June 17, 2020

Radiation Safety Short Notes

Regulations and Framework................................................................................................................................................................. 1
IRR 1999....................................................................................................................................................................................... 1
IRMER.......................................................................................................................................................................................... 1
International Commission on Radiological Protection (ICRP)...................................................................................2
HK laws and regulations.......................................................................................................................................................... 2
HA Code of Practice................................................................................................................................................................. 2
Dosimertry................................................................................................................................................................................................. 2
Radiation Risk........................................................................................................................................................................................... 3
Radiation dose and Exposure................................................................................................................................................ 3
Radiation Effects........................................................................................................................................................................ 4
Guideline..................................................................................................................................................................................... 5
Radiation safety in Fluoroscopy........................................................................................................................................................... 5
Radiation Safety in CT........................................................................................................................................................................... 5
CT dose........................................................................................................................................................................................ 5
Radiation Safety in Use of Radioisotopes......................................................................................................................................... 6
Radioactive Wastes................................................................................................................................................................... 6
Protection of Pregnant women and Children.................................................................................................................................6
Pregnant Women...................................................................................................................................................................... 6
Breast-feeding Women........................................................................................................................................................... 8
Children....................................................................................................................................................................................... 8
Management of Radiation incidents.................................................................................................................................................. 8

REGULATIONS AND FRAMEWORK

IRR 1999
Applications =
 Electrical equipment at 5kV or above, and it emits ionizing radiation
 Substance cannot be disregarded for the purpose of radiation protection
 Radon-222 concentration above 400Bq/cm3 (averaged over 24hours)
Controlled areas
 Effective dose of any person of >6mSv in a year
o Or >45mSv to eyes, >150mSv to skin/ hands/ feet
 Accessible dose rate of 7.5 µSv / hr
Radiation protection supervisors (RPS)
 Instruct workers in radiation protection
 A description of the Controlled and Supervised Areas
 A risk assessment
 Provide a clear reference to prepared contingency plans

IRMER
Aim
 Safety and effective use of ionizing radiation when exposing patients
 Protects patients from unintended, excessive, incorrect exposure
Applications
 Medical diagnosis or treatment
 Occupational health surveillance
 Health-screening
 Medio-legal exposures
Optimization
 Responsibility of both practitioner and operator
 Optimization = keep doses as low as reasonably achievable (ALARA) consistent with intended outcome
ICRP (International Commission on Radiological Protection)
 Publish reports on guidance and recommendations on all aspects of radiation protection
o “Dose limit” does not apply to medical purpose radiation dose
o Three pillars of science, values and experience
 Maintain the International System of Radiological Protection – as basis for protection standards,
legislation, programs and practice
 Radiation protection of the environment
 Principles of justification and optimization for radiation protection in medicine

ICRP 118
 Occupational exposure = Dose limit for lens of eyes becomes 20mSv/year (on average over 5 years)
o No single year exceeding 50 mSv
 The threshold of radiogenic cataract = 0.5 Gy for acute or protracted exposure

ICP103
 Exposures
o Occupational exposure, Medical exposures, Public exposures
 Levels of Radiological Protection
o Source-related approach
 Optimization using dose constraints (planned) and reference levels (emergency)
o Individual-related approach
 Protection from all sources by dose limits
 Not applicable to medical exposures, public exposures in emergency situation and in
existing exposure situation

RADIATION ORDINANCE CAP 303

Dose limit
 Dose limit of general public = 1 mSv per year
 Whole body of worker = 20 mSv
 Abdomen of female worker = 5mSv (any consecutive 3 months interval)
 Material protection in case of static irradiating apparatus
o dose rate < 3 µGy per hour
licence
 Licenses have to be renewed every year.
 Radioactive substance
o Inside RS store room < 10 µSv/h
o Outside RS store room < 1 µSv/h
o All incidents of “Abnormal Occurrence” shall be reported to the Radiation Board within 48 hours
of the discovery of the incidents

HA Code of Practice
 Adequate protection = ALAR principle, plus <3/10 of dose limits
 Risk assessment and audits to be done at least once a year
 When shielding is provided, instantaneous dose rate should NOT exceed 3 µSv/hour
o Radiation level outside xray room is less than 3 µGv/hour
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  TLD badge to be worn all times on duty, and return monthly
Designation of areas
 Controlled areas = 3/10 annual dose limit (6mSv / year)
 Supervised Areas = >1/10 of annual dose limit for workers (2 mSv/year)
 Pregnant women should not be classified to work in controlled areas
 Classified workers – may receive a dose >6 mSv / transport of unsealed radioactive substance.

Dose limits for adult occupationally exposed workers

Therefore, occupational monthly dose limit is 1.67mSv/year

DOSIMERTRY
Radiation detectors
 Gas filled detectors – detect electric charge after gas ionized
o E.g. GM counter, ion chamber
 Scintillation detectors – detect light
o E.g. Gamma camera, contamination monitor
 Semiconductor detectors – electron-hole pairs
o E.g. Selenium flat panel detector
 TLD Thermoluminescent dosimetry
o Measure organ dose and effective dose directly

Dose-Area Product
 Measure amount of radiation that patient absorbs
 DAP is independent of (1) distance between Xray tube to measuring device, or (2) position
 For comparison of radiation dose with same type of exam
 Unit = dGycm2
o 200µGym2 = 20dGycm2

Entrance Surface Dose

 Unit = Gy
 Distance dependent (patient size dependent)
 Usually equals to dose to skin
 Also include scatter radiation from the body

Exposure index
 Actual detector dose level of a digital clinical radiograph
 Indicate a under-/over-exposed images
 Improve operator awareness

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RADIATION RISK
Radiation dose and Exposure
 Exposure – Unit: Roentgen
 Absorb dose – Unit: Gray (J/kg)
 Effective dose – Unit Sievert

Background dose and Common Imaging dosage

Effective dose
 Effective dose includes the radiation dose of the entire body and describes the risk of developing cancer.
 The effective dose is expressed in mSv (millisievert).
 The effective dose can be used to compare the relative risks of the various X-ray examinations.
Tissue Weighting Factors
 The tissue weighting factors can be used to estimate individual tissue/organ risks.

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ICRP Operational Dose Quantities for External Exposure
 Control of effective dose = taking dose equivalent to 10mm depth
 Control of dose to skin = dose equivalent to 0.07mm depth

Radiation Effects
Stochastic effect (Probabilistic)
Follow the Linear-no-threshold (LNT) theory:
 No minimum exposure is harmless
 No threshold dose for appearance
 Damages due to various episodes of exposure are accumulated
 Probability of risk is directly proportional to amount of exposure
 Severity of the effect is independent of the dose received
 A latent period is seen between time of exposure to the events to manifest
 Application to low radiation only

Deterministic effects
 The likelihood and severity of the effects are dose-dependent.
 From a certain threshold dose, the body is no longer able to repair the radiation-induced cellular damage.
 Usually applicable to short term effects after high radiation dose.

Harmful effects of Radiation

 Carcinogenesis
o IRCP estimation = 5.5% per Sv
 Hereditary effects (genetic mutations, chromosomal aberrations)
o 0.2% per Sv in general population
o 0.1% per Sv in working population

Guideline
X-ray facilities and Dose limit
 < 3 µSv / hr for public (including staff outside X-ray room)
 Outside door with door open – 0.1 µSv for 15s
Scatter radiation
 Keep a 3-feet distance from the patient
 I-131 have a dose rate of 20µSv/hr; and drop to 5µSv/hr after 10 days

RADIATION SAFETY IN FLUOROSCOPY

Dose reduction methods
 Minimize beam on time
o Continuous mode (3x) vs. Pulse mode (1x) vs. Cine mode (6x)
 Use tight collimation (to reduce scatter and for better contrast)
o Keep detector as close to patient as possible
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 o Tube as far as possible (at least FSD 30cm) to reduce skin dose
 Keep kVp as high as possible; and tube current (mA) as low as possible
 Minimize room lighting
 Close shutter for small object  reduction of 50% of dose
 Use of 0.1mm Cu plate + 1mm Al plate to reduce skin dose by 30-50% in pediatric setting
 Change projections angle for long procedures  reduce local skin dose
 Don’t overuse magnification

Radiation protection in Fluoroscopy

 Minimize bean-On time + field size
 Wear apron and use shielding to minimize exposure
o Table side shielding, mobile shields, overhead suspension shield
o For 100kV: not less than 0.25mm lead. For >100kV: not less than 0.35mm lead
o 0.5mm shield = >95% attenuation (i.e. 500-1000µSv/hr at 1m  25-50 µSv/hr)
 *Not as effective for high-energy Tc-99m gamma photons; only 70% of dose reduced
 Minimize scatter radiation by distance
o Inverse-square Law = 0.1% at 1m
o The focal-spot to skin distance should never be less than 30cm
 Avoid lateral projection (reduce dose by a factor of 5) ‘.’ Back scatter
 If cumulative skin dose is above 3Gy, FU in 10-14 days after exposure

RADIATION SAFETY IN CT
CT dose
 Relative dose of a CT compared to a CXR = 100-250 CXR

CT dose index (CTDI)

Indices
 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.
 CTDI has taken into account the peak dose, shape of dose profile,
 CTDIw is closer to the human dose profile as compared with the CTDI100
o 2/3 CTDI100 (periphery) + 1/3 CTDI100 (center)
 CTDIvol = CTDIw / pitch factor
o Pitch = table distance travelled in one 360degree gantry rotation divided by beam collimation
 Dose length product (DLP) = CTDIvol x scan length
o Scan length = number of rotations x distance travelled by couch/rotation
 Multiple Scan Average Dose (MSAD) = CTDI / pitch
o = average dose at a particular depth from the surface, resulting from a large series of CT slices
Practical points
 CTDI is for comparison purposes only
 CTDI does NOT represent actual absorbed or effective dose for the patient
 CTDI dose NOT measure the peak skin dose
Diagnostic reference levels (DRLs)

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  As an important item for optimization
 Quantities selected =
o Air kerma-area product (KAP),
o Entrance surface air kerma (ESAK),
o volume CT dose index (CTDIvol) and Dose-length product (DLP)
 Dose levels for typical examinations on standard size adults and children, broadly defined by types of
imaging (CT, fluoroscopy, Xray)
 To highlight unusual high radiation dose

Unsolved: #22, 23
 #22 –
 #23 – D (DLP) / E (MSAD)?

CT Dose reduction
 Decreased kVp and mA for decreased dose (with reasonable image quality)
 Faster gantry spinning
 X-ray beam filtration
 Bean fluence shaping
 Pre-patient collimation / shorter scanning distance
 High detector geometric efficiency

CT fluoroscopy
 high skin doses when scanning in the same place continuously
 entrance surface dose rates can range from 4 mGy/s to 9 mGy/s, they should be mindful of the
fluoroscopy time taken to reach a specified dose (e.g. 1 Gy)
 the time limit should be set such that the dose at the periphery position in a standard CTDI phantom
should NOT exceed 500mGy


RADIATION SAFETY IN USE OF RADIOISOTOPES

Radioactive Wastes
 Radioactive wastes are usually short-lived
 Disposure stored with a suitable period for decay
o Sharps contaminated with radioactivity
o Articles contaminated with radioactivity / infectious agents
o Food residue
o But NOT INCLUDE excreta from patients

PROTECTION OF PREGNANT WOMEN AND CHILDREN

Pregnant Women
 Termination of pregnancy – only consider if foetal dose >100mGy

Risk of radiation during pregnancy

 Most significant during early fetal period

Stage of gestations
 Pre-implantation (Day 1-10)
o Embryonic cells are rapidly growing, but not differentiating
o If exposed to radiation  all or nothing effects
 Organogenesis (Weeks 3-7)
o Limited dose of 100 mGy to prevent abortion, malformation etc.
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  Growth / fetal stage (Week 8 – birth)
o CNS is most sensitive from week 8-25 (mental retardation, microcephaly etc.)
 More sensitive in 8-15weeks
o Limited dose of 100mGy to prevent lower IQ
 1000mGy may lead to severe mental retardation / microcephaly

Radiation protection for Pregnant Women

ICRP 10-day rule and 28-day rule

Pre-conception irradiation of gonads

 NO apparent effect of radiation to gonads before conception
 High doses to ovaries / testes may result in sterilization
 General advices is to shield gonads for external radiation, but the benefit is small

Dose limit
 Set limit for occupational exposure to radiation = 1 mSv during whole period of pregnancy
 Foetal dose of 100mGy = 3 pelvic CT, 20 AXR

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Breast-feeding Women
 Many radionuclides concentrate in breast milk
 Total cessation of breast-feeding required for I-131
 No actions needed for other radionuclides = Tc-99m

Children
 Pregnant women should NOT be allowed to help during paediatric examinations
 Scaling factors needed to scale down activity by use of body weight
 High fluid intake, active bladder emptying  enhance elimination of gonadal and bladder dose
 Proper use of eye shield, gonadal shield and breast shield
 Thyroid blocking may be administered
Radiation harm to Children
 Exposure of young children, the risk is higher, by a factor of 2-5
o ‘.’ Longer life expectancy, developing organs more sensitive
 Radiation induced tumour = leukaemia, skin, thyroid, breast, brain tumours
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MANAGEMENT OF RADIATION INCIDENTS

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