PR 00 Introduccion motivacion

8/2/2019 PR 00 Introduccion motivacion

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IAEAInternational Atomic Energy Agency

RADIATION PROTECTION INDIAGNOSTIC ANDINTERVENTIONAL RADIOLOGY

L 0. Principles of Radiation Protection andMotivation for the Course

IAEA Standard Syllabus Course on Radiation Protection in Diagnostic and Interventional Radiology


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IAEA

Introduction to Radiation Protection in Diagnostic Radiology 2

Introduction

Subject matter motivation for radioprotectionand quality assurance in diagnostic andinterventional radiology

Give an overview of different contributions ofradiation exposure, the principles ofradiation protection

Specifity of the medical exposure


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IAEA


Is there

RADIATIONin this room?


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IAEA


Radiation - We live with

Natural Radiation: Cosmic rays, radiation within ourbody, in food we eat, water we drink, house we livein, lawn, building material etc.

Human Body: K-40, Ra-226, Ra-228

e.g. a man with 70 kg wt. 140 gm of K140 x 0.012%=0.0168 gm of K-400.1 Ci of K-40

24,000 photons emitted/min

(T1/2 of K-40 = 1.3 billion yrs)


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IAEA


K-40 Estimate for Lean Body Mass

Body weight = Fat + lean body mass

K-40 directly related to lean body mass

Whole body counter used


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IAEA



Earth: Top 1m of 0.1 acre garden

=1200 kg of K of which K-40 =1.28 Kg

= +3.6 Kg of Th + 1 Kg Ur

Gy/yrNew Delhi 700

Bangalore 825

Bombay 424

Kerala 4000

(in narrow coastal strip)


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IAEA Introduction to Radiation Protection in Diagnostic Radiology 8


Food Radioactive levels (Bq/kg)

Daily intake(g/d)

Ra-226 Th-228 Pb-210 K-40

Rice 150 0.126 0.267 0.133 62.4

Wheat 270 0.296 0.270 0.133 142.2

Pulses 60 0.233 0.093 0.115 397.0

OtherVegetables

70 0.126 0.167 -- 135.2

LeafyVegetables

15 0.267 0.326 -- 89.1

Milk 90 -- -- -- 38.1CompositeDiet

1370 0.067 0.089 0.063 65.0

Dose equivalent=0.315 mSv/yr

Total dose from Natural sources = 1.0 to 3.0 mSv/yr


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Radiation from Natural Sources

Normally 1-3 mSv/year

In areas of high background, 3-13 mSv/year


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DO WE NEED

RADIATION

PROTECTION ?


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Drinking Hot Coffee

Excess Temperature = 60 - 37 = 23

1 sip = 3ml

3x 23 = 69 calories


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Lethal Dose= 4Gy

LD 50/60 = 4 Gy

For man of 70 kg

Energy absorbed = 4 x 70 = 280 Joules

= 280/418= 67 calories

= 1 sip


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SO WE NEED

RADIATION

PROTECTION


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We live with1-3 mSv

Can kill4000 mSv

Radiation

Where to stop, where is the safe point?What are the effects of radiation?


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Death

Cancer

Skin Burns

Cataract

InfertilityGenetic effects

What can radiation do?


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CAN X-RAY

CAUSE

DEATH?


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Dose

Deterministic effects

Cataract

infertility

erythema

epilation

500 mSv cataract150 mSv for sterility (temporary-males)

2500 mSv for ovarian

Effect

OBJECTIVES OF RADIATION


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OBJECTIVES OF RADIATIONPROTECTION

PREVENTION of deterministic effect

LIMITING the probability of stochastic effect

HOW? Up to what point?


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OPTIMIZATION

principle

To what extent OPTIMIZATION ?Over-stretching OPTIMIZA TION

F t f id i l i l t di f


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Features of some epidemiological studies ofradiation-induced cancer risks

Life Span Study Massachusetts Children in

(LSS) of Ankylosing tuberculosis patients Israel irradiated

Japanese atomic Spondylitis given chest for ringworm UK National Registry for

bomb survivors Study (ASS) fluoroscopies of the scalp Radiation Workers

Parameter (Shimizu et al) (Weiss et al) (Boice et al) (Ron et al) (Kendall et al)

Population 75991 14109 2573 10834 95217

size (with DS86 doses)

Period of 5-55 years Up to over Up to over 50 years Up to 32 years Up to 40 yearsfollow-up following exposure 50 years

(mean 25.2 (mean 30 years) (mean 26 years)

years)

Ranges of:

(a) ages at All Virtually all Under 15 to over 40 0-15 years 18-64 years

exposure 15 years

(b) sexes Similar numbers of 83.5% male Female Similar number of 92% male

males and females males and females

ethnic Japanese Western (UK) Western (N. American) African and Asian Western (UK)

groups

Setting in War Medical:ther- Medical:diagnostic Medical:therapy Occupational

which apy for non- for non-malignant

exposure malignant diseasewas received disease

F t f id i l i l t di f


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Features of some epidemiological studies ofradiation-induced cancer risks (cont.)

Life Span Study Massachusetts Children in

(LSS) of Ankylosing tuberculosis patients Israel irradiated

Japanese atomic Spondylitis given chest for ringworm UK National Registry

bomb survivors Study (ASS) fluoroscopies of the scalp for Radiation Workers

Parameter (Shimizu et al) (Weiss et al) (Boice et al) (Ron et al) (Kendall et al)

Range of All All (but Mainly breast & lung mainly brain, All

organs mainly those bone marrow,

irradiated in proximity thyroid, skin

to spine and breast

Availability Organ doses: Mean organ Organ doses: Brain, thyroid & Individual whole-body

of dose individual basis doses: indiv. Individual basis skin doses: external doses

estimates only for red individual basis

bone marrow

at present

Range dose Mainly 0-4 Gy Mainly 0-20 Gy Mainly 0-3 Gy Brain: 0-6 Gy Mainly 0-0.5 Sv

(mean 1.5 Gy) (mean 0.034 Sv)

Thyroid:0-0.5 Gy

(mean 0.09 Gy)

Dose rate High High High, but highly High Low

fractionated

Radiation Mainly low-LET Low-LET Low-LET Low-LET Mainly low-LET

Quality


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Dose Limits (ICRP 60)

Occupational PublicEffective dose 20 mSv/yr averaged* 1 mSv in a yr

over 5 yrs.

Annual equivalent

dose to

Lens of eye 150 mSv 15 mSv

Skin 500 mSv 50 mSv

Hands & Feet 500 mSv

* with further provision that dose in any single yr > 30 mSv (AERB)and =50 mSv (ICRP)

N.B.: M.P.D. 1931 = 500 mSv, 1947=150 mSv, 1977=50 mSv &

in 1990=20 mSv

Changes in Dose Limit (ICRP)


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mSv

Year

Changes in Dose Limit (ICRP)(Safe levels)

0

100

200

300

400

500

1931 1947 1977 1990


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WHAT IS

BASIS FOR

DOSE LIMITS?


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WHY

REDUCTION IN

DOSE LIMITS?


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PRINCIPLES

OFRADIATION

PROTECTION


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1. Justification of practices

2. Optimization of protection by

keeping exposure as low asreasonably achievable

3. Dose limits for occupational


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HOW TO APPLY

THESE PRINCIPLES IN

DIAGNOSTIC RADIOLOGY?


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How much time one works with radiation?

RADIOGRAPHY


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Radiation ON Time

Workload=100 exposures/day

CxR = 50x50 m sec = 2500 = 2.5

LS = 50x800 m sec = 40000=40s

Total time = 45 sec/day

Not greater than 1 min/day

S ff D


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Staff Doses

Dose limit ICRP = 20 mSv/yr.

Radiography work 0.1 mS/yr.

i.e. 1/200th ofdose limit

Radiation Doses in Radiological Exam


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Relative Dose Received

number of chest x-rays0 50 100 150 200

Arm, head,ankle & foot (1)Head & Neck (3)

Head CT (10)Thoracic Spine (18)Mammography, Cystography (20)

Pelvis (24)Abdomen, Hip, Upper & lower femur (28)

Ba Swallow (30)

Obsteric abdomen (34)Lumbo-sacral area (43)

Cholangiography (52)Lumber Myelography (60)

Lower abdomen CT male (72)Upper Abdomen CT (73)Ba Meal (76)

Angio-head, Angio-peripheral (80)Urography (87)

Angio-abdominal (120)Chest CT (136)

Lower Abd. CT fem. (142)Ba enema (154)

Lymphan. (180)

mSv.05

0.15

0.49

0.92

1.0

1.22

1.4

1.5

1.7

2.15

2.59

3.0

3.61

3.67

3.8

4.0

4.36

6.0

6.8

7.13

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9.0

Radiation Doses in Radiological Exam.(as multiple of chest x-ray)


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IS IT POSSIBLE TO GET

DETERMINISTIC EFFECTS INRADIOGRAPHIC WORK ?

For staff, for patient..??

Radiography


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Radiography

Risk of Staff Patient Public

DeathSkin burnInfertilityCataractCancerGenetic effect

UU

UU

UU

U: unlikely


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FLUOROSCOPY

ANDCT


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Fluoroscopy

Barium study: 3-6 min/pt x 8 patients/d=40 min/d

ANGIOGRAPHY Diagnostic = 50 min/d Therapeutic = 2-5 hr/d

CT = 10-45 min/d

Fluoroscopy ( l th i )


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Fluoroscopy (excl. ther angio)

Risk of Staff Patient Public

DeathSkin burn

InfertilityCataractCancerGenetic effect

UU

UU

UU

U: unlikely

S


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Summary

1. Radiation we live with

2. Radiation that can be lethal

3. Radiation effects

4. Dose limits

5. Principles of protection

6. Application of protection principles indiagnostic radiology

R di h


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IAEA Part 1: Introductory lecture42

Radiotherapy

One of the main treatment modalities forcancer (often in combination withchemotherapy and surgery)

It is generally assumed that 50 to 60% ofcancer patients will benefit from radiotherapy

Minor role in other diseases

Siemens Oncology

Obj ti f th M d l


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Objectives of the Module

To become familiar with the principles of radiotherapy

the role of radiotherapy in cancer management

the cost effectiveness of radiotherapy

To appreciate the importance of radiationdose in radiotherapy


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IAEA Part 1: Introductory lecture 44

Aim

To kill ALL viablecancer cells

To deliver as muchdose as possible tothe target whileminimising the dose

to surroundinghealthy tissues

target

Patient

Critical

organs

Beam

directions

P ti F t


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Prognostic Factors

Cancer type and stage

Patient performance

Radiation dose

...survival

time

Good prognosis

Bad prognosis

P ti F t


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Prognostic Factors

Cancer type and stage

Patient performance

Radiation dose

...

Accurate dose delivery

matters!


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Doseresponse

100% response

means the tumouris cured with

certainty (TCP) or

unacceptable normal

tissue damage (e.g.

paralysis) is

inevitable


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Doseresponse

Therapeutic window:

Maximum probabilityof Complication FreeTumour Control

Dose sho ld be acc rate


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Dose should be accurate

To target: 5% too low - may result in clinically detectable

reduction in tumour control (e.g. Head and neckcancer: 15%)

To normal tissues: 5% too high - may lead to significant increase in

normal tissue complication probability =

morbidity = unacceptable side effects


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Deviations from Prescribed

Dose

May involve severe or even fatalconsequences.

IAEA Basic Safety Standards (SS 115):require prompt investigation by

licensees in the event of an accidental

medical exposure

Options for dose delivery


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Options for dose delivery

External beam radiotherapy = dose isdelivered from outside the patient usingX Rays or gamma rays or high energy

electrons (refer to part 5 of the course) Brachytherapy = dose delivered from

radioactive sources implanted in the

patient close to the target (brachys =Greek for short distance; refer to part 6of the course)

External beam radiotherapy


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External beam radiotherapy

IAEA Training Material on Radiation Protection in Radiotherapy


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Radiation Protection in

Radiotherapy

IAEA Training Material on Radiation Protection in Radiotherapy

The IAEA


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IAEA Part 0: Lecture CourseOutline54

The IAEA

International Atomic Energy Agency Statutory function: to establish standards

of safety for the protection of health and

to provide for the applications of thesestandards.

Objective to accelerate and enlarge thecontribution of atomic energy to peace,health and prosperity throughout the world.


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Radiotherapy

Constitutes a peaceful

application of ionizing radiation Is an essential part of cancer

management

Issues of safety, quality assurance andorganization must be considered

VARIAN Oncology

Content of the Lecture Course


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Content of the Lecture Course

A Background (Radiotherapy, effectsof radiation, principles of protection)

B Properties of equipment used inradiotherapy

C Radiation exposure (Occupational,medical and accidental)

D Associated issues (Transport,discharge of patients, organization)


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IAEA Part 0: Lecture Course Outline 57

Essential Reading

International Basic SafetyStandards for Protectionagainst Ionizing Radiation

and for the Safety ofRadiation Sources,Vienna 1996 (IAEA, FAO,ILO, OECD/NEA, PAHOand WHO)


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RADIATION PROTECTION IN NUCLEARMEDICINE

Part 0: Introduction to Nuclear Medicine

NUCLEAR MEDICINE


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IAEA Part 0. Introduction toNuclear Medicine59

Clinical problem

Radiopharmaceutical Instrumentation

Diagnosis and therapy withunsealed sources

NUCLEAR MEDICINE

RADIOPHARMACEUTICALS


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Radionuclide Pharmaceutical Organ Parameter

+ colloid Liver RES

Tc-99m + MAA Lungs Regional

perfusion

+ DTPA Kidneys Kidneyfunction

RADIOPHARMACEUTICALS

HISTORY-RADIONUCLIDES


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1896 Natural radioactivity Becquerel1898 Radium Curie

1911 Atomic nucleus Rutherford

1913 Model of the atom Bohr

1930 Cyclotron Lawrence1932 Neutron Chadwick

1934 Artificial radionuclide Joliot-Curie

1938 Production and identification of I-131 Fermi et al

1942 Nuclear reactor Fermi et al

1946 Radionuclides commercially available Harwell

1962 Tc99m in nuclear medicine Harper

HISTORY-RADIONUCLIDES

PIONEERS


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Henri Becquerel Ernest Rutherford Maria Curie

Frederique Joliot-Irene Curie

PIONEERS

CURRENT METHODS-THERAPY


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Radiopharmaceutical For treatment of Route of Maximum

administration activity

I-131 iodide Thyrotoxicosis Oral 1 GBq

I-131 iodide Carcinoma of thyroid Oral 20 GBq

I-131 MIBG Malignancy IV 10 GBq

P-32 phosphate Polycythaemia vera IV or oral 200 MBq

Sr-89 chloride Bone metastases IV 150 MBq

Y-90 colloid Arthritic conditions Intra-articular 250 MBq

malignant effusions Intra-cavitary 5 GBq

Er-169 colloid Arthritic conditions Intra-articular 50 MBq

Re-186 colloid Arthritic conditions Intra-articular 150 MBq

CURRENT METHODS-THERAPY

HISTORY-THERAPY


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1936 Therapeutic use of Na-24 (leukemia) Hamilton et

al

1936 Therapeutic use of P-32 (leukemia and Lawrence

polycythemia vera)

1941 Therapeutic use of iodine in hyperthyroidism Hertz et al1942 Therapeutic use of iodine in treatment of

metastasis from thyroid cancer

1945 Therapeutic use of Au-198 in treatment of Muller

malignant effusion

1958 Treatment of bone metastasis with P-32 Maxfield1963 Medical synovectomy using Au-198 Ansell

HISTORY-THERAPY

I-131 THERAPY


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The absorbed dose to be delivered should be determined

from uptake measurements, effective half-life of the radio-

pharmaceutical and the size of the thyroid.

The radiopharmaceutical is administered p.os.

Hyperthyroidism

Cured after Hypothyroidism3-4 months 1 year after 7 years

85% 98% 14.8% 27.9%

I-131 THERAPY

RADIOSYNOVECTOMY


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RADIOSYNOVECTOMY

PAIN PALLIATION


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PAIN PALLIATION

Intravenous injection of

a radiopharmaceutical which

includes e.g. Sr-89 orSm-153

ANNUAL FREQUENCY-THERAPY


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Thyroid (tumours & hyperthyroidism) 0.39

Polycythemia vera 0.034Other tumours 0.003

Others 0.001

Total 0.428

Number of patients per 1000 population

about 3% of all nuclear medicine

(Sweden 1995)

CURRENT DIAGNOSTIC METHODS


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Imaging

Bone, Brain, Lungs , Thyroid, Kidneys, Liver/spleen,Cardiovascular, Stomach/GI-tract, Tumours, Abscesses .

Non-imaging (probes)

Thyroid uptake, Renography, Cardiac output, Bile acid

resorption.

Laboratory tests

GFR, ERPF, Red cell volume/survival, Absorption

studies (B12, iron, fat), Blood volume, Exchange-

able electrolytes, body water, bone metabolism..

Radioimmunoassays (RIA) Radioguided Surgery

CURRENT DIAGNOSTIC METHODS

Documents

PR 00 Introduccion motivacion