Radiation Effects,

Risk and Dose

FRCR Part 1
Will Mairs

william.mairs@christie.nhs.uk

The Christie NHS Foundation Trust

 What we are going to cover
• Radiobiology for Radiation Protection purposes

• Dose definitions

• Sources of exposure

• Threshold doses for tissue reactions

• Linear No Threshold (LNT) model for calculating

stochastic risk

• In utero exposure

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 The Problem - Ionisation
• If an electron is removed
from a neutral atom, it is no
longer neutral but positively
X-rays (or other radiations)
charged.

• The electron will only be

removed if the x-rays have
enough energy to
overcome the binding e-
energy of the electron.

• The process of removing

an electron from a neutral
atom is called Ionisation

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 Biological Damage

indirect
OH-
x H2O
H+
e-

direct

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Outcomes at Cellular Level

• cell repair

• cell death

• cell damage

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 Types of Damage
Tissue reactions:
• Previously called deterministic effects
• Due to cell death
• Examples: skin burn, sterility and cataracts*

Cancer and hereditary effects:

• Latent damage
• Previously called stochastic effects

Other non-cancer effects:

• Cardiovascular disease
• Gastro diseases

*new assessment of evidence for cataracts includes an alternative

stochastic model

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 Definitions of Radiation Dose

Absorbed dose Unit = gray

Radiation weighting

Equivalent dose Unit = sievert

Tissue weighting

Effective dose Unit = sievert

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 Absorbed Dose –
dose to a particular place in the body

• Energy deposited per Kg

• Units : Joules (unit of energy) per kg (units of

mass)

• Special Unit: Gray (Gy)

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 Equivalent Dose
– considers types of radiation
• Different types of ionising radiation differ in the way they
interact with biological material
• E.g. alpha particles are heavily charged and deposit their energy densely in
their path through tissue

• Equal absorbed dose does not mean equal biological

damage

• Equivalent dose = Absorbed dose  Radiation WF (reflecting

relative biological harm)

• Unit is Sievert (Sv)

• 1 Sv of alphas gives the same risk of inducing cancer as 1
Sv of x-rays (if delivered to the same tissue!)

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 Radiation Weighting Factors

Type of radiation Radiation weighting factor

X-rays, Gamma rays, 1

betas
Protons 2

Alphas 20

Neutrons Depends on Neutron energy

(approximately 2 – 20)

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 Effective Dose –
averaged over whole body
• Different organs in the body are more radiosensitive than
others i.e. breast tissue is more sensitive than the gonads or
skin

• There are Tissue Weighting Factors to calculate effective

dose:
-Equivalent dose to each organ x Tissue WF
-Add up the doses for each organ

• Unit: Sievert (Sv)

• It gives a broad indication of the detriment to health from
exposure to ionising radiation - allows us to estimate
stochastic risk

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 Collective Effective Dose

• Effective dose summed over a population

• S=Total no people x average effective dose

• Units: man sievert

person sievert

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What radiation sources are you
exposed to?

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 Sources of Radiation Dose
• Radon in air • Food

• Discharge from nuclear • Air travel

industry

• CT scan of chest • Building materials and rocks

• Smoke detectors • Cosmic radiation

• Occupational dose of • Single chest X-ray

Interventional Radiologist (plain film)

Put them in order of dose (per year)

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 In order

• CT scan of chest • Food

• Radon in air • Single chest X-ray

(plain film)
• Occupational dose of
Interventional Radiologist • Air travel

• Building materials and • Discharges from nuclear

rocks industry

• Cosmic radiation • Smoke detectors

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 Background radiation

Average effective dose in UK

 2.2mSv from natural sources

Radionuclides in air (Radon and Thoron) 1.3 mSv

Building materials and rocks 0.35 mSv

Cosmic radiation 0.33 mSv

Food 0.25 mSv

HPA-RPD-001 2005
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 Variation across country

Cornwall

Derbyshire

Northamptonshire

Greater
Manchester

Isle of Wight

0 1 2 3 4 5 6
Effective Dose mSv pa

HPA-RPD-001 2005
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 Other sources
(effective dose)

• Discharges from nuclear industry

• Average in UK: 0.0009 mSv pa
• Highest critical group: local fishing community 0.3 mSv pa

• Smoke alarms
• Average dose if installed in bedroom 0.00006 mSv pa

• Air travel
• Average dose per year 0.01mSv pa (0.004mSv/h)
• Air crew 2mSv pa

• Medical
• CT chest 8 mSv
• Chest radiograph 0.02mSv

Average annual dose for individual in UK: ~0.4 mSv

HPA-RPD-001 2005
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 Collective dose comparison

% contribution

Medical, 15
Radon, 50

Rocks and
buildings, 13

Other, 0.5 Internal, 9.5

Cosmic, 12

HPA-RPD-001 2005

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 Occupational exposure

Average effective dose pa mSv

0 0.5 1 1.5 2 2.5

Fuel reprocessing
Power stations
Defence
General Industry
Coal miners
Non-coal miners
Aircrew

HPA-RPD-001 2005
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Medical occupational exposures

Radiographers

Diagnostic
Radiologists

Cardiologists

Interventional
Radiologists
Nuc Medicine
Radiographers

0 0.2 0.4 0.6 0.8

Average whole body dose pa.

HPA-RPD-001 2005
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When to expect effects

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 Tissue Reactions
(Deterministic Effects)

• Effects are certain to occur if

sufficient radiation dose is received
i.e. there are threshold doses

• Severity will depend upon the dose

received
Severity
• Radiation Protection? – stay below
the threshold doses

Threshold Dose

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 Threshold doses (Gy) –
to particular areas
•Bone marrow
•depression of cell production 0.5
•Skin
•early transient erythema 2-24 h 2
•temporary epilation 3w 3
•main erythema 10 d 6
8
•dry desquamation 4w
10
•necrosis 10 w
•Lens
•opacities 0.5
•Testes
•temporary sterility 0.15
•permanent sterility 3.5
•Ovaries
•sterility 2.5
•Heart or brain
•circulatory disease 0.5?

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 Threshold doses (Gy) –
acute whole body exposure

Absorbed Dose Principle effect contributing Time till death

(Gy) to death (days)

1-5 Damage to bone marrow 30-60

5-15 Damage to gastrointestinal tract 10-20

and lungs

15< Damage to CNS and 1-5

cardiovascular system

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 Reported injuries to staff

• Cataract formation
Threshold 0.5 Gy
(acute or protracted)

• Skin changes

Threshold 2–10 Gy

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 Patient injury
• Chronic occlusion of RCA
• Estimated skin dose: 27 Gy
• 2 procedures within 1 week
• 150 min fluoroscopy
• DAP: 1250 Gy.cm2
• First symptoms approx 4 weeks
after procedure
• Clear evidence of radionecrosis at
6 months
• Successfully treated with graft 8 months after procedure

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 Stochastic Effects
Probability of an effect depends upon total dose
received Effect Latency
period
Severity of effect is independent of the dose

Assumed there is no threshold (i.e. any dose is

potentially bad for you) Leukaemia, A few years
bone cancer
A bit like crossing the road - the more times you
cross the more likely you are to be run over.
Many solid 10 years <
Latency period (effect not seen immediately) tumours
Radiation Protection? – avoid any exposure if
possible

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 Where do we get our data?

• In vitro studies using proliferating cells

• primary physicochemical effects
• Relative Biological Effectiveness (RBE) of different
types of radiation

• In vivo studies and follow-up of exposed populations give

effect on organism
• tissue effects (case studies where effects seen)
• stochastic effects (statistical analysis of data
looking for excess cancer incidence)

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 Where do we get our data?

• Japanese A-Bomb survivors

• Medical exposures
• RT patients have provided evidence for
healthy tissue tolerances which allow
optimisation of treatment plans (OAR on
DVH)

• Occupational exposure
• Uranium miners
• Radium dial painters
• Radiation workers
• Astronauts
• Airline workers

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 Stochastic risk estimation
Current risk factors are principally based on Japanese A-
Bomb survivors but there are some limitations.

• Bomb data at high doses and dose rate

• Extrapolation to low dose and low dose rate for

radiation protection is ‘guess’ work at present

• Based on Japanese people – other races may react

differently to the radiation and have a different natural
incidence of disease

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 Linear No Threshold (LNT) Model adopted by ICRP
Low dose (100mSv) extrapolation

Higher risk
Risk

Lower risk
Linear no threshold (LNT)
Hormesis (adaptive response)
Threshold

Nuclear industry, High dose

Radiation workers, A-bomb survivors
Low dose A-bomb
50 100 Dose (mSv)

Model uses stochastic whole body exposure risk i.e. Effective Dose
Statistical significance
Cancer is cause of death for
1 in 4 in developed world

Difficult to detect small

excess radiation induced
cancers from low doses /
dose rates

Require populations
exposed to high dose / dose
rate to be statistically
significant (or very large
numbers of people exposed
to small doses)

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Dose and Dose Rate Effectiveness Factor

• Although LNT model is assumed, in practice

there is a DDREF

• Corrects for overestimation of risk due to

linear extrapolation from high to low dose

• ICRP and HPA-RPD presently use DDREF=2

• Applied below 0.2 Gy and 0.1 Gy/h

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 Risk Coefficients
• Various scientific bodies produce risk coefficients and they
change as new evidence comes to light
• ICRP 103 cancer risk

Whole population Working population (18-64)

5.5x10-2 per Sv 4.1x10-2 per Sv

Rule of thumb:

Combined detriment due to cancer and

heritable effects is ~5% per Sv i.e. 1 in 20,000

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HPA-CRCE-028 Risk Data

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Age Dependency of Cancer Risks
Relative risk of cancer
induction

Male
Female

0 20 40 60 80
Age at exposure

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 Hereditary effects

• Risk of serious hereditary ill health from

exposure of either parent was 1 in ~75,000
per mSv (ICRP60)

• Latest estimate – 1 in 500,000 per mSv

(ICRP103)

• Natural risk of significant congenital defects is

1 in 30

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 Effective Dose and Stochastic Risk
• Effective Dose was created by the ICRP in its system of radiation
protection to allow the summation of exposures, whether whole
body or partial-body, from internal and external sources. It
provides a single measure of dose to a reference person (average
age and gender) that is roughly proportional to the total ‘radiation
detriment’ from stochastic effects associated with the exposure.
ICRP defined radiation detriment to take account of life lost from
fatal cancers and heritable effects, and the reduced quality of life
associated with non-fatal cancers and heritable effects. (It
doesn’t include non-cancer effects at this stage)

• ED is calculated to represent a hypothetical uniform whole body

exposure i.e. all organs receive the same dose

• The LNT stochastic risk model is conservative, for radiation

protection purposes. It was developed by looking at populations
and is therefore not so good at calculating risk for individuals

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 Effective Dose and Stochastic Risk in RT
• The ED concept applies only to levels of dose in radiology
and nuclear medicine and is NOT appropriate to assess
dose levels in radiation therapy

• However, it can be used when thinking about radiation

protection of staff and concomitant imaging doses (provided
not MV imaging during treatment)

• That is because in order to estimate the risk of secondary

cancers in RT you need to take account of cell killing, repair
and repopulation effects in tissues receiving high doses –
work is needed in this area!

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 Irradiation in utero
• Lethality
• early stage threshold 0.1 Gy
• later stage threshold 1 - 2 Gy

• Malformations
• due to cell killing during organogenesis
• threshold 0.4 to 2.0 Gy

• Brain development
• between 8 to 25 weeks
• 30 IQ points per Gy

• Cancer
• increased risk of childhood (<15) cancer: 8 x 10-2 Gy-1
• dose constraint of 1 mSv equates to risk of 1 in 13,000
• natural risk in UK is 1 in 500

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 Everyday risks

risk of death/yr
smoking 10 cigarettes a day 1 in 200
heart disease 1 in 300
all cancers at 40 1 in 700
home accidents 1 in 15,000
road accident 1 in 17,000
playing football 1 in 25,000
accidents at work 1 in 43,000
homicide 1 in 100,000
taking the pill 1 in 500,000
struck by lightning 1 in 1,000,000
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