Chapter 24: Radiation Protection

Slide set of 172 slides based on the chapter authored by

D. Sutton, L.T. Collins and J. Le Heron
of the IAEA publication (ISBN 978-92-0-131010-1):

Diagnostic Radiology Physics:

A Handbook for Teachers and Students
Objective:
To familiarize students with the systems of radiation protection
used in diagnostic radiology.
Slide set prepared
by E.Okuno (S. Paulo, Brazil,
Institute of Physics of S. Paulo University)

IAEA
International Atomic Energy Agency
Chapter 24. TABLE OF CONTENTS

24.1. Introduction
24.2. The ICRP system of radiological protection
24.3. Implementation of Radiation Protection in
the Radiology Facility
24.4. Medical exposures
24.5. Occupational exposure
24.6. Public exposure in radiology practices
24.7. Shielding

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 2
24.1. INTRODUCTION

• Basic radiation biology and radiation effects

demonstrate the need to have a system of radiation
protection which allows the many beneficial uses of
radiation while ensuring detrimental radiation effects
are either prevented or minimized

• This can be achieved with the twin objectives of:

preventing the occurrence of deterministic effects
limiting the probability of stochastic effects to a
level that is considered acceptable

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24.1. INTRODUCTION

In a radiology facility, consideration needs to be given to the:

• patient
• staff involved in performing the radiological procedures
• members of the public
• other staff that may be in the radiology facility, carers and
comforters of patients undergoing procedures, and persons who
may be undergoing a radiological procedure as part of a
biomedical research project

This chapter discusses how the objectives given above are reached
through a system of radiation protection and how such a system should
be applied practically in a radiology facility

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24.2. THE ICRP SYSTEM OF RADIOLOGICAL PROTECTION

• The means for achieving the objectives of radiation

protection have evolved to the point where there is
consensus on a System of Radiological Protection under the
auspices of the International Commission of Radiological
Protection (ICRP)
• The detailed formulation of the system and its principles can be
found in the ICRP publications and they cannot easily be
paraphrased without losing their essence
• A brief, although simplified, summary is given here, especially as it
applies to diagnostic radiology and image-guided interventional
procedures

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24.2. THE ICRP SYSTEM OF RADIOLOGICAL PROTECTION
24.2.1. Situations, types and categories of exposure

The ICRP Publication 103 divides all possible situations

where radiological exposure can occur into three types:
• planned exposure situations in radiology
• emergency exposure situations
• existing exposure situations

The use of radiation in radiology is a planned exposure

It must be under regulatory control, with an appropriate
authorization in place from the regulatory body before operation
can commence

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24.2. THE ICRP SYSTEM OF RADIOLOGICAL PROTECTION
24.2.1. Situations, types and categories of exposure

• Normal exposures: occur in the daily operation of a radiology facility

with reasonably predictable magnitudes
• Potential exposures: are unintended exposures or accidents. These
exposures remain part of the planned exposure situation as their
possible occurrence is considered in the granting of an authorization

The ICRP then divides exposure of individuals (both normal and

potential) into three categories :
• occupational exposure
• public exposure
• medical exposure
All three exposure categories need to be considered in the radiology
facility

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24.2. THE ICRP SYSTEM OF RADIOLOGICAL PROTECTION
24.2.1.1. Occupational exposure

Defined by the ICRP as:

• Radiation exposures of workers incurred

as a result of their work, in situations
which can reasonably be regarded as
within the responsibility of the employing
or operating management

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24.2. THE ICRP SYSTEM OF RADIOLOGICAL PROTECTION
24.2.1.2. Public exposure

• Includes all public exposures other than occupational

or medical exposures, and covers a wide range of
sources of which natural sources are by far the largest

Public exposure in a radiology facility would include

exposure:
• to persons who may happen to be close to or within
the facility and potentially subject to radiation
penetrating the walls of an X ray room
• of the embryo and foetus or pregnant workers

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24.2. THE ICRP SYSTEM OF RADIOLOGICAL PROTECTION
24.2.1.3. Medical exposure

Medical exposure is divided into three components:

• patient exposure
• biomedical research exposure
• carers and comforters exposure

An individual person may be subject to one or more of

these categories of exposure, but for radiation
protection purposes each is dealt with separately

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24.2. THE ICRP SYSTEM OF RADIOLOGICAL PROTECTION
24.2.1.3. Medical exposure

• Medical exposures are intentional exposures for the diagnostic or

therapeutic benefit of the patient
• They are a very significant and increasing source of exposure
• Advanced countries have shown an increase of 58 % in diagnostic
exposures between the UNSCEAR 2000 and 2008
• CT was by far the greatest contributor, being 7.9 % of examinations,
but 47 % of dose
• For the whole world population, the annual effective dose per person
from medical sources is 0.62 mSv compared to 2.4 mSv for natural
sources
• This rapid growth emphasises the need for effective implementation
of the radiation protection principles of justification and optimization

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24.2. THE ICRP SYSTEM OF RADIOLOGICAL PROTECTION
24.2.2. Basic framework of radiation protection
The ICRP system of radiation protection has 3 fundamental principles:
• Justification: any decision that alters the radiation exposure situation should do
more good than harm
• Optimization of protection: the likelihood of incurring exposures, the number of
people exposed, and the magnitude of their individual doses should all be kept
as low as reasonably achievable, taking into account economic and societal
factors
• Limitation of doses: the total dose to any individual from regulated sources in
planned exposure situations other than medical exposure of patients should not
exceed the appropriate limits recommended by the Commission

In a radiology facility, occupational and public exposure is subject to all

3 principles, whereas medical exposure is subject to the first two only

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24.2. THE ICRP SYSTEM OF RADIOLOGICAL PROTECTION
24.2.2. Basic framework of radiation protection

Recommended dose limits in planned exposure situationsa (ICRP 103)

Type of limit Occupational Public
Effective dose 20 mSv per year, averaged over 1 mSv in a yearf
defined periods of 5 yearse
Annual equivalent dose in:
Lens of the eyeb 20 mSv 15 mSv
Skinc,d 500 mSv 50 mSv
Hands and feet 500 mSv –
a Limits on effective dose are for the sum of the relevant effective doses from external exposure in the
specified time period and the committed effective dose from intakes of radionuclides in the same period
For adults, the committed effective dose is computed for a 50-year period after intake, whereas
for children it is computed for the period up to age 70 years
b this limit is a 2011 ICRP recommendation
c The limitation on effective dose provides sufficient protection for the skin against stochastic effects
d Averaged over 1 cm 2 area of skin regardless of the area exposed
e With the further provision that the effective dose should not exceed 50 mSv in any single year

Additional restrictions apply to the occupational exposure of pregnant women

f In special circumstances, a higher value of effective dose could be allowed in a single year, provided that

the average over 5 years does not exceed 1 mSv per year

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24.3. IMPLEMENTATION OF RADIATION PROTECTION IN
THE RADIOLOGY FACILITY
24.3.1. Introduction
The current version of the IAEA safety standard:
“International Basic Safety Standards for Protection against Ionizing
Radiation and for the Safety of Radiation Sources” (the BSS) was
issued in 1996 under the joint sponsorship of the:

• Food and Agriculture Organization of the United Nations, IAEA, International

Labour Organisation, OECD Nuclear Energy Agency, Pan American Health
Organization, World Health Organization

The BSS was published as IAEA Safety Series No. 115 and comprises four
sections: preamble, principal requirements, appendices and schedules
The purpose of the report is to establish basic requirements for protection
against exposure to ionizing radiation and for the safety of radiation sources
that may deliver such exposure

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24.3. IMPLEMENTATION OF RADIATION PROTECTION IN
THE RADIOLOGY FACILITY
24.3.1. Introduction
• The requirements of the BSS underpin the implementation of radiation
protection in a radiology facility, supplemented by the relevant IAEA
Safety Guides and Safety Reports

• IAEA Safety Reports Series No. 39 covers:

Diagnostic radiology and interventional procedures using X-rays

All IAEA publications are downloadable from the IAEA website

The International Commission on Radiological Protection (ICRP) has

addressed recommendations for radiological protection and safety in
medicine specifically in Publications:
ICRP 73
ICRP 103
ICRP 105
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24.3. IMPLEMENTATION OF RADIATION PROTECTION IN
THE RADIOLOGY FACILITY
24.3.2. Responsibilities

• Implementation of radiation protection in the hospital or medical

facility must fit in with, and be complementary to, the systems for
implementing medical practice in the facility

• Radiation protection must not be seen as something imposed from

“outside” and separate to the real business of providing medical
services and patient care

• To achieve a high standard of radiation protection, it is very

important to establish a safety-based attitude in every individual such
that protection and accident prevention are regarded as a natural part
of the every-day duty

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24.3. IMPLEMENTATION OF RADIATION PROTECTION IN
THE RADIOLOGY FACILITY
24.3.2. Responsibilities
• This objective is primarily achieved by education and training and
encouraging a questioning and learning attitude, but also by a positive
and cooperative attitude from the national authorities and the employer
in supporting radiation protection with sufficient resources, both in terms
of personnel and money

• Every individual should also know their responsibilities through formal

assignment of duties

• For an effective radiation protection outcome, the efforts of various

categories of personnel engaged in the medical use of ionizing radiation
must be coordinated and integrated, preferably by promoting teamwork,
where every individual is well aware of their responsibilities and duties

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24.3. IMPLEMENTATION OF RADIATION PROTECTION IN
THE RADIOLOGY FACILITY
24.3.3. Responsibilities of the licensee and employer

The licensee of the radiology facility, through the authorization issued

by the radiation protection regulatory body:
• has the prime responsibility for applying the relevant national regulations and
meeting the conditions of the licence
• bears the responsibility for setting up and implementing the technical and
organizational measures that are needed for ensuring radiation protection
and safety
• may appoint other people to carry out actions and tasks related to these
responsibilities, but retains overall responsibility
In particular, the radiological medical practitioner, the medical physicist, the
medical radiation technologist and the radiation protection officer (RPO) all
have key roles and responsibilities in implementing radiation protection in the
radiology facility

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24.3. IMPLEMENTATION OF RADIATION PROTECTION IN
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24.3.3. Responsibilities of the licensee and employer

With respect to medical exposure, the licensee’s key

responsibilities include ensuring that:

• the necessary personnel (radiological medical practitioners, medical

physicists, and medical radiation technologists) are employed, and that the
individuals have the necessary education, training and competence to
assume their assigned roles and to perform their respective duties
• no person receives a medical exposure unless there has been appropriate
referral, it is justified and the radiation protection has been optimized
• all practicable measures are taken to minimize the likelihood of unintended
or accidental medical exposures, and to promptly investigate any such
exposure, with the implementation of appropriate corrective actions

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24.3. IMPLEMENTATION OF RADIATION PROTECTION IN
THE RADIOLOGY FACILITY
24.3.3. Responsibilities of the licensee and employer

• Radiological medical practitioner is the generic term used in the

revised BSS, and is defined as a health professional, with education
and specialist training in the medical uses of radiation, who is
competent to independently perform or oversee procedures involving
medical exposure in a given specialty
In the radiology facility, a radiologist is the most common radiological
medical practitioner but many other medical specialists may also be in
this role, including, for example, interventional cardiologists, urologists,
gastroenterologists, orthopaedic surgeons, dentists

• Medical radiation technologist is the generic term used in the revised

BSS to cover the various terms used throughout the world, such as
radiographer and radiologic technologist

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24.3. IMPLEMENTATION OF RADIATION PROTECTION IN
THE RADIOLOGY FACILITY
24.3.3. Responsibilities of the licensee and employer

With respect to occupational exposure, key responsibilities of the

employer and licensee include ensuring that:
• occupational radiation protection and safety is optimized and that the
dose limits for occupational exposure are not exceeded
• a radiation protection programme is established and maintained,
including local rules and provision of personal protective equipment
• arrangements are in place for the assessment of occupational
exposure through a personnel monitoring program
• adequate information, instruction and training on radiation protection
and safety are provided

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24.3. IMPLEMENTATION OF RADIATION PROTECTION IN
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24.3.3. Responsibilities of the licensee and employer

The licensee also has responsibility for radiation

protection of the public which includes ensuring that:

• there are restrictions in place to prevent unauthorised

access to functioning X ray rooms

• area monitoring is carried out to assure consistency with

public exposure standards and that appropriate records
are kept

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24.3. IMPLEMENTATION OF RADIATION PROTECTION IN
THE RADIOLOGY FACILITY
24.3.4. Responsibilities of other parties

Radiological medical practitioner

• The general medical and health care of the patient is, of course,
the responsibility of the individual physician treating the patient
• But when the patient presents in the radiology facility, the
radiological medical practitioner has the particular responsibility for
the overall radiation protection of the patient
• This means responsibility for the justification of the given
radiological procedure for the patient, in conjunction with the
referring medical practitioner, and responsibility for ensuring the
optimization of protection in the performance of the examination

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24.3. IMPLEMENTATION OF RADIATION PROTECTION IN
THE RADIOLOGY FACILITY
24.3.4. Responsibilities of other parties

Medical physicist
• provides specialist expertise with respect to radiation protection
of the patient
• has responsibilities in the implementation of the optimization of
radiation protection in medical exposures, including calibration
of imaging equipment, image quality and patient dose
assessment, and physical aspects of the quality assurance
programme, including medical radiological equipment
acceptance and commissioning in diagnostic radiology
• is also likely to have responsibilities in providing radiation
protection training for medical and health personnel
• may also perform the role of the RPO, with responsibilities
primarily in occupational and public radiation protection

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24.3. IMPLEMENTATION OF RADIATION PROTECTION IN
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24.3.4. Responsibilities of other parties

Medical radiation technologist

• has a key role, and his/her skill and care in the

choice of techniques and parameters determine to a
large extent the practical realization of the
optimization of a given patient’s exposure in many
modalities

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24.3. IMPLEMENTATION OF RADIATION PROTECTION IN
THE RADIOLOGY FACILITY
24.3.4. Responsibilities of other parties

Radiation protection officer (RPO)

• has responsibilities to oversee and implement radiation protection
matters in the facility, but noting that specialist responsibilities for
patient radiation protection lie with the medical physicist
• might also be a medical physicist

Duties of the RPO include:

• ensuring that all relevant regulations and licence conditions are followed
• assisting in the preparation and maintenance of radiation safety procedures
(local rules)
• shielding design for the facility
• arranging appropriate monitoring procedures (individual and workplace)
• education and training of personnel in radiation protection

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24.3. IMPLEMENTATION OF RADIATION PROTECTION IN
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24.3.4. Responsibilities of other parties

All personnel

Notwithstanding the responsibilities outlined above, all

persons working with radiation have responsibilities for
radiation protection and safety:
• they must follow applicable rules and procedures
• use available protective equipment and clothing
• cooperate with personnel monitoring
• abstain from wilful actions that could result in unsafe practice
• undertake training as provided

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24.3. IMPLEMENTATION OF RADIATION PROTECTION IN
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24.3.5. Radiation protection programme
The BSS requires a licensee (and employer where appropriate) to:
• develop
• implement
• document
a protection and safety programme commensurate with the nature
and extent of the risks of the practice to ensure compliance with
radiation protection standards

Such a programme is often called a radiation protection

programme (RPP) and each radiology facility should have one

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24.3. IMPLEMENTATION OF RADIATION PROTECTION IN
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24.3.5. Radiation protection programme
The RPP for a radiology facility is quite complex as it needs to cover
all relevant aspects of protection of the:
• worker
• patient
• general public

• For a RPP to be effective, the licensee needs to provide for its

implementation, including the resources necessary to comply with
the programme and arrangements to facilitate cooperation between
all relevant parties
• Often radiology facilities will have a radiation protection committee,
or similar, to help supervise compliance with the RPP

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24.3. IMPLEMENTATION OF RADIATION PROTECTION IN
THE RADIOLOGY FACILITY
24.3.6. Education and training

• As already mentioned above, education and training in

radiation protection underpins much of practical
radiation protection
• Such education and training needs to occur before
persons assume their roles in the radiology facility, with
refresher training occurring subsequently at regular
intervals
normally receive this education
radiologists
and training in radiation
medical radiation technologists
medical physicists protection as part of their
professional training
Details on appropriate levels of training are given in IAEA Publication SRS 39

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24.3. IMPLEMENTATION OF RADIATION PROTECTION IN
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24.3.6. Education and training
• Other medical specialists end up in the role of the radiological medical
practitioner, such as interventional cardiologists, orthopaedic surgeons
etc
• These persons also must have the appropriate education and training
in radiation protection, and this typically needs to be arranged outside
their professional training
• Often this will fall to the medical physicist associated with the radiology
facility
• The training in all cases needs to include practical training
• Nurses may also be involved in radiological procedures and
appropriate education and training in radiation protection needs to be
given to them

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24.4. MEDICAL EXPOSURES
24.4.1. Introduction

• Dose limits are not applied to patients undergoing medical exposures

The reason for the differences between the treatment is:
medical exposures a benefit and a detriment associated
occupational or public exposures only a detriment associated

• However there is a class of medical exposure that is concerned with

exposures to volunteers in biomedical research programmes and another
to so called ‘comforters and carers’. For these groups some type of
constraint does need to be applied since they receive no direct medical
benefit from their exposure

• The concept of a source-related dose constraint was first introduced in

ICRP publication 60 and is taken to mean a dose that should not be
exceeded from a single, specific source, and below which optimization of
protection should take place

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24.4. MEDICAL EXPOSURES
24.4.1. Introduction

• The philosophical basis for the management of

medical exposures differs from that for
occupational or public exposure and,
in diagnostic radiology, is concerned with the
avoidance of unnecessary exposure through the
application of the principles of
justification and optimization

Calibration two activities that support the

Clinical dosimetry implementation of optimization

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24.4. MEDICAL EXPOSURES
24.4.1. Introduction

• The licensee of the radiology facility needs to ensure that a

medical physicist calibrates all sources used for medical
exposures, using dosimeters that have a calibration, traceable
to a standards dosimetry laboratory

• Further, the medical physicist needs to perform and document

an assessment of typical patient doses for the procedures
performed in the facility

A very important tool in the optimization process is the use of

diagnostic reference levels

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24.4. MEDICAL EXPOSURES
24.4.2. Diagnostic Reference Levels

Diagnostic Reference Levels (DRLs):

• are dose levels for typical examinations for groups of

standard-sized patients or standard phantoms and
for broadly defined types of equipment

• they do not represent a constraint on individual

patient doses but give an idea of where the indistinct
boundary between good or normal practice and bad
or abnormal practice lies

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24.4. MEDICAL EXPOSURES
24.4.2. Diagnostic Reference Levels

• DRLs are usually set using a threshold in a distribution of patient doses or

related quantities

• Frequently, when implemented at national or international level this is the

75th percentile on the observed distribution of doses to patients or phantoms
for a particular examination

• The 75th percentile is by no means set in stone – for example some authors
suggest that reference levels set at a local level may be defined as being the
mean of a locally measured distribution of doses

• Reference levels set using a distribution of doses implicitly accept that all
elements in the distribution arise from exposures that produce an image
quality resulting in the correct diagnosis being achieved

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24.4. MEDICAL EXPOSURES
24.4.2. Diagnostic Reference Levels

• In the radiology facility the DRL is used as a tool to aid dose audit,
and to be a trigger for investigation
• Periodic assessments of typical patient doses (or the appropriate
surrogate) for common procedures are performed in the facility
and comparisons made with the DRLs
• A review is conducted to determine whether the optimization of
protection of patients is adequate or whether corrective action is
required if the typical average dose for a given radiological
procedure:
(a) consistently exceeds the relevant DRL or
(b) falls substantially below the relevant DRL and the
exposures do not provide useful diagnostic information
or do not yield the expected medical benefit to patients
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24.4. MEDICAL EXPOSURES
24.4.2. Diagnostic Reference Levels

• If a local dose review demonstrates that doses do not, on

average, exceed a DRL established nationally or internationally, it
does not mean that that particular radiological procedure has been
optimized

• It just means that practice falls on one side of a divide

• There may well be scope for improvement and by establishing and

setting their own DRLs based on local or regional data, radiology
facilities may well be able to adapt local practice and more
effectively optimise exposures

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24.4. MEDICAL EXPOSURES
24.4.3. Quality assurance for medical exposures

The BSS requires the licensee of the radiology facility to have a

comprehensive programme of
quality assurance for medical exposures

The programme needs to have the active participation of the

• medical physicists
• radiologists
• radiographers
and needs to take into account principles established by
international organizations, such as WHO and PAHO, and
relevant professional bodies

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24.4. MEDICAL EXPOSURES
24.4.4. Examination of pregnant women

Special consideration should be given to pregnant women

because different types of biological effects are associated with
irradiation of the unborn child

• As a basic rule it is recommended that radiological procedures of

the woman likely to be pregnant should be avoided unless there
are strong clinical indications
• There should be signs in the waiting area, cubicles and other
appropriate places requesting a woman to notify the staff if she is
or thinks she is pregnant
• For radiological procedures which could lead to a significant dose
to an embryo or foetus, there should be systems in place to
ascertain pregnancy status

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24.4. MEDICAL EXPOSURES
24.4.4. Examination of pregnant women

• The justification for the radiological procedure would

include consideration of the patient being pregnant

• If, after consultation between the referring medical

practitioner and the radiologist, it is not possible to
substitute a lower dose or non-radiation examination, or
to postpone the examination, then the examination
should be performed

• Even then, the process of optimization of protection

needs to also consider protection of the embryo/foetus

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24.4. MEDICAL EXPOSURES
24.4.4. Examination of pregnant women

• Foetal doses from radiological procedures vary

enormously, but clearly are higher when the examination
includes the pelvic region

• At the higher end, for example, routine diagnostic

CT- examinations of the pelvic region with and without
contrast injection can lead to a foetal absorbed dose of
about 50 mGy

• The use of a low-dose CT protocol and reducing the

scanning area to a minimum would lower the foetal dose

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24.4. MEDICAL EXPOSURES
24.4.4. Examination of pregnant women

• If a foetal dose is suspected to be high (e.g. >10 mGy) it

should be carefully determined by a medical physicist and
the pregnant woman should be informed about the
possible risks

• The same procedure should be applied in the case of an

inadvertent exposure, which can be incurred by a woman
who later was found to have been pregnant at the time of
the exposure, and or in emergency situations

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24.4. MEDICAL EXPOSURES
24.4.4. Examination of pregnant women

• Irradiation of a pregnant patient at a time when the pregnancy

was not known often leads to her apprehension because of
concern about the possible effects on the foetus

• Even though the absorbed doses to the conceptus are generally

small, such concern may lead to a discussion regarding termination
of pregnancy due to the radiation risks

• It is, however, generally considered that for a

foetal dose <100 mGy, as in most diagnostic procedures,
termination of pregnancy is not justified from the point of
radiation risks

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24.4. MEDICAL EXPOSURES
24.4.5. Examination of children

• Special consideration needs to be given to the optimization

process for medical exposures of children, especially in the
case of CT
• The CT- protocol should be optimized by reducing mAs and
kV without compromising the diagnostic quality of the
images
• Careful selection of slice width and pitch as well as scanning
area should also be made
• It is important that individual protocols based on the size of
the child are used, derived by a medical physicist and the
responsible specialist

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24.4. MEDICAL EXPOSURES
24.4.6. Helping in the care, support or comfort of patients

• During a radiological procedure:

children
elderly or the infirm
may have difficulty
• Occasionally people knowingly and voluntarily (other than in their
employment or occupation) may offer to help in the care, support or
comfort of such patients

• In such circumstances the dose to these persons (excluding

children and infants) should be constrained so that it is unlikely that
his or her dose would exceed 5 mSv during the period of a patient’s
diagnostic examination

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24.4. MEDICAL EXPOSURES
24.4.7. Biomedical research

• An exposure as part of biomedical research is treated as medical

exposure and therefore is not subject to dose limits

• Diagnostic radiological procedures may be part of a biomedical

research project, typically as a means for quantifying changes in a
given parameter under investigation or assessing the efficacy of a
treatment under investigation

• The BSS requires the use of dose constraints, on a case-by-case

basis, in the process of applying optimization to exposures arising
from biomedical research

• Typically the ethics committee would specify such dose constraints

in granting its approval

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24.4. MEDICAL EXPOSURES
24.4.8. Unintended and accidental medical exposures

These include any:

• diagnostic or image-guided interventional procedure which
irradiates the wrong individual
wrong tissue of the patient
• exposure for a diagnostic or image-guided interventional
procedure which is substantially greater than intended
• inadvertent exposure of the embryo or foetus in the course of
performing a radiological procedure
• equipment, software or other system failure, accident, error or
mishap with the potential for causing a patient exposure
substantially different from that intended

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 48
24.4. MEDICAL EXPOSURES
24.4.8. Unintended and accidental medical exposures

• If an unintended or accidental medical exposure occurs,

then the licensee is required to determine the patient
doses involved, identify any corrective actions needed to
prevent recurrence, and implement the corrective
measures

• There may be a requirement to report the event to the

regulatory body

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 49
24.5. OCCUPATIONAL EXPOSURES

Detailed requirements for protection against occupational exposure

are given in Appendix I of the BSS, and recommendations on how to
meet these requirements are given in the IAEA Safety Guides:
• Occupational Radiation Protection
(Safety Standards Series No. RS-G-1.1)
• Assessment of Occupational Exposure Due to External
Sources of Radiation (Safety Standards Series No. RS-G-1.3)

Both safety guides are applicable to the radiology facility. IAEA

publication Applying Radiation Safety Standards in Diagnostic
Radiology and Interventional Procedures using X Rays (Safety
Report Series No. 39) provides further specific advice

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 50
24.5. OCCUPATIONAL EXPOSURES
24.5.1. Control of Occupational Exposure
Control of occupational exposure should be established using both:
engineering and procedural methods

room shielding specified prior establishment of controlled

to the installation areas and use of Local Rules

• It is the joint responsibility of the employer and licensee to ensure that

occupational exposures for all workers are limited and optimised and that
suitable and adequate facilities, equipment and services for protection are
provided
• This means that appropriate protective devices and monitoring equipment
must be provided and properly used and consequently that appropriate
training is made available to staff
• In turn staff themselves have a responsibility to make best use of the
equipment and procedural controls instigated by the employer or licensee

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 51
24.5. OCCUPATIONAL EXPOSURES
24.5.1. Control of Occupational Exposure

Controlled areas:
• should be established in any area in which a hazard assessment
identifies that measures are required to control exposures during
normal working conditions, or to limit the impact of potential
exposures
• will depend on the magnitude of the actual and potential exposures
to radiation

In practice, all X ray rooms should be designated as being

controlled whereas the extent of a controlled area
established for the purposes of mobile radiography will be
the subject of a hazard assessment

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 52
24.5. OCCUPATIONAL EXPOSURES
24.5.1. Control of Occupational Exposure

Warning signs should be displayed at the entrance to controlled

areas and wherever possible entrance to the area should be
controlled via a physical barrier such as a door, although this may
well not be possible in the case of mobile radiography
There should be Local Rules (LR) available for all controlled areas
• LR should identify access arrangements and also provide
essential work instructions to ensure that work is carried out
safely, including instruction on the use of individual dosimeters
• LR should also provide instruction on what to do in the case of
unintended and accidental exposures
In this context, the LR should also identify an occupational dose
above which an investigation will occur (Investigation Level)

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 53
24.5. OCCUPATIONAL EXPOSURES
24.5.2. Operational Quantities used in area and personal
dose monitoring

• For a monitoring programme to be simple and effective, individual

dosimeters and survey meters must be calibrated using a quantity that
approximates effective or equivalent dose

• Effective dose represents the uniform whole body dose that would
result in the same radiation risk as the non-uniform equivalent dose,
which for X rays is numerically equivalent to absorbed dose

• In concept at least it is directly related to stochastic radiation risk and

provides an easy to understand link between radiation dose and the
detriment associated with that dose

• However, it is an abstract quantity which is difficult to assess and

impossible to measure directly

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 54
24.5. OCCUPATIONAL EXPOSURES
24.5.2. Operational Quantities used in area and personal
dose monitoring

The need for readily measurable quantities that can be related to:
• effective dose
• equivalent dose
has led to the development of operational quantities for the
assessment of external exposure

Operational quantities:
• are defined by the International Commission on Radiation Units
and Measurements (ICRU)
• provide an estimate of effective or equivalent dose that avoids
underestimation and excessive overestimation in most radiation
fields encountered in practice
• are defined for practical measurements both for area and
individual monitoring
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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 55
24.5. OCCUPATIONAL EXPOSURES
24.5.2. Operational Quantities used in area and personal
dose monitoring

In radiation protection, radiation is often characterised

as either:
• weakly
• strongly

penetrating depending on which dose equivalent is

closer to its limiting value

In practice, the term ‘weakly penetrating’ radiation

usually applies to photons below 15 keV and
β radiation

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 56
24.5. OCCUPATIONAL EXPOSURES
24.5.2. Operational Quantities used in area and personal
dose monitoring

There are two operational quantities used for area monitoring

of external radiation:
• the ambient dose equivalent - H*(d)(Sv)
• the directional dose equivalent - H’(d,Ω) (Sv)
They relate the external radiation field to the effective dose
equivalent in the ICRU sphere phantom at depth d, on a radius
in a specified direction Ω

For strongly penetrating radiation the depth d = 10 mm is used

For weakly penetrating radiation the ambient and directional dose

equivalents in the skin at d = 0.07 mm can be used but are not likely
to be encountered in the radiological environment

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 57
24.5. OCCUPATIONAL EXPOSURES
24.5.2. Operational Quantities used in area and personal
dose monitoring

• The operational quantity used for

individual monitoring is the
personal dose equivalent - Hp(d)(Sv)
measured at a depth d (mm) in soft tissue

• Use of the operational quantity Hp(10) results in an

approximation of effective dose

• Hp(0.07) provides an approximate value for the

equivalent dose to the skin

• Hp(3) is used for equivalent dose to the lens of the eye

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 58
24.5. OCCUPATIONAL EXPOSURES
24.5.2. Operational Quantities used in area and personal
dose monitoring

• Since Hp(d) is defined in the body, it cannot be

measured directly and will vary from person to person
and also according to the location on the body where
it is measured

• However, practically speaking, personal dose

equivalent can be determined using a detector
covered with an appropriate thickness of tissue
equivalent material and worn on the body

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 59
24.5. OCCUPATIONAL EXPOSURES
24.5.3. Monitoring Occupational Dose

The main purposes of a monitoring program are to assess:

• whether staff doses are exceeding the dose limits
• the effectiveness of strategies used for optimization
It must always be stressed that the programme does not serve to
reduce doses; it is the results of those actions taken as a result of
the programme that reduce occupational exposures
• In the X ray facility, individual dose monitoring would include
radiologists, medical physicists, radiographers and nurses
• Other staff groups such as cardiologists and other specialists who
perform image-guided interventional procedures are also
candidates for individual monitoring
The monitoring period should be 1 month, and shall not exceed 3 months
The exact period should be decided by a hazard assessment

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 60
24.5. OCCUPATIONAL EXPOSURES
24.5.3. Monitoring Occupational Dose

Individual dosimeters will either be designed to estimate:

• effective dose or an
• equivalent dose to an organ such as the fingers
There are many types of individual dosimeter:
TLD, OSL, film and a variety of electronic devices
Whole body dosimeters:
• measure Hp(10) (and usually Hp(0.07))
• should be worn - between the shoulders and the waist
- under any protective clothing such as an apron
whenever one is used

When the doses might be high as, for example in

interventional radiology, two dosimeters might be required:
• one under the apron at waist level and
• one over the apron at collar level

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 61
24.5. OCCUPATIONAL EXPOSURES
24.5.3. Monitoring Occupational Dose

There are algorithms for utilising dosimeter values, from one or

more dosimeters, to estimate effective dose E

One commonly used algorithm is E = 0.5HW + 0.025 HN

• HW is the dose at waist level under the protective apron
• HN is the dose at neck level outside the apron

In all cases, it is important to know the

• wearing position
• presence or not of protective clothing
• reported dosimeter dose quantities
Dosimeters worn at the collar can also give an indication of the
dose to the thyroid and to the lens of the eye (indicative)

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 62
24.5. OCCUPATIONAL EXPOSURES
24.5.3. Monitoring Occupational Dose

Individual dosimeters for assessing

extremity doses usually come in the form
of ring badges or finger stalls which slip over
Finger stall and ring badge used for the end of the finger
extremity monitoring

• The usual reporting quantity for these devices is Hp(0.07)

• Both types will measure the dose at different places on the hand and
care must be taken when deciding which type to use
• It is very important to choose the digit and hand that are going to be
monitored – the dominant hand may not be that which will receive the
greatest exposure
• For example, a right handed radiologist may place his left hand
nearer to the patient when performing an interventional procedure

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 63
24.5. OCCUPATIONAL EXPOSURES
24.5.3. Monitoring Occupational Dose

• To ensure that the monitoring programme is carried out in the

most efficient manner:
- the delay between the last day on which an individual dosimeter
is worn and the date of receipt of the dose report from the
approved dosimetry service should be kept as short as possible
- for the same reason, it is imperative that workers issued with
dosimeters return them on time

• Results of the monitoring programme should be shared with staff

and used as the basis for implementing and reviewing dose
reduction strategies

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 64
24.5. OCCUPATIONAL EXPOSURES
24.5.3. Monitoring Occupational Dose

• If on receipt of a dose report an employee is found to have either a

cumulative or single dose that exceeds the investigation level
specified in the Local Rules an investigation should be initiated to
determine the reason for the unusual exposure and to ensure that
there is no repeat of the occurrence

• The investigation level should have been set at a level considerably

lower than the regulatory dose limit and the opportunity should be
taken to alter practice to ensure that doses are kept as low as
possible

• In the unlikely event that a regulatory dose limit is breached,

the regulatory authorities should be informed in the manner
prescribed locally

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 65
24.5. OCCUPATIONAL EXPOSURES
24.5.4. Occupational dose limits

The IAEA adopts the ICRP Recommended dose limits (ICRP 103)
Type of limit Occupational Public
Effective dose 20 mSv per year, averaged over 1 mSv in a year
defined periods of 5 years
Annual equivalent dose in:
Lens of the eye 20 mSv 15 mSv
Skin 500 mSv 50 mSv
Hands and feet 500 mSv –
The BSS also adds stronger restrictions on occupational doses for
“apprentices” and “students” aged 16 to 18 – namely dose limits of an:
• effective dose of 6 mSv in a year
• equivalent dose to the lens of the eye of 20 mSv in a year
• equivalent dose to the extremities or the skin of 150 mSv in a year

These stronger dose limits would apply, for example, to any 16-18 year old
student radiographers

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 66
24.5. OCCUPATIONAL EXPOSURES
24.5.5. Pregnant Workers

• A female worker should, on becoming aware that she is pregnant,

notify the employer in order that her working conditions may be
modified if necessary

• The employer shall adapt the working conditions in respect of

occupational exposure so as to ensure that the embryo or foetus is
afforded the same broad level of protection as required for members
of the public, that is, the dose to the embryo or foetus should not
normally exceed 1 mSv

• In general, in diagnostic radiology it will be safe to assume that

provided the dose to the employee’s abdomen is less than
2 mSv, then the doses to the foetus will be lower than 1 mSv

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 67
24.5. OCCUPATIONAL EXPOSURES
24.5.6. Accidental & Unintended Exposure

In the case of an equipment failure, severe accident or error occurring

that causes, or has the potential to cause, a dose in excess of annual
dose limit, an investigation must be instigated as soon as possible

The purpose of the investigation will be to:

• identify how and why the occurrence took place
• assess what doses were received
• identify corrective actions
• make recommendations on actions required to minimise the
possibility of future unintended or accidental exposures occurring

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 68
24.5. OCCUPATIONAL EXPOSURES
24.5.7. Records

The BSS requires that employers and licensees retain exposure

records for each worker. The exposure records should include
information on/or details of:
• the general nature of the work involving occupational exposure
• doses at or above the relevant recording levels and the data upon
which the dose assessments have been based
• the dates of employment with each employer and the doses in each
employment
• any doses due to emergency exposure situations or accidents, which
should be distinguished from doses received during normal work
• any investigations carried out

Employers and licensees need to provide workers with access to

their own exposure records

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 69
24.5. OCCUPATIONAL EXPOSURES
24.5.8. Methods of reducing occupational exposure

Reduction of staff and public dose follows the basic principles

of time, distance, and shielding which are:

• Restrict the time: the longer the exposure, the greater the cumulative dose
• Ensure that the distance between a person and the X ray source is kept as
large as practicable. Radiation from a point source follows the inverse square
law
• Employ appropriate measures to ensure that the person is shielded from the
source of radiation. High atomic number and density materials such as lead
or steel are commonly used for facility shielding

It is not always necessary to adopt all three principles. There will be occasions
when only one or two should be considered, but equally there will also be
instances when application of the ALARA principle requires the use of all three

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 70
24.5. OCCUPATIONAL EXPOSURES
24.5.8. Methods of reducing occupational exposure

• The level of occupational exposure associated with radiological

procedures is highly variable and ranges from potentially negligible
in the case of simple chest X rays to significant for complex
interventional procedures

From the occupational perspective, there are two “sources” of

radiation exposure:
• X ray tube, but in practice, with proper shielding of the X ray
head, there should be very few situations where personnel
have the potential to be directly exposed to the primary beam
• scattered radiation produced by the part of the patient’s body
being imaged

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 71
24.5. OCCUPATIONAL EXPOSURES
24.5.8. Methods of reducing occupational exposure

• Thus the main source of occupational exposure in most cases

is proximity of staff to the patient when exposures are being
made

• Further, the level of scatter is determined largely by the dose to

the patient, meaning that a reduction in patient dose to the
minimum necessary to achieve the required medical outcome
also results in lowering the potential occupational exposure

• A common and useful guide is that by looking after the patient,

staff will also be looking after their occupational exposure

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 72
24.5. OCCUPATIONAL EXPOSURES
24.5.8.1. Working at some distance from the patient

• For many situations, such as:

radiography
mammography
general CT
there is usually no need for personnel to be physically close to the
patient

• This enables good occupational radiation protection through the large

distance between the patient and personnel and the use of structural
shielding

• Appropriate room design with shielding specification by an RPO

should ensure that for these X ray imaging situations occupational
exposure will be essentially zero

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 73
24.5. OCCUPATIONAL EXPOSURES
24.5.8.2. Working close to the patient

In fluoroscopic examinations and in image-guided interventional

procedures, it is necessary to maintain close physical contact with the
patient when radiation is being used
Distance and structural shielding are not options

• Scattered radiation can be attenuated by protective clothing worn by personnel,

such as aprons, glasses, and thyroid shields, and by protective tools, such as
ceiling-suspended protective screens, table mounted protective curtains or
wheeled screens, placed between the patient and the personnel
• Depending on its lead equivalence (typically 0.3 – 0.5 mm lead) and the energy
of the X rays, an apron will attenuate 90 % or more of the incident scattered
radiation
• Protective clothing should be checked for shielding integrity (not lead
equivalence) annually, by simple X ray (fluoroscopic) screening

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 74
24.5. OCCUPATIONAL EXPOSURES
24.5.8.2. Working close to the patient

• The lens of the eye is highly radiation sensitive

• For persons working close to the patient, doses to the eyes can
become unacceptably high

• Wearing protective eye wear, especially that incorporating side

protection, can give a reduction of up to 90 % for the dose to the
eyes from scatter, but to achieve maximum effectiveness careful
consideration needs to be given to issues such as viewing
monitor placement to ensure the glasses do intercept the scatter
from the patient

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 75
24.5. OCCUPATIONAL EXPOSURES
24.5.8.2. Working close to the patient

• Ceiling-suspended protective screens can provide significant

protection, but their effectiveness depends on being positioned
correctly

• They provide protection to only part of the body – typically the

upper body, head and eyes – and their use is in addition to
wearing protective clothing, but they can remove the need for
separate eye shields

• Sometimes a protective screen cannot be deployed for clinical

reasons

• Table mounted protective curtains also provide additional

shielding, typically to the lower body and legs

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 76
24.5. OCCUPATIONAL EXPOSURES
24.5.8.2. Working close to the patient

• In image-guided interventional procedures, the hands of the operator

may inadvertently be placed in the primary X ray beam. Protective
gloves may appear to be indicated, but such gloves can prove to be
counter-productive as their presence in the primary beam leads to an
automatic increase in the radiation dose rate, offsetting any protective
value, and they can inhibit the operator’s “feel” which can be dangerous

• Gloves may slow the procedure down and also create a false sense of
safety – it is better to be trained to keep hands out of the primary beam

• Ensuring the X ray tube is under the table provides the best protection
when the hands have to be near the X ray field, as the primary beam
has been attenuated by patient’s body

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 77
24.5. OCCUPATIONAL EXPOSURES
24.5.8.2. Working close to the patient

An important factor for occupational exposure is the orientation of

the X ray tube and image receptor
• For near vertical orientations, having the X ray tube under the couch leads
to lower levels of occupational exposures because operators are being
exposed to scatter primarily from the exit volume of the patient, where
scatter is lowest
• Similarly for near lateral projections, standing on the side of the patient
opposite the X ray tube again leads to lower occupational exposure for the
same reason
• It is essential that personnel performing such procedures have had
effective training in radiation protection so that they understand the
implications of all the factors involved
• It is also essential that individual monitoring is performed continuously and
correctly

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 78
24.6. PUBLIC EXPOSURE IN RADIOLOGY PRACTICES
24.6.1. Access control

Unauthorised access by the public to functioning X ray rooms

must be prohibited

Visitors must be:

• accompanied in any controlled area by a person knowledgeable
about the protection and safety measures for that area (i.e. a
member of the radiology staff)
• provided with adequate information and instruction before they
enter a controlled area so as to ensure appropriate protection of
both the visitors and of other persons who could be affected by
their actions

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 79
24.6. PUBLIC EXPOSURE IN RADIOLOGY PRACTICES
24.6.2. Monitoring of public exposure

The programme for monitoring public exposure from

radiology should include dose assessment in the areas
surrounding radiology facilities which are accessible
to the public
• Monitoring can be achieved by use of passive devices such as TLD
placed at critical points for a short period (e.g. 2 weeks) annually or
as indicated
• Alternatively, active monitoring of dose rate or integrated dose
around an X ray room for a typical exposure in the room can be used
to check shielding design and integrity
• Monitoring is especially indicated and useful when new equipment is
installed in an existing X ray room, or the X ray procedure is altered
significantly
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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 80
24.6. PUBLIC EXPOSURE IN RADIOLOGY PRACTICES
24.6.3. Dose limits

• Some regulatory authorities, or individual

licensees/registrants may wish to apply source-related dose
constraints

• This would take the form of a factor applied to the public

dose limit (a value of 0.3 is commonly used). The purpose of
the constraint is to ensure, within reason, that the public can
be exposed to multiple sources without the dose limit being
exceeded

• For shielding calculations, the relevant annual limit is usually

expressed as a weekly limit, being the annual limit divided by
50 for simplicity

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 81
24.7. SHIELDING

• The design of radiation shielding for diagnostic installations can be

approached in a number of different ways
• There are two common approaches used internationally
NCRP report 147
British Institute of Radiology (BIR) report -
Radiation Shielding for diagnostic X rays

• These are each briefly discussed to give an idea of the different

methodologies, and examples using each approach are provided
• Reference to the original sources is advised if either method is to be
used. The necessary tabulated data are not provided in the
Handbook

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 82
24.7. SHIELDING
24.7.1. Dose and Shielding

• Dose limits and associated constraints are expressed in terms of

effective or equivalent dose

• Most X ray output and transmission data are measured in terms of

air kerma using ionisation chambers

• As a result, it is not practical or realistic to use effective dose (or its

associated operational quantities) when calculating shielding
requirements

When designing shielding, the assumption is usually

made that air kerma is equivalent to effective dose

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 83
24.7. SHIELDING
24.7.1. Dose and Shielding

• The relationship between the derived quantities and air kerma is

complex, depending on the X ray spectrum, and, in the case of
effective dose, the distribution of photon fluence and the posture of
the exposed individual
• Nevertheless, in the energy range used for diagnostic radiology air
kerma can be shown to represent an overestimate of the effective
dose
• Thus, the assumption of equivalence between air kerma and
effective dose will result in conservative shielding models
Since Hp(10) and H*(10) overestimate effective dose, caution
should be used if instruments calibrated in either of these
quantities are used to determine levels of scattered radiation
around a room as part of a shielding assessment exercise

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 84
24.7. SHIELDING
24.7.2. Primary and Secondary Radiation

The primary beam:

• consists of the spectrum of radiation emitted by the X ray tube
prior to any interaction with the patient, grid, table, image
intensifier etc
• will be collimated, in most radiographic exposures, so that the
entire beam interacts with the patient. Exceptions include
extremity radiography, some chest films and skull radiography
The fluence of the primary beam will be several orders of
magnitude greater than that of secondary radiation
Barriers are often considered as being either primary or
secondary in nature, depending on the radiation incident on
them. It is of course possible for a barrier to be both

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 85
24.7. SHIELDING
24.7.2. Primary and Secondary Radiation

There are two components to secondary radiation:

Scattered radiation: Tube leakage radiation:
• is a direct result of the coherent and • arises because X rays are emitted
incoherent scattering processes in in all directions by the target, not
diagnostic radiology just in the direction of the primary
• the amount of scatter produced beam
depends on the volume of the • the tube housing is lined with lead
patient irradiated, the spectrum of but some leakage radiation is
the primary beam, and the field size transmitted
employed • this component will be
• both the fluence and quality of this considerably harder than the
radiation have an angular primary beam but should have a
dependence very low intensity

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 86
24.7. SHIELDING
24.7.3. Distance to barriers

• It is prudent to always take the shortest likely distance

from the source to the calculation point

• However, distances should be measured to a point no

less than 0.3 m from the far side of a barrier

• For sources above occupied spaces, the sensitive

organs of the person below can be assumed to be not
> 1.7 m above the lower floor

• For occupied areas above a source, the distance can

be measured to a point 0.5 m above the floor

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 87
24.7. SHIELDING
24.7.4. Shielding Terminology
The BIR and NCRP methodologies use the following factors in the
calculations, all of which affect the radiation dose to an individual to be
shielded:
• the design or target dose P to a particular calculation point, expressed as
a weekly or annual value
• the workload W
• the occupancy T
• the distance d from the primary or secondary source to the calculation
point
In addition, the NCRP method employs the use factor U
This is the fraction of time the primary beam is directed towards a particular
primary barrier. It ranges from 0 for fluoroscopy and mammography (where
the image receptor is the primary barrier), to 1 for some radiographic
situations

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 88
24.7. SHIELDING
24.7.5. Basic Shielding Equation

The required shielding transmission B can be calculated for primary

and secondary barriers
This value can later be used to determine the barrier thickness

P 1
The basic transmission calculation is: B=
T K1
• B is the primary or secondary barrier transmission required to
reduce air kerma in an occupied area to P/T, which is the
occupancy-modified design dose
• K1 is the average air kerma per patient at the calculation point in the
occupied area and is determined from the workload W
The main difference between the two methods described here is the
manner in which K1 is determined

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 89
24.7. SHIELDING
24.7.6. Workload

• In order to determine the amount of shielding required, it is

necessary to determine the amount of radiation (primary and
secondary) that is incident on the barrier to be shielded
• The BIR and NCRP methodologies utilise measures of tube
output, but with different metrics to characterise it

In the case of shielding for CT:

the NCRP method advocates the use of dose length product or

CTDI as a measure of workload

the BIR report uses workload expressed in mAs

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 90
24.7. SHIELDING
24.7.6. Workload

• For all but CT shielding, the NCRP report advocates the

use of the total exposure expressed as the sum of the
product of exposure time and tube current measured in
mA·min as a measure of workload
Workload varies linearly with mA·min

• The way the workload is distributed as a function of kV is

referred to as the workload distribution

• The NCRP report tabulates some workload distributions

which are representative of practice in the USA

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 91
24.7. SHIELDING
24.7.6. Workload

• The BIR approach uses as indicators of workload:

patient entrance surface dose (ESD) and kerma area product (KAP)

indicator of primary radiation derive the amount of scattered radiation

• If a local dose audit is not performed, values of ESD and KAP are readily
available in the literature for a large number of examinations
• Many countries have diagnostic reference levels (DRLs) which can be used
as a basis for calculation should other data not be available and which should
result in conservative shielding models
• A potential disadvantage of this method is that many facilities do not have
access to KAP meters
• The BIR method does not use the concept of predetermined workload
distribution

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24.7. SHIELDING
24.7.7. Design Criteria and dose constraints

Occupationally exposed employees and members of the public including

employees not directly concerned with the work of the X ray rooms, need to be
considered when shielding is being designed

The BIR method:

• For members of the public applies the concept of dose constraints with the
rationale that the public should not receive any more than 30 % of their
maximum permissible dose from any one source
• 0.3 mSv/year is the upper limit in any shielding calculation involving the
public. It may be possible to employ a different constraint for employees,
depending on local regulatory circumstances, but it would be conservative to
use the same dose constraint as a design limit for both groups
• The BIR method takes attenuation of the patient and other filters, such as the
radiographic table and cassette (known as pre-filtration), into account when
performing a calculation

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24.7. SHIELDING
24.7.7. Design Criteria and dose constraints

The NCRP method:

• The NCRP report does not advocate the use of dose constraints when
determining shielding to members of the public
• It also does not take into account attenuation by the patient, but does
utilise the other elements of pre-filtration used in the BIR report
• The design limit is therefore 1 mSv/year to these uncontrolled areas
• The NCRP approach uses a design limit of 5 mSv/year when considering
protection of employees (effectively a constraint of 0.25)
• Areas where this design limit is used are termed controlled areas and are
considered to be subject to access control
• Persons in such areas will have some training in radiation safety, and
normally are monitored for radiation exposure. This nomenclature is
specific to the legislative framework in the USA

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24.7. SHIELDING
24.7.8. Occupancy

• The occupancy factor is the fraction of an 8 hour day, (2000 hour

year or other relevant period, whichever is most appropriate) for
which a particular area may be occupied by the single individual
who is there the longest

• The best way to determine occupancy is to use data derived from

the site for which the shielding is being designed, taking into
consideration the possibility of future changes in use of
surrounding rooms

• This is not always possible and so suggested figures for

occupancy levels are provided in both the BIR and NCRP reports

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 95
24.7. SHIELDING
24.7.8. Occupancy

BIR SUGGESTED OCCUPANCY FACTORS

Possible
Location Occupancy
factors
Adjacent X ray room, Reception Areas, Film Reading Area, X 100 %
ray Control Room
Offices, shops, living quarters, children’s indoor play areas, 100 %
occupied space in nearby buildings, Staff Rooms
Patient Examination and Treatment rooms 50 %
Corridors, wards, patient rooms 20 %
Toilets or bathrooms, Outdoor areas with seating 10 %
Storage rooms, Patient changing room, Stairways, 5%
Unattended car parks, Unattended waiting rooms

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24.7. SHIELDING
24.7.8. Occupancy

NCRP SUGGESTED OCCUPANCY FACTORS

Possible
Location Occupancy
factors
Offices and X ray control areas 1
Outdoor areas (car parks, internal areas – 1/40
stairwells, cleaner’s cupboards)
Corridor adjacent to an X ray room 1/5
Door from the room to the corridor 1/8

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24.7. SHIELDING
24.7.8. Occupancy

• The product of the design constraint and the reciprocal of the

occupancy factor should not exceed any dose limit used to
define a controlled area

• For example, take the situation where an occupancy factor of

2.5 % was used and regulation required that areas with annual
doses greater than 6 mSv be controlled

• The actual dose outside the barrier would be

40 x 0.3 = 12 mSv per annum and consequently the area
would need to be designated as controlled; presumably this
would not be the designer’s intention

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 98
24.7. SHIELDING
24.7.9. NCRP & BIR methodologies for shielding calculations

For radiographic and fluoroscopic applications, workload is

expressed in terms of dosimetric quantities differently by:

BIR report NCRP report

ESD and KAP machine related mA·min

For plain film radiography:

BIR report NCRP report

patient does attenuate patient does not attenuate
the X ray beam the X ray beam

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 99
24.7. SHIELDING
24.7.9.1. NCRP method: Conventional Radiology

• The easiest way to use the NCRP method is to make use of the
tabulated data on workload distributions found in the report

• The installations for which data are provided range from

mammography through general radiography/fluoroscopy, to
interventional angiography

• The tables in the report provide values of unshielded air kerma K at

a nominal focus to image receptor distance dFID, for a nominal field
area F, and a nominal value of W. These can then be used, in
conjunction with the transmission equations to determine the
required degree of shielding

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 100
24.7. SHIELDING
24.7.9.1. NCRP method: Conventional Radiology

• The tables of unshielded kerma and the extended data are based
on data from surveys carried out in the USA and may not be
representative of practice in different countries or reflect changes
that have resulted from subsequent advances in technology or
practice
• The user can however modify K for their own particular values of
W, F and dFID either manually or by using software that can be
obtained from the authors of the NCRP report to produce a user
specific workload distribution
• It should be noted that the use of additional beam filtration, such as
copper, while reducing both patient entrance dose and scatter will
also result in an increase in mA. In this case the use of mA-min as
a measure of workload may be misleading
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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 101
24.7. SHIELDING
24.7.9.2. NCRP method: Computed Tomography

• The NCRP approach to determining the shielding requirements

for CT installations proposes the use of the relationship between
dose length product (DLP) and scattered kerma

• This makes the determination of scattered radiation incident on a

barrier straightforward

• The person designing the shielding must identify the total DLP
from all of the body and head scan procedures carried out in a
year and then determine the scattered kerma using the different
constants of proportionality assigned to each

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24.7. SHIELDING
24.7.9.2. NCRP method: Computed Tomography

• If there are no DLP data available for the facility then national
DRLs or other appropriate published data can be used

• The authors of the NCRP report point out that a considerable

number of examinations are repeated with contrast but using
the same procedure identifier

• If the number of scans performed with contrast cannot be

identified, they suggest using a multiplier of 1.4 for all DLP data

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 103
24.7. SHIELDING
24.7.9.3. BIR method

The BIR approach is perhaps more empirical than that advocated

in the NCRP report, in that the shielding designer is required to
evaluate the kerma incident on the barrier using methods derived
from the actual workload, and then determine the required
transmission to reduce it to the design limit required

The primary radiation incident at

the calculation point, Kb, is
Kr is the incident air kerma on the
given by
receptor
2
 d FID  n is the number of exposures
K b = nK r  
 d + d FID  d is the receptor to calculation point
distance
dFID is the focus to receptor distance
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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 104
24.7. SHIELDING
24.7.9.3. BIR method

a) Primary Radiation - In fluoroscopy and CT the primary beam is

intercepted entirely by an attenuator and is not incident directly on any
barrier so it need not be taken into account in shielding calculations
However, in the case of plain film radiography this is not the case and two
situations have to be considered:
1. the X ray beam is attenuated by the patient and other filters
such as a table, Bucky and cassette
2. some of the beam is not intercepted by the patient and unattenuated
radiation is incident on a primary barrier

In the case 1 the air kerma incident on the image receptor can be used as
the basis for the calculation of primary barrier requirements. It is
conservative to assume that the dose to an image receptor is either
10 µGy for a 400 speed screen-film system
20 µGy for a 200 speed screen-film system or
in the case of digital radiography
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24.7. SHIELDING
24.7.9.3. BIR method

a) Primary Radiation - In the case of plain film radiography

the X ray beam is attenuated (case 1) by the patient and other
filters such as a table, Bucky and cassette:

• The radiation itself will have been hardened by the patient and
in this case the relationship between transmission and thickness
of barrier will tend towards a simple exponential which can be
defined in terms of the limiting half value layer of the exit
radiation

• The amount of lead required in the barrier can be further

reduced by allowing for attenuation in the cassette, table base
and Bucky stand as is also done in the NCRP method

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 106
24.7. SHIELDING
24.7.9.3. BIR method

a) Primary Radiation - If X ray beam is not attenuated (case 2)

by the patient and other filters such as a table, Bucky and
cassette:

• In this case the primary air kerma at a barrier can be calculated

from the sum of the values of the incident air kerma (Ki) for the
appropriate number of each type of radiograph which is then
corrected by the inverse square law

• The use of entrance surface air kerma instead of Ki is more

conservative. The former quantity is larger than Ki since it
includes backscatter

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 107
24.7. SHIELDING
24.7.9.3. BIR method

b) Secondary Radiation
1) Scatter: The BIR treatment of scattered radiation relies on the fact that
scatter kerma is proportional to the KAP and can be described using the
equation
SPKA
K scat =
11

d2

Scatter factor (µGy/(Gy⋅cm2))

10

50 kV
9
Kscat is the scatter kerma at distance d 70 kV
8 85 kV
PKA is the KAP (kerma area product) 100 kV
7 125 kV
S is a scatter factor used to derive 6

the scatter air kerma at 1m 5

Experiment and Monte Carlo simulation 3

have demonstrated that S follows the 2

shape shown in the Figure 1

0
0 20 40 60 80 100 120 140 160 180

Angle (degree)

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 108
24.7. SHIELDING
24.7.9.3. BIR method

b) Secondary Radiation
1) Scatter: It can be shown that the maximum scatter kerma at a
wall 1 metre from a patient occurs at between 115 and 120 degree
scattering angle. This is the scatter kerma used in all calculations
and can be determined from:
Smax = (0.031 kV + 2.5) µGy/(Gy·cm2)
The use of KAP to predict scatter kerma has several advantages over
the method of using a measure of workload such as milliampere minute
product as
(i) no assumptions are made on field size
(ii) KAP meters are increasingly prevalent on modern fluoroscopic and
radiographic equipment with a significant amount of published data
(iii) the KAP value is measured after filtration

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 109
24.7. SHIELDING
24.7.9.3. BIR method

b) Secondary Radiation
2) Leakage component of radiation: leakage is usually defined at
the maximum operating voltage of an X ray tube and continuously
rated tube current, typically 150 kV and 3.3 mA

It is measured over a field size of 100 cm2 at 1 m from the tube

At accelerating voltages less than 100 kV the leakage component of

secondary radiation is at least one order of magnitude less than that
of scattered radiation

As the kV decreases this ratio rises to a factor of 108

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24.7. SHIELDING
24.7.9.3. BIR method

b) Secondary Radiation
2) Leakage component of radiation:
The leakage component of the radiation is considerably harder
than that in the primary beam since it has passed through at
least 2 mm of lead

Consequently although the relative component of leakage

radiation is such that the actual value need not be calculated
when formulating the overall secondary kerma, it must be
accounted for when the actual degree of shielding required is
being determined

This is best done by using transmission curves generated by

taking leakage radiation into account
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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 111
24.7. SHIELDING
24.7.9.4. BIR method: Computed Tomography

The BIR approach makes use of the:

• manufacturer supplied isodose curves and the
• identification of critical directions from these isodose
curves made by the shielding designer

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 112
24.7. SHIELDING
24.7.9.4. BIR method: Intra Oral Radiography

• The BIR approach makes the simple and justifiable

assumption that the sum of scattered and
attenuated radiation at 1 m from the patient is
1 µGy

• It is further assumed that the beam is fully

intercepted by the patient

• This makes calculation of barrier thickness a trivial

matter

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 113
24.7. SHIELDING
24.7.10. Transmission equations and barrier calculations

• The determination of the transmission of X rays through a

material is not a trivial task given that it takes place under
broad beam conditions and that the X ray spectrum is
polyenergetic

• The so-called Archer equation describes the broad beam

transmission of X rays through a material:

1 B is the broad beam transmission factor

−
 β  β γ
B = 1 +  exp (αγx ) − 
x is the thickness of shielding material

 α  α required in mm
α, β , γ are empirically determined fitting
parameters
The parameters α and β have dimensions
mm-1 whilst γ is dimensionless
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24.7. SHIELDING
24.7.10. Transmission equations and barrier calculations

−
1 Values of α, β and γ are tabulated in
 β  β γ
B = 1 +  exp (αγx ) −  the BIR and NCRP reports for a variety
 α  α of common materials

Note that the tabulated values are for

This equation may be solved for
concrete with a density of
the thickness x as a function of
transmission B: 2350 kg/m3

The required thickness for a different

 −γ β  density of concrete
 B + 
x=
1
ln  α (+/- approximately 20 %) can be

αγ  1 + β 
determined using a density ratio
 α  correction

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 115
24.7. SHIELDING
24.7.10. Transmission equations and barrier calculations

For primary barriers:

• the total calculated shielding will include any “preshielding”
provided by the image receptor and table (if the beam intersects
the table)
• NCRP 147 and the BIR report give suggested values for
preshielding xpre, which must be subtracted to obtain the
required barrier thickness, xbarrier, which is therefore calculated as

  NTUK1 γ β  Subscript ‘P’ reflects that the barrier

  P
 + 
1   PdP  α 
2
is a primary barrier
xbarrier = ln   − xpre
αγ β The use factor U is always unity in
 1+ 
 α  the case of the BIR method

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 116
24.7. SHIELDING
24.7.10. Transmission equations and barrier calculations

For secondary barriers:

• the use factor U is not included in either method and there is
no preshielding
• The required barrier thickness is described by:

  NTK 1 γ β 
  sec
 + 
1   Pdsec  α 
2 Subscript ‘sec’ indicates that the
xbarrier = ln   barrier is a secondary barrier
αγ β
 1+ 
 α 

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 117
24.7. SHIELDING
24.7.10. Transmission equations and barrier calculations

When the beam is sufficiently filtered, transmission will be

described by a simple exponential expression

This is characterised by the limiting HVL lim =

ln 2
of the beam: α

It should be noted that the barrier

thickness required can of course be  −γ β 
 B + 
calculated as a two stage process
x=
1
ln  α

i) determine the required transmission αγ  1 + β 
ii) use Eq. for HVLlim or for x to obtain the  α 
required barrier thickness

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 118
24.7. SHIELDING
24.7.11. Worked examples

The following examples show how the

NCRP147 and BIR

methods may be used in various situations

These are illustrative only
All internal walls are assumed to be newly built with
no existing shielding

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 119
24.7. SHIELDING
24.7.11.1. Radiographic Room

Wall A
• A simple radiographic room is used to
demonstrate shielding calculations for both
Wall D

the BIR and NCRP methodologies

• The shielding requirements for walls A and B
Wall B
and the control console are determined
• For the sake of simplicity, it is assumed that
Wall C
there is no cross table radiography
performed in the direction of wall A

200 patients are examined in this room per week, with an average of 1.5
images or X ray exposures per patient. There are150 chest films and 150
over-table exposures. The chest films are routinely carried out at 125 kV
For the purposes of shielding calculations, the workload excludes any
extremity examinations that take place

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 120
24.7. SHIELDING
24.7.11.1. Radiographic Room

Wall A • Wall A is adjacent to an office that

must be assumed to have 100 %
Wall D

occupancy
The annual dose limit for occupants
will be 1 mSv
Wall B
• Wall B is next to a patient treatment
room, so has an occupancy of 50 %
Wall C
Again, the annual dose limit for
occupants will be 1 mSv

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24.7. SHIELDING
24.7.11.1. Radiographic Room

Wall A
Wall D

The NCRP calculations use the

assumptions made in NCRP 147

Wall B

Wall C Assumptions made for the BIR method (UK

data) are:
• the KAP for abdomen, and spine/pelvis examinations
can be taken as 1.5 Gy·cm2 per patient
• the average KAP per chest exposure is 0.1 Gy·cm2
• the KAP weighted average exposure is taken at 90 kV
• the ESD for a chest radiograph is 0.1 mGy

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24.7. SHIELDING
24.7.11.1. Radiographic Room

Example calculations for wall A

This wall is exposed to secondary radiation only

BIR method: The total KAP from the table exposures is

1.5 (Gy·cm2 per exam) x 150 (exams) = 225 Gy·cm2 and the total KAP from
the chest exposures is 15 Gy·cm2
For ease of computation, and to be conservative, the scatter kerma at the wall
can be calculated using a total of
225 + 15 = 240 Gy·cm2. Assuming 50 weeks per year, and using

K scat = SPKA d − 2 and Smax = (0.031 kV + 2.5) µGy/(Gy·cm2)

the maximum annual scatter kerma at the calculation point 0.3 m beyond
wall A is given by: Kscat = 50(0.031 x 90 + 2.5)240/1.82 = 19.6 mGy

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24.7. SHIELDING
24.7.11.1. Radiographic Room

Example calculations for wall A

This wall is exposed to secondary radiation only

BIR method: The required transmission will depend on the dose

constraint used in the design
If a constraint of 1 is used, B =
P 1 = 1/19.6 = 5.1x10-2
T K1
and if a constraint of 0.3 is used, B will be 0.3/19.6 = 1.53x10-2
 −γ β 
B +
The BIR report advocates using 1  α 
x= ln  
parameters for 90 kV in Eq. αγ  1 + β 
 α 
These are α = 3.067, β = 18.83 and γ = 0.773
The resulting solutions are: dose constraint of 1 mSv/year,
0.34 mm lead, dose constraint of 0.3 mSv/year, 0.63 mm lead
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24.7. SHIELDING
24.7.11.1. Radiographic Room

Example calculations for wall A

This wall is exposed to secondary radiation only

NCRP method: uses the number of patients examined in the

room, i.e. 200, as the basis for calculation
In this case the use factor is zero

Table 4.7 of the NCRP report indicates that the secondary air
kerma factor (leakage plus side scatter) to use in this case is
3.4x10-2 mGy per patient at 1 m. A workload of 200 patients
results in a total annual secondary kerma at the calculation
point of Ksec = 50 x 200 x 3.4x10-2 /1.82 = 104.9 mGy

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24.7. SHIELDING
24.7.11.1. Radiographic Room

Example calculations for wall A

This wall is exposed to secondary radiation only
NCRP method: Again, the required transmission will depend on
the dose constraint used in the design
If a constraint of 1 is used B will be 9.53 x 10-3 and
if a constraint of 0.3 is used B will be 2.86 x 10-3
The NCRP report recommends using workload spectrum specific
parameters to solve the transmission equation
For a radiographic room these are (for lead):
α = 2.298, β = 17.3 and γ = 0.619

The resulting solutions are:

dose constraint of 1 mSv/year, 0.77 mm lead
dose constraint of 0.3 mSv/year, 1.17 mm lead
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24.7. SHIELDING
24.7.11.1. Radiographic Room

Example calculations for wall B Wall A

Wall D
BIR method: Protection is required for primary
transmission through the wall behind the chest

Wall B
stand. An air gap is used and the focus to film
distance is 3 m, so the focus to calculation point
Wall C
distance is 4.3 m as the Bucky is 1 m out from
the wall

The patient entrance surface to film distance is estimated at

0.5 m, thus the focus to skin distance is 2.5 m. Because one cannot
always be certain that the patient will always intercept the X ray beam,
entrance surface dose is used to determine the air kerma at the
calculation point

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24.7. SHIELDING
24.7.11.1. Radiographic Room

Example calculations for wall B

BIR method: In the absence of the chest stand, the inverse square
law indicates a primary air kerma of
100(2.5 / 4.3)2 = 34 µGy per chest X ray

The BIR report assigns a 2.7 % transmission through the chest stand
itself, resulting in a total incident air kerma of
0.034 x 50 x 150 x 0.027 = 6.8 mGy per year
The X ray beam must be considered to be heavily filtered, so use of
limiting HVLs, as defined in HVLlim = ln 2 / α is required

The number of limiting HVLs, n, needed is easily obtained using the

relation n = log2(1/B)

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24.7. SHIELDING
24.7.11.1. Radiographic Room

Example calculations for wall B

BIR method: The required transmission, B, for

a constraint of 1 will be 2/6.8 = 0.29 and for
a constraint of 0.3 will be 0.6/6.8 = 0.09 since the occupancy of
the room adjacent to Wall B is 50 %

The limiting HVL at 125 kV is 0.31 mm lead so the resulting

solutions are:

dose constraint of 1 mSv/year, 0.5 mm lead (1.8 HVLs)

dose constraint of 0.3 mSv/year, 1.0 mm lead (3.5 HVLs)

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24.7. SHIELDING
24.7.11.1. Radiographic Room

Example calculations for wall B

NCRP method: uses the total number of patients examined in the

room as the basis for calculation. In this case the number is 200 and
not 100, the number of patients who undergo chest examinations
alone
This may appear counter intuitive but should be used since the fraction of
patients who receive examinations on the chest stand is accounted for in the
workload spectra provided in the report
Table 4.5 of the NCRP report indicates that for a chest stand in a
radiographic room, the unshielded primary air kerma is
2.3 mGy per patient at 1 m
The annual unshielded primary kerma at the calculation point is
2.3 x 50 x 200/4.32 = 1244 mGy

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24.7. SHIELDING
24.7.11.1. Radiographic Room

Example calculations for wall B

NCRP method: The required transmission, B, for
a constraint of 1 is 2/1244 = 1.6 x 10-3 and for
a constraint of 0.3 is 0.6/1244 = 4.82 x 10-4

The workload specific fitting parameters for a chest stand in a

radiographic room are given in NCRP 147 as
α = 2.264, β = 13.08 and γ = 0.56

The resulting solutions are:

dose constraint of 1 mSv per year, 1.45 mm lead
dose constraint of 0.3 mSv per year, 1.93 mm lead

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24.7. SHIELDING
24.7.11.1. Radiographic Room

Example calculations for wall B

NCRP method: The prefiltration provided by a wall mounted
imaging receptor is given as 0.85 mm lead in Table 4.6 of the
NCRP report. Thus the required protection is:
dose constraint of 1, 0.6 mm lead
dose constraint of 0.3, 1.1 mm lead

• It can easily be shown that the shielding for scatter from the
chest stand plus the table is less than is required for the
primary radiation

• Hence if the whole of Wall B is shielded as above, it will be a

scatter shield as well

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 132
24.7. SHIELDING
24.7.11.2. Mammography

Mammography installations are much simpler and are

treated in a similar manner in both reports
Public toilets

Wall A – Waiting room

Wall D –

Assume the following:

1.5m 2m • The X ray unit operates at a maximum
35 kV
1m Wall B – Corridor • The patient load is 50 patients/week
1.5m • Field size 720 cm2 maximum
1.5m
Control • Focus-detector distance 650 mm
Wall C – External (masonry) • Scattered radiation only (primary fully
intercepted by detector assembly)

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24.7. SHIELDING
24.7.11.2. Mammography

• NCRP147 assumes a conservative maximum value for

scattered radiation of 3.6 x 10-2 mGy per patient
(4 images) at 1m, assuming a conservative 100 mAs per
view

• The inverse square law can then be used to calculate

weekly dose at any point

• Instead of calculating the required barrier thickness,

NCRP147 provides simple curves of attenuation by plaster
wallboard and solid wood for doors

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24.7. SHIELDING
24.7.11.2. Mammography

• In the case of walls A and C and the entry

door, the required transmission is >1, i.e.
Public toilets

Wall A – Waiting room

Wall D –

no shielding is required. Normal wallboard

1.5m 2m construction can be used, although a solid
core timber door is suggested

Wall B – Corridor
1m
1.5m • For walls B and D, the required
1.5m
Control transmission is minimal at 0.75. From
Wall C – External (masonry) NCRP147, normal wallboard construction
will be sufficient

All mammography unit manufacturers supply a shielded area for the

operator, usually with 1 mm lead equivalence

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24.7. SHIELDING
24.7.11.3. Cardiac Catheterisation Lab

Both the BIR and NCRP

reports include indicative
calculations showing how
the respective methods can
be utilised in a
catheterisation laboratory
(cath lab)

Calculating the examples in the two reports:

BIR : a = 2.6 m, b = 9.5 m, c = 6 m, d = 6.3 m
NCRP: a = 4.0 m, b = 14.6 m, c = 9.2 m, d = 9.7 m

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24.7. SHIELDING
24.7.11.3. Cardiac Catheterisation Lab

In the example, the calculation is repeated to demonstrate each

method applied using
(i) the room geometries described in the reports and
(ii) a) a dose constraint of 0.3 (design to 0.3 mSv, assuming
100 % occupancy)
b) no dose constraint (design to 1.0 mSv, assuming 100 %
occupancy)
The workload used for the NCRP method is that in report 147 for 25
patients/week undergoing cardiac angiography. The method predicts
a total secondary air kerma of 3.8 mGy per patient at 1 m

The BIR report contains examples where the workload is

26 Gy·cm2 per examination and 50 Gy·cm2 per examination

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24.7. SHIELDING
24.7.11.3. Cardiac Catheterisation Lab

• Since a workload of 50 Gy·cm2 corresponds to a complex

examination such as a PTCA with 1 stent, that conservative value is
used here
• A conservative, operating voltage of 100 kV is assumed for
calculation of the scatter kerma using
Smax = (0.031 kV + 2.5) µGy/(Gy·cm2)

• This results in a scatter kerma of 0.28 mGy at 1 m from the patient

• Barrier requirements are calculated using the secondary
transmission parameters at 100 kV (α = 2.507, β = 1.533x101,
γ = 9.124x10-1) for the BIR example and using the coronary
angiography specific parameters (α = 2.354, β = 1.494x101,
γ = 7.481x10-1) for the NCRP example

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24.7.11.3. Cardiac Catheterisation Lab

Barrier thickness in Barrier Distance

mm lead to give same Design Limit 2.6 m 4.0 m
degree of protection NCRP BIR NCRP BIR
using calculations based 0.3 mSv 2.2 1.2 1.80 0.9
on NCRP and BIR 1.0 mSv 1.7 0.8 1.30 0.5
methods
• It can be seen that the BIR method calculates that less
shielding is needed
• An analysis of the data shows that this is mostly due
to the estimates for scatter at 1 m from the patient:

3.8 mGy for the NCRP method and

0.28 mGy for the BIR approach
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24.7. SHIELDING
24.7.11.3. Cardiac Catheterisation Lab

• The value of 50 Gy·cm2 per patient used in the BIR

method is consistent with published European data

• The implication is in this case at least, that the

NCRP workload data, measured in mA·min, are not
consistent with workloads in Europe and care
should be taken if the method is utilised in this type
of calculation

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24.7. SHIELDING
24.7.11.4. Intra oral radiography

The BIR report makes the assumption that the primary beam is
always intercepted by the patient. Provided that this is the
case, the weighted average primary plus scatter dose at a
distance of 1 m is of the order of 1 µGy per film

Required transmission (shielding), B, for

differing numbers of exposure per week
Barrier distance (m)
Films/week 1.0 1.5 2.0 2.5 3.0
10 0.58 None None None None
20 0.29 0.65 None None None
50 0.12 0.26 0.46 0.72 None
100 0.06 0.13 0.23 0.36 0.71
200 0.03 0.06 0.12 0.18 0.35

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24.7. SHIELDING
24.7.11.4. Intra oral radiography

Required transmission (shielding), B, for

differing numbers of exposure per week
Barrier distance (m)
Films/week 1.0 1.5 2.0 2.5 3.0
10 0.58 None None None None
20 0.29 0.65 None None None
50 0.12 0.26 0.46 0.72 None
100 0.06 0.13 0.23 0.36 0.71
200 0.03 0.06 0.12 0.18 0.35

The dose constraint is 0.3 mSv per annum

It can be seen that no shielding at all is required in many cases

and according to the BIR report, partition walls with
10 mm gypsum plasterboard on each side will provide adequate
protection in the majority of situations

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24.7. SHIELDING
24.7.11.5. Computed Tomography

The design of CT scanner shielding should take the

following into account:
• the X ray beam is always intercepted by the patient and
detector, thus only scattered radiation needs to be
considered
• the X ray tube operating voltage is high, from 80 to 140 kV
• the X ray beam is heavily filtered (high HVL)
• the total workload is very high, measured in thousands of
mAs/week
• the scattered radiation is not isotropic (and has more of an
“hourglass” distribution)

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24.7. SHIELDING
24.7.11.5. Computed Tomography

• One approach to shielding design is to use the manufacturer-

supplied isodose maps
• These give scattered radiation levels per unit of exposure, usually in
mA.min. The use of this approach, which is described in detail in the
BIR report, requires assessment of the total workload in mA.min
(with correction for kV where necessary) and the identification of
critical directions from the isodose map in order to calculate the
points of maximum dose

P 1
• Barrier requirements can then be determined from B=
T K1
• This process is straightforward but time consuming and is dependent
on the manufacturer supplying the correct isodose maps

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24.7. SHIELDING
24.7.11.5. Computed Tomography

• If however the NCRP method utilising the DLP (dose-length

product) is employed all the user needs is the DLP values for
each procedure type and the average number of procedures
of each type per week

• This should be ideally obtained from an audit of local

practice, but may also be a DRL (Diagnostic Reference
Level) or another value obtained from the literature

• The NCRP report provides typical US data for DLP

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24.7. SHIELDING
24.7.11.5. Computed Tomography

• Once the scatter kerma incident on the barrier has been

determined, barrier requirements can be determined using
the secondary CT transmission parameters

• for lead:
at 120 kV (α = 2.246, β = 5.73, γ = 0.547)
at 140 kV (α = 2.009, β = 3.99, γ = 0.342)

• for concrete:
at 120 kV (α = 0.0383, β = 0.0142, γ = 0.658)
at 140 kV (α = 0.0336, β = 0.0122, γ = 0.519)

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24.7. SHIELDING
24.7.11.5. Computed Tomography

• In the (common) case where both 120 and 140 kV are

used clinically, it would be prudent to use transmission
data for 140 kV. This approach assumes isotropy of
scattered radiation, but errs on the side of conservatism

• In order to reduce the scatter kerma appropriately, it is

important that all barriers extend as close as possible to
the roof, not just to the standard 2100 mm above the floor

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24.7. SHIELDING
24.7.11.5. Computed Tomography

Scatter estimation
• NCRP 147 estimates the scatter fraction/cm at 1 m from a body
These
or head
include
phantom
a small
as: tubekhead
leakage 10-5 cm-1
= 9 x component
kbody = 3 x 10-4 cm-1

• The total kerma from scatter and leakage at 1 m distance can

then be estimated as:
Ksec (head) = khead x DLP x 1.4
Ksec (body) = 1.2 x kbody x DLP x 1.4

• The factor of 1.4 allows for contrast examinations. The factor of

1.2 arises from the assumptions made by the authors of the
NCRP report

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24.7. SHIELDING
24.7.11.5. Computed Tomography

Example CT Shielding Calculation Assume that:

• 30 head and 45 body
Exterior wall, 5 m above ground
examinations are performed per
Office Control week (actual average)
• the mean DLP for head
A B
examinations is 1300 mGy·cm
• the mean DLP for body
E
C examinations is 1250 mGy·cm
D
Examinat-
Corridor ion room
• distances from scan plane to
Recovery bed bay calculation points are
(i) A = 2.5 m, (ii) B = 4.5 m,
(iii) C = 6.5 m, (iv) D = 4 m and
(v) E = 3.5 m
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24.7. SHIELDING
24.7.11.5. Computed Tomography

The scatter at each point can be calculated

• For example, take point B (control room)
The total weekly scatter (occupancy of 1) is:
K (head) = 9 x 10- 5 x 1300 x 30 x 1.4 x 12/4.52 = 0.24 mGy/week
K (body) = 1.2 x 3 x 10- 4 x 1250 x 45 x 1.4 x 12/4.52 = 1.4 mGy/week
The total scatter is thus 1.64 mGy/week

• If the target weekly dose is 0.1 mGy, corresponding to an annual dose

constraint of 5 mSv to the control room, the minimum lead shielding at
140 kV is 0.6 mm lead
• An annual dose constraint of 1 mSv would require 1mm lead and an
annual dose constraint of 0.3 mSv, 1.5 mm lead
• In all cases, the viewing window must have at least the same lead
equivalence as the wall
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24.7. SHIELDING
24.7.11.5. Computed Tomography

For other rooms the target dose will be dependent on the dose
constraint used for members of the public in the shielding design In
this example, an occupancy of 1 will be assumed for
the office
recovery bay
examination room
whilst an occupancy of 1/8 is assumed for the
corridor
as suggested in the NCRP report

A dose constraint of 1 mSv per year will be used

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24.7. SHIELDING
24.7.11.5. Computed Tomography

The required shielding can then be calculated:

Exterior wall, 5 m above ground

Office Control Office 1.5 mm

A B
Control 0.6 mm
Examination 0.8 mm
Recovery 1.2 mm
E
C Entry door 0.6 mm
D
Examinat-
Corridor ion room
Recovery bed bay

• In practice, it would not be unusual to specify all walls at

1.5 mm lead, in order to avoid errors during construction and to
allow for future layout changes

• The principal cost of shielding is the construction and erection,

rather than the lead itself
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24.7. SHIELDING
24.7.12. Construction principles

Irrespective of the calculation

methodology, the construction
of shielding barriers
is essentially the same

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24.7. SHIELDING
24.7.12.1. Shielding materials

• While lead is an obvious choice, there are other materials such

as concrete, steel and gypsum wallboard (both standard and
high density)
• Masonry bricks may also be used, but the user must be aware of
the pitfalls. The most obvious problem is voids in the brick of
block material. These must be filled with grout, sand or mortar
Even then, the actual attenuation will depend on the formulation
of the masonry and filling

• Lead will come in the form of sheet bonded to a substrate such

as gypsum wallboard or cement sheet. Sheet lead alone must
never be used as it is plastic in nature, and will deform and droop
over time

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24.7. SHIELDING
24.7.12.2. Interior walls

Interior walls are easily constructed using a

“sheet on frame” process
Lead sheet is supplied commercially in nominal mass densities,
expressed in kg⋅m-2, or lb⋅ft -2, depending on the supplier
The thickness can be calculated using the density of lead
• Gypsum wallboard is of minimal use for shielding except for
mammography and dental radiography, as it provides little attenuation at
typical X ray energies
• Gypsum may also contain small voids, and can have non-uniform
attenuation
• In some countries, high density wallboard (usually provided by barium in
the plaster) is available. Each sheet may be equivalent to about 1mm lead
at typical tube voltages

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24.7. SHIELDING
24.7.12.2. Interior walls

• Joins between sheets must have an overlap in the shielding of at

least 10 mm
• Sheets of shielding may be applied using normal fasteners
• Gaps in the barrier however such as for power outlets should be
sited only in secondary barriers, and even then must have a
shielded backing of larger area than the penetration (to allow for
angled beams)
• In general, penetrations should be located either close to the floor,
or >2100 mm above the floor, which is often above the shielding
material

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24.7. SHIELDING
24.7.12.3. Doors

• Doors are available with lead lining

• The builder must be aware that there can be discontinuities in
the shielding at the door jamb, and in the door frame in
particular
• This can be addressed by packing the frame with lead sheet of
the appropriate thickness glued to the frame

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24.7. SHIELDING
24.7.12.4. Floors and ceilings

• Concrete is a common building material for floors

• It is cast either in a constant thickness slabs (except for load-bearing
beams), or with the assistance of a steel deck former with a “W” shape
• Slabs are of varying thickness, and the slab thickness must be taken into
account if it is to act as a shielding barrier
• Formers can have a small minimum thickness, and knowledge of this is
essential
• The minimum thickness is all that can be used in shielding calculations

For diagnostic X ray shielding, most slabs provide sufficient

attenuation, but the barrier attenuation must still be calculated

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24.7. SHIELDING
24.7.12.4. Floors and ceilings

• The designer of shielding must also be aware that, unless

poured correctly, voids can form within a concrete slab

• In some cases the floor may be of timber construction, which will

sometimes require installation of additional shielding

• Another factor which must be determined is the floor-to-floor

distance, or pitch, as this will have an influence on doses both
above and below

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24.7. SHIELDING
24.7.12.5. Windows

• Observation windows must provide at least the same radiation

attenuation as the adjacent wall or door

• Normal window glass is not sufficient (except where the required

attenuation is very low, such as in mammography), and materials
such as lead glass or lead acrylic must be used

• Lead acrylic is softer than glass, and may scratch easily

• Where lead windows are inserted into a shielded wall or door, the
builder must provide at least 10 mm overlap between the
wall/door shielding and the window. This may in some cases
need to be greater, for example when there is a horizontal gap
between the shielding materials

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24.7. SHIELDING
24.7.12.6. Height of shielding

As a general rule, shielding need only extend to

2100 mm above finished floor level, but as already
stated, this will not be the case in all installations, the
most notable exception being CT

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24.7. SHIELDING
24.7.13. Room surveys

After construction of shielding, the room

must be surveyed to ensure that the
shielding has been installed as specified

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24.7. SHIELDING
24.7.13.1. Visual verification

• The simplest way to verify construction of shielding according to the design

is to perform a visual inspection during construction
• For example, if the barrier is to be constructed from lead wallboard on one
side of a timber or steel frame, as is commonly the case, the shielding can
be inspected before the second side is covered
• This is quick and allows problems to be dealt with during construction
• Additional shielding over penetrations can also be seen, and the lead sheet
thickness can be measured
• Photographs should be taken for later reference
Penetrations
Locations where Door frames
most problems Overlap between wall shielding and windows
occur include: Corners
Overlap between wall shielding sheets

This method, whilst the best, requires good co-operation and timing
between the builder and the person performing the inspection
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24.7. SHIELDING
24.7.13.2. Transmission measurements

If a visual survey cannot be performed until construction is

complete, then radiation transmission methods must be
used
These can be divided into:

• Detection of any shielding

faults (qualitative) using a radioactive isotope,
or X ray equipment, as the
• Measurement of radiation source
transmission (quantitative)

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24.7. SHIELDING
24.7.13.2. Transmission measurements

• The detection of shielding faults can be achieved with a Geiger

counter using the audible signal to indicate the level of radiation
Note however that this instrument should not be used to quantify
radiation levels owing to its poor response to low energy photons
• The best radiation source is a radioisotope with an energy similar
to the mean energy of a diagnostic beam at high kV: 241Am (60
keV), 137Cs (662 keV) and 99mTc (140 keV) are often used for this
purpose
• If such a source is used, the tester must be aware of safety
issues, and select an activity which is high enough to allow
transmission detection, without being at a level that is hazardous
• Remote-controlled sources are preferable

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24.7. SHIELDING
24.7.13.2. Transmission measurements

• Use of the X ray equipment as the source can be difficult. For radiographic
units of any type, the exposure times are so short as to make a thorough
survey almost impossible unless many exposures are made
• A distinction also has to be made between surveying for primary and
secondary radiation barriers
• If the room contains a fluoroscopy unit only, then the unit itself, with a
tissue-equivalent scatterer in the beam, can make a useful source
• In both cases a reasonably high kV and mAs/mA should be used to
increase the chance of detection of faults in shielding
• The use of radiographic film can also be useful if the shielding material is
thought to be non uniform (as might be the case with concrete block
construction). The above tests can find gaps and inconsistencies in
shielding, but cannot quantify the amount of shielding

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24.7. SHIELDING
24.7.13.2. Transmission measurements

• Quantitative transmission methods require the measurement of the

incident and transmitted radiation intensities (with correction for
inverse square law where appropriate), to allow calculation of
barrier attenuation
• For monoenergetic radiation such as from 241Am a good estimate of
lead or lead equivalence may then be made using published
transmission data
• 99mTc can also be used to determine lead thickness. However, if
used to determine lead equivalence in another material, the user
should be aware of the pitfalls of using a nuclide with energy of 140
keV as the K absorption edge of lead is at 88 keV

• For polyenergetic radiation from an X ray unit, estimation of lead

equivalence is more difficult
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24.7. SHIELDING
24.7.13.3. Rectification of shielding faults

• Any faults detected in

shielding must be rectified

• The most easily fixed

problems are gaps

• The figures show how they

can occur, and can be
rectified

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BIBLIOGRAPHY

• INSTITUTE OF PHYSICS AND ENGINEERING IN MEDICINE, Guidance on

the Establishment and Use of Diagnostic Reference Levels for Medical X ray
Exams, IPEM Rep. 88, York (2004)

• INTERNATIONAL ATOMIC ENERGY AGENCY, International Basic Safety

Standards for Protection against Ionizing Radiation and for the Safety of
Radiation Sources, Safety Series No. 115, IAEA, Vienna (1996)

• INTERNATIONAL ATOMIC ENERGY AGENCY, Occupational Radiation

Protection, IAEA Safety Standards Series, No. RS-G-1.1, IAEA, Vienna (1999).
www-pub.iaea.org/MTCD/publications/PDF/Pub1081_web.pdf

• INTERNATIONAL ATOMIC ENERGY AGENCY, Assessment of Occupational

Exposure Due to External Sources of Radiation, IAEA Safety Standards
Series, No. RS-G-1.3, IAEA, Vienna (1999). http://www-
pub.iaea.org/MTCD/publications/PDF/Pub1076_web.pdf

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 169
BIBLIOGRAPHY

• INTERNATIONAL ATOMIC ENERGY AGENCY, Radiological Protection for

Medical Exposure to Ionizing Radiation, IAEA Safety Standards Series, No.
RS-G-1.5, IAEA, Vienna (2002). www. pub.iaea.org /MTCD/
publications/PDF/Pub1117_scr.pdf
• INTERNATIONAL ATOMIC ENERGY AGENCY, Applying Radiation Safety
Standards in Diagnostic Radiology and Interventional Procedures Using X
Rays, Safety Reports Series No. 39, IAEA, Vienna (2006). http://www-
pub.iaea.org/MTCD/publications/PDF/Pub1206_web.pdf
• INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION,
Pregnancy and Medical Radiation ICRP Publication 84, Pergamon Press,
Oxford and New York (2000)
• INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION,
Radiation and Your Patient: A Guide for Medical Practitioners, ICRP
Supporting Guidance 2, Pergamon Press, Oxford and New York (2001).
http://icrp.org/docs/rad_for_gp_for_web.pdf

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 170
BIBLIOGRAPHY

• INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION,

Radiological Protection in Medicine. ICRP Publication 105. Annals of the
ICRP 37(6), Elsevier, (2008)

• INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION, The

2007 Recommendations of the International Commission on Radiological
Protection, ICRP Publication 103, Annals of the ICRP (2008)

• MARTIN, C.J., SUTTON, D.G., Practical Radiation Protection in Healthcare,

Oxford University Press, Oxford (2002)

• NATIONAL COUNCIL ON RADIATION PROTECTION AND

MEASUREMENTS, Structural Shielding Design for Medical X-Ray Imaging
Facilities, NCRP Rep. 147, Bethesda, MD, USA (2004)
www.ncrppublications.org

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Diagnostic Radiology Physics: a Handbook for Teachers and Students – chapter 24, 171
BIBLIOGRAPHY

• NATIONAL COUNCIL ON RADIATION PROTECTION AND MEASUREMENTS,

Ionizing Radiation Exposure of the Population of the United States, NCRP Rep.
160, Bethesda, MD. (2009)

• OFFICE OF ENVIRONMENT AND HERITAGE, Radiation Guideline 7:

Radiation Shielding design, assessment and verification requirements, NSW
Government, Australia, (2009). http://www.environment.nsw.gov.au/
resources/radiation/09763ShieldingGuideline.pdf

• SUTTON, D.G., WILLIAMS, J.R., (Eds), Radiation Shielding for Diagnostic X-

rays: Report of a Joint BIR/IPEM Working Party, British Institute of Radiology,
London, (2000). http://www.bir.org.uk

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