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PREFACE
ix
In the sections on the justification and responsibility
for imaging procedures, benefit versus risk, diagnostic
efficacy, and the ALARA principle are explained. The
learner is then introduced to the three cardinal rules
of radiation protection. A discussion of the responsibility for maintaining ALARA in the medical industry
follows.
Other topics covered in this chapter include patient
protection and patient education, which bring into consideration the risk of diagnostic imaging procedures
versus the potential benefit of such procedures. Ongoing discussion of the use of background equivalent radiation time (BERT) to inform patients of the amount
of radiation they will receive during a specific x-ray
procedure continues to be an important component of
this initial chapter. Discussion on the increased radiation sensitivity of children compared with adults is addressed and is followed by segments on the Alliance
for Radiation Safety in Pediatric Radiology, the Image
Gently Campaign, and the Pause and Pulse: Image Gently in Fluoroscopy Campaign that have been added
to this chapter. Discourse regarding the Image Wisely
Campaign to lower the amount of radiation used for
medically necessary imaging studies and elimination
of unnecessary procedures for adults follows. The chapter ends with a discussion about monitoring and reporting of patient radiation doses.
Chapter 2 presents information on radiation types,
sources, and dose received. Current discussions on the
electromagnetic spectrum, ionizing and nonionizing
radiation, and particulate radiation are also included.
An introduction to the concept of radiation dose to
create an appreciation of radiation doses that humans
can receive and have received is provided. A section
covering the topic of biologic damage potential, explaining how this occurs, follows. Updated information
on sources of radiation both natural and human-made
completes this chapter. Of significant importance is the
new Fig. 2.2, which provides an overview of the Average
Annual Effective Radiation Dose Per Person in the
United States (mSv) as of 2016. Also, the most recent
follow-up data regarding nuclear power plant accidents
are covered under the section on human-made (artificial) radiation.
In Chapter 3, radiation physics relevant to protection
and safety is extensively treated to enhance student learning of this subject by providing detailed essential background knowledge of subject matter that intertwines
with basic radiation physics concepts. The chapter begins
with a discussion on the significance of x-ray absorption
in biologic tissue. Subject matter related to x-ray beam
production and energy follows. Other topics addressed
are radiation attenuation, the probability of interaction
of x-rays with matter, and the various types of x-ray
interaction such as coherent scattering, photoelectric
absorption, Compton scattering, pair production, and
photodisintegration.
Whereas the first and second chapters of the text
provided a brief introduction to the topic of radiation
quantities and units of measure, Chapter 4 contains a
much more detailed discussion of this subject matter.
Beginning with the historical evolution of radiation
quantities and units of measure, the chapter progresses
with the most current information on quantities and
units that are the norm today. While some traditional
quantities and units are still in use at this time, the main
focus on this topic is a much greater emphasis on the
metric system, which is employed throughout the world.
With the addition and enhancement of information
now available in this chapter, the learner will acquire a
clearer understanding of the Système International
(SI) units of measure and terms defining radiation dose.
State-of-the-art radiation monitoring for personnel
and information on types and usage of current radiation survey instruments are covered in Chapter 5.
Characteristics and types of personnel dosimeters for
occupational monitoring are discussed. Types of radiation survey instruments for area monitoring and requirements for such devices are addressed. Properties
of instruments used to measure x-ray exposure are also
emphasized.
Chapter 6 offers a detailed overview of cell biology.
Cell chemical composition, cell structure, and cell division are thoroughly treated. Multiple illustrations
contribute to enhancing and promoting visual understanding of the material. Selected topics have been
updated. Information within this chapter serves as a
valuable prerequisite for the subject matter in the following chapter.
Chapter 7 introduces and covers in detail molecular
and cellular radiation biology and connected discussions
of ionizing radiation. An explanation of radiation energy
transfer determinants such as linear energy transfer
(LET), relative biologic effectiveness (RBE), and oxygen
enhancement ratio (OER) is also given. Molecular effects
due to radiation exposure are extensively described. This
x
PREFACE
includes effects of irradiation on somatic and genetic
cells, classification of damaging ionizing radiation, direct
and indirect action characteristics, the radiolysis of
water, specific effects of ionization on DNA and on chromosomes, and target theory. Other significant topics
such as consequences to the entire cell stemming from
irradiation, survival curves for mammalian cells, and
overall cell radiosensitivity are also treated. Closely
related to all of these are oxygen enhancement effects
and the Law of Bergonié and Tribondeau. All topics in
this chapter contain the latest information now available.
Chapter 8 is dedicated to discussion of the most
current information on early tissue reactions and their
effects on organ systems within a body that was very
significantly irradiated. These specific outcomes may
occur within minutes, hours, days, or weeks of irradiation. As a result of this, they are termed early tissue
reactions. A detailed discussion of the acute radiation
syndrome (ARS) is presented in this chapter. Examples
of human populations affected with ARS are identified
and described. Outcomes associated with ARS such
as lethality, local tissue damage, detrimental effects on
the reproductive and the hematopoietic systems, and
cytogenic (cell-producing) effects are examined.
In Chapter 9, stochastic (random) effects and late
tissue reactions of radiation in organ systems are extensively considered. Effects that occur months or years
after exposure to ionizing radiation are the focus of
this chapter. These late effects can either be delayed
tissue reactions, such as the formation of cataracts, or
can be stochastic effects such as the induction of cancer or genetic alterations. Within Chapter 9 are the
most current concepts and terminology that address
this subject matter. Other topics of great importance
include epidemiology, carcinogenesis, radiation doseresponse relationship, and risk models used to predict
different types of cancer and various late somatic effects. There is also a substantial discussion of hereditary effects that explain causes of genetic mutations,
both natural and spontaneous. Radiation interactions
with DNA macromolecules, mutagens or agents capable of inducing genetic mutations, incapacities of mutant genes, dominant or recessive point mutations, and
the doubling dose concept are also treated.
Chapter 10 addresses dose limits for exposure to ionizing radiation. The basis of the effective dose-limiting
system is reviewed, along with the identification and
current function of the various radiation protection
standards organizations. Existing US regulatory agencies
are also identified, and their specific tasks and responsibilities are earmarked. Covered in detail is the necessity
for establishing and maintaining a strong radiation
safety program, the multiple requirements for such programs, and the identification of qualified persons and/or
groups to administer and carry them out. This mandates
the formation of a radiation safety committee and a position of qualified radiation safety officer (RSO). Requirements for an RSO are specified.
Also included in this chapter is the Radiation Control for Health and Safety Act of 1968, additional information on the ALARA concept, the position of the US
Food and Drug Administration (FDA) as it relates to
patient radiation dose, and the value and importance
of the Consumer-Patient Radiation Health and Safety
Act of 1981. Radiation-induced responses of concern in
radiation protection are identified by category, and
changes in terminology from the 1970s to the present
are addressed. Current radiation protection philosophy, the basics for the effective dose-limiting system,
and the latest National Council on Radiation Protection and Measurements (NCRP) recommendations are
also described. Action limits for emergency situations
involving radiation exposure are identified followed by
a discussion on the subject of radiation hormesis. At the
conclusion of this chapter, occupational and nonoccupational dose limits are discussed.
For the ninth edition, Chapter 11 has been consider-
ably expanded and a number of new illustrations have
been added. The latest advances in imaging equipment
that pertain to radiation safety are described. Also, other
relevant devices and accessories that may be used to
provide radiation protection for the patient and the
equipment operator are reviewed in detail.
Topics presented under the heading of “Radiation
Safety Features of Radiographic Equipment, Devices,
and Accessories” include discussion of: diagnostic-type
protective tube housing and functions; the x-ray unit’s
control panel, or console; the radiographic examination
table; source-to-image receptor distance indicators;
x-ray beam limitation devices for fixed and mobile radiographic equipment; permanent and added filtration;
compensating filters; required radiation exposure characteristics; automatic exposure control (AEC); radiographic
grids; and mobile or portable radiographic units.
Under the heading of “General Information and
Radiation Safety features of Digital Imaging Equipment
PREFACE
xi
and Accessories,” topics included are digital processed
radiographic imaging modes, digital imaging overview,
computed radiography (CR), digital radiography (DR),
and repeat rates in digital imaging.
The section on “Radiation Safety Features of Fluoroscopic Equipment Devices and Accessories” covers
fluoroscopic procedures and patient irradiation rates,
non-digital fluoroscopic imaging systems, and mobile
fluoroscopic systems. Under the heading of “Radiation
Safety Features of Digital Fluoroscopic Equipment,”
digital fluoroscopy (DF) is treated, followed by a newly
included discussion of digital subtraction angiography
(DSA) and interventional systems. The chapter concludes with sections on “Radiation Safety for HighLevel Control Interventional Procedures,” which discusses the rationale for the use of high-level control
interventional procedures; and on a “Public Health
Advisory About the Danger of Overexposure of Patients
and Exposure Rate Limits.”
Chapter 12 concentrates on management of patient
radiation dose during diagnostic x-ray procedures. As
has been the case with the preceding chapters, this chapter has undergone a significant amount of revision.
Subject matter covered includes the necessity for effective communication between the radiographer and the
patient, the need for immobilization of the patient or
body part to be imaged and the types of immobilization
available, traditional specific area shielding of the patient, and recently revised protocol of patient gonadal
shielding policies by professional and scientific societies.
Other areas of radiation safety concern covered in this
chapter include discussion of appropriate technical exposure factors and the use of standardized technique
charts. Also, the use of high-kVp and low-mAs exposure
factors to reduce dose to the patient is explained.
With the widespread adoption of digital imaging
and its associated great ease of repetitive imaging, the
potential for a large increase in unnecessary repeated
digital images to achieve the highest-quality image or
to rectify poor technique became a major concern for
overexposure of the patient. The consequences of a
substantial increase in repeat rates are identified and
the benefit of a strong repeat analysis program to remedy this is examined in detail.
The use of the air gap technique to reduce scattered
radiation and the advantages of high peak kilovoltage
radiography for selective procedures are reviewed. Also
discussed at length are the avoidance of nonessential
radiologic examinations and the ability to specify the
amount of radiation received by a patient during a diagnostic imaging procedure.
Reasons why fluoroscopically guided positioning
is unacceptable are also treated. Various methods of
protecting the pregnant or potentially pregnant patient
during radiographic examinations are discussed in
detail, and examples of how to calculate an estimate
of approximate equivalent dose to the embryo-fetus
are provided. Because children are more vulnerable to
radiation exposure, several subtopics are devoted to
pediatric protection during radiographic imaging. Although the Image Gently Campaign for reduction of
dose in pediatric imaging and the Image Wisely Campaign to reduce dose for adult patients were described
in Chapter 1 of this text, they are mentioned again in
this chapter to reinforce the importance of lowering
radiation dose. The final topic covered in this chapter is
a new addition to the book that examines dual-energy
x-ray absorptiometry (DEXA, or DXA Scan) used for
bone density determinations.
Chapter 13 has been extensively redone to consider
radiation safety in multiple aspects of computed tomography. This newly reconstructed and significantly
updated chapter is designed to inform about the numerous methods employed for radiation protection
during basic and advanced CT procedures. Included
are discussions about the various degrees of CT radiation exposure, concerns related to patient dose that
include both skin dose and dose distribution, and the
viability of direct patient shielding. Detailed explanations of the methods and characteristics of both axial
and spiral, or helical, computed tomography are presented. Methods for reduction of patient dose in CT are
covered and include subsections on tube current modulation, iterative reconstruction, optimization of tube
voltage, and patient centering. CT dose parameters and
effective CT dose are also discussed in detail. Other
topics of importance that are extensively treated in this
edition are newly introduced sections on multidetector
CT (MDCT), CT cardiovascular imaging (CT CVI),
and CT CVI radiation dose. Several new illustrations
have been added to this chapter to enhance visual
learning of concepts.
Chapter 14, entitled “X-Ray Breast Imaging: Methods
and Radiation Safety Aspects,” is also a newly dedicated
selective material chapter containing new illustrations and
a significant amount of associated added information.
xii
PREFACE
The chapter begins with a general discussion about
mammography and breast compression, followed by a
section on patient dose in traditional mammography.
Topics discussed in this section include screening
mammography, dose reduction, and filtration for
mammographic equipment.
A considerable amount of new state-of-the-art material
is introduced in the sections on digital breast tomosynthesis (DBT), also known as 3D mammography. Topics
include a discussion about tomography in general and
digital breast tomography (DBT) in particular. Subtopics
under DBT include effects of tomographic angular scan
range, methods of image reconstruction, advantages of
DBT, artifacts in DBT, DBT imaging unit characteristics,
and DBT procedure steps and details. This section concludes with material on radiation dosage and a digital
breast tomography review summary.
Management of imaging personnel radiation dose
during diagnostic x-ray procedures is the prime focus of
updated Chapter 15. This chapter contains the most cur-
rent radiation safety practices for radiographers. Annual
limits for occupationally exposed personnel are identified
and include subsections on effective dose limits, annual
occupational and nonoccupational dose limits, and discussion regarding allowance for a larger equivalent dose
for radiation workers. The ALARA concept as it pertains
to protection of personnel in the clinical setting is discussed. Various methods to lower occupational dose are
identified and described. Special attention is given to protection for pregnant personnel. Subtopics in this section
include imaging department protocol, acknowledgment
of counseling and understanding of radiation safety measures, protective maternity apparel, and protocol on work
schedule alteration. The basic principles of radiation protection for personnel exposure reduction are addressed.
Material on protection during fluoroscopic procedures
includes the following: dose reduction techniques, remote
control fluoroscopic systems, protective lead curtains,
Bucky slot shielding device, and rotational scheduling of
personnel. Radiation safety during mobile x-ray examinations is another topic of discussion. Two subsections are
concerned with personnel behavior guidance, explaining
the use of protective garments and distance as a means of
protection. The latter topic explains where a radiographer
should stand while performing a mobile radiographic
examination.
Protection for the operator during C-Arm fluoroscopy and during high-level control interventional
procedures is discussed in detail. This is followed by
a description of diagnostic x-ray suite radiation protection design, which includes information on requirements for radiation-absorbent barriers, reasons
for overshielding, and calculation considerations.
Examples of the calculation of barrier shielding
requirements are also presented. Lastly, the use of
radiation caution signs is discussed.
Chapter 16, the final chapter in the text, covers the
topics of therapeutic and diagnostic radioisotopes and
associated radiation protection. This chapter, which has
been updated and expanded since the previous edition,
provides an excellent resource for qualified individuals
wanting to advance into other disciplines beyond diagnostic x-ray imaging, such as nuclear medicine or radiation therapy. Under the main heading of medical usage,
the following subtopics are included; radiation therapy,
proper handling and disposal of radioactive materials,
nuclear medicine, positron emission tomography (PET),
radiation protection and the PET-CT scanner, and a new
advanced section on radioimmunotherapy (RIT) that
has multiple illustrations to enhance visual learning.
The second half of the chapter discusses radiation
emergencies and the use of radiation as a terrorist
weapon. Subtopics in this section include radioactive
contamination, cleanup of a contaminated urban area,
and medical management of persons experiencing
radiation bioeffects.
In summary, the ninth edition of this textbook contains a large quantity of new and updated information
throughout the book. Also, the new edition includes
many new illustrations and some updated figures. Other
updated information includes photographs, diagrams,
information boxes, and tables. The changes made
throughout the textbook are intended to make it easier
for the learner to gain comprehension of traditional and
newer, more advanced subject matter. Many added and
enhanced illustrations have been included to promote
the visual learning experience.
LEARNING ENHANCEMENTS
Each chapter begins with a list of learning objectives
to master, followed by a brief chapter outline and a list
of key terms that will appear in bold print in each chapter. Following the list of key terms, an introductory
paragraph typically provides an overview of the material to be covered. Bullets are used throughout the text
PREFACE
xiii
to facilitate readability and call attention to specific
information.
Chapter content is followed by a bulleted Summary
that highlights the most important information in the
chapter. A list of general discussion questions follows.
After that are multiple-choice review questions that the
learner can use to assess knowledge acquired from completing each chapter. Instructors may use either or both
of these categories to stimulate discussion of selected
topics of interest.
Bold print has been used to focus attention on the
key terms in each chapter. These key terms will also be
discussed in the greatly enhanced glossary located in
the back matter of the textbook. Throughout the text,
information boxes are present to direct readers to important information. The back matter of the book also
contains a reference section where a listing of references by chapter can be found.
A series of nine well-developed appendices (A through
I) provide enhanced supporting material for subject
matter contained within various chapters of the text.
Answers to the multiple-choice review questions in
this text may be found on the publisher’s website,
Evolve.
Information has been presented in this textbook as
clearly and concisely as possible in a style that builds
from basic to more complex concepts. Radiographic
images, photographs, tables, information boxes, and
graphs reinforce and enhance learning and facilitate
retention of material. Throughout the textbook useful
examples are included after discussion of concepts that
may need to be reinforced.
Ancillaries
Workbook. A free-standing workbook to accompany
this textbook is also available in printed form. It contains a variety of exercises for each of the 16 chapters
in the book. Exercises included in the workbook are
matching of terms or phrases with their definitions or
other relevant facts, multiple-choice questions, true or
false statements, fill-in-the-blank statements, labeling
of diagrams or missing information in boxes or charts,
short-answer questions, general discussion or opinion
questions, and a chapter post-test to assess learning of
the subject matter covered in each chapter.
The use of the workbook, in conjunction with the
textbook, will provide a challenging but rewarding experience for the learner. It will reinforce comprehension
and help students remember important concepts and
material covered in each chapter of the textbook. The
answers to all of the exercises in the workbook are
located separately in the back matter of the workbook.
Using both the text and workbook simultaneously will
be of significant value in helping radiography students
prepare for credentialing examinations such as the
American Registry of Radiologic Technologists (ARRT)
certification examination for full-scope radiographers.
Limited-scope x-ray technologists may also find both the
textbook and workbook very helpful in preparing for
state licensing examinations.
INSTRUCTOR MATERIALS
Ancillaries for instructors are also available with this
ninth edition to assist radiologic technology educators.
Ancillaries include a test bank consisting of multiplechoice questions for each chapter, a collection
of images from the textbook, and a PowerPoint lecture
presentation. These additional materials are available
for instructors on the publisher’s website, Evolve.
The web address is http://evolve.elsevier.com/Sherer/
radiationprotection.
USING THE BOOK
The presentation of the ninth edition presumes that the
reader has some background in elementary physics,
human anatomy, and medical and imaging terminology.
Basic knowledge of units of measure [metric and English,
atomic structure, the physical concepts of energy, electric
charge, the subdivision of matter, electromagnetic radiation, x-ray production (both quality and quantity]) and
the process of ionization is useful but not mandatory,
since these concepts are generously covered in the course
of studying radiation safety. The learner will be able to
substantially build on any existing knowledge by assimilating information presented in this textbook.
To facilitate a working comprehension of the principles of radiation protection, radiobiology, and physics
related to radiation protection, study materials presented
in the ninth edition remain sophisticated enough to be
true to the subject matter’s complexity, yet concise and
sufficiently straightforward to permit comprehension by
all readers. For student radiographers and radiology
residents, this text is best used in conjunction with formal instruction presented by a qualified instructor.
xiv
PREFACE
Practicing radiographers, new medical physicists,
newly appointed radiation safety committee chairs,
radiologists, and other physicians interested in the
subject matter contained within the textbook may
utilize it as a self-learning instrument to reinforce
and broaden their knowledge of radiation safety and
also acquaint themselves with up-to-date changing
concepts and material. Also, this latest version of
the textbook can serve as a valuable resource for continuing education for practicing imaging professionals because it provides both an extensive range of
traditionally necessary information, now expanded
and updated, as well as added current state-of-the-art
methods and devices.
By mastering the material covered in this radiation
protection textbook and its ancillaries, and by applying
this knowledge in the performance of radiologic and
related procedures in the clinical setting, the reader will
help ensure the safety of patients, all diagnostic imaging
personnel, and the general public.
Mary Alice Statkiewicz Sherer, AS, RT(R), FASRT
A B O U T T H E A U T H O R S
Mary Alice Statkiewicz Sherer, AS, RT(R), FASRT, Radiologic Technology Educator/Instructor/Technologist
Emeritus, is the primary author of this textbook and the
accompanying workbook and ancillary materials. Ms.
Sherer continues to be available as a private radiography
education, radiation safety, and medical publishing
consultant. In the past, she was employed for 6 years as
an instructor for the Limited Scope X-Ray Program at
High-Tech Institute, Inc. (Anthem College), a career
college that was located in Nashville, Tennessee. Before
assuming that position in January 2004, Ms. Sherer was
employed at Summit Medical Center in Hermitage,
Tennessee for 13 years, where she performed diagnostic
imaging procedures and served as the department’s
Compliance/Education Coordinator. Prior to that position, Ms. Sherer was employed at Memorial Hospital of
Burlington County (now Virtua Health System Memorial Hospital) in Mount Holly, New Jersey, where she
served for over 16 years as radiography program director and then as educational administrative assistant for
the Department of Radiology.
After earning an ARRT certification in 1965, Ms.
Sherer filled several technical and teaching positions in
the New Jersey area and in 1980 graduated with an associate degree in science from the College of Allied
Health Professions, Hahnemann Medical College and
Hospital of Philadelphia (Hahnemann University). She
has been an active and leading member of several professional organizations, having served on committees
and task forces of the American Society of Radiologic
Technologists, as past president of the 28th Mid-Eastern
Conference of Radiologic Technologists, and as president and chairman of the Board of Directors (both
district and state levels) of the New Jersey Society of
Radiologic Technologists. Services to the ASRT include
functioning as chairperson of the Radiologic Technology
editorial review board for the membership year 1989–
1991 and participating as a member of the Committee
on Memorial Lectures for the membership years 1989–
1991 and 1991–1993.
Other responsibilities fulfilled by Ms. Sherer include:
Item Writer for Radiography Certification for the
American Registry of Radiologic Technologists (1983),
Site Visitor Team Member for the Joint Review Committee on Education on Radiologic Technology (1981–1983),
Site Visitor for the State of New Jersey, Bureau of Radiologic Certification for several years, and Critical Textbook
Reviewer for unpublished work for WB Saunders Company (1989–1992).
For the services and contributions to the profession
of radiologic technology, in June 1990, Ms. Sherer was
elevated to the status of Fellow of the American Society
of Radiologic Technologists. She continues to hold this
professional honor.
Ms. Sherer has also presented lecturers for the New
Jersey Society of Radiologic Technologists for a winter
seminar in 1978, and an Annual Meeting in 1982. As an
author she has won two first place awards for technical
writing, 1st place Graduate Essay Award at the 29th
Mid-Eastern Conference of Radiologic Technologists in
1976 and the EI DuPont DeNemours Award presented
by the Delaware Society of Radiologic Technologists at
the 25th Mid-Eastern Conference of Radiologic Technologists in 1974.
In addition to being the primary author of the first
edition of Radiation Protection for Student Radiographers
and the second through eighth editions of Radiation
Protection in Medical Radiography, as well of this edition,
Ms. Sherer is the author of Q & A: Preparation for Cre-
dentialing in Radiography, published in 1993 by WB
Saunders Company. In 1984, she was a coauthor for the
textbook, Radiation Protection for Dental Radiography,
which was published by Multi-Media Publishing, Denver. Articles written by Ms. Sherer have been published
in Radiologic Technology, The Journal of the American
Society of Radiologic Technologists, and ADVANCE for
Imaging and Radiation Therapy Professionals, a national
biweekly newspaper that was published by Merion Publications. She has also previously served as a consultant
to ADVANCE.
In 1999, Mosby produced “Radiobiology and
Radiation Protection,” the fourth program in Mosby’s
Radiographic Instructional Series, a CD-ROM (and
slide series) presentation consisting of eight modules,
xv
xvi
ABOUT THE AUTHORS
approximately 1 hour each in duration. A study guide
and an instructor’s manual accompanied the audiovisual
materials. Ms. Sherer served as chief consultant for the
development of the program and as a technical reviewer.
More recently, Ms. Sherer served as a member of the
advisory board for the second through fifth editions of
the textbook, Radiography Essentials for Limited Practice,
an Elsevier publication.
Paula J. Visconti, PhD, DABR, was the chief of
medical physics and radiation safety officer at Virtua
Health System Memorial Hospital in Mount Holly, New
Jersey, for over 30 years. She had also served for a period
as the radiation safety officer for the entire Virtua
Health System in southern New Jersey, which comprises
four hospitals.
Dr. Visconti received her PhD in experimental
atomic physics from the City University of New York in
1971. She served as a full-time instructor in the Physics
Department at the City College of New York for several
years thereafter. Dr. Visconti began her career in medical physics at Montefiore Hospital and Medical Center
in New York City, where she remained for 5 years as
an associate physicist. During that time, she lectured
extensively in radiologic physics to both therapeutic
radiology residents and student radiographers.
Dr. Visconti is a member of the Society of the Sigma
Xi, the American Association of Physicists in Medicine,
and the American College of Radiology and is certified
in therapeutic radiological physics by the American
Board of Radiology.
Dr. Visconti has served as an advisor and collaborating author during the development of the second edition of Radiation Protection in Medical Radiography
published in 1993 and all subsequent editions since that
time. She has contributed significantly to the technical
content of all these editions and also provided editing
support.
E. Russell Ritenour, PhD, DABR, FAAPM, FACR, is
currently a Professor in the Department of Radiology
and Radiological Science at the Medical University of
South Carolina. Dr. Ritenour received his PhD in physics from the University of Virginia in 1980 and completed a postdoctoral fellowship sponsored by the
National Institute of Health in medical physics at
the University of Colorado Health Sciences Center.
He stayed on the faculty at the University of Colorado
for 9 years, serving as director of the graduate medical
physics training program, until moving to the University
of Minnesota in 1989 where he served as Professor and
Chief of the physics section in the Department of Radiology, University of Minnesota Medical School, and
was Director of Graduate studies in Biophysical Sciences and Medical Physics, University of Minnesota
Graduate School, for 25 years.
During his career, Dr. Ritenour has served as radiation safety officer for several hospitals and research facilities. He is a past president of the Rocky Mountain
Chapter of the Health Physics Society and a frequent
contributor to the national Health Physics Society’s
website’s feature, “Ask the Expert.” Dr. Ritenour is a
Fellow, past president, and chairperson of the board of
the American Association of Physicists in Medicine and
a Fellow of the American College of Radiology.
In the area of radiology education and testing, he has
authored several other textbooks, audiovisual programs,
and educational websites for radiologic technologists,
radiology residents, and medical physicists. He has been
a consultant to the US Army for resident training programs, and has produced various types of training and
testing programs for the American College of Radiology
and the American Association of Physicists in Medicine.
He has also been involved in volunteer question writing
and test production with the American Registry of
Radiologic Technologists and the American Board of
Radiology since the 1980s.
Dr. Ritenour was a coauthor of the first edition of
this text with Mary Alice Statkiewicz Sherer in 1983 and
has been a coauthor of all subsequent editions.
Kelli Welch Haynes, EdD, RT(R), FASRT, is a tenured professor and Director for the School of Allied
Health at Northwestern State University in Shreveport, Louisiana. She is also a graduate faculty member.
Dr. Welch Haynes graduated from Northwestern State
with her Bachelor of Science degree in 1995, and
she graduated from Midwestern State University in
Wichita Falls, Texas, in 2000 with her Master of Science
in Radiologic Sciences with a concentration in Administration. Dr. Welch Haynes graduated from the University of Louisiana at Monroe with her Doctorate of
Education in Curriculum and Instruction with a concentration in Allied Health Education in 2018. Before
becoming an educator in August 2000, Dr. Welch Haynes
was the Director of Radiology at Promise Hospital in
Shreveport, Louisiana, for 5 years, where she performed
diagnostic radiographs examinations and computed
tomography.
ABOUT THE AUTHORS
xvii
She has been an active member of several professional organizations, having served on the boards, committees, and task forces of the Association of Educators
in Imaging and Radiologic Sciences, American Society
of Radiologic Technologists, as chapter director of the
Louisiana Alpha chapter of Lambda Nu, the national
honor society for the radiologic and imaging sciences,
and currently serves as a site visitor for the Joint Review
Committee on Education in Radiologic Technology. She
is also a member of the Association of College Educators in Radiologic Sciences.
She has created multiple online continuing education modules for the American Society of Radiologic
Technologists. Dr. Welch Haynes served as a subject
matter expert and reviewer for many radiologic sciences textbooks. In radiography, she has developed
the Mosby’s Radiographic Online (MRO) for Radiation
Protection in Medical Radiography, Bontrager’s Textbook of Radiographic Positioning, Bushong’s Radiologic
Science for Technologists: Physics, Biology and Protection, and Sectional Anatomy for Imaging Professionals.
Dr. Welch Haynes has conducted over 100 presentations at state, reginal, national, and international
levels. She has also published articles in Radiologic
Technology, The Journal of the American Society of Radiologic Technologists, Radiologic Science and Education,
and ADVANCE for Imaging and Radiation Therapy
Professionals.
Currently, Dr. Welch Haynes serves as a site visitor
for the JRCERT and as an ERB member for AEIRS.
Dr. Welch Haynes was elevated to Fellow of the ASRT
in June of 2021.
A C K N O W L E D G M E N T S
The constant encouragement and support of my family,
collaborating authors, professional colleagues, friends,
and the competent, supportive staff at Elsevier have
made the development, updating process, and production of the ninth edition of Radiation Protection in
Medical Radiography and all of its ancillaries possible to
achieve.
To my family—sons Joseph, Christopher, and Terry—
a very special acknowledgment and sincerest thanks are
given. The consistent love, support, and encouragement
you provide give me the strength and determination to
accomplish my goals in life. You are my greatest blessing.
Also, a special part of my family are my two little shihtzus, Dexter and Roxie, who were always by my side
during the writing of this edition, providing companionship, unconditional love, and support for me.
The technical integrity of this edition and a considerable amount of new information that has been added
to the ninth edition are attributed to the collaborative
efforts of two brilliant and exceptional medical physicists, Paula J. Visconti, PhD, DABR, and E. Russell Ritenour, PhD, DABR, FAAPM, FACR, and an extremely
competent radiologic technologist educator, Kelli Welch
Haynes, EdD, RT(R), FASRT whose professional expertise has greatly enhanced this publication.
Each of these individuals has made significant and
valuable contributions in terms of technical information, numerous recommendations, review of various
subject matter, editing, and development of new materials and illustrations for this new edition, thereby increasing the overall technical accuracy, timeliness, and
value of the contents of this textbook. I am sincerely
very thankful to Paula, Russ, and Kelli for all their
technical contributions and recommendations, and for
all the time each has given reviewing, writing, and assisting with editing of material in this and previous
editions. Sincere gratitude is given to Dr. Ritenour for
his participation in the development of the free standing Workbook that we have designed to accompany the
new ninth edition of the textbook. Deep appreciation
is also given to Dr. Haynes for producing the PowerPoint slide presentation to accompany this textbook.
This series is available on the publisher’s website,
Evolve.
A very special thank you is given to Terri L. Fauber,
EdD, RT (R) (M), Professor Emeritus of Radiation
Sciences, Department of Radiation Sciences, College of
Health Professions, Virginia Commonwealth University,
Richmond, Virginia, and renowned author, for writing
the Foreword for our ninth edition. We appreciate your
professional comments and endorsement of our new
edition of Radiation Protection in Medical Radiography.
Over the years many contributions of information
and illustrations have been given by many individuals,
companies, and organizations. These materials have
helped enhance the technical value and visual appeal of
this and previous editions. We are very grateful for permission for use of these materials and acknowledge
their use in the book through the process of citation,
where applicable.
We acknowledge the continuous use of some photographs and illustrations that were taken for previous editions of the book and continue to be used in this edition.
Thanks are given to those persons who participated in
earlier photo shoots and to Dr. Haynes for conducting
that photo shoot. The original photos obtained continue
to complement various sections of the text and have enhanced the visual appeal of the book.
Sincere gratitude for effective communication,
hard work, and ongoing support of our project is given
to the highly competent and wonderful staff at
Elsevier. Special acknowledgment and gratitude are
given to Executive Content Strategist, Sonya Seigafuse;
Senior Content Development Manager, Lisa Newton;
Senior Content Development Specialist, Laura Selkirk;
Senior Project Manager, Manchu Mohan; and Design
Direction, Amy Buxton. We applaud your efforts to
bring the ninth edition of this textbook, free-standing
accompanying workbook, and other ancillaries to
publication. We could not have accomplished this
enormous task without you! Thank you all.
Those who seek to learn the art and science of medical imaging are the future of the profession. To the radiography students and radiology residents who will use
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