Textbook of Radiological Safety PDF

TEXTBOOK OF
RADIOLOGICAL SAFETY
TEXTBOOK OF
RADIOLOGICAL SAFETY
K Thayalan PhD
Professor and Head
Radiological Physics Department
Barnard Institute of Radiology and Oncology
Government General Hospital and
Madras Medical College
Chennai, India
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Textbook of Radiological Safety

2010, Jaypee Brothers Medical Publishers (P) Ltd.
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system,
or transmitted in any form or by any means: electronic, mechanical, photocopying, recording,
or otherwise, without the prior written permission of the author and the publisher.
This book has been published in good faith that the material provided by author is original.
Every effort is made to ensure accuracy of material, but the publisher, printer and author
will not be held responsible for any inadvertent error (s). In case of any dispute, all legal
matters are to be settled under Delhi jurisdiction only.
First Edition: 2010

ISBN 978-81-8448-886-9
Typeset at JPBMP typesetting unit
Printed at Ajanta Offset
Dedicated to
My Parents (Late)
Thiru K Kuppusamy Jayamkondar
Thirumathi K Arukkani
Dr B R Ambedkar Institute Rotary Cancer Hospital
All India Institute of Medical Sciences
Ansari Nagar, New Delhi - 110 029
Tel (Off): 91-11-26594864, 26594798

Fax: 91-11-26589821
E-mail: gkrath@rediffmail.com
Dr GK Rath MD
Professor and Head,
Department of Radiation Oncology
Chief, DRBRAIRCH, AIIMS
Ex President, AROI
Foreword
It brings me immense pleasure to write the foreword for this book which
is focusing on radiation protection. There was a long-felt necessity for such a
textbook. Dr Thalayan has an extensive experience in the field of Medical
Physics and this book sums up his vast experience for the benefit of the readers.
The author must be complemented for the lucid style of writing. It contains all
the essential aspects of radiological safety. The chapter on "Regulations and
Dose Limits" is of particular relevance as it contains details of regulatory aspects.
The book will go a long way in helping the Radiation Oncology, Nuclear
Medicine, Radiology and Medical Physics Community and will be very useful
for the health care providers at all levels in these specialties. The chapters are
concise and complete in all aspects. Large numbers of illustrations have been
included to explain the subject matter. Bibliographies at the end of each chapter
have been included to serve as additional reading material on the subject.
I wish Dr Thalayan all success in his maiden venture.
Prof GK Rath MD
Professor and Head,
Department of Radiation Oncology
Chief, DRBRAIRCH, AIIMS
Ex President, AROI
Preface
It gives me immense pleasure to come out with a textbook on radiological safety,

a unique textbook. It is my long-felt dream to have a complete book, on
radiological safety, covering the entire fields of radiology i.e., diagnostic
radiology, nuclear medicine and radiotherapy.
Radiation is analogous to fire which has both beneficial and harmful effects.
The inherent philosophy is to minimize the hazards and maximize the benefits
in order to bring down radiation doses within the regulatory control limits by
which we can ensure the safety of the occupational workers as well as the
patient and public. Hence, it is important that every one should be aware of
the safety concepts, dose limits, regulation, waste disposal, etc., to establish a
safe work culture while handling radiation sources in the hospital. As such, no
single document is available for the above purposes, and the information is
collected from safety codes and guides of international and national agencies
like IAEA, NCRP and AERB.
An attempt has been made to bring all the relevant information including
safety terminology, biological effects, exposure control, monitoring, planning
of the installation, quality assurance, regulation, personnel safety, transport,
waste disposal and radiation emergency, etc. in the form of a book. The whole
objective is to remove misconception about radiation and prepare the minds of
younger generation to face the future challenge confidently. This book is
intended for postgraduates of medical physics, diagnostic radiology, nuclear
medicine and radiotherapy. This book may also find a place for the preparation
of RSO examinations for medical physicists.
Moreover, an attempt has been made to bring quantitative data from
international reports and recommendations, wherever necessary, with practical
examples and illustrations. This may enable the new entrants to plan a radiation
facility, carry out quality assurance and radiation survey without much
cumbersome and perform the day-to-day medical physicists job with ease and
involvement. Large numbers of tables and figures are incorporated wherever
necessary for better understanding of the reader.
I am very much thankful to my family members for their support and
cooperation. I also acknowledge the assistance offered by the Dr Kamakshi
Memorial Hospital staff, especially the medical physics colleagues, in the
preparation of the text. I also thank Mrs G Shakunthala for neatly typing the
manuscript.
I also acknowledge my teachers, by whom I got inspiration and passion
towards teaching.
I invite the readers to offer constructive comments for the future
improvement of the book.
K Thayalan
Contents
1. Safety Concepts ........................................................................................ 1

Introduction 1
Radiation units 2
Equivalent dose 4
Effective dose or effective dose equivalent 4
Committed dose 6
Collective dose 6
Genetically significant dose 7
Detriment 8
Annual limit on intake 8
ALARA 8
Sources of radiation 9
2. Biological Effects of Radiation ............................................................. 14
Cell 14
Interaction of radiation with tissue 14
Linear energy transfer 16
Biologic effects 17
Radiation effects on DNA 22
Radiation effects in utero 23
Radiation risk 24
Ten day rule and its present status 29
3. Radiation Exposure Control .................................................................. 31
Time 31
Distance 32
Shielding 34
Half value layer 35
Sources of exposure 37
Leakage limits 39
Protective barrier design 40
Facility design for diagnostic X-rays 42
Facility design for nuclear medicine 47
Facility design for radiotherapy 48
4. Planning of Radiological Facility ......................................................... 64
General guidelines 64
Establishing a diagnostic X-ray facility 65
General radiography installation 68
Fluoroscopy installation 68
Mammography installation 69
Computed tomography installation 70
Establishing a nuclear medicine facility 71
In-vivo diagnostic facility 74
In-vitro and radioimmunoassay (RIA) 75
Radionuclide therapy 78
Establishing a radiotherapy facility 79
Brachytherapy facility design 91
5. Radiation Monitoring ............................................................................. 95
Personnel monitoring 95
Film badge 96
Thermoluminescent dosimeter 97
Pocket dosimeter 100
Personnel monitoring systems and features 102
Area monitoring 103
Radiation survey in diagnostic radiology 107
Radiation survey in nuclear medicine 111
Radiation survey in radiotherapy 112
Calibration and maintenance of radiation monitoring instruments 117
6. Quality Assurance ................................................................................. 119
Introduction 119
Quality assurance for diagnostic radiology 119
Quality assurance for radiography unit 120
QA for mammography X-ray unit 133
QA for fluoroscopy X-ray unit 134
Quality assurance for computed tomography 134
Quality assurance for nuclear medicine 137
QA for gamma camera 138
QA for single photon emission computed tomography (SPECT) 140
Quality assurance for PET-CT 141
Image quality tests 146
QA for radiopharmaceuticals 147
Quality assurance for radiotherapy 154
QA for linear accelerator 154
QA for HDR brachytherapy 159
7. Regulations and Dose Limits .............................................................. 167
Atomic energy act-1962 167
Atomic energy regulatory board 167
Radiation protection rules-2004 168
Regulatory controls for diagnostic X-ray equipment and installations 181
Regulatory controls for nuclear medicine facilities 184
Regulatory control for radiotherapy equipment and installations 190
8. Personnel Protection ............................................................................. 204
Radiography 204
Protection in fluoroscopy 212
Protection in computed tomography 214
Protection in pediatric imaging 215
Pregnancy and radiation 221
Protection in nuclear imaging 227
Protection in radionuclide therapy 232
xii Pregnancy and radiation protection in nuclear medicine 233
Contents
Radioiodine therapy and pregnancy 235

Staff protection 237
Personnel safety during source transfer operations of teletherapy
and HDR brachytherapy units 238
Pregnancy and radiation protection in radiotherapy 240
Records 243
9. Transport of Radioactive Materials ................................................... 245
Introduction 245
Types of packages 246
Transport index 248
Packaging and package requirements 249
Preparation of the package for transport 253
Marking of the package 253
Labeling of the package 254
Placards 256
Booking, storage, transport and delivery of package 257
Consignors declaration 258
Tremcard 259
Information to carriers 260
10. Radioactive Waste Disposal ................................................................ 267
Introduction 267
Waste management 267
Sources and nature of waste 268
Classification of waste 269
Types of radioactive waste 270
Disposal of low activity wastes into the environment 276
Disposal of radioactive effluent into the ground 276
Disposal of P-32 and I-131 into municipal sewers by medical users 277
Disposal of radioactive waste from nuclear medicine procedures 278
Routine protective clothing 280
Decontamination procedures 281
11. Radiation Emergencies ......................................................................... 289
Type of radiation accidents 289
Diagnostic radiology-skin injuries 294
Nuclear medicine: Radiation accidents 297
Radiotherapy: Radiation emergencies 300
Brachytherapy: Radiation accidents 308
Emergency preparedness: Actions 309
Medical management of personnel exposed to radiation 313
Index .......................................................................................................... 319
xiii
Chapter
1 Safety Concepts
INTRODUCTION
Radiation is small pockets of energy, which travels as waves and transfer
energy from one point to another point. There are two types of radiation
namely: (i) photons, e.g. X,, and (ii) particles, e.g. e, p, n and . Radiation
is a double edged weapon, analogous to fire, which possess both benefits
and hazards. Radiation hazards were witnessed by the following events in
early days:
1. Uranium mine workers
2. Watch dial painters-switzerland
3. Atomic bomb explosion-Hiroshima and Nagasaki
4. Radiobiology experiments.
Radiation was used in medicine immediately after the discovery of
X-rays by W.C. Roentgen on November 15, 1895. It was used in India in
1898 within 3 years of its discovery. The Indian army employed hefty porters
to carry the cargo,(100 bounds) on a pole for 200 miles in the Hyber pass
region (Pakistan). That cargo had the first X-ray tube used in India. Major
Bewoor used it effectively in the North-West frontiers. The civilian use of
X-rays in India began in 1900 at the Government General Hospital, presently
the Barnard institute of Radiology and Oncology, Chennai.
Radiation hazards were realized in the beginning of 20th century. The
X-rays were used indiscriminately in the early years and have caused visible
damage to several physicians and X-ray enthusiasts. Within 6 months of
their use, several cases of erythema, dermatitis and alopecia were reported
among X-ray operators and their patients. In 1902 the first X-ray induced
skin cancer was reported. In 1921 Ironside Bruce, a pioneering radiologist
in a London Hospital died of cancer at the age of 38. Similarly several lives
were lost due to excessive X-ray exposures.
In 1915, the British Roentgen Society made the first radiation protection
recommendations. To regulate the safe use of radiation the British X-ray
and Radium protection committee was formed (1921). It was made as an
International Committee in 1928 and later (1950) transformed as
International Commission on Radiological Protection(ICRP). The ICRP
is the first standard setting body formed, for the purpose of radiological
safety. The similar organization at the USA is the National council on
radiation protection and measurements (NCRP), which was formed in 1946.
These bodies issue periodical reports on radiation safety aspects of various

application of ionizing radiation. These concepts are explained in the
following paragraphs and chapters.
RADIATION UNITS
Exposure Roentgen
The term exposure (X) refers the radiation quantity measured in terms of
ionization in air, in a small volume around a point. Exposure is a source
related term. Exposure from an X-ray source obeys inverse square law.
The unit of exposure is roentgen (R).
One roentgen shall be the quantity of x or gamma radiation such that
the associated corpuscular emission per 0.001293 grams of air (1cc of dry
air at NTP), produces in air, ions carrying 1 e.s.u. of quantity of electricity
of either sign. The unit may also be defined in terms of SI unit as
1R = 2.58 10-4 C / kg of air
There are some difficulties in the unit of roentgen. It is not a unit of dose,
which is a measure of absorbed energy. It can be used only up to a photon
energy of 3 MeV. It is defined only for x and gamma radiation in air.
Kerma
Kerma stands for kinetic energy released in the medium, which describes
the initial interaction of the photon with an atom, that take place in the
medium. When radiation interacts with matter, the uncharged particles
(photons and neutrons) transfer kinetic energy to the charged particles (e
and P). Kerma (K) is the measure of kinetic energy transferred to the charged
particles. It is defined as the sum of the initial kinetic energy of all the
charged ionizing particles, liberated by photons in a material of unit mass.
The unit for kerma is Joul per kilogram (J/ kg). The SI unit is Gray and the
special unit is rad.
Absorbed DoseRad / Gray

The term absorbed dose (D) refers the amount of energy absorbed per unit
mass of the substance. The unit of absorbed dose is rad (r), which means
radiation absorbed dose. 1 rad =100 ergs/gram. This unit is independent
of type of radiation and the medium. The SI unit of absorbed dose is
Gray (Gy).
1Gy = 1 J / kg
The unit rad is related to gray as 1Gy = 100 rads.
2
Safety Concepts
Exposure Rate Constant

It is defined as the exposure per hour from 1 mCi point source at a distance
of 1cm and it is expressed in R-cm2/mCi-h. For example, the exposure rate
constant of cobalt, cesium and iridium radioisotopes are 13.07, 3.26 and
4.69 respectively.
RHM and RMM

If the exposure rate constant is defined for 1Ci source at 1m, then it is called
RHM (Roentgen Hour Meter). It is defined as the exposure per hour from
1Ci point source at a distance of 1m and it is expressed in R-m2/Ci-h. In
practice RHM of a given radioisotope can be obtained by dividing the
exposure rate constant by a factor 10. Hence the RHM of cobalt, cesium
and iridium radioisotopes are 1.307, 0.326, and 0.469 respectively. Mostly
RHM is employed for calibration purposes in Brachytherapy and industrial
radiography.
Instead of hour one can also express it for one minute, then it is called
RMM (Roentgen Minute Meter). It is defined as the exposure per minute
from 1 Ci point source at a distance of 1m and it is expressed in R-m2/Ci-
min. For example, if the RHM of the cobalt radioisotope is 1.307, the
corresponding RMM value is 1.307/60 = 0.0217. RMM is the most preferred
and useful terminology in teletherapy source calibration.
RMM and CURIE

The unit of activity is curie and it is defined as the number of disintegration
per second from 1 gram of radium and it is found to be 3.7 1010. In the
case of cobalt, 0.0217 RMM corresponds to 1Ci, hence 1RMM = (1/0.0217)=
46.08 Ci. Similarly, it can be applied to different radioisotopes (Table 1.1).
Table 1.1: RHM and RMM of different radioisotopes

Radioisotope RHM RMM Activity (Ci) equivalent
to 1 RMM
Radium-226 0.825 0.0137 72.99
Cobalt-60 1.307 0.0217 46.08
Cesium-137 0.326 0.0054 185.18
Iridium-192 0.469 0.0078 128.20
Example 1: If a Cobalt teletherapy source is purchased with 200 RMM

capacity, what is the corresponding activity of the source in Ci?
1 RMM = 46.08 Ci
200 RMM = 46.08 200 = 9216.58 Ci
3
Example 2: If a Cobalt teletherapy source is purchased with 10,000 Ci

capacity, what is the corresponding RMM value?
46.08 Ci = 1RMM
10,000 Ci = (1/46.08) 10,000 = 217 RMM.
EQUIVALENT DOSE
The biological effects of radiation depend not only on absorbed dose (D)
but also on the type of radiation. Hence, the ICRP report 26 (1977) introduced
the dosimetric quantity Equivalent dose (HT). It is the absorbed dose
averaged over a tissue or organ and weighted for the radiation quality that
is of interest, and is given as
HT=D WR
Where WR is the weighting factor for the radiation type and it is analogous
to RBE in radiobiology. Earlier the term quality factor (Q) was used to evolve
dose equivalent (absorbed dose quality factor). This is discontinued now
and replaced with equivalent dose, which is an average dose and not a
point dose. Table 1.2 gives the suitable weighting factors for various type
of radiations.
Table: 1.2: Radiation weighting factors (WR)

Radiation type WR Radiation type WR
Photons (all energies) 1 Neutrons,2MeV-20MeV 10
Electrons 1 Neutrons >20MeV 5
Neutrons,<10keV 5 Protons 5
Neutrons,10keV-100keV 10 Alpha particles 20
Neutrons,100keV-2MeV 20
Sievert (Rolf Sievert, Swedish Radiologist) is the SI unit of equivalent

dose and one Sievert (Sv) =1 Joule/kilogram. Also 1 Sv=100 Rem (Radiation
equivalent men), where Rem is the special unit of equivalent dose. In
practice, milli sievert (mSv) unit is used.
1 Sv = 1000 mSv
1 mSv = 100 mRem.
EFFECTIVE DOSE OR EFFECTIVE DOSE EQUIVALENT

The whole body exposures are not uniform and dose equivalents for various
tissues may differ markedly. Hence, the radiation induced effects vary with
the sensitivity of the organ. To account these non uniform irradiation and
organ sensitivity variation, the ICRP-26 introduced the term effective dose
(E), which describes the dose to the whole body and is derived from
4 equivalent dose. It is defined as
Safety Concepts
E = WT HT
where WT is the weighting factor for the tissue T, HT is the mean
equivalent dose received by the tissue and E is the summed organ or tissue
doses as an overall whole body dose. This quantity expresses the overall
measure of health detriment associated with each irradiated tissue or organ
as a whole body dose and considers the radiosensitivity of each irradiated
organ or tissue. It is used to evaluate the probability of stochastic effects at
low doses.
The weighting factor of a particular tissue or organ is the risk of stochastic
effects being induced in the organ when singly irradiated, compared to the
total risk of inducing stochastic effects if the same radiation dose is received
by the whole body.
The Table 1.3 gives the tissue weighting factors for various tissues. It is
seen that testes and ovaries are the most radiosensitive tissues as they have
the highest value of weighting factor as per ICRP 60. However, the
radiosensitivity of the breast tissue and gonads are reassessed by the ICRP
(2005) and the revised weighting factors are given the table. Organ of higher
sensitivity carries a higher risk for a given dose. The sum of the weighting
factors is unity. The unit of effective dose is Sievert (Sv).
Table: 1.3: Tissue weighting factors (WT)

Tissue WT Tissue WT
(ICRP 60) (ICRP 2005)
Testes and ovaries(Gonads) 0.20 Bone marrow, breast 0.12
Red bone marrow 0.12 Colon, lung, stomach 0.12
Colon, lung and stomach 0.12 Bladder, esophagus 0.05
Breast, urinary bladder 0.05 Gonads, liver, thyroid 0.05
Thyroid, liver, esophagus 0.05 Bone surface, brain, kidneys 0.01
Bone surfaces 0.02 Salivary glands, skin 0.01
Remainder 0.05 Remainder 0.10
Example 3: In a CT scan study the tissues breast, lung, bone marrow and
thyroid receive dose of 21, 23.5, 5.17 and 2.30 mSv respectively. Calculate
the effective dose with both old and revised tissue weighting factors. The
effective dose:
E = WT HT
= (21 0.05+ 23.5 0.12+5.17 0.12+2.3 0.05) = 4.60 mSv(ICRP 60)
= (21 0.12+ 23.5 0.12+5.17 0.12+2.3 0.05) = 6.07 mSv (ICRP2005)
The revised tissue weighting factors predicts 32 % higher risk for a given
radiation dose.
5
COMMITTED DOSE
If an individual is subjected to a radiation burden over a period of time,
then committed dose is the term to be used. It is the absorbed dose the
individual receives as a result of the intake of radioactive material. The
individual will continue to receive a dose of radiation as long as the traces
of radioactivity remain with in the body. The factor which determines the
remaining activity in the body is the effective half life (T1/2 eff ). It is related
to the physical half life (T1/2 phys ) and biological half life (T1/2 biol) as
follows:
1 1 1
= +
T1/2 eff T1/2 phys T1/2 biol
One can not alter the physical half life, which is a character of a given
radionuclide. Whereas the biological half life can be reduced by increasing
the rate of excretion of the radionuclide from the body. For example, a
radio nuclide has a physical half-life of 6 hours and a biological half-life of
3 hours, then 1/ T1/2 eff = (1/6) + (1/ 3), and T1/2 eff = 2 hours. The effective
half-life is always less than either the physical or biological half-life
The committed dose equivalent is the quantitative assessment of the
effect of a particular intake of radioactivity over the whole of a individuals
working life. It is defined as the dose equivalent accumulated over a period
of 50 years following the intake of radioactive material. In the case of
children the period is taken as 70 years. It is defined
HT(t) = HT t
where t is the period of time in years. If the committed organ or tissue
equivalent dose is multiplied by the suitable tissue weighting factors then
the sum of the products is called committed effective dose (E(t)).
E(t) = HT(t) WT
The other factors which influences the dose equivalent are; (i) the
concentration of the activity in the organ,(ii) whether the concentration is
uniform or localized, (iii) decay system, (iv) radiation weighting factor, (v)
size and shape of the organ,(vi) proximity of other organs and (vii)
weighting factor of the organ.
COLLECTIVE DOSE
To assess the overall effect of radiation dose on a large group of people, the
individual dose may be multiplied by the population number exposed and
it is called the collective dose. If N is the number of population receiving a
mean organ equivalent dose HT , over a period of time t, then the collective
equivalent dose (ST) is given by
6
Safety Concepts
ST = HT(t) N
Collective Effective Dose Equivalent

In a similar way the collective effective dose (S) can be defined. It is the
whole body exposure to a population group exposed to radioactive
materials in the environment and can cover successive generations of the
populations being studied.
S = E(t) N
In a country, if a population of 10 million people are exposed to a
background dose of 3 mSv, then the collective effective dose is 30,000 man-
Sv.
The collective effective dose equivalent (CEDE), can be used as a method
to assess the impact of human health from population radiation exposures
and it is expressed in person-Sv. The CEDE values for different occupations
are given in Table 1.4
Table 1.4: Annual collective effective dose equivalents

for workers in various occupations in USA
Occupation Annual collective effective
dose equivalents (person-Sv)
Nuclear power operation 550
Medicine 420
Industry 390
Airline crews and attendants 170
Uranium miners 110
The uranium miners CEDE is small due to relatively small size of the
workforce involved in the occupation. The total annual CEDE for all
occupationally exposed workers is about 2000 PersonSv, for all
occupations. Whereas the annual CEDE attributable to natural background
radiation for the same population is about 3200 person-Sv. It means that
the occupational workers getting an additional 63% (2000/3200) over the
natural background.
In general the CEDE is decreasing in medicine due to small size of the
exposed population and improved health physics practices.
GENETICALLY SIGNIFICANT DOSE

The genetically significant dose (GSD) is defined as that equivalent dose
that, if received by every member of the population, would be expected to
produce the same genetic injury to the population as do the actual doses
received by the irradiated individuals. It is expressed in Sievert (Sv). It is 7
used to assess the genetic risk or detriment to the whole population from
radiation exposure, especially in medicine. It assumes a linear dose effect
relationship. For example, the patients undergo X-ray examinations may
receive a dose of about 10.0 mGy. If the same dose was received by every
member of the population, it would be expected to produce the same total
genetic effect on the population. The GSD accounts the child bearing
potential of the patient population.
The genetically significant dose (GSD) is used to assess the genetic risk
or detriment to the whole population from radiation exposure. In this the
equivalent dose to the gonads of each exposed individual is weighted for
the number of progeny expected for a person of that sex and age. Annual
GSD from all radiation sources is about 1.3 mSv that includes 1.02 mSv
(78%) from natural background and 0.28 mSv (22%) from technological
sources (NCRP-report 93,1987). Among the technological sources, the major
contributor is diagnostic X-rays, 0.20 mSv (15%). Among the 15 %, one-
third is attributable to male and two-third to females. The higher proportion
of female component is due to the location of the ovaries within the pelvis,
which places them in the primary beam during most abdomino pelvic
examinations.
DETRIMENT
Detriment is a measure of harm caused by exposure to radiation. It is the
expectation of harm incurred from an exposure to radiation, taking into
account not only the probability of each type of deleterious effect, but also
the severity of the effect. Usually several parameters (e.g, probability of
death and reduction of life expectancy) are considered to arrive the mean
health detriment. Health detriment is an estimate of the risk of reducing in
length and quality of life occurring in a population following exposure to
ionizing radiations.
ANNUAL LIMIT ON INTAKE

The Annual limit on intake (ALI) is the that quantity of radionuclide which,
taken into the body during 1 year, would lead to a committed effective
dose equal to the occupational annual limit on effective dose.
ALARA
As Low As Reasonably Achievable (ALARA) term was introduced by ICRP-
26. It states that doses to patients and staff should be kept as low as
reasonably achievable. Every reasonable effort must be made to reduce
radiation levels below the stated dose limits within economic and social
limits.
8
Safety Concepts
SOURCES OF RADIATION
The sources of radiation are classified into (i) Natural radiation sources,
(ii) Enhanced natural sources, (iii) Artificial radiation sources (man made)
and (iv) Occupational exposures. The annual average per capita total
effective dose equivalent is 3.6 mSv (NCRP-93,US data). About 82% of
the above exposure (3 mSv) arise from naturally occurring sources, 18%
(0.6 mSv) arise from technologic enhancements of naturally occurring
sources and artificial radiation sources (diagnostic X-ray is the major
contributor). Background radiation involves both natural and man made
low level radiation exposure to all members of the public. This will vary
with region and Kerala and Brazil have high background levels of radiation
(100 mSv/year).
Natural Radiation Source

The natural radiation sources includes (i) Cosmic rays,(ii) Terrestrial
(Primordial) radionuclides, and (iii) Internal Radioisotopes.
Cosmic Rays
Cosmic rays are extraterrestrial radiation that strikes the earths atmosphere,
that includes primary and secondary. Primary cosmic rays, in which protons
accounts for 80%. The primary cosmic rays collide with atmosphere,
producing showers of secondary particles (electrons, muons) and
electromagnetic radiations. The average per capita equivalent dose is
270 Sv per year, which makes 8% of the natural background.
Cosmic exposures increase with altitudes. It is estimated that at 30,000 ft
altitude the equivalent dose is about 5 mSv per hour and it is doubling in
every 1500 feet. It is greater at the earth poles than the equator. Structures
provide some protection against cosmic rays, and hence the indoor effective
dose is 20% lesser than outdoor.
Air travel increases individuals cosmic ray exposures. Air crews and
frequent fliers receive an additional annual equivalent dose of 1mSv. A 5
hr transcontinental jet aircraft travel result in 25 Sv equivalent dose. Apollo
astronauts received an average equivalent dose of 2.75 mSv during the
lunar mission. A part of secondary cosmic ray particles collide with stable
atmospheric nuclei and produces cosmogenic radionuclides; e.g.147 N (n,p)
14
6
C, but their contribution to natural background is very little.
Terrestrial Radiations
Terrestrial radionuclides that have been present on earth since its formation
are called primordial radionuclides. Their physical half lives are comparable
to the age of the earth (4.5 billion yeras). Their decay products are the major
contributors of terrestrial radiations. They mainly contribute in the form of
external exposure, inhalation, and ingestion. 9
External exposure: K-40,U-238, and Th-232 are mainly responsible for

external exposure and they account an equivalent dose of 280 Sv per year.
This may vary depending upon the local concentration of terrestrial
radionuclides.
Inhalation: Rn-222 (U-238) is a noble gas, decays to polonium-218 by alpha
emission with half life of 3.8 days. Its decay products are the most significant
source of inhalation exposure. It is deposited in the tracheobronchial region
of the lung. Radon concentration vary widely both seasonal and diurnal. It
emanates from sail and is restricted by structures. Weatherproofing of
homes, energy conservation techniques, decreased ventilation are resulting
in higher indoor radon concentration. Radon inhalation accounts an
equivalent dose of 2 mSv/year to the bronchial epithelium. It accounts for
about 55% of natural background, which can be easily measured and
reduced.
Ingestion: Ingestion of food and water is the second largest source of natural
background in which K-40 is the most significant. It is a naturally occurring
isotope of potassium having higher concentration at the skeletal muscle. It
accounts an average equivalent dose rate of 400 Sv/year.
Internal Radionuclides
Internal radionuclides includes K-40 and C-14, which are present the in the
human body. The main contributor is K-40,which emits and rays and
decays with a half life of 1.3 109 years.
Enhanced Natural Sources

Enhanced natural sources mainly consists of consumer products. The largest
contributor is tobacco products, which burdens the bronchial epithelium.
It produce an effective dose equivalent of 2.8Sv/year.
Radon gas dissolved in domestic water supply can contribute 10-60 Sv/
year. Building materials consists of uranium, thorium and potassium and
these are present in brick, concrete, granite which may contribute an annual
effective dose of 30 Sv /year.
Mining and agricultural activity contribute to a lesser level by fertilizers
(uranium, thorium decay products and K-40).
Cumbustible fuels including coal, natural gas and consumer products
includes smoke alarms (americium-241), gas lantern mantles (thorium),
dental prostheses, certain ceramics, optical lenses (uranium) contribute <1%
annual effective dose
Artificial Sources
The artificial sources of radiation includes medical exposure, radioactive
10 fallout, nuclear power and occupational exposure.
Safety Concepts
Medical Exposure
The majority of the exposure is from medical X-rays (Fluoroscopy &
Computed tomography) which contribute to 58% of the artificial radiation
exposure. Next contributor is the nuclear medicine which is 21%. Both
produces an annual average effective dose equivalent of 540 Sv per year.
It accounts for about 69% of artificial radiation.
Consumer Products
It accounts to 16% of the artificial radiation exposure. Substances in
consumer products such as tobacco, the domestic water supply, building
materials, and to a lesser extent, smoke detectors, televisions, and computer
screens, account for the above exposures.
Radioactive Fallout
It arises from atmospheric testing of nuclear weapons and consists of
Carbon-14 (70%) and other radionuclides including H-3, Mn-54, Cs-136,
137, Ba-140, Ce-144, plutonium and transplutonium elements. It results in
an annual effective dose equivalent of <10 Sv. It contributes 2% of the
manmade radiation exposures.
Nuclear Fuel Cycle

The contribution from nuclear power production is very minimal, which is
about 1% of artificial radiation (Annual effective dose is <0.5 Sv). It involve
all phases of fuel cycle; mining, manufacturing, reactor operations, and
waste disposal. The most significant contributor is Carbon-14.
Occupational Exposure
The occupational exposures associates with uranium mining (12 mSv per
year), nuclear power operations, medical diagnosis and therapy, aviation
and research, non uranium mining, and application of phosphate fertilizers.
It contributes about 2 % of the artificial radiation exposure.
Radiologist, X-ray technologist receive an average annual effective dose
of 1 Sv. However special procedures involving fluoroscopy and cini-
radiology (e.g. cardiac catheterization) may exceed 15 mSv. These are only
partial body exposures (head & extremities), if lead apron is used during
the procedure. The occupational exposures for various categories are listed
in Table 1.5. The UNSCEAR and the NCRP have published the global annual
dose contribution from various sources of radiations, which is presented
in Table 1.6.
The average annual effective dose equivalent to a population from all
radiation sources, is obtained by dividing the annual collective effective
dose equivalent by the size of the population. The Fig. 1.1 shows the %
contribution of various radiation sources to the total average effective dose 11
Table 1.5: Annual occupational effective dose equivalent (US Data)

Category Average annual total effective
dose equivalent (mSv)
Uranium miners 12.0
Nuclear power operations 6.0
Airline crews 1.7
X-ray and Nuclear Medicine technologists 1.0
Radiologists 0.7
equivalent in the US population, which is estimated as 3.0 mSv/year,

excluding smoking. Smoking is the largest contributor (45%) to the average
population effective dose equivalent. Hence, lung is the organ that receives
highest dose equivalent from both smokers (polonium-210) and non
smokers (radon-222). The Fig. 1.2 highlights the % contribution of various
types of manmade radiation sources.
Table 1.6: Global annual radiation dose distribution
from various sources of radiation
Sources UNSCEAR (1993), NCRP-93(1987),
Percentage and mSv/year Percentage and mSv/year
Radon 48.3% 1.30 55% 2.0
Gamma rays 17.1 0.46 8 0.28
Cosmic rays 14.5 0.39 8 0.27
Medical 11.2 0.3 15 0.53
Internal 8.6 0.23 11 0.40
Radioactive fall out 0.3 0.007 <0.3
Occupational <0.1 0.002 0.3 0.01
discharges <0.1 0.001 0.1

Products <0.1 0.0005 3.0 0.07
Total 100 2.69 mSv/year 100 3.6 mSv/year
12 Fig. 1.1: The % contribution of various types of man-made sources to the total
average effective dose equivalent to the US population
Safety Concepts
Fig.1.2: The % contribution of various components of man-made radiation

sources (Source BEIR VII Report)
Medical use of radiation warrant an optimal compromise between clinical

utility and radiation dose to patients, staff and the public. The success of
radiation protection mainly lies on the education of staff. They should be
educated on radiobiology, genetics, risk analysis, methods of reducing
radiation dose, decay patterns of radioactivity released in the environment
and absorbing power of different materials to different radiation.
BIBLIOGRAPHY
1. David JD, Patrick AK, Eugene RJ. The physics of diagnostic imaging (2nd edn.)
Hodder Arnold, UK 2006.
2. Donald TG, Paul C, Martin V. Principles of Radiological physics, (5th edn.)
Churchill Livingstone 2007.
3. International Commission on Radiological Protection ICRP 26 Annals of ICRP.
Pergamon press 1997.
4. Jerrold TB et al. The essential physics of medical imaging, (2nd edn.) Lippincott
Williams & Wilkins 2002.
5. Thayalan K. Basic radiological physics. Jaypee brothers Medical publishers (P) 13
LTD, New Delhi 2001.
Chapter
2 Biological Effects
of Radiation
Radiation biology is a scientific discipline which deals with the study of

the action of ionizing radiation on healthy and diseased tissue. It makes us
to understand the sequence of events (damage or repair) that occurs after
the absorption of radiation energy. There are many variables that determine
the biological response to radiation exposure. These include the dose,
dose rate, fractionation, nature of exposure (whole body/partial body), cell
cycle, presence of radioprotectors /sensitizers and age of the exposed
individual etc.
CELL
Cell is the basic unit of life. Living organisms are made up of either a single
cell or many cells. Human being is a multi-cellular organism built up of 10
14
cells. Cell consists of a nucleus, which is surrounded by a viscous liquid
known as cytoplasm. Both the cell and cytoplasm are enveloped by a
membrane, which is known as cell membrane or plasma membrane.
The constituents of cytoplasm control the functions of the cell. The
nucleus contains tiny thread like structures known as chromosomes, which
are made up of deoxyribonucleic acid (DNA) and protein. The DNA
molecules contain all the information required for the cellular function in
coded form and thus control the nature and growth of the individual.
Sections of chromosomes, which contain information for specific functions,
are called genes. Cells of similar nature constitute a tissue and different
tissues form an organ. Many organs constitute a system (like respiratory
system, digestive system, hemopoietic system and nervous system).
Cells are mainly classified into two categories: (i) somatic cells, and
(ii) reproductive (or germ) cells. Somatic cells constitute various tissues
such as skin, liver, brain etc. Germ cells are those, which participate in the
reproductive process. They are sperm in males and ovum in females. All
somatic cells in human body contain 46 chromosomes as 22 pairs and two
sex determining chromosomes. Reproductive cells contains only 23
chromosomes.
INTERACTION OF RADIATION WITH TISSUE

Radiation deposits energy in tissues randomly and rapidly (<10-10Sec) via
excitation, ionization and thermal heating, in turn produces moving
Biological Effects of Radiation
electrons. These electrons interact with atoms and molecules leading

to chemical and molecular changes. These changes may appear as
biological effects such as chromosome breakage, cell death, oncogenic
transformation and acute radiation sickness. These effects appear after
a period of time (latent period), which may vary from minutes to years.
Major portion of the radiation energy appear as heat, with little biologic
significance.
Radiation interactions that produce biologic effects are classified as direct
and indirect action. In direct interaction, the radiation ionize or excite the
molecules such as DNA, RNA and protein directly. It involves rupture of
cell membrane and break of chromosome structure, resulting in DNA
strands break. The fragments of chromosomes produced in a direct
interaction, can join together to form chromosomes with abnormal
structures. This is known as chromosomal aberration. The frequency of
chromosomal aberrations increases with the radiation dose and hence the
magnitude of aberrations is a biological indicator of radiation dose absorbed
in human body. Chromosomal aberration analysis (CAA) is useful in
determining the radiation dose received by a person who is accidentally
exposed to high radiation dose (>100 mGy).
In indirect mode, the radiation interacts with the medium and produce
radicals which in turn interact with the target molecule. For example,
radiation interacts with oxygen and water molecules present in the cell.
These interactions produce a large number of free radicals, which are
uncharged atoms or molecules with an unpaired electron and hence
are highly reactive. Human body tissue is composed of 70-85% water,
and the major interaction (three-fourth) is indirect action. The X and rays
effects in macromolecules of living system are mainly due to indirect
interactions.
The absorption of radiation by a water molecule (radiolysis) results in
ion pairs (H2O+, H2O ),which are unstable and forms free radicals H*
(hydrogen) and OH* (hydroxyl) as follows:
H2O H2O+ + H2O (ion pairs)
H2O+ H+ + OH*
H2O H*+ OH
OH* + OH* = H2O2 (hydrogen peroxide)
H* + O2 = HO2* (Hydroperoxyl radical)
Free radicals are extremely reactive chemical species and perform variety
of reactions. They act as strong oxidizing or reducing agents by combining
with macromolecules. For example, free radicals interfere with cell functions
and may inactivate cellular mechanism or break DNA bonds. The damaging
effects of free radicals is enhanced with presence of oxygen. In the case of
low LET radiation, free radicals are the primary agents that cause the
15
biologic effects. Approximately two-third of all radiation induced damage

is considered to be caused by the hydroxyl free radical.
Repair mechanisms exists within cells which repair the cells and return
to pre irradiated state. For example DNA single strand break, base damage
can be repaired, by specific endonucleases and exonucleases that are
present. The Fig. 2.1 presents the physical and biologic responses to ionizing
radiation.
Fig. 2.1: Interaction of radiation in cell: Physical

and biological response of ionizing radiation
Cells are more radiosensitive during the phase of cell division known as
mitosis, when the chromatin material is being distributed to daughter cells.
Hence rapidly dividing cells like intestinal epithelium, bone marrow cells,
reproductive cells are more radiosensitive. Highly differentiated tissues
like muscle and brain are least radiosensitive.
Direct and indirect interactions of radiation with cell ultimately result
in (i) cell modifications like gene mutation, cell transformation and
chromosome aberrations and (ii) cell death.
LINEAR ENERGY TRANSFER

The linear energy transfer (LET) is a parameter that describes the average
energy deposition per unit path length of the incident radiation and it is
expressed in keV/m. All radiations are capable of producing same type
of biologic effects, but the magnitude of the effect per unit dose differs. In
other words different radiations of equal dose do not produce the same
level of biologic response. To evaluate the effectiveness of different
radiations the term Relative biological effectiveness (RBE) was introduced
and it is defined as follows:
Dose of 250 kVp X-rays required to produce certain effect
16 RBE =
Dose of test radiation required to produce the same efffect
These effects or endpoint includes chromosomal mutation, cataract

formation and acute lethality etc. The relationship between RBE and LET
is shown in Fig. 2.2. The RBE is proportional to LET at the beginning, which
is relevant for low LET radiations (X, , e). Later it increases with LET,
suggesting deposition of higher energy in the tissue, which is applicable to
high LET radiations(). Beyond 100 keV/m, the RBE decreases with
increasing LET, due to overkill. This means that radiation deposits excess
energy than that necessary to kill the cell. RBE also depends on the total
dose and dose rate of the radiation. The LET of the X and rays and tissue
penetration are listed in Table 2.1 below.
Fig. 2.2: The relation between LET and RBE
Table 2.1: The LET of X and rays and tissue penetration in HVL
X and LET(keV/m) HVL(mm) in Tissue Source
rays Energy (keV)
80 1.0 38 Diagnostic X-rays
120 1.4 43 Co-57
140 1.5 46 Tc-99m
364 2.8 65 I-131
511 3.5 70 Positron emitters
1000 5.2 100 Co-60
BIOLOGIC EFFECTS
The harmful effects of radiation in human body are classified as (i) somatic
effects and (ii) Genetic effects. The radiation effects, arises due to the damage
of the somatic cell are called somatic effects. It is produced in an exposed 17
individual during his life time. The magnitude of the somatic effects vary
with nature of exposure (whole body or partial exposure). The hereditary
effects are due to damage to reproductive cells and manifest in the progeny
of the exposed person.
Early Somatic Effects (Whole Body Irradiation)

Somatic effects may appear immediately after exposure, within a few hours
to weeks or much later (after years - decades). The early effects are due to
an acute exposure (large doses over a short period of time) and attributed
to depletion of cell population due to cell death. Table 2.2 shows the early
somatic effects due to the acute whole body exposure to low LET radiation.
The amount of radiation damage depends on the rate at which the
radiation is delivered. High dose delivered in a short time may result in
severe damages to tissues. The same dose delivered over several months
allows the repair mechanisms to function fully. Hence, somatic effects listed
in the table may not manifest, if the person receives the dose over a
prolonged period.
Table 2.2: Early somatic effects due to acute whole

body exposure to low LET radiation*
Dose range Effect
Less than 0.1 Gy No detectable damage
Above 0.1 Gy Chromosome aberrations detectable(1-2 dicentrics in 500
cells)
Above 0.5 Gy Above effect + transient reduction in WBC count: emporary
sterility in males
Above 1.0 Gy Above + radiation sickness like loss of appetite, nausea,
vomiting , diarrhea (NVD) : complete recovery possible at low
doses
Above 3.0 Gy Severity of above effects increases + damage to blood forming
organs (bone marrow, spleen, lymph node): death in 4-8 weeks
possible (> 10%)
3.0 to 5.0 Gy All the above with increased severity + Anemia, infection, high
fever (bone marrow syndrome), about 50% of the exposed
persons may die within 60 days (LD 50/60).
8.0 to 15.0 Gy Severity of above effects increases + cells in the
gastrointestinal system get severely damaged leading to
gastrointestinal syndrome (GIS) like diarrhea, weight loss and
fever. Death may occur in 1-2 weeks (100 %).
Above 10.0 Gy All the above + manifestation of skin damage
> 25 Gy All the above + severe depression, fatigue, delirium, coma
etc. (Central nervous system syndrome[CNS]). Death occurs
in a few hours to days.
*Source: AERB lecture notes
18
Early Somatic Effects (Partial Body Irradiation)

Partial body exposure to the above dose ranges produces only local effects.
A whole body exposure to a dose of 4 Gy can be lethal. But exposure of a
part of the body to the dose will not be life threatening. However, it can
produce certain serious local effects (Table 2.3). The seriousness of the local
effects too depends on the dose rate and the period of exposure etc. All the
early somatic effects do have a threshold dose, below which they do not
occur. Beyond the threshold dose, severity of the effect increases with the
dose. Since the threshold doses are much higher than the normal
occupational dose, these effects may not occur from normal occupational
exposure to radiation.
Table 2.3: Early somatic effects due to acute

partial body exposure to low LET radiation
Dose Region Effect
0.15 Gy Testes Temporary sterility
3.5 6.0 Gy Testes Permanent sterility
1.5 2.0 Gy Ovaries Temporary sterility
2.5 6.0 Gy Ovaries Permanent sterility
3 Gy Hair follicles Epilation (fall of hair)
5 Gy Eye Cataract (after 2-3 years)
6 Gy Skin Reddening of skin (erythema)
Permanent epilation
10-20 Gy Skin Burns, blisters, wounds, death of
tissues
Late Somatic Effects

Exposure to low levels of radiation over a prolonged period, may lead to
late effects. Persons who recover from early somatic effects too may develop
late somatic effects in life. Late effects are characterized by latent period,
which can be as long as 30 years. The important late effects are cataract and
cancer. Dose needed to produce cataract may be greater than 8 Gy of
fractionated irradiation (not acute) with low LET radiation and the latent
period may be 5-10 years. The biological process required to transform the
damaged cells to a cancer cell is very complex and the latent period may
vary from 2-5 years for leukemia (blood cancer) and 5-30 years or more in
the case of cancers of the lung, bone etc.
Hereditary Effects
Hereditary effects occur in the progeny of exposed individuals when
reproductive cells carrying radiation-induced damages (mutations)
participate in the process of fertilization. Only that amount of radiation
dose to reproductive organs, which occurs up to the time of conception,
can affect the general characteristics of the offspring. However, the present 19
knowledge on hereditary effects is limited to laboratory animals. No

evidence for increase in hereditary effects was observed in human
population exposed to both high and low dose of radiation. Hereditary
and both early and late somatic effects of radiation can be classified into
two categories, namely (i) deterministic effects and (ii) stochastic effects.
Deterministic Effect
A deterministic effect (non stochastic) is one which increases in severity
with increasing absorbed dose in affected individuals. It results in cell
killing due to degenerative changes in the exposed tissues. It may appear
at higher doses (> 0.5 Gy) and soon after the dose is received. It have
threshold dose, below which the effect is not seen. All somatic effects except
cancer, as mentioned above are deterministic effects of radiation. All these
effects will definitely appear in the exposed individual, if the radiation
dose received is above the respective threshold doses. Examples are skin
erythema, epilation, organ atrophy, fibrosis, cataract, blood changes, and
reduction in sperm count. The radiation dose required to produce such
effects are very large and are likely to occur only as the result of radiation
accidents and patients irradiated in radiotherapy. It is unlikely in diagnostic
Radiology, both for patients and occupational workers. As such
deterministic effects can be completely avoided by limiting the dose levels
well below the threshold doses.
Stochastic Effect
A stochastic effect is one in which the probability of occurrence increases
with increasing absorbed dose rather than its severity. It is very important
at very low levels (< 0.5 Gy). Any dose, however small, is effective for a
certain level of risk for induction of stochastic effects. The risk increases as
the dose increases. It have no threshold dose and the chance of occurrence
increases with dose and independent of sex and age. Stochastic effects are
the principle health risk from low level radiation, which is likely in
diagnostic radiology and Nuclear medicine. Radiation induced cancer and
genetic effects are examples for stochastic effects. Hence the risk of stochastic
effects cannot be completely avoided. However, it can be minimized to an
acceptable level.
Radiation Induced Cancer

Radiation induced cancers may appear only some years after the radiation
was received. This is known as latent period, which may extend from 10 to
30 years. The risk of inducing a particular type of cancer is measured by
comparing the number of cancers produced in the irradiated population
sample in excess of those expected in the same size of un irradiated
population sample. This is known as Risk factor for the particular cancer.
20 Leukemia has the highest risk factor among all cancers, since tissue cells
are rapidly dividing. There is no safe dose limit and all doses of radiation
carry some form of risk. Hence, radiation induced cancers can not be
prevented, only be reduced by minimizing the radiation dose.
Genetic Effects
The radiation effects produced in the successive generation of the exposed
individual are called genetic effects.
Genetic effects are caused by radiation induced damage to the genes or
chromosomes in the ova or spermatozoa. The above damage is due to
ionization and subsequent faulty recombination of the molecules which
make up the chromosomes. As a result the biological code contained by
the genes on the chromosomes gets altered and produce structural
abnormality in the chromosome. It will be passed on to the future
generations if reproduction takes place.
Severe genetic effects are not observed due to short life span of the
individual and inability to reproduce. Only less severe effects are seen in
the human population as a result of reproduction. Epidemiological studies
carried out on 30,000 children born to the survivors of atom bomb (500
mSv) do not show an increase in the incidence of genetic disorders. There
is no direct evidence of either elevated cancer risks or genetic disorders
among human population exposed to low level radiation.
To protect the future generations, minimize the use of artificial radiations
and adopt protection devices such as gonad shield in children, during
radiography. Fig. 2.3, summarizes both early and late biologic effects due
to radiation exposure from 0.001 mSv to 20 Sv.
Fig. 2.3: The early and late biologic effects of radiation 21

with dose ranging from 0.001 mSv to 20 SV
RADIATION EFFECTS ON DNA

The ionizing radiation deposits energy in the DNA molecule and produce
chemical changes, which leads to structural changes. This includes (i)
hydrogen bond breakage, (ii)molecular dehydration, and (iii) intermolecular
and intramolecular cross linking. The rupture of hydrogen bond, which
link the DNA base pairs, may result in irreversible structural changes in
the molecule. DNA molecular breakage may occur as single strand breaks,
double strand breaks, base loss or base changes occurring in DNA. Single
strand breakage between the sugar and the phosphate can rejoin. Oxygen
can cause the broken strand become peroxidized, and prevent it from
rejoining. Thus presence of oxygen potentiates the radiation damage.
A double strand break are genotoxic lesions that can result in chromosome
aberrations. This may lead to carcinogenesis through activation of
oncogenes, inactivation of tumor suppressor genes, or loss of
herterozygosity. Single strand breaks are easily repairable than double
strand breaks as far as the low LET radiation is concerned (Fig. 2.4).
Fig. 2.4: Radiation action on DNA molecule:

Single and double strand breaks
Molecular cross linking is another common structural change, as result
of reactive sites at the point of chain breakage. Cross linking may be between
two DNA molecules, DNA and a protein, two base pairs within DNA. The
22 loss of change of base is considered as mutation.
Chromosome breaks produced by radiation do occur and can be

observed microscopically. Chromosomal damage that occurs before DNA
replication is called chromosome aberrations, whereas that occur after DNA
synthesis is called chromatid aberrations. In the later, only daughter of the
one of the damaged chromatids pair is affected. Repair of chromosomal
aberrations depends on stage of the cell cycle, and type and location of the
lesion. There is a strong force of cohesion between broken ends, resulting
in rings and dicentrics formation.
Chromosomal aberrations in human lymphocytes can be scored and used
as a biological dosimeter to estimate radiation dose. For this lymphocytes
are cultured from human blood sample. It is stimulated to divide, allowing
karyotype to be performed. The cells are arrested at metaphase, and the
frequency of rings and dicentrics are scored. Total body doses > 0.25 Gy
can be estimated in the above method.
RADIATION EFFECTS IN UTERO

Developing embryo is extremely sensitive to ionizing radiation, as it is
characterized by cell proliferation, migration and differentiation. As per
the Bergonie and Tribondeaus laws of radiosensitivity, highly differentiated
cells are more radiosensitive. The response after radiation depends upon
the total dose, dose rate, radiation quality and gestation period of the
pregnant women. The type of damage includes prenatal death, congenital
abnormalities, growth impairment, reduced intelligence, genetic aberrations
and an increased cancer risk.
Gestational periods is divided into three stages namely (i) Preim-
plantation, (ii)major organogenesis, and (iii) fetal stage. These stages
vary with radiosensitivity and result in different radiation response at each
stage.
Preimplantation begins with the union of the sperm and egg and continue
until the zygote is embedded in the uterine wall. During this period (9-14
days) the conceptus is more sensitive, any radiation damage may result in
prenatal death. The congenital abnormalities are low, though it is not
completely absent. The most sensitive time of exposure in humans is 12 hr
after conception (when two pronuclei fuse together to one cell) and again
at 30 and 60 hr, when the first two divisions occurs. Animal study revealed
an increase in the spontaneous abortion rate after a dose of about 50-100
mGy during the preimplantation period. Later a radiation dose of >250
mGy is required induce prenatal death and the spontaneous abortion rate
is reported as 30-50%.
Major organogenesis is the period between 2-8 wk (15-50 days) after
conception. It is the critical period for radiation induced birth defects in
human. The embryonic malformations includes cataract, mental retardation,
microcephaly, microphthalmia, growth retardation, skeletal defects and
carcinogenesis. Exposure >100 mGy from the Hiroshima atomic bomb
23
resulted an increase in the incidence of microcephaly. Exposures in excess

of 1Gy are associated with a high incidence of CNS abnormalities.
The fetus stage is between 50-280 days, prenatal death and congenital
anomalies are negligible. However growth retardation, abnormalities of
the nervous system and sense organs are the primary. There is risk of
childhood leukemia is significant. The damage manifests later in life as
behavioral alterations or reduced intelligence (IQ).
RADIATION RISK
Radiation risk is a probability, that a given individual will incur a deleterious
effects as a result of a dose of radiation. It includes (i) somatic risk (ii) genetic
risk and (iii) fetal risk. Scientists have developed dose response models to
predict the risk of cancer in human populations, due to low level radiation
exposure. These models led to dose response curves, whose shape are non
threshold linear, linear quadratic and quadratic as shown in Fig. 2.5.
Fig. 2.5: The linear and non linear models of radiation effects
A non threshold linear curve overestimates the incidence of cancer at

lower doses from low LET radiation. Hence, it is used in radiation protection
for estimating risk. A linear quadratic dose response model predicts lower
incidence of cancer than the linear model at low doses and higher incidence
at intermediate doses.
The risk estimates were revised in 1990 after reassessing the Japanese
atomic bomb survivors, which resulted an increase in risk estimation. The
reasons for the above are (i) revised neutron dosimetry which incorporated
greater risk from low LET radiation, (ii) large number of cancer cases is
seen among bomb survivors, and (iii) revised model projects risk beyond
the period of observation.
24
Risk Models
There are two type of risk models namely (i) Mutiplicative, and (ii) Additive
risk models (Fig. 2.6). The multiplicative model predicts that, after a latent
period, the excess risk is a multiple of the natural age specific cancer risk
for a given population. It accounts for age and cancer risk at the time of
exposure. The risk increases with age (predicts greater risk at older age).
The Fig. 2.6(a) describes the differences in magnitude of the projected cancer
risk for a given exposure at different ages.
The additive risk model which predicts a fixed increase in risk unrelated
to the spontaneous age-specific cancer risk at the time of exposure
(Fig. 2.6(b)). In this model a constant increment in incidence is added to the
spontaneous disease incidence through out the life. Both models do not
describe cancer risk adequately, after exposure. The necessary modification
in the risk estimate is provided by the BEIR report, which is explained in
later paragraphs.
(a) (b)
Fig. 2.6: The multiplicative model and additive model
Relative Risk
Relative risk (RR) is another way of expressing the risk from radiation in
an exposed population. It is the ratio of the cancer incidence in the exposed
population to that in general population. For example, a relative risk of 1.2,
predicts a 20 % (120/100) increase over the spontaneous rate of cancer
incidence.
The excess relative risk = RR-1= 1.2-1=0.2
To detect the above relative risk (1.2), with a statistical confidence of
95% (p< 0.5),when the spontaneous incidence in the population is 2 %, one
must require a study sample of population of >10000.
25
Absolute Risk
Another way of expressing risk is the absolute risk. It is expressed as number
of excess radiation induced cancers per 104 people /Sv-year.
Example 1: The risk is 4 per 10,000 person - Sv and the latency period is 10
years. What is the risk of developing cancer in the next 40 years, from a
dose of 0.1 Sv?
Actual duration = 40 10 = 30 years
Dose = 0.1 Sv
Risk = 4 10-4
Risk of developing cancer = 30 0.1 4 10-4 = 12 10-4
If 10000 people are exposed to a dose of 0.1 Sv, 12 additional cases of
cancer will be seen in that population in the next 40 years.
BEIR Report V and VII Risk Estimate

The National research council committee on the Biological effects of ionizing
radiation (BEIR) report V has been published in 1990 on the title Health
effects of exposure to low levels of ionizing radiation. As per the report
the radiation induced mortality at low exposure level is 4 % per Sv and it is
8% for high dose rates. This is in agreement with the ICRP estimate, which
is 4 % per Sv for a population of adult workers and 5 % per Sv for the whole
population (includes young ones). The BIER V committee advocate the
linear dose response model for all cancers except leukemia and bone cancer,
to which linear quadratic model is recommended.
BEIR VII report (2003) gives the most up-to-date and comprehensive
risk estimates for cancer and other health effects from exposure to low level
ionizing radiation. That is, it accounts for both cancer incidence and cancer
mortality. It supports a linear-no-threshold (LNT) risk modelthat
the risk of cancer proceeds in a linear fashion at lower doses without a
threshold and that the smallest dose has the potential to cause a small
increase in risk to humans. There is a linear dose-response relationship
between exposure to ionizing radiation and the development of solid
cancers in humans. It is unlikely that there is a threshold below which
cancers are not induced, but at low doses the number of radiation-induced
cancers will be small.
Other health effects (such as heart disease and stroke) occur at higher
radiation doses, but additional data must be gathered before an assessment
of any possible dose response, that can be made between low doses of
radiation and non cancer health effects. The report also concludes that with
low dose or chronic exposures to low LET irradiation, the risk of adverse
heritable health effects to children conceived after their parents have been
exposed is very small compared to baseline frequencies of genetic diseases
in the population.
26
Radiation related cancer mortality risks for woman averaged is 37.5%

higher than for men in the solid tumors. Exposure in infants, as compared
to adults, produces 3-4 times the cancer risk. Female infants have almost
double the risk of males.
BEIR VII lifetime risk model predicts that approximately one individual
in 100 persons would be expected to develop cancer (solid cancer or
leukemia) from a dose of 100 mSv while approximately 42 of the 100
individuals would be expected to develop solid cancer or leukemia from
other causes. Lower doses would produce proportionally lower risks. For
example, it is predicted that approximately one individual in 1000 would
develop cancer from an exposure to 10 mSv.
Somatic Risk
Somatic risks may arise from both stochastic and deterministic effects.
Cancer induction is the largest risk of radiation. Bone marrow,
gastrointestinal tract mucosa, breast tissue, gonads and lymphatic tissue
are most susceptible for cancer induction. Caner risk are higher for children
than for adults. Radiation may induce both benign and malignant tumors
with latent period. Cancer risk is estimated as 4 10-2 /Sv. The ICRP
recommended risk factors are given in the Table 2.4 below.
Table 2.4: ICRP 60 Risk factors

Assumed radiation risks ICRP Publication 60
Workers 4.0 10-2 Sv-1 for fatal cancer
0.8 10-2 Sv-1 for non fatal cancer detriment
0.8 10-2 Sv-1 for severe genetic effects
5.0 10-2 Sv-1 for fatal cancer
Members of the public 1.0 10-2 Sv-1 for non fatal cancer
1.3 10-2 Sv-1 for severe genetic effects
Embryo-fetus Not specifically stated
Genetic Risk
Genetic risk is the result of radiation exposure to the gonads. Genetic risk
analysis assume that the (i) exposed population consists of all ages and
both sexes and (ii) severe genetic effects in the next two generations.
The genetically significant dose (GSD) is an index to estimate the
radiation induced mutation in germ cells of a given population. The
sensitivity of a population to radiation induced damage is measured by
doubling dose. It is defined as the dose required per generation to double
spontaneous mutation rate. The spontaneous mutation rate is about
5 10-6 per locus and 15 10-4 per gamete for chromosome abnormalities.
The doubling dose for humans is estimated as ~1Gy per generation, which 27
is extrapolated from animal data.
A dose 100 mGy would produce only about 200 additional genetic
disorders per 1 million live births (0.02 % per 100 mGy) in the first
generation, whereas the normal incidence is about 1 in 20 (5%).
Hence the 100 mGy dose can cause additional genetic disorders of about
0.4 % {(5.02-5)/5) 100} only. The usual diagnostic and occupational
exposures would not be expected to result in any significant genetic risk to
their progeny.
Fetus Risk
Doses lower than 100 mGy generally carry negligible risk. To avoid
congenital abnormalities abortion may be advised, only when doses are
>100 mGy. The fetal dose from Medical Diagnostic procedures
rarely exceeds 50 mGy. This will not put the fetus any significant increase
in risk for congenital malformation or growth retardation. It is estimated
that the excess risk of childhood cancer from in utero irradiation is
approximately 6% per Gy. The relative incidence of various health effects
with radiation exposure in utero at various stages of gestation are shown
in Fig. 2.7.
Fig. 2.7: Health effects of radiation exposure

in utero at various stages of gestation
Radiopharmaceuticals administered to pregnant women is associated
with radiation risk to the fetus. There are two type of radiopharmaceuticals:
(i) those that cross placenta and (ii) those that remain on the maternal side.
For example radioiodine can cross the placenta and concentrate on the fetal
thyroid after 13 th week of gestation. It may be 55 to 75 % between 14 and
28 22 weeks of gestation. This may result in hyperthyroidism or ablation.
Estimate shows that the dose to the fetal thyroid may range from 230 to 580
mGy / MBq for gestational period of 3 and 5 months. Total body fetal dose
estimate ranges from 0.072 to 0.27 mGy / MBq during pregnancy.
Example 2: Calculate the risk for radiation workers and the public for a
annual effective dose limit of 20 mSv and I mSv respectively (Assume the
risk coefficient is 4 10-2 per Sv).
Worker: Annual dose limit = 20 mSv = 0.02 Sv
Annual risk = 0.02 4 10-2 = 8 10-4
Public: Annual dose limit = 1 mSv = 0.001 Sv
Annual risk = 0.001 4 10-2 = 4 10-5
TEN DAY RULE AND ITS PRESENT STATUS

Ten day rule was postulated by ICRP for woman of reproductive age. It
states that whenever possible, one should confine the radiological
examination of the lower abdomen and pelvis to the 10 day interval
following the onset of menstruation. The original proposal was for 14 days,
but this was reduced to 10 days to account for the variability of the human
menstrual cycle. In most situations, there is growing evidence that a strict
adherence to the ten day rule may be unnecessarily restrictive. When the
number of cells in the conceptus is small and their nature is not yet
specialized, the effect of damage to these cells is most likely to take the
form of failure to implant, or of an undetectable death of the conceptus;
malformations are unlikely or very rare. Since organogenesis starts 3 to 5
weeks post conception, it was felt that radiation exposure in early pregnancy
couldnt result in malformation.
The main risk is that of abortion if the radiation exposure results in death
of the conceptus. It requires a fetal dose of more than 100 mGy for this to
occur. Based on this, it was suggested to do away with the 10 day rule and
replace it with a 28 day rule. This means that radiological examination, if
so justified, can be carried throughout the cycle until a period is missed.
Thus, the focus is shifted to a missed period and the possibility of pregnancy.
If there is a missed period, a female should be considered pregnant unless
proved otherwise. In such a situation, every care should be taken to explore
other methods of getting needed information by using non radiological
examinations.
BIBLIOGRAPHY
1. AERB short course on radiation safety, lecture notes 2008.
2. BEIR VII: Health Risks from Exposure to Low Levels of Ionizing Radiation,
National Academies Press, 500 Fifth Street, NW, Washington, DC 20001; 800:
624-6242; www.nap.edu.
3. Donald TG, Paul C, Martin Vosper. Principles of Radiological physics, (5th edn.)
Churchill Livingstone 2007.
29
4. Jerrold TB, Seiber JA, Edwin ML, John MB. The essential physics of medical
imaging, (2nd edn.), Lippincott Williams & Wilkins 2002.
5. Mettler FA, Upton AC. Medical effects of ionizing radiation, (2nd edn.),
Philadelpia:WB saunders, co. 1995.
6. National research council, Committee on the biological effects of ionizing
radiations. Health effects of exposure to low levels of ionizing radiation (BEIR
V). Washington, DC: National Academy Press, 1990.
30
Chapter
3 Radiation Exposure
Control
The four principal methods by which radiation exposures to persons

can be minimized are (i) Time (ii) Distance, (iii) Shielding, and (iv)
Contamination control. The following paragraphs will explain their role
and application in medicine.
TIME
The total dose received by a radiation worker is directly proportional to
the total time spent in handling the radiation source. Lesser the time spent
near the radiation source, lesser will be the radiation dose. As the time
spent in the radiation field increases, the radiation dose received also
increases. Hence, minimize the time spent in any radiation area. Techniques
to minimize time in a radiation field should be recognized or practiced.
All radiation sources do not produce constant exposure rates. Diagnostic
X-ray machines typically produce high exposure rates over brief time
intervals. For example, chest X-ray produces an skin entrance exposure of
20 mR in less than 1/20 of a second, equivalent to 1440 R/hr. Hence,
radiation exposure can be minimized by not energizing the X-ray tube,
when personnel are nearer to the machine.
Nuclear medicine procedure produce lower exposure rate for extended
periods of time. The exposure rate at 1m from a patient injected with 20
mCi of Tc-99m, for bone scan is 1 mR/hr. It reduces to 0.5 mR/hr after 2
hours, due to decay and urinary excretion. Hence both the knowledge of
exposure rate and how it changes with time are important elements in
reducing personnel exposures.
The time spent near the radiation source can be minimized by under
standing the task to be performed and the suitable equipment to complete
them in short interval with safety. Hence, one has to plan the radiation
procedure, practice the procedure with out radiation and share the essential
duties, to reduce radiation exposure. For example, fluoroscopy screening
time should be kept short by the use of last frame hold facility, in addition
to the use of foot switch.
Example 1: A radiographer is performing barium examination under
fluoroscopy and the equipment is ON for 3 minutes for each examination.
The radiation level at the location of the radiographer is 100 mR/h. How
many such procedures the radiographer can carry out per week?
The annual equivalent dose limit prescribed for the radiographer is

(occupational worker) 20 mSv = 2000 mrem 2000 mR
2000 mR
The permitted weekly dose = = 40 mR
50 weeks
Exposure rate at the location of radiographer
= 100 mR/h
100
= mR/min
60
100 mR
The exposure in each procedure = 3 min = 5 mR
60 min
Hence, the number of procedures the radiographer can associate with
40 mR
in one week = =8
5 mR
Example 2: An operator is handling 10 mCi of I-131 source with 30 cm
tongs. Within how much time the technician will receive the weekly
permissible equivalent dose? (assume 1R=1 rad, 20 =2.18 R-cm2/mCi-hr
for I-131)
Exposure level at 30 cm from 10 mCi of I-131 source = 2.18 10 mCi /(302)
= 0.024 R/hr
= 24 mR/hr
2000 mR
Weekly permissible exposure = 40 mR
50 weeks
40 mR
Allowed time of work = = 100 minutes
24 mR/hr
DISTANCE
Radiation intensity (exposure rate) from a point source decreases with
distance, due to divergence of the beam. It is governed by the inverse square
law, which states that the exposure rate from a point source of radiation is
inversely proportional to the square of the distance. If the exposure rate is
X1 at distance D1, then the exposure rate X2 at another distance D2 is given
by
2
D
X 2 = X1 1 (1)
D2
Doubling the distance from the X-ray source decreases the X-ray beam
intensity by a factor of 4. If the exposure rate is 100 mR/hr at 1 m, then it
will be 25 mR/hr at 2 m (Fig. 3.1). Larger the distance, lesser will be the
32 radiation dose. This relationship is valid for point sources only, whose
Radiation Exposure Control
dimensions are very small compared to distance under consideration. Thus

the relationship is not valid near (<1 m) a patient injected with radioisotopes,
since the exposure rate decreases less rapidly than inverse square law.
Fig. 3.1: The inverse square law: As the distance increases by a factor 2, the
radiation intensity decreases by a factor of 4
In diagnostic radiology at 1m from a patient, the scattered radiation is

about 0.1-0.15% of the intensity of the primary beam. Hence, all personnel
should stand as far away as possible during X-ray procedures. Personnel
should stand at least 2 m from the X-ray tube and the patient and behind
the shielded barrier or out of the room, whenever possible.
In nuclear medicine it is difficult to shield the technologist from the
radiation emitted from the patient, during patient imaging and distance is
the only primary dose reduction method. The nuclear medicine
technologists receive the annual dose mainly by patient imaging. Hence,
imaging rooms should be designed to maximize the distance between the
source and control console. Because most of the time the technologists spend
their time at the control console for acquisition and image processing.
Unshielded radiation sources should never be manipulated by hand. Tongs
or other handling devices are used to increase the distance between source
and hand. A typical exposure rate with distances, for a nuclear medicine
facility is given in Table 3.1.
Table 3.1: Exposure rate with distance in nuclear medicine

Radionuclide10 mCi Exp rate (mR/hr) at 1cm Exp rate (mR/hr)at 10 cm
Ga-67 7500 75
Tc-99m 6200 62
I-123 16300 163
I-131 21800 218
Xe-133 5300 53
Tl-201 4500 45
Example 3: The exposure rate from a fluoroscopic X-ray machine is 5 R/

min at 50 cm. What would be the exposure rates at (i) 40 cm, and (ii) 60 cm?
33
1. X1 = 5 R/min, D1 = 50 cm, D2 = 40 cm , X2 = ?
X 1 ( D1 )2 5 R / min ( 50 cm )2

X2 = = = 7.81 R/ min
( D2 ) ( 40 cm )
2 2
2. X1 = 5 R/min, D1 = 50 cm, D2 = 60 cm , X2 = ?
5 R / min ( 50 cm )2

X2 = = 3.47 R/ min
( 60 cm )
2
Example 4: What would be the radiation level at 10 cm from a 5 mCi source

of Co-60? (Given, = 13 R-cm2/mCi-hr for Co-60)
Exposure level at 1 cm from 5 mCi Co-60 source = 13 5= 65 R/hr
X1 = 65 R/hr, D1 = 1 cm, D2 = 10 cm , X2 = ?
X 1 ( D1 )2 65 R / hr ( 1 cm )2

X2 = = = 0.65 R/ hr = 650 mR/hr
( 2) ( )
2 2
D 10 cm
Example 5: What would be the distance required to reduce the radiation

level from a 10 mCi Ir-192 source to 2mR/hr? (Given, =4.69 R-cm2/mCi-
hr for Ir-192)
Exposure rate at 1cm from 10 mCi Ir-192 source = 4.69 10
= 46.9 R/hr
= 46900 mR/hr
X1 = 46900 mR/hr, D1=1 cm, D2= ? cm, X2 = 2 mR/hr ?
X 1 ( D1 )2

X2 =
( D2 )
2
46900 mR / hr ( 1 cm )2
2 mR/hr = , D2 = 153 cm or 1.53 m
( D 2 cm )
2
SHIELDING
When maximum distance and minimum time do not ensure an acceptably
low radiation dose, adequate shielding must be provided, so that radiation
beam will be sufficiently attenuated. The material that attenuates the
radiation exponentially is called a shield and the shield will reduce exposure
to patients, staff and the public.
When a photon passes through an absorber (Fig. 3.2) of thickness x, both
absorption and scattering takes place. As a result, the transmitted beam
will have less number of photons. This can be represented by the relation
34 I = I0 e- x (2)
where I is the number of transmitted photons, I0 is the number of incident

photons, e is the base of natural logarithm and is the linear attenuation
coefficient.
Fig. 3.2: Attenuation of radiation through a shielding material
HALF VALUE LAYER

The linear attenuation coefficient is defined as the reduction in the radiation
intensity per unit path length and is expressed in cm-1. The linear attenuation
coefficient is related to the term half value layer (HVL) as follows:
0.693
= (3)
HVL
The thickness of material that attenuates radiation beam by 50 % is the
half-value layer or half value thickness (HVT). The reduction factor offered
by one HVT is 2 and by 2 HVT is 2 2 or 22. Hence, the reduction factor
offered by n HVT of the shielding material is 2n. For diagnostic X-ray beam
energies, the HVL for soft tissue ranges from 2.5 to 3.0 cm. The Table 3.2
indicates the decrease of radiation intensity with increasing HVTs (for
heavily filtered X-ray beam).
35
Table 3.2: Relation between half value layer and % of transmission

No. of HVTs % transmission
0 100.0
1 50.0
2 25.0
3 12.50
4 6.25
5 3.12
6 1.56
10 0.09
Tenth Value Layer

There is another interesting term called tenth value layer (TVL or TVT),
which gives the thickness of material that attenuates the radiation beam by
90 %. The reduction factor offered by one TVT is 10, and by 2 TVT is 10 10
or 102 and 10n for n TVT and so on. The TVT and HVT can be related by
using the equation:
2.303
TVT = (4)

2.303
=
( 0.693 / HVT )
= 3.32 HVT
For a given material, both HVT and TVT depend upon the energy of the
incident radiation and the shielding material. Table 3.3 shows the HVT
and TVT values for gamma rays with respect to concrete, steel and lead.
Table 3.3: HVT and TVT values of concrete, steel and lead for Ir-192,Cs-137
and Co-60 (IAEA Safety series 47)
Source Concrete, mm Steel, mm Lead, mm
HVT TVT HVT TVT HVT TVT
IR-192 43 152 13 43 6 16
CS-137 48 175 16 53 6.5 22
Co-60 62 218 21 71 12 41
The shielding type, thickness and the location are functions of photon
energy, number, intensity, source geometry and exposure rate. Hence, the
reduction in intensity depends upon the nature and thickness of the shield
and energy of the radiation. The thicker the shielding, lesser the radiation.
In diagnostic energy range, X-ray attenuation is primarily by photoelectric
36 effect and to some extent by compton effect. Photoelectric effect varies with
atomic number (Z) and is proportional to Z 3. Hence, one can compare lead
(Z=82) and aluminium (Z=13) as shielding material for the same thickness
(g/cm2), with their atomic numbers. The reduction in intensity caused by
lead over aluminium is given by
3
82
= 250.3
13
In other words, 1 gm/cm2 of lead will be as effective as 250 g/cm2 of
aluminium. Hence in many situations, lead is used as shielding material to
reduce the volume of shielding. Lead, brick and concrete, are the most
commonly used materials for shielding radiation exposure in medicine.
Lead aprons, gonad shield, lead gloves, lead bricks, and lead glass are also
used as shield.
The NCRP-49 (1976) describes the structural shielding design and
evaluation for Medical use of X-rays and rays of energies up to 10 MeV.
When the report was made single phase generator was in use, the annual
dose limit is 100 mrem per year, neglected the image receptor attenuation,
and considered low speed film-combination. Hence, strict adherence of
NCRP-49 would result in expensive shielding procedures.
The factors to be considered while determining the amount and type of
shielding are (i) ALARA principle, personnel radiation must be kept As
Low As Reasonably Achievable, (ii) Personnel exposures should not exceed
the regulatory limits. This is 30 mSv for occupational workers and I mSv
for the general public in India. The corresponding limits in USA is 50 mSV
and 1 mSv respectively and (iii) The dose equivalent to the controlled area
(restricted entry) should not exceed 0.6 mSv per week. The corresponding
limit for the uncontrolled area is 0.02 mSv per week.
SOURCES OF EXPOSURE
The radiations used in medical application appear in three forms namely
(i) primary radiation, (ii) scattered radiation and (iii) leakage radiation. The
scattered and leakage radiations are jointly called as secondary radiation
(Fig. 3.3).
Primary Radiation
The radiation passing through the open area defined by the collimator of
the X-ray tube / radiation equipment is called primary radiation. The
amount of primary radiation depends on output, number of patients per
week, and fraction of time the radiation beam is directed towards any
particular location. Concrete, lead and steel are used as primary barrier
shielding material, depending upon the structural and spatial
considerations. For example concrete is preferred for the construction of
walls and ceiling, because it is cheep. Whenever there is shortage of space, 37
lead and steel can be used as primary barriers.
Fig. 3.3: The various sources of exposure namely primary,

scattered and leakage radiations
Scattered Radiation
Scattered radiation from a patient, tabletop, collimator or shield is also a
source of radiation. Scattered radiation is due to the interaction of the
primary with the patient, causing a portion of the primary radiation to get
redirected. The fluence of scattered radiation depends on (i) the volume of
the patient irradiated, (ii) spectrum of the primary beam, (iii) field size,
and (iv) scattering angle. Scattered radiation must be considered as a separate
source, for radiation safety purposes and in general it has low energy.
In diagnostic radiology, the quality of the scattered radiation is assumed
to be same as that of the incident beam. It is about 0.1-0.15% of primary at
1m from patient, for a field area of 20 20 sq cm.
In mega voltage radiations, the ratio of scattered dose to the incident
dose is denoted as , which varies with scatter angle and beam quality.
The is assumed to be 0.1% of the primary for 90 degree scatter. The
maximum energy of the 90 scattered photon is 500 keV. The transmission
of the above beam is similar to that a 500 kVP primary beam. The penetrating
power of scattered beam is greater at smaller scatter angle. Also greater
fraction of primary is scattered at smaller angles.
Leakage Radiation
Leakage radiation is the one that emanates from the source housing, other
38 than primary. The quality of the leakage radiation is approximately the
same as that of the primary beam. Since it passes through the source housing,
its effective energy is very high in diagnostic X-rays.
LEAKAGE LIMITS
Leakage Limits for X-ray Housing

The leakage radiation through the protective X-ray tube housing in any
direction, averaged over an area not larger than 100 cm2 with no linear
dimension greater than 20 cm, shall not exceed an air kerma of 1 mGy in
one hour at a distance of 1.0 m from the X-ray target. This will be applicable
to all types of X-ray tubes except mammography. In mammography the
corresponding leakage limit is 0.02 mGy at 5 cm from any point on the
external surface of X-ray tube housing (AERB /SC/MED-2). The NCRP
report 102 supersedes the previous NCRP report 33 and recommend the
following limits:
1. 5-50 kVp: The leakage exposure rate shall not exceed 0.1 R in any 1 hour
at any point 5 cm from the source assembly.
2. 50-500 kVp: The leakage exposure rate at a distance of 1 m from the source
shall not exceed 1 R in any 1 hour. In addition, these assemblies shall
limit exposure rate to 30 R/h at 5 cm from the surface of the assembly.
3. Greater than 500 kVp: The absorbed dose rate due to leakage radiation
(excluding neutrons) at any point outside the maximum field size, but
within a circular plane of radius 2 m that is perpendicular to and centered
on the central axis at the normal treatment distance, shall not exceed
0.2% of the useful beam dose rate at the treatment distance. Except for
the area defined above, the leakage dose rate from the source assembly
at any point at a distance of 1 m from the electron path between the
source and the target shall not exceed 0.5% of the useful beam dose rate
at the treatment distance. The neutron contribution to the dose within
the useful beam shall be kept well below 1% of the X-ray dose. Outside
the useful beam, the neutron dose should be reduced to as low as
practicable.
Leakage Limits for Cobalt Teletherapy

For Cobalt teletherapy, in the beam off position, the leakage radiation
measured at a distance of 1 m from the source shall not exceed 20 Gy/h.
At any readily accessible position 5 cm from the surface of the housing the
leakage radiation shall not exceed 200 Gy/hr. In the beam on position,
the leakage radiation measured at a distance of 1m from the source shall
not exceed either 10 mGy/h or 0.1% of the useful beam air kerma rate at
1 m from the source, whichever is greater (AERB/SC/MED-1).
However, the recent NCRP report 102 summarizes the cobalt teletherapy
leakage as follows: The leakage dose rate from the source housing with the
39
beam in the OFF position shall not exceed 2 mrad/h on the average and 10
mrad/h maximum in any direction, at a distance of 1 m from the source.
With the beam in the ON position, the leakage dose rate from the source
housing shall not exceed 0.1% of the useful beam dose rate, both measured
at a distance of 1 m from the source. In addition, for sources that give rise
to a useful beam dose rate of less than 10,000 rad /h at 1m, the leakage
from the source housing shall not exceed 1 rad/h at 1m from the source.
Leakage Limits for Brachytherapy

The Brachytherapy source storages (LDR/HDR equipments), emergency
storages and in house transport containers, must meet the following limits
for leakage radiation.
1. The air kerma rate of the leakage radiation measured at any readily
accessible position 5 cm from the surface of the storage must not exceed
200 Gy/ hr, and
2. At 1m from the centre of the storage the air kerma rate of leakage
radiation must not exceed 20 Gy/hr.
3. In the case of emergency storage container or an in house transport
container, the air kerma rate of the leakage radiation measured at a
distance of 5 cm from the surface of the container must not exceed 2
mGy/hr and at a distance of 1 m from the source of the container
must not exceed 100 Gy/hr (AERB/SC/MED-3).
PROTECTIVE BARRIER DESIGN

Protective barriers are designed to ensure that the dose equivalent received
by any individual does not exceed the applicable maximum permissible
value. Barrier should protect all the three types of radiation namely primary,
scattered and leakage radiations. A barrier sufficient to attenuate the useful
beam to the required degree is called the primary barrier. The required
barrier against leakage and scattered (stray) radiation is called the secondary
barrier. The following materials are used as barriers:
Lead (Most commonly used material because of its high attenuation
properties and low cost), concrete, leaded glass, leaded acrylic and gypsum.
The amount of attenuation necessary depends on five factors:
Workload
Use factor
Occupancy factor
Distance
Radiation exposure level.
Work Load (W)

Workload is a measure of expected exposure levels obtained from the patient
40 load and machine ON time. It is expressed in mA-min/week in diagnostic
radiology (< 500 kVp), which can be obtained by multiplying the maximum
mA with beam on time in minutes/week. For mega voltage machines, it is
expressed in weekly dose (Gy/week) delivered at 1m from the source. This
can be obtained by multiplying the number of patients treated per week
with dose delivered per patient at 1m.
Use Factor (U)

It is the fraction of the operating time during which the radiation under
consideration is directed towards a particular barrier (wall) per week. The
use factor for different barriers are as follows:
Primary barrier: U=0 to 1
Secondary barrier: U=1
Floor: U=1
Walls: U=1/4
Ceiling: U=1/4 to 1/2
Occupancy Factor (T)

The occupancy factor relates to the amount of time rooms adjacent to the
treatment room are occupied. An area below ground would have no
occupancy at all and therefore T would equal zero. Areas that are
intermittently occupied, such as corridors, would have a slightly greater
occupancy and an area such as an office even greater. It is defined as the
fraction of the operating time during which the area of interest is occupied
by the individual. Table 3.4 shows type of occupancy and occupancy factors
(NCRP 49).
Table 3.4: Occupancy factors (NCRP 49)

Type of occupancy Occupancy factor (T)
Office, reception, shops, children 1 (Full occupancy)
play areas, staff rooms, control room
Corridor 1/4 (Partial occupancy)
Toilet, bath rooms, outside areas with
seating, store rooms 1/16 (Occasional occupancy)
Distance (d)
It is the distance in meters from the radiation source to the area to be protected.
Inverse square law is assumed for both primary and stray radiation.
Radiation Exposure Level (XT or P)
It represents the exposure (mR/week) at a given location in an adjacent
area. It is function of technique, workload, primary, scattered and leakage
level and corresponding distance to the point of interest. 41
FACILITY DESIGN FOR DIAGNOSTIC X-RAYS
Workload
A busy diagnostic X-ray unit will have a workload of 1,000 mA.min/week,
whereas small clinics may have 100 mA.min/week. For example, the
workload of a hospital with 20 patients per day, 3 films per patient, and
50 mAs per film will be calculated as follows:
W = (20 patients/day) (5 days/week) (3 films/patient)
(5 mAs/film) (1 min/60 s)
= 25 mA-min/week
In general higher kVp settings decrease the workload. This is due to (i)
increase of output (mR/mAs) as the kVp increases and (ii) less attenuation
of the incident beam by the patient reduces the mAs, at higher kVp. The
workload values for various types of radiographic rooms are given in the
Table 3.5 (NCRP report No.49). These are overestimated values as it is based
on slower (speed100) film-screen receptors.
Table 3.5: Workload for diagnostic X-ray
Procedure Patient load/day W (mA. min/wk), W (mA. min/wk),
100 kVp 125 kVp
Chest,3 films/patient 60 250 150
Fluoroscopy 24 750 300
General radiography 24 1000 400
Special procedures 8 700 280
Shielding Calculation for Diagnostic X-ray

The X-ray tube output (mR/mAs) is determined by direct measurement.
Otherwise it can be obtained from the graph between mR/mAs verses
X-ray tube potential as a function of HVL (Fig. 3.4).
The primary beam exposure per week (XP) at 1m from the source, is the
product of W and the tube current measured at 1m from the source. For
example an X-ray tube operating with a workload of 300 mA min/week
with out put is 5 mR/mAs at 1m, then
XP = workload tube out put (5)
= 300 (mA.min/wk) 5 (mR/mAs)
= 300 (mA.min/wk) 60 5 (mR/mA.min)
= 90,000 mR/wk
The exposure due to scattered radiation from the patient is a fraction of
the incident primary exposure. The scatter fraction (S) is 0.15% at 1m for a
42 400 cm2 field size at 125 kVp. This will vary with field size, kVp and the
Fig. 3.4: The Tube output in mR/mAs at a distance of 1 m with variation of HVL
in mm for Al. (Inverter generator,5% ripple,1.2 mm Al inherent filtration)
scattering angle. The scattered radiation (Xs) is the product of the incident
exposure, scatter fraction, and the ratio of the maximum field size relative
to 400 cm2. Hence, the scattered radiation exposure per week at 1m from
the scatter is
Xp field size
XS = 2 S (6)
dsca 400
S = scatter fraction (0.15%)

dsca = distance to the scatter
For example, a chest imaging is done at a SID of 180 cms with field size
of 900 cm2 (30 30). The patient thickness is 30 cm. Hence, the source of
patient to distance is 180 30 = 150 cm
90 , 000 0.15 900

XS = 2
1.5 100 400
= 135 mR/wk
The exposure due to leakage radiation can not exceed 100 mR/hr at 1m
from the source, for the maximum tube current and maximum kVp. This
may be written as 100 mR/mAmax hour at 1 m. This can also be expressed
in mR/mA.min, by dividing by 60. Then the leakage radiation (XL) per
week is the product of the leakage radiation per mA min and the work
load (Assume maximum m A=5, W = 300 mA.min). 43
Maximum leakage = 100 mR/mA 60

= 1.67 mR/mA min
XL = (1.67 mR/mA min) W (mA min/wk) (7)
= (1.67/5 mA min) 300 (mA min/wk)
= 100.2 mR/wk
The total weekly exposure (X) is due to primary, scatter and leakage
radiations can be calculated, for an unshielded condition as follows:
exposure X P X XL
X = U pri + S 2 + (8)
week dpri
2 2
dsec dleak
For example as shown in the Fig. 3.5, if a wall is positioned at 2.5 m from
the source, and it is 0.5 m from the chest stand, then dpri=2.5m, dleak=2.5m,
dsec=0.5, and U =1/4, using this in the above equation,
Fig. 3.5: A model X-ray layout for barrier calculation
90.000 1 135 100.2

X = 2.5 2 4 + 0.5 2 + 2.5 2

= 4156 mR/wk
If Xlimit is the regulatory limit of radiation exposure for an partial
occupancy (corridor, T=1/4) area, then
Xlimit = 2 (mR/wk) / T, for uncontrolled area, since T =1/4 =0.25
= 2 (mR/wk) / 0.25
= 8 mR/wk
44
The attenuation offered by the barrier is given by the relation

Xlimit =X e- T (9)
where the linear attenuation coefficient m = 0.693/HVL or = 2.303/TVL
and T is the thickness of the attenuator. The HVL and TVL represents the
half value layer and tenth value layer of the construction material of the
barrier. The HVL and TVL are functions of the kVp and workload. The
values of the same is given Table 3.6 for various diagnostic energies for
lead and concrete
Xlimit = X e-(2.303 T/ TVL)
Xlimit/X = e-(2.303 T /TVL)

by taking logarithm, and solving for T, the equation may be written as
T = 0.434 ln (X / Xlimit) TVL
By substituting the values of exposure (X) and exposure limits (Xlimit)
from above and TVL of concrete for 125 kVp (Table 3.6)
4156 mR/wk
T = 0.434 ln 66 = 179.1 mm
8 mR/wk
This may be approximated as 18 cm or 7 inch concrete thickness. If brick
is used as construction material then 10.5 inches thickness will offer the
same protection. Instead of concrete if lead is used, then TVL =0.93, for 125
kVp from the table (3.6), then
T = 0.434 ln (4156/8) 0.93
= 2.52 mm.
Usually lead is specified in weight per square foot (lb/sq.ft) and 1mm of
1
lead thickness = 2 lb/sq ft. There is some practical difficulty in handling
2
lead greater than 2 lb/sqft, and hence that is the recommended minimal
thickness. In this calculation, the attenuation offered by the screen-film is
not accounted. Hence, the wall thickness is over estimated. Any way it is
good to compensate increased workload of the future.
Similar way the calculation is repeated for all the three walls (B, C,
and D) and ceiling for the layout in Fig. 3.5. In multiple floor buildings,
the floor also should be considered for barrier calculations. The
calculated shielding should extend up to a height of 7 feet from the
floor. All X-ray rooms need not be designed with concrete. For
example, mammography unit operates within 35 kVp and 2 sheets of
gypsum drywall (1.6 cm thickness) is sufficient, to achieve the required
radiological safety.
45
Table 3.6: HVL &TVL Values of lead and concrete for

various diagnostic X-ray energies
Peak voltage, HVL,Lead TVL,Lead HVL,Concrete TVL,concrete
kV (mm) (mm) (mm) (mm)
50 0.06 0.17 4.3 15
70 0.17 0.52 8.4 28
100 0.27 0.88 16.0 53
125 0.28 0.93 20.0 66
150 0.30 0.99 22.4 74
Shielding Design for Computed Tomography
Work Load
In the case of CT scan all the walls in the room are secondary barriers, and
the detector plays the role of primary barrier. The measured data from a
individual CT scan is required to determine the amount of scattered
radiation, arising from the gantry. Normally, these measured data are
provided as exposure lines from the isocenter of the gantry on a per slice
basis for a given mAs (Fig. 3.6). The work load of a CT scan is calculated
from average number of patients per week, fraction of head verses body
scans, and the average mAs per patient.
Fig. 3.6: CT scan layout: Exposure levels measured from

the isocentre of the gantry in mR / hour
46
The workload of a head CT scan having 20 abdominal scan per day, 30

slices per scan with 250 mAs per slice can be calculated as follows. 50 % of
the scans are pre and post contrast and 50 % are with out any contrast
(assume 1.5 studies /patient)
W = (20 patients /day) (5 day /wk) (30 slices /study)
(1.5 studies /patient)
= 4500 slices /wk
Shielding Calculation
If each slice provides 0.08 mR exposure at a distance of 3.5 m from the
iocentre, for 100 mAs, then the weekly exposure (X) is
= 4500 slices (0.08 /100mAs) (250 mAs /slice)
= 900 mR/week
If the permissible limit is 2 mR /week, for a occupancy of T=1/4=0.25,
then
Xlimit = (2 mR /week) / 0.25
= 8 mR /week
The required concrete shielding to reduce the exposure to 8 mR /week is
T = 0.434 ln (X / Xlimit) TVL
= 0.434 ln (900 /8) 66
= 135.2 mm or 13.5 cm or 5.31 inches
If lead is used instead concrete, then
T = 0.434 ln (900 /8) 0.93
= 1.90 mm
This thickness is equal to 5 lb /sq ft. Similar calculation needs to done
for other walls, floors and ceilings.
Now a days spiral CT scanners are used with increased acquisition speed
and efficiency, which demands high output X-ray tubes. These scanners
provides additional radiation burden to the workers and public. For
example, a 64 slice CT scan handles 150 patient /week, 5 rotation per patient
with 250 mAs exposure per rotation. Assume the exposure level at the wall
level is 0.13 mR for 100mAs. The corresponding weekly exposure is
= 150 patient /week (5 rotation /patient) (0.13 mR /100 mAs)
(250 mAs / rotation)
= 243.7 mR /week.
FACILITY DESIGN FOR NUCLEAR MEDICINE

The radiation exposure in nuclear medicine may vary from natural
background to 100 R/hr. This is calculated by using the specific exposure
rate constant () of the radionuclide, which is defined as the exposure rate
in R/hr at 1 cm from 1mCi of the radionuclide. 47
Exposure rate (R/hr) = A/d2 (10)

where A is the activity in mCi, and
d is the distance in cm from a point source of radioactivity.
Most of the low energy photons are attenuated by air and other
intervening materials. Hence, the exposure rate constant do not account
photon energy below certain levels. If the exposure rate constant accounts
photon energy greater than 20 keV, then it is denoted as 20.
Example 6: A vial contains 100 mCi of I-131, having a 20 =2.18 R-cm2/
mCi-hr. What will be the exposure at 100 cm, if a nursing staff sit for
1 hour.
Exposure = (2.18 R-cm2 / mCi-hr) (100 mCi) (1 hr) (1/100 cm2 )
= 0.0218 R
= 21.8 mR
In general, there is no need to shield the walls of the nuclear medicine
laboratory. However tungsten, lead and lead glass are used as shielding
materials to give personnel protection. These are used to design syringe
shield, L-bench, lead pigs, transport container and waste dust bin etc. The
Table 3.7, presents the exposure rate constants and HVL for various
radioisotopes.
Table.3.7: Exposure rate constants and HVL for various radionuclides

Radionuclide 20 (R-cm2 / mCi-hr) Half value layer,Lead, mm
I-131 2.18 3.0
Mo-99 1.47 7.0
Tc-99m 0.62 0.3
F-18 5.66 3.9
Ga-67 0.75 1.0
Cs-137 3.25 5.5
FACILITY DESIGN FOR RADIOTHERAPY

1. Workload: In radiotherapy, the workload is obtained by multiplying
number of patient treatment per week with delivered dose for each
patient. It is expressed in Gy/week. For example, if a linear accelerator
treats 50 patients per day with dose of 4 Gy for each patient at 1m,
then
W = (4 Gy /patient) (50 patient /day) (5 days /week)
= 1000 Gy /week
NCRP Report 49 suggests a workload figure of 1000 Gy/week
based on a dose of 4 Gy at 1 m per patient, assuming a five day week
48 for megavoltage facilities.
For dual energy machines the same workload figure of 1000 Gy/
week may be used. NCRP Report 51 suggests an assumed workload
of 500 Gy/ week for the higher energy, with the remainder of the
workload being attributed to lower energy X-rays or electrons.
2. Use Factor: A use factor (U) describes the different beam orientations
used for treatment when calculating the required barrier thickness for
each beam orientation. If conventional treatment techniques are to be
used, NCRP Report 49 suggests a use factor of 1 for the floor with the
beam pointing vertically down, and 0.25 for each wall and ceiling, if
specific values are not available. These use factors may depend on the
particular use of the facility and also on the energy used. For example,
a facility performing a large number of total body irradiations may have
a use factor greater than 0.25 for one wall, and lower for other walls.
3. Occupancy Factor: The occupancy factor (T) for an area should be
considered as the fraction of time spent by a single person; who is
there longest. It is most likely that the target group for shielding
purposes will be non radiation workers employed by the hospital.
The occupancy factor is best defined as the fraction of an 8 h day or
2000 h year for which a single individual may occupy a particular
area. Occupancy factors are based on local regulations and the specific
conditions at the facility under consideration.
IDR and TADR

The instantaneous dose rate (IDR), is the direct reading of the dosimeter
that gives a reading in dose per hour, averaged over one minute. When
calculating the required barrier shielding it is useful to calculate the expected
IDR for comparison with direct measurement after the facility has been
built and the treatment unit installed. The time averaged dose rate (TADR)
is the barrier attenuated dose rate averaged over a specified time. TADR is
proportional to IDR, and incorporates the W,U and dose output rate (DR0)
of the unit.
The TADR is estimated over 8 h (R8), by taking into account the workload
and occupancy factor as unity. For megavoltage treatment units, although
the unit may be in use for 8 h per day, it is likely that the total beam-on time
per day will be much less. The TADR, or R8, is then determined from the
IDR multiplied by the daily beam on time and then divided by the length
of the working day:
Daily beam on time
TADR = IDR (11)
Length of working day
or, It can also be expressed as follows:
Wd U
R 8 = IDR (12)
8 DR o
49
where R8 is the TADR averaged over an 8 h day, in mSvh1 ;
IDR is in mSvh1 averaged over 1 min at a point 0.3 m beyond the barrier,
with the machine operating at the dose output rate DR0 ;
Wd is the daily workload defined at 1 m, in Gy for an 8 h day;
U is the use factor (=1 for secondary barriers or the maze entrance);
DR0 is the dose output rate at 1 m, in Gyh1 or Svh1.
From the above, the weekly TADR (RW) may be calculated, as follows:
WU
R W = IDR (13)
DR o
where W is the weekly workload, for 40 hours.

The TADR 2000 is the time averaged dose rate estimated over 2000 h.
This takes into account the workload, use factor and occupancy factors.
According to guidance from the United Kingdom, if the IDR is less than 7.5
mSvh1 and the TADR is less than 0.5 mSvh1 or the TADR 2000 is less
than 0.15mSvh1, the area need not be supervised.
Primary Barriers
Weekly Dose Rate Method

Let P is the permissible dose equivalent limit for a given area in Sv/wk. If
B is the required attenuation of the barrier to reduce the primary beam
dose to P, then
P ( d + SAD )
2
WUT B
P= or B= (14)
( d + SAD )
2
WUT
where d is the distance between the isocentre and the area of interest
outside the primary barrier in meters,
SAD is the source to axis distance in meters,
W is the work load in Gy/week
U is the use factor, and
T is the occupancy factor.
NCRP-51 has given the beam attenuation curves for various energies
and barrier materials, under broad beam geometry. By referring these
attenuation curves, the barrier thickness can be obtained. Fig. 3.7 gives the
model attenuation curves for various electron beam energies with concrete
of density 2.35 g/cc as barrier material.
The thickness of concrete required can be determined from attenuation
graphs, or by the use of TVLs. The number of TVLs required to produce
this attenuation is determined from:
Number of TVL (n) = log10 (1/B) (15)
50
Fig. 3.7: Attenuation curves for various electron beam energies under broad
beam geometry, for concrete with density 2.35 g / cc as barrier material
The Table 3.8, presents the TVL values in meters for various construction
materials, with variable beam energies. Then, the thickness of the barrier is
calculated by using the equation
S = T1+ (n 1)Te (16)
where, T1 is the first TVL and Te is the equilibrium or subsequent TVL of
concrete as given in the NCRP report No.51. The Table 3.9 presents the first
TVL (T1) and subsequent TVL(Te) for various construction material with
respect to energy.
P ( d + SAD )
2
Primary barrier B=
WUT
Assume P = 0.12 mSv/week, d = 3 m, U = 0.25, T= 1, W = 384 103 mGy/wk
0.12 ( 3 + 0.8 )
2
B= = 1.81 105
384 10 0.25 1
3
Number of TVLs = log 10 (1/B)

= log 10 (1/ 1.81 105)
= 4.74
The TVL for 60Co in concrete (density 2350 kgm3) is 218 mm (Table 3.8).
Therefore, the required thickness for the primary barriers is 4.74 218
=1033 mm.
51
Instantaneous Dose Rate Method

The barrier thickness required to reduce the IDR to an acceptable level on
the far side of the barrier is determined as follows:
The attenuation required BIDR is given by:
PIDR ( d + SAD )
2
B IDR = (17)
DR 0
where PIDR is the instantaneous design dose limit, in Svh1;
d is the distance from the isocentre to the point of interest on the far side
of the barrier, in metres;
SAD is the sourceaxis distance (usually 1 m for linear accelerators);
DR0 is the dose rate at the isocentre (1 m), in Gyh1.
The number of TVLs of concrete is then determined from Eq.(15) in the
same way as for the weekly dose rate method. Wall thicknesses determined
for primary barriers will be more than adequate to shield against leakage
and scattered radiation and no further calculations are required.
Table 3.8: TVL values for various construction materials, with variable beam
energies (Source: IAEA safety series 47)
Co-60a 4MVb 6MVb 10MVb 15MVb 18MVb 20MVb 24MVb
TVL for concrete (density 2350 kg . m-3) (in mm)
Primary beam 218 290 343 389 432 445 457 470
gamma/X-rays
Leakage gamma 218 254 279 305 330 330 343 356
and X-rays (900)
TVL for steal (density 7800 kg . m-3) (in mm)
Primary beam 71 91 98 105 108 111 111 107
gamma/X-rays
Secondary beam 69 79 80 85 87 87 88 89
gamma/X-rays
TVL for lead (density 11360 kg . m-3) (in mm)
Primary beam 41 53 55 56 57 56 55 52
gamma/X-rays
Secondary beam 40 47 45 46 47 47 49 51
gamma/X-rays
a: NCRP report 49(1976), b: Varian Associates, Nelson and LaRiviere (1984).
Width of the Primary Wall

The primary barrier width is made equal to the maximum field size at the
barrier plus 1 foot (0.305 m) on either side to prevent radiation from leaking
through the secondary barrier that abuts the primary. Most of the linear
accelerator has 40 cm 40 cm as maximum field size at 1m from the target.
52
Table 3.9: Tenth value layers for primary barriers, for concrete(2.35 g/cm3),
steel (7.87 g/ cm3) and lead (11.35 g/cm3) Vs beam energies (NCRP 151,2005)
End point energy (MV) Shield material T1 (cm) Te(cm)
6 Concrete 37 33
Steel 10 10
Lead 5.7 5.7
10 Concrete 41 37
Steel 11 11
Lead 5.7 5.7
15 Concrete 44 41
Steel 11 11
Lead 5.7 5.7
18 Concrete 44 41
Steel 11 11
Lead 5.7 5.7
20 Concrete 46 44
Steel 11 11
Lead 5.7 5.7
25 Concrete 49 46
Steel 11 11
Lead 5.7 5.7
Co-60 Concrete 21 21
Steel 7 7
Lead 4 4
When the collimator is rotated to 45 , the above dimension become equal

to its diagonal (56.6 cm). Then the horizontal barrier width (W), required is
given by
W = 0.566 d + (0.305 2)
= 0.566 d + 0.61 (18)
where d is the distance from the source to the barrier.
Secondary Barrier for Scattered Radiation

If Bp is the transmission factor required to reduce the scattered dose to an
acceptable limit P in the area of interest, then
P dsca 2 dsec 2
BP = (19)
WT ( F / 400 )
where P, W and T have the same meaning as above,

dsca is the distance from the radiation source to the patient, in m.
dsec is the distance from the patient to the point of interest, in m.
is the scatter fraction defined at dsca. The scatter primary ratio () is
dependent on the energy of the X-ray beam and the scattering angle.
53
F is the field area incident on the patient, in cm2.
The is the reflection coefficient of the barrier material, which is defined

as the fractional scatter at 1m from the scatter, for a beam area of 400 cm2
incident at the scatter. It is the ratio of the scattered dose to the incident
dose, which varies with scattering angle and beam quality. Table 3.10 gives
the values for different scattering angles.
Radiation scattered by a patient or phantom is usually less than 0.1% of
the incident radiation per 0.1 m2 area irradiated. For large scatter angles,
the energy of the scattered radiation will be degraded and the protection
designed against leakage radiation should provide adequate protection
against scattered radiation from the patient. However, when the scatter
angle is small, patient scatter should not be ignored. For small scatter angles
(10), the value of the scatter fraction a may be as high as 0.0178 for 24 MV
X-rays and the scattered photons have energies close to that of the incident
beam.
The use factor for the secondary barrier is unity. The required thickness
is obtained from attenuation curves of the NCRB-51 report.
Table 3.10: The values of for different scattering

angles for Co-60 and 6MV beams (IAEA safety series 47)
Scattering Co-60 (10-3) 6MV(10-3) 10MV(10-3) 18MV(10-3) 24MV(10-3)
angle
10 11 16.8 16.9 24.3 27.4
20 80 11.5 10.3 11.7 12.7
30 6.0 5.36 6.73 7.13 7.21
45 3.7 2.97 3.25 3.05 3.06
60 2.2 1.74 1.84 1.42 1.37
90 0.91 0.727 0.714 0.375 0.353
135 0.54 0.488 0.370 0.259 0.233
150 0.15 0.328 0.316 0.226 0.212
Secondary Barrier for Scattered Radiation, When the Primary

Beam Strikes the Wall
The barrier transmission factor (BW) needed to shield against scattered
radiation when the primary beam strikes a wall is given by the following
equation:
Pdw 2 dr 2
BW = (20)
AWUT
where dw is the distance from the radiation source to the scattering surface
(wall), in m;
dr is the distance from the scattering surface (wall) to the point of interest,
in m;
is the wall reflection coefficient, which depends on the wall material,
54 scattering angle, and beam energy,
A is the field area projected on the scattering surface (wall), in m2.

The photons scattered by the wall and by the patient are of about the
same energy. If the thickness required to shield from patient scatter is
different from that needed to shield from wall scatter by one TVL or more,
use the larger thickness, otherwise, use the larger thickness and add one-
half value layer (HVL). If the thickness required to protect from leakage
differs from that required to protect from scatter by less than one TVL, use
the greater thickness and add one HVL of shielding material for the energy
of the leakage radiation. If the two thicknesses for leakage and scatter
protection differ by more than one TVL use the greater thickness.
Ceiling
The roof section that can be struck directly by the radiation beam must be
a primary barrier and the formulae used to determine the required thickness
are the same as above. The design dose limit for the roof will depend on
the location of the bunker. If it is a single storey building, then the only
consideration may be the limitation of access to the roof space. However, if
the building is overlooked, then the effect of skyshine must be considered
which may result in the irradiation of nearby buildings. If there is a nuclear
medicine department nearby, then it should be noted that gamma cameras
and possibly other imaging equipment are particularly sensitive to low
levels of radiation that can affect certain patient investigations. If the
building has further floors above the bunker, then consideration should be
given to locating a storage room or plant room immediately above the
bunker (A plant room is used to house the chiller unit for the linear
accelerator or heating and ventilation system plant). A storage room or
plant room will have limited occupancy and access can be restricted, thus
allowing a greater design dose limit than if an office was placed directly
above the bunker.
Secondary Barrier for Leakage Radiation

For a linear accelerator, national and international protocols state that the
leakage from the treatment head must not exceed 0.5% of the primary beam,
outside the useful beam at 1 m from the path of the electrons between the
gun and target window and averaged over 100 cm2. In the plane of the
patient, the leakage must not exceed an average of 0.1% and a maximum of
0.2% over a 2 m radius measured from the beam central axis. In general,
manufacturers have protected their machines to better than 0.1%, and it
would be reasonable to assume this value when determining the required
secondary barrier thickness. If BL is the transmission factor required to
reduce the leakage dose to the permissible limit P, then
1000Pds 2
BL = (21) 55
WT
where dS is the distance from the isocentre to the area of interest for
secondary barrier. The leakage radiation is present, whenever the machine
is switched on and hence the use factor is unity (U=1). Since the use factor
is unity the average position of the treatment head is taken to be at the
isocentre so the distance ds is measured from the isocentre.
In the case of mega voltage machine > 500 kVp, the leakage is 0.1%
through the source housing, which is equal to 1/1000. The quality of the
leakage radiation is the same as primary. Hence, the transmission curves
of the primary can be used for leakage radiation.
Concrete, lead or steel are used as barrier materials, which depends on
structural and spatial considerations. Since concrete is relatively cheep, it
is commonly used as a barrier material to design walls and ceilings. High
density concrete (3.4-3.5 g/cc), lead and steel are recommended as barriers,
whenever there is a scarcity of space. A number of different materials such
as magnetite, barites, iron scrap and hematite may be mixed with concrete.
The physical properties of common shielding materials are given in
Table 3.11. The leakage radiation barrier thickness is always greater than
scattered radiation, since leakage radiation is more penetrating in nature.
In the case of low energy, the difference in barrier thickness is very small.
An optimally designed primary barrier will ensure adequate protection
against scattered and leakage radiation.
Table 3.11: Physical properties of common shielding materials

Shielding material Density, g/cm3 Atomic number
Concrete 2.35 11
High density concrete 3.4-3.5 26
Low-carbon steel 7.90 26
Lead 11.4 82
Worked Examples
Example 7: A 60Co treatment facility, has 40 patients/day (8h) and the dose
delivered per patient at the isocentre is 3 Gy. The facility is used for 5 days
per week. The source specification is 0.8 Gy/min at 1 m, and the isocentric
distance of the treatment unit (SAD) is 80 cm. Calculate the DR0, workload,
and beam on time per day
The dose rate at the isocentre = 0.8 (100/80)2 60 =75 Gy/h.
The dose rate at 1 m (DR0) = 0.8 60 = 48 Gy/h
Workload = 40 3 5 = 600 Gy/week at the isocentre (at 80 cm) or
0.8 2
= 600 = 384 Gy/week at 1 m.
1.0 2
56
The total dose delivered at the isocentre per day = 40 3 =120 Gy.
Total beam-on time per day =120 75 = 1.6 h.
Example 8: Calculate the primary barrier thickness by using weekly

workload method and IDR (Assume effective dose limit as 20 mSv per
year).
P = 0.40 mSv /week,d= 3 m,
W = 384 Gy /week at 1 m = 384 103 mGy/week
SAD = 0.8 m, U=0.25, T=1
DR0 = 48 Gy /h = 48 106 Gy /h
P ( d + SAD ) 0.4 ( 3 + 0.8 )

2 2
B= = = 6.01 10 5
WUT 384 10 0.25 1
3
Number of TVLs = log 10 [1/ (6.01 10-5)] = 4.22

The TVL for 60Co in concrete (density 2350 kgm3) is 218 mm and hence
the required thickness for the primary barriers is (4.22 218) 920.2 mm.
For this barrier thickness the IDR beyond the barrier is determined.
DR 0 6.01 10 5 48 10 6
IDR = = = 199.7 Sv/h
( d + SAD ) ( 3 + 0.8 )
2 2
Example 9: Calculate the primary barrier thickness by using weekly

workload method (equation 14). (Assume P = 0.3 mSv/year as limit for
design purposes).
P = 0.3 mSv/50 week= 6 Sv/week
d = 3 m, W= 384 Gy/week at 1 m
SAD = 0.8 m
U = 0.25, T=1
P ( d + SAD ) 6 ( 3 + 0.8 )
2 2
B= = = 9.03 10 7
WUT 384 10 6 0.25 1
Number of TVLs = log 10 [1/ (9.03 10-7)] = 6.04

Therefore, a (6.04 218)1317 mm thick concrete primary barrier is
required to shield a public area with an occupancy of 1. For a public area
with occupancy factor of 0.5, a similar calculation gives the barrier thickness
of 1252 mm. For a public area with an occupancy factor of 0.2, the barrier
requirement is 1165 mm.
57
Example 10: For leakage radiation from the treatment head, the
manufacturers specification should be used. There may be two values of
leakage radiation quoted by the manufacturer, one when the source is in
the safe position and one when the source is exposed for treatment; the
larger value should be used in the shielding calculations. This value is
usually less than the 0.1% (1/1000) of the primary radiation that is allowed.
To determine the required barrier thickness, Eq.(21)is used. In this example:
ds the distance from the isocentre to just outside the secondary
barrier = 2.6 m
P the design limit for a public area is 20 Sv/week (1mSv/50 week)
T, the occupancy is 1.
1000 20 2.6 2
B= = 3.52 10 4
384 10 6 1
Number of TVLs = log 10 [1/ (3.52 104 )] = 3.45

The thickness of concrete required is 3.45 218 = 752.1 mm
DR 0 B 48 10 6 3.52 10 4
IDR = = = 2.49 Sv/h
1000 dS 2
1000 2.6 2
Example 11: The barrier thickness necessary to shield against radiation

scattered by the patient is determined from Eq. (19);
P is 20 Sv/week
dsca the isocentric distance is 0.8 m;
dsec has the same value as dS in the previous calculation, 2.6 m;
the scatter fraction for 90 degree scatter is 0.0009 per 400 cm2 of
area irradiated;
F is the maximum field area incident on the patient (20 cm 20 cm) =400
cm2
P dsca 2 dsec 2
BP =
WT ( F / 400 )
20 0.8 2 2.6 2
BP = = 2.5 10 4
0.0009 384 10 6 1 ( 400 / 400 )

58
This is similar to the number of TVLs required to shield against leakage

radiation. For 90 degree scatter the energy of the scattered radiation will be
degraded and the protection designed for the leakage radiation should
provide adequate protection against radiation scattered from the patient.
Example 12: It is proposed to design a 6 MV linear accelerator facility for a

work load of 1000 Gy /week at the isocentre. The location of a particular
primary walls is at 3.6 m from the isocentre. Assume the use factor and
occupancy factor are unity.
The permissible limit (P) is 1 mSV per year= 1mSv / 50 week = 0.02 mSv/
week
SAD = 1 m, d = 3.6 m
W = 1000 Gy/week
U = 1, T = 1
0.02 10 3 ( 3.6 + 1)
2
B= = 0.423 10 6
1000 1 1

The actual thickness required (S) = T1 + (n 1)Te
= 0.37 + (6.37 1) 0.33
= 2.14 m
Since, the first TVL(T1) and subsequent TVL (Te) for 6MV is 0.37 and 0.33
m, from Table 3.9.
Example 13: Find the width of a primary barrier, which is 3.6 m away from
a 6 MV Linear accelerator.
By using equation 18,
W = 0.566 d + 0.61
= (0.566 3.6) + 0.61
= 2.03 + 0.61
= 2.64 m
Facility Design for Brachytherapy

To determine the required attenuation of the primary barriers, Eq. (14) is
used. For brachytherapy the workload W is based on the dose delivered
per treatment and the number of treatments:
59
W = RAKR A t n (22)
where RAKR is the reference air kerma rate for a source of unit activity;
A is the total activity (activity per source number of sources);
t is the average duration of treatment in hours;
n is the number of treatments per week.
Using the AAPM Report 21 specifications, the workload may be
represented by:
W = Sk t n
where Sk is the air kerma strength of the source in units of U or
Gym2h1.
Similarly, the dose rate D0 will be given by:
D0 = RAKR A (23)
or, using the AAPM Report 21 specifications:
D0 = Sk
For brachytherapy the sources are not collimated so the use factor U
will always be unity. A modified version of Eq. (14) for brachytherapy
shielding may be written as:
P d2 P d2
B= or B= (24)
RADR A t n T Sk t n T
where P is the design limit;
d is the distance, in m, from the exposed source position to the point of
interest outside the barrier;
T is the occupancy of the area outside the barrier.
The RAKR values of different Brachytherapy sources are given in
Table 3.12.
Table 3.12: Physical data of Brachytherapy radionuclides

Nuclide Mean photon Half-life RAKR (Gy
energy(MeV) MBq-1 . m2 . h-1)
Co-60 1.25 5.27 y 0.308
I-125 0.028 60.1 d 0.034
Cs-137 0.662 30.0 y 0.077
Ir-192 0.37 74.0 d 0.111
Au-198 0.42 64.7 h 0.056
Ra-226 0.78 1600 y 0.195
Unlike megavoltage bunkers, brachytherapy rooms are not used so

regularly. Their use is often limited by the number of operating room
sessions available for placing the source applicators in the patient.
Consequently, basing the shielding design on an annual dose limit may
result in high IDRs outside the barriers. This may necessitate these areas
60
being designated as controlled areas during the course of the treatment if
the IDR exceeds 7.5 mSvh1. It is therefore recommended that the IDR be
assessed (based on the maximum number of sources normally used) and
also the maximum dose rate (based on the maximum number of sources
available) before finalizing the shielding design. The Table 3.13, presents
the minimum concrete thickness required to reduce the dose rate to 7.5
and 2.5 mSv/h at a distance of 3 m from the source.
Table 3.13: Typical concrete barrier thickness required

at 3 m from the radiation source
Type Radionuclide Activity, Thickness (mm) to reduce
GBq the dose rate to
7.5 Sv/h 2.5 Sv/h
MDR afterloading Caesium-137 22.2 280 360
HDR after loading Iridium-192 370 440 510
HDR after loading Cobalt-60 185 680 770
Example 14: The Caesium manual after loader has 5 sources of each 100
mCi (3.7 GBq), to be used for gynaecological treatments. The reference air
kerma rate (RAKR) for 137Cs is 0.077 GyMBq1m2h1.. The intended
workload is 5 treatments per week. The shielding design will be based on
the use of 5 sources per patient with a total activity of 18.5 GBq (0.5 Ci). The
average treatment duration is 30 h to deliver an absorbed dose of 30 Gy to
the prescription point. The weekly workload is obtained from Eq.(22):
W = 0.077 18.5 103 30 5 = 2.13 105 Gy.m2
The design limit is 20 mSv /week for a public area (T=0.1) at 3.5 m from
the treatment position of the sources. The required transmission through
the barrier is determined from Eq. (24):
20 3.5 2
B= = 1.15 10 2
2.13 10 5 0.1
The number of TVLs required is log 10[1/(1.15) (10-2)] = 1.93.
The TVL for caesium 137 for concrete is 175 mm and the total thickness
of concrete required is 1.93 175 mm =337.7 mm.
Example 15: A HDR Brachytherapy machine has 10 Ci (370 GBq) activity

of Iridium -192 source, the average photon energy is 0.38 MeV and the
RAKR is 0.111 mGyMBq1m2h1.. The intended workload is 20 treatments
per week. The shielding design will be based on the use of 10 Ci sources
per patient with average treatment duration of 5 min (0.08 h), to deliver an
absorbed dose of 8 Gy to the prescription point. The weekly workload is
obtained from Eq. (22):
W = 0.111 370 103 0.08 20 = 6.57 104 Gy.m2 61
The design limit is 20 Sv/week for a public area (T=0.1) at 3.5 m from
the treatment position of the sources. The required transmission through
the barrier is determined from Eq. (24):
20 3.5 2
B= = 3.7 10 2
6.57 10 4 0.1
The number of TVLs required is log 10[1/(3.7 10-2)] = 1.43
The TVL for Iridium -192 for concrete is 152 mm and the total thickness
of concrete required is 1.43 152 mm =217.3 mm.
Example 16: The HDR unit contains 20 60Co sources each of 18.5 GBq (500
mCi). The reference air kerma rate (RAKR) for 60Co is 0.308 mGyMBq
1
m2h1. The intended workload is 30 treatments per week. Calculate the
dose rate and the barrier thickness in concrete.
The dose rate is calculated by using the equation 23;

Do = 0.308 18.5 103 20 = 113,960 mGym2h1
To reduce the dose rate to the design limit is 7.5 mSvh1 at 3.5 m (UK
data)
7.5 ( 3.5 )
2
B= = 8.1 10 4
113 , 960
The number of TVLs required is log 10[1/(8.1 10-4)] = 3.09
The TVL for Cobalt -60 for concrete is 218 mm and the total thickness of
concrete required is 3.09 218 mm =673.6 mm.
BIBLIOGRAPHY
1. AERB safety code: Brachytherapy sources equipment and installations. SC/
MED-3. 1988.
2. AERB safety code: Medical diagnostic X-ray equipment and installations.
SC/MED-2(Rev.1)2001.
3. AERB safety code:Telegamma therapy equipment and installations. SC/MED-
1.1986.
4. FM Khan. The Physics of Radiation therapy, (3rd edn.) Lippincott Williams &
Wilkins 2003.
imaging, (2nd edn.), Lippincott Williams & Wilkins 2002.
6. NCRP. Medical X-ray, electron beam and gamma ray protection for energies
up to 50 MeV. Report No. 102. Bethesda, MD: National Council on Radiation
Protection and Measurements, 1989.
7. NCRP. Radiation protection design guidelines for 0.1-100 MeV particle
accelerators facilities. Report No.51. Washington DC: National Council on
Radiation Protection and Measurements,1977.
62
8. NCRP report 151.Structural Shielding Design and Evaluation for Megavoltage

X- and Gamma-Ray Radiotherapy Facilities. National Council on Radiation
Protection and Measurements 7910 Woodmont Avenue, Suite 400/Bethesda,
MD 20814-3095.
9. NCRP. Structural shielding design and evaluation for medical use of X-rays
and gamma rays of energies up to 10MeV. Report no.49. Washington,DC:
National Council on Radiation Protection and Measurements, 1976.
10. Patton HM. Shielding Techniques for radiation oncology facilities, (2nd edn.)
Medical physics publishing. www.medical physics.org 2002.
11. Radiation protection in the design of radiotherapy facilities, Safety reports series
No. 47. International Atomic Energy agency Vienna, 2006.
63
Chapter
4 Planning of
Radiological Facility
GENERAL GUIDELINES
While planning a radiation facility, consideration should be given to
radiation safety, economy and convenience. The following features are very
important while planning a radiation installation either it is diagnostic
radiology or Nuclear medicine or Radiotherapy facility.
1. Location: The site or room should be located as far away as feasible
from areas of high occupancy and general traffic, such as maternity
and pediatric wards and other departments of the hospital that are
not directly related to radiation and its use. It should be preferably at
the extreme end of the hospital and be easily accessible to various
departments of the hospital.
2. Layout: The layout of rooms should aim at providing integrated
facilities so that handling of radiation equipments and related
operations can be conveniently performed with adequate protection.
The installation should permit safe and easy transport of equipments
and nonambulatory patients.
3. Room size: The room must be spacious enough to permit the radiation
equipment and accessories, use and servicing of the equipment with
safety and convenience. It should facilitate the wheeling in of patients
in and around the couch of the unit. Proper grouping of the rooms
comprising the installation should be done bearing in mind their
dependence on each other.
4. Shielding: Appropriate structural shielding shall be provided for the
walls, ceiling, floor, doors and windows, so that the doses received by
the occupational workers and members of the public are kept to a
minimum and shall not exceed the annual effective doses as prescribed
by the competent authority. The current limits are 30 mSv and 1 mSv
for the workers and the members of the public.
5. Doors: The number of doors for entry and windows should be kept
minimum. It should permit safe and easy transport of equipment and
nonambulatory patients. The doors shall provide the same shielding
as that of the adjacent walls, in case persons are likely to be present in
front of them, when the machine is energized.
6. Openings and ventilation: Unshielded openings, if provided in the
room for ventilation or natural light must be located above a height of
2 m from the ground or finished floor level outside the room.
Planning of Radiological Facility
7. Equipment layout: The radiation equipment must be installed in such

a way that in normal use the useful beam is not directed towards control
panel, doors, windows, dark room and areas of high occupancy. The
useful beam should preferably be directed towards unoccupied areas.
Sufficient area should be left all around the couch for safe and free
movements of equipment/ trolley, staff and service personnel.
8. Interlock: Suitable electrical interlocks between door, equipment and
control panel must be provided, wherever it is necessary.
9. Warning light and placard: A suitable warning signal such as the red
light must be provided at a conspicuous place outside the room and
kept ON when the unit is in use, to prevent entry of persons not
connected with the examination or treatment. An appropriate warning
placard must also be posted outside the room entrance or door.
10. Air conditioning: The treatment room may be airconditioned to control
temperature, pressure and humidity. It will ensure long-term, trouble
free, safe operation of the equipment. Spilt AC with sufficient capacity
to suit the room size is preferable than window ACs.
11. Waiting area: In order to avoid the crowding of patients and relatives
near the entrance door, waiting area must be provided outside and
adjacent to the equipment room. It should have sufficient area to match
the patient workload with toilet facility.
12. Emergency and trolly bay: There should be exclusive room for handling
emergency. In addition, space must be provided to accommodate trolly
and wheel chairs etc.
ESTABLISHING A DIAGNOSTIC X-RAY FACILITY

1. Room size: The room housing an X-ray unit shall be not less than 18
m2 for general purpose radiography and conventional fluoroscopy
equipment. The size of the room housing the gantry of the CT unit
shall not be less than 25 m2. Also, not more than one unit of any type
shall be installed in the same room, and no single dimension of these
X-ray rooms shall be less than 4 m. In the case of mammography, the
room size shall be not less than 10 m2, and no single dimension of the
room shall be less than 3 m. A typical layout for a diagnostic X-ray
department is shown in Fig. 4.1.
2. Wall thickness: If the X-ray installation is located in a residential
complex, it shall be ensured that
i. Walls of the X-ray rooms on which primary X-ray beam falls is
(are) not less than 35 cm or 14 inch thick brick or equivalent,
ii. Walls(s) of the X-ray room on which scattered X-ray fall is (are) not
less than 23 cm or 9 inch thick brick or equivalent, and
iii.There is a shielding equivalent to at least 23 cm or 9 inch thick
brick or 1.7 mm lead in front of the door(s) and windows of the
X-ray room to protect the adjacent areas, either by general public
65
or not under possession of the owner of the X-ray room. The density
of the normal masonary brick is considered as 1.6 g/cc.
iv.The ceiling must have a thickness of concrete (density 2.35 g/cc),
not less than 6 inch or 13.5 cm.
3. Control room: For equipment operating at 125 kV or above, the control
panel must be installed in a separate control room located outside but
contiguous to the machine room and provided with appropriate
shielding, direct viewing (1.5 mm lead equivalence) and oral
communication facilities between the operator and the patient. The
X-ray units operating below 125 kVp in diagnostic radiology are
exempted from the above class and may be located away from the
primary beam, inside a stationery /mobile protective barrier. The
protective barrier should have sufficient lead equivalence (1.5 mm).
Both control console and machine can be housed in the same room.
4. Doors: Doors to be lined with 1.5 mm thick lead sheet with proper
overlapping at the joint and junction and wall of 9 inch thickness of
brick and ceiling of 6 inch of concrete.
5. Viewing window: Lead glass of suitable dimensions are provided as
viewing windows of 1.5 mm thick lead equivalents.
6. Mobile protective barrier: Control panel should be kept behind the
mobile protective barrier (MBP) of thickness 1.5 mm lead equivalence.
7. Dark room: The dark room should be located in such a way that the
primary beam is not directed on it. Appropriate shielding must be
provided for the dark room to ensure that undeveloped X-ray films
66 Fig. 4.1: A Typical layout of a diagnostic X-ray department

stored in it will not be exposed to more than an air kerma rate of 10

Gy per week.
8. Placard: A warning placard as shown in the Fig. 4.2, must be posted
outside the room entrance or door.
9. Approval: Two copies of the X-ray room layout drawn to scale 1:50,
are to be sent for approval to Head, Radiological Safety Division,
Atomic Energy Regulatory Board, Niyamak Bhavan, Anusaktinagar,
Mumbai-400094 from radiation safety point and along with a required
fee in the form of demand draft for an appropriate amount, drawn in
favour of pay and accounts officer, AERB, payable in Mumbai, towards
charges for approval of the layout. Mobile units does not require plan
approval unless they are used as fixed units.
Controlled and Uncontrolled Areas

A controlled area is a limited access area in which the occupational exposure
of personnel to radiation is under the supervision of an individual in charge
of radiation protection. This implies that access, occupancy and working
conditions are controlled for radiation protection purposes. In facilities that
use X-rays for medical imaging, these areas are usually in the immediate
areas where X-ray equipment is used, such as X-ray procedure rooms and
X-ray control booths or other areas that require control of access, occupancy
and working conditions for radiation protection purposes. The workers in
these areas are primarily radiologists and radiographers who are specifically
trained in the use of ionizing radiation and whose radiation exposure is
usually individually monitored.
Uncontrolled areas for radiation protection purposes are all other areas
in the hospital or clinic and the surrounding environment. Uncontrolled
areas are those occupied by individuals such as patients, visitors to
the facility, and employees who do not work routinely with or around
radiation sources. Areas adjacent to but not part of the X-ray facility are
also uncontrolled areas.
Fig. 4.2: X-radiation warning sign 67

GENERAL RADIOGRAPHY INSTALLATION

These X-ray units are operated in the range of 50-150 kVp applied voltage.
Objects that are irradiated are considered as primary barriers. Additional
shielding must be provided for the wall behind the chest stand. Provisions
are made to observe and communicate with the patient on the table. The
operator should be in the control area. The shield at the control (protective
barrier) must be a permanent /mobile one with 2.1 m height. It should not
be used as primary barrier. The viewing window at the control barrier must
be 45 45 cm size and centered. A typical model plan is shown in the Fig. 4.3
Area: 18 sq.m. (Not to scale)
MPB: Mobile Protective Barrier of 1.5 mm lead equivalence
V W: Viewing window of 1.5 mm lead equivalence
W: Window or ventilator at a height of 2.0 m from the finished floor
level outside the X-ray room.
D: Entrance door lead lined with 1.0 mm of lead sheet with proper
overlapping at all the joints.
Walls of minimum 23 cm thick brick and ceiling 15 cm concrete.
Fig. 4.3: Model plan for a general radiography room
FLUOROSCOPY INSTALLATION
Fluoroscopic imaging systems are usually operated at potentials ranging
from 60 to 120 kVp. A primary barrier is incorporated into the fluoroscopic
68
image receptor. Therefore, a protective design for a room containing only
a fluoroscopic unit, consider only secondary protective barriers against

leakage and scattered radiations. However, provisions are made with
primary barriers so that the function of the room can be changed at a later
date without the need to add additional shielding. Most modern
fluoroscopic X-ray imaging systems also include a radiographic X-ray tube.
The shielding requirements for such a room are based on the combined
workload of both units. A typical model plan is shown in the Fig. 4.4.
Area: 7.5 5 =37.5 sq.m. (not to scale)
V W: Viewing window of 1.5 mm lead equivalence
level outside the x-ray room
D: Entrance door lead lined with 1.5mm of lead sheet with proper
overlapping at all the joints and junctions.
MAMMOGRAPHY INSTALLATION
Mammography units are typically operated between 25-30 kVp. The walls
are constructed with bricks or gypsum wall board. Adequate protective
barrier of lead acrylic or lead glass are incorporated into dedicated
mammography units. Doors need special attention as they offer poor
attenuation than Brick or gypsum wall board. Gypsum wall board may
contain voids and non uniform areas. Hence, higher thickness of gypsum
wall board is recommended than that calculated. A typical model plan is
shown in the Fig. 4.5.
Fig. 4.4: A typical layout of a fluoroscopy installation

69
Fig. 4.5: Model plan for a mammography room
Area: 3 5.5 =16.5 sq.m (Not to scale)

level outside the X-ray room.
D: Entrance door lead lined with 1.0 mm of lead sheet with proper
overlapping at all the joints.
COMPUTED TOMOGRAPHY INSTALLATION

Computed tomography (CT) employs a collimated X-ray fan-beam that is
intercepted by the patient and by the detector array. Consequently, only
secondary radiation is incident on protective barriers. The operating
potential, typically in the range of 80 to 140 kVp, as well as the workload
are much higher than for general radiography or fluoroscopy. Due to the
potential for a large amount of secondary radiation, floors, walls and ceilings
need special consideration. Additionally, scattered and leakage radiations
from CT systems are not isotropic. The radiation levels in the direction of
the gantry are much less than the radiation levels along the axis of the
patient table. A typical model plan is shown in the Fig. 4.6.
Area: 7 7.5 =52.5 sq.m. (not to scale)
70 V W: Viewing window of 1.5 mm lead equivalence
Fig. 4.6: Model plan for a computed tomography room

level outside the X-ray room
D: Entrance door lead lined with 1.5mm of lead sheet with proper
overlapping at all the joints and junctions.
ESTABLISHING A NUCLEAR MEDICINE FACILITY
General Guidelines
1. Location: The installation should be located in a relatively
unfrequented part of the building so that access to the area can be
easily controlled. It shall be located away from high patient or public
occupancy areas and sources of intense radiation. Fire hazard potential
should be minimum in the area chosen. The location of the installation
or the facilities provided be such that the possibilities for spread of
both surface and air-borne contamination are minimal. The location
should be chosen that the minimum expenditure on shielding,
radiation levels can be effectively maintained with permissible limits
in the immediate vicinity.
2. Hot labs and radioactive storage areas should be located away from
other busy work areas, public corridors, secretarial offices and away
from imaging and low level counting rooms.
3. Areas of high activity and contamination shall be demarcated by
physical barriers. Active areas shall be arranged in increasing order of 71
the activity with entrance from lowest active area.
4. Walls, floor and doors of the active areas shall have hard, washable,
nonporous and leak proof covering. Work surfaces shall be covered
with nonporous and non reactive material.
5. Work benches should be sufficiently sturdy to support lead shielding.
6. Wash basins and sinks should be conveniently available where
unsealed radioactive materials are handled. It is desirable that the sinks
in hot labs have foot or elbow operated taps.
7. Plumbing shall provide direct flow of liquid effluents from active areas
either directly to the delay tank or to the ultimate discharge point.
Drain pipes and delay tank shall be leak proof and corrosion resistant.
8. The laboratory design should permit separate storage of glassware
and work tools (tongs, stirring devices) not used with radioactive
materials to prevent needless contamination or mixture with similar
items used with radioactive preparations.
9. Ventilation system shall be of once-through type with unidirectional
air flow from areas of lower activity to higher activity. The exhaust
from fume hoods shall be let out directly into the open after filtering.
10. Air conditioning is essential to maintain a clean, dust free and dry
environment for electronic instruments that are sensitive to heat and
moisture changes; high humidity is bad for electronic components,
causing corrosion as well as current leakage. Instruments must be
housed in an air conditioned environment, and a dehumidifier may
be needed to maintain humidity at about 50%.
11. Running hot and cold water must be available.
12. Warning light and placard: A suitable warning signal such as the red
light must be provided at a conspicuous place outside the room and
kept ON when the unit is in use, to prevent entry of persons not
connected with the examination or treatment. An appropriate warning
placard must also be posted outside the room entrance or door
(Fig. 4.7A) . Storage containers shall be posted with a different placard
(Fig. 4.7B).
Fig. 4.7: Placard for storage radiation and containers rooms
13. Planning and approval of nuclear medicine laboratory: Two copies

of the layout of the nuclear medicine laboratory (drawn to scale 1:50)
72
indicating the various rooms along with their dimensions, positions

of doors, windows, exhausts, along with fume hoods, workbenches,
sinks and other details should be sent to the Head, Radiological safety
division, AERB, Niyamak Bhavan, Anus akti Nagar, Mumbai-400 094.
A site plan (drawn to scale 1:500) indicating the location of the nuclear
medicine laboratory and the occupancies around it including
those above the ceiling and below the floor, if any, should also be sent
to AERB.
Categorization
In the past, consideration was given to the categories of nuclear medicine
ranging from simple imaging or in vitro laboratories to more complex
departments, performing a full range of in vitro and in vivo procedures.
These departments also involved in advanced clinical services, training
programs, research and development. Now a days all assays (radioassays
or enzyme linked immunosorbent assays (ELISAs) are done in biochemistry
laboratories, whereas nuclear medicine departments are involved largely
in diagnostic procedures, radionuclide therapy and nonimaging in vitro
tests including RIAs. The level of nuclear medicine services is categorized
according to three levels of need:
Level 1
This level is appropriate where only one gamma camera is needed for
imaging purposes. The radiopharmaceutical supply, physics and radiation
protection services are contracted outside the centre. Other services, such
as radiology, cover receptionist and secretarial needs. A single imaging
room connected to a shared reporting room should be sufficient, with a
staff of one nuclear medicine physician and one technologist, with backup.
This level is appropriate for a private practice.
Level 2
This level is appropriate for a general hospital where there are multiple
imaging rooms in which in vitro and other nonimaging studies would
generally be performed as well as radionuclide therapy.
Level 3
This level is appropriate for an academic institution where there is a need
for a comprehensive clinical nuclear medicine service, human resource
development and research program. Radionuclide therapy for inpatients
and outpatients is provided.
73
IN-VIVO DIAGNOSTIC FACILITY
Introduction
An in-vivo diagnostic facility need optimal space, equipment and
manpower. The design and planning should address many factors including
radiation safety. The following are very important on radiation safety point
of view:
1. Walls and doors of laboratories should be painted with good quality
washable paint;
2. Work table tops should have a smooth laminated finish;
3. Floors should be impervious to liquids;
4. There should be an adequate supply of lead containers and shielding
lead bricks;
5. Remote handling devices are desirable;
6. Ventilated fume cupboards are desirable.
Equipment
While the capacity and quantity of individual pieces of equipment needed
depend on the volume of the service, minimum requirements are as follows:
1. A collimated scintillation probe and counting system for uptake
measurements of thyroid function and other in vitro and diagnostic
studies.
2. An isotope dose calibrator.
3. A portable contamination monitor (acoustic dose-rate meter) and/or
a survey meter to monitor beta and gamma contamination.
4. A gamma camera with computer and appropriate clinically proven
software. Rectilinear scanners are no longer appropriate. If only one
gamma camera is funded, it should have its own computer for static,
dynamic and preferably SPECT studies with its various clinically
proven acquisition and processing protocols.
5. Provision must be made for a reasonable range of collimators (low
energy general purpose, high energy, etc.), including a pinhole
collimator.
Imaging Rooms
Imaging rooms should be at least as large as given in the manufacturers
recommendations, but preferably larger, to accommodate patients on
stretchers. A larger area provides a more pleasant working environment
and reduces the risk of radiation to staff. In some hospitals, rooms should
have double glazed and insulated windows to avoid the buildup of dust.
Tight fitting oversize doors and efficient heating, air conditioning and
humidity control units are also required. All rooms should have their own
74 separate power supply and stabilizers and be equipped with hand
washbasins with hot and cold running water. An intercom and/or telephone
are important for facilitating communication. A typical floor plan of a
nuclear medicine facility is shown in the Fig. 4.8 and a typical plan of a
radioisotope is shown in Fig. 4.9.
Fig. 4.8: A typical floor plan of a nuclear medicine department
IN-VITRO AND RADIOIMMUNOASSAY (RIA)

The design and structure of the building can affect the quality of an RIA
centre. Premises should generally provide working conditions that are
hygienic and spacious. A patient reception area with a waiting room and
an area for taking blood samples should be available. The reception area
should be equipped with a couch, resuscitation trolley and other special
facilities. It is essential to reserve an area for record keeping and the sorting
75
and labeling of samples.
Fig. 4.9: Typical plan of a radioisotope laboratory
Floors and bench tops should be smooth and of nonabsorbent material

to facilitate cleaning and decontamination in the event of chemical or radioactive
spillage. Sinks should be conveniently located at each workbench. A
separate washbasin, labelled to this effect, should be reserved for the
washing of hands of laboratory personnel, with its use prohibited for any
other purpose. The washing-up area for glassware, used RIA tubes and
reusable pipette tips should have one or two large sinks and a drying oven.
A storage room for buffer chemicals, solvents, test tubes and other
consumables is provided. A laboratory preparing its own tracers using
imported 125I sodium iodide would need a hot laboratory with sufficient
space to accommodate a fume cupboard, fraction collector and/or high
performance liquid chromatography (HPLC) system, as well as a
refrigerator in which to store stock solutions of radioactive material. The
areas designated for assays are separated from those reserved for other
activities such as patient reception, record keeping and computing.
Types of RIA Laboratories

RIA laboratories are graded on the basis of nature and scope of activity. A
76
Grade 1 laboratory is a basic one using reagents, whether obtained in bulk
or as commercial kits, from an outside source, with minimal production of

reagents confined to standards and quality control material for the simpler
analytes. A Grade 2 laboratory would similarly use primary reagents
obtained from elsewhere but in addition produce its own tracers, at least
for selected procedures, using 125I produced elsewhere in the country or
obtained from abroad. A centre that, in addition to all of the above activities,
also produces polyclonal antibodies falls into Grade 3. A Grade 3 laboratory
could serve as a national or regional reagent production and distribution
centre, or organize and operate an External Quality Assurance Services
(EQAS). Finally, monoclonal antibody production centers, if they are also
engaged in RIA, are classified as Group 4.
Radiopharmacy
The layout of the department should enable an orderly flow of work and
avoid the unnecessary carriage of radioactive materials within the
department. It should be away from gamma cameras, patient waiting areas
and offices. It is also important to consider whether there are working areas
above or below the radiopharmacy laboratory, in order to avoid
unnecessary radiation exposure to people working in those areas. The access
to the radiopharmacy should be restricted, and for security reasons,
laboratories should be lockable. All surfaces of the radiopharmacy, walls,
floors, benches, tables and seats should be smooth, impervious and non-
absorbent, to allow for easy cleaning and decontamination. Floor surfaces
and benches should be continuous and coved to the wall to prevent
accumulation of dirt or contamination.
The radiopharmacy needs to be equipped with at least one isotope
calibrator so that all activity can be measured accurately. In addition, a
reference source (e.g. 137Cs) will be necessary to ensure continuing reliability
of the calibrator. Since, radiopharmacies will be handling unsealed sources
of radioactivity, contamination monitors will be required to check for any
radioactivity that may have been spilt.
Storage areas will be necessary for radioactive materials as well as for
nonradioactive components used in radiopharmaceutical preparation.
These areas will need suitable shielding and, depending on the type of
product being prepared, a refrigerator and freezer may also be required.
A typical radiopharmacy layout is shown in Fig. 4.10.
Fig. 4.10: A basic radiopharmacy facility

77
RADIONUCLIDE THERAPY
Introduction
The therapeutic use of radionuclides may be a potential radiation risk for
both family members and individuals close to the patient, as well as health
workers and the environment. Radionuclides must be used in strict
accordance with safety measures and any special instructions, and all
precautions must be taken to avoid unnecessary exposure to radiation. The
following steps are to be taken before commencing therapy procedures.
Licensing
The administration of therapeutic doses of radionuclides must be under
the responsibility of a physician who is licensed under AERB regulations
to administer radioactive materials to humans. Radioactive material for
diagnosis or therapy should only be used and stored at medical institutions
which possess regulatory license. Technical staff, physicists and nurses may
also be subjected to licensing.
Facility design and construction

When designing therapy units, it is important to bear in mind the following:
a. Patients must be housed in a separate room, with dedicated bathroom
and toilet.
b. Access to the treatment room must be controllable.
c. Any required shielding must be designed for the proposed floor plan in
the eventuality of pregnant patients in adjacent rooms.
It is both easier and less costly to design a unit correctly from the start
than to modify it later. Close cooperation between the nuclear medicine
staff and architects and builders is vital. If an existing space is to be modified,
it may be necessary to determine experimentally the adequacy of walls
and floors as radiation shields. If any building work is to be performed, a
regular inspection of work in progress is advisable to ensure adherence to
agreed plans and specifications. In particular, it should be noted that:
i. Brick walls often have inadequate mortar joints, which can be a
shielding problem.
ii. Flooring should be free of open joints and sealed to the walls, a fact
often forgotten by builders.
Responsibilities
The physician administering the therapeutic radionuclide dose is ultimately
responsible for taking every precaution to avoid unnecessary radiation to
staff, other patients, visitors and the general public. Before commencing
therapy, agreement should be reached on medical and radiation safety
78 protocols.
Records
A record keeping system must be in place before treatment commences. In
addition to normal medical records, a logbook should be kept, listing the
patients name, the radiopharmaceutical and radioactive quantities
administered, and the administration date.
Training
Radionuclide therapy may involve staff outside the nuclear medicine
department, especially nurses and medical staff. A little effort devoted to
familiarization and training in the medical and safety aspects of radionuclide
therapy can avoid potentially serious problems later.
ESTABLISHING A RADIOTHERAPY FACILITY
Location
Radiotherapy departments are usually located on the periphery of the
hospital complex to avoid radiation protection problems arising from
therapy rooms being adjacent to high occupancy areas. As pointed out in
NCRP 49, operational efficiency, initial cost, as well as provision for future
expansion and/or increased workload, should be considered when locating
a therapy installation. Proximity to adjunct facilities, ready access for in-
patients and outpatients, and consolidation of all therapeutic radiological
services, however, may be more important than construction cost. For rooms
below ground level, the reduction in shielding costs for floors and outside
walls should be weighed against the expense of excavation, watertight
sealing and of providing access.
Access
Access to the room for the delivery and replacement of the treatment unit
must be considered. Patients may arrive in wheelchairs or on trolleys or
beds. Entrance to the room may be through a shielded door or via a maze.
It is necessary to include in the room design an open access conduit for
dosimetry equipment cables. This dosimetry duct should always be through
a secondary barrier so that the primary beam can never strike it. Ideally it
should run at an angle through the barrier to the treatment control area.
Also, for security purposes, radiotherapy facilities using radioactive sources
should be located in areas where access by members of the public to the
rooms where sources are used and stored can be restricted. Further, the
proximity of source storage facilities to personnel that may respond in the
event of a security breach should also be considered.
Room Size
The room should be large enough to allow full extension of the couch in
79
any direction, with room for an operator to walk around it. The desirable
size depends upon the type of treatments; for example, a total body
irradiation (TBI) procedure will require a larger treatment distance to one
wall. For intraoperative procedures (IORT) that require extensive support
staff and equipment, the room may need to be larger. The accessory
equipment such as electron applicators, breast positioning boards, etc. are
usually stored within the room, and should be located to minimize the
walking distance for each patient set-up.
Maze
In order to reduce the radiation dose near the entrance, a restricted access
passage way leading to the room may be incorporated in the design. This
passage way is termed as the maze. Ideally this should be long in length
and small in width. The minimum width may be determined by the
dimensions of the treatment unit to be delivered by this route or by access
for a hospital bed. A maze ensures the exit of the photon radiation after
sufficient scattering. A maze reduces the need for a heavy shielding door.
If the length of the maze is sufficient, or if there are enough bends, there
may be no need for a radiation protection door at the maze entrance.
However, it is recommended that a physical barrier such as a normal door(s)
or gate be installed to discourage entry to the maze during patient treatment.
Linear accelerators usually require a gate to prohibit entry during treatment
times and /or motion detectors to detect unauthorized entry, if a shielded
door is not required to reduce dose rates. Another advantage of a maze is a
route for ventilation ducts and electrical conduits without compromising
the shielding.
Doors and Interlocks

The treatment room is a controlled area and a barrier be installed at the
entrance to the maze or treatment room to restrict access during exposures.
If a shielded barrier is required to reduce dose rates, a motorized door may
be necessary. A motorized door must have a manual means of opening the
door in the event of a power or mechanical failure. There should also be an
emergency means by which the motion of the door is stopped. Additionally,
any motorized door that is too heavy to be stopped manually should have
sensors that stop the motion of the door to prevent injury to personnel and
patients.
All doors, gates, photoelectric beams and motion detectors must be
interlocked to the treatment unit to prevent an exposure if a door is open.
The interlock must also ensure that when the door is opened the irradiation
will be terminated. The radiation output of the device should not be resumed
automatically after the door is closed again. The interlock should be fail-
safe so that safety is not jeopardized in the event of failure of any one
80 component of the system.
In certain centers, it is advised that a door-reset switch be situated near

the exit from the treatment room at the position where the person leaving
the room has a clear view of the room. Only after activation of the reset
switch can the radiation be turned on. If there is a maze, this switch should
have a delayed action to allow the person time to leave the room and maze
after resetting the switch. This switch should be connected in series with a
second switch just outside the door. The same person should operate both
switches. In cases where the door is clearly visible from the control panel,
closing the door may activate the second switch. Only after activation of
both switches can the radiation be turned on (IPEM Report 75).
In facilities using radioactive sources, a barrier that restricts access to
the treatment room outside normal working hours may also meet certain
specifications. An unauthorized access to the source can be detected in a
timely fashion. To achieve this, a video camera that provides continuous
remote surveillance of the device, a photoelectric beam or motion detector
system installed in the maze and/or treatment room, or a door interlock
can be incorporated. If these devices indicate the potential presence of an
unauthorized person, an alarm should indicate this locally and remotely
so that personnel can respond in a timely fashion. These technical measures
will be independent of any interlocks that terminate the radiation beam
during normal operation because they will not be operational when the
treatment unit is powered off outside operational times.
Treatment Control Area

The treatment control area is where the operators control the machine. This
area should be close to the entrance to the treatment bunker so that the
operators can view the entrance area. The control area should be sufficiently
large to accommodate the treatment unit control console and associated
equipment. There may be computer terminals for record and verification,
electronic portal imaging, hospital information system and dosimetry
equipment, as well as closed circuit TV monitors for patient observation.
There should be clear access to any dosimetry ducts.
Patient Observation and Communication

The operator should be able to visually monitor the patient during treatment
with closed circuit TV. Two cameras are recommended. These should be
situated 15 off and above the gantry rotation axis for optimum observation
of the patient on the treatment couch. The cameras should be located far
away from the radiation source, consistent with tele-zoom capabilities, to
minimize degradation of the image receptor by scatter radiation. There
should also be provision for two way audio communication between the
treatment control area and the room. A patient activated alarm may be
required for patients unable to give an audible call. 81
Ducts and Shielding

Ducts and conduits between the treatment room and the outside must be
adequately shielded. This includes ducts for cables necessary to control
the treatment unit, heating and ventilation ducts, ducts for physics
equipment and other service ducts. It is recommended that ducts should
only penetrate the treatment room through secondary barriers. No duct
with a diameter greater than 30 mm should penetrate the primary shielding.
The ducts should be placed in such a way that radiation passing through
them will require the least amount of compensation for the barrier material
it displaces. No duct should run orthogonally through a radiation barrier.
It could either run at an angle through the barrier or have one or more
bends in it so that the total length of the duct is greater than the thickness
of the radiation barrier. If required, lead or steel plates are suitable materials
to compensate for the displaced shielding. To shield the scattered radiation
that passes along the duct, it is better to place the additional shielding
outside the treatment room, where the radiation has a lower average energy
and therefore, less shielding material is needed as shown in Fig. 4.11.
Treatment machine cables are usually run below the floor level under
the primary or secondary barriers, before bending up to reach the treatment
control area. Provided there are no rooms below, additional shielding is
not usually required unless the treatment control area is directly behind a
primary barrier, and the cable passes beneath the same primary barrier.
Water pipes and narrow electrical conduits are usually placed in groups
inside a larger duct. It is recommended that they also should not penetrate
through barriers, but follow the maze to exit the treatment room as described
above or follow a route beneath the shielding barrier.
Heating and ventilation ducts should not penetrate through primary
barriers because of their large cross-sectional area, which makes it costly to
compensate for the shielding material they displace. If the ducts must pass
through a secondary barrier, the cross-section of the duct should have a
high aspect ratio to decrease the radiation passing through the duct as a
result of multiple scattering interactions with the duct/shielding walls. The
axis of the duct and the longer side of the duct cross-section should be as
orthogonal as possible to the direction of the leakage radiation from the
target towards the duct.
The amount of additional shielding required to shield penetrations in
shielding walls depends on the energy of the radiation beam, the room
layout and the route of the duct(s). The shielding must be evaluated carefully
if the ducts must penetrate the primary barrier. The recommended
placement of these ducts is above a false ceiling along the path of the maze,
to exit the maze at or near the external maze door where the photon and/
or neutron fluence are lowest. For accelerators of energies up to 10 MV,
usually no additional shielding around the duct is required. For higher
82
energies, an additional shielding is required. If it is necessary for the ducts
Fig. 4.11: A bend in duck to avoid radiation streaming
to pass through the secondary barrier, they should be placed as high as

possible to minimize the scattered radiation to personnel outside the room.
Conduit
Conduits are required for dosimetry cables, beam data acquisition system
control cables, quality assurance (QA) equipment cables, and in vivo
dosimetry equipment cables. The conduits are usually PVC pipes of 80 to
100 mm diameter included in the concrete formwork. They should be
inclined at an angle (20 to 45 degree, in the vertical and horizontal planes),
and penetrate through the secondary barrier but not through the primary
barrier. If the openings are at least 300 mm above floor level they are more
convenient to use. Ideally, the opening in the treatment control area should
be at the counter top level and the opening in the treatment room side
should be at a different level but within easy reach. Conduits as described
above usually do not need additional shielding unless the barrier is
constructed of material with a much higher density than 2350 kgm3.
Room Lighting and Lasers

To set up a patient for radiotherapy treatment, the room lights should be
dimmable so that the field light of the treatment unit and the alignment
lasers can be seen easily. It is useful to be able to control the room lights
and lasers from the treatment unit control pendant in the treatment bunker.
When the field light is switched on the room lights should dim to a pre-set
(but variable) level, and the alignment lasers should also be switched on.
Since fluorescent lights do not dim very satisfactorily, it is recommended
that incandescent lights be used for the dim level. The main room lighting
can be fluorescent lights that extinguish when the field light is turned on
and the incandescent room lights are used for the dim level. When the field 83
light is switched off, the main room lighting is switched on and the lasers
switched off. The dimmable lights may remain on at all times.
Karzmark et al, recommend that if junction boxes or alignment lasers
are to be inset in the walls, then the voids need to be backed with 40 mm
thick steel plate with a 30 mm margin all around. Depending on the
occupancy of the adjacent area, it may be acceptable to have a reduction in
the shielding over a small area, especially in a secondary barrier.
Four alignment lasers are recommended in total. Three lasers projecting
a cross: two aligned with the gantry positions of 90 and 270, and one
mounted in the ceiling directly above the isocentre. The fourth laser should
project a sagittal line along the gantry axis. This laser is usually mounted
on an angled bracket on the wall opposite the gantry. The laser switching
should be controlled from the hand pendant, but it is also useful to be able
to switch them off independently for QA tests.
Construction Materials
To house radiation treatment facilities, concrete will usually be the material
of choice since it is the least expensive. However, if space is at a premium it
may be necessary to use a higher density building material. Table 4.1 lists
a range of typical building materials with their densities. Concrete density
will vary according to the aggregate used. Most published data assume a
density for concrete of 2350 kgm3. For therapy installations operating over
500 kV, Compton absorption dominates and the shielding material will
absorb the radiation according to the density of material.
Table 4.1: Building materials and their densities, (IAEA-47)
Building material Density (kg.m-3) Comment
Concrete 2350 Will vary with mineral content
Barytes concrete 3400-3500 Most commonly used for dense
concrete but expensive
Iron ore with ferrosilicone 4000-5400 Range of densities which depend on
proportions of ore mixture to sand
Ledite 3844 and 4613 Pre-moulded high density inter-
locking blocks from atomic inter-
national, Inc
Clay bricks 1600 May be used for installations up to

Breeze blocks 1100-1400 500 kV with supplementary lead or
steel shielding
Earth fill 1600 May be useful in bunker which is
below ground level
Steel 7900 Normally used as supplementary
Lead (solid) 11340 Shielding on an existing treatment
room
Concrete is normally specified by strength, with density being of
84 secondary importance. Strength is increased by increasing the proportion
of cement in the mix, while increasing the proportion of aggregate increases

density. Increasing the amount of water in the mix will reduce the overall
density as air pockets may be left as the mix dries out. To guard against air
pockets it is customary to vibrate the concrete mix as it is poured.
Each barrier should be formed in one pour to avoid seams between
different layers. Preformed concrete blocks only have a density of 2000
kgm3, but some special dense building bricks are available. Examples of
such bricks are barites, or barium and magnetite bricks, which have a density
of around 3000 kgm3. If using dense bricks, it is important to use heavy
mortars to avoid shine paths between the bricks. Ordinary sand mortar
only has a density of 2000 kgm3. If space is at a premium, then special high
density concretes or high density materials such as steel or lead can be
used. Steel plate is often used in existing rooms that need to be upgraded.
The steel plate is usually formed in 10 mm thick sheets and fixed one layer
at a time to the existing wall, taking care that the fixings do not overlie each
other.
For therapy installations operating above 10 MV, shielding against
neutrons must be considered. Concrete contains a relatively high hydrogen
content and is therefore efficient at shielding against fast neutrons. The
tenth value layer (TVL) for the primary X-ray beam is approximately double
that for the photo-neutrons produced by medical linear accelerators, so
any shield designed as a primary barrier against X-rays will be more than
adequate against photo neutrons. The fast neutrons are reduced in energy
by elastic scattering interactions with hydrogen. After a number of collisions
they become slow neutrons, which undergo capture reactions with many
materials and penetrating capture gamma rays are emitted. The capture
gamma ray spectrum in concrete extends to greater than 8.0 MeV and the
average energy is 3.6 MeV. The capture of slow neutrons by hydrogen in
concrete results in a pronounced peak in the photon spectrum at 2.21 MeV.
Boron and cadmium have large cross-sections for the capture of slow
neutrons. Boron is incorporated into polyethylene, which has high hydrogen
content to form an efficient neutron shield. Slow neutron capture in the
boron results in the production of a low energy gamma ray of 0.473 MeV.
A 5% composition by weight of boron in polyethylene is commonly used
in neutron shielding doors in treatment rooms.
Air Conditioning
The treatment room as well as the control room should be air conditioned.
The opening for the air conditioners should be provided in the specified
outer wall of the treatment room in the case of Cobalt teletherapy room.
The lower end of the openings should be located at a minimum height of
2.5 m from the floor level outside and further be covered with a baffle
arrangements (4.12). The width of the baffle and the length of its vertical
portion should be such that 30 cm wide overlap is available all around the
85
openings. If split type air conditioners

are planned, the baffle arrangements
are not necessary. However conduit
for passing the AC duct is to be
provided in the specified wall at an
angle to avoid direct scattered
radiation passing through it.
Warning Signs and Lights

It is recommended that an illuminated
warning sign be displayed at the
entrance to the maze or treatment
bunker. It should be possible to see a Fig. 4.12: Baffle design for air
warning sign from any position within conditioner or exhaust
the treatment bunker. These signs
should be mounted at eye level (1650 mm above finished floor level) and
interlocked with the treatment unit control. The illuminated signs may have
two or three stages. For a two stage sign, the first stage will be illuminated
when there is power to the treatment unit, and the second stage will
illuminate when the beam is turned on. For a three stage sign, stage one
will be illuminated when there is power to the treatment unit, stage two
will light when the treatment unit is programmed to deliver a radiation
beam and stage three will illuminate when the beam is turned on. A warning
sign should indicate the nature of the hazard. If there are controlled areas
with restricted access outside the treatment bunker these should be labeled
appropriately.
A suitable warning sign such as the redlight must be provided at a
conspicuous place outside the room and kept ON when the unit is in use,
to prevent entry of persons not connected with the examination or treatment.
An appropriate warning placard (Fig. 4.13) must also be posted outside
the room entrance or door.
86 Fig. 4.13: Radiation warning placard

Associated Facility
The supporting facility of the radiotherapy department such as simulator
room, treatment planning system, mould room, Medical physicists room,
radiation oncologists room, examination room, nurses room, and record
room etc, should be incorporated in the layout as shown in the Fig. 4.14
A typical lay out of a Tele-Cobalt installation is given Fig. 4.15 A and the
cross sectional view is given in 4.15 B. Similary, the model plan of a 6 MV
and 15 MV linear accelerator is given in Fig. 4.16 and 4.17 respectively.
However, these plans are only models for teaching and training purposes,
one has to individually design the facility for the local need, by taking into
account all the parameters, including the regulatory concern.
Fig. 4.14: A model layout of radiotherapy department
Additional Installation Requirements

1. Fire protection should be provided. Heat detectors or photoelectric
smoke detectors are recommended.
2. Electrical protection as per the local regulation (e.g. earth leakage
circuit) must be ensured.
3. Two way patient monitoring intercom system with two video cameras
mounted in the treatment room and monitors in the control area in
addition an independent intercommunication between treatment room
and control desk. The intercom should be voice activated or permanent
one.
87
Model Plan 1
(A)
(B) AA cross section
Fig. 4.15 A and B: A model tele therapy cobalt installation
4. CCTV to monitor the patient and treatment, one fixed and one movable
88 camera. Do not locate in the primary beam.
Model Plan 2
BB: cross section
Not to scale, all dimensions are in meters, concrete density 2.35 g/cc
Area : 11.28 10.06 = 113.47 sq m, isocenter height =1.295 m from finished floor.
L: Lasers, Sagittal laser height: 2.4-2.6 m
AA: AA Cross section, BB: BB Cross section, CC:CC Cross sections.
Fig. 4.16: Model layout of a 6 MV high energy linear accelerator

89
Model Plan 3
Not to scale, all dimensions are in meters and concrete density 2.35 g/cc.
Area : 12.65 10.97 = 138.77 sq m, isocenter height=1.295 m from finished floor.
L: Lasers, sagittal laser height: 2.4-2.6 m
AA: AA Cross section, BB: BB Cross section,CC:CC Cross sections.
BB: cross section

90
Fig. 4.17: Model layout of a 15 MV high energy linear accelerator
5. CCTV monitors may be mounted on or under shelf and must be visible

during treatment.
6. Provision of In room monitor to have free view from every side of the
couch. Do not locate in the primary beam.
7. Lasers should be fixed at a height of 2.4-2.6 m from finished floor level.
Do not locate in the primary beam.
8. Provide battery working emergency light.
9. Provide an outside phone line for remote diagnostics modem.
10. Environmental specifications: Humidity range:40% to 80 % relative
humidity, non condensing, Temperature range: 19 to 27 C.
11. The room lights, setup lights, closed circuit television system and In
room monitor can be controlled by a single room master switch, often
outside the room. The room lights can be on a separate circuit.
12. Set up lights are usually located above and to either side of the
longitudinal axis. The operation is independent of the pendant and
couch controls.
13. Provide a dimmer switch for set up lights, to adjust the illumination
level, so that they are dim enough for clear visibility of the lasers.
14. Provide emergency off switches in room, but do not locate in primary
beam.
15. Provide a key switch located at the control console to switch ON/OFF
the In room monitor and all monitors and printers at the control
console.
16. Provide enough power outlets at the control console and also near the
back of the accelerator and the modulator.
17. Provision for wedge tray and compensator tray storage.
18. Provision for block tray storage.
19. Provision for electron applicator storage.
20. Provision for immobilization (acquaplast) systems.
BRACHYTHERAPY FACILITY DESIGN

Brachytherapy is a radiation treatment with sealed radioactive sources that
may be placed within body cavities, within the tissues or very close to the
surface to be treated. The duration of the treatment may range from a few
minutes for HDR brachytherapy up to several days for LDR interstitial
therapy. Many different nuclides are available for clinical use. They may
be of low energy requiring minimal shielding or high energy requiring the
use of specially designed rooms. LDR brachytherapy is performed either
by manually loading sources into applicators that have been positioned in
the patient or by remote after loading. The remote after loader stores the
sources in a shielded position and, when required, will drive them into the
applicators. It will also retract the sources during the treatment, whenever
a person needs to attend to the patient and also at the end of the prescribed
treatment time.
91
Rooms used for LDR Brachytherapy may not need special shielding. The
layout of the room should allow patients to be nursed safely and also to be
used for nonbrachytherapy patients. HDR brachytherapy is only performed
with remote after loading units,and requires special facilities.
When designing a room for brachytherapy, the following points should be
considered:
i. Which treatment techniques will the room be used for?
ii. What is the likely number of patients per day/week/year?
iii. How much radioactivity will be used per treatment/procedure?
iv. Which nuclides will be used and what is their energy?
v. Where will sources be stored prior to use and after their removal?
vi. How will the security performance objectives for brachytherapy be
achieved?
In brachytherapy, the protection must be sufficient to reduce the primary
and scattered radiation to the design limit in all directions since the sources
are unshielded in all directions. The dose rate within the room will be much
more higher and the room will be designated as controlled area. The dose
rate outside the brachytherapy room should be reduced to less than 1 mSv
per year. The patient receiving brachytherapy will attenuate the radiation.
The extent of the attenuation will depend on the energy of the nuclide in
use, the size of the patient and the location of the source(s) within the patient.
Since brachytherapy sources are not collimated, the shielding
requirements will be based on the transmission of the primary beam through
the barriers. If possible the room should be designed so that there is no
direct line from the door to the patients bed. If there is sufficient space for
a maze, a protected room door may be unnecessary, but otherwise a lead-
lined door will normally be needed.
A , monitor which measures the dose rate in the patient area should
be clearly visible at the entrance to the controlled area. It is recommended
that there be remote viewing of the patient from the nurses station by
closed circuit TV, together with a two way intercom to reduce the amount
of time nursing staff need to spend in the radiation environment. It should
be possible to view access to the room from the nurses station.
LDR and MDR Treatment Rooms

For remote after loading systems (either LDR or MDR) the treatment room
door will be interlocked to the after loading unit so that the radiation
exposure of nursing staff is minimized. Mobile lead shields may be used to
reduce radiation dose rates when ideal requirements are not possible. The
weight and the need to maintain manoeuvrability of the shield limit the
thickness and size of mobile lead shields. Lead shields typically have a
thickness of 25 mm and a shielded area of 700 to 1000 mm by 500 to 600
mm. They are usually designed to protect the abdomen of a worker who
92 stands behind them.
Some after loading machines allow the treatment of more than one patient
at a time so a suite of rooms will be required. Space will be needed for the
after loading machine itself and the source transfer tubes. Ideally, the after
loading unit will be stored outside the treatment room in a separate closed
area. This allows for servicing of the unit when a patient not receiving
Brachytherapy occupies the treatment room.
HDR Treatment Rooms

HDR remote after loading units need special facilities. All the walls, the
floor and the ceiling will be primary barriers and must be of adequate
thickness to protect the staff, who remain outside the room during the
patient treatment. It is advisable to limit the position of the source within
the room otherwise all the shielding requirements will need to be
determined based on the source being in any position within the room.
This may make the barriers unnecessarily thick. HDR sources are usually
192
Ir or 60Co. For both sources, the high activity and HDR require that the
room have concrete barriers 400 to 800 mm thick. They will also need a
heavy lead door unless a maze has been included in the design. HDR units
are often installed in former radiotherapy treatment rooms that already
have sufficiently thick walls, ceilings, floors and mazes or shielded doors.
In HDR brachytherapy, the patients are often treated directly after the
appliances have been positioned. Ideally, there will also be an X-ray facility
within the room so that the correct placement of the applicators can be
confirmed immediately prior to the treatment being delivered. A waiting
Fig. 4.18: Model plan for a HDR brachytherapy room 93

area for a patient on a trolley may be required where the patient may be
nursed while the treatment planning calculations are completed. A HDR
facility should have an interlocked room door so that the source is returned
to the safe position whenever the door is opened, and there should be a
radiation warning sign at the room entrance indicating the on-off status
of the source. A model layout of a HDR room is shown in Fig. 4.18.
Area: 9.5 6.6 = 62.7 Sq.m.
Wall: Concrete 45 cm, density 2.35 g/cc
Z.M: Zone monitor at 2 m from floor
D: Door ordinary with a glass to peep window.
BIBLIOGRAPHY
1. AERB safety code: Brachytherapy sources equipment and installations, AERB
/ SC / MED-3.
2. AERB safety code: Medical diagnostic X-ray equipment and installations, SC /
MED-2 (Rev.1).
3. AERB safety code: Nuclear medicine facilities, SC/MED-4(Rev.1).
4. AERB safety code: Telegamma therapy equipment and installations, SC/
MED-1.
5. Basic radiological physics, Thayalan K. Jaypee brothers Medical publishers (P)
Ltd. New Delhi 2001.
6. IAEA safety report series 47: Radiation protection in the design of Radiotherapy
facilities, 2006.
7. Nuclear medicine resources book, IAEA, Vienna, 2006.
8. Planning of Teletherapy installations, Users guide, BARC/ RPSD /RASS /
TELE-3, 1995.
94
Chapter
5 Radiation Monitoring
Radiation exposure must be monitored for both personnel safety and

regulatory purposes and it should be carried out periodically. It should
also ensure the safety of personnel, patients and the public. The Atomic
energy (Radiation protection) rules, 2004 (Earlier RPR-1971, Atomic Energy
Act, 1962) insists the radiation monitoring a mandatory one. As per the
rules all radiation workers should be monitored with a suitable radiation
detecting device. There are two type of monitoring namely (i) Personnel
Monitoring and (ii) Area monitoring.
PERSONNEL MONITORING
The aim of personnel monitoring is stated as follows: (i) Monitor and control
individual doses regularly in order to ensure compliance with the stipulated
dose limits, (ii) Report and investigate over exposures and recommend
necessary remedial measures urgently, (iii) Maintain life time cumulative
dose records of the users of the service. Hence, the radiation received by all
the radiation workers during their work should be regularly monitored
and a complete up to date record of these doses should be maintained.
Personnel monitoring is usually done by employing (i) Film badges or
(ii) Thermoluminescent dosimeters (TLD) or optically stimulated luminance
dosimeter (OSL), and (iii) Pocket dosimeter.
The personnel monitoring devices provide (i) occupational absorbed dose
information, (ii) assurance that dose limits are not exceeded, and (iii) trends
in exposure to serve as check on working practice. In India, country wide
personnel monitoring service is offered by the Personnel dosimetry and
dose record section, Radiological Physics & Advisory Division (RPAD),
CT&CRS building, Bhabha Atomic Research Centre (BARC),
Anusaktinagar, MUMBAI-400094.The BARC has accredited M/s Avanttech
laboratories (P) Ltd, Chennai and M/s Renantech Laboratories (P) Ltd,
Mumbai, to provide personnel monitoring services in India.
The requirements of an ideal personnel monitoring systems are (i)
instantaneous response, (ii) distinguish between different types of radiation,
(iii) accurately measure the dose equivalent from all forms of ionizing
radiation with energies from keV-MeV, (iv) independent of angle incidence,
(v) small, light weight, rugged, easy to use, (vi) inexpensive, unaffected by
environment conditions (heat, humidity, pressure), and (vii) unaffected by
non ionizing radiation. No such dosimeter, satisfying all the above features
is available as on date. However, one can be satisfied to some extend by
selecting a particular type for a given application.
FILM BADGE
A film badge is used to measure external individual doses from X, beta,
gamma and thermal neutron radiations. It consists of a film pack loaded in
a film holder having suitable metallic filters. The film holder is made up of
plastic with stainless steel lining as shown in the Fig. 5.1. It is capable of
holding one or more photographic films of size 4 cm 3 cm, wrapped
inside by a light tight polythene or paper cover. The metallic filters are
fixed on both sides of the holder which help to identify the type and energy
of incident radiation. There are three types of holders (i) chest holder, (ii)
wrist holder, and (iii) head holder. The film should be loaded in the film
holders, so that the flap side of the film pack is always facing the body.
Fig. 5.1: Film badge
The film holder has 6 filters namely open, plastic, cadmium, thin copper,
thick copper, and lead. All the filters has 1mm thick except thin copper
which is 0.15 mm thick. The filters assess the penetrating power of the
radiation and thus permit the energy to be estimated. Thus, it will identify
alpha, beta, neutron, low energy X-rays, high energy X-rays and gamma
rays, over a range of energies from 10 keV to 2 MeV. There are two films in
the badge, one is slow and the other is fast. The slow film is meant for
96 recording high exposure. Film badge is worn compulsorily at chest level. If
Radiation Monitoring
a lead apron is used, the film badge is worn under the apron at chest level.
The film badge worn at the chest level represents the whole body dose
equivalent.
The supply of film is for a period of one calendar month (4 weeks).
When radiation passes through the filter it causes formation of the latent
image in the film. After 4 weeks the film is returned to the agency for dose
computation, where the film is processed, the optical densities under
different filters are measured by a densitometer. Using standard calibration
curves, the dose under each filter is evaluated. A control film is always
needed to assess the background level of radiation. Each institution should
keep one film, loaded in a chest holder as control. This control badge should
be kept in a cool, dry and radiation free area. Monthly dose reports are sent
to the individual institutions after processing the film packs. These reports
contain monthly doses and up to date cumulative doses of the current year.
The doses are reported in mSv and the minimum dose that a film badge
can detect is about 0.2 mSv. The advantages of film badge are (i) it is a
permanent record (ii) nature of exposure, types of radiation and energy
can be evaluated, and (iii) least expensive device. Film badge can be used
to measure radiation from 10 mR to 1000 R with a accuracy of 10%. The
film badges are used only by persons directly working with radiation
sources. It is also worth to note that the film badge is used to measure the
radiation dose to which the user is exposed. It does not protect the user
from the radiation.
THERMOLUMINESCENT DOSIMETER
The film badge has some disadvantages such as fading at high temperatures
and humidity, high sensitivity to light, pressure and chemicals, complex
dark room procedure and limited self-life etc. Hence, thermoluminescent
dosimeter (TLD) badges are used currently in India instead of film badges.
It is based on the phenomenon of thermoluminescence, the emission of
light when certain materials are heated after radiation exposure. It is used
to measure individual doses from X, beta and gamma radiations. It gives
very reliable results since no fading is observed under extreme climatic
conditions. The typical TLD badge consists of a plastic cassette in which a
nickel coated aluminum (Al) card is placed as shown in the Fig. 5.2.
1. TLD card: The TLD card consists of 3 CaSO4: Dy-teflon disc of 0.8 mm
thick and 13.2 mm diameter each, which are mechanically clipped over
three symmetrical circular holes each of diameter 12 mm, on a nickel
plated aluminum plate (52.5 mm 29.9 mm 1 mm). An asymmetric V
cut provided at one end of the card ensures a fixed orientation of card in
the TLD cassette. The card is enclosed by a paper wrapper in which
users personnel data and period of use is written. The thickness of the
wrapper (12 mg/cm2) makes the measurements equivalent to 10 mm
depth below the skin surface. To protect the TLD discs from mishandling,
97
the card along with its wrapper is sealed in a thin plastic (polythene)
pouch. The pouch also protects the card from radioactive contamination
while working with open sources.
2. TLD cassette: TLD cassette is made of high impact plastic. There are
three filters in the cassette corresponding to each disc namely, Cu + Al,
Perspex and open. When the TLD card is inserted properly in the cassette,
the first disc (D1) is sandwiched between a pair of filter combination of
1 mm Al and 0.9 mm Cu (thick:1000 mg/cm2). The copper filter is nearer
to the TLD disc and the Al should face the radiation. The second disc
(D2) is sandwiched between a pair of 1.5 mm thick plastic filters (180
mg/ cm2). The third disc (D3) is positioned under a circular open window.
A clip attachment affixes the badge to the users clothing or to the wrist.
Fig. 5.2: TLD badge Al cards and its holder with filters
The metallic filter is meant for gamma radiation, and the perspex is for
beta radiation. The filters are mainly used to make the TLD discs energy
independent. When the TLD disc is exposed to radiation, the electrons in
the crystal lattice are excited and move from the valency band to conduction
band. There they form a trap just below the conduction band. The number
of electrons in the trap is proportional to the radiation exposure and thus it
stores the absorbed radiation energy in the crystal lattice.
After radiation exposure the dose measurements are made by using a
TLD reader (Fig. 5.3). The reader has heater, Photo multiplier tube (PMT),
amplifier, and a recorder. The TLD disc is placed in the heater cup or
planchet, where it is heated for a reproducible heating cycle. While heating,
the electron return to their ground state with emission of light. This emitted
light is measured by the PMT, which converts light into an electrical current
(signal). The PMT signal is then amplified and measured by a recorder.
The reader is calibrated in terms of mR or mSv, so that one can get direct
dose estimation. The discs are reusable after proper annealing. This badge
98 can cover a wide range of dose from 10 mR to 10,000 R with a accuracy of
10%.
Now a days widows based computer controlled TLD readers are

available. They are capable of analyzing TLD chips, ribbons, powder, discs,
pellets, rods and microcubes. They display digital glow curve and
temperature profile. They can handle one or more planchets at a time either
with manual drawer or computer controlled drawer function.
Programmable annealing oven is also available along with the system.
TLD badges do not provide a permanent record and it is available for
extremity dosimetry and finger dosimetry (ring). LiF can also be used as
TLD phosphor, which has wide dose response, 10 mSv to 1000 Sv. Its
effective atomic number is close to that of tissue with an accuracy of 2%
TLD badges are normally worn at the chest level, that is expected to
receive the maximum radiation exposure. Most of the radiation workers
used to wear the badge at the waist level which is not correct. During
fluoroscopy, it is preferable for the radiologist to wear at the collar level in
front of the lead apron to measure the dose to the thyroid and lens of the
eye, since most of the body is shielded from the radiation exposure. Pregnant
radiation workers should wear a second badge at waist level (under the
lead apron) to assess the fetal dose. Additional wrist badge is advised for
procedures involving nuclear medicine, brachytherapy source handling
and interventional radiology.
Fig. 5.3: TLD reader for dose estimation
Guidelines for Using TLD Badge

1. TLD badges are to be used only by persons directly working in
radiation. Administrators, dark room assistant, sweepers etc., need
not be provided with TLD badges.
2. TLD badge is used to measure the radiation dose. It does not protect
the user from the radiation.
3. The name, personnel number, type of radiation (X or gamma), period
of use, location on the body (chest or wrist) etc., should be written
legibly in block letters on the front side of the badge.
99
4. A TLD badge once issued to a person should not be used by any other
person.
5. Each institution must keep one TLD card loaded in a chest TLD holder
as control, which is required for correct dose evaluation. It should be
stored in a radiation free area, where there is no likely hood of any
radiation exposure.
6. TLD badge should be worn compulsorily at the chest level. It represents
the whole body dose equivalent. If lead apron is used, TLD badge
should be worn under the lead apron.
7. While leaving the premises of the institute, workers should deposit
their badges in the place where control TLD is kept.
8. A badge with out filter or damaged filter should not be used. It is
replaced by a new holder.
9. Every radiation worker must ensure that the badge is not left in the
radiation field or near hot plates, ovens, furnaces, burners etc.
10. Every new radiation worker has to fill up the personnel data form,
and should be sent to BARC, Mumbai or to the accredited agency.
11. All the used or unused TLD badges should be return, after every service
period (quarterly) in one lot so as to reach 10th of next month/quarter.
12. Contact for all correspondence regarding TLD badge service, to the
officer in charge, Personnel dosimetry & Dose record section,
Radiological physics & Advisory division, Bhabha Atomic Research
Centre, CT & CRS Building, Anusakti nagar, Mumbai-400094.
Optically Stimulated Luminance Dosimeter

Dosimeters using optically stimulated luminance (OSL) is also available
now a days alternative to TLD. The principle of OSL is similar to TLD except
the heating. Instead of heating, laser is used to stimulate light emission.
Crystalline aluminum oxide activated with carbon (Al2O3: C) is commonly
used as OSL dosimeter. It has broad base response and capable of detecting
low doses as 10 mSv. The OSL dosimeter can be re read several times and
it can also differentiate between static and dynamic exposures.
POCKET DOSIMETER
Film and TLD will not show accumulated exposure immediately. In
addition to the regular film badges, the radiation doses received by the
radiation worker can be assessed by wearing a pocket dosimeter, which
gives instantaneous radiation exposure. This is very useful in nonroutine
work, in which the radiation levels vary considerably and may be quite
hazardous (cardiac cath lab). The main advantage of pocket dosimeter lies
in its ability to provide instant on the spot check of radiation dose received
by the personnel. Suitable protective measures can be undertaken
100 immediately to minimize future exposures. The dose can be read off directly
by the person during or after any radiation work.
It is an ion chamber with a quartz fiber suspended with in an air filled

chamber, on a wire frame as shown in the Fig. 5.4. It has a built-in capacitance
which can be charged by an external potential (charger). The positive
charge is placed on the wire frame, by means of the charger. The quartz fiber
is bent away from the frame due to coulombic repulsion. This can be visible
through an optical lens system upon which an exposure scale is
superimposed.
Fig. 5.4: Pocket dosimeter
These dosimeters should be fully charged prior to their use so that the
initial reading of the dosimeter is set at zero. When exposed to radiation,
ion pairs are produced in the air. These ion pairs partially neutralize the
positive charge, reducing the coulombic repulsion and allowing the fiber
to move. Hence, the quartz fiber move closer to the wire frame, that can be
seen as down range excursion of the hair line fiber on the exposure scale
(graticule). The movement of the quartz fiber is proportional to the radiation
exposure, which is measured in Roentgen (R).The Roentgen is the unit of
exposure = 2.58 10-4 C/kg. The dose in air can be calculated from the
exposure, where 1R exposure is equal to 8.76 mGy (0.876 rad) of air dose.
The dosimeter is available in different ranges varying from 0-200 mR, 0-
500 mR, 0-5R, 0-20R,0-200R and 0-600R for measurement of X and gamma
rays. It can detect photon energies from 20 keV-2 MeV. For personnel
monitoring, smallest range (0-200 mR) should be employed. A typical
commercial chamber with charger is shown in the Fig. 5.5. These dosimeters 101
are available both in analog and digital types. Digital dosimeters use either
GM tubes or diodes and solid state electronics. The dose measurement range
of pocket dosimeter is 10 Sv to 100 Sv.
The accuracy of the pocket dosimeter is about 10%. Pocket dosimeters
are small in size and easy to use and do not provide permanent record.
Sudden mechanical shock may result in wrong reading. Hence, these
dosimeters should be handled with care so as to indicate reliable reading
of the doses received.
Now a days digital pocket dosimeters are available with easy display of
instant radiation measurements. Presently semiconductor diode based
pocket dosimeters with digital display are also available. They have good
energy and polar response, with reliable readings, matching to TLD badges.
They make loud beep sounds for every 15 to 30 minutes on background.
The sound become more frequent as dose rate increases, and becomes
continuous sound at high radiation fields. The energy range of these
dosimeters are 45 keV to 6 MeV and are available in mR and mSv display.
Fig. 5.5: A commercial pocket dosimeter with charger
PERSONNEL MONITORING SYSTEMS AND FEATURES

The common problems associated with personnel monitoring dosimeters
includes (i) leaving dosimeters in a radiation field, when not worn, (ii)
radionuclide contamination of the dosimeter, (iii) lost or damaged
dosimeters, (iv) not wearing the dosimeter while working in radiation. If
the body is between the dosimeter and radiation source, the attenuation
102 will cause a significant reduction in exposure. Most of the time the workers
do not remain in fixed geometry, while doing radiation work. As a result

the radiation exposure becomes multidirectional and the recorded value is
the average exposure for that individual. It is with in 10-20% of the
individuals true exposure. The various type of monitoring systems are
summarized in Table 5.1.
Overexposure
If a person receives more than 10 mSv in one quarter, it will be considered
as over exposure and the same is reported promptly to the institution and
the individual. As per the existing AERB regulatory limits, the effective
dose constraint for consecutive 5 years shall be 100 mSv, i.e. average 20
mSv for every year of the sliding 5 years block, the dose limit in any single
year should not exceed 30 mSv. The Radiological Physics and Advisory
Division (RPAD), BARC will advise the respective institution to take the
following actions:
1. The radiological safety officer (RSO) of the concerned institution should
examine the working conditions and the circumstances that might have
resulted in to the above excessive exposure and report the details to
Personnel dosimetry and Dose records section, RPAD, BARC, in the
given proforma within 15 days, from the date of receipt.
2. A written statement from the individual, explaining the causes for the
reported exposure should also be forwarded along with the RSO
investigation report. This is to take preventive steps to avoid such
exposure in future.
Table 5.1: Comparison of personnel monitoring systems

Dosimeter Radiation Range Features
Film badge , , X-rays : 0.1-15,000 mSvb, Permanent record
: 0.5-10,000/mSv
TLD , , X-rays 0.01-106/mSv No permanent record
Patient dosimetry
OSL , , X-rays 0.01-106/mSv Reread dosimeter
Differentiate static
and dynamic exposures
Pocket dosimeter , X-rays 0-200 mR Special monitoring
0-500 mR Direct reading
0-5000 mR
AREA MONITORING
The assessment of radiation levels at different locations in the vicinity of
radiation installation is known as area monitoring or radiation survey. These
measurements will give an idea about the radiation status of the installation.
On the basis of measurements taken, one could confirm the adequacy or 103
inadequacy of the existing radiation protection status. In case the radiation

levels are found to be higher than the permissible levels, suitable remedial
measures can be taken. Instruments used for the above purposes are called
radiation survey meters and area monitors. In general, any survey meter/
area monitor should consists of two main parts namely:
1. A device which detect the radiation, and
2. A display system to measure the radiation.
These instruments differ from each other in the medium in which the
response takes place and in the method by which the response is detected
and quantified. Following are the different type of meters generally used
for radiation survey and area monitoring:
1. Ionization type (air)
2. Geigher-Muller (GM) type (Neon and halogen), and
3. Scintillation detector type [NaI (Tl), ZnS (Ag)].
Selection of a particular detector depends on a variety of factors like
type of radiation to be detected and quantity to be measured, response of
detector for the energy and type of radiation etc. They can be used as
portable radiation survey meters, capable of measuring radiation count
rate in mR/h or R/h. They are available in the form of vehicle mounted
radiation meters, zone monitors and door way mounted meters etc.
Ionization Chamber Survey Meter

Ionization chamber usually consists of an outer cylinder (cathode) coated
inside with graphite to make it conducting and a central electrode (anode)
insulated from the chamber wall (Fig. 5.6). The cylinder is filled either with
air or suitable gas acting as an interacting and detection medium and a
suitable voltage is applied across the electrodes. When the chamber is
exposed to radiation, the radiation produces ionization in the gas. Under
suitable electric field, positive and negative ions are collected respectively
by cathode and anode of the chamber. The movement of ions produces an
electric current in the outer electronic circuit of the chamber. The strength
of this current is proportional to the number of ionization events caused by
the energy absorbed in the air chamber and will serve as a measure for
quantifying the exposure/exposure rate or dose/dose rate.
In ionization chambers the electric field applied is only just sufficient to
collect all the primary ions produced by radiation, before they recombine.
During this mode, any change in the applied voltage will not affect the
number of ionizations produced in the chamber by the radiation. Number
of ionizations will be purely dependent on the energy dissipated in the
medium. Hence, energy discrimination is possible with ionization chambers
for heavily charged particles by pulse height analysis. Since ionization
chambers collect only primary ions, electronic amplification of charge is
necessary for display purpose. This makes ionization chamber based
104 instruments somewhat delicate and susceptible to extreme climatic
conditions. For X-ray and gamma ray dose measurements, these are
operated in current modes. These current is very small (pico-nano Ampere)
and requires very sensitive electrometers for measurement.
Ionization chambers for low level X-ray monitoring (exposure/ exposure
rate) are fabricated out of air-equivalent materials (bakelite, tufnol) and
they can be used over a wide range of energies from 7 keV to 2 MeV. A
typical survey meter consists of a 500 cc chamber connected to a battery
operated electrometer and can measure exposure rates from a few mR/h
to about 10 R/h. Some of these are provided with an end window of thin
mylar film for beta radiation detection.
Fig. 5.6: Ion chamber
Ion chambers for radiotherapy are fabricated with phenolic wall material
with 200-350 cc chamber volume and operated both in dose and dose rate
mode. It is recommended to use pressurized ion chambers (8 atmospheres
or 125 psi) for in radiotherapy. They provide enhanced sensitivity and
improved energy response for the measurement of dose and dose rate.
They allow fast response time to radiation leakage, scatter beams and
pinholes. In addition, the low noise chamber bias supply provides for fast
background settling time. It is capable of measuring gamma energy >25
keV, and beta energy >1 MeV.
Ionization chambers are used whenever accurate measurements are
required. They approximate the condition under which the roentgen is
defined. Ion chambers are used to measure X-ray machine outputs, estimate
radiation levels in brachytherapy, and in monitoring radionuclide therapy
patients, and survey the radioactive material packages. Ion chambers are
influenced by changes in temperature, pressure, photon energy and
exposure rate. These limitations are less important in medical applications
(5% loss of exposure rate at 10 R/hr).
Ion chambers are capable of monitoring higher radiation exposure rate
levels, and available in different ranges: 0-5 mR/hr, 0-50 mR/h, 0-500 mR/
h, 0-5 R/h, and 0-50 R/hr. They response slowly (8-2 seconds) to rapidly
changing exposure rates and hence needs warm up and stabilization before
measurements are made.
105
Now a days survey meters are provided with lot of special features like
auto ranging and auto zeroing, optional beta slide, simultaneous
measurement of dose and dose rate, operated by two 9 volts alkaline
batteries check source, communications interface with windows based excel
add-in for data logging, programable flashing LCD display and audible
alarm with dose equivalent energy response (SI units).
GM Type Survey Meters

In GM survey meter a higher electric field (500-1300 V) is applied between
anode and cathode of a chamber, which is filled with a gas of low electron
attachment coefficient (e.g argon and neon). The electrons produced in the
chamber will have sufficient energy to produce secondary and tertiary
ionization during their acceleration towards anode. This results in an
amplification of ionization events in the chamber. This is known as gas
amplification (avalanche) which depends on the nature of gas and the
pressure of gas.
In GM counters, use of very thin wire as the anode enables the production
of high electric field close to the anode. Also the primary avalanche is
followed by a successive avalanches due to secondary phenomena
(excitation of gas atoms and production of UV photons). Hence, the whole
wire is covered by a sheath of electrons. The gas amplification ( 108) is
independent of primary ionization (i.e. type and energy of radiation).
GM type instruments are very sensitive and useful for monitoring of
low level radiation. Since electronic amplification is not necessary, the
electronic circuit of GM is very simple, compared to that of ionization
chamber. This feature makes the GM type instruments rugged and less
costly. GM counters used for radiation monitoring generally use a mixture
of gases (argon, neon and chlorine/ bromine). It detect the presence and
provide a semi quantitative estimate of the radiation field magnitude. It
provides measurements in counts per minute (cpm). It also provides an
approximate measurement of mR/hr, since it dose not reproduce the
conditions under which exposure is defined. But the relationship between
cpm and mR/hr is a complicated function of photon energy.
GM counters for X-rays and gamma rays monitoring use copper or
chromium cathodes for better efficiency (Fig. 5.7). The primary photons
interact with the cathode materials to produce secondary electrons. Since,
GM meters are pulsed in nature, they should be used only in X-ray units,
that emits continuous X-rays. They should not be used in X-ray units, that
emits pulsed X-rays (e.g. Linear accelerators).
GM type meters mainly used as radioactive contamination monitor with
thin window (1.5-2 mg/cm2), and large surface area. It will respond to alpha
(> 3 MeV), beta (> 45 keV) X, and Gamma rays (> 6 keV) radiations. GM
detector is sensitive to particle radiation, but relatively insensitive to and
106 gamma radiations. It is suitable to measure natural background radiations,
which are 50-100 cpm. It is mainly used in nuclear medicine for low level
contamination surveys.
GM counters have long dead time (100 sec) and result in 20% loss at
100,000 cpm measurements. They should not be used in high level radiation
fields or when accurate exposure rates are required.
Radiation Survey
Radiation survey is a procedure in which the exposure rates are measured
in and around a radiological equipment by using suitable survey
instruments. This is to safety status the quality of the radiological unit. It
also ensure that the radiation doses received by the radiation workers are
as low as reasonably achievable (ALARA) and they are unlikely to receive
doses higher than the maximum permissible limits. No machine should be
subjected for patient use (either imaging or treatment), until the radiation
survey is carried out. It is to be carried out at time of installation, repeated
weekly/quarterly/ annually or after every major repair of the radiation
equipment. For example, nuclear medicine require weekly radiation survey,
quarterly survey for radiotherapy and annual survey for diagnostic
radiology. Radiation survey protocol should be made by the hospital for a
specific equipment. The various procedures involved in the radiation
survey, for each discipline are explained in the following pages.
Fig. 5.7: GM type radiation survey meter
RADIATION SURVEY IN DIAGNOSTIC RADIOLOGY
Introduction
The aim of conducting radiological protection survey of a diagnostic
installation is to ensure that good quality images are obtained with
minimum doses to patients. The surveillance program also fulfill the
requirement in respect of filter, collimator, leakage radiation, safe work 107
practices and proper installation planning. Separate protocols of radiation

survey should be made available for general X-ray unit, mammography,
fluoroscopy and CT scanner. But there are some general requirements of
survey for all the above equipments.
Radiation protection survey is the evaluation of potential radiation
exposure levels at various locations in the installation and the leakage levels
incidental to the use of diagnostic equipment under specified conditions.
The evaluation includes: (i) inspection of the equipment, (ii) examination
of its location with reference to controlled and noncontrolled areas in the
immediate environment and (iii) measurement of exposure levels in the
environment arising from the operations of the equipment.
Inspection of the Equipment

1. Tube housing leakage
2. Total filtration
3. Tube screen alignment
4. Table top exposure.
General Checks
1. Ensure that the X-ray diagnostic equipment is so installed that under
no circumstances the X-ray beam is directed towards entrance door,
patients waiting area, other occupied areas in the immediate vicinity
of X-ray room, dark room, film storage, opening in the walls etc.
2. Ensure that control panel is sufficiently shielded with lead lined
protective barrier having lead glass windows giving clear view of the
rest of the room.
3. Check whether the focus- to- table distance is as per the specification.
The X-ray unit should permit a focusfilm distance of at least 1.0 meter
for all normal radiography and up to 2.0 meter for chest radiography.
The focus-to-table top distance should not be less than 30 cm for
fluoroscopy units.
4. Check whether the timer of fluoroscopy machine is functioning properly.
The maximum range of timer should not exceed 5 minutes. There should
be provision for audible signal at the end of the preset time.
5. Check the dark room layout and ensure that the safe light and
processing unit are adequate.
6. Ensure that protective devices like lead apron, lead rubber gloves etc.,
are provided and are in good condition.
7. Ensure that the walls for exhaust/ventilation are provided at least 2
meters above the finished floor level outside and otherwise that the
openings are provided with sufficient shielding.
8. Ensure that warning sign (red light and placard) is provided at the
entrance of diagnostic room to restrict the entry of public during the
108
operation of diagnostic equipment.
Instruments and Accessories

1. A water phantom (30 30 30 cm3) to simulate patient scatter condition
or a plastic bucket ( 9 liters) full of water.
2. Ionization chamber type survey meter.
3. Measuring tape.
Workload
To establish the doses that are likely to be received by the radiation workers
and public, it is necessary to know the work load. To calculate the work
load, the number of exposures (Nj) of various types (j) per week is noted.
The average mAs (Ej) for each such exposure should also be noted. Then
the workload can be calculated by using the relation given below. A model
workload calculation is given in Table 5.2.
n
N E
j=1
j j
W= =( ) mA min/wk
60
Table 5.2: A typical calculation of workload
Type of mAs per exam. No. of exams. No. of exams. Total mAs
examination per day per week per week
Chest 15 25 255 15 25 5 =1875
Skull 40 5 55 40 5 5 =1000
Extremities 10 20 205 10 20 5 =1000
Abdomen 100 10 105 100 10 5 =5000
Total workload, mAs per week = 8875
Total workload, mAmin per week = 8875 / 60 min = 147.9
Survey Procedure
The sketch of the layout of the installation is drawn and dimensions of the
room is measured. The location of the control panel, mobile protective
barrier, cassette pass box, doors, windows/ ventilators, passages, dark room
and patient waiting areas are indicated in the sketch.
A water phantom of not less than 30 30 30 cm3 dimension is set on
the table, to create maximum scatter conditions. The source to image
distance (SID) is kept as 100 cm. The collimator is opened for its maximum
field size. The machine is operated under maximum kVp and nominal mA
settings. The radiation levels are measured at various locations, using a ion
chamber type survey meter. These locations include control panel,
radiologist position, patient waiting area, doors (both opened and closed
position), behind 4 walls of the room, ceiling, below the floor (if the unit is
not in the basement) dark room any other location of interest. This is
repeated for both vertical and horizontal orientations of the X-ray room. 109
With the knowledge of the workload, the radiation exposure per week, at
various locations can be calculated by using the relation:
Exposure rate measured ( mR/hr )
Radiation exposure = W ( mA min/ wk )
60 mA
=( ) mR/wk
The measured readings are tabulated as shown below (Table 5.3).
Table 5.3: Radiation survey measurements

Locations Exposure rate level (mR/hr)
Beam facing up Beam facing down Horizontal beam
Example 1: If the unit is operated for 100 mA and the exposure level
measured at entrance door is 180 mR/h. Calculate the radiation level for a
total work load of 148 mAmin per week at entrance door level.
The weekly Radiation level = (180 mR/100 mA60 min) 148 mAmin /
week = 4.44 mR/wk.
Example 2: The instrument reading is 360 mR/h (for tube current 60 mA)
at the operator position behind the mobile protective barrier. Calculate the
weekly exposure received by the operator(assume work load as 148
mAmin/wk).
The weekly exposure =(360 mR/60 mA60 min) 148 mAmin / week
= 14.8 mR/wk.
Note: The Permissible dose limit to radiation worker is 20 mSv per year or
0.4 mSv per week or 40 mR/week. Hence, the exposure level at the control
panel is within permissible limits.
Example 3: The exposure level at the corridor is 30 mR/h (for tube current
60 mA), calculate the weekly exposure to the public (assume the workload
as 148 mAmin).
The exposure level at the corridor =(30 mR/60 mA60 min) 148 mAmin
/ week = 1.23 mR/wk.
Note: The permissible dose limits for the general public is 1.0 mSv per year
or 0.02 mSv per week or 2 mR/week. Hence, the exposure level in the
110 corridor is well within permissible limits.
RADIATION SURVEY IN NUCLEAR MEDICINE

Nuclear medicine radiation survey require the following instruments
namely (i) Portable ion chamber survey meter and (ii) GM type
contamination monitor. These instruments are kept at good working
conditions and needs to be calibrated at regular intervals (once in 3 year).
Contamination is the major source of spread of radioactive material in
nuclear medicine. Hence, contamination control methods are designed to
prevent their spread to personnel and other work areas. Contamination is
classified as (i) external contamination and (ii) internal contamination.
External contamination is not a series health hazard, but the later gives rise
to significant radiation exposures. Hence, internal contamination needs to
be prevented by proper radiation survey. The effectiveness of the
contamination control is monitored by GM counter survey, at the end of
the week, followed by swipe test of the areas.
The sketch of the layout of the Nuclear medicine laboratory is drawn
and dimensions of the various rooms are marked. The location of the
machine room, control panel, source storage, injection room, fume hood,
sink, active toilet, patient waiting room, examination room, radioactive
waste storage, isolation ward and nurses station etc. are indicated in the
sketch. GM counter survey is carried out at the above locations and are
recorded in cpm. In addition, ion chamber survey are also carried out in
the above locations and recorded in mR/hr. This will identify the areas of
high exposure rates especially from radioactive waste and waste storage
rooms.
Swipe Test
Swipe tests are performed by using small pieces of filter paper or cotton at
various locations of the nuclear medicine laboratory. Later, these swipes
are counted under the NaI (Tl) gamma well counter. Areas that are having
twice the background levels are said to be contaminated. Effective
decontamination methods are employed to bring back the areas to normal
level. Additional swipe tests are performed to confirm the decontamination.
Personnel hands, shoes and clothing should be monitored for contamination
by the contamination monitor. The accepted level of contamination limits
are 0.01 ci per 100 sq.cm, for Tc-99m and 0.0001 Ci per 100 Sq.cm for I-
131 respectively.
Radionuclide Therapy
I-131 is commonly used for the treatment of thyroid cancer and
hyperthyroidism. Once the patient is administered with I-131, it is excreted
in all the body fluids including urine, saliva and perspiration. Hence,
exposure rates at 1 m from the patient, bedside, doors and in the adjacent
rooms should be measured with ion chamber type surveymeter. The 111
measured levels are posted at the adjacent rooms with suitable instructions
to the nursing staff and visitors. The exposure rate measurements are
repeated daily, until it comes down to 1.2 GBq (33 mCi) at 1m from the
patient. After the patient is discharged, the room is decontaminated,
followed by GM counter radiation survey for contamination purpose.
Spillage
Accidents may happen in nuclear medicine due to radioactive spill, which
may be minor or major spill. A minor spill is one in which the activity is
less than a mCi. If it is more than a mCi then it is called major spill and the
Radiation safety officer (RSO) should be informed. He has to investigate
and advise corrective measures. As a first step spills should be contained
with absorbent material. The area is isolated and posted with warning
signal. Decontamination should be carried out from the perimeter of the
spill toward the center to spread the contamination. Decontamination is
usually done by absorbing the spill and cleaning the areas with detergent
and water. A swipe test and GM survey should follow to ensure
decontamination. The protective clothing of the personnel involved in the
decontamination procedure should also be surveyed with GM counter. If
the spill involves volatile radionuclides, then it may lead to internal
contamination, warranting bioassays. In the bioassay the personnels
thyroid is subjected for external counting with a NaI (Tl) detector for
radioiodine. This is followed by radioactivity measurement of urine.
RADIATION SURVEY IN RADIOTHERAPY

Setting up a Radiotherapy facility involves three major steps namely
installation, acceptance testing and commissioning. The vendor does the
installation part, while the hospital physicists take care of the acceptance
testing and commissioning. After the installation, the medical physicists
should carry out radiation protection survey of the installation. The survey
will ensure that the exposure levels outside the room will not exceed the
permissible limits, considering the dose rate, machine on time, use factors,
and occupancy factors for the adjacent areas. A good survey program
includes checking the equipment specification, calibration of the machine,
measurement of head leakage, area survey, testing of interlocks, warning
lights, and emergency switches. The survey should duplicate the conditions
that are expected during the patient treatment in terms of work load, use
factor and occupancy factor.
Radiotherapy uses three category of equipments namely (i) linear
accelerator, (ii) Tele-Cobalt unit and (iii) Brachytherapy systems/sources.
Hence, specific radiation survey procedure is essential for each one. The
following radiation survey meters and items are made available for a
112 successful survey program.
1. Pressurized Ion chamber survey meter

2. GM type Contamination monitor
3. Neutron survey meter (BF3)
4. Radiographic film
5. Water phantom.
Linear Accelerator
Source ON Position Leakage

The gantry of the linear accelerator unit is placed at 180. Choose 20
measurement points located on the surface of a sphere of radius 2 m from
the source. Consider 2 points on the poles of the sphere, 4 equally spaced
points on its equator and distribute the remaining points uniformly on the
surface of the sphere. Now, the collimator is closed completely and it is
covered with 2 TVL of lead shielding (Fig. 5.8). The ion chamber is
positioned at any one of the location point at 2 m from the source. The
CCTV camera is positioned, to cover the ion chamber location. This will
enable us to read the ion chamber through the TV monitor. The machine is
switched ON and the ion chamber reading is noted. The ion chamber
position is changed to different location points around the head at the same
2 m distance from the source. The readings in exposure rates (mR/h) are
noted for all the 20 locations individually. The tolerance limit is 0.2 % of the
useful beam dose rate at the treatment distance.
Fig. 5.8: Linear accelerator, radiation survey leakage

measurements in mR/h at 2m, for source ON condition
Area Survey
The sketch of the linear accelerator installation is drawn on a paper. The
occupancy around the installations, controlled area and uncontrolled areas 113
are marked in the drawing. Mark number of locations in the drawing, in

which the exposure rate is to be measured. These locations may includes
control panel, door all four sides, above ceiling, below floor and patient
weighting area etc. The linac machine is set at 100 cm (SSD), with maximum
field size (40 cm 40 cm). The gantry is kept at 0 degree position. A water
phantom (30 cm 30 cm 30 cm) is kept in the couch to create maximum
scatter condition. Now the unit is switched ON and the exposure rate is
measured in the above locations by using a wide range ion chamber survey
meter. It is repeated to complete the measurements in all the locations. Similarly,
the exposure rate measurements are repeated for different gantry positions of
90,180 and 270 degree. The readings are tabulated as shown below (Table 5.4):
Table 5.4: Measured exposure rates in mR/h at different locations

Survey meter: Wide range ion chamber
Make: ..........................................................
Model: .......................................................... Date: ..................................
Gantry A B C D E F G H I
position
0
90
180
270
Cobalt-Teletherapy Machine Survey

In the case of Cobalt-teletherapy machine radiation survey, the head leakage
for both source OFF and source ON conditions and area survey of the
installation are the essential procedures to be carried out.
Head Leakage-source OFF Condition

The gantry of the teletherapy unit is placed at 90 or 270 degree and the
machine is switched off. Measure the exposure rate (mR/h) at 5 cm from
the surface of the source head, at eight different positions around the gantry
as shown in the Fig. 5.9. A wide range ion chamber may be used for the
measurement. The tolerance limit is < 20 mR/h, when the unit is loaded
with maximum capacity source.
Similarly, the exposure rates (mR/h) are measured at 1m distance from
the source, for different locations (8) around the source. The tolerance limit
is < 2 mR/h on the average and 10 mR/h maximum in any direction, at a
distance of 1m from the source.
Head Leakage Source ON Position

The gantry of the machine is positioned at 180 degree and the collimator is
114
closed completely and it is covered with 2 TVL of lead shielding (Fig. 5.10).
Fig. 5.9: Cobalt teletherapy machine. Fig. 5.10: Cobalt teletherapy machine,
Radiation survey, leakage exposure Radiation Survey: Exposure rate
measurements in mR/h, for source measured in mR/h for source ON
OFF condition position
The ion chamber is positioned at 1m from the source around the head. The
CCTV camera is positioned, to cover the ion chamber location. This will
enable us to read the ion chamber through the TV monitor. The machine is
switched on and the ion chamber reading is noted. The ion chamber position
is changed to different locations around the head at the same 1m distance
from the source. The readings in exposure rates (mR/h) are noted for at
least 8 locations around the head. The tolerance limit is < 0.1 % of the useful
beam dose rate, measured at a distance of 1 m from the source.
Area Survey
The sketch of the teletherapy installation is drawn on a paper. The
occupancy around the installations, controlled area and uncontrolled areas
are marked in the drawing. Mark number of locations in the drawing, in
which the exposure rate is to be measured. These locations may includes
control panel, door, all four sides, above ceiling, below floor and patient
weighting area etc. The teletherapy machine is set at 80 cm (SSD), with
maximum field size. The gantry is kept at 0 degree position. A water
phantom (30 cm 30 cm 30 cm) is kept in the couch to create maximum
scatter condition. Now the unit is switched ON and the exposure rate is
measured by using a wide range ion chamber survey meter. It is repeated to
complete the measurements in all the locations. Similarly, the exposure rate
measurements are repeated for different gantry positions of 90, 180 and 270
degree. The readings are tabulated as shown in the case of linear accelerator.
Primary Barrier Adequacy

This survey will revel and ensure the shielding adequacy of the primary
barriers. The collimator is set for larger field size (35 cm x 35 cm) and the 115
gantry is kept at 90 degree. Now the beam is focused towards the primary
wall 1.The exposure rate behind the barrier is measured by using the ion
chamber survey meter. Then the gantry is set at 270 degree and the exposure
rate is measured behind the primary wall 2. Similarly, measurements are
made by focusing the beam towards ceiling and basement if any. The
measurements are recorded as follows (Table 5.5):
Table 5.5: Measured exposure rate in mR/h

Survey meter: Wide range ion chamber
Make: ..........................................................
Model: .......................................................... Date: ..................................
Measurement A B C D E F G H Mean
position
Primary wall 1
Primary wall 2
Above ceiling
Below floor
HDR Brachytherapy Survey

The high dose rate Brachytherapy equipment require radiation protection
survey measurements for both source OFF and ON condition. When the
source is in OFF condition, the leakage radiation levels in mR/h is measured
both at 5 cm from the surface of the treatment head and at 1 m from the
center of the treatment head at various positions as shown in the Fig. 5.11.
A wide range survey meter of ion chamber type can be used to perform
the measurements. The measured readings are tabulated as shown in the
Table 5.6.
116 Fig. 5.11: HDR Brachytherapy system: OFF position leakage measurements
Radiation survey measurements are also carried out when the source is
in ON condition. Various locations are selected in and around the HDR
installation and radiation levels are measured by using the above survey
meter, by simulating the HDR treatment with out patient. The readings are
tabulated as shown in Table 5.7.
CALIBRATION AND MAINTENANCE OF

RADIATION MONITORING INSTRUMENTS
Radiation monitoring instruments should be kept in good working
condition. They should be periodically checked to confirm that reliable
readings are indicated. They should also be checked after any servicing or
repairs. The simplest method of checking the instrument performance is to
use the instrument just after it has been calibrated by the manufacturer
and to record for future reference, the exposure rate at a specific distance
from a radiation source of known strength. Performance check can then be
made at any time, by comparison of the recorded reading with the check
reading made at the same distance from the radiation source, after making
necessary corrections for radioactive decay of the radiation source. If the
check reading after corrections varies considerably, the instrument should
be got serviced and recalibrated by the manufacturer. In addition, the
operational and handling instructions should be scrupulously observed to
ensure prolonged and trouble free performance of the instrument.
Table 5.6: Radiation levels at 5 cm and 1 m during source OFF condition

Survey meter: ............................................ Date: ..................................
Make: ............................................ Activity: ...........................
Model: ..................................
Positions 5 cm from the source Positions 1 m from the centre of the
housing, mSv/hr source housing, Sv/hr
1 13
. .
. .
. .
12 16
Table 5.7: Radiation levels during source ON condition

Survey meter: ............................................ Date: ..................................
Make: ............................................ Activity: ...........................
Model: ..................................
Position Radiation levels, Sv/hr
1
.
.
10 117
BIBLIOGRAPHY
1. Instructions to High dose rate Brachytherapy users: Nucletron India (P) Ltd,
Chennai.
imaging, (2nd edn.) Lippincott Williams & Wilkins 2002.
3. Khan FM. The Physics of Radiation therapy, (3rd edn.). Lippincott Williams &
Wilkins 2003.
4. Ramesh C. Nuclear medicine physics, (5th edn.). Lippincott Williams & Wilkins
2004.
5. Thayalan K. Basic radiological physics, Jaypee bothers medical publishers P
Ltd, New Delhi 2001.
118
Chapter
6 Quality Assurance
INTRODUCTION
The term quality assurance (QA) describes a program that is designed to
control and maintain the standard of quality set for that program. In medical
use of radiation, QA is essentially a set of policies and procedures to maintain
the quality of patient care. This is policies only by proper evaluation of the
radiological equipment. The general criteria of standard of quality is set by
the profession collectively. It is designed specifically for an institution to
meet those standards. Professional organizations like American College of
Radiology (ACR), and the American Association of Physicists in Medicine
(AAPM) have recommended QA programs for Radiological practice.
The objective of quality assurance program is a systematic monitoring of
the quality and appropriateness of patient care. The QA should be organized
as a program which includes the staff training, equipment and facility. The
implementation of QA involve administrative, clinical, physical and technical
aspects and hence, team work is essential for achieving good quality.
The QA programs are developed for a specific application and the
following paragraphs will explain the QA procedures related to (i) Diagnostic
radiology, (ii) Nuclear medicine, and (iii) Radiotherapy.
QUALITY ASSURANCE FOR DIAGNOSTIC RADIOLOGY

The goal of QA in diagnostic radiology is to obtain optimal image with
minimum radiation dose and at minimum cost. To achieve the above goal,
systematic QA programs are to be developed and implemented in all
diagnostic X-ray facilities. This will enable us to monitor periodically the
performance of the X-ray unit.
A Radiological image may be good to look, due to proper density and
positioning. If it do not reveal anatomic details, then its image quality is
not assured. The radiologists may not be able to extract diagnostic
information from the radiograph, which may leads to repeat examination
(retake). Retakes result in unnecessary radiation dose to patients, staff and
public, increase the workload and cost. The parameters which affects the
image quality are applied tube voltage (kVp), tube current (mA), time of
exposure (s), focal spot size, contact between film and screen, beam
alignment, congruence of optical and radiation fields and Focus to film
distance (FFD), film processing conditions and viewing conditions etc.
The quality assurance (QA) program begins with performance evaluation

tests of the X-ray unit at the manufacturing site, followed by acceptance
tests after the installation is completed. Then QA tests are carried out at
regular intervals and also after every major repair. The reasons to test the
imaging equipment are to observe the equipment performance at installation
in order to determine that it is working properly, to determine that it is
currently working as well as it did at the time of installation, or to determine
that repairs or modifications have improved recent improper performance.
Every QA program involves the following steps that includes (i)
performing the QA tests, (ii) record the results, (iii) analyze the result, (iv)
take corrective and preventive measures, and (v) repeat the QA again. In
general the mechanical characteristics, the control panel display/indicators
and the tube housing details are checked initially and it is followed by the
set of tests listed below.
QUALITY ASSURANCE FOR RADIOGRAPHY UNITS

1. Congruence of Radiation and optical fields
2. Central beam alignment
3. Focal spot size
4. Tube voltage (kVp)
5. Timer check
6. Total filtration
7. Linearity of mA loading stations
8. Timer linearity
9. Out put consistency
The various tests, their frequency and the tools required for each test are
summarized in the Table 6.1.
Table 6.1: QA tests, their frequency and tools required
Test Frequency Test tool
kVp Once in 3 years KVp meter
Timer Once in 3 months Spinning top /KVp/ timer meter
and dose measuring meter
Out put, mR/mAs Monthly Dose measuring meter
Inherent filtration Once in 3 months Dose measuring meter and
aluminium absorbers
Focal spot size Once in a year Focal spot test tool with non-
screen film cassette
Central beam alignment Once in 2 months Beam alignment test tool with
screen film cassette
Congruence of radiation Once in 2 months Collimator test tool, with
and optical field Annually and whenever screen film cassette
Grid alignment film density appears Grid alignment test tool
120 nonuniform
Quality Assurance
Congruence of Radiation and Optical Fields

The optical field in the X-ray equipment is used for defining the radiation
field and to limit the same only to the area of clinical interest on the patient.
If the optical field and radiation field are not congruent, the area of clinical
interest may be missed in the radiograph leading to retake and unnecessary
radiation dose to patients.
The collimator test-tool is used for testing the congruence of optical and
radiation fields. This test tool consists of a fibre glass board of size 24 cm x
27 cm with a rectangular area 20 cm x 16 cm marked on it by coating of
X-ray opaque material. This rectangular area is divided into four equal
segments by two graduated perpendicular bisectors. Two concentric circles
of radii 4 mm and 8 mm are engraved in the centre, which enable the use of
this test-tool in conjunction with the beam alignment test-tool.
Procedure
The table is kept horizontal with the help of a spirit level. A screen type
cassette, loaded with a medium speed X-ray film is placed on the table.
The collimator test-tool is kept above a screen type cassette. Focus-to-film
distance (FFD) is kept as 100 cm, to obtain the shift of fields directly in
terms of percentage of FFD. The light field is adjusted to coincide with the
rectangular area marked on the test-tool. The film is then exposed under
suitable kV and mAs (Fig. 6.1A) and developed.
From the radiograph, the shifts (X, X, Y, Y) between the edges of optical
and radiation fields are measured (Fig. 6.1B). It should be within 2% of FFD.
The difference in the dimensions of the optical and radiation fields
(A) (B)
Figs 6.1A and B: (A) Setting of the Beam alignment and Collimator test tool,
121
(B) Congruence of radiation and optical fields
(X+X,Y+Y) are also recorded. It should be within 3% of FFD. The difference

between the sums of the length and width of optical and radiation fields
are also computed. The tolerance should not exceed 4% of FFD.
Central Beam Alignment

If the X-ray beam is not perpendicular to the image receptor, the image
may be distorted. This may result in loss of minute details. If grid is used,
the distortion will be magnified resulting in total loss of minute details.
The beam alignment can be tested using a beam alignment test tool.
The test tool consists of a clear transparent acrylic cylinder of inner
diameter 6.3 cm, outer diameter 7.5 cm and length 15.2 cm. Acrylic circular
discs, each of 6 mm thickness are fastened on both sides of the cylinder.
Stainless steel balls of diameter 1.6 mm are co-axially fixed at the centre of
both these discs.
Beam alignment test is usually carried out along with the test for
congruence of optical and radiation field. To do this, the procedure for the
congruence of optical and radiation field is repeated. The beam alignment
test tool is kept on the collimator test-tool such a way that the stainless
steel ball of the lower side of the tool is just above the center of the collimator
test-tool. The film is exposed and processed.
If the beam alignment is perfect, the image of the top ball will merge
with the image of the ball at bottom. The deviation of beam from the
perpendicular is determined from the location of the image of the top steel
ball in the circles in the radiograph. If the images of the two steel balls
overlap, the central ray of the beam is within 0.5 (Fig. 6.2). If the image of
the top ball falls within the image of the inner circle, the central ray lies
within 1.5 0 from the perpendicular. If it falls between the images of inner
and outer circles, the central ray is within 1.50 to 30 from the perpendicular.
Tolerance for the beam alignment is 1.50.
(A) (B) (C)

Figs 6.2A to C: Interpretation of the image of the two steel
balls in the beam alignment test tool
Focal Spot Size
122 The ability for resolving the smallest size of the image (i.e. detail) in a
radiograph depends on the focal spot size. Since, the focal spot size may be
Quality Assurance
altered as a result of bombardment of electrons on the target, it has to

be checked periodically to ensure that focal spot size is within acceptable
limits.
Focal spot size is evaluated using the focal spot test tool based on the
principle of minimum resolution. Bar/hole test pattern is employed for
evaluating focal spot by minimum resolution. At minimum resolution, the
edge gradient (penumbra) of one pattern of the pair overlaps with the image
of other and the images of both the patterns of the pair cannot be resolved
separately. In this condition, the focal spot size (f) is related with line width
and magnification (M) as follows:
M
f= line width
( M 1)
The test-tool consists an acrylic hollow cylinder of about 6.0 cm
diameter and 15 cm height. An acrylic circular disc is fastened on one
end of the cylinder. Bar patterns engraved on tungsten plate is mounted
on this circular disc. The bar test pattern consists of 12 groups of lines
(slits) of sizes gradually reducing in dimensions. Each group consists of
six lines arranged such that a subgroup of three parallel lines is
perpendicular to the other sub-group. The sizes and spacing of the slits in
these groups decreases by steps of 16% from 0.84 line pair/ mm to 5.6 line
pair /mm.
The focal spot size values quoted in the reference Table 6.2, are computed
for a magnification of 4/3. This magnification is effected by maintaining
the focus to film distance as 60 cm so that the test tool kept on the image
receptor will have test pattern at 45 cm from the focus (60 cm -15 cm, which
is the length of test-tool). Magnification is calculated as the ratio between
focus-to-film distance and focus to object distance (60/45 = 4/3).
Table 6.2: Effective focal spot size, for a magnification of 4/3

Smallest group lp/mm Effective focal
resolved spot size (mm)
1 0.84 4.3
2 1.00 3.7
3 1.19 3.1
4 1.14 2.6
5 1.68 2.2
6 2.00 1.8
7 2.38 1.5
8 2.83 1.3
9 3.36 1.1
10 4.00 0.9
11 4.76 0.8
12 5.66 0.7
123
Fig. 6.3: Bar test pattern for testing focal spot size and its image
To carry out the test, the focal spot test tool is placed on a nonscreen
cassette loaded with film. The FFD is kept at 60 cm (Fig. 6.3). Nonscreen
technique is necessary to avoid blurring of images of test-pattern. The tool
is placed over the cassette so that the vertical patterns are within the anode
to cathode direction. The film is exposed and processed. The bar pattern
on the radiograph is observed and the smallest group in which all six bars
(both vertical and horizontal) are clearly resolved is identified. Minimum
resolvable line pair size and the corresponding focal spot size can be
obtained from the Table 6.2. The vertical and horizontal groups give vertical
and horizontal dimensions of the focal spot.
Tube Voltage
The applied kilovoltage (kVp) affects the quality and quantity of X-rays
reaching the image receptor. This in turn influences the contrast and density
of the radiograph. If there is a variation in the the kVp setting, it will affect
the image quality. Hence it is necessary to check the kVp settings
periodically. This can be done using a kVp meter.
The kVp meter, employs two solid-state detectors with different beam
hardening filters. When exposed to radiation, the ratio of the signals
produced by these detectors will be proportional to the peak tube voltage.
A ratio circuit with analog digital circuit (ADC) or a micro processor
software system displays the peak kilovoltage, digitally corresponding to
a particular ratio of either analog or digital signals. This method is
instantaneous and direct reading. Corrections for beam filtration should
124 be applied if necessary.
Quality Assurance
The beam centered on the marked area on the top cover of the kVp meter.
Proper distance is selected between the focus and the meter. Then it is
exposed for a given kVp, mA and time settings. The kVp meter reading is
noted. Similar measurements are taken for different kVp settings. The
variation between the set kVp and the measured kVp is found. The tolerance
is 5kVp.
Timer Checking
If the exposure time set on the diagnostic X-ray unit is not optimal, the
radiograph can be under exposed or over exposed. This may leads to repeat
examinations. Hence, there is a need to test the timer of the X-ray unit
periodically.
Manual spinning top (for single phase half wave and full wave rectified
systems only) and motorized synchronous tops (for single phase three phase
and high frequency systems) can be used to test the accuracy of the timer.
Spinning top consists of a rotating circular brass plate with a small
rectangular portion cut (hole) at its periphery (Fig. 6.4). Since, the rectangular
cut portion is moving with the brass plate, the film receives exposure only
when x-ray pulses are produced. Production of X-ray pulses depends upon
the rectification of the x-ray unit. A single phase half wave rectified system
produces 50 pulses/s and therefore 50 X-ray pulses are generated per
second. The time taken for one pulse is 0.02 s (1s/50). If it is a single phase
full-wave rectified unit, it will produce 100 X-ray pulses per second and
the time taken for each pulse is 0.01 s. Hence, for a set time of 0.5 s the half
wave and full wave rectified unit emits 25 and 50 pulses respectively.
Fig.6.4: Spinning top test-tool
To check the timer, the spinning top is placed on a cassette, loaded with
film. For a set time, the unit is energized, while the top is rotating. The 125
experiment is repeated to cover the entire range of the timer. The pulses
passing through the hole of the circular plate, produces equally spaced
rectangular density patterns, on the film. The spacing between the patterns
depends upon the speed of rotation of the spinning top.
Number of density patterns on the film
Time =
pulse frequency
In the case of three phase and high frequency units, synchronous spinning
tops are used. These units produce density patterns, which may appear as
an arc of continuous trace of density. In such cases, the angle subtended by
the arc at the center of the image of the circular plate is measured with a
protractor. The exposure time is calculated as the ratio of angle subtended
by the arc to the total angle (360). The speed of rotation (typically one
rotation per second) of the disc is suitably selected. Now a days, meters
incorporating solid state detectors are available for the measurement of
exposure time.
Total Filtration
All diagnostic X-ray units must have fitted with a minimum thickness of
filter, to cut off low energy components from X-ray beam. The low energy
X-rays do not contribute to the image formation, but gives unnecessary
patient exposure. If the filtration is too high, image contrast will be reduced.
Therefore, the total filtration provided for the X-ray tube shall be optimum
for patient safety and image quality. For this purpose regulatory bodies
recommend total filtration requirement for X-ray machines for different
maximum rated tube potentials. Atomic Energy Regulatory Board
recommends the total filtration requirements of X-ray diagnostic equipment
as follows:
Maximum rated tube potential (kVp) Minimum total filtration (mm Al)
Less than 70 1.5
70 to and including 100 2.0
Above 100 2.5
Total filtration includes the inherent filtration and the added filtration.
Hence, total filtration evaluation is necessary to verify whether the added
filtration is adequate or not. Total filtration of the X-ray tube is evaluated
by determining the half value thickness of the beam, by using a pocket
dosimeter. The HVT is measured for the maximum operating potential of
the tube.
The pocket dosimeter is kept at the centre of radiation field of area 20
cm 20 cm at a distance of 100 cm from the target. For a given kVp and
mAs the dosimeter is exposed and the reading is noted. The measurement
126 is repeated and the average is obtained. An aluminum filter of 0.5 mm is
Quality Assurance
interposed (at the collimator level) and the measurements are repeated.
Similar measurements are repeated for aluminum filters of thickness 1, 1.5,
2, 3, 4 and 5 mm.
Transmission curve of the X-ray beam can be plotted on a graph between
the absorber thickness and measured dosimeter readings. The absorber
thickness for 50 % transmission will be the half value thickness of the X-ray
beam. Total aluminum filtration could be determined from HVT using
calibration Tables 6.3 and 6.4.
Table 6.3: HVT as a function of filtration and tube potential

(Single phase generators)
Total Peak potential (kVp)
filtration 30 40 50 60 70 80 90 100 110 120
(mm Al) Half value thickness (mm Al)
0.5 0.36 0.47 0.58 0.67 0.76 0.84 0.92 1.00 1.08 1.16
1.0 0.55 0.78 0.95 1.08 1.21 1.33 1.46 1.58 1.70 1.82
1.5 0.78 1.04 1.25 1.42 1.59 1.75 1.90 2.08 2.25 2.42
2.0 0.92 1.22 1.49 1.70 1.90 2.10 2.28 2.48 2.70 2.90
2.5 1.02 1.38 1.69 1.95 2.16 2.37 2.58 2.82 3.06 3.30
3.0 1.49 1.87 2.16 2.40 2.62 2.86 3.12 3.38 3.65
3.5 1.58 2.00 2.34 2.60 2.86 3.12 3.40 3.68 3.95
Table 6.4: HVT as a function of filtration and tube

potential (three phase generators)
Total Peak potential (kVp)
filtration 60 70 80 90 100 110 120 130 140
(mm Al) HVT ( mm Al)
2.5 2.2 2.4 2.7 3.1 3.3 3.6 4.0
3.0 2.3 2.6 3.0 3.3 3.6 4.0 4.3 4.6 5.0
3.5 2.6 2.9 3.2 3.6 3.9 4.3 4.6
Linearity of mA Station
The linearity of mA can be tested by measuring the radiation output of the
machine. A pocket dosimeter and charger is used to measure the radiation
output.
The charged pocket dosimeter is kept at the centre of the radiation field
of area 20 cm 20 cm at a distance of 100 cm from the focus. For a fixed
kVp and time an available mA station is selected. The tube is energized
and the dosimeter reading is noted. The measurements are repeated 5 times,
to eliminate statistical variations. Similar measurements are made by
keeping the kVp and time constant, for other mA stations. For each
measurement X (mR / mAs) is calculated.
127
X max X min
The coefficient of linearity =
X max + X min
The coefficient of linearity is evaluated, which should not exceed 0.1.
Linearity of Timer
To test the linearity of timer, the pocket dosimeter is used. The charged
pocket dosimeter is kept at the centre of the radiation field size of 20 cm
20 cm, at a distance of 100 cm from the focus. The dosimeter is exposed to
50 kV, 200 mA and 0.5 s. The dosimeter reading is noted and the
measurements are repeated 5 times. Similar measurements are made for 1s
and 1.5 s, by keeping the kVp and mA constant. For each measurement
The average and the X (mR / mAs) is calculated.
X max X min
The coefficient of linearity =
X max + X min
Coefficient of linearity should not exceed 0.1.
Output Consistency
To test the out put consistency, the pocket dosimeter is used. The charged
pocket dosimeter is kept at the centre of field size 20 cm 20 cm at a distance
of 100 cm from the focus. For a fixed mA and time an available kVp station
(say 70) is selected and the tube is energized. The dosimeter reading is
noted and the measurements are repeated 5 times. Similar measurements
are made for three more kVp, by keeping mA and time constant. For each
kVp the average dosimeter reading and the X (mR / mAs) is calculated.
The consistency at each kVp station is checked by evaluating the coefficient
of variation.
1
1 ( X X ) 2
2
Coefficient of variation (COV) = i

X ( n 1)

Coefficient of variation should not exceed 0.05.
Tube Housing Leakage

The radiation leakage measurement is carried with an ionization radiation
survey meter. For checking the leakage radiation, the collimator of the tube
housing is fully closed and the tube is energized at maximum rated tube
potential and current at that kVp. The operating time should be greater
128
Quality Assurance
than the time constant of the survey meter. The exposure rate at one meter
from the target is measured at different locations (anode side, cathode side,
front back and top) from the tube housing and collimator. From the
maximum leakage rate (X, mR/h) for both tube housing and collimator,
leakage in 1 hour is computed by assuming workload as 180 mAmin in 1
hour. The maximum radiation leakage at 1 m from the focus, for work load
of 180 mAmin in 1 hour is calculated as follows:
Maximum leakage = (X mR/hr 180 mA.min in one hour) / ( 60 min
Applied mA)
The tolerance limit of leakage radiation at 1 m from the focus is < 115
mR in one hour.
Quality Assurance Test Format
1. Congruence of radiation and optical fields

2. Central beam alignment.
Operating parameters: focus to film distance: 100 cm, kV : 50kV,
mAs : 20 (mA = , s = )
a. Shift in the edges of the radiation field
X = .......... cm % of TFD
X = ........ cm % of TFD
Y = .......... cm % of TFD
Y = .......... cm % of TFD
Tolerance : 2 % of TFD
b. Difference in the dimensions of the radiation and optical fields
X + X = .......... cm % of TFD
Y + Y = .......... cm % of TFD
c. Difference between sums of lengths and widths of optical and
radiation fields
X + X + Y + Y = .......... cm % of TFD
d. Observe the images of the two steel balls on the radiograph and
evaluate tilt in the central beam.
The tilt in the central beam is
Tolerance: Tilt < 1.50
129
3. Focal spot size

Operating parameters: Distance: 60 cm, kVp:70, mAs:40-50 (mA= 40-50,
s = 1.6)
(nonscreen film technique)
Large focus size: Stated - mm --mm
Measured--mm mm
Small focus size: Stated - mm mm
Measured --mm -mm
Tolerance: (i) + 0.5 f for f < 0.8 mm
(ii) + 0.4 f for 0.8 f 1.5 mm
(iii) + 0.3 f for f > 1.5 mm
4. Tube voltage
Operating parameters: Distance: 40 50 cm
Applied kVp Measured kVp
60 kVp, (40 mAs)

80 kV, (25 mAs)
100 kV, (20 mAs)
120 kV,(15 mAs)
Tolerance : 5 kV
5. Timer checking
Operating parameters:Distance: 100 cm, kVp: 70, mAs: 40 - 80
Applied time: (i) 0.4 s and (ii) 0.8 s
Number of slit patterns on developed film:
for (i), time = sec.
for (ii), time = sec.
Arc measured :
for (i), time = sec
for (ii), time = sec
Tolerance : 10 % of the set time
130
Quality Assurance
6. Total filtration
Operating parameters: Focus to detector distance: 100 cm
kVp : 100, mAs : 20 (mA : 100 , Time : 0.2 s)
Added filter Output Percentage
(mm Al ) 1 2 Average transmission
0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
Total filtration = mm of Al.

Tolerance : 1.5 mm Al for kVp 70
2.0 mm Al for kVp 100
2.5 mm Al for kVp > 100
7. Linearity of mA loading station
Operating parameters : Distance : 100 cm, kVp : 60, Time : 1.0 s.
mA range Output Average mR/mAs
1 2 3 4 5 (X)
100
200
300
X max X min
The coefficient of linearity = (COL)
X max + X min
Tolerance : < 0.1
8. Linearity of timer
Operating parameters: Distance : 100 cm, kVp : 50, mA : 200
Time Output Average mR/mAs
1 2 3 4 5 ( X)
0.5
1.0
1.5
X max X min
The coefficient of linearity (COL) =
X max + X min 131
Tolerance : COL < 0.1
9. Output consistency
Operating parameters: Distance : 100 cm
Applied mAs Output (mR) Average mR/mAs
kV (X)
1 2 3 4 5
70
80
100
120
1
( X i X )2 2

n 1
Coefficient of variation (COV) =
X
COV = for 70 kVp, for -80 kVp,
for -100 kVp, for 120 kVp
Tolerance : COV < 0.05
Operating parameters:
Applied voltage: kVp, mAs : ( mA, 1.5 s)
(Maximum) (minimum)
Back
X-ray tube
Left Right
Collimator
Front
Location Exposure level (mR/h)

(at 1.0 m Left Right Front Back Top
from the focus)
Tube
Collimator
Work load = 180 mA min in one hour
(X mR / hr 180 mA min in one hour)
Maximum leakage =
(60 min Applied mA)
The tolerance limit of leakage radiation at 1 m from the focus is < 115
132
mR in one hour.
Quality Assurance
QA FOR MAMMOGRAPHY X-RAY UNIT

Mammography requires careful optimization of technique and equipment.
Even a small change in equipment performance, film processing,
patient setup, or film viewing conditions can decrease the sensitivity of
mammography. Hence, thorough performance testing is necessary to
determine the baseline values and to monitor with periodic quality control
testing.
The above mentioned tests for general radiography X-ray units can be
repeated for mammography also. In addition, the compression needs to be
calibrated and the Automatic exposure control device must be checked.
Mammography test phantom can be used to optimize the techniques. It
simulates the radiographic characteristics of compressed breast tissues, and
contains components that model breast disease and cancer in the phantom
image. It is composed of an acrylic block, a wax insert, and an acrylic disk
attched to the top of the phantom.It is intended to mimic the attenuation
characteristics of a standard breast of 4.2 cm compressed breast thickness
of 50 % adipose and 50 % glandular tissue composition. The wax insert
contains 6 cylindrical nylon fibers of decreasing diameter, 5 simulated
calcification groups (Al2O3) of decreasing size, and 5 low contrast disks, of
decreasing diameter and thickness, that simulates masses (Fig. 6.5).
Fig. 6.5: Mammography accreditation phantom composed of a wax insert containing

133
6 nylon fibers, 5 Aluminum oxide speck groups and 5 discs simulating masses
Identification of the smallest objects of each type that are visible in the
phantom image indicates system performance. As per the recommendation
at least 4 fibers, 3 calcification groups , and 3 masses must be clearly visible,
at an average glandular dose of less than 3 mGy. The optical density at the
centre of the phantom image must be at least 1.2.
QA FOR FLUOROSCOPY X-RAY UNIT
Table Top Exposure Rate

The maximum kVp and mA is selected in the machine. A pocket dosimeter
is kept on the table, below the centre of the image intensifier (II) tube field.
The unit is energized and the dosimeter reading is noted. Two more readings
are taken and average is found in R/min.
The tolerance is < 5.7 R/min.
Focus to Table Top Distance

The distance between the focus to table top is measured in cm. It should
not be less than 30 cm.
Low Contrast Sensitivity

The diameter of the smallest size of the hole, which is clearly seen on the
monitor is found. Tolerance limit: A hole of 1/8 diameter.
High Contrast Sensitivity

Wire mesh lines and bar strips are tested for resolution. The number of
mesh lines that are resolved is noted. The tolerance is 30 lines/inch. In the case
of bar strips, the resolved bar strips is noted. The tolerance is 1.5 lp/mm.
Image Intensifier Assembly Leakage

A given kVp, mA and exposure time is selected. The maximum radiation
leakage level at 5 cm from the surface of the image intensifier (II) assembly
is measured in mR/hr. Then the leakage level for 1 hour is calculated, for a
workload of 180 mAmin. The recommended limit for radiation leakage
levels at 5 cm from the surface of image intensifier (II) assembly is 100 mR
in 1 hour.
QUALITY ASSURANCE FOR COMPUTED TOMOGRAPHY
Mechanical Tests
Alignment of Table Gantry
The congruence between the gantry midline and table midline is checked
134 using plumb line. The tolerance should be with in 5 mm.
Quality Assurance
Scan Localization Light Accuracy

A non screen cassette loaded with film is used for this study. The kVp,
mAs and slice thickness is suitably selected. The alignment of the internal
laser light and the external laser light is checked. The tolerance should be
with in 2 mm.
Gantry Tilt
A non screen cassette loaded with film is used for this study. A particular
kVp and mAs is selected in the scanner. The gantry is tilted for a set value
and the corresponding tilt is measured. The difference between the set and
measured gantry tilt is found. The tolerance should be with in 3
Table Position /Increment

A non screen cassette loaded with film is used for this study. An initial
table position is chosen (arbitrary) and a given load is put on the couch.
The kVp, mAs and the slice thickness is selected. The table is set with
different increments from the reference position; say 1 cm, 2 cm, 3 cm,
4 cm, and 5 cm respectively. At the same time the couch increments are
measured correspondingly. The difference between the set couch position
and the measured is found. The tolerance should be with in 2 mm.
Collimator Test
Radiation Profile Width
A non screen cassette is used for this study. A given kVp and mAs are
selected. For a given slice thickness the density profile is recorded on the
film. This is repeated for different slice thicknesses. From the density profile,
the profile width, i.e., full wave half maximum (FWHM) is found for each
slice thickness. The tolerance should be within 1 mm.
Set slice thickness, mm Measured density width (FWHM)
X-ray Generator Tests

Measurement of Operating Potential
The kVp meter is used to do this study. A given mA station is selected on
the scanner. Now, a kVp is set on the scanner and the same is measured
with kVp meter. This is repeated for different kVp readings. Later, the mA
station is changed and the measurements are repeated and the results are
recorded as given below. The tolerance should be with in 2 kVp. 135
Set kVp mA station 1 mA station 2 mA station 3 mA station 4
Measurement of mA Linearity
Follow the procedure described for the basic radiography unit, previously.
The tolerance limit for coefficient of linearity is 0.05
Measurement of Timer Linearity

Output Consistency
Fix the mAs and slice thickness as constant and vary kVp and make
measurements with pocket dosimeter or remote control exposure meter.
Resolution
Low Contrast Resolution
A low contrast resolution test phantom is used for this study. A given kVp,
mAs and slice thickness is set on the scanner. The phantom exposed for a
given window width. The resolution is measured from the phantom in
mm and the percentage of contrast difference is calculated. The tolerance
is 5.0 mm at 1% contrast difference(minimum) and the expected is 2.5 mm
at 0.5 % contrast difference.
High Contrast Resolution

A high contrast resolution test phantom is used for this study. A given
kVp, mAs and slice thickness is set on the scanner. The phantom exposed
for a given window width, using a high resolution algorithm. The size of
the smallest resolvable bar /hole pattern is found in mm or lp/cm and the
percentage of contrast difference is calculated. The tolerance is 1.6 mm or
3.12 lp/cm at 10% contrast difference and the expected high contrast
resolution is 0.8 mm or 6.25 lp/cm.
Radiation Dose Tests

Measurement of Computed Tomography Dose Index (CTDI)
A pencil type ionization chamber with suitable electrometer is used in
136 conjunction with a head/body CT phantom. The phantom is positioned in
Quality Assurance
the couch and the ionization chamber is inserted in it. The kVp is set as 80
for a mAs of 100. For a given slice thickness the axial dose and peripheral
dose is measured in mGy, then mGy / mAs is arrived. Then, the kVp is
changed to 100, and 140 with same mAs and slice thickness and the
measurements are repeated. This procedure is completed both for head
and body phantoms. The mean of the peripheral dose is found for both
head and body phantoms. Then the axial CTDI and the mean peripheral
CTDI is found. From the above the weighted CTDI is calculated .The
tolerance is 20 % of the quoted value (expected) and the minimum is 40
% of the quoted value.
Measurement Head phantom Body phantom
Axial dose, (mGy/mAs)

Peripheraldose, (mGy/mAs)
(i)
(ii)
(iii)
(iv)
Mean peripheral dose
CTDTC
CTDIP
Weighted CTDI, (CTDIW)= 1/3 (CTDTC) +2/3 (CTDIP) = mGy/mAs.
Tube Housing Leakage

Repeat the procedure followed previously for general radiography X-ray
units.
QUALITY ASSURANCE FOR NUCLEAR MEDICINE

Quality assurance in Nuclear medicine is essential to ensure that the
equipment is always performing to its specifications. The type of QA
program and acceptance testing guidelines vary with type of equipment
and country. However, the Joint Commission on the Accreditation of Health
care Organizations (JCAHO), US and the National Electrical Manufacturers
Association (NEMA) guidelines form the basis for most of the QA tests.
A typical QA program involve daily measurements of flood-field
uniformity, weekly checks of spatial resolution and spatial linearity, and
semi annual checks of other performance parameters. All the measurements
must be taken under the same conditions (pulse height window width,
correction algorithm, and correction circuitry on or off), similar to that of
clinical studies. 137
QA FOR GAMMA CAMERA
Intrinsic Resolution
The intrinsic resolution is determined with out a collimator using a linearity
test pattern. The test pattern with strip width of 1 mm is placed on the
surface of the NaI (Tl) crystal housing. A point source Tc-99m is placed at
distance equal to 5 UFOV from the camera face. The UFOV is the field of
view of the gamma camera after masking off the portion of the camera face
affected by edge packing effects. Data are collected, until the peak channel
records at least 1000 counts. The count rate should be < 30,000 cps to avoid
pile up related mispositioning. Two sets image are taken and recorded, by
rotating the text pattern to 90 degree. This will enable to record X and Y
resolution. Profiles through the images of the line sources are taken at
different locations across the gamma camera face and fitted to a Gaussian
function. The FWHM and FWTM (Full width tenth maximum) of the profiles
are measured in both X and Y directions. The typical values of intrinsic
spatial resolution are 2.5 to 3.5 mm.
System Resolution
This measurement is made with collimator and should be repeated for each
collimator. The source consists of two 1 mm diameter line sources, placed 5
cm apart at a distance of 10 cm from the front face of the collimator. To account
scattering, a 10 cm plastic is placed between the sources and collimator and
the measurement is taken. Again it is repeated with 5 cm plastic, placed
behind the sources. Images are acquired and profiles taken through the
image of the line sources are fitted to Gaussian functions, to determine the
FWHM and FWTM. The typical resolution is 8-14 mm for Tc-99m.
Spatial Linearity
Spatial linearity describes lack of spatial distortion. It is a measure of the
cameras ability to portray the shapes of objects accurately. This require the
slit pattern, line source, and conditions, used for intrinsic resolution. The
measurements are taken with two orientations of the test pattern, rotated
to 90 degree. This will provide linearity measurements for both X and Y
directions. Two more measurements are made from the resulting images.
The differential spatial linearity is the deviation of the measured distance
between two slits from the actual distance. The maximum deviation of the
location of the slits from their true location will give the absolute spatial
linearity. Once again it is done for UFOV and CFOV conditions.
Uniformity
This is studied from flood-field images acquired without collimator. A Tc-
138 99m source is placed at a distance of 5 UFOV. The counting rate is, 30000
Quality Assurance
cps and there should be minimum of 4000 counts in each pixel of the image.
Then it smoothed with 9 point (3 3) smoothing filter with following
weightings:
1 2 1
2 4 2
1 2 1
From this the Integral uniformity and differential uniformity are arrived
as follows.
Max. count Min. count

Integral uniformity ( % ) =
Max. count + Min. count
This is calculated for both UFOV and CFOV. The typical tolerance value
is 2 4%
100 ( high -low )

The differential uniformity ( % ) =
( high + low )
where high refers the maximum count difference, low refers the
minimum count difference for any five consecutive pixels in the image.
Counting Rate Performance

Two Tc-99m sources are placed about 1.5 m away from the camera face.
The total activity is sufficient to cause 20% loss in the observed counting
rate, relative to true counting rate. Counting rates are measured with both
sources (R12) and with each individual sources, namely R1 and R2. All
measurements are taken in the same source geometry. The dead time (t)
and 20% count rate loss (R20) are calculated as follows:
2R 12 ( R 1 +R 2 )
t= ln
( R1 + R 2 ) R 12
0.8
R 20 % = ln 0.8
t
Energy Resolution
The energy resolution is measured with a flood illumination of the gamma
camera face, with out collimator. Tc-99m source is suspended at a distance
of 5 UFOV above the camera face. The resulting pulse height spectrum is
analyzed to determine the FWHM of the Tc-99m photo peak. It is usually
reported in keV or in % energy resolution based on the photo peak energy.
Typical values are 8% to 11% for Tc-99m.
139
System Sensitivity
It is to be measured for each collimator. The low energy collimator is tested
with Tc-99m, medium energy collimator is tested with In-111 and I-131 is
used for high energy collimator. A solution of the radionuclide is placed in
10 cm diameter dish to a depth of 2-3 mm. The source is placed at 10 cm
from the camera face. The sensitivity is calculated by drawing a circular
region of interest (ROI) around the image of the dish and integrating all
the counts in that region. A second image is recorded for an equal imaging
time with the source removed, to provide the background.
( counts in ROI background )
Sensitivity (cps / Bq ) =
time (s) source activity (Bq )
The typical sensitivity is on the order of 1-1.5 10-4 cps/Bq or 0.01% to
0.015 %.
QA FOR SINGLE PHOTON EMISSION

COMPUTED TOMOGRAPHY (SPECT)
Many of the above QA procedures described for gamma camera can also
be used for SPECT. However, there are some special requirements as follows:
i. Flood field uniformity
ii. System alignment.
In SPECT, non uniformities can lead to ring (single head system) and
arc (multi head system) artifacts. Hence, uniformities of 1% or better are
desirable for gamma camera detectors used as SPECT. To detect non
uniformities of this order at least 10,000 counts (Poisson statistics) are
required per image element. For example, an image matrix of 64 64, may
require about 41 million counts. It is also necessary to measure the
reconstructed image uniformity, which can be done similar to volume
sensitivity measurements. In this, an image of a uniform cylinder is
reconstructed with suitable attenuation and scatter corrections, by using
relevant reconstruction algorithms and filters. The correction tools should
not cause any artifacts.
The system alignment test verify the mechanical centre of rotation
coincidence with the centre of rotation (COR) defined for the projection
data (reconstruction). If it is not correct additional blurring or ring artifacts
may arise. In the case of multi headed systems, all the heads should be
accurately aligned in the axial direction. Otherwise this may enhance the
blurring and artifacts.
System alignment errors can be measured by recording profiles from
different projection angles (0, 90, 180 and 270 degrees) for a point source
placed off center in the FOV of the SPECT system. A typical protocol
involves N number of projection profiles at equal angle intervals over 360.
140 For each projection the centroid (rcen, zcen) of the image of the point source
Quality Assurance
on the gamma camera face is determined. Where r and z are the radial and
axial coordinate respectively. The average COR error and the Axial
deviation error are given as follows:
N
1
Errcor = rcen
N
n =1
1 N
ErrAX = z z cen
N n =1
where zcen is the point spread function (PSF) centroid in the z direction
and z is the mean value of zcen.
QUALITY ASSURANCE FOR PET-CT

Performance evaluation for Positron emission tomography (PET)
[National electrical measurements association (NEMA) NU2-2001 (N-01)]
protocol)
Spatial Resolution
It represents the ability of the system to distinguish between two points of
radioactivity in an image. In discrete element systems, smaller detector
elements with higher stopping power for 511 keV have the best potential
for providing high spatial resolution. In NEMA-01 protocol, it is measured
by imaging three 18F point source(PS).
A solution of water and 18F with a concentration higher than 185 MBq/
cc is prepared. A drop of the solution was then used to produce three point
sources. Glass capillaries with an ID of 1 mm is used to contain the PS.
Using a source holder, the three glass capillaries containing the PS are
positioned in the the centre of the axial FOV of the scanner at: (i) x = 0 cm,
y = 1 cm; (ii) x = 0 cm, y = 10 cm; (iii) x = 10 cm, y = 0 cm. Once in place, the
three point sources are aligned (axially) in the scanner FOV using laser
lights. Two sets of EM measurements, consisting of 20 acquisitions axially
spaced at 0.5 mm are performed in 2D. The two sets of measurements are
centred at two axial positions in the scanner FOV: in the centre and at one-
quarter of the axial FOV (3.8 cm). Acquisition time for each single acquisition
was 1 min. The two sets of measurements are then repeated in 3D mode.
Image reconstruction of the PS is performed for both 2D and 3D data
(FOV 25 cm) and each of the three sources are visualized. Transverse spatial
resolution is calculated for each PS position as FWHM and FWTM of the
resulting point spread function, by interpolation between adjacent pixels
on the radial (vertical) and tangential (horizontal) profiles. An axial profile
is derived from the number of counts in each slice against the slice number
and axial resolution is measured as the FWHM and FWTM of such a profile.
Radial and tangential resolutions (FWHM and FWTM) for each radial
position (1 and 10 cm) are averaged over both axial positions. 141
Sensitivity
The sensitivity of a scanner represents its ability to detect annihilation
radiation. In the N-01 protocol, the absolute sensitivity of a scanner is
measured as the coincidence event rate per unit activity (cps/MBq) from
sufficiently low activity line source(LS) suspended within the scanner FOV
in the absence of attenuating media.
A solution of water and 18F with a concentration greater than 1.7 MBq/
cc is prepared. The LS is prepared by filling a polyethylene tube (ID 1 mm,
OD 3 mm) in the central 70 cm and activity is measured. The N-01 sensitivity
phantom consists of five concentric aluminium tubes, 700 mm long and
stacked one inside the other. The diameters of each tube are:
i. 1st tube: ID 3.9 mm, OD 6.4 mm
ii. 2nd tube: ID 7.0 mm, OD 9.5 mm
iii. 3rd tube: ID 10.2 mm, OD 12.7 mm
iv. 4th tube: ID 13.4 mm, OD 15.9 mm
v. 5th tube: ID 16.6 mm, OD 19.1 mm.
Using a phantom holder, the LS, inserted in the smallest aluminium tube,
is centred along the x, y and z axis of the scanner FOV. A set of five 2D EM
scans are acquired. In each subsequent scan (60 s each), an additional
aluminium tube is added around the LS, so that during the last scan, the LS
is surrounded by the 5 aluminium tubes. A second set of measurements
(five scans) are taken to estimate the sensitivity in 3D mode. The phantom
is then positioned at x=10 cm and y=0 cm with respect to the centre of the
scanner FOV and 2D and 3D measurements are carried out following the
same protocol as before (for x = 0 and y = 0).
Raw data sinograms are used in the analysis of sensitivity. The five scans
in each set of measurements are corrected for radioactive decay. The analysis
is first performed for each plane. Count rates Rj (j=1,5) are plotted versus
the sleeve thickness Xj. The count rate in the absence of attenuation (R0)
was calculated by extrapolating the resulting exponential attenuation curve
to Xj=0.
Rj = R0 exp ( 2 Xj)
where is the linear attenuation coefficient. The sensitivity for each plane
is calculated by dividing the extrapolated R0 by the measured activity. Total
system sensitivity is calculated as the sum of sensitivity per plane over the
47 planes.
Scatter Fraction and Count Rates

The scattering of annihilation photons leads to falsely positioned
coincidence events. Variations in design cause PET scanners to have
different sensitivities to scattered radiation. The intrinsic scatter function
is a measure of the relative system sensitivity to scatter. For a given source
142 distribution, a lower scatter fraction is more desirable, regardless of the
Quality Assurance
accuracy of the method for scatter correction, because correction techniques

cannot compensate on the noise introduced by the unwanted events and
can potentially add bias to the image. The scatter fraction (SF) is defined as
the ratio of the scattered events to the total events, which are measured at
a sufficiently low counting rate that random coincidences, dead time effects,
and pileup are negligible. Total events are the sum of the unscattered events
and scattered events.
The phantom is a 20 cm diameter solid polyethylene cylinder with an
overall length of 70 cm. The phantom has a hole at 4.5 cm from its centre,
which goes through the whole phantom, parallel to its central axis. In the
hole a Teflon LS (ID 2.3 mm), as long as the phantom, can be inserted to
contain radioactivity. The LS is filled in its 70 cm central part with a solution
of water and 18F. Two tests are performed, in 2D and 3D, with an initial
activity of 2,664 MBq and 1,776 MBq, respectively. In both tests, the phantom
is positioned at x=0 cm, y=0 cm and axially centred in the scanner FOV. In
both acquisitions, random coincidences are measured by the delayed event
(DE) technique. In each test (2D and 3D), 22 EM frames are acquired. Frames
1 to 4 are acquired for 900 s with no delay between consecutive frames. The
remaining 18 frames are acquired for 1,500 s with a delay of 1,500s between
each consecutive pair of frames.
Raw data sinograms are used in the analysis of the scatter fraction and
count rates (SF & CR) test. 3D sinograms are rebinned by using a single
slice-rebinning algorithm. Scatter component is calculated as for the N-94
over a fixed FOV of 40 cm diameter. Only the final frames of the SF & CR
test (when the random rate was negligible, below 1%) are used to calculate
the scatter fraction. Scatter fraction is calculated as the ratio between scatter
component and total events. The total counts rate within a 24 cm transverse
FOV is determined as a function of the radioactivity decay. The T rate (Rtrues)
is determined by subtracting the random and scatter rates from the total
prompts event rate (Rtotal). The Noise equivalent count (NEC) rate is
calculated as follows:
R 2 trues
NEC =
R trues + R scatter + kR random
Two NEC rate curves were then generated, with k=1 and k=2.
Accuracy of Corrections for Count Losses and Random

The same data set as was acquired for the SF & CR test is used. Data are
reconstructed with all count rate dependent corrections (dead-time losses
and random coincidences) applied. A circular ROI (18 cm diameter) is
drawn, centred on the reconstructed images of the phantom. 2D and 3D
data sets are reconstructed as for the count rate accuracy test of the N-94.
The resulting dead-time and random corrected true image count rate (R)
143
was plotted as a function of activity concentration. The residual dead-time

error is calculated as follows:
% r = 100[1 (R Rextrap)]
where Rextrap is the linear function of the true count rate extrapolated
from the low count rate (where dead-time and random coincidences rate
are negligible).
Image QualityAttenuation and Scatter

Correction Accuracy
It is desirable to compare the image quality of different imaging systems
for a standardized imaging situation that stimulates a clinical imaging
condition. In this, the scanners image contrast and signal noise ratios are
tested under conditions that stimulate a clinical whole body study.
Overall image quality (IQ), as well as attenuation and scatter correction
accuracy, is evaluated using a phantom simulating a human torso in size
and shape. The IQ phantom contains six coaxial isocentre spheres with
diameters of 1.0, 1.3, 1.7, 2.2, 2.8 and 3.7 cm. A cylindrical insert of 5 cm
diameter, as long as the phantom, is also positioned in the centre of the
phantom. The cylinder is a cold insert with a density of 0.30 g/cc to simulate
the lungs. Four of the spheres, with diameters of 1.0, 1.3, 1.7 and 2.2 cm, are
used to simulate hot lesions, while the other two are used to simulate cold
lesions. The phantom is filled with a solution of water and 18F (5.3 kBq/cc),
and the spheres with a concentration eight times higher than the
background, to simulate a lesion to background (L/B) ratio of 8.
In a second experiment, radioactivity concentration in the hot spheres is
such that the L/B is 4. Once filled, the phantom is positioned with the
spheres both in the transverse plane and along the z-axis of the scanner
FOV. To simulate body activity from outside of the scanner FOV, the
phantom used for the SF & CR test is positioned at one edge of the IQ
phantom. For this test, the LS of the external phantom is filled with an
activity of 165.5 MBq.
A CT scan of the phantom is used for acquisition (140 kV, 90 mA). For
both the experiments (L/B=8 and 4), six interleaved acquisitions (2D and
3D) are performed. The acquisition time for each 2D and 3D measurement
is 8 min and 20s and 7 min and 19 s respectively. These times are derived,
based on a whole body examination designed to cover a 100 cm axial FOV
in 60 min, using a slice overlap for 2D and 3D mode of 5 and 11 slices,
respectively.
Data were corrected for random coincidences, geometry, normalization,
dead-time losses, scatter and attenuation. In order to evaluate the hot and
cold sphere contrast, circular ROIs with a diameter equal to the physical
size of each sphere are drawn on CT images and copied to PET images.
144 Twelve background ROIs (37 mm diameter) are drawn on the central slice
Quality Assurance
and on slices 10 mm and 20 mm from the central slice. ROIs of smaller

size (10, 13, 17, 22, 28 mm) are drawn concentric to the 37 mm background
ROIs. Finally, an ROI of 5 cm in diameter is drawn (in each slice of the
phantom) on the central cylindrical insert to assess the accuracy of the
attenuation and the scatter correction. Different parameters used to evaluate
the IQ test are:
i. The hot sphere contrast recovery coefficient (HC_RC),
ii. The cold sphere contrast (CC),
iii. The accuracy of attenuation and scatter correction (A Clung), and
iv. The background variability (BVj), are calculated as follows:
HC _ RC =
(C hot / C bkgd 1 )
(a hot / a bkgd 1)
where Chot and Cbkgd are the average of the counts measured in the hot
spheres ROI and the average counts in all background ROIs respectively,
while ahot/abkgd is the ratio of the activities in the hot sphere and background.
C
CC = 1 cold
C bkgd

where Ccold is the average of the counts measured in the cold spheres
ROI.
Clung
AClung = 100
C bkgd

where Clung is the average counts in the lung insert ROI.
SD j
BVj = 100
C bkgdj

where SDj is the standard deviation of the background ROI counts for
sphere j.
Performance Evaluation of CT
Performance evaluation tests of CT includes (i) electromechanical, (ii) image
quality, and (iii) radiation safety. Detailed information are also available in
AAPM report No. 39 (9), AAPM-TG 66 (10) recommendations.
Electromechanical Tests
These tests include the congruence of gantry laser and imaging plane,
localization of CT and pseudo CT centre, orthogonality of table top long
axis to imaging plane, accuracy of table vertical and longitudinal movement,
radiation and sensitivity profile widths and tests on X-ray generator.
145
Gantry and Couch

Congruence of gantry laser with centre of imaging plane and gantry tilt
accuracy are verified using ready pack film(Kodak-X-V) adopting the
method described in AAPM -39(9). CT center and pseudo CT center an
arbitray point exactly 60 cm inferior from CT centre are localized using a
commercially available laser calibration phantom. For this purpose 0.1 cm
thick tranverse images are acquired at the mid plane of two parallel slabs
of the phantom separated by 60 cm.
This test is also used to quantify longitudinal table motion accuracy and
orthogonality of table top longitudinal axis to the image acquisition plane.
Calibrations of table linear scales are verified by moving the table both
vertically and longitudinally in steps of 1 cm using an independent
measuring scale. Table indexing accuracy and reproducibility are tested
by irradiating a ready back film placed perpendicular to the scan plane,
under scanner control longitudinal spacing of 0, 5, 10, 20 and 30 cm using
0.1 cm slice thickness.
Radiation Sensitivity and Profile Widths

A ready pack film placed horizontal to the table top and at the CT centre is
exposed using all available slice thickness. The exposed films are measured
using film scanner with 0.01 cm step size and the FWHM of optical density
profiles corresponding to every slice thickness is obtained. These FWHM
values represent the radiation profile widths. Independent verification
profile width has to be done by using vendor supplied phantom.
X-ray Generator
Tests on the X-ray generator include evaluation of peak potential (kVp),
timer accuracy(s),mAs linearity and repeoducibility. Non invasive
measurement of kVp for different mAs are performed using suitable meters
and the method adopted by AAPM-39(9). Linearity of mAs for different
kVp is verified by obtaining the product of dose and time at different mA
and time settings.
IMAGE QUALITY TESTS
Image Uniformity and Pixel Noise

A 20 cm x 2.5 cm thick water phantom is scanned by using head scanning
ptotocol. Mean CT number of water contained with in a circular region of
1 cm2 (400 pixels) is obtained at different locations corresponding to 12, 3, 6
and 9 oclock positions and at the centre of the phantom using system
software. Image homogeneity defined as the edge-to-centre difference in
mean CT number is than caculated.Image noise is determined using the
146 relation
Quality Assurance
% of noise = ( CS 100) w
where is the standard deviation of CT numbers of water within the
region of interest,
( mm mw )
CS is the contrast scale defined as CS = , (m and w) are
( CTm CTw )
the linear attenuation coefficients for the subject material and water
respectively, and
CTm and CTw are the measured CT numbers of the subject material and
water.
Low and High Contrast Resolution

Repeat the procedure that are given for QA test for CT scans in diagnostic
radiology in this chapter.
CT Number Linearity
A CT number linearity test phantom is used and the phantom is scanned at
130 kVp with 1 cm slice thickness. The phantom consists of seven cylindrical
inserts of different materials (air, perspex, polypropylene, backelite,
polystyrene, nylon and Teflon) which stimulate attenuation coefficient of
various organs ranging from lung to bone. CT numbers for all these
materials are measured from the scan image using system software and
compared with the standard value.
Radiation Safety
The CTDI is measured on the surface and centre for both head and body
phantom by using the CT pencil ionization chamber. The scan protocol is
usually 1 cm slice thick, axial mode with 80-130 kVp and 100 mAs. Then,
the weighted computed tomography dose index (CTDTw) is calculated.
For detail procedures refer the QA test for CT scans in diagnostic
radiology in this chapter.
QA FOR RADIOPHARMACEUTICALS
Introduction
All radiopharmaceuticals administered to patients must have the safety,
quality and efficacy required for their intended use. The employment of
short lived radionuclides in radiopharmaceuticals posses problems in
quality control testing, since it is not possible to complete the necessary
quality control testing before the products use-by date. This makes it
imperative to employ a range of quick validation techniques in order to
test the final product. 147
Control of Starting Materials

One of the major aspects of quality control is the source and purity of the
non radioactive starting materials. It includes components of kits for
technetium radiopharmaceuticals, target materials for use in nuclear
reactors or cyclotrons, adsorbents used in columns inside radionuclide
generators, and eluents and diluents used in the preparation of the final
product. To carry out QA one may require mass spectroscopy and nuclear
magnetic resonance spectroscopy etc. which are not usually available in a
hospital setup. Hence, it is advisable to purchase materials from
radiopharmaceutical manufacturers who might have performed the above
quality control procedures on the materials they are supplying.
Testing the synthesis of non radioactive materials may require the use
of analytical techniques such as infrared and ultraviolet spectroscopy, mass
spectroscopy and nuclear magnetic resonance, and the department should
ensure that it has access to such facilities. Details of the synthesis and
analysis of certain kits are provided in IAEA-TECDOCs 649 and 805.
Information on the specifications that radiopharmaceuticals should meet
is also available in national and international pharmacopoeias.
If the product has been approved for marketing by an appropriate
authority, the user department should have little or no testing to perform
on it. Continued satisfactory use of the product enables the user to build
up confidence in the quality of the supplier.
Radionuclide Activity
It is necessary to ensure that the correct activity is administered to the
patient. Accurate measurement must be taken place during the preparation
of radiopharmaceuticals and the dispensing of individual doses. There is
therefore a requirement for control of the dose calibrator to ensure its correct
functioning and accuracy. It is always advisable to measure the vial before
and after dispensing the radiopharmaceutical into the syringe. The
difference between the readings gives a more reliable indication of the
dispensed activity.
Radionuclide Purity
Radionuclidic purity is defined as the percentage of the activity of the
radionuclide concerned to the total activity of the sample. All radioactive
materials are likely to have some radionuclidic impurities, albeit at very
low levels, which can make their determination difficult. The situation most
relevant to hospitals and clinics is the determination of levels of 99Mo in
99m
Tc eluted from a generator. Fortunately, this can readily be determined
by a screening method since the principal gamma energy of 99Mo (740 keV)
is much higher than that of 99mTc (140 keV). The total activity of a sample is
148 measured in the normal way in a dose calibrator. The sample is then placed
Quality Assurance
inside a lead pot 6 mm in thickness, which attenuates virtually all the 140
keV gamma rays of technetium but only approximately 50% of the 740 keV
gamma rays of 99Mo, and the activity is remeasured using calibration factors
supplied with the instrument. It is then possible to calculate the amount of
99
Mo present and express this as a percentage of the 99mTc. Most
pharmacopoeias have a limit of 0.1% of Mo at the time of administration,
and any eluates that exceed this limit must not be used. The determination
should therefore be carried out on the first eluate of a generator and on
other eluates as deemed necessary.
Radiochemical Purity
The radiochemical purity is defined as the proportion of the total
radioactivity of the nuclide concerned present in the stated chemical form.
For many radiopharmaceuticals the radiochemical purity will be expected
to be greater than 95%, but this is not universally so. Manufacturers will
normally declare the radiochemical purity, for which further testing is not
necessary. For materials prepared in-house, either totally from original
materials or purchased kits, radiochemical purity determinations are useful
to establish the suitability of the final product. Low radiochemical purities
may lead to an unintended biodistribution of the radiopharmaceutical. For
diagnostic agents, this may lead to confusion in the diagnosis and for
therapeutic radiopharmaceuticals it can produce significant dosimetric
problems. A range of techniques is available for such determinations, but
the techniques must be reliable and simple, and preferably rapid, to perform
such that, in an ideal situation, the radiochemical purity of materials
containing short lived radionuclides can be established prior to their
administration.
The simplest and most widely used technique is that of planar
chromatography, using suitable stationary phases (e.g. paper or thin layers
of silica gel) and readily available mobile phases (e.g. saline, acetone and
butanone). The choice of stationary and mobile phases is determined by
the nature of the radiopharmaceutical, and must be such that the various
radiochemical species have different mobilitys. Suitable systems for a range
of radiopharmaceuticals are given in IAEA-TECDOCs 649 and 805. The
techniques can be carried out with very simple apparatus, for example with
beakers or measuring cylinders as chromatography tanks; in view of the
scale of the operation only small volumes of solvent are needed. The levels
of each species can be determined by scanning the stationary phase with a
suitable detector or cutting it into sections and placing each in a counter.
However, the limitations of these simple systems need to be borne in
mind, since in many of them only certain impurities (e.g. pertechnetate in
Tc radiopharmaceuticals) migrate with the solvent. Most of the activity
may remain at the point of application on the chromatography strip and
thus be unresolved. Alternative techniques such as electrophoresis or HPLC
149
offer advantages in that they can give more precise information about the
radiochemical nature of the species present. Commercial manufacturers of
radiopharmaceuticals use HPLC routinely. The technique utilizes the
separating power of adsorbent materials packed into stainless steel columns
through which a solvent is pumped at high pressure. Different
radiochemical species are identified by monitoring the eluate from the
column and noting the time at which radioactivity is detected.
This technique has limitations in that the apparatus is expensive and
may not be routinely available to hospital radiopharmacies. In addition,
certain radiochemical species, for example, hydrolyzed reduced Tc in Tc
radiopharmaceuticals, may be retained on the column used to achieve the
separation and may not therefore be accounted for in the analysis.
Recent developments have included the introduction of cartridges
containing the same absorbents used in HPLC, but which can be loaded
and eluted with syringes. By using appropriate eluents, different species
can be selectively removed from the cartridge and, providing a sufficiently
high radioactive concentration is used, activity can be determined with a
dose calibrator or other simple scalar. Thus, the hospital radiopharmacy
can benefit from the resolving power of absorbents used in HPLC, but
without the expense of the equipment required.
Chemical Purity
In addition to the problems of ensuring the correct chemical purity of
starting materials for radiopharmaceuticals, there are certain situations
where the chemical purity of the final material can be affected by the process
used in the preparation. The most likely situation to be met in
radiopharmacies is the presence of Al ions in Tc radiopharmaceuticals.
These can arise from alumina being washed off the columns used in
Tc generators. Very high levels of Al can be toxic to patients, but it is
unlikely that such problems will arise from administration of a
radiopharmaceutical. However, lower levels can adversely affect
radiopharmaceutical formation or stability, for example of colloidal
radiopharmaceuticals, where the trivalent Al cation can alter the surface
charge of particles and lead to aggregation and hence an altered
biodistribution. Aluminium can be detected by a simple colorimetric limit
test, using either a solution or indicator strips containing an Al sensitive
marker such as chromazurol-S. By comparing the colour obtained with a
small volume of the eluate of a Tc generator and that from a solution
containing a specified concentration of Al ions (generally 5 or 10 parts per
million), it can be determined that the Al content of the eluate is below the
specified level and hence suitable for use. Metal impurities may reduce the
efficiency of 111In radiolabelling.
150
Quality Assurance
Determination of Particle Size

Lung imaging agents are normally based on macro aggregates of human
albumin. A particle size range of 10-100 mm is generally specified as being
optimal. Some pharmacopoeias state that there should be no particles larger
than 150 mm. Particle size can be determined by light microscopy, using a
graduated slide to ensure that there are no oversize particles and that a
suitable range of sizes is present. The limitations of the method are that it is
usually only possible to observe a limited number of particles and that
prolonged observation subjects the eyes to an increased radiation burden.
These limitations can be overcome by reconstituting a macro aggregate kit
with saline and observing nonradioactive particles. Colloidal particles
cannot be visualized by normal light microscopy and, in situations where
it is important to know the particle size distribution, more elaborate
techniques such as light scattering or membrane filtration will have to be
used. These may not be readily available in hospital radiopharmacies.
Particulate Contamination
Products for parenteral administration should be free from gross particulate
contamination. The use of clean glassware, kits, reagents and equipment is
the best way to minimize contamination. However, on occasions, particles
can be present in the final solution as a result of coring of the rubber stopper
if it is repeatedly punctured. Control can be exercised by visual inspection
of the final radiopharmaceutical, while ensuring that adequate measures
are taken to protect the eyes. The required level of protection can be achieved
by viewing through lead glass screens or by using mirrors to view vials
placed behind lead shields. It should be pointed out that such techniques
may not detect small amounts of particulate contamination and are not
suitable for radiopharmaceuticals which themselves are particulate.
Control of pH
For some radiopharmaceuticals, control of pH is essential to ensure they
retain their original specification. For example, indium (111In) chloride must
be maintained at a pH of 1.5. If the pH rises, the material becomes colloidal
and unsuitable for labeling reactions. With Tc compounds, the chemical
composition and hence biodistribution of DMSA complexes is affected by
the final pH of the solution. The normal renal imaging agent must be
maintained at a pH below 3.5. The easiest method of determining pH is to
use narrow range pH papers, since only small samples are needed. Papers
are readily available from a variety of sources. Assessment of pH is
subjective and such papers are normally only accurate to about 0.5 of a pH
unit. For the majority of radiopharmaceuticals these limitations are not
normally detrimental.
151
Sterility and Apyrogenicity

Radiopharmaceuticals administered parenterally need to be sterile and
apyrogenic. Although, these objectives can be achieved by the use of a
suitable sterilization technique during preparation of the radio-
pharmaceutical, it is often necessary to use an aseptic technique to prepare
the final radiopharmaceutical, having started with sterile materials (e.g.
kits and generator eluate).
Control of the environment in which such manipulations take place is
important. Sterility testing of radiopharmaceuticals present difficulties and
it is often impracticable to apply tests described in pharmacopoeias; this is
not only because of the radioactive nature of the material but also, as is the
case with Tc radiopharmaceuticals, because the batch may consist of a single
container. This introduces serious problems with sample sizes and makes
the test statistically unsatisfactory. In addition, there is evidence that
microorganisms do not survive in Tc radiopharmaceuticals, and hence
allowing them to decay in order to make testing easier can reduce the value
of the test. As a compromise it is probably better to withdraw a small sample
of the radiopharmaceutical whilst it is still active and place it in a suitable
culture medium that can be shielded until decay has occurred. It can then
be incubated in the normal way.
Alternatively, for Tc radiopharmaceuticals, the culture medium can be
added to the remnants of the kit vial at the end of the working day. The
vial is kept shielded until inactive and then incubated. Inevitably this means
that the result of the test is only obtained retrospectively. In view of these
limitations, a more satisfactory technique to ensure sterility of aseptically
prepared radiopharmaceuticals involves staff simulating exactly the
preparation techniques using culture media. Such tests have the advantages
of being more sensitive and of using non-radioactive materials, and can be
performed earlier.
Determination of the apyrogenicity of injections is currently required
only when the volume administered exceeds 15 ml. This rarely occurs with
radiopharmaceuticals and hence the test is not usually performed in hospital
radiopharmacies. If a hospital is involved in the development of new agents,
it may be prudent to assess the apyrogenicity, particularly if materials of
animal origin are used in the preparation. The use of the limulus lysate test
for pyrogens is now becoming widely accepted in preference to the rabbit
test, but rigorous controls must be used to validate the test. Commercial
manufacturers frequently use the limulus lysate test in the control of their
materials.
Ongoing Evaluation of Product Performance

Diagnostic radiopharmaceuticals of appropriate quality should have a
152 defined biodistribution within patients. If such observations are made
Quality Assurance
regularly, confidence in the quality of the materials being administered to

patients is gained. When nuclear medicine images are reported, unexpected
biodistributions are sometimes observed and may result from problems
with the radiopharmaceutical, or alternatively may be due to the patients
condition or even the medication the patient may be taking. It is worth
trying to determine the cause of the problem. If the problem has occurred
with all patients who received that particular batch of radiopharmaceutical,
the problem is likely to lie with the product. An example is the visualization
of the stomach in patients undergoing bone imaging with a technetium
phosphonate complex.
This indicates the presence of pertechnetate in the radiopharmaceutical
and may have arisen as a result of an incomplete reaction when preparing
the kit or of instability after preparation. If this occurs on a regular basis
with different batches of the same radiopharmaceutical, action is necessary
to eradicate the problem. This may involve review of the methods used in
preparation or a change in purchasing patterns of materials. However, it is
not acceptable merely to rely on the biodistribution in patients as the only
quality control testing to be performed. In situations where an unexpected
biodistribution is seen in one patient but not in others who received the
same product, a patient related cause might be responsible. If this can be
identified, it can provide useful information for future reference and to
prevent misdiagnosis occurring.
On rare occasions, an adverse reaction may occur in a patient to whom
a radiopharmaceutical has been administered. This does not mean that the
product is necessarily defective. The prevalence of such reactions has been
estimated as 3 per 105 administrations and, as such, departments might not
encounter a similar situation for many years. Fortunately, adverse reactions
that do occur are generally mild and self-limiting and do not require
extensive treatment. The adverse reaction most commonly encountered
involves the development of skin rashes a few hours after administration
of 99mTc bone imaging agents. Histamine release in the patient is frequently
implicated as the cause of the problem, and hence symptomatic treatment
with an antihistamine is sometimes beneficial. There are occasions when a
severe anaphylactic reaction can occur immediately after administration
and prompt action, including administration of adrenalin, may be necessary.
Since the occurrence of such events is so low, they should be reported to the
manufacturer of the product and, as necessary, to national authorities. In
this way a database on the possible reactions that can occur is developed and
information can be disseminated. Departments can then be prepared to deal
with such events if they occur, thereby enhancing the quality of patient care.
SUMMARY
Each department needs to have its own quality assurance program to ensure
that the products administered to patients are of the desired quality. This
153
requires the development of appropriate documentation systems, record

keeping and quality control testing protocols. These will be influenced by
the range of products prepared, the source of the starting materials (e.g.
from a commercial manufacturer or prepared in-house) and the facilities
used for the preparation. In addition, it is important that the results obtained
are reviewed and acted upon where necessary in order to maintain the
quality of the products. One vital component in the assurance of quality of
products is to have well trained competent staff who have the necessary
skills and knowledge to deal with radioactive pharmaceutical products.
QUALITY ASSURANCE FOR RADIOTHERAPY

Quality assurance (QA) is the method of subjecting the newly installed
equipment to an exhaustive performance testing to determine that the
equipment is meeting the vendors technical specifications and hospitals
clinical specifications. Usually the QA tests are performed at the time of
installation, known as acceptance testing and repeated periodically. The
periodic QA will ensure the integrity of its basic physical and functional
specification through time. This will also ensure that the fundamental
parameters have not changed since last measured. Some of the basic QA
parameters and procedures are given below. However, individual hospital
has to devise their own QA methodology and periodicity to suit their
machine and model.
QA FOR LINEAR ACCELERATOR
Radiation Survey
Radiation protection survey involves the measurement of head leakage,
area survey and test of interlocks, warning lights and emergency lights.
The survey is evaluated on the basis of clinical use, by taking into account
the workload, use factor and occupancy factors. The detail procedure of
survey is explained in chapter five under area survey.
Jaw Symmetry
To study jaw symmetry, a machinists dial indicator is used. First the gantry
is set at horizontal and jaws open to a large field size. The feeler of the dial
indicator is made to touch the face of the one of the jaws and the indicator
reading is noted. Now the collimator is rotated to 180 degrees and the feeler
is touching the opposite jaw and the dial reading is again noted. The
difference between the two readings is noted. The symmetry error is of
the difference in readings. The procedure is repeated for the second jaw.
Spirit level is used to check the collimator angle. The tolerance for symmetry
error is 1 mm.
154
Quality Assurance
Coincidence
Collimator Axis, Light Beam Axis and Cross-hairs Coincidence
Gantry is set at vertical and the SSD is set at 100 cm. A graph paper is fixed
on the couch and the field size is kept as 10 10 cm. Switch on the light
field and mark the edges of the light field, intersection of diagonals and the
position of the cross hairs images. Rotate the collimator through 180 degrees
and mark the above parameters in the graph paper. Check the coincidence
of light field edges, intersection of diagonals and position of cross hair
images. If there is a misalignment it should be adjusted to bring down to
coincidence.
Optical and Radiation Beam Congruence

A therapy verification film back is placed on the couch with SSD of 100 cm.
A field size of 10 cm x 10 cm is set and collimator angle is set to 0 degree.
The light beam is made on and the light field edges and the centre is marked
with lead wires or radio opaque markers. A plastic (2-5 mm) sheet is placed
over the film pack to give electronic buildup and eliminate electron
contamination. The film is exposed so that a optical density of around 1 is
achieved. The procedure is repeated for a collimator angle 90, 180 and 270
degrees. The coincidence of the optical and radiation beam is checked
visually or by cross beam optical density profiles (Fig. 6.6). The tolerance is
3 mm.
Mechanical Isocenter
Collimator Rotation
A graph sheet is fixed on the couch and front pointer is put on the accessory
mount with a gantry angle of 0 degree. With the pointer extended, the
SAD is set to 100 cm. Now the pointer tip position is marked on the graph
sheet. The collimator is rotated to 90,180 and 270 degree and each time the
pointer tip position is noted. A sharp edge or wiggler may be attached to
the end of the pointer rod to have effective observation. The tolerance of
the isocenter is 2 mm diameter.
Gantry Rotation
In the above procedure, another horizontal rod with fine pointer is
positioned by means of a stand. The stand should be kept away to avoid
gantry collision. The horizontal rod tip and the front pointer tip are made
to coincidence at 100 cm SAD with gantry position of 0 degree. The gantry
is rotated to 90,180 and 270 degrees and the displacement between front
pointer tip and the horizontal rod tip is observed. The tolerance of the
isocenter is 1mm.
155
Fig. 6.6: Optical and radiation field field congruence:

9 MeV electron and 6 MV photon beams (For color version see plate 1)
Radiation Isocenter
Collimator
The gantry is set to vertical, 0 degree with a SAD of 100 cm. A ready pack
film is kept flat on the couch. The upper jaws are fully opened and the
lower jaws are closed to have a narrow slit of beam. A build up sheet is
placed over the film and it is exposed to create a density of about 1. The
collimator is rotated to different angles (4-8 angles) and each time the film
is exposed. The procedure is repeated for upper jaws of narrow slit, while
the lower jaws are wide open. The developed film will show the star pattern
with dark centre region (Fig. 6.7). Using a film marker lines are drawn
through the middle of the slit images, which will show clearly the
intersection point. The lines should intersect with in a 2 mm diameter
circle.
Gantry
A ready pack film is sandwiched between two plastic sheets and it is kept
on the couch vertically. This means that the plane of the film should be
perpendicular to the plane of the couch top. A slit beam is created by moving
the jaws optimally, parallel to the gantry axis. The film is exposed for
different gantry angles (12 to 30 degree) and the final star pattern is obtained
156 (Fig. 6.8). The lines should intersect with in a 2 mm diameter circle.
Quality Assurance
Table
The above procedure is repeated. The gantry and the collimator is in fixed
position. The table is rotated (4-8 times) to different angles and each time
the film is exposed. A final star pattern is obtained and it is examined
(Fig. 6.9). The lines should intersect with in a 2 mm diameter circle.
Fig. 6.7: Mechanical isocenter verification: Collimator rotation
Isocenter shift by
Isocenter shift by
gantry rotation
table rotation
The shift is found The shift is found

to be with in 2 mm to be with in 2 mm
Fig. 6.8: Mechanical isocenter Fig. 6.9: Mechanical isocenter

verification: Gantry rotation verification: Couch rotation
Multiple Beam Alignment Check

When more than one beam is used misalignment may occur. This may be
due to (i) focal spot displacement, (ii) asymmetry of collimator jaws, and
(iii) displacement in the collimator rotation axis or the gantry rotation axis
(Lutz et al,1981). To check the beam misalignment a split field test is
recommended. A ready pack film is sandwiched between buildup sheet
and is exposed twice. First the one half (region 1) of the field is exposed, by
blocking the other half (region 2). The gantry is rotated through 180 degree 157
and exposed again by blocking region 1. The relative shift of the two images
is the indicator of the misalignment.
Photon Beam Data

Energy
Photon beam energy is specified by the depth dose distribution. A central
axis depth dose curve measured with a suitable ion chamber in a water
phantom can be compared with published data (BJR 25). The ion chamber
should have a small internal diameter (< 3 mm), to minimize displacement
correction. It is advisable to compare depth dose ratios for depths beyond
dose maximum, instead of absolute values of depth dose. The recommended
depth for depth ratios are 10 and 20 cm. The acceptance criteria is specified
in terms of depth dose variance for 10 10 cm field size,100 SSD, at 10 cm.
The acceptable difference is 2 % from the published data. The measured
depth dose data is to be used for clinical dose calculations.
Field Flatness
Field flatness for photon beams is defined as the variation of dose relative
to the central axis over the central 80 % of the field size at a depth of 10 cm
in a plane perpendicular to the central axis. The AAPM -TG 45 specified
flatness in terms of maximum percentage variation from the average dose
across the central 80 % of the width at half maximum (FWHM) of the profile
in a plane transverse to the beam axis. It is given by the relation:
Mm
F= 100
M+m
where M and m are the maximum and minimum dose values in the
central 80% of the profile. The tolerance limit is 3 %. The flatness should
be checked for 10 cm and Dmax depths, for maximum field sizes. Beam
profiles are generated for inplane, cross plane and diagonal directions and
checked for flatness for each given field size.
Field Symmetry
The profile generated with the above procedure can be used for checking
the field symmetry. Usually the profile is folded at the centre and hence
the two peripheral halves should be compared at the reference depths. This
should not differ more than 2 % at any pair of points located symmetrically
with respect to the central ray.
Electron Beam Data

Energy
The electron energy is specified by practical electron range (RP) and the
158
most probable energy (EP)O as per AAPM-TG 25. The RP is the depth of the
Quality Assurance
point where the tangent to the descending linear portion of the curve
intersects the extrapolated background. For range determination one can
use ion chambers, diodes or film and RP is found from the depth dose curves.
The acceptance limit for the probable energy is 0.5 MeV of the nominal
energy. In addition, film dosimetry can be used to find R100, R90, R80, and R50.
Flatness and Symmetry

The flatness of the electron beam is specified in a reference plane
perpendicular to the central axis, at the depth of the 95% isodose beyond
the depth of dose maximum (AAPM-TG 20). The variation of dose relative
to the dose at central axis should not exceed 5 % over an area confined
within lines 2 cm inside the geometric edge of the fields equal to or larger
than 10 10 cm.
Beam symmetry compares a dose profile on one side of the central axis
to that of other side. It should not be more than 2 % any pair of points
located symmetrically on opposite sides of the central axis.
Other Checks
In addition to the above, it is desirable to check the wedge angle ( 2 degree),
isocenter shift with couch up and down motion ( 2 mm), optical distance
indicator ( 2 mm), field size indicator ( 2 mm), gantry and collimator
angles (1degree), laser lights alignment with isocenter ( 2 mm) and table
top sag with lateral and longitudinal travel under distributed weight
(2 mm) etc. The AAPM-TG 40 has recommended the daily, monthly and
annual QA to be carried out in a linear accelerator (Table 6.6).
QA FOR HDR BRACHYTHERAPY
Electrical and Mechanical Tests

After the installation of the HDR unit, the electrical and mechanical tests
should be carried out. In the electrical tests, the interlocks in the treatment
room doors, guide tube and treatment unit, applicator and guide tubes,
emergency stop button to interrupt the irradiation are to be tested. Source
safe display and treatment ON/OFF indicator are also be tested. Control
console display and control console functions should also be tested for
electrical safety. The mechanical tests included are functioning of sensors
like pressure, torque, optical and coupling between (i) guide tube and unit,
(ii) guide tube and applicator and (iii) drive cable and source etc. Time
taken to drive the source to ON/OFF position and integrity of applicators
are also very important.
159
Table 6.6: QA for Linear accelerators

Daily Monthly Annual
X-ray out put X-ray PDD Field size dependence of
X-ray output,
Electron out put Electron PDD Out put factor constancy
for electron applicators,
Localizing lasers X-ray beam flatness Off axis factor constancy,
and symmetry,
Distance indicator Electron beam flatness Monitor chamber linearity,
and symmetry,
Door interlock Safety interlocks X-ray out put vs gantry
(emergency switch, angle,
wedge and electron cone),
Audiovisual monitor Light and radiation field Electron out put vs gantry
coincidence, angle,
Gantry and collimator Off axis factor constancy
angle indicators, vs gantry angle,
Wedge and tray position, Collimator rotation
isocenter,
Applicator position, Gantry rotation isocenter,
Field size indicators, Couch rotation isocenter,
Cross hair centering, Coincidence of collimator,
gantry, couch axis with
isocenter,
Couch position indicators, Table top sag,
Latching of wedges and tray Vertical travel of table,
Jaw symmetry, Safety interlocks,
Field light intensity. Arc mode,
Positional Accuracy
Applicator Integrity
The positional accuracy is tested by combining auto radiography and
radiography. A graph sheet is pasted on the therapy verification film. Over
the graph sheet the tandem of the standard gynaec applicator (IU3) is fixed.
A small lead wire is kept at the end of the tandem in a transverse direction
(Fig. 6.10A). The film is exposed with suitable factors with a X-ray machine.
This will confirm the mechanical integrity of the applicator. Now the
applicator is moved laterally and fixed in a different position in the film.
Using the graph sheet the tip of the applicator must be maintained in the
same level as before. Then the applicator is connected to the HDR unit in
channel 3. Programs are made to create dwell positions at 1500, 1450, 1400
and 1350 (50 mm gap). Autoradiography was performed in HDR for a
period of 0.3 s or less at each dwell position. Later the whole test package is
taken to X-ray machine and again exposed. When the film exposed, the
160 remaining part of the film was shielded with lead partition. This is repeated
for various other applicators.
Quality Assurance
Pin Prick Method

A graph sheet is pasted on a therapy verification film. The gynec tandem
or a flexible implant tube pasted on the graph sheet. A pin is used to mark
several cardinal treatment lengths, 1500, 1480, 1460, 1440, 1420 and 1400
mm parallel to the applicator. The distance between the applicator and the
pin prick is 50 mm on both sides. The applicator is connected to the transfer
tube and the HDR source is used to expose the film. The film was developed
and checked for the positioning accuracy and Uniformity. The criteria for
positional accuracy is 1 mm.
Staggered Autoradiography
Staggered autoradiography is used to confirm the correct delivery of each
unique sequence of dwell positions to the programmed channel, the correct
Fig. 6.10A: Radiography and autoradiography (For color version see plate 1)
161
Fig. 6.10B: Staggered autoradiography (For color version see plate 2)
spacing of adjacent dwell positions, and the accurate relative positioning

of the most dwell position. Autoradiography is performed for 1-6 channels,
with dwell spacing of 15 mm, consisting of 8 dwell positions. The dwell
time for each dwell is selected optimally to create a optical density of around
one. The first position in each catheter was offset from the previous one by
2.5 mm, resulting in a pattern of descending dots in which errors are readily
discernible. In the same way, all the 18 channels has to be tested (Fig. 6.10B).
Temporal Accuracy
Verification of temporal accuracy consists of identically measuring the
length of time the HDR source remains at the specific dwell position and
comparing it with the set time. In this study the timer error, timer linearity
and end error were determined.
Timer Error
The HDR system is programed for 60 seconds in 1385 position 21 and the
charge for 60 Seconds is noted as R1. Again the system is programed for 60
seconds and the machine is made ON. At 30 Seconds an interruption is
made and the system is restarted again. The accumulated charge taking
the additional transit time into consideration is noted as R2.Five sets of
reading are taken as follows and the average R1 and R2 were found.
Reading Charge 1 Charge 2 Charge 3 Charge 4 Charge 5 Change

nC nC nC nC nC Average,nC
R1
R2
Timer Error = (R2-R1) t /(2R1-R2)
Timer Linearity
The HDR system is programmed for about 320 Seconds at distance 1385
position 21 and the charge for 300 Seconds (T) is noted using an independent
timer. Five sets of readings are taken and the average of five sets of reading
(Qave) is found and the corrected current ( Icor = Qave/T) is calculated
Reading Charge 1 Charge 2 Charge 3 Charge 4 Charge 5 Change

nC nC nC nC nC (Qave) nC
R1
Now the system is programmed for 60 sec (Tset) and the charge for 60
seconds is noted by operating the machine timer. Five sets of reading are
taken and the average is found. Then the value of the Tmeas is calculated
using the formula T =Qave/Icor. Similarly, the readings were taken for 120
162 Sec, 180 Sec, 240 Sec,meas
and 300 Sec and the readings are tabulated as follows:
Quality Assurance
Tset, Charge1, Charge 2 Charge 3 Charge 4, Charge 5, Average Tmeas =

sec nC nC nC nC nC charge Qave/Icor
(Qave)nC
60
120
180
240
300
A graph has been plotted with Tset in X-axis and Tmeas in Y-axis. From the
graph the slope is found using the most deviated readings on both sides.
Linearity Error = 1 [Tmeas max (T1) Tmeas min (T2)] 100 %
Tset corresponds to T1-Tset corresponding to T2
End error is the intercept at Y-axis. Alternatively, the intercept can also
be calculated by using Excel Sheet.
Leakage and Contamination

The HDR machine is connected with a flexible implant tube and made ready
for dummy treatment. Trial treatment is performed with the Ir-192 Source
for about 5 times.
The flexible implant tube is now cut longitudinally and the wipe test is
performed using gauze. The gauze is tested for contamination using a
contamination Monitor and the reading is recorded as CPM.
Source Strength Verification

The HDR system is to be calibrated with re-entrant type ion chamber (well
chamber). As a first step the axial response of the chamber is obtained, by
programing all dwell positions (say1-48). The secondary standard dosimeter
is used to measure the current in nA. Repeated readings are taken for at
least 2 times for a given dwell position and tabulated as shown below. A
plot is made between dwell position and relative meter readings. The dwell
position (Dwellmax) corresponding to the maximum response is found.
Dwell position Meter reading, nA (i) Meter reading, nA (ii)
Now the machine set for the dwell position of Dwellmax and the
measurements are repeated for 3 times. The readings are tabulated as given 163
below and the average of the readings is also found. The temperature (T)
and pressure (P) parameters are also noted.
Dwell position Meter reading, Meter reading, Meter reading, Average Meter
nA (i) nA (ii) nA (iii) reading ,nA (M)
Dwellmax
Activity = M N Ktp
where Ktp is the temperature and pressure correction factor
= ((273.15 + T)/(273.15 + 22)) * 1013/P) and
N is the Chamber calibration factor = ( ) GBq/nA
The % of variation of the measured activity with that of the stated activity
(ventors) is calculated as follows:
Stated activity Measured activity
% variation = 100
Stated activity
QA for Treatment Planning System

Quality assurance of treatment planning system (TPS) is an essential and
indispensable part before commissioning any TPS. After installation the
TPS is tested for its accuracy of (i) digitization of coordinates, (ii) data
transfer from orthogonal radiographs, (iii) dose calculation at selected
anatomical points, and (iv) computational algorithm etc.
A 5 cm, 10 cm and 12 cm catheter length is drawn in a graph sheet and
its AP and lateral images are fed into the system through the digitizer. A
printout is obtained and its dimensions are compared with input data.
Similarly input is made through keyboard and the hard copy is compared.
This can be repeated for different catheter lengths and orientation with
marking points. The tolerance limit for data transfer is 1 mm.
A single pellet is programmed in a gynaec application, so that it can
deliver a dose of 10 Gy at 10 mm distance. The isodose print out is made
and checked. The treatment time can be verified by either by (i) Mante
carlo data or (ii) Meisberger polynomial. The tolerance limits is 3 % for
dose.
Periodic QA schedule
Four flexible catheters are taped on a sheet and placed on the ready pack
film at 2 cm apart. Dummies were inserted in each catheter, making sure
that the stop collar on the dummies abuts the coupler on each catheter
(Fig. 6.11). After radiographing the dummies, the HDR machine is
164 programmed to dwell 0.1 sec at each dwell position. At each catheter, dwell
Quality Assurance
Fig. 6.11: Periodic quality assurance test (For color version see plate 2)
positions are 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, 41, 45, 48. After the exposure,
the HDR machine is again programmed as follows:
Catheter 1 Dwell 5 Length 1490
After HDR autoradiography, the film is developed and the maximum
deviation from the dummy position is checked and the tolerance is 2 mm.
BIBLIOGRAPHY
1. Advances in Diagnostic Medical physics Proceedings of the international
symposium on advances in diagnostic Medical physics and workshop on
Cyclotron PET/CT, July 13-16, 2006, Edited by GS Pant, Himalaya publishing
house, Delhi.
2. Comprehence QA for radiation oncology: Report of AAPM radiation therapy
Task Group 40. Med Phys1994;21:581-618.
3. Faiz M.Khan: The Physics of radiation therapy, (3rd edn.) Lippincott Williams
& Wilkins, 2003.
4. Jeffrey W, Zuoferg Li; Mate carlo dosimetry of the Microselectron pulsed and
high dose rate Ir-192 sources. Med phys 1995;22(6):809-19.
165
5. Nath R, Biggs PJ, Bova FJ, et al. AAPM code of practice for radiotherapy
accelerators: report of AAPM radiation therapy Task Group No. 45. Med Phys
1994;21:1093-1121.
6. Nuclear Medicine resources book, IAEA, Vienna 2006.
7. Performance evaluation of the new whole-body PET/CT scanner: Discovery
ST: Valentino Bettinardi et.al. European Journal of Nuclear Medicine and
Molecular Imaging Vol. 31, No. 6, 2004;867-81.
8. QA Instructions to users: Nucletron India, No 3,Dsilva road, Mylapore,Chennai-
600 004.
9. Thayalan K. Physical and dosimetric studies of High dose rate Brachytherapy
system with clinical correlation, in carcinoma of the uterine cexvix-PhD thesis.
The Tamilnadu Dr MGR Medical university, Chennai 2003.
166
Chapter
7 Regulations and
Dose Limits
ATOMIC ENERGY ACT-1962

The primary legislation to regulate the use of ionizing radiation, in India is
the Atomic Energy Act,1962. The Act and the secondary legislation, viz.
Radiation Protection Rules 1971 (RPR-1971) provides necessary regulatory
infrastructure for effective implementation of radiation protection program.
The RPR-1971 was revised in 2004 and named as Atomic Energy (Radiation
Protection) Rules, 2004.
The Act empowers the Government of India to exercise control over
protection and the use of Atomic energy. It offers special provisions to
safety, under section 17 and powers to make rules under section 30 of the
Act. The Act envisage control over premises where radioactive substances
are handled or radiation generating equipments are operated. The Act
emphasizes safety while working with radiation. It deals with control over
possession, use, sale and transport of radioactive materials and cognizance
of offences. The legislation and various rules related to radiation protection
in medicine are listed below. Most of them are available in the form of
codes and guides:
1. Atomic Energy Act 1962 (33 of 1962)
2. Atomic Energy Regulatory Board, 1983
3. Atomic energy (Radiation protection) Rule 2004
4. Safe disposal of Radioactive Waste Rules, 1987
5. Radiation Surveillance procedures for medical applications-1989
6. AERB Safety code SC/MED-1, Telegamma therapy equipment and
installation, 1986
7. AERB Safety code SC/MED-2, Medical diagnostic X-ray equipment
and installations, 2001
8. AERB Safety code SC/MED-3, Brachytherapy sources, equipment and
installation, 1988
9. AERB Safety code SC/MED-4(rev.1), Nuclear medicine facilities, 2001
10. AERB Safety code SC/TR-1, Transport of radioactive material.
ATOMIC ENERGY REGULATORY BOARD

The Atomic Energy Regulatory Board (AERB), was constituted on
November 15, 1983, by the President of India by exercising the powers
conferred by section 27 of the Atomic Energy Act 1962 (33 of 1962). It is an
apex body that regulates the use of ionizing radiation in the country. The
AERB is entrusted with the responsibility of developing and implementing
appropriate regulatory measures aimed at ensuring radiation safety in
applications involving ionizing radiations. The board is fully empowered
to lay down standards and frame rules and regulations.
The chairman AERB is the competent authority, recognized by the
Government for enforcing provisions of radiation safety in the use of
ionizing radiation. AERB has jurisdiction over all the units of the department
of Atomic energy and all radiation installations in the country. The mission
of the board is to ensure that the use of ionizing radiation and nuclear
energy does not cause undue risk to health and environment.
The board covers the safety aspects of all areas of nuclear fuel cycle and
use of radiation in medicine, agriculture, industry and research and
transport of radioactive materials. The board is assisted by Health, safety
and environment group of BARC viz. Radiological physics and advisory
division (RPAD), advisory committees and task groups.
The major objectives of AERB is to develop and publicize specific codes
and guides, which will deal with the radiation safety aspects of various
applications of radiations. It will also issue authorization related to site,
design, manufacture, construction, commissioning, operation, maintenance,
and decommissioning and disposal of radioactive sources.
RADIATION PROTECTION RULES-2004

[Published in the Gazette of India: September 11, 2004]
Part-II-Section 3-Sub-section (I)
Government of India
Department of Atomic Energy
Mumbai, the 25th August, 2004
G.S.R. 303. In exercise of the powers conferred by Section 30 read with

section 3 and clause (i) and sub-clauses (c) and (d) of clause (ii) of Sub-
Section (1), Sub-section (4) of Section 14, and Sections 16, 17 and other
relevant Sections of the Atomic Energy Act (33 of 1962) and all other powers
enabling it in this behalf, and in supercession of Radiation Protection Rules
1971 except as respects things done or omitted to be done before such
supercession, the Central Government hereby makes the following rules,
namely:-
Rule 1. Short Title, Extent and Commencement

1. These rules may be called the Atomic Energy (Radiation Protection)
Rules, 2004.
2. These rules shall apply to practices adopted and interventions applied
168 with respect to radiation sources.
Regulations and Dose Limits
3. They extend to the whole of India.

4. They shall come into force from the date of their final publication in the
Official Gazette.
Rule 2. Definitions
Define the various terms and terminology used in the Atomic energy Act
and ARPR 2004.
Rule 3. Licence
1. No person shall, without a licence (a) establish a radiation installation
for siting, design, construction, commissioning and operation; and
(b) decommission a radiation installation.
2. No person shall handle any radioactive material, or operate any radiation
generating equipment except in accordance with the terms and
conditions of a license.
(Radiation installation in medicine includes the (i) the medical X-ray
equipments, (ii) radiation therapy equipments, and (iii) nuclear medicine
equipments. Any institution desire to start a radiation facility has to
obtain License, authorization, registration, consent from AERB).
3. A license shall be issued for sources and practices associated with the
operation of -
i. Nuclear fuel cycle facilities;
ii. Land based high intensity gamma irradiators other than gamma;
irradiation chambers;
iii. Particle accelerators used for research and industrial applications;
iv. Neutron generators;
v. Facilities engaged in the commercial production of radioactive material
or radiation generating equipment;
vi. Telegamma and accelerators used in radiotherapy;
vii. Computed tomography (CT) unit;
viii. Interventional radiological X-ray unit;
ix. Industrial radiography; and
x. Such other source or practice as may be notified by the competent
authority, from time to time.
Provided that for sources and practices associated with the operation of-
i. Brachytherapy;
ii. Deep X-ray units, superficial and contact therapy X-ray units;
iii. Gamma irradiation chambers;
iv. Nuclear medicine facilities;
v. Facilities engaged in the commercial production of nucleonic gauges
and consumer products containing radioactive material; and
vi. Such other source or practice as may be notified by the competent
authority, from time to time; an authorization shall be necessary. 169
i. Provided further that for sources and practices associated with the
operation of -
ii. Medical diagnostic X-ray equipment including therapy simulator;
iii. Analytical x-ray equipment used for research;
iv. Nucleonic gauges;
v. RIA laboratories;
vi. Radioactive sources in tracer studies;
vii. Biomedical research using radioactive material; and
viii. Such other source or practice as may be notified by the competent
authority, from time to time;
a registration shall be necessary.
Provided also that for -
i. Approval for siting, design, construction, commissioning and
decommissioning of a radiation installation;
ii. Approval for sealed sources, radiation generating equipment and
equipment containing radioactive sources, for the purposes of
manufacture and supply;
iv. Approval for package design for transport of radioactive material;
v. Approval for shipment approval for radioactive consignments; and
vi. Such other source or practice as may be notified by the competent
authority, from time to time;
consent shall be necessary.
4. The license shall not be transferable without the prior approval of the
competent authority.
Rule 4. Fees for License

The competent authority may prescribe by notification in the Official
Gazette, appropriate fees payable for issuance of license specified in these
rules.
Rule 5. Exemption
The use and disposal of an substance and materials which spontaneously
emit radiation not exceeding the level of radiation prescribed by notification
issued under clause (i) of Sub-section (1) of Section 2 of the Act and the
use of radiation generating equipment, devices or appliances emitting
radiation not exceeding the limit determined by the Central Government
under clause (g) of Section 3 of the Act, are exempted from the purview of
rule 3.
Rule 6. Exclusion
Exposures resulting from naturally occurring radionuclides present in
the human body, cosmic radiation at the earth surface, unmodified
170 concentrations of radionuclides in raw materials and from other sources
and practices which may be prescribed as not amenable for control, are
excluded from these rules.
Rule 7. Conditions Precedent to the Issuance of a License

1. An application for license shall be made to the competent authority by
an employer or a person duly authorized by him.
2. No license to handle radioactive material, or to operate radiation
generating equipment, shall be issued to a person unless, in the opinion
of the competent authority -
a. The application for such license is for purposes envisaged by the Act;
b. Documentation relevant to the license and complete in all respects is
submitted to the competent authority;
c. In respect of approval for siting, design, construction, commissioning
and decommissioning, of a radiation installation, the proposed
equipment, facilities and handling procedures afford adequate
protection during normal or intended operations;
d. The applicant has demonstrated compliance with the provisions of
the relevant safety codes and safety standards specified by the
competent authority; and
e. In respect of license for operation of a radiation installation.
i. All the requirements relating to safety specified by the competent
authority in the relevant safety codes and safety standards have
been satisfied in the construction of the radiation installation;
ii. Workers have appropriate training and instructions in radiation
safety, in addition to the appropriate qualification and training
required for performing their intended tasks;
iii.A Radiological Safety Officer is designated in accordance with
rule 19;
iv.Appropriate radiation monitors and dosimetry devices are
available with the applicant for purposes of radiation surveillance;
v. the equipment, facilities and handling procedures afford adequate
protection during normal operations, minimize occurrence of
potential exposures and enable appropriate remedial actions to be
taken in the event of an accident.
3. No type approval of sealed sources, radiation generating equipment
and equipment containing a radioactive source for the purpose of
manufacture and supply or package design approval for transport of
radioactive material or shipment approval for radioactive
consignment or any other approval as notified under third proviso to
rule 3, by the competent authority may be issued unless, in the opinion
of the competent authority, the applicant has demonstrated
compliance with the relevant safety codes and safety standards
specified by him.
171
Rule 8. Issuance of License

The license shall be issued within a period of one hundred and eighty days
from the date of receipt of the application subject to the condition that all
the requirements for issuance of the license have been duly fulfilled.
Rule 9. Period of Validity of License

Every license issued under rule 3 shall, unless otherwise specified, be valid
for a period of 5 years from the date of issue of such license.
Rule 10. Suspension, Modification or Withdrawal

of a License
The competent authority may -
i. If in its opinion, the licensee has contravened any of the provisions of
these rules; or
ii. Considers it to be necessary in public interest pertaining to radiation
safety; after giving a show cause notice to the licensee and also giving
him an opportunity to make a representation within a period of thirty
days from the date of receipt of the notice by him against the action
proposed to be taken and on consideration of his representation,
a. Suspend the operation of the license for a specified period of time; or
b. Revoke or modify the terms and conditions of the license.
Rule 11. Modification of Radiation Installation or

Change in Working Condition
No modification to an existing radiation installation or no change in working
conditions therein, affecting safety shall be done without the prior approval
of the competent authority.
Rule 12. Restrictions on Use of Sources
1. The licensee shall not handle any source:-
a. Other than those specified in the license;
b. For any purpose other than those specified in the license; and
c. In any location except as specified in the license.
2. The licensee shall ensure that individuals other than those who may be
specified in the license do not handle the source.
Rule 13. Restriction on Certain Practices

1. Practices such as deliberate addition of radioactive substances in
foodstuffs, beverages, toys, personal ornaments, and cosmetics or any
other commodity or product intended for ingestion, inhalation or
percutaneous intake by, or application to, a human being and sale, import
or export of such products shall not be permitted.
172 2. Activation of the aforesaid products shall not be permitted.
Rule 14. Radiation Symbol or Warning Sign

1. The radiation symbol or warning sign shall be conspicuously and
prominently displayed at all times -
a. On externally visible surfaces of radiation equipment, and containers
for storage of radioactive materials; packages for radioactive materials
and vehicles carrying such packages;
b. At the entrance to the room housing the radiation generating
equipment; and
c. At the entrance of controlled area and supervised area.
2. The radiation symbol shall not be used for any purpose other than those
mentioned in these rules.
3. The specification of the radiation symbol or warning sign shall be as
prescribed by the competent authority, by order for that purpose.
Rule 15. Dose Limits and Other Regulatory Constraints

The licensee shall ensure compliance with the dose limits and other
regulatory constraints specified by the competent authority by order under
these rules.
Rule 16. Safety Standards and Safety Codes

The competent authority may issue safety codes and safety standards, from
time to time, prescribing the requirements for radiation installation, sealed
sources, radiation generating equipment and equipment containing
radioactive sources, and transport of radioactive material and the licensee
shall ensure compliance with the same.
Rule 17. Prohibition of Employment of Persons below

Certain Age
1. No person under the age of 18 years shall be employed as a worker.
2. No person under the age of 16 years shall be taken as trainee or employed
as an apprentice for radiation work.
Rule 18. Classified Worker

The employer shall designate as classified workers, those of his employees,
who are likely to receive an effective dose in excess of three tenths of the
average annual dose limits notified by the competent authority and shall
forthwith inform those employees that they have been so designated.
Rule 19. Radiological Safety Officer

Every employer shall designate, with the written approval of the competent
authority, a person having appropriate qualifications as Radiological Safety
Officer.
173
Rule 20. Responsibilities of the Employer

1. Every employer shall:
a. Ensure that provisions of these rules are implemented by the licensee,
Radiological Safety Officer and other worker(s),
b. Provide facilities and equipment to the licensee, Radiological Safety
Officer and other worker(s) to carry out their functions effectively in
conformity with the regulatory constraints,
c. Prior to employment of a worker, procure from his former employer,
where applicable, the dose records and health surveillance reports,
d. Upon termination of service of worker provide to his new employer
on request his dose records and health surveillance reports,
e. Furnish to each worker dose records and health surveillance reports
of the worker in his employment annually, as and when requested by
the worker and at the termination of his service,
f. Inform the competent authority if the licensee or the Radiological
Safety Officer or any worker leaves the employment, and
g. Arrange for health surveillance of workers as specified under rule 25.
2. The employer shall be the custodian of radiation sources in his possession
and shall ensure physical security of the sources at all times.
3. The employer shall inform the competent authority, within 24 hours, of
any accident involving a source or loss of source of which he is the
custodian.
Rule 21. Responsibilities of the Licensee

1. The responsibility for implementing the terms and conditions of the
license shall rest with the licensee.
2. The licensee shall comply with the surveillance procedures, safety codes
and safety standards specified by the competent authority.
3. Every licensee shall establish written procedures and plans for
controlling, monitoring and assessment of exposure for ensuring
adequate protection of workers, members of the public and the
environment and patients, wherever applicable.
4. The licensee shall comply with the provision of rules for safe disposal of
radioactive waste issued under the Act.
5. Without prejudice to the generality of the above, the licensee shall
a. Not allow workers, other than those specified in sub-clause (ii) of clause
(e) of sub-rule (2) of rule 7 and already dealt with under rule 17.
b. Maintain records of workers as specified under rule 24;
c. Arrange for preventive and remedial maintenance of radiation
protection equipment, and monitoring instruments;
d. In consultation with the Radiological Safety Officer, investigate any
case of exposure in excess of regulatory constraints received by
174 individual workers and maintain records of such investigations;
e. Inform competent authority promptly of the occurrence, investigation

and follow-up actions in cases of exposure in excess of regulatory
constraints, including steps to prevent recurrence of such incidents;
f. Carry out physical verification of radioactive material periodically
and maintain inventory;
g. Inform appropriate law enforcement agency in the locality of any loss
of source;
h. Inform the employer and the competent authority of any loss of source;
i. Investigate and inform the competent authority of any accident
involving source and maintain record of investigations;
j. Verify the performance of radiation monitoring systems, safety
interlocks, protective devices and any other safety systems in the
radiation installation;
k. In consultation with Radiological Safety Officer, prepare emergency
plans, as specified in rule 33, for responding to accident to mitigate
their consequences and ensure emergency preparedness measures;
l. Conduct or arrange for quality assurance tests of structures, systems,
components and sources and related equipment;
m.Advise the employer about the modifications in working condition
of a pregnant worker;
n. Inform the competent authority if the Radiological Safety Officer or a
worker leaves the employment; and
o. Inform the competent authority when he leaves the employment.
6. The licensee shall ensure that the workers are familiarised with contents
of the relevant surveillance procedures, safety standards, safety codes,
safety aides and safety manuals issued by the competent authority and
emergency response plans.
Rule 22. Responsibilities of the Radiological Safety Officer

1. The Radiological Safety Officer shall be responsible for advising and
assisting the employer and licensee on safety aspects aimed at ensuring
that the provisions of these rules are complied with.
2. The Radiological Safety Officer shall:-
a. Carry out routine measurements and analysis on radiation and
radioactivity levels in the controlled area, supervised area of the
radiation installation and maintain records of the results thereof;
b. Investigate any situation that could lead to potential exposures;
c. Advise the employer regarding -
i. The necessary steps aimed at ensuring that the regulatory
constraints and the terms and conditions of the license are adhered
to;
ii. The safe storage and movement of radioactive material within the
radiation installation;
175
iii. Initiation of suitable remedial measures in respect of any situation

that could lead to potential exposures; and
iv. Routine measurements and analysis on radiation and radioactivity
levels in the off-site environment of the radiation installation and
maintenance of the results thereof.
d. Ensure that -
i. Reports on all hazardous situations along with details of any
immediate remedial actions taken are made available to the
employer and licensee for reporting to the competent authority
and a copy endorsed to the competent authority;
ii. Quality assurance tests of structures, systems, components and
sources, as applicable are conducted; and
iii. Monitoring instruments are calibrated periodically.
e. Assist the employer in -
i. Instructing the workers on hazards of radiation and on suitable
safety measures and work practices aimed at optimizing exposures
to radiation sources; and
ii. The safe disposal of radioactive wastes; and
iii. Developing suitable emergency response plans to deal with
accidents and maintaining emergency preparedness.
f. Advise the licensee on -
i. The modifications in working condition of a pregnant worker; and
ii. The safety and security of radioactive sources.
g. Furnish to the licensee and the competent authority the periodic
reports on safety status of the radiation installation; and
h. Inform the competent authority when he leaves the employment.
Rule 23. Responsibilities of Worker

1. Every worker shall observe the safety requirements and follow safety
procedures and instructions and shall refrain from any wilful act that
could be detrimental to self, co-workers, the radiation installation and
public.
2. The worker shall:-
a. Provide to the employer information about his previous occupations
including radiation work, if any;
b. Make proper use of such protective equipment, radiation monitors
and Personnel monitoring devices as provided; and
c. Inform the licensee and the Radiological Safety Officer, of any accident
or potentially hazardous situation that may come to his notice;
3. A female worker shall, on becoming aware that she is pregnant, notify
the employer, licensee and Radiological Safety Officer in order that her
working conditions may be modified, if necessary.
176
Rule 24. Records of Workers

1. Every licensee shall maintain complete and up-to-date records of -
a. personnel monitoring under Clause (b) of sub-rule (2) of rule 27, in
the format as specified by order by the competent authority; and
b. the health surveillance specified in rule 25.
2. Such records shall be preserved during the working life of each worker,
and afterwards until the worker attains or would have attained the age
of 75 years, or not less than 30 years after the termination of the work
involving occupational exposure whichever is later.
3. A worker shall have access to his personnel monitoring and the health
surveillance records.
Rule 25. Health Surveillance of Workers

1. Every employer shall provide the services of a physician with appropriate
qualifications to undertake occupational health surveillance of classified
workers.
2. Every worker, initially on employment, and classified worker, thereafter
at least once in three years as long as the individual is employed, shall
be subjected to the following -
a. general medical examination as specified by order by the competent
authority; and
b. health surveillance to decide on the fitness of each worker for the
intended task;
3. The health surveillance shall include -
a. special tests or medical examinations as specified by order by the
competent authority, for workers who have received dose in excess
of regulatory constraints; and
b. counseling of pregnant workers.
Rule 26. Medical Exposures

The licensee carrying out diagnostic or therapeutic work using radiation
generating equipment, sealed or unsealed sources, shall for optimizing the
medical exposure ensure that -
a. Performance of the equipment is verified periodically by appropriate
quality assurance tests;
b. Records are maintained for a period specified by the competent authority
of -
i. radiation doses received by therapy patients;
ii. activity administered to patients for diagnostic and therapeutic
purposes; and
iii.other relevant parameters.
c. The exposure of humans for biomedical research is carried out only on
healthy volunteers with their prior consent in writing. The methodology, 177
the number of volunteers and the radiation dose they are subjected to
shall be reviewed by the ethical review committee constituted by the
employer; and
d. Any accidental medical exposure is investigated and a written report is
submitted to the competent authority.
Rule 27. Radiation Surveillance Requirements

1. The competent authority may by order specify appropriate radiation
surveillance requirements and procedures and the employer and the
licensee shall comply with them.
2. Without prejudice to the generality of the foregoing provisions, such
radiation surveillance requirements and procedures may provide that -
a. the siting, design, construction, commissioning, operation, servicing
and maintenance and decommissioning of facilities involving the use
of radiation, and disposal of radioactive material shall be done in
accordance with the specifications laid down by the competent
authority in the relevant safety codes and safety standards;
b. the workers shall be subjected to personnel monitoring and health
surveillance and appropriate records shall be maintained;
c. transport of radioactive material in public domain shall be in
accordance with the procedures laid down by the competent authority
and in accordance with the other regulations pertaining to transport
by different modes; and
d. appropriate quality assurance requirements in the above.
Rule 28. Directives in the Cases of Exposures in Excess of

Regulatory Constraints
a. When, in the opinion of the competent authority, any worker has
exceeded the dose constraints, the competent authority may, without
prejudice to other course of action available, issue appropriate directives
for controlling further exposure and the employer shall comply with
the directives.
b. If a worker discontinues radiation work under the directives of the
competent authority issued under this rule, the employer shall assign
alternative work not involving exposure to radiation, until the competent
authority is satisfied about the fitness of the worker to resume radiation
work.
c. The employer shall comply with restrictions, if any, that the competent
authority may impose in this regard.
Rule 29. Power to Appoint or Recognize Persons or Agencies

The competent authority may, from time to time, appoint or recognize
178 persons or agencies having the qualifications and expertise, prescribed in
the relevant safety code, for the purpose of performing any of the functions
entrusted to them by the authority and for ensuring compliance with
radiological surveillance.
Rule 30. Inspection of Premises, Radiation Installations

and Conveyances
1. Any person duly authorized under Sub-section (4) of Section 17 of the
Act may, for the purposes of enforcement of these rules, inspect any
premises, or radiation installation, or conveyance.
2. The date and time of inspection may or may not be informed to the
employer or the licensee prior to the inspection.
3. The employer and the licensee shall extend all assistance to enable the
inspection to be carried out effectively and unhindered.
4. The findings of the inspection shall be forwarded to the licensee for
necessary corrective actions.
5. Inspection may be carried out at all licensing stages, namely, siting,
construction, commissioning, operation and decommissioning.
6. The person authorised to conduct inspection may
a. Inspect, from safety point of view, to ensure that the licensee has
fulfilled the radiological safety requirements for carrying out the
practices at the radiation installation as per the stipulations laid down
in the licence. This shall include -
i. Checking, whether the safety related structures, systems,
components and devices are of approved quality based, on the
relevant safety codes and safety standards specified by the
competent authority and that they are functioning as per the design
intent, checking that respective operating personnel are competent
to operate the facility;
ii. That the facilities are operating as per the approved technical
specification; and
iii. Conducting all such examinations (including verification of
relevant records) as may be considered necessary.
b. Make such tests and measurements as may be necessary for the
purpose of assessing radiation safety;
c. Investigate unusual incidents or accidents, if any, that had occurred
at the radiation installation and arrive at the reasons for the same and
recommend corrective measures;
d. Review and verify whether the corrective actions have been
implemented; and
e. Inspect radioactive consignments in any conveyance carrying
radioactive material and inspect any package containing radioactive
material.
179
Rule 31. Power to Investigate, Seal or Seize Radiation

Installation or Radioactive Material and to give Direction
to the Employer
1. Any person duly authorised under Section 17 of the Act, may, after
inspection, carry out investigation for the purposes of determining
contravention of any of the provisions of these rules;
2. The investigation may be carried out against a complaint or on suspicion
or after an unusual incident or accident;
3. The person authorised to investigate may -
a. Seal any radiation installation or any conveyance carrying radioactive
materials or seize any radioactive material or contaminated
equipment; and
b. Indicate in writing to the employer any recommendation aimed at
ensuring adequate protection and the licensee shall comply with the
same.
Rule 32. Directives in Case of Accidents

1. In the event of an accident involving the source or release of radioactive
material, the competent authority may -
a. Intervene and issue such directions as deemed fit and proper under
the circumstances in the interest of radiation safety and the employer
shall act as per the directions of the competent authority and shall
make every effort to mitigate the consequences of the accident, or
b. The competent authority may assign experts to give advice or render
assistance in mitigating the consequences of the accident and the
expenses incurred, if any, shall be reimbursed by the employer.
2. In the interest of safety of the radiation installation, workers, public and
the environment, the competent authority may issue such directions as
it may deem fit for ensuring safety including the immediate shutting
down of the radiation installation and the employer shall comply with
the directions.
Rule 33. Emergency Preparedness

1. The licensee shall prepare emergency response plans as specified by the
competent authority in the relevant safety codes and maintain emergency
preparedness.
2. The licensee shall submit the response plans for plant emergencies and
site emergencies to the competent authority for approval.
3. The licensee shall submit the response plans for off-site emergencies
prepared by the appropriate authorities to the competent authority for
review.
4. In respect of radiation installations governed by clause (a) of sub-rule
180 (3) of rule 3 and clause (b) of sub-rule (3) of rule 3, emergency response
plans shall be submitted to the competent authority prior to the

commissioning of the installations.
5. Any modification to the emergency plan shall require prior approval of
or review by the competent authority.
Rule 34. Decommissioning of Radiation Installation

1. When a radiation installation or radiation generating equipment ceases
to be in use, the employer shall ensure its decommissioning.
2. No employer shall decommission a radiation installation without the
prior approval of the competent authority.
3. The decommissioning plan shall take due cognizance of disposal of
radioactive wastes, recycling of materials, and reuse of equipment and
premises.
4. The licensee shall comply with such directive as may be issued by the
competent authority to ensure adequate protection of the persons in and
around the decommissioned installation.
Rule 35. Offences and Penalties

Any person who contravenes the provisions of these rules or any of the
terms and conditions of license issued hereunder, shall be punishable as
provided for under the Act.
[F.No. AEA/30(1)/2002-ER],V.P. RAJA. Jt. Secy.
REGULATORY CONTROLS FOR DIAGNOSTIC

X-RAY EQUIPMENT AND INSTALLATIONS
1. Design certification: Every medical diagnostic X-ray equipment shall
meet the design safety specifications stipulated in the safety code (SC/
MED/-2(Rev.1)).The manufacturer/vendor shall obtain design
certification from the competent authority prior to manufacturing the
X-ray equipment.
2. Type approval /No objection certificate: Prior to marketing the X-ray
equipment the manufacturer shall obtain a Type approval certificate from
the competent authority for indigenously made equipment. For
equipment of foreign make, the importing /vending agency shall obtain
a No Objection Certificate (NOC) from the competent authority, prior to
marketing the equipment. Only Type approved and NOC validated
equipment shall be marketed in the country.
3. Approval of layout: No X-ray unit shall be commissioned unless the
layout of the proposed X-ray installation is approved by the competent
authority. The application for approval shall be made by the person
owning responsibility for the entire X-ray installation.
4. Registration of X-ray equipment: Acquisition of an X-ray equipment,
by purchase, transfer, gift, leasing or loan, shall be registered with the 181
competent authority by the person acquiring the equipment.
5. Commissioning of X-ray equipment: No X-ray equipment shall be

commissioned unless it is registered with the competent authority.
6. Inspection of X-ray installations: The diagnostic X-ray installations shall
be made available by the employer/owner for inspection, at all
reasonable times, to the competent authority or its representative, to
ensure compliance with the safety code.
7. Decommissioning of X-ray installations: Decommissioning of X-ray
equipment shall be registered with the competent authority immediately
by the employer /owner of the equipment
8. Certification of RSO: Any person accepting assignment to discharge
the duties and functions of RSO in diagnostic X-ray installations shall
do so only after obtaining certification from the competent authority for
the purpose. Such certification shall be granted on the basis of adequacy
of the persons qualifications, experience and testing /survey / dosimetry
equipment available
9. Certification of service engineers: Only persons holding valid certificate
from the competent authority shall undertake servicing of X-ray
equipment. Certification shall be granted on the basis of qualifications,
training, experience and safety record of such person and availability of
servicing facilities.
Any person who contravenes the provisions of these rules or any
other terms or conditions of license/registration /certification granted
to him/her by the competent authority, shall be punishable under
sections 24,25 and 26 of the Atomic Energy Act,1962. The punishment
may include fine, imprisonment, or both, depending on the severity of
the offence.
Personnel Requirements
Every hospital shall have a qualified RSO (either full time or part time),
Radiologist, X-ray technologist and a service engineer. He should be
delegated with the responsibility of ensuring radiation safety applicable to
the installation. The minimum qualification and experience required are
given the safety code AERB/SC/MED-2 (Rev.1).
Personnel Responsibilities
Manufacturer
The manufacturer /vendor of the equipment shall make available to the
user the procedures to QA tests, exposure charts, operating manuals and a
copy of safety documents issued by the competent authority from time to
time, and maintenance facilities during useful life time of X-ray equipment.
In the case of CT scan, the manufacturer shall provide the required
phantoms for dosimetry and image quality checks.
182
Service Engineer
The service engineer undertaking services in a radiological installation shall
immediately report to the competent authority, about the equipment, which
is no longer safe for use. He should furnish brief description of the
equipment, its location, address, the name and address of the owner and
the nature of defects that make the equipment hazardous.
Employer
The employer should ensure the availability of qualified RSO and qualified
personnel for handling the X-ray equipment. He should also provide the
required equipments and facilities to discharge their duties. The employer
shall also be responsible for ensuring that personnel monitoring devices
are made available to the radiation workers.
The employer should ensure that persons handling medical X-ray
equipment are duly abide by the provisions of the safety code. He should
also ensure the availability of safety codes, issued by the competent
authority to the workers.
Radiologist
The radiologist shall undertake an X-ray examination on the basis of medical
requirement. He/she so conduct the examination as to achieve maximum
reduction in radiation dose to the patient while retaining all clinically
important information.
X-Ray Technologist
X-ray technologist and other attending staff shall ensure appropriate patient
protection, public protection and operational safety in handling X-ray
equipment and other associated facilities.
Student/Trainee
Medical students/trainees shall not operate X-ray equipment except under
direct supervision of authorized operating personnel.
Radiological Safety Officer (RSO)

The RSO assist the employer to fulfill the regulatory requirements,
applicable to that installation. He shall implement all radiation surveillance
measures, conduct periodic radiation protection surveys, maintain proper
records of periodic QA tests and personnel doses, instruct all workers on
relevant safety measures, educate and train new entrants, and take local
measures. This includes the issuance of administrative instructions in
writing, to deal with radiation emergencies.
The RSO shall ensure that all radiation measuring and monitoring
instruments in his custody are properly calibrated and maintained in good 183
condition. Suitable records of such surveys, including layout drawings,

dose mappings, deficiencies noticed and remedial actions taken, shall be
maintained for future follow up.
REGULATORY CONTROLS FOR NUCLEAR MEDICINE FA-

CILITIES
Consent
1. The consent for any practice involving radiation exposure is based on a
system of notification, registration, authorization, license or exemption
from regulatory control as established by the competent authority.
2. The consent is issued on the basis of written application. The consentee
shall ensure that persons handling radioactive materials for nuclear
medicine purposes are familiar with the mandatory provisions of RPR
2004. Radiation surveillance procedures for Medical applications of
radiation, 1989. Radiation surveillance procedures for transport of
Radioactive material, 1988, Atomic energy (safe disposal of radioactive
waste) rules 1987, and safety directives issued by the competent authority
from time to time, and other instructions of the competent authority in
specific cases. The consentee shall ensure compliance with the mandatory
requirements specified in the above documents.
3. The consentee shall designate with the approval of the competent
authority a person having suitable qualifications, to function as RSO.
Nuclear medicine facilities carrying out diagnostic in-vivo/in-vitro
investigations shall an RSO of level-II ,whereas facilities where therapy
is also carried out shall have RSO of level-III.
4. Authorization from competent authority is required to procure
radioactive material. The consentee shall be solely responsible for the
safety and security of the radioactive material, its proper use, and the
safe disposal of wastes. The consentee shall maintain an up to date
inventory and account for decay and disposal of sources.
5. The nuclear medicine facility shall not be commissioned until the
competent authority approves the facility. Any change or modification
to an already approved facility shall be carried out only with the prior
approval/sanction of the competent authority.
6. Transport of radioactive material in public domain shall be in accordance
with the provisions of code AERB/SC/TR-1.
7. The consentee shall not take the radioactive material out of the approved
premises. The consentee shall not lend, gift, transfer, or sell any
radioactive material and shall not receive radioactive material other than
those specified in the authorization.
8. Radioactive material shall not be disposed off without prior approval of
the competent authority.
184
9. Any person duly authorized by the competent authority may inspect

the nuclear medicine facility, the radioactive sources available in house,
the radioisotope inventory, logbooks, records of area monitoring and
contamination monitoring, instruments and devices used for the above
and / or quality assurance programme, records of unusual occurrences
during handling of the sources and transport of radioactive materials.
If, on inspection, any evidence of non compliance of any of the mandatory
provision is noticed, the inspectors may
a. Seal the institution or transport or conveyance carrying radioactive
materials or seize radioactive material or contaminated equipment,
and
b. Indicate in writing to the consentee any modification aimed at
providing adequate protection, and the consentee shall comply with
the same
10. The nuclear medicine facility shall be decommissioned only after prior
approval of the competent authority and after all radioactive and
contaminated materials from the facility. Prior approval of the competent
authority is necessary for reuse of the facility.
11. Any person who contravenes the provisions of these rules or any other
terms and conditions of approval granted to him/her by the competent
authority, shall be punishable under sections 24,25 and 26 of the Atomic
Energy Act, 1962. The punishment may include fine, imprisonment, or
both, depending on the severity of the offence.
Every nuclear medicine department shall have a qualified nuclear medicine
physician, nuclear medicine technologist, and a RSO either Level-II or Level-
III. The minimum qualification and experience required are given the safety
code AERB/SC/MED-4 (Rev.1).
Consentee
The consentee shall employ adequate number of personnel, provide
appropriate equipment and tools to concerned persons for safe handling
of radioactive material. He shall also provide personnel monitoring devices
to the radiation workers. He shall constitute a local safety committee to
review the operational safety, quality assurance, ethical aspects and
regulatory compliance. He should report the competent authority about
the safety committee, change in safety and unusual occurrence if any. He
should also ensure the availability of safety codes, issued by the competent
authority to the workers.
185
Nuclear Medicine Physician

i. The efficacy of new nuclear medicine procedures is based on the
experience of previous clinical trails, animal experiments and published
literature. Prior clearance from the nuclear medicine committee is
required for any trail.
ii. Prevent any possibility of misadministration and promptly report to
the consentee and the competent authority about misadnistration,
adverse reaction or death of a patient, administered with radioactivity
iii. A consent is obtained from the patient for all nuclear medicine
procedures. The patient should be informed about the safety measures,
to avoid radiation exposures to the family members.
iv. After administration of radioisotope, the patient should be kept under
isolation, if admitted to the hospital. Spread of contamination and
radiation exposure to others should be prevented.
v. The nurses and ancillary staff should be instructed about radiation safety
and precautions to be adopted during nursing the patient.
Nuclear Medicine Technologist

i. He should ensure proper functioning of all equipments, carry out
periodic calibration, QA checks and maintenance
ii. He should ensure the purity of radiopharmaceutical, route of
administration and the accuracy of dosage before giving to the patient.
He should also take precautions to avoid misadministration.
iii. Spillage of radioactivity or contamination of the patient, premises,
persons and material should be avoided.
iv. The RSO should be informed about any mishap in dispensing /
administration of dosage to the patient or any unusual incident. He
should also assist the RSO in maintaining the records of inventory, use,
waste disposal of sources and other safety matters.
Radiological Safety Officer (RSO)

The RSO assist the consentee to fulfill the regulatory requirements, and
ensure safety, security and containment of radioactive sources. He shall
carry out radiation and contamination monitoring of work areas, therapy
patients, patient areas, management of cadavers containing radionuclides,
radioactive waste disposal sites and public areas, and maintain record of
findings.
The RSO shall ensure that all radiation measuring and monitoring
instruments in his custody are properly calibrated and maintained in good
condition. He should capable of managing emergency situations, report
unusual incident in writing to the consentee and take remedial measures.
He should maintain records of the doses of workers, inventory of sources
186 received, used, disposed, any unusual incident, cause of such incident and
remedial measures taken.
Management of Cadavers Containing Radionuclides

1. All reasonable efforts should be made to remove fluids or organs in which
radionuclide is concentrated, provided the collective equivalent dose
received in the procedure will be less than that in handling the cadaver
as it is.
2. No special precautions are normally necessary for embalming, burial or
cremation of the corpse containing the quantities less than that specified
in the Table 7.1.
Table 7.1: Maximum activities of radionuclides for disposal of

corpses without special precautions
Radionuclide Postmortem / Burial, MBq Cremation, MBq
embalming, MBq
131
I 10 400 400
90
Y (colloid) 200 2000 70
198
Au (Colliod) 400 400 100
32
P 100 2000 30
89
Sr 50 2000 20
3. The following precautions shall be observed in respect of dead bodies

containing quantities more than that given in the above table:
i. Cremation: Prior authorization, and specific precautions to be
observed during cremation, shall be obtained from RSO.
ii. Burial: Relatives shall be prevented from coming into contact with
the body and people must not stay near the coffin. The hospital staff
and the persons involved in washing, preparing and transporting
the body to the burial ground shall be instructed by RSO on dose-
reducing precautions. The body shall be handled with disposable
gloves and kept on plastic sheets to control spread of contamination.
iii. Embalming: Embalming is undesirable and, if unavaiodable, shall
be done by injection method. All contamination control measures
shall be observed under the guidance of RSO.
4. Autopsy on contaminated cadavers shall be performed only in a special
autopsy room provided with facilities such as a plastic covered table,
water proof flooring, receptacles for organs, instrument cabinet and a
washing stand for pathologist. A refrigerator for keeping the cadavers
at temperatures below -10 degree shall be provided. The RSO shall
supervise autopsy procedures and subsequent decontamination
operations.
AERB Guidelines for Starting Radioisotope Laboratory

Radioisotopes in India can be procured and handled only by the users duly 187
authorized by AERB. This authorization is based on the radiological safety
status of the institution intending to establish a radioisotope laboratory.

For this purpose it is mandatory that the plan of the radioisotope laboratory
is approved by AERB from radiation safety standpoint. The plan of the
radioisotope laboratory will depend upon the type of the radioactive
material used, its physical from, activity and the type of experiments to be
carried out using the radioactive materials. In general, the minimum
requirement is of two rooms of suitable dimensions (adjacent to each other),
one for storage and handling of radioisotopes and the other for counting of
radioactive samples.
Based on the above, one should send to AERB, two copies of the layout
of the radioisotope laboratory (drawn to scale 1:50) indicating therein the
rooms meant for storage and handling of radioisotopes and counting of
radioactive samples. It should also indicate the dimensions of the rooms,
positions of the doors, windows, exhausts, fume hoods, workbenches and
other fixtures. A site plan (drawn to scale 1:500) of building should also be
sent marking clearly therein the location of radioisotope laboratory and
the occupancies around it including those above the ceiling and below the
floor, if any.
The institution is required to pay Rs. 750/- (for Govt. department,
University, Public Sector undertaking)/Rs.1500/- (for Pvt. Bodies) as charges
towards the approval of the plan. After approval of the plan and equipping
and furnishing the laboratory as per this guideline, the institution should
approach AERB for commissioning the laboratory for handling
radioisotopes and for issuance of authorization / NOC for procurement of
radioisotopes.
Further, the radioisotope laboratory has to be classified for regular
procurement of handling of radioisotopes. The classification will depend
upon the quantity of radioisotope used and the required handling facilities.
AERB Classification of Radioisotope Laboratories

The Atomic Energy Regulatory Board (AERB) proposes to classify
institution using unsealed radioisotope for non clinical applications in the
country and to specify the activities of the radioisotopes which can normally
be handled by each user institution. This classification will be broadly based
on the relevant recommendations of the International Commission on
Radiological Protection (ICRP) and International Atomic Energy Agency
(IAEA). Accordingly the radioisotopes have been arranged in four groups
based on their radio toxicity as per Annexure-I.
Based on the facilities available as per Annexure-II the institution using
radioisotope will be divided into three types, namely TYPE-I, TYPE-II and
TYPE-III laboratories. The maximum authorized limits of activities that
can be procured routinely from Board of Radiation and Isotope Technology
(BRIT), will depend on the classification of the laboratories and
188
radionuclides which can be handled at a time will also depend on whether

the operations are (i) simple wet, (ii) complex wet, (iii) simple drying, and
(iv) dry and dusty. Once the laboratories are classified, the supply of the
radionuclides within specified limits will be effected by BRIT, without
clearance for individual radionuclides from AERB, in most cases. The
recommended procedure for supply of radioactive material is given in the
enclosed Annexure-III. The table giving activities of radionuclides of
different group that can be procured and handled by each type of
laboratories is also enclosed in Annexure-IV. If two or more radionuclides
from the same group or different group are ordered, the quantities ordered
should be so adjusted that the overall limits are not exceeded. These
procedures will help in reducing the delay in the authorization and supply
of radionuclides available in India, to a considerable extent. However, this
will also involve more detailed accounting of radionuclides by the user
institution.
AERB Guidelines to Set Up a Radioimmunoassay (RIA)

Laboratory
Introduction
Radioimmunoassasy has been established as a versatile and unique
procedure. The advantage of this technique is that it does not involve
administration of radioisotopes to the patient and so no radiation exposure
to the patient. These assays are useful for the clinical evaluation of the
concentration levels of vitally important biological ingredients such as
hormones, vitamins, steroids, drugs etc., thereby enabling early diagnosis
of various diseases and better management of treatment. RIA work involves
the handling and use of very small quantities of radioisotopes, usually not
exceeding 3.7 MBq of lodine-125 and Tritium (3H). Radiation Protection
Rules (2004) promulgated under the Atomic Energy Act, 1962 requires that
the user should obtain authorization from Atomic Energy Regulatory Board
(AERB) for handling radioisotopes. Usually, these authorizations are issued
subject to the user satisfying the basic safety requirements and adequate
trained staff.
Minimum Facilities Required

The equipment and facilities normally available in a hospital or pathological
laboratory can be readily supplemented and used for RIA work. If ready-
to-use kits are employed, the manipulations are simple and do not result
in any significant radiation exposure to the working personnel. Normally
no personnel monitoring is required for persons working in RIA
laboratories. However, precautions should be taken to safeguard against
spread of contamination to the counting tubes and the counter itself. This
can be achieved to a large extent by good work practice. Any liquid waste 189
arising from the RIA procedure can be disposed off in the sink provided in
the storage area and the used RIA vials should be disposed off in such a
way as to avoid reuse. One of the suggested methods is to crush them
before disposal.
The personnel engaged in the actual work should have adequate
knowledge of the basic procedures of counting and should be aware of
some simple precautions to be taken in handling of radioactivity. A four
weeks training course on RIA and its Clinical Applications is conducted
normally twice a year by the Radiopharmaceuticals Division of BARC. For
further details, correspondence can be had with Head, Radiopharma-
ceuticals Division, BARC, Trombay, Bombay 400 085. If labeling with
radioiodine (involving use of a few millicuries of 125I) is contemplated, extra
precautions and facilities will be required.
Procedure for Authorization

As a first step the intending user should send two copies of the layout of
his proposed RIA laboratory to Head, Radiological safety division,
Anushaktinagar, Mumbai-400 094 for approval. The AERB may review the
layout, suggest modifications from radiation safety standpoint, which
should be implemented by the party and a revised plan submitted for final
approval. If found suitable from radiation safety point of view, one of the
copies of the layout will be duly approved and sent back by AERB to the
institution. When the laboratory is duly constructed and equipped with
fittings, fixtures and handling equipment and the qualified staff duly
appointed, AERB should be approached for issuance of NOC/authorization
for the procurement of RIA kits. If the information is in order and facilities
found adequate, AERB will issue the requisite NOC/ authorization. In India,
RIA kits are supplied by the Board of Radiation & Isotope Technology, Project
House, V.N.Purav Marg, Deonar, Mumbai-400 094 on the basis of the
authorization issued by AERB to the user. For import of kits, the intending
user has to obtain a No Objection Certificate from Head, RSD, AERB.
For all information pertaining to availability and use of RIA kits supplied
by BRIT, the user should correspond with Head, Radiopharmaceuticals
Division, BARC, Bombay 400085. For matters pertaining to planning of
RIA laboratory, issuance of NOC / authorization and commissioning /
decommissioning the RIA laboratory the user is advised to contact Head,
RSD, AERB, Mombay 400 094.
REGULATORY CONTROL FOR RADIOTHERAPY EQUIPMENT

AND INSTALLATIONS
Teletherapy Installation
1. Handling of a telegamma therapy source/equipment or Linear
190 accelerator shall be done only in accordance with the terms
and conditions of a license granted by the competent authority.

Compliance with the safety code is a prerequisite for the issuance of the
said license.
2. Telegamma therapy sources and equipment/linear accelerator shall meet
the design safety specifications stipulated in the safety code. The
manufacturer/vendor must obtain design certification from the
competent authority prior to marketing the Linear accelerator / tele
gamma therapy equipment.
A type approval certificate for the sources/equipment
manufactured in the country or a No Objection Certificate (NOC) for
the sources/equipment imported into the country, as the case may be.
3. The construction of the teletherapy insatallation shall be undertaken only
after obtaining prior approval from the competent authority for the room
design and equipment layout from the radiation protection point of view.
Any change in the parameters necessitating augmentation of radiation
shielding or modification in the approved plan shall be carried out only
with the concurrence of the competent authority.
4. The teletherapy installation shall be made available by the licensee for
inspection by the competent authority or its representative.
5. Decommissioning and disposal of Linear accelerator/Tele gamma
sources/equipments shall be undertaken with prior approval of the
competent authority.
6. The employer must ensure that persons handling Teletherapy/tele
gamma therapy equipment duly abide by the provisions of the safety
code and their further elaboration in various guides issued by the
competent authority. He must also ensure that any other measures of
safety as the competent authority may stipulate at any time in each
individual case are duly implemented without any delay.
7. Telegamma therapy sources shall not be transported in public domain
with out prior approval of the competent authority. The transport
requirement should comply the transport code AERB/SC/TR-1,1986.
8. Teletherapy/Tele gamma therapy sources/equipment shall be used only
in the premises authorized in the license. Sources should not be taken
out of the said premises for any purpose without the prior approval of
the competent authority.
9. Telegammatherapy/teletherapy equipments shall not be lent, gifted,
transferred, sold or disposed off by the licensee with out the prior
approval of the competent authority.
authority, shall be punishable under sections 24, 25 and 26 of the Atomic
Energy Act, 1962. The punishment may include fine, imprisonment, or
191
Brachytherapy Sources, Equipment and Installations

1. Handling of a Brachytherapy source shall be done only in accordance
with the terms and conditions of a license granted by the competent
authority. Compliance with the safety code is a prerequisite for the
issuance of the said license.
2. Brachytherapy sources and equipment shall meet the design safety
specifications stipulated in the safety code. The manufacturer/vendor
must obtain design certification from the competent authority prior to
marketing the teletherapy / tele gamma therapy equipment.
A type approval certificate for the sources /equipment manufactured
in the country or a No Objection Certificate (NOC) for the sources/
equipment imported into the country, as the case may be.
3. The construction of the brachytherapy installation rooms shall be
undertaken only after obtaining prior approval from the competent
authority for the room design and equipment layout from the radiation
protection point of view. Any change in the parameters necessitating
augmentation of radiation shielding or modification in the approved
plan shall be carried out only with the concurrence of the competent
authority.
4. The brachytherapy installation and its sources shall be made available
by the licensee for inspection by the competent authority or its
representative.
5. Decommissioning and disposal of Brachytherapy sources/equipments
shall be undertaken with prior approval of the competent authority.
6. The employer must ensure that persons handling teletherapy / tele
gamma therapy equipment duly abide by the provisions of the safety
code and their further elaboration in various guides issued by the
competent authority. He shall also ensure that any other measures of
safety as the competent authority may stipulate at any time in each
individual case , are promptly implemented.
7. Radioactive sources shall not be transported in public domain with out
prior approval of the competent authority. The transport requirement
should comply the transport code AERB/SC/TR-1,1986.
8. Radioactive sources shall be used only in the premises authorized in the
license. Sources should not be taken out of the said premises for any
purpose without the prior approval of the competent authority.
9. Radioactive sources shall not be lent, gifted, transferred, sold or disposed
off by the licensee with out the prior approval of the competent authority.
authority, shall be punishable under sections 24, 25 and 26 of the Atomic
Energy Act, 1962.The punishment may include fine, imprisonment, or
192
Every institution having a radiotherapy facility shall have qualified full
time Radiation therapist, Medical physicist, Technician (Radiation therapy),
Radiological safety Officer (RSO) Level-III and a service engineer. The
minimum qualification and experience required are given the safety code
AERB/SC/MED-1 and AERB/SC/MED-3.
The team comprising of radiation therapist, Medical physicist and Therapy
technicians shall carry out radiation therapy with due regard to patient
protection and operational safety in handling the tele-gamma therapy /
linear accelerator/Brachytherapy sources and equipment. However, the
ultimate responsibility of proper treatment shall vest with the radiation
therapist.
1. License: The responsibility of ensuring radiation safety, availability of
qualified personnel and providing them requisite facilities to discharge
their duties and functions shall rest with the licensee. He shall ensure
due compliance with the terms and conditions of the license issued to
him by the competent authority. Further he shall provide all necessary
facilities to the RSO to discharge his duties and functions.
2. Employer: The employer shall provide adequate number of personnel
and facilities to the licensee to discharge his responsibilities effectively.
It is the responsibility of the employer to inform the competent
authority if the RSO, the licensee or technologists leaves the institution.
3. Manufacturer: The manufacturer /vendor of the equipment shall
provide to the user the procedures to QA tests, operating manuals
and operation and maintenance details and a copy of safety documents
issued by the competent authority from time to time. The vendor shall
provide the central axis depth dose and isodose curves for single fields.
In the case of Brachytherapy, the vendor must provide the certified
strength and out put of each of the sources along with isodose curves.
4. Radiological safety officer (RSO): The RSO shall instruct all radiation
workers on relevant safety measures, educate and train new entrants,
implement all radiation surveillance measures. He shall control storage
and movement of sources in Brachytherapy and conduct periodical
surveys. He shall maintain proper records of the personnel doses,
conduct periodic radiation surveys and take suitable local measures,
including clear administrative instructions in writing, to deal with
radiation emergencies. The RSO shall ensure that all radiation
measuring and monitoring instruments are properly calibrated and
maintained in good working condition. All radiation workers should
be trained by the RSO in the management of radiation emergencies.
193
AERB Specification for the Layout of Radiotherapy Facility

To establish a Radiotherapy facility, the user institution must go through
the Regulatory requirements as mentioned in the Atomic Energy (Radiation
Protection) Rules, 2004 and AERB Safety Codes (AERB/SC/MED-1 and
3). No regulatory clearance is issued for establishing the radiotherapy facility
by AERB, unless the user complies with the regulatory requirements,
specified in these documents. The first step to establish a Radiotherapy
facility is to submit the layout plan of the radaition installation and get it
approved from AERB from radiation safety standpoint. It is advisable to
take services of experienced Radiation Oncologists, Medical Physicists, the
Supplier of Radiotherapy Equipments and Architects to prepare the layout
plan of the Radiotherapy facility. The room layout plans (to scale 1: 50) and
the site layout plan (to scale 1: 500) must be prepared and sent along with
the filled in proforma AERB/RSD/RT/PLAN to the Head, Radiological
safety Division, Atomic Energy Regulatory Board, Niyamak Bhavan,
Anushaktinagar, Mumbai-400094 for approval.
i. Plan approval: It is recommended to prepare the layout drawings (to
scale) as per the standard layouts prepared by AERB and submitted
to the Head, Radiological Safety Division, AERB for approval. The
standard layouts are prepared based on typical workload for various
facilities and for full occupancies around the installation from radiation
safety standpoint. The standard layouts are advantageous as they allow
structures to be built in future around the installations without any
modification.
ii. Site selection: The location of the radiotherapy installation should be
so chosen that it is away from unconnected facilities and is close to the
related facilities such as Simulator Room, Mould Room, Patient Waiting
Area, Treatment Planning System Room, Radiation Oncologist(s)
Room, Medical Physicist (s) Room etc.
iii. Construction material: The construction material to be used for
radiotherapy room should be concrete of density 2.35 gm/cc. However,
where structural requirements so demand, RCC may be used. In case
hematite concrete is used, the thicknesses may be reduced in inverse
proportion to the ratio of the densities.
iv. Viewing system: For observing the patient under treatment and the
gantry movement from the control room (in case of teletherapy)
appropriate viewing system must be provided. This can be achieved
by providing Closed Circuit TV System (CCTV). In addition a backup
arrangement must be made, which can be achieved by either having a
spare Closed Circuit TV System (CCTV) or by using mirrors and an
observation window of appropriate dimensions and at a convenient
height from the floor must be provided in the interloacked door for
observing the patient conveniently from the operators position.
194
v. Conduit: A conduit of 5 cm diameter should be provided in the wall

as shown in the standard drawings to enable cables of radiation
measuring instruments to pass through from the control room to the
treatment room. The conduit should be fixed in the specified wall at
an angle between 20 to 45 to the horizontal. The lower end of the
conduit should be located in the treatment room at a height between
15 cm to 20 cm from the inside finished floor level. Any conduit
required in the maze wall can be parallel to the floor at a height of
15 cm to 20 cm from treatment floor level.
vi. Door interlock: The door leading to the treatment room may be an
ordinary wooden door of width 150 cm. This door should be so
interlinked to the control panel by electrical interlocks that the unit
cannot be operated when the door is open. The door opening to control
room, which is provided to keep the control panel as well as the
treatment room secured, may be a collapsible grill door or any other
type as per requirement.
vii. Air conditioning: The treatment room should be air-conditioned. In
case central air-conditioning is to be provided in the radiation therapy
room, the ducts for central air conditioning should be taken along the
wall of the entrance door and left at the desired location without
making any opening on any wall. In case split air conditioners are to
be provided in the radiation therapy room, conduits of minimum
diameter consistent with the requirement and making an angle
between 20 to 45 with the horizontal should be provided. The
opening of these conduits in the treatment room should be at a height
about 1.5 m from the floor of treatment room. The details may be
finalized in consultation with AC Engineers. Altoght it is not common
nowadays, if window air-conditioning is to be provided in the radiation
therapy room, it must be provided on the secondary walls(not on the
primary wall) in case of teletherapy installation. Moreover, the lower
end of the openings should be located at a minimum height of 250 cm
from the floor level outside and should further be covered with a baffle
arrangement. The thickness of the baffle must not be less than 30 cm
of concrete and width of the baffle and the length of its vertical portion
should be such that 30 cm wide overlap is available all around the
openings. The dimensions should be the minimum required for fixing
the air conditioners. The length may be decided in consultation with
the firm installing the air conditioners and should be such as to permit
efficient functioning of the air conditioners. In the case of accelerator
installations special ventilation arrangements are required. It is
desirable that the control room is also air conditioned. Air conditioners
for the control room may be located anywhere in its brick walls as per
convenience.
195
viii. Warning lights: A red warning light should be provided above the
interlocked door and should be so interlinked to the control panel that
the light glows when the source is in the ON position.
ix. Other requirements: Electrical ducting requirements and also any pit,
load specifications, conduit etc. should be decided in consultation with
the firm installing the unit, before commencement of the actual
construction work.
x. Construction restraints: It may be necessary for the installation of the
unit that some portion of the wall or ceiling be constructed after
bringing the crates carrying the unit into the treatment room. This
may be decided in consultation with the firm installing the unit. It
may also be ensured from the supplier of the unit before starting
construction work that the maze/labyrinth provided in the drawing
is adequate for the movement of the various components of the
radiotherapy unit with or without crates.
xi. Associated facility: Associated and supporting facilities of the
radiation therapy department include simulator room, treatment
planning system room and mould room, doctors room, physicists
room, examination room, etc. relative to the radiotherapy room.
The institution must show all these facilities in the installation site plan.
xii. Ramp: In case of Telecobalt installations, a ramp may be provided in
close proximity to the teletherapy installation to facilitate easy
movement of the crates carrying the unit to the teletherapy room.
The ramp is also useful in future during source replacement
operation, which is to be carried out once in every 5-7 years. For this
work, a new cobalt-60 source is brought in a transport container
weighing 2-3 tons. This container is to be unloaded from a truck and
taken into the telecobalt room. The height and slope of the ramp should
be so adjusted that the transport container can be unloaded with ease
from the truck and transported into the teletherapy room on a suitable
trolley.
xiii. Beam stopper: In certain instances, it is difficult to meet the shielding
requirements of a teletherapy installation due to structural and space
constraints. This situation may arise when (i) a teletherapy unit is to
be installed in an existing room, (ii) a stationary telecobalt unit in an
existing installation is to be replaced by a rotational telecobalt unit or
(iii) a telecobalt unit is to be replaced by an accelerator. This difficulty
can be circumvented by installing a teletherapy unit with a beam
stopper. The beam stopper completely intercepts the primary beam
and reduces its intensity approximately by a factor of 1000 and thereby
decreases the shielding requirements for the primary barrier.
xiv. Starting construction work: No construction work should be
undertaken by the institution unless prior approval of AERB for the
196 specific layout of the installation has duly been obtained by the
institution.
DOSE LIMITS
Several scientific groups provide information and recommendations
concerning radiation safety. These groups include the National Council on
Radiation Protection (NCRP), the International Commission on Radiological
Protection (ICRP), the International Atomic Energy Agency (IAEA), and
the American National Standards Institute (ANSI). Scientists with these
agencies have determined acceptable dose limits for the radiation worker.
No clinical evidence of harm would be expected in an adult working within
these limits for an entire lifetime. Committees of scientists in the field of
radiation science and biology periodically review the literature and, if
indicated, recommend changes in the dose limits. These groups provide
only recommendations without the force of law and do not enforce or
establish radiation safety policy.
Dose Philosophy
The aim of radiation protection should be to prevent deterministic effects
and to limit the probability of stochastic effects to levels deemed to be
acceptable. This could be achieved, (i) by setting limits well below threshold
dose to deterministic effects, and (ii) the probability of stochastic effects
could be reduced by limiting exposures As Low As reasonably achievable
(ALARA). In order to minimize the biological effects associated with
radiation, dose limits and administrative control levels have been
established. As a general approach, three principles designed to control
radiation exposure are, ICRP-60 (1990);
The Justification principle
The Optimization principle
The Dose limitation.
a. Justification
All exposure either diagnostic or therapeutic shall be under taken
only if the benefit gained out weighs the detriment.
No practice shall be adopted unless it produces a net positive benefit.
b. Optimization
All exposures which are justified shall be under taken with a minimum
possible dose.
Every effort shall be taken to reduce the dose to As Low As Reasonably
Achievable (ALARA), taking into account the economic and social
considerations.
c. Dose limits
The equivalent doses to individuals result in from above practices
should be subjected to dose equivalent limits.
These are aimed at ensuring that no individual is expected to radiation
risks that are judged to be unacceptable from these practices in normal
circumstances. 197
The Tables 7.2 and 7.4 list the ICRD and NCRP dose limits for various
applications of radiation, followed by Government of India (AERB) dose
limits.
Table 7.2: Dose limits (ICRP -60,1990)

Application Occupational, mSv/year Public, mSv/year
Effective Dose (Based 20* (50 mSv annual 1 (if needed, higher
on stochastic effects) effective dose limit and values provided that the
100 mSv in 5 y cumulative annual average over 5 y
effective dose limits) does not exceed 1 mSv)
Eye Lens (Based on 150 15
deterministic effects)
Skin (skin 100 sq.cm) 500 50
(Based on deterministic
effects)
Hands, and feet (Based 500 50
on deterministic effects)
Fetus 2, after diagnosis
*Averaged over any 5 consecutive years. The maximum effective dose limit is 50
mSv/ year
Note: 1mSv= 100 mRem
Table 7.3: Dose limits,(NCRP-91,1987)

Application Occupational, mSv/year Public, mSv/year
Effective Dose 50 1
Eye Lens 150 50
All others (Skin, extremi- 500 50
ties, breast,lung, etc.)
Embryo-Fetus 5, (0.5 mSv per month)
Dose limits
(AERB, Government of India, 2001)
Workers
1. The cumulative dose over a block of five years shall not exceed 100 mSv
2. The effective dose in any calander year during a five year block shall not
exceed 30 mSV.
3. a. The equivalent dose in any calendar year to the lens of the eye shall
not exceed 150 mSV.
b. The equivalent dose in any calendar year to the skin,the hands and
198 feet shall not exceed 500 mSv.
4. In case of women worker of reproductive age,once pregnancy has been

established, the conceptus shall be protected by applying a
supplementary equivalent dose limit to the surface of the womens
abdomen (lower trunk) of 2 mSv for the remainder of the pregnancy.Internal
exposures shall be controlled by limiting intakes of radionuclides to about
1/20 of ALI. The employment shall be of such type that it does not cary
a probability of high accidental doses and intakes.
Trainess
5. The effective dose in any calendar year shall not exceed 6 mSv.
Public
6. The effective dose in any calendar year shall not exceed 1 mSv.
7. In special circumstances, a higher value of effective dose is allowed in a
single year, provided that the effective dose averaged over a 5 year period
does not exceed 1 mSv/y.
Why the Public Dose Limits is less?

For a variety of reasons, dose limits for the general population are set lower
than those for radiation workers. Justifications for this approach include
the following:
The public includes children who might represent a group at increased
risk and who may be exposed for their whole lifetime.
It is not the decision or choice of the public that they be exposed.
The public is exposed for their entire lifetime; workers are exposed only
during their working lifetime and presumably only while on the job.
The public may receive no direct benefit from the exposure.
The public is already being exposed to risks in their own occupations.
The public is not subject to the selection, supervision, and monitoring
afforded radiation workers.
Dose Limits to Patients

Dose limits do not apply for radiation exposure of patients, since the
decision to use radiation is justified depending upon the individual patient
situation. When it has been decided that a medical procedure is justified,
the procedure should be optimized. This means that the conditions should
achieve the clinical purpose with the appropriate dose. Safe limits are
determined only for the staff and not for patients.
Radiation Limits for Shielding Design

NCRP 1993, recommends a fraction of one-half of that effective dose (E)
value, or 5 mSv /y, and a weekly shielding design limit of (P) of 0.1 mGy 199
air kerma for controlled areas. In case of uncontrolled areas the effective
limit shall not exceed 1 mSv/y. This recommendation can be achieved for
the medical radiation facilities with a weekly shielding design limit of 0.02
mGy air kerma for uncontrolled areas.
In the United Kingdom, a design dose limit of 6 mSv/y is used for controlled
areas. If no special procedures are to be performed, then the dose will be
distributed evenly throughout the year and the weekly dose limit will be
(6 50) 0.12 mSv week1. For public areas a design limit of 0.3 mSv/y is
used, or (0.3 50) 6 Sv week1. Depending on local regulations, other
limits may be applied and different barrier thickness may be calculated.
Annexure-I
Classification of Isotope
(According to Relative Radio-toxicity per Unit Activity)
Annexure-II
Criteria for grading laboratories
Type-I (Simple)
A simple chemical laboratory with good ventilation

200 Two rooms, one for handling and one for counting
Contamination Monitor
Ordinary storage (with security)
Sink ordinary
Table surface to be covered with smooth non-absorbent material
Remote handling tongs
Propipettes / Remote pipettes
Foot operated dustbins.
Type-II (Medium)
Three rooms/more storage, preparation and one/more handling rooms
Special table, floor and wall surfaces
Proper ventilation
Storage safe concrete/steel/lead
Stainless steel sink (elbow/foot operated tap)
Fume-hood with special exhaust system
Contamination Monitor & Radiation Surveymeter
Personnel Monitoring Badges
Planned radioactive waste disposal methods
Face mask, Glove box, Surgical gloves
Remote handling tongs
Propipettes / Remote pipettes
Type-III (Stringent)
Large-scale laboratory multiroom complex with clear segregation of areas based
on use, scale and type of operation with the radioisotopes, the actual facilities
required by the user will be determined. A general list is given below
Special table, floor and wall surfaces
Proper ventilation
Storage safe concrete/steel/lead
Stainless steel sink (elbow/foot operated tap)
Fume-hood with absolute filter incorporated near the junction of hood and
ventilation duct
Contamination Monitor and Radiation Surveymeter
Air/Alarm monitor
Foot, Hand and clothing monitor
Pocket monitor
Whole Body Counter
Personnel Monitoring Badges
Bioassay
Dilution and Distribution room
Decontamination room
Respirators
201
Shoe barrier
Master-Slave manipulator
Planned radioactive waste disposal methods
Annexure-III
Required procedures for expeditious supply of radioactive
material for research users handling unshielded sources
1. Specify the nature and quantity of radionuclides available with your department
/ institution on the date of placing orders for radionuclides with the Senior
Manager, Technical Co-ordination & Logistics, Board of Radiation & Isotope
Technology (BRIT), V.N.Purav Marg, Deonar, Mumbai 400 094.
2. Specify clearly the type of operation with radionuclide to be procured (eg. simple
dry operation, complex wet operation, normal chemical operation etc.) At the
time of ordering for the radionuclide with BRIT/requesting No Objection
Certificate (NOC) for importing the radionuclide.
3. All orders/requests for NOC of radionuclides should be routed through the
Head of the institution/department, specifying clearly therein the name of the
authorised person(s),who will be handling the radionuclides and the department,
in which the sources will be handled.
4. The institution shall ensure that all radiation workers in laboratories handling
or are likely to get exposed to radiation from radionuclides other than H-3, C-14
and S-35 wear individual personnel monitoring badges. These can be had from
the Head, Personnel Monitoring Section, CTCRS, BARC, Anushaktinagar,
Mumbai 400 094.
5. The institution/department is recommended to evolve an efficient record
keeping system in respect of radionuclides stored/handled, date of procurement
of radioisotope along with activity on that date, purpose of use, mode of disposal,
person(s) handling, etc. This shall be made available to the officials of this
Division while conducting the radiation protection survey of the laboratory for
verification.
Annexure-IV
Classification of research institutions using unsealed sources
Group of Prescribed limit for handling radionuclides

radionuclide * Type-I Type-II Type-III
I 5 Ci 5 mCi > 5 mCi

II 50 Ci 50 mCi > 50 mCi
III and IV 500 Ci 500 mCi > 500 mCi
202
Modifying factors according to type of operation
Type of operation Example Modifying factor
Normal chemical operations Analysis, simple chemical 1.00

preparations
Complex wet operations With risk of spills 0.10
Simple dry operations Manipulation of powders and volatile 0.10
radiioactive compound
Dry and dusty operations Grinding 0.01
BIBLIOGRAPHY
1. AERB safety code: Brachytherapy sources equipment and installations, AERB/
SC/MED-3.
2. AERB safety code: Medical Diagnostic X-ray equipment and installations:
AERB/SC/MED-2 (Rev.1).
3. AERB safety code: Nuclear medicine facilities, AERB/SC/MED-4(Rev.1).
4. AERB safet0y code: Telegamma therapy equipment and installations, AERB/
SC/MED-1.
5. Atomic energy (Radiation protection) Rules, 2004:Published in the Gazette of
India: September 11, 2004.
6. International commission on radiological protection,1990 Recommendations
of the ICRP, Publication 60, Pergamon press, Oxford (1991).
7. National radiological protection Board, Doses to patient from medical x-ray
examinations in the UK: 2000 review, NRBP-W14, Chilton (2002), 1.
203
Chapter
8 Personnel Protection
DIAGNOSTIC RADIOLOGY
The personnel working in the radiological departments should receive
exposures well below the regulatory limits on the lines of ALARA principle.
Hence the training, equipment and work practices are so designed to
minimize the time with radiation sources. It should also maximize the
distances between the worker and radiation sources, and provide the use
of appropriate shielding when working with radiation sources, including
the patient. Hence, sufficient protective devices should be offered to the
personnel. In addition, there are certain personnel requirements,
responsibilities, to be adhered to achieve complete safety. This safety should
cover all the personnel including staff, patient and public.
RADIOGRAPHY
Protective Devices
Personnel protection may be achieved by using several protective devices
and adopting good work practices. These devices should include lead apron,
thyroid shield, gonad shield and lead glass, ceiling mounted barriers etc.
especially in radiography and fluoroscopy imaging. All individuals working
in the radiation room must wear a lead apron, when the X-ray tube is
operated.
Lead Apron
The lead apron should have a lead

equivalent thickness of 0.25-0.5 mm.
Usually it is made up of rubber material to
provide flexibility and handling (Fig. 8.1).
Aprons protect the torso of the body and
are available wrap around designs. This is
to protect the back side when the worker
is exposed to scattered radiation. The
attenuation offered by the lead apron is as
follows:
0.25 mm: >90% scattered radiation is
attenuated Fig. 8.1: Lead apron
Personnel Protection
0.5 mm: 95-99% scattered radiation is attenuated.

Though higher thickness aprons offer greater protection, it weighs 50-
100% more than the 0.25 mm thickness. It is a great matter of concern in
fluoroscopy. The weight of the apron become the limiting factor in the ability
of the radiologist and other workers to complete the examination. There
are some design(Skirt-vest) which put much weight on the hips instead of
the shoulders. The lead aprons do not cover the arms, lower legs, the head
and neck, thyroid and eyes.
Thyroid Shield and Lead Glass

Personnel can wear thyroid shield and lead glasses for protection in the
imaging room. The thyroid shield (Fig. 8.2A) is made up of lead and wraps
around the persons neck. It offer protection similar to that of lead apron.
Lead glasses attenuate the X-rays about 30-70%, depending upon the content
of the lead. Hence, the weight is a major concern in the lead glass. Normal,
lead glasses used in the hospital may offer 20% attenuation. Protective
gloves made up of 0.5 mm lead thickness, may offer protection to the hands
(Fig. 8.2B).
A B
B
Figs 8.2A and B: Thyroid shield and protective gloves
Ceiling Mounted Barriers

Ceiling mounted barriers are used in cardiac catheterization laboratories
and interventional imaging works. These devices are placed between patient
and the personnel in the room. The ceiling mounted system is counter
balanced and easily positioned. Lead glass or leaded acrylic shields are
transparent and often provide greater attenuation than lead aprons.
Organ Shield
Whenever required, suitable shielding material should be used to shield
the organs of interest or critical organs. For example when limb (hand) is 205
X-rayed lead apron may be provided to the

patient. Similarly gonadal shield (Fig. 8.3)can be
provided to the patient to protect the gonads
from primary beam. The gonad shield should
have a lead thickness of 0.5 mm of lead. Shields
should not interfere with the anatomy under
investigation. The use of gonad shield can
reduce the absorbed dose in the testes by up to
95%, while the reduction of absorbed in the Fig. 8.3: Gonad shield
ovaries, can be about 50 %.
The eyes should be shielded for X-ray examinations involving high
absorbed doses in the eyes, such as conventional petrous bone tomography.
This is very important when multiple X-ray examinations are needed.
Absorbed dose in the eyes can be reduced by 50-75 % by shielding the
eyes. The use of the posterior-anterior projection rather than the anterior-
posterior projection can reduce the absorbed dose in the eyes by 95 %.
Work Practice
Occupancy in the Room

Only persons whose presence is necessary should be in the imaging room
during the exposure. Overcrowding should be avoided. All such persons
must be protected with lead aprons/shields. The X-ray room shall be kept
closed during the radiation exposure.
Assistance to Patients
Holding of children or infirm patients for X-ray examination shall be done
only by an adult relative or escort of the patient. Hospital personnel should
not hold the patients during imaging procedure. No person should routinely
hold patients during diagnostic examinations, certainly not those who are
pregnant or under the age of 18 years. Such persons shall be provided with
protective aprons and gloves. Immobilization devices (Mechanical
supporting or restraining devices) shall be used to prevent movement of
children during exposure. In no case shall the film of X-ray tube be held by
hand. In no instance shall the holders body be in the useful beam, and
should be as far away from the primary beam as possible.
Protection in Radiography
The goal of diagnostic radiology is to have optimal balance between image
quality and dose to the patient. Any request for X-ray imaging needs to be
justified, on benefit vs risk point of view. When complex examinations
involving X-rays are referred, one has to find the truthfulness of the
206 reference. There is a need for standardization of techniques and procedures
and optimization of protection measures.
Equipment and Peripherals

Patient dose can be reduced by selecting optimal equipment and its
peripherals. Constant potential / High frequency generator can reduce dose
significantly. The other methods are use of fast screen-film combination
(e.g. rare earth, 400 speed for pediatric), low attenuation (e.g. carbon fiber)
materials for cassette fronts, antiscatter grid interspacing and table tops
and grid removal etc.
Tube Voltage (kVp)

Increasing kVp result in greater transmission of X-rays through the patient.
This means that the absorption is lesser in the patient even though the
exposure / mAs is higher. The best way to reduce patient dose is reduction
of mAs. But this will reduce the image contrast due to higher effective energy
of the X-ray beam. Hence, one has to balance between patient dose and
image contrast. As a rule of thumb, patient exposure can be reduced by
using a higher kVp and lower mAs.
Filtration
A filter is a metallic sheet introduced in the path of X-rays in order to reduce
patient dose. Diagnostic X-ray consists of both low and high energy X-
rays. The high energy X-rays transmit through the patient and contribute
to the image formation. Whereas the low energy X-rays are absorbed in the
first few cm of tissue, there by increasing the radiation dose to skin. Filtration
can remove selectively low energy X-rays, and there by reducing patient
dose and skin injuries. As the filtration is increased, the beam become
hardened and decreases the image contrast. Filtration also decreases tube
output and hence an optimal filtration is required for each X-ray unit. The
recommended beam filtration is follows:
i. General radiography
1.5 mm Al below 70 kVp
2.0 mm Al between 70 and 100 kVp
2.5 mm Al above 100 kVp.
ii. Mammography
Be 1 mm + Mo 0.03 mm (Mo target)
Be 1 mm + Rh 0.025 mm (Rh target).
In mammography, Mo target with Rh filter is commonly used. Whereas
Mo can not be used as filter in mammography X-ray tubes with Rh targets.
Field Area
Reduction of the field size by collimation is another important dose
reduction technique. Hence, minimal field size to cover the patient volume
is sufficient. Field size reduction reduces the scatter there by reducing the
dose to adjacent organs. The scatter incident on the detector also decreases, 207
resulting in improved image contrast. Hence, the rule of thumb is use

smallest possible field size and good collimation(Fig. 8.4A and 8.4B).
208 Figs 8.4A and B: Field size and dose reduction

The decrease in X-ray field size also reduces the total radiation energy
delivered to the patient, and therefore the mass of the skin and internal
tissues irradiated. In radiography projections, the gonads should be kept
outside the X-ray beam by carefully adjusting the X-ray field. When the
testes are located just a few centimeters outside the X-ray field edge, the
absorbed dose in the testes can be one-fourth or less of that when testes are
in the field (Fig. 8.5).
Fig. 8.5: Change in absorbed dose in testes with distance

between edge of the X-ray field and testes
Source to Object Distance

The radiation intensity from a point source varies inversely as the square
of the distance from the source. Increasing the source to object distance
(SOD) and source to image distance (SID), will reduce the patient dose. As
the SOD/SID is increased there is a reduced beam divergence, which reduce
the volume of patient irradiation. This will enable us to decrease the integral
dose. Increased SOD also facilitate reduction of patient exposure due to
tube leakage, since the tube is away from the patient. Where as decrease of
SOD, increases the radiation intensity sharply at the surface of the patient
(Fig. 8.6).
In radiography and fluoroscopy with stationary X-ray equipment, the
SOD should be not less than 45 cm. When the SID is less than 100 cm, the
quality of the diagnostic information becomes poorer, there fore longer
SID has clinical advantages. Photofluorography and radiography of the
chest should be performed with a SID of at least 120 cm. In the case of
C-arm units fixed SID is used, therefore increase of SOD is the only way of 209
reducing patient dose. Hence in fluoroscopy minimum distance between

source and the patient must be not less than 30 cm.
Fig. 8.6: Dependence of absorbed dose in the skin on the distance from the
X-ray source; the skin to image receptor distance is constant at 25 cm
Carbon Fiber Materials

The use of carbon fiber materials for the patient support, in anti scatter
grids and for the radiographic cassette face, in place of conventional
materials, allows transmission of a larger proportion of the X-ray beam. At
an X-ray tube voltage of 80 kV, the use of carbon fiber materials enables the
absorbed dose in the skin of the patient to be reduced. The overall reduction
of absorbed dose in the skin of the patient facing the X-ray tubes, from the
combined use of carbon fibre materials in patient supports, anti scatter grids
and radiographic cassettes, is in the range of about 30 % to more than 50%.
If the X-ray tube voltage is not changed, the percentage reductions in
absorbed dose in deeper tissues will be similar.
Image Receptors
The speed of the image receptor determines the number of X-ray photons
necessary to produce an optimal image signal. This is directly related to
the patient dose. Higher speed (400) system require less exposure to produce
the same optical density, and decreases the patient dose. Faster film
increases the quantum mottle and faster screen (thick) decreases the spatial
210 resolution. Thus, higher speed film-screen reduces the patient dose, but
limited by image quality.
Computed radiography (CR) uses photostimulable storage phosphor

(PSP) detectors and the digital radiography (DR) receptors have wide
latitude. These systems allow post processing methods, to manipulate image
density for optimal viewing. They compensate for under or over exposure
and reduce retakes. Under exposed images are associated with
high quantum mottle and poor contrast resolution. Over exposed
images contribute higher patient dose. The PSP receptor system is
equivalent to 200 speed screen-film system in terms of quantum mottle
and noise for adult abdomen and chest radiography. In the case of
extremities imaging, the CR should be used at higher exposure levels (e.g.
speed 75-100). Whereas in pediatric imaging increased speeds (e.g. 400) is
recommended.
Conventional screen-film has inherent safety feature. If high kV is used
the film becomes over dark, there by increasing the patient dose. One can
easily identify this and carry out necessary remedial measures. In digital
image receptors, one can not notice this adverse effect on image quality,
since it is adjusted in post processing. Therefore, higher patient exposures
may go unnoticed. Hence, digital image receptors require strict quality
assurance check.
Image Intensifier
The image intensifier has wide dynamic range and the entrance exposure
is controlled by light limiting aperture or electronic of the subsequent
detector (e.g. TV camera).The entrance exposure is 1mR per image in
fluoroscopy, and 4 mR per image for digital subtraction angiography. Any
reduction in exposure is limited by quantum mottle.
Patient Positioning
The collimator is adjusted to exclude radiosensitive organs such as gonads,
breast and eyes (Fig. 8.7).
Patient Motion
Patient motion is a matter of concern in diagnostic imaging. It may cause
motion artifacts, which may increase repeat X-rays. This will increase the
patient dose. To reduce patient motion (i) short exposure times, (ii) use of
immobilization or sedation, (iii) entertainment, or distracting devices should
be applied and adopted. In addition, reduction of repeat films can also
reduce patient dose significantly. Hence, the film reject rate due to all causes
should be kept below 5%. Proper instruction to the patient, checking
the factors before exposure, proper darkroom procedure, and periodic
maintenance of automatic processors may also help to reduce repeat
X-rays and patient dose.
211
Figs 8.7A and B: (A) Wrong positioning, and (B) correct positioning
PROTECTION IN FLUOROSCOPY
Fluoroscopy imaging contributes large portion of dose in medical imaging
due to continuous X-ray production and real time image output. Though
the exposure technique are moderate (3 mA, 80 kVp), the examination on
time extend from minute to hours. Cini angiography studies employ high
exposure rates of 20 to 70 R /min with short exposure times. Some systems
have turbo mode where the exposure rate may exceeds 20 R/min and hence
this mode should be used judiciously. The patient dose also depends upon
the angulation of the beam through the patient. Exposure rates are greater
in lateral examination than that of anteroposterior. For example, a
fluoroscopy imaging involves a technique of, 2 mA, 80 kVp,10 min on time,
delivers an exposure of 6 R at 1 m. Then the skin entrance exposure will be:
2
100
Entrance exposure = 6 = 67 R
30
Thus, in fluoroscopy the entrance dose is higher. The entrance exposure
of various imaging systems like Radiography, fluoroscopy and CT scan
are given in Table 8.1.
Table 8.1: Radiation dose in various imaging systems

EXAM Radiography (mGy) Fluoroscopy (mGy) CT (mGy)
Chest 0.14 3.6 13.2
Abdomen / pelvis 0.53 6.4 21.5
212
The source to object distance should be not less than 30 cm. The patient
entrance dose is limited to a maximum of 10 R / min, with automatic
exposure control (AEC), and 5 R / min without AEC. The X-ray tube is
provided with multiple focal spots (0.3, 0.6, and 1.2 mm) to handle adult
and pediatric patients. Intensifiers are available in different sizes (4.5, 9,
and 12 inch) and proper selection of intensifier mage size to match a specific
institution is very important.
Dose Reduction in Fluoroscopy

The most important method of dose reduction in fluoroscopy is to limit the
beam ON time, by using short burst of exposures. One can also use the last
image-hold facility, to view the image even after the exposure. This will
reduce the fluoro time by 50-80% in many procedures. Pulsed fluoroscopy
reduces dose by allowing frame rates lesser than real time. It may be used
along with digital image memory to reduce patient dose. This is a suitable
technique in patients where higher temporal resolution is not required.
Use of optimal image intensifier system (conversion gain, high contrast
ratio, spatial resolution and contrast sensitivity) can also reduce the patient
dose. Reducing the field size by collimation will also reduce the integral
dose. Maintaining much distance between the X-ray tube and patient will
also reduce the skin dose. Though magnification technique improves spatial
resolution, it also increases the patient dose and hence used sparingly.
Dose -Area Product (DAP) meter should be used to measure the dose in
fluoroscopy. It is a radiolucent ionization chamber positioned across the
primary beam, beyond the collimator (Fig. 8.8). The ionization signal
generated is proportional to the beam area. If the DAP meter is calibrated
with field size, source to object distance (SOD), source to detector distance
(SDD) and collimation, then patient dose can be estimated. Real time display
of patient dose can help the physician to modify the procedure, to minimize
skin injuries. It is easy to identify the patient who may be at risk, due to
radiation. Hence, physician training plays an important role in dose
reduction methods.
Fig. 8.8: Dose area product meter

213
PROTECTION IN COMPUTED TOMOGRAPHY

Computed tomography (CT) is a valuable and life saving imaging tool in
medical imaging. In CT scans automatic exposure modes are not available.
Most CT scanners use fixed kVp and mAs regardless of patient size. Fixed
techniques in CT may lead to unnecessary patient dose; e.g. neonatal,
children. CT scan is the major contributor of patient dose. It performs 8 %
diagnostic issues, but provides 48% of the populations collective dose (US
data) as shown in the Fig. 8.9.
Few models now offer modulation of mA as a function of rotation angle.
This will compensate the thickness variation in torso of body from AP to
lateral projections, which will reduce the patient dose. Therefore, the
training of the technologists is very important in CT scan imaging. He
should know the way of reducing patient dose, by reducing mAs for thinner
patients.
Fig. 8.9: Frequency distribution of medical imaging and

patient radiation dose in %
The Food and drug administration (FDA), USA has issued a public health
notification (2002) regarding CT scan dose reduction that includes:
i. Reduce tube current, (increases the image noise),
ii. Increase pitch or table increment (increase the effective slice thickness),
214
iii. Use noise reduction algorithms,
iv. Pediatric protocols,

v. Develop and use a chart or table of tube-current settings based on
patient weight or diameter and anatomical region of interest,
vi. Reduce the number of multiple scans with contrast material,
vii. Eliminate inappropriate referral.
The reduction of current and increased pitch though reduces the patient
dose, but increases the noise and slice thickness. Hence, optimal balancing
is necessary in devising the techniques. A technical chart can be devised
involving kVp, mA and thickness of the patient (Table 8.2).
The chart is devised with 120 kVp, 300 mAs, 5 mm slice and pitch 1, for
creating a good quality image of a 32 cm torso. For a 30 cm patient about
half of the mAs (160) is sufficient to produce the same quality of image. For
a 20 cm patient only 7 mAs is required, which reduces the patient dose by
43 %. Thus, the technical chart is very useful to reduce patient dose, with
proper selection of mAs for each patient.
PROTECTION IN PEDIATRIC IMAGING

Children have higher radiation sensitivity than adults and have a longer
life expectancy (larger window to express radiation damage). Increasing
numbers of radiological examinations are being performed in infants and
children. Millions of children undergo high dose procedures such as
computed tomography and interventional procedures. A pediatric
radiological procedure should be individually planned and projections
should be limited to what is absolutely necessary for a diagnosis. Therefore,
imaging techniques that do not use ionizing radiation should always be
considered as an alternative.
Table 8.2: Technique chart (120 kVp, 300 mAs, 5 mm slice, Pitch = 1)
Patient diameter (cm) % mAs mAs
14 0.3 1
16 0.6 2
18 1.2 4
20 2.2 7 (43% dose!)
22 4.2 13
24 7.9 24
26 15 45
30 53 160
32 100 300
34 188 564
36 352 1,058
Children are more vulnerable to the late somatic effects and genetic effects
of radiation than adults (epidemiologic study). Children receive a higher
dose, when adult settings are used. Children are 10 times more sensitive to 215
radiation than adults and girls are more sensitive than boys. The Risk for
developing a radiationrelated cancer can be several times higher for a
young child compared with an adult exposed to an identical technique.
Radiation Risks in children is a public health issue. Hence, one has to examine
the following issues before carry out the imaging:
i. Justification of requested examinations,
ii. Vetting of referrals for complex examinations,
iii. Standardization of techniques and procedures,
iv. Optimization of protection measures.
Typical values of Entrance Surface Dose (ESD) per radiograph and Dose
Area Product (DAP) for common paediatric fluoroscopy examinations are
given in Table 8.3.
Pediatric Radiography
Equipment and Peripherals

The selection of equipment associated peripherals should suit the pediatric
imaging work, so that the radiation dose will be lesser. This includes
(i) fast screen-film combination (e.g. rare earth, 400 speed for pediatric),
(ii) low attenuation (e.g. carbon fiber) materials for cassette fronts,
anti-scatter grid interspacing, table tops, (iii) grid removal, and (iv) constant
potential/High frequency generator.
Table 8.3: Typical dose levels in paediatric radiology
Examination Entrance surface dose (Gy)
Age
0 1 5 10 15
Abdomen AP 110 340 590 860 2010
Chest PA/AP 60 80 110 70 110
Pelvis AP 170 350 510 650 1300
Skull AP / 600 1250 / /
Skull LAT / 340 580 / /
Dose area product (mGycm2)
MCU 430 810 940 1640 3410
Barium meal 760 1610 1620 3190 5670
Barium swallow 560 1150 1010 2400 3170
Special Considerations
Dose to the children can be reduced significantly by adopting either one or
combination of the following: This includes (i) Higher kVp and lower mAs,
(ii) Increased filtration, (iii) Field size reduction (Collimation), (iv) Shielding
216 of gonads, thyroid and lens, (v) Increased Source-Object Distance (SOD),
and (vi) Posteroanterior projections in female patients.
Patient Motion
Patient motion should be avoided during examinations under radiation.
To fulfill this one can adopt the following: (i) Short exposure times, (ii)
Immobilization or sedation of the patient (Fig. 8.10), and (iii) incorporation
of entertainment, or distracting devices.
Figs 8.10A and B: Immobilization of child during chest radiography

(For color version see plate 3)
Dose Reduction Methods in Pediatric Radiography

Anti-scatter grids are normally not required in pediatric radiography as
the gain in image quality does not justify the increase in patient dose, except
in children in their teens and when the body build is such as to increase
scatter
Good image detail is achieved by maintaining a balance between the
use of a small focal spot size and a short exposure time.
High speed screen-film combinations should be used where possible to
enable reduction in radiation exposure and exposure time, as the reduced
resolution obtained is comparatively insignificant for the majority of
clinical indications.
The use of Automatic Exposure Control (AEC) is generally not
appropriate in children as the sensors (size and geometry) are normally
designed for adult patients. Instead, exposure charts corresponding to
radiographic technique, patient thickness in the X ray beam and presence
or absence of anti-scatter grid are much safer and easier to use.
The radiation beam should be limited using collimation.
Shielding devices should be appropriately positioned to be efficient for
protecting the tissues for which they are placed and to avoid unnecessary
repeat examinations.
Immobilization, when required, should be provided by specialized 217
devices, if possible.
Pediatric Fluoroscopy
Fluoroscopy offer much higher dose to the children than radiography
imaging. Hence, optimal selection of equipments and specialized techniques
are very much essential. The Image intensifier should have diameter of 4.5
in (11 cm).The generator should have range of mAs from 0.1 to 6, so that
one can have varying techniques from 100 mA 1ms to 800 mA 7ms.
This is suitable for imaging children having weight from 3-140 kg at 65-75
kVp. The X-ray tube should have at least two focal spots namely 0.3 mm
(3-4 years child) and 0.6 mm (8 years children). The cine frame rate should
be >60 fps.
i. Dose reduction methods in fluoroscopy.
ii. The patient should be positioned as close as possible to the image
intensifier.
iii. The X-ray tube should be as far away as possible from the patient
table in order to avoid excessive skin dose.
iv. The lowest frame rate acceptable and last-image-hold facility should
be used.
v. Some centres prefer to set a floor (a kVp) below which the system
will not go, such as 70 kVp for paediatric patients and 80 kVp for
adults.
vi. Additional copper filtration also reduces patient dose.
Pediatric Computed Tomography

CT and interventional procedures are high dose procedures in radiology
and yield higher individual patient doses than other radiological procedures
do. The patient dose in CT is an important issue for children as reports
suggest that in some centres the exposure factors used for scanning children
are the same as for adults. This problem is relatively lesser in interventional
procedures as the machine, on the basis of the body thickness falling in the
X-ray beam, automatically adjusts factors in most modern equipment. CT
scanning contributes most collective dose from radiographic exposures due
to the increasing use of this modality.
CT scans are increasingly used in pediatric imaging and mostly fixed
kVp and mAs, regardless of patient size is used. There is a potential increase
in the radiation exposure to children undergoing these scans. About 4.7
million CT examinations are performed annually on children in the US. CT
in children has increased about 8 fold since 1980, with annual growth of
about 10 % per year. Children receive higher doses than necessary, when
adult settings are used. The effective dose from single pediatric CT ranges
from 1-30 mSv, and one third of the children have three scans, which will
triple the cancer risk. There is no need for these large doses and CT settings
can be reduced significantly with out losing the image quality. Hence,
218 children should not be scanned using adult techniques, and pediatric CT
protocol or dose reduction methods should be made available.
Dose Reduction Methods

Using the PMMA phantom (Fig 8.11), ACR CT Accreditation program, the
CTDIvol can be calculated. For a adult body this is about 25 mGy and head
it is 75 mGy. Taking these as baseline data, dose reduction factors can be
designed. The pediatric protocol is obtained as follows:
Table 8.4 and 8.5 presents the reduction factors for pediatric abdomen
and thorax and head respectively.
Pediatric mAs = Baseline data Reduction factor (RF)
Fig. 8.11: ACR accredited PMMA Phantom (For color version see plate 3)
Table 8.4: Patient thickness, age and reduction factors for

pediatric abdomen and thorax
PA Thick (cm) Age Abdomen RF Thorax RF
9 Newborn 0.43 0.42
12 1 0.51 0.49
14 5 0.59 0.57
16 10 0.66 0.64
19 15 0.76 0.74
22 S Adult 0.90 0.82
25 M Adult Baseline Basline
31 L Adult 1.25 1.16
Table 8.5: Patient thickness, age and reduction factors for pediatric head
PA Thick (cm) Age Pediatric Head mAs RF
12 New born 0.74
16 1 0.86
17 5 0.93
19 M Adult Baseline
Example 1: An adult thorax is examined at a technique of 120 kVp, 0.5 sec
scan time, 200 mA, pitch=1and FOV=35 cm. What is the appropriate 219
pediatric technique for a 5 year old thorax at a pitch of 1?
From the Table 8.4 the RF for 5 year old thorax is 0.57, then
Pediatric mA = Baseline RF
= 200 mA x 0.57
= 144 mA.
Example 2: An Adult head is examined at a CT technique of 140 kVp, 0.5

sec scan time, 400 mA, pitch=1 and FOV=25 cm. What is the appropriate
technique for a one year old head?
From Table 8.5 the RF for a one year old head is 0.86, then
Pediatric mA = Baseline RF
= 400 mA 0.86
= 344 mA.
In general a head examination with adult protocol (200 mAs) may give
23-49 mGy organ dose in brain. If the mAs is adjusted to 100 and dose
become 11-25 mGy. Similarly the abdomen dose reduces from 21-43 mGy
to 5-11 mGy if the mAs is adjusted as shown in the Table 8.6
Table 8.6: Pediatric organ and effective doses with normal and adjusted mAs
for head and abdomen examinations
Exam Organ Organ dose Efective dose
(mGy) (mGy)
Head (200 mAs) Brain 23-49 1.8-3.8
Head (100 mAs, adjusted) Brain 11-25 0.9-1.9
Abdomen (200 mAs) Stomach 21-43 11-24
Abdomen (50 mAs adjusted) Stomach 5-11 3-6
Dose Reduction Methods in Paediatric Chest CT

i. Image quality in CT is generally more than what is required for
confident diagnosis. Awareness on this can help in significant
reduction in patient dose.
ii. Radiologists and physicians should be aware that images with low
noise, even if they do not look very crisp, may provide the diagnostic
information.
iii. mAs reduction at defined kVp has been used with success by many
centres and is the most efficient method of dose management in
children as also in adults. There is lack of consensus on kVp reduction
in CT examination.
iv. Many authors suggest using 100 to 200 mAs settings for high resolution
chest CT in children. However, reliable diagnostic studies can be
obtained using much lower mAs. In cooperative children who are able
to breath-hold as low as 34 mAs can be used and in non-cooperative
220 children 50 mAs.
v. Whenever radiosensitive tissues such as breast and thyroid fall within

the exposed area, they should be shielded. Breast-anlage (primordium
or the first rudiment of the breast, the underdeveloped tissue)
protection using for example 2 mm thick bismuth coated latex shielding
reduces the dose to the breast-anlage by approximately 40%.
vi. Recent technology developments include automatic tube current
modulation where the tube current is adjusted according to thickness
and density of tissues to maintain a constant level of image noise.
Dose Reduction Methods in Pediatric Abdominal CT

Strategies should include obtaining only necessary CT examinations. MRI
and US should take priority. If possible, the examination should be tailored
to answer the specific question asked by the referring clinician, for example,
pelvic scanning is not always necessary when an abdominal scan is
requested and it may be possible to curtail follow-up CT exams to a specific
organ. In addition, imaging parameters such as kVp and mAs need to be
adjusted for patient size. Size-based tables for abdominal multidetector CT
and body CT angiography in children are available. In one study, children
were classified by colors based on weight and this was shown to
significantly reduce scanning errors in settings for pediatric multi-detector
CT.
Recent technology developments include automatic tube current
modulation where the tube current is adjusted according to thickness and
density of tissues to maintain a constant level of image noise. Finally, the
use of multiphase scanning should be curtailed as much as possible.
PREGNANCY AND RADIATION

It is unlikely that radiation from diagnostic radiological examinations will
result in any deleterious effects on the child, but the possibility of a radiation-
induced effect cannot be entirely ruled out. The effects of exposure to
radiation on the conceptus depend on the time of exposure with respect to
the date of conception and the amount of absorbed dose.
Effects on Radiation Exposure In Utero (ICRP-84)

i. Prenatal doses from most properly done diagnostic procedures present
no measurable increase in the risk of prenatal death, malformation, or
the impairment of mental development over the background incidence
of these entities. Higher doses, such as those involved in therapeutic
procedures, can, however, result in significant fetal harm.
ii. There are radiation-related risks throughout pregnancy that are related
to the stage of pregnancy and the foetal absorbed dose. Radiation risks
are most significant during organogenesis and the early foetal period,
somewhat less in the second trimester, and least in the third trimester. 221
iii. During the period of 25 weeks post conception, the central nervous
system (CNS) is particularly sensitive to radiation. Fetal doses in
excess of about 100 mGy may result in a verifiable decrease of IQ.
During the same time, foetal doses in the range of 1,000 mGy (1 Gy)
result in a high probability of severe mental retardation. The sensitivity
is highest 815 weeks post conception. The CNS is less sensitive to
these effects at 1625 weeks of gestational age and rather resistant
after that.
iv. Radiation has been shown to cause leukemia and many types of cancer
in both adults and children. Throughout most of pregnancy, the
embryo/ fetus is assumed to be at about the same risk for potential
carcinogenic effects of radiation as are children.
Chest and Extremity Radiography in Pregnancy

Medically indicated diagnostic studies remote from the fetus (e.g.
radiographs of the chest or extremities) can be safely done at any time during
pregnancy if the equipment is in proper working order. Commonly,
the risk of not making the diagnosis is greater than the radiation risk
involved.
If an examination is typically at the high end of the diagnostic dose range
and the fetus is in or near the radiation beam or source, care should be
taken to minimize the dose to the fetus while still making the diagnosis.
Tailoring the examination and examining each radiograph as it is taken
until the diagnosis is achieved and then terminating the procedure can do
this.
CT and Pregnancy
Occasionally, a patient will not be aware of a pregnancy at the time of an
X-ray examination, and will naturally be very concerned when the pregnancy
becomes known.
In such cases, the radiation dose to the fetus/conceptus should be
estimated, but only by a medical physicist/ radiation safety specialist
experienced in dosimetry. The patient can then be better advised as to the
potential risk involved. In many cases there is little risk, as the irradiation
will have occurred in the first 3 weeks following conception. In a few cases
the conceptus will be older and the dose involved may be considerable. It
is, however, extremely rare for the dose to be high enough to warrant
advising the patient to consider terminating the pregnancy.
If a calculation of radiation dose is required in order to advise the patient,
the radiographic factors should be noted if known. Some assumptions may
be made in the dosimetry, but it is best to use actual data. The patients
date of conception or date of LMP (last menstrual period) should also be
222 determined.
Cardiac Catheterization and Pregnancy

There will be many situations where the benefit of performing the procedure
is much greater than any small possible harm that might arise from the
radiation exposure. However, as always with any medical exposure, each
particular procedure must be clinically justified, including in this situation
taking into account when the procedure needs to occur. Once justified, due
care is taken to optimise how the procedure is performed so as to minimise
radiation exposure to the fetus, consistent with achieving the desired clinical
outcome. The radiation exposure to foetus predominantly arises from
scattered radiation within the patient. Some of the main methods for
minimizing the dose to the foetus include:
i. Restricting the X-ray beam size to being as small as is necessary for
the clinical purpose;
ii. Choosing the direction of the primary beam so that it is as far away
from the foetus as possible;
iii. Selecting appropriate exposure factors; and
iv. Ensuring that the overall exposure time is as small as possible.
For well performed procedures, estimated foetal doses are typically quite
small, and well below the level of concern for radiation effects. As a final
comment, putting a lead apron on the table to cut down any primary beam
from the X-ray tube reaching the fetus has very little effect, but it can be
reassuring to the patient and staff and thus is recommended provided the
use of the apron does not compromise the performance of the procedure.
Termination of Pregnancy after Radiation Exposure

According to ICRP 84, termination of pregnancy at fetal doses of less than
100 mGy is not justified based upon radiation risk. At fetal doses between
100 and 500 mGy, the decision should be based upon the individual
circumstances.
The issue of pregnancy termination is undoubtedly managed differently
around the world. It is complicated by individual ethical, moral, and
religious beliefs as well as perhaps being subject to laws or regulations at a
local or national level. This complicated issue involves much more than
radiation protection considerations and require the provision of counseling
for the patient and her partner.
At foetal doses in excess of 500 mGy, there can be significant foetal
damage, the magnitude and type of which is a function of dose and stage
of pregnancy. Many believe that this dose can cause sterility in the exposed
individual, but really it is not so. The gonads are radiosensitive organs in
the human body. The threshold radiation dose for permanent sterility in
men is 3500 - 6000 mGy, and for women 2500 - 6000 mGy. As diagnostic
X-ray examinations involve small doses (Table 8.7), they imply no risk of
sterility. 223
Table 8.7: Approximate foetal doses from common diagnostic procedures in

United kingdom (Sharp, Shrimpton, and Buiy, 1998)
Conventional X-ray examinations Mean (mGy) Maximum (mGy)
Abdomen 1.4 4.2
Chest < 0.01 < 0.01
Intravenous urogram 1.7 10
Lumbar spine 1.7 10
Pelvis 1.1 4
Skull < 0.01 < 0.01
Thoracic spine < 0.01 < 0.01
Fluoroscopic examinations Mean (mGy) Maximum (mGy)
Barium meal (UGI) 1.1 5.8
Barium enema 6.8 24
Computed tomography Mean (mGy) Maximum (mGy)
Abdomen 8.0 49
Chest 0.06 0.96
Head < 0.005 < 0.005
Lumbar spine 2.4 8.6
Pelvis 25 79
Continuation of Work of a Pregnant Employee

in X-ray Department
A pregnant worker can continue working in an X-ray department as long
as there is reasonable assurance that the foetal dose can be kept below 1
mGy during the pregnancy. In interpreting this recommendation, it is
important to ensure that pregnant women are not subjected to unnecessary
discrimination. There are responsibilities for both the worker and the
employer. The first responsibility for the protection of the conceptus lies
with the woman herself, who should declare her pregnancy to management
as soon as the condition is confirmed. The ICRP -84 recommend the
following:
i. Restricting dose to the conceptus does not mean that it is necessary
for pregnant women to avoid work with radiation or radioactive
materials completely, or that they must be prevented from entering or
working in designated radiation areas. It does, however, imply that
the employer should carefully review the exposure conditions of
pregnant women. In particular, their working conditions should be
such that the probability of high accidental doses and radionuclide
intakes is insignificant.
ii. When a medical radiation worker is known to be pregnant, there are
three options that are often considered in medical radiation facilities:
a) no change in assigned working duties; b) change to another area
where the radiation exposure may be lower; or c) change to a job that
224 has essentially no radiation exposure. There is no single correct answer
for all situations, and in certain countries there may even be specific
regulations. It is desirable to have a discussion with the employee.
The worker should be informed of the potential risks, local policies,
and recommended dose limits.
iii. Change to a position where there is no radiation exposure is sometimes
requested by pregnant workers who realize that risks may be small
but do not wish to accept any increased risk. The employer may also
arrange for this in order to avoid future difficulties in case the employee
delivers a child with a spontaneous congenital abnormality (which
occurs at a rate of about 3 in every 100 births). This approach is not
required on a radiation protection basis, and it obviously depends on
the facility being sufficiently large and flexibility to easily fill the
vacated position.
iv. Changing to a position that may have lower ambient exposure is also
a possibility. In diagnostic radiology, this may involve transferring a
technician from fluoroscopy to CT scanning or some other area where
there is less scattered radiation to workers. In nuclear medicine
departments, a pregnant technician can be restricted from spending a
lot of time in the radiopharmacy or working with radioiodine solutions.
In radiotherapy with sealed sources, pregnant technicians or nurses
might not participate in manual brachytherapy.
v. An ethical consideration is involved in both of these last two
alternatives since another worker will have to incur additional
radiation exposure because a co-worker became pregnant.
vi. There are many situations in which the worker wishes to continue
doing the same job, or the employer may depend on her to continue in
the same job in order to maintain the level of patient care that the
work unit is customarily able to provide. From a radiation protection
point of view, this is perfectly acceptable providing the foetal dose
can be reasonably accurately estimated and falls within the
recommended limit of 1 mGy fetal dose after the pregnancy is declared.
It would be reasonable to evaluate the work environment in order to
provide assurance that high-dose accidents are unlikely.
vii. The recommended dose limit applies to the fetal dose and it is not
directly comparable to the dose measured on a personal dosimeter. A
personal dosimeter worn by diagnostic radiology workers may
overestimate fetal dose by about a factor of 10 or more. If the dosimeter
has been worn outside a lead apron, the measured dose is likely to be
about 100 times higher than the fetal dose. Workers in nuclear medicine
and radiation therapy usually do not wear lead aprons and are exposed
to higher photon energies. In spite of this, fetal doses are not likely to
exceed 25% of the personal dosimeter measurement.
viii. Finally, factors other than radiation exposure should be considered in
evaluating pregnant workers activities. In a medical setting there are 225
often requirements for lifting patients and for stooping or bending

below knee level. There are a number of national groups that have
established non-radiation related guidelines for such activities at
various stages of pregnancy.
ix. Occasionally, there are situations where family members provide
essential medical care, either in the hospital or at home, to patients
who have received radionuclides. In such circumstances, public dose
limits do not apply to the family member. Efforts should optimally be
directed at not involving females who are or may potentially be
pregnant. If it is essential to involve the help of a pregnant female, it
should be done in such a way that the foetal dose from this involvement
does not exceed 1 mGy.
Chance of Approaching the Dose Limits of Exposure

Radiation doses to occupationally exposed staff working with radiological
equipment are generally low and it is unlikely that the equivalent dose
limit recommended by the ICRP will be approached. However, for some
fluoroscopic examinations there is a potential for higher radiation doses to
staff. During interventional radiology procedures, particular radiation
protection problems arise from the extended fluoroscopy times and from
the use of certain radiological equipments, which may not have lead rubber
protective curtains. Consequently, the implications of the ICRP
recommendations on the radiation exposure of the fetus of staff performing
fluoroscopy procedures should be assessed.
Counseling of Patients
Patients who have received diagnostic studies while pregnant are often
alarmed because of emotional perceptions surrounding radiation. The
health professionals should advise patients about the steps that will be
taken for risk assessment and provide appropriate information regarding
the risk associated with diagnostic (and therapeutic) radiation exposure
during pregnancy. The following points should be considered:
i. It is unlikely that radiation from diagnostic radiological examinations
will result in any deleterious effects on the child, but the possibility of
a radiation-induced effect cannot be entirely ruled out.
ii. The patient should be counseled that the risk assessment is being done
not because there is reason to believe there is great risk in her
circumstance but because it is one of the precautions normally
taken whenever a pregnant woman receives certain diagnostic studies
(Note: this applies only to diagnostic studies. The risk from therapeutic
studies may be severe, such as fetal thyroid ablation).
iii. Each case must be assessed according to the gestational age when
226 exposed and the radiation levels received by the conceptus from each
exposure.
iv. A precise fetal dose assessment requires numerous pieces of

information about the X-ray system, the examinations conducted, the
patient size, etc. Therefore, typical fetal dose numbers should be used
with the understanding that there may be a significant difference
between the typical dose numbers and the dose numbers resulting
from an actual dose assessment.
v. The dose evaluation may take up to a week to complete.
vi. When all the information is acquired, the radiation risk will be assessed
and will be reviewed along with other possible risks of pregnancy so
that the physician, the patient, and other involved persons understand
the circumstances and can thus make a reasonable decision regarding
the management of the pregnancy.
Other Factors
Identification of the patient, female patient of reproductive age,
determination of pregnancy status are necessary before performing any
kind of imaging. Elimination of screening X-ray exams can significantly
reduce population dose. Yearly dental check up with X-ray examinations
should be avoided. Use of high speed films or DR systems in dental X-ray
imaging can reduce the patient dose. Mammography examination should
not be used as a screening procedure in patients with age less than 35-40,
unless there is a familial history of breast cancer.
The repeat X-ray exams ranges from 1 15%. This number will be higher
in (i) training centers, due to lack of experience, (ii) mobile X-rays(chest,
lumbar spine, thoracic spine, kidneys, ureter, bladder and abdomens), due
to proper positioning difficulty. Lack of automatic exposure control may
also increase the repeat X-rays and technique chart of various examinations
should be posted at the control panel. This will enable the technologist to
select correct radiographic technique. The retakes are monitored
periodically and suitable action must be taken to improve image quality.
Improperly loaded cassettes, excessive fog due to light leak or poor film
storage conditions, processor artifacts due to dirty components or
contaminated chemicals, uncalibrated X-ray unit or improper imaging
techniques can also increase the retakes. A periodic quality assurance
program to test the performance of the X-ray unit, image receptors and
film processing systems is necessary.
NUCLEAR MEDICINE
PROTECTION IN NUCLEAR IMAGING
Protective Devices
The radiation exposure rate in nuclear medicine ranges from 100 R/hr to
227
natural background. Hence, protective devices with suitable shielding
material should be used for personnel protection. Usually tungsten or lead

are used as shielding materials in nuclear medicine. These materials are
used to design the following protective devices:
i. Syringe shield (Exposure decreases 100 fold)
ii. Leaded glass (Radio pharmaceutical preparation areas)
iii. Lead pigs (dispensing system)
iv. Waste storage: Lead dust bin.
The radiation levels from a medium size unshielded technetium
generator having 500 mCi (18.5 GBq) would be 6 mSv / h at 0.5 m. A typical
shielding used is 9.5 cm of lead, that includes the core shielding of 5.0 cm
lead + additional shielding of 4.5 cm. This shielding is in higher than the
minimum required shielding. For example, 6.3 cm lead shielding (9 HVL)
is the minimum required to keep the radiation level at 15.0 Sv/h, in the
case of Mo (HVL =7 mm lead)
Syringe shielding is made up of 3 mm thick lead to reduce finger and
body doses by about 200 times from syringe activities. The dose rate from
an unshielded vial containing 100 mCi (4 GBq) of 99mTc would be 800 Sv/
h at 30 cm. The required minimum thickness of shielding is 1.5 mm Pb
(HVL =0.25 mm Pb), to keep the surface dose level with in regulatory limits.
Personnel Wear
The personnel should wear laboratory coat, disposable gloves, finger ring
TLD dosimeter, body dosimeters and lead apron. But lead apron has limited
value in nuclear medicine as it do not attenuate medium energy photons
(140 keV).
Radiation Dose from Patients

The nuclear medicine patients contribute radiation exposure to staff and
hence reasonable distance should be kept by the staff (Table 8.8.). Patient
who have received radionuclide injection should be kept in a separate areas
in the department. Suitable precautions are required to reduce staff radiation
dose. For example, a patient with 800 MBq of Tc-99m activity yield a
exposure of 160 Sv / h at 30 cm, and 6 Sv / h at 1m respectively. Wearing
a lead apron of 0.25 mm Pb may reduce the exposure from 160 to 10 Sv /
h at 30 cm. Patients should be given instructions leaflet detailing contact
with other people and appropriate action if clothing becomes contaminated.
Table 8.8: Occupational staff exposure from patients

Radionuclide Half life Activity (MBq) Exposure(Sv / h at 1m)
67
Ga 78 h 150 1.6
111
In 2.8 d 80 2.4
99m
Tc 6.0 h 800 6.0
131
I 8.0 d 40 0.9
228 201
Tl 73 h 80 0.3
Patient Dose Reduction

When using radionuclides for patient studies the following points will
reduce dose to the staff:
i. Good counting statistics in laboratory tests
ii. A diagnostic image in a reasonable time
iii. Acceptable radiation dose to the patient from the target organ and
excretion path way
iv. Cost of expensive isotopes (123I,111I).
However, the patient radiation doses in nuclear medicine studies are
much lower than the radiology investigations using X-rays. For example, a
urogram using iodine contrast may yield an ovarian dose of 30 mSv, bladder
wall dose of 43 mSv and whole body dose of 30 mSv respectively.
Pediatric Exposure
The injected activity depends upon the weight and age of the patient.
Guidelines are given for a standard man on the radiopharmaceutical
package. Several multiplication factors are used for obtaining children doses
from the adult dose as follows:
i. Body surface area (BSA) 1.73
ii. Childs age +1, divided by age +7
iii. Childs weight 70 kg
iv. Childs height 174 cm.
For static imaging studies first three steps (i, ii and iii) are used and for
dynamic study last step (iv) is used. Most radionuclides used in nuclear
medicine investigations are concentrated in breast milk. A neonate thyroid
gland can receive a high radiation dose from these nuclides in mothers
milk. Hence either nuclear medicine investigations should be avoided or
the mother is instructed to bottle feed after the investigation for a suitable
period. Over 90 % of the Tc-99m activity appears in the breast milk over 24
h and breast feeding can continue after this term. The trauma imposed on
the child and mother restricting contact should be weighed against the
radiation risk.
Contamination Control
Contamination control measures are designed to prevent radioactive
material from coming into contact with personnel and prevent its
spread to other work surfaces. Protective clothing (disposable plastic
gloves, lab coats, closed toed shoes) and handling precautions are the basic
methods of contamination control. The personnel and work surfaces are
routinely surveyed for contamination and areas should be classified as
radioactive and non radioactive. The work surfaces where unsealed
radioactive material is handled should be covered with plastic backed
229
absorbent paper. When it is contaminated or worn, it should be changed.

Volatile radionuclides (e.g. I-131, Xe-133 gas) should be stored in a 100%
exhaust fume hood to prevent airborne contamination and subsequent
inhalation.
Collimators of scintillation cameras should be covered with plastic to
avoid contamination. Personnel should discard gloves in the radioactive
waste dustbin after work and monitor their hands, shoes and clothing for
contamination at periodic intervals. All personnel should wash their hands
after handling radioactive material (before eating or drinking), to minimize
internal contamination. For skin contamination, wash with soap and warm
water and any aggressive decontamination may create aberrations, that
can enhance internal absorption. External contamination is not a health
hazard, where as internal contamination can give significant radiation
exposures.
To monitor the contamination control, a contamination monitor with
GM type survey meter is used at the end of the day. Swipe tests (filter
paper, alcohol wipes, or cotton tipped swipes) are taken on weekly basis
at various locations of the nuclear medicine department. These swipe
samples are counted in a NaI (Tl) gamma well counter. Areas that are in
twice the background level are said to be contaminated. The contaminated
areas are decontaminated followed by additional swipe tests. The
GM survey is repeated to confirm decontamination. In the areas of
radioactive waste and storage, the radiation levels are higher and hence
exposure rate meters (ion chamber) survey is carried out to detect high
exposure rates.
Safety Work Practices that Can Reduce Internal Radia-

tion Dose
i. Label all radioactive containers with radionuclide name, calibration
date, activity and chemical form.
ii. Personnel should wear laboratory coats and gloves when handling
radioactive sources. Gloves should be handled so as to avoid
contamination of their inside surfaces. Lab coats, aprons, and other
protective clothing should not be taken home.
iii. Handbags, handkerchives, key chains etc. should not be brought
inside the laboratory.
iv. No eating, drinking, smoking or applying of cosmetics should occur
in areas where open sources may be present.
v. No foodstuffs or drinks should be stored where radioactive sources
are kept, such as laboratory refrigerators.
vi. Do not pipette radioactive materials by mouth.
vii. Persons with an open wound should not work with radioisotope.
230
viii. Personnel should wash their hands after working with radioactive
sources, and they should be checked for contamination by a
monitor.Hands should also be monitored before going to lunch or
on breaks and before leaving at the end of the day.
ix. Work should be performed on absorbent pads to catch spills and
prevent spattering of liquids.
x. Pipettes and stirring rods should be placed in non porous trays or
pans.
xi. Work with radioactive gases or other volatile materials should be
performed in a ventilated fume hood. These materials also should be
stored in a hood.
xii. Work areas should be kept tidy. Radioactive trash, contaminated
pads, and so forth should be disposed of promptly.
xiii. Radioactive storage areas (hot labs) should not be used to store other
materials, such as office supplies or linens.
xiv. Needless contamination of light switches, doorknobs, and other items
that could result in unsuspected contamination to personnel should
be avoided.
xv. Containers with sharp or broken edges should not be used for
radioactive materials.
xvi. Radioactive materials should be stored when they are not in use.
xvii. Discard all radioactive materials in the radioactive waste dustbin
xviii. Ensure that X-133 ventilation studies are performed in a room with
negative pressure with respect to hall way (if the exhaust rate is higher
than the supply rate, then air will flow from hall way to room).
xix. Spills or accidents should be reported to the radiological safety officer
(RSO).
Labeling and Identity

The vial radiation shield containing radiopharmaceutical vial is labeled
with radiopharmaceutical name, and patients name. Syringe containing a
radiopharmaceutical must be labeled with radiopharmaceutical name and
patient name. The patients identity must be verified by two ways (Name
and social security number). In the case of women patient, whether she is
pregnant or not is to be ascertained, by a pregnancy test. If she is a mother,
breast feeding is ruled out.
Activity >30 Ci, of I-131 therapeutic require a written direcetive
consisting the patient identity, radionuclide, radiopharmaceutical, activity
and the rute of administration. Women, nursing the infants should
be advised to discondinue breast feeding, until the radioactivity in the
breast milk reduces to a safe level. The recommended cessation of breast
feeding periods are given the Table 8.9 and 8.10 for Tc-99m and I-31
respectively.
231
Table 8.9: Cessation of breastfeeding after administration

of TC-99m, radiopharmaceutical to mothers
Activity Imaging Breast milk, safe Cessation of
level, Ci /ml breast feeding
10 mCi Thyroid scan 8.2 x 10-2 24 hr
5-25 mCi, Tc-kits All 8.2 x 10-2 24 hr
3-5 mCi, MAA Lung perfusion 1.2 x 10-1 10 hr
10-15 mCi,DTPA Renal scan 1.2 x 10-1 17 hr
5 mCi Liver spleen scan 1.6 x 10-1 15 hr
15-25 mCi,MDP Bone scan 2.1 x 10 -1 17 hr
Table 8.10: Cessation of breast feeding after administration

of I-131, radiopharmaceutical to mothers
Activity Imaging Breast milk, safe Cessation of breast
level, Ci/ml feeding
5 Ci Thyroid uptake 4.1 x 10-7 68 days
10 mCi Thyroid cancer scan 4.1 x 10-7 Discontinue
33 mCi Out patient therapy 4.1 x 10-7 Discontinue
100 mCi Thyroid cancer 4.1 x 10-7 Discontinue
Treatment (ablation)
PROTECTION IN RADIONUCLIDE THERAPY

The treatment of thyroid cancer, and hyperthyroidism with I-131(8 days
half life), require patient isolation. Once it is administered, I-131 is excreted
through urine, saliva and perspiration. Hence before administration, plastic
backed absorbent paper is used to cover floor, bed, mattress, light switches,
toilet, and telephone. Patients meals are served by disposable meal trays.
Waste containers are placed in patients room to dispose meal trays and
contaminated linens. The radiation survey is made around the bedside,
doorway and the neighboring room and the levels are posted for
information along with instructions to nurses and visitors. The nursing
staff should wear dosimeters, disposable shoe covers and gloves. The
visitors are instructed to wear disposable shoe covers and the visiting times
are limited
Patient with I-131 therapy may be discharged once the activity <33 mCi
or dose rate at 1m <0.07 mSV / hr. After the discharge the room is
completely surveyed and decontaminated. It has to be confirmed by swipe
tests and GM survey. If the total dose equivalent is >1mSv, the patient may
be discharged with instructions. This is to minimize radiation exposure
and contamination to other individuals. The radiation safety instructions
that may be given to the patients are as follows:
232
First 4 Days
i. Wash cups, plates, and eating utensils immediately after use, or use
disposables.
ii. Do not kiss anybody.
iii. Use individual towels and wash clothes.
iv. Sleep in a separate bed.
v. At the end of 2 days, all personnel clothing should be washed separately.
vi. Contact with infants and pregnant women should be avoided.
vii. Stay 3 feet away from other people.
viii. Double flesh the toilet for the first 2 days, as the urine contain large
portion of activity.
Next 3 Days
ix. Avoid sitting close to others for hours together. This is to avoid
radiation exposure from patient thyroid to others.
x. Avoid holding infants / children for long periods in a day.
Breastfeeding
xi. Breast feeding must be discontinued. Follow the physicians advise
carefully.

PROTECTION IN NUCLEAR MEDICINE
As with diagnostic radiology procedures, the pregnant patient can be
apprehensive after a procedure has been performed. In the case of nuclear
medicine, the patient may be even more apprehensive, realizing that an
administered radioactive material has been incorporated into her body,
that it will be there for some time and that it potentially may cross the
placenta to the fetus. As a result of this, more careful explanation to the
patient and her husband or other appropriate persons may be needed to
put the potential radiation risks into perspective. In contrast to diagnostic
radiography examinations, fetal doses in nuclear medicine depend
predominantly upon administered activity, and they are independent of
the imaging equipment.
Woman of Childbearing Age and

Nuclear Medicine Examinations
In women of childbearing age, the possibility of pregnancy and the
justification for the examination should be considered. The ICRP-84 report
recommended precautions to prevent or minimize irradiation of the fetus
include the following:
i. The patient must be carefully interviewed to assess the likelihood of
pregnancy. Particular discretion is required to ascertain the possibility 233
of pregnancy in an adolescent. In order to minimize the frequency of

unintentional radiation exposures of the embryo or foetus, advisory
notices should be posted at several places within the nuclear medicine
department, and particularly at its reception area. For example:
If it is possible that you might be pregnant, notify the physician or technician
before receiving any radioactive material.
ii. Many patients incorrectly assume that irradiation from a nuclear
medicine examination begins when the gamma camera begins imaging,
and they may not mention a potential pregnancy until after the
radiopharmaceutical has been administered. Therefore, before
administering radiopharmaceuticals, it is necessary to consider as
pregnant any woman of reproductive age presenting herself for a
nuclear medicine examination at a time when a menstrual period is
overdue or missed, unless there is information that precludes pregnancy
(e.g. hysterectomy or tubal ligation). If the menstrual cycle is irregular,
and a non-technetium or therapeutic radiopharmaceutical is being
administered, a pregnancy test may be indicated before proceeding.
iii. Many laboratories also ask all females to indicate if they are breast-
feeding, since many radiopharmaceuticals can be transferred to a baby
via breast milk. Cessation of breastfeeding for at least some period is
recommended for most nuclear medicine studies. Breastfeeding is
usually stopped for 3 weeks after all 131I and 125I radiopharmaceuticals
except labeled hippurate, and after 22Na, 67Ga, and 201T1. It is stopped
for 12 hours after iodine labeled hippurates and all 99mTc compounds
except labeled red blood cells, -phosphonates, and DTPA, and for at
least 4 hours after the latter compounds.
iv. Occasionally, questions arise about the advisability of becoming
pregnant after a nuclear medicine examination or treatment. The ICRP
has recommended that a woman not become pregnant until the
potential fetal dose from remaining radionuclides is less than 1 mGy.
This is not usually a consideration except for radioiodine therapy or
radiopharmaceuticals labeled with 59Fe (for metabolism studies) or 75Se
(for adrenal imaging). As a result of the long physical half-lives of
these radionuclides and their long residence times in the body, it is
recommended that pregnancy be avoided for 6 and 12 months
respectively. The special conditions related to radioiodine therapy are
discussed later.
Actions and Precautions that can Reduce

Radiation Exposure to the Fetus
Pregnancy need not be considered a contradiction for nuclear medicine
procedures, in particular diagnostic ones involving short lived
radionuclides, provided there are strong clinical justifications and effort
234 has been made to explore alternatives involving non-ionizing radiation.
Since radionuclides in maternal tissues contribute to fetal dose, maternal

hydration and frequent voiding can reduce the fetal dose after the
administration of a number of radiopharmaceuticals.
Irradiation of the fetus results from placental transfer and distribution
of radiopharmaceuticals in the fetal tissues, as well as from external
irradiation from radioactivity in the mothers organs and tissues. The
physical, chemical, and biological properties of the radiopharmaceuticals
are the critical factors in possible placental transfer.
Using smaller administered activities and longer imaging times can
reduce the absorbed dose to the foetus. This is feasible if the patient is not
too sick and is able to remain still. Occasionally, the sequence of the
examinations and choice of radiopharmaceutical can be adjusted to reduce
radiation dose.
Typical fetal doses from nuclear medicine examinations for common
radiopharmaceuticals are presented in the following Table 8.11.
Table 8.11: Fetal whole body dose from common nuclear medicine examinations
in early pregnancy (Dose includes maternal and fetal self-dose contributions).
(Adapted from Russell, Stabin, Sparks, et al. 1997, ICRP 53, and ICRP 80)
Radiophar- Procedure Administered Early Nine months
maceutical activity (MBq) pregnancy (mGy)
(mGy)
99m
Tc Bone scan (phosphate) 750 4.6-4.7 1.8
99m
Tc Lung perfusion (MAA) 200 0.4-0.6 0.8
99m
Tc Lung ventilation (aerosol) 40 0.1-0.3 0.1
99m
Tc Thyroid scan (pertechnetate) 400 3.2-4.4 3.7
99m
Tc Red blood cell 930 3.6-6.0 2.5
99m
Tc Liver colloid 300 0.5-0.6 1.1
99m
Tc Renal DTPA 750 5.9-9.0 3.5
67
Ga Abscess / tumor 190 14-18 25
123
I Thyroid uptake1) 30 0.4-0.6 0.3
131
I Thyroid uptake1) 0.55 0.03-0.04 0.15
131
I Metastases imaging1) 40 2.0-2.9 11.0
1)
Foetal thyroid doses are much higher than foetal whole body dose, viz. 5-15 mGy / MBq for
123
I and 0.5-1.1 Gy / MBq for 131 I.
RADIOIODINE THERAPY AND PREGNANCY
Treatment of Pregnant Patients with Radionuclides

As a rule, a pregnant woman should not be treated with a radioactive
substance unless the radionuclide therapy is required to save her life: in
that extremely rare event, the potential absorbed dose and risk to the foetus
should be estimated and conveyed to the patient and the referring physician.
Considerations may include terminating the pregnancy.
Radioiodine therapy is essentially contraindicated in patients who are
known to be pregnant. Radioiodine easily crosses the placenta and the fetal 235
thyroid begins to accumulate iodine at about 10 weeks of gestational age.

If radioiodine treatment of thyroid carcinoma is to be performed, it should
be delayed until after delivery. If this is done, the physician should also be
aware that radioiodine is excreted in breast milk and breastfeeding should
be stopped completely after a therapeutic dose. If this is not done the infant
may become permanently hypothyroid or be at high risk for subsequent
thyroid cancer.
In women, thyroid carcinoma comprises over 80% of cancer of the head
and neck diagnosed between the ages of 15 45 years. Thyroid cancers are
relatively non-aggressive compared to most other cancers. As a result both
surgical and radioiodine treatment are often delayed until after pregnancy.
In general, if any therapy is to be performed during pregnancy, it will be
surgery during the second or third trimester.
Steps to be taken in Patients Found to be Pregnant

after Administration of Radioiodine Therapy
A major problem occurs when a female, who is not thought to be pregnant,
is treated for thyroid carcinoma and is found to be pregnant after the
administration of radioiodine. Menstrual history is often not adequate to
ensure that a patient is not pregnant. In most developed countries, it is
common practice to obtain a pregnancy test prior to high-dose 131I scanning
or therapy for women of childbearing age unless there is a clear history of
prior tubal ligation or hysterectomy precluding pregnancy. In spite of the
above, it still happens that pregnant women are treated, either because of
false histories or because the pregnancy is at such an early stage that the
pregnancy test is not yet positive.
Most commonly, the pregnancy is early and the major problem is fetal
whole body dose due to gamma emissions from radioiodine in the maternal
bladder. During pregnancy, the whole body dose to the conceptus is in the
range of 50100 mGy/MBq of administered activity. This dose can be
reduced by hydrating the patient and by encouraging frequent voiding.
If the conceptus is more than 8 weeks post conception (and the foetal thyroid
may accumulate iodine) and the pregnancy is discovered within 12 hours
of iodine administration, giving the mother 60 130 mg of stable potassium
iodide (KI) will partially block the foetal thyroid and reduce thyroid dose.
Twelve hours after radioiodine administration, this intervention is not very
effective.
Risk to a Pregnant Woman, When a Family Member is

Treated with Radioiodine
Patients treated with radioiodine can be a significant radiation source to
pregnant family members. The dose to a family member staying at a distance
236 of 0.5 meters from a patient until the radioactivity totally decays (about 10
weeks) is about 1.3 mGy from a hyperthyroid patient and 6.8 mGy from a
thyroid cancer patient. Also, these patients must be careful not to transfer
radioiodine contamination to family members by direct or indirect means.
Avoid of Pregnancy after Radionuclide Therapy

Most female patients are advised not to become pregnant for at least 6
months after radiotherapy with radioiodine. This is not based upon potential
heritable radiation effects, but rather upon the need to be sure (1) that the
hyperthyroidism or cancer is controlled, and (2) that another treatment
with radioiodine is not going to be needed when the patient is pregnant. It
is also based upon the fact the ICRP has recommended that enough radio-
iodine be cleared to ensure that the unborn child does not receive a dose in
excess of 1 mGy unless it is medically necessary for the health of the mother.
There are occasional circumstances in which 32P, 89Sr, or 131I meta-
iodobenzylguanidine are used for therapy. In order to keep the dose to the
foetus below 1 mGy, pregnancy should be avoided for 3, 24, and 3 months
respectively.
STAFF PROTECTION
Pregnant Staff and Continuation of Work

For most diagnostic procedures, there would be no need for pregnant staff
to take any additional precautions other than limiting their direct contact
to as short as necessary. Because the exposure from patients who have been
administered radiopharmaceuticals is quite low, there is no radiological
reason not to continue imaging procedures. Moreover, the International
Basic Safety Standards require that notification of pregnancy shall not be
considered a reason to exclude a female worker from work. If the institution
administers therapeutic activities of 131I for thyroid cancer, should be
considered refraining from this particular part of the practice. Not only
that there are higher exposures associated with the administration of 131I,
but also iodide is volatile, increasing the potential for internal uptake.
Some radiopharmaceuticals cross the placenta freely, e.g. radioactive
iodides, and are taken up in foetal tissues, where they irradiate the tissues.
Some analogues of natural metabolites (e.g. radiostrontium for calcium
and radiocaesium for potassium) are less readily transferred. Radiopharma-
ceuticals that are retained by the mother, and do not cross the placenta
(e.g. radiocolloids), only act as external sources of irradiation to the fetus.
Maternal Hydration
In the case of radiopharmaceuticals that are rapidly eliminated by the
maternal kidneys, the urinary bladder, acting as a reservoir, is a major source
of foetal irradiation. After the administration of such radiopharmaceuticals,
237
maternal hydration and frequent voiding should, therefore, be encouraged.
For those radiopharmaceuticals that have gastrointestinal excretion however,

administration of laxatives is only rarely helpful in reducing fetal dose.
A typical example of sequence is a ventilation perfusion lung scan
ordered on a pregnant patient to exclude a pulmonary embolus. In routine
operation, many laboratories will perform the ventilation scan first and then
do the perfusion scan. This has advantages in some situations. In the specific
case of a suspected pulmonary embolus, the perfusion scan can be performed
first, and if the result is normal, a ventilation scan is not needed at all.
The choice of radiopharmaceuticals for the ventilation portion of the
lung scan can also affect fetal dose. If the scan is performed with 133Xe gas,
there is very little fetal dose; however, one can also do ventilation scans
using 99mTc-DTPA aerosol. This will be absorbed and excreted via the
kidneys, and while in the bladder it will contribute to fetal dose.
RADIOTHERAPY
Teletherapy equipment or Brachytherapy equipment, including sources

and accessories, shall not be used unless all the relevant quality assurance
tests have been satisfactorily performed. These tests should be repeated
periodically and their records are maintained in the form of log book.
Appropriate equipments and accessories must be made available for
performing dosimetry, treatment planning, simulation and quality
assurance. These instruments are calibrated and maintained in good
working condition.
In Brachytherapy the applicator / sources in the patient must be verified
with the help of radiography or autoradiography. The position of the
sources are retained in the same way through out the treatment time. If the
treatment time is in the order of minutes, then the operator should watch
the treatment, in order to terminate the treatment with in the intended time.
PERSONNEL SAFETY DURING SOURCE

TRANSFER OPERATIONS OF TELETHERAPY
AND HDR BRACHYTHERAPY UNITS
Owing to the decay of the radiation sources, in radiotherapy units,
replacement of the decayed sources with fresh sources of higher activity is
necessary and the frequency of replacement depends upon the half life of
radioactive source used (e.g. 5 yrs. for cobalt-60). Sometimes, the repair
work of the units head also demands source transfer operation. The activity
of these sources is dependent on the make and model of the therapy unit.
The activity of a teletherapy source is much higher that that in a remotely
controlled after loading brachytherapy unit. Therefore, more attention is
needed during the source transfer of the teletherapy units. Ignoring any of
238 the recommended procedures and steps may result in a serious radiation
accident and elaborate and expensive management of the situation.
Make and Models

Different types and makes of teletherapy and brachytherapy units are
installed and subsequently serviced by various manufacturers, all over
India. Table 8.12 gives details about some of the teletherapy units available
in the country and the type of source drawer of each mode, which is replaced
during the source transfer operation. Table 8.13 gives the details about the
remotely controlled brachytherapy units available in India.
Table 8.12: Teletherapy units

Model of the unit Type of source drawer Local agents
Theratron-780 Cylindrical M/s Kirloskar Theratronics
780C, 780E, Pvt, Ltd., New Delhi
Phoenix
Theratron-1000E
Equinox, 80/100
Shinva FCC 8000 Cylindrical M/s. Indelelect Technologies
Shinva FCC 8000 F Chennai
Bhabhatron-II Cylindrical M/s Panacea Medical
Technologies Pvt.Ltd.,
Bengaluru
ATC-C9 Capsule UB Electronics
Instruments Ltd.
Alcyon Head @ Varian Medical India Pvt. Ltd.,
Mumbai
@ : Source is loaded in units head.
The new sources loaded in drawers or capsules are transported in special

source flasks designed for the particular make and model of the therapy
unit. The source flask is used to carry out the source transfer operation.
The decayed source is first removed from the unit and loaded into source
flask. New source is then loaded into the unit. During repair works
(involving head of the unit) also, the source flask is used for removing the
source from the unit and for reloading it into the therapy unit on completion
of the repair work.
Table 8.13: Brachytherapy units

Model of the Unit Local agents
Selectron LDR M/s. Nucletron India Pvt. Ltd.,Chennai
Microselectron HDR
Microselectron HDR Genie
Gamma Med plus iX M/s. Varian Medical Systems India Pvt. Ltd.
Varisource iX Mumbai
Flexitron M/s.Isodose Control,Tiruchirapalli,
Gynie and Multisource BEBIG, Eckert and Ziegler,Chennai 239
General Precautions
1. It is the responsibility of serving company to ensure safe transport of
the source flask loaded with new source either supplied by Board of
Radiation and Isotope Technology (BRIT), Mumbai or imported and the
return of the decayed source back to the supplier. All the regulations for
safe transport should be strictly followed.
2. All the gadgets required for the source transfer operation as per the check
list should be made available before undertaking the operation. Non-
standard gadgets which may delay the source transfer operation and
may lead to radiation accidents should not be used.
3. Personnel monitoring badges, Pocket dosimeters and Pocket alarm type
radiation monitor should be used by all personnel involved in the
operation.
4. Proper procedure should be adopted for the alignment of the source
flask with the unit head. Necessary coupling devices should be used to
facilitate proper alignment.
5. Proper arrester/s should be provided on the source flask after removing
the lids so that source drawer does not slip down accidentally during
the alignment process.
6. After confirming the alignment between the source flask and unit head,
the source flask should be immobilized. Also, all unnecessary materials
around the flask should be removed.
7. In case the source transfer operation is to be carried out in the ON
position (like in Philips or Picker units), proper locking device should
be provided to prevent the movement of the system in case of power
failure.
8. Wherever dummy drawer is required in the source transfer operation
(theratron and Siemens Model), source transfer operation without
dummy drawer should not be carried out.
9. After the transfer of the new source into the teletherapy unit, proper
arrester or arresting plates should be employed to prevent the slipping
of the source drawer, in case the unit is moved accidentally.
10. Proper functioning of the unit, after loading of new source, should be
checked with shutter open to minimum size and beam pointing opposite
to maze wall.
11. Parking rod required for pushing the stuck source drawer or shutter
should always be available in the control room.

PROTECTION IN RADIOTHERAPY
Special care needs to be taken when considering radiotherapy for patients
during pregnancy. There are no hard and fast rules, but the patient, family
240 members, treating oncologist and other team members should carefully
discuss the decisions made.
Pregnant Woman and Radiotherapy

Pregnant patients can be treated with radiotherapies, but important factors
must be considered. The most important considerations, as suggested by
the ICRP, include:
1. The stage and aggressiveness of the tumor;
2. The location of the tumor;
3. Potential hormonal effects of pregnancy on the tumor;
4. Various therapies and their length, efficacy, and complications;
5. Impact of delaying therapy;
6. Expected effects of maternal ill-health on the fetus;
7. The stage of pregnancy;
8. Fetal assessment and monitoring;
9. How and when the baby could be safely delivered;
10. Whether the pregnancy should be terminated;
11. Legal, ethical, and moral issues.
Reduction of Fetal Dose When a Pregnant

Patient Undergoes Radiotherapy
The first consideration is if the treatment can be postponed until the fetus
is at a later gestation age. If the decision is made that radiotherapy is
necessary, it is important to calculate the dose to the fetus before the
treatment is given. When external radiotherapy is used for treatment of
tumors at some distance from the fetus, a very important factor in fetal
dose is the distance from the edge of the radiation field. The American
Association of Physicists in Medicine (AAPM) recommends that the
following points for consideration:
1. Complete all planning as though the patient were not pregnant. If the
foetus is near the treatment beam, do not take portal localization films
with open collimation and blocks removed.
2. Consider modifications to the treatment plan that would reduce the
radiation dose to the fetus (e.g. changing field size, radiation energy). If
possible use photon energies of less than 25 MV.
3. Estimate dose to the fetus using phantom measurements, a shield may
be constructed with 4-5 half-value layers of lead.
4. Document the treatment plan and discuss it with the staff involved in
patient set-up. Document the shielding (perhaps with a photograph).
5. Check the weight- and load-bearing specifications of the treatment couch
or other aspects of shielding support.
6. Be present during initial treatment to assure that shielding is correctly
placed.
7. Monitor the fetal size and growth throughout the course of treatment
and reassess fetal dose if necessary.
8. On completion of treatment, document the total dose including the range 241
of dose to the fetus during therapy.
9. Consider referring the patient to another institution if equipment and

personnel are not available for reducing and estimating the fetal dose.
Pregnant Patient with Cervical Carcinoma

Who Needs Radiotherapy Treatment
The patient diagnosed as cervical cancer may be treated with radiotherapy
with external and Brachytherapy treatment. If she is found to be pregnant
unfortunately, it is likely that pregnancy will be terminated.
Carcinoma of the cervix is the most common malignancy associated with
pregnancy. Cervical cancer complicates about one out of 1250 to 2200
pregnancies. This rate, however, varies significantly by country. Cervical
cancer is often treated by surgery/radiotherapy (external beam
radiotherapy and brachytherapy) and the absorbed doses required with
both forms of radiotherapy will cause termination of pregnancy. If the tumor
is infiltrative and is diagnosed late in pregnancy, an alternative is to delay
treatment until the baby can be safely delivered. Regardless of protective
measures, radiotherapy involving the pelvis of a pregnant female almost
always results in severe consequences for the fetus, most likely fetal death.
Avoid of Pregnancy after Receiving Radiotherapy

for Breast Cancer Treatment
The wait can be substantial and needs to be discussed with her radiation
oncologist. Most radiation oncologists advise their patients not to become
pregnant for 1-2 years after completion of therapy. This is not primarily
related to concerns about potential radiation effects, but rather to
considerations about the risk of relapse of the tumour that would require
more radiation, surgery, or chemotherapy.
Illustration 1
A patient just finished four weeks of radiation treatment to the neck area
for non-Hodgkins lymphoma. After one month, she got pregnant. What
are the possible effects on the fetus?
There is no likely effect. Radiation exposure occurred before conception,
so any effect on the offspring would be classed as genetic effect. No data
from humans show any statistically significant genetic effect in any
population, even the Japanese atomic bomb survivors. All estimates of
genetic radiation risk come from studies of rodents, which show that males
are far more sensitive than females. However, it is not easy to extrapolate
this data to humans. There is very low risk of any effect on the unborn
child. The World Health Organization estimates that the worldwide
incidence of inherited disease (ranging from severe to as trivial as an
inconspicuous birthmark) is about 10%. In the unfortunate event that the
242 child is born with any genetic abnormality, it is extremely unlikely that it
would be related to the earlier radiation exposure.
Illustration 2
What is the risk to a foetus if a man who has had a radiation pellet inserted
into his prostate for cancer treatment comes into close proximity with a
pregnant woman?
There is no danger involved. Prostate brachytherapy can be performed
with permanent implantation of radioactive 103Pd or 125I seeds, and the
patient is discharged from hospital with these in place. The short range of
the emissions from these radionuclides is the reason that the patient can be
discharged and is the reason that these patients pose no danger to pregnant
family members. Other brachytherapy patients are kept in the hospital until
the sources are removed. While these patients can occasionally be a source
of radiation to a pregnant family member, the potential dose to the fetus is
very low, irrespective of the type of brachytherapy.
RECORDS
Treatment records must be maintained to facilitate unambiguous and
correct treatment follow up. In teletherapy the following records and log
books are required.
1. Patient case sheet
2. Patient simulation register
3. Patient planning (TPS) register
4. Patient Treatment register
5. QA register (daily/quarterly/annually)
6. Calibration register
7. Radiation survey register
8. Machine log book (for each machine)
In brachytherapy also all the above records and log books are required.
In addition, the following log books are maintained
9. Source inventory register
10. Source movement register
11. Source disposal register
The number of logbook and type of entries varies with the machine and
type of treatment. Every machine should have a separate machine log book
and the entries are made as follows in Table 8.14:
Table 8.14: Model log book

Date defect Reported solutions Serviced Down time Instructions, Physicist
to whom by If any /RSOsign
243
BIBLIOGRAPHY
1. Europian commission, European Guidelines on Quality Criteria for Diagnostic
Radiographic Images in Paediatrics, EUR-16261, Luxembourg 1996.
2. International commission on radiological protection, 1990 Recommendations
of the ICRP, Publication 60, Pergamon Press, Oxford 1991.
3. International commission on radiological protection, Pregnancy and Medical
Radiation, Annals of the ICRP, Publication 84, Pergamon Press, Oxford 2000.
4. International commission on radiological protection, Radiation Dose to Patients
from Radiopharmaceuticals, ICRP Publication 53, Pergamon Press, Oxford 1988.
5. International commission on radiological protection, Radiation Dose to Patients
from Radiopharmaceuticals, ICRP Publication 80, Addendum to ICRP 53,
Pergamon Press, Oxford 1998.
6. International commission on radiological protection, Pregnancy and Medical
Radiation, ICRP Publication 84, Pergamon Press, Oxford and New York 2000.
7. International commission on radiological protection, Managing Patient Dose
in Digital Radiology, ICRP Publication 93, Pergamon Press, Oxford and New
York 2004.
8. National radiological protection board, Doses to Patient from Medical X Ray
Examinations in the UK: 2000 review, NRPB-W14, Chilton 2002. 1.
9. Russell JR, Stabin MG, Sparks RB. Radiation absorbed dose to the embryo/
foetus from radiopharmaceuticals, Health Phys 1997;73:756-69.
10. Stovall M, Blackwell CR, Cundiff J, Novack DH, Palta JR, Wagner LK, et al.
Foetal dose from radiotherapy with photon beams: Report of AAPM Radiation
Therapy Committee Task Group No. 36, Med. Phys. 1995;22(1):63-82.
244
Chapter
9 Transport of
Radioactive Materials
INTRODUCTION
Radioactive materials are transported in a variety of types of packages.
Transport includes any operation incidental to the whole course of carriage,
such as loading, unloading and storage in transit. There is a need for certain
safety requirements during such transports. These requirements must
ensure the safety of persons, property and the environment against
radiological hazards involved in transport.
To minimize the hazards during transport of radioactive materials and
to ensure safe transport of radioactive materials several procedures are
adopted, which include;
1. Limiting the amount of radioactive material in a package, depending
on the ability of the package to withstand both normal and accidental
conditions encountered during transport,
2. Limiting the radiation level on the surface of the package and at a
distance of 1 meter from the surface of the package, and
3. Segregating such packages from passenger areas and undeveloped
photographic films. The segregation distance is such that, it should
limit the exposure of undeveloped photographic film to 0.1mSv per
consignment of such film.
4. The Types of package must be specified and the quantity of
radioactive material in a package must not exceed the activity limits
specified by the competent authority.
5. Packages must be designed to confirm the category and Transport
index in accordance with the conditions and requirements, that are
specified.
6. Each package of gross weight exceeding 30 kg must have its gross
weight legibly and durably marked on the outside of the packaging
7. The labels must be fixed on two opposite sides of the outside of a
package or on the outside of all four sides of a freight container or
tank.
8. Large freight containers carrying packages other than excepted
packages, and tanks must bear four placards.
9. Each consignment of radioactive material is accompanied with
declaration document as specified.
10. In case of emergency, the local police should be informed, to initiate

steps to cordon off the area. The competent authority should be
informed within 24 hours.
Radioactive materials should be properly packed prior to transport and
should be accompanied by appropriate transport certificates. Prior to
undertaking the transport of radioactive material, the consigner should
approach the Radiological safety division, AERB for permission and advice.
The Atomic Energy Regulatory Board (AERB) has issued certain
guidelines in the form of codes SC/TR-1, SC/TR-3, and SG/TR-3 for
transport of radioactive materials. The main objective of the above code
are that, the doses to persons engaged in transport and other persons are
as low as reasonably achievable, during such transport.
TYPES OF PACKAGES
Radioactive packages are classified into five types depending on total
activity in a package, specific activity of the material, and whether the
material is fissile or not. Sturdiness, shielding integrity of the packaging
and the quantity of radioactive material determine the type of the package.
The package types are;
a. Type A
b. Type B
c. Excepted packages
d. Industrial packages
e. Fissile packages.
Type A Packages
Type A packages are required to withstand the normal conditions of
transport without loss or dispersal of their contents or loss of adequate
shielding integrity. The total activity of radioactive material in Type A
package is limited. Type A packages must not contain activities greater
than A1 for special form radioactive material or A2 for all other radioactive
material. A1 is the maximum activity of special form radioactive material
permitted under provisions of the type A package. A2 is the maximum
activity of radioactive material, other than special forms of radioactive
material permitted under provisions of the Type A package. The values of
A1 and A2 of important clinical radionuclides are given in the Table 9.1
(AERB safety code SC/TR-1,1986).
The special form of radioactive material means either an indispersible
solid radioactive material or an ordinarily unbreakable metallic sealed
capsule containing the radioactive material. The sealed capsule should be
so constructed that it can be opened only by destroying the capsule. Special
radioactive material should (i) have at least one dimension not less than 5
246 mm, and (ii)comply with the prescribed test requirements.
Transport of Radioactive Materials
Table 9.1: A1 and A2 values for clinical radionuclides

Radionuclide A1 (TBq) A1 (Ci) A2 (TBq) A2 (Ci)
Co-60 0.4 10 0.4 10
Cs-137 2 50 0.5 10
I-131 3 80 0.5 10
Ir-192 1 20 0.5 10
P-32 0.3 8 0.3 8
Ra-226 0.3 8 2 10-2 5 10-1
Sr-90 0.2 5 0.1 2
Tc-99m 8 200 8 200
I-125 20 500 2 50
Type B Packages
Type B packages are designed to withstand both normal and accidental
conditions of transport. Radioactive materials in quantities greater than
those allowed in Type A packages are shipped in Type B packages. The
design of the packages are subject to the approval of the competent
authority.
Type B packages must not contain (i) activities greater than those
authorized for the package design (ii) radionuclides different from those
authorized for the packages design or (iii) contents in a form, or a physical
or chemical state different from those authorized for the package design,
as specified in their certificates of approval.
Type B packages are divided into two basic categories namely Type B(U)
and Type B(M).The type B(U) packages meet the most stringent
requirements; it is considered that safety is entirely built in to these
packages. The design of this package is subject to the approval by the
competent authority of the country of origin. Type B(M) packages do not
meet all the requirements applicable to Type B(U) packages; however, they
must incorporate alternative design features and operational controls must
be instituted so as to achieve the same level of safety as for Type B(U). The
design and shipment of Type B (U) package is subject to multilateral
approval (country of origin and the country through which it is transported).
Excepted Packages
Excepted package means a packaging containing excepted quantities of
radioactive material that is designed to meet the general requirements for
all packaging and packages. These packages are permitted to contain small
quantities of radioactive materials and are excepted from various specific
packaging and labeling requirements.
An excepted package must not contain activities greater than A1 and A2
values of the radionuclides. For transport by post, the total activity in each
package must not exceed one tenth of the above relevant limit specified. 247
Industrial Packages
The total activity in a single package of low specific activity (LSA) material
or in a single package of surface contaminated object (SCO) must be so
restricted that the external radiation level at 3 m from the unfinished material
or object or collection of objects does not exceed 10 mSv/h and the activity
in a single package must also be so restricted that the activity limits for a
conveyance specified by the competent authority.
LSA material means radioactive material which by its nature has a limited
specific activity, or radioactive material for which limits of estimated
average specific activity apply. External shielding materials surrounding
the LSA materials must not be considered in determining the estimated
average specific activity. The LSA has three groups namely LSA-I, LSA-II
and LSA-III.
SCO means a solid object which is not itself radioactive but which has
radioactive material distributed on its surfaces. SCO has two groups namely
SCO-I and SCO-II.
Fissile Packages
Fissile material means uranium-233, uranium-235, plutonium-238,
plutonium-239, plutonium-241 or any combination of these nuclides.
Criticality safety in transport of fissile material is ensured by limiting the
quantity and geometric configuration of the fissile material, package design
features and by controlling the number of packages to be carried on a single
conveyance or to be stored together in transit.
All packages containing fissile material must comply with the applicable
activity limits specified in the safety code. Packaging containing fissile
material must not contain (i) a mass of fissile material greater than that
authorized for the package design (ii) any radionuclide or fissile material
different those authorized for the package design or (iii) contents in a form
or physical or chemical state, or in a spatial arrangement, different from
those authorized for the package design, as specified in their certificates of
approval.
The packages containing fissile materials, which may be LSA, SCO, Type
A or Type B, are subjected to multilateral approval.
TRANSPORT INDEX
The Transport index (TI) of a package is the number expressing the
maximum radiation level in mrem /h at 1m from the external surface of
the package. If the radiation level is measured in mSv /h, it should be
multiplied by 100,to arrive mrem /h. The values of TI are 0, 1-10 and more
than 10.
248
Categories
There are three categories of packages namely (i) category I-White, (ii)
category II-yellow, and (iii) category III-Yellow.
Category I-white
The maximum radiation level at any point on the external surface of the
package should not be more than 0.005 mSv/h or 0.5 mrem/h. The
Transport index is zero.
Category II-Yellow
package should be more than 0.005 mSv/h, but not more than 0.5 mSv/h
or 50 mrem/h. The Transport index is more than zero, but not more than 1.
Category III-Yellow
package should not be more than 0.5 mSv/h, but not more than 2 mSv or
200 mrem/h. The Transport index is more than 1, but not more than 10.
PACKAGING AND PACKAGE REQUIREMENTS

The package should satisfy the following general and specific requirements
before they are used for actual transport.
General Requirements
1. The packages must be so designed in relation to its mass, volume and
shape that, it could be easily and safely handled and transported.
2. The lifting attachments on the package should not fail when used in the
indented manner.
3. The external surface of the package should be free from protruding
features and can easily decontaminated.
4. The outer layer of the package must be designed as to prevent the
collection and the retention of water.
5. The package should be capable of withstanding the effects of acceleration,
vibration etc. during transport.
6. The material of the packaging and the components must be physically
and chemically compatible with one another, and with radioactive
contents.
7. All valves through which the radioactive contents could otherwise escape
must be protected against unauthorized operation.
8. Packages to be transported by air, should with stand ambient
temperatures ranging from 40C to + 55C
9. Packages with liquid radioactive material, transported by air, must with 249
stand an internal pressure of not less than 95 kPa.
Additional Requirements for Type A Packages

1. The smallest overall external dimension of the packaging must not be
less than 10 cm.
2. The outside of the package must incorporate a seal, to serve as proof
against tamper. It will prevent unintentional release of radioactivity.
3. Any tie-down facility on the package should withstand both normal
and accidental conditions.
4. The design of the package must take into account temperatures ranging
from 40-75C, for the components of the packaging.
5. The design, fabrication and manufacturing techniques must be in
accordance with national and international standards.
6. The containment system is securely closed by a positive fastening device.
It can not be opened unintentionally.
7. The package containment system must retain its radioactive contents
under a reduction of ambient pressure to 25 kPa.
8. When the packages are subjected to specified tests, it would prevent
(i)loss or dispersal of the radioactive material, and (ii) loss of shielding
integrity, which may result >20% radiation level on the external surface
of the package.
9. If the packages carries liquid radioactive material, it should
accommodate variations in the temperature of the contents, dynamic
effects and filling dynamics.
10. If the liquid volume is less than 50 ml, it is provided with sufficient
absorbent material to absorb twice the volume of the liquid contents.
Test for Type A Package

The Type A package tests are (i) water spray test, (ii) free drop test, (iii)
stacking test, and (iv) penetration test. These tests will demonstrate the
ability of the package to withstand normal conditions of transport. After
the specimen is subjected to tests, suitable assessment must be made to
assure that the requirements of the packages are fulfilled in conformance
with the performance and acceptance standards.
Water Spray Test

The specimen must be subjected to a water test that simulate exposure to
rainfall of approximately 5 cm per hour for at least one hour.
Free Drop Test

The specimen must drop on to the target so as to suffer maximum damage
in respect of the safety features to be tested. The height of drop measured
from the lowest point of the specimen to the upper surface of the target
must be not less than 1.2 m for packages weighing up to 5000 kg.
250
Stacking Test
The specimen must be subjected to a compressive load equivalent of 5 times
the mass of the actual package for a period of 24 hours.
Penetration Test
The specimen is placed on a rigid flat horizontal surface. A bar of 3.2 cm
diameter with a hemispherical end and a mass of 6 kg must be dropped
and directed to fall, with its horizontal axis vertical, on to the centre of the
weakest part of the specimen. The height of drop of the bar must be 1m.
Additional Requirements for Type B Packages

1. The package should meet the requirements of general requirements 1-8
and that of Type A package (1-10).
2. The packaging is so designed, that if it were subjected to the prescribed
tests it would retain sufficient shielding to ensure that the radiation level
at 1 m from the surface of the package would not exceed 10 mSv/h with
the maximum radioactive contents which the package is designed to
carry.
3. The package must withstand heat generated within the package, so that
the heat should not (i) alter the arrangement, geometrical form or the
physical state of the radioactive contents, (ii) lessen the efficiency of the
packing, and (iii) accelerate corrosion in combination with moisture.
4. If it were subjected to water spray test, free drop test, compression test
and penetration test the loss of radioactive contents should be less than
A2 10-6 per hour.
5. If the package is subjected to mechanical test, thermal test and water
immersion test, it would restrict the accumulated loss of radioactive
contents in a period of one week to not more than 10 A2 for Krypton-85
and not more than A2 for all other radionuclides.
Test for Type B Package

The test for Type B packages are (i) mechanical test, (ii) thermal test and
(iii) water immersion test. These tests will demonstrate the ability of the
package to withstand accident conditions in transport. After the specimen
is subjected to tests, suitable assessment must be made to assure that the
requirements of the packages are fulfilled in conformance with the
performance and acceptance standards.
Mechanical Test
This consists of three different drop tests. For drop I, the specimen must be
dropped from 9 m onto the target so as to suffer the maximum damage.
For drop II, the specimen must be dropped from 1 m, so as to suffer the
251
maximum damage onto a bar rigidly mounted perpendicularly on the
target. The bar must be a solid mild steel of circular section (15 0.5 cm) in
diameter and 20 cm long. For drop III, a 500 kg mass is dropped from 9 m
height onto the specimen. The mass must consist of a solid mild steel plate
1m by 1m and must fall in a horizontal altitude.
Thermal Test
The specimen must be subjected to a fuel source (hydrocarbon /air fire),
having a emissivity coefficient of 0.9 and average flame temperature of
800C for a period of 30 minutes. The fuel source must extend horizontally
at least 1m, and must not extend more than 3 m, beyond the external surface
of the specimen. The specimen must be positioned 1m above the surface of
the fuel source. After the thermal test, the specimen must not be cooled
artificially and any combustion materials of the specimen must be allowed
to proceed naturally.
Water Immersion Test

The specimen must be immersed under a head of water of at least 15 m for
a period of not less than 8 hours in the altitude which will lead to a maximum
damage. For demonstration purposes, an external gauge pressure of at least
150 kPa must be considered to meet these conditions.
Package Handling
Packages weighing <5 kg are not provided with handling facilities, and
one can hold them with hands. Packages weighing not more than 30 kg, is
provided with manual handling facility. Two or more persons should be
employed for handling the packages up to 100 kg. During manual handling,
operations should be completed quickly, by keeping the packages as far
away as possible. Mechanical handling devices (crane, chain pulley block
etc.) should be employed to handle the packages, if the weight is > 100 kg.
If the weight of the package is not known, it must be handled only by
mechanical means.
Storage in Transit Requirements

1. Packages of radioactive materials should be kept segregated from areas
routinely occupied by passengers and public.
2. The number of packages stored in an area should be restricted to ensure
that the sum of the transport indexes of the packages stored in the area
does not exceed 50.
3. Radioactive consignments should not be stored together with other
dangerous goods (explosives, inflammables etc).
4. They should also be so separated from underdeveloped X-ray and
photographic films or plates so that these are not exposed to more than
0.1mGy (10 mR), during the entire duration of the transport including
252
storage in transit.
5. Persons working in the storage area should spend minimum possible

time in the vicinity of the packages, relevant to their work.
6. When the consignment is brought for booking, it should be forwarded
for transport as soon as possible.
7. The packages must be delivered to the consignee or his authorized
representative only.
8. An unclaimed or damaged package should not be auctioned or otherwise
disposed off.
9. If the package is damaged, do not touch the package, isolate it by
cordoning about 5 m around it, and inform the competent authority.
Package Radiation Levels

Radiation levels under normal transport conditions are limited so that
maximum radiation level at the package surface should not be greater than
2 mSv/h (200 mR/h) and the maximum radiation level at 1m from the
surface should not be greater than 0.1 mSv/h (10mR/h).
PREPARATION OF THE PACKAGE FOR TRANSPORT

1. The source should be transported only in an approved transport
container. Alternatively the original container in which the fresh source
was received can be used, provided if it is in good condition.
2. The source should be loaded in the container properly and carefully.
3. The source should be secured within the shielded container by means of
appropriate locking mechanisms incorporated in the design of the
shielded container.
4. The lid of the container should be closed, so that the source is not released
during the transport.
5. The container should be loaded in an outer container such as wooden or
metallic box. It is provided with spacers within for preventing movement
of the shielded container inside during transport. It should be ensured
that the outer container deployed is in a good condition and is provided
with locking facility and strong lifting handles.
6. The outer container should be locked and tied with crossed metal straps
and sealed, then only it is called transport package.
7. The maximum radiation levels on the outer surface of the package and
at a distance of 1m from the surface should be measured (mSv/h) by
using a working radiation survey meter and recorded. This will be useful
to find the correct transport index (TI). The measured value is multiplied
by 100, to get the appropriate TI.
MARKING OF THE PACKAGE

Write or inscribe the following information durably, clearly and legibly on
the outer side of the package. 253
1. Addresses of the CONSIGNOR and the CONSIGNEE.

2. Type of package (e.g. Type A/Type B etc.).
3. UNITED NATIONS NUMBER (UN NO.), and the PROPPER SHIPPING
NAME (please refer Table 11.3).
4. Gross weight of the package if it exceeds 30 kg for domestic transport
and 50 kg for international transport.
5. Competant authority (i) identification mark allocated to that design and (ii)
serial number to identify each package, if it is a Type B(U)/B(M) package.
6. In the case of Type B(U) or B(M), the outer surface should have the trefoil
symbol (Fig. 9.1), which must be marked by embossing, stamping or
other means resistant to the effects of fire and water.
Fig. 9.1: The trefoil symbol
LABELING OF THE PACKAGE

Appropriate labels indicating the category of the package should be affixed
on two opposite sides on the exterior of each package. In the case of a tank
or freight container it should be on the outside of all four sides. Each label
should be completed with the information required, i.e. with the content,
activity and transport index. The criteria for determination of the category
of the package are given in the Table 9.2 below:
Table 9.2: Category of package, radiation level and transport index

Category Maximum radiation level at the external Transport Index
surface of the package, mSv/h, (mrem /h)
I WHITE 0.005 (0.5) 0
II YELLOW 0.5 (50) 1
254 III YELLOW 2.0 (200) 10
Both the limits should be satisfied for a package to belong to a specified

category. If either of the limits is exceeded, the package would belong to
the next higher category.
CAUTION: If either the radiation level on the surface of the package
is more than 2.0 mSv/h or Transport Index is more than 10, the
package should not be forwarded for transportation without prior
permission of the competent authority.
The Category I WHITE label background color must be white, the color
of the trefoil and the printing must be black, and the color of the category
bar must be red (Fig. 9.2).
Fig. 9.2: Category I WHITE label Fig. 9.3: Category II YELLOW label
(For color version see plate 3) (For color version see plate 3)
In the case of Category II

YELLOW label, the background
color of the upper half of the label
must be yellow and the lower half
white, the color of the trefoil and
the printing must be black, and the
color of the category bar must be red
(Fig. 9.3).
In the case of Category III
YELLOW label, the background
color of the upper half of the label
must be yellow and the lower half
white, the color of the trefoil and the
printing must be black, and the color
of the category bar must be red Fig. 9.4: Category III YELLOW label
(For color version see plate 4) 255
(Fig. 9.4).
PLACARDS
Large freight containers carrying packages other than excepted packages,
and tanks must bear four placards as specified in Fig. 9.5. These placards
must be affixed in a vertical orientation to each side wall and each end wall
of the freight container or tank. Any placards which do not relate to the
contents must be removed. Instead of using a label and a placard, it is
permitted as an alternative to use enlarged labels, with minimum dimension
of 25 cm.
Fig. 9.5: Placard, the minimum dimensions is 25 cm. The figure 7 must not be less
than 25 mm height. Background colour of the upper half must be yellow and the lower
half is white, trefoil and the printing must be black (For color version see plate 4)
If the freight container is packed with radioactive material comprised of
a single United Nations commodity, the appropriate United Nations
number (Table 9.3) for the consignment must also be displayed, in black
digits not less than 65 mm height, either in the lower half of the above
placards or in the placard shown in Fig. 9.6.
Fig. 9.6: Placard for separate display of united nations number. The background
color must be orange and border and the united nations number must be black.
256 The **** denote the space for UN number of radioactive material (For color version
see plate 4)
Table 9.3: United nations number and proper shipping name

UN No. Proper shipping name and description
2910 Radioactive material excepted package-Limited quantity of material
2911 Radioactive material excepted package-Instruments or articles
2909 Radioactive material excepted package-Articles manufactured from
natural Uranium or depleted Uranium or Natural Thorium.
2908 Radioactive material excepted package-Empty packaging
2912 Radioactive material, Low specific activity (LSA-I)
3321 Radioactive material, Low specific activity (LSA-II).
3322 Radioactive material, Low specific activity (LSA-III)
2913 Radioactive material, Surface contaminated objects
(SCO-I or SCO-II).
2915 Radioactive material Type A package, non special form.
3332 Radioactive material Type A package, special form.
2916 Radioactive material Type B(U) package.
2917 Radioactive material Type B(M) package.
BOOKING, STORAGE, TRANSPORT

AND DELIVERY OF PACKAGE
The package should not be transported as a personal luggage in a bus or in
a shared Taxi or in the passenger compartment of a train or in the passenger
cabin of an aircraft. It is always booked as an item of cargo. The package
should not be dispatched by post. The package is declared as a radioactive
consignment in the transport documents. For road transport, the consigner
shall declare the consignment by its proper shipping name. The package is
provided with transport documents, which include (i) Consigners
declaration, (ii) TREM card (Transport emergency card), (iii) Instructions
to the carrier and (iv) Instructions about emergency measures in case of
transport incidents.
The key of the lock should be sent along with the transport documents
to the CONSIGNEE. The package should not be dispatched with out prior
permission of the COMPETENT AUTHORITY. The CONSIGNEE should
be informed before dispatching the package and ensured that the
CONSIGNEE is prepared to receive the consignment. The CARRIER is
provided with documents entitled INSTRUCTIONS TO THE CARRIER,
while booking the package for transport. The CONSIGNOR, CONSIGNEE
and CARRIER should contact the competent authority immediately in the
event of :
a. Any untoward incident /accident during transport
b. Non delivery of the package to the destination within the normal period.
It should be ensured that the CONSIGNEE has received the consignment
or not and the same is informed to the competent authority. A Check list
should be filled to ensure that all the requirements for safe transport of
radioactive material are complied with. 257
CONSIGNORS DECLARATION
This is to certify that the package containing radioactive material as
identified by the following details is safe for transport by rail, road, sea or
air.
Package forwarded by (consignor)

Package addressed to (consignee)
Proper shipping name Radioactive material
package, Non fissile
UN class of dangerous goods 7
United Nations No. UN NO.
Subsidiary risk Nil
Name of the radioactive material
Quantity/Activity of radioactive material RMM on -
Packages details
Dimensions of package
Weight of the package
Type of package*
Radiation level on the surface of the
package in mSv/h
Transport index of the package
Category of the package
*In the case of Type B(U)/(M) package, competent authority identification number
should also be given.
I hereby declare that the contents of this consignment are fully and accurately
described above by the proper shipping name and are classified, packed, marked
and labeled and are in all respects in proper condition for transport according to
the AERB Safety code, AERB/SC/TR-1,currently in force.
Date: Signature:
Name and Address:
258
TREMCARD
Cargo In-dispersible radioactive material
Nature of Hazard Radioactive material, Potential external exposure
Emergency action 1. Inspect the package visually. If it is intact, ensure
onward journey in the same or another vehicle.
2. In case of fire, fight from a distance
3. If the package appears to be damaged cordon a
distance of 3 m around the package.
4. Obtain the names and addresses of persons who
might have been exposed to radiation and convey
the particulars to the Head, AERB and to the Head,
RP and AD, BARC, Mumbai.
Contact telephone a. Contact the consignor at the address given on the
numbers for advice and package
assistance b. Chairman, Crises Management Group, DAE,
Mumbai-400001, Tel : 022 22023978, 22830441,
FAX: 022 228304441
c. Head, Radiological Safety Division, AERB, Niyamak
Bhavan, Anushatinagar, Mumbai-400 094, Tel:022
25990655, FAX:022 25990650
d. Head, Radiological Physics and Advisory division,
BARC, CT and CRS, Anushaktinagar, Mumbai-
400094, Tel:022 25519209, FAX: 022 25519209
Telegram REGATOM,CHEMBUR or HEAD,RP and AD, BARC-
CHEMBUR
FAX 022 25583230 (AERB),022 255055151(BARC)
259
INFORMATION TO CARRIERS
1. The package should be transported by the most direct route.
2. Intermediate off-loading and reloading of the package should be
avoided.
3. Package should be handled carefully. Suitable mechanical means should
be deployed for handling packages weighing more than 30 kg.
4. Persons should not be allowed to sit on the package or spend more
time than the necessary time in the vicinity of the package.
5. The package should not be transported along with other dangerous
good such as explosives and inflammables.
6. The package should not be transported/stored together with
photosensitive films/plates.
7. The package should be kept segregated from spaces occupied by
passengers and public.
8. If several packages containing radioactive material are to be transported,
then the total number of packages loaded in a single vehicle should not
be so restricted that the sum of the transport indexes of the packages
does not exceed 50, except in case of executive use. Further the total
number of packages staked in a storage area should be so limited that
in a given stack the above limit of 50 of the sum of transport indexes is
not exceeded and such stacks containing radioactive consignments are
separated by at least 6 meters.
9. If the shipment is under explosive use, i.e. the entire conveyance is for
the proposed transport of radioactive material then (a) there should not
be any intermediate loading and unloading operations of other goods.
(b) Nothing other than the intended radioactive material along with its
accessories should be carried in this vehicle.
10. At the destination, it should be ensured that the package is delivered to
the consignee to whom it is indeed addressed.
11. One copy of the TREMCARD should be carried in the vehicle carrying
the radioactive cargo. If the package(s) get (s) involved in an accident
or get (s) damaged during transport, the instructions specified in the
TREMCARD should be implemented.
12. If the package is not claimed by the consignee at the destination, it should
not be auctioned or otherwise disposed of. The matter should be brought
to the notice of the consigner and Head, RSD, AERB, Niyamakbhavan,
Anushaktinagar, Mumbai-400094 and such measures as recommended
in this regard by HEAD, AERB, Mumbai, should be duly implemented.
260
Annexure-I
Check list for preparing, marking and labelling
a package to transport radioactive material
Type of the package: Type A /Type B (U)/Type B (M)/

other (please specify)
If Type B(U) or Type B(M), give the Competent Authority Identification No.
_________
Preparation of the package
1. Whether it was confirmed with radiation survey meter that the radiation source
is in its proper storage place in the shielded container/source housing/
radiography camera.
Yes/No
2. Whether the source is locked/arrested in its shielded position.
Yes/No
3. Whether all the nuts and bolts meant for fastening the shielding are properly in
place, secured and tightened.
Yes/No
4. Whether the shielded container is properly immobilized in the outer container/
box (package) with the help of wooden spacers, etc.
Yes/No
5. Whether the outer box (package) is properly closed with the help of fasteners/
bolts, steel straps etc. and the nuts/bolts are properly tightened.
Yes/No
6. Whether the package is properly locked and sealed with crossed steel strips.
Yes/No
Markings of the package
1. Whether the Gross weight of the package is marked on it, if the weight exceeds
30 kg.
Yes/No
2. Whether the package is marked on the out side with name, address and telephone
number of consignor (sender) and consignee (receiver).
Yes/No
3. Whether the shielded container inside the package is marked with name, address
and telephone number of consignor (sender) and consignee (receiver).
Yes/No
4. Whether the proper shipping name of the radioactive material is marked on the
package.
Yes/No
261
5. Whether the proper United Nation Number is marked on the package.

Yes/No
6. Whether the Type of package is marked on it.
Yes/No
7. Whether all the markings made on the package are legible and durable.
Yes/No
Labeling
1. Whether label of proper category is selected based on the radiation.

Yes/No
2. Whether the package is labeled with two numbers of selected category labels
affixed on two opposite sides of the package.
Yes/No
3. Whether these labels are properly filled-in with respect to (a) Name of Radio
nuclide (b) Activity in becquerel (c) Transport Index.
Yes/No
Transport documents
1. Whether the Consignors declaration along with particulars of the consignment

are provided in proper format.
Yes/No
2. Whether a copy of instructions to the carrier is provided to the carrier and the
carrier is properly informed regarding the radioactive nature of the consignment
and the hazards associated with it.
Yes/No
3. Whether the TREMCARD is provided to the driver of the vehicle and whether it
forms a part of the Transport Document.
Yes/No
4. Whether the copy of Emergency instructions in writing is provided to the
driver of the vehicle.
Yes/No
Prior to actual transport of the package
1. Whether the carrier is informed that the package should not be carried in the
passenger compartment of a train, an aircraft or passenger cabin of a ship or in
a passenger bus or a shared taxi or any shared rented vehicle.
Yes/No
2. Whether the carrier is informed about the care to be taken during handling and
carriage of the package in trans-shipments, etc.
Yes/No
262
3. Whether carrier is informed about the proper stowage of the package in the
vehicle during the transport.
Yes/No
4. Whether the carrier is informed that the package should be immobilized during
the transport.
Yes/No
5. Whether the consent of the consignee is obtained before dispatching the
package.
Yes/No
Consignors Signature:
Name and address
Date:
Seal.
263
Annexure-II
Instructions in writing regarding Practical Measures
for Transport Incidents Involving Radioactive Cargo
(AERB/RSD/TRANSPORT EMERGENCY/REV.6)
1. About the package: Packaging which are permitted to be used for transport of
radioactive materials are generally designed to prescribed standards aimed at
prevention of release of the contents and of excessive exposure of public of
radiation. Essentially there are two types of packages, namely, Type A and Type
(B)U/(M).
If a Type A package is involved in an accident which may result in the package
falling off the vehicle, it is very unlikely that the package will be broken open. If
the accident is severe such as vehicle rolling over, then the package may be
damaged through the loss of shielding or release of the contents may not occur.
A Type B package is designed to withstand severe accidents
Only those packagings whose design and specifications have been duly
approved by Atomic Energy Regulatory Board (AERB) for Type B(U)/(M) and
registered in AERB for industrial and Type A package, are deployed for the
transport of radioactive material in India. It is such a package which is loaded in
the vehicle.
2. Nature of Hazard: The hazard associated with radioactive consignment is
exposure to radiation. Such exposure may be external and/or internal in nature.
If the radioactive content is an in dispersible solid or capsule, the hazard is
likely to be external. If the content is in dispersible form, in the unlikely event of
a severe accident, the potential for internal and some times, in addition, external
exposure may exist.
3. Protective devices to be carried in the vehicle: The driver of the vehicle and his
assistant should each have some protective device if the vehicle carries a package
containing dispersible radioactive material.
The protective equipments include,
Two pairs of rubber shoes
Two pairs of latex gloves
Coveralls, 2 numbers
Big empty polythene bags: 6 numbers
Big (3 m x 3m) polythene sheets
One kg of cotton wool.
If the vehicle does not carry any package containing dispersible radioactive
material the protective equipment would not be required from radiation safely
standpoint.
4. Emergency action and first aid: If an accident occurs, dont panic. Rescue the
injured. If life is at stake, save life. It is unlikely that in a transport accident
involving the commonly deployed small Type A and Type B(U)/(M) packages
any significant injury to the rescuer will result from radiation. If any of the
264 packages which are damaged in the accident was containing radioactive material
in a dispersible form, which could not be breathed in, hold a cloth towel or a
handkerchief over your mouth and nose.
If there is fire, summon assistance from the local public and fire brigade.
Fight fire from a distance. Follow these instructions:
Fight fire as far upwind as possible
Keep out of smoke, fumes and dust
Wear the coverall, gloves and shoes and cover mouth and nose with
handkerchief
Spend minimum time near the package
Keep by standers upwind at least 5 m away
Inspect the packages. If the packages appear to be intact, ensure onward
journey in the same vehicle. If the vehicle cannot be release for onward journey
for a long time, then arrange for onward journey of the package in some
other vehicle.
If the package appears to be damaged, wrap it in a polythene bag, segregate
the package and cordon a distance of 5 m around the package.
If the contents of the package appears to have spilled, then take the following
measures:
Assume that the area and the objects on which the spillage has occurred are
contaminated.
Wear the shoes, gloves and coveralls
Collect the spillage, using cotton wool, in a polythene bag
Wrap the damaged package in polythene bags
Cover the contaminated objects and contaminated area with polythene sheets.
Do not eat, drink or smoke within the cordon
Take measures to prevent a fire accident.
Seek assistance from AERB/BARC as directed in para 5 below
Do not allow the public within the cordon unless so advised by the radiological
safety authorities from AERB/BARC, Mumbai.
All persons who were engaged in the emergency response measures should
carefully and thoroughly wash the affected parts of the skin with plenty of water.
Obtain the names and addresses of persons who may have been exposed to
radiation and convey the particulars to the Head, RSD, AERB, Niyamak Bhavan,
Anushaktinagar, Mumbai 400 094.
5. Telephones for advice and assistance for advice and assistance contact:
Chairman
Crisis Management Group, DAE
Mumbai400 001
Tel.(round the clock) 022-22023978, 22830441, Fax:022-22830441.
Head, Radiological Safety Division, AERB
Niyamak Bhavan, Anushaktinagar,
Mumbai-400 094,
Tel.(off) 022-25990655, 27824986 (Res), Fax:022-25990650
265
Head, Radiological Physics and Advisory Division

BARC, CT and CRS, Anushaktinagar
Mumbai-400 094,
Tel. 022-25519209 (Off), 022-25517812 (Res), Fax: 022-25519209
While seeking advice and assistance furnish the furnish the following particulars:
The place where the accident occurred.
The date and time of occurrence of the incident.
Whether the incident involved impact, fire or both.
Details of emergency action taken.
The condition of the packages, whether damage/Spillage suspected.
The name and addresses of persons who may have been exposed to radiation.
Act exactly in accordance with the instructions given by the above authorities.
Onward journey of the packages which were damaged in the incident may be
arranged only after obtaining clearance from the above authorities.
6. General: Every driver should ensure that he is completely familiar with the
Instructions in Writing.. and the procedures recommended in the
TREMCARD. Prior to undertaking the journey, the driver should ensure that he
carries the following items with him:
the Instructions in writing..

the TREMCARD
the protective devices as specified in para 3 above.
The assistant accompanying the driver should also be familiar with these
instructions.
BIBLIOGRAPHY
1. AERB safety code No.SC/TR-3: Emergency response planning and
preparedness for Transport accidents involving radioactive material.
2. AERB Safety code No.SG/TR-3:Procedure for forwarding, transport, handling
and storage of radioactive consignments.
3. AERB safety code: No.SC/TR-1:Transport of radioactive materials
266
Chapter
10 Radioactive Waste
Disposal
INTRODUCTION
Every industry generates some amount of waste and nuclear industry is
one among them. The waste generated in the nuclear industry is called
radioactive waste, which may be in soild, liquid or gaseous form. Hazards
related to radioactive waste give rise to certain amount of fear and
unacceptability in the minds of public. The radioactive waste needs to be
managed safely to ensure protection of man and environment, without
imposing significant burden on future generations. If not handled carefully,
ionizing radiations emitted by the radioactive waste can cause somatic and
genetic effects in the living beings. Radioactive waste can be treated some
extent by physicochemical methods, adopted to conventional pollutants.
However, they undergo decay and the radiation comes to the background
level after a certain period of time. This period depends upon the half life
of the waste, which vary from seconds to thousands of years. Hence,
effective waste management methods are the need of the hour.
WASTE MANAGEMENT
The basic objective of radioactive waste management is:
i. Protection of human health,
ii. Protection of environment, and
iii. Protection of future generation.
To achieve this the methods adopted in the practice includes:
i. Minimize the generation of radioactive waste,
ii. Recycling and reuse the waste material, and
iii. Minimize the exposure to operation staff and public.
The basic approaches used in the management of radioactive wastes are:
i. Delay and decay
ii. Dilute and disperse
iii. Concentrate and contain.
The delay and decay is suitable only for short half life isotopes. For
example I-131 (HL-8 days) in small volumes may be retained till the activity
levels comes down to the desired values, suitable for release into the
environment. Where as the later two methods are generally adopted in the
management of all radioactive wastes.
Delay and Decay

It is based on the fact that radionuclides lose their radioactivity through
decay, and this fact may be utilized in the treatment not only of intermediate
and high level solid, liquid and gaseous wastes but in some cases also in
that of low-level wastes. The aim is to ease problems in subsequent handling
or to lessen risks of releases to the environment, taking advantage of the
decay of some radionuclides particularly those having short half lives
with the passage of time. The principle is especially useful for those
installations where a substantial reduction in the activity level of a waste
stream can be achieved by delaying discharge of effluents for a few days.
Dilute and Disperse

The principle of dilution and dispersion is based on the assumption that
the environment has a finite capacity for dilution of radionuclides to an
innocuous level. The application of this principle requires an understanding
of the behaviour of radioactive materials in the environment and of the
ways in which the released radionuclides, particularly those that are
considered to be critical, may lead later to the exposure of man. It is
especially important to take into consideration environmental processes
which may cause reconcentration of radionuclides.
Concentrate and Contain

The principle of concentration and containment derives from the concept
that the majority of the radioactivity generated in nuclear programs must
be kept in isolation from the human environment. Since some radionuclides
take a long time to decay to innocuous level, some wastes must be contained
for extended period of time.
The principle is invoked in techniques for air and gas cleaning; the
treatment of liquid wastes by scavenging and precipitation; ion exchange
and evaporation; the treatment of low-level, solid wastes by incineration,
baling and packaging the treatment of intermediate-level solid and liquid
wastes by insolubilization in asphalt; conversion of high-level liquid wastes
to insoluble solids by high-temperature calcinations or incorporation in
glass; tank storage of intermediate and high-level liquid wastes; storage
of solid wastes in vaults or caverns; and disposal of solid and liquid wastes
in deep geological formations.
SOURCES AND NATURE OF WASTE

Mainly radioactive waste is generated from:
i. Nuclear fuel
ii. Research and power generation reactions, and
268 iii. Isotope applications.
Radioactive Waste Disposal
In nuclear fuel it begins with the mining, milling, refining of U and Th

from their ores, fuel fabrication and fuel reprocessing. The second type
includes isotope production and electricity generation. The third, isotope
application includes medicine, nuclear research, industry and agriculture.
The waste generated may be liquid, solid or gaseous with radioactive
content varying from insignificant to extremely high levels.
Wide range of radionuclides are used in medicine for treatment,
diagnosis and research. The waste arises from the above applications are
called medical radioactive waste, which require a comprehensive
management system. The type of radioactive waste that may arise in
medicine are mainly from radiotherapy and nuclear medicine. The sources
from which the wastes arises are source storage, preparation, source
administration and injection needles, counting room, toilet-improper use
(vomiting by patients) and decontamination. In radiothepay the waste arises
from;
i. Used Tele-cobalt -60 sources, enriched uranium components (shutter,
collimator etc.), and
ii. Used Brachytherapy sources (Co-60, Cs-137, Ir-192, and I-125), leaking
sources and contaminated cotton, etc.
In nuclear medicine the radioactive waste arises from:
iii. Decayed sealed sources
iv. Spent radionuclide generators (99mTc,81mKr,and 185mAu etc.)
v. Laboratory solutions of low activity
vi. Low activity liquid washings from vials
vii. Liquid scintillants immiscible with water
viii. Biologically contaminated solid waste (e.g. syringes, vials)
xi. Radioactive gases.
CLASSIFICATION OF WASTE
The radioactive waste is classified as solid, liquid and gaseous. The liquid
and gaseous wastes are further categorized on the amount of radioactivity.
The solid waste is categoried, depending on the radiation dose on the waste
package. In India, conforming with the internationally acceptable norms
and standards, the Atomic Energy regulatory Board (AERB) has categorized
these wastes, as given the Table 10.1.
Table 10.1: Classification of radioactive waste

Category Solid Liquid Gaseous
Surface dose, mGy/h Activity, Bq /ml Activity, Bq /ml
I <2 <3.7 10-2 3.7 10-6
II 2-20 3.7 10 to 3.7 10 3.7 10-6 to 3.7 10-2
-2 1
III >20 3.7 101 to 3.7 103 >3.7 10-2

IV Alpha bearing 3.7 103 to 3.7 108 -
V - >3.7 108 - 269
The liquid waste of categories III and IV need to be properly shielded

whereas category V requires shielding as well as cooling during handling,
storage, treatment and disposal. The classification signifies the basic
requirements for safe handling and disposal of wastes.
The term low level waste (LLW), intermediate level waste (ILW) and
high level waste (HLW) are also employed in normal practice and for day
to day working. Waste trace levels to fractions of mCi comes under low
level waste. Where as, 1mCi-1Ci / litre and 1Ci-100 Ci / litre comes under
intermediate and high level waste category. These terms give an idea about
magnitude of the radioactive contents and the associated radiation. The
ICRP-25 classification of nuclear medicine laboratory is given in Table 10.2
Table 10.2: Classification of nuclear medicine laboratories

in terms of activity (ICRP-25)
Classification Low Medium High
Group 2:
I, I
125 131
< 500 kBq, 500 kBq-500 MBq 500 MBq-5 GBq
Group 3:
201
Tl, 32P, 51Cr, 99
Mo < 5 MBq 5 MBq-5 GBq **5 GBq-500 GBq
Group 4:
99m
Tc, 133Xe < 500 MBq *500 MBq-500GBq 500 GBq-50 TBq
*supervised areas ** Generator room
TYPES OF RADIOACTIVE WASTE
Liquid Waste
Liquid waste includes contaminated water and effluent, waste arising from
chemical processing and decontamination solutions, solvents, blood or
body fluids, discharged liquid radiopharmacheuticals, wound and
oral discharges, urine etc. The waste that includes both radioactivity
and a hazardous chemical component is referred as mixed waste. A
safe disposal is one in which no member of the public should get more
than the effective dose limits. The liquid discharge systems should be 10-4
to 10-5 Ci / ml.
Low and intermediate active liquid waste from different sources is
normally collected and transported to the treatment facility by means of
permanent pipelines systems. In some cases, where volume involved is
small, specially designed tankers are used for collection and transportation.
A wide variety of treatment methods are available to meet specific
requirement of decontamination. Decontamination factor is defined as a
ratio of radioactivity content of untreated and treated waste. The commonly
employed processes and the corresponding decontamination factors are
270 given in Table 10.3.
Table 10.3: Decontamination factors for various processes

Processes Decontamination factor
Chemical precipitation 10-100
Ion exchange 10-10,000
Reverse osmosis 10-50
Evaporation 1000-10,000
Chemical Treatment
In this insoluble flocs of phosphates, sulphates, hydroxides and complex
metal ferrocyanides are used to remove radionuclides from the waste.
Certain selected chemicals such as calcium or barium chloride, trisodium
phosphate or sodium sulphate, potassium ferrocyanide, copper sulphate
and ferric ion are mixed with the effluents in predetermined quantities at
an optimum pH value. The resulting precipitate flocs incorporating
radioactivity are allowed to settle and are separated from the supernate
liquids depleted in radioactive content. The sludges are further concentrated
and dewatered by filtration or centrifuging. The resulting solids have highly
concentrated activity and are subjected to further processing before disposal.
Ion Exchange
This is the technique used for removal of specific radionuclides from the
bulk of wastes. Naturally occurring ion exchange materials like vermiculite
and bentonite are most commonly used for this purpose. Synthetic ion
exchangers are also used for the decontamination of the waste. These are
specially useful for both clean liquids as well as those containing high
percentage of dissolved salts. Mobile transportable ion-exchange system is
also in use.
Reverse Osmosis
It is an important process used in the decontamination of low and
intermediate level liquid wastes. It employs membranes like polyamide
and pressure of the order of 20 kgcm2. The waste is pretreated for pH
adjustment and then filtered for removal of complex agents. The membrane
separates the waste into two components, reject and permeate. The volume
of waste is normally reduced by a factor of 10 by this process. If required,
the concentrate is further treated by evaporation, prior to its solidification.
Evaporation
It is used for concentrating the liquid waste. Steam and natural evaporation
methods are employed, depending upon the activity, volumes involved
and climatic conditions. For intermediate level and high level waste, steam
evaporation is preferred whereas for large volumes involving low activity, 271
natural evaporation is desirable. Very high volume reduction with

practically zero release of activity is possible by use of non boiling solar
pans. Solar evaporation process is efficient for tritiated water.
Solid Waste
Solid waste is generated at different stages in many different forms
which include tissue papers, plastics, contaminated materials,
discarded containers, protective wears, worn out metallic parts
and equipment and accessories, spend radiation sources etc. Solid
radioactive waste also consists of general biomedical waste, that
includes protective clothing, plastic sheets and bags, gloves, masks, filters,
overshoes, paper wipes, towels, metal and glass, hand tools and discarded
equipment.
Disposal of Radioactive Solid Waste

The waste material is segregated into:
i. Compressible and combustible, and
ii. Non-compressible and non-combustible waste.
The solid waste material can be concentrated and disposed by the
following methods:
i. Incineration
ii. Burial of solid waste in the ground
iii. Storage of protected material
iv. Sea dumping.
Up to 2 mCi can be disposed as ordinary waste. Occasional release up to
100 mCi in ordinary dust bin is allowed. Sealed sources > 10 mCi should
not be disposed and they must be kept for decay. Higher activities can be
buried or burnt and short lived activity up to 1mCi can be burnt.
Incineration
Incineration will substantially reduce the volume of wastes, but the total
radioactive content will not be reduced. Depending upon the physical and
chemical characteristics of the compound involved, the activity may be
deposited in the gaseous effluents, inside surface of the incinerator and in
the ash. The activity associated with the incinerated waste must be restricted
to the public exposure limits.
This method is suitable in reducing the volume of the waste with little
escape of activity to the environment. The incinerators are specially designed
to remove the radioactivity from combustion gases by the use of scrubbers
and filters and to ensure that the radioactive ash is contained so as to not to
cause an airborne hazard.
272
Burial of Solid Waste

Any site chosen for such burial operations should be examined carefully
with regard to its geologic and hydrologic properties and an assessment
should be made of the possible contamination of water supplies and of
ecological systems that might lead to human exposures. The depth chosen
for burial must be sufficient to prevent leakage of any harmful level of
radioactivity into usable surface waters or ground waters. The whole of
the burial area and its immediate vicinity should be isolated suitably and
fenced to prevent use of the area. A central record should be maintained of
all burials, inorder to assure that the area is kept under continuing
surveillance. Under such conditions some loaching of the radioactivity
into the ground water can take place, and this may therefore be considered
under the principle of dilute and disperse to a small extent.
a. Unprotected material: The following method is suitable for low level
radioactive waste. The burial must be carefully controlled to avoid spread
of contamination to surface ground waters. The choice of burial site is
very important and it should be suitably cordoned off. The solid type
is also important since fixation on a good exchange material
(e.g.montmorrillonite), will reduce the movement of activity in the
ground. In this method one should ensure that the radioactivity is in
the form of completely insoluble material. The size of the pits is
120 cm 120 cm and depth of the pit should be such that there should be
120 cm of earth above. The amount in the pit should be restricted and
the minimum distance between the pits should be 180 cm. Not more
than 12 burial pits per year and after 7-8 half lives, the pits can be empted
into the municipal dump and reused. A record should be maintained
about the location of each pit, the identity and quantity of each
radionuclide buried in it. The maximum disposal limits for ground burial
is given in the Table 10.4.
b. Protected material: Highly radioactive materials can also be buried in
the soil if a material is treated in such a way that no loaching of the
material can occur. In general, this involves packing the waste material
in steel drums or concrete blocks. In the case of very high radioactive
materials, a concrete tomb is constructed underground and the material
fed into the tomb via a chute from the surface. After the tomb is filled up
the whole construction is filled with asphalt and sealed.
Municipal dumps can be used for protected burial, because it is normally
ensured that they carefully sited to prevent contamination of surface or
other waters with conventional non-radioactive pollutants. The radioactive
materials should be packed in steel bins and then must be buried beneath
at least 1.5 meters of other rubbish. Up to 1 mCi can be buried in a municipal
site in a form unattractive for salvage.
273
Table 10.4: Disposal limits for ground level

Radionuclide Maximum activity in a pit (MBq)
3
H 9250
14
C 1850
24
Na 370
32
P 370
35
S 1850
45
Ca 370
59
Fe 370
99
Mo 370
125
I 37
131
I 37
Storage
The purpose of protective storage is:
i. To avoid dust hazard,
ii. To provide shielding, and
iii. To prevent accumulation in working areas.
Normally short lived isotopes are stored for decay. Long lived
radioisotopes are stored and disposed to centralized waste management
facility, BARC, Kalpakkam or Mumbai. There the waste is disposed off in
engineered structures such as reinforced concrete trenches and the tile holes
depending upon the waste and the radioactivity. In the case of
Brachytherapy solid wastes, it is stored and then returned to the supplier,
which is the procedure adopted in the country as on date. The storage area
should be in accessible to unauthorized persons. Usually foot operated dust
pins with plastic bag is used in hospitals to store solid waste. Proper labeling
of the container along with records are mandatory. The radiation level at 1
meter should not exceed 1.5 mR/h in such storages.
Sea Dumping
This method of disposal for solid active waste can be carried out after
carefully choosing an area on the basis of oceanographic studies. For
low activity solid waste use is made of relatively shallow waters
of approximately 100 fathoms. This method is practiced in the U.K and in
the US both packed and unpackaged wastes are dumped in to water
exceeding 1000 fathoms in depth. Containers used for sea dumping should
be designed, constructed and filled in such a manner as to ensure the
following:
i. That they can not be easily damaged or broken and will reach the
bottom with out appreciable loss of contents;
ii. They are free from voids;
iii. They have density of 1.2 g/cc;
274
iv. They are provided with sufficient shielding for safe storage;
v. They are of a size and shape to be handled quickly and conveniently.
Although no general legislative control exists for the dumping of
material outside territorial waters, it is highly desirable that careful
records are maintained of the total activity content and weight of all
consignments.
Gaseous Waste
Gaseous waste management is very important to take care of airborne
radioactive particles and gases. The main contaminants of importance in
nuclear facility are radio-iodine, tritium, fission products, noble gases etc.
Once the effluent is released in the air the operator has no control and hence
can not escape the consequences arising out of air pollution. The emission
of activity to the atmosphere may give rise to three possible types of hazard:
(i) a direct irradiation hazard from the radioactive clout itself or from
material which is deposited on the ground, (ii) inhalation hazard to people
breathing the cloud, and (iii) an ingestion hazard from material that finds
its way into food chains. The type of hazard depends on the circumstances
of a particular emission. For most isotopes the hazard is usually caused
either by first or third types.
Therefore the airborne activity in the working area should be kept within
limits (Table 10.5). The removal of particulate and gaseous contaminants
from gaseous effluents is a complex and expensive one. It is advisable to
design the plant and buildings so that the volume to be treated is as small
as possible. This may be achieved by providing separate ducking systems
for radioactive and non radioactive effluents and filtration system for the
radioactive fraction alone. In addition, negative pressure compared to
atmosphere is maintained in the working areas to restrict the release of
activity to the environment. The ventilation exhaust system is provided
with suitable devices to contain airborne radionuclides. The exhaust gases
are treated for removal of and retention of particulate activity by using
high efficiency particulate air (HEPA) filters along with other cleaning
techniques.
Table 10.5: Air concentration that would result annual

dose limits to occupational workers
Radionuclide Air concentration borne (Ci / ml)
18
F 3 10-5
99m
Tc 6 10-5
131
I 2 10-8
14
C 1 10-6
133
Xe 1 10-4
275
DISPOSAL OF LOW ACTIVITY

WASTES INTO THE ENVIRONMENT
The principle involved is dilute and disperse. Disposal of diluted waste
can be done into the sea, river or into the ground. It will depend upon the
proximity of the facilities producing or treating the wastes to the types of
environment mentioned aforesaid. Sea is a unique medium for disposal of
low activity waste because dilution, factors are large and maximum
permissible levels for discharge are higher than those for fresh water bodies,
as drinking water tolerances are not involved. However, dilution may be
partly off set by concentration of some radioactive species in marine life
which may enter into feed cycles ending in consumption by human beings.
Hence, any projected sea or river disposal scheme must be preceded by
extensive trails to determine the dilution of foreign solution discharged at
various points in the sea or river. By these the degree of horizontal and
vertical mixing is obtained on discharge to the sea or river as well as the
effects of winds and tides upon the dispersal of the material. Detailed
biological experiments must also be done to determine the pattern of up
take of radioactivity by marine fauna and flora, especially those involved
in food cycles.
For the disposal of liquid wastes into rivers the following factors should
be considered: flow rate, nature of river bed, turbidity, currents etc.
Consideration must be given to the types of water utilization such as
drinking, industrial and agricultural uses and appropriate correction factors
should be applied to arrive at the permissible discharges. Dilution of low-
level liquid wastes can be achieved by
a. Addition of uncontaminated liquid to reduce the concentrations prior
to discharge.
b. Release of the liquid wastes at small rates over long periods of time.
c. Release of wastes into large bodies of water.
DISPOSAL OF RADIOACTIVE EFFLUENT INTO THE GROUND

The liquid waste injected into the ground will tend to percolate downwards
until it reaches the ground water table, when it begins to travel forward in
the direction of underground water flow; in doing so, the activity is diluted
by the natural water flowing in the ground. In addition, if the permeability
and porosity of the formation are such that underground water is
appreciable in volume but not too rapid in rate, the combination of dilution
and the decay afforded by an appreciable retention time may be such that
the waste levels are below the dose equivalent limits, by the time the waste
reaches the environment, by discharging to springs, streams or the sea.
The retention time may be extended by chemical reactions between the
waste and the soil, and in very favorable circumstances very high retention
276 times may be encouraged. The factors determining the applicability of
ground disposal methods are two, namely (i) hydrological, and (ii) chemical.
The desirable factors for hydrological factors for ground disposal can be
summarized as follows:
i. A deep water table with good flow gradients.
ii. Appreciable permeability to allow rates of flow sufficient to be useful.
iii. A fairly high porous thick formation to restrict rates of flow.
iv. Wide spacing of water bodies such as lakes and streams so that long
distances of underground flow are involved.
v. Relatively low rainfall. Although the ground water flow may then be
slight, the porosity of unsaturated formation in an area of low rainfall
may afford high retention volumes.
In addition to the hydrological phase retention in the ground there may
be further retention of certain species due to chemical reactions with
constituents of the soil or rock. These reactions are precipitation and ion
exchange. The precipitation characteristics will depend upon the natural
pH of the soil. Ion exchange properties of soil depend upon the type and
amount of clay minerals present, and in soils rich in organic matter to the
humus content as well.
In any case ground disposal requires detailed study of hydrological and
chemical characteristics of the soil where the disposal is contemplated.
DISPOSAL OF P-32 AND I-131 INTO

MUNICIPAL SEWERS BY MEDICAL USERS
The various waste disposal methods are (i) toilet disposal, where the patient
administered with radioactive isotopes is allowed to use the toilet without
restriction, (ii) Batch bottle disposal, where the radioactive material is
collected in a 5 litre bottle, diluted to the top and poured into the sink, and
(iii) constant drip discharge: In order to maintain a uniform discharge in
case where the activity to the disposed of is more than 10 mCi of P-32 and
I-131 a day for 4.5 million litres of sewage flow, it is necessary to use a
constant drip discharge bottle. As a rule of thumb, up to 100 mCi of P-32 or
I-131 may be discharged through a constant drip discharge bottle during a
6 hour day light period, when the flow in a sewage system is 4.5 million
litres during dry weather. The limit is subject to revision depending upon
variation in flow rate and actual radioactive measurements in the sledges.
Any waste disposal method must take into account the following:
i. Permissible concentrations applicable from the standpoint of
community safety, especially with regard to sanitation workers and
sewage plant personnel (Tables 10.6 and 10.7).
ii. To formulate practicable rules and activity discharge based on the
average water consumption and average isotope concentration level
arising there from.
iii. To ensure that the degree of dilution envisaged will be at the discharge
point from the institution into the sewage system into which the 277
radioactive wastes are discharged.
iv. To bear in mind that it would be unreasonable to insists upon the

dilution of radioactive waste in the sewage to the level established as
maximum permissible limits for drinking water.
v. to ensure that the external radiation hazard to sanitation and sewage
plant personnel will not be more than that caused by accidental
immersion in a concentration of 0.1 mCi / litre of sewage.
vi. The hazard to the general population in the event of the sludge
containing radioactive material being used as fertilizer.
Table 10.6: Airborne, water and sewer concentrations that would

result annual dose limits for public
Radionuclide Environmental concentrations (Ci/ml) Sewer
Air Water concentration (Ci / ml)
18
F 3 10-9 3 10-5 3 10-4
99m
Tc 2 10-7 1 10-3 1 10-2
131
I 2 10-10 1 10-6 1 10-5
14
C 3 10-9 3 10-5 3 10-4
133
Xe 5 10-7
DISPOSAL OF RADIOACTIVE WASTE

FROM NUCLEAR MEDICINE PROCEDURES
Radioactive waste from nuclear medicine procedures can be dealt with
either by simply storing the waste safely until radioactive decay has reduced
the activity to a safe level or possibly by disposal of low activity waste into
the sewage system, if permitted by the local regulatory authority. Long
half-life or high activity waste may need long term storage in a suitable
storage area. Waste materials from the drawing up of patient injections
can be divided into two groups, those with long and those with short half-
lives.
Table 10.7: Disposal limits for sanitary sewage systems

Radionuclide Maximum limit on total Average monthly concentration of
discharge per day (MBq) radioactivity in the discharge
(MBq / m3)
3
H 92.5 3700
14
C 18.5 740
24
Na 3.7 222
32
P 3.7 28.5
35
S 18.5 74
45
Ca 3.7 10.1
99
Mo+99mTc 3.7 185
125
I 3.7 22.2
131
I 3.7 22.2
278
Technetium-99m waste normally requires storage for only 48 hours, in a

plastic bag inside a shielded container. The container should be labeled
with the radionuclide and date. Gallium-67, I-131 and other longer half-life
materials should be placed in a separate labeled and dated plastic bag and
stored safely. Sharp items, such as needles, should be separated and placed
in a shielded plastic container for safety. When disposing of waste, attention
should be paid to the following points:
1. Normally once the surface dose rate in any individual bag of waste is
below 5 mGy/h it can be disposed of.
2. Disposable gloves should be worn and caution exercised when handling
sharp items.
3. Any labels and radiation symbols should be removed.
4. Waste should be placed in a locally appropriate waste disposal
container, for example, a biological waste bag.
5. Formulate practicable rules and discharge levels based on average water
consumption and isotope concentration.
6. The radiation hazard to sanitation workers and sewage personnel <
that from accidental immersion of 0.1 mCi / litter.
7. The effective dose limits should not be exceeded.
8. If the effluents is used for agricultural purposes the levels should be
reduced by 10. Possible build up of activity in irrigated land and crops
to be considered.
9. Total activity released should not exceeded 1 Ci / year.
10. Long lived isotopes other than 3H and 14 C should not be released to
sink.
Each type of waste in nuclear medicine requires special consideration
since biological contamination (e.g. blood) may be a more series hazard.
Accepted levels for disposal of radioactive waste under controlled and non
controlled conditions are given in Table 10.8. A controlled disposal is
defined as disposal with permission from the regulatory authority. Records
should be kept listing initial activities and recommended disposal dates
for medium and long half life nuclides.99mTc waste should be kept for an
appropriate decay period before disposal (24h); no record normally required
for decayed 99mTc contaminated items.
Table 10.8: Discharged activity limits for non controlled and controlled conditions
Classification Non controlled (Bq) Controlled (Bq)
Group 1
Group 2: 125I, 131I 5 104 (1.4 Ci) 1 107 (270 Ci)
Group 3: 201 Tl, 32P, 67Ga, 51Cr, 5 105 (14 Ci) 5 106 (140 Ci)
111
In, 57Co, 58Co, 99Mo
Group 4: Tc, 133Xe
99m
5 106 (140 Ci) 5 107 (1.4 Ci)
279
99m
Tc Generators
A Mo-99 generator with activity of 345 mCi decays to 140 Ci after 31 days.
It can be disposed under controlled conditions with proper authorization.
Spent generators should be removed to a separate store room or bunker
for the required decay period. Storage room should be provided with
shielding, so that the exposure should not exceed the effective dose limits.
Patient Waste
Special toilet should be available to nuclear medicine patients. The toilet
should have direct access to the sewage system and should not run under
the nuclear medicine department, since high activities will affect the
performance of counters and imaging devices by increasing background
activity levels. Patients excreta are exempted from disposal restrictions.
Urine and feces should be discharged using a toilet connected directly to a
main sewer.
ROUTINE PROTECTIVE CLOTHING
Laboratory Coat
Conventional white cotton drill or nylon coat of proper size which should
extend below the knees are suitable for clean areas.
Overalls (Boiler suit)

These are one-piece cotton drill garments so designed as to cover the body
completely except for the head and neck, wrists and hands, and feet and
angles. The fastenings for these garments are usually at the front. They are
extremely useful as they protect all the clothing worn below.
Aprons
In areas in which the processes involves work at benches with liquids, an
apron of suitable impervious material such as PVC, Polyethylene or
neoprene will be found useful in preventing the clothing below from
becoming contaminated by corrosive liquids or dust.
Rubber Gloves
For general laboratory work, surgical gloves are adequate for most
operations. Where it is necessary to handle beta active material directly
with the hands, rubber gloves of a heavier type or leather gloves may be
used to reduce the beta radiation dose to the hands.
Foot Wear
These should be preferably rubber-soled to prevent the uptake of
280
contamination and to facilitate cleaning. It is recommended that the pattern
of the rubber sole should not be too deeply indented. The upper part of the
shoes should be well waxed to resist the absorption of contaminated
solutions.
Overshoes
These are worn over the normal walking shoe and are suitable for use by
visitors to active areas or for general use in laboratories. The conventional
rubber overshoes are suitable but the soles should not be too deeply
indented. A cheaper form of overshoe made of rubber, plastic or canvas is
also available.
Rubber Boots
These are particularly useful for wear in areas in which the processes involve
contaminated solutions or wet conditions, such as in areas being
decontaminated. The half length rubber boot is usually adequate for this
purpose. The soles of these boots should not be too deeply indented.
Breathing Apparatus
For work in areas of low or medium level of airborne activity, a full face
respirator with an efficient filter provides adequate protection. The filter
used must be reliable; suggested types are the resin wool and charcoal or
the highly efficient paper filters which are commercially available. Care
must be taken to ensure that these respirators fit properly and do not allow
air to be taken in from the sides of the face-piece. For work in areas of very
low activity a half-face respirator may be used.
DECONTAMINATION PROCEDURES
Decontamination is the process of removal of radioactive contamination
from the skin or from surfaces such as the wall or floor of working areas.
Radioactive contamination may exist in loose form or may be more or less
fixed as a result of physical and chemical factors. Whenever possible
contamination should be cleaned up as soon as it occurs. This further
prevents the spread which makes the eventual decontamination more
necessary.
Skin and Surface Contamination

In decontaminating the skin, while it would be ideal to remove the entire
contamination, this may not always be possible, because the drastic
measures which may be necessary in certain causes could result in such
damage to the skin that the radioactive material could gain entry into the
body and so give rise to an internal hazard. In such cases, it should
be considered satisfactory to reduce the levels of contamination to 281
within permissible limits. Similar considerations would apply to the

decontamination of surface such as walls, floors, and table tops, and for
contaminated equipment. There could, however, be situations in which
experimental requirements render it essential that the decontamination be
absolute. On the other hand, in dealing with contamination of certain
articles and types of equipment, it might turn out to be more economical to
store the contaminated object temporarily, with a view of letting the activity
die down naturally to within permissible level, or to dispose of it as waste.
The above considerations imply the setting up of maximum permissible
levels of contamination for the skin and for surfaces in controlled and
uncontrolled areas.The fundamental principles which are applicable to all
decontamination procedure are;
a. Wet decontamination method should always be used in preference to
dry.
b. Mild decontamination method should be tried before resorting to
treatment which can damage the surfaces involved.
c. Precautions must always be taken to prevent the further spread of
contamination during decontamination operations.
d. Where possible, contamination involving short lived activities should
be isolated and segregated to allow natural decay to take its course.
Decontamination of Personnel
Once a radioisotope has become lodged in the body, very little can be done
to increase the rate of elimination. This means that every effort must be
made to prevent contamination entering the body. To this end it is vital
that all personnel should obey the house rules and always wear the correct
protective clothing. Even so, contamination incidents are bound to occur
and so a knowledge of the current treatment is vital.
The first action when dealing with a contaminated person is to ascertain
whether or not he is injured. If he has a serious injury then he must be
given first-aid treatment as quickly as possible. Following any necessary
medical treatment, the next action are aimed at removing the contamination
before decontamination can be started a careful survey must be carried out
over the entire body with a suitable contamination monitor to determine
the location of the contamination. In the case of partial contamination it is
only necessary to contaminate the affected areas.
Soap and water is the first requirement for removing contamination from
the hands and other exposed areas of the skin. The soap chosen should be
mild to that it will not produce skin damage after frequent use.
For hands, soft-bristle nail brush should be provided for use in
conjunction with soap and water over the entire surface of the hands and
the wrists. Particular attention should be given to the nails, to the ridges
between the fingers and to the edges of the hand. Frequent rinsing is
282 essential during the entire operation.
For the face, copious amounts of water and soap should be used, the
hands alone being used to create the lather. Isolated areas of high
contamination should be carefully scrubbed. All personnel should
be instructed to keep the eyes and the mouth closed during treatment
and to rinse the fact frequently with copious amounts of water. While
using towels, or other materials suitable for drying, rubbing should be
avoided. All cases of face contamination should be referred to the medical
officer.
Contamination of hair should be washed several times with an efficient
shampoo and copious amounts of water should be used for rinsing. The
latter is particularly important to ensure that contamination removed from
the hair does not remain in the ears or on the face.
In the event of contamination which persists even after the above-
mentioned procedure have been followed a number of times, the individual
concerned should be referred to the medical department where more
effective decontamination can be carried out under medical supervision.
It is essential that skin decontamination should not be taken to the point of
damaging the skin.
In case of contaminated small open wounds, cuts, punctures etc., the
wound should be immediately washed, bleeding should be encouraged if
necessary, and the medical officer should be consulted.
Whenever internal contamination occurs, it essentially becomes a medical
problem, parallel in some ways to the absorption of chemical toxins. All
corrective measures should be carried out under medical supervision.
When contamination has been swallowed, substances designed to
prevent or reduce absorption from the gastrointestinal tract, e.g. antacids
or ion exchange resins, may be administered promptly after the intake. If
radionuclides of high toxicity, such as Pu, are absorbed through a wound
or inhaled in a soluble form. Certain chemical called chelating agents may
be administered to promote excertion. Unfortunately, these substances
tend to be chemically toxic themselves. The absorption of certain
radioisotopes can be blocked by the prior ingestion of substantial amounts
of a stable isotope of the same element. For example, the uptake of
radioiodine to the thyroid can be greatly reduced by previous ingestion of
a 200 mg tablet of potassium iodate. This has an important application in
the even of a reactor accident.
Decontamination of Working Areas

A preliminary contamination survey will indicate those areas which require
decontamination and such areas should be clearly marked. The
decontamination measures should be restricted to those areas and every
endeavor should be made to prevent the spread of contamination.
The decontamination measures taken will depend upon the nature of
the contamination, i.e. whether it is in loose form or is reactively fixed, and
283
details of decontamination procedures are given in this order in the

following sections.
Removal of Loose Contamination

Special decontamination apparatus, such as vacuum cleaners fitted with
special filters, may be used to remove loose contamination. No attempt
should be made to brush or dust it off, though in the case of slight
contamination on the floor a wet medium such as dampened sawdust
sprinkled over the contaminated area before brushing is acceptable. For all
other surfaces, wet methods such as webbing are essential. The removal of
contamination should be done with the minimum of rubbing and the swabs
should be frequently discarded as radioactive waste. Decontamination
solutions which contain complexing agents are particularly useful in such
cases.
Where there is copious loose contamination, a suitable strippable lacquer
may be carefully applied to the contaminated surfaces. This lacquer is
allowed to dry and in so doing will take up the contamination. Afterwards
the strippable lacquer can be removed together with the contamination.
During this operation, care should be taken in using the spraying device to
avoid disturbing the loose contamination and thus giving rise to an airborne
hazard. As a precaution, personnel should be in fully protective clothing.
After shipping, the affected areas should be washed as described above.
Removal of relatively Fixed Contamination

Only wet methods should be used. The first wash should be with suitable
detergent solution which will remove loose contamination and all grease-
held material. Only light rubbing should be used at this stage and the swabs
should be discarded frequently as radioactive waste. Contamination
remaining after this treatment should be removed by further washing with
suitable decontaminating solutions. The decontaminating solutions to
remain in contact with the contaminated surfaces as long as possible so
that chemical reaction at the surface may assist the decontamination.
Contamination remaining after several attempts at removal with the
above treatment will normally be confined to small areas (unless a major
spill has occurred) and further proprietary abrasive cleaners are useful for
general application in this spotting treatment. Metal polish can be used to
advantage on metal surfaces, abrasive creams containing a complexing
agent, may be rubbed into the affected areas and left in contact for a period
before being washed off. More stringent treatment would involve the use
of steel wool or a similar scouring agent.
If contamination persists, it will be necessary to remove the surface on
which the contamination is fixed, unless it is so fixed and in such small
284 amount that it can be left in place. In the latter case, precautions should be
taken to seal in the contamination with concrete, paint or other appropriate

material. Such sealed in contamination must be recorded so that in any
further modifications to the building, suitable precautions can be taken
against dispersing the contamination and creating a hazard.
Decontamination of Equipment
It is impossible to describe here the measures to be used in the
decontamination of the individual pieces of equipment encountered in
radiation work. However, such items of equipment may be conveniently
classified into groups according to the material of which they are made,
and the decontamination.
Decontamination methods for equipment are of two kinds:
a. Removal of contamination without damage to the surface below.
b. Removal of the surface of the equipment together with the adhering
contamination.
In all cases the first method should be used initially and only if
several attempts fail should the second method be tried, since damaged
surfaces may be unsuitable for reuse because of their tendency to collect
contamination easily.
Decontamination of equipment should be carried out as soon as possible
after its removal from the active area. Contamination left in situ over periods
of time becomes fixed and becomes increasingly difficult to remove.
All decontamination should be carried out using wet methods. The
routine to be followed is the same for all equipment, the only difference
being in the reagents used for various materials. The routine procedures
are:
a. Wash in detergent solution at raised temperature. This will remove all
loose and grease-held contamination. This may be followed by swabbing
and light scrubbing with the same solution.
b. Decontaminated equipment should be washed in clean water and dried
before monitoring.
c. Further scrubbing and also steeping technique may be used, where
contamination remains after the above treatment. In the latter, the
equipment is placed in solutions of suitable decontaminating reagents,
preferably at raised temperatures, and is left there for suitable periods
of time. The inclusion of complexing agents in the decontaminating
solution is recommended to prevent redeposition of the contamination.
d. Equipment is washed in clean water on removal from the decontamination
solution and is then dried before being monitored.
e. Further methods will depend upon the extent and nature of residual
contamination, when contamination still remains after the above
treatment.
If the contamination is present in spots, a treatment known as
spotting may be carried out using abrasive or strong acids on the small
285
areas involved. Where acid are used, care should be taken to ensure that
the surface of the equipment is not unduly etched.
If the contamination is general, it may be possible to apply abrasive
over the whole surface, but if this fails, steepage in acid solution will be
necessary. Precautions should be taken to prevent the acids from
damaging the surface of the equipment more than is absolutely necessary
to remove the contamination. Special apparatus in the form of fume
hoods or gloves boxes will be necessary for the acid treatment, because
of noxious fumes.
f. Equipment should be well washed and dried before monitoring.
Protective Clothing
The protective clothing requirements in a contaminated area depend on
the nature and amount of the contamination. For low levels of surface
contamination an ordinary laboratory coat with overshoes and gloves may
be sufficient. When there are substantial levels of airborne contamination
it is usually necessary to have a fully-enclosed dry suit and a filter mask or
a mark fitted with an air supply. Again, when the contamination is in liquid
form, it is often necessary to wear a fully enclosed PVC suit with a filter
mask or fresh air supply.
Whatever the standard of protective clothing, the change and barrier
arrangements must be efficient and should have the following facilities:
a. Wash hand basin (and possibly a shower) and monitoring instruments
(for example, a hand and clothing monitor).
b. Suitable stowage on the non-active side of the barrier for the workers
personal clothing.
c. Conveniently-placed protective clothing ready for use.
d. Containers for used clothing and radioactive waste.
e. Notice boards at the barrier, stating no unauthorized entry, the hazards
in the area, the clothing to be worn and any other precautions to be
taken.
f. Emergency instructions: Detailing actions in the event of possible
incidents such as critically, fire, serious personal contamination,
should be posted in the area. Consideration must also be given to suitable
emergency exists.
Special arrangements are made for laundering clothing worn in
contaminated areas and the effluent from laundry facilities is treated as
liquid radioactive waste.
Decontamination of Protective Clothing

Routine protective clothing should be cleaned regularly to avoid the build-
up and fixation of contamination. For similar reasons, the clothing should
286 not be left in storage for long periods before cleaning, as experience indicates
that such storage, results in the contamination being fixed and renders
decontamination increasingly difficult. Another measure taken in such

clothing to avoid build-up and fixation of contamination is to provide no
pockets or belts and to minimize folds.
White Coats and Coveralls

In small establishments it will not usually be necessary to segregate this
clothing, before washing, according to the different contaminants and
different levels of contamination. However, in larger establishments where
a variety of radioactive material is used, it is often necessary to segregate
the clothing to prevent cross contamination during the cleaning process.
Contaminated clothing should be handled as little as possible, since it
can give rise to airborne contamination.
The process used in cleaning this type of clothing is not dissimilar to the
processes adopted in conventional laundries. It is useful to remember that
the more stringent washing solutions used necessitate the use of suitably
resistant metals in the construction of washing machine.
The actual routine of washing will depend on experience, but as a guide
it is usual to give clothing two full washes (of 10 min each) with a rinse
(of 5 min) in clear water after each wash.
The reagents or soaps used will also depend upon experience, but a
washing solution consisting of unbuild detergents, sodium metasilicate,
sodium acid phosphate and citric acid has given good results with this
type of clothing.
The clothing should be dried thoroughly before being monitored.
Rubber Gloves
It is essential that the personnel wearing these gloves, and particularly the
heavy rubber gloves, should wash them on completion of their work. Bulk
collection of contaminated gloves is most unsatisfactory, since there is no
efficient way in which they may be washed in large numbers without
transferring contamination to the inside.
Good-quality soap or detergents and scrubbing brushes should be
provided at appropriate places where personnel may wash their gloves.
The gloves should be well scrubbed and rinsed and then dried with paper
towels or preferably with small pieces (say 2 x 1 ft) or toweling, which
have proved economical and more satisfactory than paper towels. The
small towels should be used once only and then placed in a suitable
collecting bin.
Respirators and Dust Masks

The only satisfactory way in which these items may be cleaned is by
individual swabbing with suitable detergents. The detergent used should
be mild one and unlikely to cause skin complaints if it comes into contact
287
with the faces of individuals.
Small cloth or cotton swabs should be used all over and inside the face-
pieces. These swabs should be changed frequently. Care should be taken
to clean the outside first and then the inside using clean swabs. The fact-
pieces should be well swabbed with clean water, following the detergent
treatment, and then dried.
Impressive Protective Clothing

On completion of an operation involving the use of this kind of clothing
and where extra contamination is expected, it is essential that the operator,
still wearing the suit should pass though some form of washing. This may
consist of an installed shower or simply of a rinse with buckets of water.
There is obviously a need to choose the correct position for this so as to
prevent dispersal of contamination, and it should be followed by washing
with detergent and soap solution, assisted by swabs and soft bristled
brushes. Operations in these suits usually involve at least two individuals
and it is a convenient practice for them to wash each other. Afterwards the
suits should be rinsed in clean water and quickly dried.
When dry, the suit is removed and monitored. Any residual
contaminating can be treated separately with mild abrasive pastes or similar
material.
Suitable detergents should be used for washing these suits and it is also
advantageous to use solutions containing weak citric acid and completing
agents such as ethylene-diamine-tetra-acetic acid (EDTA).
Footwear
Rubber-soled shoes may require decontamination from time to time. The
soles should be scrubbed with detergent and complexing solutions, and
for resistant contamination it may be necessary to remove the surface of
the rubber by the application of acetone or by mechanical buffing. Where
mechanical buffing is used, it will be necessary to provide for local air
extraction on the machine. The upper part of the shoes, if kept properly
waxed, can be easily decontaminated.
Rubber boots should be cleaned after each operation. Scrubbing in
detergent and complexing solutions should be followed by the use of
abrasive pastes necessary. Resistant contamination will necessitate the
removal of the rubber surface by acetone or mechanical buffing. Precautions
should be taken to prevent contaminated liquids from entering the boots.
BIBLIOGRAPHY
1. Chandrani L, et al. Radionuclides in Bio-Medical sciences-An introduction;
Foundation books Pvt.Ltd, New Delhi 2004.
2. David JD, Hodder A, et al. The Physics of Diagnostic imaging: (2nd edn.),
London 2006.
3. Kanwar Raj, et al. Management of Radioactive waste: Indian association for
288 radiation protection, C/o RP&AD, BARC, Mumbai 2001.
4. Simon RC, et al. Physics in Nuclear medicine: (3rd edn.) Saunders, 2003.
Chapter
11 Radiation Emergency
A radiation accident is an unusual occurrence resulting from the loss of

control over a radiation source which could directly or indirectly involve
hazards to life, health and property. A radiation accident could occur at
any stage of an operation involving radiation sources. For examples, a beam
of X-ray could be inadvertently turned towards a wall to which it should
not normally be directed. As a result of which persons in the adjoining
room who may not even routine radiation workers could be exposed to
relatively high levels of radiation. Radiation accidents would normally
conform to one of the following:
1. Accidental external exposure to excessive amounts of radiation (e.g. A
person remains inadvertently close to a strong source or accidentally
exposed to beam of radiation).
2. Accidental spill or explosion in a working place resulting in surface and
air contamination of the surroundings and contamination of personnel.
In such cases the intake of radioactive substances into the body could be
by inhalation, through open wounds or absorption through skin.
3. Dispersal of radioactive material to the environment as a result of an
explosion, fire, mechanical shock or other incident occurring in a public
place (e.g.Transport of radioactive substances).
TYPE OF RADIATION ACCIDENTS

1. On-site accidents: High levels of exposure to radiation occur as a result
of a person inadvertently entering a high radiation field. For example, a
person walking towards the X-ray beam, when the machine is ON. In
such places where there is potential for accidents, appropriate control
measures should be taken well in advance to ensure that the chances of
any person being accidentally exposed to high levels of radiation are
minimized. Such measures includes (i) the provision of interlocks which
could ensure that no person can enter the radiation area when the
exposure is in progress, (ii) provision of visual or aural indication to
identify high radiation level areas, (iii) provision of adequate radiation
alarms which can be either located at strategic points or carried by
individuals whenever they are near high radiation level areas, and (iv)
the absorption of detailed administrative procedures such as provision
of suitable cordonedoff areas and prohibition of entry into such areas

during radiation operations. A second category of accidental radiation
exposure, which could arise in a radiation work area, could result from
one of the following contingencies:
i. The inability to get a remotely controlled source back into its shielded
container because of mechanical or pneumatic failure.
ii. Accidental breakage of a sealed source or the container of an open
source, resulting in high contamination of both surface and air in the
vicinity.
iii. Break down of crucial ventilation systems in areas where open sources
are being handled.
iv. Accidents which could involve fire or explosion and which could result
in the breakdown of the integrity of shielding or dispersal of
radionuclides in the environment of the laboratory (e.g. criticality
accident in nuclear reactor).
2. Off-site accidents: This type of accident may occur in areas to
which public have access and may result from one of the following
contingencies:
i. Unplanned release of airborne activity to the environment of a
radiation facility owing to unusual conditions such as fire, explosion,
breakdown of the ventilation system or breakdown of the filter system.
ii. Accident to consignments of radionuclides when such consignments
are in a carrier such as a truck, train or aircraft, or when such
consignments are held in storage during transit.
3. Classification of radiation accidents: Accidents involving radiation
sources and radioactive minerals can be generally classified as (i) external
radiation, and (ii) radioactive contamination. External radiation can result
in whole body exposure,partial body exposure or localized skin exposure.
Radioactive contamination may be external or internal. External
contamination can occur as a result of spillage of radioactive material
on skin or hands coming in contact with loose radioactive material.It
can cause irradiation of the skin and underlying tissues as well as provide
a potential for the material to enter the body subsequently. If the
possibility is high, if the integrity of the skin is lost due to wounds,
abrasions or chemicals.
Internal contamination occurs most often as a result of inhalation of
radioactive materials in finely divided form. As mentioned above, it may
also occur when contamination present on the skin penetrates the outer
layer and enters systemic circulation. Internal contamination can also occur
as a result of eating with contaminated hands or consuming contaminated
water; which is quite uncommon.
In the case of external irradiation, first aid is not required, unless it is
accompanied by traumatic injury. In radioactive contamination there is no
290 immediate risk to life. In order to minimize the long term sequela, it is
Radiation Emergency
necessary to block or minimize systemic uptake and hasten the biological

elimination of the contaminant. First aid, if administered to the person
within a short period at the accident place is sufficient.
Emergency Procedures
The first step in dealing with radiation accident is to identify, segregate
and treat all persons who are exposed to radiation, both external and
internal. Immediate steps should be taken to assess the extent of exposure
by sending the personnel monitoring TLD badges used by the exposed
persons for dose evaluation. Biological monitoring and body burden
measurements must also be conducted immediately.
If the radiation fields are higher, special radiation measuring devices
will be required. These instruments must cable of measuring much higher
dose and dose rate, which are not common. Some times they are
telescopically coupled to the meters, so that the detector would be in close
proximity with high radiation field and the person reading the meter is
away from the radiation field. Such instruments should be periodically
calibrated and kept in good working conditions. Air and surface
contamination samples should be analyzed urgently to take further action.
The instruments required to carry out this work should also be made
available. The following guidelines may be adopted during emergency.
1. Evacuate the immediate area, by ensuring that the radiation field and
the extent of contamination is kept minimum.
2. Identify and isolate all persons, who might have exposed or
contaminated. Arrange immediate evaluation of their TLD badges and
collect samples from body fluids such as blood, urine etc. for analysis.
3. In the case of personnel contamination, carry out decontamination.
4. Regulate entry to the area of accident, so that further exposures and
contamination may be prevented.
5. Notify promptly to the appropriate authorities through media such as
fax, mobile and telephone, and seek suitable advice. Arrange for
immediate availability of experts, who are trained to deal with
emergencies.
6. Contain contamination within the accident site. In case of radioactive
liquid spillage, clean up the contamination immediately. Routine
protective measures such as wearing gloves and segregating the mop as
radioactive waste should be adopted. If there is relatively large release
of radioactive powder or aerosol in the room, that room must be
immediately isolated from its surroundings by shutting off mechanical
ventilation and by closing windows and doors. Entry into the room
except the experts should be forbidden. A room with heavy air
contamination will be decontaminated from within by drawing the air
of the room through an appropriate filter.
291
7. Priority should be given to human safety and the personnel dose should
be restricted with in limits (ICRP has recommended 10 rem dose limit
for planned special exposures). The staff are instructed in basic
emergency procedures including the persons to be contacted in case of
an accident. The same may be displayed at suitable locations in the
radiation installation. Mock- up operations for dealing with complicated
situations associated with high radiation fields and contamination areas
should always be part of a radiation emergency procedure.
8. Maintain complete records of the accident and follow up procedures.
This simple instruction is often not followed, resulting in enormous
complications in investigating such incidents and in the adoption of
subsequent remedial measures.
9. If the accident is in the public area, the area should be cordoned off and
appropriate authorities will be contacted for further action.
Responsibility in the Control of Radiation Accidents

The responsibility for controlling the use of radiation sources with in country
should rest on the public authorities and the users of the source.The
government should designate and define functions of those public
authorities which are responsible for the control of radiation sources and
dealing with radiation accidents. These public authorities will:
1. Arrange for control of the uses of radiation sources through licensing
and regulations.
2. Prescribe protection standards and guidelines.
3. Establish lines of authority among national bodies.
4. Define the authority to be notified in the event of a radiation accident.
5. Establish necessary liaison with national authorities in neighboring
countries.
6. Determine the need for trained personnel in the sate and arrange for
training, if necessary.
7. Determine and periodically review the availability and location of trained
personnel, and all other necessary equipment and services.
The responsibility for immediate action following an accident originating
with in the establishment will rest on the operator or user. In accordance
with the requirements of his work and regulations applied by the public
authorities, the user should establish an internal organization, that will:
1. Ensure that he is prepared, within the limits imposed by his resources,
to deal with any accident that may occur within his premises.
2. Arrange for assistance from public authorities and other off-site
organizations if necessary.
3. Provide immediate notification of the designated public authorities of
accidents whose consequences may extend off-site.
4. Provide assistance to public authorities as required.
292
Radiation Emergency
5. Provide notification of designated public authorities of all radiation

accidents.
6. Keep adequate records, and make an analysis of any radiation accidents
that occur.
Emergency Protective Clothing

Provision of the protective clothing is usually indicated in areas where the
operations concerned will expose the personnel involved to a high risk of
contamination and of breathing contaminated air. Before wearing
emergency protective clothing, including fully impervious clothing, one
has to have a full change, which implies removal of all personnel clothing
and the wearing of simple clothing supplied by the laboratory. A typical
change would be drill trousers underwear, shirt, socks and shoes.
Fully Impervious Clothing

This consists of garment so designed that they cover the individual
completely, except for the head and neck and the hand and feet with a
layer of impervious material. As a breathing apparatus to be worn the same
time, hoods of similar material are used. Finally complete exclusion from
contamination is obtained by wearing rubber gauntlet gloves pulled well
over the cuffs of the protective suit and rubber boots with the bottom of the
impervious suit trousers brought over them.
Pressurized Clothing
This is suit made of impervious material which completely encloses the
individual. Such a suit effectively isolates the individual inside from any
contamination on the surfaces or in the air. Compressed air supplied to the
suit enables normal breathing during operations.
The compressed air line delivers its air immediately in front of the face,
as this arrangement provides plenty of air for breathing and at the same
time helps to reduce the misting of the transparent head piece. Complete
protection of the hands and wrists is afforded by wearing rubber gloves,
which are securely taped to the suit to prevent the ingress of any
contamination. Rubber boots are usually worn with the suit.
Assistance is always necessary to dress an individual in any impervious
clothing. Such assistance is particularly essential when impervious clothing
is being removed. If the individual concerned undresses it is more than
likely that he will become contaminated from the active material present
on that suit.
Breathing Apparatus
When compressed air supply is not available for use in the pressurized
suits described above, breathing sets may be used. These comprise a well
fitted face piece in which suitable goggles are inserted. This face piece is 293
attached to a cylinder. Regulating valves attached to the cylinders enable

the wearer to control his air supply. This breathing set may be used in
conjunction with the fully protective impervious clothing and, so desired,
the individual concerned can enter a contaminated atmosphere under
emergency or maintenance conditions.
DIAGNOSTIC RADIOLOGY-SKIN INJURIES

In India eight incidents have been reported in medical applications. Six of
these incidents were associated with teletherapy units, due to which 24
persons received low radiation doses and one person received a high dose
on hand, requiring amputation. Two incidents were reported with x-ray
fluoroscopy, during cardiac catheterization and pace maker insertion. The
two patients received very high doses to the skin of their back.
Interventional radiology using fluoroscopy equipment for image
guidance may pose greater risk of X-ray induced injuries. Interventional
radiology finds application in Cardiology, General radiology, and Neuro-
radiology. The reason for higher risk includes (i) more extended periods of
time, (ii) multiple use of radiography, (iii) relatively high radiation exposure
for both patients and personnel. About 700,000 procedures are carried out
/ year globally and more than 70 injuries have been reported.
Fluoroscopy exposure may leads to deterministic effects, that includes
erythema, skin ulcer, temporary epilation, and dermal fibrosis. But these
effects vary with fluoroscopy time, dose rate, fractionation of dose, mode
of operation, patient age, and site of exposure. Skin injuries have been
reported in patients undergone prolonged fluoroscopy guided
interventional procedures such as percutaneous transluminal coronary
angioplasty (PTCA), radiofrequency cardiac catheter ablation, vascular
embolization etc. The cumulative skin doses in some patients may exceed
10Gy, which is sufficient to cause radiation induced skin injury (Fig. 11.1
to 11.6).These injuries may appear only after a threshold period of several
months.
The risk of deterministic and stochastic effects of radiation exposure
varies for different areas of the skin. The age of the patient, undergoing
long fluoroscopic time of imaging is also an important factor. The most
common interventional procedures like PTCA and percutaneous
translumunal angioplasty (PTA) are used in patient population over 40
years of age. Small numbers of adults and children are also treated using
interventional procedures. It is essential to differentiate between
interventional procedures in adults, in young adults and in children. If
areas of the skin are likely to be exposed to levels of absorbed doses that
approach the skin tolerance, the patient should be informed in advance
about the possible effects of treatment. All relevant parameters should be
documented for all interventional procedures.
294
Radiation Emergency
Figs 11.1A to C: A 49 year old woman with 8 year history of refractory supraventricular
tachycardia AC, Photographs show sharply demarcated erythema above right elbow
at 3 weeks after radiofrequency cardiac catheter ablation (A), tissue necrosis 5
months after procedure (B), and deep ulceration with exposure of the humerus at
6.5 months (C), (AJR:177, July 2001) (For color version see plate 5)
Fig. 11.2: 56 year old man with obstructing lesion of right coronary artery.
Photograph of right postero-lateral chest wall at 10 weeks after percutaneous
transluminal coronary angioplasty shows 12 6.5 cm hyperpigmented plaque
with hyperkeratosis below right axilla (For color version see plate 5)
Fig. 11.3: A 75 year old woman with 90% stenosis of right coronary artery.
Photograph of right lateral chest obtained 10 months after percutaneous
transluminal coronary angioplasty shows area of hyper- and hypopigmentation,
skin atrophy, and telangiectasia (poikiloderma) (For color version see plate 6)
295
Fig. 11.4: Skin necrosis (erythema

and hyper-pigmentation), 3 years after
angioplasty examination (For color
version see plate 6)
Fig. 11.5: A 17 year old girl with history

of cardiac arrhythmia underwent two
cardiac ablation procedures in 13
months. Photograph taken 2 years
after last intervention shows atrophic
indurated plaque with skin telangi-
ectasia at right lateral chest wall
involving posterolateral aspect of
breast. Induration resulted in limited
movement of right arm. Risk of breast
cancer is increased (For color version
see plate 7)
Fig.11.6: A 49 year old man with history of liver cirrhosis and intractable upper
gastrointestinal bleeding who underwent two transjugular intrahepatic portosystemic
shunt (TIPS) placements and one attempted TIPS placement within a week.
Photographs show progression of ulceration. (A) Secondary ulceration with
surrounding rings of de- and hyperpigmentation 6 months later. (B) Small blisters
developed at 7.5 months after procedure. Wound is very painful. (C) Wound has
progressed in size and depth at 10 months. (D) Nonhealing ulcer with exposure
of deep tissues, including spinous process of vertebra, at 22 months. (E) At 23
months, musculocutaneous skin grafting was performed. Disfigurement is
296
permanent.(AJR:177, July 2001) (For color version see plate 7)
Radiation Emergency
NUCLEAR MEDICINE: RADIATION ACCIDENTS

The IAEA report 17 (2000) has reported 7 accidents in the case of unsealed
sources. A therapeutic dose of 370 MBq was prescribed to a wrong patient
because two patients had the same name. Among the two patients, one for
iodine administration and other for treatment of a lung disease, with
identical name were there. The physician familiar with the patient was not
available and another physician was assigned to administer the dose. The
lung disease patient was administered with I-31 of 370 MBq activity. In
another event a patient came for a diagnostic bone scan was administered
with 333 MBq of I-131,instead of 740 MBq of Tc-99m for bone scan study.
In another event a 60 year old women was referred to the nuclear
medicine for thyroid ablation. The physician prescribed 6475 MBq of I-131
by oral administration. The technician with out reading the labels picked
up two vials containing 6475 MBq and 5180 MBq of I-131 and administered
both the activity to the patient. In another event a patient was prescribed
370 MBq for a thyroid treatment. A capsule containing 370 MBq was
ordered. The supplier sent a capsule containing 444 MBq. Though the
technician calibrated the dose, but misread the activity of 444 as 370 MBq.
The patient was administered with 444 MBq, which resulted in an
overdosage of 20%.
Another event includes, administration of 180 MBq of I-131 for a whole
body scan, to a feeding mother. The scan indicated an unusual high breast
uptake of I-13l, which resulted a 300 Gy thyroid dose and 0.17 Gy whole
body dose to the infant. Both the physician and technologists have failed to
confirm that the patient was not breast feeding. In another event a therapy
dose of 7400 MBq was administered to an 87 year old patient. After 34
hours the patient experienced cardiac failure and 16 staff members
attempted to resuscitate the patient, to insert pacemaker etc. Blood and
urine contaminated with radioactivity were spilled, but the personnel
clothing were not checked for activity. A dose of 0.3 Gy was reported in
one of the nursing staff.
In another event a patient was to be administered with 259 MBq of I-
131.There were two capsule of 130 MBq each in the vial, which were labeled
correctly. When the vial is inverted only one capsule fell out and the same
was administered. That is patient was given 130 MBq instead of 259 MBq
acitivity, 50% of the prescribed dose.
Radiation Emergencies in Radioisotope Laboratory

Radiation emergencies in radioisotope laboratory would normally involve
only spillage of radioactive liquids. The prepardness and procedures to
meet such emergencies are discussed below:
297
Emergency Preparedness
1. Charts detailing various steps to be taken by the radiation workers in
case of emergency should be conspicuously displayed in the laboratory.
2. All radiation monitoring and measuring instruments should be routinely
checked and kept in working condition.Handling equipment such as
tongs, forceps etc. must be kept in ready access.
3. The ventilation system of the radioisotope laboratory should be routinely
checked and maintained properly.
4. Ready availability of a decontamination kit containing all the items of
decontamination should be ensured to deal with an accidental spill
effectively.
5. A proper inventory of radioisotopes received, used and disposed should
be maintained.
Emergency Procedures
It is very difficult to make rules to manage variety of radiation accidents.
However, spillage of radioactivity is the most likely accident in radioisotope
laboratory, which require the following procedures to be recommended in
dealing with such emergencies:
1. Confine the spill immediately, by droping paper towels or other
absorbent material into it.
2. Evacuate the immediate area so that persons will not walk over the
spill and spread the contamination.
3. If the spilled material has splashed on to a person or clothing,
immediate steps should be taken to remove the laboratory coats or
outer garments and to leave them in the contaminated area. Hands
and other contaminated areas on the body should be washed
thoroughly with soap and water. Care should be taken not to abrade
or inflame the skin surface. If internal contamination has taken place,
immediate action should be taken to minimize the deposit of
radioactivity in internal organs and tissue and enhance the excretion
of the ingested radioactive material, under expert medical supervision.
Bioassay or whole body counting, if facilities are available, should be
carried out to confirm internal contamination.
4. Contaminated area should be decontaminated by experienced persons
wearing surgical gloves, shoe covers and a surgical face mask if
available. Tongs or forceps should be used to remove the contamination
by absorbent material. The absorbent material so collected should be
kept in a polythene bag to be treated as radioactive waste. After as
much contamination as possible has been removed in this way, the
surface should be washed with damp-not wet-paper towels held by
forceps, always working towards the centre of contaminated area,
298 rather than away from it.
Radiation Emergency
5. A contamination monitor should be used to monitor the area as well

as personnel during the procedure of decontamination. The
contamination monitor should be operated by someone who is not
involved in the clean up, so that the instrument does not become
contaminated when the decontamination procedure is over. The
contaminated gloves, shoe covers etc. should be kept in a polythene
bag for decay or ultimate disposal as radioactive waste. The forceps /
tongs should be kept separately covered in polythene bag for decay of
radioactivity in it.
6. In case of a large release of radioactive powder or aerosol in a room,
such a room must be immediately isolated from its surroundings by
shutting off mechanical ventilation and by closing windows and doors.
A room with heavy air contamination can be decontaminated from
with in by drawing air of the room through an appropriate filler.
7. Maintain complete records of the accident giving details of the
radioisotope, activity involved etc. and follow up procedures.
For effective management of any kind of radiation emergency, the
RSO should educate and familiarize all radiation workers with the
steps to be taken to meet the emergency. Use of radionuclides in
research applications will not give significant exposure to general
public, provided certain basic precautions are taken. These precautions
mainly involve good accuracy for the radionuclides, good work
practice and a well controlled programme for the disposal of
radioactive waste.
Procedures for Handling Spills

Accidental spills of radioactive materials are quite common in nuclear
medicine departments, but they are not life threatening hazards. Hence
spills should be treated as events completely with out hazard and the staff
should aware of the procedures to be followed. The steps involved in the
radioactive spill are:
To inform,
To contain, and
To decontaminate.
1. Individuals in the immediate work area should be informed that the
spill has occurred so that they can avoid contamination if possible.
Individuals outside the immediate area should be warned so that they
do not enter it. The RSO should be informed so that he /she may begin
supervising further action as soon as possible.
2. The laboratory personnel should attempt to control the spill to prevent
further spread of contamination, without risking themselves. A flask
that has been tipped over should be uprighted. Absorbent pads should
be thrown over a liquid spill. Doors should be closed to prevent the
escape of airborne radioactivity. The spill area should be closed off to 299
prevent entry, especially by persons who might not be aware of the

spill. Personnel monitoring for contamination should be started as soon
as possible, so that contamination and uncontaminated persons can
be segregated. To prevent further spread of radioactivity, contaminated
individuals should not be allowed to leave the area until they are
decontaminated. The uncontaminated individuals should not be
allowed to enter the spill area. Contamination monitoring should be
done using a sensitive radiation monitoring instrument appropriate
for the type of radioactivity involved. It is advisable that each laboratory
have on hand a thin window GM counter survey meter for handling
such situations.
3. Personnel decontamination procedures should receive first priority,
followed by decontamination of work areas, etc. Personnel involved
in decontamination procedures should wear protective clothing to
avoid becoming contaminated themselves in the process.
Contaminated skin should be flushed thoroughly with water. Special
attention should be given to open wounds and contamination around
the eyes, nose and mouth. Contaminated clothing should be removed
and placed in plastic bags for storage. After major localized areas of
personnel contamination have been attended to, a shower bath may
be required to remove more widely distributed contamination.
Decontamination of laboratory and work areas should not be attempted
except under the supervision of RSO. If the work surfaces and floors are
constructed from a non absorbent material, soap and water is generally
used for decontamination. Contaminated areas should be cleaned from
outside in to minimize the spread of contamination. Porous or cracked
surfaces may create difficult problems. If complete decontamination is not
possible, it may be necessary to cover and shield the affected surfaces or
perhaps even to remove and replace them.
RADIOTHERAPY: RADIATION EMERGENCIES

A situation in a beam therapy facility can be considered as an emergency,
if it could result in higher actual or potential radiation doses than those in
normal situations to personnel, patients or public. In 2000, the International
atomic energy Agency (IAEA) published its report No 17 Lessons learned
from accidental exposures in Radiotherapy. It described 92 accidents
resulting in an incorrect dose to the patient. Out of 92, 32 of these accidents
were related to the use of sealed sources (brachytherapy).
In the case of telegamma units, two potentially hazardous situations
may arise:
i. The source does not, or only partially, go back to OFF position; in
other words, it continues to be in the ON position even after the
termination of the set treatment.
300 ii. The source falls off from the source head.
Radiation Emergency
The type of situations where the telegamma source continues to be in

the ON position, vary with the source ON-OFF mechanism in the unit.
They include failure of (i) pneumatic system (ii) shutter to close, and (iii)
drum to rotate, to bring the source back to OFF position at the end of the
set treatment time. The emergency situation continues until the source is
completely shielded by mechanical manual or other means. In certain
systems emergency may caused by leakage of mercury which functions as
a shield, thus leaving the source in the ON position even after the set
treatment time is over.
In medical accelerators, normally such type of emergency does not occur.
However, recently a few cases of computer software mix-up, resulting in
the wrong selection of electron mode, have been reported. The following
paragraph discusses several instance of such emergency situations in
teletherapy units which have occurred in this country and abroad.
Emergency Situations
Leakage of Mercury (Shutter)

In September 1980, the film badges worn by the radiation therapist, the
physicist and the technologist of a hospital recorded high doses. On
investigation it was noted that this was caused by an emergency situation
of an Eldorado A Unit 2. Here the source is stationary and shielded in OFF
position by mercury between the source and the collimator. When the source
is made ON the mercury is pumped out and stored in a reservoir and
held there against gravity. Small mass of mercury started leaking from this
reservoir when the source was ON. The leakage of mercury was noted
and they arranged to collect the leaking mercury and put it back into the
unit as immediate remedial measure. But some quantity of mercury was
lost in this process and hence the efficiency of mercury as the shield was
gradually reduced. This process continued until December 23, 1980, when
the treatment by the unit had to be discontinued for want of spare parts.
Later, the hospital staff developed a special filter, which when incorporated
into the unit, completely prevented the leakage of mercury. A number of
overexposures to personnel were reported during this period. Based on
chromosome aberration test reports, the individual equivalent dose, ranging
from 20 to 50 rem were estimated to have been caused by this emergency.
Failure of Shutter Movement

1. In July 1984 a case of malfunctioning of the mobile shutter of a Theratron-
B unit was reported. The shutter mechanism was working only when
the unit was pointed downwards. The mobile shutters were encountering
the obstructions on its path and as a result, the shutter used to remain
partially open during the OFF position. The source was unloaded and
the shutter were removed and examined. It was observed that the mobile 301
shutter had lost its integrity and that a tiny particle removed from it got
embedded in the housing and caused the obstruction. The shutter was
thoroughly cleaned, polished and lubricated and the unit re
commissioned. During this emergency the doses to personnel involved
in the repair work were negligible.
2. The shutter mechanism of a Gammatron unit, serviced during the source
replacement on December 13, 1984, failed to function and remained open
at the end of set treatment time on January 23, 1985. The service engineers
reported that the shutter developed extraordinary friction. Treatment
was stopped until April 16, 1985, when the source was unloaded and
shutter repaired. The individual doses received by personnel during the
repair were less than 10 mrem.
3. In another emergency on November 23, 1985 the shutter of a Gammatron
unit remained in open position and could not be closed, even manually.
The service engineers reported that the source had to be unloaded prior
to shutter repair. It was ascertained that the shutter mechanism had
developed extraordinary friction due to damage in the ball bearing
movement system. For want of spare parts, to be imported, the unit could
not be used for treatment for about 16 months. The source was unloaded
on April14, 1987 and the unit was repaired. The personnel dose during
the repair was less than 10 mrem.
4. In another case of Gammatron unit, the shutter failed to close at the end
of the set treatment time in October, 1986. The patient was immediately
removed and defect was rectified by the hospital engineer.
Pneumatic System Failure

Recently, two cases of source stuck in the ON position for Gammarex-
R unit have been reported. In both cases, the source drawer did not return
to the parking position at the end of the set treatment time, and the sources
were pushed back to OFF position manually with the T-rod. Personnel
exposure were well within permissible levels. In one case, subsequently
the source was unloaded, the drawer and its passage area thoroughly
cleaned and the source replaced.
Improper Functioning of Timer

A typical case of improper functioning of the timer of Picker unit has been
reported. The timer was observed to reset the time automatically at the
end of the set treatment time. This resulted in the source to be in the ON
position continuously until the timer was manually interrupted. Even
though such an incident has not been reported in India, a formal intimation
regarding this malfunction was sent to all users of Picker unit. It was
confirmed that the timers in the Picker units in India were functioning
properly.
302
Radiation Emergency
Software Mix-up in Accelerator

Two incidents of massive overdoses of patients took place in a hospital in
USA from Therac-25 accelerator on March 21 and April 11, 1986, with
Malfunction-54 occurring in both the cases. A third case with the same
accelerator which occurred on April 25, 1985 was reported later. Another
similar incident from a different hospital using the same model of accelerator
occurred on January 17, 1987, though the reported malfunction was of a
different nature. The first two patients died and the third patient was
seriously maimed.
The Malfunction-54 occurred when the technician inadvertently
selected photon beam mode for a patient who was to be treated with electron
beam of lower energy. The operator realizing the mistake promptly
corrected for the mode using the edit-key facility. The computer displayed
the electron beam mode and the beam ON command was given to start
the treatment. The treatment was abruptly terminated after one second
with the patient writhing in pain calling for help from inside treatment
room. The physicist later simulated the malfunction and measured the dose
in water phantom as 25000 rads in one second. AECL subsequently
informed all Therac-25 users to suspend the use of this accelerator. A plan
for correcting the errant software was submitted by AECL to Food and
Drugs Administration, U.S.A.
In the meantime the fourth incident occurred where although the photon
beam mode was selected the heavy metal target did not come into position
into the path of the electron beam and instead a light field mirror came in
position to intercept the electron beam. Corrective action plan was amended
accordingly.
San Jose, Costa Rica

A radiotherapy overexposure occurred at the San Juan de Dios Hospital in
San jose, Costa Rica in august and September 1996. About 115 patients
who were treated for neoplasm by radiotherapy were affected. Out of the
115 patients 42 died and 73 were alive. The radiation exposure was a major
factor for death in 3 patients and partial in 4 patients. The event occurred
on August 22,1996,when a Cobalt-60 source was replaced. After the source
loading, the new source was calibrated, and an error was made in calculating
the dose rate. This miscalculation resulted administration of higher doses
to the patients than prescribed.
Panama Accident
A radiation accident occurred in the National institute of oncology, Panama
in May 2001,in which 28 patients undergoing radiotherapy in cobalt unit
were affected. The IAEA team visited the place on May 22, 2001 and reported
that out of 28,eight patients had died. The death of five is due to radiation 303
over exposure, one death is related to cancer and remaining two death, no
conclusion was made.
The cause for the accident due to wrong data entry into the treatment
planning system (TPS) computer. The spatial coordinates of the shielding
block has to be fed into the TPS in way that one shield at time. From August
2000, the coordinates of the all the shielding blocks were entered as a single
block, which resulted incorrect dose and treatment times. Lack of written
procedures and manual check when the data input procedure was changed,
resulted radiation overexposure to the above patients.
Ottawa Hospital Cancer Center

A relocation of an orthovoltage treatment unit from one campus to the
other in the Ottawa hospital cancer centre in the Fall 2004, was followed by
an error at the time of recommissioning. The error was reflected as incorrect
output tables for all 4 beam qualities and for all field sizes other than 10 x
10 cm2. A total of 1019 patient treatments were delivered to 620 patients
using the incorrect orthovoltage output tables during November 2004 to
November 2007. Patients were under dosed to a maximum of 17 %. No
overexposure was reported and the cause was due to the omission of a
back scatter conversion factor for all the fields other than 10 x 10 cm2
(www.iaea.org).
Overexposure During Source Exchange

Two radiation workers, while working on a source exchange of a decayed
cobalt-60 source in a hospital in the state of Sao Paulo, Brazil on july 21,
2008, received significant overexposure. The workers transferred the source
drawer from the unit head to the transfer cask with the help of tool. When
the tool was pulled out, the source drawer momentarily came out of the
transfer flask before the worker pushed back. They received a whole body
equivalent dose of 135 mSv and 0.7 mSv respectively. Later on August 15,
2008 it was found that one of the fingers of the individual was blistering.
The extremity dose was estimated as 25 Sv.
Different types and degrees of emergency as discussed above can
potentially occur in beam therapy facilities. The facility and the radiation
safety officer must be prepared to meet such kinds of emergencies at any
time. Line of action to be followed may vary with the type of emergency
and the personnel must be clearly aware of the same
Radiation Emergencies-Fall of Source Drawer

During source replacement or source head repair of telegamma therapy
units with source ON-OFF mechanism, serious accidents can take
place unless proper care is taken. Recently, two such serious accidents
304 have taken place in India in two different institutions. In each case, sources
Radiation Emergency
loaded in parallopiped shape source drawer fell down from the

source head during repairing of shutter mechanism. In one case, it was
cobale-60 source of 6000 RHM and in the other it was Caecium-137 source
of 2050 Ci.
1. First Incident: The first incident took place when two under trained-
staff members of the institution tried to repair the shutter mechanism of
a Gammatron-3 teletherapy unit. They removed the gear box mounted
at the back side of the drum shutter to look for any foreign particles
obstructing the movement. Later they removed the front plate as well as
the arresting strip of the drawer. The head was tilted through +300 in the
forward direction and the unit was rotated to bring it to a convenient
position. The source drawer, which was lying freely in the cavity slipped
down from the head. Realizing the seriousness of the situation, they
came out and locked the room immediately. They received whole body
equivalent dose of 29.50 mSv (2950 mrem) and 12.40 mSv (1240 mrem).
Source Retrieval Operation
The retrieval operation was planned on the basis of information collected
during a preliminary visit to assess the situation. The details available
from the layout of the installation were also useful in planning the
management of the accident. Temporary extra shielding was planned
for secondary walls to be provided by piling up sand bags upto 1 meter
height. An aluminium tray with a groove like depression at the bottom
to sit on the source drawer (Fig. 11.7) was designed and fabricated. It
was planned to cover the source drawer with the above tray and to fill it
up with lead shots through a polystyrene pipe by personnel positioned
behind the maze wall.
Fig. 11.7: Aluminium tray designed to cover the source drawer
Area monitoring of the entrance to the treatment area and other

areas of interest were carried out using a Teleflex cable of 12 m length 305
connected to the detector, keeping the meter of the monitoring instrument

outside the room. The radiation levels at various points measured before
and after providing temporary shielding are given in table 11.1. The
various location in which radiations were measured are given in Fig
11.8. Since there was no lead glass viewing window and since the CCTV
was focused to the couch, a mirror mounted on a wheel trolley was
employed at the entrance of the treatment room to locate the source
drawer. With the help of this mirror, it was observed that the major
length of the source drawer was hidden by the base drum of the couch,
which was locked to the ground. Further, a raised wooden platform
made of interlocked portions was provided in the room for the
convenience of patients as it lowered the height of the couch. The source
drawer was lying on this platform. As such, positioning the aluminium
tray to cover the source drawer and to fill it up with lead shorts were not
viable to persons positioned behind the temporary shielding erected at
the entrance position.
A rehearsal of the operation with a dummy drawer was conducted
in the adjacent teletherapy room. It was concluded that aluminum tray
can be placed over the source drawer by one person entering the room
with a remote handling tong of 2.0 m length and that the equivalent
dose for this operation will be about 15 mSv (1500 mrem). Actually, this
job could be carried out with an equivalent dose of 12.5 mSv (1250 mrem)
to the operator.
In the wall common to control room and treatment room, a tapered
hole was drilled at the height of 2.5 m from the floor for the passage of
polystyrene pipe to facilitate filling up of the aluminum tray had to be
shielded, temporarily. Lead shots (about 40 Kg) packed in cloth bags
were used for this purpose. This was carried out for a collective
equivalent dose of 0.025 mansievert (2.5 manrem). The exposure rate at
the drilling position was then reduced to 5 mR/h from 200 mR /h.
Polystyrene pipes of 5 cm in diameter and 6 meter in length were
extended to the aluminium tray through the hole drilled on the wall at
Control room. About 350 Kg of lead shorts of diameter 1-2 mm were
poured into the aluminium tray through this pipe. This brought down
the radiation level inside the treatment room to a workable level. All
unwanted materials and a major portion of the wooden platform inside
the room were quickly removed.
The source drawer was lying at the middle the platform. To transfer
the drawer into a transport flask, the drawer hade to be brought to the
edge of the platform. Another aluminium tray of slightly larger size and
smaller grove for source drawer to exactly fit in (to reduce streaming)
was fabricated and positioned in line with the aluminum tray with lead
shots in it, which was covering the source drawer. The source drawer
306 was then transferred to the groove of the second tray. After emptying
Radiation Emergency
the first tray, it was used in line with the second tray for shifting the
source drawer further close to the edge of the platform to enable it to be
loaded into the transportation flask. Before loading source drawer into
the transportation flask, shielded source drawer had to be lifted through
20 cm to bring the source drawer in line with the cavity loading the
fallen source drawer into transportation flask, the teletherapy unit was
repaired and subsequently the source loading was carried out. The
equivalent doses received by personnel involved in the retrieval
operation are given in Table 11.1. The total collective equivalent dose
was about 0.07 man sievert (7.0 man rem).
Table 11.1: Radiation levels in and around the Telecobalt facility before and after
providing temporary shielding at the entrance and maze region (The source drawer
with 60Co source of 222 TBq (6,000 Ci) was lying on the wooden platform inside
the treatment room. The source was facing the ceiling. The locations where radiation
levels were measured are numbered and marked in Fig.11.8)
Radiation levels in and around the Telecobalt facility
Before providing After providing
temporary shielding temporary shielding
Location Location Air kerma Exposure Air kerma Exposure
number description rate (mGy h-1 ) rate (mR h-1) rate (mGy h-1) rate,(mR h-1)
1. Behind the 1.74 200 0.35 40
maze wall
2. 0.87 100 0.87 100
3. 0.44 50 0.44 50
4 0.87 100 0.87 100
5. 1.74 200 1.74 200
6. 6.97 800 1.31 150
7. Entrance to 43.50 5 103 5.22 600
8. treat room 522.00 60 103 522.00 60 103
9. 104.40 12 103 43.50 5 103
10. Door 0.17 20 0.04 4
11. Control panel 0.02 2 8.70 103 1
2. Second incident: In this case a source drawer containing 2050 Ci Caesium-

137 fell down during repairing of the shutter mechanism of a Ceasa -
Gammatron unit by the service engineers, who missed to arrest the source
drawer.
Retrieval operation
The radiation levels in the control room and surrounding areas were
not very high and operation of retrieval could be managed from the
entrance door.
The fallen source drawer was covered by an aluminium tray and it
was filled with lead shots. A second compact tray of mild steel mounted
on a mild steel plate with three hooks on each side was fabricated and
307
placed in line with the first aluminium tray. The second tray was filled
Fig. 11.8: Lay out of the teletherapy facility,

where radiation levels are measured
with lead bricks and lead shots and source drawer was transferred below
this tray (on the M.S. Plate). By using chain pulley system the source
drawer shielded under the mild steel tray and resting on the mild steel
plate was lifted and placed on a trolley which was provided with 10 cm
thick layers of interlocking lead bricks covering the entire base of the
mild steel tray. Additional shielding by interlocking lead bricks were
provided on three sides and on the top of the tray and the trolley was
positioned in a corner of the room. Later the source drawer was loaded
into the teletherapy head after the repair of the unit. The total collective
equivalent dose in the operation was about 0.02 mansievert (2 manrem).
From the above incidents we can conclude that unless proper care
is taken during servicing or source loading, serious accidents involving
high exposure to personnel and long down time of machine can take
place. In addition, skillful planning of management of accident is
necessary for keeping radiation dose to the minimum to personnel
involved in the operation.
BRACHYTHERAPY: RADIATION ACCIDENTS

The IAEA report No 17, presents 32 accidents related to Brachytherapy
.The type and number of accidents is summarized in the Table 11.2. Errors
in the specification of the source activity, dose calculation or the quantities
and units resulted in doses that were up to 170% of the prescribed dose.
308 Some accidents were related to human mistakes, for example, the use of an
incorrect source due to fading of the color coding. This is listed under
Radiation Emergency
other in the table, which also includes accidents caused by badly

implanted sources, removal of the sources by the patient or otherwise
dislodged sources. The most severe accident was due to equipment failure,
where a lethal dose was delivered to a patient.
Table 11.2: Type and number of accidents reported in

Brachytherapy treatments (IAEA 2000)
Accident caused by Number of cases
Dose calculation error 6
Error in quantities and units 2
Incorrect source strength 7
Equipment failure 4
Other 13
Total 32
HDR Brachytherapy units have higher potential for damage to patients

as a result of misadministration. In one HDR event the patient was
prescribed a dose of 35 Gy to lung. There was a kink in the catheter which
positioned the source 26 cm away from the target site. The error was not
discovered until the treatment was over. Because of this error, hypopharynx
received 35 Gy and the target received only 1 Gy.
The other events includes using a HDR prescription for the wrong
patient, and malfunction of the HDR equipment etc. Over all the treatment
delivery errors can be summarized as follows: positioning of the active
source train outside the treatment volume, mispositioning of dose
prescription points and failure to detect a source that separated from its
cable and remained in the implanted catheter for 91 hours. IAEA reported
that the misadministration is due to malfunctioning equipment, such as
catheters do not allow full movement of sources. It also mentioned the
inadequacy of personnel training which caused the misadministration.
The above demonstrates the need for a well designed programme of
quality assurance in any Brachytherapy department. Its goal should be the
consistency of the administration of each individual treatment, the
realization of the clinical intent of the radiation oncologist, and the safe
execution of the treatment with regard to the patient and staff.
EMERGENCY PREPAREDNESS: ACTIONS

In spite of preventive measures, accidents or un usual events may occur.
The safety assessment will identify accident scenarios and situations, and
counter measures for mitigation are designed. Some of the actions in the
emergency response plan need to be taken immediately, with out hesitation
or mistakes. To achieve this personnel need to be trained and simulation
drills carried out. A clear and concise list of actions and responsible officers
309
is posted in relevant places. There is a written documentation of rules for
action and training, including simulating exercises, for the emergency

response plan, which needs to be periodically reviewed.
Line of Command of Actions

The RSO must establish the line of command of actions to be taken, in the
case of any emergency. This will include the type of immediate action to be
taken and persons to be contacted. The addresses and telephone numbers,
if any, of these persons must be conspicuously displayed.
Source not Returning to OFF Position
Removal of the Patient

If the source does not return to OFF position after the set treatment time
is over, the technician must remove the patient without himselft getting
directly exposed to the primary beam. This would also imply that an audio-
type gamma zone monitor is available, calibrated and working, which will
indicate that the source is ON or OFF. To facilitate such action, the
RSO must routinely advise the workers regarding the route to be taken by
them inside the treatment room for various directions of primary beam. It
must be clearly demonstrated to the staff that the dose equivalent to the
worker for such a procedure will be only of the order of 10-20 mrem. They
must also be told to be in the treatment room only for the minimum time
required and, in any case, not to expose any part of their body including hands,
to the primary beam. After the patient is removed, the technician must lock
the room, inform the RSO immediately, and wait for further instruction.
Restoring the Source to OFF Position

The RSO must try to return the source to the OFF position as specified
for the unit concerned and with appropriate care. This may involve
procedure such as pushing the source drawer to the parking position with
a T-rod, pressing a popped-up button on the source head, rotating a wheel
in the gantry, or by switching off electric power as specifically directed in
the Instruction Manual supplied by the manufacturer.
If this procedure does not result in returning the source to the OFF
position, the RSO must leave the treatment room. The room must be closed
immediately and the service engineers of the company concerned may be
summoned for appropriate assistance. Administrative action will include
vacating for shielding adjacent rooms and areas and cordoning off the
facility as required.
Requirement of Equipments and Accessories

The follow up materials and equipments must be available in the hospital
310 and be kept outside the telegamma room. It must be possible to procure
Radiation Emergency
items such as sand bags, lead shots, etc. at very short notice in case of
emergency.
1. Survey meter: Properly calibrated and maintained survey meters of
appropriate ranges must be available at all ranges. A wide range survey
meter with long cable facility is desirable.
2. T-rod: T-rod or other such equipment meant for the unit.
3. Manual: Operation/service manual of the unit which will give details
regarding type of source drawer etc. must be kept at easy accesses. In
one of the recent major incidents the instruction manual was located
only a after prolonged search.
4. Binoculars: Binoculars could be of help to verify whether the source
is in the ON or OFF position, as also its location, if it has fallen
down.
5. Lead shots: 300-400 kilograms of small sized lead shots, of about 1-2
mm diameter. This will be needed to shield the source in case it falls
off from the unit.
6. Lead wool: Several kilograms of lead wool preferably packed in bags
will be needed to be thrown over the source from a safe distance, so
that the source can be initially shielded, before its actual retrieval. This
will enable personnel to approach closer to the source for the retrieval
work.
7. Lead bricks: Several lead bricks of standard size, regular and
interlocking type, will be useful to shield the source further, once the
lead shots and lead wool are thrown to cover the source.
8. Sand bags: Generally, a telegamma-particularly telecobalt-room is
designed such that two walls will act as primary walls and the
remaining two as secondary walls. However, if the source falls on the
floor, all walls become primary walls. Hence, additional shielding may
be needed for the secondary walls, and in some cases, depending on
the location in the room where the source has fallen, for primary wall
too. A number of sand bags may need to be arranged on these walls,
so that the exposure rates outside are within permissible levels.
9. Long handled tongs: Long handled tongs on which the radiation probes
could be fixed will be needed to monitor the radiation levels at various
locations in the telegamma room. This will help in deciding the course
of action to be followed.
10. Long pipe and funnel: A long pipe is needed so that the lead shots can
be dropped through a funnel connected to one end kept near the door
or maze in such a way that radiation is avoided by the worker to the
extent possible. The pipe must be in an inclined position, in such a
way that the other end is over the source.
11. Transport container: The transport container (source flask) must be
available locally with the servicing firm, so that remedial action can
be initiated immediately in the case of the source fall. It must also be 311
stressed that in case of major repairs of the head, drawer or shutter,

the source, if needed, must be unloaded prior to such work.
12. Personnel monitoring dosimeters: All personnel in the telegamma
room including casual workers must wear personnel monitoring
dosimeters.
Legal and Regulatory Requirements

Rule 20 of Atomic Energy (Radiation protection) rules, 2004 stipulates that
the employer is the custodian of radiation sources in his possession and
shall ensure physical security of the sources at all times. The employer
shall inform the competent authority, within 24 hours, of any accident
involving a source or loss of source of which he is a custodian.
The worker shall inform the licensee and RSO, of any accident or
potentially hazardous situation that may come to his notice. The licensee
shall prepare emergency response plans and submit to the competent
authority for approval.
It is the duty of the radiological safety officer to investigate and
initiate prompt and suitable remedial measures in respect of any
situation including emergencies that could lead to radiation hazards. He
should develop suitable emergency response plans to deal with
accidents and maintaining emergency preparedness. The RSO must send a
report of the emergency to the Head, Radiological safety division, AERB,
MUMBAI. The report should give details of the incident, including the
causes, remedial action, dose received and steps taken to avoid such
emergencies in future.
Prevention of Emergency
Generally, emergencies arise in the case of old and poorly maintained units.
It must be stressed that proper work discipline, as well as regular servicing,
maintenance and quality assurance tests of the teletherapy unit and
associated equipment will definitely help to prevent potential emergencies.
It must be pointed out that most of the major incidents involving telegamma
units have occurred during source transfer or repair work. It must be
ensured that any servicing of the source head must be done only by
experienced engineers and in the presence of the RSO. In many cases,
emergencies arise because of temptations to compromise on or by-pass of,
simple requirements of radiation safety. These should never be resorted
to. Typical example include arrestor not provided to prevent movement of
source drawer and transport container not immobilized during source
transfer operation. Periodic drills must be arranged by the RSO to simulate
emergency situations. This will also help to avoid tendency for complacency
among the staff.
312
Radiation Emergency
MEDICAL MANAGEMENT OF PERSONNEL

EXPOSED TO RADIATION
Partial Body Exposures Localized

Exposure (Radiation Burns)
In localized exposure, a small part of the body is exposed to radiation.
Most commonly, hands, feet, legs and face are irradiated but any other
part of the body may also be involved. Skin is the first organ to be exposed
following irradiation. The earliest damage seen in transient erythema which
comes immediately after exposure and is due to dilation of capillaries
resulting from histamine like substances released by injured cells. This is
followed 2-4 weeks later by fixed erythema which may come in waves is
much deeper and more prolonged than the transient erythema. If the dose
is more than 3Gy (300 rad) epilation, dry, moist desquamation and
ultimately necrosis of the epidermis result. Long term sequelae are
pigmentation, atrophy of dermis, sweat glands, sebaceous glands and hair
follicles, fibrosis of dermis and increased susceptibility to trauma and
chronic ulceration. Damage to the germinal cells in the basal layer is critical
in the pathogenesis of erythema and desquamation. It is the dose to these
cells that determines the severity of skin damage.
Skin Effects Following Exposure
Transient Erythema
Early transient erythema may occur in a matter of hours following doses of
more than 2 Gy, because of changes in permeability of capillaries. The main
wave of erythema peaks at 10 days to 2 weeks and requires a larger dose of
about 6 Gy.
Epilation
Epilation or hair loss, occurs if there is sufficient reduction in the replicative
capacity of germinal cells or the matrix of the hair follicles. Temporary
epilation may occur after doses of about 3 Gy, with an on set at about 3
weeks and regrowth requiring 5 weeks or more. Epilation is permanent if
the dose exceeds about 7 Gy. Some of the radiation effects and the levels at
which these may occur are given below in Table 11.3.
Dry Desquamation
Dryoeneum, much like a sun burn, may occur after single doses of
more than 14 Gy, because of depopulation of clonogenic cells in the
epidermis. Healing requires the repopulation of basal cells from surviving
clonogens.
313
Table 11.3: Radiation effects and radiation dose

Radiation effects Threshold dose of X and rays Time of onset
Early transient erythema 2 Gy 2-24 h
Temporary epilation 3 Gy 3 wk
Dry desquamation 14 Gy 4 wk
Secondary Ulceration 24 Gy 6 wk
Late erythema 15 Gy 8-10 wk
Ischemic dermal necrosis 18 Gy >10 wk
Telangiectasis 10 Gy >52 wk
Moist Desquamation
Moist desquamation requires higher doses greater than 18 Gy and also
results from depopulation of clonogenic cells in the epidermis. Healing is
caused by repopulation of surviving clonogens or micration of clonogenes
from the edges of the irradiated area. These effects may cause substantial
discomfort, but provided they are not severe, they heal and clear up as the
population of basal cells recovers.
Transepidermal Burn
This is similar to second degree thermal burns with a latent period of 1-2
weeks. Radiation burns are sometimes deceptive on superficial appearance
as damage to important organs in subcutaneous tissue nerve endings, hair
follicles, sweat glands, endothelium of blood vessels may not be obvious.
Among these, the injury to the endothelium of blood vessels is the most
serious. It produces endartritis obliterans, leading to necrosis of overlying
tissues, which continues to progress for several months. The severity of
burns depends on the dose and dose-rate and doses of 30 Gy (300 rad) or
above blistering and skin loss may take place. In such cases, besides
subcutaneous tissues other internal structures are affected and may give
rise to radiation necrosis of bone, muscle and other internal organs. Initial
symptoms are erythema, pain, swelling, itching, or tingling and epilation.
Full Thickness Radiation Burn

This is similar to third degree burns and a serious version of transepidermal
injury. The injury extends up to the dermis and produces prompt and severe
pain. In case damage to circulation is present, the healing will take long
time and surgical intervention may be required. Pain is an important feature
of the exposure of skin, particularly in the extremities, to high doses of
radiation. This pain is maximum with the appearance of vascular lesions.
The pain is experienced during the first few days, lasting several hours
and it may last for long periods.
314
Radiation Emergency
Long Term Effects

Long-term sequelae, include dermal atropy, telangiectasia, and necrosis.
These effects occur months to years after higher doses of radiation (10-18
Gy) and are caused by primarily by vascular damage to the dermis. Late
effects also may develop after unusually severe early effects, in which case
they are referred to as consequential late effects.
Management of Radiation Burns
History
A detailed history of accident with name, age and sex of the person, the
nature of radiation and energy, possibility of whole body exposure or
contamination etc. should be collected. Personal TLD badges will provide
some idea about the exposure. Some times the patient may not aware of
irradiation and dose. Complete examination of the skin repeatedly on the
first day is required to see is there any prodromal erythema. The time at
which transient erythema occurred, along with other symptoms, will enable
the physician to come to a rough conclusion regarding the dose and the
ultimate prognosis, with the development of fixed erythema.
Investigation
The following investigations and procedures are recommended:
1. Complete blood count
2. Blood lymphocyte culture and Chromosomal analysis
3. Sperm count
4. Culture and antibiotic sensitivity test
5. Estimation of radionuclides in urine and stools
6. Serial color photography
7. Thermography
8. Non invasive vascular studies
9. Radioisotope scintigraphy
10. Slit lamp examination of eyes
11. Physical dosimetry
Samples should be taken immediately for items 1-5 in the above list.
Concurrently photographs should be taken and dosimeters sent for
evaluation of dose. Scintigraphy may be done before slit examination in
view of blood contamination with 99mTC. Even after the area of burn becomes
apparent, the underlying damage cannot be observed with accuracy
clinically. Thermography and scitigraphy offer a means of detecting areas
affected significantly by localized irradiation, and the functional status of
the organ. This information is helpful in planning any surgical intervention
with out waiting for the clinical symptoms to unfold fully.
315
If there is leucopenia in the first week, it is suggestive of whole body

exposure. There is danger of infection which should be treated vigorously.
Surgical intervention should be kept to the minimum during this phase of
bone marrow depression which usually lasts about 4-8 weeks.
Specific Treatment
1. Mild erythema: This may become dry and start itching in 3-4 weeks. A
bland lotion or steroid ointment should be applied locally. No tight
clothing should be worn on the affected part.
2. Transepidermal burn: Pain should be relieved by analgesics, and drug
like phenylbutazone,which cause bone marrow depression should be
used. Sterile protective dressings should be used. Systemic antibiotics
should be given for prevention of infection. Usually the burns will heal
without skin grafting in the absence of infection.
3. Full thickness radiation burn: The burns may progress from initial
blistering to skin loss and deep tissue necrosis, giving rise to severe
pain,tissue loss and infections. This will require surgical intervention,
the timing of which will be difficult to decide due to slow progression of
burn. Bone marrow depression may further complicate the condition.
In case there is leucopenia at 2-6 weeks, surgical treatment should be
kept at minimum until haematopoietic recovery takes place (usually in
about 6-8 weeks). In case the involved area is more than a few square
cms (2-3 sq.cm) skin grafting will be required. Larger areas involving
necrosis and gangrene of distal portions of fingers of extremities will
require amputation. In beta-ray burns, early excision and skin grafting
may spare the patient from pain and discomfort. Lastly, follow up of
such cases is important because healed radiation burns may result in
weak atrophic skin that is subject to chronic and recurrent ulceration.
The time for amputation and reconstructive surgery depends on the
following determinants:
i. Intractable pain
ii. Size and location of injury
iii. Degree of control over infection
iv. Degree to which vascular damage can be estimated
v. Value of the part.
BIBLIOGRAPHY
1. A practical guide to quality control of Brachytherapy equipment: ESTRO Booklet
No.8 2004.
2. AERB safety code: Medical management of persons exposed in Radiation
accidents.AERB/SG/MED-1, 1990.
3. Chandrani L, et al. Radionuclides in Bio-Medical sciences-An introduction;
Foundation books Pvt. Ltd, New Delhi 2004.
316
Radiation Emergency
4. Jerrold TB, Seiber, JA, Edwin ML, John MB. The essential physics of medical
Imaging, (2nd edn.) Lippincott Williams and Wilkins 2002.
5. Lecture notes: Training course on Radiation safety for Radiation therapy
technologists; RSD, AERB and RPAD, BARC, Mumbai.
6. Safety report series No 17: Lessons learned from accidental exposures in
radiotherapy, IAEA,Vienna, 2000.
317
Index
A Brachytherapy: radiation accidents 308
Absolute risk 26 Breastfeeding 233
Absorbed dose-rad/gray 2 Breathing apparatus 281, 293
Accuracy of corrections for count losses Burial of solid waste 273
143
Actions and precautions that can reduce C
radiation exposure to the fetus 234 Calibration and maintenance of radiation
Additional installation requirements 87 monitoring instruments 117
Additional requirements for type A Carbon fiber materials 210
packages 250 Cardiac catheterization and pregnancy
Additional requirements for type B 223
packages 251 Category III-yellow 249
AERB classification of radioisotope Category II-yellow 249
laboratories 188 Category I-white 249
AERB guidelines for starting radioisotope Ceiling mounted barriers 205
laboratory 187 Ceiling 55
AERB guidelines to set up a radioim- Cell 14
munoassay (RIA) laboratory 189 Central beam alignment 122
AERB specification for layout of radio- Chance of approaching dose limits of
therapy facility 194 exposure 226
Air conditioning 85 Chemical purity 150
Alignment of table gantry 134 Chemical treatment 271
Annual limit on intake 8 Chest and extremity radiography in
Applicator integrity 160 pregnancy 222
Aprons 280 Classification of waste 269
Area monitoring 103 Cobalt-teletherapy machine survey 114
Area survey 113, 115 Collective dose 6
Artificial sources 10 Collective effective dose equivalent 7
Assistance to patients 206 Collimator axis, light beam axis and
Associated facility 87 cross-hairs coincidence 155
Atomic energy act-1962 167 Collimator rotation 155
Atomic energy regulatory board 167 Collimator test 135
Avoid of pregnancy after radionuclide Committed dose 6
therapy 237 Computed tomography installation 70
Avoid of pregnancy after receiving Concentrate and contain 268
radiotherapy for breast cancer Conduit 83
treatment 242 Congruence of radiation and optical
fields 121
B Consent 184
BEIR report V and VII risk estimate 26 Consentee 185
Biologic effects 17 Consignor's declaration 258
Booking, storage, transport and delivery Construction materials 84
of package 257 Consumer products 11
Brachytherapy facility design 91 Contamination control 229
Brachytherapy sources, equipment and Continuation of work of a pregnant
installations 192 employee in X-ray department 224
Control of PH 151 Early somatic effects (whole body

Control of starting materials 148 irradiation) 18
Controlled and uncontrolled areas 67 Effective dose or effective dose equivalent
Cosmic rays 9 4
Counseling of patients 226 Effects on radiation exposure in utero
Counting rate performance 139 (ICRP-84) 221
CT and pregnancy 222 Electrical and mechanical tests 145, 159
CT number linearity 147 Electron beam data 158
Emergency preparedness: actions 298,
D 309
Decontamination of equipment 285 Emergency procedures 291, 298
Decontamination of personnel 282 Emergency protective clothing 293
Decontamination of protective clothing Emergency situations 301
286 Employer 183
Decontamination of working areas 283 Energy resolution 139
Decontamination procedures 281 Energy 158
Delay and decay 268 Enhanced natural sources 10
Determination of particle size 151 Epilation 313
Deterministic effect 20 Equipment and peripherals 207, 216
Detriment 8 Equipment 74
Diagnostic radiology-skin injuries 294 Equivalent dose 4
Dilute and disperse 268 Establishing a diagnostic X-ray facility 65
Disposal of low activity wastes into the Establishing a nuclear medicine facility
environment 276 71
Disposal of P-32 and I-131 into municipal Establishing a radiotherapy facility 79
sewers by medical users 277 Evaporation 271
Disposal of radioactive effluent into the Excepted packages 247
ground 276 Exposure - roentgen 2
Disposal of radioactive solid waste 272 Exposure rate constant 3
Disposal of radioactive waste from
nuclear medicine procedures 278 F
Distance 32, 41 Facility design and construction 78
Doors and interlocks 80 Facility design for brachytherapy 59
Dose limits to patients 199 Facility design for diagnostic X-rays 42
Dose limits 197 Facility design for nuclear medicine 47
Dose philosophy 197 Facility design for radiotherapy 48
Dose reduction in fluoroscopy 213 Failure of shutter movement 301
Dose reduction methods in paediatric Fetus risk 28
chest CT 220 Field area 207
Dose reduction methods in pediatric Field flatness 158
abdominal CT 221 Field symmetry 158
Dose reduction methods in pediatric Film badge 96
radiography 217 Filtration 207
Dose reduction methods 219 Fissile packages 248
Dry desquamation 313 Flatness and symmetry 159
Ducts and shielding 82 Fluoroscopy installation 68
Focal spot size 122
E Focus to table top distance 134
Early somatic effects (partial body Footwear 280, 288
320 irradiation) 19 Free drop test 250
Index
Full thickness radiation burn 314 Investigation 315

Fully impervious clothing 293 In-vitro and radioimmunoassay (RIA)
75
G In-vivo diagnostic facility 74
Gantry and couch 146 Ion exchange 271
Gantry rotation 155 Ionization chamber survey meter 104
Gantry tilt 135
Gaseous waste 275 J
General checks 108 Jaw symmetry 154
General guidelines 64, 71
General precautions 240 K
General radiography installation 68 Kerma 2
General requirements 249
Genetic effects 21 L
Genetic risk 27 Labeling and identity 231
Genetically significant dose 7 Labeling of the package 254
GM type survey meters 106 Laboratory coat 280
Guidelines for using TLD badge 99 Late somatic effects 19
LDR and MDR treatment rooms 92
H Lead apron 204
Half value layer 35 Leakage and contamination 163
HDR brachytherapy survey 116 Leakage limits for brachytherapy 40
HDR treatment rooms 93 Leakage limits for cobalt teletherapy
Head leakage source on position 114 39
Head leakage-source off condition 114 Leakage limits for X-ray housing 39
Hereditary effects 19 Leakage of mercury (shutter) 301
High contrast resolution 136 Leakage radiation 38
High contrast sensitivity 134 Legal and regulatory requirements 312
Licensing 78
I Line of command of actions 310
IDR and TADR 49 Linear accelerator 113
Image intensifier assembly leakage 134 Linear energy transfer 16
Image intensifier 211 Linearity of MA station 127
Image quality tests 146 Linearity of timer 128
Image quality-attenuation and scatter Liquid waste 270
correction accuracy 144 Long term effects 315
Image receptors 210 Low and high contrast resolution 147
Image uniformity and pixel noise 146 Low contrast resolution 136
Imaging rooms 74 Low contrast sensitivity 134
Impressive protective clothing 288
Improper functioning of timer 302 M
Incineration 272 Mammography installation 69
Industrial packages 248 Management of cadavers containing
Information to carriers 260 radionuclides 187
Inspection of the equipment 108 Management of radiation burns 315
Instantaneous dose rate method 52 Marking of package 253
Instruments and accessories 109 Maternal hydration 237
Interaction of radiation with tissue 14 Measurement of computed tomography
Internal radionuclides 10 dose index (CTDI) 136 321
Intrinsic resolution 138 Measurement of MA linearity 136
Measurement of operating potential Patient motion 211, 217

135 Patient observation and communication
Measurement of timer linearity 136 81
Mechanical isocenter 155 Patient positioning 211
Mechanical test 251, 134 Patient waste 280
Medical exposure 11 Pediatric computed tomography 218
Medical management of personnel Pediatric exposure 229
exposed to radiation 313 Pediatric fluoroscopy 218
Minimum facilities required 189 Pediatric radiography 216
Model plan 88 Penetration test 251
Moist desquamation 314 Performance evaluation of CT 145
Multiple beam alignment check 157 Periodic QA schedule 164
MTC-99 generators 280 Personnel monitoring systems and
features 102
N Personnel requirements 182, 185, 193
Natural radiation source 9 Personnel responsibilities 182, 185, 193
Nuclear fuel cycle 11 Personnel safety during source transfer
Nuclear medicine physician 186 operations of teletherapy and HDR
Nuclear medicine technologist 186 brachytherapy units 238
Nuclear medicine: radiation accidents Personnel wear 228
297 Photon beam data 158
Pin prick method 161
O Placards 256
Occupancy factor (t) 41 Pneumatic system failure 302
Occupancy in the room 206 Pocket dosimeter 100
Occupational exposure 11 Positional accuracy 160
Ongoing evaluation of product perfor- Pregnancy and radiation protection in
mance 152 nuclear medicine 233
Optical and radiation beam congruence Pregnancy and radiation protection in
155 radiotherapy 240
Optically stimulated luminance dosimeter Pregnancy and radiation 221
100 Pregnant patient with cervical carcinoma
Organ shield 205 242
Ottawa hospital cancer center 304 Pregnant staff and continuation of work
Output consistency 128, 136 237
Overalls (boiler suit) 280 Pregnant woman and radiotherapy 241
Overexposure during source exchange Preparation of package for transport
304 253
Overshoes 281 Pressurized clothing 293
Prevention of emergency 312
Primary barrier adequacy 115
P
Primary barriers 50
Package handling 252
Primary radiation 37
Package radiation levels 253
Procedure for authorization 190
Packaging and package requirements
Procedures for handling spills 299
249
Protection in computed tomography
Panama accident 303
214
Partial body exposures - localized
Protection in fluoroscopy 212
exposure (radiation burns) 313
Protection in nuclear imaging 227
322 Particulate contamination 151
Protection in pediatric imaging 215
Patient dose reduction 229
Index
Protection in radiography 206 Radiation survey in nuclear medicine

Protection in radionuclide therapy 232 111
Protective barrier design 40 Radiation survey in radiotherapy 112
Protective clothing 286 Radiation survey 107, 154
Protective devices 204, 227 Radiation units 2
Radioactive fallout 11
Q Radiochemical purity 149
QA for fluoroscopy X-ray unit 134 Radiography 204
QA for gamma camera 138 Radioiodine therapy and pregnancy
QA for HDR brachytherapy 159 235
QA for linear accelerator 154 Radiological safety officer (RSO) 183,
QA for mammography X-ray unit 133 186
QA for radiopharmaceuticals 147 Radiologist 183
QA for single photon emission computed Radionuclide activity 148
tomography (SPECT) 140 Radionuclide purity 148
QA for treatment planning system 164 Radionuclide therapy 78, 111
Quality assurance for computed tomo- Radiopharmacy 77
graphy 134 Radiotherapy: radiation emergencies
Quality assurance for diagnostic radio- 300
logy 119 Reduction of fetal dose when a pregnant
Quality assurance for nuclear medicine patient undergoes radiotherapy
137 241
Quality assurance for PET-CT 141 Regulatory controls for diagnostic X-ray
Quality assurance for radiography units equipment and installations 181
120 Regulatory controls for nuclear medicine
Quality assurance for radiotherapy 154 facilities 184
Quality assurance test format 129 Removal of loose contamination 284
Removal of relatively fixed contami-
R nation 284
Radiation dose from patients 228 Removal of the patient 310
Radiation dose tests 136 Requirement of equipments and
Radiation effects in utero 23 accessories 310
Radiation effects on DNA 22 Respirators and dust masks 287
Radiation emergencies in radioisotope Responsibility in the control of radiation
laboratory 297 accidents 292
Radiation emergencies-fall of source Restoring the source to "off" position
drawer 304 310
Radiation exposure level (XT or P) 41 Reverse osmosis 271
Radiation induced cancer 20 RHM and RMM 3
Radiation isocenter 156 Risk models 25
Radiation limits for shielding design Risk to a pregnant woman, when a
199 family member is treated with
Radiation profile width 135 radioiodine 236
Radiation protection rules-2004 168 RMM and curie 3
Radiation risk 24 Room lighting and lasers 83
Radiation safety 147 Routine protective clothing 280
Radiation sensitivity and profile Rubber boots 281
widths 146 Rubber gloves 280, 287
Radiation survey in diagnostic radiology Rule 1. Short title, extent and
107 commencement 168 323
Rule 10. Suspension, modification or Rule 34. Decommissioning of radiation

withdrawal of a license 172 installation 181
Rule 11. Modification of radiation Rule 35. Offences and penalties 181
installation or change in working Rule 4. Fees for license 170
condition 172 Rule 5. Exemption 170
Rule 12. Restrictions on use of sources Rule 6. Exclusion 170
172 Rule 7. Conditions precedent to the
Rule 13. Restriction on certain practices issuance of a license 171
172 Rule 8. Issuance of license 172
Rule 14. Radiation symbol or warning Rule 9. Period of validity of license 172
sign 173
Rule 15. Dose limits and other regulatory S
constraints 173 Safety work practices that can reduce
Rule 16. Safety standards and safety internal radiation dose 230
codes 173 San Jose, Costa Rica 303
Rule 17. Prohibition of employment of Scan localization light accuracy 135
persons below certain age 173 Scatter fraction and count rates 142
Rule 18. Classified worker 173 Scattered radiation 38
Rule 19. Radiological safety officer 173 Sea dumping 274
Rule 2. Definitions 169 Secondary barrier for leakage radiation
Rule 20. Responsibilities of the employer 55
174 Secondary barrier for scattered radiation,
Rule 21. Responsibilities of the licensee when the primary beam strikes
174 the wall 53, 54
Rule 22. Responsibilities of the Service engineer 183
radiological safety officer 175 Shielding calculation 47
Rule 23. Responsibilities of worker 176 Shielding calculation for diagnostic
Rule 24. Records of workers 177 X-ray 42
Rule 25. Health surveillance of workers Shielding design for computed tomo-
177 graphy 46
Rule 26. Medical exposures 177 Shielding 34
Rule 27. Radiation surveillance require- Skin and surface contamination 281
ments 178 Skin effects following exposure 313
Rule 28. Directives in the cases of Software mix-up in accelerator 303
exposures in excess of regulatory Solid waste 272
constraints 178 Somatic risk 27
Rule 29. Power to appoint or recognize Source not returning to "off" position 310
persons or agencies 178 Source on position leakage 113
Rule 3. Licence 169 Source strength verification 163
Rule 30. Inspection of premises, Source to object distance 209
radiation installations and Sources and nature of waste 268
conveyances 179 Sources of exposure 37
Rule 31. Power to investigate, seal or Sources of radiation 9
seize radiation installation or Spatial linearity 138
radioactive material and to give Spatial resolution 141
direction to the employer 180 Specific treatment 316
Rule 32. Directives in case of accidents Spillage 112
180 Stacking test 251
Rule 33. Emergency preparedness 180 Staff protection 237
324
Index
Staggered autoradiography 161 Treatment control area 81

Steps to be taken in patients found to be Treatment of pregnant patients with
pregnant after administration of radionuclides 235
radioiodine therapy 236 Tremcard 259
Sterility and apyrogenicity 152 Tube housing leakage 128, 137
Stochastic effect 20 Tube voltage (KVP) 124, 207
Storage in transit requirements 252 Type A packages 246
Storage 274 Type B packages 247
Student/trainee 183 Type of radiation accidents 289
Survey procedure 109 Type-I (simple) 200
Swipe test 111 Type-II (medium) 201
System resolution 138 Type-III (stringent) 201
System sensitivity 140 Types of packages 246
Types of radioactive waste 270
T Types of RIA laboratories 76
Table position /increment 135
Table top exposure rate 134 U
Teletherapy installation 190 Uniformity 138
Temporal accuracy 162 Use factor (U) 41
Ten day rule and its present status 29
Tenth value layer 36 W
Termination of pregnancy after Warning signs and lights 86
radiation exposure 223 Waste management 267
Terrestrial radiations 9 Water immersion test 252
Test for type A package 250 Water spray test 250
Test for type B package 251 Weekly dose rate method 50
Thermal test 252 White coats and coveralls 287
Thermoluminescent dosimeter 97 Width of the primary wall 52
Thyroid shield and lead glass 205 Woman of childbearing age and nuclear
Timer checking 125 medicine examinations 233
Timer error 162 Workload (W) 40, 42, 46, 109
Timer linearity 162 Work practice 206
Total filtration 126 Workers 198
Training 79
Transepidermal burn 314 X
Transient erythema 313 X-ray generator 135, 146
Transport index 248 X-ray technologist 183
325

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TEXTBOOK OF

JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD

Textbook of Radiological Safety

First Edition: 2010

Tel (Off): 91-11-26594864, 26594798

It gives me immense pleasure to come out with a textbook on radiological safety,

1. Safety Concepts ........................................................................................ 1

Radioiodine therapy and pregnancy 235

These bodies issue periodical reports on radiation safety aspects of various

Absorbed DoseRad / Gray

Exposure Rate Constant

RHM and RMM

RMM and CURIE

Table 1.1: RHM and RMM of different radioisotopes

Example 1: If a Cobalt teletherapy source is purchased with 200 RMM

Example 2: If a Cobalt teletherapy source is purchased with 10,000 Ci

Table: 1.2: Radiation weighting factors (WR)

Sievert (Rolf Sievert, Swedish Radiologist) is the SI unit of equivalent

EFFECTIVE DOSE OR EFFECTIVE DOSE EQUIVALENT

Table: 1.3: Tissue weighting factors (WT)

Collective Effective Dose Equivalent

Table 1.4: Annual collective effective dose equivalents

GENETICALLY SIGNIFICANT DOSE

ANNUAL LIMIT ON INTAKE

Natural Radiation Source

External exposure: K-40,U-238, and Th-232 are mainly responsible for

Enhanced Natural Sources

Nuclear Fuel Cycle

Table 1.5: Annual occupational effective dose equivalent (US Data)

equivalent in the US population, which is estimated as 3.0 mSv/year,

Fig.1.2: The % contribution of various components of man-made radiation

Medical use of radiation warrant an optimal compromise between clinical

Radiation biology is a scientific discipline which deals with the study of

INTERACTION OF RADIATION WITH TISSUE

electrons. These electrons interact with atoms and molecules leading

biologic effects. Approximately two-third of all radiation induced damage

Fig. 2.1: Interaction of radiation in cell: Physical

LINEAR ENERGY TRANSFER

These effects or endpoint includes chromosomal mutation, cataract

Fig. 2.2: The relation between LET and RBE

Early Somatic Effects (Whole Body Irradiation)

Table 2.2: Early somatic effects due to acute whole

Early Somatic Effects (Partial Body Irradiation)

Table 2.3: Early somatic effects due to acute

Late Somatic Effects

knowledge on hereditary effects is limited to laboratory animals. No

Radiation Induced Cancer

Fig. 2.3: The early and late biologic effects of radiation 21

RADIATION EFFECTS ON DNA

Fig. 2.4: Radiation action on DNA molecule:

Chromosome breaks produced by radiation do occur and can be

RADIATION EFFECTS IN UTERO

resulted an increase in the incidence of microcephaly. Exposures in excess

A non threshold linear curve overestimates the incidence of cancer at

Fig. 2.6: The multiplicative model and additive model

BEIR Report V and VII Risk Estimate

Radiation related cancer mortality risks for woman averaged is 37.5%

Table 2.4: ICRP 60 Risk factors

Fig. 2.7: Health effects of radiation exposure

TEN DAY RULE AND ITS PRESENT STATUS

The four principal methods by which radiation exposures to persons

The annual equivalent dose limit prescribed for the radiographer is

dimensions are very small compared to distance under consideration. Thus