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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

APPENDIX H NCRP 10CFR Part 35.50 Training for Radiation Safety Officer
357
(C) Mathematics pertaining to the use
and measurement of radioactivity;
(D) Radiation biology; and
(E) Radiation dosimetry; and
(ii) One year of full-time radiation safety expe-
rience under the supervision of the individual identified as the Radiation Safety
Officer on a Commission or an Agreement
State license or permit issued by a Commission master material licensee that authorizes similar type(s) of use(s) of byproduct
material. An Associate Radiation Safety Officer may provide supervision for those areas for which the Associate Radiation Safety
Officer is authorized on a Commission or
an Agreement State license or permit issued
by a Commission master material licensee.
The full-time radiation safety experience
must involve the following—
(A) Shipping, receiving, and performing
related radiation surveys;
(B) Using and performing checks for
proper operation of instruments
used to determine the activity of dos-
ages, survey meters, and instruments
used to measure radionuclides;
(C) Securing and controlling byproduct
material;
(D) Using administrative controls to
avoid mistakes in the administration
of byproduct material;
(E) Using procedures to prevent or mini-
mize radioactive contamination and
using proper decontamination pro-
cedures;
(F) Using emergency procedures to con-
trol byproduct material; and
(G) Disposing of byproduct material; and
(2) This individual must obtain a written attestation,
signed by a preceptor Radiation Safety Officer or
Associate Radiation Safety Officer who has experience with the radiation safety aspects of similar
types of use of byproduct material for which the
individual is seeking approval as a Radiation
Safety Officer or an Associate Radiation Safety
Officer. The written attestation must state that
the individual has satisfactorily completed the
requirements in paragraphs (b)(1) and (d) of
this section, and is able to independently fulfill
the radiation safety-related duties as a Radiation
Safety Officer or as an Associate Radiation Safety
Officer for a medical use license; or
(c) (1) Is a medical physicist who has been certified by
a specialty board whose certification process
has been recognized by the Commission or an
Agreement State under § 35.51(a), has experience with the radiation safety aspects of similar
types of use of byproduct material for which
the licensee seeks the approval of the individual as Radiation Safety Officer or an Associate
Radiation Safety Officer, and meets the requirements in paragraph (d) of this section; or
(2) Is an authorized user, authorized medical physi-
cist, or authorized nuclear pharmacist identified
on a Commission or an Agreement State license,
a permit issued by a Commission master material licensee, a permit issued by a Commission
or an Agreement State licensee of broad scope,
or a permit issued by a Commission master
material license broad scope permittee, has experience with the radiation safety aspects of
similar types of use of byproduct material for
which the licensee seeks the approval of the
individual as the Radiation Safety Officer or
Associate Radiation Safety Officer, and meets the
requirements in paragraph (d) of this section; or
(3) Has experience with the radiation safety aspects
of the types of use of byproduct material for
which the individual is seeking simultaneous
approval both as the Radiation Safety Officer
and the authorized user on the same new medical use license or new medical use permit issued by a Commission master material license.
The individual must also meet the requirements in paragraph (d) of this section.
(d) Has training in the radiation safety, regulatory issues,
and emergency procedures for the types of use for
which a licensee seeks approval. This training requirement may be satisfied by completing training that is
supervised by a Radiation Safety Officer, an Associate
Radiation Safety Officer, authorized medical physicist, authorized nuclear pharmacist, or authorized
user, as appropriate, who is authorized for the type(s)
of use for which the licensee is seeking approval.
From the United States Nuclear Regulatory Commission, Washington, D.C. Available at https://www.nrc.gov/
reading-rm/doc-collections/cfr/part035/part035-0050.
html

I
A P P E N D I X
Consumer-Patient Radiation Health and Safety
Act of 1981*
SUBTITLE I—CONSUMER-PATIENT RADIATION HEALTH AND SAFETY ACT OF 1981
Short Title
[42 USC 10001.] note
SEC. 975. This subtitle may be cited as the “consumerpatient radiation health and safety act of 1981.”
Statement of Findings
[42 USC 10001.]
SEC. 976. The congress finds that . . .
(1) it is in the interest of public health and safety to
minimize unnecessary exposure to potentially hazardous radiation due to medical and dental radiologic
procedures;
(2) it is in the interest of public health and safety to
have a continuing supply of adequately educated
persons and appropriate accreditation and certification programs administered by state governments;
(3) the protection of the public health and safety from
unnecessary exposure to potentially hazardous radiation due to medical and dental radiologic procedures and the assurance of efficacious procedures are
the responsibility of state and federal governments;
(4) persons who administer radiologic procedures, in-
cluding procedures at federal facilities, should be
required to demonstrate competence by reason of
education, training, and experience; and
*Modified from Consumer-Patient Radiation Health and
Safety Act of 1981, Chapter 107, Secs. 10001-8 (Aug. 13, 1981).
(5) the administration of radiologic procedures and the
effect on individuals of such procedures have a substantial and direct effect upon United States interstate commerce.
Statement of Purpose
[42 USC 10002.]
SEC. 977. It is the purpose of this subtitle to—
(1) provide for the establishment of minimum standards
by the federal government for the accreditation of
education programs for persons who administer radiologic procedures and for the certification of such
persons; and
(2) ensure that medical and dental radiologic proce-
dures are consistent with rigorous safety precautions
and standards.
Definitions
[42 USC 10003.]
SEC. 978. Unless otherwise expressly provided, for purposes of this subtitle, the term—
(1) “radiation” means ionizing and nonionizing radia-
tion in amounts beyond normal background levels
from sources such as medical and dental radiologic
procedures;
(2) “radiologic procedure” means any procedure or article
intended for use in—
(A) the diagnosis of disease or other medical or den-
tal conditions in humans (including diagnostic
x-rays or nuclear medicine procedures); or
(B) the cure, mitigation, treatment, or prevention of
disease in humans that achieves its intended
purpose through the emission of radiation;
358

APPENDIX I Consumer-Patient Radiation Health and Safety Act of 1981
359
(3) “radiologic equipment” means any radiation elec-
tronic product that emits or detects radiation and is
used or intended for use to—
(A) diagnose disease or other medical or dental con-
ditions (including diagnostic x-ray equipment);
or
(B) cure, mitigate, treat, or prevent disease in hu-
mans that achieves its intended purpose through
the emission or detection of radiation;
(4) “practitioner” means any licensed doctor of medi-
cine, osteopathy, dentistry, podiatry, or chiropractic who prescribes radiologic procedures for other
persons;
(5) “persons who administer radiologic procedures”
means any person, other than a practitioner, who
intentionally administers radiation to other persons
for medical purposes and includes medical radiologic technologists (including dental hygienists and
assistants), radiation therapy technologists, and
nuclear medicine technologists;
(6) “Secretary” means the Secretary of Health and Human
Services; and
(7) “State” means the several states, the District of
Columbia, the Commonwealth of Puerto Rico, the
Commonwealth of the Northern Mariana Islands,
the Virgin Islands, Guam, American Samoa, and the
Trust Territory of the Pacific Islands.
the Secretary determines appropriate. Such standards shall not be applicable to educational pro-
grams for practitioners.
[Regulation.]
(b) Within 12 months after the date of enactment
of this act, the Secretary, in consultation with the
Radiation Policy Council, the Administrator of
Veterans’ Affairs, the Administrator of the Environ-
mental Protection Agency, interested agencies of the
States, and appropriate professional organizations,
shall by regulation promulgate minimum standards
for the certification of persons who administer ra-
diologic procedures. Such standards shall distinguish
between certification of (1) medical radiologic tech-
nologists (including radiographers), (2) dental auxil-
iaries (including dental hygienists and assistants), (3)
radiation therapy technologists, (4) nuclear medicine
technologists, and (5) such other kinds of health
auxiliaries who administer radiologic procedures as
the Secretary determines appropriate. Such stan-
dards shall include minimum certification criteria
for individuals with regard to accredited education,
practical experience, successful passage of required
examinations, and such other criteria as the Secretary
shall deem necessary for the adequate qualification
of individuals to administer radiologic procedures.
Such standards shall not apply to practitioners.
Promulgation of Standards
[Regulation. 42 USC 10004.]
SEC. 979.
(a) Within 12 months after the date of enactment of this
act, the Secretary, in consultation with the Radiation
Policy Council, the Administrator of Veterans’ Affairs, the Administrator of the Environmental Protection Agency, appropriate agencies of the States,
and appropriate professional organizations, shall by
regulation promulgate minimum standards for the
accreditation of educational programs to train individuals to perform radiologic procedures. Such standards shall distinguish between programs for the
education of (1) medical radiologic technologists
(including radiographers), (2) dental auxiliaries (including dental hygienists and assistants), (3) radiation therapy technologists, (4) nuclear medicine
technologists, and (5) such other kinds of health
auxiliaries who administer radiologic procedures as
Model Statute
[42 USC 10005.]
SEC. 980. In order to encourage the administration of
accreditation and certification programs by the states,
the Secretary shall prepare and transmit to the states a
model statute for radiologic procedure safety. Such
model statute shall provide that—
(1) it shall be unlawful in a state for individuals to perform
radiologic procedures unless such individuals are certi-
fied by the state to perform such procedures; and
(2) any educational requirements for certification of indi-
viduals to perform radiologic procedures shall be lim-
ited to educational programs accredited by the state.
Compliance
[42 USC 10006.]
SEC. 981.
(a) The Secretary shall take all actions consistent with
law to effectuate the purposes of this subtitle.

360
APPENDIX I Consumer-Patient Radiation Health and Safety Act of 1981
(b) A state may utilize an accreditation or certification
program administered by a private entity if—
(1) such state delegates the administration of the
state accreditation or certification program to
such private entity;
(2) such program is approved by the state; and
(3) such program is consistent with the minimum
federal standards promulgated under this sub-
title for such program.
(c) Absent compliance by the states with the provisions
of this subtitle within 3 years after the date of enactment of this act, the Secretary shall report to the
Congress recommendations for legislative changes
considered necessary to ensure the states’ compli-
ance with this subtitle.
[Report to Congress.]
(d) The Secretary shall be responsible for continued moni-
toring of compliance by the states with the applicable
provisions of this subtitle and shall report to the Senate
and the House of Representatives by January 1, 1982,
and January 1 of each succeeding year the status of the
states’ compliance with the purposes of this subtitle.
(e) Notwithstanding any other provision of this section,
in the case of a state that has, prior to the effective date
of standards and guidelines promulgated pursuant to
this subtitle, established standards for the accredita-
tion of educational programs and certification of ra-
diologic technologists, such state shall be deemed to
be in compliance with the conditions of this section
unless the Secretary determines, after notice and
hearing, that such state standards do not meet the
minimum standards prescribed by the Secretary or
are inconsistent with the purposes of this subtitle.
Federal Radiation Guidelines
[42 USC 10007.]
SEC. 982. The Secretary shall, in conjunction with the
Radiation Policy Council, the Administrator of Veterans’ Affairs, the Administrator of the Environmental
Protection Agency, appropriate agencies of the states,
and appropriate professional organizations, promulgate
Federal radiation guidelines with respect to radiologic
procedures. Such guidelines shall—
(1) determine the level of radiation exposure due to ra-
diologic procedures that is unnecessary and specify
the techniques, procedures, and methods to mini-
mize such unnecessary exposure;
(2) provide for the elimination of the need for retakes
of diagnostic radiologic procedures;
(3) provide for the elimination of unproductive screen-
ing programs;
(4) provide for the optimum diagnostic information
with minimum radiologic exposure; and
(5) include the therapeutic application of radiation to
individuals in the treatment of disease, including
nuclear medicine applications.
Applicability to Federal Agencies
[42 USC 10008.]
SEC. 983.
(a) Except as provided in subsection (b), each depart-
ment, agency, and instrumentality of the executive
branch of the federal government shall comply with
standards promulgated pursuant to this subtitle.
[Regulations.]
[38 USC 101 et seq.]
(b) (1) The Administrator of Veterans’ Affairs, through
the Chief Medical Director of the Veterans’ Adminis-
tration, shall, to the maximum extent feasible consis-
tent with the responsibilities of such Administrator and
Chief Medical Director under subtitle 38, United States
Code, prescribe regulations making the standards pro-
mulgated pursuant to this subtitle applicable to the
provision of radiologic procedures in facilities over
which the Administrator has jurisdiction. In prescribing
and implementing regulations pursuant to this subsec-
tion, the Administrator shall consult with the Secretary
in order to achieve the maximum possible coordination
of the regulations, standards, and guidelines, and the
implementation thereof, which the Secretary and the
Administrator prescribe under this subtitle.
[Report to congressional committees.]
(2) Not later than 180 days after standards are promul-
gated by the Secretary pursuant to this subtitle, the
Administrator of Veterans’ Affairs shall submit to
the appropriate committees of Congress a full re-
port with respect to the regulations (including
guidelines, policies, and procedures thereunder)
prescribed pursuant to paragraph (1) of this sub-
section. Such report shall include—
(A) an explanation of any inconsistency between
standards made applicable by such regulations
and the standards promulgated by the Secretary
pursuant to this subtitle;

APPENDIX I Consumer-Patient Radiation Health and Safety Act of 1981
361
(B) an account of the extent, substance, and results
of consultations with the Secretary respecting
the prescription and implementation of regulations by the Administrator; and
(C) such recommendations for legislation and ad-
ministrative action as the Administrator determines are necessary and desirable.
[Publication in Federal Register.]
(3) The Administrator of Veterans’ Affairs shall publish
the report required by paragraph (2) in the Federal
Register.

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