2. 1 Radiation Biology Acute Radiation Syndrome Early and Late Effects of Radiation Exposure Radiolysis of Water Target Theory Poison Water Theory Direct/Indirect Hit Theory Law of Tribondeau and Bergonie Cardinal Principles of Radiation Protection-Time, Distance, Shielding -patient -Technologist

3. Terminology 2 Acute radiation syndrome Chronic radiation syndrome Radiosensitivity Radiolysis of water Target theory Direct/indirect hit Threshold Linear/non-linear Somatic effects Genetic effects Early effects Late effects Prodromal stage Latent stage Manifest illness Erthema

4. Radiation Biology 3 Radiation Biology History 1895-Roentgen announces discovery of X-rays 1896-(4 months later) Reports of skin effects in x-ray researchers 1902-First cases of radiation induced skin cancer reported 1906-Pattern for differential radiosensitivity of tissues was discovered.

5. Largest sources of man-made radiation are medical and dental x-rays Largest sources of man-made radiation are medical and dental x-rays. 4

6. 5 THE EARLY YEARS

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8. Radiation Accidents 7

9. Slotin Accident 8 Look for the footprints toward the end of the video

10. How Does Radiation Damage Occur?

11. Radiation Biology 10 Radiation can cause biological changes Technologists should have an understanding of: Cellular biology How radiation interacts with cells in order to protect oneself and the patient.

12. Ionization Ionizing Radiation can remove tightly bound electrons from their atomic orbits This causes the atom to become charged or ionized The atom can then react with neighboring atoms, forming new chemical bonds

13. Cellular Level 12

14. Possible Effects to Cells 1.Radiation may pass through cell without doing any damage. 2.Damage may occur but be repaired. 3.The damaged cell may reproduce in its damaged form. 4.The cell may die.

15. Cellular Levels 14 Radiation passes thru individual without any damage to cells No damage Radiation causes injury to cell but cell is able to repair damage Injury/damage Cells repair but incorrectly causing deformity Cells incorrectly repair Radiation causes cell to die Cells die

16. Undamaged Cell

17. Damaged Cell

18. Cell Sensitivity 17 1. Stem cells are radiosensitive. 2. The younger the tissues and organs, the more radiosensitive 3. When level of metabolic activity is high, radiosensitivity is high 4. As proliferation rate for cells and growth rate for tissues increases, the radiosensitivity increases. Law of Bergonie and Tribondeau

19. Cell Sensitivity Early Effect: (ACUTE)  radiation response occurs within minutes/days after exposure acute radiation syndrome-3 types, depending on exposure local tissue damage  Late Effect: (CHRONIC)  radiation response not observable for months or years leukemia cataracts other cancers local tissue damage Life span shortening genetic damage 18

20. Linear Response to radiation: A.Non-threshold: Assumes no dose is safe B.Threshold: Assumes minimum dose needed to produce a response A dose response relationship is produced by extrapolating high dose experimental data to low doses. 19

21. Cell Sensitivity 20 Diagnostic radiology is almost exclusively concerned with the late of effects for radiation exposure. This assumes a linear non- threshold dose-response relationship. No dose is considered safe.

22. Basic Cell Structure 1. Two parts: 1. Nucleus- contains DNA 2. Cytoplasm is 80% water 2. DNA is at risk when a cell is exposed to ionizing radiation 21

23. Cell Structure 22 Genetic: Reproductive Cells Somatic: All other cells, non- reproductive cells

24. Radiation Damage Mechanisms 1. Direct Action: Direct ionization of the DNA molecule, which may result in genetic damage. 2. Indirect Action: Radiation ionizes water, which causes free radicals to form. Free radicals attack targets such as DNA. Much more common.

25. HOH + recombine to H 2 O 24

26. Direct Effect Photon ionizes “master molecule” Master molecule is destroyed, cell dies, damaged Indirect Effect Photon ionized non-critical molecule Transfer energy to master molecule Most frequently water molecules 25

27. Let’s Play Jenga !! 26

28. Target theory suggests that a key molecule must be inactivated. The key molecule is assumed to be DNA. When interaction occurs between radiation and target molecule, it is considered a “hit” An indirect hit has a larger target area because of the mobility of the free radicals Radiation acts randomly. 27

29. B3…..miss……..A4…..hit…….You sunk my Battleship!!! 28

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31. Damage from Radiation Exposure Acute High dose in short time Local: burns, hair loss, desquamation, blistering, damage to blood vessels, sterility, cataracts Whole-body: reduction in blood cell counts, nausea, radiation sickness Chronic Low dose over long period of time Cancer, anemia, cataracts

32. Appearance of Biological Effects Prompt/Acute effect – effects seen immediately after large doses of radiation are delivered over a short period of time Examples: radiation sickness and burns threshold of 50 rad Delayed effects- may appear months or years after a radiation exposure Examples: cataract formation and cancer induction threshold depends on effect (may be no threshold)

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34. ACUTE RADIATION SYNDROME 33 Acute Radiation Syndrome – full body exposure given in a few minutes.

35. Look around, be a Rad Geek 34 Military Nuclear Accidents Proliferation of Fluoroscopy Exams and Radiation Safety

36. Early Effects-ARS 35 Each syndrome has 3 main sub-stages prodromal stage latent stage manifest illness cell death/repair

37. Total Body Response to Radiation 36 Acute Radiation Syndromes – full body exposure given in a few minutes. 3 stages of response: 1. Prodromal -NVD stage (nausea, vomiting, diarrhea) 2. Latent Period-Feels well while undergoing biological changes leads to recovery or death 3. Manifest Illness-Full effects felt, leads to recovery or death

38. 37  Hematologic syndrome  Prodromal  Latent  manifest  GI syndrome  Prodromal  Latent  manifest  CNS syndrome  Prodromal  Latent  manifest ACUTE RADIATION SYNDROME

39. Hematopoietic Syndrome (Hematologic) Prodromal Stage: Mild symptoms appear within a few hours and last for several days Latent Period: May last up to 4 weeks Manifest Illness: Vomiting, diarrhea, fatigue and fever – Decline in blood cells – Recovery in 2 to 4 weeks…May last up to 6 months Possible death due to infection, dehydration or hemorrhage

40. Gastrointestinal Syndrome Prodromal Stage: Vomiting and diarrhea occur within hours and last up to one day Latent Period: Lasts 3-5 days Manifest Illness: Nausea, vomiting and diarrhea – Worsens to bloody stools Death within 4 to 10 days after exposure primarily due to intestinal cell damage – Also damage to blood-forming tissue results in hemorrhaging and dehydration.

41. Central Nervous System Syndrome Prodromal Stage: Severe nausea and vomiting within a few minutes – Nervousness, confusion, burning skin, vision loss, possible loss of consciousness Latent Period: May last up to 12 hours, or not at all Manifest Illness: Disorientation, loss of muscle control, breathing problems, seizures, coma Death within a few days of exposure – due to increased fluid in brain (pressure) – Death occurs before hematologic and gastrointestinal symptoms appear

42. 3 Acute Radiation Syndromes 41 1. Hematologic : results in infection, hemorrhage & anemia 2. Gastrointestinal : results in diarrhea, nausea & vomiting, fever 3. Central Nervous System : results in convulsions, coma, & eventual death from increased intracranial pressure. CNS least sensitive in ADULTS – MOST sensitive in the FETUS

43. Cherynobyl Fall out 42

44. 43 For Chernobyl : o 11,000 mrem- current background in red zones o 12 mrem is your average background radiation. o This is a thousand times greater than the normal background level of radiation o Approximately 15-20% of babies are born healthy.

45. Late Effects 44  Late Effects  Local Tissue Effect  Erythema  Cataracts  Life Span Shortening  Cancers/Malignancies  Genetic Effects

46. Late Effects of Radiation 45 1. Somatic Effects: develop in the individual who is exposed Most common: Skin Damage, Cataract formation & Carcinogenesis 2. Genetic Effects: develop in future generations as a result of damage to germ cells.

47. Fukushima, Japan 46 Fukushima 50 occupational exposure due to rescue work After reading this article, write your thoughts on the rescue workers in Japan. Include allowable exposures to workers, possible acute affects, their prognosis for long term health.

48. Radiation Protection 47 Cardinal Principles of Radiation Protection Time Distance Shielding ALARA

49. Time, Distance and Shielding 48 Cardinal Principles of Radiation Protection

50. Cardinal Principles of Protection 49 Triad of Radiation Safety 1. Time 2. Distance 3. Shielding *Apply to the patient & Technologist

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52. Over Radiation to Skin Too much time under beam 51 Skin burns from 30 min of beam on time

53. Acute Localized Radiation Effects The Table 2-2 provides examples of possible radiation effects to skin caused by typical fluoroscopy exposures. Note that patient and technique factors can substantially increase exposure rates, significantly reducing the time necessary for the subsequent effect. Table 2-2: Dose and Time to Initiate Localized Radiation Effects 52.7 of an hour isapproximately 42 miutes

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55. This is an actual arm tatoo. Now that’s dedication ! 54

56. Distance 55 Louis Slotin Critical Accident estimated exposure map

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58. Shielding A lead protective shield is placed Between the x-ray tube and the individuals exposed Absorbs unnecessary radiation 57

59. TYPES OF SHIELDING 58 1. Contact 2. Shaped 3. Shadow

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63. Breast Shield shadow shields 62

64. SHIELDING 63 1. TECHNOLOGIST. 5 mm LEAD Lead apron Gloves Thyroid shield Glasses 2. PATIENT –. 5 mm LEAD Gonadal Shielding

65. As Low As Reasonably Achievable 64

66. Primary Barriers 65

67. Stay out of primary beam 66

68. Image Wisely 67 Image Wisely website

69. PROTECTING THE PATIENT and THE TECHNOLOGIST RISK VS. REWARD 68

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