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==More In-Depth Information==
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Children are more sensitive to radiation exposure than adults. Depending on their age, organ, and tumour type, children are reported to be, on average, two to three times more sensitive to radiation than adults, and the younger the infants or children, the more radiosensitive they are at high doses. So, the potential risks of ionising radiation in paediatric patients need to be considered. Physicians should exercise caution when using ionising radiation to image or treat children. In nuclear medicine, a lower administered activity than that would be used for an adult may be used; acceptable images could still be obtained as the size of a child is typically smaller than that of an adult.
For [[Application_of_ionising_radiation_in_healthcare#Diagnostic_Radiology|diagnostic radiology]], the following should be taken into consideration: (1) select the most optimised imaging protocol based on the patient’s age and size; (2) repeat imaging, or phases (e.g. CT), need to be justified relative to the importance of the additional information being gained vs the additional radiation dose; and (3) only image the indicated area. [[ICRP Publication 121]] Radiological Protection in Paediatric Diagnostic and Interventional Radiology<ref name="Pub121"/> and [https://www.imagegently.org Image Gently] provide more details. It is worthwhile to note that where applicable, non-ionizing radiation imaging modalities may be considered.
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When a patient is exposed to external sources of radiation during [[Application_of_ionising_radiation_in_healthcare#Diagonstic_Therapy|diagnostic radiology]] or [[Application_of_ionising_radiation_in_healthcare#Radiation_Therapy|radiation therapy]], there is no residual radiation in the patient after the procedure, and they pose no radiation risk to people around them. However, when [[Application_of_ionising_radiation_in_healthcare#Nuclear_Medicine|nuclear medicine]] is used for diagnostic radiology or radiation therapy, protection of family members or the others who provide care to the patient, and the protection of the public the patient may come into contact, should be considered.<ref name="Pub094">[[ICRP Publication 94]] Release of patients after therapy with unsealed radionuclides. Ann. ICRP 34(2), 2004.</ref><ref name="Pub105"/>
For diagnostic nuclear medicine procedures (e.g. bone or myocardial perfusion scans), where the source of radiation is inside the body, radiopharmaceuticals retained in these patients emit radiation but the level of radiation is sufficiently low that these patients do not pose a radiation risk to those around them. These patients are generally discharged immediately after the procedure and instructed that they can carry on their normal daily activities.
For specific therapeutic [[Application_of_ionising_radiation_in_healthcare#Nuclear_Medicine|nuclear medicine]] (e.g. unsealed source therapy) or radiation oncology (e.g. brachytherapy) procedures, such as <sup>131</sup>I therapy for thyroid cancer or some forms of hyperthyroidism, the patient has significant amounts of residual radioactivity in their body that they may pose a slight risk to the others. Thus, radiation safety counselling is required to reduce the exposure of other individuals. Depending on the quantity of radionuclide, the treatment facility may need to hold (e.g. admit) the patient until the quantity is sufficiently reduced through a combination of radioactive decay and biological elimination. In addition, these patients are generally given radiation protection instructions, such as avoiding prolonged close contact with children or pregnant women for a specific period of time post therapy. The radiation safety advice will depend on the burden of underlying disease being treated and the treatment dose of <sup>131</sup>I administered.
Radiation safety advice related to implanted therapeutic sources (e.g. brachytherapy) will vary based on the specific radioactive source used. For some sources, such as <sup>125</sup>I used for prostate cancer, present very low risk to others. For other sources, such as <sup>192</sup>Ir, there may be a radiation risk to others and these patients are usually hospitalised with restricted close contact to others until the source is removed.
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The principles for the protection of workers from ionising radiation are discussed fully in [[ICRP Publication 75]] General Principles for the Radiation Protection of Workers.<ref name="Pub075">[[ICRP Publication 75]] General Principles for the Radiation Protection of Workers. Ann. ICRP 27(1), 1997.</ref> These principles apply to healthcare staff working in [[Application_of_ionising_radiation_in_healthcare#Diagnostic_Radiology|diagnostic radiology]], [[Application_of_ionising_radiation_in_healthcare#Interventional_Procedures|interventional procedures]], [[Application_of_ionising_radiation_in_healthcare#Nuclear_Medicine|nuclear medicine]], and [[Application_of_ionising_radiation_in_healthcare#Radiation_Therapy|radiation therapy]] facilities.<ref name="Pub105"/> ICRP has recently published recommendations on occupational radiological protection in interventional procedures.<ref name="Pub139">[[ICRP Publication 139]] Occupational Radiological Protection in Interventional Procedures. Ann. ICRP 47(2), 2018-1.</ref>
The control of occupational radiological exposure in healthcare can be simplified and made more effective by the designation of workplaces into two types: controlled areas and supervised areas. In a controlled area, normal working conditions, including the possible occurrence of minor mishaps, require workers to follow well-established procedures and practices aimed specifically at controlling radiation exposures. A supervised area is one in which the working conditions are kept under review, but special procedures are not normally needed.
Individual monitoring for external radiation is simple and does not require a heavy commitment of resources. In medicine, it should be used for all those who work in controlled areas.
In several areas of healthcare, the control of occupational exposure is of particular importance, including nursing of brachytherapy patients when the sources have been implanted, palpation of patients during procedures utilising fluoroscopy, fluoroscopically guided [[Interventional Application_of_ionising_radiation_in_healthcare#Interventional_Procedures|interventional procedures]] such as in heart catheterisation, or radiopharmaceutical preparation by staff in [[Application_of_ionising_radiation_in_healthcare#Nuclear_Medicine|nuclear medicine]]. In all these procedures, careful shielding and time limits are needed. Individual monitoring with careful scrutiny of the results is also important. In brachytherapy, frequent and careful accounting of sources is essential.
===Protecting pregnant workers===
[[File:ICRPGuide.JPG|50px|link=Guide_to_Radiological_Protection_in_Healthcare]]Take me back to the ICRP's [[Guide_to_Radiological_Protection_in_Healthcare|Guide to Radiological Protection in Healthcare]]!
==References==
