RADIATION PROTECTION AND SAFETY IN MEDICAL SECTOR

Lecturer
Pr. Malika ÇAOUI
Nuclear Medicine

Semester : 1
Module
Academic Year : 2024-2025 BIOPHYSICS

Module Element
RADIATIONS BIOPHYSICS
Learning Objectives

Acquire fundamental notions in radiation protection:

• Have a global view on the organization of Radiation Protection (RP) at the international and national levels:
organizations and actors
• Integrate the general principles of RP
• Initiate the application of RP standards in a medical environment to:
• Identify the risks of IR exposure related to the different equipment using the IR
• Be an active player to ensure compliance with RP guidelines

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 Plan
Organization of radiation protection
• Organization and organisms of radiation protection
• Independent organ in Morocco: AMSSNUR

General objectives of radiation protection

• Principles of justification, optimization and limitation
• Measures against External Exposure
• Measures against contamination

Application of radiation protection standards in the medical sector

• Classification of workers Annual dose limits - Zoning and signage
• Medical surveillance of the worker
• Notions of Radiation Protection of Patients
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 Organization of radiation protection

• International Regulation

• Organisms of radiation protection

• Independant Organ in Morocco : AMSSNUR

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 Introduction

Radiation protection :
- "All rules, procedures and means of prevention and monitoring aimed at preventing or reducing the harmful effects of IR on persons,
directly or indirectly, including environmental damage” Extract - Law 2006-686 : juin 13- 2006- Fr”

Many beneficial applications:

- Radiation and radioactive substances from power generation to uses in medicine, industry and agriculture .

Applications radiations rise so risks rise too to workers, public and to the environment
- These applications have to be assessed, controlled.

Standards of safety: regulate activities:

Medical uses of radiation, operation of nuclear installations, production, transport,
use of radioactive material, management of radioactive waste.

Radiations, used appropriately, are beneficial in medical applications

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 Radiation Protection

Radiation Protection

• The benefits of radioactivity applications must be greater than the risks associated with its use.

• But the risks linked to its use impose a strict respect of safety standards in order to protect the users,
the public from serious consequences on health as well as on the environment.

• Precautionary principle and sensibilization of the use of IR

• Radiation protection: all measures adopted to ensure the protection of humans (workers, patients,
public and environment) from the detrimental effects of IR
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 International Regulations
• Establishment of the Organization: International awareness of the harmful effects of radioactivity from the first uses

• Creation of the ICRP: In 1928, the ICRP established the first preventive measures for the use of X-rays and radium.

• Strict regulations in each country, supervised by international authorities: The ICRP and the IAEA (International Atomic
Energy Agency: United Nations Organization).

• Today, a chain of organizations share different roles:

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 Radiation Protection

RP: General Objectives

Radiation Protection

Based on scientific data acquired by The use of IR
and natural radioactivity

Best compromise: “Benefits – Risks ”


Therefore : Principle of Precaution and Awareness of the use of IR

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 Organisation de la Radioprotection

Organization of Radiation protection


Global research: Based on scientific data acquired by using IR and natural radioactivity
→ Synthesis of this research knowledge


Establishment of Recommendations and International Standards:
Find the best compromise between Advantages and Disadvantages


Establishment of standards (regulations) → Transposition into state legislation
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 Organisation de la Radioprotection

Organisms of Radiation protection


UNESCEAR : United Nations Scientific Committee on the Effects of IR. Synthesizes scientific publications and writes reports


ICRP : Produces syntheses of scientific data, Proposes modalities for the management of radiological risk


IAEA : Establishes safety standards and basic norms: Provides guidelines for all nations


EURATOM: Directives transposed into the national legislation of each Member State
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RADIOACTION PROTECTION AND SAFETY
General Objectives

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 Radiation Protection

General Principles
Three Basic principles in regulatory: ICPR (1928)
1- Justification: Avoid exposure that is unnecessary or potentially hazardous

2- Optimization : Any justified practice must be reduced as far as is reasonably possible by maintaining the
exposure at the lowest possible level.
Principle « ALARA » (As Low As Reasonably Achievable).

3- Limitation of individual expositions: For any professional or public person. Individual Dose Limits:
not be exceeded under normal conditions of life or work
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 Measures against External Exposure

Multiply the distance to the source by 2, divide the dose received by 4

H1 et H2 : Equivalente doses
d1 et d2 : respective distances
H1/ H2 = (d2 / d1)2 → D :
a rule that obeys the inverse
square law of distance.

« Radiation protection in medical sector » Emmanuelle Martin- PSRM 13

 Means of Radiation Protection

TIME – DISTANCE
External Exposure SCREEN
Person doen’t radiate

External Contamination Containment S*

Sealed source
Sujet irradiated : contaminates External Protection

Internal Contamination
External Protection
Continuous Lesions - Isolation S*
Hygiene
External Décontamination
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 Penetration abilities of different types of IR

Each radiation source differs in its ability to penetrate various materials, such as paper, skin, lead and water.
Les RI « Dossiers Pédagogiques » 15
 Measures to prevent contamination

It is caused by an abnormal dissemination of substances*. It can concern:

The work environment
⁃ Surface contamination :
⁃ A porous surface traps the radioactivity
⁃ A smooth surface facilitates decontamination but is easily transferred to the operator
⁃ Atmospheric: inside the atmosphere of the room
Corporeal :
• External contamination concerns the body surface (skin, hair).
• Internal contamination of the body, by inhalation or ingestion: the duration of exposure is generally more important
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Application of radiation protection standards in the medical sector

• Persons in charge of radiation protection

• Sealed and unsealed sources
• Radiation Classification of Workers
• Annual Dose Limits
• Zoning : Signage
• Medical surveillance of the worker
• Radiation protection of the patient

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 Persons in charge of radioprotection

Administration:
• Head of the establishment: Responsible for Radiation Protection in the institution
• Work physician : Surveillance and dosimetric follow-up of the exposed worker: Aptitudes Assessments
• Radiation Protection Officer : RPO ( Fr = Person Competent in RP) : Radiation protection of the personnel - Public (Places)
• Committee for Health and Safety at Work: ensure the safety of personnel at work

Radiology Services - Nuclear Medicine - Radiotherapy

• Physician: Responsible for activities and ensures compliance with standards - Provides training
• Medical physicist: Quality control: Techniques - Equipment - Dose estimation - Participates in training
• Technicians : Application of instructions - Protection of their workstation - Training 18
 Radiation Protection Organization in Hospital

Hospital Head • Responsible for implementation,

• Designates PCR and Physician,
Responsible Activity • Coordinates the work
• Responsible for employee protection

PCR • Presence – Diploma : Required

• Take measures under the responsibility
Med RadioPhysicist • Technical - Control - Consulting - Training

Work Physician • Med follow-up: Ability - Controls

• Monitoring of workstations
Hyg Com
• Application of instructions
• Protection of their position
Workers Opérators
• Must be trained and informed

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Sealed sources and Unsealed sources

Sealed sources ("closed" sources):

- Structure or packaging that prevents, in normal use, any dispersion of radioactive material into the environment.
- Ex: X-ray tube used in radiology

Unsealed sources (liquid or unconfined sources)

- Structure and packaging under normal conditions of use do not prevent dispersion of the radioactive substance into
the environment.
- Ex: Nuclear medicine: Radiopharmaceutical drugs administered to the patient are unsealed sources* (Liquids)
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 Radiological Classification of Workers

Workers category A:
- Workers, under normal working conditions, are susceptible to receive
- An annual effective dose > 6 mSv (but always < 20 mSv),
- Or a dose equivalent to 3/10 of another limit
- Pregnant women and apprentices < 18 years old are excluded from this category A.

Workers category B:
- Are susceptible to exceeding a limit for the public
- But do not risk to exceed an effective dose of 6 mSv /year or 3/10 of another limit set for category A
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 Annual Dose Limits (mSv)

Category A Category B Public

E = Eext + Eint 20 6 1
H skin (1 cm²) 500 150 50
H extremities 500 150
H lens 150 45 15
- Annual Dose Limits (mSv) by category of personnel and exposed organ
- Category B" limits are 3/10 of "Category A" limits.
- Fetus < 1 mSv for the duration of the pregnancy
- Limits under special authorization (cat A): 2 times an annual limit
- Emergency situation: no limit but with recommended values
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 Zoning : Signalization
Supervised Area Controlled areas : Green – Yellow – Orange - Red

Radioactive Material

Under normal working conditions:

• A zone is defined controlled: when workers are susceptible to receiving : E of 6mSv/year or 3/10 of the other limits:
(≈150 mSv) or crystalline (≈ 45 mSv)
• A zone is said to be monitored, when workers are susceptible to receive: E > 1mSv / year, or > 1/10 of the other limits
(≈50 mSv) or crystalline (≈15 mSv). 23
 Zoning for fixed installations

Annual Limit 1 mSv/an 6 mSv/an 20 mSv/an

SUPERVISED CONTROLED CONTROLED CONTROLED PROHIBITED

AREA AREA AREA AREA AREA

E in average 80µSv: 1 m 7,5 µSv: 1h 25 µSv : 1h 2 mSv: 1h 100 mSv: 1h

Débit E/h 2 mSv/h 100 mSv/h

H extremities in 1h 0,2 mSv 0,65 mSv 50 mSv 2,5 Sv
Category A Unlimited Unlimited Unlimited Limited Very limited
Category B Unlimited Unlimited Limited Very limited Exceptional
Public Limited Exceptional Exceptional
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 Medical surveillance of the worker
Medical surveillance of exposed personnel : Role of the work physician
• Periodic medical examinations: initial medical examination of aptitude and periodic medical examination.
• Exposure sheet - Special medical record - Individual medical monitoring card

Exposure supervision:
• Passive external dosimetry : By delayed reading dosimeters (RX, R,  , n)
Periodic monitoring of external irradiation.
• Operational external dosimetry : Electronic dosimeter with immediate reading.

Internal dosimetry: for contamination

• Anthropogammetry: to detect and identify the quantity of a Radio Nucleid → 
• Radiotoxicology : to detect the presence of a NR in excreta (urine, stool) 25
 Radiation protection of the patient : is it a necessity?
Medical imaging by IR is an important exposure factor:
• Medical imaging has become an indispensable tool in medical practice.
• Of course, all the new techniques using IR tend to reduce the doses without losing quality: to respect the principle of optimization
• However, the demand for these explorations is constantly increasing because they are very efficient but also sometimes very
irradiating, so it is necessary to
- Optimize the dosimetric dose cost with using : Diagnostic Reference Levels (DRL) of dose+++ therefore respecting procedures
and quality assurance of the equipment.
- In radiology (standard-CT) : annual control of routine and irradiating examinations to ensure compliance with dose levels..
- In nuclear medicine: annual control on 20 consecutive patients for 2 different examinations, of the activity administered in a
concern of optimization. 26
Regulatory requirements +++
Application of the principle of justification: ensure that the prescription is justified:
• Justification of any prescription before it is executed : the benefit/risk

Application of the principle of optimization:

• Choice of equipment and technique.
• Respect of the protocol according to the procedure guide with periodic controls
• Dose assessment and protection of surrounding tissue
• Maintenance and quality assurance

Responsibility and traceability of procedures:

• Indicate the dose delivered to the patient on the examination report++++ : obligation
• Inform the patient and his family orally and in paper about the procedure (nuclear medicine: patient is himself a source, in
hospital and after discharge).Justification de toute prescription avant d’être réalisée : l’avantage / risque 27
Injection of a radioactive treatment to a
A technician prepares an injection for the scintigraphy
patient with a leaded syringe behind a
leaded protective screen in a leaded hood.

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IRSN - Faire avancer la sûreté nucléaire – Juil 2015
Gamma cameras controlled from an isolated room
IRSN - Faire avancer la sûreté nucléaire – Juil 2015 29
Accompanying parent puts on a lead apron for protection
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IRSN - Faire avancer la sûreté nucléaire – Juil 2015
 SitReferences

- IAEA: International Atomic Energy Agency: http://www-naweb.iaea.org/NAHU

- ICRP: International Commission on Radiological Protection: www.icrp.org/
- IRSN: Institut de Radioprotection et de Sureté Nucléaire: http://www.irsn.fr
- IRSN - Advancing nuclear safety - July 2015
- ASN: Autorité de Sureté Nucléaire: http://www.asn.fr:
- IRPA: International Radiation Protection Association: www.irpa.net
- EURATOM: European Atomic Energy Community: "Publication of the new Euratom Directive of 5 December 2013: ASN continues its
commitment to updating basic radiation protection standards"
- EANM: European Association of Nuclear Medicine: http://www.eanm.org/
- SFR: French Society of Radiology: http://www.sfrnet.org/sfr/
- SFMN: French Society of Nuclear Medicine: http://www.sfmn.org
- CNEBMN: Collège National de Biophysique et de Médecine Nucléaire: http://www.cnebmn.org/
- Main radiopharmaceuticals used in nuclear medicine and their production method " From research to industry CEA-INSTN " Pr. Akli
Hammadi
- Elements of radioprotection for nuclear physicians and radiopharmacists-Rr. Jean Baptiste Fleutot- Medical advisor of the DSND- INSTN
course - 2009

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