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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5196_Библиотеки_им_академика_М_И_Перельмана.pdf
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- •Foreword
- •Preface
- •Goal of the textbook and accompanying ancillaries
- •Content
- •New to this edition
- •Chapter contents
- •Instructor materials
- •Using the book
- •About the authors
- •Acknowledgments
- •Learning enhancements
- •Ancillaries
- •Workbook.
- •1 Introduction to radiation protection
- •Objectives
- •Key terms
- •Team concept in the medical field
- •Control of radiant energy
- •Goals of radiation protection
- •Concept of radiation protection
- •Introduction to radiation quantities and units of measure
- •Absorbed dose (milligray [mGy]).
- •Effective dose (millisievert [mSv]).
- •Need to safeguard against adverse biologic effects of ionizing radiation
- •Justification and responsibility for imaging procedures: Benefit verses risk
- •As low as reasonably achievable (ALARA) principle
- •Cardinal rules of radiation protection
- •Responsibility for maintaining ALARA in the medical industry
- •Patient protection and patient education
- •Educating patients about imaging procedures
- •Background equivalent radiation time
- •Increased radiation sensitivity of children
- •Alliance for radiation safety in pediatric imaging
- •Image gently campaign
- •Pause and pulse: Image gently in fluoroscopy campaign.
- •Image wisely campaign
- •Monitoring and reporting radiation dose
- •The NEXT program and reference values
- •Protocols for dose alerts
- •Summary
- •General discussion questions
- •Review questions
- •2 Radiation: Types, sources, and doses received
- •Objectives
- •Key terms
- •Radiation
- •Types of radiation
- •The electromagnetic spectrum
- •Ionizing and nonionizing radiation
- •Particulate radiation
- •An introduction to the concept of radiation dose
- •Biologic damage potential
- •Sources of radiation
- •Natural radiation.
- •Terrestrial radiation.
- •Cosmic radiation.
- •Terrestrial and internal radiation.
- •Air travel.
- •Nuclear fuel for the generation of power.
- •Atmospheric fallout from nuclear weapons testing.
- •Nuclear power plant accidents.
- •Three mile Island unit 2.
- •Chernobyl.
- •Thyroid cancer, leukemia, and breast cancer as a result of the chernobyl disaster.
- •Fukushima Daiichi nuclear plant disaster.
- •Medical radiation.
- •Summary
- •General discussion questions
- •Review questions
- •3 Interaction of X-radiation with matter
- •Objectives
- •Key terms
- •Significance of X-ray absorption in biologic tissue
- •X-ray beam production and energy
- •Production of primary radiation
- •Energy of photons in a diagnostic X-ray beam
- •Attenuation
- •Direct and indirect transmission X-ray photons
- •Absorption vs. scatter.
- •Attenuation vs. transmission.
- •Direct transmission vs. indirect transmission.
- •Primary, exit, and attenuated photons
- •Probability of photon interaction with matter
- •Processes of interaction
- •Coherent scattering
- •Process of coherent scattering.
- •Photoelectric absorption
- •Process of photoelectric absorption.
- •Probability of occurrence of photoelectric absorption.
- •Mass density and effective atomic number of different body structures.
- •Body part thickness and density differences.
- •Effects of attenuation on radiographic images.
- •Impact of photoelectric absorption on radiographic contrast.
- •Photodisintegration
- •Process of photodisintegration.
- •Summary
- •General discussion questions
- •Review questions
- •4 Radiation quantities and units
- •Objectives
- •Key terms
- •Historical evolution of radiation quantities and units
- •Discovery of X-rays
- •First reports of injury
- •Use of contrast media to ensure visualization of anatomic structures.
- •Compton scattering
- •Process of compton scattering in a patient.
- •Pair production
- •Process of pair production.
- •Use of annihilation radiation in positron emission tomography.
- •Investigation of methods for reducing radiation exposure
- •Skin erythema dose
- •The modern era of radiation protection
- •Quantities and units in use today
- •Radiation quantities and their SI units of measure
- •Exposure
- •Air kerma
- •Absorbed dose
- •Equivalence of radiation-produced damage from different sources of ionizing radiation
- •Equivalent dose
- •Effective dose
- •Collective effective dose
- •Total effective dose equivalent
- •Summary
- •General discussion questions
- •Review questions
- •5 Radiation monitoring
- •Objectives
- •Key terms
- •Personnel monitoring
- •Requirement for personnel monitoring
- •Purpose of personnel dosimeters
- •Placement of personnel dosimeters
- •During routine radiographic procedures.
- •When a protective apron is worn.
- •As a second monitor when a protective apron is worn.
- •As a monitor for the embryo-fetus.
- •Extremity dosimeter
- •Advantages of the TLD ring dosimeter.
- •Disadvantages of the TLD ring dosimeter.
- •Record of radiation exposure
- •Personnel dosimeters for occupational monitoring
- •Characteristics
- •Types
- •Optically stimulated luminescence dosimeter.
- •Energy discrimination.
- •Control monitor.
- •Advantages of the OSL dosimeter.
- •Disadvantages of the OSL dosimeter.
- •Personnel monitoring report.
- •Change in employment by radiation worker.
- •Direct ion storage dosimeter.
- •Advantages of the direct ion storage dosimeter.
- •Disadvantages of the direct ion storage dosimeter.
- •Radiation survey instruments for area monitoring
- •Radiation detection and measurement
- •Types of instruments
- •Requirements
- •Gas-filled radiation survey instruments
- •Ionization chamber–type survey meter (cutie pie).
- •Sensitivity ranges and uses.
- •Advantages and disadvantages.
- •Proportional counter.
- •Geiger–Müller survey meter
- •Sensitivity and use.
- •Components.
- •Disadvantages.
- •Instruments used to measure X-ray exposure
- •Summary
- •General discussion questions
- •Review questions
- •6 Overview of cell biology
- •Objectives
- •Key terms
- •The cell
- •Cell chemical composition
- •Protoplasm
- •Organic compounds
- •Proteins.
- •Structural and enzymatic proteins.
- •Repair enzymes.
- •Hormones and antibodies.
- •Carbohydrates.
- •Lipids.
- •Nucleic acids.
- •Deoxyribonucleic and ribonucleic acids.
- •Nitrogenous organic bases in DNA.
- •DNA: The master chemical substance.
- •Structural differences between DNA and RNA.
- •Messenger RNA.
- •Transfer RNA.
- •Ribosomal RNA.
- •Chromosomes and genes.
- •The human genome.
- •Inorganic compounds
- •Function of water within and outside of the cell.
- •Function of mineral salts within the cell.
- •Cell structure
- •Cell membrane—a “plastic storage bag” to contain the cell
- •Cytoplasm
- •Cytoplasmic organelles
- •Endoplasmic reticulum—the “highway” of the cell.
- •Golgi apparatus or complex—Hauls “Freight” within and out of the cell.
- •Mitochondria—the “power-generating station” of the cell.
- •Lysosomes—”garbage bags” with “poison pills.”
- •Ribosomes—”manufacturing facilities” of the cell.
- •Centrosomes—”weavers of the spindle.”
- •Nucleus—information-processing and administrative center
- •Cell division
- •Mitosis
- •The four phases of mitosis.
- •Prophase.
- •Metaphase.
- •Anaphase.
- •Telophase.
- •Meiosis
- •Multiple births.
- •Summary
- •General discussion questions
- •Review questions
- •7 Molecular and cellular radiation biology
- •Objectives
- •Key terms
- •Ionizing radiation
- •Radiation energy transfer determinants
- •Linear energy transfer
- •Radiation categories according to linear energy transfer.
- •Low–linear energy transfer radiation.
- •High–linear energy transfer radiation.
- •Risk of damage to DNA.
- •Probability of interaction with DNA.
- •Relative biologic effectiveness
- •Oxygen enhancement ratio
- •Molecular effects of irradiation
- •Effects of irradiation on somatic and genetic cells
- •Radiolysis of water
- •Ionization of water molecules.
- •Production of free radicals.
- •Production of cell-damaging substances.
- •Organic free radical formation.
- •Indirect action characteristics
- •Single-strand break.
- •Double-strand break.
- •Chromosome effect after a double-strand break in the same rung of DNA.
- •Mutation.
- •Covalent cross-links.
- •Effects of ionizing radiation on chromosomes
- •Radiation-induced chromosome breaks.
- •Chromosomal fragments.
- •Chromosome anomalies.
- •Summary of structural changes caused by ionizing radiation.
- •Consequences to the cell from structural changes within the nucleus
- •Target theory
- •Effects of irradiation on the entire cell
- •Instant death
- •Reproductive death
- •Apoptosis
- •Mitotic death
- •Mitotic delay
- •Interference with function
- •Survival curves for mammalian cells
- •Cell radiosensitivity
- •Cell maturity and specialization
- •Oxygen enhancement effects
- •Law of Bergonié and Tribondeau
- •Effects of ionizing radiation on human cells and tissues
- •Blood cells
- •Hematologic depression.
- •Depletion of immature blood cells.
- •Repopulation after a period of recovery.
- •Effects on stem cells of the hematopoietic system.
- •Effects of ionizing radiation on lymphocytes.
- •Effects of ionizing radiation on neutrophils.
- •Effects of ionizing radiation on thrombocytes (platelets).
- •Occupational radiation exposure monitoring.
- •Epithelial tissue.
- •Muscle tissue.
- •Nervous tissue.
- •Nerve tissue in the human adult.
- •Nerve tissue in the embryo-fetus.
- •Reproductive cells
- •Spermatogonia.
- •Ova.
- •Summary
- •General discussion questions
- •Review questions
- •Objectives
- •Key terms
- •Somatic and genetic effects
- •Somatic effects
- •Early tissue reactions
- •Acute radiation syndrome (ARS).
- •Symptoms of acute radiation syndrome.
- •Hematopoietic syndrome.
- •Gastrointestinal syndrome.
- •Cerebrovascular syndrome.
- •Lethal dose
- •LD 50/30.
- •LD 10/30, LD 50/60, and LD 100/60.
- •Repair and recovery
- •Local tissue damage
- •Effects on the skin
- •Effects on the reproductive system
- •Hematologic effects
- •Hematopoietic system.
- •Cytogenetic effects
- •Summary
- •General discussion questions
- •Review questions
- •Objectives
- •Key terms
- •Epidemiology
- •Carcinogenesis
- •Radiation dose–response relationship
- •Dose–response curves
- •Threshold and nonthreshold relationships
- •Risk models used to predict cancer risk and heritable damage in human populations
- •Risk models used to predict leukemia, breast cancer, and heritable damage
- •Risk model used to predict high-dose cellular response
- •The rationale for risk model selection
- •Somatic effects
- •Late somatic effects
- •Low-level effects summary
- •Major types of late effects
- •Risk estimates for cancer
- •Absolute risk and relative risk models.
- •Epidemiologic studies for determining the risk of cancer.
- •Radiation-induced cancer.
- •Radium watch-dial painters.
- •Uranium miners.
- •Early medical radiation workers.
- •Incidence of breast cancer in radiation treatment of benign postpartum mastitis.
- •Japanese atomic bomb survivors
- •Atomic bomb detonation on Hiroshima and Nagasaki.
- •Data obtained from epidemiologic studies.
- •Incidence of breast cancer in japanese women.
- •Radiation dose and radiation-induced leukemia.
- •Conclusions from the Chernobyl nuclear disaster
- •Need for follow-up studies.
- •Worldwide effects of the accident.
- •Thyroid cancer from the accident.
- •Life span shortening
- •Animal studies.
- •Human studies
- •American radiologists.
- •American radiologic technologists.
- •Embryologic effects (birth defects)
- •Stages of gestation in humans.
- •Embryonic cell radiosensitivity during the first trimester of pregnancy.
- •Embryonic cell radiosensitivity during the second and third trimesters of pregnancy.
- •Embryonic effects resulting from the chernobyl nuclear power plant accident.
- •Review of fetal effects by UNSCEAR.
- •Effects of low-level ionizing radiation on the embryo-fetus.
- •Genetic (hereditary) effects
- •Irradiation mutations
- •Natural mutations
- •Other agents of genetic mutations
- •Incapacities of mutant genes
- •Dominant or recessive point mutations
- •Ionizing radiation as a possible cause of genetic (hereditary) effects
- •Doubling dose concept
- •Summary
- •General discussion questions
- •Review questions
- •Objectives
- •Key terms
- •Basis of effective dose limiting system
- •Radiation protection standards organizations
- •International commission on radiological protection
- •National council on radiation protection and measurements
- •National academy of sciences/National research council committee on the biological effects of ionizing radiation (NAS/NRC-BEIR)
- •US regulatory agencies
- •Nuclear regulatory commission
- •Agreement states
- •Environmental protection agency (EPA)
- •US food and drug administration (FDA)
- •Occupational safety and health administration (OSHA)
- •Radiation safety program
- •Requirement
- •Radiation for health and safety act of 1968
- •Code of standards for diagnostic X-ray equipment
- •ALARA concept
- •Model for the ALARA concept
- •Food and drug administration white paper
- •Consumer-patient radiation health and safety act of 1981
- •Radiation-induced responses of concern in radiation protection
- •Categories for radiation-induced responses
- •Changes in terminology from the 1970s to the present
- •Tissue reactions.
- •Early and late tissue reactions.
- •Stochastic effects.
- •Current radiation protection philosophy
- •Occupational risk
- •The vulnerability of the embryo-fetus to radiation exposure
- •Basis for the effective dose limiting system
- •Concept underlying radiation protection
- •Tissue weighting factor
- •Current national council on radiation protection and measurements recommendations
- •National council on radiation protection and measurements reports
- •International commission on radiological protection recommendation for downward revision of the annual effective dose limit.
- •Limits for nonoccupationally exposed individuals.
- •Limits for pregnant radiation workers.
- •Limits for education and training purposes.
- •Limits for tissues and organs exposed selectively or together with other organs.
- •Negligible individual dose.
- •Action limits
- •Radiation hormesis
- •Occupational and nonoccupational dose limits
- •Effective dose limits for radiation workers and the population as a whole
- •Special limits for selected areas
- •Summary
- •General discussion questions
- •11 Equipment design for radiation protection
- •Objectives
- •Key terms
- •Radiation safety features of radiographic equipment, devices, and accessories
- •Diagnostic-type protective tube housing and functions
- •Control panel, or console
- •Radiographic examination table
- •Source-to-image receptor distance indicator
- •X-ray beam limitation devices for fixed and mobile radiographic equipment
- •Light-localizing variable-aperture rectangular collimators.
- •Construction.
- •Skin sparing.
- •Luminance.
- •Coincidence between the radiographic beam and the localizing light beam.
- •Positive beam limitation.
- •Filtration
- •Purpose and effects of radiographic beam filtration.
- •Types of filtration.
- •Requirement for total filtration.
- •Filtration for general diagnostic radiology.
- •Compensating filters
- •Required radiation exposure characteristics
- •Exposure reproducibility.
- •Exposure linearity.
- •Automatic exposure control (AEC) and phototiming
- •Radiographic grids
- •Grid ratio and patient dose.
- •Effect of source-skin distance on patient entrance exposure.
- •Mobile, or portable, radiographic units
- •General information and radiation safety features of digital imaging equipment and accessories
- •Digital processed radiography imaging modes
- •Digital imaging overview
- •Computed radiography (CR)
- •Kilovoltage.
- •X-ray beam collimation.
- •Use of radiographic grids.
- •Digital radiography (DR)
- •Digital radiography systems advantages and disadvantages.
- •Repeat rates in digital imaging
- •Radiation safety features of fluoroscopic equipment, devices, and accessories
- •Fluoroscopic procedures and patient irradiation rates
- •Fluoroscopic imaging systems: Non-digital
- •Brightness of the fluoroscopic image and patient absorbed dose.
- •Pulsed fluoroscopy.
- •Limiting fluoroscopic field size.
- •Radiation delivery factors
- •Selection of technique exposure factors for adult patients.
- •Selection of technique factors for children.
- •Filtration.
- •Cumulative timing device.
- •Entrance irradiation rate limitations.
- •Primary protective barrier.
- •Fluoroscopic exposure control switch.
- •Mobile fluoroscopic systems
- •Radiation safety features of mobile C-arm fluoroscopy.
- •Radiation safety features of digital fluoroscopic equipment
- •Digital fluoroscopy (DF)
- •Pulsed progressive systems.
- •Last image hold.
- •Digital subtraction angiography (DSA) and interventional systems
- •Interventional procedures.
- •Digital subtraction angiography.
- •Roadmapping.
- •Radiation safety for high-level control interventional procedures
- •Public health advisory about the dangers of overexposure of patients and exposure rate limits
- •Use of fluoroscopic equipment by non-radiologist physicians
- •Summary
- •General discussion questions
- •Review questions
- •Objectives
- •Key terms
- •Effective communication
- •Verbal messages and body language
- •Importance of patient instructions
- •Appropriate communication for procedures that will cause pain or discomfort
- •Repeat radiographic exposures resulting from poor communication
- •Immobilization
- •Need for patient immobilization
- •Types of patient motion
- •Protective shielding
- •Need for protective shielding
- •Gonadal shielding
- •CARES committee.
- •Technical exposure factors
- •Appropriate selection
- •Use of standardized technique charts
- •Use of high-kVp and low-mAs exposure factors to reduce dose to the patient
- •Postprocessing of the radiographic image
- •Quality control program
- •Air gap technique
- •Reduction of scattered radiation
- •High peak kilovoltage radiography
- •Repeat images
- •Consequences of repeat images
- •Increase in repeat rates
- •Concern about risk of exposure during diagnostic imaging procedures
- •Nonessential radiologic examinations
- •Specifying the amount of radiation received by a patient during a diagnostic imaging procedure
- •Skin dose.
- •Gonadal dose
- •Difference in gonadal dose received by male and female patients.
- •Bone marrow dose.
- •Fluoroscopically guided positioning
- •Protecting the pregnant or potentially pregnant patient
- •Position of the american college of radiology on abdominal radiologic examinations of female patients
- •Determining the possibility of pregnancy
- •Irradiation during an unknown pregnancy
- •Procedure to follow and responsibility for absorbed dose determination to the patient’s embryo-fetus
- •Sample cases to estimate approximate equivalent dose to the embryo-fetus
- •Sample cases to obtain an approximate estimate of the fetal equivalent dose
- •Irradiating a known pregnant patient
- •Pediatric considerations during radiographic imaging
- •Vulnerability of children to radiation exposure
- •Children require smaller radiation doses than do adults
- •Patient motion and motion reduction methods
- •Gaining cooperation during the procedure
- •Collimation
- •Patient protection in computed tomography for adults and children: Similarities and necessary changes
- •Image gently campaign
- •Image wisely campaign
- •Summary
- •General discussion questions
- •Review questions
- •13 Special considerations on safety in computed tomography
- •Objectives
- •Key terms
- •Patient dose in computed tomography
- •Radiation exposure
- •Concerns related to patient dose: Skin dose and dose distribution
- •Direct patient shielding
- •Helical, or spiral, computed tomography
- •Methods for reduction of patient dose in CT
- •Tube current modulation
- •Iterative reconstruction
- •Optimization of tube voltage
- •Patient centering
- •Computed tomography dose parameters
- •Effective computed tomography dose
- •Multidetector computed tomography scanning (MDCT)
- •MDCT collimation, slice width, and slice number
- •MDCT advantages
- •Slice thickness and reconstruction interval
- •Computed tomography cardiovascular imaging (CT CVI)
- •Basic heart anatomy and processes
- •Phases of the cardiac cycle
- •CT cardiovascular imaging (CT CVI)
- •ECG gated imaging.
- •Heart beat rate.
- •CT CVI imaging metrics
- •Temporal resolution (TR).
- •Spatial resolution (SR).
- •Contrast resolution (CR).
- •Metrics summary.
- •CT CVI and radiation doses
- •Patient radiation doses and volume scanning
- •Radiation dose and image noise
- •Summary
- •General discussion questions
- •Review questions
- •Objectives
- •Key terms
- •Mammography and breast compression
- •Patient dose in mammography
- •Mammography screening
- •Dose reduction in mammography
- •Filtration for mammographic equipment
- •Digital breast tomosynthesis/3D mammography
- •Tomography
- •Digital breast tomosynthesis (DBT)
- •Effects of tomographic angular scan range
- •On the depth resolution of structures.
- •On in-plane image quality.
- •Effects summary.
- •Image reconstruction (IR)
- •Advantages of DBT
- •Reduce the need for follow-up imaging.
- •Detect more cancers than a standard mammogram alone.
- •Improve breast cancer detection in dense breast tissue.
- •Artifacts in digital breast tomography
- •Artifacts due to motion.
- •Artifacts due to method of acquisition.
- •Artifacts due to reconstruction process.
- •Properties of DBT summarized
- •Expanding the angular sweep of the X-ray tube.
- •Increasing the number of projections for a given angular range.
- •Number of projections required depends on:
- •DBT imaging unit characteristics
- •DBT procedure: Steps and details
- •Radiation dosage
- •DBT summary
- •Summary
- •Discussion questions
- •Review questions
- •Objectives
- •Key terms
- •Annual limit for occupationally exposed personnel
- •Effective dose limits
- •Annual occupational and nonoccupational effective dose limits
- •Allowance for a larger equivalent dose for radiation workers
- •ALARA concept
- •Dose-reduction methods and techniques
- •Repeats in digital imaging
- •The patient as a source of scattered radiation
- •Scattered radiation—occupational hazard
- •Filtration of the diagnostic X-ray beam
- •Protective apparel
- •Technical exposure factors
- •Patient restraint
- •Protection for pregnant personnel
- •Imaging department protocol
- •Acknowledgment of counseling and understanding of radiation safety measures
- •Protective maternity apparel
- •Work schedule alteration
- •Basic principles of radiation protection for personnel exposure reduction
- •Time
- •Distance
- •Application of the inverse square law.
- •Shielding
- •Protective structural shielding.
- •Primary protective barrier.
- •Secondary protective barrier.
- •Control-booth barrier.
- •Clear lead–acrylic secondary protective barrier.
- •Clear lead–acrylic overhead protective barrier.
- •Accessory protective devices.
- •Requirements for lead aprons and gloves.
- •Neck and thyroid shield.
- •Protective eyeglasses.
- •X-ray tube housing cables
- •Protection during fluoroscopic procedures
- •Personnel protection
- •Dose-reduction techniques
- •Remote-control fluoroscopic systems
- •Protective curtain
- •Bucky slot shielding device
- •Rotational scheduling of personnel
- •Protection during mobile X-ray examinations
- •Use of protective garments
- •Distance as a means of protection
- •Protection during C-arm fluoroscopy
- •Personnel exposure resulting from scattered radiation
- •Need for protective apparel for all personnel and monitoring of imaging personnel
- •Positioning of the C-arm fluoroscope
- •Exposure reduction for personnel
- •Protection during high-level control interventional procedures
- •Increased importance of radiation safety techniques
- •Knowledge of dose-reduction techniques required by the radiographer
- •How the radiologist or other interventional physician can reduce radiation exposure
- •Extremity monitoring
- •Diagnostic X-ray suite protection design
- •Requirement for radiation-absorbent barriers
- •Reason for overshielding
- •Radiation shielding categories
- •Primary radiation.
- •Scatter radiation.
- •Leakage radiation.
- •Calculation considerations
- •Workload.
- •Inverse square law.
- •Use factor.
- •Occupancy factor.
- •Controlled and uncontrolled areas.
- •Calculating barrier shielding requirements
- •Primary barrier calculation.
- •Secondary barrier calculation.
- •Scatter radiation.
- •Leakage radiation.
- •Current approaches to shielding
- •Radiation caution signs
- •Beam-on indicator sign
- •General posting
- •Summary
- •General discussion questions
- •Review questions
- •16 Radioisotopes and radiation protection
- •Objectives
- •Key terms
- •Medical usage
- •Radiation therapy
- •Iodine-125.
- •Iodine-131.
- •Proper handling and disposal of radioactive materials
- •Nuclear medicine
- •Iodine-123.
- •Technetium-99m.
- •Positron emission tomography and computed tomography
- •Imaging.
- •Fluorine-18.
- •Radiation protection and the PET-CT scanner
- •Radioimmunotherapy (RIT)
- •The immune system
- •Monoclonal antibodies
- •Agents of RIT and their destructive capabilities
- •How RIT is performed
- •Radiation safety considerations
- •Imaging for RIT proper treatment delivery
- •Summary of RIT
- •Radiation emergencies: Use of radiation as a terrorist weapon
- •Contamination
- •Cleanup of a contaminated Urban Area
- •Medical management of persons experiencing radiation bioeffects
- •Summary
- •General discussion questions
- •Review questions
- •Image gently pledge
- •Image wisely pledge
- •Pledge for imaging professionals
- •Electron volt common energy designations
- •Common frequency spectrum designations
- •§ 35.50 training for radiation safety officer and associate radiation safety officer
- •Subtitle I—consumer-patient radiation health and safety act of 1981
- •Short title
- •Statement of findings
- •Statement of purpose
- •Promulgation of standards
- •Model statute
- •Compliance
- •Federal radiation guidelines
- •Applicability to federal agencies
- •References
- •Chapter 1
- •Chapter 2
- •Chapter 3
- •Chapter 4
- •Chapter 5
- •Chapter 6
- •Chapter 7
- •Chapter 8
- •Chapter 9
- •Chapter 10
- •Chapter 11
- •Chapter 12
- •Chapter 13
- •Chapter 14
- •Chapter 15
- •Chapter 16
- •GLOSSARY
- •Index

A P P E N D I X
Standard Designations for Metric System
Lengths, Electron Volt Energy Levels, and
Frequency Spectrum Ranges
Metric System Equivalents for Length*
Length Symbol Power of 10 Fractional Form Power of 10 Decimal Form
Yottameter Ym 1,000,000,000,000,000,000,000,000 1,000,000,000,000,000,000,000,000 10
Zettameter Zm 1,000,000,000,000,000,000,000 1,000,000,000,000,000,000,000 10
Exameter Em 1,000,000,000,000,000,000 1,000,000,000,000,000,000 10
Petameter Pm 1,000,000,000,000,000 1,000,000,000,000,000 10
Terameter Tm 1,000,000,000,000 1,000,000,000,000 10
Gigameter Gm 1,000,000,000 1,000,000,000 10
Megameter Mm 1,000,000 1,000,000 10
Kilometer km 1000 1000 10
Hectometer hm 100 100 10
Dekameter dam 10 10 10
Meter m 1 1 10
Decimeter dm 1/10 0.1 10
Centimeter cm 1/100 0.01 10
Millimeter mm 1/1000 0.001 10
Micrometer µm 1/1,000,000 0.00001 10
Nanometer nm 1/1,000,000,000 0.000000001 10
Picometer pm 1/1,000,000,000,000 0.000000000001 10
Femtometer fm
Attometer am 1/1,000,000,000,000,000,000 0.000000000000000001 10
Zeptometer zm 1/1,000,000,000,000,000,000,000 0.000000000000000000001 10
Yoctometer ym 1/1,000,000,000,000,000,000,000,000 0.000000000000000000000001 10
*Bold print indicates those metric system equivalents for length that are most frequently used.
1/1,000,000,000,000,000 0.000000000000001 10
C
Scientific
Notation
24
21
18
15
12
9
(m)
6
(m)
3
(m)
2
(m)
1
(m)
0
(m)
21
22
23
26
29
212
215
218
221
224
(m)
(m)
(m)
(m)
(m)
(m)
(m)
(m)
(m)
(m)
(m)
(m)
(m)
(m)
(m)
Electron Volt Common Energy Designations
The abbreviation eV stands for electron volt; 1 eV is defined as the energy acquired by an electron when it is
moved through a 1-V potential difference by a battery
or some other mechanism.
The following terms designate various powers of 10
multiples of 1 eV:
1 KeV 5 1000 eV 5 10
3
eV
1 MeV 5 1,000,000 eV 5 106 eV
1 GeV 5 1,000,000,000 eV 5 109 eV
347

348
APPENDIX C Standard Designations
The following terms designate various powers of 10
fractions of 1 eV:
1 meV 5 0.001 eV 5 1023 eV
1 µeV 5 0.000001 eV 5 1026 eV
1 neV 5 0.000000001 eV 5 1029 eV
Common Frequency Spectrum Designations
The abbreviation Hz stands for hertz, which is the standard unit for frequency; 1 Hz is, by definition, equal to
one repeatable cycle of a phenomenon or event (e.g., a
water wave rising from flat to crest, descending to
trough, and returning to flat) occurring in 1 second. Ten
hertz corresponds to 10 such cycles occurring every
second, whereas 0.1 Hz corresponds to only 1/10th of a
cycle occurring each second.
The following terms designate frequency ranges that
constitute various powers of 10 multiples of 1 Hz:
1 KHz 5 103 Hz
1 MHz 5 106 Hz
1 GHz 5 109 Hz
1 THz 5 1012 Hz
1 PHz 5 1015 Hz
1 EHz 5 1018 Hz

A P P E N D I X
Periodic Table of Elements
D
349

350
APPENDIX D Periodic Table of Elements
2
slatemnoNslateM
Other nonmetals
Noble gases
Halogens
Metalloids
10
He
4.003
9
8
7
6
5
18
36
Ar
Ne
20.18
39.95
F
17
Cl
19.00
35.45
S
O
16
16.00
32.07
P
N
15
14.01
30.97
C
14
Si
12.01
28.09
B
13
Al
10.81
26.98
54
Kr
83.79
35
53
Br
79.90
34
52
Se
78.97
33
51
As
74.92
32
50
Ge
72.64
31
49
Ga
69.72
30
48
Zn
65.39
29
47
Cu
63.55
28
46
Ni
58.69
27
45
Co
58.93
Xe
I
Te
Sb
Sn
In
Cd
Ag
Pd
Rh
86
118
Rn
Og
(222)
131.3
85
At
Ts
117
(210)
126.9
84
127.6
83
121.8
82
118.7
81
114.8
80
112.4
79
107.9
78
106.4
77
102.9
Po
Bi
Pb
Tl
Hg
Au
Pt
Ir
Lv
116
(209)
115
Mc
209.0
Fl
114
207.2
113
Nh
204.4
112
Cn
200.5
111
Rg
197.0
110
Ds
195.1
Mt
109
192.2
71
(294)
70
(293)
69
(293)
68
(289)
67
(289)
66
(286)
65
(285)
64
(281)
63
(281)
62
(278)
Lu
Yb
Tm
Er
Ho
Dy
Tb
Gd
Eu
Sm
Lr
103
175.0
173.0
168.9
167.3
164.9
162.5
158.9
157.2
152.0
150.4
(262)
102
No
(259)
101
Md
(258)
100
Fm
(257)
99
Es
(252)
98
Cf
(251)
97
Bk
(247)
96
Cm
(247)
95
Am
(243)
94
Pu
(244)
61
26
44
Fe
55.85
25
43
Mn
54.94
24
42
Cr
52.00
Alkali metals
Atomic number
Atomic weight
Chemical symbol
Posttransition metals
Alkaline earth metals
Transition metals
4
12
Be
9.012
V
23
41
50.94
22
40
Ti
47.88
21
39
Sc
44.96
20
38
Ca
Mg
24.31
40.08
Ru
Tc
Mo
Nb
Zr
Y
Sr
76
108
Hs
Os
101.1
75
Re
(97)
74
W
95.95
73
Ta
92.91
72
Hf
91.22
88.91
56
Ba
87.62
(270)
190.2
107
Bh
(270)
186.2
106
Sg
(269)
183.9
105
Db
(270)
180.9
Rf
104
(267)
178.5
88
Ra
(226)
137.3
93
Np
Pm
(145)
60
Nd
144.2
59
Pr
140.9
58
Ce
140.1
57
La
138.9
(237)
U
92
238
91
Pa
231
90
Th
232.0
89
Ac
(227)
Actinides
Lanthanides
Z
M
X
1
3
H
1.008
11
Li
6.941
K
19
Na
22.99
37
39.10
55
87
Fr
Rb
Cs
85.47
(223)
132.9
From Murray RL, Holbert KE: Nuclear energy: an introduction to the concepts, systems, and applications of nuclear processes, ed 8, Philadelphia, 2020, Elsevier.

A P P E N D I X
E
Relationship Among Photons,
Electromagnetic Waves, Wavelength,
and Energy
Before 1900, all attempts to use current theories and
concepts in physics to explain the measured energy
distribution of radiation from a heated body failed
grievously. In that year, a German physicist, Max Planck,
introduced the concept of a “quantum,” or discrete unit
of energy, to resolve these discrepancies. According to
Planck’s theory, whenever radiation is emitted or
absorbed by a hot object, the energy of that radiation is
not emitted or absorbed continuously but rather in
discrete amounts, which he called quanta.
Mathematically, a single such amount or energy
quantum is given by the following equation:
E hf
where f is the frequency of the radiation and h is a proportionality constant called, appropriately, Planck’s con-
stant. This quantum of energy has since received the
name photon. Thus the energy of a photon varies directly
as the frequency of the associated radiation. Because the
frequency f and the wavelength w of any type of radiation are related by the simple expression
c fw
where c is the speed of light (300,000,000 m/sec in a
vacuum), then
E hf hc/w
This result shows that the energy of a photon
decreases as the wavelength of the radiation increases
(e.g., photons of infrared light are less energetic than
those of ultraviolet light because infrared wavelengths
are longer than ultraviolet wavelengths). Einstein used
these ideas to successfully explain the emission of electrons from a metallic surface when visible light radiation
was directed at it. This process is called the photoelectric
effect. The incident light-produced electrons, or photoelectrons, were found to have energies that depended on
the wavelength of the focused light but were completely
independent of the intensity or brightness of that light.
This phenomenon could not be explained by traditional
physics. However, it was fully explicable in terms of the
new concept of radiation energy (quanta or photons)
and the energy relation given in the last equation. That
relation contains no reference to the brightness of the light
and, instead, shows that the incident light’s energy,
and consequently its ability to eject electrons from the
metallic surface, is mainly dependent upon the light’s
wavelength. For his work in this area, Einstein received
the Nobel Prize in Physics in 1921.
To summarize, photons are the particles associated
with the electromagnetic (EM) radiation spectrum
(within which visible light and x-rays are included).
When energy is transferred from an EM wave through
interaction with matter, the energy is transferred by
photons in discrete, or integral, amounts. Each such
discrete amount is directly proportional to the frequency of the EM radiation or inversely proportional to
its wavelength.
351

F
A P P E N D I X
Electron Shell Structure of the Atom
Other than the hydrogen atom, all atoms contain more
than one electron. The purpose of this appendix is to describe, without delving too extensively into the details of
modern physics, specifically quantum mechanics, how
electrons are arranged—that is, ordered—in multielectron
atoms. To accomplish this, two discovered principles that
serve as the foundations for this discussion must be introduced. These are, simply, that electrons in undisturbed or
stable atoms are always distributed in the lowest overall
energy configuration or energy states and that no two electrons can ever occupy the exact same energy level (in more
precise terminology, no two electrons in an atom can exist
in the exact same quantum state). The latter restriction was
postulated from careful analysis of observed atomic spectral lines by the German physicist Wolfgang Pauli in 1925
and has since been known as the Pauli Exclusion Principle.
Early in the 20th century it was discovered that the
distribution of electrons within an atom relative to the
nucleus is not continuous or equally spaced but rather is
specifically “discrete.” This means that atomic electrons
do not locate in a uniform way about the nucleus as
marbles in a bowl or stack up one right after the other
according to distance from the nucleus. Rather it was
determined that their “most probable” allowable locations are in certain concentric “shells” of limited capacity
that radially fan out from the nucleus. The existence of
these electron shells was first determined experimentally
from x-ray absorption studies—that is, missing spectral
lines (absent wavelengths or frequencies) that are observed as black segments in an atom’s energy spectrum
after a beam of x-rays is passed through samples of that
atom or element. And this has been found to be true for
all elements. These missing wavelengths (w) or frequencies (f) are directly related to the energies of x-ray photons (E 5 hf 5 hc/w) that have been absorbed by the
atoms within the target samples. Through examination
of such spectra in detail, it became possible to map out
the actual pattern of electron energy levels within various atoms. This led to a direct correlation between the
Bohr solar system model of the atom, in which groups of
electrons were believed to orbit the nucleus at certain
distances, and the concept of electron shells that were
formed by these orbiting electron groups. Each electron
shell was associated with a particular orbital radius at
which some electrons were most likely to be found. The
smaller the radius, the more tightly were these electrons
held in their orbits about the nucleus, or in terms of
energy, the greater was their binding energy and, consequently, the effort needed to free them from the attraction of the nucleus. For electron groups or electron shells
farther away from the nucleus, the binding energies progressively decreased with distance until one reached the
outermost shell, in which electrons needed only a few
electron volts of additional energy to escape the atom.
These electrons are therefore the predominant category
of atomic electrons removed by ionizing radiation and
also, quite importantly, the electrons most often involved
in chemical reactions. For this reason they are given the
special name “valence” electrons.
The electron shells were labeled in order of increasing
distance from the nucleus with capital letters, beginning
with the letter K, designating the innermost electron
shell, and progressing through L, M, N, O, P, and Q.
Again, from exhaustive spectral analysis, it was found that
each electron shell except for the K shell was composed of
multiple subshells labeled with lowercase letters s, p, d, f,
g, h, and i, and these subshells were limited in the maximum number of electrons they could contain (s, 2; p, 6;
d, 10; f, 14; g, 18; h, 22; i, 26). The theoretical rules that
govern this are beyond the scope of this appendix. The
following table demonstrates the electron shell occupancies for a number of atoms.
352

APPENDIX F Electron Shell Structure of the Atom
Atom Atomic Number Electron Shells Electron Subshells and Electron Occupancy
Hydrogen 1 K s 1
Helium 2 K s 2
Lithium 3 K s 2
L s 1
Carbon 6 K s 2
L s 2
p 2
Oxygen 8 K s 2
L s 2
p 4
Sodium 11 K s 2
L s 2
p 6
M s 1
Argon 18 K s 2
L s 2
p 6
M s 2
p 6
Calcium* 20 K s 2
L s 2
p 6
M s 2
p 6
N s 2
Krypton 36 K s 2
L s 2
p 6
M s 2
p 6
d 10
N s 2
p 6
*Because the electrons in an unexcited atom will always be arranged in the lowest overall energy configuration, there will be situations in which small subshells of higher shells will begin filling up before large subshells of lower shells are completely filled.
353

G
′
A P P E N D I X
Compton Interaction
The principle of conservation of mass–energy is that for
an isolated system (i.e., a system on which no external
energy source or energy drain is active), the total mass
plus energy of all the particles comprising the system
remains constant. This restraint, however, does not prevent mass–energy transfers between individual particles
within the system.
The linear momentum of a particle is defined as the
product of its mass and its velocity. A photon, which is
the particle associated with electromagnetic radiation,
moves at the speed of light; consequently, according to
Einstein’s theory of relativity, a photon must be a massless entity. Because of the equivalence between mass, m,
and energy, E, given by the famous relation
2
5E mc
where c is the speed of light in a vacuum, one can associate with the photon a mass equivalent given by
2
E/c
Then the photon can be considered to have a linear
momentum given by the product of the “mass equivalent” and the velocity of the photon.* The principle
of conservation of linear momentum states that, for
an isolated system, the sum of the linear momenta
of all its particles is constant. Exchanges of linear
*Linear momentum 5 mass times velocity
Photon mass equivalent 5 E/c
Magnitude of photon velocity 5 speed of light, c
Photon linear momentum, p, therefore, is given by:
p 5 (E/c
Since E 5 hc/w (see Appendix E), then we can also write that:
p 5 E/c 5 (hc/w)/c 5 h/w
2
2
) (c) 5 E/c
momentum between particles within the system can,
of course, occur.
The Compton interaction is, most simply, a billiard
ball–like collision between an incident x-ray photon and
the weakly bound outer electron of a target atom. Application of the principles of conservation of mass–energy and
the conservation of linear momentum to the x-ray photon
and outer electron system leads to equations that can be
used to predict the energies and angles of scattering
of both particles after their collision. If the energy of the
incident photon is E, the following energy balance relation
can be written:
E E K
where E9 is the photon’s energy after the collision and K
is the recoil kinetic energy of the “struck” electron.
Several important types of Compton interactions
will now be described. These effects depend on the magnitude of the photon’s incident energy, E, and the angle
at which the photon interacts with the electron.
Case 1: The photon makes a head-on collision with the
electron.
Result: The ejected electron travels or scatters directly
forward, and the photon travels or scatters backward
(180-degree scatter angle).
Energy Situations:
a. E 511 keV (low energy range):
E9 is approximately equal to E
K is almost zero
b. E 5 511 keV:
E9 5 E/3
K 5 (2/3) E
c. E 511 keV (high energy range):
E9 is approximately zero
K 5 E to good approximation
354

APPENDIX G Compton Interaction
355
Case 2: The photon grazes the electron.
Result: The photon emerges from the collision nearly
undeflected from its initial direction, and the struck
outer electron scatters at right angles.
Energy situation result:
E9 is approximately equal to E.
K is approximately zero.
Collisions of this nature, in which the incident photon
loses little or no energy, are especially important in the
planning of radiation shielding for therapeutic x-ray
suites.

H
A P P E N D I X
NCRP 10CFR Part 35.50 Training for Radiation
Safety Officer and Associate Radiation
Safety Officer
§ 35.50 TRAINING FOR RADIATION SAFETY OFFICER AND ASSOCIATE RADIATION SAFETY OFFICER
Except as provided in § 35.57, the licensee shall require
an individual fulfilling the responsibilities of the Radiation Safety Officer or an individual assigned duties and
tasks as an Associate Radiation Safety Officer as provided in § 35.24 to be an individual who—
(a) Is certified by a specialty board whose certification
process has been recognized by the Commission or
an Agreement State and who meets the requirements
in paragraph (d) of this section. The names of board
certifications that have been recognized by the Commission or an Agreement State are posted on the
NRC’s Medical Uses Licensee Toolkit web page. To
have its certification process recognized, a specialty
board shall require all candidates for certification to:
(1) (i) Hold a bachelor’s or graduate degree from
an accredited college or university in physical science or engineering or biological science with a minimum of 20 college credits
in physical science;
(ii) Have 5 or more years of professional experi-
ence in health physics (graduate training
may be substituted for no more than 2 years
of the required experience) including at least
3 years in applied health physics; and
(iii) Pass an examination administered by diplo-
mates of the specialty board, which evaluates
knowledge and competence in radiation physics and instrumentation, radiation protection,
mathematics pertaining to the use and measurement of radioactivity, radiation biology,
and radiation dosimetry; or
(2) (i) Hold a master’s or doctor’s degree in phys-
ics, medical physics, other physical science,
engineering, or applied mathematics from
an accredited college or university;
(ii) Have 2 years of full-time practical training
and/or supervised experience in medical
physics—
(A) Under the supervision of a medical
physicist who is certified in medical
physics by a specialty board recognized by the Commission or an
Agreement State; or
(B) In clinical nuclear medicine facilities
providing diagnostic or therapeutic
services under the direction of physicians who meet the requirements for
authorized users in §§ 35.57, 35.290,
or 35.390; and
(iii) Pass an examination, administered by dip-
lomates of the specialty board, that assesses
knowledge and competence in clinical diagnostic radiological or nuclear medicine
physics and in radiation safety; or
(b) (1) Has completed a structured educational pro-
gram consisting of both:
(i) 200 hours of classroom and laboratory
training in the following areas—
(A) Radiation physics and instrumentation;
(B) Radiation protection;
356
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