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Radiation Protection

Tahreem Shahid

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Radiation protection, also known as radiological protection,
is defined by the International Atomic Energy Agency
(IAEA) as "The protection of people from harmful effects of
exposure to ionizing radiation, and the means for achieving
this". The IAEA also states "The accepted understanding of
the term radiation protection is restricted to protection of
people. Suggestions to extend the definition to include the
protection of non-human species or the protection of the
environment are controversial". Exposure can be from a
radiation source external to the human body or due to the
bodily intake of a radioactive material.

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Natural and Manmade sources
 SOURCES OF RADIATION
• Natural radiation:
1. External: Cosmic and gamma radiation
2. Internal: radionuclides with in the body
• ingested or inhaled
• Medical procedures:
1. Diagnostic
2. Therapeutic
• Nuclear weapons/industry/accidents
7
Radiation Injury
• Tissue damage or changes caused by ionizing radiation.
MECHANISM
• Ionization (direct hit)
• Free radical formation (indirect hit)
What happens after hit?

• Apoptosis
• Survive
• Repair
• Stochastic changes

DAMAGE TO DNA

DAMAGE REPAIRED CELL NECROSIS OR TRANSFORMED

APOPTOSIS CELL
CHAIN OF EVENTS FOLLOWING EXPOSURE TO IONIZING
RADIATION

exposure

ionization

free radicals
(chemical changes)

molecular changes
(DNA,RNA, ENZYMES)

SUBCELLULAR D A M A G E
(MEMBRANES, NUCLEI, C H R O M O S O M E S )

CELLULAR LEVEL

CELL DEATH CELLULAR TRANSFORMATION

DETERMINISTIC EFFECTS M AY BE S O M E REPAIR
STOCHASTIC EFFECTS
Radiosensitivity
Depends on
• Metabolism
• Proliferation
• Age
Radiation Health Effects

TYPE
OF
EFFECTS

CELL DEATH CELL TRANSFORMATION BOTH

DETERMINISTIC STOCHASTIC ANTENATAL
Somatic somatic & hereditary somatic and
Clinically attributable epidemiologically hereditary expressed
attributable in large in the foetus, in the live
in the exposed
populations born or descendants
individual
16
 RADIATION EFFECTS
DETERMINISTIC EFFECT
• Mechanism is cell killing
• Has a threshold dose
• Deterministic in nature
• Severity increases with dose
• Occurs only at high doses
• Can be completely avoided
• Causal relationship between
radiation exposure and the effect established at low doses
• Sure to occur at an adequate
dose
STOCHASTIC EFFECT
• Mechanism is cell modification
• Has no threshold
• Probabilistic in nature
• Probability increases with dose
• Occurs at even at low doses
• Cannot be completely avoided
• Causal relationship cannot be
• Occurs only among a small
percentage of those exposed
 RADIATION
DETERMINISTIC EFFECT
• Radiation Sickness
• Radiation syndromes
– Haematopoietic syndrome
– GI syndrome
– CNS syndrome
• Damage to individual organs
• Death
• Late damage
EFFECTS
STOCHASTIC EFFECT
• Chromosomal damage
• Cancer Induction (Several years
after exposure to radiation)
• Genetic Effects (Hereditary
in future generations only)
• Somatic Mutations
• Deterministic
(Threshold/non-stochastic)
• Existence of a dose threshold
value (below this dose, the effect
is not observable)
• Severity of the effect increases
with dose
• A large number of cells are
involved

R
a
d
i
a
t
 Threshold Doses for Deterministic Effects

• Cataracts of the lens of the eye 2-10

Gy
• Permanent sterility Severity of
effect
• males 3.5-6 Gy
• females 2.5-6 Gy

• Temporary sterility
• males 0.15 Gy
• females 0.6 Gy dose
threshold
• Stochastic(Non-Threshold)
– No threshold
– Probability of the effect increases with dose
– Generally occurs with a single cell
– e.g. Cancer, genetic effects
 SO WE NEED
RADIATION
PROTECTION!!!
 OBJECTIVES OF RADIATION
PROTECTION
• PREVENTION of deterministic effect
• LIMITING the probability of stochastic effect

HOW? Up to what point?

 Radiation

We live with Can kill

1-3 mSv 4000 mSv

Where to stop, where is the safe point?

Equivalent dose is a dose quantity H representing the
stochastic health effects of low levels of ionizing radiation on
the human body. It is derived from the physical quantity
absorbed dose, but also takes into account the biological
effectiveness of the radiation, which is dependent on the
radiation type and energy. In the SI system of units, the unit of
measure is the joules/kg or Sievert (Sv).
1 Sievert = 100 rem (radiation equivalent man )
It is the tissue-weighted sum of the equivalent doses in
all specified tissues and organs of the human body and
represents the stochastic health risk to the whole body,
which is the probability of cancer induction and
genetic effects, of low levels of ionising radiation.It
takes into account the type of radiation and the nature
of each organ or tissue being irradiated, and enables
summation of organ doses due to varying levels and
types of radiation, both internal and external, to
produce an overall calculated effective dose.
The SI unit for effective dose is the sievert (Sv)
Fundamental to radiation protection is the reduction of
expected dose and the measurement of dose uptake. For radiation
protection and dosimetry assessment the
International Committee on Radiation Protection (ICRP) and
International Commission on Radiation Units and Measurements
(ICRU) publish recommendations and data which is used to
calculate the biological effects on the human body of certain levels
of radiation, and thereby advise acceptable dose uptake limits.
Supporting these are preventive dose reduction techniques such as
radiation shielding, exposure planning and avoidance of ingestion of
radioactive substances. Radiation protection instruments are used to
indicate radiation hazards, and personal dosimeters and bioassay
techniques are used to measure personal dose uptake.
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Optimization
by
 Optimization of protection

Protection should be optimized in relation

to
• the magnitude of doses,
• number of people exposed
• for all social and economic strata of
patients.
• Optimization of protection can be achieved by
optimizing the procedure to administer a radiation
dose which is

as low as reasonably achievable,

so as to derive maximum diagnostic information with

minimum discomfort to the patient
• Transmitted radiation: emerging after passage through
matter
X-ray tube

Primary beam

Scattered radiation

Patient
 X-ray Tube
Position
Image Intensifier • Position the X-ray tube
under the patient not above
the patient.
• The largest amount of
scatter radiation is
produced where the x-ray
beam enters the patient.
• By positioning the x-ray
tube below the patient, you
decrease the amount of
scatter radiation that
reaches your upper body.
X-ray Tube
 Patient Protection

• Correct filtration
– 0.5 mm Al equivalent (inherent)
– Added filtration is good
– Minimum total filtration (inherent + added) must
be 2.5 mm Al equivalent
– Accurate collimation
• Minimum repeats
• Good technique to avoid re-takes:
– use of correct film for the view intended
– use of appropriate film holder
– correct film placement within film holder
– correct placement (angulation) of film holder in
patient’s mouth
– correct tube angulation
– correct exposure time
AMOUNT & TYPE OF RADIATION EXPOSURE

– TIME

– DISTANCE

– SHIELDING
 Time
• The exposure time is related to radiation exposure
and exposure rate (exposure per unit time) as
follows :
• Exposure time = Exposure
Exposure rate
Or

Exposure = Exposure rate x Time

The algebraic expressions simply imply that if the

exposure time is kept short, then the resulting dose
to the individual is small
• Distance

• The second radiation protection action relates to

the distance between the source of radiation and
the exposed individual.

• The exposure to the individual decreases inversely

as the square of the distance. This is known as the
inverse square law, which is stated mathematically
as :
1
I ~ ———
d2
- One step back from tableside:
cuts exposure by factor of 4

- Move Image Int. close to patient: less patient skin

exposure
less scatter (more dose interception by tower) sharper image

- Source to Skin Distance (SSD):

38 cm for stationary fluoroscopes 30 cm for mobile
fluoroscopes
 Equipment to Control Distance

• In case of X-ray equipment operating up to

125 kVp, the control panel can be located in
the X-ray room.
AERB recommends that the distance between
control panel and X-ray unit/chest stand
should not be less than 3 m for general
purpose fixed x-ray equipment.
• In mobile radiography,

where there is no fixed protective control booth, the

technologist should remain at least 2 m from the
patient, the x-ray tube, and the primary beam
during the exposure.

• In this respect, the ICRP (1982), as well as the

NCRP (1989a), recommended that the length of the
exposure cord on mobile radiographic units be at
least 2 m long
Shielding

• Shielding implies that

certain materials
(concrete, lead) will
attenuate radiation
(reduce its intensity)
when they are placed
between the source of
radiation and the
exposed individual.
• Lead is used as a radiation shielding material as it has
a high atomic number (i.e. 82)
• Atomic number of an element is the number of
protons in the nucleus (which is equal to the number of electrons
around the nucleus)

• For the photoelectric process, the mass absorption

coefficient increases with the cube of the atomic
number (z3)
• It is known that 0.25 mm lead thickness attenuates
66% of the beam at 75kVp

• and 1mm attenuates 99% of the beam at same kVp.

• It is recommended that for general purpose

radiography the minimum thickness of lead
equivalent in the protective apparel should be
0.5mm.
- Lead aprons: cut exposure by factor of 20
distant scatter: 0.25 mm Pb eq
direct involvement: 0.5 mm Pb
Paper Plastic Lead Concrete
 
 Alpha

  Beta
 

Gamma and X-rays


 
 Neutron


n
Four aspects of shielding in diagnostic radiology

1. X-ray tube shielding

2. Room shielding
(a) X-ray equipment room shielding
(b) Patient waiting room shielding.

3. Personnel shielding

4.Patient shielding (of organs not under

investigation)
1) X-ray tube shielding (Source Shielding)

• The x-ray tube housing is lined with thin sheets of

lead because x-rays produced in the tube are
scattered in all directions.
• This shielding is intended to protect both
patients and personnel from leakage radiation.
• Leakage radiation is that created at the X-ray
tube anode but not emitted through the x-ray
tube portal.
• Rather, leakage radiation is transmitted through
tube housing.
2) Room shielding (Structural Shielding)

The lead lined walls of Radiology department are

referred to as protective barriers because they are
designed to protect individuals located outside the
X-ray rooms from unwanted radiation.
• There are two types of protective barriers.

(a) Primary Barrier:

is one which is directly struck by the primary or the
useful beam.

(b) Secondary Barrier:

is one which is exposed to secondary radiation
either by leakage from X-ray tube or by scattered
radiation from the patient.
The shielding of X-ray room is influenced by the nature
of occupancy of the adjoining area. In this respect two
types of areas have been identified.
Control Area: Uncontrolled areas:
• Is defined as the area routinely • Are those areas which are
occupied by radiation workers not occupied by
who are exposed to an occupational workers.
occupational dose.
• For these areas, the
• For control area, the shielding
should be such that it reduces shielding should reduce the
exposure in that area to exposure rate to
<26mSv/kg/week <2.6mSv/kg/week
• GUIDELINES for shielding of X-ray examination
room and patient’s waiting room which are as
follows.

• The room housing an X-ray unit is not less than

18m2 for general purpose radiography and
conventional fluoroscopy equipment.
 Rooms housing diagnostic X-ray units and related
equipment are located as far away as feasible from

• areas of high occupancy and general traffic,

• maternity and paediatric wards
• and other departments of the hospital that are not
directly related to radiation and its use.
Shielding of the Xray control room :

• The control room of an X-ray equipment is a secondary

protective barrier which has two important aspects:
• (a) The walls and viewing window of the control booth,
which should have lead equivalents of 1.5mm.
(b) The location of control booth, which should not be located
where the primary beam falls directly, and the radiation should
be scattered twice before entering the booth. The control panel
of diagnostic X-ray equipment operating at 125 kVp or above is
installed in a separate room located outside but contiguous to
the X-ray room and provided with appropriate shielding, direct
viewing and oral communication facilities between the operator
and the patient
• Patient waiting area

• Patient waiting areas are provided outside the X-ray

room.

• A suitable warning signal such as red light and a

warning placard is provided at a conspicuous place
outside the X-ray room and kept ‘ON’ when the unit
is in use to warn persons not connected with the
particular examination from entering the room
• 3) Personnel shielding

• Shielding of occupational workers can be achieved

by following methods:

• Personnel should remain in the radiation

environment only when necessary (step behind the
control booth, or leave the room when practical)
• Lead aprons are shielding apparel recommended
for use by radiation workers. These are classified as
a secondary barrier to the effects of ionizing
radiation.
• These aprons protect an individual only from
secondary (scattered) radiation, not the
primary beam .

• The thickness of lead in the protective apparel

determines the protection it provides.
• It is recommended that women radiation workers
should wear a customized lead apron that reaches
below midthigh level and wraps completely around
the pelvis.

• This would eliminate an accidental exposure

to a conceptus
 Care of the lead apparel:

• It is imperative that lead aprons are not abused,

such as by
– dropping them on the floor,
– piling them in a heap
– improperly draping them over the back of a chair.
• Because all of these actions can cause internal
fracturing of the lead, they may compromise the
apron’s protective ability.
• When not in use,
– all protective apparel should be hung on properly
designed racks.
• Protective apparel also should be radiographed for
defects such as internal cracks and tears at least
once a year
• Other protective apparel include eye glasses
with side shields, thyroid shields and hand
gloves.
• The minimum protective lead equivalents in
hand gloves and thyroid shields should be
0.5mm.
• 4)Patient shielding

• Most radiology departments shield the worker and

the attendant, paying little attention to the
radiation protection of the patient.

• It has been recommended that the thyroid,

breast and gonads be shielded, to protect these
organs especially in children and young adults
 Rooms
Only authorized users may
have access to x-ray devices

Energized equipment must be

attended at all times

Lock lab door when

equipment not
attended

Notification of hazard presence

Signs, Posting, Warning signs
Posting, Warning sign

Door sign
Warning sign
 RADIATION
PROTECTION IN CT
SUITE
It was concluded that

• adequate shielding should be provided for the floor

and roof areas of a CT suite depending on which
floor the CT is located.

• It was proposed an additional thickness of 2.5mm

of lead or 162mm of concrete to shield the front
and rear reference points, so as to reduce the dose
to 1 mGy/year
• The highly collimated X-ray beam in CT results in
markedly non uniform distribution of absorbed
dose perpendicular to the tomographic plane
during the CT exposure.

• Therefore the size of the CT room housing the

gantry of the CT unit as recommended should
not be less than 25m2
• The greatest risk to the fetus of chromosomal
abnormalities and subsequent mental retardation is
between 8 and 15 weeks of pregnancy and
examinations involving radiation to the fetus should
be avoided during this period.

• For examinations which may involve rather heavy

doses of radiation such as Barium enemas, pelvic
or abdominal CT, the examination should be
carried out during the first 10 days of the
menstrual cycle to avoid irradiating any possible
pregnancy
 If Pelvic Area in Beam:

• No possibility of pregnancy - proceed

• Probably pregnant - radiologist decides
– delay X-ray until after delivery, or
– use non-X-ray technique (e.g. ultrasound), or
– go ahead with X-ray but keep dose low
• Possibly pregnant, low dose procedure - proceed if
period is not overdue.
• High dose procedure (10s of mGy, e.g. pelvic CT)
– X-ray in first 10 days of menstrual cycle .
Pregnancy and Mammography

“There is no requirement to enquire

about pregnancy prior to
mammography as there is no
significant dose to the fetus”
NHBSP Dec 02

For pregnant staff,

• a risk assessment must be performed,
• dose to fetus < 1 mSv for rest of
pregnancy.
Radiation detection and
measurement

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• The instruments used to detect radiation are
referred to as radiation detection devices.

• Instruments used to measure radiation are called

radiation dosimeters
 DOSIMETRY

Devices monitor and

record ionizing radiation
doses (occupational
exposure)
Must distinguish from
background radiation
 Staff Doses
Dose limit ICRP = 20 mSv/yr.

Radiography work  0.1 mS/yr.

i.e. 1/200th

of dose
limit
• Personnel Dosimetry

Personnel dosimetry refers to the monitoring of

individuals who are exposed to radiation during the
course of their work.

Personnel dosimetry policies need to be in place for

all occupationally exposed individuals.

The data from the dosimeter are reliable only when

the dosimeters are properly worn, receive proper
care, and are returned on time.
The radiation measurement is a time-integrated
dose, i.e., the dose summed over a period of time,
usually about 3 months.

The dose is subsequently stated as an estimate of

the effective dose equivalent to the whole body in
mSv for the reporting period.

Dosimeters used for personnel monitoring have

dose measurement limit of 0.1 - 0.2 mSv
Proper care includes
• not irradiating the dosimeter except during
occupational exposure
• and ensuring proper environmental
conditions

Monitoring is accomplished through the use

of personnel dosimeters such as
• the pocket dosimeter,
• the film badge
• the thermoluminescent dosimeter
 Pocket Dosimeter

• Outwardly resembles a
fountain pen .
It consists of
• a thimble ionization
chamber with an eyepiece
and a transparent scale,
• a hollow charging rod
• a fixed and a movable fiber.
• electrometer----separate
-----built-in (self
reading type)
 Film Badge Monitoring

• These badges use small x-ray films sandwiched

between several filters to help detect radiation.

• The photographic effect, which refers to the

ability of radiation to blacken photographic films,
is the basis of detectors that use film.
 Film badge

detects beta, gamma, X Ray

Wearing the badge
-wear the badge on the collar region, because the collar region
including head, neck, and lens of the eyes are unprotected.

Wearing period-
• Each member of staff wears film badge for a period of 4
weeks.

• At the end of period the film inside is changed.

• The exposed film is sent to BARC.
• Useful for detecting radiation at or above 0.1 msv (10 mrem)
Advantages

– inexpensive,
– easy to use,
– permanent record of exposure,
– wide range of sensitivity ( 0.2 – 2000 msv),
– identifies type and energy of exposure,
 disadvantages
• they are not sensitive enough to capture very low
levels of radiation( < 0.15 msv),

• Their susceptibility to fogging caused by high

temperatures , humidity and light means that they
cannot and should not be worn for longer than a 4-
week period at a stretch,

• Enormous task to chemically process a large

number of small films and subsequently compare
each to some standard test film.
Thermo luminescent dosimetry (TLD)
Monitoring
• The limitations of the film badge are overcome by
the thermo luminescent dosimeter (TLD).
• Thermo luminescence is the property of certain
materials to emit light when they are stimulated
by heat.
• Materials such as lithium fluoride (LiF), lithium
borate (Li2B4O7), calcium fluoride (CaF2), and
calcium sulfate (CaSO4) have been used to make
TLDs
• The measurement of radiation from a TLD is a two-
step procedure.

• In step 1, the TLD is exposed to the radiation.

• In step 2, the LiF crystal is placed in a TLD analyzer,

where it is exposed to heat.
• As the crystal is exposed to increasing
temperatures, light is emitted.
• When the intensity of light is plotted as a function
of the temperature, a glow curve results.

• The glow curve can be used to find out how much

radiation energy is received by the crystal because
the highest peak and the area under the curve are
proportional to the energy of the radiation.
Advantages

• The TLD can measure exposures to individuals as low as 5 mR

can withstand a certain degree of heat, humidity, and pressure
• Their crystals are reusable
• Is very compact ( suitable even for finger dosimetry)
• And instantaneous readings are possible if the department has a TLD
analyzer.
• Response to radiation is proportional upto 400 R

Disadvantages

• Very expensive
• No permanent record ( other than glow curves)
• Cannot distinguish radioactive contamination.

The greatest disadvantage of a TLD is its cost

• Badge must not be left in an area
where it could receive a
radiation exposure when not
worn by the individual (e.g. On a
lab coat or left near a radiation
source)

• Store badges in a dark area with

low radiation background (in low
light away from fluorescent or uv
lights, heat and sunlight)

• Lost or damaged badges should

be reported immediately to the
radiation safety officer and a
replacement badge will be issued
117
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Regulatory bodies

• the International Commission for Radiation

Protection ( ICRP),
• the National Commission for Radiation Protection (NCRP ) in
America,
• Pakistan Nuclear Regulatory Authority (PNRA) regulatory
infrastructure since 1965,
• Pakistan Nuclear Safety and Radiation Protection Ordinance
1984.

121
 Dose Limits Recommended by ICRP (1991)
Exposure Dose Limit (mSv per year)
Condition
Occupational Apprentices Public
(16-18 years)
Whole body: 20 mSv per year, 6 mSv in a year 1 mSv in a year,
(effective dose) averaged over defined averaged over
period of 5 years with 5 years,
no more than 50 mSv
in a single year
Parts of the body:

(equivalent dose)

Lens of the eye 150 mSv per year 50 mSv in a year 15 mSv in a year
Skin* 500 mSv per year 150mSv in a year 50 mSv in a year
Hands and feet** 500 mSv per year 150 mSv in a year 50 mSv in a year

*Averaged over areas of no more than any 1 cm2 regardless of the area exposed. The nominal depth is 7.0 mg cm-2
**Averaged over areas of the skin not exceeding about 100 cm2
Note 1.Dose limit for Women upon declaration of pregnancy - 2 mSv measured on the surface of the abdomen
and 1/20th of ALI for exposure to internal emitters.
Note 2.Dose limits do not apply to medical exposures, to natural sources of radiation and under conditions resulting from
accidents.
 Radiation Doses in Radiological
Exam. (as multiple of chest x-ray)
Relative Dose Received
mSv
.05 Arm, head,ankle & foot (1) Head
0.15 & Neck (3)
0.49 Head CT (10)
0.92 Thoracic Spine (18)
1.0 Mammography, Cystography (20)
1.22 Pelvis (24)
Abdomen, Hip, Upper & lower femur (28) Ba
1.4 Swallow (30)
1.5 Obsteric abdomen (34)
1.7 Lumbo-sacral area (43)
2.15 Cholangiography (52)
2.59 Lumber Myelography (60)
3.0 Lower abdomen CT male (72)
3.61 Upper Abdomen CT (73)
3.67 Ba Meal (76)
3.8 Angio-head, Angio-peripheral (80)
Urography (87)
4.0 Angio-abdominal (120)
4.36 Chest CT (136)
6.0 Lower Abd. CT fem. (142)
6.8 Ba enema (154)
7.13 Lymphan. (180)
7.69
9.0 0 50 100 150 200
number of chest x-rays