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RADIATION PROTECTION IN DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY

IAEA Standard S yllabus C ourse on Radiation Protection in D iagnostic and I nterventional R adiology RADIATION PROTECTION IN DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY L 0. Principles of Radiation Protection and Motivation for the Course Introduction

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RADIATION PROTECTION IN DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY

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  1. IAEA Standard Syllabus Course on Radiation Protection in Diagnostic and Interventional Radiology RADIATION PROTECTION INDIAGNOSTIC ANDINTERVENTIONAL RADIOLOGY L 0. Principles of Radiation Protection and Motivation for the Course

  2. 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 Introduction to Radiation Protection in Diagnostic Radiology

  3. Is there RADIATION in this room? Introduction to Radiation Protection in Diagnostic Radiology

  4. 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-4 28,000 photons emitted/min (T1/2 of K-40 = 1.3 billion yrs) Introduction to Radiation Protection in Diagnostic Radiology

  5. 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 Introduction to Radiation Protection in Diagnostic Radiology

  6. 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 Gy/yr New Delhi 700 Bangalore 825 Bombay 424 Kerala 4000 (in narrow coastal strip) Introduction to Radiation Protection in Diagnostic Radiology

  7. Radiation - We live with Dose equivalent=0.315 mSv/yr Total dose from Natural sources = 1.0 to 3.0 mSv/yr Introduction to Radiation Protection in Diagnostic Radiology

  8. Radiation from Natural Sources • Normally 1-3 mSv/year • In areas of high background, 3-13 mSv/year Introduction to Radiation Protection in Diagnostic Radiology

  9. DO WE NEED RADIATION PROTECTION ? Introduction to Radiation Protection in Diagnostic Radiology

  10. Drinking Hot Coffee Excess Temperature = 60º - 37 = 23º 1 sip = 3ml 3x 23 = 69 calories Introduction to Radiation Protection in Diagnostic Radiology

  11. Lethal Dose= 4Gy X-ray LD 50/60 = 4 Gy For man of 70 kg Energy absorbed = 4 x 70 = 280 Joules = 280/418= 67 calories = 1 sip Introduction to Radiation Protection in Diagnostic Radiology

  12. Introduction to Radiation Protection in Diagnostic Radiology

  13. SO WE NEED RADIATION PROTECTION Introduction to Radiation Protection in Diagnostic Radiology

  14. Radiation We live with 1-3 mSv Can kill 4000 mSv Where to stop, where is the safe point? What are the effects of radiation? Introduction to Radiation Protection in Diagnostic Radiology

  15. What can radiationdo? Death Cancer Skin Burns Cataract Infertility Genetic effects Introduction to Radiation Protection in Diagnostic Radiology

  16. CAN X-RAY CAUSE DEATH? Introduction to Radiation Protection in Diagnostic Radiology

  17. Deterministic effects Effect Cancer Genetic Prob  dose Cataract infertility erythema epilation Dose 500 mSv cataract 150 mSv for sterility (temporary-males) 2500 mSv for ovarian Introduction to Radiation Protection in Diagnostic Radiology

  18. OBJECTIVES OF RADIATION PROTECTION • PREVENTION of deterministic effect • LIMITING the probability of stochastic effect HOW? Up to what point? Introduction to Radiation Protection in Diagnostic Radiology

  19. OPTIMIZATION principle To what extent OPTIMIZATION ? Over-stretching OPTIMIZA …………………… TION Introduction to Radiation Protection in Diagnostic Radiology

  20. 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 apy for non- for non-malignant exposure malignant disease was received disease Introduction to Radiation Protection in Diagnostic Radiology

  21. 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 Introduction to Radiation Protection in Diagnostic Radiology

  22. Occupational Public Effective dose 20 mSv/yr averaged* 1 mSv in a yr over 5 yrs. Annual equivalent dose to Lens of eye 150 mSv 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 mSv Dose Limits (ICRP 60) Introduction to Radiation Protection in Diagnostic Radiology

  23. Changes in Dose Limit (ICRP) (Safe levels) mSv Year Introduction to Radiation Protection in Diagnostic Radiology

  24. WHAT IS BASIS FOR DOSE LIMITS? Introduction to Radiation Protection in Diagnostic Radiology

  25. WHY REDUCTION IN DOSE LIMITS? Introduction to Radiation Protection in Diagnostic Radiology

  26. PRINCIPLES OF RADIATION PROTECTION Introduction to Radiation Protection in Diagnostic Radiology

  27. Justification of practices • Optimization of protection by keeping exposure as low as reasonably achievable • Dose limits for occupational Introduction to Radiation Protection in Diagnostic Radiology

  28. HOW TO APPLY THESE PRINCIPLES IN DIAGNOSTIC RADIOLOGY? Introduction to Radiation Protection in Diagnostic Radiology

  29. RADIOGRAPHY How much time one works with radiation? Introduction to Radiation Protection in Diagnostic Radiology

  30. 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 Introduction to Radiation Protection in Diagnostic Radiology

  31. Staff Doses Dose limit ICRP = 20 mSv/yr. Radiography work  0.1 mS/yr. i.e. 1/200th of dose limit Introduction to Radiation Protection in Diagnostic Radiology

  32. Relative Dose Received mSv Arm, head,ankle & foot (1) .05 Head & Neck (3) 0.15 0.49 Head CT (10) 0.92 Thoracic Spine (18) Mammography, Cystography (20) 1.0 Pelvis (24) 1.22 Abdomen, Hip, Upper & lower femur (28) 1.4 Ba Swallow (30) 1.5 Obsteric abdomen (34) 1.7 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) Angio-head, Angio-peripheral (80) 3.8 Urography (87) 4.0 Angio-abdominal (120) 4.36 Chest CT (136) 6.0 Lower Abd. CT fem. (142) 6.8 Ba enema (154) 7.13 Lymphan. (180) 7.69 9.0 0 50 100 150 200 number of chest x-rays Radiation Doses in Radiological Exam. (as multiple of chest x-ray) Introduction to Radiation Protection in Diagnostic Radiology

  33. IS IT POSSIBLE TO GET DETERMINISTIC EFFECTS IN RADIOGRAPHIC WORK ? For staff, for patient..?? Introduction to Radiation Protection in Diagnostic Radiology

  34. Radiography Risk of Staff Patient Public Death Skin burn Infertility Cataract Cancer Genetic effect × × × × U U × × × × U U × × × × U U U: unlikely Introduction to Radiation Protection in Diagnostic Radiology

  35. FLUOROSCOPY AND CT Introduction to Radiation Protection in Diagnostic Radiology

  36. Fluoroscopy 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 Introduction to Radiation Protection in Diagnostic Radiology

  37. Fluoroscopy (excl. ther angio) Risk of Staff Patient Public Death Skin burn Infertility Cataract Cancer Genetic effect × × × × U U × × × × U U × × × × U U U: unlikely Introduction to Radiation Protection in Diagnostic Radiology

  38. Summary • Radiation we live with • Radiation that can be lethal • Radiation effects • Dose limits • Principles of protection • Application of protection principles in diagnostic radiology Introduction to Radiation Protection in Diagnostic Radiology

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