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Radiation Hazards

Early Effects

• Cells having high mitotic activity are most


radiosensitive
1. Skin
2. G.I tract
3. Red bone marrow
4. Oropharynx
5. Testes
6. ovaries
• Skin lesions– affects the basal cells
1. Skin erythema (Reddening)
2. Thinning of skin
3. Blistering
4. Poorly healing ulcer
5. malignant
• G.I Tract-- Loss of epithelium & impaired
renewal leads to diarrhoea
• Testes– affects spermatagonia
• Ovaries– mature follicle
• Oropharynx- moderate dose
1. Reddening & swelling of laryngeal lining
2. White diptheroid membrane– epithelite
3. Large dose– slow healing ulceration &
fibrosis
• Red bone marrow
1. WBC count drops in 2 days
2. Platelets by 6 days
3. RBC by 110 days
Late effects
• In High dose
1. Carcinogenesis
2. Cataractogenesis
3. Life-shortening
Carcinogenesis
1. Breast cancer– mammography
2. Skin cancer– superficial x-ray therapy for
acne
3. Bone cancer– jaw cancer in women doing
radium painting of watches
4. Liver cancer– Thorotrast injection in
angio & hepatography
5. Lung cancer– uranium mines workers
6. Thyroid cancer– x-ray therapy for enlarged
thymus
7. Leukemia
Cataractogenesis
• A single ray of 250 rad produces non-
progressing cataract, whereas 500 rad
produce progressive cataract
• It is a non-stochastic effect
Life shortening
• It is a stochastic effect, i.e as dose was
increased average survival decreased
• Low dose effects
1. Somatic-- Carcinogenesis
2. Genetic-- a) Gene mutation
b) Chromosomal aberrations
1. Somatic-- Carcinogenesis
• Repetitive small doses of ionizing radiation
do increase the chances of cancer especially
leukemia in of child whose mother is
exposed to radiation during pregnancy
• A point change in DNA macromolecule is
called Gene mutation

• Injury to the chromosomes with resulting


break & structural changes is called
Chromosomal aberrations
Radiation injury to embryo & fetus
• Pre-implantation stage (0 to 10 days)
small dose of 5-15 rad can kill the embryo, but
surviving embryo are normal except chromosomal
damage
• Organogenesis stage (11 to 41 days)
every embryo surviving radiation develops an
anomaly especially in organs undergoing most
active multiplication (mitosis) & differentiation
(maturation)
• From 17th day till delivery, neuroblasts,
which are very radiosensitive, are present
throughout the CNS & a small dose of 25
rad can be lethal this is reason for such large
CNS anomalies
• Less than 2-3 wks- lethal effect with
absorption, low anomalies
• 4-11 wks– severe anomalies of many
organs
• 11-16 wks– microcephaly, stunted
growth , genital organ
anomalies
• 16-20 wks– mild microcephaly,
stunted growth, mental
retardation
• More than 30 wks– rare visible abnormalities
Acute Whole body radiation syndrome
• Occurs in industrial accident with high
level radioactive material, in nuclear plant,
explosion of nuclear weapons
1. Sub-clinical syndrome
2. Hematopoietic syndrome
3. G.I syndrome
4. Neurovascular syndrome
Sub-
Sub-clinical syndrome
• Below 25 rad– no change in blood count, but
chromosomal aberrations
• 25-50 rad– WBC temporary fall
• 50-200 rad– nausea, vomiting, moderate
recoverable WBC count fall
Hematopoietic syndrome

• Exposure 200- 800 rad


1. Prodromal– 2 hours to 2 days– nausea, malaise
2. Latent– 2 days to 3 wks– bone marrow & lymph
shows loss of cells
3. Manifest– full blown syndrome–
fever,malaise,diarrohea, petechiae, pancytopenia
4. Recovery– lower dose 200-300 rad 5wks to 6
months incomplete recovery, more than 500 rad
fatal outcome due to severe leucopoenia,
infection & haemorrhage
G.I syndrome
• Exposure 800-5000 rad
1. Prodromal– within 2 hrs nausea,vomiting
2. Latent– may not be present– last 2-5 days
3. Manifest– 1-2 wks-- fever, increasing diarrohea
due to denudation of small bowel lining
epithelium, dehydration due to associated no
fluid reabsorption, sepsis, depletion of WBC,
shock, death
Neurovascular syndrome
• Exposure 5000 rad
• Symptoms start in few min– nausea, vomiting,
rapid dehydration, drowsiness, ataxia, convulsion
due to cerebral edema, vasculitis & injury to
nerves
• Death occurs within few days
• Bone marrow & G.I syndrome may be associated
Background Radiation
A. External sources
1. Cosmic rays
a. primary– arising from sun
b. secondary– cosmic rays --interaction
with nuclei in earth
atmosphere
2. Natural radioactive minerals within the
earth– uranium, thorium, actinium
3. Radionuclides – carbon 14, hydrogen 3
B. Internal sources-- natural radioactive
nuclides in tissue of body & materials of
detectors– K 40, C 14, Pb 210.
• Stochatic effect– it is a probability that a
particular effect will occur, usually for small
absorbed dose. Does not have threshold dose
• Nonstochastic effect– increases in severity with
increasing absorbed dose thereby increasing injury
to normal cells. It has threshold limits & can be
avoided
• ALARA concept– As Low As Reasonably
Achievable
• Reducing exposure limits further than
recommended by balancing of benefits vs cost
• Planning radiology department protection
• Promoting awareness within department
• Protective shielding
1. Pocket dosimeter
2. Film badges
3. Thermoluminescent dosimeter (TLD)
badges
Pocket Dosimeter
• Resembles fountain pain with in-built
ionization chamber & electrometer
Adv- immediate reading
Dis-adv– easily damaged
unreliable in inexperienced hands
Film Badges
• Dental film with copper & plastic filters
with lead backing
Adv–
1. simple to use
2. Inexpensive
3. Readily processed
4. Permanent record
Disadvantages
• Damageable
• Not reusable
• Lower sensitivity
• Error about 10 to 20 %
• Can be fogged by heat
TLD Badges
• Crystalline material trap electrons in crystal
lattice which are released in form of light
when heated in controlled condition.
• Measured by photomultiplier device
• Lithium fluoride is material used
• Advantages
1.Very small
2.Sealed in Teflon (less chance of damage)
3.Low exposure limit
4.Accuracy + 5%
5.Less sensitive to heat
6.Reusable worn after in 3 months
Disadvantages

 Expensive
 No permanent record
Protective Measures

1. Exposure time– total dose to a person for


particular rate is directly proportional to
exposure time
2. Distance– Longer the distance less is exposure
3. Lead barrier– thickness of lead barrier is stated
in half-value layer (HLV), decreases exposure to
one half
Dose reduction in Radiography
Beam filtration– Aluminium
Beam collimation
Gonadal shielding
High speed image receptor
Optimum film processing
High kV
Careful technique selection
Protection in Mammography

Skillful technique
Dedicated mammographic machine
Molybdenum targets & filters
Low dose mammographic screens & films
Efficient Breast compression device
Protection in Fluoroscopy
Intermittent fluoroscopy
Restriction of field size– collimation
Correct operating factors– increase kVp, decrease
mA decreases, with no change in brightness
Filtration– 2.5 mm aluminium filters
Exposure limits– 10 R/min in automatic exposure
control & 5 R/min without automatic exposure
control
Protective barrier– 2mm lead