Introduction to Radiation Protection

What is Radiation?

The transfer of kinetic energy, or energy of motion from one location to another through “Matter”.

What are types of Radiation?

Natural and Human made

What is Natural Radiation? (Background)

Cosmic, substances, present on earth. (Cannot control)

What is Human-Made Radiation? (Artificial)

• Nuclear industry, medical +Dental exposures, consumers products.

• Medical and dental exposures constitute and the greatest source of human-made radiation. (Can control)

Ionizing Radiation

Radiation that produces positively and negatively charged particles (Ions) when passing through matter. (X- Ray)

What are X- Ray qualities?

Invisible

Varying degree of penetration in tissue

Travel in a straight line and at the speed of light

have a wide range of energies

What is Ionizing Radiation?

Exposure to radiation always involve a risk for biologic changes that can not be ignored.

• The benefit of an improved diagnosis' of disease must out weight the risk

EYES

• High does can trigger cataracts months later

Thyroid

• Hormone glands vulnerable to cancer. Radioactive iodine builds up on thyriod. Children most at risk

LUNGS

• Vulnerable to DNA damage when radioactive material is breathed in

STOMACH

• Vulnerable if radioactive materail is swallowed

REPRODUCTIVE ORGANS

• High does can cause infertile

SKIN

• High doses can cause burning and redness

Bone Marrow

• Produces red and white cells. Radiation can lead to leuemkia and other immune system dieases’s

Who discovered X rays?

Wilhelm Conrad Röntgen

When did Wilhelm Conrad Röntgen discover X rays?

Nov 8th of 1895

How did Wilihelm Conrad Röntgen discover X rays?

Röntgen discovered X-rays by accident while experimenting with electricity and cathode-ray tubes in his laboratory in Germany. His wifes hand was the 1st X ray and X was known to be the unknown variable

Is Cr resuable?

Yes

What is the electromagnetic spectrum of X rays and Gamma rays?

Higher energy, Higher frequency, and short wavelengths (High energy)

What is the electromagnetic specturm of microwaves

Lower energy, Lower frequency, and longer wavelength (Low energy)

What is the Consequences for X ray?

There are short term and long term affects.

• It can affect specific organs or organ systems

• Cancers

• Heredity effects

• Cataracts

• Etc

• Skin burns

Somatic cells

The cells that perform all the body’s functions

• They possess paired chromosomes

• 46 chromosomes total, 23 pairs

(To self cells)

What is Germ cells?

The reproductive cells of an organism

• They possess half the number of chromosomes

• Total of 23 chromosomes, no pairs

What is Radiography?

Making of records, radiographs of internal structures of the body by passages of x rays through the body

Team concept in medicine

• In medicine physicians, nurses, medical assistants, specitaly, care physicians, and radiology work togthere in treatment of the patient

• Radiology team includes and is not limited to radiologic technologists assistants, students, and physicists

• The joint Commission (DNV) encourages health care providers to function as effective team members while establishing a culture of quality, patient safety, and high reliability.

• This is the best handled with open communications and patient charting

• Communication is key as it helps with the care for the patient. They also teach to know how put orders in.

What are the technologits responsibilities?

• Education in the safe operations of X ray producing imaging equipment

• Follow established procdeure’s

• Select X ray Machine settings that significantly reduce radiation exposure to pateint’s and to themsleves.

What is Radiation Protection?

An effective measure employed by radiation workers to safeguard pateint’s, personnel, and general public from unnecessary exposure to ionizing radiation.

What is ALARA?

It stands our for AS LOW AS REASONABLY ACHIEVABLE

• Must be maintained by every health care facility personnel

• Must show that all resonable actions that will reduce dose to pateints and personnel

What is the Cardinal Rules?

• Time

• Distance

• Shielding

Cardinal rule- Time

Patients

• Reduce the amount of X ray “beam on” time

Staff

• Shorten the length of time spent in a room where x radiation is produced

Cardinal rule- Distance

Patient

• Use as much distance as warranted between the x ray tube and the patient for the examination

Staff

• Stand the greatest distance possible from an energized X ray beam

Cardinal Rule- Shielding

Patient

• Always shield the patient with appropriate gonadal and or specific area shielding devices

STAFF

• Interpose a radiation- absorbent shielding material between the radiographer and the source of radiation

Patients sheild’s

Technologits should cover the patient reproductive organs with in 4-5 cm of the primary beam

Three types of sheilds

Flat- Contact place directly over the gonads

Shaped- Cup shaped to protect male gonads

Shadow- Mounted to the side of the collimator of x ray tube on a flexible arm

What are some possible staff shielding that could be used?

Goggle for the eye, Thyroid collar for thyroid protection, Lead gown for body protection

ARRT STANCE ON SHEILDING

In short our positions are that:

• Healthcare institutions may adopt varying degree of gonadal and fetal shielding recommendations

• (VERY IMPORTANT) Schools with imaging must teach students about shielding and the effects of fetal and gonadal radiation exposure

• ARRT exams may not specifically refer to gonadal and fetal shielding procedures’s. but they will include topics on patient radiation exposures and protections.

• Students and RT have the responsibility to act in the best interests of each patient

What does ARRT STAND FOR?

The Americans registry of Radiologic technologist

Wisconsins: AAH policies

1- Ask pateint’s ages 12-52 years old on the pregnancy status and the last LMP date

2- Pregnancy form is required is possible chance of being pregnant. (Fill out pregnancy release form if radiographing the abdomen or pelvic region)

3- Do not shield, regardless of the age

Shouldn’t we shield the gonads, especially for children, to minimize the risk of genetic damage to future generations?

There is no evidence that radiation from medical imaging damages reproductive cells such as eggs or those that produce sperm.

Shouldn’t we continue to shield the gonads so that we don’t increase the risk of infertility?

The dose required to cause infertility in much higher (More than 100 times) than that used during a medical imaging exam

Why should we no longer shield pateint’s routinely?

Shields may cover up parts of the body that doctor needs to be able to see. If this happens, we may have to repeat the image.

Why are we doing this now?

The change in practice is due to improvements’s in imaging technology and a better understanding of how radiation might affect the body

Should we still shield pediatric or pregnant pateint’s?

Fetal and gonadal shielding should not be used by default, regardless of the pateint’s age, sex, or pregnancy status. (In limited circumstances, it may be in the best interest of an extremely anxious patient to use shielding)

Patients and especially parents of pediatric patient expect to use shielding. Shouldn’t we keep shielding because it makes people feel safer?

Although pateint’s expect to be shielded because it has been common practice for many decades. We should explain to the patient the benefits from shielding are negligible and that there is no value to continuing the practice.

Patients protection and Patients education

Patients needs to be made aware of specific procedure’s that they having done. -

• Including prep, what to expect, post op instructions (History, symptoms)

Risk of imaging procedures’s vs potenial benefits.

• Consent forms for needle work procedures’s

• Pregnancies consent forms

Ten day Rule

Applies to female pateint’s in there reproductive years

*If possible abdominal x rays should be scheduled during the 10 days following onset of mensuatration

Screening needs to completed if the patient is having DX images of abdomen, pelvis, or femur

• Many ER pateint’s will be pregnancy tested before x rats are ready

What is the rule for screening?

Pre service will questions patient born female, age 12 through 52 years about pregnancy status prior to scheulding the following exams. This will be x ray/fluoroscopic exams of abdomen, pelvic or upper femur

Increased radiation Sensitivity in children

• Children are more radiosensitive than adults

• Exposure to radiation early in life may lead to measurable increase in care incidence as they grow older

• Risk is greater for females than males

• The most sensitive time is while the baby is in utero

• In WI we will not be shielding children. We can however rightly collimate to the beam

Pledges (Image Gently Campaign)

• Encourages the use of dose reduction techniques

• Training in dose reduction techniques

• Provides information on pediatric Ct dose reduction

Pledges (Image Wisely Campaign)

Objectives include

• Lowering the amount of radiation used in medically necessary imaging studies

• Eliminating unnecessary procedures

• Website offers resources for radiologists, physicits, and other health care professionals

Dose Alerts

X ray rooms are equipped with both audible and visual aids to indicate when X ray radiation is in use

Audible- Will only be heard near the source of exposure

Visuals- Signs places outside the imaging room to alert people from entering the room

Fluoroscopy

During Fluoroscopy timers are built into the equipment to alert the radiologits when they have used 5 minute of radiation. (Hear and see it)

It will shut down after 5 minutes of safety concerned.

Know where the button is

Alert must be acknowledge or the system will shut down in the middle of the procedure

Radiation exiting equipment (Diagnostic Radiology equipment)

• The radiation beam pointing at the patient is a primary beam

• Leakage radiation escapes from the X ray tube housing

• Scatter Radiation exits from the patient (unintentional or unwanted radiation)

Radiation Exiting Equipment (Diagnostic Fluoroscopy)

X ray tube is in the table

Radiation exits from table toward the room

Where should you be positioned when you are performing a x ray?

Try to be behind a wall if possible (Non portable)

Where should you be positioned if there is no wall to go around?

In a portable situation you need to be 2 meters or in other words 6 feet when not having a wall to go behind, or as far as you can go.

How can you be protected in fluoroscopy ?

• Protective curtain or sliding panel

• Thyriod sheild

• Protection lead apron

ALSO

there is a full wrap protection and there is only a frontal protection. (Staying safe while wearing lead)

Radiation Monitoring

ALWAYS HAVE IT ON, AND KEEP AWAY FROM SUNLIGHT

EXCHANGE on the 1st of the month

Dosimeters- device used to measure radiation doses. There are multiple types of dosimeters’s

• Optically stimulated luminescence dosimeter (OSL)- flim badges we use at clinical

• Work at collar level, outside of leaded apparel, facing forward

• Exchange for new badge each month

Pregnant Student

Declaring pregnancy is voluntary

• Must declare pregnancy status to be considered a pregnant worker

• You will not a get a fatal monitor until you declare pregnancy

• Second radiation badge is issued for the fetus

Fetus is allowed 0.5mSv/month, monitored by the OSL badge

Body Badge is worn at the collar and the fetal monitor is worn at the waist

Natural or Human made

Ask your self did people make it or did it come up on its own.

• House energy underground (Natural)

• Secuitry check (Human made)

Which department will cause ionizing radiation?

If you mean how to tell whether a test uses ionizing radiation:

• X-ray / CT scan: ✅ Uses ionizing radiation.

• Fluoroscopy: ✅ Uses ionizing radiation.

• Mammogram: ✅ Uses ionizing radiation.

• Nuclear medicine scans (PET, bone scan, etc.): ✅ Uses ionizing radiation.

• MRI: ❌ No ionizing radiation.

• Ultrasound: ❌ No ionizing radiation.

For a chest X-ray specifically, you can tell because it uses an X-ray beam to create the image. The radiation is ionizing, but the dose from one chest X-ray is quite low.

Where is the X ray source located on the X ray room and fluro?

• Regular X-ray: usually on top/above the patient for exams like a chest X-ray.

• Fluoroscopy: usually under/below the patient/table (tube underneath, detector above).