BIOHAZARDS OF

RADIATION
BY DR SAMEERA K ZAMAN
FCPS RADIOLOGY
 RADIATION HAZARDS

 Radiation injury causes changes in the living

tissues and radiation sickness

 Somatic effects - harmful to the person

 Genetic effects - reflected in the offspring
 BIOLOGICAL EFFECTS OF
RADIATION
 Somatic:
 Affects cells originally exposed
 Affects blood, tissues, organs, possibly entire body
 Effects range from slight skin redness to death (acute
radiation poisoning)

 Genetic:
 Affects cells of future generations
 Reproductive cells- most sensitive
 DIRECT EFFECTS
 Radiation decomposition i.e. splitting of water into H+
and OH- and also splitting of other solvents of the
body.

 Kinetic energy of the incident photons heats up the

molecules of the living tissues

 Incident radiation when traveling through the body

tissues knock out the bound electrons free from their
parent atoms or molecules. These free electrons are
highly unstable and interact with other atoms and
molecules within the irradiated system.
 INDIRECT EFFECTS
 Since 80% of the biological tissue is water

 Most of the incident radiation energy is absorbed by the water

molecules and these are broken into very unstable and reactive
components. These then react with body molecules and cause
the cell damage. They also break chemical bonds in
macromolecules of the body such as proteins, lipids and other
nucleic acids etc causing cellular damage, cell death and
mutations.

 The biological effects are enhanced by the presence of oxygen

which is always present in the cells.
 RADIO-SENSITIVE CELLS

 Lymphoid cells
 Epithelial cells of the small intestine
 Haemopoietic cells
 Germinal cells
 Epithelial cells of the skin
 Connective tissue cells
 Cartilage and growing bone cells
 Cells of the brain and spinal cord
 Cells of the skeletal muscles and mature bone
 EFFECTS OF RADIATION
 The early effect of radiation is a result of direct injury
to the tissues. Simultaneous and considerable
destruction to the radiosensitive cells lead to radiation
sickness. These effects appear within days or weeks
after exposure and include nausea, vomiting, malaise,
diarrhea, fever; hemorrhage, loss of appetite, fall of
hair and death etc are the dangerous effects of
radiation.

 The delayed effects of radiation includes Shortening of

life span, leukemia, malignant tumors and cataract.
These appear after months or even many years of
exposure.
 TYPE OF RADIATION- SOURCE &
HEALTH EFFECTS
 Ultraviolet radiation
 UV tanning equipment (sun lamps, beds and tanning booths)
 Short term effect - sunburn
 Infra-red radiation
 Infra-red heat lamps used in deep heat treatments
 Infra-red hair dryers
 Short term effect- conjunctivitis
 Long term effect - premature skin aging, skin cancer and
cataracts, burns to skin and eye tissue
 Lasers
 Beauty industry treatments such as skin exfoliation and hair
removal
 Effect- skin damage, eye damage, including blindness
 RADIATION DOSE

 The unit Rad (radiation absorbed dose) is used as the unit

of absorbed dose following exposure to any type of
ionizing radiation.
 The biological effects of various types of radiations differ
a lot.
 To equate all types of radiation in terms of biological
effects, the unit Rem (roentgen equivalent man) was
evolved.
 One rem = rad x quality factor.
 Quality factor relates to the biological effectiveness of the
given radiation. The quality factor for X-Rays is one.
 PREGNANT WOMAN AND
PERSONS UNDER 18 YEARS OF
AGE

 Pregnant woman and persons under 18 years of age

should not be involved in radiographic work as it
may adversely affect the growing fetus and the
gonads of the persons exposed which may cause
sterility or infertility.
 PREGNANCY AND LACTATION

 Raising the awareness of patients for the need to inform the

possibility of pregnancy

 28 day rule- In a young patient who has missed a period,

pregnancy should be excluded

 If appropriate employ tests that do not use ionizing

radiation

 Fetus more sensitive in 1st and 2nd trimesters predominantly

during 3 to 8weeks and 12-17weeks respectively so non-
urgent imaging studies should be avoided in this window.
 EFFECTS ON FETUS
 Miscarriage and fetal death in the first few weeks

 Malformations within first 8 weeks of implantation

 CNS abnormalities during 8 to 25 weeks

 Malignancy can also result, with the most common

radiation-induced cancer being childhood leukemia.

 Fetal Exposure: The maximal limit of ionizing

radiation to which the fetus should be exposed during
pregnancy is a cumulative dose of 5 rad.
 BENEFITS VERSUS RISK
 The effect of ionizing radiation on our bodies differs
according to its type and energy. 

 International Commission on Radiological Protection

(ICRP) recommends that any exposure above the natural
background radiation should be kept as low as reasonably
achievable and below the individual dose limits.

 Natural background radiation range from1.5 to 3.5

millisievert per year (mSv/y) but

 The individual dose limit for members of the general public

is 1 mSv (100mrem) per year.
 RISKS
 No dose, however small, is entirely without risk

 Average lifetime risk of induction of cancer from

exposure to 5msv is 1 in 4000 and to 20msv is 1 in
1000

 Risk is considerably great in children and young adults

 Hence, all imaging procedures should be justified

 PLAIN RADIOGRAPHY
INVESTIGATION DOSE(msv) EQUIVALENT NATURAL BACKGROUND
RADIATION

 Chest 0.02 3 days

 C spine 0.1 15 days

 T spine 0.7 4 months

 L spine 1.3 7 months

 Abdomen 1.0 6 months

 CT-SCAN
INVESTIGATION DOSE(msv) EQUIVALENT NATURAL BACKGROUND
RADIATION

 Head 2.3 1 year

 C spine 1.5 8 months

 Chest 8.0 3.6 years

 Abdomen 10.0 4.5 years

 Pelvis 10.0 4.5 years

 RISKS

 Risk is a deferred risk that may occur 5 to 15 years

after exposure.

 Use of medical imaging is rising so population

exposure to ionizing radiation is increasing and
majority of them is from CT scans

 Risk is cumulative
 RISK ASSESSMENT

 Radiogenic cancer elevated risk is currently only

consistently able to be demonstrated in those groups
of study populations exposed to high-dose radiation
(>1 Sv).

 “Cancer and other health effects have not been

observed consistently at low doses (<0.1 Sv) because
the existence of a risk is so low as to not be detectable
by current epidemiological data and methods.”
 RISKS FROM LOW-DOSE
RADIATION

 Methodological difficulties inherent in low-dose

epidemiological studies suggest that precisely
quantifying cancer risks at doses below 0.1 Sv is
unlikely.

 The fact that risks cannot be directly estimated at

low doses does not imply that risks do not exist.
 RISKS FROM LOW-DOSE
RADIATION
 Reasonable evidence for an increased cancer risk is shown at
acute doses greater than 5 mSv.

 Good evidence of an increased cancer risk is shown at acute

doses greater than 50 mSv.

 Reasonable evidence for an increased cancer risk is shown for

protracted doses greater than 50 mSv.

 Statistically significant evidence for an increased cancer risk

is shown for protracted doses greater than 100 mSv.
 BENEFITS

 There is no restriction on levels of exposures used

in medicine, however:

 Exposures must be justified in terms of expected

improvement in the clinical management of the patient.

 All reasonable steps must be taken to keep exposures

low without compromising the procedure
(optimization).
 BENEFITS

 The radiation dose in justified practices should be

kept as low as possible without diminishing
diagnostic quality.

 Practices should be limited only to those who will

receive benefit.
 BENEFITS

 Justification is the responsibility of the referring

physician and the physician who carries out the
exam.
 There must be clinical indications for the exam.
 There must be expected diagnostic yield.
 Results should be expected to influence diagnosis and
medical care.
 BENEFITS

 “The physician who carries out the exam has the

responsibility for the control of all aspects of the
conduct and extent of the exam.” [Optimization]
 BENEFITS

 “For most diagnostic examinations, the associated

radiation hazards are typically much lower than the
benefits from the acquired information.”

 “Regardless of this, care should be taken in the

selection of the examination in order to be sure that
the most appropriate examination has been selected
and that the examination techniques have been
optimized.”
 BENEFITS

 “The degree of safety [of radiation exams in

medicine] is now high and an examination,
recommended on the basis of the clinical judgment
of a qualified physician, generally brings to the
patient a benefit that outweighs the unavoidable
radiation risk.”
 APPROPRIATE
REQUESTING
 Cannot ignore the increasing use of ionizing radiation so all
requests should be subject to Justification and Optimisation

 Radiologist has the knowledge and experience to determine

the radiation risks and consider alternative investigations

 Referring doctor who has seen the patient can best assess
the potential benefits

 Justification should be a joint responsibility

 Optimisation is to achieve diagnostic quality images by

using low radiation dose
 RESPONSIBILITIES OF REFERRING
DOCTOR
 Avoid unnecessary duplication of tests

 Ensure that test could potentially change

management

 Provide adequate clinical details

 Be aware that many imaging tests have risks

 Consult with imaging colleagues if appropriate

 Consider the use of US or MRI (non ionizing) when

appropriate
 PRINCIPLES OF RADIATION
SAFETY
 The distance between the radiation source and personnel
exposed should be increased. Usually doubling the
distance from the source will reduce the radiation exposure
by a factor of four.

 Allow only the operator in the x- ray room when exposures

are made.

 Behind the Shielding screen or atleast 6 feet away from the

source the exposure should be made.

 Fluoroscopy should never be used as a substitute for a non

motion radiographic procedure as amount of radiations is
extremely large in fluoroscopy.
 USE OF PROTECTIVE BARRIERS AND
REDUCTION OF UNNECESSARY
RADIOGRAPHY
 Use the lead shielding material in the gloves and aprons
which reduces the dose of scatter radiation.
 Check the shielding material periodically for cracks etc.
 Never fold the protective aprons.
 Gloves and goggles should be used during exposure.
 X-Ray room should be located away from the public
places to prevent the inadvertent exposure of the public.
 Make sure workers display signs warning other persons
that radiation- emitting equipment is in use.
 USE OF PROTECTIVE BARRIERS AND
REDUCTION OF UNNECESSARY
RADIOGRAPHY
 Check the equipment periodically for possible leakage
 Display warning signs near the location of X-Ray unit
regarding potential hazards.
 The wall of the X-Ray room should be atleast 22 cm
thick.
 Use of intensifying screens minimizes the exposure
factors.
 Provide workers with instruction and training on the
health effects associated with radiation exposure and
the safe use of equipment.
 USE OF THE RADIATION MONITORING
DEVICES

 Users may receive a dosimeter badge or ring to

monitor radiation exposure.

 Two film badges should be used one at the belt

level to monitor whole body exposure and the other
above the protective apparel, at the neckline, to
estimate exposure to the skin of the head, neck and
eyes.
LEAD APRON
THYROID LEAD APRON
LEAD GLOOVES
GOOGLES
 INTENSIFYING SCREEN
 Intensifying screens are
used in the x-ray
cassette to intensify the
effect of the x-ray
photon by producing a
larger number of light
photons. It decreases the
mAs required to
produce a particular
density and hence
decreases the patient
dose significantly.
WARNING SIGN
 GOALS OF RADIATION SAFETY

 Eliminate deterministic effects

 Reduce incidence of stochastic effects

 EXPOSURE TO IONIZING
RADIATION CAUSES TWO TYPES
OF EFFECTS
 Deterministic Effects:
 A minimum threshold dose must be attained for the effect
to occur.
 Also referred to as “non-stochastic” effects
 Examples include cataract formation, skin reddening, and
sterility.

 Stochastic Effects:
 The effect may (potentially) occur following any amount of
exposure – there is no threshold.
 Examples include cancer and genetic defects.
DETERMINISTIC VS STOCHASTIC
EFFECTS
 Radiology Technician uses
Collimation and Lead Apron to
reduce unwanted exposure
 PREGNANCY

 MRI: There are no documented adverse effects

upon the fetus, but it is recommended that all non-
essential studies be avoided in the first trimester.

 Ultrasound: Recommended that the average power

setting for ultrasound studies in the area of the fetus
be kept to a minimum consistent with achieving a
diagnostic study.
 CONSENT FORMS
 1-5 rem: Inform the patient and family of the risks
and benefits, and have the patient sign the informed
consent form.

 > 5 rem: Counsel patient and family about risks

and benefits. Referring physician, radiologist, and
radiation physicist should all write notes in the
patient’s chart explaining the circumstances and
medical justification for the exam or procedure.
Have the patient sign the informed consent form.