RADIATION BIOLOGY &
PROTECTION
Ghaida A. AlJamal, B.D.S., MS., Dip (ABOMR)
Associate Professor of Oral and Maxillofacial
Radiology
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Dose-Response Curve
LINEAR RESPONSE TO
RADIATION –
ASSUMES NO PHOTON
IS SAFE
A. DIAGNOSTIC X-RAY
- No Threshold –
LOW DOSE – OVER
LONG EXPOSURE
B. Early Radiology
Exposure
Threshold amount 3
needed to see effect
SOMATIC & GENETIC
STOCHASTIC VS NON STOCHASTIC
• A=
“CHANCE”EFFECTS
GENETIC Damage,
LEUKEMIA, CANCER
DIAGNOSTIC RADIOLOGY
B - Determined Dose
SKIN ERYTHEMA,
CATARACTS,
STERILITY
RAD -MALIGNANCIES 4
Ionization
The process of converting
electrically neutral atoms
into ions
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Ionization
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Ionizing Radiation
Electromagnetic
X-rays, gamma rays
Particulate
Alpha particles, electrons
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Attenuation
Reduction of x-ray beam intensity
(that reaches film) by interaction with
matter
1. Coherent scattering
2. Compton scattering
3. Photoelectric absorption
9% of x-rays not attenuated 8
Coherent Scattering
Low-energy x-ray interacts with
outer-shell electron and causes it to
vibrate briefly. Scattered x-ray of
same energy as primary x-ray is
then emitted, going in a different
direction than primary x-ray.
Electron not ejected from atom. (No
ionization).
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Coherent Scattering
scattered x-ray
primary x-ray
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Compton Scattering
Outer shell electron ejected
(Ionization)
Scatter radiation results
Occurs 62% of the time
30% of scatter exits head
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Compton Scattering
Recoil electron
primary x-ray
scattered x-ray
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Photoelectric Absorption
Inner-shell electron ejected
(Ionization)
Low-energy characteristic
x-rays produced
Complete absorption
Occurs 30% of the time
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Photoelectric Absorption
photoelectron
primary x-ray
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Basic Cell Structure
Two parts:
1. Nucleus
2. Cytoplasm
Nucleus contains
chromosomes –
genetic info (DNA)
DNA is at risk when a cell
is exposed to ionizing
radiation
Cytoplasm – 80% water
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DNA
Critical Molecule
(Target)
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Cellular Absorption
Direct vs. Indirect Hit
Direct Hit Theory: Indirect Hit Theory:
• When radiation • Occurs when water
interacts with DNA. molecules are ionized
• Break in the bases or • Produces chemical
phosphate bonds changes – injury or cell
death
• Can injure or kill the
• Vast majority of cellular
cell damage is from indirect
hit.
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Radical
Atom or molecule that has
an unpaired electron in the
valence shell, making it
highly reactive
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Biologic Effects
Mutations
Cell death
Sublethal injury
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Cellular Repair
1. Damage to biologic molecules
(single-strand break of DNA)
2. Removal of damaged section by
cell enzymes
3. Placement of new material by
other cell enzymes
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Radiosensitivity of Cells
• Bergonie & Tribondeau (1906) – method of classifying
a cell’s response to radiation according to sensitivity.
• Cells are most sensitive during active division
(primitive in structure & function).
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The Law of
Bergonie & Tribondeaux
Cells that are most sensitive to radiation:
•Young – immature cells
•Stem Cells
•Highly dividing (mitotic) cells
•Highly metabolic
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Radiosensitive Cells
Many mitoses
Undifferentiated
Germ cells, skin, mucosa,
erythroblasts
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Radioresistant Cells
Few mitoses
Well differentiated
Nerve, muscle, bone
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Radiation Effects Influenced by:
Total dose
Dose rate
Total area covered
Type of tissue
Age
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Whole-body Radiation
vs.
Specific-area Radiation
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Somatic Cell Damage
(affects individual)
vs.
Genetic Cell Damage
(affects offspring)
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Total Body Response to Radiation
• Acute Radiation Syndrome – full body exposure given in a
few minutes.
• 3 stages of response:
1. Prodromal Stage: NVD stage (nausea, vomiting,
diarrhea)
2. Latent Period: Feels well while undergoing
biological changes
3. Manifest Stage: Full effects felt, leads to recovery or
death
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3 Acute Radiation Syndromes
Early Effects
• Bone marrow syndrome: results in
infection, hemorrhage & anemia
• Gastrointestinal syndrome: results in
diarrhea, nausea & vomiting, fever
• Central nervous syndrome: results in
convulsions, coma, & eventual death from
increased intracranial pressure.
CNS least sensitive in ADULTS –
MOST sensitive in the FETUS
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Late Effects of Radiation
• Somatic Effects: develop in the individual who is exposed
Most common: Cataract formation &
Carcinogenesis
• Genetic Effects: develop in future generations as a result
of damage to germ cells.
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DOSIMETRY
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TYPES OF RADIATON
(ALL CAUSE IONIZATION)
• PARTICULATE • ELECTROMAGNETIC
• ALPHA • XRAY
• BETA • GAMMA
• FAST NEUTRONS • (damage caused by
indirect action = free
• Unit of measure is radicals – can be
the curie (Ci) or repaired)
becquerel (Bq)
• Very low energy =
More destructive
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QUALITY FACTOR
Qualifies what the damage is from different types of
radiation
• Example: QF for X-ray is 1
• QF for alpha is 20
• Alpha is 20 x more damaging to tissue
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Units of Radiation Measurement
• To quantify the amount of radiation a
patient or worker receives
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Units of Radiation Measurement
Roentgen (R) Coulombs per kilogram
rad Gray
rem Sievert
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ROENTGEN (R)
• SI unit = C/KG
• THE QUANTITY OF X-RADIATION
• ONLY EXPOSURE IN AIR
• OUTPUT OF XRAY TUBE
• DOES NOT INDICATE ACTUAL
PATIENT EXPOSURE OR
ABSORBTION
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RADIATION ABSORBED DOSE
(RAD) SI = GRAY (Gy)
• MEASURES THE AMOUNT OF
ENERGY ABSORBED IN ANY
MEDIUM. (the patient)
• 1 Gy = 100 rads
• 1/100 Gy = 1 rad
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Radiation Equivalent Man
• DOSE EQUIVALENT – Used for employee
• Traditional Unit = REM
• SI Unit = Sievert (Sv)
• 1 Sv = 100 rem
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RADIATION EQUIVALENT MAN
(REMS) SI UNITS = SEIVERT
• Not all types of radiation produce the
same responses in living tissue
• The unit of dose equivalence,
expressed as the product of the
absorbed dose in rad (or gray) and
quality factor.
• RAD x QF = REM
• used for occupational exposures
• can be used when for dose of patient 42
Rad VS. Rem
• 1 RAD X QF = 1 REM
• 1 GRAY X QF = 1 SIEVERT
• QF FOR X-RAYS = 1
• So…… Rads = Rems
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R = 1 rad = 1 rem 1
1 Gray = 1 Sievert
1000 mrem = 1 rem
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Why did the bunny die??
BUNNY A BUNNY B
• Received 200 rads • Received 200 rads
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Why did the bunny die??
BUNNY A BUNNY B
200 rads x 1 for 200 rads x 20 for alpha
X-RAY = 200 REMs = 4000 REMs
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Background Radiation
360 mrem/year
(3.6 mSv/year)
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Background Radiation
360 mrem (3.6 mSv)/year
Radon 200 mrem (55%)
Cosmic 27 mrem (8%)
Rocks/soil 28 mrem (8%)
Internal 40 mrem (11%)
Medical x-rays 39 mrem (11%)
Nuclear medicine 14 mrem (4%)
Consumer products 10 mrem (3%)
Other sources <1 mrem (1%)
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Background Radiation
(Natural)
External (16%)
Cosmic
Terrestrial
Internal (Food - 11%)
Radon (55%)
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Background Radiation
(Man-made)
Medical (11%)
(Dental - 0.1%)
Nuclear Medicine (4%)
Consumer Products (3%)
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Surface Exposure
Periapical/BW: 100 mrem (F-speed)
250 mrem (D-speed)
Panoramic: 500 mrem
FMS: 2 rem (F-speed)
Lateral Ceph: 150 mrem
Chest Film: 20 mrem
1 mrem = .001 rem or 1000 mrem = 1 rem 51
Effective dose
• Effective dose is used in radiation protection, to
compare the stochastic risk of a non-uniform
exposure to ionizing radiation.
• It is not intended as a measure for acute or threshold
effects of radiation exposure such as erythema,
radiation sickness or death.
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Effective Dose Equivalent
FMS (round, F) 6.8 mrem
FMS (rect., F) 2.7 mrem
Panoramic 0.7 mrem
Ceph 22.0 mrem
Chest 8.0 mrem
1 mrem = 10 µSv
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Equivalent Background
Exposure
FMS (round, F) 5 days bkgr
FMS (rect., F) 2 days bkgr
Panoramic (rare) 10 hours bkgr
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MPD
Maximum Permissible Dose
Radiation Workers (Over 18)
50 mSv, 20mSV averaged
over 5 years ICRP
General Public
5 mSv (0.5 rem) NCRP
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Fetus Exposure
• Radiation exposure is most harmful during the first
trimester of pregnancy
• Embryo-Fetus Exposure limit
– 0.05 rem or 0.5 mSv PER MONTH
– 0.5 rem or 5 mSv total gestaion
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Cardinal Principles of Protection
• Triad of Radiation Safety
1. Time
2. Distance
3. Shielding
*Apply to the patient & Technologist
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60-cycle Alternating Current
Constant Potential (800 cycles/sec.)
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Focus Film Distance
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Intraoral Film Speed
D-speed (Ultraspeed)
F-speed (Insight)
Larger silver halide crystals
60 % less radiation than D
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Screen Speed
Fast less exposure
less detail
Medium compromise between
speed and detail
Slow (Detail) more detail
more exposure
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Lead Apron
Psychology
Protection
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Lead Apron/
Thyroid Collar
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Technique
Taking films - Proper film
placement and exposure
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Paralleling Technique
ring close to face
skin surface
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Processing
Correct time, temperature
Proper safelighting
Light-tight darkroom
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X-ray Protection for the Operator
Do not hold film for patient
Utilize barriers if available; drywall
adequate
Follow position and distance rule
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Required to wear film badge if you expect
to exceed MPD during calendar quarter
(1.25 rem)
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Biologic effects of radiation
• Dental radiographs during
pregnancy
– Radiation dose to fetus
extremely low
– Needed radiographs can be
taken during pregnancy with
usual precautions
– Some dentists prefer to
postpone until after delivery
for peace of mind
• However, untreated dental
infections can harm fetus
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