ACADEMY OF HEALTH SCIENCES M PNFX7101 DEPARTMENT OF PREVENTIVE HEALTH SERVICES 0508 NUCLEAR, BIOLOGICAL, CHEMICAL SCIENCES BRANCH

Radiation Safety Briefing REFERENCES: Hall, Eric J.; Radiobiology for the Radiologist, 5th ed., Philadelphia: Lippincott Williams & Wilkins, 2000 AR 11-9, The Army Radiation Safety Program, 28 May, 1999 TB MED 521, Management and Control of Diagnostic X-ray, Therapeutic X-ray and Gammabeam Equipment, June 1981 TERMINAL LEARNING OBJECTIVE: Identify the potential radiation hazards in diagnostic radiology and the precautions necessary to maintain exposures as low as reasonably achievable as well as describe recommended measures to maintain total fitness. ENABLING LEARNING OBJECTIVE: 1. Given a DD 1952, properly complete the Dosimeter Application IAW AR 11-9. 2. Given a list of radiation effects, select the statement which describes that effect IAW Hall. 3. Given a list of statements about radiation protection, select the statement which describes the as-low-as-reasonably-achievable (ALARA) concept IAW AR 11-9. NOTES A. DD Form 1952, Dosimeter Application and Record of Occupational Radiation Exposure 1. For the X-ray survey class, complete cells indicated in Figure 1 (left). Under pay grade, civilians should either Check the box or print CIV In the box. For military, print your grade (e.g., E-5, O-2). Include the address to send the dosimetery results to, for most students, this will be the address of the office where dosimetry results are maintained or your office address. Turn over form to sign. 2. On the reverse, review the Privacy Act. The only item of concern is the Social Security Number. This number is used to uniquely identify the wearer. For non-US residents without an SSN, another unique identifier (e.g., passport number, Social Insurance Number, etc.) is used. The birthdate is not Privacy Act data, it is used to verify that the applicant is older than 18 years of age.

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Figure 1. DD 1952 Dosimeter Application and Recor of Occupa e 2, n rd ational Radia ation Exposu ure B. Biological Effects of Ionizing Radiation s 1. When ionizing radiation strikes the W g s body, it rando omly hits or misses m millions of cells. m ells re a. For the ce which ar not hit, the radiat tion simply passes p through and no harm is done. a b. If a cell is hit directly, the cell may be co ompletely killed or just damaged. Some of th he possible results from cellular r radiation interactions include:

Fig gure 2. Poss sible Radiation Effects

(1) Repai - the dama ir aged cell can repair itsellf so no perm n manent damage is cause ed. This is the normal outcome fo low doses of low LET radiation co s or s ommonly encou untered in the workplace e.
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(2) Cell death - the ce can die lik millions o normal cells do natura ell ke of ally. The dea ad cell de ebris is carried away by the blood an a new ce is usually generated nd ell throug normal biological processes to re gh eplace it. (3) Mutate - in a very small numb of events a damage cell may e ber s, ed exhibit a cha ange in the cell's reprod ductive struc cture allowin the cell to regenerate as a potentially ng o pre-ca ancerous cell. Over a pe eriod of man years or d ny decades, this may result in a t full-blo own, malignant cancer. c. Because dead cells are rapidly re a emoved by b biological pro ocesses, rad diation safety is y primarily concerned with cellular effects whic result in d c w ch damage to c crucial reproduct tive structure such as th chromoso es he omes and th components (e.g., heir genes, DN etc.). NA, d. The natur severity and time of appearance of biologica effects dep re, a a al pends upon the type of inc cident radiat tion, the tota radiation d al dose and dos se. 2. Io onizing radia ation loses energy by pro oducing ion pairs as it pas sses through h matter. The linear energy m l y tr ransfer, LET, is the amount of energy a ra f adiation deposits per unit of path le ength (i.e., kiloelectron vo olts/micron - keV/m). a. Mass, cha arge and velocity of a particle all a 3. nergy Transf (LET) fer Figure 3 Linear En affect the rate at whic ch ionization occurs and is related to the range o the radiation in that m n o of material. (1) Heavy and/or high charged particles (e. g., -particle neutrons protons) h y hly es, s, have a high LET and lo energy ra h ose apidly with d distance, con nsequently t they have a short range and do not penetrate deeply. e (2) Radia ation with a lo range (e ong e.g., x- / -ra ays, high-ene ergy -partic cles) travel greate distances between int er teractions an have a lo LET. nd ow eases with th square of the charge on the incident particle. The higher the he f r b. LET incre ty, charge of the particle and the low its velocit the great likelihood that charge f wer ter d ed particle will produce io w onization. c. In tissue, the biologic effect of rad diation depe ends on the a amount of en nergy transf ferred sue o rget and is th herefore a fu unction of LE The LET of ET. T to the tiss volume or critical tar diagnostic x-rays is approximately 3 keV/m. c y

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3. In radiation biology resea n arch, many different type and energ d es gies of radia ation are use ed and it become difficult to compare th results of the experim es o he f ments based solely on LET; d ral logic effectiv veness, RBE was devel E, loped. The RBE a more gener term, the relative biol re elates the va arious radiation effects to 250 kV x-r o rays.

RBE is a mea R asurement of the effectiv o veness of a radiation in producing a specific outcome com mpared to a reference radiation of 25 kV x-rays r 50 s. 4. Because LET depends to a great B T o ex xtent on the specific tiss sue, the re elationship between LET and RBE b T is not easy to derive. Fig s o gure 4 co ompares some RBE values to the LET in water. Notice that some . t ra adiations wit different RBEs have th R th same LET while some high LET he T e ra adiations hav relatively similar ve y LET. a. RBE is initially propor rtional to LET and, as the LET for ionizing F Figure 4. LE and RBE in Water ET radiation increases, so does the s RBE. Thi increase is primarily th result of is he higher ion nization dens and mor optimal sity re energy de eposition for high-LET ra r adiations. b. Beyond 100 keV/m of tissue, the RBE o e decreases with increa asing LET. As more A ionization are produc in the bi ns ced iological system, part of the en p nergy deposited in the system is wasted due to an overk effect. e kill Fig gure 5. LET versus RBE E

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D ble ng 5. Direct Action - It is possib for ionizin ra adiation to in nteract direct with critic tly cal elements in th cell, ioniz he zing or exciting atoms within the target molecule (i.e., DNA is m th most sens he sitive structu in the nu ure ucleus) and initiating a chain of events which may e h ead gical change or damage. . le to biolog a. Direct act tion is the do ominant dam maging process with high LET radiation (e.g., w T particles, protons, and neutrons) because d the ioniza ation track is very dense. tion is assoc ciated with ra adiation b. Direct act effects for which a ze threshold dose is r ero d postulated (e.g., gene effects). In this d etic scenario, damage ma be transm ay mitted to succeedin generatio of cells, making ng ons the damage cumulativ with radia ve ation dose. Figure 6. Direct and Indirect Act tion ndirect Action - Absorptio of radiatio on on 6. In energy may result in free-radical form r mation. Here the atoms / molecules have an e unpaired elec ctron in the outer shell (e o e.g., OH-) an exhibit a h nd high degree of chemical l re eactivity. The two substa e ances in a ce likely to b involved in free radica formation are ell be al ox xygen and water (H2O -- H2O+ + e-). The hyd w droxyl radica (OH-) is th major al he ox xidizing age resulting from ionization of water . ent a. Although free radicals are extrem s mely reactive most of the reactions r e, e recombine to o gen er 1 s using any biological effe ects. form oxyg and wate in about 10-5 seconds without cau b. Biological effects occur when the free radical s interact wiith nearby ch l hemical compounds which the can dama critical c compone en age cell ents. Thus, free radicals s may act as oxidizing or reducing agents and may form pe a o eroxides when they reac ct with water, these may inactivate cellular mec y c chanisms or interact with genetic ma h aterial in the cell l. c. Considere the princi diation in hu ed ipal action of ionizing rad umans.

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7. Fractionation - Radiation ex xposure delivered in ntermittently at high dose e ra allows fo some repa ate or air of sublethal damage. f d Effect is LET dependent. E a. A single-d dose surviva al curve for x-rays and neutrons (left) shows that x-ray have a ys larger initial shoulder than neut trons. The RBE actually varies with dose getting larg e, ger as the siz of the dos ze se is reduced d.

F Figure 7. Fr ractionation

b. Giving the radiation dose in 4 equ fractions shows that it requires m e d ual more total do ose to reach the same surviving fracti point (10 -2) and pres t ion 0 sents a differ rent RBE (i.e e., remembe RBE is the relationshi of that dos to 250 kV photons). Each of the xer, e ip se V ray fractio curves be on egins with the large shou ulder which e effects the s shape of the survival curve. c 8. Protraction - The dose ra also affec P T ate cts th shape of the survival graph. he a. Radiation exposure delivered at a n d low dose rate, continu uously over time is les effective than the sam ss t me exposure at a high do rate. ose b. As the do rate is low ose wered and treatment time protrac t cted, more and more sublethal damage can be e repaired during the ex d xposure, so the surviv curve bec val comes shallower r. (1) There is a point at which near e rly all sub blethal dama is age repair red. Figur 8. Protrac re ction

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(2) In som cells the cell cycle ca progress until the cells become f me an frozen in the radios sensitive pha of the cy ase ycle (i.e., the G2 phase). e 9. Oxygen Effec - Cells are more sensi O ct e itive to x-ray in the pres ys sence of mo olecular oxyg gen th in its abs han sence (i.e., hypoxia). h eeded to a. The ratio of doses ne produce the same lev of cell t vel killing und hypoxia to the aerate der ed conditions is the oxyg s gen enhancem ment ratio (O OER). The OER varie from about 3 at high es doses to about 2 for x-ray doses a x below 2 Gy (200 rad). G b. It is believ that free radical ved e formation increases in the n presence of oxygen. ct vival for highc. The effec of cell surv LET partic cles (e.g., -particles, protons, neutrons) is significantly n different. (1) For -particles, th OER is he essen ntially 1 (i.e., there is no oxyge effect). en (2) For ne eutrons, ther is an re oxyge effect, but it is much en t smalle than for xer -rays (e.g., about 1.6). a F Figure 9. Oxy ygen Effect

F nie bondeau exa amined cells for s 10. In 1906, two French scientists, Bergon and Trib diosensitivity The Law of Bergonie and Tribon y. ndeau states s: rad p c e tive to radiat tion. a. Actively proliferating cells are the most sensit b. The degre of differentiation of ce is invers ee ells sely related t their radio to osensitivity. c. Radiosen nsitivity of cells is proport tional to the duration of mitotic and developmen ntal activity that they must pass through. In general ter n rms, this means that rap pidly dividing cells that are poorly dif g fferentiated a and sitive. The g th have a lo mitotic period are ve radiosens hat ong p ery general rule as well as t the ex xceptions (e e.g., lymphoc cytes) are lis sted in the ta able.
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Summary - Factors Affecting Rad y A diation Resp ponse Physical Biologiical Linear Energy Tra r ansfer (LET) ) Celll type (Bergo onie & Tribo ondeau) Relative Biologica Effectivene (RBE) al ess R Reproductive rate e M Mitotic future (lifetime) e Fractionation action D Degree of sp pecialization (differentiat tion) Protra Oxy ygen effect Age (at exposure see leukemia risk c e chart) Sex x Stat of health te 11. Ra adiation expo osure carries some risk of radiation effects. This risk is rela ated to the va arious physic and biolo cal ogical factors of the expo s osure. Expo osure risks fo people are or e oft divided into two broa classes, stochastic (o probabilist and non-stochastic ( ten ad s or tic) (or de eterministic). a. Stochastic / probabilis risks are so called b stic e because the effect has a statistical probability of occurrin the proba y ng, ability of the effect occur rring increas with dose ses e, however the severity of the effect is not affec t t cted by dose It is also a e. assumed tha at there is no threshold, consequent any expo tly osure carries some non-z s zero risk of t the effect occ curring. Examples of sto ochastic effe ects include c cancer and genetic / hereditary effects. Th y hus, if somat cells (i.e. , any body c tic cells except germ cells) are exposed to radiation, the probability of cance increases with dose, p t er probably with hout threshold. However, the severity of the canc er is not dos se-related; a cancer indu uced by 1 Gy (100 rad) is no worse tha one induc by 0.1 G (10 rad). n an ced Gy b. Non-stoch hastic / dete erministic risk are more related to ra ks adiation dose effects wh hich prevent cells from sur rviving or rep producing. A such, the effects h As ese have a measurab threshold (which vari among in ble d ies ndividuals), below this th hreshold, the e effect is not observed (e.g., loss of too few ce n d o ells). The m magnitude of the injury is related to the total do ose. Examples of non-st tochastic eff fects include erythema (s e skin reddening epilation (hair loss), and cataract g), a ts. eterministic / non-stocha astic effects have been w docume well ented in accidental 12. De ex xposures, ato bomb ex om xposures to both the Jap b panese and Marshall Isla anders, and
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Chernobyl. Most of these effects require an acute exposure in excess of 2 Gy (200 rad). Some of the well documented deterministic effects include: a. Acute Radiation Injury - Acute, large doses of radiation may damage a sufficient number of radiosensitive cells to produce mild symptoms of radiation sickness within a few days to a few weeks. The immediate somatic effects may include symptoms such as blood changes, nausea, vomiting, hair loss, diarrhea, dizziness, nervous disorders, hemorrhage, and maybe death. Without medical care, half of the people exposed to a whole body acute exposure of 4 Gy (400 rad) may die within 60 days (LD50/60). Regardless of care, persons exposed to an acute exposure exceeding 7 Gy (700 rad) are not likely to survive (LD100). Exposed individuals who survive acute whole body exposures may also develop other delayed somatic effects such as epilation, cataracts, erythema, sterility and/or cancers. (1) Hematopoietic syndrome (1 - 8 Gy) - The hematopoietic stem cells are the most radiosensitive tissues in the body. Radiation doses of 2 Gy (200 rad) or more can damage the blood forming capability of the body. Acute doses kill some of the mitotically active precursor stem cells, diminishing the subsequent supply of mature red cells, white cells, and platelets. As mature circulating cells die and the supply of new cells is inadequate to replace them, the physiological consequences of hematopoietic system damage become manifest. The Hematopoietic syndrome includes such symptoms as increased susceptibility to infection, bleeding, anemia, and lowered immunity. One of the principal causes of death after total-body irradiation is infection. For doses below 7 Gy (700 rad), the hematopoietic syndrome starts about 8 - 10 days post exposure with a serious drop in granulocyte and platelet counts. Pancytopenia (i.e., reduction of all types of blood cells) follows about 3 - 4 weeks later, becoming complete at doses above 5 Gy (500 rad). Petechiae (small hemorrhage under the skin) and purpura are evident, and bleeding may be uncontrolled, causing anemia. There may be fever and rises in pulse and respiratory rates due to endogenous bacterial and mycotic infections. The infections may become uncontrolled due to impaired granulocyte and antibody production. If at least 10% of the hematopoietic stem cells remain uninjured, recovery is possible. Otherwise, death occurs within 4 - 6 weeks. (2) Gastrointestinal syndrome (8 - 30 Gy) - At doses above 8 Gy (800 rad), injury to the gastrointestinal tract contributes increasingly to the severity of the manifestillness phase. Such high exposures inhibit the renewal of the cells lining the digestive tract. These cells are short lived and must be renewed at a high rate. High exposures then lead to depletion of these cells within a few days. The physiological consequences of gastrointestinal injury may vary depending upon the region and extent of damage. The small intestine contains the most sensitive of these tissues followed by the stomach, colon, and rectum. The mouth and esophagus respond similarly to the skin. Thus, the result of high exposures is a breakdown of the mucosal lining and ulceration of the intestine. As the mucosa breaks down, bacteria can enter the bloodstream and are unchallenged because of the curtailed production of granulocytes. Beginning at approximately 12.5 Gy (1250 rad), early mortality occurs due to dehydration and electrolyte imbalance
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from leakage through the extensively ulcerated intestinal mucosa. These conditions develop over a few days and are characterized by cramping, abdominal pain, and diarrhea, followed by shock and death. (3) Central nervous system syndrome (> 30 Gy) - CSN symptoms are identified almost immediately and consist of disorientation, apathy, ataxia, prostration and often tremor and convulsions. The cause of death includes vascular damage, meningitis, myelitis, and encephalitis. Fluid infiltrates into the meninges, brain and choroid plexus causing edema, this pressure may cause pressure on critical structures. b. Cataracts seem to have a threshold of about 2 Gy (200 rad) and are more probable from acute neutron doses. They tend to have a long latent period. They can be distinguished from age-induced cataracts because senile cataracts begin in the anterior pole of the lens whereas radiation cataracts begin as a small dot in the posterior pole. c. Hair loss (epilation) can occur after acute doses of 2 - 5 Gy (200 - 500 rad). Temporary hair loss in radiotherapy patients begins in about 3 weeks and hair begins to return during the second month continuing up to 1 year. Single doses of 7 Gy (700 rad) may cause permanent epilation with a latent period of less than 3 weeks. Hair follicles of children are more sensitive than those of adults. Body hair tends to be less sensitive than the scalp and beard. d. Skin erythema (reddening) occurs from a single dose of 6 - 8 Gy (600 - 800 rad) with a threshold of 4 Gy (400 rad) in sensitive individuals. The higher the radiation dose, the more quickly the erythema appears. Early erythema is thought to be due to the release of vasoactive amines. Erythema increases during the first week and usually fades during the second week, only to return and may last for 20 - 30 days. e. Sterility, depending on dose may be either temporary or permanent in males. Although females require a higher dose, sterility is usually permanent. The female threshold for permanent sterility usually requires doses exceeding 2 Gy (200 rad) to the reproductive cells. Male, temporary sterility may occur at a threshold of 0.5 Gy (50 rad). 13. Stochastic / probabilistic effects have been demonstrated through epidemiological studies of acutely exposed populations. The two main categories of stochastic effects are carcinogenic and genetic. a. Cancer - Radiation is considered a generic carcinogen. That is, while cancers may be produced by ionizing radiation, the cancers are indistinguishable from spontaneous or non-radiation cancers. Additionally, there is usually a long, variable latent period (> 5 to 30 years) from radiation exposure to cancer manifestation, making cause and effect difficult to identify. Another reason it is difficult to pin-point cause is that the normal cancer incidence is relatively high (i.e., the fatal cancer risk from all causes in the U.S. is about 20% or one person in five), the number of cancers expected from radiation exposure are a fraction of
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1% of the normal incidence. The table lis the susce f sts eptibility of ti issues to radiation-induced cancer and, in parenthe esis, some o the mean latent period in of ds years for onset.

e ulation studie of radiatio induced c es on cancers used to generat the d te Some of the popu table data include d e: Le eukemia - ea radiologists, atom bo arly omb survivo ankylosin spondylit ors, ng tis pa atients Br reast - TB pn neumothorax patients, a x atom bomb s survivors Th hyroid - ringw worm and th hymus irradia ated patients s Bo - radium dial painter one m rs Lu - uranium miners ung m e h hown to caus genetic m se mutations in f fruit b. Genetic effects - While radiation has been sh flies and mice, there is no evidence of mutag enic effects seen in atom bomb m i m survivors after three generations. Some of th reasons f this lack o evidence are g he for of that it is difficult to ext d trapolate animal data to man, the re eproductive c cycle in man is n long and the mutation risk, even at 5 rem, is s t n a small and no detectable The two ot e. major non n-human sou urces that de emonstrate g genetic effec are: cts Fr flies - Mu ruit uller, 1927 Mice - Russell, 1950s 14. Te eratogenic ef ffects result from both st tochastic an non-stoch nd hastic effects Birth defe s. ects are known to occur in 3 - 5% of all new e o 5 wborns and they are the leading cau of infant e use t mo ortality in the United Sta e ates, account ting for more than 20% of all infant d e deaths. a. Dose dep pendent - There is a dose dependen in that th lowest dos associate ncy he se ed with terato ogenic effec in man is 0.1 Sv (10 r cts rem). The th hreshold for concern is 0 0.05 Sv (5 rem m). b. Time dependent - The effects var with the s tage of preg e ry gnancy and t risks are the e higher during the earl stages ly

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(1) Preim mplantation (0 - 1 week post concept 0 p tion) - the ris during this period tend to sk s ds be an all or none risk, damage results in p prenatal dea manifest as a ath ted sponta aneous abortion, the wo oman would experience a normal me enstrual cyc cle and never be awa of the conception. are (2) Organ nogenesis (2 - 8 2 weeks - this is a s) sensit tive period due to the mass of undiffe erentiated and rapidly dividing ce y ells. Possible outcome at es stage include pren natal death, perinatal death (still birth) or b malformation. (3) Fetal growth (8 - 40 4 weeks - once s) organogenesis ha as passe effects may ed, m be developmental. ts Effect seen in pregnant atom bo omb surviv vors include CNS chang ges, mental retard dation, microc cephaly, and an d increa ased risk of child c cance both leuke er, emia and tu umors. This last effect also docum mented by Stewa et. al. art, c. Summary - Thus the y teratogen effects ar nic re seen to be determinis / stic cell killing effects that g t
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Figure 1 Teratoge 10. enic Effect

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result in fe death, gross malformations and growth reta etal g d ardations. T They are also o stochastic / probabilis effects th result fro cell muta c stic hat om ations and pr roduce leuke emia and other cancers. The first table demonstra r T e ates the risk to the fetus and the sec cond table illustrates the ris of NOT de sk eveloping ch hildhood can ncer for vario doses. ous

15. Th here have be extensiv studies of radiation ef een ve f ffects. Beca ause of the la arge populat tions req quired for sm dose eff mall fects, most of these stud o dies have loo oked at sma aller populati ions ex xposed acute ely. The ma goal of these studies has been to understand the risk to the ain o d hu uman popula ation from ex xcessive and unneces d/or ssary radiation exposure Through t e. the ye ears, various dose-respo onse models have been proposed an debated. Each mode nd el ha some valid and eac can be co as dity ch orrectly appli ed to a subs of the da set ata. The problem is that low-dos effects are not the same as high- dose effects se e s Thres shold - this model postula m ates a minim mum dose re equired for a effect. an Deterministic effects have a th hreshold. No-threshold - this model sug s ggests that a dose has consequen any s nce, stochas / stic probabilistic effects theoretica have no threshold. ally Linear - this mode assumes el that th effect incr he reases in direct proportion to the t dose, this has bee seen in en certain dose ranges for cell killing effects. Linear-quadratic - this hat model suggests th at e lower doses, there is less sequently damage and cons isk ere less ri while the is increa ased risk at high h doses s. Horme - this model esis Fiigure 11. Do ose-Respon Model nse sugge ests that very low y doses may actually enhance functions lik immune re s f ke esponse and may have d positiv effects. ve While all of th models ha a basis in fact, for re W he ave egulatory pu urposes, it is assumed th s he ef ffect of radia ation is detrim mental and the model us to predict this effect is the linea no t sed t ar, th hreshold model. The be enefit to using this mode l is the likelih hood that it o overestimate es th risk. How he wever, adopt tion of the model reinforc a fear of radiation exposure in m m ces f many members of the populatio m t on.
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C. Radia ation Protection Practice es 1. ALARA philos A sophy: Mea asures taken to maintain exposures As Low As R n n Reasonably Achievable. Workers use time, distance, and sh ielding to ke their radiation expos A W e eep sure ALARA. A a. Time. (1) The le time you are expose to ess u ed x-rays the less ex s, xposure you will u receiv ve. (2) Use established te e echniques, avoid a retake es. (3) Do no remain in an fluoro roo ot a om unless needed, wear a protec s w ctive apron unless behind the oper rators protec ctive shield. b. Distance. (1) Radia ation intensity decreases with y s the sq quare of the distance from the so ource. If at 3 feet it is 10 00 mrem/hr, at 6 feet it is only 25 t 5 mrem/hr (i.e., inve erse square law). (2) When using porta n ables, take F Figure 11. T Time - Distan - Shieldi nce ing advan ntage of the long exposu ure switch to remain at least 6 fee from the tu h a et ubehead. c. Shielding. (1) Radia ation intensity is decreas by shield y sed ding material (e.g., lead) ). (2) Rema behind th operator shield (contr booth) du ain he s rol uring x-ray production. able machin or if in a (3) Use protective ap p prons when taking x-rays with a porta t s ne fluoroscopic / card diac cath suite. Wear pr rotective glo oves if your h hand will be in eam. the be (4) Alway shield pat ys tients when the shield (e t e.g., protectiv apron, go ve onad shield, etc.) will no interfere with the study ot w y. 2. Personal dos P simeter
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a. Whole bo dosimete will be issued to each student ody er (1) Wear only your do osimeter (2) Return dosimeter to storage rack r before leaving x-r lab for e ray breaks/lunch and at close of day. d b. Wear the dosimeter between sho b oulders and waist with windo facing out t, ow t. c. When using a protect tive apron, and you a y osimeter, wea the ar have only a single do dosimeter outside the apron. If you have r e a second dosimeter, wear the wh w hole body dosi imeter beneath the apro and on the secon collar ba nd adge at the collar, c outside th apron. Th second badge he his b measures thyroid and lens dose. s d 3. Radiation pro R otection guid des a. For adult, radiation workers, the whole bod dose limit is 5000 dy t mrem/yr (5.0 rem/yr). ( b. Minors (under 18 yea of age) ars are allowe 10% of th adult ed he limit. a. Declared pregnant wo orkers are allowed 500 mrem to the fetus 5 during the gestation period. e p d. Expected exposure during course, 0 - 10 mrem 4. Pregnancy Surveillance Program P P a. Students who are pre egnant, or wh suspect t ho that they mig be pregn ght nant, should inform the instructor or their supe e o ervisor b. Pregnant students will receive ad dditional instr ruction from the Radiatio Protectio on on n ure r w exposure can be maintained n Officer on how to insu that their already low radiation e as low as reasonably achievable. . c. Declared pregnant wo orkers expos sures are lim mited to 500 mrem durin the entire ng gestation period.
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5.

Radiation Protection Office Location and Staff 1. RPO: Location: Rm 0410, Willis Hall 2. Telephone: x6011/6632 3. Dosimetry Coordinator: x2614/1869

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M PNFX7101 0508 APPENDIX A INSTRUCTOR'S GUIDE EFFECTS ON THE EMBRYO/FETUS OF EXPOSURE TO RADIATION AND OTHER ENVIRONMENTAL HAZARDS In order to decide whether to continue working while exposed to ionizing radiation during her pregnancy, a woman should understand the potential effects on an embryo/fetus, including those that may be produced by various environmental risks such as smoking and drinking. This will allow her to compare these risks with those produced by exposure to ionizing radiation. Table 1 provides information on the potential effects resulting from exposure of an embryo/fetus to radiation and nonradiation risks. The second column gives the rate at which the effect is produced by natural causes in terms of the number per thousand cases. The fourth column gives the number of additional effects per thousand cases believed to be produced by exposure to the specified amount of the risk factor. The following section discusses the studies from which the information in Table 1 was derived. The results of exposure of the embryo/fetus to the risk factors and the dependence on the amount of the exposure are explained. RADIATION RISKS Childhood Cancer Numerous studies of radiation-induced childhood cancer have been performed, but a number of them are controversial. The National Academy of Science (NAS) BEIR report reevaluated the data from these studies and even reanalyzed the results. Some of the strongest support for a casual relationship is provided by twin data from the Oxford survey. For maternal radiation doses of 1,000 millirems, the excess number of deaths (above those occurring from natural causes) was found to be 0.6 death per thousand children. Mental Retardation and Abnormal Smallness of the Head (Microcephaly) Studies of Japanese children who were exposed while in the womb to the atomic bomb radiation at Hiroshima and Nagasaki have shown evidence of both small head size and mental retardation. Most of the children were exposed to radiation doses in the range of 1 to 50 rads. The importance of the most recent studies lies in the fact that investigators were able to show that the gestational age (age of the embryo/fetus after conception) at the time the children were exposed was a critical factor. The approximate risk of small head size as a function of gestational age is shown in Table 1. For a radiation dose of 1,000 millirems at 4 to 7 weeks after conception, the excess cases of small head size was 5 per thousand; at 8 to 11 weeks, it was 9 per thousand. In another study, the highest risk of mental retardation occurred during the 8 to 15 week period after conception. A recent EPA study has calculated that excess cases of mental retardation per live birth lie between 0.5 and 4 per thousand per rad. Genetic Effects Radiation-induced genetic effects have not been observed to date in humans. The largest source of material for genetic studies involves the survivors of Hiroshima and Nagasaki, but the 77,000 births that occurred among the survivors showed no evidence of genetic effects. For doses received by the pregnant worker in the course of employment considered in this guide, the dose received by the embryo/fetus apparently would have a negligible effect on descendants. A-1

M PNFX7101 0508 NONRADIATION RISKS Occupation A recent study involving the birth records of 130,000 children in the State of Washington indicates that the risk of death to the unborn child is related to the occupation of the mother. Workers in the metal industry, the chemical industry, medical technology, the wood industry, the textile industry, and farms exhibited stillbirths or spontaneous abortions at a rate of 90 per thousand above that of workers in the control group, which consisted of workers in several other industries. Alcohol It has been recognized since ancient times that alcohol consumption had an effect on the unborn child. Carthaginian law forbade the consumption of wine on the wedding night so that a defective child might not be conceived. Recent studies have indicated that small amounts of alcohol consumption have only the minor effect of reducing the birth weight slightly, but when consumption increases to 2 to 4 drinks per day, a pattern of abnormalities called the fetal alcohol syndrome (FAS) begins to appear. This syndrome consists of reduced growth in the unborn child, faulty brain function, and abnormal facial features. There is a syndrome that has the same symptoms as full-blown FAS that occurs in children born to mothers who have not consumed alcohol. This naturally occurring syndrome occurs in about 1 to 2 cases per thousand. For mothers who consume 2 to 4 drinks per day, the excess occurrences number about 100 per thousand; and for those who consume more than 4 drinks per day, excess occurrences number 200 per thousand. The most sensitive period for this effect of alcohol appears to be the first few weeks after conception, before the mother-to-be realizes she is pregnant. Also, 17% or 170 per thousand of the embryo/fetuses of chronic alcoholics develop FAS and die before birth. FAS was first identified in 1973 in the United States where less than full-blown effects of the syndrome are now referred to as fetal alcohol effects (FAE). Smoking Smoking during pregnancy causes reduced birth weights in babies amounting to 5 to 9 ounces on the average. In addition, there is an increased risk of 5 infant deaths per thousand for mothers who smoke less than one pack per day and 10 infant deaths per thousand for mothers who smoke one or more packs per day. Miscellaneous Numerous other risks affect the embryo/fetus, only a few of which are touched upon here. Most people are familiar with the drug thalidomide (a sedative given to some pregnant women), which causes children to be born with missing limbs, and the more recent use of the drug diethylstilbestrol (DES), a synthetic estrogen given to some women to treat menstrual disorders, which produced vaginal cancers in the daughters born to women who took the drug. Living at high altitudes also gives rise to an increase in the number of low-birth-weight children born, while an increase in Down's Syndrome (mongolism) occurs in children born to mothers who are over 35 years of age. The rapid growth in the use of ultrasound in recent years has sparked an ongoing investigation into the risks of using ultrasound for diagnostic procedures.

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M PNFX7101 0508 TABLE 1. EFFECTS OF RISK FACTORS ON PREGNANCY OUTCOME

Number Occurring from Natural Causes Excess Occurrence from Risk Factor

Effect RADIATION RISK Childhood Cancer Cancer death in children Abnormalities Small head size Small head size Mental retardation

Risk Factor

1.4 per thousand

Radiation dose of 1000 mrem received before birth

0.6 per thousand

Radiation dose of 1000 mrem received during specific periods after conception: 40 per thousand 40 per thousand 4 per thousand 4-7 weeks after conception 8-11 weeks after conception Radiation dose of 1000 mrem received 8 to 15 weeks after conception 5 per thousand 9 per thousand 4 per thousand

NON-RADIATION RISKS Occupation Stillbirth or spontaneous abortion Alcohol Consumption Fetal alcohol syndrome Fetal alcohol syndrome Fetal alcohol syndrome Perinatal infant death (around the time of birth) Smoking Perinatal infant death Perinatal infant death 23 per thousand 23 per thousand Less than 1 pack per day One pack or more per day 5 per thousand 10 per thousand 1 to 2 per thousand 1 to 2 per thousand 1 to 2 per thousand 23 per thousand 2 - 4 drinks per day More than 4 drinks per day Chronic alcoholic (more than 10 drinks per day) Chronic alcoholic (more than 10 drinks per day) 100 per thousand 200 per thousand 350 per thousand 170 per thousand 200 per thousand Work in high-risk occupations (see text) 90 per thousand

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M PNFX7101 0508 APPENDIX B PREGNANT WORKER'S GUIDE POSSIBLE HEALTH RISKS TO CHILDREN OF WOMEN WHO ARE EXPOSED TO RADIATION DURING PREGNANCY During pregnancy, you should be aware of things in your surroundings or in your style of life that could affect your unborn child. For those of you who work in or visit areas designated as Restricted Areas (where access is controlled to protect individuals from being exposed to radiation and radioactive materials), it is desirable that you understand the biological risks of radiation to your unborn child. Everyone is exposed daily to various kinds of radiation: heat, light, ultraviolet, microwave, ionizing, and so on. For the purposes of this guide, only ionizing radiation (such as x-rays, gamma rays, neutrons, and other high-speed atomic particles) is considered. Actually, everything is radioactive and all human activities involve exposure to radiation. People are exposed to different amounts of natural "background" ionizing radiation depending on where they live. Radon gas in homes is a problem of growing concern and is estimated to contribute an average of 150 mrem per year to the average annual dose. Background radiation comes from three sources (other than radon): Source Terrestrial -- radiation from soil and rocks Cosmic -- radiation from outer space Radioactivity normally found within the human body TOTAL: Dosage range (geographic and other factors) NOTE: Average Annual Dose 50 millirem 50 millirem 25 millirem 125 millirem 75 to 5,000 millirem

Radiation doses in this document are described in two different units. The rad is a measure of the amount of energy absorbed in a certain amount of material (100 ergs per gram). Equal amounts of energy absorbed from different types of radiation may lead to different biological effects. The rem is a unit that reflects the biological damage done to the body. The millirad and millirem refer to 1/1000 of a rad and a rem, respectively.

The first two of these sources expose the body from the outside, and the last one exposes it from the inside. The average person is thus exposed to a total dose of about 125 millirems per year from natural background radiation. In addition to exposure from normal background radiation, medical procedures may contribute to the dose people receive. On average, people receive about 40 mrem per year from medical sources, although the exposure to individuals are highly variable, depending on the specific procedures that the individual has been subjected. The following table lists the average doses received by the bone marrow (the blood-forming cells) from different medical applications.

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M PNFX7101 0508 X-Ray Procedure Normal chest examination Normal dental examination Rib cage examination Gall bladder examination Barium enema examination Pelvimetry examination Average Dose 10 millirem 10 millirem 140 millirem 170 millirem 500 millirem 600 millirem

NOTE: Variations by a factor of 2 (above and below) are not unusual. NRC POSITION NRC regulations and guidance are based on the conservative assumption that any amount of radiation, no matter how small, can have a harmful effect on an adult, child or unborn child. This assumption is said to be conservative because there are no data showing ill effects from small doses; the National Academy of Sciences recently expressed "uncertainty as to whether a dose, of say, 1 rad would have any effect at all". Although it is known that the unborn child is more sensitive to radiation than adults, particularly during certain stages of development, the NRC has not established a special dose limit for protection of the unborn child. Such a limit could result in job discrimination for women of child-bearing age and perhaps in the invasion of privacy (if pregnancy tests were required) if a separate regulatory dose limit were specified for the unborn child. Therefore, the NRC has taken the position that special protection of the unborn child should be voluntary and should be based on decisions made by workers and employers who are well informed about the risks involved. For the NRC position to be effective, it is important that both the employee and the employer understand the risk to the unborn child from radiation received as a result of the occupational exposure of the mother. This document tries to explain the risk as clearly as possible and to compare it with other risks to the unborn child during pregnancy. It is hoped this will help pregnant employees balance the risk to the unborn child against the benefits of employment to decide if the risk is worth taking. This document also discusses methods of keeping the dose, and therefore the risk, to the unborn child as low as is reasonably achievable. RADIATION DOSE LIMITS The NRC's present limit on the radiation dose that can be received on the job is 1,250 millirems per quarter (3 months) (NOTE: The limit is 3,000 millirems per quarter if the worker's occupational dose history is known and the average dose does not exceed 5,000 millirems per year.) Working minors (those under 18) are limited to a dose equal to one-tenth that of adults, 125 millirems per quarter. Because of the sensitivity of the unborn child, the National Council on Radiation Protection and Measurements (NCRP) has recommended that the dose equivalent to the unborn child from occupational exposure of the expectant mother be limited to 500 millirems for the entire pregnancy. The 1987 Presidential guidance specifies an effective dose equivalent limit of 500 millirems to the unborn child if the pregnancy has been declared by the mother; the guidance also recommends that substantial variations in the rate of exposure be avoided. The NRC has proposed adoption of the above limits on dose and rate of exposure. ADVICE FOR EMPLOYEE AND EMPLOYER B-2

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Although the risks to the unborn child are small under normal working conditions, it is still advisable to limit the radiation dose from occupational exposure to no more than 500 millirems for the total pregnancy. Employee and employer should work together to decide the best method for accomplishing this goal. Some methods that might be used include reducing the time spent in radiation areas, wearing some shielding over the abdominal area, and keeping an extra distance from radiation sources when possible. The employer or health physicist will be able to estimate the probable dose to the unborn child during the normal nine-month pregnancy period and to inform the employee of the amount. If the predicted dose exceeds 500 millirems, the employee and employer should work out schedules or procedures to limit the dose to the 500-millirem recommended limit. It is important that the employee inform the employer of her condition as soon as she realizes she is pregnant if the dose to the unborn child is to be minimized. INTERNAL HAZARDS This document has been directed primarily toward a discussion of radiation doses received from sources outside the body. Workers should also be aware that there is a risk of radioactive material entering the body in work places where unsealed radioactive material is used. Nuclear medicine clinics, laboratories, and certain manufacturers use radioactive material in bulk form, often as a liquid or a gas. A list of the commonly used materials and safety precautions for each is beyond the scope of this document, but certain general precautions might include the following: 1. 2. 3. 4. 5. Do not smoke, eat, drink, or apply cosmetics around radioactive material Do not pipette solutions by mouth Use disposable gloves while handling radioactive material when feasible Wash hands after working around radioactive material Wear lab coats or other protective clothing whenever there is a possibility of spills.

Remember that the employer is required to have demonstrated that it will have safe procedures and practices before the NRC issues it a license to use radioactive material. Workers are urged to follow established procedures and consult the employer's radiation safety officer or health physicist whenever problems or questions arise.

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