TEXTBOOK OF

RADIOLOGICAL SAFETY
 TEXTBOOK OF
RADIOLOGICAL SAFETY

K Thayalan PhD
Professor and Head
Radiological Physics Department
Barnard Institute of Radiology and Oncology
Government General Hospital and
Madras Medical College
Chennai, India

JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD

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Textbook of Radiological Safety

© 2010, Jaypee Brothers Medical Publishers (P) Ltd.

All rights reserved. No part of this publication should be reproduced, stored in a retrieval system,
or transmitted in any form or by any means: electronic, mechanical, photocopying, recording,
or otherwise, without the prior written permission of the author and the publisher.

This book has been published in good faith that the material provided by author is original.
Every effort is made to ensure accuracy of material, but the publisher, printer and author
will not be held responsible for any inadvertent error (s). In case of any dispute, all legal
matters are to be settled under Delhi jurisdiction only.

First Edition: 2010

ISBN 978-81-8448-886-9
Typeset at JPBMP typesetting unit
Printed at Ajanta Offset
 Dedicated to
My Parents (Late)
Thiru K Kuppusamy Jayamkondar
Thirumathi K Arukkani
 Dr B R Ambedkar Institute Rotary Cancer Hospital
All India Institute of Medical Sciences
Ansari Nagar, New Delhi - 110 029

Tel (Off): 91-11-26594864, 26594798

Fax: 91-11-26589821
E-mail: gkrath@rediffmail.com

Dr GK Rath MD
Professor and Head,
Department of Radiation Oncology
Chief, DRBRAIRCH, AIIMS
Ex President, AROI

Foreword

It brings me immense pleasure to write the foreword for this book which
is focusing on radiation protection. There was a long-felt necessity for such a
textbook. Dr Thalayan has an extensive experience in the field of Medical
Physics and this book sums up his vast experience for the benefit of the readers.
The author must be complemented for the lucid style of writing. It contains all
the essential aspects of radiological safety. The chapter on "Regulations and
Dose Limits" is of particular relevance as it contains details of regulatory aspects.
The book will go a long way in helping the Radiation Oncology, Nuclear
Medicine, Radiology and Medical Physics Community and will be very useful
for the health care providers at all levels in these specialties. The chapters are
concise and complete in all aspects. Large numbers of illustrations have been
included to explain the subject matter. Bibliographies at the end of each chapter
have been included to serve as additional reading material on the subject.
I wish Dr Thalayan all success in his maiden venture.

Prof GK Rath MD
Professor and Head,
Department of Radiation Oncology
Chief, DRBRAIRCH, AIIMS
Ex President, AROI
 Preface

It gives me immense pleasure to come out with a textbook on radiological safety,

a unique textbook. It is my long-felt dream to have a complete book, on
radiological safety, covering the entire fields of radiology i.e., diagnostic
radiology, nuclear medicine and radiotherapy.
Radiation is analogous to fire which has both beneficial and harmful effects.
The inherent philosophy is to minimize the hazards and maximize the benefits
in order to bring down radiation doses within the regulatory control limits by
which we can ensure the safety of the occupational workers as well as the
patient and public. Hence, it is important that every one should be aware of
the safety concepts, dose limits, regulation, waste disposal, etc., to establish a
safe work culture while handling radiation sources in the hospital. As such, no
single document is available for the above purposes, and the information is
collected from safety codes and guides of international and national agencies
like IAEA, NCRP and AERB.
An attempt has been made to bring all the relevant information including
safety terminology, biological effects, exposure control, monitoring, planning
of the installation, quality assurance, regulation, personnel safety, transport,
waste disposal and radiation emergency, etc. in the form of a book. The whole
objective is to remove misconception about radiation and prepare the minds of
younger generation to face the future challenge confidently. This book is
intended for postgraduates of medical physics, diagnostic radiology, nuclear
medicine and radiotherapy. This book may also find a place for the preparation
of RSO examinations for medical physicists.
Moreover, an attempt has been made to bring quantitative data from
international reports and recommendations, wherever necessary, with practical
examples and illustrations. This may enable the new entrants to plan a radiation
facility, carry out quality assurance and radiation survey without much
cumbersome and perform the day-to-day medical physicist’s job with ease and
involvement. Large numbers of tables and figures are incorporated wherever
necessary for better understanding of the reader.
I am very much thankful to my family members for their support and
cooperation. I also acknowledge the assistance offered by the Dr Kamakshi
Memorial Hospital staff, especially the medical physics colleagues, in the
preparation of the text. I also thank Mrs G Shakunthala for neatly typing the
manuscript.
I also acknowledge my teachers, by whom I got inspiration and passion
towards teaching.
I invite the readers to offer constructive comments for the future
improvement of the book.

K Thayalan
 Contents

1. Safety Concepts ........................................................................................ 1

Introduction 1
Radiation units 2
Equivalent dose 4
Effective dose or effective dose equivalent 4
Committed dose 6
Collective dose 6
Genetically significant dose 7
Detriment 8
Annual limit on intake 8
ALARA 8
Sources of radiation 9
2. Biological Effects of Radiation ............................................................. 14
Cell 14
Interaction of radiation with tissue 14
Linear energy transfer 16
Biologic effects 17
Radiation effects on DNA 22
Radiation effects in utero 23
Radiation risk 24
Ten day rule and its present status 29
3. Radiation Exposure Control .................................................................. 31
Time 31
Distance 32
Shielding 34
Half value layer 35
Sources of exposure 37
Leakage limits 39
Protective barrier design 40
Facility design for diagnostic X-rays 42
Facility design for nuclear medicine 47
Facility design for radiotherapy 48
4. Planning of Radiological Facility ......................................................... 64
General guidelines 64
Establishing a diagnostic X-ray facility 65
General radiography installation 68
Fluoroscopy installation 68
Mammography installation 69
Computed tomography installation 70
Establishing a nuclear medicine facility 71
In-vivo diagnostic facility 74
In-vitro and radioimmunoassay (RIA) 75
 Textbook of Radiological Safety

Radionuclide therapy 78
Establishing a radiotherapy facility 79
Brachytherapy facility design 91
5. Radiation Monitoring ............................................................................. 95
Personnel monitoring 95
Film badge 96
Thermoluminescent dosimeter 97
Pocket dosimeter 100
Personnel monitoring systems and features 102
Area monitoring 103
Radiation survey in diagnostic radiology 107
Radiation survey in nuclear medicine 111
Radiation survey in radiotherapy 112
Calibration and maintenance of radiation monitoring instruments 117
6. Quality Assurance ................................................................................. 119
Introduction 119
Quality assurance for diagnostic radiology 119
Quality assurance for radiography unit 120
QA for mammography X-ray unit 133
QA for fluoroscopy X-ray unit 134
Quality assurance for computed tomography 134
Quality assurance for nuclear medicine 137
QA for gamma camera 138
QA for single photon emission computed tomography (SPECT) 140
Quality assurance for PET-CT 141
Image quality tests 146
QA for radiopharmaceuticals 147
Quality assurance for radiotherapy 154
QA for linear accelerator 154
QA for HDR brachytherapy 159
7. Regulations and Dose Limits .............................................................. 167
Atomic energy act-1962 167
Atomic energy regulatory board 167
Radiation protection rules-2004 168
Regulatory controls for diagnostic X-ray equipment and installations 181
Regulatory controls for nuclear medicine facilities 184
Regulatory control for radiotherapy equipment and installations 190
8. Personnel Protection ............................................................................. 204
Radiography 204
Protection in fluoroscopy 212
Protection in computed tomography 214
Protection in pediatric imaging 215
Pregnancy and radiation 221
Protection in nuclear imaging 227
Protection in radionuclide therapy 232
xii Pregnancy and radiation protection in nuclear medicine 233
 Contents

Radioiodine therapy and pregnancy 235

Staff protection 237
Personnel safety during source transfer operations of teletherapy
and HDR brachytherapy units 238
Pregnancy and radiation protection in radiotherapy 240
Records 243
9. Transport of Radioactive Materials ................................................... 245
Introduction 245
Types of packages 246
Transport index 248
Packaging and package requirements 249
Preparation of the package for transport 253
Marking of the package 253
Labeling of the package 254
Placards 256
Booking, storage, transport and delivery of package 257
Consignor’s declaration 258
Tremcard 259
Information to carriers 260
10. Radioactive Waste Disposal ................................................................ 267
Introduction 267
Waste management 267
Sources and nature of waste 268
Classification of waste 269
Types of radioactive waste 270
Disposal of low activity wastes into the environment 276
Disposal of radioactive effluent into the ground 276
Disposal of P-32 and I-131 into municipal sewers by medical users 277
Disposal of radioactive waste from nuclear medicine procedures 278
Routine protective clothing 280
Decontamination procedures 281
11. Radiation Emergencies ......................................................................... 289
Type of radiation accidents 289
Diagnostic radiology-skin injuries 294
Nuclear medicine: Radiation accidents 297
Radiotherapy: Radiation emergencies 300
Brachytherapy: Radiation accidents 308
Emergency preparedness: Actions 309
Medical management of personnel exposed to radiation 313
Index .......................................................................................................... 319

xiii