Radiation Safety in X Ray Densitometry

•X-ray densitometers expose patients to extremely small amounts of radiation in

comparison to plain X-ray techniques.
•These amounts are often so small that they are biologically insignificant.
•Similarly, the technologist operating an X-ray densitometer on a regular basis is
extremely unlikely to be exposed to a significant amount of radiation.
•Nevertheless, no amount of radiation should be considered inconsequential.
•The principle of “as low as reasonably achievable” (ALARA) should always be given
the highest priority in the operation of these devices.
Radiation Basics
•X-rays are a form of electromagnetic energy.
•When energy is released and then transmitted through a substance, it is called
radiation.
•The substance through which the radiation has passed is said to have been
“irradiated” or “exposed” to radiation.
•Ionizing radiation is radiation that causes the release of an electron from its orbit
around an atom when the radiation passes through the substance containing that
atom.
•X-rays and -rays are also forms of ionizing radiation.
Radiation Quantities
Radiation Quantities
A review of the terminology describing the quantities of radiation that the patient
and thetechnologist are exposed to is necessary before discussing the potential
effects of ionizing radiation on living tissues and the exposure levels produced
during various densitometry exams.
The Curie (Ci): is used to quantify the amount of a radioactive material, not the
radiation emitted by the material.
–The SI unit equivalent to the Ci is the becquerel (Bq).
•The Roentgen (R): is used to describe a quantity of radiation exposure, but is only
used to describe the interaction of X-rays and -rays with air.
● The roentgen is based on the electrical charge created by the liberation of
electrons that occurs during ionizing.
● In densitometry, the R is rarely used except to describe measured amounts
of scatter radiation in the air when the devices are in use. This quantity is
quite low and expressed in milliRoentgens (mR).
● The SI equivalent is the coulombs per kilogram (C/kg).
The Rad: is both the abbreviation and acronym for radiation absorbed dose.
➔ It is commonly used to express the quantity of radiation received by a
patient.
➔ The SI rad equivalent is the Gray (Gy)
➔ For medical X-rays, 1 R is considered to be approximately equal to 1 rad
because the radiation exposure to human tissue from 1R is only about 5%
more than 1 rad.
The Rem: is also both an abbreviation and acronym for rad equivalent man.
➔ The rem expresses the quantity of radiation received by a patient, but unlike
the rad, the quantity has been adjusted to reflect the type or quality of
radiation involved.
➔ This recognizes that different types of ionizing radiation have different
potentials to do harm.
➔ The exposure from medical X-rays in rads or rems is often called the skin
dose.
➔ The SI equivalent of the rem is the Sievert (Sv).
➔ Rem(0.01) = Sv

Radiation Safety
Effective dose equivalent
➔ The effective dose equivalent (HE) is a concept, rather than a particular unit
of measure.
➔ The concept is an attempt to relate the magnitude of an exposure in rems or
Sv to the risk created by that exposure.
➔ In other words, the effective dose equivalent is a measure of risk from an
exposure and not a measure of the exposure itself.
➔ As in rem, recognizing that different types of radiation have different
potentials to do harm; different tissues or organs in the body have different
sensitivities to radiation.
➔ This is the concept behind the effective dose equivalent.
➔ Tissue weighting factors (wT) are assigned to the various tissues in the body.
➔ The HE is determined by multiplying the value in rems or Sv by the wT.
➔ Because the wT has no units of its own, the HE is still expressed in rems or
Sv.
•The International Commission on Radiological Protection (ICRP) determines the
various wT’s.
•The body as a whole is assigned a wT of 1, ovaries and testes: 0.08, thyroid and
liver: 0.04, red bone marrow, breast, colon and lung: 0.12.
•The HE that is calculated for the exposure of any given area of the body is an
expression of the risk that would result if the entire body was exposed to the same
amount of radiation.
•For example, the HE for a radiographic absorptiometry study of the phalanges is
stated as being less than 0.0001 mrem.
•This means that the risk of the radiation exposure from such study of the
phalanges is the same as if the entire body was exposed to less than 0.0001 mrem.
•This is not a measure of the amount of radiation exposure to the phalanges.
•The effective dose equivalent is an expression of the biologically important risk
associated with any given amount of radiation exposure.

Harmful effects of Ionizing Radiation

•Ionizing radiation has the potential to harm living tissue.
The largest source of man-made ionizing radiation is medical X-rays.
•In comparison to natural environmental radiation, man-made sources of ionizing
radiation contribute very little to the total annual radiation exposure of an
individual.
•Nevertheless, ionizing radiation does have the potential to do harm.
•The decision to expose a patient to ionizing radiation, no matter how small in
amount, should not be made lightly.
•Although ionizing radiation can cause an increase in the expected number of
mutations, the mutations that result are not unique.
•The incidence of almost all types of cancer is increased after exposure to high
doses of ionizing radiation, but these are the same cancers seen in individuals who
have not been exposed.
•Acute lethal radiation syndromes as well local tissue damage from radiation
cannot occur with the devices used in densitometry.
Radiation Doses in Densitometry
•The X-ray tube used in densitometry devices have peak kilovoltage (kVp) and
milliampere (mA) characteristics that prohibit the generation of high doses of
radiation.
•The technologist should be familiar with the patient with the patient doses for
various types of X-rays densitometry studies and how these doses compare to other
types of radiation exposure.
•A certain amount of radiation exposure occurs as a result of sources in the
environment.
•The effective dose from natural background sources is estimated to be 0.6-0.7
mrem/day or about 240 mrem/year.
•A PA spine DXA pencil-beam study generally results in an effective dose of only
0.1 mrem.
•QCT spine bone density studies do result in an effective dose of about 3 mrem. If a
scout scan precedes the study the total is about 6 mrem.
•By comparison, the effective dose for an AP chest X-ray is about 5 mrem and for a
plain lateral lumbar spine film about 70 mrem.
•Fan-array DXA scanners tend to have higher effective doses per scan than
pencil-beam. This is because of higher X-ray tube voltages and currents that are
employed in these scanners.
•A PA spine DXA fan-array the effective dose is about 0.67 mrem.
•The skin and the effective doses seen in bone densitometry studies will vary
depending upon the scan speed and scan length.
•The dose will increase as the scan speed decreases and the scan length increases.
•The effect of increasing scan length on increasing dose, however, makes it even
more important that the technologist both perform and recognize a technically good
study to avoid repeat stars and excessive scanning.
Radiation Protection Programs
•Radiation protection programs, even in bone densitometry facilities, are based on
the premise that any unnecessary radiation exposure is unacceptable, no matter
how small.
•The guiding principle of all such programs is known as “ALARA”.
There are three aspects to any radiation protection program.
➔ Protection of the public
➔ Protection of the patient
➔ Protection of the technologist
Protection of the public
•Members of the public refers to individuals not undergoing
radiological procedures and who do not work with
radiation-producing devices or substances.
•May receive a dose of 0.1 rem per year
•The 1st measure is to post the room in which the
densitometer is kept. Posting means placing radiation
warning signs on the entrance to the room and restricting
access.
•Consideration should also be given to a radiation survey.
•A radiation physics can document readings with a counter in and around the
densitometer when the densitometer is in operation.
•Such readings should be taken at different distances from the X-ray tube and
outside of the room as well.
Protection of the patient
•The patient undergoing the study is not technically considered a “member of the
public”.
•The technologist is responsible to perform every test correctly.
➔ This includes the correct choice of the scan mode and speed, correct patient
positioning, and correct data acquisition and analysis.
•Within the area, there should also be signs that prompt a woman to disclose a
pregnancy or the possibility of pregnancy.
•In clinical medicine, there is any reason to perform a bone density on a woman
who is pregnant or who might be pregnant.
•Do not assume because the sign is posted on the wall that the patient has read it.
•Ask the question directly, explain that the risk is virtually negligible but that their
safety is paramount.
**Use the “10-day rule”, which states that a radiologic exam should only be
performed within 10 days of a woman’s last menstrual period.**
Protection to the technologist
•Protection for a technologist involves three concepts: time, distance, and shielding.
•Distance for pencil-beam DXA 3 ft; fan-array beam 10 ft from the X-ray tube when
in operation. These recommendations are based on the assumption that the
machine is being maximally utilized.
•If studies are infrequent, the potential exposure is greatly reduced. In any case the
technologist should not stand or sit within 3 ft of the X-ray tube in operation.
•Tracking radiation exposure over time is an additional safeguard.
•Always use your personal monitoring devices.