Radiation Safety

Star Hospitals
 OUTLINE OF PRESENTATION

SOURCES OF RADIATION
EFFECTS OF
BIOLOGICAL EFFECTS
RADIATION

RADIATION RADIATION UNITS

DOSIMETRY
PROTECTION METHODS OF RADIATION
PROTECTION
• Radiation is emission or transmission of energy
in the form of waves or particles through space
or through a material medium.
 Introduction

• Radiation, when used for Imaging, has immense

diagnostic implications and affects most key
decisions in patient care.

• However, its use needs to be thoroughly regulated

as it can have severe detrimental effects on both
the patient as well as the staff involved in its daily
use.
 Types of Radiation

• Despite being of several types, differentiating Non

ionizing from Ionizing Radiation is the key to safe use
of Radiation in Medicine.
 Ionizing vs. Non-Ionizing
Radiation
Ionizing Radiation
• A radiation that has sufficient
energy to remove electrons
from atoms or molecules as it
passes through matter.
• Examples: x-rays, gamma
rays, beta particles, and alpha
particles
Non-Ionizing Radiation
• A radiation that is not as
energetic as ionizing
radiation and cannot remove
electrons from atoms or
molecules.
• Examples: light, lasers,
microwaves, and radar
 Sources of Radiation

• Naturally occurring
eg. - Radon and Cosmic rays.

• Man made
eg. - X-rays.
Consumer Products as radiation source
 X-Rays

X Rays are produced through a process of

removing an inner shell orbital electron, causing rearrangement
of the atomic electrons with the release of the elements that are
characteristic of X-Ray energy.
• Uses: Diagnostic radiology, Nuclear medicine,
Fluoroscopy, and Interventional radiology.

• Uses outside Radiology: Urology, Orthopedic

surgery, Gastroenterology, Vascular surgery , etc.,
Ionization of an Atom
 Ionizing Radiation at the Cellular Level

• Causes breaks in one or both

DNA strands or;

• Causes Free Radical

formation
Cellular Effects

Cell death

Cell repair

Cell change
 BIOLOGICAL EFFECTS
• SOMATIC EFFECTS
1. Chronic skin changes eg ulcerations
2. Cataract
3. Aplastic anemia
4. Shortening of life span
5. Premature aging
6. Reduced fertility
7. Malignancies - Leukemia,skin cancer, CA breast

• GENETIC EFFECTS - Mutations

 GENETIC DISEASES
. MENDELIAN DISEASES - Caused by mutations in single genes
and show simple predictable patterns. 3 types -

1.Autosomal dominant : eg.,Achondroplasia

2.Autosomal recessive : eg.,Sickle cell anemia
3.Sex linked : eg.,Hemophilia

II. CHROMOSOMAL DISEASES - Caused by gross abnormalities in

structure or no.of chromosomes. eg.,Down’s 23 triploid.

III. MULTIFACTORIAL Both genetic & environmental factors

Eg.,cleft lip (congenital)
 Radiation effects on fetus :

1.During implantation- 0 to 9 days - Lethal

2.During organogenesis -10 days to 6 wks – Malformations

3.Growth period - 6wks to term - Growth disturbance

4. 30 wks onwards -Increased risk of childhood malignancies

 Radiation Risk Categories

• Deterministic (non-stochastic)

• Stochastic
 Deterministic Radiation Risks

• Effect has known threshold radiation dose

• Severity is dose related
• Examples
– Erythema
– Cataract formation
– Blood changes, reduced sperm production

• Clearly addressed by regulations

 Stochastic Radiation Risks
• Severity of condition independent of dose
• No threshold
• Probability increases with dose

• Examples
– Genetic effects
– Fetal abnormalities
– Cancer
 Cornerstone of radiation safety

• ALARA : As Low As Reasonably Achievable

meaning, making every reasonable effort to maintain

exposures to radiation as far below the dose limits as is
practicable consistent with the purpose for which the licensed
activity is undertaken.

• Limiting exposure
 ALARA Policy
Correct
• Exposure factors
• Radiographic technique

Appropriate
• Radiation protection
• Development / viewing techniques
• Positioning for examination

Minimize repeat examination

Continuing medical education

 Radiation Safety:
Whom are we protecting?
• Patient

• Physicians & Staff

• General Public
 There are three types of Radiation that
people are exposed to:

• 1. Primary X ray beam

• 2. Scatter Radiation

• 3. Leakage Radiation
 Primary X-Ray Beam

• Beam coming from Primary Beam

(High Intensity)
x-ray tube II
Tube
• Operator should
avoid primary beam
– keep hands, etc. out
of primary beam X
area
• Source of most X-Ray
Tube
patient exposure
 Scatter (Indirect) Radiation

• Arises mostly from TV Camera

patient II
• Emitted in all directions Tube

– intensity varies Patient

• Much lower intensity Table

than primary
• Source of virtually all
operator exposure X-Ray
Tube
 Leakage Radiation
TV Camera

• Some radiation leaks II

Tube
through x-ray tube
housing Patient

• Intensity much lower

Table

than scatter
– Negligible contribution
X-Ray
Tube
• Three cardinal rules of radiation protection:

 Time  Less Time = Less Exposure

 Distance  Greater Distance = Less Exposure

 Shielding  More Shielding = Less Exposure

Time, Distance & Shielding
 Time
Make sure the fluoroscopist knows the total fluoro time
& Only required people should be present
 Distance
Stand as far away from the patient during fluoro as feasible.
When not assisting, stand in the control booth.
Shielding
Shielding Properties
Operator Radiation protection equipments

• Lead screen

• Lead Glass

• Lead lined doors

• Concrete walls / 9 inch

brick wall
Operator Radiation protection equipments

• Lead apron

• Lead glove

• Lead thyroid shield

• Lead glasses
All workers in the x-ray
room during studies must
have a lead apron.
 Lead Shield Care

•Hang aprons and shields on

racks.

•Do not bend or fold lead

aprons or shields. Folding can
cause cracks and tears in the
protective material.

•Periodically inspect shields for

evidence of damage.

•Remove damaged ones from

use.
 Portable Radiography
• Wear lead apron, thyroid shield and
gloves.

• Ensure patient is as still as possible.

• Use long handled cassette holders.

• No worker should be in the direct

beam.

• Do not direct the x-ray beam at a

corridor or into an area where others
may be exposed inadvertently.

• Stand as far from the x-ray tube and

patient as feasible.
 Fluoroscopy equipment

• Fluoroscopy delivers a dose of approximately 5 Rads per

minute.

• Do not remove lead drapes which provide shielding and

reduce scatter radiation reaching the operator.

• Ensure fluoro is energized only when a technician or a doctor

is actively looking at the fluoro image.

• Use of intermittent fluoro reduces patient and operator

exposure.
 RADIATION PROTECTION FOR PATIENTS

• Identify your patient.

• Restricting Access to X-ray Rooms.

 PROTECTION OF PATIENT
WAYS TO MINIMISE PATIENT EXPOSURE

• Use of higher KvP with an appropriate reduction in mAs

results in less radiation dose. However, KvP must be
appropriate for the study.

• Filtration
• Collimation
• Use of faster film/screen combination
• Avoid repeat study
• Gonadal Shielding
 What Else Can You Do?

• Close collimation reduces patient’s

and staff’s exposure dose.
 Collimation
• Reducing field size causes significant
reduction in scatter radiation

II II
Tube Tube

X-Ray X-Ray
Tube Tube
 RADIATION PROTECTION IN FEMALES
• Protect gonads at all ages by (1) beam restriction (2) Shielding

• Follow 10 day rule : any x-ray examination should be carried out within 10 days of
onset of menstruation.
Least likelihood of conception taking place.

• History – LMP, possibility of pregnancy

• Pregnant Pts.
Avoid x-ray by alternate modality – US
MRI in II & III Trimesters
If X-ray is indicated – involve Pt., family, ref. Dr., radiologist
ALARA

• Pregnant radiation worker: Radiation dose should not exceed 0.5m Sv per
month.
 Pediatric patients

• More radiosensitive than adults due to sensitive cells and

developing organs

• Gonad shielding important

• Radiographic examinations difficult:

– Patient movement
– Exposure technique more critical
 Radiation Units
• Roentgen (R)

• Rad / Gray (Gy)

• Rem / Sievert (Sv)

 Radiation Units
Units of measure used in radiation protection
1 R = 1 rad = 1 rem

Exposure Absorbed Dose

Dose Equivalent
• A measure of • A measure of energy
deposition per unit • It is numerically equal to
ionization produced in mass irradiated. the absorbed dose by a
air by X or gamma quality factor
• 1 rad = 1000 mrad
• SI Units: sievert (Sv)
radiation. • SI Units: gray (Gy)
• 1 Sv = 100 rem
• Unit: roentgen (R) • 1 Gy = 100 rad
 Estimates of the dose
Single Radiograph Effective Dose, mrem (mSv)
Skull (PA or AP) 3 (0.03)
Skull (lateral) 1 (0.01)
Chest (PA) 2 (0.02)
Chest (lateral) 4 (0.04)
Chest (PA and lateral) 6 (0.06)
Thoracic spine (AP) 40 (0.4)
Thoracic spine (lateral) 30 (0.3)
Lumbar spine (AP) 70 (0.7)
Lumbar spine (lateral) 30 (0.3)
Abdomen (AP) 70 (0.7)
Abdomen 53 (0.53)
Pelvis (AP) 70 (0.7)
Pelvis or hips 83 (0.83)
Bitewing dental film 0.4 (0.004)
Limbs and joints 6 (0.06)
 Estimates of the dose
Complete Exams Effective Dose, mrem (mSv)
IVP ( 6 films) 250 (2.5)
Barium swallow (24 images, 106 sec fluoro) 150 (1.5)
Barium meal (11 images, 121 sec fluoro) 300 (3.0)
Barium follow‐up (4 images, 78 sec fluoro) 300 (3.0)
Barium enema (10 images, 137 sec fluoro) 700 (7.0)
CT head 200 (2.0)
CT chest 800 (8.0)
CT abdomen 1,000 (10)
CT pelvis 1,000 (10)
PTCA 750–5,700 (7.5–57)
CT Coronary angiogram 460–1,580 (4.6–15.8)
Mammogram 13 (0.13)
Lumbar spine series 180 (1.8)
Thoracic spine series 140 (1.4)
Cervical spine series 27 (0.27)

Note: A lumbar spine series typically consists of five films.

A CT chest = 400 Chest X-rays
• 1 CT HEAD == 100 CHEST XRAYS

• 1 CT ABDOMEN == 400 CHEST XRAYS

 Personnel monitoring device

• TLD Badge

• To be worn by the technician

/ doctor
 Radiation Badges
• All badges are BARC certified to ensure maximum accuracy,
• Wear only your own badge,
• Leave it in a cool, dry place away from radiation when not in use,
• Return your badge in a timely manner.
• Notify your RSO immediately when a badge is lost.
• Do not - Take your badge home,
Wash / Get it wet,
expose to heat / other source of radiation,
open the badge,
wear the badge for personal x-ray or NM exams.
Annual Dose Limits
 CONCLUSION
 Justification – ensuring patient is not irradiated unjustifiably.

 Personnel must wear protective aprons, use shielding, monitor

their doses, and know how to position themselves and the
machines for minimum dose.

 No amount of radiation is SAFE

 ALARA principle should be followed

 Remember to

• Protect YOURSELVES & the PATIENTS

thank you