dr. Rita Zahara, Sp.

Ok
Application
Radiation is used in medicine in three ways
1. Diagnostic radiology
uses x-ray machines to obtain images of the inside of the patient's body
2. Nuclear medicine
uses radioactive substances introduced into the patient for diagnosis or treatment
3. Radiotherapy
uses high-power x-ray machines or radioactive sources to treat cancer
 RADIASI
• Suatu cara perambatan energi
dari suatu sumber ke lingkungannya

• Radiasi 2 jenis :
1. Radiasi mengion (ionizing
radiation
2. Radiasi tidak mengion (non-
ionizing radiation)
 RADIASI MENGION
(ionizing radiation)
- Energi besar (diatas 12 eV),
diakibatkan o/ disintegrasi
atom membentuk ion

- Radiasi mengion dibagi 2

1. Elektromagnetik : X-Ray,
gamma ray
2. Partikel : elektron, netron,
proton, alpha
Spektrum Gelombang Elektromagnetik
Sumber Pemaparan Radiasi
Mengion :
- Industri tabung sinar katoda
- Pembangkit tenaga nuklir
- Pertambangan
- Rumah sakit (kedokteran gigi,
umum, radiologi, lab.)
- Lembaga penelitian
- Pertanian
- dsb.
Aplikasi Radiasi
Radiation sterilization Polyethylene foam Glass craft

silicon to semiconductor
New chrysanthemum Radial tire
The airport body scanners
machines produce so little low intensity x-ray radiation that a person would have
to undergo 1,000 to 2,000 screens to receive radiation similar to one chest x-
ray.
Estimated dose of radiation/year, US

Source Dose/year (mSv)

- Radon 24
- Cosmic/outer space 0,27
- Terrestrial/earth 0,28
- Internal(K40,C14) 0,39
Total Natural 0,94

- Medical X-ray 0,39

- Nuclear medicine 0,14
- Consumer product 0,10
- Occupational 0,009
- Nuclear fuel <0,01
- Fallout: atomic weapon <0,01
- Miscellaneous <0,01
Total artificial <0,66
Kasus Chernobyl,
(Rusia, 27 April 1986 ) :
-Chernobyl Death Toll :
- 56 meninggal + 4.000 cancer fatalities
(996,000, in fact)

- International Nuclear and Radiation Event Scale

(INES) : Level 7 – Major Accident
Efek Radiasi Mengion :
Menyebabkan terjadinya kerusakan atom/ molekul yg
dilaluinya

Efek radiasi mengion 2 jenis :

1. Efek stokastik,
- Tergantung pd frekuensi pemajanan, tingkat
keparahan tidak tergantung pd dosis
- Contoh: mutagen (kerusakan gen/chromosom),
teratogen (cacat bayi dalam kandungan), dan
karsinogen (menyebabkan kanker).
2. Efek Non-stokastik/Deterministik
- Efek yg ditimbulkan tergantung pd frekuensi dan dosis
- Efek ini terjadi karena adanya kematian sel.
- Contoh : erythema pd kulit, katarak pd mata
 Efek Radiasi Akut
(Radiation Sickness)
- Mual, muntah, sakit kepala,erythema
(stlh 24 jam)
- Sakit perut, demam (2-3 hari)
- Diare, dehidrasi (minggu ke 2)
- Rambut rontok, lesu, demam, perarahan
(minggu ke 3)
- Jika gejala diatas semakin parah dpt timbul
perdarahan hebat yg menyebabkan kematian
(4-6 minggu setlh radiasi)
Victim of Chernobyl

a. Five-year-old Alec Zhloba from a town in Belarus is suffering from

leukemia. Some 70 percent of the fallout from the 1986 Chernobyl
disaster fell on Belarus.
b. These children live in a village not far from the Chernobyl nuclear plant.
Four years after the 1986 Chernobyl accident, these children are suffering
intestinal problems from exposure to radiation
At least 3 million children need physical treatment due to chernobyl
accident
Radiation burns
(28 days, 2400-4800 rad)
 Efek paparan radiasi oleh Ir-192 (185 GBq) selama
2 jam

Hari ke-5

Hari ke-21
Hari ke-11
Acute ulceration

3 days 10 days
Figures 1 & 2. acute ulceration in a Peruvian patient
who inadvertently placed a 26-Ci (0.962-TBq) irridiun-192
( 192 Ir) source in his back pocket, 3 days and 10 days
post exposure. The source remained in the patient's
pocket for approximately 6.5 hours (photos courtesy of Ricks RC and
reprinted with permission)
Radiation accident, Goiania, Brazil, Sept 13, 1987
Radiation accident, Goiania, Brazil, Sept 13, 1987
• Sumber : Ce-137
• symtoms: gastrointestinal and flu-like
symptoms, hair loss, malaise
• Korban : 112.800 orang dimonitor (sept-
Des 1987); 249 orang terkontaminasi(628)
4 meninggal 1st days, Total 60 org;
• Lingkungan : 2000 m2 terkontaminasi; 7 rumah
dihancurkan; 3500 m3 limbah;275 truk
• International Nuclear and Radiation Event Scale (INES) : Level 5 -
Accident with wider consequences
Goiania Radiation accident

a. radiotherapy unit in Goiania from which the cesium source was taken.
b. a tele-therapy unit
c. Goiania Olympic stadium where screening for cesium radiation exposure was performed
d. Contaminated rubble from a demolished house in Goiania, Brazil
a. Cesium-137 (60 died; 628 contaminated; over 6,000 exposed;
spread 100 miles away) source: GP,sept07
b. A graves of four Goiania residents who died from exposure to
radiation and were buried in lead coffins surrounded by concrete.
KECELAKAAN RADIASI PLTN FUKUSHIMA
11 March 2011 (2011-03-11)

• International Nuclear and Radiation Event Scale (INES) : Level 7- Major Accident
International Nuclear and Radiological Event Scale

(INES)

• 7 – Major Accident
• 6 – Serious Accident
• 5 – Accident With Wider Consequences
• 4 – Accident With Local Consequences
• 3 – Serious Incident
• 2 – Incident
• 1 – Anomaly
• 0 – Deviation (No Safety Significance)
Standar Pemajanan
Ambang batas yg direkomendasikan o/
International Commission on Radiological
Protection didasarkan pd dosis ekivalen yg
diterima oleh seluruh tubuh dalam
pemajanan/tahun, yaitu :

-20 mSv/tahun u/ tenaga kerja

-1 mSv/tahun u/ masy. Umum
(PP No.63/2000 ttg Keselamatan dan
kesehatan thd Pemanfaatan Radiasi Pengion)
Persyaratan proteksi radiasi

• Justifikasi :Tdk menerapkan

/menggunakan radiasi, kecuali jika
ada positive net benefit
• Optimisasi :Prinsip ALARA (as low as
reasonably achievable)
• Limitasi : Standar pemajanan/ Dosis
sesuai rekomendasi
 Pengendalian
- Isolasi peralatan dan daerah
radiasi dg penyekatan
- Maksimalisasi jarak, menjauhkan
TK dari sumber radiasi
- Membatasi waktu pemajanan
- Pemasangan pagar, label dan
tanda peringatan bhy radiasi
- Penggunaan APD(pakaian, kaca
mata, dsb.)
- Pelatihan dan pengawasan
- Emergency preparadness, kesiap-
siagaan jika terjadi keadaan
darurat
Radiation Shielding Material
Alpha dpt dihambat dengan bhn tipis, mis.
kertas atau lapisan luar kulit mati
Beta penyekatan dg bhn spt aluminium dan
plastik/Al dg ketebalan sp 1 cm
Gamma & Semakin tebal dan tinggi berat jenis
X-ray bhn, semakin besar intensitas radiasi
yg diserap. Pb / tembok beton
Neutron dihambat dg penyekatan bhn yg
mengandung kadar hidrogen tinggi,
shg bhn cair spt air, poliethilen,
parafin dsb. banyak digunakan
Risk factors
(Timbulnya kanker pd organ tubuh, menurut UN
Scientific Committee on the Effects of Atomic
Radiation- UNSCEAR)

Body organ Risk factor

- Gonads 1 x 10-2 / Sv
- Breast 2,5 x 10-3 / Sv
- Bone 5 x 10-4 / Sv
- Lung 2 x 10-3 /Sv
- Thyroid 5 x 10-4 /Sv
- Red bone marrow 2 x 10-3 /Sv
Examples of various tissues and their relative
radiosensitivities are listed below.
High Radiosensitivity
Lymphoid organs, bone marrow, blood, testes, ovaries, intestines
Fairly High Radiosensitivity
Skin and other organs with epithelial cell lining (cornea, oral cavity, esophagus,
rectum, bladder, vagina, uterine cervix, ureters)
Moderate Radiosensitivity
Optic lens, stomach, growing cartilage, fine vasculature, growing bone
Fairly Low Radiosensitivity

Mature cartilage or bones, salivary glands, respiratory organs, kidneys, liver,

pancreas, thyroid, adrenal and pituitary glands

Low Radiosensitivity
Muscle, brain, spinal cord
Effect of Radiation on Cells
• Inhibition of cell division
• Damage to chromosome (number of structure)
• Damage to genes (mutation)

Pemajanan radiasi dlm jaringan tubuh tergantung pd sifat

fisik dan kimia dr bahan radioaktif.
Contoh :
- Radioaktif iodine, umumnya mempengaruhi/terkonsentrasi
pd kelenjar thyroid;
- Strontium-90, mengendap pada tulang;
- Cesium, pd jaringan lunak
Setelah terakumulasi, konsentrasinya dpt menurun setelah
beberapa waktu melalui peluruhan atau proses biologi
(Iodine-131, waktu peluruhan 7 hr; plutonium-239, 24 000 th;
strontium-90, 28 tahun)
PERATURAN PERUNDANG-UNDANGAN
• UU No. 1/1970 ttg Keselamatan Kerja
• UU No. 10/1997 ttg Ketenaganukliran
• PP No.63/2000 ttg Keselamatan dan
Kesehatan thd Pemanfaatan Radiasi
Pengion
 Old & new radiation unit

quantity Old unit New unit Relationship

Activity Curie(Ci) Becquerel (Bq) 1Ci=3.7x1010Bq

Absorbed Rad (rad) Gray (Gy) 1 rad=0.01 Gy

dose
Dose Rem(rem) Sievert (Sv) 1 rem =0.01 Sv
equivalent
Konversi :
Dosis ekivalen = dosis absorbsi x quality factor
Sievert = Gray x QF
Rem = rad x QF

1 Gray = 100 rad = 1 J/kg

1 Sv = 100 rem
1 rad = 1.15 roentgen = 0,01 Gray
1 roentgen = 0,87 rad

Dosis radiasi : jml energi yg diserap oleh jaringan tiap

satuan massa pd tempat pengukuran( satuan rad )
 Hierarchy of Dose quantities
• Absorbed dose
(energy imparted by radiation to unit mass of tissue)

• Dose equivalent
(absorb dose weighted for harmfulness of different radiations)

• Effective dose equivalent

(dose equivalent weighted for susceptibility to harm of different
tissues/risk weighting factors)

• Collective effective dose equivalent

(effective dose equivalent to a group from a source of radiation)
RADIASI TIDAK MENGION
(Non ionizing radiation)
• Energi rel. rendah (<12 eV, tdk mengion)
• Spektrum radiasi elektromagnetik tdk
mengion
- Frekuensi : 3.105-3.1015 Hz
- Panjang gelombang : 103 m-102 nm
• Yg termasuk radiasi tdk mengion
- Frekuensi radio/TV
- Gelombang mikro
- Infra merah
- Sinar tampak
- Ultra violet
1. Gelombang mikro (Microwave)
• Spektrum :
- f : 3.108 Hz – 3.1011 Hz (0,3 - 300 GHz)
- Relatif tdk berbahaya pd pemajanan luar tp sgt
berbahaya jika tertelan/terhirup : 1m – 1 mm
• Sumber :
- alamiah : matahari, bumi, bulan
- buatan : satelit komunikasi, radar, hp, unit
diatermi, dapur peleburan logam/plastik
• Gel mikro : 3
- Frek. Ultra (ultra high frequency-UHF):0,3-3 GHz
- Frek Super (super high frequency – SHF): 3-30
GHz
- Frek Tertinggi (extra high frequency – EHF):30-
300 GHz
Efek Microwave thd Kesehatan
• Pengaruh termal dan non termal (medan EM,
molekuler dan modulasi)
• Pemajanan melalui proses absorbsi, dipantulkan,
dan dpt berpenetrasi ke dlm tubuh tergantung pd
panjang gelombang. Jaringan dg kandungan air >
akan memudahkan absrbsi gel mikro ke dlm
tubuh.
• Radiasi menyebabkan gangguan sistem syaraf,
gangguan reproduksi dan dugaan leukemia

Kasus :Koki pizza menderita kerusakan liver serius

akibat radiasi microwave oven (tanpa tutup
pelindung)
Standar pemaparan gel. mikro
Kepmenaker No. 51/men/1999 ttg NAB
faktor fisik di TK u/ radiasi gel mikro dg
frek. 3-300 GHz adl 10 mW/cm2 berlaku u/
pemajanan seluruh tubuh dari satu
sumber pemajanan a/ lebih untuk waktu
maksimum 6 menit
2. Infra Red
• Spektrum :
- f : 3.1011 – 3.1014 Hz
-  : 1 mm – 1000 nm
• Sumber : dapur peleburan, pengelasan,
lampu pemanas/pengering
• Efek kesehatan : Katarak pd mata, kulit
terbakar (dugaan : gannguan reproduksi,
sistem syaraf, jantung)
• Standar :10 mW/cm2 u/ radiasi infra red
dg  > 770 nm
3. Radiasi Sinar Tampak (visible spectrum)
• f : 3.1014 – 3,5.1014
 : 1000 nm – 500 nm

• Sumber : lampu, sinar/pengelasan, dapur

peleburan,

• Efek u/ lingkungan kerja : pencahayaan

kurang dan kesilauan (glare) : kelelahan,
ketdk nyamanan yg dpt menyebabkan
kecelakaan kerja
• Standar : Intensitas radiasi sinar tampak
10 mW/cm2 u/ 10.000 dtk (3 jam)
4. Ultra Violet
  : 400 nm -180 nm
f : 3,5. 1014 – 3.1015 Hz
• Sumber : sinar matahari, lampu
merkuri/halogen, las listrik, pemotong
logam
• Ultra violet dibagi 3, dari segi efek yg
ditimbulkan :
- UV-A : 400-300 nm, pigmentasi kulit
- UV-B : 320-280 nm, erythema pd kulit
- UV-C : 200-180 nm, katarak pd mata
Health effect
Pada kulit dan mata dimana energi radiasi diserap.

Acute :
- Pd mata Photokeratitis (inflamation of cornea)
dan conjunctivis
- Radiation burn (sunburn)
Chronic :
- Cataract(clouding of the lens)
- Premature ageing, keratosis (dry,spot on the skin)
- Skin cancer
Who is at risk?
- Outdoor workers (gardener, road
worker, building & construction
workers, surveyors, forestry workers,
agriculture workers, mining workers,
harbour workers, traffic officer
- Fair skin
Pengendalian
• Elimination
• Substitution with safer alternative
• Engineering control (reduction to
minimum level)
• Administrative control (job rotation, 10-
2pm; etc)
• PPE (clothing, sunglasses, creams SPF15+)
UV radiometer
• Australia has the highest incidence of
skin cancer in the world.
• 2 dr 3 Australian yg mencapai usia
75th diperkirakan menderita kanker
kulit
Skin cancer
1. Basal cell carcinoma (BCC)
- Sering dijumpai, bentuk yg rel. tdk berbahaya
- Benjolan di permukaan kulit (muka, leher)
2. Squamous cell carcinoma (SCC)
- Jarang ditemukan (20% kasus kanker kulit),
lebih berbahaya
- Kulit merah, melepuh/luka, dpt menjalar
3. Melanoma
- Paling jarang ditemukan (5% kasus), paling
berbahaya, sangat fatal
- Berawal dari tumor hasil sel yg berpigmentasi
di epidermis
Karsinoma Sel Basal
Exposure assessment
• Job tasks
• Hours of the day
• Availability of natural shade
• Feasibility of artificial shade (canopies,
etc)
• Rescheduling tasks where nat./art. shade
is inadequate
• Reorganizing work (indoor/outdoor)
• Availability of control option
5. Gelombang Radio/TV
• f : 3.105-3.108 Hz
 : 1000 m – 1 m

•Sumber : TV, radio, sistem komunikasi, radar

• Umumnya non thermal (medan listrik dan

Efek :

magnet) : gangguan sistem syaraf, jantung,

reproduksi, kanker pd anak2 (Dugaan;
percobaan binatang)
LASER
• Akronim: Light Amplification by
Stimulated Emission of Radiation
• Merambat pada satu arah panjang
gel. Sinar paralel, Koheren,
tekonsentrasi
• Bahaya: terutama pada mata, dan
kulit
• Jenis :Kristal ruby; Laser gas( CO2,
CO, HeNe, argon, Nitrogen,
krypton); semikonduktor
Aplikasi
- Operasi medis (bloodless
surgery), perawatan kulit
& gigi,
- Pengelasan, pemotongan,
pengeboran
- Komunikasi (via fiber
glass)
- Entertainment (laser light,
laser disc, hologram, dsb)
- Senjata laser
5 Klasifikasi LASER
(Standard internasional)
• Klas 1 : intensitas radiasi rendah, tanpa
resiko
• Klas 2 : intensitas rendah, memancarkan
radiasi tampak (400-700 nm)
• Klas 3A : intensitas lebih tinggi,
memancarkan radiasi tampak
• Klas 3B: intensitas tinggi, visible a/
invisible, immediate eye damage
• Klas 4: intensitas tinggi, berbahaya
Electric & Magnetic Field (EMF)
(Efek pada binatang/ percobaan
laboratorium)
• Nervous system;
• change in balance between white &
red blood cell
• Heart; Change in electrical hearth
activity
• Genetic effect; Infertility,
Chromosomal change
• Immune system
Studi pd manusia :
• Fewer children were born to workers exposed to high
voltage lines; 8% anak cacat dibanding 3% dari kontrol
group (Swedia)
• More death due to leukemia (confounding factor :
benzene )- USA
• 30 pekerja instansi listrik di Paris: kesehatan baik, bukan
perokok&peminum alkohol, 7 - 20 tahun masa kerja, alat
dosimeter setiap 30 detik mengunjukkan nilai paparan
elektromagnetik yang terjadi.
Hasil :penelitian ini dapat dinyatakan bernilai amat
meyakinkan yang membuktikan untuk pertama kalinya,
bahwa paparan spektrum elektromagnetik (teg. Tinggi)
yang berjalan terus-menerus dan kumulatif tidak
menimbulkan efek yang mengganggu (American Journal
of Physiology, June 2005)
• DR Sudarti (Univ Jember;Kompas 24 Jan 2006)
- SUTET mempengaruhi faktor psikis warga; rasa
tdkaman/depresi (suara berisik spt letusan yg
muncul malam hari krn arus listrik dg beban
puncak)
- Tidak berpengaruh langsung pada kesehatan
- Mempengaruhi kualitas suara dan gambar TV

Voltage Levels
• Low voltage lines : < 1000 V
• Medium voltage : 1000 V – 60 000 V
• High voltage : 60 000 – 150 000 V
• Extra High voltage : > 150 000 V
Dirty bombs contain radioactive material blown up
using conventional explosives, which disperse the
often highly poisonous radioactive substances
TERIMA KASIH