Operational Health Physics Training (Moe)
Operational Health Physics Training (Moe)
Operational Health Physics Training (Moe)
Health
Physics
Training (Moe)
5-2
H20*+H" + OH",
in which the hydrogen radical H" has an unpaired e- and the OH" radical
will have nine e-, one of which will be unpaired. The free radicals are
very reactive chemically, and when combining can produce hydrogen peroxide
W202>, which is a chemical poison, and the HO" radical which is more
2
damaging than peroxide. Further effects are produced when the
radicals and ions interact with other cell material. In this way, damage
is caused in a direct and indirect manner. 2 The role that each type of
action plays in the total damage to the cell is still an unsolved problem.
Of the damage which is done, the effects are greatest in the nucleus of
the cell, but injury to the cytoplasm can also cause serious effects in
the cell.
The total effect on cell processes is a function of the dose of
radiation. The cell processes will be affected in varying degrees up to
the ultimate result-cell death. Some damage to the cell may be repaired.
This can be accomplished by action of the cell itself, or by replacement
of badly injured cells in a given tissue through mitosis of healthy cells.
On the other hand, if the extent of the damage to an organ is quite large,
Operational
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the organ may not be able to repair itself, That is, damaged cells may
show confused growth but eventually be unable to divide. Or the cells may
begin to exhibit uncontrolled growth. Although many factors are important
in assessing the total damage, it seems likely that most cell functions
and structures are somewhat impaired by radiation.
B. Radiosensitivity
Since the cells which make up the tissues of the body differ both in
appearance and function, one might suspect that their response to
radiation would also differ. Such is the case, and this property is known
as the radiosensitivity of the cell. The first statement about this
property was given by Bergonie and Tribondeau. They found that the
radiosensitivity of a tissue is directly proportional to the reproductive
capacity and varies inversely with the degree of differentiation. Since
then, other factors have been found which affect the radiosensitivity.
Among these are the metabolic state of the cell, the state of cell
division, and the state of nourishment. It turns out that to produce a
given effect, the necessary radiation dose varies inversely as the
relative sensitivity of the given tissue.
Thus, cells which are most active in reproducing themselves, cells
which have a high metabolic rate (rate of chemical changes) in the cell,
and those cells which are more nourished than others are more sensitive to
radiation. 4 Also, there is evidence that cells are more susceptible to
radiation at certain stages of division than at others. Moreover, cells
not fully mature will also be more harmed by radiation than mature cells.
In the body, bone marrow, lymphoid tissues, and the reproductive organs
rank among the most radiosensitive. Muscle and bone cells are the least
radiosensitive.
C. Radiation Damage
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80
20
0
DOSE (Gy)
Figure 5.1 Dose -effect relationship.
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dose to 50% of the exposed), is used. Moreover, since the time for an
effect to show up may also vary, the symbol LD50,30 (lethal dose to 50%
of the exposed within 30 days of irradiation) may be used.
Getting back to the dose-effect curve, we note that at D50,
half of the exposed would show the particular biological effect. This
means that a single value of the dose cannot adequately describe the
probability for &LJ individuals. That is, almost half of those exposed
show the effect for less than D50. On the other hand, half have not yet
shown the effect at D50. This type of statistical behavior is typical of
the response to radiation seen in mammals and implies a normal
distribution of sensitivity with respect to dose. 2
2. Tvne of Radiation
BE, and high LET radiation is more effective in producing damage then low
LET.
For low LET radiation (electrons), the ion density is low so
that recombination of ions and radicals is less likely. This allows ions
and radicals to diffuse through the medium easily to form other products.
This would increase the contribution of indirect effects. In addition, the
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DOSE
Figure 5.2 Survival curves for low LET and high LET radiation.
.
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3. Absorbed Dose
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5. Dose Distribution
6. Age At Irradiation
but are relatively radioresistant when mature. 7 Whereas, for the ovary,
sensitivity for sterility decreases with age. Damage to the germ cells is
of concern only during the period of child bearing. Some effects are ir-
relevant when the life expectancy of the individual is much less than the
latent period required for the effect to show up.
The somatic effects which are observed can be loosely divided into
early and late effects. Although quite an arbitrary grouping, early
effects are classed as those which appear within a few weeks after the
exposure. The range of these effects as well as their duration depend upon
the dose. For very high whole body doses, there are three basic forms of
early or acute damage. In the range above about 20 Gy (2000 rad), the dose
is fatal within a day or tw~.~ The same symptoms appear when the head
suffers severe irradiation, which points to a breakdown of the central
nervous system. This type of acute radiation syndrome is thus referred to
as central nervous svstem death (CNS death).
For the range 5-20 Gy (500-2000 rad), symptoms may appear within
hours. Death often occurs within a week or so. In this mode, the damage to
the lining of the intestinal tract is the most severe. This form is called
gastrointestinal tract death (GI death). At the lower end of this dose
range, it is possible for one to survive this mode of death only to fall
victim to the effects which prevail at lower doses.
At doses < 5 Gy (500 rad), the most important effect is damage to
the blood forming organs. Since these centers are located in the bone
marrow, this mode of death is often called bone-marrow death. The first
signs may appear within a few days, depending upon the dose, and the total
effect may not develop for a few weeks. Severe changes occur when the dose
is > 2 Gy (200 rad). In the range above 3 Gy (300 rad), the damage is
severe enough so that death becomes more and more probable.
In the preceding sections, the results are based on x and 7 ray
data. As such, the conversion to rem for other types of radiation is not
justified in this instance.
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The main clinical effects which follow acute exposure to total body
doses of ionizing radiation are nausea, vomiting, loss of appetite and
fatigue for doses > 1 Gy (100 rad) or so. 3 As indicated above, the time
of onset, the severity and the duration of the effects depend on the dose
and the exposed organs. A summary of clinical effects for acute doses is
given in Table 5.1 and may be used as a rough guide. Note the virtual
absence of any symptoms in the dose range below 1 Sv (100 rem). Some
people would be expected to have mild symptoms in the range 0.5-l Sv (50-
100 rem), because of differences among individuals. Below 0.5 Sv (50 rem),
however, no symptoms at all are expected. In fact, special techniques are
needed to detect doses this low. 4
Death occurs in a larger fraction of cases as the dose increases. If
the dose becomes large enough, all cases of exposure result in death. In
the range where survival is possible, the concept of the median lethal
dose (LD50) is used. For man, the best estimate places the LD50 in the
range of 3 to 5 Gy (300-500 rad). Of course, in this range all would have
severe symptoms. Note that this dose refers to short-term total body
radiation.
1. Cancers
Incidence of None
1 Sv: 5%
3 sv: 100% 100% 100% 100%
Vomltlng: 2 sv: 50%
Central
Leadlng Organ: None Hematopoletic Tissue G.I.Tract
Nervous System
Diarrhea, Fever,
Severe Leukopenla, Hemorrhage, Infection, Convulsions, Tremor,
Characterlstlc None Moderate Leukopenla Disturbance of
signs: Purpura, Epilatlon Above 3 Sv Electrolyte Balance Ataxla, Lethargy
Respiratory Failure
Cause of Death: Hemorrhage, Infection Circulatory Failure
Brain Edema
. . .. . .
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may be induced by radiation in nearly all human tissue. The main sites of
solid tumors are the breast in women, thyroid, lung and some digestive
organs. These tumors have long latent periods (approximately 10 to > 30
years) and occur in larger numbers than leukemia.6 Leukemia (abnormal
increase in white blood cells) has a much shorter latent period. The
incidence peaks within a few years of exposure and returns to normal
levels after about 25 years.l' Reference 6 contains an extensive
discussion on radiation induced cancers and presents data on the incidence
in specific organs. The ICRPl' has estimated that the fraction of all
cancers, for both sexes and all ages, is 1.25~10-~ Sv-l
(1.25~10~~ rem-l).
2. Tissue Effects
3. Life-span
Effects on the embryo depend upon the dose as well as the age
of the embryo. The younger the embryo, the more it is affected.1 Here,
as in the case of other late effects, the results of damage are the same
as those caused by other agents. The effects on the fetus are so much more
important since minor damage may be amplified during growth into a major
anomaly. Relatively high doses can cause death, malformation, growth
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G. Hereditarv Effects
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the harmful traits has made estimates of the magnitude of these effects
uncertain. When more diseases and effects can be related to certain types
of mutations, then better estimates can be made. -
Genes may be dominant or recessive. When genes differ-; the tr&-
which results may be determined by either gene_,. or some intermediate trait
may occur. If the trait is determined by one or the other of the genes,
this gene is then a dominant gene. The other is a recessive gene.
Mutations in dominant genes give rise to damage in the offspring of the
first generation. Damage to offspring caused by recessive genes occurs
only if the same altered gene is received from each parent. Unless these
changes occur frequently, recessive damage won't show up for many
generations.
It is estimated that already about 10% of human liveborn offspring
suffer from serious disorders of genetic origin. In evaluating radiation
induced genetic effects in humans, mouse data must be used.6 The
estimates of the increased serious genetic disorders in humans due to
radiation exposure are small relative to the natural incidence cited
above. That is, the ICRPl' has estimated that the fraction of effects to
be expected, in the first two generations, can be taken as about 4x
10q3 Sv-l (4x10m5 rem-l).
For some of the effects that have been mentioned, the relative
damage or severity of the effect increases with increased dose. Higher
doses produce . a greater degree of that type of damage. On the other hand,
for some effects, increasing the dose increases the chance, or probability
of the effect occurring. The terms "nonstochastic" and "stochastic"
effects have been employed by the ICRPl' to distinguish between these.
Nonstochastic effects are those in which the severity of the effect varies
with the dose. For these types of effects, a threshold dose may exist.
That is, if the dose is kept below the threshold dose, the effect will not
be observed. Nonstochastic effects are considered to result from the
collective injury of a substantial number of cells in the tissue. 7
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For more discussions on risk and risk factors, for both radiation
workers as well as risks in everyday living, one may consult References 11
and 12, respectively.
The ICRP makes a further point in their recommendations. They
recommend that all necessary exposures be kept as low as reasonably
achievable, taking into account economic and social factors. lo This part
of the recommendations is referred to as optimization. That is, achieving
the optimum net benefit such that the increased protection cost to reduce
exposures is balanced by the reduction in the expected harm (detriment).
with food and oxygen, and remove waste products. White cells help to
combat infections, and the platelets aid in blood-clotting action. Plasma
is a viscid liquid which contains water, proteins, salts, and free ions.
Blood contains about 45% red cells, approximately 1% white cells and
platelets, and 54% plasma.
Bone centers are filled with marrow, either red or yellow. Red
marrow is found in the skull, breastbone, ribs, pelvis, and spine of
adults. The red marrow provides the blood-forming function. Yellow marrow
provides fat storage.
White cells are the first to be affected by radiation. Although
there are subtypes of white cells which differ in their sensitivity, the
net effect of irradiation is to reduce the number of white cells. This
lack of white cells is known as leukopenia. For acute whole body doses > 1
Gy (100 rad), the maximum drop in the leukocytes is seen within 2-5 weeks.
The platelets drop in number somewhat more slowly. A few weeks later, a
loss of red cells (anemia) occurs.
The loss of white cells affects resistance to infection. The
drop in the platelet number affects clotting action, so that open wounds
may not heal. Anemia causes a general weakness in the individual. Recovery
will take place if the damage to the bone marrow is not too great. The
marrow will regenerate and produce new blood cells to replace the cells
which were lost. When the damage to the red marrow is too great, the
effects are likely to be permanent. The LD50j60 is not known precisely,
but is estimated to lie in the range 2.5-5 Gy (250-500 rad).
For fractionated or protracted doses, the effects are not as
severe due mainly to replacement and some repair. Although dose rate
influence on damage is not well known for humans, it is believed that the
blood forming system can withstand 3-10 Gy (300-1000 rad) if protracted
over several months. The threshold dose for nonstochastic effects is 2 Gy
(200 rad).
With respect to leukemia, the red bone marrow is believed to be
the main tissue involved. The risk factor is taken as 2~10~~
sv- 1 (2x10m5 rem-l).
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2. Lvmnhatic System
4. Renroductive Organs
5. Nervous Svstem
The nervous system, composed of the brain, spinal cord, and the
peripheral nerves, acts to coordinate body activity. The spinal cord and
peripheral nerves are highly radioresistant, but the brain is more
sensitive than often supposed. Lesions and functional impairment have been
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6. Thyroid Gland
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7. Eves
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8. Lungs
The lungs are cone-shaped organs made up of very small air sacs
called alveoli. When a person breathes, the air is directed down the
trachea (wind pipe). From there, two large tubes (bronchi) direct the air
toward each lung section. Many small tubes (bronchioles) branch out from
the bronchi to connect with the alveoli in the lungs.
During breathing, each air sac is expanded and compressed by
lung muscles, and is thus filled and emptied. Air passes through the walls
of the alveoli into tiny blood vessels (capillaries).
The effects produced in the lung by radiation are the result of
damage to the air sacs. The lungs are not normally affected by external
radiation. As in the case of the thyroid, the greater hazard occurs from
internal radiation from inhaled dust and vapors. However, when a major
portion of the lungs are irradiated at high dose, a fatal pneumonia may
result. The LD5() in man for acute exposure is about 8-10 Gy (800-1000
rad) for gamma rays. The damage which occurs is to the alveoli and the
lung blood vessels. The tissues of the upper respiratory tract are
relatively less radiosensitive. The threshold dose for nonstochastic
damage in the lung is 40 Gy (4000 rad).
Cancer of the lung has been observed in miners exposed to high
radon concentrations. There is also evidence that external irradiation can
induce lung cancer in man. The risk factor for lung cancer is 2~10~~
sv- 1 (2x10W6 rem-l).
10. Kidnevs
The heart and blood vessel system are damaged seriously only
for very high doses of radiation. The heart is not highly radiosensitive,
but can be damaged by doses in the range 40-60 Gy (4000-6000 rad). The
threshold for inducing inflammation of the lining surrounding the heart
(pericarditis) is 40 Gy (4000 rad). Blood vessels show damage after 40-60
Gy (4000-6000 rad). In many cases, vascular damage in advance of tissue
effects suggests that this is an important factor in tissue injury.
12. Skin
The degree of skin damage varies with the dose and the species
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13. Hair
14. Bones
growth may be seen. Mature bone in adults can withstand fractionated doses
of 65 Gy (6500 rad) in a 6-8 week period.
In adults, the developing bone cells lining the bone cavity are
the radiosensitive cells at risk with respect to cancer. The risk factor
is taken as 5~10~~ Sv-l (5~10~~ rem).
15. Muscle
16. Breast
REFERENCES
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11. Lapp, R.E. and Russ, G.D., RADIATION RISKS FOR NUCLEAR WORKERS,
Atomic Industrial Forum, Inc., Public Affairs and Information
Program, Washington, D.C. (1979).
12. Cohen, B.L. and Lee, I., A Catalog of Risks, Health Physics 36,
707-722 (1979).
BIBLIOGRAPHY
NCRP Report No. 64, Influence of Dose and its Distribution in Time on
Dose-Response Relationships for Low-LET Radiation, NCRP Publications,
Bethesda, MD (1980).
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NCRP Report No. 53, Review of NCRP Radiation Dose Limit for Embryo and
Fetus in Occupationally Exposed Women, NCRP Publications, Bethesda, MD
(1977) .
Cohen, B.L., Failures and Critique of the BEIR III Lung Cancer Risk
Estimates, Health Physics 42, 267-284 (1982).
ICRP Publication No. 18, The RBE for High-LET Radiations with Respect to
Mutagenesis, Pergamon Press, Oxford, England (1972).
NCRP Report No. 54, Medical Radiation Exposure of Pregnant and Potentially
Pregnant Women, NCRP Publications, Bethesda, MD (1977).
QUESTIONS
5.2 What are main component elements of the basic unit of structure in
the body?
5.3 What are the two principal parts of a cell? What does each part do?
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5.4 What tiny parts in the nucleus of a cell determine the hereditary
traits of a daughter cell? To what are they attached?
List A List B
5.7 Name two changes to atoms or molecules that will occur when radia-
tion passes through living cells.
5.8 What terms are given to the fragments of molecules that result from
radiation?
5.10 What term indicates that dose of radiation below which no effects
are observed?
5.14 Define the term "median lethal dose" and indicate its symbol. What
level of dose does this term represent in man?
5.18 List some of the qualitative results that apply to high LET and low
LET radiation.
. l
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5.24 List the three types of blood cells and the fluid that transports
them through the body. Indicate the principal function of each.
5.34 What organ of the body is easily damaged by radiation, but has a
tremendous capacity for repair?
5.36 Explain why the study of hereditary effects resulting from radiation
is difficult.
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PROBLEMS
5.1 The following table is adapted from the National Safety Council,
Accident Facts, 1979. Calculate the risk (the probability of death
per person/year) for each profession. How do these compare with
cancer risk due to radiation?
Number of Accidental
Occupation Deaths for 10,000 Workers
for 40 Years
a. Mining 252
b. Construction 228
C. Agriculture 216
e. Government 44
Answers: a. 6.3x10-4/person-year
b. 5.7x10-4/person-year
C. 5.4x10-4/person-year
d. 2.9x10-4/person-year
e. l.lx10-4/person-year
Answer: a) - 18 b)- 30