INTRODUCTION

Months after the discovery of x-rays,

they were immediately applied to the

healing arts. Clarence Daly (Thomas Edisons

assistant) was the 1st American victim of radiation fatality.

- In 1931, 1st dose-limiting recommendations were made by NCRP. - providing radiation protection for workers and the general public is the main practice of health physics.

- HEALTH PHYSICISTS design equipment, calculate and construct barriers, and develop protocols to maintain radiation-exposure ALARA.

HEALTH PHYSICS
Health Physics is concerned with providing occupational radiation protection and minimizing radiation dose to the public.

Health Physicist is a radiation scientist concerned with the research, teaching or operational aspects of radiation safety.

CARDINAL PRINCIPLES OF RADIATION PROTECTION

all health physics activity in radiology is designed to minimize radiation exposure to pts and personnel. - 3 cardinal principles designed for nuclear activities 1. time 2. distance 3. shielding

CARDINAL PRINCIPLES OF RADIATION PROTECTION

1. Keep the time of exposure to radiation as short as possible. 2. Maintain a large distance as possible between the source of radiation and the exposed person. 3. Insert shielding material between the radiation source and the exposed person.

Minimize TIME

The dose to an individual is directly related to the duration of exposure. If the time is doubled, the exposure is also doubled. TIME = exposure rate X exposure time

TIME: Sample Solving

A radiation worker is exposed to 230 mR/hr from a radiation source. If the worker remains at that position for 36 minutes, what will be the total occupational exposure? Occupational exposure (time) 36 minutes = 230 mR/hr . = 138 mR 60 mins/hr

TIME: Sample Solving

The parent of a pt is asked to remain next to the pt during fluoro, where the radiation exposure level is 600 mR/hr. If the allowable daily exposure is 50 mR, how long may the parent may remain? Occupational exposure (time) = exposure / exposure rate = 50 mR / 600 mR/hr = 5 minutes

Sample Solving
A fluoroscope emits 4.2 R/min at the tabletop for every mA of operation (4.2 R/mAmin). What is the pt exposure in a BE exam that is conducted at 1.8 mA and requires 2.5 mins of fluoroscopic time? 4.2 R Pt exposure = mAmin = (1.8 mA)(2.5 min) = 18.9 R

 In radio, exposure time is kept low to reduce motion blur. In fluoro, exposure time must also kept low to reduce pt and personnel exposure. 5-minute reset timer in all fluoro machines reminds the radiologists that a considerable fluoro time has elapsed. -records the amount of x-ray beam on-time

Maximize DISTANCE
-as the distance between the radiation

source and the person increases, the

radiation exposure decreases.

DISTANCE: Sample Solving

An x-ray tube has an output intensity of 2.6 mR/mAs at 100-cm SID when operated at 70 kVp. What would be the radiation exposure at 350 cm from the target? I1 = (d2)2 = (2.6 mR/mAs) (100 cm)2 I2 (d1)2 (350 cm)2 = (2.6 mR/mAs) (0.08) = 0.21 mR/mAs

-during fluoro, the RT should remain a large distance from the radiation source. In radio, the distance is usually fixed depending on the type of exam.

-Isoexposure lines= are lines on the plot plan that represents the positions of equal radiation exposure in fluoro room.
-at normal position, the exposure rate is 300 mR/hr

TWO STEPS BACK is equivalent to 5 mR/hr exposure rate to the RT.

-however, this exposure reduction method doesnt commend the rule of thumb/ inverse square law.

Sample Solving:
What is the approximate occupational exposure of an RT at a position where the exposure rate is 300 mR/hr, and farther back where the exposure rate is 20 mR/hr during a fluoro exam lasting 4 mins, 15 secs?
Occupational exposure = 1st position: (300 mR/hr)(4.25mins)= 21.25 mR

2nd position: (20 mR/hr)(4.25mins)= 1.4 mR

Maximize SHIELDING
Shielding in diagnostic radiology consists of lead. the amount that a protective barrier reduces radiation intensity can be estimated by: - HVL - TVL *Protective apparel - apron 0.5 mm Pb = 2 HVLs

Dose Limits
*MPDradiation dose that would be

expected

to

produce

no

significant

radiation effects.

- rad dose below MPD, no responses

- rad dose at MPD level, risk might occur

- replaced by DL

WHOLE-BODY DOSE LIMITS

*Radiation Workers = DL 50,000 mrem/wk (1902) 50 mSv/yr 150 mSv/yr = eye lens 500 mSv/yr = body organs 10 mSv/yr = whole body x age 5 mSv = during pregnancy - 0.5 mSv/monthly

Dose Limits Recommended by NCRP

A. Occupational exposures 1. Effective dose a. Annual: 50 mSv b. Cumulative: mSv x age 2. Equivalent annual tissues and organs a. Eye lens dose for 150 mSv 10

b. Thyroid, skin, hands, feet

B. Public exposures (annual) 1. Effective dose, freq expo 2. Equi dose for tissue and organs a. Eye lens

500 mSv
1 mSv 15 mSv

Dose Limits Recommended by NCRP

b. Skin, hands, feet C. Education & training expo (annual) 1. Effective dose 2. Equivalent dose for tissues and organs 1 mSv 50 mSv

a. Eye lens
b. Skin, hands, feet D. Embryo-fetus exposures

15 mSv
50 mSv

1. Total equivalent dose

2. Equivalent dose in 1mo E. Negligible individual dose (annual)

5 mSv
0.5 mSv 0.1 mSv

essentially, all of our radiation exposure

occurs during fluoroscope and the

trunk is shielded by a lead apron, radiation monitoring/ measuring device

is positioned in the COLLAR, ABOVE

THE PROTECTIVE APRON.

DOSE LIMITS FOR TISSUES AND ORGANS

50 mSv/yr whole-body DL is an effective dose (NCRP) SKIN -DL: 500 mSv/yr -nonpenetrating rays (a, B, grenz) EXTEMITIES -DL: 500 mSv/yr -personnel monitoring devices are worn on wrist or finger

PUBLIC EXPOSURE
-DL: 5 mSv/yr if exposure is infrequent -DL: 1 mSv/yr if exposure is frequent =used by physicists to compute protective barrier thickness

radiation exposure of the general public is rarely measured because it is not necessary. Most radiology personnel do not receive even this level of exposure.

EDUCATIONAL CONSIDERATIONS

-DL: 1 mSv/yr = students under 18 -ICRP = issued a recommendation including an annual whole-body DL of 20 mSv.

X-RAYS AND PREGNANCY

Radiobiologic Considerations
radiation-response exposure in utero is both time-related and dose related.

Time Dependence
- Irradiation during the 1st 2 weeks of pregnancy is least hazardous. - The most likely biologic response to irradiation during the 1st 2 weeks of pregnancy is resorption of embryo. No other response is likely to occur. - No concern on the possibility of radiation-induced congenital abnormalities

Time Dependence
- 2nd to 10th week= Major Organogenesis - If irradiation occurs with higher dose, congenital abnormalities may result *early skeletal deformities *late neurologic deficiencies - During 2nd and 3rd trimester the principal response would be the appearance of malignant disease during childhood.

Time Dependence
- No radiationresponses during pregnancy would likely to occur at less than 25 rad. - Such dose level is highly unlikely yet possible with patients who receive multiple x-ray examinations of the abdomen or pelvis. - There are no other significant responses after irradiation.

Dose Dependence
- after the utero is irradiated with dose of 200 rad, it is nearly certain that each of the noted effects will occur. - spontaneous abortion during the 1st 2 weeks of pregnancy is unlikely at radiation doses less than 25 rad. - a 1% increase in congenital abnormalities is estimated to follow after a 10-rad fetal irradiation. - Relative Risk is used to assess childhood malignancy radiation risks.

Pregnant RT
- DL: 0.5 mSv/mo (pregnant women) - DL: 5 mSv (fetus for the entire pregnancy) - *most of RT receive < 1 mSv/yr - the length of the apron (0.5 mm Pb = attenuate 90% of rays @ 75 kVp) need not extend below the knees, but wraparound aprons are preferred during pregnancy.

Pregnant RT
- the pregnant RT should be provided with a second personnel monitoring device. must be positioned under the Pb apron at waist level
- Attenuation by the maternal tissues overlying the fetus reduces the dose to the fetus (30% or 300 uSv)

Management Principles

1) NEW EMPLOYEE TRAINING

2) PERIODIC IN-SERVICE TRAINING

3) COUNSELING DURING PREGNANCY

NEW EMPLOYEE TRAINING

*orientation and training *each RT should be provided with a copy of the facility radiation protection manual and other appropriate materials *a female employee must voluntarily notify her supervisor when she is pregnant or suspects that she is pregnant

Pregnancy in Diagnostic Radiology

Human Responses to Low-Level X-ray Life-span shortening 10 days/rad

Cataracts
Leukemia Cancer Genetic effects Death from all causes Effects of Irradiation In Utero 0-14 days

None below 200 rad

10 cases/ 106/ rad/ yr 2 cases/ 104/ rad Doubling dose= 50 rad 2 deaths/ 104/ rad Spontaneous abortion

2-10 weeks
2nd 3rd trimester 0-9 months Protective Measures for Pregnant RT *Two occupational radiation monitors *Dose limit: 5 mSv/9mos, 0.5 mSv/mo

Congenital abnormalities
Cell depletion: no effect @ < 50 rad Latent malignancy Genetic effects

IN-SERVICE TRAINING

*conducted at monthly intervals *at least twice each year such training should be devoted to RADIATION PROTECTION, and a portion of these sessions should be directed at the potentially pregnant employee
*EMPHASIZE
*the effective RDL is 50 mSv/ yr *environmental background radiation is approximately 1 mSv/yr

*occupational exposures are closer to the latter than the former

COUNSELING DURING PREGNANCY

*review of pregnant employees radiation exposure hx *appropriate schedule modification *In ONCOLOGY, pregnant RT is not advised to participate in brachytherapy *In NUCLEAR MEDICINE, pregnant RT should handle only small quantities of radioactive material and should not elute or inject radioactive material.

The Pregnant Patient

- if the state of pregnancy is known, the radiologic exam should not be conducted. - if radiographic exam is too essential to be done, proper techniques of minimizing pt dose must also be observed, consent form must be signed -use of high kVp technique is done

The Pregnant Patient

Elective Booking
-a safeguard against the irradiation of an unsuspected pregnancy -determine the time of the pts previous menstrual cycle -xray exam in which the fetus is not in or near the primary beam may be allowed

The Pregnant Patient

Patient Questionnaire
- Are you or could you be pregnant? -What was the date of your last menstrual period?

The Pregnant Patient

Posting

 Heath Physics is concerned with the research, teaching and operational aspects of radiation exposure. Occupational radiation exposure in measured in mSv (mrem) The description of such exposure is effective dose (E). -effective dose accounts for radiation type and the relative radiosensitivity of tissues and organs.