▫ Step back from the table when assistance is not
required
▫ Use all protective shielding (apron, curtain, Bucky
slot cover & the radiologist)
• During Radiography:
▫ Stand behind a control booth barrier
▫ Wear an apron when not behind a protective
barrier
 GUIDELINES FOR REDUCING
OCCUPATIONAL EXPOSURE
• During Mobile Radiography
▫ Wear an apron
▫ Maintain maximum distance from the source
▫ Never direct the primary beam toward oneself or
others
 NOTE
• Each mobile x-ray unit should have a protective
apron assigned to it
• The exposure cord on a portable unit must be at
least 2 m long
• The useful beam should never be directed toward
the operating console
• In diagnostic radiology, at least 95% of the
radiologic technologist’s
• occupational exposure comes from fluoroscopy &
mobile radiography
RADIATION DETECTION & MEASURING
DEVICE

• Photographic emulsion
• Ionization Chamber
• Proportional Counter
• Geiger-Muller Counter
• Thermoluminescence Dosimetry
• Optically-Stimulated Luminescence Dosimetry
• Scintillation Detection
 PHOTOGRAPHIC EMULSION
• The earliest radiation detection device
• The primary means of radiation detection and
measurement
• Characteristics
▫ Limited range
▫ Sensitive & energy dependent
• Application:
▫ The making of a radiograph
▫ The radiation monitoring of personnel (film
badge)
 FILM BADGE
• Pack of photographic film used for approximate
measurement of radiation exposure to radiation
workers
• The most widely used & most economical type
• Optical Density: related to the exposure
received by the film badge
• Metal Filters Composition:
▫ Aluminum
▫ Copper
 FILM BADGE
• Advantages:
▫ Inexpensive
▫ Easy to handle
▫ Easy to process
▫ Reasonably accurate
▫ They have been used for several decades
 FILM BADGE
• Disadvantages:
▫ Cannot be reused
 Rationale: because they incorporate film as the
sensing device
▫ Cannot be worn for longer than 1 month
 Rationale: possible fogging due to temperature &
humidity
▫ Sensitive to temperature & humidity
▫ Exposures less than 10 mR (100 μGya) cannot be
measured
 GAS-FILLLED DETECTORS
• Consists of a cylinder filled with air & a central
collecting electrode
• Used widely as a device to measure radiation
intensity
• Used to detect radioactive contamination
• Three Types:
▫ Ionization chamber
▫ Proportional counter
▫ Geiger-Muller counter
 IONIZATION CHAMBER
• The instrument of choice for measuring
radiation intensity
• Characteristics: wide range, accurate &
portable
• Uses: survey for radiation levels 1 mR/hr or 10
µGy/hr
 PORTABLE ION CHAMBER SURVEY
INSTRUMENT
• A portable ion chamber
survey instrument
• The most familiar
• Used principally for area
radiation surveys
• Useful for radiation
surveys when exposure is
in excess of 10 μGya/hr (1
mR/hr)
 ION CHAMBER DOSIMETER

• More accurate ion

chamber
• Used for precise
calibration of the
output intensity of
diagnostic x-ray
imaging systems
 DOSE CALIBRATOR

• A configuration of an
ion chamber
• Another application of
precision ion chamber
• Used in nuclear
medicine laboratories
for the assay of
radioactive material
 PROPORTIONAL COUNTER
• Used primarily as stationary laboratory
instruments for the assay of small quantities of
radioactivity
• Assay of small quantities of radionuclides
• Characteristics:
▫ Laboratory equipment
▫ Accurate & sensitive
▫ Ability to distinguish between alpha & beta
radiation
 GEIGER-MULLER COUNTER
• Used for contamination control in nuclear
medicine laboratories
• Characteristics:
▫ limited to 100 mR/hr
▫ portable
• Uses: survey for low radiation levels &
radioactive contamination
 QUENCHING AGENT

• Added to the filling gas of the Geiger counter to

enable the chamber to return to its original
condition
▫ Rationale: to enable the chamber to return to its
original condition so that a second ionizing event
can occur
 PORTION OF GAS-FILLED
PERFORMANCE CURVE
• Region of
recombination
• Ion chamber or
ionization region
• Proportional region
• Geiger-muller region
• Region of continuous
discharge
 REGION OF RECOMBINATION

• Very low voltage

• No electrons are attracted to the central
• Ion pairs recombine
ION CHAMBER/IONIZATION REGION (I)

• Voltage is increased (100-300 V)

• Electrons are attracted to the central electron &
collected
 PROPORTIONAL REGION (P)

• Voltage is further increased

• Electrons are accelerated more rapidly to the
central electron
• Secondary electrons are produced & also
collected
• Total number of electrons collected increases
 GEIGER-MULLER REGION (GM)

• Voltage is sufficiently high

• Cascade of secondary electrons are produced
• All molecules of the gas are ionized
• Large number of electrons are liberated
• Large electron pulse
REGION OF CONTINUOUS DISCHARGE
(CD)

• Voltage is increased still further

• Electrons continues to be stripped from atoms
• Continuous current or signal are produced
• Instrument is useless for the detection of
radiation
• The chamber is damaged
THERMOLUMINESCENCE DOSIMETRY
(TLD)
• The emission of light by a thermally stimulated
crystal following irradiation
• Material: lithium fluoride (LiF)
• Advantages:
▫ Size
▫ Reusable
• Used for both patient & personnel radiation
monitoring
 STEP PROCESS
• Exposure to ionizing radiation
• Subsequent heating
• Measurement of the intensity of emitted light
THERMOLUMINESCENCE DOSIMETRY
(TLD)
• Characteristics:
▫ wide range, accurate & sensitive
 As low as 5 mrad (50 µGyt)
 Modest accuracy
 >10 rad (100 mGyt)
 5% better accuracy
▫ Responds proportionately to dose
▫ Rugged
▫ Does not give immediate results
 OPTICALLY STIMULATED LUMINESCENCE
DOSIMETRY (OSL)
• Developed by Laundauer in late 1990s
• Material: Aluminum oxide (Al2O3)
• Advantages Over TLD:
▫ More sensitive – 1 mrad or 10 µGyt
▫ Reanalysis
▫ Wide dynamic range
▫ Excellent long-term stability
 STEP PROCESS
• Exposure to ionizing radiation
• Laser illumination
• Measurement of the intensity of stimulated light
emission
 SCINTILLATION DETECTION

• Basis for the gamma camera

• Used in the detectors arrays of CT imaging
system
• Used as IR in digital imaging system
• Used to monitor the presence of contamination
• Used to monitor low levels of radiation
 SCINTILLATION DETECTION

• Characteristics: limited range, very sensitive,

& stationary or portable instruments
• Materials: NaI:Tl or CsI:Tl
• Portable Scintillation Detector: more
sensitive than a Geiger counter
 SCINTILLATION DETECTION

• Basis for the gamma camera

• Used in the detectors arrays of CT imaging
system
• Used as IR in digital imaging system
• Used to monitor the presence of contamination
• Used to monitor low levels of radiation
RADIOBIOLOGY
 RADIOBIOLOGY
• The study of the effects of ionizing radiation on
biologic tissue
• Ultimate goal: to accurately describe the
effects of radiation on humans
• Dose-response relationships: develop to
predict the effects & manage accidental exposure
 RADIATION RESPONSES
EARLY EFFECT LATE EFFECT
• Early response • Late response
• Response occurs w/in • Response is not observed for
minutes or days months/years
• Response increases in • Response increases in
severity with increasing incidence with increasing
radiation dose radiation dose
• Follows high-dose exposure • Nonthreshold
• Threshold • Examples:
• Example: ▫ Radiation-induced cancer
▫ Skin burns ▫ Leukemia
▫ Genetic effects
 DOSE RESPONSE RELATIONSHIP
• A mathematical & graphic function that relates
radiation dose to observed response
• Used to provide the basis for radiation dose
management activities
• Important Applications:
▫ Used to design therapeutic treatment routines for
patient with cancer
▫ Provides the basis for radiation control activities
• Two Characteristics:
▫ Threshold or nonthreshold
▫ Linear or nonlinear (S-type)
 DOSE RESPONSE RELATIONSHIP
• A mathematical & graphic function that relates
radiation dose to observed response
• Used to provide the basis for radiation dose
management activities
• Important Applications:
▫ Used to design therapeutic treatment routines for
patient with cancer
▫ Provides the basis for radiation control activities
• Two Characteristics:
▫ Threshold or nonthreshold
▫ Linear or nonlinear (S-type)
 LINEAR DOSE-RESPONSE
RELATIONSHIP

• The response is directly proportionate to the

dose
• Note: linear-nonthreshold type is used in
establishing radiation protection guidelines for
diagnostic imaging
 NONLINEAR DOSE-RESPONSE
RELATIONSHIP

• The response is not directly proportional to the

dose
• Note: diagnostic radiology is concerned almost
exclusively with the late effects of radiation
exposure & therefore, with linear, nonthreshold
dose-response relationships
 NONTHRESHOLD DOSE-RESPONSE
RELATIONSHIP

• Any dose, regardless of its size, is expected to

produce a response
• Intersects the dose axis at zero or below
 THRESHOLD DOSE-RESPONSE
RELATIONSHIP

• The level below which there is no response

• Dose below which a person has a negligible
chance of sustaining specific biologic damage
• DT: the threshold dose
▫ Intersects the dose axis greater than zero
• Below DT: no response is observed
 LINEAR-THRESHOLD RELATIONSHIP
• Intercept the dose axis at
some value greater than zero
• Indicates that at lower doses
of radiation exposure (to the
left of the line intersecting
the x-axis), no response is
expected
• When the threshold dose is
exceeded, the response is
directly proportional to the
dose received
 LINEAR-NONTHRESHOLD
RELATIONSHIP
• Intersects the dose axis at
zero or below
• Indicates that no level of
radiation can be considered
completely safe
• A response occurs at every
dose
• The degree of response to
exposure is directly
proportional to the amount
of radiation received
 LINEAR-NONTHRESHOLD
RELATIONSHIP
• Basis for radiation protection guidelines
• Basis for current dose limits
• The results of extrapolation
• Radiation-induced cancer
• Radiation-induced leukemia
• Radiation induced genetic effect/damage
• Radiation-induced malignant disease
 LINEAR-NONTHRESHOLD
RELATIONSHIP

• Single-hit chromosome aberrations

• Radiation-induced thyroid cancer (preneoplastic
thyroid nodularity)
• Radiation-induced life-span shortening
• Chronic lymphocytic leukemia
 NONLINEAR-NONTHRESHOLD
RELATIONSHIP
• Referring to varied responses
that are produced from
varied doses, with any dose
expected to produce a
response
• Indicates that no level of
radiation can be considered
completely safe
 NONLINEAR-NONTHRESHOLD
RELATIONSHIP
• A response occurs at every
dose
• The degree of the response is
not directly proportional to
the dose received
• The effect is large even with a
small increase in dose
 NONLINEAR-NONTHRESHOLD
RELATIONSHIP

• Multi-hit chromosome aberrations

 NONLINEAR-THRESHOLD
RELATIONSHIP
• Indicates that at lower doses
of radiation exposure (to the
left of the curve intersecting
the x-axis), no response is
expected
• When the threshold dose is
exceeded, the response is not
directly proportional to the
dose received
 NONLINEAR-THRESHOLD
RELATIONSHIP

• Radiation-induced cataracts
• Acute radiation syndrome
• Radiation-induced death
• Skin effects from high-dose fluoroscopy
 THRESHOLD DOSES
• CHROMOSOME ABERRATION = 5 rad
• GONADAL DYSFUNCTION = 10 rad
• REDUCED SPERMATOZOA = 10 rad
• HEMATOLOGIC DEPRESSION = 25 rad
• DEATH = 200 rad
• ERYTHEMA = 200 rad
• TEMPORARY STERILITY = 200 rad
• TEMPORARY EPILATION = 300 rad
• PERMANENT STERILITY = 500 rad
• PERMANENT EPILATION = 700 rad
• MOIST DESQUAMATION = 15,000 rad