10 - Radiation Biological Effects

ORAL & MAXILLOFACIAL
RADIOLOGY
RADIATION BIOLOGICAL
EFFECTS
DR.MOHAMMED R. SHAMIAH
MSC. ORAL & MAXILLOFACIAL SURGERY

 Introduction.
 Mechanisms of Injury.
 Classifications of action of radiation on cells.
 Factors determining the degree of radiation
injury.
 The harmful effects in dental radiology.
 Basic principles of radiation genetics.
 Sources of Radiation Exposure.
Dr.Mohammed R. Shamiah 2
INTRO.
 All ionizing radiations are harmful and produce
biologic changes in living tissues.
 The damaging biologic effects of x-radiation were
first documented shortly after the discovery of x-
rays.
 Since that time, information about the harmful
effects of high-level exposure to x-radiation has
increased on the basis of studies of atomic bomb
survivors, workers exposed to radioactive materials,
and patients undergoing radiation therapy.
 Although the amount of x-radiation used in dental
radiography is small, biologic
Dr.Mohammed damage does occur.
R. Shamiah 3
MECHANISMS OF INJURY
In diagnostic radiography, not all x-rays pass

through the patient and reach the dental x-
ray film; some are absorbed by the patient’s
tissues.
Absorption, refers to the total transfer of

energy from the x-ray photon to patient
tissues.
 What happens when x-ray energy is absorbed by
patient tissues?
Chemical changes occur that result in biologic damage.
Two specific mechanisms of radiation injury are possible:
(1) ionization
(2) free radical formation.
RADIATION-INDUCED TISSUE
DAMAGE
 The action of radiation on cells and the

resultant damage are classified as:
I. Direct action or damage as a result of

ionization of macromolecules.
II. Indirect action or damage as a result of the

free radicals produced by the ionization of
water.
I. DIRECT ACTION OR DAMAGE
• The X-ray photons, or high-energy ejected electrons,

interact directly with and ionize vital biologic
macromolecules such as DNA, RNA, proteins and
enzymes.
• This ionization results in the breakage of the macromolecule’s

chemical bonds, causing them to become abnormal
structures, which may in turn lead to inappropriate chemical
reactions.
• Rupture of one of the chemical bonds in a DNA
macromolecule may sever one of the side chains
of the ladder-like structure.
• This type of injury to DNA is called a point mutation.
 The subsequent chromosomal effects from
direct damage could include:
• Inability to pass on information.

• Abnormal replication.
• Cell death.
• Only temporary damage.
(The DNA being repaired successfully before
further cell division).
 If the radiation directly affects somatic cells,
the effects on the DNA (and hence the
chromosomes) could result in a radiation-
induced malignancy.
 If the damage is to reproductive stem cells,

the result could be a radiation-induced
congenital abnormality.
 What actually happens in the cell depends on
several factors, including:
● The type and number of nucleic acid bonds that

are broken.
● The intensity and type of radiation.
● The time between exposures.
● The ability of the cell to repair the damage.
● The stage of the cell’s reproductive cycle when
irradiated.
II. INDIRECT ACTION OR DAMAGE
 This process, involves the ionization of the

water molecule producing both ions and
free radicals which can combine to damage
the vital biologic macromolecules such as
DNA.
 The free radicals can recombine to form
hydrogen peroxide, a cellular poison and a
hydroperoxyl radical, another toxic substance.
 Both of these substances are highly reactive

and produce biological damage.
 By themselves, free radicals may transfer excess energy
to other molecules, thereby breaking their chemical
bonds and having an even greater effect.
 As about 80% of the body consists of water, the mast

majority of the interactions with ionizing radiation are
indirect.
CLASSIFICATION OF THE BIOLOGICAL
EFFECTS
 Whatever the actual mechanism for the

DNA and cellular damage, the biological
effects of ionizing radiation are classified
into two main categories:
i. Tissue reactions (deterministic effects)

ii.Stochastic effects.
i. TISSUE REACTIONS
(DETERMINISTIC EFFECTS)
• These are the non-cancer damaging effects, to the body of
the person exposed, that will definitely result from a specific
high dose of radiation.
• The severity of the effect is proportional to the dose

received, and in most cases a threshold dose exists below
which there will be no effect.
• They were previously referred to as deterministic effects, but

are now referred to as tissue reactions by the International
Commission on Radiological Protection (ICRP) because it
now recognizes that some of these effects are not
determined solely at the time of irradiation but can be
modified after radiation exposure.
- They are further subdivided into:
1. Early tissue reactions – appearing shortly

after exposure, e,g. skin erythema or
mucositis
2. Late tissue reactions – appearing months

to years after exposure, e.g.
osteoradionecrosis.
ii. STOCHASTIC EFFECTS
• Stochastic effects are those that may develop.
• Their development is random and depends on the laws of
chance or probability.
• These damaging effects may be induced when the body is
exposed to any dose of radiation.
• Experimentally it has not been possible to establish a safe dose
– i.e. a dose below which stochastic effects do not develop.
• It is therefore assumed that there is no threshold dose, and that
every exposure to ionizing radiation carries with it the possibility
of inducing a stochastic effect.
• The lower the radiation dose, the lower the probability of cell
damage.
• However, the severity of the damage is not related to the size of
the inducing dose. Dr.Mohammed R. Shamiah 18
- This is the underlying philosophy behind present
radiation protection recommendations.
- Stochastic effects are further subdivided into:
● Cancer induction.
● Heritable effects (genetic effects).
FACTORS DETERMINING THE DEGREE
OF RADIATION INJURY
1. Total dose:
More damage occurs when tissues absorb large
quantities of radiation.
2. Dose rate:
More radiation damage takes place with high dose rates
because a rapid delivery of radiation does not allow time
for the cellular damage to be repaired.
3. Amount of tissue irradiated:
Total-body irradiation produces more adverse systemic effects
than if small or localized areas of the body are exposed(as
nuclear energy disaster), because of the damage to the blood-
forming tissues.
4. Cell sensitivity:
More damage occurs in cells that are most sensitive to
radiation, such as rapidly dividing cells and young cells.
5. Age:
Children are more susceptible to radiation damage
than are adults.
THE HARMFUL EFFECTS IN DENTAL
RADIOLOGY
In dentistry, the size of the doses used routinely are

relatively small and well below the threshold doses
required to produce tissue reactions (deterministic
effects).
However, the stochastic effects can develop with
any dose of ionizing radiation.
Dental radiology does not usually involve irradiating

the reproductive organs, thus in dentistry the
heritable effects are of limited importance and the
main concern is that of cancer induction.
SOURCES OF RADIATION EXPOSURE
 Humans are exposed daily to background radiation, a form of

ionizing radiation that is ubiquitous in the environment
(Naturally ).
1) Cosmic radiation originates from the stars and the sun.

A person’s exposure to cosmic radiation depends on altitude:
the higher the altitude, the greater is the exposure to cosmic
radiation.
2) Terrestrial radiation also occurs naturally and is emitted from

radioactive materials present in the earth and air.
Examples as potassium-40 and uranium.
For example, geographic areas that contain more radioactive
materials (e.g., Denver) Dr.Mohammed R. Shamiah 25
3) Modern technology has created artificial, or man-
made, sources of radiation.
Consumer products (e.g., luminous wristwatches,
televisions), fallout from atomic weapons, weapons
production and the nuclear fuel cycle are all sources
of radiation exposure.
4) Medical radiation, another source of radiation
exposure, is the greatest contributor to artificial
radiation exposure.
Medical radiation includes medical radiographic
procedures, dental radiography, fluoroscopy, nuclear
medicine, and radiation therapy.
Sources of radiation in the United States from medical
examinations and consumer products.
•Thank you

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ORAL & MAXILLOFACIAL

MSC. ORAL & MAXILLOFACIAL SURGERY

In diagnostic radiography, not all x-rays pass

Absorption, refers to the total transfer of

 The action of radiation on cells and the

I. Direct action or damage as a result of

II. Indirect action or damage as a result of the

• The X-ray photons, or high-energy ejected electrons,

• This ionization results in the breakage of the macromolecule’s

• This type of injury to DNA is called a point mutation.

• Inability to pass on information.

 If the damage is to reproductive stem cells,

● The type and number of nucleic acid bonds that

 This process, involves the ionization of the

 Both of these substances are highly reactive

 As about 80% of the body consists of water, the mast

 Whatever the actual mechanism for the

i. Tissue reactions (deterministic effects)

• The severity of the effect is proportional to the dose

• They were previously referred to as deterministic effects, but

1. Early tissue reactions – appearing shortly

2. Late tissue reactions – appearing months

- Stochastic effects are further subdivided into:

In dentistry, the size of the doses used routinely are

Dental radiology does not usually involve irradiating

 Humans are exposed daily to background radiation, a form of

1) Cosmic radiation originates from the stars and the sun.

2) Terrestrial radiation also occurs naturally and is emitted from

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