11/10/2014

Efek Radiasi Pengion

pada Kesehatan
Zubaidah Alatas

Pusat Teknologi Keselamatan dan Metrologi Radiasi

Badan Tenaga Nuklir Nasional (BATAN)

Forum Diskusi Proteksi Radiasi

Di Bidang Radiologi Diganostik
RS Cipto Mangunkusumo, Jakarta
13 November 2014

Interaksi Radiasi Dengan Tubuh

DNA..............Kromosom.................sel.....................tubuh

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Interaksi Radiasi dengan Kromosom

(Aberasi Kromosom)
Disentrik

Translokasi

Fragmen
Asentrik

Fragmen Asentrik

Insersi

Translokasi

Cincin

Aberasi Kromosom dan Dosimeter Biologi

Digunakan secara luas sebagai biomarker akibat paparan
radiasi berlebih
Pengamatan dilakukan terhadap sel darah limfosit pada
analisa sitogenetik
Frekuensi aberasi kromosom (disentrik & cincin)
menggambarkan dosis radiasi yang diterima
Rentang dosis: 0,5 Gy 8 Gy
Frekuensi disentrik menurun dengan bertambahnya waktu
(tidak stabil)
Analisa dilakukan dalam waktu 24 jam -30 hari pasca
paparan radiasi

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Efek Radiasi pada Sel

Sel tanpa kerusakan
Sel rusak dan diperbaiki sempurna

Sel tidak normal

Sel mati

Jenis Efek Radiasi

Sel Hidup

Tanpa Efek

Perbaikan DNA
sempurna

Sel Mati

Efek Deterministik

DNA tidak dapat

diperbaiki

Sel Abnormal

Efek Stokastik

Perbaikan DNA
tidak sempurna

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Efek Deterministik

Efek Stokastik

Squamous cell carcinoma

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Efek Stokastik

Efek Herediter
A cohort of 31,150 children born to parents who were
within 2 km of the hypocenter at the time of the
bombing was compared with a control cohort of
41,066 children. But, no statistical abnormalities were
detected
Intensive studies of 70,000 offspring of the atomic
bomb survivors have failed to identify an increase in
congenital anomalies, cancer, chromosome
aberrations in circulating lymphocytes or mutational
blood protein changes.

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Radiasi tidak menyebabkan terjadinya mutasi baru tetapi hanya

menambah frekuensi mutasi yang sudah ada di alam
Brenner DJ,2005

Efek karsinogenik

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Efek karsinogenik

Radiological hazards
Equivalent of normal
daily background
radiation

Risk of fatal cancer /

death

X-ray Limbs

1 day

0.0001%(1 in
million)

X-ray CXR

3 days

0.0003%

X-ray Skull

9 days

0.001%

Mammogram

2 months

0.005%

Modality

X-ray - Abdomen, 4 months

Pelvis, Spine

0.01%(1 in 10,000)

CT Chest,
abdomen or
pelvis

0.1%

3.5 years

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Risiko radiasi dari

teknik pencitraan diagnostik
Belum ada publikasi akhir data penelitian skala besar
tentang risiko kanker akibat pemindaian CT
Asumsi

berdasarkan
kasus paparan radiasi lain :
Atomic bomb survivors
Kecelakaan radiasi pada jumlah besar pekerja radiasi
Komite ilmiah pengkajian perkiraan risiko radiasi
(BEIR, ICRP, UNSCEAR)

Radiation exposure varies among and within CT types

Average exposure among Japanese

atomic bomb survivors

Smith-Bindman et al., Arch Intern Med, 2009

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Atomic Bomb Survivor Data

Largest longitudinal study to
date
Life Span Study of the 120,000
survivors (median dose was 40
mSv)
Followed for cancer
incidence over 55 years
Direct, statistically significant
evidence for risk in the dose
range from 5-150 mSv
Even at very low doses (10 mSv), survivors were at a
significantly increased risk of developing cancer

Pierce, DA and Preston, DL. Radiation-related cancer risks at

low doses among atomic bomb survivors. Radiation
Research, 200, 154(2): p. 178-86.

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Efek Deterministik
Jaringan/organ

Dampak

Dosis ambang (mSv)

Seluruh tubuh

Kematian
Sindrom prodromal/awal

2000
500

Sumsum tulang

Penurunan sel darah

500

Kulit

Eritema
Pengelupasan kulit
Pelepuhan
nekrosis

300
500
1500
25000 50000

Lensa mata

Kekeruhan
katarak

500
2000 10000

Testis

Sterilitas sementara
Sterilitas permanen

150
3500

Ovarium

Sterilitas sementara
Sterilitas permanen

650
2500 6000

Clinical course
Respon kulit terhadap radiasi - radiation
dermatitis atau cutaneous radiation syndrome
(CRS)
Jenis respon kulit - bergantung dosis:
1. Initial erythema
2. Dry desquamation
3. Erythema proper
4. Moist desquamation
5. Ulceration and necrosis
6. Late effects: dermal atrophy, hyperpigmentation,
fibrosis

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Efek Deterministik pada Kulit

23 Gy

eritema awal dalam 6-24 jam utk 2-3 hari

38 Gy

eritema 7 10 hari utk beberapa minggu

eritema dan epilasi

deskuamasi kering (pengelupasan kulit) 3-6 minggu

12-20 Gy

>20 Gy

blister (deskuamasi basah) dlm 4-6 minggu

ulceration (tukak/borok)
nekrosis (kematian jaringan ) dlm 10 minggu
atropi dalam bulanan-tahunan

X-Ray Burns
500+ rad
5,000+ rad

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Efek Deterministik pada Mata

Occupational dose from diagnostic x-ray is a threat
for cataract formation.
o Wear eye shields, esp. during fluoroscopy

Efek Radiasi pada Organ Reproduksi

Testis

Target : sel spermatogonium

0.15 Gy : oligospermia
< 1 Gy : steril mingguan
1 - 3 Gy : steril 1 - 2 tahun
3.5 6 Gy : dosis ambang
steril permanen

Badan Tenaga Nuklir Nasional

Ovarium
Target : sell oocytes
0.65 Gy : steril sementara
5 7 Gy: steril usia 40-an
12 15 Gy: steril utk 20-an
2.5 6 Gy : dosis ambang
steril permanen

24

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Efek Radiasi pada Janin

Risiko akibat radiasi pada masa kehamilan adalah
bergantung pada usia kehamilan dan dosis yang
diterima
Efek utama :
Prenatal or neonatal death
Congenital abnormalities
Growth impairment
Reduced intelligence
Genetic abnormalities
Cancer induction

Dosis ambang retardasi mental (penurunan IQ):

* 0,1 Gy pada kehamilan 8 15 minggu
* 0,4 -0,6 Gy pada kehamilan 16 25 minggu

SINDROMA RADIASI AKUT

adalah sekumpulan simpton yang timbul akibat
pajanan radiasi dosis tinggi pada seluruh tubuh
secara akut
Tahapan terjadinya SRA :
Sindroma prodromal simpton awal segera pasca
pajanan umumnya berlangsung beberapa jam
Masa laten (tenang) terbebas dari sakit
beberapa hari - sampai 2 minggu
SRA yang timbul : sistem hematopoitik,
sistem pencernaan
sistem syaraf pusat
Masa penyembuhan

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SRA plus sindroma kutanius pada kasus Chernobyl

Jumlah Sel Limfosit Absolut

Setiap 4 - 6 jam pada 48 jam pertama

Normal: sekitar 2500 sel/ml
300 -1200 sel/ml: dirawat
< 300 sel/ml: kritis

1:
2:
3:
4:

1 Gy
4 Gy
6 Gy
7 Gy

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Diagnostic Radiology
Certainly a potential for stochastic effects
However, deterministic effects very unlikely in
diagnostic radiology
o except in fetal exposures

Interventional Radiology
Fluoroscopically-guided procedures
High doses to patient AND workers
Dose to Patient
o typical fluoroscopy doses: tens to thousands
of millirem (0,1 10 mSv)
o typical interventional fatal cancer risk ~ 0.001
Dose to Radiologist
o tens of millirad ( 0,1 mGy) to head or
extremities per procedure
Deterministic effects are possible

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Interventional Radiography
Dose
o some fluoroscopy entrance doses are from
hundreds to thousands of rads (100-1000 mGy)
o epilation and erythema most frequently reported
effects

> 200 rad (2000 mGy) erythema

> 300 rad (3000 mGy) temporary epilation
> 700 rad (7000 mGy) permanent epiliation
> 1200 rad (12000 mGy) delayed necrosis
> 1400 rad (14000 mGy) dry desquamation
> 1500 rad (15000 mGy) late erythema
> 1800 rad (18000 mGy) moist desquamation
> 2400 rad (24000 mGy) ulceration

From FDA, Sept 1994, Avoidance of serious x-ray induced skin injuries to

patients during fluoroscopically-guided procedures

Fluoroscopy time to reach threshold
Effect

Threshold
Dose

High-level dose rate

of 200 Gy/min
10 min

Time to
onset of
effect

Early transient erythema

2 Gy

Typical fluoro. dose

rate of 20 mGy/min
1 hr 42 min

Temporary epilation

3 Gy

2 hr

15 min

3 weeks

Main erythema

6 Gy

5 hr

30 min

10 days

Permanent epilation

7 Gy

6 hr

35 min

3 weeks

Dry desquamation

10 Gy

8 hr

50 min

4 weeks

Invasive fibrosis

10 Gy

8 hr

50 min

Dermal atrophy

11 Gy

9 hr

55 min

> 14 wks

Telangiectasis

12 Gy

10 hr

1 hr

> 52 wks

Moist desquamation

15 Gy

12 hr

1 hr 15 min

4 weeks

Late erythema

15 Gy

12 hr

1 hr 15 min

6-10 wks

Dermal necrosis

18 Gy

15 hr

1 hr 30 min

> 10 wks

Secondary ulseration

20 Gy

17 hr

1 hr 40 min

> 6 wks

hours

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Chronic radiation dermatitis

(After multiple coronary angiography and angioplasty procedures)

> 6-8 weeks

redness, peeling

16-18 weeks
Small ulcerated area

18-21 month
Tissue necrosis

Shope T. Radiation-induced skin injuries from fluoroscopy. FDA/CDRH, 1995

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