Radiation

Uses, Hazards & Protection

Dr. O. P. Gurjar
Associate Professor
Govt. Cancer Hospital,
M.G.M. Medical College, Indore
ominbarc@gmail.com
Radiation
Sources of Radiation
Use of Radiation
Radiation Effects
Radiation Safety
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 Radiation
The term radiation applies to the emission and propagation of energy
through space or a material

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Types of Radiation
 Radiation is classified in to two main categories
Non-ionizing radiation (can not ionize matter)
Ionizing radiation (can ionize matter)

 Ionizing radiation contains two major categories

Directly ionizing radiation (charges particles)
electrons, protons, alpha particles, heavy ions
Indirectly ionizing radiation (neutral particles)
photons, (x-rays, gamma rays), neutrons

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 Types of ionizing
radiation

Photon
EM radiation Particles

X-rays Gamma rays Electrons Ions Neutrons

EB β-rays

Commonly used in Protons, α-rays,

Medical Field heavy ions

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Initial History of Ionizing Radiation
 1895 X Rays discovered by Roentgen
 1896 First skin burns reported
 1896 First use of X Rays in the treatment of cancer
 1896 Becquerel: Discovery of radioactivity
 1897 First cases of skin damage reported
 1898 Ra222 discovered
 1902 First report of X Ray induced cancer
 1911 First report of leukaemia in humans and lung cancer from
occupational exposure
 1911 94 cases of tumour reported in Germany (50 being
radiologists)
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 Sources
of
Radiation

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Radiation has been there all the time ever since
the life began and even before that
Each of us is exposed to radiation from a variety of naturally
occurring sources. Most exposure comes from breathing radon
in the atmosphere (approx 1.26mSv/Yr).
 Cosmic rays (nuclear reactions in space or from our own sun)
 Terrestrial radiation (usually high in rocky mountain region;
Highest background radiation is in coastal belt of Kerala due
to thorium-containing monazite sand. (approx 13 mSv/Yr)
 People in some areas of Ramsar, a city in northern Iran,
receive an annual radiation absorbed dose from background
radiation that is up to 260 mSv/Yr.

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Internal exposure (radioactive materials which are present in
our body: carbon-14, hydrogen-3, strontium-90, potasium-40
and very small amount of uranium and thorium; concentration
of these materials in body depends on geographical region)

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Manmade sources
 Medical x-rays (Diagnostic and Therapeutic)
 Nuclear medicine procedures
 Consumer products (e.g. tobacco, watches with
luminous dials, color television etc.)
 Nuclear reactors
 Nuclear weapon testing
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Use of Radiation
in
Medical Field

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Interaction of Radiation with Matter

 There are mainly five types of interactions:

1. Coherent scattering

2. Photoelectric scattering (≤ 1 MeV)

3. Compton scattering (1 MeV to 10 MeV)

4. Pair production (=/> 1.02 MeV)

5. Photodisintegration (In high Z materials and E≈ 7 MeV)

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Radiodiagnosis
Photoelectric scattering (≤ 1 MeV)

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Diagram of an x-ray Tube

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Radiotherapy
Compton scattering (1 MeV to 10 MeV)

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Brachytherapy

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 External Beam Radiotherapy

Teletherapy machine having

Co-60 Source

Medical Linear Accelerator

With On-Board-Imaging system
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Gamma Knife
Having 201 Co-60 source

Cyber Knife with

6MV x-ray Photon Energy
& Imaging system

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Proton Therapy machine

PDD of Photon and Proton beam

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 Most Common is Linear Accelerator
Table: X-ray photon and electron energies in Linear Accelerators
Photons Electrons

4 MV (Dose maximum at 1.0 cm) 4 MeV (90% Dose at 1 cm, 80% Dose at 4/3 cm)

6 MV (Dose maximum at 1.5 cm) 6 MeV (90% Dose at 1.5 cm, 80% Dose at 2 cm)

10 MV (Dose maximum at 2.5 cm) 9 MeV (90% Dose at 2.25 cm, 80% Dose at 3 cm)

15 MV (Dose maximum at 2.8 cm) 12 MeV (90% Dose at 3 cm, 80% Dose at 4 cm)

18 MV (Dose maximum at 3.5 cm) 15 MeV (90% Dose at 3.75 cm, 80% Dose at 5 cm)

24 MV (Dose maximum at 4.0 cm) 18 MeV (90% Dose at 4.5 cm, 80% Dose at 6 cm)

21 MeV (90% Dose at 5.25 cm, 80% Dose at 7 cm)

Two to three photon energies are available along with 4 - 7 number

of above electron energies with a single Clinac 24
Diagram of Medical Linear Accelerator
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Different radiotherapy techniques
 Three dimensional conformal radiation therapy (3DCRT) technique

 Intensity Modulated radiation therapy (IMRT) technique

 Image Guided Radiation Therapy (IGRT) Technique

 Stereotactic radiation therapy (SRT)

 Stereotactic radiosurgery (SRS)

 Stereotactic body radiation therapy (SBRT)

 Volumetric modulated arc therapy (VMAT)

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Dose calculations algorithms
 Pencil Beam algorithm

 Anisotropic analytical algorithm (AAA)

 Acuros XB (AXB) algorithm

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Treatment procedure

Figure: (a) Patient immobilization using thermoplastic sheet and

(b) CT machine “Siemens SOMATOM Definition AS scanner”

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Figure: Treatment planning

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Figure: Patient setup verification
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Figure: Treatment plan delivery 33
Quantities and Units for
Radiation

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Quantities and Units for
Radiation
Exposure

Absorbed Dose

Equivalent Dose

Effective Dose

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Exposure X
Amount of ionization produced by
photons in air per unit mass of air.
1R = 2.58x10-4 C of charge per kg of air
SI unit of exposure is C/kg

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Absorbed dose D
the amount of energy deposited per
unit mass in any target material
applies to any radiation
1 Gy) = 1 joule/kg
old unit the rad = 0.01 Gy

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Equivalent Dose H
takes into account the effect of the
radiation on tissue by using a
radiation weighting factor WR
measured in Sievert (Sv)
old unit the rem = 0.01 Sv
H = D x wR

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 Radiation Weighting Factors (ICRP report 60)

NOTE: The ‘radiobiological effectiveness’ for different radiation types depends

on the endpoint looked at. The ICRP figures given on the previous slide apply
only for stochastic effects.
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Effective Dose E
Takes into account the varying sensitivity of
different tissues to radiation using the Tissue
Weighting Factors wT
Measured in sievert (Sv)
Used when multiple organs are irradiated to
different dose, or sometimes when one organ
is irradiated alone
E = Sumall organs (wT H) = Sumall organs (wT wR D)

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Tissue Weighting Factors (ICRP 60)

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Radiation Effects

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Radiation Effects
Ionizing radiation
interacts at the cellular
level:
 ionization
 chemical changes
 biological effect

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The target in the cell: DNA

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Radiation effects on humans
STOCHASTIC DETERMINISTIC
EFFECTS EFFECTS

CANCER
LENS INJURIES

HEREDITARY
DISORDERS IN THE SKIN INJURIES
DESCENDANTS

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Deterministic effects
 Due to cell killing
Severity of effect  Have a dose threshold -
typically several Gy
 Specific to particular tissues
 Severity of harm is dose
Dose dependent
threshold

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Examples of Deterministic effects
Skin erythema (skin reddening)
Epilation (loss of hair)
Kidney failure
Cataracts of the lens of the eye 2-10 Gy

Permanent sterility
 males 3.5-6 Gy
 females 2.5-6 Gy
Temporary sterility
 males 0.15 Gy
 females 0.6 Gy

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Depend on dose delivery mode:

single high dose most effective

fractionation increases threshold dose in most

cases significantly
decreasing the dose rate increases threshold in

most cases
Threshold may differ in different persons

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Stochastic effects
Probability of effect
Due to cell changes (DNA) and

proliferation towards a malignant

disease
Severity (example cancer) independent

of the dose dose

No dose threshold - applicable also to

very small doses

Probability of effect increases with dose

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Cancer induction: The most important stochastic effect for
radiation safety considerations
Hereditary: (genetic) - assumed stochastic incidence, however,
manifests itself in future generations

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Quantification of Stochastic Effects
Total lifetime risk of fatal cancer for general
population = 5% / Sv
Lifetime fatal cancer risk for cancer of :
bone marrow 0.5 % / Sv
bone surface 0.05 % / Sv
breast 0.2 % / Sv
lung 0.85 % / Sv
thyroid 0.08 % / Sv
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 Comment on Fetus/Embryo
Fetus/embryo is more sensitive to ionizing radiation than
the adult human
Increased incidence of spontaneous abortion a few days
after conception
Increased incidence
Mental retardation Deterministic effect
Microcephaly (small head size) especially 8-15 weeks
after conception
Malformations: skeletal, stunted growth, genital
Higher risk of cancer (esp. leukemia)
Both in childhood and later life
Stochastic effect
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 Pregnancy & Exposure
Abdominal & Pelvis Examination
Weeks from LMP
0-5 5+ to 25 25+ to End of Term
X-rays/CT can take place A Big No. A Radiologist may allow
Unless it is a Question of One or Two radiographs.
Life and Death

Dividing cells are more sensitive to radiation

Cells are not dividing. Major Organogenesis Major Organogenesis is

No Mitotic activity starts. High Mitotic over and cell division
Index slows down

Radio-sensitivity is Radio-sensitivity is Radio-sensitivity is Low

least Highest

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 Non-cancer Stochastic Effects of
Radiation
The data has been analysed to determine the non-cancer
mortality for those who died between 1950 - 1990.
A statistically significant increase with radiation dose has
been shown for:
Stroke
Heart Disease
Respiratory Diseases
Digestive Diseases

Shimizu T et al, Radiation Research, 1999; 152:374-389

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Radiation Doses
to Adults
from
common
Imaging
Examinations

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Summary
Cancer induction is the most significant risk from
exposure to ionizing radiation at low doses
Cancer induction is a stochastic effect

At high radiation doses also deterministic effects

play a role

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Radiation Safety

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ALARA
The linear extrapolation hypothesis has been
widely adopted in radiological protection and
has led to the formulation of the ALARA (As
Low As Reasonably Achievable) principle.

This states that exposure to radiation which

can be decreased without loss of critical
diagnostic information and without too much
expense or inconvenience should be reduced.

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Why Radiation Safety?
It is a repetitive job.
Long term effects are not known, only
predictive in nature (Random) but one thing is
certain: The higher the dose, the more is the
probability of occurrence of the effects.
Low dose area: means Dose Monitoring to
keep tab on the dose using TLD.
Accidents can not be eliminated but can be
minimized through Training and updates.
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Radiation Protection
1. It starts with the manufacturer

2. Radiation safety Devices and periodic testing of these

devices

3. Radiation Safety achievements (following AERB guidelines)

4. Work Practices of the users in the Department

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Radiation Monitoring Devices
Personnel radiation monitoring
dosimeters
- TLD badge
- Pocket dosimeter

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Survey meter

Gamma area monitor

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Objectives of Radiation Protection
1. To minimize radiation risk to the patient
2. To ensure adequate protection of personnel
operating radiation equipment
3. To ensure adequate protection of the public
near areas where radiation equipment is
operated.

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How to achieve these objectives
There are responsibilities of the radiographer/RT
technologist to use Safe practices
Responsibilities of the Hospital to make Radiation Safety
Devices available to the Staff.
Use of safe equipment –Installation of AERB Type Approval
by Owner/Hospital
Periodic Quality Assurance Performance of radiation
equipment following AERB guidelines.
Regular up-dates on safe practices and reviews of
responsibilities.

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Responsibilities of Radiographer/
RT-Technologist
1. Understand Radiation Safety like a thorough understanding of safe
working methods and appropriate techniques and procedures;

2. Recognize the radiation hazards associated with Radiation

exposure and take measures to minimize them;

3. Strive to reduce all patient exposures to radiation to the lowest

practical values

4. Participate fully in the established Quality Assurance program for

the facility

5. Follow the safety instruction of RSO and inform about each and
every matter related to machine problem / radiation safety

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Responsibilities of the Hospital
1. Make sure all regulatory compliances are met with.
2. Establish safe working conditions for staff
3. Ensure that Radiographers/Technologists employed, are trained
properly –proper AERB’s educational qualifications.
4. Implementing and maintaining a Quality Assurance program for the
facility & maintaining and keeping all records of the QA program.
5. Ensure that staff are made aware of the QA program and Radiation
Protection by follow up on adherence to Radiation safety.
6. Mandatorily implement the suggestions of RSO related to safe use
of radiation
7. Provide all the necessary QA / safety tools demanded by RSO; there
are certain instruments which are not mandatory as per AERB but
they must be in department for better quality in use of radiation for
diagnosis/radiotherapy
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Golden Rules: TDS & R

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Follow The Golden rule

Minimum

Maximize

Between the beam

and the operator

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Inverse Square Law: Radiation Fall Off
Source

2d

Doubling the distance

from the source divides the
dose by a factor of 4
D/22

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The R of Radiation Protection

R stands for rotation

Rotate the staff
Divide the radiation load

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Radiation Safety Devices
(Radiology)

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Protective barriers Pb
Glass

Use of Movable protective

barriers provide protective
position during x-ray
examinations.

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 Radiation Safety: Use RP Devices
Use of Radiation safety devices
for
 self,
patients & attendents
(when required)

Pb Aprons

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Thyroid Shield

Pb goggles

Cieling suspended Pb
Glass usually found in
Cath labs
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Protection tools

SCREEN AND
CURTAIN
GOGGLES
THYROID

Make sure all the necessary protective tools come with the
machine 77
Make good use of them !!
Work Culture
The Door is lead lines
but it is open
Patient in Changing
Room
Exposes the Waiting
members of public

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 Correct Use of thyroid Shield
The shield should cover
the neck properly
A loose thyroid shield
may not actually be a
shield.

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 ALARA

Good use of
Good use
Collimation
of
Distance
Good Use of
Pb Apron

Good Use of
Chord
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 Signage is important
To caution or warn about the presence of radiation in
the vicinity.

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Signage is information for patient

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Signage

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 Thank You
for
Your Attention

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Dose Limits
The limits on effective dose apply to the sum of effective
doses from external and internal sources excluding the
exposures due to natural background radiation and
medical exposures

Workers:
The occupational exposure of any worker shall be so
controlled that the following limits are not exceeded:

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 an effective dose of 20 mSv/y averaged over five
consecutive years (calculated on a sliding scale of five
years);
 an effective dose of 30 mSv in any year;
 an equivalent dose to the lens of the eye of 150 mSv in a
year;
 an equivalent dose to the extremities (hands and feet) of
500 mSv in a year;
 an equivalent dose to the skin of 500 mSv in a year;
 limits given above apply to female workers also. However,
once pregnancy is declared the equivalent dose limit to
embryo/fetus shall be 1 mSv for the remainder of the
pregnancy.
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Trainees
The occupational exposure of apprentices and trainees
between 16 and 18 years of age shall be so controlled that
the following limits are not exceeded:
 an effective dose of 6 mSv in a year;
 an equivalent dose to the lens of the eye of 50 mSv in a
year;
 an equivalent dose to the extremities (hands and feet) of
150 mSv in a year;
 an equivalent dose to the skin of 150 mSv in a year.

Note: Apprentices and trainees in radiation facility, if any,

shall be of age above 16 years only.

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Public
The estimated average doses to the relevant members
of the public shall not exceed the following limits:
 an effective dose of 1 mSv in a year;
 an equivalent dose to the lens of the eye of 15 mSv in a
year; and
 an equivalent dose to the skin of 50 mSv in a year.

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X-ray Room
• No Occupancy
above or below
• On Slab 1/8 inch lead
(blue)
Leakage
• Shielding should
be floor to 7’ 60.0"

• 1/16 inch thick Scatter

Switch
secondary, 1/8 Location 42
"
inch thick
primary
1/16 inch lead
(red)

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Radiotherapy Room Design

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Telecobalt Installation

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6MV Accelerator Installation

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15MV Accelerator Installation

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Ir-192 HDR Brachytherapy Installation

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Co-60 HDR Brachytherapy Installation

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Radiology Room Design

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