BOOK
Radiation Protection in Medical Radiography - E-Book
Mary Alice Statkiewicz Sherer | Paula J. Visconti | E. Russell Ritenour | Kelli Haynes
(2017)
Additional Information
Book Details
Abstract
Gain a full understanding of both basic and complex concepts in radiation protection, biology, and physics. Beautifully designed and easy to follow, Radiation Protection in Medical Radiography, 8th Edition promotes the safe use of ionizing radiation in all imaging modalities, including the effects of radiation on humans at the cellular and systemic levels, regulatory and advisory limits for human exposure to radiation, and the implementation of radiation safety practices for patients and personnel. This market-leading text reflects the latest ARRT and ASRT curriculum guidelines to help you succeed on the ARRT exam. Plus, the new edition includes tables with sensitivity ranges to provide easy reference for each type of dosimeter.
- Convenient, easy-to-use features include chapter outlines and objectives, listing and highlighting of key terms, and bulleted summaries, general discussion questions, and review questions to enhance student comprehension and retention.
- NCRP and ICRP content includes guidelines, regulations, and radiation quantities and units, explaining the effects of low-level ionizing radiation, demonstrating the link between radiation and cancer and other diseases, and providing the regulatory perspective needed for practice.
- Clear and concise writing style covers complex concepts in radiation protection, biology, and physics in a building-block approach from basic to more complex concepts.
- Timely coverage of radiation protection regulations addresses radiation awareness and education efforts across the globe.
- NEW! Chapter Radiation Safety in Computed Tomography and Mammography compiles content on tomography and mammography into one chapter.
- UPDATED! Full-color equipment images and illustrations reinforce important information.
- UPDATED! Content reflects the latest ARRT and ASRT curriculum guidelines.
- Review questions are included at the end of chapters to assess your comprehension, with answers on the Evolve companion website.
- NEW! Key-word glossary helps you find and understand need-to-know terms.
- NEW! Additional tables with sensitivity ranges makes each type of dosimeters easy to reference
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Radiation Protection in Medical Radiography | i | ||
| Copyright Page | iv | ||
| Dedication | v | ||
| Reviewers | vii | ||
| Foreword | ix | ||
| Preface | xi | ||
| Content | xi | ||
| New to This Edition | xi | ||
| Chapter Contents | xi | ||
| Learning Enhancements | xiv | ||
| Ancillaries | xiv | ||
| Workbook | xiv | ||
| Instructor’s Ancillaries | xv | ||
| Using the Book | xv | ||
| About the Authors | xvii | ||
| Acknowledgments | xix | ||
| Table Of Contents | xxi | ||
| 1 Introduction to Radiation Protection | 1 | ||
| Chapter Outline | 1 | ||
| Objectives | 1 | ||
| Key Terms | 2 | ||
| Team Concept in the Medical Field | 3 | ||
| Control of Radiant Energy | 3 | ||
| Goals of Radiation Protection | 3 | ||
| Concept of Radiation Protection | 3 | ||
| Introduction to Radiation Quantities and Units of Measure | 4 | ||
| Exposure (coulomb per kilogram [C/kg] or milliroentgen [mR]). | 4 | ||
| Absorbed Dose (milligray [mGy]). | 4 | ||
| Effective Dose (millisievert [mSv]). | 4 | ||
| Need to Safeguard Against Adverse Biologic Effects of Ionizing Radiation | 4 | ||
| Justification and Responsibility for Imaging Procedures | 5 | ||
| Benefit Versus Risk | 5 | ||
| Diagnostic Efficacy | 5 | ||
| As Low as Reasonably Achievable (ALARA) Principle | 6 | ||
| Cardinal Rules of Radiation Protection | 6 | ||
| Responsibility for Maintaining ALARA in the Medical Industry | 6 | ||
| Patient Protection and Patient Education | 8 | ||
| Educating Patients About Imaging Procedures | 8 | ||
| Risk of Imaging Procedure Versus Potential Benefit | 8 | ||
| Background Equivalent Radiation Time | 9 | ||
| Increased Radiation Sensitivity of Children | 10 | ||
| Alliance for Radiation Safety in Pediatric Imaging | 10 | ||
| Image Gently Campaign | 11 | ||
| Image Wisely Campaign | 11 | ||
| Monitoring and Reporting Radiation Dose | 11 | ||
| The NEXT Program and Reference Values | 12 | ||
| Protocols for Dose Alerts | 12 | ||
| Summary | 12 | ||
| References | 13 | ||
| General Discussion Questions | 14 | ||
| Review Questions | 14 | ||
| 2 Radiation | 16 | ||
| Chapter Outline | 16 | ||
| Objectives | 16 | ||
| Key Terms | 16 | ||
| Radiation | 17 | ||
| Types of Radiation | 17 | ||
| The Electromagnetic Spectrum | 17 | ||
| Ionizing and Nonionizing Radiation | 17 | ||
| Particulate Radiation | 19 | ||
| An Introduction to the Concept of Radiation Dose | 20 | ||
| Biologic Damage Potential | 20 | ||
| Sources of Radiation | 21 | ||
| Natural Radiation. | 21 | ||
| Terrestrial radiation. | 21 | ||
| Cosmic radiation. | 23 | ||
| Terrestrial and internal radiation. | 24 | ||
| Manmade (Artificial) Radiation. | 24 | ||
| Consumer products containing radioactive material. | 24 | ||
| Air travel. | 24 | ||
| Nuclear fuel for the generation of power. | 25 | ||
| Atmospheric fallout from nuclear weapons testing. | 25 | ||
| Nuclear power plant accidents. | 25 | ||
| Three Mile Island Unit 2. | 26 | ||
| Chernobyl. | 27 | ||
| The ETHOS project. | 27 | ||
| Thyroid cancer, leukemia, and breast cancer as a result of the Chernobyl event. | 28 | ||
| Nuclear power plant accidents as a consequence of natural disasters. | 30 | ||
| Fukushima Daiichi Nuclear Plant crisis. | 30 | ||
| Medical radiation. | 31 | ||
| Summary | 32 | ||
| References | 33 | ||
| General Discussion Questions | 35 | ||
| Review Questions | 35 | ||
| 3 Interaction of X-Radiation With Matter | 37 | ||
| Chapter Outline | 37 | ||
| Objectives | 37 | ||
| Key Terms | 37 | ||
| Significance of X-Ray Absorption in Biologic Tissue | 38 | ||
| X-Ray Beam Production and Energy | 38 | ||
| Production of Primary Radiation | 38 | ||
| Energy of Photons in a Diagnostic X-Ray Beam | 39 | ||
| Attenuation | 40 | ||
| Direct and Indirect Transmission X-Ray Photons | 40 | ||
| Primary, Exit, and Attenuated Photons | 40 | ||
| Probability of Photon Interaction With Matter | 41 | ||
| Processes of Interaction | 41 | ||
| Coherent Scattering | 41 | ||
| Process of Coherent Scattering. | 44 | ||
| Photoelectric Absorption | 45 | ||
| Process of Photoelectric Absorption. | 45 | ||
| Probability of Occurrence of Photoelectric Absorption. | 46 | ||
| Mass Density and Effective Atomic Number of Different Body Structures. | 47 | ||
| Body Part Thickness and Density Differences. | 47 | ||
| Effects of Attenuation on Radiographic Images. | 47 | ||
| Impact of Photoelectric Absorption on Radiographic Contrast. | 48 | ||
| Use of Contrast Media to Ensure Visualization of Anatomic Structures. | 49 | ||
| Compton Scattering | 49 | ||
| Process of Compton Scattering in a Patient. | 50 | ||
| Pair Production | 52 | ||
| Process of Pair Production. | 52 | ||
| Use of Annihilation Radiation in Positron Emission Tomography. | 54 | ||
| Photodisintegration | 54 | ||
| Process of Photodisintegration. | 54 | ||
| Summary | 54 | ||
| Reference | 55 | ||
| General Discussion Questions | 55 | ||
| Review Questions | 55 | ||
| 4 Radiation Quantities and Units | 57 | ||
| Chapter Outline | 57 | ||
| Objectives | 57 | ||
| Key Terms | 58 | ||
| Historical Evolution of Radiation Quantities and Units | 58 | ||
| Discovery of X-Rays | 58 | ||
| First Reports of Injury | 59 | ||
| Investigation of Methods for Reducing Radiation Exposure | 60 | ||
| Skin Erythema Dose | 60 | ||
| Early Definition of Quantities and Units | 60 | ||
| The Modern Era of Radiation Protection | 62 | ||
| Quantities and Units in Use Today | 63 | ||
| Radiation Quantities and Their SI Units of Measure | 64 | ||
| Introduction | 64 | ||
| Exposure | 64 | ||
| Air Kerma | 66 | ||
| Absorbed Dose | 66 | ||
| Equivalence of Radiation-Produced Damage From Different Sources of Ionizing Radiation | 68 | ||
| Equivalent Dose | 68 | ||
| Effective Dose | 69 | ||
| Collective Effective Dose | 71 | ||
| Total Effective Dose Equivalent | 71 | ||
| Summary | 72 | ||
| References | 73 | ||
| General Discussion Questions | 73 | ||
| Review Questions | 73 | ||
| 5 Radiation Monitoring | 75 | ||
| Chapter Outline | 75 | ||
| Objectives | 75 | ||
| Key Terms | 75 | ||
| Personnel Monitoring | 76 | ||
| Requirement for Personnel Monitoring | 76 | ||
| Purpose of Personnel Dosimeters | 76 | ||
| Placement of Personnel Dosimeters | 76 | ||
| During Routine Radiographic Procedures. | 76 | ||
| When a Protective Apron Is Worn. | 76 | ||
| As a Second Monitor When a Protective Apron Is Worn. | 77 | ||
| As a Monitor for the Embryo-Fetus. | 77 | ||
| Extremity Dosimeter | 77 | ||
| Record of Radiation Exposure | 77 | ||
| Personnel Dosimeters | 78 | ||
| Characteristics | 78 | ||
| Types | 78 | ||
| Optically Stimulated Luminescence Dosimeter. | 78 | ||
| Energy discrimination. | 79 | ||
| Optically stimulated luminescence dosimeter sensitivity. | 80 | ||
| Control monitor. | 80 | ||
| Advantages of the OSL dosimeter. | 80 | ||
| Disadvantages of the OSL dosimeter. | 80 | ||
| Personnel monitoring report. | 80 | ||
| Change in employment by radiation worker. | 80 | ||
| Thermoluminescent Dosimeter (TLD). | 83 | ||
| Advantages of the thermoluminescent dosimeter over the traditional film badge. | 83 | ||
| Disadvantages of the thermoluminescent dosimeter. | 84 | ||
| Pocket Ionization Chamber. | 84 | ||
| Types. | 84 | ||
| Components. | 84 | ||
| Special charging unit. | 84 | ||
| Advantages. | 85 | ||
| Disadvantages. | 85 | ||
| Digital Ionization Dosimeter. | 85 | ||
| Summary of Advantages and Disadvantages of Personnel Monitoring Devices. | 86 | ||
| Radiation Survey Instruments for Area Monitoring | 86 | ||
| Radiation Detection and Measurement | 86 | ||
| Types of Instruments | 88 | ||
| Requirements | 88 | ||
| Gas-Filled Radiation Survey Instruments | 88 | ||
| Ionization Chamber–Type Survey Meter (Cutie Pie). | 88 | ||
| Sensitivity ranges and uses. | 88 | ||
| Advantages and disadvantages. | 88 | ||
| Counter. | 88 | ||
| Geiger–Müller Survey Meter | 89 | ||
| Sensitivity and use. | 89 | ||
| Components. | 89 | ||
| Disadvantages. | 89 | ||
| Instruments Used to Measure X-Ray Exposure in Radiology | 89 | ||
| Summary | 90 | ||
| References | 91 | ||
| General Discussion Questions | 91 | ||
| Review Questions | 91 | ||
| 6 Overview of Cell Biology | 93 | ||
| Chapter Outline | 93 | ||
| Objectives | 93 | ||
| Key Terms | 93 | ||
| The Cell | 94 | ||
| Cell Chemical Composition | 94 | ||
| Protoplasm | 94 | ||
| Organic Compounds | 95 | ||
| Proteins. | 95 | ||
| Structural and enzymatic proteins. | 95 | ||
| Repair enzymes. | 95 | ||
| Hormones and antibodies. | 96 | ||
| Carbohydrates. | 96 | ||
| Lipids. | 97 | ||
| Nucleic Acids. | 97 | ||
| Deoxyribonucleic and ribonucleic acids. | 97 | ||
| Nitrogenous organic bases in DNA. | 97 | ||
| DNA: the master chemical substance. | 99 | ||
| Structural differences between DNA and RNA. | 99 | ||
| Messenger RNA. | 99 | ||
| Transfer RNA. | 99 | ||
| Ribosomal RNA. | 100 | ||
| Chromosomes and genes. | 100 | ||
| The human genome. | 101 | ||
| Inorganic Compounds | 102 | ||
| Function of Water Within and Outside of the Cell. | 102 | ||
| Function of Mineral Salts Within the Cell. | 103 | ||
| Cell Structure | 103 | ||
| Cell Membrane—A “Plastic Storage Bag” to Contain the Cell | 103 | ||
| Cytoplasm | 103 | ||
| Cytoplasmic Organelles | 103 | ||
| Endoplasmic Reticulum—The “Highway” of the Cell. | 104 | ||
| Golgi Apparatus or Complex—Hauls “Freight” Within and Out of the Cell. | 105 | ||
| Mitochondria—The “Power-Generating Station” of the Cell. | 105 | ||
| Lysosomes—“Garbage Bags” With “Poison Pills.” | 106 | ||
| Ribosomes—“Manufacturing Facilities” of the Cell. | 106 | ||
| Centrosomes—“Weavers of the Spindle.” | 106 | ||
| Nucleus—Information-Processing and Administrative Center | 107 | ||
| Cell Division | 107 | ||
| Mitosis | 107 | ||
| Interphase. | 110 | ||
| The Four Phases of Mitosis. | 110 | ||
| Prophase. | 110 | ||
| Metaphase. | 110 | ||
| Anaphase. | 111 | ||
| Telophase. | 111 | ||
| Meiosis | 111 | ||
| Multiple Births. | 111 | ||
| Summary | 113 | ||
| References | 114 | ||
| General Discussion Questions | 114 | ||
| Review Questions | 114 | ||
| 7 Molecular and Cellular Radiation Biology | 116 | ||
| Chapter Outline | 116 | ||
| Objectives | 116 | ||
| Key Terms | 117 | ||
| Ionizing Radiation | 117 | ||
| Radiation Energy Transfer Determinants | 117 | ||
| Linear Energy Transfer | 117 | ||
| Radiation Categories According to Linear Energy Transfer. | 118 | ||
| Low–linear energy transfer radiation. | 118 | ||
| High–linear energy transfer radiation. | 118 | ||
| Risk of damage to DNA. | 119 | ||
| Probability of interaction with DNA. | 119 | ||
| High–linear energy transfer radiation and internal contamination. | 119 | ||
| Relative Biologic Effectiveness | 120 | ||
| Use of the Relative Biologic Effectiveness Concept for Specific Experiments. | 120 | ||
| Oxygen Enhancement Ratio | 120 | ||
| Molecular Effects of Irradiation | 121 | ||
| Effects of Irradiation on Somatic and Genetic Cells | 121 | ||
| Classification of Ionizing Radiation Interaction | 121 | ||
| Direct Action Characteristics | 122 | ||
| Radiolysis of Water | 122 | ||
| Ionization of Water Molecules. | 122 | ||
| Production of Free Radicals. | 122 | ||
| Production of Undesirable Chemical Reactions and Biologic Damage. | 122 | ||
| Production of Cell-Damaging Substances. | 122 | ||
| Organic Free Radical Formation. | 123 | ||
| Indirect Action Characteristics | 124 | ||
| Effects of Ionizing Radiation on DNA | 124 | ||
| Single-Strand Break. | 124 | ||
| Double-Strand Break. | 124 | ||
| Chromosome Effect After a Double-Strand Break in the Same Rung of DNA. | 125 | ||
| Mutation. | 125 | ||
| Covalent Cross-Links. | 126 | ||
| Effects of Ionizing Radiation on Chromosomes | 126 | ||
| Radiation-Induced Chromosome Breaks. | 126 | ||
| Chromosomal Fragments. | 126 | ||
| Chromosome Anomalies. | 127 | ||
| Summary of Structural Changes Caused by Ionizing Radiation. | 127 | ||
| Consequences to the Cell From Structural Changes Within the Nucleus | 127 | ||
| Target Theory | 128 | ||
| Effects of Irradiation on the Entire Cell | 131 | ||
| Instant Death | 131 | ||
| Reproductive Death | 131 | ||
| Apoptosis | 131 | ||
| Mitotic Death | 132 | ||
| Mitotic Delay | 132 | ||
| Interference With Function | 132 | ||
| Survival Curves for Mammalian Cells | 132 | ||
| Cell Radiosensitivity | 133 | ||
| Cell Maturity and Specialization | 133 | ||
| Oxygen Enhancement Effects | 133 | ||
| Law of Bergonié and Tribondeau | 133 | ||
| Effects of Ionizing Radiation on Human Cells and Tissues | 134 | ||
| Blood Cells | 134 | ||
| Hematologic depression. | 134 | ||
| Depletion of immature blood cells. | 134 | ||
| Repopulation after a period of recovery. | 134 | ||
| Effects on stem cells of the hematopoietic system. | 134 | ||
| Whole-body doses in excess of 5 Gyt. | 134 | ||
| Effects of ionizing radiation on lymphocytes. | 135 | ||
| Effects of ionizing radiation on neutrophils. | 135 | ||
| Effects of ionizing radiation on thrombocytes (platelets). | 135 | ||
| Radiation exposure during diagnostic imaging procedures. | 135 | ||
| Monitoring of patients undergoing radiation therapy treatment. | 136 | ||
| Occupational radiation exposure monitoring. | 136 | ||
| Epithelial Tissue. | 136 | ||
| Muscle Tissue. | 136 | ||
| Nervous Tissue. | 136 | ||
| Nerve tissue in the human adult. | 136 | ||
| Nerve tissue in the embryo-fetus. | 136 | ||
| Reproductive Cells | 137 | ||
| Spermatogonia. | 137 | ||
| Ova. | 137 | ||
| Summary | 138 | ||
| References | 140 | ||
| General Discussion Questions | 140 | ||
| Review Questions | 140 | ||
| 8 Early Tissue Reactions and Their Effects on Organ Systems | 142 | ||
| Chapter Outline | 142 | ||
| Objectives | 142 | ||
| Key Terms | 143 | ||
| Somatic and Genetic Effects | 143 | ||
| Somatic Effects | 143 | ||
| Early Tissue Reactions | 143 | ||
| Acute Radiation Syndrome (ARS). | 144 | ||
| Symptoms of acute radiation syndrome. | 145 | ||
| Hematopoietic syndrome. | 145 | ||
| Gastrointestinal syndrome. | 145 | ||
| Cerebrovascular syndrome. | 147 | ||
| Major response stages of acute radiation syndrome. | 148 | ||
| Acute radiation syndrome as a consequence of the Chernobyl nuclear power plant accident. | 148 | ||
| Acute radiation syndrome as a consequence of the atomic bombing of Hiroshima and Nagasaki. | 149 | ||
| Lethal Dose | 149 | ||
| LD 50/30. | 149 | ||
| LD 10/30, LD 50/60, and LD 100/60. | 149 | ||
| Repair and Recovery | 150 | ||
| Local Tissue Damage | 150 | ||
| Effects on the Skin | 150 | ||
| Effects on the Reproductive System | 152 | ||
| Hematologic Effects | 153 | ||
| Hematopoietic System. | 153 | ||
| Cytogenetic Effects | 153 | ||
| Summary | 155 | ||
| References | 156 | ||
| General Discussion Questions | 157 | ||
| Review Questions | 157 | ||
| 9 Stochastic Effects and Late Tissue Reactions of Radiation in Organ Systems | 159 | ||
| Chapter Outline | 159 | ||
| Objectives | 159 | ||
| Key Terms | 160 | ||
| Epidemiology | 160 | ||
| Radiation Dose–Response Relationship | 160 | ||
| Dose–Response Curves | 160 | ||
| Threshold and Nonthreshold Relationships | 160 | ||
| Risk Models Used to Predict Cancer Risk and Heritable Damage in Human Populations | 161 | ||
| Risk Models Used to Predict Leukemia, Breast Cancer, and Heritable Damage | 162 | ||
| Rationale for Risk Model Selection | 162 | ||
| Risk Model Used to Predict High-Dose Cellular Response | 162 | ||
| Somatic Effects | 162 | ||
| Late Somatic Effects | 163 | ||
| Risk Estimate for Contracting Cancer From Low-Level Radiation Exposure | 163 | ||
| Low-Level Effects Summary | 164 | ||
| Major Types of Late Effects | 164 | ||
| Risk Estimates for Cancer | 164 | ||
| Absolute Risk and Relative Risk Models. | 164 | ||
| Epidemiologic Studies for Determining the Risk of Cancer. | 164 | ||
| Models for Extrapolation of Cancer Risk From High-Dose to Low-Dose Data. | 165 | ||
| Carcinogenesis | 165 | ||
| Radiation-Induced Cancer. | 166 | ||
| Radium watch-dial painters. | 166 | ||
| Uranium miners. | 166 | ||
| Early medical radiation workers. | 167 | ||
| Patients injected with the contrast agent Thorotrast. | 167 | ||
| Infants treated for an enlarged thymus gland. | 167 | ||
| Incidence of breast cancer in radiation treatment of benign postpartum mastitis. | 167 | ||
| Children of the Marshall Islanders. | 168 | ||
| Japanese atomic bomb survivors | 168 | ||
| Atomic bomb detonation on Hiroshima and Nagasaki. | 168 | ||
| Data obtained from epidemiologic studies. | 168 | ||
| Incidence of leukemia rate of other radiation-induced malignancies. | 169 | ||
| Incidence of breast cancer in Japanese women. | 169 | ||
| Effectiveness of ionizing radiation as a cancer-causing agent. | 169 | ||
| Radiation dose and radiation-induced leukemia. | 170 | ||
| Evacuees from the Chernobyl nuclear disaster | 170 | ||
| Need for follow-up studies. | 170 | ||
| Evacuation of people within 36 hours after the accident. | 170 | ||
| Worldwide effects of the accident. | 170 | ||
| Attempts by physicians to prevent thyroid cancer in children. | 170 | ||
| Incidence of thyroid cancer and breast cancer since the accident. | 170 | ||
| Why early studies did not demonstrate a significant increase in the incidence of leukemia after the accident. | 171 | ||
| Subsequent findings. | 171 | ||
| Life Span Shortening | 172 | ||
| Animal Studies | 172 | ||
| Human Studies | 172 | ||
| American radiologists. | 172 | ||
| American radiologic technologists. | 172 | ||
| Cataractogenesis | 173 | ||
| Embryologic Effects (Birth Defects) | 174 | ||
| Stages of Gestation in Humans. | 174 | ||
| Embryonic Cell Radiosensitivity During the First Trimester of Pregnancy. | 174 | ||
| Embryonic Cell Radiosensitivity During the Second and Third Trimesters of Pregnancy. | 174 | ||
| Embryonic Effects Resulting From the Chernobyl Nuclear Power Plant Accident. | 175 | ||
| Review of Fetal Effects by UNSCEAR. | 175 | ||
| International Chernobyl Project. | 175 | ||
| Effects of Low-Level Ionizing Radiation on the Embryo-Fetus. | 175 | ||
| Genetic (Hereditary) Effects | 175 | ||
| Cause of Genetic Mutations | 175 | ||
| Natural Spontaneous Mutations | 175 | ||
| Mutagens Capable of Inducing Genetic Mutations | 176 | ||
| Radiation Interaction With DNA Macromolecules | 176 | ||
| Incapacities of Mutant Genes | 176 | ||
| Dominant or Recessive Point Mutations | 176 | ||
| Ionizing Radiation as a Possible Cause of Genetic (Hereditary) Effects | 176 | ||
| Doubling Dose Concept | 177 | ||
| Summary | 177 | ||
| References | 178 | ||
| General Discussion Questions | 179 | ||
| Review Questions | 179 | ||
| 10 Dose Limits for Exposure to Ionizing Radiation | 181 | ||
| Chapter Outline | 182 | ||
| Objectives | 181 | ||
| Key Terms | 182 | ||
| Basis of Effective Dose Limiting System | 183 | ||
| Radiation Protection Standards Organizations | 183 | ||
| International Commission on Radiological Protection | 183 | ||
| National Council on Radiation Protection and Measurements | 184 | ||
| United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) | 184 | ||
| National Academy of Sciences/National Research Council Committee on the Biological Effects of Ionizing Radiation (NAS/NRC-BEIR) | 185 | ||
| US Regulatory Agencies | 185 | ||
| Nuclear Regulatory Commission | 185 | ||
| Agreement States | 186 | ||
| Environmental Protection Agency (EPA) | 186 | ||
| US Food and Drug Administration (FDA) | 187 | ||
| Occupational Safety and Health Administration (OSHA) | 187 | ||
| Radiation Safety Program | 187 | ||
| Requirement | 187 | ||
| Radiation Safety Committee and Radiation Safety Officer | 187 | ||
| Responsibilities of the Radiation Safety Officer. | 187 | ||
| Required Training and Experience for a Radiation Safety Officer. | 188 | ||
| Authority of the Radiation Safety Officer. | 188 | ||
| Radiation Control for Health and Safety Act of 1968 | 188 | ||
| Code of Standards for Diagnostic X-Ray Equipment | 188 | ||
| ALARA Concept | 189 | ||
| Model for the ALARA Concept | 189 | ||
| Food and Drug Administration White Paper | 189 | ||
| Consumer-Patient Radiation Health and Safety Act of 1981 | 190 | ||
| Radiation-Induced Responses of Concern in Radiation Protection | 190 | ||
| Categories for Radiation-Induced Responses | 190 | ||
| Recent Changes in Terminology | 190 | ||
| Tissue Reactions. | 191 | ||
| Early and late tissue reactions. | 191 | ||
| Stochastic Effects. | 191 | ||
| Current Radiation Protection Philosophy | 192 | ||
| Effective Dose Limiting System | 192 | ||
| Revised Concepts of Radiation Exposure and Risk | 193 | ||
| Occupational Risk | 193 | ||
| Vulnerability of the Embryo-Fetus to Radiation Exposure | 193 | ||
| Basis for the Effective Dose Limiting System | 193 | ||
| Concept Underlying Radiation Protection | 193 | ||
| Tissue Weighting Factor | 193 | ||
| Current National Council on Radiation Protection and Measurements Recommendations | 194 | ||
| National Council on Radiation Protection and Measurements Reports | 194 | ||
| Cumulative Effective Dose (CumEfD) Limit. | 194 | ||
| International Commission on Radiological Protection Recommendation for Downward Revision of the Annual Effective Dose Limit. | 194 | ||
| Limits for Nonoccupationally Exposed Individuals. | 195 | ||
| Limits for Pregnant Radiation Workers. | 195 | ||
| Limits for Education and Training Purposes. | 195 | ||
| Limits for Tissues and Organs Exposed Selectively or Together With Other Organs. | 195 | ||
| Negligible Individual Dose. | 195 | ||
| Action Limits | 196 | ||
| Radiation Hormesis | 196 | ||
| Occupational and Nonoccupational Dose Limits | 197 | ||
| Effective Dose Limits for Radiation Workers and the Population as a Whole | 197 | ||
| Special Limits for Selected Areas | 198 | ||
| Summary | 198 | ||
| References | 199 | ||
| General Discussion Questions | 199 | ||
| Review Questions | 200 | ||
| 11 Equipment Design for Radiation Protection | 201 | ||
| Chapter Outline | 201 | ||
| Objectives | 201 | ||
| Key Terms | 202 | ||
| Radiation Safety Features of Radiographic Equipment, Devices, and Accessories | 202 | ||
| Diagnostic-Type Protective Tube Housing | 202 | ||
| X-Ray Tube Housing Construction and Functions. | 203 | ||
| Control Panel, or Console | 203 | ||
| Radiographic Examination Table | 203 | ||
| Source-to-image Receptor Distance Indicator | 203 | ||
| X-Ray Beam Limitation Devices | 204 | ||
| Additional Types of X-Ray Beam Limitation Devices. | 204 | ||
| Light-Localizing Variable-Aperture Rectangular Collimators | 204 | ||
| Construction. | 204 | ||
| Skin sparing. | 205 | ||
| Luminance. | 205 | ||
| Coincidence between the radiographic beam and the localizing light beam. | 206 | ||
| Positive beam limitation. | 206 | ||
| Alignment of the x-ray beam. | 208 | ||
| Cones. | 208 | ||
| Flared metal tubes and straight cylinders. | 208 | ||
| Beam-defining cones used in dental radiography. | 208 | ||
| Filtration | 208 | ||
| Purpose of Radiographic Beam Filtration. | 208 | ||
| Effect of Filtration on the Absorbed Dose to the Patient. | 208 | ||
| Types of Filtration. | 209 | ||
| Requirement for Total Filtration. | 210 | ||
| Filtration for General Diagnostic Radiology. | 210 | ||
| Compensating Filters | 211 | ||
| Exposure Reproducibility | 211 | ||
| Exposure Linearity | 212 | ||
| Usage of Screen-Film as an Image Receptor and Recording Medium | 212 | ||
| Radiographic Grids | 212 | ||
| Construction, Purpose, Technical Value, and Impact of Radiographic Grid on Patient Dose. | 212 | ||
| Summarizing the Function of a Radiographic Grid. | 213 | ||
| Grid Ratio and Patient Dose. | 213 | ||
| Mobile Radiography | 214 | ||
| Requirement. | 214 | ||
| Use of Mobile Units. | 214 | ||
| Effect of Source-Skin Distance on Patient Entrance Exposure. | 214 | ||
| General Information and Radiation Safety Features of Digital Imaging Equipment, Devices, and Accessories | 214 | ||
| Digital Imaging | 214 | ||
| Conventional Radiography: Analog Image. | 214 | ||
| Digital Radiography. | 215 | ||
| Repeat Rates in Digital Radiography. | 215 | ||
| Computed Radiography. | 216 | ||
| Avoiding overexposure of the patient. | 216 | ||
| Kilovoltage. | 217 | ||
| X-ray beam collimation. | 218 | ||
| Use of radiographic grids. | 218 | ||
| Radiation Safety Features of Fluoroscopic Equipment, Devices, and Accessories | 218 | ||
| Fluoroscopic Procedures and Patient Radiation Exposure Rate | 218 | ||
| Fluoroscopic Imaging Systems | 219 | ||
| Image Intensification Fluoroscopy | 219 | ||
| Benefits. | 219 | ||
| Brightness of the Fluoroscopic Image. | 219 | ||
| Milliamperage Required and Effect on Patient Dose. | 219 | ||
| Multifield, or Magnification, Image Intensifier Tubes. | 219 | ||
| Multifield or Magnification with Digital Detectors. | 221 | ||
| Pulsed and Interrupted Fluoroscopy | 221 | ||
| Effect on Patient Dose. | 221 | ||
| Limiting Fluoroscopic Field Size | 222 | ||
| Benefit of fluoroscopic field size limitation. | 222 | ||
| Fluoroscopic beam length and width limitation. | 222 | ||
| Technical Exposure Factors | 222 | ||
| Selection of technical exposure factors for adult patients. | 222 | ||
| Selection of technical exposure factors for children. | 222 | ||
| Filtration | 222 | ||
| Purpose and requirements. | 222 | ||
| Half-value layer. | 222 | ||
| Cumulative Timing Device | 222 | ||
| Exposure Rate Limitations. | 223 | ||
| Primary Protective Barrier. | 223 | ||
| Fluoroscopic Exposure Control Switch. | 223 | ||
| Radiation Safety Features of Mobile C-Arm Fluoroscopy Equipment, Devices, and Accessories | 223 | ||
| Mobile C-Arm Fluoroscopy | 223 | ||
| Radiation Safety Features of Digital Fluoroscopic Equipment, Devices, and Accessories | 225 | ||
| Digital Fluoroscopy | 225 | ||
| Use of Pulsed Progressive Systems for Dose Reduction. | 225 | ||
| Use of Last Image Hold Feature for Dose Reduction. | 225 | ||
| Radiation Safety for High Level Control Interventional Procedures | 225 | ||
| High Level Control Interventional Procedures | 225 | ||
| Justification for Use of High Level Control Interventional Procedures. | 225 | ||
| Public Health Advisory About the Dangers of Overexposure of Patients and Exposure Rate Limits. | 225 | ||
| Use of Fluoroscopic Equipment by Nonradiologist Physicians. | 227 | ||
| Summary | 228 | ||
| References | 229 | ||
| General Discussion Questions | 230 | ||
| Review Questions | 230 | ||
| 12 Management of Patient Radiation Dose During Diagnostic X-Ray Procedures | 232 | ||
| Chapter Outline | 232 | ||
| Objectives | 232 | ||
| Key Terms | 233 | ||
| Effective Communication | 234 | ||
| Verbal Messages and Body Language | 234 | ||
| Importance of Clear, Concise Instructions | 234 | ||
| Appropriate Communication for Procedures That Will Cause Pain or Discomfort | 234 | ||
| Repeat Radiographic Exposures That Result From Poor Communication | 234 | ||
| Immobilization | 235 | ||
| Need for Patient Immobilization | 235 | ||
| Types of Patient Motion | 235 | ||
| Protective Shielding | 236 | ||
| Need for Protective Shielding | 236 | ||
| Gonadal Shielding | 236 | ||
| Use of Gonadal Shielding Devices. | 236 | ||
| Dose Reduction From the Use of Gonadal Shielding for Female and Male Patients. | 236 | ||
| Placement of Gonadal Shielding Devices. | 236 | ||
| Types of Gonadal Shielding Devices. | 238 | ||
| Flat contact shields. | 238 | ||
| Shadow shields. | 238 | ||
| Shaped contact shields. | 238 | ||
| Clear Lead shields. | 239 | ||
| Specific Area Shielding | 240 | ||
| Need for Specific Area Shielding. | 240 | ||
| Benefit of Specific Area Shielding. | 241 | ||
| Technical Exposure Factors | 241 | ||
| Selection of Appropriate Technical Exposure Factors | 241 | ||
| Use of Standardized Technique Charts | 241 | ||
| Use of High-kVp and Low-mAs Exposure Factors to Reduce Dose to the Patient | 242 | ||
| Postprocessing of the Radiographic Image | 243 | ||
| Quality Control Program | 243 | ||
| Air Gap Technique | 243 | ||
| Reduction of Scattered Radiation | 243 | ||
| High Peak Kilovoltage Radiography | 243 | ||
| Repeat Images | 244 | ||
| Consequence of Repeat Images | 244 | ||
| Benefit of a Repeat Analysis Program | 244 | ||
| Benefit Versus Risk | 245 | ||
| Nonessential Radiologic Examinations | 245 | ||
| Concern About Risk of Exposure From Diagnostic Imaging Procedures | 245 | ||
| Specifying the Amount of Radiation Received by a Patient From a Diagnostic Imaging Procedure | 246 | ||
| Skin Dose. | 246 | ||
| Entrance Skin Exposure | 246 | ||
| Conversion of entrance skin exposure to patient skin dose. | 246 | ||
| Measuring skin dose directly. | 246 | ||
| Gonadal Dose | 246 | ||
| Difference in gonadal dose received by human male and female patients. | 246 | ||
| Genetically significant dose. | 246 | ||
| Genetically significant dose considerations. | 246 | ||
| Bone Marrow Dose. | 247 | ||
| Fluoroscopically Guided Positioning | 247 | ||
| Protecting the Pregnant or Potentially Pregnant Patient | 248 | ||
| Position of the American College of Radiology on Abdominal Radiologic Examinations of Female Patients | 248 | ||
| Determining the Possibility of Pregnancy | 248 | ||
| Irradiation During an Unknown Pregnancy | 248 | ||
| Procedure to Follow and Responsibility for Absorbed Equivalent Dose Determination to the Patient’s Embryo-Fetus | 249 | ||
| Sample Cases to Estimate Approximate Equivalent Dose to the Embryo-Fetus | 250 | ||
| Sample Cases to Obtain an Approximate Estimate of the Fetal Equivalent Dose | 251 | ||
| Irradiating a Known Pregnant Patient | 251 | ||
| Pediatric Considerations During Radiographic Imaging | 251 | ||
| Vulnerability of Children to Radiation Exposure | 251 | ||
| Children Require Smaller Radiation Doses Than Do Adults | 253 | ||
| Patient Motion and Motion Reduction Methods | 254 | ||
| Gaining Cooperation During the Procedure | 254 | ||
| Gonadal Shielding and Gonadal Dose | 254 | ||
| Collimation | 255 | ||
| Patient Protection in Computed Tomography for Adults and Children: Similarities and Necessary Changes | 255 | ||
| Image Gently Campaign | 255 | ||
| Image Wisely Campaign | 255 | ||
| Summary | 255 | ||
| References | 256 | ||
| General Discussion Questions | 257 | ||
| Review Questions | 258 | ||
| 13 Special Considerations on Safety in Computed Tomography and Mammography | 260 | ||
| Chapter Outline | 260 | ||
| Objectives | 260 | ||
| Key Terms | 261 | ||
| Patient Dose in Computed Tomography | 261 | ||
| Radiation Exposure | 261 | ||
| Concerns Related to Patient Dose: Skin Dose and Dose Distribution | 261 | ||
| Direct Patient Shielding | 262 | ||
| Spiral, or Helical, Computed Tomography | 262 | ||
| Methods for Reduction of Patient Dose in CT | 263 | ||
| Tube Current Modulation | 263 | ||
| Iterative Reconstruction | 263 | ||
| Optimization of Tube Voltage | 264 | ||
| Patient Centering | 264 | ||
| Computed Tomography Dose Parameters | 264 | ||
| Effective Computed Tomography Dose | 266 | ||
| Goal of Computed Tomography Imaging From a Radiation Protection Point of View | 267 | ||
| Patient Dose in Mammography | 267 | ||
| Mammography Screening | 268 | ||
| Dose Reduction in Mammography | 268 | ||
| Filtration for Mammographic Equipment | 268 | ||
| Summary | 269 | ||
| References | 270 | ||
| General Discussion Questions | 271 | ||
| Review Questions | 271 | ||
| 14 Management of Imaging Personnel Radiation Dose During Diagnostic X-Ray Procedures | 273 | ||
| Chapter Outline | 274 | ||
| Objectives | 273 | ||
| Key Terms | 274 | ||
| Annual Limit for Occupationally Exposed Personnel | 275 | ||
| Effective Dose Limits | 275 | ||
| Annual Occupational and Nonoccupational Effective Dose Limits | 275 | ||
| Allowance for a Larger Equivalent Dose for Radiation Workers | 275 | ||
| ALARA Concept | 275 | ||
| Dose-Reduction Methods and Techniques | 276 | ||
| Avoiding Repeat Imaging | 276 | ||
| The Patient as a Source of Scattered Radiation | 276 | ||
| Scattered Radiation—Occupational Hazard | 276 | ||
| Filtration of the Diagnostic X-Ray Beam | 276 | ||
| Protective Apparel | 276 | ||
| Technical Exposure Factors | 278 | ||
| Repeats in Digital Imaging | 278 | ||
| Patient Restraint | 278 | ||
| Protection for Pregnant Personnel | 278 | ||
| Imaging Department Protocol | 278 | ||
| Acknowledgment of Counseling and Understanding of Radiation Safety Measures | 279 | ||
| Protective Maternity Apparel | 279 | ||
| Work Schedule Alteration | 280 | ||
| Basic Principles of Radiation Protection for Personnel Exposure Reduction | 280 | ||
| Time | 280 | ||
| Distance | 280 | ||
| Application of the Inverse Square Law. | 280 | ||
| Shielding | 281 | ||
| Protective Structural Shielding. | 281 | ||
| Primary protective barrier. | 282 | ||
| Secondary protective barrier. | 282 | ||
| Control-booth barrier. | 282 | ||
| Clear lead–acrylic secondary protective barrier. | 283 | ||
| Clear lead–acrylic overhead protective barrier. | 283 | ||
| Accessory Protective Devices. | 283 | ||
| Requirements for lead aprons and gloves. | 284 | ||
| Neck and thyroid shield. | 284 | ||
| Protective eyeglasses. | 285 | ||
| X-Ray Tube Housing Cables | 285 | ||
| Protection During Fluoroscopic Procedures | 285 | ||
| Personnel Protection | 285 | ||
| Dose-Reduction Techniques | 286 | ||
| Remote Control Fluoroscopic Systems | 286 | ||
| Protective Curtain | 286 | ||
| Bucky Slot Shielding Device | 286 | ||
| Rotational Scheduling of Personnel | 286 | ||
| Protection During Mobile Radiographic Examinations | 286 | ||
| Use of Protective Garments | 286 | ||
| Distance as a Means of Protection | 287 | ||
| Where the Radiographer Should Stand During a Mobile Radiographic Procedure | 287 | ||
| Protection During C-Arm Fluoroscopy | 287 | ||
| Personnel Exposure From Scattered Radiation | 287 | ||
| Need for Protective Apparel for All Personnel and Monitoring of Imaging Personnel | 287 | ||
| Positioning of the C-Arm Fluoroscope | 288 | ||
| Exposure Reduction for Personnel | 288 | ||
| Protection During High Level Control Interventional Procedures | 288 | ||
| Increased Importance of Radiation Safety Techniques | 288 | ||
| Knowledge of Dose-Reduction Techniques Required by the Radiographer | 289 | ||
| How the Radiologist or Other Interventional Physician Can Reduce Radiation Exposure | 289 | ||
| Extremity Monitoring | 289 | ||
| Diagnostic X-Ray Suite Protection Design | 290 | ||
| Requirement for Radiation- Absorbent Barriers | 290 | ||
| Reason for Overshielding | 290 | ||
| Radiation Shielding Categories | 290 | ||
| Primary Radiation. | 290 | ||
| Scatter Radiation. | 290 | ||
| Leakage Radiation. | 291 | ||
| Calculation Considerations | 291 | ||
| Workload. | 291 | ||
| Inverse Square Law. | 291 | ||
| Use Factor. | 292 | ||
| Occupancy Factor. | 292 | ||
| Controlled and Uncontrolled Areas. | 292 | ||
| Calculating Barrier Shielding Requirements | 293 | ||
| Primary Barrier Calculation. | 293 | ||
| Secondary Barrier Calculation. | 294 | ||
| Scatter radiation. | 294 | ||
| Leakage radiation. | 295 | ||
| New Approaches to Shielding | 295 | ||
| Radiation Warning Signage | 295 | ||
| Beam-On Indicator Sign | 296 | ||
| General Posting | 296 | ||
| Summary | 296 | ||
| References | 297 | ||
| General Discussion Questions | 298 | ||
| Review Questions | 298 | ||
| 15 Radioisotopes and Radiation Protection | 300 | ||
| Chapter Outline | 300 | ||
| Objectives | 300 | ||
| Key Terms | 301 | ||
| Medical Usage | 301 | ||
| Radiation Therapy | 301 | ||
| Iodine-125. | 301 | ||
| Iodine-131. | 303 | ||
| Handling and Disposal of Radioactive Materials | 303 | ||
| Nuclear Medicine | 304 | ||
| Iodine-123. | 304 | ||
| Technetium-99m. | 304 | ||
| Positron Emission Tomography and Computed Tomography | 304 | ||
| Imaging. | 305 | ||
| Fluorine-18. | 305 | ||
| Radiation Protection | 306 | ||
| Radiation Emergencies: Use of Radiation as a Terrorist Weapon | 309 | ||
| Contamination | 309 | ||
| Cleanup of a Contaminated Urban Area | 310 | ||
| Medical Management of Persons Experiencing Radiation Bioeffects | 310 | ||
| Summary | 311 | ||
| References | 313 | ||
| General Discussion Questions | 313 | ||
| Review Questions | 313 | ||
| Appendix A Relationships Between Systems of Units | 315 | ||
| Appendix B Standard Designations for Metric System Lengths, Electron Volt Energy Levels, and Frequency Spectrum Ranges | 318 | ||
| Electron Volt Common Energy Designations | 318 | ||
| Common Frequency Spectrum Designations | 319 | ||
| Appendix C Periodic Table of Elements | 320 | ||
| Appendix D Chance of a 50-KeV Photon Interacting With Atoms of Tissue as It Travels Through 5 cm of Soft Tissue | 322 | ||
| Appendix E Relationship Among Photons, Electromagnetic Waves, Wavelength, and Energy | 323 | ||
| Appendix F Electron Shell Structure of the Atom | 324 | ||
| Appendix G Compton Interaction | 326 | ||
| Appendix H Revision of 10 CFR Part 35* | 328 | ||
| § 35.50 Training for Radiation Safety Officer | 328 | ||
| Appendix I Consumer-Patient Radiation Health and Safety Act of 1981* | 329 | ||
| Subtitle I—Consumer-Patient Radiation Health and Safety Act of 1981 | 329 | ||
| Short Title | 329 | ||
| Statement of Findings | 329 | ||
| Statement of Purpose | 329 | ||
| Definitions | 329 | ||
| Promulgation of Standards | 330 | ||
| Model Statute | 330 | ||
| Compliance | 330 | ||
| Federal Radiation Guidelines | 331 | ||
| Applicability to Federal Agencies | 331 | ||
| Appendix J Image Gently Pledge | 332 | ||
| Appendix K Image Wisely Pledge | 333 | ||
| Pledge for Imaging Professionals | 333 | ||
| Glossary | 334 | ||
| A | 334 | ||
| B | 335 | ||
| C | 335 | ||
| D | 337 | ||
| E | 338 | ||
| F | 339 | ||
| G | 340 | ||
| H | 341 | ||
| I | 341 | ||
| J | 342 | ||
| K | 342 | ||
| L | 342 | ||
| M | 343 | ||
| N | 344 | ||
| O | 345 | ||
| P | 346 | ||
| Q | 348 | ||
| R | 348 | ||
| S | 349 | ||
| T | 351 | ||
| U | 352 | ||
| V | 352 | ||
| W | 352 | ||
| X | 352 | ||
| Index | 353 | ||
| A | 353 | ||
| B | 353 | ||
| C | 354 | ||
| D | 356 | ||
| E | 358 | ||
| F | 359 | ||
| G | 359 | ||
| H | 360 | ||
| I | 360 | ||
| J | 361 | ||
| K | 361 | ||
| L | 361 | ||
| M | 362 | ||
| N | 363 | ||
| O | 363 | ||
| P | 364 | ||
| Q | 366 | ||
| R | 366 | ||
| S | 368 | ||
| T | 369 | ||
| U | 369 | ||
| V | 369 | ||
| W | 370 | ||
| X | 370 | ||
| Z | 370 |