Radiation Protection: Principles, Methods and Monitoring Moderator: Mr Anoop BharadwajRetrospective + “..the surgeons of Vienna and Berlin believe that the Roentgen photograph is destined to render inestimable services to surgery.” — JAMA, 1896 + “(Radiation is) the most serious agent of pollution of the environment and the greatest threat to man’s survival on earth.” — E.F. Shumacher, in Small is Beautiful, 1973Introduction + The acceptance by society of the risks associated with radiation is conditional on the benefits to be gained from the use of radiation. + Nonetheless, the risks must be restricted and protected against by the application of radiation safety standards. * Itis therefore essential that activities involving radiation exposure be subject to certain standards of safety in order to protect the individuals who are exposed to radiation: — Occupationally, — For medical diagnostic or therapeutic purposes — As members of the public.Radiation EffectsEffects of Radiation Exposure Vv Radiation Exposure y Stochastic Effects / Probablistic Have no threshold levels of radiation dose. The probablity of the effects is proportional to the dose. A latent period is seen between the time of exposure and the events to manifest Severity independant of dose received Seen when the cells are modified rather than killed. Vv v Vv v Non stochastic effects/ Deterministic Have definite threshold levels of radiation dose. The probablity of the effects is proportional to the dose. A latent period is seen between the time of exposure and the events to manifest Severity may be proportional to the dose received. Seen when the cells are killed or loose capability to divide.Deterministic Stochastic, Quadratic Stochastic, LinearStochastic Effects + These are primarily of two types: — Carcinogenesis — Hereditary effects + Both have: A random nature of appearance. No threshold dose for appearance. Definite latent period for appearance after exposure. Probablity of induction increases with the dose received. Severity of the effect is independent of the dose received. A risk that can be defined on epidemiological studies only.Radiation Induced Carcinogenesis * Data from BIER V (US population) and the UNSCEAR (Japanese Atomic Bomb survivors) show that: — Relative risk of radiation induced cancers is a linear function of doses upto 2 Sv — At lower dose range of 0 -0.5 Sv risks are slightly higher than the extrapolated risk. — Risk of radiation induced cancers varies with age with patients at younger age being more susceptible. — Females < 15 years are most susceptible.Risk Estimates for Carcinogenesis * Cancer accounts for ~ 25% of all deaths in developed nations * The annual risk of fatality from cancer is shown in the table below. + ICRP estimates that for each radiation induced cancer 13 -15 years of life will be lost (but most will occur at ages of 68 - 70 yrs) Working Population 8 x 10° per Sv 4x 10° per Sv Whole Population 10 x 10° per Sv 5 x 10? per SvRadiation induced Hereditary effects « Radiation induced hereditary effects are secondary to mutations which are passed on to the progeny * Radiation doesnot cause new types of mutations but increases the frequency of naturally occuring mutations * Three classes of hereditary effects are known: — Gene mutations — Chromosomal abberations ( Down's Syndrome) — Multifactorial (Neural tube defects) + ICRP estimates that risk of hereditary effects due to radiation exposure is: — 0.2% per Sv in general population — 0.1% per Sv in working populationRadiation induced Mutations + Radiosensitivity of different mutations vary widely - so an average mutation risk is considered. + Low dose rate radiation is less effective in inducing mutations * Time interval between exposure and conception plays an important protective role. — A period of 6 months is therefore recommended between radiation exposure and conception. * Radiation induced mutations can be transmitted across the generations. + Average “doubling dose” for humans is considered to be 1.56 SvRisk estimates of Hereditary effects Mendelian mutations Chronic multifactorial diseases Congenital abnormal- ities Total Total risk per Gy 16500 65000 60000 738000 NA 750 - 1500 250 - 1200 2000 3000 - 4700 0.41 - 0.64 % 1300 - 2500 250 -1200 2400 - 3000 3950 - 6700 0.53 - 0.91%Fetal Effects « Radiation risks to fetus are related to: — Exposure magnitude — Time of pregnancy + Radiation risks are most significant during organogenesis and in the early fetal period. + Threshold for malformations: — 100 - 200 mGy (Malformations) — 100 mGy (Mental Retardation): Risk coeffecient is 0.4 per Sv + A exposure 1mSv is safe for a fetus - normal exposure from background radiation + Adose > 0.1 Sv is considered the threshold beyond which an MTP should be considered.Fetal Effects * Time of radiation vs effect: — 2-3 weeks: Most embryos are aborted -— 4-11 weeks: Severe abnormalities in most organs — 11 - 16 weeks: Mental retardation and stunting more common - 16 - 25 weeks: Mild degree of mental retardation and microcephaly — > 30 weeks: Usually leads to functional disabilities in later life * Carcinogenesis: — Most exposures implicated occur in 3" trimester — Doses more than 1 mSv will increase the risk - but no threshold apparent. — Excess absolute risk - 6% per Sv.ICRP quantities for Stochastic effects + The concept of detriment as recommended by the ICRP for stochastic effects includes the following quantities: — The probability of fatal cancer attributable to radiation exposure; — The weighted probability of incurring a non-fatal cancer — The weighted probability of severe hereditary effects — The length of lifetime lost, if the harm occurs. Detrimen: (107? Sv“ i)! Non-fatal Severe hereditary Exposed population Fatal cancer? cancer effects Toul Adult workers 40 08 08 55 Whole population 50 10 13 13 Rounded values. "For fatal cancer, thedetsiicat is equa to the probability coefficientSafety Standards + These are defined based on the knowledge of the knowledge of effects of radiation and the principles of radiation protection. + The UNSCEAR (United Nations Scientific Committee on the Effects of Atomic Radiation, 1955) is the central body which collects the data regarding this. * The IAEA uses the data from ICRP in designing the safety standards. + Consensus guidelines on these safety standards are published as International Basic Safety Standards for Protection against Ionizing Radiation and for the Safety of Radiation rces (referred to as BSS) + Latest version - 1996 (IAEA safety series 115)Types of Radiation ExposuresICRP Reference Man The concept of a ‘reference human’ to help manage the many different situations in which human beings would or could be exposed to ionising radiations. ICRP published comprehensive report on Reference Man in 1975 (ICRP, 1975) - recent revision is in ICRP 2002. The purpose of Reference Man was: — Create points of reference for the procedure of dose estimations to humans. — Derivation of relevant quantities and units for their interpretation — Considering the relationships between doses to different parts of the human body and their effects. Most countries have modified the concept of reference man — e.g. Indian Reference ManICRP Reference Man + ICRP 89 has given definitions and data for reference humans of both sexes in 6 different age groups: — Newborn -—1Yr - 5Yr - 10Yr - 15Yr — Adult + Reference man is defined as being between 20-30 years of age, weighing 70 kg, is 170 cm in height, and lives in a climate with an average temperature of from 10 to 20 C. He isa Caucasian and is a Western European or North American in habitat and custom.” + Recently weight has been revised to 73 Kgs.Indian Reference Man Indian Adult* | ICRP Reference Man Indian RF’, Body mass (kg) 52 10 oot it (cua) a 170 015 Marenals(g) m0 01 Brait(g) 1400 Om Hears) 330 008 Kidneys(g) 310 7) Livei(g) TS ous Tungs(@i 1000 Cevophagus om Pancieasig) 1 Sin O01 Spleenig) TR) Stomaci 008 % ‘Thyroid 004 D 1 Remainder 001 Gonad 0 10) 1.00 “Jain S.C, Mehta S.C., Kumar B., Reddy A.R. and Nagaratnam A . (1995) Formulation of the Reference Indian Adult: Anatomical and Physiological Data. Health Phys. 68, 509-522.Types of exposure * 2 types of exposure have been defined by the ICRP: — Normal exposures — Potential exposures « Humans can be exposed to radiation while: — Persuing their normal occupation (Occupational exposure) — Undergoing some medical or dental procedures for diagnosis or evaluation (Medical exposure) — During normal daily life (Public exposure)Normal Exposures + These are defined as the radiation exposure that will occur as a matter of course in the industry or in the medical procedures. « The exposure will have a predictable magnitude albiet with certain degree of uncertainity. * Controlling the doses delivered in these normal exposures is the method specified by IAEA.Potential Exposures + These are exposures that are feasible but not certain to occur. * These can become actual exposures if there is equipment malfunction, design flaws of operating failures. * The primary means for controlling potential exposures is by optimizing the design of installations, equipment and operating procedures with the following aims: — To restrict the probability of occurrence of events that could lead to unplanned exposures — To restrict the magnitudes of the exposures that could result if such events were to occur.Occupational Exposures + Occupational exposure which is defined as all exposures of workers incurred in the course of their work (with the exception of exposures excluded from the BSS and exposures from practices or sources exempted by the BSS).Medical Exposures + Medical exposure which is defined as exposure incurred: — By patients as part of their own medical or dental diagnosis or treatment — By persons, other than those occupationally exposed, knowingly while voluntarily helping in the support and comfort of patients — By volunteers in a programme of biomedical research involving their exposure. « Three broad classes: — Patients — Caregivers — Medical test subjectsPublic Exposure + Public exposure, which is defined as exposure incurred by members of the public from radiation sources, — Excludes any occupational or medical exposure and the normal local natural background radiation — But includes exposure to authorized sources and practices and from intervention situations.Radiation Protection QuantitiesQuantities for radiation protection The absorbed dose is the basic physical dosimetry quantity, but it is not entirely satisfactory for radiation protection purposes because the effectiveness in damaging human tissue differs for different types of ionizing radiation. So other qunatities that have been proposed to quantify the biological and physical effect of the radiation dose are: — Organ dose (Mean Physical Dose, D,) — Equivalent dose (Modifier for radiation type, H,) — Effective dose (Modifier for organ type, E) — Committed dose (Modifier for the time of exposure) — Collective dose (Modifier for the population exposed)+ The organ dose (D_) is defined as the mean dose ina specified tissue or organ of the human body. + Unit is cGy / Kg or joules / Kg D,=+- fo dm=£" OT ny my mz isthe mass of the organ or tissue under consideration; & _ isthe total energy imparted by radiation to that tissue or organ.Equivalent Dose + The extent of biological effect produced by radiation depends on: — The physical organ dose — The characteristics of the radiation beam employed. — The pattern of dose deposition. + The equivalent dose (H,) is the organ dose multiplied by a radiation weighting factor w, to account for the effectiveness of the given radiation in inducing health effects. Hy = weD rp Ay YirgDre If more than one type of radiation is used.Equivalent Dose + The SI unit for equivalent dose is joules/kg or sievert * One Sievert = 100 rem (radiation equivalent man) + Older ICRP recommendations used the quantity of dose equivalent (H) * This was the dose to the a point in the organ multiplied by the radiation weighting factor (w,). * Radiation Weighting factor is a somewhat arbitrarily chosen conservative value based on a range of RBEs related to the linear energy transfer (LET) of the radiation.Radiation Weighting Factors Photons all energies 1 Electrons all energies 1 Protons, other than fission fragments, energy more than 2 MeV 5 Neutrons energy < 10 KeV 5 10 KeV to 100 Kev 10 100 KeV to 2 MeV. 20 > 2 MeV to 20 Mev 10 > 20 Mev 5 Alpha particles, fission fragments, heavy nuclei 20 1) Quality factors for various radiation types; Source: ICRP publication 60 2) Excludes Auger electrons 3) All values relate ta radiation incident on the hody for external radiation and for internal sources, emitted from the sourceEffective Dose + The probablity of stochastic effect in a tissue depends on the type of tissue irradiated. + For the same equivalent dose the probablity of stochastic effects in two organs will vary — so the concept of effective dose. Previously the concept of Effective dose equivalent was used which defined the effective dose to a point (as in Dose Equivalent)Effective Dose: Definition + The Effective dose (E) is defined as the summation of tissue equivalent doses, each multiplied by the appropriate tissue weighting factor (w,), to indicate the combination of different doses to several different tissues in a way that correlates well with all stochastic effects combined (ICRP Publication 60) + The unit for effective dose is also Joules / Kg or Seivert (Sv) E= SiwyEffective Dose: Tissue Weighting Factors + Tissue weighting factors w-_ should represent the relative contribution of an organ or tissue to the total detriment due to the effects resulting from a uniform irradiation of the whole body. * They represent the likely proportionate risks of stochastic events when tissues are irradiated. « For low doses, individual organ or tissue detriments can be treated as additive and the total detriment to the whole body is the summation of individual detriments. + For the whole body w, = 1 ; soa uniform equivalent whole body radiation dose has a effective dose EF = 1 x H,= H,Tissue Weighting Factors (MNTISSHe NM Weighting)Factors) For purposes of calculation, the Gonads 0.20 remainder is composed of the following Breast 0.12 additional tissues and organs: Red Bone Marrow 0.12 : parenals Colon 0.12 rn Upper large intestine, Lung 0.12 + Small intestine, Stomach 0.05 + Kidney, Breast 0.05 : fuscle, Bladder 0.05 > Spleen.” Liver 0.05 + Thymus and Esophagus 0.05 * Uterus Thyroid 0.05 These organs are choosen as they are likely to be selectively irradiated. Remainder 0.05 Total 1.00 Source ICRP Publication 60Tissue Weighting factors Those exceptional cases in which a single one of the remainder tissues or organs receives an equivalent dose in excess of the highest dose in any of the twelve organs for which a weighting factor is specified, a weighting factor of 0.025 should be applied to that tissue or organ and a weighting factor of 0.025 to the average dose in the rest of the remainder as defined above.Effective dose: Use and Limitations + Effective dose is a useful concept as: — It measures the degree of harm from a given dose of radiation — It can be used to compared different types of radiation — Can be used to compare the dose from various types of exposures. + Limitation: — Tissue weighting factors are defined based on flawed estimates of stochastic effects + For the whole body the ICRP recommends the use of Effective doses for defining safety standards e.g. annual dose limits. — For individual organs and extremities, however equivalent doses are used.Committed Dose + Useful concept for nuclear medicine * Relates to the time which a radionuclide will remain inside the body. * Itis defined as the specific time integral of the dose received by the body after exposure to a specific radionuclide. « Acommitted effective dose and equivalent dose may also be defined by multiplying the tissue and radiation weighting factors with the committed dose.Collective Dose The collective dose relates to exposed groups or populations Is defined as the summation of the products of the mean dose in the various groups of exposed people and the number of individuals in each group. Can be defined for effective (E) or equivalent doses (H). The unit of collective dose is the man-sievert (man-Sv). eee —- = eee ee t+ + eee0e@ ) @ ee E,x6 E,x4 E,x9