Shahad Al-Ward

DOS 516: Fundamentals of radiation Safety

The Public and Radiation Safety

The Public and Radiation Safety

Explaining my profession to family and friends often leads to questions like, "Why did you
choose this profession? Isn't it dangerous for you and your patients?" Concerns about radiation
have grown due to media reports highlighting its potential risks, especially in medical
procedures. A series of articles in The New York Times in 2009 and recent studies have fueled
public apprehension, even suggesting a slight increase in cancer risk from computed tomography
(CT) scans in children.[1] This heightened media coverage has stirred fear around medical
procedures involving ionizing radiation. However, what many may not realize is that hospitals
and medical facilities have rigorous safety measures in place to protect the public, patients, and
staff. Based on my research from two review papers, I aim to reassure the public about their
general safety during these procedures.

The first article titled "Medical Radiation Accidents and Unintended Events: A Review of Safety
Measures in Nuclear Medicine" dispels concerns about radiation exposure in nuclear medicine
procedures.[2] These safety measures extend to any other medical discipline involving radiation,
such as radiation therapy and medical imaging. The review paper also addresses unintended
exposures. In most cases, they lead to a minimal increase in the risk of stochastic effects,
primarily cancer induction. In a 10-year study analyzing radiation incidents reported via an
internal system, it was found that in 50% of the diagnostic radiology incidents, patients received
an effective dose of less than 0.1 mSv, and in 74% of cases, the effective dose was below 1 mSv.
[3]
To put this in perspective, the annual dose limit for infrequent exposure set for the public by
the Nuclear Regulatory Commission (NRC) is 5 mSv.[4]

Incident prevention is a core focus for medical radiation professionals. They actively implement
measures such as strict quality assurance, adherence to regulations and guidelines, and the
precise use of calibrated equipment for administering radiation. Patient safety is paramount, with
a meticulously planned process (treatment planning) justified through collaboration between
referring physicians and dosimetrists.[2] This involves following strict clinical protocols where
normal tissues surrounding the tumor are not to exceed certain dose thresholds. For example,
when treating head and neck tumors, the maximum dose to the larynx should not exceed 66 Gy
at any given point, otherwise it will lead to vocal dysfunction (toxicity end point). [5] Moreover,

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Shahad Al-Ward
DOS 516: Fundamentals of radiation Safety
The Public and Radiation Safety

these plans undergo rigorous checks by physicists and physicians. Each patient plan, undergoes
through a process of patient-specific quality assurance (QA) where the dose is delivered to a
radiation detector that measures the dose. The measured dose is then compared to the planned
dose to ensure the difference between the doses is accordance with certain clinical tolerances. [6]

Staff protection is also crucial. Staff members are rigorously and routinely trained to maintain
safe distances from radiation sources, limit exposure time, and wear protective clothing,
including gloves, and aprons.[2] These precautions ensure their safety while delivering care to
patients. The importance of incident reporting and investigation is emphasized in this article,
ensuring thorough documentation and analysis to enhance safety practices.

The second article that I chose is titled "Safety in Radiation Oncology: The Role of International
Initiatives by the International Atomic Energy Agency". [7] Before delving into this article, it is
important to highlight that the International Atomic Energy Agency (IAEA) sets global standards
and provides guidance to promote safe nuclear energy use worldwide. In contrast, the NRC
focuses on regulating nuclear activities within the United States, prioritizing safety, security, and
environmental protection.

This article mentions that the IAEA conducts comprehensive audits of radiotherapy services,
rectifying any shortcomings in radiotherapy facilities to ensure quality and safety. The IAEA also
plays a pivotal role in developing a safety reporting and analysis system, "Safety in Radiation
Oncology." This system facilitates incident reporting, analysis, and learning from past incidents
to enhance safety measures. The IAEA promotes safe procurement of radiation therapy
equipment and provides guidelines for quality assurance of treatment planning systems.
Moreover, the IAEA offers education and training programs in radiation safety for professionals
involved in radiation therapy, including radiation protection officers, regulators, and therapy
staff. It supports member states in establishing and strengthening national legal and regulatory
frameworks for radiation safety, offering financial support and expert guidance for equipment
procurement and infrastructure development.

Recognizing the higher risk of incidents in understaffed institutions, the IAEA has developed
staffing guidelines for radiation therapy centers. These guidelines consider patient numbers and
the tasks involved, ensuring adequate staffing levels for safe treatment.

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Shahad Al-Ward
DOS 516: Fundamentals of radiation Safety
The Public and Radiation Safety

The IAEA collaborates with international efforts to enhance interoperability in radiation

oncology, ensuring seamless data flow and communication during different treatment phases.
Case studies exemplify how these initiatives have successfully improved patient care and safety,
even in countries with limited radiation therapy facilities.

In summary, concerns about radiation exposure in medical procedures are addressed through
stringent safety standards, minimal risks from unintended exposures, proactive prevention, staff
training, and incident reporting. International efforts led by the IAEA further ensure safety in
radiotherapy services, staffing, and education, assuring the public of their safety during such
procedures.

References:

1- Moore QT. Medical radiation dose perception and its effect on public health. Radiol Technol.
2014;85(3):247-255.
2- Marengo M, Martin CJ, Rubow S, Sera T, Amador Z, Torres L. Radiation Safety and
Accidental Radiation Exposures in Nuclear Medicine. Semin Nucl Med. 2022;52(2):94-113.
doi:10.1053/j.semnuclmed.2021.11.006
3- Martin CJ. A survey of incidents in radiology and nuclear medicine in the West of
Scotland. Br J Radiol. 2005;78(934):913-921. doi:10.1259/bjr/20111483
4- U.S. Nuclear Regulatory Commission. Biological Effects of Radiation. [Internet]. Available
from: https://www.nrc.gov/reading-rm/doc-collections/fact-sheets/bio-effects-radiation.html
Accessed [12/03/2023].
5- Marks LB, Yorke ED, Jackson A, et al. Use of normal tissue complication probability models
in the clinic. Int J Radiat Oncol Biol Phys. 2010;76(3 Suppl):S10-S19.
doi:10.1016/j.ijrobp.2009.07.1754
6- Kron T, Fox C, Ebert MA, Thwaites D. Quality management in radiotherapy treatment
delivery. J Med Imaging Radiat Oncol. 2022;66(2):279-290. doi:10.1111/1754-9485.13348
7- Abdel-Wahab M, Rosenblatt E, Holmberg O, Meghzifene A. Safety in radiation oncology:
the role of international initiatives by the International Atomic Energy Agency. J Am Coll
Radiol. 2011;8(11):789-794. doi:10.1016/j.jacr.2011.07.014