X-RAY PRODUCTION

X-rays are generated via interactions of the accelerated electrons with electrons of tungsten
nuclei within the tube anode. There are two types of X-ray generated: characteristic radiation and
bremsstrahlung radiation.

Historical Introduction
X-rays were discovered during the summer of 1895 by Wilhelm Röntgen at the University of
Würtzburg (Germany). Röntgen was interested in the cathode rays (beams of electrons)
developed in discharge tubes, but it is not clear exactly which aspects of cathode rays he
intended to study. By chance he noticed that a fluorescent screen (ZnS + Mn++) lying on a table
some distance from the discharge tube emitted a flash of light each time an electrical discharge
was passed through the tube. Realizing that he had come upon something completely new, he
devoted his energies to investigating the properties of the unknown ray “X” which produced this
effect. The announcement of this discovery appeared in December 1895 as a concise ten page
publication. The announcement of the discovery of X-rays was received with great interest by
the public. Röntgen himself prepared the first photographs of the bones in a living hand, and use
of the radiation was quickly adopted in medicine. In the succeeding fifteen years, however, very
few fundamental insights were gained into the nature of X-radiation.
Production of X-rays

A schematic x-ray tube is shown below. The glass tube is evacuated to a pressure of air, of about
100 pascals, recall that atmospheric pressure is 106 pascals. The anode is a thick metallic target;
it is so made in order to quickly dissipate thermal energy that results from bombardment with the
cathode rays. A high voltage, between 30 to 150 kV, is applied between the electrodes; this
induces an ionization of the residual air, and thus a beam of electrons from the cathode to the
anode ensues. When these electrons hit the target, they are slowed down, producing the X-rays.
The X-ray photon-generating effect is generally called the Bremsstrahlung effect, a contraction
of the German “brems” for braking, and “strahlung” for radiation. The radiation energy from an
X-ray tube consists of discrete energies constituting a line spectrum and a continuous spectrum
providing the background to the line spectrum.

Properties of X-rays
 X-rays travel in straight lines.
 X-rays cannot be deflected by electric field or magnetic field.
 X-rays have a high penetrating power.
 Photographic film is blackened by X-rays.
 Fluorescent materials glow when X-rays are directed at them. Photoelectric emission can
be produced by X-rays.
 Ionization of a gas results when an X-ray beam is passed through it.
 1. A current is passed through the tungsten filament and heats it up.
2. As it is heated up the increased energy enables electrons to be released from the filament
through thermionic emission.
3. The electrons are attracted towards the positively charged anode and hit the tungsten
target with a maximum energy determined by the tube potential (voltage).
4. As the electrons bombard the target they interact via Bremsstrahlung and characteristic
interactions which result in the conversion of energy into heat (99%) and x-ray photons
(1%).
5. The x-ray photons are released in a beam with a range of energies (x-ray spectrum) out of
the window of the tube and form the basis for x-ray image formation. X-ray beam is
directed towards the patient

Key points

 X-rays are produced by interaction of accelerated electrons with tungsten nuclei within
the tube anode
 Two types of radiation are generated: characteristic radiation and bremsstrahlung
(braking) radiation
 Changing the X-ray machine current or voltage settings alters the properties of the X-ray
beam
Cathode

Filament

 Made of thin (0.2 mm) tungsten wire because tungsten:

o has a high atomic number (A 184, Z 74)
o is a good thermionic emitter (good at emitting electrons)
o can be manufactured into a thin wire
o has a very high melting temperature (3422°c)
 The size of the filament relates to the size of the focal spot. Some cathodes have two
filaments for broad and fine focusing

Focusing cup

 Made of molybdenum as:

o high melting point
o poor thermionic emitter so electrons aren't released to interfere with electron
beam from filament
 Negatively charged to focus the electrons towards the anode and stop spatial spreading

Anode

 Target made of tungsten for same reasons as for filament

 Rhenium added to tungsten to prevent cracking of anode at high temperatures and usage
 Set into an anode disk of molybdenum with stem
 Positively charged to attract electrons
 Set at angle to direct x-ray photon beam down towards patient. Usual angle is 5º - 15º

Definitions

 Target, focus, focal point, focal spot: where electrons hit the anode
 Actual focal spot: physical area of the focal track that is impacted
 Focal track: portion of the anode the electrons bombard. On a rotating anode this is a
circular path
 Effective focal spot: the area of the focal spot that is projected out of a tube

 
 

Stationary anode: these are generally limited to dental radiology and radiotherapy systems.
Consists of an anode fixed in position with the electron beam constantly streaming onto one
small area.

Rotating anode: used in most radiography, including mobile sets and fluoroscopy. Consists of a
disc with a thin bevelled rim of tungsten around the circumference that rotates at 50 Hz. Because
it rotates it overcomes heating by having different areas exposed to the electron stream over time.
It consists of:

 Molybdenum disk with thin tungsten target around the circumference

 Molybdenum stem, which is a poor conductor of heat to prevent heat transmission to the
metal bearings
 Silver lubricated bearings between the stem and rotor that have no effect on heat transfer
but allow very fast rotation at low resistances
 Blackened rotor to ease heat transfer

Heating of the anode

This is the major limitation of x-ray production.

Heat (J) = kVe x mAs

or
Heat (J) = w x kVp x mAs

key:

kVe = effective kV
w = waveform of the voltage through the x-ray tube. The more uniform the waveform the lower
the heat production
kVp = peak kV
mAs = current exposure time product

Heat is normally removed from the anode by radiation through the vacuum and into the
conducting oil outside the glass envelope. The molybdenum stem conducts very little heat to
prevent damage to the metal bearings.

Heat capacity

A higher heat capacity means the temperature of the material rises only a small amount with a
large increase in heat input.

Temperature rise = energy applied / heat capacity

Tube rating

Each machine has a different capacity for dissipating heat before damage is caused. The capacity
for each focal spot on a machine is given in tube rating graphs provided by the manufacturer.
These display the maximum power (kV and mA) that can be used for a given exposure time
before the system overloads. The maximum allowable power decreases with:

 Lengthening exposure time

 Decreasing effective focal spot size (heat is spread over a smaller area)
 Larger target angles for a given effective focal spot size (for a given effective focal spot
size the actual focal spot track is smaller with larger anode angles. This means the heat is
spread over a smaller area and the rate of heat dissipation is reduced)
 Decreasing disk diameter (heat spread over smaller circumference and area)
 Decreasing speed of disk rotation

Other factors to take into consideration are:

 By using a higher mA the maximum kV is reduced and vice versa.

  A very short examination may require a higher power to produce an adequate image. This
must be taken into consideration as the tube may not be able to cope with that amount of
heat production over such a short period of time.

Anode cooling chart

As well as withstanding high temperatures an anode must be able to release the heat quickly too.
This ability is represented in the anode cooling chart. It shows how long it takes for the anode to
cool down from its maximum level of heat and is used to prevent damage to the anode by giving
sufficient time to cool between exposures.

Anode heel effect

An x-ray beam gets attenuated on the way out by the target material itself causing a decrease in
intensity gradually from the cathode to anode direction as there is more of the target material to
travel through. Therefore, the cathode side should be placed over the area of greatest density as
this is the side with the most penetrating beam. Decreasing the anode angle gives a smaller
effective focal spot size, which is useful in imaging, but a larger anode heel effect. This results in
a less uniform and more attenuated beam.

** smaller angle = smaller focal spot size but larger anode heel effect **
 

Others

Window: made of beryllium with aluminium or copper to filter out the soft x-rays. Softer (lower
energy) x-ray photons contribute to patient dose but not to the image production as they do not
have enough energy to pass through the patient to the detector. To reduce this redundant
radiation dose to the patient these x-ray photons are removed.

Glass envelope: contains vacuum so that electrons do not collide with anything other than target.

Insulating oil: carries heat produced by the anode away via conduction.

Filter: Total filtration must be >2.5 mm aluminium equivalent (meaning that the material
provides the same amount of filtration as a >2.5 mm thickness of aluminium) for a >110 kV
generator

Bremsstrahlung/Braking X-ray generation

 When an electron passes near the nucleus it is slowed and its path is deflected. Energy
lost is emitted as a bremsstrahlung X-ray photon.
 Bremsstrahlung = Braking radiation
 Approximately 80% of the population of X-rays within the X-ray beam consists of X-
rays generated in this way.

The X-ray spectrum

ORIGIN OF X-RAY SPECTRA

The interpretation of X–ray spectra according to the Bohr theory (LN-1) of electronic levels was
first (and correctly) proposed by W. Kossel in 1920: the electrons in an atom are arranged in
shells (K, L, M, N, corresponding to n = 1, 2, 3, 4, ..., etc.). Theory predicts that the energy
differences between successive shells increase with decreasing n and that the electron transition
from n = 2 to n = 1 results in the emission of very energetic (short wavelength) radiation (fig. 1),
while outer shell transitions are associated with small ΔE, i.e. with the emission of radiation of
long wave lengths , inner shell transitions are associated with large ΔE, the emission of radiation
of short wave lengths. X-rays are generated by inner shell electron transitions

 As a result of characteristic and bremsstrahlung radiation generation a spectrum of X-ray

energy is produced within the X-ray beam.
  This spectrum can be manipulated by changing the X-ray tube current or voltage settings,
or by adding filters to select out low energy X-rays. In these ways radiographers are able
to apply different spectra of X-ray beams to different body parts.

The X-ray beam

Key points

 X-rays travel in straight lines

 Body parts further away from the detector are magnified compared with those that are
closer
 Occasionally magnification can be helpful in localising abnormalities

X-rays travel in straight lines and a beam of X-rays diverges from its source. Structures the beam
hits first will be magnified in relation to those which are nearer the detector. To reduce
magnification the X-ray source can be moved further away from the subject. Structures that need
to be measured accurately should be placed closer to the detector.

Radiation Detector

A radiation Detector or particle detector is a device that measures this ionization of many types
of radiation, like- beta radiation, gamma radiations, and alpha radiation with the matter. Thus,
creating electrons and positively charged ions.

¶WHERE/WHEN YOU’D NEED RADIATION DETECTORS

An important part of knowing what type of detector to use is to have an idea of how and where it
will be used.  Different applications and settings call for different types of detectors, as each
detector type has various ways it can be specialized to fit a role. The applications for radiation
detection instruments can be broadly categorized into a few different core tasks:

•Measurement

•Protection
•Search.

~Radiation measurement tasks are for situations where there is a known presence of
radioactive materials which need to be monitored. The goal with this type of detection is
awareness. Awareness of the strength of an established radioactive field, the boundaries of a
radioactive area, or simply of the spread of radioactive contamination. These are settings where
the presence of radiation is expected, or at least considered likely. The requirements for detectors
involved in these settings are unique, often with relatively higher measurement ranges or with
modifications needed to specifically look for one type of radiation.

~Radiation protection is similar to radiation measurement applications in the sense that it is

usually in a setting where radiation is expected to be found. However, the goals are different.
With radiation measurement settings, the goal is to monitor the radioactivity itself, to be aware of
fluctuations, boundaries, etc. With radiation protection, the goal is monitoring people. Radiation
dosimetry is the most common example of this, with radiation badges being worn by medical
personnel, nuclear industry workers, and many other occupationally exposed workers all over the
world.  The importance of this is that it provides protection from the most harmful effects of
radiation exposure through awareness, in that a wearer can keep informed of how much radiation
they’ve been exposed to, and how that corresponds to potential health effects, and alter their
behavior or position or schedule accordingly.

~Radiation search differs from the other two basic categories of radiation detection applications
in that it is predicated both on the fact that radiation is not expected in the area, and the desire to
keep things that way. Primarily the goal of radiation security personnel, first responders, or
groups such as customs & border inspectors, radiation search has a different set of requirements
to mirror the significantly different circumstances in which it takes place. Detectors need to be
highly sensitive, with the concern being more about smaller, concealed radioactive sources or
materials. Spectroscopy is often very helpful as well, since it is typically a small subset of
radioactive isotopes that are of concern, and being able to filter those out that are present due to
legitimate reasons such as medical treatment or just an accumulation of a naturally occurring
radioactive substance is important.

 These three categories, and the varying tasks that fit inside them, help determine what the best
type of instrument or detector is best suited for the task. 
 TYPES

 When talking about radiation detection instruments, there are three types of detectors that are
most commonly used, depending on the specific needs of the device. These are:

•Gas-Filled Detectors

•Scintillators

•Solid State detectors. 

Each has various strengths and weaknesses that recommend them to their own specific roles.

 GAS FILLED: The first type of radiation detector, gas-filled detectors, are amongst the most
commonly used. There are several types of gas-filled detector, and while they have various
differences in how they work, they all are based on similar principles.  When the gas in the
detector comes in contact with radiation, it reacts, with the gas becoming ionized and the
resulting electronic charge being measured by a meter. The different types of gas-filled detectors
are: ionization chambers, proportional counters, and Geiger-Mueller (G-M) tubes. The major
differentiating factor between these different types is the applied voltage across the detector,
which determines the type of response that the detector will register from an ionization event.

 ION CHAMBER: At the lower end of the voltage scale for gas-filled detectors are Ionization
Chambers, or Ion Chambers. They operate at a low voltage, meaning that the detector only
registers a measurement from the “primary” ions (in actuality pair of ions created: a positively
charged ion and a free electron) caused by an interaction with a radioactive photon in the
reaction chamber.  Thus the measurement that the detector records is directly proportional to the
number of ion pairs created. This is particularly useful as a measure of absorbed dose over time. 
They are also valuable for the measurement of high-energy gamma rays, as they don’t have any
of the issues with dead time that other detector types can have. However, ion chambers are
unable to discriminate between different types of radiation, meaning they cannot be used for
spectroscopy. They can also tend towards being more expensive than other solution. Despite this,
they are valuable detectors for survey meters. They are also widely used in laboratories to
establish reference standards for calibrations.

 PROPORTIONAL :The next step up on the voltage scale for gas-filled detectors is the
proportional (or gas-proportional) counter. They are generally devised so that for much of the
area inside the chamber, they perform similarly to an ion chamber, in that interactions with
radiation create ion pairs.  However, they have a strong enough voltage that the ions “drift”
towards the detector anode.  As the ions approach the detector anode, the voltage increases, until
they reach a point where a “gas amplification” effect occurs. 
Gas amplification means that the original ions created by the reaction with a photon of radiation
causes further ionization reactions, which multiply the strength of the output pulse measured
across the detector. The resulting pulse is proportional to the number of original ion pairs
formed, which correlates to the energy of the radioactive field that it is interacting with. The
makes proportional counters very useful for some spectroscopy applications, since they react
differently to different energies, and thus are able to tell the difference between different types of
radiation that they come into contact with. They are also highly sensitive, which coupled with
their effectiveness at alpha and beta detection and discrimination, makes this type of detector
very valuable as a contamination screening detector.

 GM TUBE: The last major class of gas-filled detectors is the Geiger-Mueller tube, the origin of
the name “Geiger Counter.” Operating at a much higher voltage than other detector types, they
differ from other detector types in that each ionization reaction, regardless of whether it is a
single particle interaction or a stronger field, causes a gas-amplification effect across the entire
length of the detector anode. Thus they can only really function as simple counting devices, used
to measure count rates or, with the correct algorithms applied, dose rates. After each pulse, a G-
M has to be “reset” to its original state.  This is accomplished by quenching. This can be
accomplished electronically by temporarily lowering the anode voltage on the detector after each
pulse, which allows the ions to recombine back to their inert state. This can also be accomplished
chemically with a quenching gas such as halogen which absorbs the additional photons created
by an ionization avalanche without becoming ionized itself. Due to the extensive reaction G-M
tubes experience with each pulse of radiation, they can experience something called “dead time”
at higher exposure rates, meaning that there is a lag between the pulse cascade and when the gas
is able to revert to its original state and be ready to detect another pulse. This can be
accommodated for with calibration, or with algorithms in the detection instruments themselves to
“calculate” what the additional pulses would be based on the existing measurement data.

 SCINTILLATORS: The second major type of detectors utilized in radiation detection

instruments are Scintillation Detectors. Scintillation is the act of giving off light, and for
radiation detection it is the ability of some material to scintillate when exposed to radiation that
makes them useful as detectors. Each photon of radiation that interacts with the scintillator
material will result in a distinct flash of light, meaning that in addition to being highly sensitive,
scintillation detectors are able to capture specific spectroscopic profiles for the measured
radioactive materials.

 Scintillation detectors work through the connection of a scintillator material with a

photomultiplier (PM) tube. The PM tube uses a photocathode material to convert each pulse of
light into an electron, and then amplifies that signal significantly in order to generate a voltage
pulse that can then be read and interpreted. The number of these pulses that are measured over
time indicated the strength of the radioactive source being measured, whereas the information on
the specific energy of the radiation, as indicated by the number of photons of light being
captured in each pulse, gives information on the type of radioactive material present. Due to their
high sensitivity and their potential ability to “identify” radioactive sources, scintillation detectors
are particularly useful for radiation security applications. These can take many forms, from
handheld devices used to screen containers for hidden or shielded radioactive material, to
monitors set up to screen large areas or populations, able to differentiate between natural or
medical sources of radiation and sources of more immediate concern, such as Special Nuclear
Material (SNM).

SOLID STATE: The last major detector technology used in radiation detection instruments are
solid state detectors.  Generally using a semiconductor material such as silicon, they operate
much like an ion chamber, simply at a much smaller scale, and at a much lower voltage.
Semiconductors are materials that have a high resistance to electronic current, but not as high a
resistance as an insulator. They are composed of a lattice of atoms that contain “charge carriers,”
these being either electrons available to attach to another atom, or electron “holes,” or atoms
with an empty place where an electron would/could be. Silicon solid state detectors are
composed of two layers of silicon semiconductor material, one “n-type,” which means it contains
a greater number of electrons compared to holes, and one “p-type,” meaning it has a greater
number of holes than electrons. Electrons from the n-type migrate across the junction between
the two layers to fill the holes in the p-type, creating what’s called a depletion zone. This
depletion zone acts like the detection area of an ion chamber.  Radiation interacting with the
atoms inside the depletion zone causes them to re-ionize, and create an electronic pulse which
can be measured. The small scale of the detector and of the depletion zone itself means that the
ion pairs can be collected quickly, meaning that the instruments utilizing this type of detector can
have a particularly quick response time. This, when coupled with their small size, makes this
type of solid state detector very useful for electronic dosimetry applications.  They are also able
to withstand a much higher amount of radiation over their lifetime than other detectors types
such as G-M Tubes, meaning that they are also useful for instruments operating in areas with
particularly strong radiation fields.

RADIATION DAMAGE
Radiation is present in the environment naturally and we are all exposed to some extent. The
effect this radiation has on humans depends on the type, source and level of radiation and on the
age of the patient.

Ionising radiation: Ionising radiation is electromagnetic (EM) radiation that causes ionisation of
atoms. The minimum energy needed to ionise any atom is approximately 10 eV.

Ionising radiation includes:

 X-rays
 Neutrons
 Beta particles
 Alpha particles

When the radiation interacts with the body damage is caused to irradiated cells by two
mechanisms:

~Indirectly: ionisation produces free radicals which then damage DNA and cell membranes

~Directly: release of energy from ionisation event is enough to break molecular bonds directly

It also damages non-irradiated cells via:

 Genomic instability in progeny of cells: DNA defects passed on

 Bystander effect: release of chemicals and transmitters affect cells around the irradiated
cell

 Pregnancy: Radiation-related risks throughout pregnancy depend upon the stage of the
pregnancy and the absorbed dose. The highest risk is during the early fetal period, then
the 2nd trimester, and finally the 3rd trimester. Preconception irradiation of either
parent's gonads has not been shown to result in a higher risk of cancer or malformations
in their children.

 To cause malformations, typically to the central nervous system, the threshold is ≥100-
200 mGy. These levels are very rarely reached with CT or conventional x-ray scans but
can be reached with fluoroscopically guided interventional procedures of the pelvis or
radiotherapy.
 In females of child-bearing age there must be an attempt to determine whether the patient
is, or could be, pregnant before exposure to radiation. One missed menstruation in a
regularly menstruating woman should be considered positive for pregnancy until proven
otherwise.
  The natural childhood risk of cancer is approximately 1 in 500. From the table below you
can see that the risk of childhood cancer is very low for most studies. At the highest
doses, however, the childhood cancer risk can be double the natural risk.

 Breastfeeding: Some radionuclides are excreted in breast milk. It is recommended to

suspend breastfeeding in the following situations:

Some biological effects such as skin damage are dose dependent, whereas others, such as
development of cancer, are random. Dose dependent biological effects become measurable
above 50mSv (millisieverts) and a whole body dose of greater than 10Sv (sieverts) is universally
lethal. The average radiation dose per person in the UK is 2.6mSv per year, 2.2mSv of which is
background and 0.4mSv relates to medical exposure. Diagnostic investigations typically involve
doses between 0.02mSV (chest X-ray) to 10mSv (CT abdomen). This means that a chest X-ray
amounts to 3 days of background radiation and a CT abdomen is equivalent to 4.5 years! Some
body parts are more susceptible to the random damaging effects of radiation. These are generally
tissues with rapidly dividing cells, for example, radiation dose to the stomach is over 20 times
more likely to result in a fatal cancer than the same dose to bone. Radiation exposure to
reproductive organs carries further potential risk to future generations. Children are more
radiosensitive than adults and irradiation of a fetus should be avoided wherever possible.

X-rays are potentially harmful to both patients and hospital staff therefore, requests for
radiological examinations should be clinically justified

X-ray safety

Referrers for radiological investigations are required to provide sound clinical reasons to justify
exposing patients to radiation. Local rules of the X-ray department must be adhered to, as
ignoring them may result in breaking the law.

All X-rays may cause alteration of cellular division and other intracellular processes and are
therefore potentially harmful to the human body. For this reason all medical exposure to
radiation should be justified in terms of risk to benefit ratio.

Safety principles

Several principles should be adhered to in order to reduce risk to patients.

JUSTIFICATION - Potential benefit of radiation exposure should outweigh risk.

OPTIMIZATION - Measures should be in place to reduce dose to patients and staff.

LOCAL RULES - Measures to ensure wider regulations are enforced, for example that X-ray
machines are correctly installed and used, and that referrals are justified.

Risks to staff: Staff are also at potential risk from radiation exposure. The doses that radiologists
and radiographers are exposed to are generally small. However, local rules are enforced to ensure
that dosimetry badges and protective clothing such as lead aprons are worn, in order to monitor
and reduce staff radiation dose.

Knowledge of the Inverse square law helps in reducing dose. “This states that the dose to a
given area is quadrupled be halving the distance from the radiation source”. Simply put, standing
back from a source of radiation reduces dose to staff. This is particularly important during
interventional radiology cases when radiologists or radiographers are working close to the X-ray
beam.

Dosimetry badges

There are three general groups of dosimetry badges:

1. Film badges
2. Thermoluminescent Detectors (TLDs)
3. Electronic Dosimeters

If an employee is provided with a dose badge they are required to wear them under IRR 17. They
measure staff doses to ensure that dose limits are complied with and to determine who should be
classified.

Film Badges

These use a silver-halide film (similar to that used in plain film radiography). They are an old
technology and have been largely replaced with TLDs.

Advantages

 Cheap
 Can distinguish between different energies of photons
 Can measure doses from different types of radiation
 Provide a permanent record
 Accurate for exposures > 100 millirem

Disadvantages
  Film fogging over time
 Prolonged exposures can adversely affect the film
 Not accurate to exposures < 20 millirem
 Must be developed and read by a processor, which is time consuming
 Must be changed every 1 month due to fogging over time

Thermoluminescent Detectors (TLDs)

This is the most commonly used dosimeter. To read absorbed radiation the TLD is heated and
visible light is released from the crystal in proportion to absorbed radiation. This is then
measured to calculate the amount of radiation the dosimeter has been exposed to. Calcium
fluoride and lithium fluoride are commonly used. The TLD must be used in its casing as this
applies filters to correct for deep and superficial absorption through the skin. Calibration post-
read-out is still required to correct for differential absorption. The rate of changing the TLDs
varies between institutions. Some institutions may use area monitoring instead of individual
monitoring if the expected doses are low.

Advantages

 Can be made very small for finger/eye doses

 Can be reused

Disadvantages

 Cannot distinguish between different types of radiation

 More expensive than film badges
 Once read out, record is lost i.e. can't provide permanent record

Electronic Dosimeters

Most commonly used electronic dosimeter uses silicone diode detector. They can provide a
direct electronic readout and live/real time readouts and don't need the processing that is required
for the other types of dosimetry badges. Require yearly battery replacement and checking.

Advantages

 Very sensitive. Nearly 100x more sensitive than a TLD and can measure to nearest 1 µSv
 Good for measuring pregnancy doses
Disadvantages

 High initial cost

CLINICAL APPLICATION OF X-RAY

X-rays are a form of electromagnetic radiation that can pass through solid objects, including the
body. X-rays penetrate different objects more or less according to their density. In medicine, X-
rays are used to view images of the bones and other structures in the body.

To obtain an X-ray image of a part of the body, a patient is positioned so the part of the body
being X-rayed is between the source of the X-ray and an X-ray detector. As the X-rays pass
through the body, images appear in shades of black and white, depending on the type of tissue
the X-rays pass through.

 To obtain an X-ray image of a part of the body, a patient is positioned so the part of the body
being X-rayed is between the source of the X-ray and an X-ray detector. As the X-rays pass
through the body, images appear in shades of black and white, depending on the type of tissue
the X-rays pass through.
 For example, the calcium in your bones makes them denser, so they absorb more radiation
and appear white on X-rays. Thus when a bone is broken (fractured), the fracture line will appear
as a dark area within the lighter bone on an X-ray film.

Less dense tissue such as muscle or fat absorbs less, and these structures appear in shades of gray
on X-ray film. Air absorbs little of the X-rays, so the lungs and any air-filled cavities appear
black on an X-ray film. If pneumonia or tumors are present in the lungs, they are denser than the
air-filled areas of the lungs and they will appear as whiter spots on X-ray film.

The most common form of X-ray used is X-ray radiography, which can be used to help detect or
diagnose:

 Bone fractures
 Infections (such as pneumonia)
 Calcifications (like kidney stones or vascular calcifications)
 Some tumors
 Arthritis in joints
 Bone loss (such as osteoporosis)
 Dental issues

Also,
   Radiation therapy. X-rays play an important role in the fight against cancer, with high
energy radiation used to kill cancer cells and shrink tumours. ...
 Airport security i.e screening of passengers
 Revealing counterfeit art.

RADIOISOTOPE PRODUCTION
A radioactive isotope, also known as a radioisotope, radionuclide, or radioactive nuclide, is any
of several species of the same chemical element with different masses whose nuclei are unstable
and dissipate excess energy by spontaneously emitting radiation in the form of alpha, beta, and
gamma rays.

The atom is the basic building block of matter. The atom consists of positively charged nucleus
and surrounded by a number of negatively charged electron, so that atom as a whole is
electrically neutral. The nucleus consists of positive-charged proton and neutral-charged neutron
referred as nucleons. The number of proton present in the nucleus is called atomic number (Z),
and total number of neutrons and protons present in the nucleus is called mass number (A). The
atomic number of an element is the same, but different mass numbers are called isotope of an
element. If the nucleus contains either excess of neutrons or protons, the force between these
constituents will be unbalanced leading to unstable nucleus. An unstable nucleus will
continuously vibrate and will attempt to reach stability by undergoing radioactive decay. The
number of neutrons determines whether the nucleus is radioactive or not. The radioactive
isotopes of an element are called radioisotopes; they are natural and artificially produced by
nuclear reactors and accelerators. The discovery of radioisotope was one of the result works on
the radioactive element. The way in which isotope arises in the radioactive element can be
understood in terms of effects of radioactive decay on the atomic number Z and mass number A.
The unstable nuclei of an element can undergo the variety of processes resulting in the emission
of radiation in two forms, namely, radioactivity and nuclear reactions. In a radioactive decay, the
nucleus spontaneously disintegrates to different species of nuclei or to a lower energy state of the
same nucleus with the emission of alpha (α), beta (β), and gamma (γ) radiation is called
radioactivity. The radioactivity was discovered by Henry Becquerel in 1896. Alpha, beta, and
their ionizing property were discovered by Rutherford in 1899, and gamma was discovered by
Villard in 1900. In nuclear reaction, the nucleus interacts with another particle or nucleus with
subsequently emission of radiation as one of its final products. In some cases, the final product is
also radioactive. The radiation emitted in both these processes may be electromagnetic (X-rays
and γ-rays) or particle-like α, β, and neutrons. The nuclear reactions were discovered by
Rutherford in 1917.

The type of emission of ionizing radiations

The ionizing radiations such as α, β, and γ except neutron are originated from unstable nuclei of
an atom in an element undergoing radioactive decay.
Alpha radiation: Some naturally occurring heavy nuclei with atomic number 82 < Z < 92 and
artificially produced transuranic element Z > 92 decay by alpha emission, in which the parent
nucleus loses both mass and charge. The alpha particle is emitted in preference to other light
particles such as deuteron (2H), tritium (3H), and helium (3He). Because energy must be released
in order for decay to take place at all. The alpha particle has very stable and high binding energy,
has tightly bound structure, and can be emitted spontaneously with positive energy in alpha
decay, whereas 2H, 3H, and 3He decay would require an input energy. It has less penetrating and
high ionizing power.

Beta radiation: Beta particles are fast electron or positron; these are originated from weak
interaction decay of a neutron or proton in nuclei, which contains an excess of the respective
nucleon. In a neutron-rich nucleus, neutron can transform itself in to a proton by emission of beta
particles and antineutrino. Similarly, in the nuclei with rich proton, it transforms into neutron by
emission of neutrino and positron. These radiations are high penetrating and less ionizing power:

n→p+e−+ν−
E2

Similarly in the nuclei with rich proton, the decay is

p→n+e++ν
E3

Gamma radiation:The emission of gamma rays is usually the most common mode of nuclear
excitation and also occurs through internal conversion.

X-ray radiation: X-rays arises from the electron cloud surrounding the nucleus. They were
discovered by Roentgen in 1895. X-rays are produced in X-ray tube by fast moving electron
which is suddenly stopped by target.

Neutron radiation: It is a neutral particle that produces ionization indirectly by emission of γ-

rays and charged particles when interacting with matter. These charged particles produce the
ionization. It has more penetrating than gamma ray and can be stopped by thin concrete or
paraffin barrier. They are produced by nuclear reaction and spontaneous fission in nuclear
reactors. The characteristic emission of α, β, γ, and neutron

Classification of radiation

Depending on its effects on matter and its ability to ionize the matter, radiation is classified in
two main categories: ionizing and nonionizing radiations.
 Ionizing radiation: Radiation passing through the matter which breaks the bonds of atoms or
molecules by removing the electron is called ionization radiation. It passes through the matter or
living organisms, and it produces various effects. Ionizing radiation is produced by radioactive
decay, nuclear fission, and fusion, by extremely hot objects, and by particle accelerators. The
ionizing radiation is again divided into two types: direct and indirect ionizing radiation.

Direct ionizing radiation: Directly ionizing radiation deposits energy in the

medium through direct Coulomb interaction between the ionizing charged particles and
orbital electrons of atoms in the medium, for example, α, β, protons, and heavy ions.

Indirect ionizing radiation:Indirectly ionizing radiation deposits energy in the

medium through a two-step process; in the first step, charged particles are released in the
medium. In the second step, the released charged particles deposit energy to the medium
through direct coulomb interaction with orbital electron of the atoms in the medium, for
example, X-rays, photons, γ rays, and neutrons.

Nonionizing radiation: Nonionizing radiation is part of the electromagnetic radiation where

there is insufficient energy to cause ionization. But it has sufficient energy only for excitation
and not to produce ions when passing through matter Radiowaves, microwaves, infrared,
ultraviolet, and visible radiation are the examples of nonionizing radiations. Nonionizing
radiation is essential to life, but excessive exposures will cause biological effects.

Sources of natural and artificial radiation

There are two important sources of radiation: they are natural and man-made.

Natural background radiation: The radiation that exits all around us is called natural
background radiation. All living organisms including man have been continuously exposed to
ionizing radiations emitted from different sources, which always existed around us. The sources
of natural radiation are cosmic rays and naturally occurring primordial radionuclides such as
238
U, 232Th, 235U, and their decay products as well as the singly occurring natural radionuclides
like 40K and 87Rb, which are present in the earth crust, soil, rocks, building materials, ore, and
water in the environment. Background radiation is a constant source of ionizing radiation present
in the environment and emitted from a variety of sources. Natural radiations originated from
three major sources: terrestrial, extraterrestrial, and internal (intake of natural radionuclides and
their daughter product) sources of radiation.
 Artificial or man-made radiation: In addition to natural background radiation, human beings
are exposed to man-made radiation obtained from nuclear installations, nuclear explosions,
nuclear fuel cycle, radioactive waste releases from nuclear reactor operations, and accidents and
other industrial, medical, and agricultural uses of radioisotopes. The most significant sources of
exposure, which gives the largest contribution to the public is from medical diagnostic X-rays,
nuclear medicine, and nuclear therapy. This is also generated from consumer products such as
combustible fluids (gas and coal), TV, luminous watches and dials, and electron tubes. The
public are exposed to the radiation from the nuclear fuel cycle, which includes the entire
sequence from mining and milling of uranium, the actual production of power at a nuclear power
plant, and residual fallout from nuclear weapon testing and accident. The public are not exposed
to all the sources of radiation, for example, patients who are treated with the medical irradiation
or the workers of nuclear industry may receive higher radiation exposure than the public.

Applications of radioisotope

The applications of radioisotopes have played a significant role in improving the quality of life
of human beings.

Radiotracer (radioisotopes): Radiotracers are widely used in medicine, agriculture, industry,

and fundamental research. Radiotracer is a radioactive isotope; it adds to nonradioactive element
or compound to study the dynamical behavior of various physical, chemical, and biological
changes of system to be traced by the radiation that it emits.

Medicine: Nowadays radiotracer has become an indispensable and sophisticated diagnostic tool
in medicine and radiotherapy purposes.

Diagnostic purpose: The most common radioactivity isotope used in radioactive tracer is
technetium (99Tc). Tumors in the brain are located by injecting intravenously 99Tc and then
scanning the head with suitable scanners.131I and most recently 132I and 123I are used to study
malfunctioning thyroid glands. Kidney function is also studied using compound containing 131I.
33
P is used in DNA sequencing. Tritium (3H) is frequently used as a tracer in biochemical studies.
 C has been used extensively to trace the progress of organic molecule through metabolic
14

pathways.

A most recent development is positron emission tomography (PET), which is a more precise and
accurate technique for locating tumors in the body. A positron emitting radionuclide (e.g., 13N,
15
O, 18F, etc.) is injected to the patient, and it accumulates in the target tissue. As it emits positron
which promptly combines with nearby electrons, it results in the simultaneous emission of two γ-
rays in opposite directions. These γ-rays are detected by a PET camera and give precise
indication of their origin, that is, depth also. This technique is also used in cardiac and brain
imaging.

In Compound X-ray tomography or CT scans:The radioactive tracer produces gamma rays or

single photons that a gamma camera detects. Emissions come from different angles, and a
computer uses them to produce an image. CT scan targets specific area of the body, like the neck
or chest, or a specific organ, like the thyroid

Therapeutic: The most common therapeutic use of radioisotopes is 60Co, used in treatment of
cancer. Sometimes wires or sealed needles containing radioactive isotope such as 192Ir or 125I are
directly placed into the cancerous tissue. The radiations from the radioisotopes attack the tumor
as long as needle/wire is in place. When the treatment is complete, these are removed. This
technique is frequently used to treat mouth, breast, lung, and uterine cancer. 131I is used to treat
thyroid for cancers and other abnormal conditions of thyroid. 32P is used to treat excess of red
blood cells produced in the bone marrow.

Agricultural research: Development of high yielding varieties of plants, oil seeds, and other
economically important crops and protection of plant against the insects are the thrust area of
agricultural research.

New varieties of crops: The irradiated seeds of wheat, rice, maize, cotton, etc., are undergoing
profound genetic changes in order to improve crop varieties and mutation breeding. These
varieties of crops are more disease resistant and have high yields. Several countries all over the
world produce new variety of crops from radiation-induced mutants

Eradication of insect and pests: The best technique for the control of insects and pests is sterile
insect technique (SIT). Irradiation is used to sterilize mass-reared insects so that, while they
remain sexually competitive, they cannot produce offspring. As a result, it enhances the crop
production and preservation of natural resources.

Food preservation and sterilization: As per WHO reports, about 25–35% of world food
production is susceptible to the attack by pests, insects, bacteria, and fungi causing a great loss of
the economy of the country. Food irradiation has more advantages than conventional methods.
All types of radiations are not recommended for food irradiation; only three types of radiation
are recommended by CODEX general standard for food irradiation which are 60Co or 137Cs, X-
rays, or electron beams from particle accelerators The food products are exposed to γ-radiations
from the intense controlled sources to kills pests, bacteria, insects, and parasites and extends
shelf-life but also reduces the food’s nutritional value somewhat by destroying vitamins A, B 1
(thiamin), C, and E. No radiation remains in the food after treatment.

Depending on the radiation dose and its application, radiations are classified into three
categories: they are low dose (<1 kGy), medium dose (1–10 kGy), and high dose (>10 kGy) .

Effects of exposure to radioisotope

Biological effects of radiations

The harmful effects that are produced in human beings who are exposed to radiations are called
health effects. The result of all the physical interaction processes between incident radiation and
the tissue of a cell is a trail of ionized atoms and molecules. The radiation is directly interacting
with sensitive critical sites of the tissue (DNA) to produce damage by breaking chemical bonds.
The chemically active free radicals are indirectly produced by interaction of primary radiation
Direct action

Radiation attacks DNA molecule directly as a result the ionization is produced and the bond is
disrupted within a few nanometers of the DNA molecule.

Indirect action: Indirect action is due to the chemical radicals which are produced by radiation
that interact with water molecule; it comprises about 80% of tissue. Free radicals are important
since they can diffuse far enough to reach and induce chemical changes at critical sites in
biological structures. The chemical damage produced by the breaking of DNA by the action of
free radicals.

These free radicals interact with DNA to produce the damage. DNA is made up of double-helix
structure; if the radiation/free radical breaks only one strands, it is easily repaired by opposite
strand as a template. If double strand breaks the repair of the cell is not possible; as a result
mutations or changes in DNA code this leads to a cell death or cancer. To a certain extent, these
molecules are repaired by natural biological processes, and this ability to self-heal or self-repair
depends on the extent of damage. The biological effect of radiation on living cell may result in
three outcomes:

1. Death of the cells

2. Impairment in the natural functioning of cell leading to somatic effects such as cancer
 3. A permanent alteration of the cell which is transmitted to later generation, that is, genetic
effect.

Oxygen effect is another effect produced by organic free radicals. The amplification of the
Chemical action of free radicals due to the presence of oxygen in tissue is called oxygen effect. It
has consequences that irradiated cell have a lower chance of survival in tissue rich in oxygen
than in tissue less rich in oxygen.

Biological effects of radiation are broadly classified into deterministic effect and stochastic
effects.

Deterministic effect: These effects of damage from the radiation can be long term or short term.
The large amount of radiation which is exposed to short interval of time is called acute radiation
effects. Small amount of radiation dose exposed to longer period is called delayed effect or
chronic effect. Deterministic effects are severe, if dose exceeds a threshold level (500 mSv). The
severity of these effects in an exposed individual increases with the dose above the threshold
with DNA of the tissue. Both direct and indirect damages produced in DNA by radiation

Stochastic effect: These effects are associated with long-term low-level exposure. They have no
apparent threshold. The risk from the exposure increases with increasing the dose, but the
severity of the effect is independent of the dose . In stochastic effect (the effect rate increases
with increase in the dose rate. But in deterministic effect there is apparent threshold, thereafter
the effect rate increases rapidly with increase in the dose.

With the chronic exposure, there is a delay between the exposure and observed health effects.
These effects include cancer and other health outcomes such as benign tumor, cataracts, and
potentially harmful genetic effects. Cancer and genetic effects are recognized as stochastic
effects.

Genetic effect

These effects are not immediate. They are produced in the future generation. The experimental
evidences from animal studies show that the radiation can cause genetic effects, but the studies
of the survivors of Hiroshima and Nagasaki gives no indication of these effects on human beings.
There is a considerable uncertainty about the low dose is beneficial or harmful. In the published
literature, data and reports regarding health effects of low doses are two classes of thoughts. The
first thought favors in linear no-threshold (LNT) hypothesis adopted by major scientific, official,
and governmental organizations such as ICRP, NCRP, NAS-NRC, WHO, and UNSCEAR for
risk assessment and states that the low radiation is harmful. The other school of thought believes
in the beneficial features (hormesis hypothesis) of such a low-level exposure. According to this
hypothesis, very low dose of radiation is beneficial, that is, to stimulate repair mechanism and
induce activity of DNA region . Over 3000 research papers show that low-dose irradiation is
stimulatory and beneficial in a wide variety of microbes, plants, invertebrates, and vertebrates
this was excepted by France, Japan, and China. The epidemiological studies of irradiated
population exhibit reduced risk of cancer from low dose of radiation

Radiation is not only the cause of cancer. Cancer is always a cancer. Lung cancer caused by
smoking tobacco is medically identical to lung cancer caused by inhalation of radioactive gas. If
a patient suffers from cancer, there is no absolute certainty that the reason was radiation. Even if
a cancer patient has received a lifetime dose of 500 mSv which is many times higher than the
annual dose limit for professional radiation workers, then it is ten times more likely that his or
her cancer was caused by another reason than radiation.

Radiation protection, safety, and dose limits

Radiation protection and safety standard sources for occupational and public radiation exposure
are established by Basic Safety Standards (BSS) and ICRP recommendations. The system is
based on the following general principles:

1. Justification: The practices or a source of radiation exposure is to provide the benefit for
the exposed individuals or to the society; otherwise it cannot be considered.
2. Optimization: In relation to any particular source within a practice, the magnitude of
individual’s doses, the number of people exposed, and the likelihood of incurring
potential exposures should be minimum, and dose is as low as reasonably achievable
(ALARA). The economic and social factors are being taken into account with the
restriction that the doses to the individuals delivered by the source be subject to dose
constraints.
3. Dose limitation: The exposure of individuals resulting from the normal and all the
relevant practices should be subject to dose limits. In any normal circumstances, the
individuals should not be exposed to more than the specified dose limits. Not all sources
are susceptible to control by action at the source, and it is necessary to specify the sources
to be included as relevant before selecting a dose limit.

According to Basic Safety Standards, the dose limit is defined as the value of effective dose or
equivalent dose to individuals from controlled practices that shall not be exceeded

. Control of occupational and public exposure

According the International Labor Office (ILO), the occupational exposure refers to the exposure
of a worker that is received or committed during the period of work. Radiation protection of
workers is essential for the same and acceptable use of radiation, radioactive materials, and
nuclear energy. The IAEA and ICRP frame a norm and regulations to protect the workers. In
medical professionals, to minimize the radiation exposure, one can follow as low as reasonably
achievable (ALARA) and personnel shielding options (e.g., two-piece wraparound aprons,
thyroid shields, and eye protection) which should be used to effectively attenuate scattered X-ray
levels. For medical exposure of patients, dose limit is not appropriate to apply. Therefore
medical radiation does not have dose limits and generally used diagnostic reference level (DRL)
as a reference value.

To decrease radiation exposure risks, any medical radiation exposure must be justified, and the
examinations which use ionizing radiation must be optimized. Justification means that the
examination must be medically indicated and useful. Optimization means that the imaging
should be performed using doses that are as low as reasonably achievable (ALARA), consistent
with the diagnostic task.

The control of public exposure is normally exercised by the application of controls at the source
rather than in the environment. According to ICRP recommendations, the dose limits should not
exceed 1 mSvy−1 (excluding normal background radiation). However, in special circumstances, a
higher value can be allowed in a single year, provided that the average over 5 years does not
exceed 1 mSvy−1.

For controlling the occupational exposure, the following three parameters are considered:

1. Distance: The distance between the source and exposing worker should be large to reduce
the amount of radiation received by the workers.
2. Time: The radiation dose is directly proportional to the time spent in the radiation.
Therefore the time of exposure should be as small as possible.
3. Shielding: Depending upon the type of radiation, different materials are used for
shielding. For gamma radiation high-atomic-numbered elements are used, because the
rate of energy loss is directly proportional to Z 5. For neutron, high absorption cross
section and low-atomic-numbered elements are used for shielding; hydrogen and
hydrogen-based materials are well suited for neutron shielding. The plastic can be used to
form an efficient barrier for dealing with high-energy beta radiation.

Radioactive Waste Management

Most of the tertiary care hospitals use radioisotopes for diagnostic and therapeutic applications.
Safe disposal of the radioactive waste is a vital component of the overall management of the
hospital waste. An important objective in radioactive waste management is to ensure that the
radiation exposure to an individual (Public, Radiation worker, Patient) and the environment does
not exceed the prescribed safe limits. Disposal of Radioactive waste in public domain is
undertaken in accordance with the Atomic Energy (Safe disposal of radioactive waste) rules

Classification of Radioactive Waste

Radioactive waste can be classified in following ways.

According to level of activity:

 High level waste

 Medium level waste
 Low level waste

According to the form:

 Solid waste
 Liquid waste
 Gaseous Waste

According to half- life:

 Long half-life waste (Half-life more than a month)

 Short half-life waste (Half-life less than a month)

The hospital radioactive waste is mostly composed of low level waste and occasional medium
level waste with short half-lives. The high level waste is usually associated with nuclear industry
and nuclear reactors.

Radioactive Waste Management in a Hospital

The management of radioactive waste involves two stages: collection and disposal.

The radioactive waste should be identified and segregated within the area of work. Foot operated
waste collection bins with disposable polythene lining should be used for collecting solid
radioactive waste and polythene carboys for liquid waste. Collecting radioactive waste in
glassware should be avoided. Each package is monitored and labeled for the activity level before
deciding upon the mode of disposal. Some hospitals that have incinerators and permission to
dispose of combustible radioactive waste through incineration may also segregate combustible
radioactive waste from non-combustible waste. When two different isotopes of different half-
lives like Tc-99m and I-131 are used, separate waste collection bags and bins should be used for
each. Each bag or bin must bear a label with name of the isotope, level of activity and date of
monitoring.
Radioactive waste disposal

The collected radioactive waste is disposed as per the following:

 Dilute and Disperse

 Delay and Decay
 Concentrate & Contain (Rarely used)
 Incineration (Rarely used)

Dilute and Disperse:

Low activity solid article may be disposed off as ordinary hospital waste provided the activity of
the article does not exceed 1.35 microcuries (50 KBq) or the overall package concentration does
not exceed 135 microcuries / m3 (5MBq / m3). Such articles include vials, syringes, cotton swabs,
tissue papers etc. Similarly, liquid radioactive waste with activity less than microcurie level can
be disposed off into the sanitary sewerage system with adequate flushing with water following
the disposal. However, the maximum limit of total discharge of liquid radioactive material into
sanitary sewerage system should not exceed the prescribed limits

Delay and Decay:

Medium activity radioactive waste and those with half-lives of less than a month may be stored.
The storage room should be properly ventilated with an exhaust system conducted through a duct
line to a roof top exit. The storage space should have lead shielding of appropriate thickness (10
HVL) to prevent radiation leakage. The radioactive waste should be stored for a minimum period
of about 10 half lives when after decay only 0.1% of the initial activity remains. The waste is
then monitored for the residual activity and if the dose limit is low it is disposed off as low
activity solid or liquid waste. Most of the low and medium level radioactive hospital waste is of
short half-life permitting this type of waste disposal.

Concentrate and Contain

This technique of radioactive waste disposal is sometimes used for radioactive materials with
very high activity levels and for those with long half-lives (longer than a month). Their disposal
by delay and decay method is impractical because of longer storage period, particularly if space
availability is limited. Radioactive waste is collected in suitably designed and labeled containers
and then buried in exclusive burial sites approved by the competent authority. In day-to-day
work of a hospital, we do not come across radioactive waste of this nature and as such, this
method of radioactive waste disposal is rarely used.

Incineration
Insoluble liquid waste such as that from the liquid scintillation systems may be disposed off by
incineration. Inceneration reduces the bulk of waste and the activity is concentrated in a smaller
volume of ash for further disposal. Since incinerators used for radioactive waste disposal release
part of the radioactivity into the atmosphere they should operate under controlled conditions and
in segregated places. Ashes collected have to be disposed off as solid radioactive waste
separately.

Environmental concerns and public pressure severely restrict the methods of ground burial and
incineration as regular options of radioactive waste disposal. For these reasons, incineration and
burial are rarely recommended.

Special situations of Radioactive Waste Management in a Hospital

Disposal of sealed sources

Hospitals use sealed sources for a variety of applications, including teletherapy, brachytherapy,
blood irradiation, calibration etc. Most of these sources are relatively small with activities
ranging from a few up to a few hundred MBq, except the teletherapy and blood irradiation
source, which may have high activities. Once the source becomes weak for further applications it
has to be removed and replaced. Hospitals ordering and using such equipments must enter into a
contract for safe removal and replacement of the sealed radioactive source with the suppliers.
While ordering such equipment and the source, the Radiation Safety Officer of the hospital
should be taken into confidence.

Disposal of gaseous waste

Volatile radioactive sources like Iodine-131 and Iodine-125 release radioactive vapors,
generating airborne radioactive waste. The containers of such radioactive substances should be
opened under fume hoods connected through duct lines to highest roof top exit. Before the
vapors are diluted and dispersed into the atmosphere, they should pass through charcoal and
particulate air filters. Hospitals using radioactive gases should have efficient laminar airflow
system. Other gaseous radioactive waste generating isotopes used are Xenon-133, Carbon-14,
Hydrogen-3, Nitrogen-13, Technetium-99m aerosols.

Disposal of excreta and urine of patients administered high doses of radioisotopes:

Patients administered high therapeutic doses of radioisotopes (e.g., Iodine-131 in thyroid cancer)
are admitted in isolation wards until their radiation emission levels are within the minimum safe
limits (3 mRoentgens per / Hour at 1meter distance). The excreta and urine of patients admitted
in a high dose isolation ward (e.g. Iodine −131) after getting flushed passes the PVC pipes
through the shortest route possible into customized storage tanks, called delay tanks for storage
before dispersal into the sewerage system The delay tank should be located in an area where
there is minimal movement of public. The tank should be leak proof, corrosion free and should
have smooth surface from inside. The capacity of the tank depends on the number of patients
admitted each day. A facility admitting two patients would require two delay tanks of 6000 liters
each. This capacity is based on the presumption that on an average each patient uses about 100
liters of water per day. At that rate, each patient will use 3000 liters per month and two patients
will use 6000 liters. At the end of one month as the tank will be full, it is closed and the gate
valve of the second tank is opened. The full tank is kept closed for the period of one month that
the second tank takes to fill. As such, each tank holds the radioactive waste for 2 months that is
sufficient for the decay of Iodine-131 to low levels (Delay & Decay). However before releasing
the effluent of the tank into the public sewerage system a sample is collected to check the
activity, this should not be more than 1.2 microcuries per liter. No hospital is permitted to release
into public sewerage system an aggregate 37 G Bq (1 Curie) of liquid radioactive waste in one
year.

Management of cadavers containing radioactive material:

Sometimes a situation may arise when a patient suffering from a disease such as thyroid cancer is
administered a high dose of iodine-131 and the patient dies while she or he is in the hospital and
still has very high levels of radioactivity in her or his body. In such a situation, one has to inform
the Radiation Safety Officers who in collaboration with the Nuclear Physician supervise the
future course of action. If high activity is concentrated in an organ like residual thyroid, than the
same may need to be removed (Autopsy). If the activity is in a metastatic site, an effort to
remove that site may also be undertaken. Once it is established that the cadaver has radioactivity
less than the safe limit recommended by the competent authority, the dead body may be handed
over for disposal through burial or cremation without any special precautions. In case, the levels
of radioactivity are high than the corpse is retained in the hospital mortuary until the activity
decays to safe limits.

Advisory / Regulatory bodies and Record keeping

The usage of radioisotopes and disposal of radioactive waste is done in accordance to

recommendations and guidelines issued by various international and national bodies.
Institutional Head, Departmental Head, and Radiation Safety Officer of the institution have to
co-ordinate their activities with the national regulatory body. Authorisation for procurement,
usage and disposal of radioactive waste from the regulatory body is mandatory

Radiation Safety Officer (RSO):

The employer shall employ a RSO with the requisite minimum qualification approved by the
competent authority . The RSO shall advise and assist the employer in safe disposal of
radioactive waste in accordance to the guidelines issued from time to time by the competent
authority. The RSO has the key role to ensure all aspects of radiation safety, including safe
disposal of radioactive waste in the institution. However, the ultimate responsibility for the same
rests with the employer.

Record Keeping:

Proper records in the form of logbook must be maintained. Details of diagnostic and therapeutic
radioisotopes procured and administered should be recorded. The records must also include the
details of radioactive waste generated with the activity levels and the levels at the time of their
disposal. The activity levels in the effluent of delay tank must be recorded prior to disposal into
public sewerage system. The total activity disposed off annually in the sewerage system should
be recorded. The names of persons authorized for administration and disposal of radioisotopes
must be recorded. In the event of death of a patient containing high levels of radioactivity, C