IAEA Standard Syllabus Course on Radiation Protection in Diagnostic and Interventional Radiology

RADIATION PROTECTION IN
DIAGNOSTIC AND
INTERVENTIONAL RADIOLOGY

L 0. Principles of Radiation Protection and

Motivation for the Course

IAEA
International Atomic Energy Agency
Introduction

• Subject matter motivation for radioprotection

and quality assurance in diagnostic and
interventional radiology
• Give an overview of different contributions of
radiation exposure, the principles of
radiation protection
• Specifity of the medical exposure

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 Is there
RADIATION
in this room?

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Radiation - We live with

Natural Radiation: Cosmic rays, radiation within our

body, in food we eat, water we drink, house we live
in, lawn, building material etc.
Human Body: K-40, Ra-226, Ra-228
e.g. a man with 70 kg wt. 140 gm of K
140 x 0.012%=
0.0168 gm of K-40
0.1 Ci of K-40
24,000 photons emitted/min
(T1/2 of K-40 = 1.3 billion yrs)

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K-40 Estimate for Lean Body Mass

• Body weight = Fat + lean body mass

• K-40 directly related to lean body mass
• Whole body counter used

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 Radiation - We live with

Earth: Top 1m of 0.1 acre garden

=1200 kg of K of which K-40 =1.28 Kg
= +3.6 Kg of Th + 1 Kg Ur
μGy/yr
New Delhi, India 700
Bangalore, India 825
Bombay, India 424
Kerala, India (in narrow
Coastal strip) 4000
Ramsar, Iran 10000
Guarapari, Brazil 8760

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Radiation - We live with
Food Radioactive levels (Bq/kg)
Daily intake
Ra-226 Th-228 Pb-210 K-40
(g/d)
Rice 150 0.126 0.267 0.133 62.4
Wheat 270 0.296 0.270 0.133 142.2
Pulses 60 0.233 0.093 0.115 397.0
Other
70 0.126 0.167 -- 135.2
Vegetables
Leafy
15 0.267 0.326 -- 89.1
Vegetables
Milk 90 -- -- -- 38.1
Composite
1370 0.067 0.089 0.063 65.0
Diet

Dose equivalent=0.315 mSv/yr

Total dose from Natural sources = 1.0 to 3.0 mSv/yr
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Radiation from Natural Sources

• Normally 1-3 mSv/year

• In areas of high background, 3-13 mSv/year

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 DO WE NEED
RADIATION
PROTECTION ?
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Drinking Hot Coffee

Excess Temperature = 60º - 37 = 23º

1 sip = 3ml
3x 23 = 69 calories

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Lethal Dose= 4Gy ra y
X

LD 50/60 = 4 Gy
For man of 70 kg

Energy absorbed = 4 x 70 = 280 Joules

= 280/418= 67 calories
= 1 sip

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 SO WE NEED
RADIATION
PROTECTION
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 Radiation

We live with Can kill

1-3 mSv 4000 mSv

Where to stop, where is the safe point?

What are the effects of radiation?

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What can radiation do?

Death
Cancer
Skin Burns
Cataract
Infertility
Genetic effects
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 CAN X RAYS
CAUSE
DEATH?
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 Deterministic effects
Effect

Cancer Cataract
Genetic infertility
Prob  dose erythema
epilation
Dose
500 mSv cataract
150 mSv for sterility (temporary-males)
2500 mSv for ovarian

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OBJECTIVES OF RADIATION
PROTECTION

• PREVENTION of deterministic effect

• LIMITING the probability of stochastic effect

HOW? Up to what point?

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Optimization

• Optimization balances diagnostic image

quality with dose to the patient.
• High dose >> High image quality
• Low dose may imply low image quality
• However, there are a range of doses where
image quality is clinically acceptable– want
to be in that range

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Optimizaiton

• Optimization is not ALARA

• A certain amount of radiation is needed to
provide the clinical image quality necessary
for diagnostic purposes

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Which Exposure is Optimum?

Little difference in
noise between 6
and 3 mGy,
6.0 mGy 3.0 mGy therefore 6 mGy is
too high.
0.6 mGy too noisy.
Optimum between
1.5 mGy 0.6 mGy
1.5 and 3.0 mGy.

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 OPTIMIZATION
principle
To what extent OPTIMIZATION ?
Over-stretching OPTIMIZA …………………… TION

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Features of some epidemiological studies of
radiation-induced cancer risks
Life Span Study Massachusetts Children in
(LSS) of Ankylosing tuberculosis patients Israel irradiated
Japanese atomic Spondylitis given chest for ringworm UK National Registry for
bomb survivors Study (ASS) fluoroscopies of the scalp Radiation Workers
Parameter (Shimizu et al) (Weiss et al) (Boice et al) (Ron et al) (Kendall et al)

Population 75991 14109 2573 10834 95217

size (with DS86 doses)

Period of 5-55 years Up to over Up to over 50 years Up to 32 years Up to 40 years

follow-up following exposure 50 years
(mean 25.2 (mean 30 years) (mean 26 years)
years)

Ranges of:
(a) ages at All Virtually all Under 15 to over 40 0-15 years 18-64 years
exposure  15 years
(b) sexes Similar numbers of 83.5% male Female Similar number of 92% male
males and females males and females
© ethnic Japanese Western (UK) Western (N. American) African and Asian Western (UK)
groups

Setting in War Medical:ther- Medical:diagnostic Medical:therapy Occupational

which IAEA apy for non- for non-malignant
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exposure malignant disease
 Features of some epidemiological studies of
radiation-induced cancer risks (cont.)
Life Span Study Massachusetts Children in
(LSS) of Ankylosing tuberculosis patients Israel irradiated
Japanese atomic Spondylitis given chest for ringworm UK National Registry
bomb survivors Study (ASS) fluoroscopies of the scalp for Radiation Workers
Parameter (Shimizu et al) (Weiss et al) (Boice et al) (Ron et al) (Kendall et al)

Range of All All (but Mainly breast & lung mainly brain, All
organs mainly those bone marrow,
irradiated in proximity thyroid, skin
to spine and breast

Availability Organ doses: Mean organ Organ doses: Brain, thyroid & Individual whole-body
of dose individual basis doses: indiv. Individual basis skin doses: external doses
estimates only for red individual basis
bone marrow
at present
Range dose Mainly 0-4 Gy Mainly 0-20 Gy Mainly 0-3 Gy Brain: 0-6 Gy Mainly 0-0.5 Sv
(mean 1.5 Gy) (mean 0.034 Sv)
Thyroid:0-0.5 Gy
(mean 0.09 Gy)
Dose rate High High High, but highly High Low
fractionated
Radiation Mainly low-LET Low-LET Low-LET Low-LET Mainly low-LET
Quality
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 Dose Limits (ICRP 60)
Occupational Public
Effective dose 20 mSv/yr averaged* 1 mSv in a yr
over 5 yrs.
Annual equivalent
dose to
• Lens of eye 150 mSv1 15 mSv
• Skin 500 mSv 50 mSv
• Hands & Feet 500 mSv

* with further provision that dose in any single yr > 30 mSv (AERB)
and =50 mSv (ICRP)
N.B.: M.P.D. 1931 = 500 mSv, 1947=150 mSv, 1977=50 mSv &
in 1990=20 mSvICRP
1
In a statement (Statement on Tissue Reactions Approved by the Commission on April 21, 2011) proposed a
limit of 20 mSv/yr, averaged over 5 years, not exceeding 50 mSv at any single year .

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Changes in Dose Limit (ICRP)
(Safe levels)
mSv
500

400

300

200

100

0
1931 1947 1977 1990

Year
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 WHAT IS
BASIS FOR
DOSE LIMITS?
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Epidemiological studies have proven that there is
an increased risk for cancer following exposure to
radiation

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 WHY
REDUCTION IN
DOSE LIMITS?
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 PRINCIPLES
OF
RADIATION
PROTECTION
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1. Justification of practices
2. Optimization of protection by
keeping exposure as low as
reasonably achievable
3. Dose limits for occupational

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 HOW TO APPLY
THESE PRINCIPLES IN
DIAGNOSTIC RADIOLOGY?

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 RADIOGRAPHY
How much time one works with radiation?

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Radiation ON Time

Workload=100 exposures/day
CxR = 50x50 m sec = 2500 = 2.5
LS = 50x800 m sec = 40000=40s
Total time = 45 sec/day
Not greater than 1 min/day

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 Staff Doses
Dose limit ICRP = 20 mSv/yr.

Radiography work  0.1 mS/yr.

i.e. 1/200th of
dose limit

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Radiation Doses in Radiological Exam.
(as multiple of chest X ray)
Relative Dose Received
mSv
.05 Arm, head,ankle & foot (1)
0.15 Head & Neck (3)
0.49 Head CT (10)
0.92 Thoracic Spine (18)
1.0 Mammography, Cystography (20)
1.22 Pelvis (24)
1.4 Abdomen, Hip, Upper & lower femur (28)
1.5 Ba Swallow (30)
1.7 Obsteric abdomen (34)
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)
4.0 Urography (87)
4.36 Angio-abdominal (120)
6.0 Chest CT (136)
6.8 Lower Abd. CT fem. (142)
Ba enema (154)
7.13
Lymphan. (180)
7.69
9.0 0 50 100 150 200
number of chest X rays
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 IS IT POSSIBLE TO GET
DETERMINISTIC EFFECTS IN
RADIOGRAPHIC WORK ?

For staff, for patient..??

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 Radiography
Risk of Staff Patient Public
Death No No No
Skin burn No No No
Infertility No No No
Cataract No No No
Cancer U U U
Genetic effect U U U

U: unlikely
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 FLUOROSCOPY
AND
CT

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Fluoroscopy and CT

Barium study: 3-6 min/pt x 8 patients/d

=40 min/d

ANGIOGRAPHY
• Diagnostic = 50 min/d
• Therapeutic = 2-5 hr/d

CT = 10-45 min/d

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Fluoroscopy (excl. inv angio)
Risk of Staff Patient Public
Death No No No
Skin burn No No No
Infertility No No No
Cataract No No No
Cancer U U U
Genetic effect U U U

U: unlikely
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Summary

1. Radiation we live with

2. Radiation that can be lethal
3. Radiation effects
4. Dose limits
5. Principles of protection
6. Application of protection principles in
diagnostic radiology

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