Radiation Protection in Nuclear Medicine: Part 1: Biological Effects of Ionizing Radiation

International Atomic Energy Agency
RADIATION PROTECTION IN NUCLEAR MEDICINE

Part 1: Biological Effects of Ionizing Radiation
Objective
To become familiar with the mechanisms of different types of biological effects following exposure to ionizing radiation and results of epidemiological studies of exposed population to ionizing radiation. To be aware of the models used to derive risk coefficients for estimating the detriment
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Part 1. Biological effects of ionizing radiation
Contents
Basic concepts, cellular effects Deterministic effects Stochastic effects Effects on embryo and fetus Risk estimates
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Part 1. Biological Effects

Module 1.1. Basic Concepts
Early Observations of the Effects of Ionizing Radiation

1895 X-rays discovered by Roentgen
1896
1896 1896
First skin burns reported

First use of x-rays in the treatment of cancer Becquerel: Discovery of radioactivity
1897
1902 1911 1911
First cases of skin damage reported

First report of x-ray induced cancer First report of leukaemia in humans and lung cancer from occupational exposure 94 cases of tumour reported in Germany (50 being radiologists)
Part 1. Biological effects of ionizing radiation 5
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Effects of Radiation Exposure

Information comes from:
studies of humans (epidemiology) studies of animals and plants (experimental radiobiology) fundamental studies of cells and their components (cellular and molecular biology)
The key to understanding the health effects of radiation is the interaction between these sources of information.
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Radiation exposure affects

Chromosomes
the center of life:
the cell
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The critical target: DNA
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Interaction of ionizing radiation with DNA
DIRECT ACTION
INDIRECT ACTION
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Damage to DNA
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Exposure of the Cell

No change
radiation hit cell nucleus!
DNA mutation
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Outcomes after cell exposure
Mutation repaired
Viable Cell
Unviable Cell
Cell death
DNA Mutation
Cell survives but mutated
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Cancer?
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How is DNA repaired?
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Altered base
Enzyme Glycosylases recognizes lesion and releases damaged base
AP-endunuclease makes incision and releases remaining sugar
DNA-polymerase fills resulting gap but nick remains DNA ligase seals the nick. Repair completed.
DNA has been repaired with no loss of genetic information

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Repair
The human body contains about 1014 cells. An absorbed dose of 1 mGy per year (natural sources) will produce about 1016 ionizations, which means 100 per cell in the body. If we assume that the mass of DNA is 1% of the mass of the cell, the result will be one ionization in the DNA-molecule in every cell in the body each year.
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order of magnitudes
999 of 1000 lesions are repaired 999 of 1000 damaged cells die (not a major
problem as millions of cells die every day in every person) many cells may live with damage (could be mutated)
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Cell killing Radiosensitivity
RS = Probability of a cell, tissue

or organ of suffering an effect per unit of dose. Bergonie and Tribondeau (1906): RS LAWS: RS will be greater if the cell:
Is highly mitotic. Is undifferentiated.
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RADIOSENSITIVITY
High RS Medium RS Low RS
Bone Marrow Spleen Thymus Lymphatic nodes Gonads Eye lens Lymphocytes
(exception to the RS laws)
Skin Mesoderm organs (liver, heart, lungs)
Muscle Bones Nervous system
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Biological Effects at Cellular Level

Cellular effects of ionizing radiation are studied by cell survival curves
% survival cells (semi logarithmic) n = targets
Possible mechanisms of cell death: Physical death Functional death
Death during
100%
Dq
(threshold)

D0
Dose
interphase Mitotic delay Reproductive failure
(radiosensitivity)
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Factors Affecting Radiosensitivity

LET (linear energy transfer): RS Dose rate: RS Temperature RS Increase RS: OXYGEN, cytotoxic drugs. Decrease RS: SULFURE (cys, cysteamine)
M G2 G1
% survivor cells
Physical
LET LET
Chemical
G0
Biological
Cycle status:
RS: G2, M RS: S
Repair of damage (sub-lethal damage may be repaired e.g. fractionated dose)

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Cell Survival Radiation Quality

low LET Lg LET Surviving fraction
.. ..... .... ... .........
low LET high LET

Hg LET high LET
Absorbed dose
LET (linear energy transfer) is the amount of energy (MeV) a particle will loose in traversing a certain distance (m) of a material.
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Ionization Pattern
Adapted from Marco Zaider (2000)

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Biological Effects
Direct effects Indirect effects Repair
Primary damage
Cell death
Modified cell
Damage to organ
Somatic cells
Germ cells
Death of organism
Cancer Leukemia
Hereditary effects
Deterministic effects
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Stochastic effects
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Timing of Events leading to Radiation Effects

10-15 10-12 10-9 10-6
TIME (sec)
Energy deposition Excitation/ionization Initial particle tracks Radical formation Diffusion, chemical reactions Initial DNA damage
PHYSICAL INTERACTIONS
PHYSICO-CHEMICAL INTERACTIONS
10-3 100 103 106
1 ms
DNA breaks / base damage
1 second Repair processes Damage fixation 1 hour 1 day 1 year Cell killing Mutations/transformations/aberrations Proliferation of "damaged" cells Promotion/completion
BIOLOGICAL RESPONSE
10 9 100 years
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Teratogenesis Cancer Hereditary defects
MEDICAL EFFECTS
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Module 1.2. Deterministic Effects
Effects of Cell Death

Probability of death 100%
Dose (mSv) D
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Deterministic Effects
SEVERITY Most radiosensitive individual Most radioresistant individual
Diagnostic threshold
FREQUENCY
Threshold dose
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ABSORBED DOSE
10
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Threshold Doses for Deterministic Effects
Cataracts of the lens of the eye
0.5 Gy [ICRP statement on tissue reactions (http://www.icrp.org/docs/icrp%20stateme nt%20on%20tissue%20reactions.pdf)]
Permanent sterility Temporary sterility

males females
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males females
Severity of effect
3.5-6 Gy 2.5-6 Gy
0.15 Gy 0.6 Gy threshold

dose
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Note on Threshold Values
Depend on dose delivery mode:
single high dose most effective fractionation increases threshold dose in

most cases significantly decreasing the dose rate increases threshold in most cases
Threshold may differ in different persons

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Systemic Effects

Effects may be morphological and/or functional Factors: Which Organ Which Dose Effects Immediate (usually reversible): < 6 months e.g.: inflammation, bleeding. Delayed (usually irreversible): > 6 months e.g.: atrophy, sclerosis, fibrosis. Criteria of dose < 1 Gy: LOW DOSE 1-10 Gy: MODERATE DOSE > 10 Gy: HIGH DOSE Regeneration means replacement by the original tissue while Repair means replacement by connective tissue.
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Skin Effects Following the

Histologic view of the skin
EPIDERMIS
RS laws (Bergonie and Tribondeau), the most RS cells are those from the basal stratum of the epidermis. Effects are:
DERMIS
From Atlas de Histologia.... J. Boya
Basal stratum cells, highly mitotic, some of them with melanin, responsible of pigmentation.
Erythema: 1-24 hours after irradiation of about 3-5 Gy Alopecia: 5 Gy is reversible; 20 Gy is irreversible. Pigmentation: Reversible, appears 8 days after irradiation. Dry or moist desquamation: traduces epidermal hypoplasia (dose about 20 Gy). Delayed effects: teleangiectasia, fibrosis.
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Skin Effects
Injury
Early transient erythema Temporary epilation Main erythema Permanent epilation Dry desquamation Invasive fibrosis Dermal atrophy Telangiectasis Moist desquamation Late erythema Dermal necrosis Secondary ulceration
Threshold Weeks to Dose to Onset Skin (Sv)

2 3 6 7 10 10 11 12 15 15 18 20 <<1 3 1.5 3 4 >14 >52 4 6-10 >10 >6
Skin damage from prolonged fluoroscopic exposure
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Skin Effects
By handling unshielded syringes and vials containing radioactive material the threshold dose of skin erythema will be reached in a short time. Example: The dose rate at the surface of a vial containing 30 GBq Tc99m is of the order of 2 Gy/h meaning that the threshold dose will be reached after 2 h of exposure. This corresponds to 36 s per working day in a year
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Skin Effects
Example: After an extravascular injection of 500 MBq of a Tc99m radiopharmaceutical, the locally absorbed dose at the injection site might be as high as 5-20 Gy!
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Effects in Eye
Histologic view of eye:
Eye lens is highly RS. Coagulation of proteins occurs with doses greater than 2 Gy. There are 2 basic effects:
Sv single brief exposure 0.5-2.0 Sv/year for many years > 0.1
Effect Detectable opacities

From Atlas de Histologia.... J. Boya
Eye lens is highly RS, moreover, it is surrounded by highly RS cuboid cells.
Visual impairment (cataract)
5.0
> 0.15
The ICRP has stated in 2011 that the threshold for tissue reactions in lens of the eye is 0.5 Gy. http://www.icrp.org/docs/icrp%20statement%20on%20tissue%20reactions.pdf
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Eye Injuries
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Whole Body Response : Adult

Chronic irradiation syndrome
Whole body clinic of a partial-body irradiation Mechanism: Neurovegetative disorder Similar to a sick feeling Quite frequent in fractionated radiotherapy
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Acute irradiation syndrome

1-10 Gy 10-50 Gy
Steps:
1. Prodromic
> 50 Gy 2. Latency 3. Manifestation

BMS (bone marrow) GIS (gastro intestinal)
CNS
(central nervous system)
Lethal dose 50 / 30
Dose
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Lethal Dose 50/30
It is an expression of the per cent

lethal dose as a function of time. It means: Dose which would cause death to 50% of the population in 30 days. Its value is about 2-3 Gy for humans for whole body irradiation.
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Whole Body Exposure

Absorbed dose Syndrome or (Gy) tissue involved 1-10 Bone marrow syndrome Symptoms Leucopenia, thrombopenia, hemorrhage, infections Diarrhoea, fever, electrolytic imbalance Cramps, tremor, ataxia, lethargy, impaired vision, coma
40
10-50
Gastrointestinal
>50
Central nervous syndrome
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Whole Body Exposure

Absorbed dose (Gy) 1-10 Therapy Prognosis Lethality 0-90%
Symptomatic Excellent to Transfusions of uncertain leucocytes and platelets. Bone marrow transplantation Growth stimulating factors Palliative Symptomatic Very poor Hopeless
10-50 >50
90-100% 100%
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Module 1.3. Stochastic Effects
Stochatic Effects of Ionizing Radiation
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Health consequences of Chernobyl accident
1800 children diagnosed with thyroid cancer (1998)
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Thyroid cancer diagnosed up to 1998 among children 0-17 years at the time of the Chernobyl accident
300 250
Number
200 150 100 50 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 Year
Belarus Russian Federation Ukraine Total
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Genetic Effects
Frequency (%) 10
0 10 20 30 40 Absorbed dose (Gy)
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Genetic Effects

Ionizing radiation is known to cause heritable mutations in many plants and animals BUT 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.
Neel et al. Am. J. Hum. Genet. 1990, 46:1053-1072
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Module 1.4. Effects on Embryo and Fetus
Sensitivity of the Early Conceptus
Till early 1980s, early conceptus was

considered to be very sensitive to radiation although no one knew how sensitive? Realization that:
organogenesis starts 3-5 weeks after conception In the period before organogenesis high radiation
exposure may lead to failure to implant. Low dose may not have any observable effect.
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Incidence of Prenatal & Neonatal Death and Abnormalities
Hall, Radiobiology for the Radiologist pg 365
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Pre-Implantation
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Pre-Implant Stage (up to 10 days)

Only lethal effect, all or none Embryo contains only few cells which are
not specialized If too many cell are damaged-embryo is resorbed If only few killed-remaining pluripotent cells replace the cells loss within few cell divisions Atomic Bomb survivors - high incidence of both - normal birth and spontaneous abortion
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Fetal Radiation Risk
There are radiation-related risks throughout Radiation risks are most significant during
pregnancy which are related to the stage of pregnancy and absorbed dose organogenesis and in the early fetal period somewhat less in the 2nd trimester and least in the third trimester
Most risk
Less
Least
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Radiation-Induced Malformations
Malformations have a threshold of 100-200

mGy or higher and are typically associated with central nervous system problems Fetal doses of 100 mGy are not reached even with 3 pelvic CT scans or 20 conventional diagnostic x-ray examinations These levels can be reached with fluoroscopically guided interventional procedures of the pelvis and with radiotherapy
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Central Nervous System Effects
During 8-25 weeks post-conception the

CNS is particularly sensitive to radiation Fetal doses in excess of 100 mGy can result in some reduction of IQ (intelligence quotient) Fetal doses in the range of 1000 mGy can result in severe mental retardation particularly during 8-15 weeks and to a lesser extent at 16-25 weeks
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Heterotopic gray matter (arrows) near the ventricles in a mentally retarded individual occurring as a result of high dose in-utero radiation exposure
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Effects on Embryo and Fetus
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Effects on Embryo and Fetus

Age Threshold for lethal effects (mGy) 100 250 500 >500 >1000 Threshold for malformations (mGy) No effect 250 250 500
1 day 14 days 18 days 20 days 50 days
50 days to birth
>1000
>500
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Leukemia and Cancer
Radiation has been shown to increase
the risk for leukemia and many types of cancer in adults and children Throughout most of pregnancy, the embryo/fetus is assumed to be at about the same risk for carcinogenic effects as children
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Leukemia and Cancer
The relative risk may be as high as 1.4
(40% increase over normal incidence) due to a fetal dose of 10 mGy Individual risk, however, is small with the risk of cancer at ages 0-15 being about 1 excess cancer death per 1,700 children exposed in utero to 10 mGy
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Module 1.5. Risk Estimates
Risk Estimates
Risk = probability of effect Different effects can be looked at - one

needs to carefully look at what effect is considered: E.g. Thyroid cancer mortality is NOT identical to thyroid cancer incidence!!!! Risk estimates usually obtained from high doses and extrapolated to low doses
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Epidemiological Data:
Hiroshima-Nagasaki Patients with ancylosing spondylitis cervical cancer tuberculosis mastitis tinea capitis thymus enlargement thyrotoxicosis hemangiomas and more may come Chernobyl Techa river Semiplatinsk Nevada ..
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Populations used in the UNSCEAR Reports

Characteristic Atomic Bomb Survivors 86,500 0 -> 90 28.8 y 0.24 Gy 0.01 6.0 Gy Instantaneous / whole-body Spondylitis Series 14,000 > 15 23.0 y 1.9 Gy 0 8.06 Gy Fractionated / partial-body Chronic / partial-body Cervical Cancer Series 83,000 < 30 -> 70 7.6 y Inhomogeneous
Number Age at irradiation Average follow-up Mean dose Range of doses Type of irradiation
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How to Use Epidemiological Data to Estimate Radiation Risks at Low Doses?
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Dose-Response Curve
Frequency of leukemia (cases/1 miljon)
Equivalent dose (mSv)

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Mortality of the Atomic Bomb Survivors

Dose response curve for Solid Cancer
The dose response is linear up to about 3 Sv The excess lifetime risk per Sv for those The lowest dose at which there is a
Pierce DA et al, Rad Res 1996; 146:1-27
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with a slope of 0.37 ERR/Sv
exposed at age 30 is estimated at 0.10 and 0.14 for males and females respectively statistically significant excess risk is shown to be 50 mSv
Latest news from the Hiroshima-Nagasaki Cohort

Extra years 1986-1990 There are now 10 500 survivors with DS86-dosimetry out of a total population of 86 572, who were irradiated 44% had died by the end of 1990. The data is incomplete in that deaths in the first five years are not included. 7 827 have died from cancer, there being 420 excess cancer deaths. 1950-90 (1986-90) Leukemia ? 87 (3) Solid cancer ? 335 (88) ------------------------------------------------------------------420 Risk for children/Risk for adults = 1.4 - 1.7 1945-1950
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Radiation Risks
Linear-Quadratic Model
PROBABILITY OF FATAL CANCER
Deterministic effects
Observations
ABSORBED DOSE
10
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What happens at the low-dose end of the graph?
a) b) c) d)
Linear extrapolation Threshold dose Lower risk per dose for low doses Higher risk per dose for for low doses
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P = A*D + B*D2
P is the probability of cancer induction
The quotient A/B is called DDREF (Dose and Dose Rate Effectiveness Factor) and has been assigned by ICRP the value 2 for low LET radiation, low doses and low dose rates. Low doses: <0.2 Gy(Sv) Low dose rates: < 0.1 Gy(Sv)/hour (ICRP) 0.1 Gy(Sv)/day (NCRP)
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Epidemiological Evidence
10000
Cancer deaths /year/1M people
1000
100
Linear No-Threshold (LNT) Hypothesis reduced at low dose and dose rate by a factor of 2 - in general agreement with data
natural cancer mortality additional cancer deaths due to radiation
10
1 0.1 1 10 100 1000 10000
Dose (mGy)
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Cancer
initiation pre-cancer stage
Elimination and repair
promotion latency period growth
detection
period of suffering death lifetime loss

metastasis
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Carcinogenic Effects
An assessment of the atomic bomb survivors showed:
the leukaemia risk peaked at 10 years after exposure thyroid cancer was the first solid cancer reported
the incidence of breast cancer was higher in young women than older women
other cancer, with a latent period of up to 30 years, included lung, stomach, colon, bladder and oesophagus
Shimizu et al JAMA 1990, 264:601-604

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Variation of Cancer Incidence with time following the Atomic Bombs
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Variation of Cancer Incidence with time following the Atomic Bombs
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Time Projection Models
Lifetime Expression, Comparison of Absolute and Relative Risk Models

Incidence Absolute Risk Incidence Relative Risk
Incidence after irradiation Spontaneous incidence
xo
xo+l
90
xo
xo+l
90
ICRP 60
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Radiation Risks
Effect
Hereditary effects Fatal cancer Fatal cancer Health detriment Health detriment
Population
Whole population Whole population Working population Whole population Working population
Exposure period
Lifetime
Probability ICRP 1990
Probability ICRP 2007
1 %/Sv 0.2 %/Sv (all (all generations) generations) 5 %/Sv 4 %/Sv 7.3 %/Sv 5.6 %/Sv 5.7 %/Sv 4.2 %/Sv
Lifetime Age 18-65 Lifetime Age 18-65
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Risk (%/ Sv) for Cancer induction by Age at exposure and Sex
20 Male 15 Female
10
10
20
30 40 50 60 (age at exposure)
70
80
80
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Life-time risk of dying from radiation induced cancer 5% per sievert

UNSCEAR has recently (2008) further assessed the cancer risk from radiation exposures. For a population of all ages and both genders, the lifetime risk of dying from radiation induced cancer after an acute dose of 1000 mSv is about 9% for men and 13% for women or 11% as a mean. Applying a DDREF of 2, these data confirm the 10 years old ICRP estimate.
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Effects at Low Doses
In the latest Hiroshima-Nagasaki Life Span Study (19861990), LSS Report 12, (Pierce et al., 1996) find the nominal estimates of risk (5% per Sv) to apply down to a dose of about 50 mSv. For childhood cancer following fetal irradiation, very similar risk estimates (6% per Sv) are found to apply to doses of 10 mSv (Doll and Wakeford, 1997). The risk estimates and the uncertainties associated with them are expected to apply at low doses.
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Uncertainties in Fatal Cancer Risk Estimate (5% per Sv)
0.027 0.020 0.013 0.007 0.000
Probability
Frequency chart
100 000 Trials Shown
0.00 1.20
2.75
5.50
8.25 8.84
11.0
Lifetime Risk Coefficient (%/Sv)
Probability distribution of lifetime risk coefficient. The 90% confidence interval is shown by the arrows (5% should be read as 1% - 9%).
NCRP, 1997
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Uncertainties in Fatal Cancer Risk Estimates
Sensitivity chart of uncertainty component influence (population of all ages)

From NCRP, 1997
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Radiation Risks - Embryo and Fetus
Threshold dose deterministic effects Mental retardation Cancer and leukemia before 10 y of age lifetime Hereditary effects
50-100 mSv 40% / Sv
2% / Sv 15% / Sv 1% / Sv
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TYPES OF EFFECTS FOLLOWING IRRADIATION IN UTERO
Time after conception First three weeks 3rd through 8th weeks 8th through 25th weeks 4th week throughout pregnancy
Effect
Normal incidence in live-born 0.06 (1 in 17) 5 x 10-3 (1 in 200) 1 x 10-3 (1 in 1000)
No deterministic or stochastic effects in live-born child Potential for malformation of organsa Potential for severe mental retardationb Cancer in childhood or in adult lifec
a b c
Deterministic effect. Threshold ~ 0.1 Gy 30 IQ units shift: 8-15th week; <30 IQ units shift: 16 - 25th week Risk in utero ~ risk < 10 years of age
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Radiation Risks Embryo and Fetus
Dose (mGy) 1 10 50 100
Lethal effects malformations none -> none -> none -> none -> 1*10-4 1*10-3 5*10-3 1*10-2
4*10-2
Mental retardation 4*10-4 4*10-3 2*10-2 4*10-2

7*10-3
Cancer & leukemia before 10 years 5*10-5 5*10-4 2.5*10-3 5*10-3

1*10-3
Cancer & leukemia whole life 1.5*10-4 1.5*10-3 7.5*10-3 1.5*10-2

0.2
Other reasons 3*10-3
Data from Sweden 1992

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Risks in a Pregnant Population not Exposed to Medical Radiation
Spontaneous abortion > 15% incidence of genetic abnormalities 410% intrauterine growth retardation incidence of major malformation 4% 4% 2-
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Probability of bearing healthy children as a function of radiation dose
Dose to conceptus Probability of Probability of no (mGy) above natural no malformation cancer background (0-19 years) 0 97 99.7 1 5 10 50 100 >100
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97 97 97 97 97 possible, see text

99.7 99.7 99.6 99.4 99.1 higher

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Approximate fetal whole body dose (mGy) from common nuclear medicine procedures done in early and late pregnancy
Procedure Tc-99m Bone scan Lung V/Q scan Liver colloid Thyroid scan Renal DTPA Red Cell 750 240 300 400 750 930 4.7 0.9 0.6 4.4 9.0 6.0 1.8 0.9 1.1 3.7 3.5 2.5 Activity (MBq) Early
9 months
I-123 Thyroid uptake
30 0.55
0.6 0.04
0.3 0.15
90
I-131 Thyroid uptake

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Doses and Risks for in Utero Radiodiagnostics

Exposure Mean fetal dose (mGy) Hered. Disease Fatal cancer to age 14 y 7.7 10-5 4.8 10-4 8.4 10-5 9.6 10-5 9.5 10-5 5.1 10-5 2.4 10-4 7.1 10-5 7.7 10-4 1.0 10-4 1.3 10-4 91
X-ray Abdomen 2.6 Barium enema 16 Barium meal 2.8 IV urography 3.2 Lumbar spine 3.2 Pelvis 1.7 Computed tomography Abdomen 8.0 Lumbar spine 2.4 Pelvis 25 Nuclear medicine Tc bone scan 3.3 Tc brain scan 4.3
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6.2 10-5 3.9 10-4 6.7 10-5 7.7 10-5 7.6 10-5 4.0 10-5 1.9 10-4 5.7 10-5 6.1 10-4 7.9 10-4 1.0 10-5
Comment on Fetus/Embryo

Fetus/embryo is more sensitive to ionizing radiation than the adult human Increased incidence of spontaneous abortion a few days after conception Increased incidence
Mental retardation Microcephaly (small head size) especially 8-15 weeks after conception Malformations: skeletal, stunted growth, genital Both in childhood and later life
Higher risk of cancer (esp. leukemia)
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Scale of Radiation Exposures

10000
Cancer deaths /year/1M people
1000
Bone scan
100
CT scan Annual Background
Typical Radiotherapy Fraction
10
natural cancer mortality additional cancer deaths due to radiation
1 0.1 1 10 100 1000 10000
Dose (mGy)
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Example for Risk Calculation
Assume
Risk of 0.05 per Sv 1,000 people are exposed to 5 mSv/y for 20 y Expected additional cancer deaths is
0.05 [cancers/Sv]x0.005[Sv/y]x20[y]x1,000[people] = 5 additional cancer deaths due to radiation (5/1000)
General population: 23% (230/1000) of all
deaths due to cancer (difficult to ascertain 5 additional ones caused by radiation) Calculations become more complex for individual tissue exposures vs. whole body exposures
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Radiation Risks in X-RAY Examination
Examination
Skin dose Effective dose Risk (mGy) (mGy) (%) 30 40 10 2 3 8 5 2.5 0.25 0.025 0.04 0.025 0.013 0.0013 0.00013
Urography Lumbar spine Abdomen Chest Extremities
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Radiation Risks in Nuclear Medicine
Examination
Radiopharmaceutical
Effective dose (mSv) 23 3.6 1.1 0.9 0.01
Risk (%) 0.12 0.018 0.006 0.005 0.00005
Myocardium Tl-201 chloride Bone Tc-99m MDP Thyroid Tc-99m pertechnetate Lungs Tc-99m MAA Kidney clearance Cr-51 EDTA
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Average Annual Risk of Death in the UK from Industrial Accidents and from Cancers due to Radiation Work
Coal mining Oil and gas extraction Construction Radiation work (1.5 mSv/y) Metal manufacture All manufacture Chemical production All services 1 in 7,000 1 in 8,000 1 in 16,000 1 in 17,000 1 in 34,000 1 in 90,000 1 in 100,000 1 in 220,000
These figures can be compared to an estimate of 1 in 17000 for 1.5 mSv/year received by radiation workers
From L Collins 2000

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Comparison of Radiation Worker Risks to Other Workers

Mean death rate 1989 (10-6/y) Trade 40 Manufacture 60 Service 40 Government 90 Transport/utilities 240 Construction 320 Agriculture 400 Mines/quarries 430
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Safe industries 2 mSv/y (100 mSv over a lifetime)
max permissible exposure (20 mSv/year or 1000 mSv over a lifetime

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Risks
The following activities are associated with a risk of death that is 1/1000000
10 days work in a nuclear medicine department smoking 1.4 cigarette living 2 days in a polluted city traveling 6 min in a canoe 1.5 min mountaineering traveling 480 km in a car traveling 1600 km in an airplane living 2 months together with a smoker drinking 30 cans of diet soda
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Risks
Expected reduction of life
Unmarried man Smoking man Unmarried woman 30% overweight Cancer Construction work Car accident Accident at home Administrative work Radiological examination
3500 days 2250 days 1600 days 1300 days 980 days 300 days 207 days 95 days 30 days 6 days
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Questions??
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Discussion
A woman was referred to a bone scan. After the examination she turned out to be pregnant at a very early stage. She is extremely worried and wants to have an abortion. Discuss how to act.
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Discussion
Dose fractionation results in: increased radiation sensitivity for photons? decreased radiation sensitivity for photons? decreased radiation sensitivity for heavy charged particles? increased radiation sensitivity for heavy charged particles?
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Discussion
A patient (radiobiologist) wants to know the radiation risk he will suffer in an examination of the cerebral blood flow (1000 MBq 99mTc).
What to answer?
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Where to Get More Information
Other sessions

Further readings
Part 2 Radiation Physics

WHO/IAEA. Manual on Radiation Protection in Hospital and General Practice. Volume 1. Basic requirements ICRP publications (41, 60, 84) UNSCEAR reports ALPEN E.L Radiation Biophysics. Academic Press, 1998 RUSSEL, J.G.B., Diagnostic radiation, pregnancy and termination, Br. J. Radiol. 62 733 (1989) 92-3.
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Radiation Protection in Nuclear Medicine: Part 1: Biological Effects of Ionizing Radiation

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RADIATION PROTECTION IN NUCLEAR MEDICINE

Part 1. Biological effects of ionizing radiation

Part 1. Biological effects of ionizing radiation

International Atomic Energy Agency

Part 1. Biological Effects

Early Observations of the Effects of Ionizing Radiation

First skin burns reported

First cases of skin damage reported

Effects of Radiation Exposure

Part 1. Biological effects of ionizing radiation

Radiation exposure affects

the center of life:

Part 1. Biological effects of ionizing radiation

Part 1. Biological effects of ionizing radiation

The critical target: DNA

Part 1. Biological effects of ionizing radiation

Interaction of ionizing radiation with DNA

Part 1. Biological effects of ionizing radiation

Part 1. Biological effects of ionizing radiation

Exposure of the Cell

radiation hit cell nucleus!

Part 1. Biological effects of ionizing radiation

Outcomes after cell exposure

How is DNA repaired?

Part 1. Biological effects of ionizing radiation

AP-endunuclease makes incision and releases remaining sugar

DNA has been repaired with no loss of genetic information

Part 1. Biological effects of ionizing radiation

Part 1. Biological effects of ionizing radiation

Cell killing Radiosensitivity

RS = Probability of a cell, tissue

Is highly mitotic. Is undifferentiated.

Part 1. Biological effects of ionizing radiation

Skin Mesoderm organs (liver, heart, lungs)

Muscle Bones Nervous system

Part 1. Biological effects of ionizing radiation

Biological Effects at Cellular Level

Possible mechanisms of cell death: Physical death Functional death

interphase Mitotic delay Reproductive failure

Part 1. Biological effects of ionizing radiation

Factors Affecting Radiosensitivity

RS: G2, M RS: S

Repair of damage (sub-lethal damage may be repaired e.g. fractionated dose)

Cell Survival Radiation Quality

low LET high LET

Part 1. Biological effects of ionizing radiation

Adapted from Marco Zaider (2000)

Part 1. Biological effects of ionizing radiation

Timing of Events leading to Radiation Effects

10-3 100 103 106

DNA breaks / base damage

Teratogenesis Cancer Hereditary defects

Part 1. Biological effects of ionizing radiation

International Atomic Energy Agency

Part 1. Biological Effects

Effects of Cell Death

Part 1. Biological effects of ionizing radiation

Threshold Doses for Deterministic Effects

Cataracts of the lens of the eye

0.5 Gy [ICRP statement on tissue reactions (http://www.icrp.org/docs/icrp%20stateme nt%20on%20tissue%20reactions.pdf)]

Permanent sterility Temporary sterility