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FINAL PROGRAM
55th Annual Meeting of the Health Physics Society
(American Conference of Radiological Safety)
22nd Biennial Campus Radiation Safety Officers Meeting
27 June - 1 July 2010 Salt Palace Convention Center
Salt Lake City, Utah
8:30 AM-Noon 150 ABC
WAM-E: NCRP Special Session - Overview of Current
Report and Conference Activities of the National
Council on Radiation Protection and MeasurementsCo-Chairs: Thomas Tenforde, Rich-
ard Toohey8:30 AM WAM-E.1Overview of Current Report and Conference Activities of National Council on Radiation Protection and Measurements (NCRP)Tenforde, T.S.National Council on Radiation Pro-tection and MeasurementsReports of Program Area Com-mittee 1 on Basic Criteria, Epide-miology, Radiobiology and Risk9:00 AM WAM-E.2Scientific Committee 1-16 Report on “Uncertainties in the Estimation of Radiation Risks and Probability of Disease Causation”Hoffman, F.O.SENES Oak Ridge, Inc.9:15 AM WAM-E.3Scientific Committee 1-17 Report on “Second Cancers and Cardiopulmo-nary Effects after Radiotherapy”Gilbert, E.S., Travis, L.B.National Cancer Institute, University of Rochester Medical CenterReports of Program Area Com-mittee 2 on Operational Radiation Safety9:30 AM WAM-E.4Scientific Committee 2-3 Report on “Fluoroscopically Guided Interven-tional Procedures”Balter, S.Columbia University
9:45 AM WAM-E.5Report No . 162 on “Self Assess-ment of Radiation Safety Programs”Myers, D.S.Lawrence Livermore Laboratory, LivermoreReports of Program Area Com-mittee 4 (PAC 4) on Radiation Protection in Medicine10:00 AM Break in Exhibit Hall10:30 AM WAM-E.6Overview of Current NCRP Activi-ties in Radiation Protection in Medi-cineBushberg, J.T.University of California, Davis Health System10:45 AM WAM-E.7Scientific Committee 4-2 Report on “Population Monitoring and Radio-nuclide Decorporation Following a Radiological or Nuclear Incident”Vetter, R.Mayo ClinicReports of Program Area Com-mittee 5 on Environmental Ra-diation and Radioactive Waste Issues11:00 AM WAM-E.8Scientific Committee 5-1 Report on “Approach to Optimizing Decision Making for Late-Phase Recovery from Nuclear or Radiological Terror-ism Incidents”Chen, S.Argonne National Laboratory
11:15 AM WAM-E.9Scientific Committee 64-22 Report on “NCRP Scientific Committee 64-22: Design of Effective Radiological Effluent Monitoring and Environ-mental Surveillance Programs”Kahn, B.Georgia Institute of TechnologyReports of Program Area Com-mittee 6 on Radiation Measure-ments and Dosimetry11:30 AM WAM-E.10Summary of NCRP Report No . 158: “Uncertainties in the Measurement and Dosimetry of External Radia-tion”Simon, S.L., Beck, H.L.National Cancer Institute11:45 AM WAM-E.11Scientific Committee 6-3 Report on “Uncertainties in Internal Radiation Dose Assessment”Bouville, A., Bell III, R.National Cancer Institute
Overview of Current Report and Conference Activities of NCRP
Thomas S. TenfordePresident
NCRP Special Session55th Annual Health Physics Society Meeting
Salt Lake City, UtahJune 30, 2010
1929: U.S. Advisory Committee on X-ray and Radium Protection
1946: U.S. National Committee on Radiation Protection
1964: National Council on Radiation Protection and Measurements (NCRP) chartered by U.S. CongressLauriston Sale Taylor
June 1, 1902 – November 26, 2004
NCRP History
Cornerstones of role in radiation health protection:
1. Provide information and recommendations in the public interest about:a. protection against radiation; andb. radiation measurements, quantities and units.
2. Develop basic concepts of radiation protection;3. 3) Facilitate effective use of combined resources
of organizations concerned with radiation protection;
4. Cooperate with national and international governmental and private organizations; and
5. Disseminate the results of the Council’s work.
Key Elements of NCRP’s CharterUnder U.S. Public Law 88-376
RadiationProtectionin Medicine
Radiation Bioeffects: Mechanisms &Dose Response
Operational & Environmental
Radiation Safety
Homeland Security: Nuclear/Radiological
Terrorism Countermeasures
RadiationDosimetry &
Measurements
Focal Areas of NCRP Reports and Conferences
Nuclear Energy & Health/Environmental
Protection
NCRP Strategic Program Plan
Detection of Terrorist Weapons & Materials:
• Commentary No. 16: Screening of Humans for Security Purposes Using Ionizing Radiation Scanning Systems (2003)
• Commentary No. 17: Pulsed Fast Neutron Analysis System Used in Security Surveillance (2003)
• Commentary No. 20: Radiation Protection and Measurement Issues Related to Cargo Scanning with Accelerator-Produced High- Energy X Rays (2007)
NCRP Publications on Nuclear and Radiological Terrorism
Detection of Terrorist Weapons & Materials:
In 2009-2014 NCRP is preparing a series of six Commentaries (2) and Reports (4) on Radiation Health Protection Aspects of the U.S. Department of Defense Program to Develop Active Detection Technologies (ADTs) for Nuclear and Radiological Materials That Represent a Threat to National Security [ADT methods under consideration include high-intensity bremsstrahlung radiation, monoenergetic gamma rays, and particulate radiations including neutrons, protons, and muons]
NCRP Publications on Nuclear and Radiological Terrorism (cont.)
Countermeasures to Terrorism Acts:• Report No. 138: Management of Terrorist
Events Involving Radioactive Material (2001) • Commentary No. 19: Key Elements of
Preparing Emergency Responders for Nuclear or Radiological Terrorism (2005)
• Proceedings of 40th Annual NCRP Meeting (April 14-15, 2004): Advances in Consequence Management for Radiological Terrorism Events [published in Health Physics, Vol. 89(5), 2005]
NCRP Publications on Nuclear and Radiological Terrorism (cont.)
Countermeasures to Terrorism Acts:• Report No. 161 (2 volumes – Handbook and
Scientific and Technical Bases): Management of Persons Contaminated with Radionuclides (2008)
• Report No. 165: Responding to Radiological and Nuclear Terrorism: A Guide for Decision Makers (2010)
• Report of Scientific Committee 4-2: Population Monitoring and Radionuclide Decorporation Following a Radiological or Nuclear Incident (publication expected in 2010)
NCRP Publications on Nuclear and Radiological Terrorism (cont.)
NCRP Publications on Nuclear and Radiological Terrorism (cont.)
Late-Phase Recovery from an Act of Terrorism:
• Report of Scientific Committee 5-1: Approach to Optimizing Decision Making for Late-Phase Recovery from Nuclear or Radiological Terrorism Incidents (publication expected in 2013)
• Report No. 155: Management of Radionuclide Therapy Patients (2006)
• Report No. 159: Risk to the Thyroid from Ionizing Radiation (2008)
• Proceedings of the 43rd Annual NCRP Meeting (April 16-17, 2007): Advances in Radiation Protection in Medicine [published in Health Physics, Vol. 95(5), 2008]
Radiation Protection in Medicine
Radiation Protection in Medicine (cont.)
Reports in preparation:• Scientific Committee 1-17: Second Cancers
and Cardiovascular Effects After Radiotherapy (publication expected in 2010)
• Scientific Committee 2-3: Radiation Dose Management for Fluoroscopically Guided Interventional Medical Procedures (publication expected in 2010)
• Scientific Committee 4-3: Diagnostic Reference Levels in Medical Imaging: Recommendations for Application in the United States (publication expected in 2011)
Radiation Protection in Medicine (cont.)
Reports in preparation (cont.):
• Scientific Committee 4-4: Adverse Effects of Radiation on the Gonads, Embryo, and Fetus (publication expected in 2011)
• Summary of Workshop on Computed Tomography in Emergency Medicine: Ensuring Appropriate Use (September 23-24, 2009); basis for 2010 consensus paper on “Guidelines for Application of Computed Tomography in Emergency Medicine”
• Report No. 156: Development of a Biokinetic Model for Radionuclide-Contaminated Wounds and Procedures for Their Assessment, Dosimetry and Treatment (2006)
• Report No. 158: Uncertainties in the Measurement and Dosimetry of External Radiation (2007)
• Report No. 163: Radiation Dose Reconstruction: Principles and Practices (2009)
• Report No. 164: Uncertainties in Internal Radiation Dosimetry (2009)
Dosimetry and Measurements
• Report No. 152: Performance Assessment of Near-Surface Facilities for Disposal of Low-Level Radioactive Waste (2005)
• Report No. 154: Cesium-137 in the Environment: Radioecology and Approaches to Assessment and Management (2006)
• Report No. 157: Radiation Protection in Educational Institutions (2007)
Operational Health and Environmental Radiation Protection
Operational Health and Environmental Radiation Protection (cont.)
• Report No. 162: Self Assessment of Radiation Safety Programs (2010)
• Scientific Committee 64-22: Design of Effective Effluent Monitoring and Environmental Surveillance Programs (publication expected in 2011)
• Report of Scientific Committee 2-5: Investigation of Radiological Incidents (publication expected in 2012)
Fundamental Radiobiology and Health Protection
• Scientific Committee 1-13: Potential Impact of Individual Genetic Susceptibility and Previous Radiation Exposure on Radiation Risk for Astronauts (publication expected in 2010)
• Scientific Committee 1-16: Uncertainties in the Estimation of Radiation Risks and Probability of Disease Causation (publication expected in 2011)
• Scientific Committee 1-20: Variation in Biological Effectiveness of Photons as a Function of Energy (publication expected in 2013)
• Primary Goal: Prepare definitive publication(s) during 2011 to 2016 on biological effects and potential human health implications of exposure to low dose and low dose-rate radiation; planning workshop held at NCRP on December 1-2, 2008
• Important topics under consideration include: – up-to-date reviews of laboratory and human
epidemiology studies– effects of radiation quality and dose rate– integration of results into reliable, predictive
models of human health effects at low doses– health protection and regulatory implications of
findings, and effective communication of projected risks of low-dose radiation exposure
NCRP’s Strategic Initiative on Biological and Human Health Effects of Low-Dose Radiation
Areas of Increasing Importance to NCRP are the Safety, Health and Environmental Protection Aspects
of a Growing Nuclear Industry Worldwide(Proceedings of 2009 Annual Meeting to be
published in Health Physics in 2010)
The hallmark of NCRP activities is providing reliable recommendations for radiation protection policies and practices based on scientific consensus
• View NCRP website at http://NCRPonline.org• View and purchase NCRP publications at
http://NCRPpublications.org• Proceedings of 2010 Annual Meeting: Communication
of Radiation Benefits and Risks in Decision Making will be published in Health Physics in 2011
• NCRP 2011 Annual Meeting: Scientific and Policy Challenges of Particle Radiations in Medical Therapy and Space Missions
• March 7-8, 2011 at Hyatt Regency Conference Center in Bethesda, Maryland
NCRP’s Primary Role in Radiation Health Protection Guidance
Scientific Committee 1-16
Uncertainties in Estimationof Radiation Risks and
Probability of Causation
F. Owen Hoffman
SENES Oak Ridge, Inc 102 Donner Dr.
Oak Ridge, TN 37830
Members of NCRP SC 1-16
• Julian Preston (Chair)
• John Boice• Bertrand Brill• Ranajit
Chakraborty• Rory Conolly• Richard Hornung
• Roy E. Shore• Gayle Wolschak• Owen Hoffman
(Advisor)• Charles Land
(Advisor)• David C. Kocher
Objectives of NCRP SC 1-16
• Analyze uncertainty relating absorbed organ doses to the risk of disease– Including cancer, non-cancer, and severe
genetic defects• Build upon recent NCRP reports that
address uncertainty in– External dose (SC 6-1)– Internal dose (SC 6-3)– Dose reconstruction (SC 6-4)
Uncertainties Addressed by NCRP SC 1-16
• Extrapolation of risk from the Life Span Study (LSS) of Japan– to the US and other populations with
baseline rates different than in Japan
• Extrapolation of risk from acute exposure– to chronic and fractionated exposures
• Extrapolaton of risks from exposure to external radiation sources– to exposure to internal emitters
Sources of Uncertainty Addressed by NCRP
SC 1-16
• Extrapolation of risk estimates from high energy gamma ray exposures to situations involving– low energy photons
– low energy electrons
– neutrons of various energies
– alpha particles
• Modify or reduce uncertainty in risk estimates by– combining information from epidemiology
and biological studies– combining information from multiple
epidemiological cohorts using meta and pooled analyses
• Evaluate effect of dose uncertainty on risk estimation– Size, shape, and confidence interval of the
dose-response function
Evaluation of Uncertainties
• Contrast uncertainties for risks to individual organs with– Risks to related groups of organs– Risks to all tumors combined from
uniform whole body exposure
• Evaluate methods to quantify combined uncertainty in risk from – Uncertainty in dose– Uncertainty in risk per unit dose
Evaluation of Uncertainties
• Evaluate risk and uncertainty – using mortality versus morbidity as risk
endpoint • Evaluate uncertainty in lifetime risks
for populations versus subgroups– subgroups identified by age, sex, lifestyle,
and other factors affecting the baseline risk
• Evaluate the effect of variations in baseline risks for different population subgroups
Evaluation of Uncertainties
Evaluation of Uncertainties• Uncertainty in risk depends on
assessment objectives– Lifetime risk to populations vs. subgroups
vs. individuals– Probability of Causation/Assigned Share
(PC/AS) for an individual with a specific disease diagnosed in a given year
• Risk uncertainty in decision-making– Required by law (EEOICPA) for Federal
radiation worker compensation program– Role of risk and uncertainty in situations
unrelated to compensation is less clear
Progress to Date within NCRP SC 1-16
• Work still in progress– internal drafting stage
• Once initial draft completed– it will be subjected to several rounds of
review, revision, and editing before a final report is issued
• Some subjects will be referred to other committees for further evaluation– e.g., NCRP SC 1-20, risk of exposure to
low energy photons
1
SC 1-17: Second Cancers and Cardiac
Effects After Radiotherapy
Ethel Gilbert National Cancer Institute
Lois B. Travis, Chair SC-17University of Rochester Medical Center
55th Annual Health Physics Society MeetingSalt Lake City, Utah
June 30, 2010U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
Natio
nal C
ance
r Ins
titut
e
SC 1-17 Committee Members
Lois B. Travis, Chair U. of Rochester Medical Center
John Boice, Vice-chair International Epidemiology Institute
Kimberly Applegate Riley Hospital for Children
Louis S. Constine U. of Rochester Medical Center
Andrea Ng Brigham and Women’s Hospital
Ching-Hon Pui St. Jude’s Children’s Hospital
Xie George Xu Rensselaer Polytechnic Institute
Ethel Gilbert National Cancer Institute
Ann Kennedy U. of Pennsylvania Medical School
Joachim Yahalom Memorial Sloan-Kettering Cancer Ct.
James Allan, Consultant Newcastle U. Medical School
Patients with Cancer* 5 y Relative Survival Rate
* Cancer at all sites; all age, race and sex groups.
Cancer Survivorship: U.S.• 12.1 million survivors as of 2007 • Number has tripled since 1971• 3% of U.S. population
Complications of Cancer and Its Treatment
Medical (multiple organ systems) • Second primary cancers• Cardiac disease • Hematologic, pulmonary, renal,
endocrine, gonadal• Neurologic, fatigue, weight gain
Psychosocial (anxiety, depression) Societal (employment, insurance)
SC 1-17: Second Cancers and Cardiac Effects After Radiotherapy
“The primary purpose of this Report is to provide a comprehensive assessment of the risk of second primary cancers and cardiac disease following radiotherapy among the growing number of cancer survivors worldwide.”
Sections of the Report
1. Executive Summary2. Introduction3. Radiobiology and cancer biology4. Epidemiologic Methods5. New Radiotherapy Methodologies and
Technologies6. Radiotherapy: Dosimetry7. Genetic underpinnings8. Second cancer risks in adults and children9. Dose-response relationships10. Cardiac effects11. Conclusions and recommendations
External Beam Radiotherapy
• Used in treatment of cancer since the 1920’s
• Exposes not only the tumor but surrounding tissues – Dose drops exponentially with distance from
tumor– Dose to nearby tissues can exceed 20 Gy,
depending on tumor dose
Estimated Mean Dose (Gy) from 35 Gy
to Mantle or Inverted-Y
Fields (Hodgkin Lymphoma)
Organ or site Mantle Inverted-YBrain 0.4 0.02Larynx 18 0.06Thyroid 35 0.08Breast 24 1.3Lung 14 1.5Upper esophagus 35 0.08Lower esophagus 27 11Stomach 1.4 13Pancreas 1.0 20Bladder 0.05 21
Changes in Radiotherapy
• Ability to concentrate energy deposition in the tumor has increased dramatically
• Modern treatment planning has benefitted by the ability to visualize tumors in 3 dimensions
• Has led to decreases in dose to surrounding tissues
New Modalities of Radiotherapy
• Intensity modulated radiation therapy (IMRT)– Improved tumor coverage– Reduced high dose to normal tissues– Increased medium/low-dose exposure
• Proton and heavy ion therapy• Tomotherapy• Gamma knife and cyber knife• Electron beam therapy• Neutron therapy
Epidemiologic Studies to Evaluate Second Cancer Risk
• Long-term follow-up necessary– Can not directly evaluate risks of most recent
treatments
• Direct study needed because of very large doses
Epidemiologic Studies to Evaluate Second Cancer Risk
• Cohort Studies– Defined group of 1st cancer survivors
followed for subsequent cancer– Limited treatment data – Evaluate patterns of risk by site, gender,
latency, age at exposure, attained age
• Case-Control Studies– Study cases and sample of matched controls– Collect detailed treatment data– Dose-response analyses
Findings from Cohort Studies
• Little evidence of radiotherapy-related risk until at least 5 years after 1st cancer diagnosis
• Excess risk can persist for 30+ years
• Relative risks are largest for patients who are young at 1st cancer diagnosis
• Absolute risks increase with increasing attained age
Primary Cancers and Radiation- Related Second Cancers
Primary cancer
Second cancers associated with radiation therapy
Hodgkin lymphoma
Breast, lung, esophagus, stomach, pancreas, colorectal, skin, thyroid, sarcoma, head and neck, mesothelioma, leukemia
Testicular cancer
Lung, thyroid, esophagus, stomach, pancreas colorectal, renal, bladder, sarcoma, mesothelioma, leukemia
Breast cancer
Contralateral breast, lung, sarcoma, esophagus, leukemia
Prostate Bladder, colorectal, sarcomaCervical Bladder, renal, rectal, uterine, ovarian, leukemia
Case-Control Studies
• Report reviews studies with individual dose estimates for several 2nd cancers:– Leukemia, Breast, Lung, Thyroid, Bone,
Brain• Dose-response analyses
– Quantify risk as a function of dose– Evaluate shape of dose-response
• Modification of dose-response by other risk factors such as chemotherapy, smoking, etc.
Dose-Response for Leukemia Following Cervical Cancer
(Boice et al. 1987)
Dose-Response for Breast Cancer Following Hodgkin Lymphoma
(Travis et al. 2003)
Dose (Gy)
Cases/Controls
Relative Risk (95% CI)
0.0-3.9 15/76 1.04.0-6.9 13/30 1.8 (0.7 – 4.5)
7.0-23.1 16/30 4.1 (1.4 – 12)23.2-27.9 9/30 2.0 (0.7 – 5.9)28.0-37.1 20/31 6.8 (2.3 – 22)37.2-40.4 12/31 4.0 (1.3 – 13)40.5-61.3 17/29 8.0 (2.6 – 26)
Dose-Response for Thyroid Cancer Following Childhood Cancer
(Sigurdson et al. 2005)
Cardiac Disease
• Cardiac disease increased among survivors of lymphoma, breast cancer, testicular cancer
• Effects of radiotherapy on cardiac disease not as well studied as second cancers
• Absolute risks could be large
Cumulative Incidence of Cardiac Disorders Following Childhood Cancer
(Mulrooney 2009)
Overarching Research Recommendations
• Institute long-term and large-scale follow- up of existing cancer survivors– Children of special importance– Develop integrated measures to evaluate the
life-long burden according to prior treatment – Integrate epidemiologic studies with molecular
and genetic approaches • Establish prospective cohorts of cancer
patients– Newer treatments (e.g. IMRT, proton therapy)– Include biological samples
Areas of Specific Recommendations
• Dose-response• Adolescent and young adult cancer
survivors• Molecular and genetic underpinnings• Interactions between radiotherapy and
other risk factors• Comparison of risk of second cancers
and cardiac disease after different radiation modalities
• Risk prediction models
1
RADIATION DOSE MANAGEMENT FOR FLUOROSCOPICALLY GUIDED
INTERVENTIONAL MEDICAL PROCEDURES (NCRP Scientific Committee 2-3)
Stephen Balter, Ph.D.(on behalf of the scientific committee)Health Physics Society -
Salt Lake City –
June 2010
Timeline and Status
•
NOV/DEC 2009 –
NCRP Program Area Committee Review
•
FEB/MAR 2010 –
NCRP Council and Outside Review
•
JUL 2010 –
Pending Council Approval (subject to further revisions)
•
Publication Expected in 3rd
or 4th
Quarter 2010
Intent
•
Addressed to policy makers.•
Not a complete how-to handbook.
•
Supplements other NCRP reports.•
Background material on clinical procedures is included.
•
Related nonradiation
risks are reviewed.
SC 2-3 Members
•
Stephen Balter, Chair, Columbia University •
Donald L. Miller, Vice Chair, USUHS
•
Beth A. Schueler, Vice Chair, Mayo Clinic •
Jeffrey A. Brinker, Johns Hopkins Hospital
•
Charles E. Chambers, Penn State College•
Kennith
F. Layton, Baylor University Medical Center
•
M. Victoria Marx, University of Southern California•
Cynthia H. McCollough, Mayo Clinic
•
Keith J. Strauss, Harvard Medical School•
Louis K. Wagner, U. of Texas Medical School
SC 2-3 Consultants
•
John F. Angle, University of Virginia•
Lionel Desponds, GE Healthcare
•
Andrew Einstein, Columbia University•
John W. Hopewell, University of Oxford
•
Norman J. Kleiman, Columbia University•
Matthew Williams, Columbia University
•
Marvin Rosenstein, NCRP Staff Consultant
Organization of the Report•
Executive Summary
31 Recommendations•
Main Sections–
Clinical, Dosimetry, Biology
–
Fluoroscopic Equipment and Facilities–
Protection of the Patient
–
Protection of Staff–
Administrative and Regulatory Considerations
•
Appendices (12) •
References (>425)
Uses ICRU Report 74 Style Notation
•
Ka,r = air kerma
at the reference point
•
PKA
= air kerma-area product
•
Ka,i
= incident air kerma•
Dskin,e
= entrance skin dose•
Dtissue,max
= peak tissue dose
A Patient Undergoing an FGI Procedure Is Not an ICRP “Average”
Person
ICRP population
•
M:F = 1:1•
Reference size
•
All ages•
Average health
•
Average life expectancy
Patient population
•
M:F variable•
Variable size
•
Older•
Sick individuals
•
Decreased life expectancy
Patient Benefits of FGI Procedures
•
Relief of symptoms•
Improvement in quality of life
•
Increased life span•
Decreased morbidity and shorter recovery time as compared to more invasive treatments
Risk
Radiation risk should be one of the many risks included in the risk-benefit analysis of FGI procedures.
Effective Dose
Effective Dose (E) shall not be used for quantitative estimates of stochastic radiation risk for individual patients or patient groups.
Effective dose (E) may be used as a qualitative indicator of stochastic radiation risk for classifying different types of procedures into broad risk categories.
Special Populations
Equipment that is routinely used for pediatric procedures should be appropriately designed, equipped, and configured for this purpose. Procedure planning for FGI procedures on pregnant patients shall include feasible modifications to minimize dose to the embryo-fetus.
Potentially-High Radiation Dose Procedures
A FGI procedure should be classified as a potentially-high radiation dose procedure if more than 5 % of cases of that procedure result in Ka,r exceeding 3 Gyor PKA exceeding 300 Gy cm2 .Potentially-high radiation dose procedures should be performed using equipment designed for this intended use.
Patient Dose Records
Patient dose data shall be recorded in the patient’s medical record at the conclusion of each procedure. This shallinclude all of the following that are available from the system: Dskin,max, Ka,r, PKA, fluoroscopy time, number of fluorographic images.
Fluoroscopy time should not be used as the only dose indicator during potentially-high radiation dose FGI procedures.
All available dose indicators shall be used in such procedures.
Fluoroscopy time is a poor dose metric !
≈
2,100noncardiac
interventionsKa,r
= 0.41 + 0.037 FminR2
= 0.50
RAD-IR I
≈
1,700 coronary-artery proceduresKa,r = 0.53 + 0.12 Fmin
R2
= 0.68
IAEA-SRS 59
Substantial Dose Procedures I
If a substantial radiation dose level is exceeded, the interventionalist shallplace a note in the medical record, immediately after completing the procedure, that justifies the radiation dose level used.
Default values: •
Ka,r
> 5 Gy•
PKA
> 500 Gy
cm2
•
Fluoroscopy time > 60 min
Substantial Dose Procedures II
If a substantial radiation dose level is exceeded, the patient and any caregivers should be informed, prior to discharge, about possible deterministic effects and recommended follow-up.
Follow-up for possible deterministic effects shallremain the responsibility of the interventionalist for at least one year after an FGI procedure. Follow-up may be performed by another healthcare provider.
All relevant signs and symptoms shall be regarded as radiogenic unless an alternative diagnosis is established.
Patient Quality and Safety Management
Facilities shall have a process to review all relevant radiation doses for patients undergoing FGI procedures.Guidance levels, based on measured dosimetric quantities (in particular PKA or Ka,r to manage stochastic effects and overall performance, and Ka,r to manage deterministic effects) should be used for quality assurance purposes.•
Stochastic risk
•
Deterministic injuries
Protective Barriers
All spaces outside the procedure room (including control rooms) should be designed to limit E to not more than 1 mSv y−1. Spaces within the FGI-procedure room intended exclusively for routine clinical monitoring of patients (or similar activities) should be shielded to limit E to not more than 1 mSv y−1.Door interlocks that interrupt x-ray production shall not be permitted at any entrances to FGI-procedure rooms.
Protection of Staff
Determinations of occupational doses shall take into account the personal protective equipment used by each individual in the FGI environment.A collar monitor may be used to estimate equivalent dose to the lens of the eye if a worker exclusively uses under-table x-ray geometry; otherwise an eye dose monitor should be placed on the collar or closer to the lens of the eye.… A single personal monitor worn under the protective apron shall not be used in the FGI environment.
Dose Limits -
Staff
Policies and procedures shouldbe in place so that in the event of a time-critical urgent or emergent situation, as defined in this Report, advanced provision exists for exceeding an annual occupational dose limit.
Investigations
Investigations should occur if personal monitor readings for an individual are substantially above or below the expected range for that individual’s duties.
23
Training, Privileges, and Supervision
A FGI procedure shall be performed or supervised only by a physician or other medical professional with fluoroscopic and clinical privileges appropriate to the specific procedure.Every person who operates or supervises the use of FGI-equipment shall have current training in the safe use of that specific equipment.
24
Equipment Quality
Interventionalists and qualified physicists should participate in the process for purchase and configuration of new fluoroscopes and fluoroscopy facilities. A qualified physicist shall perform acceptance and commissioning tests before first clinical use of new, newly installed, or newly repaired fluoroscopy equipment, and shall perform subsequent periodic tests.
5
NCRP
Report No. 162
Self Assessment of Radiation Safety
Programs
David Myers, CHPLawrence Livermore National Lab
Program Area Committee 2: Operational Radiation Safety -
Rpt.134 -
Operational Radiation Safety Training (2000)
-
Rpt.144 -
Radiation Protection of Particle Accelerators
(2003)
-
Rpt.147 -
Structural Shielding Design of Medical Imaging
Facilities (2004)
-
Rpt.151 -
Structural Shielding Design for Photon
Radiotherapy Facilities (2005)
-
Rpt.157 -
Radiation Protection in Educational Institutions
(2007)-
Rpt.162 -
Self Assessment of Radiation Safety Programs
(2010)
Definition of Self Assessment
•
Process that institution uses to review its own activities and performance in relation to:
-
Regulations
-
Standards
-
Internal policies
-
Implementing procedures
-
Best Practices
- Goals
•
Institution controls what is assessed and who does it
•
Tailored to size and complexity of program
Why Should
HP’s be Interested?
•
Most operational HP’s have lots of experience in being audited or inspected
•
Typically have less experience in assessing their own programs
•
Useful for evaluating existing programs
•
Good place to start on if you don’t have a program
General Objectives and Specific Purposes of SA•
Identify and correct deficiencies and improve performance
•
Specific purposes
-
ensure a safe workplace
-
assess compliance
-
encourage continuous improvement
-
identify noteworthy practices
-
identify areas for further evaluation
-
provide opportunity for learning
Three Primary Types
of Assessment
•
Compliance-Based-
does program meet regulations?
•
Risk-Based-
what could go wrong?
•
Performance based-
evaluates overall effectiveness and efficiency of program
-
most comprehensive of the three types of assessment
Institutional Responsibilities for Self Assessment
•
Upper management -
provide support and resources
•
Line Management -
encourage worker participation
•
Radiation Safety Program Personnel -
develop and
implement SA program
•
Workers -
need to actively participate
•
Minimize conflict-of-interest
Self Assessment Planning
•
Selecting program elements to be assessed (e.g., external dosimetry, training, ALARA program, contamination control)
•
Establish the schedule to cover all program elements
•
Is an external audit on the schedule?
•
Reviewing past self assessment results
•
Identifying the necessary resources
Methods and Techniques for Performing Self Assessments•
Evaluate monitoring results –
personnel dosimetry,
radiation surveys, swipes, etc.
•
Workplace observations –
minimize disruptions
•
Interviews of workers –
avoid leading questions
•
Use of checklists –
should be institution specific
•
Document review –
incidents and unplanned exposures
Conducting the Assessment
•
Entrance meeting to introduce participants
•
Discussion of assessment activities with participants
•
Daily team conferences –
coordinate activities
•
Management briefings –
frequent updates (particularly if
any serious deficiencies are found)
•
Exit meeting –
no surprises
Documentation and Follow-up Activities•
Written report –
avoid personal information
•
Communication of assessment results and recommendations
•
Legal considerations –avoid drawing legal conclusions
•
Development of corrective action plan
•
Follow-up on corrective actions
PAC 2 Committee Members
Report 162 available: http://NCRPpublications.org
Dave Myers, Chair
Edgar Bailey
Ken Miller
Carol Berger
John Poston
Mary Birch
Kathy Pryor
John Frazier
Josh Walkowicz
Eric Goldin
James Yusko
NCRP Overview Program Area Committee 4
Radiation Protection in Medicine
Jerrold T. Bushberg Ph.D., DABMPScientific Vice-President
National Council on Radiation Protection and Measurements
Bethesda, Maryland
Health Physics Society Annual MeetingNCRP Special Session
Salt Lake City, UTJune 30, 2010
PAC 4 Membership, Jerrold T. Bushberg, Vice President
• E. Stephen Amis• James A. Brink• John F. Cardella• Cindy C. Cardwell• Marc Edwards• Donald P. Frush• Ronald E. Goans
• Linda A. Kroger• Edwin M. Leidholdt• Fred A. Mettler, Jr.• Theodore L. Phillips• J. Anthony Seibert• Stuart C.White• Shiao Y. Woo
PAC 4 Membership Broad Base of Experience & Expertise
Presidents ACR, ARR, CRCPD, ASTRO, AAPM, RRS5 Chairs of Radiology / Radiation OncologyExperts in CV & IR Radiology, Pediatric Radiology, Radiation Oncology, Nuc Med, Dentistry & Occup medExperts in Dx, Nuc Med & Therapy PhysicsMembers of Image Gently & Image WiselyExperts in Hospital Radiation Safety State & Fed RegulatoryExperts on acute & chronic effects of medical radiation.Members & Advisors to ICRP, IAEA, FDA, UNSCEAR, IOM…
Over 300 person-y of experience in Radiation Protection in Medicine
Recent NCRP Publications
Report No.161 (2009):Management of Persons Contaminated
With Radionuclides: William J. Bair, ChairUpdate & expansion of 1980 NCRP Report No. 65, Management of Persons Accidentally Contaminated with Radionuclides
Management of Persons Contaminated With Radionuclides
Broader coverage of radionuclides & possible exposure and response scenariosMultipurpose handbook that provides quick reference information for early actions & longer-term management and treatmentIssued in two volumes– Volume I: Handbook for managing contaminated persons– Volume II: Provides the scientific and technical bases for the
recommended management procedures including detailed discussions of internal dosimetry models
Management of Persons Contaminated With Radionuclides
Volume I Contains Four Major Sections:Section 1: Update of the “yellow” section of NCRP Report No. 65; contains quick reference information for emergency responderSection 2: Recommendations on onsite and pre-hospital actions that should be taken by responders;Section 3: Extensive discussion of actions that should be taken in the treatment of contaminated patients at a medical facility;Section 4: Recommendations on post-treatment follow-up and guidance on contamination control in handling decedents
Current PAC 4 Scientific Committees
SC 4-2 Report:Population Monitoring and Decontamination Following a Nuclear or Radiological Incident”Richard Vetter, Chair
SC 4-3 Report: Diagnostic Reference Levels in Medical Imaging: Recommendations for Application in the United States, James Brink, Chair
Sc 4-4 Report:Risks of Ionizing Radiation to the Developing Embryo, Fetus and Nursing Infant, Robert Brent, Chair
ICRP introduced the concept of DRLs in ReportNo. 60 (1990), and subsequently recommended their use in ICRP Report No.73 (1996). DRLs serve as a means to investigate and identify practices where the level of patient dose or administered activity is unusually high, relative to benchmark data.The goal is to optimize the dose and image qualityDRLs are not intended for regulatory or commercial purposes or to establish a legal standard of care.
SC 4-3: Diagnostic Reference Levels (DRLs) in Medical Imaging
Recommendation for Application in the U.S.
SC 4-3: Diagnostic Reference Levels (DRLs) in Medical Imaging
Recommendation for Application in the U.S.
DRLs are defined, developed and utilized in different way around the world. The NCRP report will contain a comprehensive discussion of the history and applications of DRLs in the U.S., Europe, and elsewhere.The report will consolidate and recommend
DRLs in adults & children for a number of examinations: Radiography, Fluoroscopy, CT, Interventional Procedures, Dental and Nuclear Medicine.
SC 4-4: Risks of Ionizing Radiation to the Developing Embryo, Fetus and Nursing Infant
Supersedes:--1977 NCRP Report 54 Medical Radiation Exposure of Pregnant and Potentially Pregnant Women--1994 Commentary No. 9 Considerations Regarding the Unintended Radiation Exposure of the Embryo, Fetus or Nursing Child
SC 4-4: Risks of Ionizing Radiation to the Developing Embryo, Fetus and Nursing Infant
The report will provide a comprehensive update and discussion of:Birth defects and developmental
abnormalities that can result from ionizing and non-ionizing (US & MRI) irradiation of an embryo, fetus, or nursing infantDose to embryo, fetus, from a variety of medial imaging procedures including the dose to nursing infants from radiopharmaceuticles administered to the mother
SC 4-4: Risks of Ionizing Radiation to the Developing Embryo, Fetus and Nursing Infant
Effective methods of communicating the risks & responding to FAQs from patientsConveying the scientific basis that effect the decisions on whether and when diagnostic or therapeutic radiological procedures can be performed with minimal risk to the developing embryo or fetus.
Radiation Protection in Medicine
• Proceedings of the 43rd Annual NCRP Meeting (2007): Advances in Radiation Protection in Medicine published in Health Physics, Vol. 95(5), 2008
NCRP Web SiteMain Page
Conference on Control of CT Doses in Conventional Imaging and Applications in Emergency Medicine September 2009. Consensus guidance publication (to be issued in 2010)
Future NCRP Activities Radiation Protection in Medicine
Genetic Susceptibility to Radiation-Induced Cancer
Operational Radiation Safety for PET and Fusion Imaging Systems and Radionuclide Production
Update of NCRP Report No. 102 (1989): Medical X-Ray, Electron Beam and Gamma-Ray Protection for Energies up to 50 MeV(Equipment Design, Performance and Use)
Future NCRP Activities Radiation Protection in Medicine
Update of NCRP Report No. 68 (1978): Radiation Protection in Pediatric Radiology
CQI in Medical Imaging
Commentary on Guidance for IRB on Evaluating & Communicating Radiation Risks for Studies on Human Subjects
Richard J. Vetter, Ph.D. CHP(on behalf of Scientific Committee 4-2)
NCRP Special Session55th Annual Health Physics
Society MeetingSalt Lake City, Utah
June 30, 2010
Population Monitoring and Radionuclide Decorporation
Following a Radiological or Nuclear Incident
SC 4-2 Members
• Steven M. Becker• Eugene H. Carbaugh• James R. Cassata• Scott Davis• Fun H. Fong, Jr. • P. Andrew Karam
Richard J. Vetter, Chair,
• Steven H. King• Adela Salame-Alfie• Lin-Shen Casper Sun• Katherine Uraneck• George J. Vargo
Bruce B. Boecker, NCRP Staff Consultant
Acknowledgements
Major Funding:• Centers for Disease Control &
Prevention
Technical Assistance:• Wesley Bolch• Badal Juneja
Intent
• Addressed to federal, state and community emergency planners.
• Provide general advice on screening public for internal contamination following RDD or IND.
• Use of GM to Screen for internal contamination: limited list of radionuclides.
• Advise physicians on use of CDG for limited list of radionuclides.
• Second in series of two on management of persons contaminated with radionuclides (NCRP Report Nos. 161, Vol 1 & 2; No. 166)
Radionuclides Considered in This Report
Radionuclide• Co-60• Sr-90• I-131• Cs-137• Ir-192• Ra-226• U-235, 238• Pu-238, 239• Am-241
GM Rapid Screen• Yes• No• Yes• Yes• Yes• No• No• No• No
Radiological Triage & Screening
• General guidance:– NCRP Commentary 19– NCRP 161 (control zones; CDG)– Highest priority: critically injured
• Surveying for external contamiantion• Screening at the scene vs. hospital• Biodosimetry
Radiological Triage & Screening
• Priority:– Patients who have suffered life-
threatening injuries should be given medical care immediately, without regard to contamination.
• Objective:– Determine whether level of internal
contamination in a patient exceeds the CDG.
Clinical Decision Guide (CDG: Concept and Use
• The CDG provides an important measure that physicians should use when considering the need for medical treatment of individuals having an internal radionuclide deposition.
• If threshold for CDG has been exceeded, physician should consider decorporation.
Clinical Decision Guide (CDG: Concept and Use
• CDG: - maximum once in a lifetime intake of
radionuclide that represents stochastic risk in the range of risks associated with guidance on dose limits for emergency situation.
- Does not cause deterministic effects.- 250 mSv effective dose in adult- 50 mSv effective dose in child- Fact sheets provided for each radionuclide
CDG for Some Radionuclides
RadionuclideCo-60 (M)*Sr-90 (F)I-131 (V)Cs-137 (F)Ir-192 (M)Ra-226 (M)U-235 (M)U- 238 (M)Pu-238 (M)Pu-239 (M)Am-241 (M)*Inhalation type
MBq uCi35 9508.3 2300.26 6.958 160059 16000.11 3.10.12 3.20.12 3.20.008 0.220.0076 0.20.0093 0.25
Direct (in vivo) Screening
• GM detector• Whole-body & lung counter• Nuclear medicine thyroid probe• Nuclear medicine gamma camera• Portal monitor
Indirect (in vitro) Screening
• Nasal swab• Urine sample• Fecal sample
GM Method for Rapid Screening
• Tables for reference male, reference female, and 10 y old child.
• Distances of 6 and 30 cm from sternum and spine.
• Times: 1 to 72 h post intake.• Radionuclides: Co-60, Cs-137, Ir-192.• Any radioiodine in thyroid, treat per FDA
recommendations.
GM Method for Rapid Screening
(Net cpm
corresponding to 1 CDG @ 6 cm 1 h after intake)
RadionuclideMale
Co-60 (M)Cs-137 (F)Ir-192 (M)
FemaleCo-60 (M)Cs-137 (F)Ir-192 (M)
ChildCo-60 (M)Cs-137 (F)Ir-192 (M)
AP PA
12,900 92006300 3800
14,400 9500
15,400 970010,000 510017,800 10,200
2500 16002300 12002900 1700
Medical Management
• Based on detailed guidance from NCRP Report No. 161.
• General guidance for treatment of internal contamination.
• Triage.• Prioritizing children and pregnant women.• Self treatment.• Wound management.• Medical management of radionuclides in this
Report.
Scalability
• Use of mass casualty incident response tiers for Emergency Department response to injuries from an explosive radiological device.
• Tiers based on scope of incident:- Emergency Department only- Assistance from other departments- Hospital Wide- Community wide- Regional- National
Assessment of Current U.S. Capacity
• Equipment & resources• Laboratory capabilities• Training needs• Volunteers to support screening• Biodosimetry
Summary
• Stabilize critically injured prior to external decontamination.
• For some radionuclides of concern, 1 CDG is easily detected with a GM survey meter.
• Use bioassays to screen individuals contaminated with radionuclides that don’t emit gammas.
• Use REAC/TS to assist with bioassays and biodosimetry.• Watch CDC website for additional screening tables.• Follow medical management guidelines if CDG threshold
is exceeded.• Be prepared to scale up to screen large numbers of
people following a RDD or IND.
S.Y. Chen, PhD, CHPArgonne National LaboratoryArgonne, IL
Presented at 55th Annual Meeting of the Health Physics SocietySalt Lake City, UtahJune 27 – July 1, 2010
Scientific Committee 5-1 Report on “Approach to Optimizing Decision Making for Late-Phase Recovery from Nuclear or Radiological Terrorism Incidents”
RDDs and INDs May Derive from Many Sources
“Radiological Dispersal Device” (RDD) refers to any method used to deliberately disperse radioactive material in the environment in order to cause harm.
“Improvised Nuclear Device”(IND) refers to any device incorporating radioactive materials designed to result in the dispersal of radioactive material or in the formation of nuclear-yield reaction.
The Response and Management Are Represented in Three Sequential Phases
Protective Action Guides (PAGs) Issued By the Department of Homeland Security for RDDs and INDs*
PHASE Protective Action PAG
Early Sheltering-in-place or evacuation of the publicAdministration of prophylactic drugs – potassium iodine Administration of other prophylactic drugs or decorporation agents
1 to 5 rem projected dose
5 rem projected dose to child thyroid
Intermediate Relocation of the public
Food interdiction
Drinking water interdiction
2 rem projected dose first year. Subsequent yeas, 0.5 rem/y projected dose.0.5 rem projected dose or 5 rem to any individual organ or tissue in the first year, whichever is limiting.0.5 rem projected dose in the first year
*The final version of the guidance, Planning Guidance for Protection and Recovery Following Radiological Disposal Device(RDD) and Improvised Nuclear Device (IND) Incidents, was published by DHS in Federal Register, Vol. 73, No.149 (August 1, 2008). It is to be noted that it does not contain a PAG for the Late Phase.
The “Optimization” Process Requires Multi-Faceted Effort
• Key Considerations– Pubic Health– Social Economics– National Security– Public Welfare – Communication
• Decision Process– A Graded Approach– Qualitative and Quantitative Assessments– Evaluation of Remedial Options
• Cost-Benefit Analysis• Technology Evaluation• Short- and Long-Term Feasibility• Land Use Options
– Stakeholder Involvement– Implementation of the Decision
Recent Reports Identify Needs to Address Long Term Recovery
• GAO Report (JAN 2010) – Report to Congressional Committees
“Combating nuclear terrorism – actions needed to better prepare to recover from possible attacks using radiological or nuclear materials”
• Homeland Security Affairs Journal, Paper (JAN 2010) – S.Y. Chen and T.S. Tenforde
“Optimization approach to decision making on long-term cleanup and site restoration following a nuclear or radiological terrorism incident”
Cleanup of Urban Area Presents Special Challenges
• Statutory cleanup requirements such as CERCLA have applied mostly to non- urban areas
• No clear federal guidance on long-term recovery phase
• Policy on radioactive waste disposal may not be applicable
• Recovery effort faces competing priorities
• Returning the society to “normalcy” becomes the top priority
The Late-Phase Actions Involve Many Complex Issues
Relevant Issues and Competing Factors
•Wide-area cleanup issues•Availability of effective cleanuptechnologies•Nonspecific cleanup criteria (long-term health risks)•Accommodation with existingcleanup statutory requirements•Waste generation and disposalissues
•Potential cleanup costs•Inexperience in managing the late-phase activities•Competing priorities of the society
0.01
0.1
1
10
100
0 10 20 30 40 50 60 70 80 90 100
Cleanup Criteria (mrem/yr)
Affe
cted
Are
a (k
m2 )
Stable ConditionsStable Conditions with ExplosionNeutral ConditionsNeutral Conditions with Explosion
Past Experiences Offer Valuable Lessons
Goiania, Brazil (1987)Chernobyl, Ukraine (1986)
Current Federal Cleanup Guidance Is Part of the Optimization Process
• Current Cleanup Guidance– EPA CERCLA (i.e., Superfund) cleanup– NRC License Termination Rule (10 CFR 20, Subpart E)– DOE cleanup of nuclear weapons complex
• Major Differences with Event-Related Situations– Incident vs. nonincident situations– Urban vs. rural contamination– Above ground vs. subsurface contamination– Cleanup costs and funding mechanisms– Applicability of current regulatory requirements – Allocation of other priorities vs. long-term health risks– Involvement of different stakeholder groups
Liberty RadEx – Recovery Exercise for RDD
Recommendations
• Develop Further Guidance on for Optimization Process– Principles and Approach to Optimization– Key Components and Parameters– Technical Basis and Requirements– Implementation Procedures– Develop Case Examples– Develop National Disaster Recovery Strategy
• Identify and Address Relevant Issues– Address Policy Needs– Fill Technical Gaps and Provide Assessment Tools– Vet the Issues through Recovery Exercises (for RDD)
• Liberty RadEx (April 2010, Lead by EPA)– Obtain Lessons Learned
Design of Effective Radiological Effluent
Monitoring and Environmental
Surveillance Programs
Bernd KahnGeorgia Institute of Technology
Scientific Committee 64-22
Bernd Kahn, ChairJames D. Berger Richard E. JaquishJohn E.Glissmeyer Janet A. JohnsonCarl V. Gogolak Shyam K NairNorbert Golchert
Consultants/Advisors:Bruce A. Napier Richard ConatserJohn E. Till
Staff consultant: E. Ivan White
Content
• Executive Summary• Introduction• Program Description• Program Planning• Quality Assurance/Quality Control• Environmental Pathways• Modeling Predictions• Effluent Monitoring• Environmental surveillance• Communication the Results
Section 2 –
Program Description -
1
Definitions• Effluent monitoring: collection and analysis of
airborne and aqueous samples, and measurement of effluent stream radiation, before or at their entry into the environment.
• Environmental surveillance: Collection and radiochemical analysis of samples of air, water, foodstuff, biota, soil, and other media and measurement of external radiation.
Section 2 -
Program Description –
2
Objectives• Guidance to control releases• Compliance with regulations and guides• Information for stakeholders and program
manager• Research to improve program • Documentation, historical and legal
Section 2 -
Program Description -
3
Emphasis on integrating effluent monitoring and environmentasl survaillance
• Accurate monitoring at the point of release• Surveillance near point of exposure• Combine to test models, notably site-specific
transfer factors
Section 3 –
Program Planning – Use of Data Quality Objectives
• Involve stakeholders (whose interest?)• Clarify study objectives (why?)• Define appropriate data to collect (how used?)• Select data collection conditions (where, when?)• Specify data quality and quantity (reliable,
sensitive?)• Optimize design (cost effective?)• Maintain optimization (utilize feedback?)
Section 4 –
Quality Assurance and Quality Control -
1
Data Life Cycle concept:• Planning – 18 basic elements: organization,
actions, records, audits• Implementation – Quality Assurance Project
Plan• Assessment – validation, verification, evaluation• Decision making – radionuclide releases are
acceptable, unacceptable, or require further measurements
Section 4 -
Quality Assurance and Quality Control -
2
Quality Assurance: • sample/monitor pertinence• Shipping/transmission reliability• Storage stability• Analysis and measurement trust• Calculating and reporting validityQuality Control:• In sampling, analysis, measurement, reporting• Based on internal and external tests• Assure identity, accuracy, precision, sensitivity
Section 5 –
Environmental Pathways -
1
Scientific and technical knowledge bases:• Meteorology • Geology and subsurface hydrology• Surface hydrology• Radioecology• Demography and land use• Physiology and metabolism
Section 5 –
Environmental Pathways -
2
Surveys, measurements, and studies• Literature search and expert advice• Continuous and intermittent data collection
(wind and weather, surface water flow, population, crops)
• Identification of critical radionuclides, pathways, and exposed persons
• Calculation of site-specific transfer factors
Section 6 –
Modeling Predictions -
1
Release conditions• Continuous with fluctuations• Periodic• Accident/incidentTransport and fate• Single medium, intermedia, multimedia• Radionuclide concentrations, radiation dose• Individual, population group• Human, other biota
Section 6 –
Modeling Predictions -
2
Application• Dose prediction, pre-operation• Guidance for monitoring and surveillance
planning• Dose estimation from effluent monitoring• Confirmation of surveillance resultsMathematical treatment options• Dynamic or steady state (e.g., annual average)• Deterministic (point value) or probabilistic
(statistical range)
Section 7 –
Effluent Monitoring -1
Considerations• Airborne (gases and particles) and liquid
(soluble and suspended)• Continuous or intermittent (regular or
occasional)• Routine or incident/accident response• In-line monitoring or off-line sampling
Section 7 –
Effluent Monitoring -
2
Specifications• Representative locations and times• Operating reliability and access for repair• Precision (reproducibility) and sensitivity
(detection limit)• Accuracy (checked by standards)• Range (from detection limit to accident scenario
maxima)• Operation and placement defined by the
monitoring plan
Section 8 –
Environmental Surveillance -
1
Range of Guidance
• Environmental media (air, water, vegetation, food, biota, soil, etc.)
• Sample collection devices• Radioanalytical methods• Radiation detection instruments
Section 8 –
Environmental Surveillance -
2
Focus on• Reliable methods• New methods• Techniques for unusual requirements• Sources of information• Sensitivity, precision, sample load. scheduling
Section 9 –
Communication
Data review and evaluation• Verification and validation• Data Quality AssessmentData organization and reporting• Management, formatting, presentation, and
storage• Uncertainty and sensitivity reportingAssessment of impacts • Radiation dose and risk
Summary
History of NCRP SC 64-22 Report• Report writing 1997 – 1999• Work suspended for lack of funds• Draft written 2006• Report writing renewed October 2009• Updated draft submitted to NCRP for
membership review June 2010• If approved, publication anticipated 2011
NCRP Report No.158: “Uncertainties in the Measurement and Dosimetry of
External Radiation”
Steven L. SimonNational Cancer InstituteNational Institutes of HealthBethesda, MD
Harold L. BeckU.S.D.O.E. (ret.)New York City, NY
Harold L. Beck, ChairmanUSDOE/EML (Retired) New York, NY
Leslie A. BrabyTexas A&M University College Station, Texas
Frederick M. CummingsIdaho National Laboratory Idaho Falls, ID
Kenneth R. KasePalo Alto, California
Thomas B. KirchnerCEMRC Carlsbad, New Mexico
David A. Schauer National Council on Radiation
Protection and Measurements Bethesda, Maryland
Steven M. Seltzer National Institute of Standards and Technology Gaithersburg, Maryland
Steven L. SimonNational Cancer Institute National Institutes of health Bethesda, Maryland
Chris G. SoaresNational Institute of Standards and Technology Gaithersburg, Maryland
R. Craig YoderLandauer, Inc. Glenwood, Illinois
NCRP Report No. 158 is 1 of 3 reports in a related series of reports supported by the Defense Threat Reduction Agency.
Other reports in the series are:
Report No. 164 : “Uncertainties in Internal Radiation Dose Assessment” (chair: A. Bouville)
Report No. 163: “Radiation Dose Reconstruction: Principles and Practices” (chair: B. Napier) – in press.
Report
No.
158
reviews
the
sources
of
uncertainty
associated
with
measurements
of
external
radiation
as
well
as
the
uncertainty
in
relating
the
measured
quantities to absorbed dose to various body organs.
The report provides:
•Estimates of the magnitude and probability distribution of all major sources of uncertainty in external dose estimation.
•A discussion of measurement uncertainties for all major instrument types used for measuring external radiation.
•A discussion of the principles of uncertainty and error, and of various probability density functions (PDF) useful for describing uncertainty.
•A discussion of methods for combining uncertainties to estimate the total uncertainty in an organ dose.
• A number of examples (case studies) that illustrate the concepts discussed.
STATISTICAL CONCEPTSReport 158 presents statistical concepts that are used in evaluating uncertainty in dosimetry, including:
• Basic concepts, e.g, precision, bias
• Meaning and types of uncertainty: aleatory and epistemic
• Classification of uncertainty: classical and Berkson
•Probability distributions, their characteristics and related confidence intervals,
• Concepts for assigning types of distributions to data sets
INSTRUMENTATION: Report 158 discusses measurement uncertain- ty for instruments used in external dose assessment (1 of 2):
Instrument System Primary Use Major Sources of Uncertainty
Area Monitors for Photon and Charged Particle Radiation FieldsIon Chambers Gamma Energy, angular responseGM Counters Gamma, beta Energy, angular response Scintillation Detectors Gamma, charged
particlesEnergy, angular response
Diodes Gamma, charged particles
Energy, angular response
Film and TLD Gamma Calibration, processing, fading
In Situ Gamma Spectrometry
Gamma Calibration, unfolding
Area Monitors for Neutron and Mixed Radiation FieldsTissue Equivalent Proportional Counters
Mixed fields LLD, angular responses
Multi-Detector Neutron Spectrometers
Neutrons Unfolding, response matrix
Scintillation Detectors for Neutron Spectrometry
Neutrons Gamma-neutron discrimination
H and He Proportional Counters
Mixed fields Pulse height discrimination
Activation detectors Neutrons Cross sections, angular response
Instrument System Primary Use Major Sources of Uncertainty
Personal Monitors for Photon and Charged Particle Radiation ExposureFilm Dosimeters Gamma, beta Calibration, processingTLD Dosimeters Gamma Calibration, processing,
fadingOptically Stimulated Luminescence
Gamma Similar to TLD
Electronic Dosimeters Gamma, charged particles
Detector dependent
Personal Monitors for Neutrons and Mixed Radiation Fields
NTA Film Neutrons Fading, energy response
TLD Neutrons Neutron-gamma partitionTrack Etch Detectors Heavy ions Track counts, angular
responseNeutron Bubble Detectors Neutrons Temperature
INSTRUMENTATION: Report 158 discusses measurement uncertain- ty for instruments used in external dose assessment (2 of 2):
ORGAN DOSE ESTIMATION (1/2): Report 158 discusses sources and magnitudes of uncertainties in:
(1) Converting area measurements (i.e., field dosimetry measurements) to organ dose,
(2) Converting personal dosimeter measurements to organ dose,
(3) Radiation-related factors that affect conversions from measurements to organ dose (e.g., geometry and energy),
ORGAN DOSE ESTIMATION (2/2): Report 158 discusses sources and magnitudes of uncertainties in:
(4) Non-radiation-related factors that affect conversions from measurements to organ dose (e.g. variations in body organ size and shape, phantom model, etc.), and
(5) Biological variability (e.g., actual body organ size and shape).
The literature on gamma and neutron organ dose estimation is reviewed in detail and a quantitative analysis of uncertainties of photon dose conversion factors is provided.
ThyroidEsophagus
HeartLungLver
StomachGI tract
Energy (MeV) AP PA
ICRP GM GSD ICRP GM GSD0.01 2.9E-04 2.2E-04 1.9 4.8E-04 2.2E-04 4.20.02 1.4E-02 1.3E-02 1.6 3.2E-02 1.5E-02 2.90.03 7.0E-02 8.5E-02 1.2 1.7E-01 1.2E-01 1.50.04 2.1E-01 2.5E-01 1.2 4.5E-01 3.5E-01 1.30.05 4.0E-01 4.6E-01 1.2 7.7E-01 6.3E-01 1.20.06 5.7E-01 6.4E-01 1.2 1.0E+00 8.6E-01 1.20.07 7.0E-01 7.6E-01 1.2 1.2E+00 1.0E+00 1.20.08 7.7E-01 8.4E-01 1.2 1.3E+00 1.1E+00 1.20.1 8.2E-01 9.0E-01 1.1 1.3E+00 1.2E+00 1.10.2 7.8E-01 8.5E-01 1.1 1.2E+00 1.1E+00 1.10.3 7.6E-01 8.1E-01 1.1 1.1E+00 9.9E-01 1.1
Example uncertainties of photon dose factors (DT /Ka ) for RBM by energy and geometry based on evaluation of multiple phantoms and known irradiation geometry.
Example uncertainties of photon dose factors (DT /Ka ) for RBM by energy but poorly understood irradiation geometry.
Energy(MeV)
AP or PA(equally likely)
Unknown Irradiation Geometry
(AP, PA, LLAT, RLAT, ROT equally likely)
ROT (for comparison only)
GM GSD GM GSD GM GSD0.01 2.2E-04 2.89 8.8E-05 7.62 6.2E-05 12.80.015 3.2E-03 2.08 1.9E-03 3.28 2.1E-03 2.970.02 1.4E-02 2.19 9.9E-03 2.32 1.1E-02 2.090.03 1.0E-01 1.44 7.3E-02 1.56 8.1E-02 1.330.04 2.9E-01 1.32 2.2E-01 1.45 2.4E-01 1.210.05 5.4E-01 1.27 4.0E-01 1.41 4.4E-01 1.170.06 7.4E-01 1.24 5.6E-01 1.38 6.1E-01 1.140.07 8.8E-01 1.24 6.7E-01 1.37 7.3E-01 1.140.08 9.7E-01 1.21 7.4E-01 1.35 8.0E-01 1.110.1 1.0E+00 1.19 7.9E-01 1.34 8.5E-01 1.100.15 9.9E-01 1.18 7.7E-01 1.31 8.3E-01 1.090.2 9.5E-01 1.15 7.5E-01 1.29 8.0E-01 1.070.3 9.0E-01 1.14 7.2E-01 1.26 7.7E-01 1.06
Variation photon dose factors (DT /Ka ) for RBM by body mass index (BMI) of phantoms – a source of additional uncertainty for real persons (example: AP geometry, 60 kVp x-rays)
BMI
95% CI on regressionD
T/ K
a
PROPAGATING UNCERTAINTY
Possibly the area least familiar to HPs are methods to correctly combine uncertainties from multiple parameters, assumptions, and sources of uncertainty.
Two methods discussed are:
(1) Monte Carlo (numerical simulation)
(2) Analytical and Mathematical Approximation
X+Y X+Y
Many simulationsFew simulations
[ ] [ ] [ ]kj
n
j
n
jk kjj
n
j jn XX
Xf
XfX
XfXXXf ,cov2var),,,(var
1
2
121 ∑∑∑
= >= ⎥⎥⎦
⎤
⎢⎢⎣
⎡
∂∂
×∂∂
+⎥⎥⎦
⎤
⎢⎢⎣
⎡
∂∂
=K
Fifty (50) pages of Report 158 are devoted to detailed examples of real-world analyses of uncertainty in external dose estimations. Examples demonstrate many of the concepts discussed.
Example 1: Uncertainty in external dose reconstruction for an atomic veteran – applicable to those working on military dose reconstruction for compensation.
Example 2: Estimation of organ dose and related uncertainty for radiologic technologists – applicable to those working in reconstruction of occupational exposure in medicine.
Example 3: Uncertainty in Techa River cohort external dosimetry – applicable to those working on environmental dose reconstruction.
Example 4: Uncertainty in neutron doses for multi-site leukemia case control study – applicable to those working on occupational dose reconstruction for epidemiology.
Example 5: Uncertainty in external dose reconstruction for an energy employee – applicable to those working in occupational dose reconstruction for compensation.
Report 158 reminds us in great detail that:
•Organ doses cannot be measured directly but must be estimated using models that convert measured quantities such as exposure, fluence, phantom measurements to organ dose.
•Estimates of dose may pertain to theoretical persons, representative persons, or actual individuals.
•Exposure conditions will vary in terms of geometry of irradiation, radiation type, and energy.
•Uncertainty will depend on the complexity of the radiation exposure scenario as well as the quality and quantity of the model input (measurement data), uncertainty in the model itself, and the number and importance of assumptions made.
Possibly the most important attribute of Report 158 is that it discusses each of the concepts for estimating uncertainty of external dose separately, and provides the theory as well as the practical steps for combining uncertainty from diverse sources into a single numerical statement of uncertainty (or conversely, of confidence).
Report 158 clarifies all basic concepts of external dose assessment and estimation of uncertainties.
Jack J. FixHealth Physics,
June 96(6): 682, 2009
If you are interested in external dose estimation, I urge you to buy this report!
THANK YOU FOR YOUR THANK YOU FOR YOUR ATTENTIONATTENTION..
UNCERTAINTIES IN INTERNAL RADIATION DOSE ASSESSMENT
(Summary of NCRP Report No. 164)
André Bouville and R Thomas Bell III(on behalf of Scientific Committee 6-3)
Health Physics Meeting - Salt Lake City – 30 June 2010
Objective of the Report
• The objective of the Report is to review the current state of knowledge of uncertainties in internal dose assessments, including uncertainties in the measurements that are used to perform these assessments.
Intent and content
• Addressed to health physicists, radiation protection professionals, and medical physicists
• Review of the main sources of uncertainty and of ways to quantify them
• Estimates of uncertainties in the doses per unit intake
• Examples of application of the methods
Committee Members
• André Bouville, Chair, NCI• Iulian Apostoaei, SENES Oak Ridge • Wesley Bolch, University of Florida• Anthony James, Washington State University• Kimberlee Kearfott, University of Michigan• Guthrie Miller, Los Alamos National Laboratory• David Pawel, USEPA• Charles Potter, Sandia National Laboratories • George Sgouros, Johns Hopkins University• Richard Toohey, Oak Ridge Associated Universities
Consultants• Alan Birchall, HPA, UK• Dunstana Melo, NCI• Matthew Puncher, HPA, UK• Michael Stabin, Vanderbilt University
Advisor• Richard Leggett, Oak Ridge National Laboratory
NCRP Staff• Thomas Bell III
Organization of the Report
• Main Sections– Methods to determine internal doses– Types and categories of uncertainties– Statistical methods – Uncertainties in the measurements– Uncertainties in the intakes– Uncertainties in the models and parameters– Uncertainties in the dose coefficients– Examples (17)
• Appendices (9)
Fields of application
• Research (epidemiology): YES
• Compensation (legal): YES
• Regulation (dose limits): NO
Dose endpoints
• Effective dose (wR ; wT ): NO
• Equivalent dose (wR ): NO
• Absorbed dose (physical quantity): YES
Exposure situations
• Type: retrospective or prospective
• Setting: environmental, occupational, or medical
• Target: specific or unspecified individual
Examples of exposure situations
• Specific individual: – Retrospective, occupational: worker with
positive bioassay data– Retrospective, environmental: subject of
an epidemiologic study– Prospective, medical: treatment planning
• Unspecified individual:– Retrospective, environmental: child
exposed to last year’s release– Prospective: worker in a plant to be built.
Models
• Uptake
• Systemic
• Dosimetric
Respiratory tract model
25475
ET1
ET2
BB
Albb
5 main regions
bb
ET1
ET2
AI1 AI2 AI3
BB1
bb1bb2
BB2
bbseq
BBseq
LNTH
LNET ETseq
ENVIRONMENT
GI-TRACT0.001
0.01
0.012
.020.00010.00002
0.03
0.03 10
1
.001
Extrathoracic
Thoracic
100
Particle transport
Respiratory tract model
ETET11
ETET22
BBBB
bbbb
AIAI
Rate constant Rate (d-1)
λST 24λSI 6λULI 1.8λLLI 1
f1λs
λs λSI
GI tract model
Wound model
Systemic model (Pu)
ICRP 56+ type models
Gonads
Blood
Urinary Bladdercontents
Urine
Kidney
Soft tissues Intermediate Rapid Slow
Skeleton
(with remodelling)
Skeleton
Cortical volume
Cortical surface
Cortical marrow
Trabecular
volumeTrabecular
surfaceTrabecular
marrow
Liver
Liver 2
Liver 1
GI contents
Dosimetric models
•
Calculate the doses to target organs per decay of a radionuclide in source organs.
•
Tools:–
Radionuclide decay data (new ICRP values)
–
Anthropomorphic phantoms (Wes Bolch)
–
Radiation transport software (MCNP)
Newborn Male Newborn Female 1‐year Male 1‐year Female 5‐year Male 5‐year Female
10‐year Male 10‐year Female 15‐year
Male 15‐year Female Adult Male Adult Female
UF Family of Hybrid Phantoms
Statistical methods
• Classical
• Bayesian
• Mixture of classical and Bayesian
Intake, RN Form Tissue
Lower Bound(Gy/Bq)
Upper Bound(Gy/ Bq)
Ratio
Inhalation ,14C
CO2 RBM 4 10–12 2 10–10 50
Inhalation , 90Sr
Unknown LungBoneRBM
5 10–10
3.8 10–8
2 10–9
3 10–6
5.8 10–6
3 10–7
6,000150150
Ingestion ,131I
Food Thyroid 1.8 10–
71.0 10–
65.4
Ingestion ,137Cs
Food ColonRBM
6 10–9
8 10–93 10–8
1.6 10–
8
52
Inhalation ,137Cs
Unknown LungColonRBM
1 10–9
1 10–9
1 10–9
6 10–7
1 10–8
1 10–8
6001010
Uncertainties in dose per unit intake: unspecified healthy adult
List of examples
• Atomic veteran (occ.)• Chernobyl (env.)• Thyroid cancer (med.)• Lymphoma (med.)• Lymphoma (med.)• Tritium (occ.)• Nuclear reactor (occ.)• DoE worker (occ.)• Sr-90 (env.)
• DU shrapnel wound• Pu-238 (occ.)• Goiania (env.)• Pu wound (NCRP)• Inhaled DU
(Bayesian/WelMos)• Inhaled Am-241• Information transfer• Mayak (Bayesian)
Status of the Report
• Final draft:– August 2009– Accepted for publication
• Expected year of publication: 2010
THE ENDThank you for your attention.