Manual on

THERAPEUTIC USES
OF IODINE-131
Incorporating:
Applications Guide
Procedures Guide
Basics Guide

,JCY
PRACTICAL RADIATION SAFETY
MANUAL

Manual on
THERAPEUTIC USES OF IODINE-131

incorporating:
Applications Guide
Procedures Guide
Basics Guide

INTERNATIONAL ATOMIC ENERGY AGENCY

MANUAL ON THERAPEUTIC USES OF IODINE-131
IAEA, VIENNA, 1996
IAEA-PRSM-6 (Rev.1)

I' IAEA, 1996

Permission to reproduce or translate the information

in this publication may be obtained by writing to the
International Atomic Energy Agency,
Wagramerstrasse 5, P.O. Box 100, A-1400 Vienna, Austria.
Printed by the IAEA in Austria
March 1996
 FOREWORD

The use of radiation sources of various types and activities is

widespread in industry, medicine, research and teaching in virtu-
ally all Member States of the IAEA and is increasing. Although a
number of accidents have caught the attention of the public in re-
cent years, the widespread use of radiation sources has generally
been accompanied by a good safety record. However, the control
of radiation sources is not always adequate. Loss of control of
radiation sources has given rise tounplanned exposures to workers,
patients and members of the public, sometimes with fatal results.
In 1990 the IAEA published a Safety Series book (Safety Se-
ries No. 102) providing guidance on the safe use and regulation of
radiation sources in industry, medicine, research and teaching.
However, it was felt necessary to have practical radiation safety
manuals for different fields of application aimed primarily at per-
sons handling radiation sources on a daily routine basis, which
could at the same time be used by the competent authorities, sup-
porting their efforts in the radiation protection training of workers or
medical assistance personnel or helping on-site management to
set up local radiation protection rules.
A new publication series has therefore been established. Each
document is complete in itself and includes three parts:
— Applications Guide — which is specific to each application of
radiation sources and describes the purpose of the practice, the
type of equipment used to carry out the practice and the precau-
tions to be taken.
— Procedures Guide — which includes step by step instructions
on how to carry out the practice. In this part, each step is
illustrated with drawings to stimulate interest and facilitate
understanding.
— Basics Guide — which explains the fundamentals of radiation,
the system of units, the interaction of radiation with matter, radi-
ation detection, etc., and is common to all documents.
The initial drafts were prepared with the assistance of S. Orr
(UK) and T. Gaines (USA), acting as consultants, and the help of
the participants of an Advisory Group meeting which took place in
Vienna in May 1989: J.C.E. Button (Australia), A. Mendonca
(Brazil), A. Olombel (France), F. Kossel (Germany), Fatimah,
M. Amin (Malaysia), R. Siwicki (Poland), J. Karlberg (Sweden),
A. Jennings (Chairman; UK), R. Wheelton (UK), J. Glenn (USA) and
A. Schmitt-Hannig and P. Zurtiga-Bello (IAEA).
 These drafts were revised by R. Wheelton from the National
Radiation Protection Board in the UK and B. Thomadsen from Wis-
consin University in the USA. In a second Advisory Group meeting
held in Vienna in September 1990, the revised drafts were
reviewed by P. Beaver (UK), S. Coornaert (France), P. Ferruz
(Chile), J. Glenn (USA), B. Holliday (Chairman; UK), J. Karlberg
(Sweden), A. Mendonca (Brazil), M.A. Mohamad-Yusuf (Malaysia),
J.C. Rosenwald (France), R. Wheelton (UK), A. Schmitt-Hannig
(Germany), and P. Ortiz and P. Zufiiga-Bello (IAEA). Finalization of
all six manuals was carried out by A. Schmitt-Hannig, Federal
Office for Radiation Protection (Germany) and P. Zufiiga-Bello
(IAEA).
 CONTENTS

Applications Guide 7

Principles of radioactive iodine-131 therapy 7

Radiation protection in iodine-131 therapy 8
Evaluation of exposure to personnel 11
Preparation for an iodine-131 treatment programme 11
Model rules for safe use of radiopharmaceuticals 12
Radiation safety check list for discharged patients
containing radionuclides 14
Instructions for family of released patient 15

Procedures Guide 16

Basics Guide for Users of Ionizing Radiation 47

Production of radiation 48
Radiation energy units 50
Radiation travelling through matter 50
Containment of radioactive substances 54
The activity of sources 55
Measurement of radiation 57
Radiation and distance 60
Examples of calculations 62
Radiation and time 63
Radiation effects 63
 APPLICATIONS GUIDE:
THERAPEUTIC USES OF IODINE-131

Principles of Radioactive lodlne-131 Therapy

As the distance from a source of radiation increases, the

intensity of the radiation from the source decreases as the
increase square of this distance. This principle can be
used to advantage by placing radioactive sources near
cancer cells so they receive high doses of radiation, while
normal, healthy cells further away receive lower, less
damaging doses. This form of treatment is called
brachytherapy. The ultimate approach is to place the radio-
active material inside the cancer cells themselves. In such
a case, the dose to the cell containing the radioactive
material becomes extremely high. If the normal cells do not
absorb the radioactive material, their dose remains quite
low. Because iodine is taken into thyroid cells, radioactive
iodine, usually the isotope 1-131, can be used in just such
a manner to treat some types of thyroid cancers, or for
treatment of thyroid hormone overproduction (hyper-
thyroidism).

For treatment with 1-131, a patient is given the material

either orally (solution or capsules) or intravenously. For
treatment of hyperthyroidism, patients usually take about
1 GBq of 1-131. Patients undergoing treatment for cancer
therapy often take from 3 to 6 GBq of 1-131. It is not recom-
mended to let the patient return home immediately.
Instead, he or she should be kept at the hospital for a
period of between some hours and several days. The
maximum activity at which a patient is allowed to return
home depends on national practice and on the individual
situation of the patient. It usually ranges between 0.2 and
1 GBq.

The physical characteristics of 1-131 are shown below.

lodine-131 emits both beta and gamma radiation. The dose
to the cells containing the iodine is mostly due to the emit-
ted beta particles and the dose at a distance is mostly due
to the gamma rays.
7
CHARACTERISTICS OF IODINE-131

Gamma factor Halt-value

S(MeV)
? (mSvat1m
p e r G B q x h)
layer in lead
(cm)

8 d beta 0.61 (max) 0.364 0.058 0.3

gamma

The activity of a sample of 1-131 decays over time with a

half-life of 8 days. Thus, a vial containing 2 GBq of 1-131
today will contain 1 GBq in 8 days, 0.5 GBq in 16 days, and
so on. In the body the amount of radioactive iodine
decreases much faster, because, in addition to radioactive
decay, the body also excretes iodine. In a normal person,
the amount of 1-131 in the body decreases by half about
every three days. The time required for the activity in the
body to fall by half is called the effective half-time. The
effective half-time can become much longer than 3 days
(but never longer than 8 days) in patients with certain
diseases which cause the retention of iodine.

Radiation Protection in lodine-131 Therapy

Radiation protection associated with 1-131 treatments

must address the hazards of radiation exposure and radio-
active contamination. Lost or unaccounted for radioactive
material has also to be considered.

Radiation exposure

The three main considerations are time, distance and

shielding.
Time: When preparing the radioactive material for a
patient, be sure to plan what to do and have all
equipment and containers ready before taking
the material out of the shielded container. Staff
coming in contact with a patient containing
radioactive iodine should not stay near the
patient longer than the time which is needed to
nurse the patient properly.
Distance: Never handle the radioactive material, either
the capsules or the vial containing the material
as a liquid, with the fingers; rather, use instru-
ments such as forceps. At all times, stay as far
from the sources as possible and still perform
necessary functions quickly. Nurses should
perform functions with as much distance
between them and the patient as possible,
without sacrificing patient care.

Shielding: lodine-131 should be kept behind shielding

(lead bricks in the storage room, or a shielded
transportation container when in transit),
except during assay and when being given to
the patient. Once the iodine is in the patient,
shielding barriers should be used to provide
some protection for the staff and visitors.
Usually, a centimetre or two of lead is required
to reduce the dose rates to acceptable levels.
Fluoroscopy aprons provide no protection
against the radiation from 1-131.

For the safety of the patients and the public, the dose rate
outside the room should be kept to acceptable levels, such
as 6 fiSv/h in areas to which the public has access. To
comply with these requirements it may be necessary to
shield the treatment rooms or to leave adjacent rooms
empty (except for other iodine therapy patients).

Radioactive contamination

When working with 1-131, radioactive contamination

always presents a potential hazard. The danger from such
contamination comes from the possibility that persons
working with either the material itself or a patient contain-
ing some iodine may take some of the radioactive iodine
into their body, giving high doses of radiation to their
thyroids. Iodine can be absorbed into the body by the
mouth, directly through the skin, or by inhaling vaporized
iodine in the air. The first line of defence against radio-
active contamination is to ALWAYS WEAR DISPOSABLE
PLASTIC WHEN WORKING WITH 1-131 OR INSTRU-
MENTS USED TO HANDLE 1-131.
9
Important sources of radioactive contamination include:

Airborne iodine vapours. Iodine gives off vapours. Solu-

tions containing 1-131 pose the greatest danger. Con-
tainers of 1-131 should always be stored and handled under
a fume hood. With respect to this risk, capsules should be
used instead of liquids.

Patients' body fluids. Approximately 80% of the iodine

given to a patient comes out in the urine during the first
24 hours. That means that the patient's urine contains
large amounts of 1-131. In all cases this urine must be col-
lected and treated as radioactive waste, according to the
local rules. It is good practice for thyroid cancer treatment
to store the urine of the first 24 hours after treatment in
closed containers in a locked and shielded room for
approximately two months to allow for decay, and then
release it to the sewer system. However, the best solution
is to treat the patient in a special room where the toilet is
connected to a separate storage container. When nursing
the patient the staff should always wear disposable plastic
gloves and aprons to protect clothing. Upon release of the
patient, the linen and cloths must be checked for contami-
nation, and if contaminated, must be cleaned separately.
Any item which cannot be cleaned must be stored in the
radioactive source storage room, where, over time,
through radioactive decay, the contamination will even-
tually disappear.

Contact with the source material. Radioactive iodine fre-

quently contaminates the outside of containers. The con-
tamination can be spread by people touching the container
itself, or the instruments used to handle the container.
Assume that all handling tools used with 1-131 could be
contaminated. Store them on disposable paper pads (to
prevent contamination of the tabletop) near the hood.
Never touch these instruments without wearing gloves,
and never use them for other purposes.

Spilling the material. To restrict the risk of contamination

from a vial accidentally spilled it should always stay on a
disposable, plastic backed absorbent pad on a tray with
lips around the edge to contain this contamination. In
Table II, model rules for the safe use of radiopharmaceuti-
cals are given.
10
Prevention of loss or unaccounted disappearance of
radioactive material

A careful accounting system for radioactive material from

its arrival through its use or disposal provides the best
prevention against loss. The system should include a
record book which contains at least the following informa-
tion: isotope, date, lot or batch number and the vial's serial
number, date of assay, total assay activity and volume.
The same information must also appear on labels for the
vials.

After being used, the vials themselves can be stored in a

locked storage room awaiting decay of the radioactivity
before being disposed of as normal waste.

Evaluation of Exposure to Personnel

Monitoring personnel working with 1-131 must include

evaluation of their exposure to the radiation from the
iodine, and whether they took any iodine into their body.
Their personal dosimeter indicates the exposure level. To
make sure that there is no significant amount of iodine
taken into their body, they could have a thyroid count, just
as the patients do.

Preparation for an lodlne-131 Treatment Programme

Before an 1-131 treatment programme is started, it should

be ensured that:
(1) All staff involved in planning the programme are
properly trained and know the rules as given in
Table II.
(2) The facility has a radioactive storage and prepara-
tion room with a shielded area under a hood for
storage of the material. The room should have walls
and floors with surfaces that are easy to clean. The
storage room should not be a passageway, nor a
shared room such that persons not involved with the
1-131 treatments spend time in the room. The storage
facility should provide secure closure to prevent
unauthorized access to the sources, and also main-
tain acceptable radiation levels, such as 20 ^Sv/h, to
11
 persons around the facility. A thick leaded glass win-
dow protects the eyes of persons working with the
sources.
(3) The treatment room could be either a room adjacent
to the storage and preparation room or the patient
room itself, which should have walls and floors with
surfaces that are easy to clean.
(4) The facility has an adequate supply of long handled
instruments for use in handling the sources, trays
with lips and absorbent pads.
(5) All persons involved in the programme have and
wear personal dosimeters and there are two Geiger
counters available: one for use in the storage room,
and one outside the storage room for use if a source
spills and contaminates the other detector.
(6) An accounting system has been established to keep
track of the source material.
(7) A proper system has been established for radio-
active waste disposal, especially for urine disposal.
lodine-131 provides effective treatment for some thyroid
patients, but can be dangerous if approached casually, or
without thorough preparation.

Model Rules for Safe Use of Radiopharmaceuticals

You may use the following model rules or, if you prefer,
develop your own similar rules for safe use of radio-
pharmaceuticals.

MODEL RULES
(1) Wear laboratory coats or other protective clothing at
all times in areas where radioactive materials are
used.
(2) Wear disposable gloves at all times while handling
radioactive materials.
(3) Either after each procedure or before leaving the
area, monitor your hands for contamination in a low
background area with a crystal probe or camera.
(4) Use a syringe shield for routine preparation of multi-
dose vials and administration of radiopharmaceuti-
cals to patients, except in those circumstances in
12
 which their use is contraindicated (e.g. recessed
veins, infants). In these exceptional cases, consider
the use of other protective methods such as remote
delivery of the dose (e.g. through the use of a butter-
fly valve).
(5) Do not eat, drink, smoke or apply cosmetics in any
area where radioactive material is stored or used.
(6) Do not store food, drink or personal effects in areas
where radioactive material is stored or used.
(7) Wear personnel monitoring devices at all times while
in areas where radioactive materials are used or
stored. These devices should be worn as prescribed
by the Radiation Safety Officer. When not being
worn to monitor occupational exposures, personnel
monitoring devices should be stored in the work
place in a designated low background area.
(8) Wear a finger exposure monitor during the elution of
the generator, during the preparation, assay and
injection of radiopharmaceuticals and when holding
patients during procedures.
(9) Dispose of radioactive waste only in designated,
labelled and properly shielded receptacles.
(10) Never pipette by mouth.
(11) Wipe-test all byproduct material storage, preparation
and administration areas weekly for contamination. If
necessary, decontaminate or secure the areas for
decay.
(12) With a radiation detection survey meter, survey the
generator storage, kit preparation and injection
areas daily for contamination. If necessary, decon-
taminate or secure the area for decay as appropriate.
(13) Confine radioactive solutions in shielded containers
that are clearly labelled. Radiopharmaceutical multi-
dose diagnostic vials and therapy vials should be
labelled with the isotope, the name of the compound
and the date and time of receipt or preparation. A
logbook should be used to record the preceding
information and total prepared activity, specific
activity as Bq/cm 3 at a specified time, total volume
prepared, total volume remaining, the measured
activity of each patient dosage, and any other
appropriate information. Syringes and unit dosages
should be labelled with the radiopharmaceutical
name or abbreviation, type of study, or the patient's
name.
13
(14) Assay each patient dosage in the dose calibrator
before administering it. Do not use a dosage if it is
more than 10% off from the prescribed dosage,
except for prescribed dosages of less than 10 /iCi.
When measuring the dosage, you need not consider
the radioactivity that adheres to the syringe wall or
remains in the needle. Check the patient's name and
identification number and the prescribed radio-
nuclide, chemical form and dosage before
administering.
(15) Always keep flood sources, syringes, waste and
other radioactive material in shielded containers.
(16) Because even sources with small amounts of radio-
activity exhibit a high rate on contact, you should use
a cart or wheelchair to move flood source waste and
other radioactive material.

Radiation Safety Check List for

Discharged Patients Containing Radionuclides

Name of patient: Age:

Address: Tel. No.:

Name of person interviewed:

Description of dwelling:
In multifamily buildings, possible proximity of neighbours.
Household: Names, relationships, ages:

Regular visitors to dwelling:

Persons regularly visited by patient outside dwelling:

Matters discussed:
Handling of extruded source
Importance of separate beds
Importance of distance
Importance of special care in regard to young persons
Procedure in case of hospitalization or death
Film badges issued:
Identification card, or wristband issued:

Date:
Physician or Radiation
Protection Supervisor

This should be a part of the patient's record

14
 Instructions for
Family of Released Patient

Name of patient:
Name of hospital: Address: Tel. No.:
For further information contact: Tel. No.:
Please show this form to every physician consulted concerning
the patient until
(date)
was treated on: , 19
(Name of patient)

with GBq of in the form of

NO SPECIAL RADIATION SAFETY PRECAUTIONS ARE
NECESSARY AFTER
(date)

UNTIL THAT DATE:

Persons under 45 years of age should not remain closer than the
following distances from the patient, for the time period indicated:
a) to
(date) (date)
Permissible distance metres or more, for hours per week.
(At other times, remain farther than 2 metres.)
b) to
(date) (date)
Permissible distance metres or more, for hours per week.
(At other times, remain farther than 2 metres.)
Note: During the above times brief periods of closer contact (for
example while shaking hands, or kissing the patient) are
permissible.

SPECIAL PRECAUTIONS:
a) Spouse or other person caring for patient:

b) Children or pregnant women:

c) Sleeping arrangements:

IF THE PATIENT IS TO BE HOSPITALIZED, OR IF DEATH

SHOULD OCCUR, NOTIFY THE FOLLOWING INDIVIDUAL(S)
IMMEDIATELY:

A copy of this form should be kept with the patient's record.

15
PROCEDURES GUIDE: THERAPEUTIC USES OF IODINE-131

Follow authorized procedures when carrying out iodine therapy.

Only trained personnel who have had medical examinations and wear a
dosimeter should carry out iodine therapy. In normal circumstances, such per-
sonnel should not have received greater than the dose limit (50 mSv to the whole
body) in the current calendar year.
Before proceeding with the work, read and ask questions about these safety
guides. Discuss the contributions all the personnel involved will make to this
important work.
Make sure that the integrity of the shielding is correct and that the hood's
exhaust is working properly.
oo

'I
V

=
=£=»
After each preparation the surface should be monitored to detect possible con-
tamination. Make sure that the rates in the source storage room are checked
periodically (for example every six months) and that they are below acceptable
levels, such as 20 /*Sv/h.
 When ordering 1-131, be sure the delivery service knows where in the hospital
to deliver the material. Make sure that the package is expected and that no one
will open it upon arrival.

CO
IV)
o

Upon receiving a package of 1-131, put on a pair of disposable plastic gloves.

Check the box. If the box looks damaged in any way, contact your supervisor.

\
 Wear your personal dosimeter when working in the source storage room. Before
entering the room, make sure that a Geiger counter is available in the source
storage room and that it is working properly: check the batteries of the counter,
and test the counter with a check source, if available; take note of the reading
before entering the room. Be aware of the sound of the Geiger counter as you
work in the room. If the counter sounds more active than usual without explana-
tion (such as removing a vial of 1-131), leave the room and contact your super-
visor or radiation expert.

ro
 When working with radioactive iodine, keep the sources behind shielding blocks
whenever possible and handle the vials with forceps or similar long handled
instruments.

ro
 Prepare the sources so that the correct activity is given according to the following
rules:
\ (1) Keep the vials under the hood and on trays with lips, lined with plastic
backed absorbent pads.
(2) Keep vials in their lead shielded containers at all times.
(3) Always use a lead syringe holder
(4) Cover the container with lead after use.
(5) Do not smoke, eat or drink.

/ V^^J
 Check the activity using an activity meter, such as a well type ionization cham-
ber, which has been properly calibrated.

en
Enter the information about the use of the iodine for the patient in the logbook
If the administration of 1-131 to the patient takes place far from the preparation
room, use a transport container with absorbent pads.
Make sure that a 'Caution: Radioactive Materials' sign is on the transport con-
tainer, marked with '1-131', the activity and the date. Take the prepared sources
to where they will be used, travelling by the most direct route that avoids the
more heavily occupied areas.
Administer the iodine to the patient according to one of the following procedures:
Procedure 1: Administration by taking iodine capsules.
— Remove the lead container from the transport box and put it on the table
close to the patient.
— Have the patient remove the vial from the lead container and take the
capsules himself.
— Make sure that all precautions are taken in case of patient vomiting (see
emergency procedures).
Procedure 2: Administration by taking iodine in liquid form.
— Remove the lead container from the transport box and put it on the table
close to the patient.
— Have the patient sip the liquid using a straw or pipette.
— Rinse the vial at least two times and have the patient drink the liquid.
— Make sure that all precautions are taken in case of patient vomiting (see
emergency procedures).
Procedure 3: Intravenous administration
— Take out from the vial the required amount of activity using a shielded
syringe.
— Put it in an infusion bottle where the iodine is diluted.
— Link the bottle to the patient using an inravenous catheter.
— Keep the patient in bed until the bottle is empty.
— Remove the bottle and the catheter and dispose of them as radioactive
waste.
If appropriate, move in shields to provide some protection for the nursing staff.
Remember that shielding must be quite thick to protect from 1-131 radiation.
Fluoroscopy aprons provide no protection against the radiation from 1-131.
Make sure that a copy of radiation isolation nursing instructions (a sample can
be found in the Applications Guide) and a 'Caution: Radioactive Materials' sign
is on the door to the patient's room and in the patient's chart. Write the allowed
times (see the Applications Guide) in the instructions.
Make sure that the nursing staff is aware of the following rules:
Pregnant staff may not enter the room.
Minimize the time spent near the patient, while still performing necessary
nursing care.
Keep as far from the patient as possible while performing nursing duties
and stand behind the shield when possible.
Wear disposable plastic gloves whenever touching anything in the room,
and leave the gloves in the garbage container in the room when leaving.
Wear a gown over clothing if handling a urine bag or bed pan.
Only adult visitors are allowed in the room. They should be properly
instructed about precautions to be taken against radiation exposure
through contamination.
Urine must be collected or flushed down the toilet according to the local
rules. Excreta can be flushed down the toilet without any problem. Make
sure the nursing staff knows who to contact in case of a problem.
(8) Bed linen and cloths must be checked for contamination at the end of the
treatment.
Return the transport box, lead container and vial to the material storage room.
Store the vial for decay with other waste contaminated with iodine.
The patient should be kept at least two hours and, if possible, one day in the
hospital. In the case of cancer treatment, the patient should generally be held
several days. In all cases, the dose rate at 1 m from the patient should be down
to acceptable levels, such as 5 /*Sv/h. Appropriate instructions should be given
to patients containing radioactive materials.
Check the room with a Geiger counter to detect any significant contamination.
Give special attention to linen and clothes, door handles, telephones, etc. Any-
thing that shows 'counts' more than three times the background is considered
contaminated, and must be cleaned as described below or disposed of as radio-
active waste.
Some situations may occur which require special actions, such as the following:
EMERGENCY 1: IF A SHIPMENT OF 1-131 FAILS TO ARRIVE ON
SCHEDULE, OR WITHIN A REASONABLE TIME
THEREAFTER
Check first all possibilities in the hospital, then call the company and inform them
of the failure so they can trace the shipment and find out where the radioactive
material is.
CO
00

EMERGENCY 2: IF A SMALL AMOUNT OF LIQUID IODINE SPILLS

Quickly blot the spill with an absorbent pad to keep it from spreading.
Take a plastic bag which should be always available, to hold articles contami-
nated during the cleaning, and some damp paper towels. Remove the pad from
the spill, and wipe with a towel from the edge of the contaminated area toward
the centre.
•ft
o

-1 Dry the area and wipe it with a paper towel moistened with alcohol. Test the towel
for radioactivity with a Geiger counter. Any count in excess of three times the
background count rate indicates contamination. If contamination is still found
upon counting, repeat the cleaning with paper towels. A mild solvent cleaning
fluid may be used, but very abrasive cleansers should be avoided. After cleaning,
repeat the wipe test. Continue the cycle of cleaning and wipe testing until the
wipe sample indicates less than three times background. Notify your supervisor
of the situation.
EMERGENCY 3: IF LARGE AMOUNTS OF LIQUID IODINE SPILLS (vial
itself, urine, vomit)
KEEP CALM! Cover the spill with absorbent pads to contain the liquid.
Close door and windows and notify everyone in the room that radioactive liquid
has been spilled.
Everyone in the room go the the door and kick off their shoes with their feet, step-
ping out of the room as their feet leave their shoes. DO NOT WALK FURTHER!
Remove your gloves and shoes if they have been in contact with the spill and
leave them together with anything which could be contaminated by the spill.
Close the door.
Call for assistance. If no one can hear, one person only should walk no further
than is necessary to find someone to call a radiation expert and get a Geiger
counter. (The one left in the room may be contaminated.)
Using the Geiger counter, measure the radiation count rates all over the bodies
of those persons who were in the room, with particular attention to the hands and
feet.
Remove immediately any contaminated clothing and place it in a large plastic
bag or other container and dispose as radioactive waste.
Wash any contaminated skin with a mild soap and plenty of water; do not use
a hard brush, or abrasive soap. After washing, take measurements again with the
Geiger counter. The washing and measuring should be repeated until no counts
above background can be measured or until the count rate does not change after
three cycles of washing. Skin moisturising lotion should be applied between
washings, if available.
BASICS GUIDE FOR USERS OF
IONIZING RADIATION

47
 BASICS GUIDE FOR USERS OF
IONIZING RADIATION

Production of Radiation

Radioactive substances are predictable and continuous

emitters of energy. The energy emitted can be in the form
of alpha (a) particles, beta (0) particles and gamma (7)
rays. Interaction of these radiations with matter can, in
certain circumstances, give rise to the emission of X rays
and neutron particles.

Gamma and X rays consist of physical entities called pho-

tons that behave like particles, suffering collisions with
other particles when interacting with matter. However,
large numbers of photons behave, as a whole, like radio or
light waves. The shorter their wavelength the higher the
energy of the individual photons.

The very high energy of gamma rays and their ability to

penetrate matter results from their much shorter wave-
lengths.

Y-rays Optical light Microwave

X-rays Heat Radio

44 _ c * S>
01 n, 01 O C
. 2 ^ «; = o -o
> .o oi >, o !r

Spectrum of radiations similar to gamma rays.

48
X rays are produced by an X ray machine only when it is
electrically supplied with thousands of volts. Although they
are similar to gamma rays, X rays normally have longer
wavelengths and so they carry less energy and are less
penetrating. (However, X rays produced by linear accelera-
tors can surpass the energies of gamma radiation in their
ability to penetrate materials.) The output of X radiation
generated by a machine is usually hundreds or even thou-
sands of times greater than the output of gamma radiation
emitted by a typical industrial radioactive source. However,
typical teletherapy sources are usually thousands of times
greater in output than industrial radiography sources.

The gamma rays from iridium-192 (192lr) are of lower ener-

gies than those of cobalt-60 (""Co). These are useful
differences which allow selection from a wide range of
man-made radionuclides of the one that emits those radia-
tions best suited to a particular application.

Beta particles are electrons and can also have a range of

energies. For example, beta particles from a radionuclide
such as hydrogen-3 (3H) travel more slowly and so have
almost one hundredth of the energy of the beta particles
from a different radionuclide such as phosphorus-32 (^P).

Neutron particle radiation can be created in several ways.

The most common is by mixing a radioactive substance
such as americium-241 (241Am) with beryllium. When it is
struck by alpha particles emitted by the americium-241,
beryllium reacts in a special way. It emits high energy, fast
neutrons. Americium-241 also emits gamma rays and so
from the composite americium-241 /beryllium source are
produced. Another way to create neutrons is using a
radiation generator machine combining high voltages and
special targets. Special substances in the machine com-
bined with high voltages can generate great numbers of
neutrons of extremely high energy.

Alpha particles in general travel more slowly than beta par-

ticles, but as they are heavier particles they are usually
emitted with higher energy. They are used in applications
which require intense ionization over short distances such
as static eliminators and smoke detectors.
49
Radiation Energy Units

A unit called the electron-volt (eV) is used to describe the

energy of these different types of radiation. An electron-
volt is the energy aquired by an electron accelerated
through a voltage of one volt. Thus, one thousand volts
would create a spectrum (range) of energies up to
1000 eV. Ten thousand volts would create X rays of up to
10 000 eV. A convenient way of expressing such large
numbers is to use prefixes, for example:

1000 eV can be written as 1 kiloelectron-volt (1 keV);

10 000 eV can be written as 10 kiloelectron-volts (10 keV);
1 000 000 eV can be written as 1 megaelectron-volts (1 MeV);
5 000 000 eV can be written as 5 megaelectron-volts (5 MeV).

Radiation Travelling Through Matter

As radiation travels through matter it collides and interacts

with the component atoms and molecules. In a single colli-
sion or interaction the radiation will generally lose only a
small part of its energy to the atom or molecule. However,
the atom or molecule will be altered and becomes an ion.
Ionizing radiation leaves a trail of these ionized atoms and
molecules, which may then behave in a changed way.

After successive collisions an alpha particle loses all of its

energy and stops moving, having created a short, dense
trail of ions. This will occur within a few centimetres in air,
the thickness of a piece of paper, clothing or the outside
layer of skin on a person's body. Consequently, radio-
nuclides that emit alpha particles are not an external haz-
ard. This means that the alpha particles cannot cause
harm if the alpha emitter is outside the body. However,
alpha emitters which have been ingested or inhaled are a
serious internal hazard.

Depending upon their energy, beta particles can travel up

to a few metres in air and up to a few centimetres in sub-
stances such as tissue and plastic. Eventually, as the beta
particle loses energy, it slows down considerably and is
absorbed by the medium. Beta emitters present an internal
hazard and those that emit high energy beta particles are
also an external hazard.
50
Radionuclide Type of radiation Range of energies (MeV)

Americium-241 alpha 5.5 to 5.3

gamma 0.03 to 0.37
Hydrogen-3 beta 0.018 maximum
Phosphorus-32 beta 1.7 maximum
lodine-131 beta 0.61 maximum
gamma 0.08 to 0.7; 0.36
Technetium-99m gamma 0.14
Caesium-137 beta 0.51 maximum
(Barium-137m) gamma 0.66
lridium-192 beta 0.67 maximum
gamma 0.2 to 1.4
Cobalt-60 beta 0.314 maximum
gamma 1.17 and 1.33
Americium-241/ neutron 4 to 5
beryllium gamma 0.06
Strontium-90/ beta 2.27
(Yttrium-90) beta 2.26
Promethium-147 beta 0.23
Thalium-204 beta 0.77
Gold-198 beta 0.96
gamma 0.41
lodine-125 Xray 0.028
gamma 0.035
Radium-226 alpha 4.59 to 6.0
beta 0.67 to 3.26
gamma 0.2 to 2.4

Heavier atoms such as those of lead do absorb a greater

part of the beta's energy In each interaction but as a result
the atoms produce X rays called bremsstrah lung. The
shield then becomes an X ray emitter requiring further
shielding. Lightweight (low density) materials are therefore
the most effective shields of beta radiation, albeit requiring
larger thicknesses of material.
51
 Maximum beta Maximum range
Radionuclide particle
energy Air Plastic Softwood Aluminium
(MeV) (mm) (mm) (mm) (mm)

Promethium-147 0.23 400 0.6 0.7 0.26

Thalium-204 0.77 2400 3.3 4.0 1.5
Phosphorus-32 1.71 7100
Strontium-90/
Yttnum-90

Gamma rays and X rays are more penetrating. However,

as they cause ionization they may be removed from the
beam or lose their energy. They thus become progres-
sively less able to penetrate matter and are reduced in
number, that is attenuated, until they cease to be a serious
external hazard.

One way of expressing the quality or penetrating power of

gamma and X rays also provides a useful means of
estimating the appropriate thickness of shields. The half
value thickness (HVT) or the half value layer (HVL) is that
thickness of material which when placed in the path of the
radiation will attenuate it to one half its original value. A
tenth value thickness (TVT) similarly reduces the radiation
to one tenth of its original value.

HVT and TVT values (cm) in various materials

Hadiation Lead Iron Concrete
producer
HVT TVT HVT TVT HVT TVT

Technetium-99m 0.02
Iodine-131 0.72 2.4 4.7 15.7
Caesium-137 0.65 2.2 1.6 5.4 4.9 16.3
lridium-192 0.55 1.9 1.3 4.3 4.3 14.0
Cobalt-60 1.1 4.0 2.0 6.7 6.3 20.3
100 kVp X rays 0.026 0.087 1.65 5.42
200 kVp X rays 0.043 0.142 2.59 8.55

Material which contains heavy atoms and molecules such

as steel and lead provide the most effective (thinnest)
shields for gamma radiation and X rays.
52
 PAPER PLASTIC STEEL LEAD WAX

NEUTRONS

The penetrating properties of ionizing radiations.

Neutrons behave in complex ways when travelling through

matter. Fast neutrons will scatter (bounce) off much larger
atoms and molecules without losing much energy.
However, in a collision between a neutron and a small
atom or molecule, the latter will absorb a proportion of the
neutron's energy. The smallest atom, the hydrogen atom,
is able to cause the greatest reduction in energy.

Hydrogenous materials such as water, oil, wax and poly-

thene therefore make the best neutron shields. A compli-
cation is that when a neutron has lost nearly all its energy
it can be 'captured', that is absorbed whole by an atom.
This often results in the newly formed atom becoming a
radionuclide, which in many instances would be capable of
emitting a gamma ray of extremely high energy. Special
neutron absorbing hydrogenous shields contain a small
amount of boron which helps to absorb the neutrons.

Damage to human tissue caused by ionizing radiation is a

function of the energy deposited in the tissue. This is
dependent on the type and energies of the radiations being
used. Hence the precautions needed to work with different
radionuclides also depend on the type and energy of the
radiation.
53
Containment of Radioactive Substances

Radioactive substances can be produced in any physical

form: a gas, a liquid or a solid. Many medical and most
industrial applications use sources in which the radioactive
substance has been sealed into a metal capsule or
enclosed between layers of non-radioactive materials.
Often these sources are in 'Special Form' which means
that they are designed and manufactured to withstand the
most severe tests, including specified impact forces,
crushing forces, immersion in liquid and heat stress,
without leaking radioactive substance.

A sealed source, showing the encapsulated

radioactive substance.

All sealed sources are leak tested after manufacture and

the test (also called a wipe test) must be repeated periodi-
cally throughout the working life of the source. More fre-
quent testing is required for sealed sources which are used
in harsh environments or in applications that are likely to
cause them damage. Most sealed sources can remain
leak-free and provide good, reliable service for many years
but eventually must be safely disposed of and replaced
because the activities have decayed below usable levels.

Sealed sources present only an external hazard. Provided

that the source does not leak there is no risk of the radio-
active substance being ingested, inhaled or otherwise
being taken into a person's body.

Unsealed radioactive substances such as liquids, powders

and gases are likely to be contained, for example within a
bottle or cylinder, upon delivery, but may be released and
54
manipulated when used. Some unsealed sources remain
contained but the containment is deliberately weak to
provide a window for the radiation to emerge. Unsealed
radioactive substances present both external and internal
hazards.

A bottle of radioactive liquid.

The rubber cap sealing the bottle may be removed
or pierced to extract liquid.

The Activity of Sources

The activity of a source is measured in becquerels (Bq) and

indicates the number of radionuclide atoms disintegrating
per second (dps or s"1).

1 Becquerel is equivalent to 1 atom disintegrating

per second

Industrial and medical applications usually require sealed

sources with activities of thousands or millions of bec-
querels. A convenient method of expressing such large
numbers is to use prefixes, for example:

1 000 becquerels is written 1 kilobecquerel (1 kBq);

1 000 000 becquerels is written 1 megabecquerel (1 MBq);
1 000 000 000 becquerels is written 1 gigabecquerel (1 GBq);
1 000 000 000 000 becquerels is written 1 terabecquerel (1 TBq).
55
The activity of a source is dependent on the half-life of the
particular radionuclide. Each radionuclide has its own
characteristic half-life, which is the time it will take for the
activity of the source to decrease to one half of its original
value. Radionuclides with short half-lives are generally
selected for medical purposes involving incorporation into
the body via oral, injection or inhalation, whereas those
with relatively longer half-lives are often of benefit for medi-
cal, therapeutic (external or as temporary inserts) and
industrial applications.

Radionuclide Half-life8 Application

Technetium-99m 6.02 h Medical diagnostic imaging

lodine-131 8.1 d Medical diagnostic/ therapy
(incorporated)
Phosphorus-32 14.3 d Medical therapy (incorporated)
Cobalt-60 5.25 a Medical therapy (external)
Industrial gauging/radiography
Caesium-137 28 a Medical therapy (temporary
inserts)
Industrial gauging/radiography
Strontium-90 28 a Industrial gauging
lridium-192 74 d Industrial radiography, or
medical therapy
Radium-226 1620 a Medical therapy (temporary
inserts)
Iodine-125 60 d Medical diagnostic/therapy
Americium-241 458 a Industrial gauging
Hydrogen-3 12.3 a Industrial gauging
Ytterbium-169 32 d Industrial radiography
Promethium-147 2.7 a Industrial gauging
Thalium-204 3.8 a Industrial gauging
Gold-198 2.7 d Medical therapy
Thulium-170 127 d Industrial radiography

a
The abbreviation 'a' stands for 'year'.

When radioactive substances are dispersed throughout

other materials or dispersed over other surfaces in the
56
form of contamination, the units of measurement which are
most commonly used are:
(a) for dispersion throughout liquids Bq • mL~1
(b) for dispersion throughout solids Bq-g* 1
(c) for dispersion throughout gases
(most particularly air) BqrrT 3
(d) for dispersion over surfaces Bqcm"2
An older unit of activity which is still used, the curie (Ci),
was originally defined in terms of the activity of 1 gram of
radium-226. In modern terms:

1 Curie is equivalent to 37 000 000 000 dps, that is 37 GBq:

1 nCi 1 nC\ 1 mCi 1 Ci 10 Ci

—I 1 1 1 1-
37 Bq 37 kBq 37 MBq 37 GBq 37 TBq

Measurement of Radiation

Ionizing radiation cannot be seen, felt or sensed by the

body in any other way and, as has already been noted,
damage to human tissue is dependent on the energy
absorbed by the tissue as a result of ionization. The term
used to describe energy absorption in an appropriate part
or parts of the human body is 'dose'.

The modern unit of dose is the gray (Gy). However, in prac-

tical radiation protection, in order to take account of certain
biological effects, the unit most often used is the sieved
(Sv). For X ray, gamma and beta radiation, one sieved
corresponds to one gray. The most important item of
equipment for the user is a radiation monitoring device.
There are instruments and other devices that depend on
the response of film or solid state detectors (for example,
the film badge or thermoluminescent dosimeters).

Two types of instruments are available: dose rate meters

(also called survey meters) and dosimeters.
Modern dose rate meters are generally calibrated to read
in microsieverts per hour (/tSv-h~1). However, many ins-
truments still use the older unit of millirem per hour
(mremh' 1 ). 10 /*Svh" 1 is equivalent to 1 mremh" 1 .
57
 — BATTERIES

A typical dose rate meter.

Neutron radiation can only be detected using special dose

rate meters.
Most dose rate meters are battery powered and some have
a switch position that enables the user to check the battery
condition, i.e. that it has sufficient life remaining to power
the instrument. It is important that users are advised not to
leave the switch in the battery check position for long
periods and to switch off when not in use. Otherwise the
batteries will be used unnecessarily.

A check that an instrument is working can be made by

holding it close to a small shielded source but some instru-
ments have a small inbuilt test source. Workers should be
instructed on the use of test sources since regular checks
will not only increase their own experience but give them
confidence and provide early indication of any faults. It is
important that users recognize the great danger of relying
on measurements made using a faulty instrument.

A dosimeter measures the total dose accumulated by the

detector over a period of time. For example, a dosimeter
would record 20 /*Sv if it was exposed to 10 /tSv-h"1 for
two hours. Some dosimeters can give an immediate read-
ing of the dose. Others, like the film badge and the thermo-
luminescent dosimeter (TLD), can only provide a reading
after being processed by a laboratory.
58
 (a) Electronic
dosimeter

(b) Thermoluminescent
dosimeter

(c) Film badge

dosimeter

Personnel dosimeters.

A third type of instrument will be needed by users of

unsealed sources: a surface contamination meter. This is
often simply a more sensitive detector which should be
used to monitor for spillages. When the detector is placed
close to a contaminated surface the meter normally only
provides a reading in counts per second (cps or s~') or
sometimes in counts per minute (cpm or min'1). It needs
to be calibrated for the radionuclide in use so that the read-
ing can be interpreted to measure the amount of radio-
active substance per unit area (Bqcrrr 2 ). There are many
surface contamination meters of widely differing sensi-
tivities. The more sensitive instruments will indicate a
very high count rate in the presence of, for example
1000 B q c m ' 2 of iodine-131, but different detectors mea-
suring the same surface contamination will provide a lower
reading or possibly no response at all. When choosing a
detector it is best to use one that has a good detection effi-
ciency for the radionuclide in use and gives an audible indi-
cation. The internal hazard created by small spillages can
then be identified and a safe working area maintained.
59
 A typical surface contamination meter.

Radiation and Distance

Ionizing radiation in air travels in straight lines. In such

circumstances the radiation simply diverges from a radio-
active source and the dose rate decreases as the inverse
square of the distance from the source.

For example:

If the measured dose rate at 1 m is 400

the expected dose rate at 2 m is 100
the expected dose rate at 10 m is 4
the expected dose rate at 20 m is 1 ^Svh~ 1 ; etc.

Distance has a major effect in reducing the dose rate.

Solid shields in the radiation path will cause the radiation
to be attenuated and also cause it to be scattered in
various directions. The actual dose rate at a point some
distance from a source will not be due only to the primary
radiation arriving from the source without interaction.
Secondary radiation which has been scattered will also
contribute to the dose rate.

However, it is simple to calculate the dose rate at a dis-

tance from a source. The primary radiation energies will be
constant and known if the radionuclide is specified.
60
 After measuring the dose rate, estimates can be
made of the dose rates at different distances
from the source.

The dose rate is obtained using the equation:

Gamma factor x Source activity

Dose rate
(Distance) 2

Gamma factor is the absorbed dose rate in mSv-h 1 at

1 m from 1 GBq of the radionuclide;
Activity of the source is in gigabecquerels;
Distance is in metres from the source to the point of
interest.

Gamma emitting Gamma factor

radionuclide r
Ytterbium-169 0.0007
Technetium-99m 0.022
Thulium-170 0.034
Caesium-137 0.081
lridium-192 0.13
Coball-60 0.351

However, the dose rate from the source is best determined

using a reliable dose rate meter.
61
 Notation for the examples of calculations.

Examples of Calculations

(1) What will be the dose rate at 5 m from 400 GBq of

iridium-192?

T x A 0.13 x 400
Dose rate = mSvh"
d2

= 2.08 mSv-rr 1

(2) A dose rate of 1 mGy-h 1 is measured at 15 cm

from a caesium-137 source. What is the source's
activity?

Dose rate = 1 mSv-rr 1

0.081 x activity _„__

mSv-rr
0.0225

1 x 0.0225
Activity = GBq = 0.278 GBq
0.081

(3) A dose rate of 780 ^Gy-h' 1 is measured from

320 GBq cobalt-60. How far away is the source?

Dose rate = 0.78 m S v h " 1

_ 0.351 x 320
mSv-rr
" d*

/ 0.351 x 320
Distance m = 12 m
~ \ 0.78
62
(4) A 1.3TBq iridium-192source isto be used. What dis-
tance will reduce the dose rate to 7.5 jiGyh" 1 ?

Dose rate = 0.0075 m G y h " 1

0.13 x 1.3 x 1000

d2

,/ 0.13 x U.3 x 1000

Distance = m = 150 m
"N 0.00
0.0075

(5) A dose rate of 3 mSv-h 1 is measured at 4 m from

a gamma emitting source. At what distance will the
dose rate be reduced to 7.5 S 1 ?

Gamma factor x Activity

Dose rate =
(Distance)2
Gamma factor x Activity is the source output and is con-
stant. Therefore, Dose rate x (Distance)2 is constant.
Hence, 0.0075 x d 2 = 3 x 4 2

, 3 x 42
d = m
0.0075

80 m

Radiation and Time

Radiation dose is proportional to the time spent in the radi-

ation field. Work in a radiation area should be carried out
quickly and efficiently. It is important that workers should
not be distracted by other tasks or by conversation.
However, working too rapidly might cause mistakes to
happen. This leads to the job taking longer, thus resulting
in greater exposure.

Radiation Effects

Industrial and medical uses of radiation do not present

substantial radiation risks to workers and should not lead
to exposure of such workers to radiation in excess of any
level which would be regarded as unacceptable.
63
Possible radiation effects which have been considered by
the international bodies (e.g. the International Commission
on Radiological Protection, International Atomic Energy
Agency) are:
(a) Short term effects such as skin burns and eye
cataracts;
(b) Long term effects such as an increased disposition
to leukaemia and solid cancers.

Current recommendations for dose limitations are con-

tained in IAEA Safety Series No. 115. In summary, these
are:

(a) No application of radiation should be undertaken

unless justified;
(b) All doses should be kept as low as achievable, eco-
nomic and social factors being taken into account;
and
(c) In any case, all doses should be kept below dose
limits.

For reference, the principal dose limits specified in IAEA

Safety Series No. 115 are:

Adult workers 20 mSv per year

(averaged over five years)
Members of the public 1 mSv per year.

o
r-
o
to
O)
64
Printed by the IAEA in Austria
March 1996
IAEA-PRSM-6 (Rev.1)