FINAL PROGRAM

55th Annual Meeting of the Health Physics Society

(American Conference of Radiological Safety)

22nd Biennial Campus Radiation Safety Officers Meeting

27 June - 1 July 2010 Salt Palace Convention Center

Salt Lake City, Utah

8:30 AM-Noon 150 ABC

WAM-E: NCRP Special Session - Overview of Current

Report and Conference Activities of the National

Council on Radiation Protection and MeasurementsCo-Chairs: Thomas Tenforde, Rich-

ard Toohey8:30 AM WAM-E.1Overview of Current Report and Conference Activities of National Council on Radiation Protection and Measurements (NCRP)Tenforde, T.S.National Council on Radiation Pro-tection and MeasurementsReports of Program Area Com-mittee 1 on Basic Criteria, Epide-miology, Radiobiology and Risk9:00 AM WAM-E.2Scientific Committee 1-16 Report on “Uncertainties in the Estimation of Radiation Risks and Probability of Disease Causation”Hoffman, F.O.SENES Oak Ridge, Inc.9:15 AM WAM-E.3Scientific Committee 1-17 Report on “Second Cancers and Cardiopulmo-nary Effects after Radiotherapy”Gilbert, E.S., Travis, L.B.National Cancer Institute, University of Rochester Medical CenterReports of Program Area Com-mittee 2 on Operational Radiation Safety9:30 AM WAM-E.4Scientific Committee 2-3 Report on “Fluoroscopically Guided Interven-tional Procedures”Balter, S.Columbia University

9:45 AM WAM-E.5Report No . 162 on “Self Assess-ment of Radiation Safety Programs”Myers, D.S.Lawrence Livermore Laboratory, LivermoreReports of Program Area Com-mittee 4 (PAC 4) on Radiation Protection in Medicine10:00 AM Break in Exhibit Hall10:30 AM WAM-E.6Overview of Current NCRP Activi-ties in Radiation Protection in Medi-cineBushberg, J.T.University of California, Davis Health System10:45 AM WAM-E.7Scientific Committee 4-2 Report on “Population Monitoring and Radio-nuclide Decorporation Following a Radiological or Nuclear Incident”Vetter, R.Mayo ClinicReports of Program Area Com-mittee 5 on Environmental Ra-diation and Radioactive Waste Issues11:00 AM WAM-E.8Scientific Committee 5-1 Report on “Approach to Optimizing Decision Making for Late-Phase Recovery from Nuclear or Radiological Terror-ism Incidents”Chen, S.Argonne National Laboratory

11:15 AM WAM-E.9Scientific Committee 64-22 Report on “NCRP Scientific Committee 64-22: Design of Effective Radiological Effluent Monitoring and Environ-mental Surveillance Programs”Kahn, B.Georgia Institute of TechnologyReports of Program Area Com-mittee 6 on Radiation Measure-ments and Dosimetry11:30 AM WAM-E.10Summary of NCRP Report No . 158: “Uncertainties in the Measurement and Dosimetry of External Radia-tion”Simon, S.L., Beck, H.L.National Cancer Institute11:45 AM WAM-E.11Scientific Committee 6-3 Report on “Uncertainties in Internal Radiation Dose Assessment”Bouville, A., Bell III, R.National Cancer Institute

Overview of Current Report and Conference Activities of NCRP

Thomas S. TenfordePresident

NCRP Special Session55th Annual Health Physics Society Meeting

Salt Lake City, UtahJune 30, 2010

1929: U.S. Advisory Committee on X-ray and Radium Protection

1946: U.S. National Committee on Radiation Protection

1964: National Council on Radiation Protection and Measurements (NCRP) chartered by U.S. CongressLauriston Sale Taylor

June 1, 1902 – November 26, 2004

NCRP History

Cornerstones of role in radiation health protection:

1. Provide information and recommendations in the public interest about:a. protection against radiation; andb. radiation measurements, quantities and units.

2. Develop basic concepts of radiation protection;3. 3) Facilitate effective use of combined resources

of organizations concerned with radiation protection;

4. Cooperate with national and international governmental and private organizations; and

5. Disseminate the results of the Council’s work.

Key Elements of NCRP’s CharterUnder U.S. Public Law 88-376

RadiationProtectionin Medicine

Radiation Bioeffects: Mechanisms &Dose Response

Operational & Environmental

Radiation Safety

Homeland Security: Nuclear/Radiological

Terrorism Countermeasures

RadiationDosimetry &

Measurements

Focal Areas of NCRP Reports and Conferences

Nuclear Energy & Health/Environmental

Protection

NCRP Strategic Program Plan

Detection of Terrorist Weapons & Materials:

• Commentary No. 16: Screening of Humans for Security Purposes Using Ionizing Radiation Scanning Systems (2003)

• Commentary No. 17: Pulsed Fast Neutron Analysis System Used in Security Surveillance (2003)

• Commentary No. 20: Radiation Protection and Measurement Issues Related to Cargo Scanning with Accelerator-Produced High- Energy X Rays (2007)

NCRP Publications on Nuclear and Radiological Terrorism

Detection of Terrorist Weapons & Materials:

In 2009-2014 NCRP is preparing a series of six Commentaries (2) and Reports (4) on Radiation Health Protection Aspects of the U.S. Department of Defense Program to Develop Active Detection Technologies (ADTs) for Nuclear and Radiological Materials That Represent a Threat to National Security [ADT methods under consideration include high-intensity bremsstrahlung radiation, monoenergetic gamma rays, and particulate radiations including neutrons, protons, and muons]

NCRP Publications on Nuclear and Radiological Terrorism (cont.)

Countermeasures to Terrorism Acts:• Report No. 138: Management of Terrorist

Events Involving Radioactive Material (2001) • Commentary No. 19: Key Elements of

Preparing Emergency Responders for Nuclear or Radiological Terrorism (2005)

• Proceedings of 40th Annual NCRP Meeting (April 14-15, 2004): Advances in Consequence Management for Radiological Terrorism Events [published in Health Physics, Vol. 89(5), 2005]

NCRP Publications on Nuclear and Radiological Terrorism (cont.)

Countermeasures to Terrorism Acts:• Report No. 161 (2 volumes – Handbook and

Scientific and Technical Bases): Management of Persons Contaminated with Radionuclides (2008)

• Report No. 165: Responding to Radiological and Nuclear Terrorism: A Guide for Decision Makers (2010)

• Report of Scientific Committee 4-2: Population Monitoring and Radionuclide Decorporation Following a Radiological or Nuclear Incident (publication expected in 2010)

NCRP Publications on Nuclear and Radiological Terrorism (cont.)

NCRP Publications on Nuclear and Radiological Terrorism (cont.)

Late-Phase Recovery from an Act of Terrorism:

• Report of Scientific Committee 5-1: Approach to Optimizing Decision Making for Late-Phase Recovery from Nuclear or Radiological Terrorism Incidents (publication expected in 2013)

• Report No. 155: Management of Radionuclide Therapy Patients (2006)

• Report No. 159: Risk to the Thyroid from Ionizing Radiation (2008)

• Proceedings of the 43rd Annual NCRP Meeting (April 16-17, 2007): Advances in Radiation Protection in Medicine [published in Health Physics, Vol. 95(5), 2008]

Radiation Protection in Medicine

Radiation Protection in Medicine (cont.)

Reports in preparation:• Scientific Committee 1-17: Second Cancers

and Cardiovascular Effects After Radiotherapy (publication expected in 2010)

• Scientific Committee 2-3: Radiation Dose Management for Fluoroscopically Guided Interventional Medical Procedures (publication expected in 2010)

• Scientific Committee 4-3: Diagnostic Reference Levels in Medical Imaging: Recommendations for Application in the United States (publication expected in 2011)

Radiation Protection in Medicine (cont.)

Reports in preparation (cont.):

• Scientific Committee 4-4: Adverse Effects of Radiation on the Gonads, Embryo, and Fetus (publication expected in 2011)

• Summary of Workshop on Computed Tomography in Emergency Medicine: Ensuring Appropriate Use (September 23-24, 2009); basis for 2010 consensus paper on “Guidelines for Application of Computed Tomography in Emergency Medicine”

• Report No. 156: Development of a Biokinetic Model for Radionuclide-Contaminated Wounds and Procedures for Their Assessment, Dosimetry and Treatment (2006)

• Report No. 158: Uncertainties in the Measurement and Dosimetry of External Radiation (2007)

• Report No. 163: Radiation Dose Reconstruction: Principles and Practices (2009)

• Report No. 164: Uncertainties in Internal Radiation Dosimetry (2009)

Dosimetry and Measurements

• Report No. 152: Performance Assessment of Near-Surface Facilities for Disposal of Low-Level Radioactive Waste (2005)

• Report No. 154: Cesium-137 in the Environment: Radioecology and Approaches to Assessment and Management (2006)

• Report No. 157: Radiation Protection in Educational Institutions (2007)

Operational Health and Environmental Radiation Protection

Operational Health and Environmental Radiation Protection (cont.)

• Report No. 162: Self Assessment of Radiation Safety Programs (2010)

• Scientific Committee 64-22: Design of Effective Effluent Monitoring and Environmental Surveillance Programs (publication expected in 2011)

• Report of Scientific Committee 2-5: Investigation of Radiological Incidents (publication expected in 2012)

Fundamental Radiobiology and Health Protection

• Scientific Committee 1-13: Potential Impact of Individual Genetic Susceptibility and Previous Radiation Exposure on Radiation Risk for Astronauts (publication expected in 2010)

• Scientific Committee 1-16: Uncertainties in the Estimation of Radiation Risks and Probability of Disease Causation (publication expected in 2011)

• Scientific Committee 1-20: Variation in Biological Effectiveness of Photons as a Function of Energy (publication expected in 2013)

• Primary Goal: Prepare definitive publication(s) during 2011 to 2016 on biological effects and potential human health implications of exposure to low dose and low dose-rate radiation; planning workshop held at NCRP on December 1-2, 2008

• Important topics under consideration include: – up-to-date reviews of laboratory and human

epidemiology studies– effects of radiation quality and dose rate– integration of results into reliable, predictive

models of human health effects at low doses– health protection and regulatory implications of

findings, and effective communication of projected risks of low-dose radiation exposure

NCRP’s Strategic Initiative on Biological and Human Health Effects of Low-Dose Radiation

Areas of Increasing Importance to NCRP are the Safety, Health and Environmental Protection Aspects

of a Growing Nuclear Industry Worldwide(Proceedings of 2009 Annual Meeting to be

published in Health Physics in 2010)

The hallmark of NCRP activities is providing reliable recommendations for radiation protection policies and practices based on scientific consensus

• View NCRP website at http://NCRPonline.org• View and purchase NCRP publications at

http://NCRPpublications.org• Proceedings of 2010 Annual Meeting: Communication

of Radiation Benefits and Risks in Decision Making will be published in Health Physics in 2011

• NCRP 2011 Annual Meeting: Scientific and Policy Challenges of Particle Radiations in Medical Therapy and Space Missions

• March 7-8, 2011 at Hyatt Regency Conference Center in Bethesda, Maryland

NCRP’s Primary Role in Radiation Health Protection Guidance

Scientific Committee 1-16

Uncertainties in Estimationof Radiation Risks and

Probability of Causation

F. Owen Hoffman

SENES Oak Ridge, Inc 102 Donner Dr.

Oak Ridge, TN 37830

Members of NCRP SC 1-16

• Julian Preston (Chair)

• John Boice• Bertrand Brill• Ranajit

Chakraborty• Rory Conolly• Richard Hornung

• Roy E. Shore• Gayle Wolschak• Owen Hoffman

(Advisor)• Charles Land

(Advisor)• David C. Kocher

Objectives of NCRP SC 1-16

• Analyze uncertainty relating absorbed organ doses to the risk of disease– Including cancer, non-cancer, and severe

genetic defects• Build upon recent NCRP reports that

address uncertainty in– External dose (SC 6-1)– Internal dose (SC 6-3)– Dose reconstruction (SC 6-4)

Uncertainties Addressed by NCRP SC 1-16

• Extrapolation of risk from the Life Span Study (LSS) of Japan– to the US and other populations with

baseline rates different than in Japan

• Extrapolation of risk from acute exposure– to chronic and fractionated exposures

• Extrapolaton of risks from exposure to external radiation sources– to exposure to internal emitters

Sources of Uncertainty Addressed by NCRP

SC 1-16

• Extrapolation of risk estimates from high energy gamma ray exposures to situations involving– low energy photons

– low energy electrons

– neutrons of various energies

– alpha particles

• Modify or reduce uncertainty in risk estimates by– combining information from epidemiology

and biological studies– combining information from multiple

epidemiological cohorts using meta and pooled analyses

• Evaluate effect of dose uncertainty on risk estimation– Size, shape, and confidence interval of the

dose-response function

Evaluation of Uncertainties

• Contrast uncertainties for risks to individual organs with– Risks to related groups of organs– Risks to all tumors combined from

uniform whole body exposure

• Evaluate methods to quantify combined uncertainty in risk from – Uncertainty in dose– Uncertainty in risk per unit dose

Evaluation of Uncertainties

• Evaluate risk and uncertainty – using mortality versus morbidity as risk

endpoint • Evaluate uncertainty in lifetime risks

for populations versus subgroups– subgroups identified by age, sex, lifestyle,

and other factors affecting the baseline risk

• Evaluate the effect of variations in baseline risks for different population subgroups

Evaluation of Uncertainties

Evaluation of Uncertainties• Uncertainty in risk depends on

assessment objectives– Lifetime risk to populations vs. subgroups

vs. individuals– Probability of Causation/Assigned Share

(PC/AS) for an individual with a specific disease diagnosed in a given year

• Risk uncertainty in decision-making– Required by law (EEOICPA) for Federal

radiation worker compensation program– Role of risk and uncertainty in situations

unrelated to compensation is less clear

Progress to Date within NCRP SC 1-16

• Work still in progress– internal drafting stage

• Once initial draft completed– it will be subjected to several rounds of

review, revision, and editing before a final report is issued

• Some subjects will be referred to other committees for further evaluation– e.g., NCRP SC 1-20, risk of exposure to

low energy photons

1

SC 1-17: Second Cancers and Cardiac

Effects After Radiotherapy

Ethel Gilbert National Cancer Institute

Lois B. Travis, Chair SC-17University of Rochester Medical Center

55th Annual Health Physics Society MeetingSalt Lake City, Utah

June 30, 2010U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Institutes of Health

Natio

nal C

ance

r Ins

titut

e

SC 1-17 Committee Members

Lois B. Travis, Chair U. of Rochester Medical Center

John Boice, Vice-chair International Epidemiology Institute

Kimberly Applegate Riley Hospital for Children

Louis S. Constine U. of Rochester Medical Center

Andrea Ng Brigham and Women’s Hospital

Ching-Hon Pui St. Jude’s Children’s Hospital

Xie George Xu Rensselaer Polytechnic Institute

Ethel Gilbert National Cancer Institute

Ann Kennedy U. of Pennsylvania Medical School

Joachim Yahalom Memorial Sloan-Kettering Cancer Ct.

James Allan, Consultant Newcastle U. Medical School

Patients with Cancer* 5 y Relative Survival Rate

* Cancer at all sites; all age, race and sex groups.

Cancer Survivorship: U.S.• 12.1 million survivors as of 2007 • Number has tripled since 1971• 3% of U.S. population

Complications of Cancer and Its Treatment

Medical (multiple organ systems) • Second primary cancers• Cardiac disease • Hematologic, pulmonary, renal,

endocrine, gonadal• Neurologic, fatigue, weight gain

Psychosocial (anxiety, depression) Societal (employment, insurance)

SC 1-17: Second Cancers and Cardiac Effects After Radiotherapy

“The primary purpose of this Report is to provide a comprehensive assessment of the risk of second primary cancers and cardiac disease following radiotherapy among the growing number of cancer survivors worldwide.”

Sections of the Report

1. Executive Summary2. Introduction3. Radiobiology and cancer biology4. Epidemiologic Methods5. New Radiotherapy Methodologies and

Technologies6. Radiotherapy: Dosimetry7. Genetic underpinnings8. Second cancer risks in adults and children9. Dose-response relationships10. Cardiac effects11. Conclusions and recommendations

External Beam Radiotherapy

• Used in treatment of cancer since the 1920’s

• Exposes not only the tumor but surrounding tissues – Dose drops exponentially with distance from

tumor– Dose to nearby tissues can exceed 20 Gy,

depending on tumor dose

Estimated Mean Dose (Gy) from 35 Gy

to Mantle or Inverted-Y

Fields (Hodgkin Lymphoma)

Organ or site Mantle Inverted-YBrain 0.4 0.02Larynx 18 0.06Thyroid 35 0.08Breast 24 1.3Lung 14 1.5Upper esophagus 35 0.08Lower esophagus 27 11Stomach 1.4 13Pancreas 1.0 20Bladder 0.05 21

Changes in Radiotherapy

• Ability to concentrate energy deposition in the tumor has increased dramatically

• Modern treatment planning has benefitted by the ability to visualize tumors in 3 dimensions

• Has led to decreases in dose to surrounding tissues

New Modalities of Radiotherapy

• Intensity modulated radiation therapy (IMRT)– Improved tumor coverage– Reduced high dose to normal tissues– Increased medium/low-dose exposure

• Proton and heavy ion therapy• Tomotherapy• Gamma knife and cyber knife• Electron beam therapy• Neutron therapy

Epidemiologic Studies to Evaluate Second Cancer Risk

• Long-term follow-up necessary– Can not directly evaluate risks of most recent

treatments

• Direct study needed because of very large doses

Epidemiologic Studies to Evaluate Second Cancer Risk

• Cohort Studies– Defined group of 1st cancer survivors

followed for subsequent cancer– Limited treatment data – Evaluate patterns of risk by site, gender,

latency, age at exposure, attained age

• Case-Control Studies– Study cases and sample of matched controls– Collect detailed treatment data– Dose-response analyses

Findings from Cohort Studies

• Little evidence of radiotherapy-related risk until at least 5 years after 1st cancer diagnosis

• Excess risk can persist for 30+ years

• Relative risks are largest for patients who are young at 1st cancer diagnosis

• Absolute risks increase with increasing attained age

Primary Cancers and Radiation- Related Second Cancers

Primary cancer

Second cancers associated with radiation therapy

Hodgkin lymphoma

Breast, lung, esophagus, stomach, pancreas, colorectal, skin, thyroid, sarcoma, head and neck, mesothelioma, leukemia

Testicular cancer

Lung, thyroid, esophagus, stomach, pancreas colorectal, renal, bladder, sarcoma, mesothelioma, leukemia

Breast cancer

Contralateral breast, lung, sarcoma, esophagus, leukemia

Prostate Bladder, colorectal, sarcomaCervical Bladder, renal, rectal, uterine, ovarian, leukemia

Case-Control Studies

• Report reviews studies with individual dose estimates for several 2nd cancers:– Leukemia, Breast, Lung, Thyroid, Bone,

Brain• Dose-response analyses

– Quantify risk as a function of dose– Evaluate shape of dose-response

• Modification of dose-response by other risk factors such as chemotherapy, smoking, etc.

Dose-Response for Leukemia Following Cervical Cancer

(Boice et al. 1987)

Dose-Response for Breast Cancer Following Hodgkin Lymphoma

(Travis et al. 2003)

Dose (Gy)

Cases/Controls

Relative Risk (95% CI)

0.0-3.9 15/76 1.04.0-6.9 13/30 1.8 (0.7 – 4.5)

7.0-23.1 16/30 4.1 (1.4 – 12)23.2-27.9 9/30 2.0 (0.7 – 5.9)28.0-37.1 20/31 6.8 (2.3 – 22)37.2-40.4 12/31 4.0 (1.3 – 13)40.5-61.3 17/29 8.0 (2.6 – 26)

Dose-Response for Thyroid Cancer Following Childhood Cancer

(Sigurdson et al. 2005)

Cardiac Disease

• Cardiac disease increased among survivors of lymphoma, breast cancer, testicular cancer

• Effects of radiotherapy on cardiac disease not as well studied as second cancers

• Absolute risks could be large

Cumulative Incidence of Cardiac Disorders Following Childhood Cancer

(Mulrooney 2009)

Overarching Research Recommendations

• Institute long-term and large-scale follow- up of existing cancer survivors– Children of special importance– Develop integrated measures to evaluate the

life-long burden according to prior treatment – Integrate epidemiologic studies with molecular

and genetic approaches • Establish prospective cohorts of cancer

patients– Newer treatments (e.g. IMRT, proton therapy)– Include biological samples

Areas of Specific Recommendations

• Dose-response• Adolescent and young adult cancer

survivors• Molecular and genetic underpinnings• Interactions between radiotherapy and

other risk factors• Comparison of risk of second cancers

and cardiac disease after different radiation modalities

• Risk prediction models

1

RADIATION DOSE MANAGEMENT FOR FLUOROSCOPICALLY GUIDED

INTERVENTIONAL MEDICAL PROCEDURES (NCRP Scientific Committee 2-3)

Stephen Balter, Ph.D.(on behalf of the scientific committee)Health Physics Society -

Salt Lake City –

June 2010

Timeline and Status

•

NOV/DEC 2009 –

NCRP Program Area Committee Review

•

FEB/MAR 2010 –

NCRP Council and Outside Review

•

JUL 2010 –

Pending Council Approval (subject to further revisions)

•

Publication Expected in 3rd

or 4th

Quarter 2010

Intent

•

Addressed to policy makers.•

Not a complete how-to handbook.

•

Supplements other NCRP reports.•

Background material on clinical procedures is included.

•

Related nonradiation

risks are reviewed.

SC 2-3 Members

•

Stephen Balter, Chair, Columbia University •

Donald L. Miller, Vice Chair, USUHS

•

Beth A. Schueler, Vice Chair, Mayo Clinic •

Jeffrey A. Brinker, Johns Hopkins Hospital

•

Charles E. Chambers, Penn State College•

Kennith

F. Layton, Baylor University Medical Center

•

M. Victoria Marx, University of Southern California•

Cynthia H. McCollough, Mayo Clinic

•

Keith J. Strauss, Harvard Medical School•

Louis K. Wagner, U. of Texas Medical School

SC 2-3 Consultants

•

John F. Angle, University of Virginia•

Lionel Desponds, GE Healthcare

•

Andrew Einstein, Columbia University•

John W. Hopewell, University of Oxford

•

Norman J. Kleiman, Columbia University•

Matthew Williams, Columbia University

•

Marvin Rosenstein, NCRP Staff Consultant

Organization of the Report•

Executive Summary

31 Recommendations•

Main Sections–

Clinical, Dosimetry, Biology

–

Fluoroscopic Equipment and Facilities–

Protection of the Patient

–

Protection of Staff–

Administrative and Regulatory Considerations

•

Appendices (12) •

References (>425)

Uses ICRU Report 74 Style Notation

•

Ka,r = air kerma

at the reference point

•

PKA

= air kerma-area product

•

Ka,i

= incident air kerma•

Dskin,e

= entrance skin dose•

Dtissue,max

= peak tissue dose

A Patient Undergoing an FGI Procedure Is Not an ICRP “Average”

Person

ICRP population

•

M:F = 1:1•

Reference size

•

All ages•

Average health

•

Average life expectancy

Patient population

•

M:F variable•

Variable size

•

Older•

Sick individuals

•

Decreased life expectancy

Patient Benefits of FGI Procedures

•

Relief of symptoms•

Improvement in quality of life

•

Increased life span•

Decreased morbidity and shorter recovery time as compared to more invasive treatments

Risk

Radiation risk should be one of the many risks included in the risk-benefit analysis of FGI procedures.

Effective Dose

Effective Dose (E) shall not be used for quantitative estimates of stochastic radiation risk for individual patients or patient groups.

Effective dose (E) may be used as a qualitative indicator of stochastic radiation risk for classifying different types of procedures into broad risk categories.

Special Populations

Equipment that is routinely used for pediatric procedures should be appropriately designed, equipped, and configured for this purpose. Procedure planning for FGI procedures on pregnant patients shall include feasible modifications to minimize dose to the embryo-fetus.

Potentially-High Radiation Dose Procedures

A FGI procedure should be classified as a potentially-high radiation dose procedure if more than 5 % of cases of that procedure result in Ka,r exceeding 3 Gyor PKA exceeding 300 Gy cm2 .Potentially-high radiation dose procedures should be performed using equipment designed for this intended use.

Patient Dose Records

Patient dose data shall be recorded in the patient’s medical record at the conclusion of each procedure. This shallinclude all of the following that are available from the system: Dskin,max, Ka,r, PKA, fluoroscopy time, number of fluorographic images.

Fluoroscopy time should not be used as the only dose indicator during potentially-high radiation dose FGI procedures.

All available dose indicators shall be used in such procedures.

Fluoroscopy time is a poor dose metric !

≈

2,100noncardiac

interventionsKa,r

= 0.41 + 0.037 FminR2

= 0.50

RAD-IR I

≈

1,700 coronary-artery proceduresKa,r = 0.53 + 0.12 Fmin

R2

= 0.68

IAEA-SRS 59

Substantial Dose Procedures I

If a substantial radiation dose level is exceeded, the interventionalist shallplace a note in the medical record, immediately after completing the procedure, that justifies the radiation dose level used.

Default values: •

Ka,r

> 5 Gy•

PKA

> 500 Gy

cm2

•

Fluoroscopy time > 60 min

Substantial Dose Procedures II

If a substantial radiation dose level is exceeded, the patient and any caregivers should be informed, prior to discharge, about possible deterministic effects and recommended follow-up.

Follow-up for possible deterministic effects shallremain the responsibility of the interventionalist for at least one year after an FGI procedure. Follow-up may be performed by another healthcare provider.

All relevant signs and symptoms shall be regarded as radiogenic unless an alternative diagnosis is established.

Patient Quality and Safety Management

Facilities shall have a process to review all relevant radiation doses for patients undergoing FGI procedures.Guidance levels, based on measured dosimetric quantities (in particular PKA or Ka,r to manage stochastic effects and overall performance, and Ka,r to manage deterministic effects) should be used for quality assurance purposes.•

Stochastic risk

•

Deterministic injuries

Protective Barriers

All spaces outside the procedure room (including control rooms) should be designed to limit E to not more than 1 mSv y−1. Spaces within the FGI-procedure room intended exclusively for routine clinical monitoring of patients (or similar activities) should be shielded to limit E to not more than 1 mSv y−1.Door interlocks that interrupt x-ray production shall not be permitted at any entrances to FGI-procedure rooms.

Protection of Staff

Determinations of occupational doses shall take into account the personal protective equipment used by each individual in the FGI environment.A collar monitor may be used to estimate equivalent dose to the lens of the eye if a worker exclusively uses under-table x-ray geometry; otherwise an eye dose monitor should be placed on the collar or closer to the lens of the eye.… A single personal monitor worn under the protective apron shall not be used in the FGI environment.

Dose Limits -

Staff

Policies and procedures shouldbe in place so that in the event of a time-critical urgent or emergent situation, as defined in this Report, advanced provision exists for exceeding an annual occupational dose limit.

Investigations

Investigations should occur if personal monitor readings for an individual are substantially above or below the expected range for that individual’s duties.

23

Training, Privileges, and Supervision

A FGI procedure shall be performed or supervised only by a physician or other medical professional with fluoroscopic and clinical privileges appropriate to the specific procedure.Every person who operates or supervises the use of FGI-equipment shall have current training in the safe use of that specific equipment.

24

Equipment Quality

Interventionalists and qualified physicists should participate in the process for purchase and configuration of new fluoroscopes and fluoroscopy facilities. A qualified physicist shall perform acceptance and commissioning tests before first clinical use of new, newly installed, or newly repaired fluoroscopy equipment, and shall perform subsequent periodic tests.

5

NCRP

Report No. 162

Self Assessment of Radiation Safety

Programs

David Myers, CHPLawrence Livermore National Lab

Program Area Committee 2: Operational Radiation Safety -

Rpt.134 -

Operational Radiation Safety Training (2000)

-

Rpt.144 -

Radiation Protection of Particle Accelerators

(2003)

-

Rpt.147 -

Structural Shielding Design of Medical Imaging

Facilities (2004)

-

Rpt.151 -

Structural Shielding Design for Photon

Radiotherapy Facilities (2005)

-

Rpt.157 -

Radiation Protection in Educational Institutions

(2007)-

Rpt.162 -

Self Assessment of Radiation Safety Programs

(2010)

Definition of Self Assessment

•

Process that institution uses to review its own activities and performance in relation to:

-

Regulations

-

Standards

-

Internal policies

-

Implementing procedures

-

Best Practices

- Goals

•

Institution controls what is assessed and who does it

•

Tailored to size and complexity of program

Why Should

HP’s be Interested?

•

Most operational HP’s have lots of experience in being audited or inspected

•

Typically have less experience in assessing their own programs

•

Useful for evaluating existing programs

•

Good place to start on if you don’t have a program

General Objectives and Specific Purposes of SA•

Identify and correct deficiencies and improve performance

•

Specific purposes

-

ensure a safe workplace

-

assess compliance

-

encourage continuous improvement

-

identify noteworthy practices

-

identify areas for further evaluation

-

provide opportunity for learning

Three Primary Types

of Assessment

•

Compliance-Based-

does program meet regulations?

•

Risk-Based-

what could go wrong?

•

Performance based-

evaluates overall effectiveness and efficiency of program

-

most comprehensive of the three types of assessment

Institutional Responsibilities for Self Assessment

•

Upper management -

provide support and resources

•

Line Management -

encourage worker participation

•

Radiation Safety Program Personnel -

develop and

implement SA program

•

Workers -

need to actively participate

•

Minimize conflict-of-interest

Self Assessment Planning

•

Selecting program elements to be assessed (e.g., external dosimetry, training, ALARA program, contamination control)

•

Establish the schedule to cover all program elements

•

Is an external audit on the schedule?

•

Reviewing past self assessment results

•

Identifying the necessary resources

Methods and Techniques for Performing Self Assessments•

Evaluate monitoring results –

personnel dosimetry,

radiation surveys, swipes, etc.

•

Workplace observations –

minimize disruptions

•

Interviews of workers –

avoid leading questions

•

Use of checklists –

should be institution specific

•

Document review –

incidents and unplanned exposures

Conducting the Assessment

•

Entrance meeting to introduce participants

•

Discussion of assessment activities with participants

•

Daily team conferences –

coordinate activities

•

Management briefings –

frequent updates (particularly if

any serious deficiencies are found)

•

Exit meeting –

no surprises

Documentation and Follow-up Activities•

Written report –

avoid personal information

•

Communication of assessment results and recommendations

•

Legal considerations –avoid drawing legal conclusions

•

Development of corrective action plan

•

Follow-up on corrective actions

PAC 2 Committee Members

Report 162 available: http://NCRPpublications.org

Dave Myers, Chair

Edgar Bailey

Ken Miller

Carol Berger

John Poston

Mary Birch

Kathy Pryor

John Frazier

Josh Walkowicz

Eric Goldin

James Yusko

NCRP Overview Program Area Committee 4

Radiation Protection in Medicine

Jerrold T. Bushberg Ph.D., DABMPScientific Vice-President

National Council on Radiation Protection and Measurements

Bethesda, Maryland

Health Physics Society Annual MeetingNCRP Special Session

Salt Lake City, UTJune 30, 2010

PAC 4 Membership, Jerrold T. Bushberg, Vice President

• E. Stephen Amis• James A. Brink• John F. Cardella• Cindy C. Cardwell• Marc Edwards• Donald P. Frush• Ronald E. Goans

• Linda A. Kroger• Edwin M. Leidholdt• Fred A. Mettler, Jr.• Theodore L. Phillips• J. Anthony Seibert• Stuart C.White• Shiao Y. Woo

PAC 4 Membership Broad Base of Experience & Expertise

Presidents ACR, ARR, CRCPD, ASTRO, AAPM, RRS5 Chairs of Radiology / Radiation OncologyExperts in CV & IR Radiology, Pediatric Radiology, Radiation Oncology, Nuc Med, Dentistry & Occup medExperts in Dx, Nuc Med & Therapy PhysicsMembers of Image Gently & Image WiselyExperts in Hospital Radiation Safety State & Fed RegulatoryExperts on acute & chronic effects of medical radiation.Members & Advisors to ICRP, IAEA, FDA, UNSCEAR, IOM…

Over 300 person-y of experience in Radiation Protection in Medicine

Recent NCRP Publications

Report No.161 (2009):Management of Persons Contaminated

With Radionuclides: William J. Bair, ChairUpdate & expansion of 1980 NCRP Report No. 65, Management of Persons Accidentally Contaminated with Radionuclides

Management of Persons Contaminated With Radionuclides

Broader coverage of radionuclides & possible exposure and response scenariosMultipurpose handbook that provides quick reference information for early actions & longer-term management and treatmentIssued in two volumes– Volume I: Handbook for managing contaminated persons– Volume II: Provides the scientific and technical bases for the

recommended management procedures including detailed discussions of internal dosimetry models

Management of Persons Contaminated With Radionuclides

Volume I Contains Four Major Sections:Section 1: Update of the “yellow” section of NCRP Report No. 65; contains quick reference information for emergency responderSection 2: Recommendations on onsite and pre-hospital actions that should be taken by responders;Section 3: Extensive discussion of actions that should be taken in the treatment of contaminated patients at a medical facility;Section 4: Recommendations on post-treatment follow-up and guidance on contamination control in handling decedents

Current PAC 4 Scientific Committees

SC 4-2 Report:Population Monitoring and Decontamination Following a Nuclear or Radiological Incident”Richard Vetter, Chair

SC 4-3 Report: Diagnostic Reference Levels in Medical Imaging: Recommendations for Application in the United States, James Brink, Chair

Sc 4-4 Report:Risks of Ionizing Radiation to the Developing Embryo, Fetus and Nursing Infant, Robert Brent, Chair

ICRP introduced the concept of DRLs in ReportNo. 60 (1990), and subsequently recommended their use in ICRP Report No.73 (1996). DRLs serve as a means to investigate and identify practices where the level of patient dose or administered activity is unusually high, relative to benchmark data.The goal is to optimize the dose and image qualityDRLs are not intended for regulatory or commercial purposes or to establish a legal standard of care.

SC 4-3: Diagnostic Reference Levels (DRLs) in Medical Imaging

Recommendation for Application in the U.S.

SC 4-3: Diagnostic Reference Levels (DRLs) in Medical Imaging

Recommendation for Application in the U.S.

DRLs are defined, developed and utilized in different way around the world. The NCRP report will contain a comprehensive discussion of the history and applications of DRLs in the U.S., Europe, and elsewhere.The report will consolidate and recommend

DRLs in adults & children for a number of examinations: Radiography, Fluoroscopy, CT, Interventional Procedures, Dental and Nuclear Medicine.

SC 4-4: Risks of Ionizing Radiation to the Developing Embryo, Fetus and Nursing Infant

Supersedes:--1977 NCRP Report 54 Medical Radiation Exposure of Pregnant and Potentially Pregnant Women--1994 Commentary No. 9 Considerations Regarding the Unintended Radiation Exposure of the Embryo, Fetus or Nursing Child

SC 4-4: Risks of Ionizing Radiation to the Developing Embryo, Fetus and Nursing Infant

The report will provide a comprehensive update and discussion of:Birth defects and developmental

abnormalities that can result from ionizing and non-ionizing (US & MRI) irradiation of an embryo, fetus, or nursing infantDose to embryo, fetus, from a variety of medial imaging procedures including the dose to nursing infants from radiopharmaceuticles administered to the mother

SC 4-4: Risks of Ionizing Radiation to the Developing Embryo, Fetus and Nursing Infant

Effective methods of communicating the risks & responding to FAQs from patientsConveying the scientific basis that effect the decisions on whether and when diagnostic or therapeutic radiological procedures can be performed with minimal risk to the developing embryo or fetus.

Radiation Protection in Medicine

• Proceedings of the 43rd Annual NCRP Meeting (2007): Advances in Radiation Protection in Medicine published in Health Physics, Vol. 95(5), 2008

NCRP Web SiteMain Page

Conference on Control of CT Doses in Conventional Imaging and Applications in Emergency Medicine September 2009. Consensus guidance publication (to be issued in 2010)

Future NCRP Activities Radiation Protection in Medicine

Genetic Susceptibility to Radiation-Induced Cancer

Operational Radiation Safety for PET and Fusion Imaging Systems and Radionuclide Production

Update of NCRP Report No. 102 (1989): Medical X-Ray, Electron Beam and Gamma-Ray Protection for Energies up to 50 MeV(Equipment Design, Performance and Use)

Future NCRP Activities Radiation Protection in Medicine

Update of NCRP Report No. 68 (1978): Radiation Protection in Pediatric Radiology

CQI in Medical Imaging

Commentary on Guidance for IRB on Evaluating & Communicating Radiation Risks for Studies on Human Subjects

Richard J. Vetter, Ph.D. CHP(on behalf of Scientific Committee 4-2)

NCRP Special Session55th Annual Health Physics

Society MeetingSalt Lake City, Utah

June 30, 2010

Population Monitoring and Radionuclide Decorporation

Following a Radiological or Nuclear Incident

SC 4-2 Members

• Steven M. Becker• Eugene H. Carbaugh• James R. Cassata• Scott Davis• Fun H. Fong, Jr. • P. Andrew Karam

Richard J. Vetter, Chair,

• Steven H. King• Adela Salame-Alfie• Lin-Shen Casper Sun• Katherine Uraneck• George J. Vargo

Bruce B. Boecker, NCRP Staff Consultant

Acknowledgements

Major Funding:• Centers for Disease Control &

Prevention

Technical Assistance:• Wesley Bolch• Badal Juneja

Intent

• Addressed to federal, state and community emergency planners.

• Provide general advice on screening public for internal contamination following RDD or IND.

• Use of GM to Screen for internal contamination: limited list of radionuclides.

• Advise physicians on use of CDG for limited list of radionuclides.

• Second in series of two on management of persons contaminated with radionuclides (NCRP Report Nos. 161, Vol 1 & 2; No. 166)

Radionuclides Considered in This Report

Radionuclide• Co-60• Sr-90• I-131• Cs-137• Ir-192• Ra-226• U-235, 238• Pu-238, 239• Am-241

GM Rapid Screen• Yes• No• Yes• Yes• Yes• No• No• No• No

Radiological Triage & Screening

• General guidance:– NCRP Commentary 19– NCRP 161 (control zones; CDG)– Highest priority: critically injured

• Surveying for external contamiantion• Screening at the scene vs. hospital• Biodosimetry

Radiological Triage & Screening

• Priority:– Patients who have suffered life-

threatening injuries should be given medical care immediately, without regard to contamination.

• Objective:– Determine whether level of internal

contamination in a patient exceeds the CDG.

Clinical Decision Guide (CDG: Concept and Use

• The CDG provides an important measure that physicians should use when considering the need for medical treatment of individuals having an internal radionuclide deposition.

• If threshold for CDG has been exceeded, physician should consider decorporation.

Clinical Decision Guide (CDG: Concept and Use

• CDG: - maximum once in a lifetime intake of

radionuclide that represents stochastic risk in the range of risks associated with guidance on dose limits for emergency situation.

- Does not cause deterministic effects.- 250 mSv effective dose in adult- 50 mSv effective dose in child- Fact sheets provided for each radionuclide

CDG for Some Radionuclides

RadionuclideCo-60 (M)*Sr-90 (F)I-131 (V)Cs-137 (F)Ir-192 (M)Ra-226 (M)U-235 (M)U- 238 (M)Pu-238 (M)Pu-239 (M)Am-241 (M)*Inhalation type

MBq uCi35 9508.3 2300.26 6.958 160059 16000.11 3.10.12 3.20.12 3.20.008 0.220.0076 0.20.0093 0.25

Direct (in vivo) Screening

• GM detector• Whole-body & lung counter• Nuclear medicine thyroid probe• Nuclear medicine gamma camera• Portal monitor

Indirect (in vitro) Screening

• Nasal swab• Urine sample• Fecal sample

GM Method for Rapid Screening

• Tables for reference male, reference female, and 10 y old child.

• Distances of 6 and 30 cm from sternum and spine.

• Times: 1 to 72 h post intake.• Radionuclides: Co-60, Cs-137, Ir-192.• Any radioiodine in thyroid, treat per FDA

recommendations.

GM Method for Rapid Screening

(Net cpm

corresponding to 1 CDG @ 6 cm 1 h after intake)

RadionuclideMale

Co-60 (M)Cs-137 (F)Ir-192 (M)

FemaleCo-60 (M)Cs-137 (F)Ir-192 (M)

ChildCo-60 (M)Cs-137 (F)Ir-192 (M)

AP PA

12,900 92006300 3800

14,400 9500

15,400 970010,000 510017,800 10,200

2500 16002300 12002900 1700

Medical Management

• Based on detailed guidance from NCRP Report No. 161.

• General guidance for treatment of internal contamination.

• Triage.• Prioritizing children and pregnant women.• Self treatment.• Wound management.• Medical management of radionuclides in this

Report.

Scalability

• Use of mass casualty incident response tiers for Emergency Department response to injuries from an explosive radiological device.

• Tiers based on scope of incident:- Emergency Department only- Assistance from other departments- Hospital Wide- Community wide- Regional- National

Assessment of Current U.S. Capacity

• Equipment & resources• Laboratory capabilities• Training needs• Volunteers to support screening• Biodosimetry

Summary

• Stabilize critically injured prior to external decontamination.

• For some radionuclides of concern, 1 CDG is easily detected with a GM survey meter.

• Use bioassays to screen individuals contaminated with radionuclides that don’t emit gammas.

• Use REAC/TS to assist with bioassays and biodosimetry.• Watch CDC website for additional screening tables.• Follow medical management guidelines if CDG threshold

is exceeded.• Be prepared to scale up to screen large numbers of

people following a RDD or IND.

S.Y. Chen, PhD, CHPArgonne National LaboratoryArgonne, IL

Presented at 55th Annual Meeting of the Health Physics SocietySalt Lake City, UtahJune 27 – July 1, 2010

Scientific Committee 5-1 Report on “Approach to Optimizing Decision Making for Late-Phase Recovery from Nuclear or Radiological Terrorism Incidents”

RDDs and INDs May Derive from Many Sources

“Radiological Dispersal Device” (RDD) refers to any method used to deliberately disperse radioactive material in the environment in order to cause harm.

“Improvised Nuclear Device”(IND) refers to any device incorporating radioactive materials designed to result in the dispersal of radioactive material or in the formation of nuclear-yield reaction.

The Response and Management Are Represented in Three Sequential Phases

Protective Action Guides (PAGs) Issued By the Department of Homeland Security for RDDs and INDs*

PHASE Protective Action PAG

Early Sheltering-in-place or evacuation of the publicAdministration of prophylactic drugs – potassium iodine Administration of other prophylactic drugs or decorporation agents

1 to 5 rem projected dose

5 rem projected dose to child thyroid

Intermediate Relocation of the public

Food interdiction

Drinking water interdiction

2 rem projected dose first year. Subsequent yeas, 0.5 rem/y projected dose.0.5 rem projected dose or 5 rem to any individual organ or tissue in the first year, whichever is limiting.0.5 rem projected dose in the first year

*The final version of the guidance, Planning Guidance for Protection and Recovery Following Radiological Disposal Device(RDD) and Improvised Nuclear Device (IND) Incidents, was published by DHS in Federal Register, Vol. 73, No.149 (August 1, 2008). It is to be noted that it does not contain a PAG for the Late Phase.

The “Optimization” Process Requires Multi-Faceted Effort

• Key Considerations– Pubic Health– Social Economics– National Security– Public Welfare – Communication

• Decision Process– A Graded Approach– Qualitative and Quantitative Assessments– Evaluation of Remedial Options

• Cost-Benefit Analysis• Technology Evaluation• Short- and Long-Term Feasibility• Land Use Options

– Stakeholder Involvement– Implementation of the Decision

Recent Reports Identify Needs to Address Long Term Recovery

• GAO Report (JAN 2010) – Report to Congressional Committees

“Combating nuclear terrorism – actions needed to better prepare to recover from possible attacks using radiological or nuclear materials”

• Homeland Security Affairs Journal, Paper (JAN 2010) – S.Y. Chen and T.S. Tenforde

“Optimization approach to decision making on long-term cleanup and site restoration following a nuclear or radiological terrorism incident”

Cleanup of Urban Area Presents Special Challenges

• Statutory cleanup requirements such as CERCLA have applied mostly to non- urban areas

• No clear federal guidance on long-term recovery phase

• Policy on radioactive waste disposal may not be applicable

• Recovery effort faces competing priorities

• Returning the society to “normalcy” becomes the top priority

The Late-Phase Actions Involve Many Complex Issues

Relevant Issues and Competing Factors

•Wide-area cleanup issues•Availability of effective cleanuptechnologies•Nonspecific cleanup criteria (long-term health risks)•Accommodation with existingcleanup statutory requirements•Waste generation and disposalissues

•Potential cleanup costs•Inexperience in managing the late-phase activities•Competing priorities of the society

0.01

0.1

1

10

100

0 10 20 30 40 50 60 70 80 90 100

Cleanup Criteria (mrem/yr)

Affe

cted

Are

a (k

m2 )

Stable ConditionsStable Conditions with ExplosionNeutral ConditionsNeutral Conditions with Explosion

Past Experiences Offer Valuable Lessons

Goiania, Brazil (1987)Chernobyl, Ukraine (1986)

Current Federal Cleanup Guidance Is Part of the Optimization Process

• Current Cleanup Guidance– EPA CERCLA (i.e., Superfund) cleanup– NRC License Termination Rule (10 CFR 20, Subpart E)– DOE cleanup of nuclear weapons complex

• Major Differences with Event-Related Situations– Incident vs. nonincident situations– Urban vs. rural contamination– Above ground vs. subsurface contamination– Cleanup costs and funding mechanisms– Applicability of current regulatory requirements – Allocation of other priorities vs. long-term health risks– Involvement of different stakeholder groups

Liberty RadEx – Recovery Exercise for RDD

Recommendations

• Develop Further Guidance on for Optimization Process– Principles and Approach to Optimization– Key Components and Parameters– Technical Basis and Requirements– Implementation Procedures– Develop Case Examples– Develop National Disaster Recovery Strategy

• Identify and Address Relevant Issues– Address Policy Needs– Fill Technical Gaps and Provide Assessment Tools– Vet the Issues through Recovery Exercises (for RDD)

• Liberty RadEx (April 2010, Lead by EPA)– Obtain Lessons Learned

Design of Effective Radiological Effluent

Monitoring and Environmental

Surveillance Programs

Bernd KahnGeorgia Institute of Technology

Scientific Committee 64-22

Bernd Kahn, ChairJames D. Berger Richard E. JaquishJohn E.Glissmeyer Janet A. JohnsonCarl V. Gogolak Shyam K NairNorbert Golchert

Consultants/Advisors:Bruce A. Napier Richard ConatserJohn E. Till

Staff consultant: E. Ivan White

Content

• Executive Summary• Introduction• Program Description• Program Planning• Quality Assurance/Quality Control• Environmental Pathways• Modeling Predictions• Effluent Monitoring• Environmental surveillance• Communication the Results

Section 2 –

Program Description -

1

Definitions• Effluent monitoring: collection and analysis of

airborne and aqueous samples, and measurement of effluent stream radiation, before or at their entry into the environment.

• Environmental surveillance: Collection and radiochemical analysis of samples of air, water, foodstuff, biota, soil, and other media and measurement of external radiation.

Section 2 -

Program Description –

2

Objectives• Guidance to control releases• Compliance with regulations and guides• Information for stakeholders and program

manager• Research to improve program • Documentation, historical and legal

Section 2 -

Program Description -

3

Emphasis on integrating effluent monitoring and environmentasl survaillance

• Accurate monitoring at the point of release• Surveillance near point of exposure• Combine to test models, notably site-specific

transfer factors

Section 3 –

Program Planning – Use of Data Quality Objectives

• Involve stakeholders (whose interest?)• Clarify study objectives (why?)• Define appropriate data to collect (how used?)• Select data collection conditions (where, when?)• Specify data quality and quantity (reliable,

sensitive?)• Optimize design (cost effective?)• Maintain optimization (utilize feedback?)

Section 4 –

Quality Assurance and Quality Control -

1

Data Life Cycle concept:• Planning – 18 basic elements: organization,

actions, records, audits• Implementation – Quality Assurance Project

Plan• Assessment – validation, verification, evaluation• Decision making – radionuclide releases are

acceptable, unacceptable, or require further measurements

Section 4 -

Quality Assurance and Quality Control -

2

Quality Assurance: • sample/monitor pertinence• Shipping/transmission reliability• Storage stability• Analysis and measurement trust• Calculating and reporting validityQuality Control:• In sampling, analysis, measurement, reporting• Based on internal and external tests• Assure identity, accuracy, precision, sensitivity

Section 5 –

Environmental Pathways -

1

Scientific and technical knowledge bases:• Meteorology • Geology and subsurface hydrology• Surface hydrology• Radioecology• Demography and land use• Physiology and metabolism

Section 5 –

Environmental Pathways -

2

Surveys, measurements, and studies• Literature search and expert advice• Continuous and intermittent data collection

(wind and weather, surface water flow, population, crops)

• Identification of critical radionuclides, pathways, and exposed persons

• Calculation of site-specific transfer factors

Section 6 –

Modeling Predictions -

1

Release conditions• Continuous with fluctuations• Periodic• Accident/incidentTransport and fate• Single medium, intermedia, multimedia• Radionuclide concentrations, radiation dose• Individual, population group• Human, other biota

Section 6 –

Modeling Predictions -

2

Application• Dose prediction, pre-operation• Guidance for monitoring and surveillance

planning• Dose estimation from effluent monitoring• Confirmation of surveillance resultsMathematical treatment options• Dynamic or steady state (e.g., annual average)• Deterministic (point value) or probabilistic

(statistical range)

Section 7 –

Effluent Monitoring -1

Considerations• Airborne (gases and particles) and liquid

(soluble and suspended)• Continuous or intermittent (regular or

occasional)• Routine or incident/accident response• In-line monitoring or off-line sampling

Section 7 –

Effluent Monitoring -

2

Specifications• Representative locations and times• Operating reliability and access for repair• Precision (reproducibility) and sensitivity

(detection limit)• Accuracy (checked by standards)• Range (from detection limit to accident scenario

maxima)• Operation and placement defined by the

monitoring plan

Section 8 –

Environmental Surveillance -

1

Range of Guidance

• Environmental media (air, water, vegetation, food, biota, soil, etc.)

• Sample collection devices• Radioanalytical methods• Radiation detection instruments

Section 8 –

Environmental Surveillance -

2

Focus on• Reliable methods• New methods• Techniques for unusual requirements• Sources of information• Sensitivity, precision, sample load. scheduling

Section 9 –

Communication

Data review and evaluation• Verification and validation• Data Quality AssessmentData organization and reporting• Management, formatting, presentation, and

storage• Uncertainty and sensitivity reportingAssessment of impacts • Radiation dose and risk

Summary

History of NCRP SC 64-22 Report• Report writing 1997 – 1999• Work suspended for lack of funds• Draft written 2006• Report writing renewed October 2009• Updated draft submitted to NCRP for

membership review June 2010• If approved, publication anticipated 2011

NCRP Report No.158: “Uncertainties in  the Measurement and Dosimetry of 

External Radiation”

Steven L. SimonNational Cancer InstituteNational Institutes of HealthBethesda, MD

Harold L. BeckU.S.D.O.E. (ret.)New York City, NY

Harold L. Beck, ChairmanUSDOE/EML (Retired) New York, NY

Leslie A. BrabyTexas A&M University College Station, Texas

Frederick M. CummingsIdaho National Laboratory Idaho Falls, ID

Kenneth R. KasePalo Alto, California

Thomas B. KirchnerCEMRC Carlsbad, New Mexico

David A. Schauer National Council on Radiation

Protection and Measurements Bethesda, Maryland

Steven M. Seltzer National Institute of Standards and Technology Gaithersburg, Maryland

Steven L. SimonNational Cancer Institute National Institutes of health Bethesda, Maryland

Chris G. SoaresNational Institute of Standards and Technology Gaithersburg, Maryland

R. Craig YoderLandauer, Inc. Glenwood, Illinois

NCRP Report No. 158 is 1 of 3 reports in a related series of reports supported by the Defense Threat Reduction Agency.

Other reports in the series are:

Report No. 164 : “Uncertainties in Internal Radiation Dose Assessment” (chair: A. Bouville)

Report No. 163: “Radiation Dose Reconstruction: Principles and Practices” (chair: B. Napier) – in press.

Report 

No. 

158 

reviews 

the 

sources 

of 

uncertainty 

associated 

with 

measurements 

of 

external 

radiation 

as 

well 

as 

the 

uncertainty 

in 

relating 

the 

measured 

quantities to absorbed dose to various body organs. 

The report provides:

•Estimates of the magnitude and probability distribution of all major sources of uncertainty in external dose estimation.

•A discussion of measurement uncertainties for all major instrument types used for measuring external radiation.

•A discussion of the principles of uncertainty and error, and of various probability density functions (PDF) useful for describing uncertainty.

•A discussion of methods for combining uncertainties to estimate the total uncertainty in an organ dose.

• A number of examples (case studies) that illustrate the concepts discussed.

STATISTICAL CONCEPTSReport 158 presents statistical concepts that are used in evaluating uncertainty in dosimetry, including:

• Basic concepts, e.g, precision, bias

• Meaning and types of uncertainty: aleatory and epistemic

• Classification of uncertainty: classical and Berkson

•Probability distributions, their characteristics and related confidence intervals,

• Concepts for assigning types of distributions to data sets

INSTRUMENTATION: Report 158 discusses measurement uncertain- ty for instruments used in external dose assessment (1 of 2):

Instrument System Primary Use Major Sources of Uncertainty

Area Monitors for Photon and Charged Particle Radiation FieldsIon Chambers Gamma Energy, angular responseGM Counters Gamma, beta Energy, angular response Scintillation Detectors Gamma, charged

particlesEnergy, angular response

Diodes Gamma, charged particles

Energy, angular response

Film and TLD Gamma Calibration, processing, fading

In Situ Gamma Spectrometry

Gamma Calibration, unfolding

Area Monitors for Neutron and Mixed Radiation FieldsTissue Equivalent Proportional Counters

Mixed fields LLD, angular responses

Multi-Detector Neutron Spectrometers

Neutrons Unfolding, response matrix

Scintillation Detectors for Neutron Spectrometry

Neutrons Gamma-neutron discrimination

H and He Proportional Counters

Mixed fields Pulse height discrimination

Activation detectors Neutrons Cross sections, angular response

Instrument System Primary Use Major Sources of Uncertainty

Personal Monitors for Photon and Charged Particle Radiation ExposureFilm Dosimeters Gamma, beta Calibration, processingTLD Dosimeters Gamma Calibration, processing,

fadingOptically Stimulated Luminescence

Gamma Similar to TLD

Electronic Dosimeters Gamma, charged particles

Detector dependent

Personal Monitors for Neutrons and Mixed Radiation Fields

NTA Film Neutrons Fading, energy response

TLD Neutrons Neutron-gamma partitionTrack Etch Detectors Heavy ions Track counts, angular

responseNeutron Bubble Detectors Neutrons Temperature

INSTRUMENTATION: Report 158 discusses measurement uncertain- ty for instruments used in external dose assessment (2 of 2):

ORGAN DOSE ESTIMATION (1/2): Report 158 discusses sources and magnitudes of uncertainties in:

(1) Converting area measurements (i.e., field dosimetry measurements) to organ dose,

(2) Converting personal dosimeter measurements to organ dose,

(3) Radiation-related factors that affect conversions from measurements to organ dose (e.g., geometry and energy),

ORGAN DOSE ESTIMATION (2/2): Report 158 discusses sources and magnitudes of uncertainties in:

(4) Non-radiation-related factors that affect conversions from measurements to organ dose (e.g. variations in body organ size and shape, phantom model, etc.), and

(5) Biological variability (e.g., actual body organ size and shape).

The literature on gamma and neutron organ dose estimation is reviewed in detail and a quantitative analysis of uncertainties of photon dose conversion factors is provided.

ThyroidEsophagus

HeartLungLver

StomachGI tract

Energy (MeV) AP PA

ICRP GM GSD ICRP GM GSD0.01 2.9E-04 2.2E-04 1.9 4.8E-04 2.2E-04 4.20.02 1.4E-02 1.3E-02 1.6 3.2E-02 1.5E-02 2.90.03 7.0E-02 8.5E-02 1.2 1.7E-01 1.2E-01 1.50.04 2.1E-01 2.5E-01 1.2 4.5E-01 3.5E-01 1.30.05 4.0E-01 4.6E-01 1.2 7.7E-01 6.3E-01 1.20.06 5.7E-01 6.4E-01 1.2 1.0E+00 8.6E-01 1.20.07 7.0E-01 7.6E-01 1.2 1.2E+00 1.0E+00 1.20.08 7.7E-01 8.4E-01 1.2 1.3E+00 1.1E+00 1.20.1 8.2E-01 9.0E-01 1.1 1.3E+00 1.2E+00 1.10.2 7.8E-01 8.5E-01 1.1 1.2E+00 1.1E+00 1.10.3 7.6E-01 8.1E-01 1.1 1.1E+00 9.9E-01 1.1

Example uncertainties of photon dose factors (DT /Ka ) for RBM by energy and geometry based on evaluation of multiple phantoms and known irradiation geometry.

Example uncertainties of photon dose factors (DT /Ka ) for RBM by energy but poorly understood irradiation geometry.

Energy(MeV)

AP or PA(equally likely)

Unknown Irradiation Geometry

(AP, PA, LLAT, RLAT, ROT equally likely)

ROT (for comparison only)

GM GSD GM GSD GM GSD0.01 2.2E-04 2.89 8.8E-05 7.62 6.2E-05 12.80.015 3.2E-03 2.08 1.9E-03 3.28 2.1E-03 2.970.02 1.4E-02 2.19 9.9E-03 2.32 1.1E-02 2.090.03 1.0E-01 1.44 7.3E-02 1.56 8.1E-02 1.330.04 2.9E-01 1.32 2.2E-01 1.45 2.4E-01 1.210.05 5.4E-01 1.27 4.0E-01 1.41 4.4E-01 1.170.06 7.4E-01 1.24 5.6E-01 1.38 6.1E-01 1.140.07 8.8E-01 1.24 6.7E-01 1.37 7.3E-01 1.140.08 9.7E-01 1.21 7.4E-01 1.35 8.0E-01 1.110.1 1.0E+00 1.19 7.9E-01 1.34 8.5E-01 1.100.15 9.9E-01 1.18 7.7E-01 1.31 8.3E-01 1.090.2 9.5E-01 1.15 7.5E-01 1.29 8.0E-01 1.070.3 9.0E-01 1.14 7.2E-01 1.26 7.7E-01 1.06

Variation photon dose factors (DT /Ka ) for RBM by body mass index (BMI) of phantoms – a source of additional uncertainty for real persons (example: AP geometry, 60 kVp x-rays)

BMI

95% CI on regressionD

T/ K

a

PROPAGATING UNCERTAINTY

Possibly the area least familiar to HPs are methods to correctly combine uncertainties from multiple parameters, assumptions, and sources of uncertainty.

Two methods discussed are:

(1) Monte Carlo (numerical simulation)

(2) Analytical and Mathematical Approximation

X+Y X+Y

Many simulationsFew simulations

[ ] [ ] [ ]kj

n

j

n

jk kjj

n

j jn XX

Xf

XfX

XfXXXf ,cov2var),,,(var

1

2

121 ∑∑∑

= >= ⎥⎥⎦

⎤

⎢⎢⎣

⎡

∂∂

×∂∂

+⎥⎥⎦

⎤

⎢⎢⎣

⎡

∂∂

=K

Fifty (50) pages of Report 158 are devoted to detailed examples of real-world analyses of uncertainty in external dose estimations. Examples demonstrate many of the concepts discussed.

Example 1: Uncertainty in external dose reconstruction for an atomic veteran – applicable to those working on military dose reconstruction for compensation.

Example 2: Estimation of organ dose and related uncertainty for radiologic technologists – applicable to those working in reconstruction of occupational exposure in medicine.

Example 3: Uncertainty in Techa River cohort external dosimetry – applicable to those working on environmental dose reconstruction.

Example 4: Uncertainty in neutron doses for multi-site leukemia case control study – applicable to those working on occupational dose reconstruction for epidemiology.

Example 5: Uncertainty in external dose reconstruction for an energy employee – applicable to those working in occupational dose reconstruction for compensation.

Report 158 reminds us in great detail that:

•Organ doses cannot be measured directly but must be estimated using models that convert measured quantities such as exposure, fluence, phantom measurements to organ dose.

•Estimates of dose may pertain to theoretical persons, representative persons, or actual individuals.

•Exposure conditions will vary in terms of geometry of irradiation, radiation type, and energy.

•Uncertainty will depend on the complexity of the radiation exposure scenario as well as the quality and quantity of the model input (measurement data), uncertainty in the model itself, and the number and importance of assumptions made.

Possibly the most important attribute of Report 158 is that it discusses each of the concepts for estimating uncertainty of external dose separately, and provides the theory as well as the practical steps for combining uncertainty from diverse sources into a single numerical statement of uncertainty (or conversely, of confidence).

Report 158 clarifies all basic concepts of external dose assessment and estimation of uncertainties.

Jack J. FixHealth Physics,

June 96(6): 682, 2009

If you are interested in external dose estimation, I urge you to buy this report!

THANK YOU FOR YOUR THANK YOU FOR YOUR ATTENTIONATTENTION..

UNCERTAINTIES IN INTERNAL RADIATION DOSE ASSESSMENT

(Summary of NCRP Report No. 164)

André Bouville and R Thomas Bell III(on behalf of Scientific Committee 6-3)

Health Physics Meeting - Salt Lake City – 30 June 2010

Objective of the Report

• The objective of the Report is to review the current state of knowledge of uncertainties in internal dose assessments, including uncertainties in the measurements that are used to perform these assessments.

Intent and content

• Addressed to health physicists, radiation protection professionals, and medical physicists

• Review of the main sources of uncertainty and of ways to quantify them

• Estimates of uncertainties in the doses per unit intake

• Examples of application of the methods

Committee Members

• André Bouville, Chair, NCI• Iulian Apostoaei, SENES Oak Ridge • Wesley Bolch, University of Florida• Anthony James, Washington State University• Kimberlee Kearfott, University of Michigan• Guthrie Miller, Los Alamos National Laboratory• David Pawel, USEPA• Charles Potter, Sandia National Laboratories • George Sgouros, Johns Hopkins University• Richard Toohey, Oak Ridge Associated Universities

Consultants• Alan Birchall, HPA, UK• Dunstana Melo, NCI• Matthew Puncher, HPA, UK• Michael Stabin, Vanderbilt University

Advisor• Richard Leggett, Oak Ridge National Laboratory

NCRP Staff• Thomas Bell III

Organization of the Report

• Main Sections– Methods to determine internal doses– Types and categories of uncertainties– Statistical methods – Uncertainties in the measurements– Uncertainties in the intakes– Uncertainties in the models and parameters– Uncertainties in the dose coefficients– Examples (17)

• Appendices (9)

Fields of application

• Research (epidemiology): YES

• Compensation (legal): YES

• Regulation (dose limits): NO

Dose endpoints

• Effective dose (wR ; wT ): NO

• Equivalent dose (wR ): NO

• Absorbed dose (physical quantity): YES

Exposure situations

• Type: retrospective or prospective

• Setting: environmental, occupational, or medical

• Target: specific or unspecified individual

Examples of exposure situations

• Specific individual: – Retrospective, occupational: worker with

positive bioassay data– Retrospective, environmental: subject of

an epidemiologic study– Prospective, medical: treatment planning

• Unspecified individual:– Retrospective, environmental: child

exposed to last year’s release– Prospective: worker in a plant to be built.

Models

• Uptake

• Systemic

• Dosimetric

Respiratory tract model

25475

ET1

ET2

BB

Albb

5 main regions

bb

ET1

ET2

AI1 AI2 AI3

BB1

bb1bb2

BB2

bbseq

BBseq

LNTH

LNET ETseq

ENVIRONMENT

GI-TRACT0.001

0.01

0.012

.020.00010.00002

0.03

0.03 10

1

.001

Extrathoracic

Thoracic

100

Particle transport

Respiratory tract model

ETET11

ETET22

BBBB

bbbb

AIAI

Rate constant Rate (d-1)

λST 24λSI 6λULI 1.8λLLI 1

f1λs

λs λSI

GI tract model

Wound model

Systemic model (Pu)

ICRP 56+ type models

Gonads

Blood

Urinary Bladdercontents

Urine

Kidney

Soft tissues Intermediate Rapid Slow

Skeleton

(with remodelling)

Skeleton

Cortical volume

Cortical surface

Cortical marrow

Trabecular

volumeTrabecular

surfaceTrabecular

marrow

Liver

Liver 2

Liver 1

GI contents

Dosimetric models

•

Calculate the doses to target organs per decay of a radionuclide in source organs.

•

Tools:–

Radionuclide decay data (new ICRP values)

–

Anthropomorphic phantoms (Wes Bolch)

–

Radiation transport software (MCNP)

Newborn Male Newborn Female 1‐year Male 1‐year Female 5‐year Male 5‐year Female

10‐year Male 10‐year Female 15‐year

Male 15‐year Female Adult Male Adult Female

UF Family of Hybrid Phantoms

Statistical methods

• Classical

• Bayesian

• Mixture of classical and Bayesian

Intake, RN Form Tissue

Lower Bound(Gy/Bq)

Upper Bound(Gy/ Bq)

Ratio

Inhalation ,14C

CO2 RBM 4 10–12 2 10–10 50

Inhalation , 90Sr

Unknown LungBoneRBM

5 10–10

3.8 10–8

2 10–9

3 10–6

5.8 10–6

3 10–7

6,000150150

Ingestion ,131I

Food Thyroid 1.8 10–

71.0 10–

65.4

Ingestion ,137Cs

Food ColonRBM

6 10–9

8 10–93 10–8

1.6 10–

8

52

Inhalation ,137Cs

Unknown LungColonRBM

1 10–9

1 10–9

1 10–9

6 10–7

1 10–8

1 10–8

6001010

Uncertainties in dose per unit intake: unspecified healthy adult

List of examples

• Atomic veteran (occ.)• Chernobyl (env.)• Thyroid cancer (med.)• Lymphoma (med.)• Lymphoma (med.)• Tritium (occ.)• Nuclear reactor (occ.)• DoE worker (occ.)• Sr-90 (env.)

• DU shrapnel wound• Pu-238 (occ.)• Goiania (env.)• Pu wound (NCRP)• Inhaled DU

(Bayesian/WelMos)• Inhaled Am-241• Information transfer• Mayak (Bayesian)

Status of the Report

• Final draft:– August 2009– Accepted for publication

• Expected year of publication: 2010

THE ENDThank you for your attention.