Radiology

Lec. 5 Biological effects of radiation Dr. Areej

Types of radiation

1. Non-Ionizing Radiation: Radiation that does not have sufficient energy to

dislodge orbital electrons. ex.: microwaves, ultraviolet light, lasers, radio
waves, infrared light, and radar.
2. Ionizing Radiation: Radiation that has sufficient energy to dislodge orbital
electrons. ex.: alpha particles, beta particles, neutrons, gamma rays, and x-
rays.

Fig. 1: types of radiation

All the atoms in human body has electrical stability when x- ray photon strikes a – ve
electron in the atom of living subjects (tissues) it displace the electron leaving the
atom electrically unbalance so the atom ionized such process called (ionization), this
ionized atom has a strong tendency to seek its stability by accepting a –ve electron
from somewhere else and by doing so a new chemical is form and the cell of which
the atoms and molecules are parts can be altered. So that the basic effects of
ionization are Molecular alteration and creation of new chemicals.

Radiation biology is the study of the effects of ionizing radiation on living

systems. The initial interaction between ionizing radiation and matter occurs at the
level of the electron within the first 10-13 second after exposure. These changes result
in modification of biologic molecules within seconds to hours. In turn, the molecular
changes may lead to alterations in cells and organisms that persist for hours, decades,
and possibly even generations. They may result in injury or death of the cell or
organism.

Effects of ionizing radiation

Radiation acts on living systems through direct and indirect effects

1. Direct effect: When the energy of a photon or secondary electron ionizes

biologic macromolecules, the effect is termed direct. Those effects occurred in
specific area of the body where all exposed cells in this area are altered directly by
ionization process and death occurred at the time of mitotic cell division.
2. Indirect effect: It happened in several ways where new chemicals result from
process of ionization are in compatible with body tissues ,ex: when photon absorbed
by water in an organism, ionizing the water molecules. The resulting ions form free
radicals (radiolysis of water) that in turn interact with and produce changes in the
biologic molecules. Because intermediate changes involving water molecules are
required, so conversion of water to H2O2 which cause cellular dysfunction also x-
radiation can alter the chemical composition of hormones enzymes and other body
secretions make them partially or totally in effective such indirect effects depend on
the amount of exposure to X- ray. This series of events is termed indirect.
What are the stochastic and deterministic effects of radiation ??
Fig. 2: ionizing radiation symbol

Radio sensitivity of tissues and organs

Body tissues differ in their susceptibility to ionizing radiation. Cells are most sensitive
to radiation when they are immature, undifferentiated, and rapidly dividing. As cells
mature and become specialized they are less sensitive to radiation. The following
tissue and organs are listed in order to their susceptibility to x-ray:

1.high radio sensitivity: lymphoid organs , Blood forming tissues (bone marrow),
intestines , stem cells, lymphocyte and reproductive cells
2.intermediate radio sensitivity: Young or growing bone, Growing cartilage,
glandular tissue , salivary glands , kidney, liver, lungs and epithelium of alimentary
canal.
3. low radio sensitivity: Skin , muscle and optic lens.
4. the least effect seen in nerve tissue and adult bone.

Short term effects of radiation on tissue seen in the first days or weeks after exposure
while long term effects seen months and years after exposure. The response of cells,
Tissues and organs to irradiation depends on exposure conditions and the cell
environment, this modifying factors include

1. Dose: The severity of deterministic damage seen in irradiated tissues or organs

depends on the amount of radiation received. All individuals receiving doses
above the threshold level show damage in proportion to the dose.
2. Dose Rate: The term dose rate indicates the rate of exposure. For example, a
total dose of 5 Gy may be given at a high dose rate (5 Gy/min) or a low dose
rate (5 mGy/min). Exposure of biologic systems to a given dose at a high dose
rate causes more damage than exposure to the same total dose given at a lower
dose rate.
 3. Oxygen : The radio-resistance of many biologic systems increases by a factor
of 2 or 3 when irradiation is conducted with reduced oxygen (hypoxia). The
greater cell damage sustained in the presence of oxygen is related to the
increased amounts of hydrogen peroxide and hydroperoxyl free radicals
formed (Both peroxyl radicals and hydrogen peroxide are oxidizing agents that
can significantly alter biologic molecules and cause cell destruction. They are
considered to be major toxins produced in the tissues by ionizing radiation).

 ALARA principle (The law of radiation protection) As Low As Reasonably

Achievable: Radiographs should only be taken at the minimum dosage with
reasonable information, so the benefit from radiograph should be weighed against
the radiation dose and then decide to take radiograph or not.

Latent period: Is a period of time interposed between exposure and clinical

symptoms such period varies with the dose. So the more is sever dose the shorter is
the latent period. sometimes the latent period is as long as 25 years for some
minimum doses.

Protection of patients from x-ray:

The dentist is responsible for all aspects of safe radiation exposure in the dental
office. This done by several ways:
1. Using faster (film speed) because the faster the film the less is the amount of
radiation required to produce a radiographic image so it need less exposure time.
2. Collimation: - this done by collimating device to prevent the un necessary beam
divergence, especially rectangular collimator.
3. Filtration:- in order to absorb the long wave length X-ray photons (soft radiation)
which have no diagnostic value.
4. Exposure and developing techniques: - in order to prevent exposure of patient to
much more radiation, we should know the exposure time for each segment of the
jaw. So for anterior teeth the exposure time is 0.36 seconds for premolars is 0.40
seconds while for molars is 0.50 seconds if higher Kv. technique is used, its
possible to use a constant exposure time for whole dentition.
 * exposure time required for child and old people may have be decreased as much
as 50% while exposure time required for dense and thick objects may have to be
doubled. Some time when we use excessive long exposure time we have to
decrease the developing time to get acceptable quality of radiographic image

5. Distance and kV:- the purpose of using cylinders and cones in the X-ray machine
is to [limit the path for X-ray] so X-ray beam hit only the examined area we have
2 cone length (8and 16 inches) the long cone mean increase tube film distance and
when use higher kV With this cone we reduce the radiation dose absorbed by skin
surface.
6. Film placement and angulations:- this is important to prevent retakes and get a
radiograph with best diagnostic information.
7. Lined cylinder: - sometime lining the open cylinder by sheet of lead foil with 0.2 –
0.3 mm thickness result in elimination of scattered radiation.
8. Protective apron and thyroid collar: - sheet of lead used to cover chest and
reproductive areas of the patient so must be used in pregnant and young adult also
thyroid collar used for protection of thyroid gland. (lead apron used by operator
also for protection).
9. Using intensifying screen in extraoral film to reduce radiation dose to patients.
10. Using digital radiography that provide Dose reduction of up to 90 per cent
compared to E-speed film .

Protection of operator:
Operator received secondary radiation and generally workers in X-ray clinic should
not receive more than 5 rem of whole body radiation each year.
Operator received 3 types of radiation
1. Scattered radiation from the patient.
2. Primary beam if he stands in its path.
3. Leakage radiation from the tube head.
To minimize the exposure of operator:

1. Position: operator must stand behind the patient because the head of the patient
will absorb scattered radiation operator must stand with an angle of 90 - 135˚ to
the radiation beam because in this area we have less scattered radiation.
2. Barrier: it interpose between the source of radiation and the operator it is the most
effective method of providing safety to the operator and barrier is made of lead or
steel or concert or barium plaster of 1/16 inch.
3. Distance: the intensity of radiation inversely proportional to the distance (inverse
square law) so it's recommended for him to stand 6 feet away from the source of
X-ray radiation.

Fig 3: * position and distance rule: if no barrier is available, the operator should
stand at least 6 feet from the patient, at an angle of 90 to 135 degrees to the
central ray of the x-ray beam when the exposure is made.

Film badges

Is a blue plastic frame containing a variety of metal filters and a small radiographic
film which exposed to X-ray. it provide a permanent record of the dose received by
operators (radiographers and dentists) and it used for 1 – 3 months before being
processed for monitoring of dose received by operator.

Fig 4: film badge