Radiation protection: why should we care

By Dr. M.Shoaib Khan Ghory

Consultant Radiologist Chiniot general hospital

What is Radiation
Radiation is a process in which energetic particles or energetic waves travel through a medium or space. The radiation can either be natural or artificial. Natural causes include the cosmic rays and natural radioactivity in our surroundings. Artificial sources include the nuclear reactors and the medical sources.

 Medical sources can further be divided into therapeutic and diagnositc. The diagnostic can again be loosely divided into xray sources and the gamma ray sources.

Discovery of X-rays On 8 Nov, 1895, Wilhelm Conrad Rntgen (accidentally) discovered an image cast from his cathode ray generator, projected far beyond the possible range of the cathode rays. Further investigation showed that the rays were generated at the point of contact of the cathode ray beam on the interior of the vacuum tube, that they were not deflected by magnetic fields, and they penetrated many kinds of matter.

The first radiograph

Radiation side effects

There are many examples of radiation induced damage: to the skin and the hands suffered by the early radiologists: excess leukemias in patients treated with radiation for ankylosing spondilitis; and radiation accidents in various parts of the world.

 Two types of radiation are commonly differentiated in the way they interact with normal chemical matter:

Ionizing and Non-ionizing radiation.

Ionizing vs Non ionizing The word radiation is often colloquially used in reference to ionizing radiation (i.e., radiation having sufficient energy to ionize an atom). Ionizing an atom means that an electron is completely removed from its shell. Both ionizing and non-ionizing radiation can be harmful to organisms and can result in changes to the natural environment. In general, however, ionizing radiation is far more harmful to living organisms per unit of energy deposited than non-ionizing radiation, since the ions that are produced by ionizing radiation, even at low radiation powers, have the potential to cause DNA damage.

 By contrast, most non-ionizing radiation is harmful to organisms only in proportion to the thermal energy deposited, and is conventionally considered harmless at low powers which do not produce significant temperature rise.

Biological effects
Two categories of radiation effect:
Somatic effects which occur in the individual exposed and Genetic or hereditary effects which occur in the descendants as a result of lesion in the germ line of the exposed person

Somatic effects can be further divided into

deterministic and the stochastic effects

Deterministic effects are directly related to the amount of radiation given and has a threshold level. Example are cataracts, skin damage, bone marrow cell loss and sterility.

 Stochastic effects occur when radiation doses are very small. Here the probability of effects not the severity increases with dose. There is no threshold for these effects.

A little bit of terminology

Absorbed dose: is a measure of the energy deposited in a medium by ionizing radiation per unit mass. It is measured as joules per kilogram and represented by the equivalent SI unit, gray (Gy). Equivalent dose: is a measure of the radiation absorbed by a fixed mass of biological tissue,that attempts to account for the different biological damage potential of different types of ionizing radiation. Effective dose: is the radiation dose to a part of the body which has the same effective danger or risk to a person or organism as the same equivalent dose of radiation to the whole-body.

 For example when radiation interacts with living tissue the effect it has varies with the type of radiation. Alpha rays are 20 times more effective than beta, gamma or X-rays at causing tissue damage. To allow for this, the dose in grays is multiplied by an effectiveness factor and the new units are called sieverts (abbreviation Sv) and the dose is called the equivalent dose

Steps taken for protection

System of radiation protection was proposed by the international commission on radiological protection (ICRP) which many countries have incorporated into their legislation. Much of the evidence which has led to today's standards derives from the atomic bomb survivors in 1945, who were exposed to high doses incurred in a very short time.

 Three fundamental principles

Justification Optimization limitation

 Justification. No practice should be adopted unless its introduction produces a positive net benefit. Optimization. All exposures should be kept as low as reasonably achievable, economic and social factors being taken into account. Limitation. The exposure of individuals should not exceed the limits recommended for the appropriate circumstances.

 National radiation protection standards are based on ICRP recommendations for both Occupational and Public exposure categories.

 In any country, radiation protection standards are set by government authorities, generally in line with recommendations by the International Commission on Radiological Protection (ICRP), and coupled with the requirement to keep exposure as low as reasonably achievable (ALARA) - taking into account social and economic factors.

 The ICRP recommends that the maximum permissible dose for occupational exposure should be 20 millisievert per year averaged over five years (ie 100 millisievert in 5 years, about 8 time average dose from natural background) with a maximum of 50 millisievert in any one year. For public exposure, 1 millisievert per year averaged over five years is the limit. In both categories, the figures are over and above background levels, and exclude medical exposure.

Responsibilities

As a
Physician Radiologist

Towards
Patient Co workers General public

 Justification
is the examination justified, if yes will the exposure benefit the patients diagnosis and the management.

Optimization
Is the correct examination chosen and the procedures followed so that the optimum diagnostic images is obtained.

Limitation
Is the staff adequately protected during the procedure.

Are the standard patient exposure below the national reference values. If the questions to these is in a YES then we have minimized the risk to the patient and the staff.