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HTI37103 Radiation Protection
Lecture 13
Revision (Lecture 6-11)
Dr. Marco TAM

The ICRP Recommendations
➢ ICRP publication 103 – 2007
➢ The recommended system of radiation
protection is based upon 3 principles:
◆ Benefit of a practice must offset the
radiation detriment (Net positive
benefit)
◆ Exposures and likelihood of exposure
should be kept as low as reasonably
achievable, economic and social factors
being taken into account
◆ Dose limits should be set to ensure that no
individual faces an unacceptable risk in
normal circumstances
DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

Justification
A. Benefit vs Risk
B. Diagnostic efficacy
(Usually justified by referring doctor)
Presence or
Imaging procedure
Minimal radiation Optimal image(s) absence of disease
justified by
exposure produced revealed =
referring doctor
Diagnostic efficacy

Optimization
➢ Ensure that the appropriate equipment be used
➢ The medical practitioner, the technologist or

other imaging staff select the relevant
combination of parameters, that results in:
– minimum patient exposure consistent with
acceptable image quality and the clinical purpose
of the examination (ALARA principle),
– paying particular attention to this selection for
paediatric radiology and interventional radiology
4
Diagnostic Reference value can be used…
➢ To compare our practice (the
level of radiological risk) with
other centers.
➢ To realize if we have a
certain margin for
optimization (to improve
settings of our X-ray system
or to improve our protocols).
➢ To detect abnormal
situations with high
radiological risk for our
patients.
5
Limits and Constraints
➢ Dose limits are one of the three principles of
protection as introduced by ICRP and BSS.
Fixed dose limits are recommended by ICRP
and often enforced by a national legal process
(Radiation Protection Legislation).
➢ Dose constraints are used in an optimization

process to guide planning. Constraints and
the importance thereof may be subject to
change to achieve the optimum solution to a
problem (Best practice guidelines).

Dose Limits
• No dose limits for medical exposure of

the patient - it is always assumed
that the benefits for the patient
outweigh the risks
• Limits need to be applied for public
and occupational exposures.

Radiation Protection in Hong Kong
Legislative control
– The Radiation Ordinance Chapter 303 (Hong Kong Law)
Operational guidance
– Code of Practice on Radiation Safety & Protection in HA Hospitals
(HA’s Code of Practice)
– Local Radiological Protection Rules (e.g.

Departmental Local Rules)
8
Radiation Protection in General Radiography
• Minimizing the number of

projection, if possible.
• Avoid repeating
• Avoid artifacts
• Proper collimation
• Position in or near the center
of the image receptor
• Check for the availability of
recent radiographs/ images of
the patient taken at the same
/ different hospitals
• Periodic check DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS
Radiation Protection in General & Fluoroscopic Examinations
➢ In general radiography and fluoroscopy with X-

ray mobile equipment, the source-to-skin
distance should not be less than 30 cm
➢ In radiography and fluoroscopy with fixed
equipment, the skin-focus distance should not
be lower than 45 cm
➢ If less than 15 cm between skin and collimator,
possible skin exposure to electrons produced
by photon interaction with the collimator
➢ Fluoroscopy equipment without image
intensifiers must be replaced, or upgraded
with an image intensifier (1.5 – 2 mA vs 3 –
5 mA)
X-ray tubes
➢Standards: International Electrotechnical Commission
(IEC) and the ISO or to equivalent national standards
➢Adequate filtration (minimum 2.5 mm Al (for >70 kVp)
/ 1.5 mm Al (50-70 kVp) / 0.5 mm Al (<50 kVp) in
general radiology, minimum 2.5 mm Al for fluoroscopy
(>3mm Al with image intensification systems)),
significantly reduces the patient dose due to low
energy X-rays which do not contribute to the image
formation

Technical Adaptations for RP in General Radiography
➢It is advisable to use the highest

kVp (and the lowest mAs)
compatible with the image that
one expects to obtain. In this way
the patient dose will be minimized.
Optimization should be used to
find the proper balance between
contrast and dose
➢Short exposure times should be
used when imaging non-
cooperative patients (e.g.
Paediatric cases).
17
Technical Adaptations for RP in General
Radiography
➢ Either 10-day rule or 28-day rule
should be applied to female patients of
reproductive age
➢ 10-day rule: Restrict X-ray examination
in the first 10 days of the menstrual
cycle, when conceptions is unlikely to
have occurred.
➢ 28-day rule: Ensure last menstrual
period within the past 28 days.
Proper Radiological Positioning
➢ Maximize distance between x-ray tube
& patient.
➢ Minimize distance between patient &
Image Intensifier.
➢ Stand on side of the Image Intensifier

Protective Barriers in Fluoroscopy
Primary barrier – protection

from Primary radiation
(for the patient & staff)
➢ It is a 2.0 mm Pb eq barrier
Secondary barrier – protection
from Secondary radiation
(Scattering)
(for the staff)
➢ Protection for the
technologists, etc.

Dose Reduction in Fluoroscopy
➢ Reduce field size (collimate)

➢ Minimize field overlap.
➢ Use low pulsed fluoroscopy
➢ (7 or 3/sec)
➢ Use low frame rate
(4 or 2 or 1/sec)
➢ Avoid unnecessary runs
➢ Last image hold
➢ Screen capture

Computed Tomography Dose Index
CT dose index (CTDI) is a standardized measure of radiation dose
output of a CT scanner which allows the user to compare radiation
output of different CT scanners. In the past, CTDI100 (measured over
a 100 mm long ionization chamber) and CTDIw (weighted average
of dose across a single slice) were used; for helical scanners in
current use, the parameter CTDIvol the most relevant one.
CTDI100 is a linear measure of dose distribution over a pencil

ionization chamber and hence does not take into consideration the
topographical variation of a human body and is therefore not in
clinical use.
CTDIw is closer to the human dose profile as compared with the

CTDI100 . It is simply:
2/3 CTDI100 (edge/ periphery) + 1/3 CTDI100 (center)
CTDIvol is obtained by dividing CTDIw by pitch factor.

Computed Tomography Dose Index
Volume Computed Tomography Dose Index (CTDIvol) is a
standardized parameter to measure Scanner Radiation
Output
➢ CTDIvol ≠ patient dose
➢ CTDIvol is reported in units of mGy for either a 16-cm
(for head exams) or 32-cm (for body exams) diameter
acrylic phantom
➢ For the same technique settings, the CTDIvol reported
for the 16-cm phantom is about twice that of the 32-
cm phantom
➢ The reported CTDIvol is based on measurements
made by the manufacturer in a factory setting
Pitch
Pitch < 1 Pitch = 1 Pitch > 1

Beam Width has No overlap of Beam Some view angles are
some overlap at Width at each view angle not covered by the beam
each view angle and no view angles not width at certain table
from rotation to covered at certain table positions
rotation positions

Acquisition Parameter Settings
Parameter Relationship to CTDIvol
Scan Mode Changes in the Scan Mode may affect CTDIvol
Exposure Time Per CTDIvol relationship to exposure time per rotation is vendor
Rotation dependent
Tube Current CTDIvol  Tube Current
Tube Potential CTDIvol  (kVp1/kVp2)n n ~ 2 to 3
Tube Current Time CTDIvol  Tube Current Time Product

Product
Effective Tube Current CTDIvol  Effective Tube Current Time Product
Time Product
Field of Measurement Changes in the Field of Measurement may affect CTDIvol
Beam Shaping Filter Changes in the Beam Shaping Filter may affect CTDIvol

Acquisition Parameter Settings - Scan Mode
➢ In the Dynamic Scan Mode multiple acquisitions
covering the same body region are acquired.
Examples of these study types include:
◆ Perfusion Studies
◆ Bolus Tracking Studies
◆ Test Bolus Studies
➢ Dynamic Scans often have large CTDIvol values
because the scanner reports the sum of the CTDIvol
values from each rotation
➢ The reported CTDIvol is NOT skin dose or organ
dose

Automatic Exposure Control
➢ Automatically adapts the Tube Current or Tube Potential
according to patient attenuation to achieve a specified
image quality
◆ Automatic adjustment of Tube Current may not occur when
Tube Potential is changed
◆ Centering the patient in the centre of the gantry is VITAL for
most AEC systems
➢ AEC aims to deliver a specified image quality across a
range of patient sizes. It tends to increase CTDIvol for
large patients and decrease it for small patients relative
to a reference patient size
Image Quality Reference Parameter
➢ Changing the Image
Quality Reference
Parameter will affect the
CTDIvol
➢ Setting the IQR parameter
for “increased” image
quality (e.g. lower noise)
will result in more dose
➢ Setting the IQR parameter
for “decreased” image
quality (e.g., more noise)
will result in less dose

Effective Dose of CT
➢ CT is one of the highest dose x-ray modalities used in
the hospital
◆ Head – 2 mSv
◆ Chest – 8 mSv
◆ Abdomen and pelvis – 10 mSv
◆ CT KUB – 10-15 mSv
➢ Planar chest – 0.08 mSv
➢ CT chest is 100 times the dose of planar chest
➢ Planar IVU has effective dose 1.5 – 3 mSv
➢ CT KUB is up to 10 times the dose of planar IVU

Summary: 10 guidelines in CT

Lower Noise = Higher Patient Dose



56

Approximate radiation dose to adults from
diagnostic nuclear medicine procedures

Typical Effective Dose Values for Common PET/CT investigations
(Contributor: PET procedures)

Typical Effective Dose Values for Common SPECT/CT investigations
(Contributor: SPECT procedures)

Preparation and dispensation of radiopharmaceuticals
➢ Shields
➢ Protective clothing
➢ Tools for remote
handling of radioactive
material
➢ Containers for radioactive
waste
➢ Dose rate monitor with
alarm
➢ Contamination monitor
➢ Decontamination kit
➢ Signs, labels and records

Administration of Radiopharmaceuticals
➢ In certain circumstances staff may need to

wear a protective lead apron.
➢ This may be necessary if staff need to be
in close contact with patients containing
greater than 800 MBq of 99mTc.
➢ Protective aprons should preferably have
a thickness of 0.5 mm lead equivalent,
comprising a separate vest and skirt
that wrap around fully, as open back
designs are not recommended.
➢ All protective clothing should be examined
at least annually.

Administration of Radiopharmaceuticals
➢ Lead aprons provide little or no protection (i.e.

too thin) for higher energy photons and should not
be used for radionuclides such as gallium-67 or
iodine-131 (606 keV beta + 364 keV gamma) or
positron emitters (e.g. C-11, N-13, O-15, F-18).
➢ Staff leaving designated areas should remove
protective clothing, wash their hands and monitor
their hands, clothing and body as appropriate.
➢ Mobile shielding barriers may be required for
therapeutic nuclear medicine procedures using
gamma-emitting radionuclides.
Radiation Protection issues in NM
General principles
➢ When considering the justification for a medical
exposure, the benefit is weighed against the
detriment, including radiation effects.
➢ For diagnostic procedures the potential detriment is
the risk of inducing cancer.
➢ This risk is greater in children and decreases with
age.
➢ For effective doses greater than 100 mSv the
overall lifetime risk of fatal cancer is estimated to
be 5% per Sv. (ICRP 2007b)

Radiation Protection issues in NM
After Radiopharmaceutical administration
➢ The period of time during which patients (and their
family and friends) should observe the restrictions
will depend on the initial external dose rate from
the patient and the rate of clearance of the
radionuclide from the body.
➢ The recommended values are based on data from
Woodings (2004) and Woodings et al (2005) using
a dose constraint of 1 mSv (0.3 mSv for travel)
for children and members of the public, and 5 mSv
for the carer/partner (ARPANSA 2002a).
Periods of restriction, after discharge, for patients receiving
radioiodine (131I) therapy for thyroid cancer after
thyroidectomy
➢ Thyroid cancer patients may return to work the day after
being discharged from hospital.
➢ Public transport (airline, bus, or boat) can involve
people sitting close to each other and restrictions may
be required on travel of long duration.
➢ For long trips patients should be encouraged to find a
place where they can sit alone.
➢ Long distance travel immediately after administration is
not recommended due to the potential for travel sickness
and the possibility for contamination.

Radiation Protection Issues in NM
Avoidance of Conception
➢ The period of time for which pregnancy should be
avoided is determined by the rate of clearance of the
radionuclide from the body and by the time necessary
to ensure that the underlying disease is controlled.
➢ The ICRP has recommended that a woman not
become pregnant until the potential fetal dose would
not exceed 1 mGy (ICRP 2000a).
➢ Most female patients are advised (ICRP 2004) not to
become pregnant for at least six months after
therapy with radioiodine.
Radiation Protection Issues in NM
Avoidance of Conception
➢ Although there is no evidence that preconceptual
irradiation of males can cause any abnormality in
their offspring, it may be prudent to advise males
receiving radionuclide therapy to avoid fathering
children for a period of 4 months, which is
greater than the life of a sperm cell (ARSAC
2000).

Dose reduction in Mammography
• Dose reduction by limiting the number of projections taken or lowering

the dose associated with each projection
• Axillary projections should only be done with radiologist request
• For routine screening, only craniocaudal and mediolateral projections
of each breast with adequate compression for uniform breast tissue
compression from the nipple to the most posterior portion

Magnetic Field Hazards
➢ Anyone entering the MRI

scanner room will be
exposed to the magnetic
attraction of the scanner.
The closer you get to the
scanner, the stronger the
magnetic pull.
➢ Any ferromagnetic
object* brought into the
MRI scanner room will
become magnetized and
can become a Dangerous
Projectile! An object that is attracted by a magnet and
which can become magnetized itself

Magnetic Field Hazards
Displacement and Heating Effects
of Surgical Implants of the Patients:
➢ Cardiac pacemakers
➢ Stents and Anenurysm Clips
➢ Neurostimulators
➢ Pain control pumps
➢ Penile implants
➢ Cochlear implants

Static Field Bioeffects Summary
➢ Whole body: No effects at 2T

➢ Circulatory at 5T
➢ Extremities: No effects at 5T
➢ Discomfort; no adverse effects: 10T
➢ Conclusion: Don’t go above 2T
for head & trunk; 5T for
extremities

Gradient Magnet Bioeffects
➢ Allows spatial encoding of the

MRI signal
➢ Also critical for a wide range of
physiologic techniques.
➢ E.g. MR angiography, diffusion
and perfusion imaging.
➢ No effects at 6 T/sec.
➢ Nerve stimulation at 20 T/sec.
➢ Don’t go above 20 T/sec.

Quantify the Bioeffects by Radiofrequency
➢ SAR: Specific
Absorption Rate
◆Rate at which RF
energy is coupled
into tissues.
◆Units: Watts per
kilogram (W/kg)
➢ SAR - Time Product

◆Units: W-min/kg or
W-hr/kg
➢ Temperature (°C)
Thermal Effects of Ultrasound
➢ It affects the equilibrium

between chemical reactions
➢ It is advised that tissue
temperature increases, if
applicable, should be kept below
1.5⁰C
➢ Bone and full bladder may
further increase the operational
temperature of US

Non-thermal Effects of Ultrasound
➢ Cavitation
➢ Acoustic streaming
➢ The main effects of non-thermal
damage have been demonstrated in
mammalian tissues containing gas
where capillary bleeding has been
observed
➢ This potentially pertains to the neonatal
lung, intestine and also in the presence
of US microbubble contrast agents (e.g.
Sulphur hexafluoride (SonoVue) for
liver lesions, Perflexane lipid
microspheres for assessing cardiac
function)
Special Features of RT Department
• Almost always at the basement / ground floor

• Huge machine and thick walls (e.g. 1 m concrete + 0.5 m
steel)
• Isolated from other departments in hospital
• 24 hours ventilation

Sources of Radiation from Treatment
Machines
1. Photons
• Primary (Primary barrier)
• Leakage (Secondary barrier, maze wall, door)
• Patient scatter (Secondary barrier, door)
• Wall scatter (Secondary barrier, door)
2. Neutrons
• Primary (Primary barrier)
• Leakage (Primary barrier, secondary barrier, maze wall, door)
• Produced in laminated primary barrier (Primary barrier)
• Room and maze scattered neutrons (Door)
• Neutron induced capture gamma rays (Door)

Linac room design
• Primary & secondary barrier

• Wall thickness
• Wall material
• Maze
• Room occupancy

Shielding Goals
• Controlled areas = 0.1 mSv/wk (Equivalent to 5 mSv/yr for the fetus of

pregnant radiation workers, and 0.5 times of the 10 mSv/yr for adult
workers)
• Uncontrolled areas = 0.02 mSv/wk (Equivalent to 1 mSv/yr for the
public)

Shielding Materials

Neutron Shielding
• Photoneutron production is an issue for beams with E > 10MeV.

• More of a problem for x-ray beams than for e beams
• n production increases as E increases from 10MeV to 20 MeV,
and then remains roughly constant.
• For 15MV beam, n dose = ~0.5% of x-ray dose on treatment field, and
~0.1% of x ray dose outside the field.
• Thermal neutrons: E<0.1 MeV, after slowing by scattering events.
• Concrete barriers are sufficient for n shielding

Maze and Door
• Doors are the biggest concern. A hydrogenous material, such as

polyethylene, is added to doors to thermalize (slow down) neutrons.
• When thermal neutrons are absorbed by nuclei, neutron capture
gamma rays are produced, with energies up to 8 MeV. Thus, additional
steel or lead shielding is necessary beneath a polyethylene slab, to
attenuate the resulting gamma radiation.
• A maze can be used to reduce the need for heavy metal shielding on
treatment room doors.

Simulator
• Similar to the setting of a General X-ray / CT room

• Remote control room
• Lead glass window
• Sufficient barrier
• Door interlock
• Warning signs and light

Sealed Source
• High dose rate (HDR) brachytherapy, remote automatic machine
(afterloader) are used to deliver the sources into the patient.
• Treatment room usually incorporate with operation theatre
• C arm x ray machine
• Room design is similar to linear accelerator (Same barrier design
equations as used for external beam therapy devices with E > 500kVp)
• Additional requirements: Dose in any unrestricted area must not exceed
2 mrem (0.02 mSv) in any 1 hour.
• All barriers receive primary (source radiation is isotropic), so it makes
sense to conservatively design all barriers to be primary barriers, of the
same thickness.
• Linac vaults generally provide more than adequate shielding to house
an HDR unit
Final Examination Information
• 60% of subject grade

• Must PASS to pass the whole subject
• 3/12/2022 (Sat) 12:30-14:30 SH2
• Duration: 2 hours
• Format: 60 MCQ (50%) and about 10 Structured Q (50%)
• Bring pencil for filling MCQ answer sheet
• Follow rules of examination
• Sample structured questions uploaded to Blackboard

The End!
Hope you can get good results
in final exam!

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HTI37103 Radiation Protection

Revision (Lecture 6-11)

Dr. Marco TAM

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

➢ The medical practitioner, the technologist or

➢ Dose constraints are used in an optimization

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

• No dose limits for medical exposure of

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

– Local Radiological Protection Rules (e.g.

• Minimizing the number of

➢ In general radiography and fluoroscopy with X-

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

➢It is advisable to use the highest

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

Primary barrier – protection

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

➢ Reduce field size (collimate)

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

CTDI100 is a linear measure of dose distribution over a pencil

CTDIw is closer to the human dose profile as compared with the

CTDIvol is obtained by dividing CTDIw by pitch factor.

Pitch < 1 Pitch = 1 Pitch > 1

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

Scan Mode Changes in the Scan Mode may affect CTDIvol

Tube Potential CTDIvol  (kVp1/kVp2)n n ~ 2 to 3

Tube Current Time CTDIvol  Tube Current Time Product

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

Lower Noise = Higher Patient Dose

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

➢ In certain circumstances staff may need to

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

➢ Lead aprons provide little or no protection (i.e.

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

• Dose reduction by limiting the number of projections taken or lowering

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

➢ Anyone entering the MRI

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

➢ Whole body: No effects at 2T

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

➢ Allows spatial encoding of the

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

➢ SAR - Time Product

➢ It affects the equilibrium

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

• Almost always at the basement / ground floor

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS