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Evolution of Radiology. Notion of Radiophysics.

Ionizing Radiation protection.


1. Radiology - definition
Radiology is a medical specialty that uses imaging to diagnose and treat diseases seen within
the body. A variety of imaging modalities such as X-ray radiography, radioscopy, ultrasound,
computed tomography (CT), magnetic resonance imaging (MRI) and nuclear medicine
techniques such as planar scintigraphy, single photon emission computed tomography (SPECT),
positron emission tomography (PET) are used. Interventional radiology is the performance of
(usually minimally invasive) medical procedures with the guidance of imaging technologies.

2. Medical imaging – definition


Medical imaging is the technique and process of creating visual representations of the interior
of a body for clinical analysis and medical intervention, as well as visual representation of the
function of some organs or tissues (physiology). Medical imaging also establishes a database of
normal anatomy and physiology to make it possible to identify abnormalities. Although imaging of
removed organs and tissues can be performed for medical reasons, such procedures are usually
considered part of pathology instead of medical imaging.
Measurement and recording techniques which are not primarily designed to produce images,
such as electroencephalography (EEG), magnetoencephalography (MEG), electrocardiography
(ECG), and others represent other technologies which produce data susceptible to
representation as a parameter graph vs. time or maps which contain data about the
measurement locations. In a limited comparison these technologies can be considered as
forms of medical imaging in another discipline.

3. Component parts of medical imaging


Recent advances in imaging technology -- like CT scans, MRIs, PET scans, and other
techniques -- have had a huge impact on the medical imaging and its components such as raw
data acquisition, image processing, transmission, storage, image display, and
interpretation. The management of data during each of these operations may have a significant
impact on the quality of patient care. It is important to optimize each stage of image formation to
minimize the imaging time, radiation dose and potential side effects or patient discomfort, while
acquiring the maximum information.
A standard for handling, storing, printing, distributing and viewing any kind of medical image
regardless of the origin has been achieved through the development of Digital Imaging and
Communications in Medicine (DICOM). DICOM files can be exchanged between different
institutions worldwide that are capable of receiving image and patient data in DICOM format.
DICOM enables the integration of medical imaging devices – like scanners, servers,
workstations, printers, network hardware, and picture archiving and communication systems
(PACS) – from multiple manufacturers. The different devices come with DICOM Conformance
Statements which clearly state which DICOM classes they support. DICOM has been widely
adopted by hospitals and is making inroads in smaller applications like dentists' and doctors'
offices.
DICOM is used worldwide to store, exchange, and transmit medical images. DICOM has
been central to the development of modern radiological imaging: DICOM incorporates standards
for imaging modalities such as radiography, ultrasonography, computed tomography (CT),
magnetic resonance imaging (MRI), and radiation therapy. DICOM includes protocols for image
exchange (e.g., via portable media such as DVDs), image compression, 3-D visualization, image
presentation, and results reporting.
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PACS (picture archiving and communication system) is a healthcare technology for the
short- and long-term storage, retrieval, management, distribution and presentation of medical
images. A PACS has four major components:
• Imaging systems, such as magnetic resonance imaging (MRI), computed axial tomography
(CAT scan), and X-ray equipment.
• A secure network for distribution and exchange of patient information.
• Workstations or mobile devices for viewing, processing and interpreting images.
• Archives for storage and retrieval of images and related documentation and reports

4. Construction and principles of functioning of an X-ray tube.


X-radiation (composed of X-rays) is a form of electromagnetic radiation. Most X-rays have a
wavelength ranging from 0.01 to 10 nanometers. X-radiation is referred to with terms meaning
Röntgen radiation, after Wilhelm Röntgen, who is usually credited as its discoverer (Nov 08,
1895), and who had named it X-radiation to signify an unknown type of radiation.

There is no consensus for a definition distinguishing between X-rays and gamma rays.
One common practice is to distinguish between the two types of radiation based on their source:
X-rays are emitted by electrons, while gamma rays are emitted by the atomic nucleus. One
common alternative is to distinguish X- and gamma radiation on the basis of wavelength (or,
equivalently, frequency or photon energy), with radiation shorter than some arbitrary wavelength,
such as 10−11 m (0.1 Å), defined as gamma radiation.

In an X-ray tube, X-rays are produced when electrons that have been accelerated using a
high voltage source are abruptly decelerated by interacting with a metal target. An X-ray tube
functions as a specific energy converter, receiving the electrical energy and converting it into two
other forms of energy: x-radiation and heat. The X-ray tube contains two principal elements:
1. cathode: provides a source of electrons
2. anode: acts as the target for electrons and releases x-rays
Cathode and anode are contained in the envelope, which provides vacuum, support and
electrical insulation. The envelope is most often created from glass, although some tubes contain
envelopes made of ceramic or even metal.

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• Current (mA) is applied to filament on cathode side.
• Filament heats up – electrons are produced (i.e. an “electron cloud” around the negatively charged
filament / cathode)
• Voltage (kVp) is applied to positively charged anode
• Negative electrons are attracted across the tube to the positive anode.
• Electron beam is also directed from the cathode to the anode target by the focusing cup
• The distance between filament (cathode) and the x-ray tube target (anode) is ~ 1 cm.
• Velocity of electrons is raised from zero to ~ half the speed of light
• As electrons hit the anode, they slow down, emitting high energy photons (X-rays)

E- traveling from cathode to anode


Projectile electron interacts with the orbital electron of the target atom. This interaction results in the
conversion of electron kinetic energy into thermal energy (heat) and electromagnetic energy in the form of
infrared radiation (also heat) and x-rays.
• Most kinetic energy of projectile e- is converted into heat – 99%
• Projectile e- interact with the outer-shell e- of the target atoms but do not transfer enough energy
to the outer-shell e- to ionize
• Outer shell electrons are simply raised to an excited/ higher energy level.
• Outer shell electrons immediately drop back to their normal energy level with the emission of
infrared radiation.
• The constant excitation and return of outer shell electrons are responsible for most of the heat
generation
• Production of heat in the anode increases directly with increasing x-ray tube current
• Doubling the x-ray tube current doubles the heat produced
• Increasing kVp will also increase heat production

X-ray tube production:


• Heat (99%)
• X-rays (1%)
o Characteristic
o Bremsstrahlung

Anodes are commonly designed as beveled disks attached to the large copper rotor of the
electric motor, rotating them at the speeds up to 10000 RPM, with the temperature of 2000C.
The purpose of the rotation is to dissipate the heat.

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A medical x-ray tube using a rotating anode to prolong tube life

The focal spot at the anode converts the energy of the electrons into X-radiation and is
commonly built of tungsten (Z=74). Tungsten has the high atomic number Z and has a high
melting point of 3370C with the low rate of evaporation. Alloy containing tungsten and rhenium is
also used, since 5-10% of rhenium prevents crazing of the anode surface. The body of the anode
is made of the materials that are light and have a good heat storage capacity, like molybdenum
and graphite. Molybdenum is also often used as the surface material for the anodes used in
mammography, for its characteristics: intermediate atomic number – with the produced X-rays of
the energies suited for this purpose. Some of the anodes used for mammography are also made
of rhodium (Z=45), producing more penetrating radiation, preferably for use in dense breast
imaging.

Tungsten atom:
• The mass number (the total number of
protons and neutrons, together known as
nucleons) A = 184 (74 protons and 110
neutrons)
• Electrons:
o First Energy Level (K – shell): 2
o Second Energy Level (L – shell): 8
o Third Energy Level (M – shell): 18
o Fourth Energy Level (N – shell): 32
o Fifth Energy Level (O – shell): 12
o Sixth Energy Level (P – shell): 2

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Characteristic Radiation

• Projectile electron interact with inner


shell electron
• Projectile e- with energy high enough
to totally remove an inner-shell
electron of the target atom e.g.
tungsten
• Characteristic x-rays are produced
when outer-shell e- fills an inner-shell
• Characteristic x-rays have very
specific energies. K-characteristic x-
rays require a tube potential of a least
70 kVp

Bremsstrahlung (Continuous spectrum) Radiation


• Bremsstrahlung is a German word
meaning “slowed-down Radiation”
• Bremsstrahlung is produced by
projectile e- interacting with the nucleus
of a target atom
• A projectile e- that avoids the orbital
electrons as it passes through a target
atom may come close enough to the
nucleus of the atom to come under the
influence of its electric field
• As the projectile electron passes by the
nucleus, it is slowed down and changes
its course, leaving with reduced kinetic
energy in a different direction.
• This loss of kinetic energy reappears as
an x-ray.
• Bremsstrahlung x-rays that are produced can have any energy level up to the set kVp value. Brems
can be produced at any projectile e- value
• Brems x-rays have a range of energies and form a continuous emission spectrum

To summarize, X-rays are produced in a standard way: by accelerating electrons with a high
voltage and allowing them to collide with the focal spot. X-rays are produced when the electrons
are suddenly decelerated upon collision with the metal target. These X-rays are called the
“braking radiation” (Bremsstrahlung). If the electrons have high energy, they can expel an
electron out of the atomic shell of the bombarded atom. Electrons from higher state fill the place
of the expelled electron, emitting the X-ray photons with precise energies, determined by electron
energy levels. The X-rays produced in that way are called the “Characteristic X-rays”.

The theoretical maximum x-ray photon energy produced is equal to the voltage on the x-ray
tube.

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5. X-ray characteristics
Properties of X-Ray:
1. Fluorescence
• X-Rays cause certain substances to fluoresce, i.e. to emit light in the visible spectrum
after absorbing X-rays
• Such substances include calcium tungstate or rare-earth phosphors, both found in
intensifying screens (q.v.)
2. Photographic effect
• X-Rays produce a 'latent image' (invisible to the eye) on photographic film
• This image is made visible by processing the film
3. Penetration
• X-Rays can penetrate substances or tissues that are opaque to visible light
• They are gradually absorbed the further they pass through an object
• The amount of absorption depends on the atomic number and density of the object and on
the energy of the X-Rays
4. Excitation and ionisation
• X-Rays produce excitation and ionisation of the atoms and molecule of the substances
through which they pass
• Excitation is the process of raising an electron to a higher energy level
• Ionisation is the process in which an electron is completely removed from an atom
5. Biological effect
• X-Rays interact with living tissue and can cause biological changes
• These changes are mediated directly by excitation or ionisation of atoms or indirectly as a
result of chemical changes occurring near the cells
• Affected cells may be damaged or killed
• Genetic effects involve chromosomal damage or mutation in the reproductive cells and will
affect future generations
• Somatic effects involve damage to the other tissues and result in changes within the
individual's lifetime (e.g. radiation burns, leukaemia)
• Radiation is a particular hazard because its effects are painless, latent and cumulative

The X-rays that emerge from the x-ray tube have a range of energies, represented in a X-ray
spectrum. This spectrum has two components: the Brehmsstrahlung radiation and the
characteristic X-rays. These arise from different ways is related to the way which an individual
electron loses its energy when crashes into the anode.

There are two types of X-rays, according to their photon energy.


• Soft X-ray are defined by having photon energies below 10keV. They have less energy than
the hard x-rays, therefore they have longer wavelength. Soft X-rays are used in radiography
to take pictures of bones and internal organs. Because of their lower energy, they do not
cause much damage to tissues, unless they are repeated too often.
• Hard X-ray have photon energies above 10 keV. They have shorter wavelength than the soft
x-rays. These X-rays are used in radiotherapy, a treatment for cancer. Due to their higher
energy, they destroy molecules within specific cells, thus destroying tissue. Another use for
these X-rays is in airport security scanners to examine baggage.

Filtration
• Adding filtration is called hardening the x-ray beam because of the increase in average
energy
• Filtration more effectively absorb low-energy x-rays than high energy x-rays
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• Characteristic spectrum is not affected & the maximum energy of x-ray emission is not
affected
• Adding filtration to the useful beam reduces the x-ray beam intensity while increasing the
average energy (higher quality)

Effects of Voltage and Amperage on X-Ray Production.


• Effect of Amperage. Amperage is a measure of the amount of electrical current applied to
the filament. It is also a direct measurement of the number of free electrons available in
the X-ray tube and is independent of variations in kilovoltage. Thus the quantity of
X-radiation is in direct relation to the filament current. Typically, the amount of
current is small, so the unit milliampere (mA), milliamp for short, is used to designate
one one-thousandth of an ampere.
• Effect of Voltage. As the kilovoltage (the potential that causes the electrons to accelerate) is
changed, the kinetic energy of the moving electrons is changed, altering the energy of the
resulting X-radiation. As the kilovoltage is increased, the efficiency of converting the electrical
energy into X-rays is increased. Therefore, when kilovoltage is changed, the penetrating
capability of the generated radiation is changed.

6. Characteristics of a radiographic image


The quality of a medical image is determined by the imaging method, the characteristics of
the equipment, and the imaging variables selected by the operator. Image quality is not a single
factor but is a composite of several factors such as contrast, blur, noise, artifacts, and
distortion.

Film-Screen Characteristics
The visibility of the anatomic structures and the accuracy of their structural lines recorded
determine the overall quality of the radiographic image. For film-screen, visibility of the recorded
detail refers to the photographic properties of the image and the geometric properties refer to
how accurately the structural lines are recorded. The accuracy of the structural lines is achieved
by maximizing the amount of recorded detail and minimizing the amount of distortion. Visibility of
the recorded detail is achieved by the proper balance of radiographic density and radiographic
contrast.

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Density. Radiographic density is the amount of overall blackness produced on the processed
image. The varying densities on the processed film represent the attenuation properties of the
anatomic part imaged.
A radiograph must have sufficient density to visualize the anatomic structures of interest. A
radiograph that is too light has insufficient density to visualize the structures of the anatomic part.
Conversely, a radiograph that is too dark has excessive density, and the anatomic part cannot be
well visualized. The radiographer must evaluate the overall density on the image to determine
whether it is sufficient to visualize the anatomic area of interest. He or she then decides whether
the radiograph is diagnostic or unacceptable. If a radiograph is deemed unacceptable, the
radiographer must determine what factors contributed to the density error.

Radiograph with optimal density, insufficient density and excessive density (From Mosby’s
instructional radiographic series: radiographic imaging, St Louis, 1998, Mosby.)

Optical Density
Density on the printed radiographic image can be quantified and is therefore an objective
measure that can be used for comparison. A densitometer is a device used to numerically
determine the amount of blackness on the radiograph (i.e., it measures radiographic
density).Optical densities can range from 0 to 4 OD. However, the diagnostic range of optical
densities for general radiography usually falls between 0.5 and 2 OD. The radiation exposure to
the film-screen image receptor primarily determines the amount of optical density created on the
film after processing. The intensity of radiation exposure, or exposure intensity, is a
measurement of the amount and energy of the x-rays reaching an area of the film. When all other
factors remain the same, increasing the exposure intensity increases the optical density.

In film-screen imaging the optical densities created on the processed radiograph cannot be
altered. As a result, choosing the proper exposure intensity to create an appropriate range of
optical densities (or diagnostic densities) during film-screen imaging is critical to producing a
good-quality radiographic image. Diagnostic densities must be present in a radiographic image to
visualize the anatomic area of interest.

Image Contrast
Contrast means difference. In an image, contrast can be in the form of different shades of gray,
light intensities, or colors. Contrast is the most fundamental characteristic of an image. An object
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within the body will be visible in an image only if it has sufficient physical contrast relative to
surrounding tissue. However, image contrast much beyond that required for good object visibility
generally serves no useful purpose and in many cases is undesirable.

The physical contrast of an object must represent a difference in one or more tissue
characteristics. For example, in radiography, objects can be imaged relative to their surrounding
tissue if there is an adequate difference in either density or atomic number and if the object is
sufficiently thick. To differentiate among the anatomic tissues, there must be density differences.
Density differences are a result of the tissues’ differential absorption of the x-ray photons.
Density differences refer to an image’s radiographic contrast. Radiographic contrast affects the
visibility of the structural lines that make up the recorded image. Thus, radiographic contrast is
the degree of difference or ratio between adjacent densities. The ability to distinguish between
densities enables differences in anatomic tissues to be visualized. An image that has a
diagnostic density but no differences in densities appears as a homogeneous object.

Unlike density, which is easily measurable, contrast is a more complex characteristic. Evaluating
radiographic quality in terms of contrast is more subjective (it is affected by individual
preferences). The level of radiographic contrast desired in an image is determined by the
composition of the anatomic tissue to be radiographed and the amount of information needed to
visualize the tissue for an accurate diagnosis. For example, the level of contrast desired in a
chest radiograph is different from that required in a radiograph of an extremity.

A low-kilovoltage radiograph of chest (A) showing higher contrast than that in a high-kilovoltage
radiograph (B). (From Fauber TL: Radiographic imaging and exposure, ed 3, St Louis, 2009, Mosby.)

Radiographic images are typically described by their scale of contrast or the range of densities
visible. A radiograph with few densities but great differences among them is said to have high
contrast. This is also described as short-scale contrast. A radiograph with a large number of
densities but little differences among them is said to have low contrast. This is also described as
long-scale contrast.

The radiographer must evaluate the composition of the anatomic structure to be radiographed
and determine the factors to manipulate to produce the desired level of radiographic contrast.

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Achieving the desired level of contrast that best visualizes the anatomic area of interest
maximizes the amount of information visible for a diagnosis.

Blur and Visibility of Detail


Structures and objects in the body vary not only in physical contrast but also in size. Objects
range from large organs and bones to small structural features such as trabecula patterns and
small calcifications. It is the small anatomical features that add detail to a medical image. Each
imaging method has a limit as to the smallest object that can be imaged and thus on visibility of
detail.
The amount of blur in an image can be quantified in units of length. This value represents the
width of the blurred image of a small object. As a general rule, the smallest object or detail that
can be imaged has approximately the same dimensions as those of the image blur.

Image noise
Another characteristic of all medical images is image noise. Image noise, sometimes referred to
as image mottle, gives an image a textured or grainy appearance. The source and amount of
image noise depend on the imaging method. In most medical imaging situations the effect of
noise is most significant on the low-contrast objects that are already close to the visibility
threshold.

Artifacts
Another problem is that most imaging methods can create image features that do not represent a
body structure or object. These are image artifacts. In many situations an artifact does not
significantly affect object visibility and diagnostic accuracy. But artifacts can obscure a part of an
image or may be interpreted as an anatomical feature. A variety of factors associated with each
imaging method can cause image artifacts.

Distortion
A medical image should not only make internal body objects visible, but should give an accurate
impression of their size, shape, and relative positions. An imaging procedure can, however,
introduce distortion of these three factors.

In many situations, if a variable is changed to improve one characteristic of image quality, such
as noise, it often adversely affects another characteristic, such as blur and visibility of detail.
Therefore an imaging procedure must be selected according to the specific requirements of the
clinical examination.

7. Dosimetry
Dosimetry is the calculation and assessment of the radiation dose received by the human body.
Internal dosimetry due to the ingestion or inhalation of radioactive materials relies on a variety
of physiological or imaging techniques. External dosimetry, due to irradiation from an external
source is based on measurements with a dosimeter, or inferred from other radiological protection
instruments. Dosimetry is used extensively for radiation protection and is routinely applied to
occupational radiation workers, where irradiation is expected, but regulatory levels must not be
exceeded. Other significant areas are medical dosimetry, where the required treatment absorbed
dose and any collateral absorbed dose is monitored, and in environmental dosimetry, such as
radon monitoring in buildings.

External dose measurement


There are several ways of measuring absorbed doses from ionizing radiation. People in
occupational contact with radioactive substances or who may be exposed to radiation routinely
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carry personal dosimeters. These are specifically designed to record and indicate the absorbed
dose (or derived dosimetric index) received. Traditionally these were badges containing
photographic film (film badge dosimeter), which would be chemically developed following
exposure to indicate the total absorbed dose received. Film badges have now been largely
replaced with other devices such as the TLD badge which uses Thermoluminescent dosimetry
(TLD) or Optically stimulated luminescence (OSL) badges.

A number of electronic devices known as Electronic Personal Dosimeters (EPDs) have come
into general use using semiconductor detection and programmable processor technology. These
are worn as badges, but can give an indication of instantaneous dose rate and an audible and
visual alarm if a dose rate or a total integrated dose is exceeded. A good deal of information can
be made immediately available to the wearer of the recorded dose and current dose rate via a
local display. They can be used as the main stand-alone dosimeter, or as a supplement to such
as a TLD badge. These devices are particularly useful for real-time monitoring of dose where a
high dose rate is expected which will time-limit the wearer's exposure.

Medical dosimetry
Medical dosimetry is the calculation of absorbed dose and optimization of dose delivery in
radiation therapy. It is often performed by a professional medical dosimetrist with specialized
training in the field. In order to plan the delivery of radiation therapy, the radiation produced by
the sources is usually characterized with percentage depth dose curves and dose profiles
measured by medical physicists.

Environmental dosimetry
Environmental Dosimetry is used where it is likely that the environment will generate a significant
radiation dose. An example of this is radon monitoring. Radon is a radioactive gas generated by
the decay of uranium, which is present in varying amounts in the earth's crust. Certain
geographic areas, due to the underlying geology, continually generate radon which permeates its
way to the earth's surface. In some cases the dose can be significant in buildings where the gas
can accumulate. A number of specialised dosimetry techniques are used to evaluate the dose
that a building's occupants may receive.

Background radiation
The worldwide average background dose for a human being is about 3.5 mSv (=0.0035Sv =
0.35rems) per year, mostly from cosmic radiation and natural isotopes in the earth. The largest
single source of radiation exposure to the general public is naturally-occurring radon gas, which
comprises approximately 55% of the annual background dose. It is estimated that radon is
responsible for 10% of lung cancers in the United States.

• 1 rem is roughly the average dose received in 3 years of exposure to natural radiation.
• 1 Sv is at the bottom of the range of doses that, if received over a short period of time, are
likely to cause noticeable symptoms of radiation sickness.

8. Units of radiation. International System of Units.


9. Absorbed dose. Biological dose.
The original unit for measuring the amount of radioactivity was the curie (Ci)–first defined to
correspond to one gram of radium-226 and more recently defined as:

1 curie = 3.7x1010 radioactive decays per second

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In the International System of Units (SI) the curie has been replaced by the becquerel (Bq),
where
1 becquerel = 1 radioactive decay per second = 2.703x10-11 Ci.

Absorbed Equivalent Effective


Radio-activity
Dose (Biological Dose) dose
x 1 for x-rays and gamma rays
x tissue
x 20 for alpha particles
weighting factors
x (5 to 20) for neutrons (energy vary)
Common
Units curie (Ci) Rad rem rem
becquerel
SI Units gray (Gy) sievert (Sv) sievert (Sv)
(Bq)
1 gray = 100 rads; 1 Sv = 100 rems.

The magnitude of radiation exposures is specified in terms of the radiation dose. There are two
important categories of dose:

The absorbed dose, sometimes also known as the physical dose, defined by the amount of
energy deposited in a unit mass in human tissue or other media. The original unit is the rad [100
erg/g]; it is now being widely replaced by the SI unit, the gray (Gy) [1 J/kg], where 1 gray = 100
rad.

The biological dose, sometimes also known as the dose equivalent, expressed in units of rem
or, in the SI system, sievert (Sv). This dose reflects the fact that the biological damage caused
by a particle depends not only on the total energy deposited but also on the rate of energy loss
per unit distance traversed by the particle (or "linear energy transfer"). For example, alpha
particles do much more damage per unit energy deposited than do electrons. This effect can be
represented, in rough overall terms, by a quality factor, Q. Over a wide range of incident
energies, Q is taken to be 1.0 for electrons (and for x-rays and gamma rays, both of which
produce electrons) and 20 for alpha particles. For neutrons, the adopted quality factor varies
from 5 to 20, depending on neutron energy.

Equivalent dose (HT) is calculated by multiplying the absorbed dose to the organ or tissue (DT)
with the radiation weighting factor, wR. This factor is dependant on the type and energy of the
incident radiation. The value of wR is 1 for x-rays, gamma rays and beta particles, but higher for
protons (wR = 5), neutrons (wR is between 5 and 20 depending on energy), alpha particles and
heavy fragments (wR = 20) etc. The unit for the dose equivalent is the rem if the absorbed dose is
in rads and the sievert (Sv) if the absorbed dose is in grays.

The dose equivalent is still not the whole story. If only part of the body is irradiated, the dose
must be discounted with an appropriate weighting factor if it is to reflect overall risk. The
discounted dose is termed the effective dose equivalent or just the effective dose, expressed in
rems or sieverts.

The effective dose is the sum of weighted equivalent doses in all the organs and tissues of the
body. The effective dose is used to compare the stochastic risk of non-uniform exposure to
radiation. Body tissues react differently to radiation and cancer-induction occurs at different rate

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of dose in different tissues. Hence, the effective dose is the risk of developing fatal cancer in the
tissue in question. If the body is uniformly irradiated, the summed effective doses are equal to 1.
The effective dose is calculated by multiplying the equivalent dose (HT) by a tissue weighting
factor (WT). For any examination, the effective dose to each body part can be summed after
being multiplied by its weighting factor.

Effective dose = sum of [organ doses x tissue weighting factor]


Tissue weighting factors represent relative sensitivity of organs for developing cancer.

Tissue Weighting Factors for Individual Tissues and Organs


Tissue or Organ Tissue Weighting Factor (WT)
Gonads (testes or ovaries) 0.20
Red bone marrow 0.12
Colon 0.12
Lung 0.12
Stomach 0.12
Bladder 0.05
Breast 0.05
Liver 0.05
Oesophagus 0.05
Thyroid gland 0.05
Skin 0.01
Bone surfaces 0.01
Remainder** 0.05
Whole body 1.00
** The remainder is composed of the following additional tissues and organs: adrenal, brain, upper large
intestine, small intestine, kidney, muscle, pancreas, spleen, thymus and uterus.

Exposure Dose Limits for Radiation Workers


• occupational exposure: 20 mSV/year (effective dose)

10. Ionizing radiation protection


X-ray photons carry enough energy to ionize atoms and disrupt molecular bonds. This makes it a
type of ionizing radiation, and therefore harmful to living tissue. A very high radiation dose over a
short period of time causes radiation sickness, while lower doses can give an increased risk of
radiation-induced cancer. In medical imaging this increased cancer risk is generally greatly
outweighed by the benefits of the examination. The ionizing capability of X-rays can be utilized in
cancer treatment to kill malignant cells using radiation therapy.

Radiation protection, sometimes known as radiological protection, is defined by the International


Atomic Energy Agency (IAEA) as "The protection of people from harmful effects of exposure to
ionizing radiation, and the means for achieving this".

Ionizing radiation is widely used in industry and medicine, and can present a significant health
hazard. It causes microscopic damage to living tissue, which can result in skin burns and

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radiation sickness at high exposures (known as "tissue" or "deterministic" effects), and
statistically elevated risks of cancer at low exposures ("stochastic effects").

Deterministic (Non-Stochastic) Effects only occur once a threshold of exposure has been
exceeded. Examples:
• Skin Erythema/Necrosis/Epilation. Erythema occurs 1 to 24 hours after 2 Sv have been
received. Breakdown of the skin surface occurs approximately four weeks after 15 Sv have
been received. Epilation is reversible after 3 Sv but irreversible after 7 Sv and occurs three
weeks following exposure.
• Cataract. Cataract occurs after 2 to 10 Gy have been received, but may take years to
develop.
• Sterility. Permanent sterility occurs after 2.5 to 3.5 Gy have been received by the gonads.
• Radiation Sickness. Radiation sickness (correctly termed acute radiation syndrome)
involves nausea, vomiting, and diarrhea developing within hours or minutes of a radiation
exposure. This is due to deterministic effects on the bone marrow, GI tract, and CNS.
• IUGR/Teratogenesis/Fetal Death. Deterministic radiation exposure effects during pregnancy
depend not only on the radiation dose received but also on the gestational age at which it
occurred. The embryo is relatively radio-resistant during its preimplantation phase but highly
radiosensitive during its organogenesis (two to eight weeks) and neuronal stem cell
proliferation phases (eight to 15 weeks). Fetal radiosensitivity falls after this period. High
levels of radiation exposure in pregnancy can lead to growth retardation, in particular
microcephaly. The threshold dose for this effect is high (>20Gy) with other deterministic
effects (hypospadia, microphthalmia, retinal degeneration, and optic atrophy) having a lower
threshold level of >1Gy.

Stochastic Effects. Current thinking is that stochastic effect occurrence follows a linear no-
threshold hypothesis. This means that although there is no threshold level for these effects, the
risk of an effect occurring increases linearly as the dose increases. Examples:
• Cancer
• Hereditary Defects (e.g., Down Syndrome)

There are three factors that control the amount, or dose, of radiation received from a source.
Radiation exposure can be managed by a combination of these factors (time, distance and
shielding):
• Time: Reducing the time of an exposure reduces the effective dose proportionally. An
example of reducing radiation doses by reducing the time of exposures might be improving
operator training to reduce the time they take to handle a source.
• Distance: Increasing distance reduces dose due to the inverse square law. The Inverse
square law is based on basic Newtonian physics and can be applied to gravitation of planets,
electrostatic forces between electrically charged particles, acoustics and electromagnetic
radiation. It is applicable to the radiographer as doubling the distance away from the x-ray
source quarters the dose received. Conversely, halving the distance, increases the radiation
level by a factor of four. Good use of inverse square law principles can yield significant
reductions in both patient and operator radiation exposures.

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As shown in the image above, this law accounts for the fact that the intensity of radiation
becomes weaker as it spreads out from the source since the same amout of radiation
becomes spread over a larger area. The intensity is inversely proportional to the distance
from the source. Distance can be as simple as handling a source with forceps rather than
fingers.

• Shielding: The term 'biological shield' refers to a mass of absorbing material placed around a
reactor, or other radioactive source, to reduce the radiation to a level safe for humans. The
effectiveness of a material as a biological shield is related to its cross-section for scattering
and absorption, and to a first approximation is proportional to the total mass of material per
unit area interposed along the line of sight between the radiation source and the region to be
protected. Hence, shielding strength or "thickness" is conventionally measured in units of
g/cm2. The radiation that manages to get through falls exponentially with the thickness of the
shield. In x-ray facilities, walls surrounding the room with the x-ray generator may contain
lead sheets, or the plaster may contain barium sulfate. Operators view the target through a
leaded glass screen, or if they must remain in the same room as the target, wear lead aprons.
Almost any material can act as a shield from gamma or x-rays if used in sufficient amounts.

Thus, three basic ways to reduce external exposure to radiation are to minimize time, maximize
distance, and use shielding.

Interaction of radiation with shielding


Different types of ionizing radiation interact in different ways with shielding material. The
effectiveness of shielding is dependent on the Stopping power of radiation particles, which varies
with the type and energy of radiation and the shielding material used. Different shielding
techniques are therefore used dependent on the application and the type and energy of the
radiation.
• Alpha particles (helium nuclei) are the least penetrating. Even very energetic alpha particles
can be stopped by a single sheet of paper.
• Beta particles (electrons) are more penetrating, but still can be absorbed by a few
millimeters of aluminum. However, in cases where high energy beta particles are emitted
shielding must be accomplished with low atomic weight materials, e.g. plastic, wood, water, or
acrylic glass (Plexiglas, Lucite). This is to reduce generation of Bremsstrahlung X-rays. In the
case of beta+ radiation (positrons), the gamma radiation from the electron-positron
annihilation reaction poses additional concern.

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• Neutron radiation is not as readily absorbed as charged particle radiation, which makes this
type highly penetrating. Neutrons are absorbed by nuclei of atoms in a nuclear reaction. This
most often creates a secondary radiation hazard, as the absorbing nuclei transmute to the
next-heavier isotope, many of which are unstable.
• X-ray and gamma radiation are best absorbed by atoms with heavy nuclei; the heavier the
nucleus, the better the absorption. In some special applications, depleted uranium or thorium
are used, but lead is much more common; several centimeters are often required. Barium
sulfate is used in some applications too. However, when cost is important, almost any
material can be used, but it must be far thicker. Most nuclear reactors use thick concrete
shields to create a bioshield with a thin water cooled layer of lead on the inside to protect the
porous concrete from the coolant inside. Gamma rays are better absorbed by materials with
high atomic numbers and high density, although neither effect is important compared to the
total mass per area in the path of the gamma ray.
• Ultraviolet (UV) radiation is ionizing in its shortest wavelengths but it is not penetrating, so it
can be shielded by thin opaque layers such as sunscreen, clothing, and protective eyewear.
Protection from UV is simpler than for the other forms of radiation above, so it is often
considered separately.

Regulation of dose uptake


In most countries a national regulatory authority works towards ensuring a secure radiation
environment in society by setting dose limitation requirements that are generally based on the
recommendations of the International Commission on Radiological Protection (ICRP). These use
the following overall principles:
• Justification: No unnecessary use of radiation is permitted, which means that the
advantages must outweigh the disadvantages.
• Limitation: Each individual must be protected against risks that are far too large through
individual radiation dose limits.
• Optimization: Radiation doses should all be kept as low as reasonably achievable. This
means that it is not enough to remain under the radiation dose limits. As permit holder, you
are responsible for ensuring that radiation doses are as low as reasonably achievable, which
means that the actual radiation doses are often much lower than the permitted limit.

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Exposure Dose Limits for Radiation Workers


• occupational exposure: 20 mSV/year (effective dose)

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