Review article

Radiation protection in radiology department among health care

workers.
V. Kumar, M. Sharma, P. Shree, I.S pal, Himakshi, Anshika, S. Kar, V. Kumar
Abstract
Radiation is energy that travels through a medium in waves or particles, with two types: ionizing
and non-ionizing radiation. Ionizing radiation can cause harmful effects like cancer and direct cell
damage, but can be dangerous when used incorrectly or in high doses. The International Commis-
sion on Radiological Protection (ICRP) and the Atomic Energy Regulatory Board (AERB) work to
protect against ionizing radiation. Prioritizing radiation protection in radiography requires constant
monitoring and knowledge about its hazards. Advancements in healthcare technology increase the
use of radiation in diagnosis and therapy. To reduce health risks, healthcare professionals should
minimize exposure time, maximize distance between sources and patients, and use proper shield-
ing. The TDS principle (Time, Distance, Shielding) can be used to reduce radiation risks, and per-
sonal protective apparel can also be used.
Goals- To ascertain what barriers such as lack of knowledge, inadequate training, or a dearth of
resources keep the radiology department from adhering to radiation safety regulations.
Aim- This article's goals are to examine the information that is currently available about the variety
of radiation protection .
Techniques- Review of a few chosen works of literature, legal texts, and national and international
recommendations.
Outcomes -Clear rationale for radiological exams and methods designed to reduce radiation expo-
sure while offering the necessary diagnostic data are crucial from the standpoint of radiological
protection. Talk- Referring physicians should collaborate with radiologists who share responsibility
for selecting the most appropriate imaging modalities, and make sure they follow the established
guidelines for medical imaging.

1. INTRODUCTION

Radiation is a energy that travels through a medium in the form of waves or particles. There are
two source of radiation Natural and Man-made radiation. Some of the radiation causes Biological
effects. Radiation are of two types:- Ionizing radiation and Non-ionizing radiation. Non ionizing
radiation have energy to move the atom in the molecule or vibrate the molecule but it can’t remove
the electron from the atom. There are some types of non-ionizing radiation e.g. microwave, radio
wave etc. Ionizing radiation can remove the electron from the atom. It can cause harmful effects
like cancer. It cause direct damage to the cell. Although ionizing radiation has numerous applica-
tions in medicine, research, and construction, it can be dangerous when used incorrectly or in high
doses. When we use radiation, it is essential that we are using proper shielding to protect ourself
from it harmful biological effects. The International Commission on Radiological Protection
(ICRP) is a key organization focused on protecting against ionizing radiation. The Atomic Energy
Regulatory Board (AERB) implements safety provisions under the Atomic Energy Act, 1962. Pri-
oritizing radiation protection in radiography requires constant monitoring. It is necessary that we
have enough knowledge about radiation protection, when we are doing work under the presence of
radiation. Radiation protection is necessary to prevent the radiation worker, Patient and Public from
the hazards of radiations. Its hazards or ill effects like carcinoma and skin disorders. According to
radiation safety theory, radiation harm to human body and environment.[1,8,13,14] Due to the ad-
vancement in healthcare technology it increases the use of radiation in both diagnosis and therapy.
With the use we should we should follow the principles of radiation protection justification, im-
proving protection and safety, should be applied dose limits. In medical imaging where there is
need of ionizing radiation we should obtain accurate result by giving low dose of radiation.
It can be done by a healthcare professional who have enough knowledge about the ill effects of ra-
diation. By minimizing the time to be exposed, by maximizing the distance between the source and
patient and optimum distance between the source and radiographer and proper shielding for the
protection of patient, worker as well as public.[15,21] Workers who are working in the radiology
department are exposed by ionizing radiation. The damage depend on the duration of time. There
are some guidelines implemented and strong recommendations by the ICRP for decreasing the ra-
diation exposure known as ALARA “As low as reasonable achievable. The ALARA principles
used to decrease the exposure. ALARA suggest that we should give low exposure as much as we
can and produce the image of optimum quality.[7]
Large use of ionizing radiation increases the concern of radiation protection for both patient and staff.
Some health hazards can occur to patient. It can also occur to staff who are exposed by ionizing radia-
tion. The ill effects of ionizing radiation are skin burn, hair loss, and acute radiation syndrome. Maxi-
mum radiation effects need large amount of radiation which cannot occur by single time exposure but
could occur by Computed Tomography or by interventional procedures. Long term exposure can cause
risk of cancer.[10] Biological consequences arise from ionizing radiation's interaction with human living
tissue at the atomic level. These biological effects fall into two categories: deterministic effects, which
happen when the response's amplitude is proportionate to the absorbed dose, and non-observable effects,
which happen below a specific level. Furthermore, nondeterministic effects lack dose limits and depend
on the absorbed dose; they take into account the possibility of the change occurring rather than its severi-
ty. The patients' and the operating staff's circumstances are dangerous.[11] Radiation has different health
risks which can be increase by the increase in exposure time and by increasing dose level. The effects
includes Cancer, cataract, infertility and genetically ill health and degenerative abnormalities. Staff
working in the radiation department should have adequate knowledge about the radiation protection and
ill effects of radiation. The risks of ill effects from the radiation can be reduced by following the TDS
principle. TDS (Time, Distance, Shielding). It can be reduced by using different monitoring devices.
Monitoring devices like Personal monitoring device and area monitoring device. By using personal pro-
tective apparels like lead apron, thyroid shield, gonadal shield, lead googles [23] The hazards of radia-
tion can be decreased by TDS principle. Even we can detect the radiation exposure by using different
monitoring devices such as thermos-luminescent dosimeter (TLDs) and Geiger Muller (GM) counters.
Regular use of Personal protective equipment can provide an average of 75-80% protection to the bone
marrow. Lead shielding is very important protective measure against radiation exposure.[24] It’s the re-
sponsibility of a radiographer to take steps to protect patient from the harmful effects of radiation expo-
sure. Radiographer should protect patient form unnecessary exposure both primary and secondary expo-
sure. The gonads, thyroid and eyes should not be exposed by primary radiation exposure. There are some
essential tools which we can use to protect patient as well as ourself from radiation exposure. Tools like
collimation, cones and filters. And also scattered radiation should be reduced by using proper guidelines.
[29] Radiographers or the staff which are working there have to aware of occupational dose limits as
well as most sensitive tissues of the body and the adverse effects according to age difference. Advance
knowledge should be required to set up appropriate parameters on an radiology modality.[31]

2. BIOLOGICAL EFFECTS OF RADIATION

The harmful effects caused to human being and other living beings due to their exposure to radiation is
called as biological effects of radiation.

3. INTERACTION OF RADIATION WITH THE CELL

3.1Direct Action

Due to direct deposition of energy in THE TARGET MOLECULE (Deoxyribonucleic Acid- DNA). Di-
rect action is predominant with high LET radiation, e.g. alpha particles and neutrons.

3.2Indirect Action

Due to deposition of energy in the surrounding water & reaction of free radical formed in the water with
the Target Molecule-DNA. Indirect action is predominant with low LET radiation, e.g. X and gamma
rays.
Proportion of Indirect Effect ≈70%

4. RADIATION EFFECTS ON CELLS

Basically, there are three things that can happen:
 The radiation may pass through the cell without doing any damage to cell.
 The radiation may damage the cell so that the cell not only form to repair itself but reproduces itself
in the damaged form - Biological Response
 The radiation may cause so much damage, cells dies.
5. TYPES OF EFFECTS

5.1 Deterministic effects: Deterministic effects of radiation are health effects that are directly related to
the dose of radiation absorbed, and become more severe as the dose increases. They are also known as
acute health effects, or radiation sickness. Deterministic effects occur when cells die due to irreparable
radiation-induced DNA damage, which can lead to premature cell death or the inability of the cell to di-
vide. If cells are damaged faster than they can be repaired, the exposed person's health may be adversely
affected.

5.2 Stochastic effects: Stochastic effects of radiation are chance events that occur when ionizing radia-
tion changes the genetic material of cells, also known as stochastic radiation damage. The probability of
a stochastic effect increases with dose, but the severity of the effect is independent of the
dose. Stochastic effects are also known as delayed effects because they don't show up immediately. For
example, radiation-induced cancers are usually observed three to twenty years after exposure.

6. EFFECTIVE DOSE

Effective dose is calculated for the whole body. It is the addition of equivalent doses to all organs, each
adjusted to account for the sensitivity of the organ to radiation. Effective dose is expressed in millisie-
verts (mSv).

7. ABSORBED DOSE

The absorbed dose is the radiation energy absorbed per unit mass of an organ or tissue. The absorbed
dose describes the intensity of the energy deposited in any small amount of tissue located anywhere in
the body, and is used to assess the potential for damage to a particular organ or tissue. The unit is joule
per kilogram (J/kg), which is assigned the special name “Gray” (Gy) One hundred rad equals 1 joule/
kilogram (J/kg), which also equals 1 Gy.

8. EQUIVALENT DOSE

Equivalent dose is a dose quantity H representing the stochastic health effects of low levels of ionizing
radiation on the human body which represents the probability of radiation-induced cancer and genetic
damage.

9. RADIATION WEIGHT FACTOR

A radiation weighting factor (W) is a dimensionless constant that reflects the relative biological effec-
tiveness (RBE) of different types of ionizing radiation.

10. TISSUE WEIGHT FACTOR

The tissue weighting factor (WT) is a relative measure of the risk of stochastic effects that may occur
when a tissue is irradiated. It takes into account the different radio sensitivities of organs and tissues in
the body to ionizing radiation. The International Commission on Radiological Protection (ICRP) uses
tissue weighting factors to calculate the effective dose of radiation.

11. ICRP-PRINCIPLE FOR RADIOLOGICAL PROTECTION

11.1 JUSTIFICATION: The most common type of ionizing radiation used in medicine all over the world
are X-rays since its discovery. There are obvious benefits from medical uses of X-rays , however there
are well established health risks from radiation if improperly applied. Hence every medical procedure
involving radiation needs to be justified. It is fact that diagnostic x-ray examinations contribute the larg-
est fraction to population dose from man made radiation sources.
11.2 OPTIMIZATION: All living things are exposed to ionising radiation from the natural (called back-
ground radiation) and man made radiation sources. Ionising radiation may cause biological changes in
the exposed person hence the doses to the occupational workers shall be kept as low as reasonably
achievable (ALARA) and doses to patients shall be optimized. Suitable control measures shall be em-
ployed to minimise radiation exposure so that maximum benefits are derived with minimum radiological

11.3 DOSE LIMIT

Part of the body Occupational Exposure Public Exposure

Whole body 20 mSv/year averaged over 5 consecu- 1 mSv/y

(Effective dose) tive years

Lens of eyes 150 mSv in a year 15 mSv/y

(Equivalent dose)

Skin 500 mSv in a year 50 mSv/y

(Equivalent dose)

Extremities (Hands and Feet) 500 mSv in a year -

Equivalent dose For pregnant radiation workers, after declaration of pregnancy 1 mSv on the embryo/
foetus should not exceed .

12. TDS PRINCIPLE

Time, distance, and shielding measures minimize your exposure to radiation in much the same way as
they would to protect you against overexposure to the sun (as illustrated in the figure below):

Time: For people who are exposed to radiation in addition to natural background radiation, limiting or
minimizing the exposure time reduces the dose from the radiation source.

Distance: Just as the heat from a fire is less intense the further away you are, so the intensity and dose of
radiation decreases dramatically as you increase your distance from the source.

Shielding: Barriers of lead, concrete, or water provide protection from penetrating radiation such as
gamma rays and neutrons. This is why certain radioactive materials are stored under water or in concrete
or lead-lined rooms, and why dentists place a lead blanket on patients receiving x-rays of their teeth.
Similarly, special plastic shields stop beta particles, and air stops alpha particles. Therefore, inserting the
proper shield between you and a radiation source will greatly reduce or eliminate the dose you receive.

13. DOSIMERTY

Dosimetry is the science of measuring radiation dose, which is also known as absorbed dose. It's a
branch of radiation health and safety that involves measuring air kerma and other procedures to address
the different imaging modalities used in diagnostic radiology. Dosimetry is important because the radia-
tion dose received by patients from modern X-ray examinations can cause cancer or acute damage to
organs like the skin and eyes.

14. DOSE MONITORING DEVICES

Radiation dosimeter is a device, instrument or system that measures or evaluates, either directly or indi-
rectly, the quantities exposure, kerma, absorbed dose or equivalent dose, or their time derivatives (rates)
or related quantities of ionizing radiation. A dosimeter along with its reader is referred to as a dosimetry
system.
15. TYPES OF MONITORING DEVICES

15.1 Area monitoring devices: Area monitoring devices, also known as radiation survey meters,
are used to measure radiation levels at different locations near a radiation installation. These devices can
be portable or fixed, and can be used to measure radiation levels at fixed locations, as well as along the
boundaries of facilities.

15.1.1 The Geiger Muller (Geiger Counter) uses a gas-filled tube (cathode) surrounding a central elec-
trode (anode) made of a fine tungsten wire. The counter detects individual particles or ions, however,
too many ions will saturate the counter and it will lose accuracy. Although more sensitive than an ion
chamber survey meter – Geiger counters are typically used to detect low to medium levels of radiation,
but will lose accuracy measuring higher levels. For this reason, most industrial radiographers use the ion
chamber survey meter.

15.1.2 The Ion Chamber uses an electric field (battery operated) which is applied across a volume of
gas, between two electrodes. The ion chamber is capable of measuring all forms of ionizing radiation (x
-ray, gamma, alpha, and beta particles) and is considered more reliable with X-ray.

15.1.3 A scintillation detector, also known as a scintillation counter, is a device that detects and
measures ionizing radiation by using the scintillation effect. The scintillation effect is when a solid mate-
rial emits light when exposed to radiation. The energy of the emitted light pulse is directly proportional
to the energy of the particle that hits the scintillator.

15.2 Personnel monitoring devices: Personnel monitoring devices are designed to measure the accumu-
lated external exposure or dose that a person receives over some time interval. These devices are inte-
grating, unlike dose rate meters or surveying instruments, which give an instantaneous readout.

15.2.1 Thermoluminescent dosimeter (TLD) is a passive radiation detection device that is used for
personal dose monitoring or to measure patient dose.

15.2.1.1 Parts of TLD

 Plastic holder
 Nickel-coated aluminium card with TLD discs
 The discs are made of a thermoluminescent material, commonly calcium sulphate doped with dys-
prosium (CaSO4:Dy) or lithium fluoride (LiF)
 Nearly tissue equivalent, although not at all x-ray energies
 The discs are 0.8 mm thick and have a 1.35 cm diameter
 Three filters against each disc
 Top: aluminium and copper
 Middle: Perspex
 Lower: open
15.2.1.2 Working principle of TLD
When the radiation falls on TLD, the electrons are excited and store energy. After a varied period (can
be one month, bimonthly, quarterly or even biannual), the TLD badges are sent for reading. The TLD
reader consists of a heater. On getting heated, the excited electrons again come back to the ground state
and emit light which is then read by a photomultiplier . The light output is proportional to the radiation
exposure. If a radiation worker is wearing a lead apron, the TLD badge can be worn under the lead apron
(to reflect body dose) or outside the lead apron (to reflect extremity/thyroid dose) . TLDs can measure
doses from 0.01 mGy to 10 Gy .
15.2.2 Pocket Dosimeter: Pocket dosimeters are used to provide the wearer with an immediate reading
of his or her exposure to x-rays and gamma rays. As the name implies, they are commonly worn in the
pocket. The two types commonly used in industrial radiography are the Direct Read Pock-
et Dosimeter and the Digital Electronic Dosimeter.

15.2.2.1 Direct Pocket Dosimeter: A direct reading pocket ionization dosimeter is generally of the size
and shape of a fountain pen. The dosimeter contains a small ionization chamber with a volume of ap-
proximately two millilitres. Inside the ionization chamber is a central wire anode, and attached to this
wire anode is a metal coated quartz fiber. When the anode is charged to a positive potential, the charge is
distributed between the wire anode and quartz fiber. Electrostatic repulsion deflects the quartz fiber, and
the greater the charge, the greater the deflection of the quartz fiber. Radiation incident on the chamber
produces ionization inside the active volume of the chamber. The electrons produced by ionization are
attracted to, and collected by, the positively charged central anode. This collection of electrons reduces
the net positive charge and allows the quartz fiber to return in the direction of the original position. The
amount of movement is directly proportional to the amount of ionization which occurs. The principal
advantage of a pocket dosimeter is its ability to provide the wearer an immediate reading of his or
her radiation exposure. It also has the advantage of being reusable. The limited range, inability to pro-
vide a permanent record, and the potential for discharging and reading loss due to dropping or bumping
are a few of the main disadvantages of a pocket dosimeter. The dosimeters must be recharged and rec-
orded at the start of each working shift. Charge leakage can also affect the reading of a dosimeter. Leak-
age should be no greater than 2 percent of full scale in a 24 hour period.

15.2.3 Film Badge: A film badge dosimeter, or film badge, is a personal device that monitors the cumu-
lative radiation dose a person is exposed to from ionizing radiation. It is made up of a holder and photo-
graphic film. Film badges are the most common and cheapest device used to monitor radiation exposure,
and are usually worn at work. The badge's sensitivity to radiation depends on the photon energy, and
filters are used to measure the radiation source's penetrating power. The badge consists of two
parts: photographic film and a holder. The film emulsion is black and white photographic film with var-
ying grain size to affect its sensitivity to incident radiation such as gamma rays, X-rays and beta parti-
cles.

After use by the wearer, the film is removed, developed, and examined to measure exposure. When the
film is irradiated, an image of the protective case is projected on the film. Lower energy photons are at-
tenuated preferentially by differing absorber materials. This property is used in film dosimetry to identi-
fy the energy of radiation to which the dosimeter was exposed. Some film dosimeters have two emul-
sions, one for low-dose and the other for high-dose measurements. These two emulsions can be on sepa-
rate film substrates or on either side of a single substrate. Knowing the energy allows for accurate meas-
urement of radiation dose.

15.2.4 Optically stimulating Dosimeter (OSLD): An OSL badge, or optically stimulated luminescent
dosimeter (OSLD) badge, is a radiation detection badge that uses OSL dosimetry to measure exposure to
radioactive isotopes over time. OSL is a passive radiation protection dosimetry technology that can mon-
itor X, gamma, and beta radiation. OSL badges are used in many industries, including hospitals, medical
offices, veterinary clinics, and imaging centres. OSL badges work by storing energy when exposed to
ionizing radiation, which is then released as luminescence when the badge is illuminated with stimula-
tion light. The intensity of the luminescence depends on the dose absorbed by the badge and the intensi-
ty of the stimulation light. OSL badges can be worn for up to one year and can be re-read using light.