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Year 1: Radiation Protection > Overall > Flashcards

Overall Flashcards

1
Q

What are the two types of radiation monitoring instrument?

A

Area survey meters (area monitors) and personal/individual dosimeters

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2
Q

What is the absorbed dose, its units and what does it not consider?

A

Energy per unit mass, Gray and doesn’t consider different types of radiation or biological effects

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3
Q

Which type of dose is the basic quantity in radiation protection and which type is related to risk?

A

Equivalent dose for protection and effective dose for risk

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4
Q

What weighting factor does equivalent dose include in its calculation?

A

Radiation-weighting factors to account for the specific type of radiation

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5
Q

What is the effective dose?

A

Weighted sum of mean equivalent doses to organs (who body quantity) including organ weighting factors

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6
Q

What is the unit for equivalent and effective dose?

A

Sieverts (J/kg)

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7
Q

Is equivalent dose referring to a particular organ/tissue or whole body dose?

A

Particular organ/tissue

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8
Q

Which types of radiation have a radiation-weighting factor of 1?

A

X-rays, gamma rays and electrons

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9
Q

What are the radiation weighting factors for protons and alpha particles?

A

5 for protons and 20 for alphas

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10
Q

Is the effective dose directly measurable?

A

No

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11
Q

Operational quantities are used for practical measurements as a substitute for what?

A

Effective dose

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12
Q

What is the concept of operational quantities?

A

Based on the dose equivalent to that point and relate to the type and energy of the radiation

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13
Q

What are the three types of operational dose quantities?

A

Ambient dose equivalent, directional dose equivalent and personal dose equivalent

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14
Q

What dose quantity is the skin dose limit in IRR17?

A

Equivalent dose

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15
Q

When do you do a radiation survey?

A

Verifies construction and part of prior risk assessment

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16
Q

What factors need to be considered for the choice of instrument?

A

Radiation type (including energy), dose rate, duration and geometrical precision

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17
Q

What are the four types of detector technologies?

A

Film, gas, scintillation detectors and semiconductor detectors

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18
Q

What are examples of gas detectors?

A

Ionisation chambers, proportional counters and Geiger Muller tubes (saturation detector)

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19
Q

What does traditional film contain?

A

Silver bromide crystals on a cellulose base

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20
Q

How does an image form on traditional film?

A

Radiation releases free silver to form a latent image that can be seen after developing it

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21
Q

What are the advantages and disadvantages of film?

A

Advantages: high spatial resolution, 2D dose map, permanent, no electrical connections
Disadvantages: processing required, specific range of doses, different energy response than tissue

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22
Q

How do gas detectors work?

A

Positive and negative electrodes to make an electric field and ions are attracted to electrodes and then coulombs (current) can be converted to dose

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23
Q

In gas detectors, when could secondary ionisation occur?

A

If the field is strong enough

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24
Q

What features changes the gas detector type?

A

The amount of applied voltage across the electrodes

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25
Q

There are 6 regions of increasing applied voltage for gas filled detectors, what are they called?

A

Recombination, ionisation chamber, proportional, limited proportionality, GM counter and region of continuous discharge

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26
Q

What does a higher applied voltage for gas-filled detectors mean for the detector?

A

It is more sensitive (like GM tube)

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27
Q

Are ionisation chambers high or low voltage and does this produce secondary ionisation?

A

Relatively low voltage (below 400 V) and no

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28
Q

Is charge proportional to dose in ionisation chambers?

A

Yes

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29
Q

Are ionisation chambers low or high sensitivity and are they suitable for high dose rates?

A

Low and yes

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30
Q

What are the advantages of thimble ionisation chambers?

A

High accuracy, low dose-rate dependence, linear response and stable

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31
Q

What are the disadvantages of ionisation chambers?

A

Magnitude of reading (gain) dependent on the mass or volume of air so small chambers have poor gain (high dose needed for reliability) but large chambers have poor spatial resolution

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32
Q

Do proportional counters produce secondary ionisation?

A

Yes but only some (charge multiplication of 10^3-10^4)

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33
Q

Do proportional counters have good sensitivity and does this make them suitable for low intensity and high dose rates?

A

Yes, good for low intensities but not for high dose rates

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34
Q

How does a GM tube work (not about the electrodes)?

A

Each event completely ionises the gas and creates a Townsend avalanche, with the signal being independent on initiating energy

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35
Q

Do GM tubes need to recover between events and this makes them unsuitable for high or low dose rates?

A

Yes so not suitable for high dose rates

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36
Q

When are gas detectors used?

A

Dose-rate meters (radiation surveys, leakage measurements and QA) and contamination monitors (proactive and reactive monitoring)

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37
Q

What are the types of solid state detectors?

A

Semiconductors, scintillators and thermo-luminescent detectors (TLDs)

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38
Q

What type of solid state detectors act as solid state ion chambers?

A

Semiconductor detectors

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39
Q

Are semiconductor detectors more sensitive than ion chambers of the same volume and why?

A

Yes (10^4 times) because of lower energy per ion pair and higher density

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40
Q

What are the advantages of semiconductor diode detectors?

A

Small sensitive volume, high gain (low energy threshold for ionisation) so good for low dose rates and instant read out

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41
Q

What are the disadvantages of semiconductor diode detectors?

A

Temperature dependent, subject to radiation damage and higher response to low energy photons

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42
Q

Where are semiconductor detectors used?

A

In radiotherapy for in-vivo point-dose measurements and QA
Diagnostic (everywhere in DR)

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43
Q

What are scintillator detectors based on?

A

Scintillation- light emission, where certain crystals contain activator atoms and emit light upon absorption of radiation

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44
Q

What material are scintillators usually made of?

A

High atomic number phosphors for gamma rays (plastic for beta)

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45
Q

What is a typical scintillation probe attached to in a gamma camera?

A

Photomultiplier tube

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46
Q

What issues does doping a scintillator crystal solve?

A

Poisson noise and photon wavelength-detection efficiency issues

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47
Q

What does doping a scintillation crystal do?

A

It releases the same amount of energy but spread over a larger number of photons as more excited energy levels

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48
Q

What are the two types of scintillator?

A

Inorganic (crystalline) and organic (amorphous)

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49
Q

What is the most used scintillator material?

A

Sodium iodide doped with thallium

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50
Q

How do thermoluminescent dosimeters (TLDs) work?

A

Electrons in valence bands excite to conduction band after irradiation then fall into electron traps in the lattice, and heating the crystal allows the electron to escape

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51
Q

What are the advantages of TLDs?

A

Small size, no electrical connection and approximately tissue-equivalent

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52
Q

What are the disadvantages TLDs?

A

Time needed for prep and processing, no permanent record and low accuracy (5%)

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53
Q

What are the two types of personal dosimetry?

A

Long term ‘film badge’ and real time electronic

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54
Q

What are deterministic effects?

A

Tissue/organ reactions after cell death that will occur after a threshold dose. The severity of the effect increases with dose.

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55
Q

What are stochastic effects?

A

Probabilistic effects that are random and occur from cell mutation, like cancer. The probability is proportional to the dose

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56
Q

What are the two methods of cell damage?

A

Indirect and direct action

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57
Q

Repair mechanisms after DNA damage may lead to what options?

A

Complete repair (error free) or partial repair (including incorrect repairing)

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58
Q

What are the potential outcomes for cells with altered DNA?

A

They might be non-viable (die), unable to divide (reproductive death), or give rise to a colony of mutated cells

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59
Q

What is the linear energy transfer (LET)?

A

The amount of energy that an ionising particle transfers to the material traversed per unit distance

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60
Q

What radiation has low LET and what has high LET?

A

Low LET: X-rays and gamma rays
High LET: protons and alpha particles

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61
Q

What are cell survival curves?

A

The fraction of cells that maintain reproductive integrity vs irradiated dose

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62
Q

What is the cell survival curve shape for high and low LET radiation?

A

High LET: linear
Low LET: linear quadratic

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63
Q

What is the linear-quadratic model for low LET radiation?

A

It describes the cell survival curve for low LET radiation and is defined by S, the surviving fraction

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64
Q

What is the equation for the linear-quadratic model for low LET radiation?

A

e to the power of minus alpha D minus beta D squared (D = dose)

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65
Q

What do alpha and beta represent in the linear-quadratic model for low LET radiation?

A

Alpha is the linear component, whilst beta is the quadratic component

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66
Q

What does the alpha/beta ratio indicate generally?

A

How resistant a cell is to radiation damage. High ratio = more linear cell survival curve. Low ratio = more curvature on cell survival curve

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67
Q

What is the alpha/beta ratio in the linear-quadratic model?

A

It is the dose in gray where the linear as well as the quadratic component cause the same amount of cell killing

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68
Q

What is the bystander effect?

A

Radiation induced effects in cells adjacent to cells that have been irradiated (not received direct radiation damage themselves)

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69
Q

What is the abscopal effect?

A

Distant metastases regress despite being distal to irradiated area

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70
Q

Organ structures can be split into parallel or serial organs. What does this mean?

A

Parallel organs = damage to one subunit reduces function (eg kidney)
Serial organs= damage to one subunit can result in complete breakdown of organCa

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71
Q

Can an organ be both parallel and serial? If so, is there example of this?

A

Yes but at different levels. Eg lungs are parallel at gas exchange level but serial at high level

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72
Q

What are deterministic effects also known as?

A

Tissue effects

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73
Q

What is the threshold in deterministic effects?

A

Below the threshold there is no effect

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74
Q

What are examples of deterministic effects?

A

Reddening (erythema), blistering and necrosis

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75
Q

Are deterministic effects reversible?

A

Some are but some aren’t

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76
Q

Can deterministic effects lead to death of an individual?

A

Yes if there is a loss of cells above a certain number for that tissue or organ which has created a sever lose of function that cannot be repaired

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77
Q

Why can secondary tissue damage occur after deterministic effects?

A

Blood vessel damage and replacement of viable tissue by fibrous tissue

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78
Q

The probability related to stochastic effects is described by what model?

A

The linear no threshold model

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79
Q

Does the severity of stochastic effects increase with the dose received?

A

No

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80
Q

What is the overkill effect and what does it mean for stochastic effects?

A

High acute doses kill cells so they don’t mutate, so the probability of developing conditions like cancer may decrease

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81
Q

What is the percentage risk per Sievert for cancer induction?

A

5% per Sievert

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82
Q

How is excess absolute risk (EAR) for stochastic effects (ie independent of background risk) usually expressed?

A

Often expressed per 10^4 person-years per Gray (or Sievert)

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83
Q

What is the relation between relative risk (RR) and excess relative risk (ERR) (proportional increase in risk above background) and how is it usually expressed?

A

ERR = RR -1 and it is expressed as a fraction or percentage per Gray (or Sievert)

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84
Q

Is there a lot of evidence and data for the cancer risk of low doses and what does this lead to in radiation protection?

A

No, so no ‘safe’ level or threshold, just reduced likelihood

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85
Q

What are the different ways of quantifying cancer risk?

A

Risk of developing cancer (incidence), risk of dying from cancer (mortality), loss of life expectancy, morbidity from non-fatal cancers and risk to offspring (hereditary detriment)

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86
Q

What are hereditary effects?

A

A type of stochastic effect where mutations that manifest in a descendant of the exposed person

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87
Q

When are radiation risks more significant for foetuses?

A

During organogenesis and early development (6-5 weeks)

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88
Q

Why is the lifetime cancer risk per unit dose higher for younger people?

A

There is increased rates of cell division when young and more time to see effects

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89
Q

How many regulations and schedules are there in IRR17?

A

43 regulations and 9 schedules

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90
Q

What is the European Directive called that IRR17 is derived from?

A

Basic Safety Standards (BSS) Directive 2013

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91
Q

What is the graded approach to informing the Health and Safety Executive (HSE) before starting work with ionising radiation?

A

Employers either have to notify/register/obtain consent depending on the level of work (unless they are intending to use quantities and concentrations less than specified)

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92
Q

What type of work falls under registration to the HSE in IRR?

A

Radiation generators (like x-ray devices) that are not related to practices requiring consent and other types more relevant to nuclear energy work

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93
Q

What type of work falls under consent to the HSE in IRR?

A

Administration of radioactive substances, addition of radioactive substances into products (radiopharmacy), accelerators, long term storage or disposal of radioactive waste

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94
Q

What are the outcomes of a risk assessment for IRR?

A

Action to ensure ALARP, steps to control exposure, whether personnel monitoring is needed, work procedures for pregnant people, designated of controlled areas, training needs, Local rules, appointment of RPS’ and maintenance and testing schedules

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95
Q

For IRR, are we more concerned about deterministic or stochastic effects?

A

Stochastic

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96
Q

What is the annual limit for the whole body dose, skin/extremities and eye lens for employees?

A

Whole body: 20 mSv
Extremities/skin: 500 mSv
Eye lens: 20 mSv

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97
Q

What is the annual limit for the whole body dose, skin/extremities and eye lens for members of the public?

A

Whole body: 1 mSv
Extremities/skin: 50 mSv
Eye lens: 15 mSv

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98
Q

What are the classification values in IRR?

A

If they are likely to receive 3/10ths of any dose limit for reasonably foreseeable situations, so 6 mSv per year for whole body doses and 15 mSv per year for eyes

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99
Q

What is the required investigation limit for a whole body dose in IRR?

A

15 mSv per year (lower value when set by employer)

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100
Q

What are dose constraints and what are they for?

A

They are lower than limits (0.3 mSv per year) and they are used in planning, designating areas, local rules and classifying workers

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101
Q

What are the requirements for classified workers?

A

They have to be an adult, a doctor certified they are fit for the intended work and they require medical surveillance

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102
Q

What are the duties of employees under IRR?

A

Not knowingly expose themselves or others than is necessary, PPE (use it, report defects and return it), and cooperate with employer

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103
Q

What are some of the areas an RPA must be consulted on by an employer?

A

Risk assessments, review plans and installations, designation of areas, contingency planning, recording and assessing doses, QA, PPE

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104
Q

Who issues certification to RPAs?

A

RPA2000

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105
Q

When should an area be designated as a controlled area?

A

Person working in the area is likely to receive over 6 mSv a year, and anyone entering the area has to follow special procedures to restrict exposure and the dose rate averaged over a day is over 7.5 micro Sv/h

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106
Q

What should the local rules contain?

A

Dose investigation level, key work instructions, contingency plans, description of area covered and its designation, name the RPSsW

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107
Q

What is the role of the RPS?

A

Ensure compliance with the local rules (ultimate responsibility still likes with employer)

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108
Q

When must a radiation employer use an Approved Dosimetry Service (approved by HSE) according to IRR?

A

To record and assess all significant doses received by classified workers and for accidents that have exceeded 3/10ths of any relevant dose limit (effective dose over 6 mSv)

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109
Q

How long does the Approved Dosimetry Service keep dose assessment record for according to IRR?

A

Until the individual is 75 years old, and at least 30 years old

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110
Q

What are the requirements for the storage of radioactive substances not in use?

A

They should be in a suitable receptacle (shielded, fireproof, secure) and in a suitable store (weatherproof, ventilated, labels)

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111
Q

What comes under the notification of certain occurrences regulation in IRR?

A

A certain amount of a radioactive substance has been released into the atmosphere or spilled, or is lost or stolen. Radiation generator fails to de-energise when intended. Radioactive source fails to return to safe position

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112
Q

What are the responsibilities of the installer under IRR for equipment containing radioactive substances and radiation generators?

A

They must carry out a critical examination. Consult RPA regarding plans for installation, critical examination tests and acceptability of results. Provide employer with info for use, testing and maintenance

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113
Q

What is the critical examination for, as described in IRR?

A

It is a check of all safety features and warning devices, and that there is sufficient protection for people from radiation.

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114
Q

Where are IRR and IRMER linked?

A

Equipment, where the employer must consider restricting patient dose when purchasing, installing and maintaining equipment (including QA)

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115
Q

What pieces of legislation backs up the need for a radiation risk assessment?

A

The Health and Safety at Work Act 1974
The Management of Heath and Safety at Work Regulations 1999
IRR

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116
Q

What work needs to be covered in a radiation risk assessment and when does it need to be done?

A

Routine work and reasonably foreseeable incidents and prior to work commencing

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117
Q

What are the 5 steps of risk assessments?

A
  1. Identify hazards
  2. Decide who may be harmed
  3. Assess the risks and take action
  4. Record findings
  5. Review risk assessments
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118
Q

What are some of the named sections in a generic radiation risk assessments?

A

Background, dose rates, controls and safety features, likelihood and severity, reasonably foreseeable incidents, special arrangements, conclusions and actions

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119
Q

What is the hierarchy of controls in order from most to least effective?

A

Elimination, substitution, engineering controls, administrative controls and PPE

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120
Q

What is the advantages and disadvantages of concrete as a shielding material?

A

Advantages: Cheap and easy to source
Disadvantages: Bulky, need more material for proper shielding

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121
Q

Does steel provide more or less protection than lead?

A

Less

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122
Q

What are the advantages and disadvantages of using lead for shielding?

A

Advantages: Compact and need less for shielding
Disadvantages: Heavy, toxic and expensive

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123
Q

What material is typically used for linac room shielding?

A

High density concrete

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124
Q

What is leadite?

A

Concrete blocks with lead in it

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125
Q

What shielding is used for manual afterloading brachytherapy?

A

No particular room shielding, might use movable shields. Patient provides enough shielding for I-125

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126
Q

For high dose rate (HDR) brachytherapy, what shielding considerations are there?

A

Thick concrete walls and maze entrances, interlocked barrier, audible alarm when source exposed, warning lights

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127
Q

What is the voltage range of orthovoltage radiotherapy?

A

50-300 kV

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128
Q

For orthovoltage radiotherapy, what shielding considerations are there?

A

Standard wall materials can be used, with lead being very efficient as an additional shielding material

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129
Q

What additional concerns are there for shielding proton therapy?

A

Neutrons are produced and materials could be activated

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130
Q

When should radiation surveys be performed?

A

When new equipment is installed and following any structural changes

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131
Q

What is the energy range of linacs?

A

6-15 MV

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132
Q

The use factor is the proportion of the working day that the machine is delivering radiation, what is another name for this?

A

Duty cycle

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133
Q

What is the orientation factor for primary barriers?

A

Proportion of beam-on time when the beam is incident on the barrier

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134
Q

What is the TVL of a material?

A

Tenth value layer = the thickness of the material to reduce the radiation intensity by a factor of 10

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135
Q

What is the units of instantaneous dose rate, time averaged dose rate and TADR2000?

A

Microsieverts per hour

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136
Q

What is the instantaneous dose rate (IDR) and is it measurable?

A

Dose rate when beam is on averaged over 1 minute and yes

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137
Q

How is the time averaged dose rate (TADR) calculated and what does it indicate?

A

IDR x duty cycle x orientation factor and it indicates worst case dose rate for a working day

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138
Q

What is the time average dose rate for 2000 hours (TADR2000)?

A

TADR x occupancy and it indicates an estimated dose rate for a worker averaged over a year

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139
Q

What is the units for annual dose and how is it calculated using TADR2000?

A

mSv and TADR2000 x 2000

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140
Q

Do you use a worst case or typical case for shielding calcs and why?

A

Reasonable worst case as undershielding is worse than overshielding

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141
Q

What special areas for shielding a room may need more consideration?

A

Joints between sheets, bricks and doors, and breaks in boundaries, like holes for cables etc

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142
Q

What are the features of the floor of a nuclear medicine department

A

Impervious, washable, chemical-resistant, curved to the walls, all joints sealed and glued to the floor

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143
Q

What types of ventilation systems could be used in laboratories in which radioactive aerosols or gases may be produced?

A

Fume hood, laminar air flow cabinet, glove box and laboratory at negative pressure relative to surrounding areas

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144
Q

In nuclear medicine, what should drain pipes from radioisotopes sinks and toilets do?

A

Go as directly as possible to main building sewer (if permitted by the Environment Agency) and no connections with other non-radioactive drains in the building

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145
Q

What is in an emergency kit in nuclear medicine departments?

A

Protective clothing, absorbent materials for wiping up, decontamination materials for persons, warning notices, portable monitoring equipment, bags for waste

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146
Q

What is the temperature of the helium (cryogen) in an MRI machine?

A

4 degrees kelvin

147
Q

What are some of the hazards of the static field in MRI?

A

Projectiles (from translational force) from ferromagnetic materials, torque, Lenz’s law means conductive metals experience a force that will oppose motion

148
Q

What are some of the hazards of the gradient field in MRI?

A

Magnetophosphenes (light flashes), peripheral nerve and muscle stimulation, discomfort, limb movement and sensitivity, loud noise

149
Q

What are some of the hazards of the RF field in MRI?

A

Dielectric heating, contact burns, transdermal patches

150
Q

How is RF exposure from MRI (and other non-ionising radiation) measured and its units?

A

Specific Absorption Rate (SAR) and Watts per kilogram

151
Q

What is the MR controlled access area?

A

Space around scanners that must be strictly controlled and all must be screened before access (people and items)

152
Q

What is the MR Environment?

A

It fully contains the 0.5 mT line

153
Q

What are some of the concerns with implanted devices and MRI?

A

Movement of implant, heating, malfunction of active devices

154
Q

What are the recommendations for scanning pregnant patients with MRI?

A

Can be scanned at any point but if possible it should be postponed until after. Heating should be minimised by remaining in normal SAR mode (less than 2 W/kg) and not using gadolinium based contrast agent

155
Q

How long does a magnet quench usually take to destroy the magnetic field?

A

Around 30 seconds

156
Q

What is the hazards from cryogens in MRI?

A

They may leak during a quench and cause cold burns, frostbite or asphyxiation

157
Q

Why does MRI contrast use gadolinium chelate?

A

Free gadolinium is toxic but gadolinium is strongly paramagnetic

158
Q

Why must gadolinium based contrast agents only be given to MRI patients with proper renal function?

A

Gadolinium chelate is still nephrotoxic and can cause nephrogenic systemic fibrosis (NSF) when the gadolinium separates from the chelate over time

159
Q

What is the frequency range of diagnostic ultrasound?

A

1-20 MHz

160
Q

What is the only type of diagnostic ultrasound that is not pulsed?

A

Continuous wave doppler

161
Q

What wave characteristic of ultrasound is the most important for the mechanical effects?

A

Peak rarefaction (negative) pressure

162
Q

What is the acoustic impedance? (related to ultrasound)

A

Constant of proportionality between wave pressure and particle velocity

163
Q

For higher frequency ultrasound waves, is there more or less attenuation and does this mean more or less penetration?

A

More attenuation so less penetration

164
Q

Why must pressure values be ‘derated’ in ultrasound calculations?

A

Acoustic pressure is usually measured in water so it needs to be derated for the amount absorbed by tissue

165
Q

What does focusing ultrasound waves improve and why?

A

Lateral resolution by increasing the intensity

166
Q

What is the acoustic power (related to ultrasound)?

A

A measurement of the rate at which energy is emitted by the transducer in watts

167
Q

What is the range of acoustic power for diagnostic ultrasound?

A

From below 1-100s mW

168
Q

Why is spatial peak time averaged (SPTA) intensity used in ultrasound?

A

Since it is pulsed so averaged across one complete pulse repetition period

169
Q

What type of tissue heats up the most quickly from ultrasound?

A

Bones

170
Q

What could cause the ultrasound probe to heat up?

A

Impedance mismatch between the probe crystals and tissue results in a lot of energy absorbed by the probe face

171
Q

What type of ultrasound has the most amount of heating?

A

Doppler

172
Q

According to ultrasound guidelines, what is the maximum temperature rise above physiological levels (37 degrees) for diagnostic scans?

A

1.5 degrees

173
Q

What is the maximum elevation in temperature for foetuses and for how long for it to be potentially hazardous?

A

4 degrees for over 5 minutes

174
Q

What is the thermal index (TI) in ultrasound?

A

Rough estimate for the increase in temperature (1 TI is approx 1 degree)

175
Q

What are the subtypes of thermal indices?

A

TIS = soft tissue
TIB = bone at focus
TIC = bone at surface

176
Q

What is the equation for thermal index?

A

Highest power exposing tissue anywhere in beam divided by power required to cause a max temp rise of 1 degree

177
Q

What are ultrasound contrast agents?

A

They are microbubbles that contain a gas encapsulated in a fat or protein shell

178
Q

How do ultrasound contrast agents (microbubbles) improve sensitivity?

A

They give back a massive reflection as the size is chosen to resonate at diagnostic frequencies

179
Q

How big are ultrasound contrast agent microbubbles?

A

Less than 10 microns

180
Q

What could happen to microbubbles (US contrast agents) at a high peak rarefaction pressure?

A

The microbubble oscillates too much and ruptures releasing gas (result of acoustic cavitation)

181
Q

What are the safety concerns with using ultrasound contrast agents?

A

Injection (embolism, allergy, toxicity) and acoustic cavitation

182
Q

What are the different types of cavitation with US microbubbles contrast agents?

A

Stable cavitation (at low pressure bubbles oscillate in size but are stable) and inertial (at high pressure bubbles will grow and implode when too big)

183
Q

What can inertial cavitation of US microbubbles cause?

A

Large shear forces that can damage cells with high, localised pressures and temps with potential to cause free radical generation (prediction)

184
Q

What does the mechanical index in ultrasound quantify?

A

The likelihood of the onset of inertial cavitation

185
Q

Below what value of mechanical index is it not likely to cause inertial cavitation?

A

0.7

186
Q

If the mechanical index is above 0.7, in what conditions is there more of a concern of cavitation?

A

Microbubble contrast agents or in the presence of gas bodies (intestines and lungs)

187
Q

What is sonoporation used for in ultrasound?

A

It increases the absorption of drugs into cells

188
Q

What is acoustic force/streaming in ultrasound?

A

A radiation force exerted on tissue and it can cause fluids to flow

189
Q

What is the rough order of magnitude of the wavelength in metres for microwaves and UV?

A

Microwave = 10^-2 (ie cm)
UV = 10^-8

190
Q

What is the 3 wavelength bands for UV radiation?

A

UVA: 315 - 400 nm
UVB: 280 - 315 nm
UVC: 100 - 280 nm

191
Q

Which UV band is the most energetic and which is the most penetrative?

A

Most energetic: UVC
Most penetrative: UVA

192
Q

Which UV band is largely responsible for sun tan effects?

A

UVB

193
Q

Why does UVC radiation not contribute to solar UV radiation?

A

It gets absorbed in the outer atmosphere

194
Q

What UV effects can occur on the different parts of the eye?

A

On the cornea: photokeratitis
On the conjunctiva: photoconjunctivitis
On the lens: cataract formation (permanent or transient)

195
Q

What quantifies the UV effects on the skin?

A

Minimal Erythemal Dose (MED), which is the lowest UVR dose that will produce a barely detectable erythema

196
Q

What are the UV effects on the skin dependent on?

A

UV level, duration and frequency of exposures and individual sensitivity

197
Q

What are the natural protection mechanisms to UV radiation?

A

Skin darkening and skin thickening

198
Q

What are the effects of UV on the skin?

A

Acute effect: Erythema (skin responds by increasing blood flow), blistering
Chronic effects: induction of skin cancer
Other: ageing, loss of elasticity, dryness, blemishes, freckles and moles

199
Q

What are the beneficial and negative systemic effects of UV radiation?

A

Beneficial: produces vitamin D, seasonal affective disorder
Negative: compromised immune system, UVR is an immuno-suppressor

200
Q

What is the dose limit to the eye and skin for UV?

A

30 Jm^-2

201
Q

What is the maximum permissible exposure (MPE) time for UV radiation?

A

The dose limit (30) divided by the effective irradiance (E_eff)

202
Q

What patient safety features are there for UV radiation?

A

Glasses, protection against bare lamps and electrical hazards, and in cabinets: doors openable from within and non-skid flooring

203
Q

What does OD stand for with eye protection for UV radiation?

A

Optical density

204
Q

What are some of the medical applications of RF (radiofrequency) and microwave?

A

Diathermy, physiotherapy and microwave ablation

205
Q

What is diathermy and how can it be used in surgery?

A

Deep heating using radio and sounds waves. It can be used to seal blood vessels and cut them

206
Q

How is RF/microwaves used in physiotherapy?

A

Heat tissue for pain relief and healing

207
Q

How does microwave ablation for tumours work?

A

Microwave antenna inserted into a tumour and localised tissue heating around 55 degrees

208
Q

Should non-life supporting medical equipment have a higher or lower immunity from E fields than life-supporting equipment?

A

Lower

209
Q

What medical equipment can be affected by electromagnetic interference?

A

Electric wheelchairs, pacemakers, defibrillators, ECG monitors, syringe drivers and infusion pumps

210
Q

What parts of the electromagnetic spectrum count as optical radiation?

A

UV, visible, infrared

211
Q

What does laser stand for?

A

Light amplification by stimulated emission of radiation

212
Q

What can the lasing medium be?

A

Gas, liquid, solid or semiconductor

213
Q

What are the key properties of laser light?

A

Monochromatic (very narrow spectral range), directional (well collimated beam and parallel), coherent (in phase)

214
Q

What are the types of emissions from lasers?

A

Continuous wave and pulsed emission (free running and triggered pulsed, these subcategories depend on speed of pulse)

215
Q

What is the units of irradiance and what else can it be called?

A

Power divided by area, units of watts per square metre and power density

216
Q

What is the units of radiant exposure and what else can it be called?

A

Energy divided by area, units of joules per square metre and energy density

217
Q

What is the EM radiation type produced by a CO2 laser and where is it used normally?

A

Mid-infrared and surgery

218
Q

What delivery systems are used for lasers in general surgery?

A

Articulated arm and optical fibre

219
Q

What is a chromophore and what are the main chromophores in tissue?

A

A substance that absorbs light. Haemoglobin, melanin and water

220
Q

Why is the blink reflex aversion response a concern for the eye hazards from lasers?

A

Some people have a delayed or absent response, so they don’t have the natural protection reflex

221
Q

Why are lasers so much more damaging to the eye than lamps?

A

The light is coherent and can be focussed to a small point in the eye

222
Q

What are the potential eye effects from lasers?

A

Photokeratitis, cataract, retinal lesion, corneal burn

223
Q

What types of reflections from lasers are there?

A

Diffuse or specular (includes flat, convex and concave)

224
Q

What are some non-beam laser hazards?

A

Laser plume (class 4 lasers can generate a plume of infectious tissue), fire and explosion, hazardous substances (in laser) and laser dyes are carcinogenic

225
Q

What wattage defines class 4 lasers?

A

Anything over 0.5 W

226
Q

What is the accessible emission limit (AEL) for lasers?

A

The maximum allowable emission for each class of laser (in watts or joules)

227
Q

What is the maximum permitted exposure (MPE) for lasers?

A

Maximum exposure level at which adverse effects occurs (in Wm^-2 or Jm^-2) and values for eye and skin

228
Q

What is the nominal ocular hazard distance (NOHD) for lasers?

A

Distance at which beam irradiance equals the corneal MPE (in metres)

229
Q

How is the laser controlled area defined?

A

Usually limited by room boundaries and is closer than the NOHD, so it is where an accidental exposure may be hazardous

230
Q

What are the Laser Protection Supervisor (LPS) responsibilities?

A

Supervision of laser environment safety and ensures local rules are followed/ They are closely involved with treatments

231
Q

What are the responsibilities of the laser protection adviser (LPA)?

A

Advising on the laser control. Hazard analysis and risk assessments. Produce/advise on Local Rules.

232
Q

When does an employer need an LPA?

A

When using class 3B and 4 lasers

233
Q

What are the responsibilities of the Authorised Users for working with lasers?

A

They are approved by the Clinical Laser Expert, they have had suitable training in clinical use of laser

234
Q

Is the severity of the stochastic effects dependent or independent of the dose received?

A

Independent

235
Q

What are the ICRP’s 3 key principles of radiation protection derived from the linear no threshold model? (not time distance shielding)

A

Justification (net benefit), optimisation (ALARP), limitation (set well below any threshold level)

236
Q

What does JOPIIR stand for, which is a requirement under EU law?

A

Justification of Practices Involving Ionising Radiation Regulations 2018

237
Q

Does justification include societal gain as well as individual gain and why?

A

Yes, like screening programmes

238
Q

The ALARP principle under optimisation in IRMER applies to what features?

A

The likelihood of incurring exposure, the number of people exposed and the magnitude of their individual doses

239
Q

What does ICRP stand for? (they make recommendations and reports)

A

The International Commission on Radiological Protection

240
Q

What type of exposures count as planned exposures? (includes non-medical exposures)

A

Occupational, public, medical, medical legal and emergency

241
Q

Do dose limits apply to patients?

A

No

242
Q

What is the dose a person in the UK will get from natural background radiation in a year?

A

2-3 mSv per year

243
Q

What are some of the main sources of natural background radiation in the UK? (rough percentages for top two)

A

Radon (54%), medical (15%), internal (eg food), terrestrial and cosmic

244
Q

For x-rays and gamma radiation, the shielding attenuation equation is the dose rate after a material of thickness ‘t’ equal to what?

A

The dose rate without shielding times the exponential of minus the linear attenuation coefficient times the material thickness

245
Q

What is the HVL equation?

A

ln2 divided by the linear attenuation coefficient

246
Q

What are the route of internal exposure?

A

Inhalation, ingestion, absorption, injection

247
Q

How do you prevent internal exposure?

A

PPE, handle radioisotopes in designated areas, monitor contamination, decontamination kit (know where it is and how to use), prioritise stopping contamination spread and decontaminate spread

248
Q

What are the Environmental Permitting Regulations (EPR) for?

A

Governs the amount and types of radioactive materials released to environment and protects the public, certain workers and wildlife

249
Q

Where is EPR relevant in healthcare?

A

Nuclear medicine (radioactive patients, excreted radioactivity, unsealed sources, sealed sources for QA, waste management and brachytherapy, sealed sources for QA and calibration

250
Q

Under EPR, what does a regulated site need to do?

A

Get a permit

251
Q

What are IPEM excretion factors?

A

Guidance from IPEM of percentage excretion per radiopharmaceutical

252
Q

For an employer to get and keep a permit for EPR, what do they need to do?

A

They do an environmental impact assessment (demonstrate Best Available Techniques (BAT) and what permits are appropriate), adhere to permit contents and give a pollution inventory every year

253
Q

What factors are involved in if site needs a permit under EPR?

A

Type of tasks, radioactive materials, artificial or NORM (naturally occurring radioactive materials), activity concentration

254
Q

Do the radionuclides used in nuclear medicine considered artificial or NORM (naturally occurring)?

A

Artificial

255
Q

Are short half life radionuclides (<100s) in scope for EPR regulations?

A

No

256
Q

Who is the regulator for the permits related to EPR?

A

Environmental Agency

257
Q

What type of EA permits are there?

A

Standard (low hazard) or bespoke (must do environmental impact assessment)

258
Q

In the environmental impact assessment, what needs to be calculated?

A

The projected annual dose to critical groups (like local family, children playing in a brook), DPUR values (dose per unit released)

259
Q

There are 3 stages to an environmental impact assessment, what DPUR (dose per unit released) value for one of the critical groups means the employer has to go to stage 2?

A

If it is over 20 microsieverts

260
Q

In the environmental impact assessment, what happens in the higher stages?

A

More detail for the calculation to make it more accurate, stage 3 may require a site-specific assessment

261
Q

What does an EPR sealed source permit contain?

A

Map of site, list of specific allowed radionuclides, HASS sources (including mobile sources), required security levels, accumulation of waste, waste transfers to other premises

262
Q

What can you do with Very Low Level Waste (VLLW) under an EA permit?

A

Can dispose some sealed sources municipally (normal bin)

263
Q

What does an EPR unsealed source permit contain?

A

Map of site, list of specific allowed radionuclides, waste requirements (including limits on accumulation, disposal to sewer, transfers to other premises and onsite incineration)

264
Q

What is the A/D values related to the EA permit? (usually related to sealed sources and HASS)

A

A= activity, D = activity for a dangerous source

265
Q

What specific parts of an EA permit are unique to HASS (typical for brachytherapy)?

A

Counter-Terrorism Security Officer site visit and annual source-return (tell EA you have it), and keep EA updated on fresh and sent off sources

266
Q

What are the security requirements for HASS sources dependent on?

A

A/D ratio and specific source types

267
Q

What is covered by the Best Available Techniques (BAT) part of the environmental impact assessment?

A

Ways of optimising releases to environment to minimise impact on critical groups, employees, and the public. Includes measures at all levels (even basic ones)

268
Q

Do all permit holders from EA have to have a BAT document?

A

Yes

269
Q

Who is the ‘qualified expert’ for EPR?

A

Radioactive Waste Adviser (RWA)

270
Q

When is an RWA required?

A

If the EA permit is for the accumulation or disposal of radioactive waste

271
Q

What does CDG stand for?

A

The Carriage of Dangerous Goods and Use of Transportable Pressure Equipment Regulations 2009

272
Q

What was the CDG regulations made in compliance for?

A

ADR European Agreement Concerning the International Carriage of Dangerous Goods by Road - not just radioactive stuff

273
Q

Which class does radioactive substances count under in CDG?

A

Number 7

274
Q

Can radioactive materials be transported using public service vehicles?

A

No

275
Q

According to CDG, when are packages containing radioactive materials not allowed to be transported?

A

If the package is damaged, incorrectly labelled or if the person transporting the package is not the consignor and a transport document hasn’t been issued

276
Q

All persons involved in the carriage of dangerous goods must receive appropriate training in what areas?

A

General awareness of regulations, safety training (radiation protection), security training

277
Q

What groups of people must receive the appropriate CDG training?

A

Consignors, carriers and consignees

278
Q

What are the three steps for transport of dangerous goods?

A
  1. Determine the type of package
  2. Marking and labelling
  3. Documentation
279
Q

What are the types of packages under CDG that we will be concerned with in healthcare for radioactivity?

A

Excepted packages and Type A

280
Q

Under CDG, do type A packages require more or less package integrity requirements than type C packages?

A

Less

281
Q

What type of packages under CDG are subject to mandated tests at design/manufacture stage?

A

Type A (relevant to healthcare), also B and C

282
Q

What are excepted packages under CDG?

A

Small quantities of radioactive material are exempt from certain requirements of the transport regulations (activity limits)

283
Q

The activity limits for excepted packages under CDG are dependent on what features?

A

The type of isotope, the physical state (solid or liquid) and if it is in ‘special form’

284
Q

What are ‘special form’ materials under CDG excepted packages and do they have higher or lower activity limits?

A

Generally encapsulated and unlikely to disperse and higher limits

285
Q

What is the minimum package dimension for excepted packages under CDG and what must the packaging do?

A

10cm and must prevent leakage of radioactive material under normal conditions of transport

286
Q

Surface contamination of excepted packages under CDG have to be below what activity density?

A

4 Bq per cm squared for gamma and beta emitters

287
Q

What does the surface dose rate have to be below for excepted packages?

A

5 microsieverts per hour

288
Q

At 10 cm away from the external surface of any unpacked article for excepted packages, what should the dose limit be below?

A

100 microsieverts per hour

289
Q

Under CDG, are excepted and exempt the same thing and why?

A

No, exempt limits are lower that excepted and below this the regulations do not apply

290
Q

What classifies the different categories of type A packages?

A

The transport index, which is the dose rate at 1 m from the package in mSv/h multiplied by 100, rounded up to the nearest decimal place (except 0)

291
Q

What dose rate at 1 m in mSv/h multiplied by 100 can be classed as transport index 0?

A

0.05 or less

292
Q

What are the category names for type A packages?

A

I - White
II - Yellow
III - Yellow
III - Yellow (under exclusive use)

293
Q

What requirements are there for type A packages under CDG?

A

Minimum dimension > 10 cm ad seal for evidence it hasn’t been opened. Must be able to withstand ‘normal transport conditions’ without an increase in the max dose rate

294
Q

What test conditions are there for type A packages for it to withstand ‘normal transport conditions’?

A

Rainfall for 1 hour (water spray test)
Dropped from a height of 1 m
Stacking
Piercing
Temperature and pressure

295
Q

For liquid radiopharmaceuticals in a type A package, what is the components included in the packaging?

A

Lead pot directly containing material with absorbent material in metal can, polystyrene packing in metal can and cardboard box

296
Q

What marking and labelling should be on type A packages?

A

‘Type A’ clearly marked. Consignor and consignee name and address. Two labels with: radiation trefoil, contents, activity and transport index (only yellow)

297
Q

Any internal container in a type A package should have what on the label?

A

Radiation trefoil, isotype, activity, surface dose rate, source serial no. if applicable

298
Q

What two main document types are needed for transport under CDG?

A

Transport document (consignment certificate) and instructions for the driver

299
Q

What rules are there for people other than the driver during transport according to CDG?

A

No other person without the carriers permission. Only necessary people in vehicle for type A packages

300
Q

Do the drivers have to be certified under CDG for radioactive materials?

A

Yes or very restricted on what they can carry

301
Q

What is the total sum of transport indexes for a vehicle that it cannot exceed?

A

50

302
Q

What role does the ADR require to be appointed for packages more dangerous than excepted packages?

A

Dangerous Goods Safety Adviser (DGSA)

303
Q

Who are the duty holders under IR(ME)R?

A

Employer, referrer practitioner, operator (includes MPE)

304
Q

What are the employers duties under IR(ME)R?

A

Referral criteria, entitle duty holders, QA, dose constraints for research, training, incidents, written protocols and procedures

305
Q

Who is the referrer under IR(ME)R?

A

Registered health professional entitled under the employers procedures to refer individuals for exposure to a practitioner

306
Q

Who is the practitioner under IR(ME)R?

A

Healthcare professional entitled by the employer to take responsibility for an individual medical exposure

307
Q

What is the practitioners responsibilities under IR(ME)R?

A

Responsible for justification and authorisation of exposures and allocation of practical aspects (partially optimisation)

308
Q

Who is the operator under IR(ME)R?

A

Carries out practical aspects of an exposures and must be trained and comply with employers procedures

309
Q

What are the responsibilities of the operator under IR(ME)R?

A

Identify the patient, check pregnancy status, optimise exposure (with practitioner), monitor patients wellbeing, check justification and authorisation, comply with employers procedure, select equipment and methods

310
Q

Why are MPEs a special case of an operator?

A

They are involved in every medical exposure

311
Q

Who issues certification for MPEs (authorised assessing body)?

A

RPA2000

312
Q

How is dose minimised in diagnostic cases?

A

DRLs (local and compare them), able to assess patient dose, review DRLs when consistently exceeded, written procedures, optimisation

313
Q

How is dose minimised in therapeutic cases?

A

Radiotherapy treatment planning for every patient. Consider prognosis and verification imaging exposures

314
Q

Under IR(ME)R, can responsibility be delegated and why?

A

No, you are either responsible or not. Tasks can be delegated while retaining responsibility

315
Q

Under IR(ME)R, is a person in training or the supervisor the operator?

A

The supervisor

316
Q

Under IR(ME)R, what is required for research exposures?

A

Patients consent, ethical approval, a dose constraint if exposure is not of benefit to the patient

317
Q

Under IR(ME)R, is a QC programme required?

A

Yes

318
Q

Who enforces IR(ME)R?

A

CQC

319
Q

Are CQC inspections proactive or reactive?

A

Both

320
Q

What are the aims of CQC inspections?

A

Verify employers procedures are in place and that they are being complied with, check knowledge of responsibilities of staff

321
Q

Are prosecutions under IR(ME)R carried out under Criminal Law?

A

Yes

322
Q

When are ionising radiation exposures classed as an incident under IR(ME)R and its acronym?

A

Significant accidental or unintended exposure (SAUE)

323
Q

What does ARSAC stand for?

A

Administration of Radioactive Substances Advisory Committee

324
Q

Who is in ARSAC?

A

Committee of experts, like nuclear medicine clinicians/radiologists, medical physicists and radiopharmacists

325
Q

What do ARSAC do?

A

Advises the licensing authorities (ARSAC Support Unit, HSA) on applications from practitioners, employers and researchers who want to administer radioactive substances

326
Q

Who has to hold an ARSAC licence under IR(ME)R?

A

Practitioners and employers to hold a licence to administer radioactive substances when it results in an effective dose over 1 micro Sievert

327
Q

How long do employer and practitioners ARSAC licenses last?

A

5 years

328
Q

How many ARSAC licenses do employers and practitioners need?

A

Employers: one for each radiological installation
Practitioners: Only 1

329
Q

Who applies for the practitioner ARSAC licences and who is allowed to apply?

A

The practitioner themselves and only medically trained practitioners that are consultant grade

330
Q

What are Particular Patient Licences (PPL) for?

A

Cases for urgent medical need where the employer and practitioner must already hold an ARSAC licence and the ARSAC will put the practitioner in contact with an experienced practitioner

331
Q

When are amendments or notifications required for employer ARSAC licences?

A

Amendments: addition of a procedure or change of purpose of a procedure, or above DRL administration.
Notification: material changes like contact details, named persons etc

332
Q

How are ARSAC involved with research/ clinical trials that include radioactive administrations?

A

Assessments of research studies and the trial requires ARSAC approval (certificate for each trial)

333
Q

In the annual ARSAC guidance notes, how are the procedures listed and what is included for each of them?

A

As functional groups, including DRLs and estimated effective doses for standard sized patients and uterus doses

334
Q

From the ARSAC notes for guidance, how are children doses scaled from adult doses?

A

Fraction of adult dose related to the childs weight

335
Q

From the ARSAC guidance notes, are there recommended minimum or average activity for children?

A

Minimum

336
Q

From the ARSAC notes for guidance, what nuclear medicine procedures require a delay in conception?

A

Not many in diagnostic (only high dose of I-131) but many therapeutic doses

337
Q

From the ARSAC notes for guidance, what is the guidance for patients that are breastfeeding?

A

Possible delay test, specific written instructions including how long to interrupt breastfeeding and express and discard before the time is over, should be below 1 mSv

338
Q

What is the difference between accidental and unintended exposures?

A

Accidental = no exposure of any kind was intended
Unintended = exposure intended but gave the wrong exposure

339
Q

Who gives guidance on when statutory notification of SAUE incidents is necessary?

A

CQC/IR(ME)R

340
Q

The CQC guidance for SAUE incidents includes a table with what headings?

A

Notification code, exposure category (eg intended dose range or over/ under therapy dose, miss) and criteria for notification

341
Q

What are the most common causes of accidental exposures?

A

Often procedural errors, mistaken identity and referral issues

342
Q

How is CSAUE different to SAUE in terms of reporting to the CQC?

A

The C stands for ‘clinically’ and SAUE events that are clinically significant need to be reported to the CQC even if they don’t meet the SAUR criteria

343
Q

How quickly should the CQC be notified if an incident meets any of the SAUE criteria or is a CSAUE?

A

Immediately (within 2 weeks), which may be obvious straight away or after a preliminary investigation

344
Q

How long after incident discovery (that fulfils the notification criteria) should a final report be sent to CQC?

A

12 weeks (after full investigation)

345
Q

What are the investigation requirements under IR(ME)R for incidents for a final report?

A

Timeline, estimated dose, root cause analysis, check if part of trend, duty of candour requirements, informing referrer and practitioner, clinical impact, corrective measures, sharing learning

346
Q

What is an example of an investigation tool for clinical incidents that also satisfies IRMER investigation requirements?

A

London Protocol

347
Q

The London Protocol method is related to the swiss cheese model, what does each slice of cheese represent?

A

Factor types, like patient factors, team factors or work environmental factors. Each have contributory influencing factors associated with it.

348
Q

Is registration a requirement for operators under IR(ME)R?

A

No but employer may list registration as a criteria for a particular task. They do have to be trained

349
Q

What level of involvement do MPEs have in each type of practice?

A

Radiotherapy: closely involved
Nuclear medicine (standard therapy or diagnostic), high dose IR and CT: involved
All others: involved as appropriate

350
Q

What do MPEs have to give advice on according to IR(ME)R as a minimum?

A

Dosimetry and QA matters relating to exposures. Physical measurements for evaluation of dose delivered. Radiological equipment.

351
Q

What are the 4 key work areas for MPEs?

A

Optimisation, equipment management, dosimetry and regulation compliance

352
Q

How long are certificates from RPA2000 valid for?

A

5 years

353
Q

Who has developed an MPE syllabus incorporating the competency requirements and they are also the people that recognise MPEs?

A

The Department of Health and Social Care

354
Q

Does the MPE assessment process address the suitability of an applicant to work as an MPE in any specific field?

A

No, it is the responsibility of the employer

355
Q

What are the five questions the CQC ask of all care services? They all start with ‘are they…’ so just end the question

A

Safe, effective, caring, responsive to people’s needs, well-led

356
Q

What is the rating system for CQC inspections?

A

Outstanding, good, requires improvement, inadequate

357
Q

Each question of the CQC inspection is broken down into a further set of questions, what are these called?

A

Key lines of enquiry (KLOE)

358
Q

What are some examples of information requested in advance of a CQC inspection?

A

Equipment maintenance info, staff training records and overview of learning from incidents

359
Q

How is the CQC inspection linked to IR(ME)R legislation?

A

The key lines of enquiry relate to different regulations in IR(ME)R

360
Q

How do the CQC take action where necessary after an inspection?

A

With recommendations, improvement notices and prohibition notices

361
Q

What does Hp(0.07) mean on a dose report?

A

Dose equivalent at 0.07 mm depth is tissue, so it is the skin dose

362
Q

What does Hp(10) mean on a dose report?

A

Dose equivalent at 10 mm depth in tissue, so it is the whole body dose

363
Q

What is the MPE and spectral effectiveness (S) for 270 nm UV lamp?

A

30 J m^-2 and 1

Year 1: Radiation Protection (1 decks)

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