Veronica Ceselka

DOS 516- Fundamentals of Radiation Safety

The uptick in radiological imaging, therapy, and nuclear studies is now widespread in the
clinical aspect because the benefit for patients greatly exceeds the risks. While these innovative
practices have proven to be successful and helpful in diagnosing and treating patients with
various cancers and diseases, it’s important to address the radiation safety concerns associated
with these treatments. This essay aims to clarify the key radiation safety concerns and the steps
that radiation therapy departments must take to ensure the safety of their patients.
Medical radiation procedures account for more than 99% of radiation exposure from a
human made source.1 It is the responsibility of a healthcare worker to adhere to radiation
exposure limits and practice the basic but very affective practice of time, distance and shielding
when taking care of a patient. For example, distance can be practiced when dealing with
radioactive patients in that, exposure levels of x-ray photons emitted from a body decrease by 4-
fold when the distance from the patient is doubled (inverse square law). This practice along with
ALARA (as low as reasonably achievable), can ensure that a patient will be receiving the
minimal permissible dose possible while also maintaining great quality imaging and treatment. 1
Evolving technology has also improved diagnostic imaging and therapy techniques by allowing
for high quality images to be taken at lower doses.
A key concern for patient and public safety is the use of radioactive isotopes that remain
in the body and decay overtime. This procedure is highly regulated from the time the patient
steps foot into the nuclear or brachytherapy suite to the moment they are leaving the premise.
Even after that physicists have calculated doses exiting the patient to the public to make sure
they are not exceeding legal dose limits according to the International Commission on
Radiological Protection (ICRP) and the International Atomic Energy Agency (IAEA). 2,3
Radiation protection teams are set up in an institution to monitor and assess every patient that
receives internal isotopes.
Radiopharmaceuticals administered to a patient have been observed to eliminate from the
body very rapidly following injection or implantation and have greater dose fall off when the
patient leaves the facility. Typical isotopes used for PET scans, such as FDG, have short half-
lives, so 90% of all patient-emitted radiation is emitted during the first 6 hours of delivery and
tends toward 0 within the first 24 hours.3 Therefore, patients receiving positron emitting isotopes
Veronica Ceselka
DOS 516- Fundamentals of Radiation Safety
Patient and public safety in radiation therapy: A comprehensive analysis of radiation safety
concerns and protocols
have a low chance of exposing others when they leave the facility. In a study conducted by
Willegaignon et al., the highest doses emitted from patients to the public was that of 99mTc for
cardiac imaging that showed approximately 149 Sv at 1.0 m away from the patient. This dose is
nowhere near the established limit to the general public which is set at 1.0mSv. Even when they
recorded a dose at a shorter distance of 0.5m away from the patient they were still well under the
general public radiation limit with an estimated dose of 596 Sv (half of the general public limit
set by the ICRP and IAEA).3
An additional concern for patients is fluoroscopy, in which diagnostic radiation images
are taken over longer periods of time, in turn exposing the patient and workers longer. Using
wrap around lead shielding, ceiling suspended shielding, distance, and pulsed fluoroscopy are
methods a medical imaging professional can take to minimize exposure to themselves and others
around them.1 Regarding patient protection, Regan et al., discusses the implementation of a
Clinical Radiation Safety Office (CRSO) whose main goal is to establish a comprehensive
patient radiation dose monitoring program that aligns with Joint commission guidelines
especially for fluoroscopy. Thresholds released by the Joint Commission identified cumulative
dose windows as 6 months to 1 year and the sentinel event threshold for fluoroscopic procedures
as 1,500 rads or 15,000 mGy to a single anatomical area.1,2 The CRSO at the facility included a
patient follow-up and consultation process that allowed workers to track patients that went above
threshold levels in turn creating greater patient awareness for adverse radiation side effects on
the skin and improved patient care pre and post discharge.
Radiation is a powerful tool in the fight against many medical conditions however, its
success depends on the comprehensive approach to radiation safety. By addressing ionization
hazards and implementing extensive safety protocols the public’s fear of radiation can be put at
ease while ensuring the wellbeing of patients and those around them. Ongoing education, quality
assurance programs, and technological advancements are critical in maintaining the delicate
balance between effective treatment/medical imaging and patient radiation safety. As radiation
oncology and the world of medical imaging continues to evolve, a commitment to safety
standards will be paramount in realizing the full potential of radiation therapy for the benefit of
patients and their safety worldwide.
Veronica Ceselka
DOS 516- Fundamentals of Radiation Safety
Patient and public safety in radiation therapy: A comprehensive analysis of radiation safety
concerns and protocols

References:
1. Laquerre J. Radiation Safety for Radiologic Technologists. Radiologic Technology.
2021;92(5):469-483. Accessed December 7, 2023. https://search-ebscohost-
com.libweb.uwlax.edu/login.aspx?
direct=true&AuthType=ip,uid&db=rzh&AN=149810110&site=ehost-live&scope=site
2. Regan S, Clark J. Enriching a Culture of Radiation Safety Excellence Using a Patient
Radiation Dose Monitoring Program. Radiologic Technology. 2017;88(6):660-665.
Accessed December 7, 2023. https://search-ebscohost-com.libweb.uwlax.edu/login.aspx?
direct=true&AuthType=ip,uid&db=rzh&AN=123799444&site=ehost-live&scope=site
3. Willegaignon J, Pereira Fernandes SC, Alexandre Pelissoni R, Barbério Coura-Filho G,
Tatit Sapienza M, Alberto Buchpiguel C. Radiation safety measures in diagnostic nuclear
medicine, based on the potential radiation dose emitted by radioactive
patients. Radiologia Brasileira. 2023;56(1):13-20. doi:10.1590/0100-3984.2022.0064