Ch 10-14 Flashcards
Set of numeric dose limits that are based on calculations of the various risks of cancer and genetic (hereditary) effects to tissues or organs exposed to radiation
Effective dose (EfD) limiting system
An EfD limiting system has been incorporated into what title of the Code of Federal Regulations, Part 20, a document prepared and distributed by the U.S. Office of the Federal Register; the rules and regulations of the Nuclear Regulatory Commission (NRC) and fundamental radiation protection standards governing occupational radiation exposure are included in this document?
Title 10 of the Code of Federal Regulations
2 resources for the revised recommendations of the concept of radiation exposure and of the associated risk of radiation-induced malignancy
National Council on Radiation Protection and Measurements (NCRP) Report No. 116 International Commission on Radiological Protection (ICRP) Report No. 60
4 major organizations responsible for evaluating the relationship between radiation EqD and induced biologic effects and are also concerned with formulating risk estimates of somatic and genetic effects of irradiation
International Commission on Radiological Protection (ICRP) National Council on Radiation Protection and Measurements (NCRP) United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) National Academy of Sciences/National Research Council Committee on the Biological Effects of Ionizing Radiation (NAS/NRC-BEIR)
Evaluates information on biologic effects of radiation and provides radiation protection guidance through general recommendations on occupational and public dose limits Considered the international authority on the safe use of sources of ionizing radiation Composed of a main commission with 12 active members, a chairman, and 4 standing committees, which include committees on radiation effects, radiation exposure, protection in medicine, and the application of its recommendations Since its inception in 1928, it has been the leading international organization responsible for providing clear and consistent radiation protection guidance through its recommendation for occupational dose limits and public dose limits Only makes recommendations, does not function as an enforcement agency; each nation must develop and enforce its own specific regulations
International Commission on Radiological Protection (ICRP)
Reviews regulations formulated by the ICRP and decides ways to include those recommendations in US radiation protection criteria; nongovernmental, non-profit The council implements this task by formulating general recommendations and publishing their recommendations in the form of various reports Not an enforcement agency, enactment of its recommendations lies with federal and state agencies that have the power to enforce such standards after they have been established
National Council on Radiation Protection and Measurements (NCRP)
4 objectives of the NCRP
Collect, analyze, develop and disseminate in the public interest information and recommendations about (a) protection against radiation (referred to herein as radiation protection) and (b) radiation measurements, quantities and units, particularly those concerned with radiation protection Provide a means by which organizations concerned with the scientific and related aspects of radiation protection and of radiation quantities, units and measurements may cooperate for effective utilization of their combined resources, and to stimulate the work of such organizations Develop basic concepts about radiation quantities, units and measurements, about the application of these concepts, and about radiation protection Cooperate with the International Commission on Radiological Protection, the Federal Radiation Council, the International Commission on Radiation Units and Measurements, and other national and international organizations, governmental and private, concerned with radiation quantities, units and measurements and with radiation protection
Evaluates human and environmental ionizing radiation exposure and derives radiation risk assessments from epidemiologic data and research conclusions; provides information to organizations such as the ICRP for evaluation Another group that plays a prominent role in the formulation of radiation protection guidelines This group evaluates human and environmental ionizing radiation exposures from a variety of sources including radioactive materials, radiation-producing machines, and radiation accidents Uses epidemiologic data information acquired from the Radiation Effects Research Foundation and research conclusions to derive radiation risk assessments for radiation-induced cancer and for genetic (hereditary) effects
United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR)
Reviews studies of biologic effects of ionizing radiation and risk assessment and provides the information to organizations such as the ICRP for evaluation Another advisory group that reviews studies of biologic effects of ionizing radiation and risk assessment
National Academy of Sciences/National Research Council Committee on the Biological Effects of Ionizing Radiation (NAS/NRC-BEIR)
After radiation protection standards have been determined, responsible agencies must enforce them for the protection of the general public, patients, and occupationally exposed personnel
Regulatory agencies
5 U.S. regulatory agencies
Nuclear Regulatory Commission (NRC) Agreement states Environmental Protection Agency (EPA) U.S. Food and Drug Administration (FDA) Occupation Safety and Health Administration (OSHA)
Oversees the nuclear energy industry and enforces radiation protection standards, publishes its rules and regulations in Title 10 of the U.S. Code of Federal Regulations, and enters into written agreements with state governments that permit the state to license and regulate the use of radioisotopes and certain other material within the state Federal agency that has the authority to control the possession, use, and production of atomic energy in the interest of national security; also has the power to enforce radiation protection standards Does not regulate or inspect x-ray imaging facilities; its main function is to oversee the nuclear energy industry Supervises the design and working mechanics of nuclear power stations, production of nuclear fuel, handling of expending fuel, and supervision of hazardous radioactive waste material Controls the manufacture and use of radioactive substances formed in nuclear reactors and used in research, nuclear medicine imaging procedures, therapeutic treatment, and industry Licenses users of radioactive materials and periodically makes unannounced inspections to determine whether these users are in compliance with the provisions of their licenses Writes standards that are presented as rules and regulations Has the authority to enter into written contracts with state governments; these agreements permit the contracting state to undertake the responsibility of licensing and regulating the use of radioisotopes and certain other radioactive materials within the state
Nuclear Regulatory Commission (NRC)
Enforce radiation protection regulations through their respective health departments
Agreement states
Facilitates the development and enforcement of regulations pertaining to the control of radiation in the environment
Environmental Protection Agency (EPA)
Conducts an ongoing production radiation control program, regulating the design and manufacture of electronic products, including x-ray equipment To determine the level of compliance with standards in a given x-ray facility, it conducts on-site inspections of x-ray equipment Compliance with standards ensures the protection of occupationally and nonoccupationally exposed persons from faulty manufacturing
U.S. Food and Drug Administration (FDA)
Functions as monitoring agency in places of employment, predominantly in industry Regulates occupation exposure to radiation
Occupation Safety and Health Administration (OSHA)
Implementation of an effective radiation safety program begins with the administration of the facility; individuals in executive positions must provide the resources necessary for creating and maintaining such a program and can do what 3 things?
Delegate operation funds in the budget Oversee the development of policies and procedures Provide the equipment necessary for starting and continuing the program
3 functions of a radiation safety committee (RSC) mandated to be established by the facility by the NRC
Provides guidance for the program Facilitates ongoing operation of the program Selects a qualified person to serve as a radiation safety officer (RSO)
2 functions of an RSO
Oversee the program’s daily operation Provide for formal review of the program each year
4 things an RSO normally is
Medical physicist Health physicist Radiologist Other individual qualified through adequate training and experience
5 responsibilities of the RSO
Specifically responsible for developing an appropriate radiation safety program for the facility that follows internationally accepted guidelines for radiation protection Must ensure that the facility’s operational radiation practices are such that all people, especially those who are or could be pregnant, are adequately protected from unnecessary exposure To fulfill their responsibility, management of the facility must grant the RSO the authority necessary to implement and enforce the policies of the radiation safety program Review and maintain radiation-monitoring records for all personnel Be available to provide counseling for individuals
3 allowable pathways for a radiation safety officer to meet training and experience requirements
Certification by one of the professional boards approved by the NRC Didactic and work experience as described in detail in the regulations Identification as an authorized user, authorized medical physicist, or authorized nuclear physicist on the licence, with experience in the types of uses for which the individual has RSO responsibilities
Duties that requires the licensee to freely provide the RSO to perform
Identify radiation safety problems Initiate, recommend, or provide corrective action Stop unsafe operations involving by-product material Verify implementation of corrective actions
3 duties required that the licensee provide the RSO
Sufficient authority Organization freedom Management prerogative to perform certain duties
Law to protect the public from the hazards of unnecessary radiation exposure resulting from electronic products and diagnostic x-ray equipment
Radiation Control for Health and Safety Act of 1968
Code that applies to complete systems and major components manufactured after its effective date
Code of Standards for Diagnostic X-Ray Equipment
6 provisions included in the standards for diagnostic x-ray equipment
Positive beam limitation Appropriate minimal filtration of the x-ray beam to ensure an acceptable level of beam quality; filtration provides significant reduction in the intensity of very “soft” x-rays that contribute only to the added patient absorbed dose Ability of x-ray units to duplicate certain radiation exposures for any given combination of kVp, mA, and time to ensure both exposure reproducibility and linearity Inclusion of beam limitation devices for spot films taken during fluoroscopy; such devices should be located between the x-ray source and patient Presence of “beam on” indicators to give visible warnings when x-ray exposures are in progress and both visual and audible signals when exposure has terminated Inclusion of manual backup timers for AEC to ensure termination of the exposure if the automatic timer fails
Automatic limitation of the radiographic beam to the IR regardless of IR size
Positive beam limitation
Consistency in output in radiation intensity for identical generator settings from one individual exposure to the next The x-ray unit must be able to duplicate certain radiographic exposures for any given combo of kilovolts at peak (kVp), milliamperes (mA), and time May be verified by using the same technical exposure factors to make a series of repeated radiation exposures and then, observing with a calibrated ion chamber, how radiation intensity typically varies
Exposure reproducibility
A variance of what is acceptable for exposure reproducibility?
5% or less
Consistency in output radiation intensity at a selected kVp setting when changing from one mA and time combination to another (mAs); output of radiation that comes out The ratio of the difference in mR/mAs values between two successive generator stations to the sum of those mR/mAs values
Exposure linearity
What must exposure linearity be?
Less than 0.1 (cannot exceed 10%)
The protection from radiation exposure is as low as reasonably achievable when the expenditure of further resources would be unwarranted by the reduction of exposure that would be achieved The continuation of good radiation protection programs and practices which traditionally have been effective in keeping the average and individual exposures for monitored workers well below the limit Medical imaging personnel and radiologists share the responsibility to keep occupational and nonoccupational dose limits as low as reasonably achievable EfDs and EqDs should be well below maximal allowable levels Goal can usually be achieved through the employment of proper safety procedures performed by qualified personnel Procedures should be clearly described in a facility’s radiation safety program.
As Low as Reasonably Achievable (ALARA) Concept Optimization
What is the model for the ALARA concept?
The relationship between ionizing radiation and potential risk is assumed to be completely linear and without any threshold In the interest of safety, risk of injury should be overestimated rather than underestimated
Biologic effect and radiation dose are directly proportional
Linear
Each patient should get the right imaging exam, at the right time, with the right radiation dose FDA announced “the launch of a cooperative Initiative to Reduce Unnecessary Exposure from Medical Imaging” Working in conjunction with their partners, the FDA intends to take specific action By coordinating these efforts, the FDA will be able to “optimize patient exposure to radiation from certain types of medical exams, and thereby reduce risks while maximizing the benefits of these studies”
FDA “White Paper”
Provides federal legislation requiring the establishment of minimal standards for the accreditation of education programs for people who perform radiologic procedures and certification of such people Purpose of federal act is to ensure that standard medical and dental radiologic procedures adhere to rigorous safety precautions and standards Individual states are encouraged to enact similar statutes and administer certification and accreditation programs based on the standards therein Because no legal penalty exists for noncompliance, many states, unfortunately, have not responded with appropriate legislation
Consumer-Patient Radiation Health and Safety Act of 1981
To prevent the occurrence of serious radiation-induced conditions (acute and chronic deterministic effects) in exposed persons and to reduce stochastic effects in exposed persons to a degree that is acceptable in relation to the benefits to the individual and to society from activities that generate such exposures
Goal for radiation protection
2 all-inclusive categories encompass the radiation-induced responses of serious concern in radiation protection programs
Deterministic effects Stochastic (probabilistic) effects
Biologic somatic effects of ionizing radiation that can be directly related to the dose received that exhibit a threshold dose below which the response does not normally occur and above which the severity of the biologic damage increases as the dose increases When radiation-induced biologic damage escalates, it does so because greater numbers of cells interact with the increased number of x-ray photons that are present at higher radiation exposure Typically occur only after large doses of radiation but they could also result from long-term individual low doses of radiation sustained over several years; in either instance the cumulative amounts of such radiation doses are usually much greater than those typically encountered by a patient in diagnostic radiology
Deterministic effects
3 early deterministic effects
Erythema Blood changes (decrease pf lymphocytes and platelets) Epilation Acute radiation syndrome
3 syndromes of acute radiation syndrome (far more serious early deterministic consequences of radiation sickness)
Hematopoietic syndrome Gastrointestinal syndrome Cerebrovascular syndrome
Effects that usually occur within a few hours or days after a very high-level radiation exposure to a significant portion of the body
Acute radiation syndrome
Diffuse redness over an area of skin after irradiation
Erythema
Loss of hair
Epilation
6 late deterministic somatic effects that may occur months or years after high-level radiation exposure
Cataract formation Fibrosis Organ atrophy Loss of parenchymal cells Reduced fertility Sterility caused by a decrease in reproductive cells
Early and late deterministic somatic effects have a high probability of occurring when entrance radiation doses exceed what?
2 Gyt
The frequency of occurrence of high-dose deterministic effects follows what curve?
Nonlinear, threshold curve that is sigmoidal (S-shaped) with a threshold Not proportional to the dose
Mutational, nonthreshold, randomly occurring biologic somatic changes; chances of occurrence increase with each radiation exposure
Stochastic (probabilistic) effects
Changes to somatic cells that would affect the individual when the cells divide
Mutational
Changes to germ cells that would affect future generations
Genetic
2 examples of stochastic (probabilistic) effects
Cancer Genetic alterations
What curves may be used to demonstrate stochastic (probabilistic) effects?
Linear and the linear-quadratic dose-response curves
What is a genetic (hereditary) effect of radiation?
Mutagenesis
Irradiation of DNA of somatic cells leading to abnormalities in new cells as they divide in that individual
Mutagenesis
2 explicit objectives of radiation protection
To prevent any clinically important radiation-induced deterministic effect from occurring by adhering to dose limits that are beneath the threshold levels To limit the risk of stochastic responses to a conservative level as weighted against societal needs, values, benefits acquired, and economic considerations (ex: cancer)
Current radiation protection philosophy is based on the assumption that what relationship exists between radiation dose and biologic response?
Linear nonthreshold relationship
Probability of injury, ailment, or death resulting from an activity
Risk
Possibility of inducing a radiogenic cancer or genetic defect
Risk, in the medical imaging industry, after irradiation
_____ minimal safe dose exists
No
Current method for assessing radiation exposure and associated risk of biologic damage to radiation workers and the general public Concerns the upper boundary dose of ionizing radiation that results in a negligible risk of bodily injury or hereditary damage Upper boundary limits are designed to minimize the risk to humans in terms of deterministic and stochastic effects (upper limits do not include natural background and medical exposure) Upper boundary radiation exposure limits for occupationally exposed persons are associated with risks that are similar to those encountered by employees in other industries such as manufacturing, trade, or government, which are generally considered to be reasonably safe Radiation risks are derived from the complete injury caused by radiation exposure Includes, for the determination of EqD for tissues and organs, all radiation-vulnerable human organs that can contribute to potential risk, rather than only those human organs considered critical An attempt to equate the various risks of cancer and hereditary effects to the tissues or organs that were exposed to radiation
EfD limiting system
3 ways EfD limits may be expressed
Whole-body exposure Partial-body exposure Exposure of individual organs
The sum of what exposures is considered when EfD limits are established?
Both the external and internal whole-body exposures
The benefit obtained from any diagnostic imaging procedure must always be weighed against the ______ that is taken
Risk
The occupational risk associated with radiation exposure is generally estimated to be what chance of fatal accident over an entire career?
2.5%
Embryo-fetus in utero is particularly sensitive to radiation exposure; epidemiologic studies of atomic bomb survivors exposed in utero provided conclusive evidence of a dose-dependent increase in the incidence of severe mental retardation for fetal doses greater than approximately what?
0.4 Sievert (Sv)
Greatest risk for radiation-induced mental retardation occurred when the embryo-fetus was exposed how many weeks after conception?
8-15 weeks/first trimester
Any organ in the human body is vulnerable to damage from exposure to ionizing radiation Some organs are more sensitive to radiation than others Every organ is at some risk because of the assumed random nature of somatic or hereditary radiation-induced effects
Concept underlying radiation protection
Indicates the ratio of the risk of stochastic effects attributable to irradiation of a given organ or tissue (T) to the total risk when the whole body is uniformly irradiated Because various tissues and organs do not have the same degree of sensitivity to these effects, the system employed must compensate for the differences in risk from one organ to another
Tissue weighting factor (WT)
Published reports reflect the current position and recommendations of the NCRP on radiation protection standards
NCRP reports
What is the annual EfD limit for occupational exposure?
50 mSv
What is the cumulative EfD (cumEfD) limit for occupational exposure?
10 mSv x age
What is the annual EqD limit for occupational exposure to the lens of the eye?
150 mSv
What is the annual EqD limit for occupational exposure to localized areas of the skin, hands, and feet?
500 mSv
What is the annual EfD limit for continuous or frequent exposure to the public (ex: radiation therapy)?
1 mSv
What is the annual EfD limit for infrequent exposure to the public?
5 mSv
What is the annual EqD limits for the public to the lens of the eye?
15 mSv
What is the annual EqD limits for the public to localized areas of the skin, hands, and feet?
50 mSv
What is the annual EfD limit for education and training exposures (students) under the age of 18 years?
1 mSv
What is the annual EqD limit for education and training exposures (students) to the lens of the eye?
15 mSv
What is the annual EqD limit for education and training exposures (students) to localized areas of the skin, hands, and feet?
50 mSv
What is the monthly EqD limit for embryo and fetus exposures?
0.5 mSv
What is the EqD limit for embryo and fetus exposures during the entire gestation?
5.0 mSv
What is the annual negligible individual dose?
0.01 mSv
A radiation worker’s lifetime EfD must be limited to his or her age in years times 10 mSv
Cumulative effective dose (CumEfD) limit
2 sources of radiation EfD limits do not include
Radiation exposure from natural background radiation Medical procedures
2 exposures EfD limits include the possibility of
Internal exposure External exposure
The sum/total of both the internal and external equivalent doses
Effective dose (EfD)
2 deterministic effects of the embryo-fetus that are expected to be statistically negligible if the EqD remains at or below the recommended limit
Small head size Mental retardation
Provides a low-exposure cutoff level so that regulatory agencies may dismiss a level of individual risk as being of negligible risk
Negligible individual dose (NID)
Personnel dosimeter readings should be well below what of the maximum EfD limits, even for those technologists who receive the most exposure?
A tenth of the maximum EfD
Health care facilities, such as hospitals, establish their own internal limits that are set at levels far below the actual limits and are meant to trigger an investigation that should uncover the reason for any unusually high exposure
Action limits
How does the lead-lined metal diagnostic-type protective tube housing protect the patient and imaging personnel from off-focus, or leakage, radiation?
By restricting the emission of x-rays to the area of the useful, or primary, beam
X-rays produced in the anode but not at the focal spot Photons that pass through the housing because the lead shielding around the tube for practical reasons cannot be made perfect Radiation generated in the x-ray tube that does not exit from the collimator opening but rather penetrates the protective tube housing and, to some degree, the sides of the collimator
Off-focus/leakage radiation
X-rays emitted through the x-ray port tube window, or port
Useful, or primary, beam
The housing enclosing the x-ray tube must be constructed so that the leakage radiation measured at a distance of 1 m from the x-ray source does not exceed what when the tube is operated at its highest voltage at the highest current that allows continuous operation?
1 mGya/hr (100 mR/hr)
What is the radiographic examination table frequently made of?
Carbon fiber material
What is used to measure SID
A tape measure or laser
Distance indicators must be accurate to within what percent of the SID?
2%
Centering indicators must be accurate to within what percent of the SID?
1%
Most versatile device for defining the size and shape of the radiographic beam; most often used with multipurpose x-ray units Box shaped and contains the radiographic beam defining system
Light-localizing variable-aperture rectangular collimator
3 things that radiographic beam defining system consists of
Two sets of adjustable lead shutters mounted within the device at different levels A light source to illuminate the x-ray field and permit it to be centered over the area of clinical interest Mirror to deflect the light beam toward the patient to be radiographed
Mounted as close as possible to the tube window to reduce the amount of off-focus, or stem, radiation coming from the primary beam exiting at various angles from the x-ray tube window; reduces patient dose resulting from off-focus radiation
Upper shutters (first set of shutters)
4 x-ray beam limitation devices
Light-localizing variable-aperture rectangular collimator Aperture diaphragms Cones Cylinders
2 things x-ray beam limitation devices do
Confine the useful, or primary, beam before it enters the area of clinical interest, thereby limiting the quantity of body tissue irradiated Reduces the amount of scattered radiation in the tissue and prevents unnecessary exposure to tissues not under examination
All the radiation that arises from the interaction of an x-ray beam with the atoms of a patient or any other object in the path of the beam Compton interaction between the x-ray photons and electrons of the atoms within the attenuating object deflect x-ray photons from their initial trajectories; as a result, photons emerge from the object in all directions Greatly reduced in intensity relative to the incident beam; also quite weakened in energy and consequently in penetrability
Scatter radiation
2 benefits of restricting x-ray field size to include only the anatomic structures of clinical interest
Significant reduction in patient dose because less scatter radiation is produced by a smaller field size Improves the overall quality of the radiographic image
Mounted below the level of the light source and mirror and function to further confine the radiographic beam to the area of clinical interest Consists of two pairs of lead plates oriented at right angles to each other; each set may be adjusted independently so that an extensive variety of rectangular shapes can be selected
Lower shutters (second set of shutters)
The brightness of a surface; quantifies the intensity of a light source (i.e., the amount of light per unit area coming from its surface) Determined for measuring the concentration of light over a particular field of view Light emission
Luminance
What is the primary unit of luminance?
Candela per square meter (nit)
The sum of the cross-table and along-the-table alignment differences between the x-ray and light beams must not exceed what of the SID?
2%
Consists of electronic sensors in an IR holder that sends signals to the collimator housing; when activated, the collimators are automatically adjusted so that the radiation field matches the size of the IR May be activated with the turn of a key
Positive beam limitation (PBL)
Regulatory standards require accuracy of what of the SID with PBL?
2-3%
Simplest of all beam limitation devices Consists of a flat piece of lead with a hole of designated size and shape cut in its center; the dimensions of the hole determine the size and shape of the radiographic beam Different IR sizes and SIDs require aperture diaphragms of various sizes to accommodate them Placed directly below the window of the x-ray tube and confines the primary radiographic beam to dimensions suitable for covering a given size IR at a specified SID Limits field size, and thus the area of the body irradiated,
Aperture diaphragms
3 shapes of aperture diaphragm openings
Rectangular Square Round
Most common shape of aperture diaphragm
Rectangular
3 examinations aperture diaphragms are used in
Trauma radiographic imaging systems X-ray units designed specifically for chest radiography Dental radiographic units
3 specific areas/radiographic examinations cones are used for
Head (e.g., coned-down lat projection of the sella turcica, projections of the paranasal sinuses) Vertebral column Chest
Circular metal tubes that attach to the x-ray tube housing or variable rectangular collimator to limit the x-ray beam to a predetermined size and shape
Cones
Collimating device with the diameter of the upper end smaller than the diameter of the lower end
Flared metal tube
Collimating device with the diameter the same at both the upper and lower ends
Straight cylinder
Reduces exposure to the patient’s skin and superficial tissue by absorbing most of the lower-energy photons (long-wavelength or soft x-rays) from the heterogenous beam Increases the mean energy, or “quality,” of the x-ray beam aka “hardening” the beam; x-rays are more penetrating
Filtration
What is the effect of filtration on the absorbed dose to the patient?
Because filtration absorbs some of the photons in a radiographic beam, it decreases the overall intensity (quantity, or amount) of incident radiation The remaining photons, as a whole, are more penetrating and therefore less likely to be absorbed in body tissue Hence, the absorbed dose to the patient decreases when the correct amount and type of filtration are placed in the radiographic beam
2 types of filtration
Inherent Added
Filtration in the tube
Inherent filtration
3 examples of inherent filtration
Glass envelope encasing the x-ray tube Insulating oil surrounding the tube Glass window in the tube housing
The inherent filtration material amounts to approximately what aluminum equivalent?
0.5 mm aluminum equivalent
The light-localizing variable-aperture rectangular collimator provides an additional what amount of aluminum equivalent to the inherent filtration (the reflective surface of the collimator mirror provides most of this aluminum equivalent)?
1 mm aluminum equivalent