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GUIDED BY DR.SONIA SODHI DR.

LATA KALE

The application of radiation protection principles, collectively known as health physics The goal of health physics is to prevent the occurrence of deterministic effects and reduce the likelihood of stochastic effects by minimizing the exposure of office personnel and patients during radiographic Examinations

They are categorized as being derived from two sources: natural and artificial

Natural radiation source 1.Cosmic radiation A. Primary cosmic radiation B. Secondory cosmic radiation 2. Terrestrial radiation 3.Internal sources

Artificial sources 1.Medical diagnosis and treatment, 2.Consumer and industrial products and sources, 3.Other minor source

Natural or background radiation is the largest contributor (83%) to the radiation exposure of people Background radiation from external and internal sources yields an average annual E of about 3 msv. External Sources: External exposure results from cosmic and terrestrial radiation, both of which originate from the environment.(16%)

COSMIC RADIATION 1. primary cosmic radiation: Cosmic radiation includes energetic subatomic particles, photons of extraterrestrial origin that reach the earth

2. Secondary cosmic radiation the particles and photons generated by the interactions of primary cosmic radiation with atoms and molecules of the earth's atmosphere.

at sea level the exposure from cosmic radiation is about 0.24mSv per year; at an elevation of 1600m (approximately 1 mile it is about 0.50mSv per year) at an elevation of 3200 m (approximately 2 miles, or the it is about 1.25mSv per year) Cosmic radiation is also greater at higher latitudes Cosmic radiation also includes exposure resulting from airline travel

TERRESTRIAL RADIATION.
Elements such as thorium, uranium, radium, RN-222, and K-40 are naturally occurring radioactive elements that can be found in our everyday lives. These elements can be found in: rocks, soil and building materials food and water

Some sources are a result of ground nuclear testing,which is not naturally occurring.

Most of the gamma radiation from these sources comes from the top 20cm of soil

SOURCES OF INTERNAL RADIATION:

Radionuclides that are taken up from the external environment by inhalation and ingestion. Radon, a decay product in the uranium series,is estimated to be responsible for approximately 56% of the radiation exposure, The ubiquitous noble gas radon (radon-222)is transported in the water and air , Radon decay products become attached to dust particles that can be deposited in the respiratory tract,Exposure to this quantity lung cancer

ARTIFICIAL RADIATION
These may be categorized into three major groups-

1.medical diagnosis and treatment 2. consumer and industrial products and sources 3.Other minor sources(which, in total contribute an average annual E of about O.6mSv)

Patient dose from dental radiography is usually reported as the amount of radiation received by a target organ. The surface exposure, obtained by direct measurement, is the simplest way to record a patient's exposure to x rays Radiosensitive target organs commonly reported include bone marrow, thyroid gland, and gonads. Patient dose has also been reported as the effective dose E

PATIENT SELECTION:

Diagnostic radiography should be used only after clinical examination, consideration of the patient's history and consideration of both the dental and the general health needs of the patient. Radiographic selection criteria, also known as high yield or referral criteria, are clinical or historical findings that identify patients for whom a high probability exists that a radiographic examination will provide information affecting their treatment or prognosis.

The conduct of the examination may be divided into choice of equipment, choice of technique, operation of equipment, and processing and interpretation of the radiographic image.

selection of the image receptor, focal spot-to-film distance, x-ray beam collimation, filtration the type of leaded apron and collar.

INTRAORAL IMAGE RECEPTORS:


Beginning with the letter designation "A," film speed has almost doubled with the introduction of each new speed group Currently, intraoral dental x-ray film is available in three speed groups-D, E, and F. Clinically, film of speed group E is almost twice as fast (sensitive) as film of group D and about 50 times as fast as regular dental x-ray film F-speed film requires about 75% the exposure of E-speed film and only about 40% that of D-speed means that the 9-second exposure required for regular film in 1920 has been reduced to about 0.2 second with the use of E-speed film and 0.15 second with F-speed film.

INTENSIFYING SCREENS: use the rare earth elements gadolinium and lanthanum rare earth screens decrease patient exposure by as much as 55% in panoramic and cephalometric radiography Unlike digital intraoral imaging, there is no significant dose reduction to be gained by replacing extraoral screen-film systems with digital imaging. Image resolution with digital systems appears to approach that obtained with rare earth regular-speed screens matched with T-Mat film

The combination of proper collimation and extended source-patient distance (focal spot-to-film distance) will reduce the amount of radiation to the patient. Two standard focal spot-to-film distances (FSFDs) have evolved over the years for use in intraoral radiography, one 20cm (8 inches) and the other 41 cm (16 inches). Use of an FSFD longer distance results in a 32% reduction in exposed tissue volume. This is because at the greater distance, the x-ray beam is less divergent

The use of a longer FSFD also results in a smaller apparent focal spot size and thereby theoretically increases the resolution of the radiograph,

Collimation:

The tissue area (and volume) exposed to the primary xray beam should not exceed the minimum coverage consistent with meeting diagnostic requirements and clinical feasibility.

limiting the size of the x-ray beam even more than required by law may significantly reduce patient exposure. This results in not only decreased patient exposure but also increased image quality,

First, a rectangular position-indicating device (PID) may be attached to the radiographic tube housing,

Use rectangular rectangular PID having an exit opening of 3.5 x 4.4cm (1.38 x 1.34 inches) reduces the area of the patient's skin surface exposed by 60% over that of a round (7 cm) PID

Low-energy photons,less penetrating power, are absorbed mainly by the patient and contribute nothing to the information on the film. The purpose of filtration is to remove these low-energy x-ray photons selectively from the x-ray beam. This results in decreased patient exposure with no loss of radiologic information, When an x-ray beam is filtered with 3 mm of aluminum,the surface exposure is reduced to about 20% of that with no filtration.

The philosophy of radiation protection currently in practice, however, is based on the principles of ALARA(as low as resonably achievable). This philosophy recognizes, the possibility that, no matter how small the dose, some adverse effect may result.

Any type of ionizing radiation poses some risk. As exposure increases, so does risk. Limit your exposure whenever possible. Try to:

Minimize the time exposed Maximize the distance from exposure Use proper shielding

Leaded aprons are useful because they attenuate as much as 98% of the scatter radiation to the gonads, Thyroid shields reduce the exposure of this gland by as much as 92%

the decision of whether to use x rays when the patient is pregnant is an individual one. The patient should be made aware of both the need for radiographs and the relative magnitude of exposure before any films are made.

A significant reduction in the number of unacceptable periapical films was found when film holders were used instead of patient manual support. KILOVOLTOGE

The kilovoltage is decreased, the effective energy of the xray beam is decreased and radiographic image contrast increases,
The introduction of constant-potential (fully rectified), high-frequency or direct current (DC) dental x-ray units has made possible the production of diagnostic-quality radiographs with lower kilovoltage and at reduced levels of radiation.

MILLIAMPERE-SECONDS: Of the three technical conditions (tube voltage, filtration, and exposure time), exposure time has been shown to be the most crucial factor in influencing diagnostic quality. Optimal image density can be obtained by using values listed, after considering the age and physical stature of the patient

Every effort should be made so that the operator can leave the room or take a position behind a suitable barrier or wall during exposure of the film. Brick walls must be of sufficient density or thickness that the exposure to non occupationally exposed individuals is no greater than 100 microGy per week. The operator should stand at least 6 feet from the patient, at an angle of 90 to 135 degrees to the central ray of the x-ray beam

Neither the operator nor patient should hold the radiographic tube housing during the exposure The best way to ensure that personnel are following office safety rules is with personnel-monitoring devices. Commonly referred to as film bandges these devices provide a useful record of occupational exposure

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White and pharoh 5th edition White and pharoh 6th edition Hall EJ: Radiobiology for the Radiologist, ed 5, Baltimore, 2000, Lippincott Williams and Wilkins. National Council on Radiation Protection and Measurements: Control of radon in houses, NCRP Report 103,Bethesda, Md, 1989. National Council on Radiation Protection and Measurements: Dental x-ray protection, NCRP Report 35, Bethesda, Md, 1970. National Council on Radiation Protecti9n and Measurements: Exposure of the population in the U.S. and Canada from natural background radiation, NCRP Report 94, Bethesda, Md, 1987.

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