RADIATION DOSIMETRY

AND PROTECTION
Historical review

• Harmful effects of X rays were soon realized with severe dermatitis and
eye complaints being reported within a few months of the discovery.

• Muller won the Nobel Prize for documenting germline mutation as a

delayed effect of ionizing radiation in 1927.

• A very high incidence of mutations, leukemias and other malignancies,

genetic effects in the form of microcephaly and mental retardation were
reported in the population exposed in the atomic blasts.
Regulatory bodies

• AERB: Atomic Energy Regulatory Board, India

• NCRP: National Commission for Radiation Protection, USA
• ICRP: International Commission on Radiological Protection,
International
• ICRU: International Commission on Radiation Units and
Measurements
Functions of atomic energy
regulatory board(AERB)
• Registration of X-ray equipment
• Commissioning/decommissioning of X-ray equipment
• Design certification
• No objection certificate
• Approval of the layout
• Inspection of X-ray installations
• Certification of Radiation Safety Officer (RSO)
• Certification of service engineers
• Penalties
Radiation Protection Survey and
Program
• A Radiation Safety Committee (RSC) and a Radiation Safety Officer (RSO) should be
appointed by the hospital administration

• Duties of an RSO includes:

• Conducting radiation protection surveys on a regular periodic basis.
• Periodic quality assurance tests and maintaining a record of the same.
• Educating all radiation workers on relevant safety measures.
• Training new entrants.
• Implementing radiation surveillance measures.
• Maintaining a record of personal doses.
• Issuance of instructions about how to deal with radiation emergencies.
• Ensuring that all instruments in his/her custody are properly calibrated.
• Maintaining a record of all radiation surveys performed.
 Protection against radiation
hazard
• The ICRP has advocated three general principles for radiation protection.
These include:

 Justification: This states that the practices adopted should produce a net
positive benefit . Every diagnostic practice should be justified.

Optimization: This states that all exposures should be kept as low as

possible . The
concept of ALARA/ALARP is used.

Dose limitation: The dose should not exceed the limits that have been
recommended for a particular practice.
eLORA
• e-Licensing of Radiation Applications

• Web based information and communication technology application

establishing direct communication channel between AERB and its
stakeholders for exchange of information and communication
transaction for delivering its regulatory services.
Atomic energy (radiation
protection) rules, 2004.
• Has a total of 35 rules.
Who can be RSO?
Dose and units
Dose Conventional unit SI unit

Radiation exposure dose Roentgen Coulumbs/kg

Radiation absorbed dose RAD Gray (1 gray = 100 RADs)

Equivalent dose Rem (RAD x quality factor) Sievert (gray x quality

factor)
 Maximum permissible dose
(MPD)
• It may be defined as the dose of ionizing radiation which an individual may
accumulate over a long period of time with a negligible risk of significant body
or genetic damage.

• MPD = 5 (N - 1) R. Where N is age in years and R is the exposures in Roentgens.

The unit of MPD is rem.

• The newer recommendation is MPD = age in years x 1 rem, i.e. the individual
effective dose for a lifetime should not exceed the value of his/her age.
Estimation of patient radiation
dose
Radiational side effects
Deterministic side effects:
• Dose dependent
• Dose threshold
• Dose related severity

Stochastic side effects:

• Dose independent
• No dose threshold
• Probability event
Personnel
• Patient: Direct radiation, 50 mSv/ year. Also depends on risk benefit
ratio.

• Radiation worker: Scattered radiation, 100 mSv/ 5 years

• General public: Background radiation, 1 mSv / year

Cardinal principles of radiation protection

• Time: The time of exposure should be kept as short as possible.

• Distance: The distance between the radiation and the exposed person
should be kept as large as possible. The intensity (I) of radiation varies
inversely with the square of the distance (d)
( I α 1/d2 )

• Shielding: A shielding material should be inserted between the source of

radiation and the exposed person . The shielding can be in the form of
shielding of the X-ray tube, shielding of the room, personnel shielding or
patient shielding
The three types of radiation in radiation protection are :-

• Useful beam: It is also called the primary beam. The useful or the
primary beam is the radiation passing through the tube aperture.

• Leakage radiation: This includes all radiation passing through the tube
housing other than the useful radiation.

• Scattered radiation: This includes all the radiation that has undergone a
change in direction.
Source Shielding/Shielding of
the X-ray Tube
• The X-ray tube is lined with thin sheets of lead to prevent the X-rays
produced in the tube from scattering in all directions.

• Shielding of the source protects both patients and radiation workers

from leakage radiation.

• AERB recommends a maximum allowable leakage radiation from the

tube housing of not greater than 1 mGy/hour/100 cm.
Room Shielding
There are two types of protective barriers.
• Primary barrier: This is the one which is directly exposed to the useful
beam. .
• Secondary barrier: It is the one which is struck by radiation either by
leakage from X-ray tube or by scattered radiation from the patient.

The X-ray room shielding is influenced by the nature of occupancy of the

adjoining area. Based on this various types of areas are identified
• Control area: It is defined as the area routinely occupied by radiation
workers and exposed to an occupational dose.
• Uncontrolled area: These areas are not occupied by occupational
workers.
 Shielding of the X-ray Control
Room
• The control room of an X-ray equipment is a secondary protective
barrier.

• It should never be located where the primary beam falls directly.

• The location of the control room should be such that the radiation
should scatter twice before entering it.

• A lead equivalence of 1.5 mm is essential for the walls and the

viewing window of the control booth.
 Shielding of the Personnel
• The workers should step behind the control booth or leave the room when
possible, i.e should remain in the radiation area for as less time as possible.

• The distance between the radiation workers and the source of radiation, i.e
the X-ray tube should be maximized as the intensity of the radiation varies
inversely as the square of the distance.

• Lead aprons, lead gloves, thyroid shields and eyeglasses with side shields
should be used to protect the personnel.
• Lead aprons: Lead aprons are classified as secondary barriers as they provide
protection only from scattered radiation and not the primary beam.

• It is recommended that the minimum thickness of lead equivalence should be 0.5

mm for general purpose.

• When the apron is not being used, it should be hung on properly designed racks as
improper care may lead to internal fracturing of the lead compromising its
protective ability.

• Zero lead aprons: Have a weight 20–40% less than the conventional lead aprons.
Lead is toxic and hence disposal needs proper care. The leadfree aprons are made of
tungsten, antimony and bismuth, tin, aluminium or barium. These are recyclable and
hence disposal is not a problem.
Shielding of the Patient

Appropriate equipment Appropriate technique

• Beam filtration • Optimum film processing
• Beam collimation • Tube voltage and tube current :
• Tabletop for under couch tubes A higher kVp leads to a lesser
• Source to image receptor radiation dose because of the
distance (SID) better penetration of the beam
that leads to reduced scatter
• Anti-scatter grids within the body
Gonad shielding
Radiation protection in
interventional radiology

• Pulsed Fluoroscopy : As the name indicates, consists of pulsing the X-

ray beam. In this, the image is acquired only during a brief pulse of
the X-ray beam, say 10 millisecond. Dose is reduced in pulsed
fluoroscopy by simply reducing the fraction of time the X-ray beam is
on.

• Last Image Hold (LIH) : This enables the user to spend time
interpreting the image without use of radiation. Last image hold
combined with pulsed fluoroscopy reduces dose by 75%.
• Road Mapping : A reference static image is displayed on a second
monitor and is used as a mask for subtraction from the real time
fluoroscopy display. The only objects left in the image are the vessel of
interest and the catheter moving through it. This shortens the
procedure time.

• Dose Spreading Techniques : An alteration in the direction of the X-ray

beam can reduce the maximum dose delivered to any one point on the
patient’s skin. This can be achieved by simply rotating the C-arm a few
degrees.

• Ultra Low Dose Fluoroscopy (ULD) : In ULD fluoroscopy, the system

parameters are computer controlled and use the lowest optimal dose.
 Safety of radiographic imaging during
pregnancy
• 28 Day Rule: It states that any radiological examination, if justified can be
carried out throughout the cycle unless a period is missed. If there is a missed
period, a female should be considered pregnant unless proven otherwise.
• 10 Day Rule: It states that radiographs in the pelvic/hip/lumbar/abdominal
regions of a female of childbearing age may be taken only within 10 days from
the onset of their last menstrual period (LMP).
• The greatest risk to the fetus is between 8–15 weeks of pregnancy owing to
the risk of chromosomal abnormalities and subsequent mental retardation
and hence any radiation to the fetus should be avoided during this period.
• According to the recommendations of ACOG if these techniques (X-Ray, CT,
Nuclear Imaging) are necessary for the diagnosis to be made, they should not
be withheld from a pregnant patient.
Recommended Dose Limits to
Pregnant Women

• ICRP / AERB recommendations : In pregnant females, a

supplementary equivalent dose limit of 2 mSv applied to the surface
of her lower abdomen for the remainder of her pregnancy once
pregnancy is established
Personnel dosimetry
• Various dosimeters include pocket dosimeter, the film badge or
thermoluminescent dosimeter (TLD).
• The dose is given as an estimate of the effective dose equivalent to
the whole body in mSV for a period of 3 months usually.
• The aim of monitoring is:
• To monitor and control individual doses.
• To be able to detect overexposures and suggest corrective
measures.
• To maintain a record of the cumulative dose records.
Types of Dosimeter
• Immediate read
• Delayed read/Personnel monitors
Pocket dosimeter
 Film Badge
• A film badge uses a small double coated X-ray film sandwiched between
several filters to help detect radiation.
• At least 6 pairs of filters are used to identify various components of
incident radiation.
• The six types of windows are:
1. Open window: Alpha rays
2. Plastic: Gray—beta rays
3. Cadmium: Yellow—slow neutrons
4. Thin copper: Green-diagnostic X-rays
5. Thick copper: Pink-gamma and therapeutic rays
6. Lead: Black-fast neutrons and gamma rays
Thermoluminescent Dosimeter
(TLD)
• Certain materials known as phosphors have the tendency to emit light
when heated after absorbing energy from radiation. This property is
known as thermoluminescence.

• Examples of such material include lithium fluoride (LiF), calcium

fluoride (CaF2), calcium sulphate (CaSO4), lithium borate (Li2B4O7)

• A TLD badge should always be worn by all persons working in the

radiation and should not be shared by any other person
 Where to Wear the TLD Badge
• In radiography where no protective lead apron is being worn, a dosimeter
can be worn either at the level of the waist or at the collar area. The
trunk/waist level gives an estimate of the whole body exposure while the
collar badge gives an estimate of the radiation received to the internal
organs like thyroid.

• In fluoroscopy a protective lead apron is worn by the radiologist while

performing the various fluoroscopic procedures. In such situations two TLD
badges are to be worn ideally. One badge should be worn underneath the
lead apron and the other needs to be worn at the level of the neck/collar
region outside the lead apron.
Electronic personal dosimeter
Overexposure

• A dose exceeding 10 mSv is treated as overexposure and should be

reported immediately to the institution and the concerned individual.

• The institution should arrange to investigate the cause of overexposure

and report the findings to the appropriate authorities at BARC.

• A hematological examination including differential blood counts and

chromosomal aberration test has to be carried out on the person
receiving more than 10 mSv.
 Conclusion

• There are several technologic and scanning strategies available to image

wisely without loss of diagnostic quality.

• A periodic review of the scanning protocols and dose tracking programs

should be part of any dose management initiative.

• The goal should be to keep radiation dosages as low as reasonably

achievable while preserving diagnostic information.
THANK YOU