•
Special Report
RSNA Syllabus for Radiation Biology in Diagnostic Radiology Residency Training 1 Willard J. Howland, M.D., Marvin L. Baker, Ph.D., Donald J. Pizzarello, Ph.D., Eric J. Hall, Ph.D., Melvyn H. Schreiber, M.D., Robert J. Schulz, Ph.D., Dale E. Starchman, Ph.D., and Raymond L. Tanner, Ph.D. A guide for radiation biology program directors is presented, with an annotated bibliography. INDEX TERMS: Radiobiology. Radiological Society of North America. Radiology and radiologists • Special reports
Radiology 120:233-236, July 1976
•
• V.
In this guide for diagnostic radiology program directors, every effort has been made to ensure that practical clinical material is well represented. Basic research topics have been avoided unless they have a direct bearing on pragmatic considerations. The resident is assumed to have a moderate background in radiation physics. The annotated bibliography is a basic source of references to aid the instructors in the presentation of reasonably uniform material. It is a basic list, intended to be neither exhaustive nor exclusive. I.
Mechanisms of action Latent period Leukemia Skin cancer Thyroid tumors Other neoplasms Dose-response relationship and risk estimates Life shortening in mammalian populations
REVIEW OF RADIATION INTERACTIONS WITH MATTER
VI.
Excitation and Ionization Free radical production Chain of events between absorption of energy and expression of biological effects II.
Interphase death and reproductive death Cell cycle Cell survival curves Factors affecting radiation response Sublethal damage and repair
VII.
EFFECTS ON THE DEVELOPING EMBRYO AND FETUS
Radiosensitive periods during development Malformations; spontaneous and radiation induced Lethality; spontaneous and radiation induced Carcinogenesis and leukemeogenesis Therapeutic abortion and elective booking
TISSUE RADIOSENSITIVITY
Rapidly renewing populations (e.g., gut, hematopoetic) Slowly or nonrenewing populations (nerve tissue)
VIII. IV.
GENETIC EFFECTS
Gene mutation Chromosomal changes Extrapolation of data to humans The doubling dose for spontaneous mutations Dose protraction and genetic effects The concept of genetically significant dose
MAMMALIAN CELLULAR RADIOSENSITIVITY
III.
CARCINOGENSIS AND NONSPECIFIC LIFE SHORTENING
ACUTE RADIATION EFFECTS (Whole Body)
CNS syndrome GI syndrome HEM syndrome Immunology suppression Reproductive
COMPARISON OF NATURAL AND MAN-MADE RADIATION LEVELS
Natural background radiation Diagnosttc procedures Radiotherapy Occupation exposure Other man-made sources
1 From a special report of the Radiological Society of North America task force appointed by Dr. Raymond L. Tanner as Chairman of the Associated Science Committee. Accepted for publication in March, 1976. ss
233
234
SPECIAL REPORT
IX.
SOURCES OF PATIENT AND PERSONNEL EXPOSURE
Fluoroscopic procedures Radiographic procedures Special procedures and new modalities Nuclear medicine procedures X.
BENEFIT-RISK EVALUATIONS
Limiting patient exposure Evolution of maximum permissible dose concept Radiation risks compared with other hazards in society XI.
REGULATIONS AND RECOMMENDATIONS
Basic radiation protection criteria NCRP 33,34,37,39 State and Federal regulations
July 1976
and in vivo. Radiat Res 16:822-832, 1962. A survival curve for colony-forming units in the mouse hemopoietic system. 7. Pizzarello OJ, Witcofski RL: Basic Radiation Biology. Philadelphia, Lea-Febiger, 1967, ch 18, pp 216-221. The relative sensitivity of the nucleus and cytoplasm. 8. Puck TT, Markus PI: Action of x-rays on mammalian cells. J Exp Med 103:653-666, May 1956. The first in vitro survival curve. 9. Sinclair WK: Dependence of radiosensitivity upon cell age. [In] BNL Report 50203 (C-57): Proceedings of the Carmel Conference on Time and Dose Relationships in Radiation Biology as Applied to Radiotherapy, 1969, pp 97- 10 1. Cell sensitivity as a function of age in the mitotic cycle. 10. Sinclair WK, Morton RA: X-ray sensitivity during the cell generation cycle of cultured Chinese hamster cells. Radiat Res 29:450-474, 1966. Cell sensitivity as a function of age in the mitotic cycle.
ANNOTATED BIBLIOGRAPHY
I.
Review of Radiation Interactions with Matter 1. Johns HE, Cunningham JR: The Physics of Radiology. Springfield, III, Thomas, 3d ed, 1969, ch V, ch XVIII. V: the mechanisms by which x rays interact and transfer energy to matter; XVIII (18.01-18.03): microscopic aspects of ionizing radiation, linear energy transfer, and radical production. 2. Lea DE: Actions of Radiations on Living Cells. New York, Cambridge, 1962. A classic text of interest to the instructor; chapters I and II: ionization, excitation, dosimetry, chemical effects, mechanisms for biological action.
III.
Tissue Radiosensitivity 1. Andrews JR: The Radiobiology of Human Cancer Radiotherapy. Philadelphia, Saunders, 1968, pp 95-105. The radiation response of organs and tissues. 2. Hall EJ, ed: Radiobiology for the Radiologist. Hagerstown, Md, Harper, 1973, ch 10, pp 187-197. Sensitivity of tissues. 3. Rubin P, Casarett GW: Clinical Radiation Pathology. Philadelphia, Saunders, 1968, vol I. Classification of tissues according to radiosensitivity. IV.
Mammalian Cellular Radiosensitivity 1. Andrews JR: The Radiobiology of Human Cancer Radiotherapy. Philadelphia, Saunders, 1968, ch 3, pp 25-50. Cellular radiosensitivity and the cell cycle. 2. Elkind MM, Sutton H: Radiation response of mammalian cells grown in culture. I. Repair of x-ray damage in surviving Chinese hamster cells. Radiat Res 13:556-593, Oct 1960. Repair of sublethal damage. 3. Hall EJ: Radiation dose-rate: a factor of importance in radiobiology and radiotherapy. Br J Radial 45: 81-97, Feb 1972. Dose-rate effects. 4. Hall EJ, ed: Radiobiology for the Radiologist. Hagerstown, Md, Harper, 1973, ch 2, pp 13-49. Reproductive death, cell survival curves, and cellular sensitivity. Ch 5, pp 79-95: the cell cycle and variation of radiosensitivity with cell age; ch 6, pp 95-133: repair of sublethal damage; ch 7, pp 133-145: sensitizers and protectors. 5. Hewitt HB, Wilson CW: The effect of tissue oxygen tension on the radiosensitivity of leukaemia cells irradiated in situ in the livers of leukaemic mice. Br J Cancer 13: 675-684, Dec 1959. The dilution assay technique and the first in vivo survival curve. 6. McCulloch EA, Till JE: The sensitivity of cells from normal mouse bone marrow to gamma radiation in vitro II.
Acute Radiation Effects 1. Bond VP, Fliedner TM, Archambeau JO: Mammalian Radiation Lethaly. New York, Academic, 1965. This classic text reviews in detail mammalian response to whole body irradiation, including basic cellular radiobiology and the kinetics of cell proliferation in both the irradiated and unirradiated animal. The syndromes are reviewed in detail. The bibliography, though dated, is extensive. 2. Fabrikant JI: Radiobiology. Chicago, Yearbook, 1972, pp 187-207,286-317. Immunobiology and reproductive biology in relation to radiation exposure; good reference list. 3. Key CR: Studies on the acute effects of the atomic bomb. Hum Pathol 2:475-484, Dec 1971. Symposium pathology study at the Atomic Bomb Casualty Commission; numerical data on the pathology of the bomb casualties. 4. Ohkita T: Acute effects. Radiat Res 16 (Suppl): 49-66, 1975. The supplement, and particularly this article, provide a current summary of the studies involving Japanese bomb victims. Details of the radiation syndromes, some of their underlying pathology, organ effect, and dose-rate data are provided; protection and recovery are included. Extensive bibliography. 5. Upton AC: Radiation Injury: Effect Principles and Perspectives. Chicago, Univ of Chicago, 1969, pp 1-31. This short work provides a brief and readable description
Vol. 120
SPECIAL REPORT
of the syndromes and some of their underlying pathology. Organ effect information, dose-rate data, protection, and recovery are included. 6. Prasad KN, ed: Human Radiation Biology. Hagerstown, Md, Harper, 1974, pp 149-318. An extensive description of the acute radiation syndromes. Modifications of the syndromes and patient management; some case history data and considerable organ system data. Effects of radiation on the reproductive system are extensively covered; good bib;liographies with each chapter. V.
Carcinogenesis and Nonspecific Life Shortening 1. Hall EJ,ed: Radiobiology for the Radiologist. Hagerstown, Md, Harper, 1973, ch 12, pp 213-220. Nonspecific life shortening and radiation carcinogenesis. 2. Upton AC: Radiation carcinogenesis. [In] Dalrymple GV, Gaulden ME, Kollmorgen GM, et ai, eds.: Medical Radiation Biology. Philadelphia, Saunders, 1973, ch 10. 3. Mole RM: Ionizing radiation as a carcinogen: practical questions and academic pursuits. Br J Radiol 48: 157, 1975. VI.
Genetic Effects 1. The Effects on Population of Exposure to Low Levels of Ionizing Radiation, ch 5. Washington, National Academy of Sciences-National Research Council, 1972. A comprehensive treatment of genetic effects, including fundamental data, mechanisms, sources, benefit-risk analysis, and an extensive list of references (94). 2. Hall EJ, ed: Radiobiology for the Radiologist. Hagerstown, Md, Harper, 1973, ch 12, pp 220-228. Genetic abnormalities, radiation-produced genetic effects, experimental data, and the genetic dose concept. Comprehensive list of references. VII. Effects on the Developing Embryo and Fetus 1. Rugh R: X-ray induced teratogenesis in the mouse and its possible significance to man. Radiology 99: 433-443, May 1971. Data at different gestational ages and extrapolation to ages of man. 2. Hall EJ: Effects on the embryo and fetus. [In] Hall EJ, ed: Radiobiology for the Radiologist. Hagerstown, Md, Harper, 1973, ch 13, pp 231-237. The incidences of lethal and teratogenetic effects of radiation in the mouse relative to number of days post-conception; extrapolation to comparable developmental ages in the human embryo. 3. Rugh R: Radiobiology and the human embryo and fetus. [In] Dalrymple GV, Gaulden ME, Kollmorgan GM, et ai, eds: Medical Radiation Biology. Philadelphia, Saunders, 1973, ch 5, pp 83-96. 4. VanCleave CD: Long term effects of prenatal irradiation. [In] VanCleave CD, ed: Late Somatic Effects of Ionizing Radiation. USAEC Division of Technical Information TID-24310, 1969, ch 6, pp 188-195. The effects of prenatal irradiation in terms of functional changes other than carcinogenic which may be expressed in later life:
235
Special Report
general growth retardation, gonadal hypoplasia, and degrees of arrest in the lung, heart, and kidney. 5. Prasad KN: Radiation hazards to the human fetus. [In] Prasad, KN, ed: Human Radiation Biology. Hagerstown, Md, Harper, 1974, ch 16, pp 319-339. The evidence of carcinogenic and leukogenic effects of in utero irradiation in humans. 6. Greim ML: The effects of radiation on the fetus. [In] Dalrymple GV, Gaulden ME, Kollmorgen GM, et ai, eds: Medical Radiation Biology. Philadelphia, Saunders, 1973, ch 5, pp 97-99. The rationale for therapeutic abortion; dose levels from diagnostic procedures expected to cause abnormalities in man; the "1 O-day" rule. 7. Bennett R: Some aspects of radiation protection in a diagnostic department. Emphasizing elective examination of females of reproductive age. Australas Radiol 13:224-229, 1969. This and the following reference define elective examination and give examples of the procedures used in instituting such a plan. 8. Dalrymple GV, Barnhard HJ: Protection of potentially pregnant women. Appendix II. [In] Dalrymple GV, Gaulden ME, Koltmorgan GM, et ai, eds: Medical Radiation Biology. Philadelphia, Saunders, 1973, pp. 301-304. VIII. Comparison of Natural and Man-Made Radiation Levels 1. Prasad KN: Maximum permissible dose. [In] Prasad KN, ed: Human Radiation Biology. Hagerstown, Md, Harper, 1974, ch 23, pp 452-453. External and internal sources of background radiation. 2. Hall EJ: Late effects of radiation. [In] Hall EJ, ed: Radiobiology for the Radiologist. Hagerstown, Md, Harper, 1973, ch 12, pp 213-228. Tables compare the levels of radiation contributed by diagnostic radiology, radiotherapy, nuclear medicine, occupational exposure, and other man-made sources to the levels of natural background radiation. Exposures are considered in terms of GSD. 3. Population exposure to x rays, U.S. 1970. [In] DHEW Publication (FDA) 73-8047: A Report on the Public Health Service X-Rays Exposure Study, Nov 1973. Principle findings and summary of highlights, ch 5 and 6, pp 27 -55. Estimates of mean surface exposure intergral values for radiographic films for the U.S. in 1970. IX.
Sources of Patient and Personnel Exposure 1. Johns HE, Cunningham JR: The Physics of Radiology. Springfield, III, Thomas, 3d ed, 1969, ch XVI-sect 16.12. Patient exposure in diagnostic radiology: typical radiographic factors, skin exposure, transmission, gonadal dose, doses to other organs, and methods of reducing dose. Ch XVII: radiation protection for both external and internal sources. 2. Hendee WR: Medical Radiation Physics. Chicago, New York Medical, 1970, ch XVI-XVIII. Internal dosimetry techniques and principles of radiation safety including licensing and development of a protection program for use of radio-pharmaceuticals.
236
SPECIAL REPORT
3. Wagner HN Jr, ed: Principles of Nuclear Medicine. Philadelphia, Saunders, 1968, ch XVI-XVIII. Internal dosimetry techniques and principles of radiation safety, including licensing and development of a protection program for use of radio-pharmaceuticals. 4. Report of Committee II on Permissible Dose for Internal Radiation. Recommendation of the International Commission on Radiation Protection, Pergammon, 1959. Basic principles of internal dosimeters and values of maximum permissible body burden of radionuclides; maximum permissible concentration of these nuclides in air and in water (or food). 5. Journal of Nuclear Medicine: Supplements 1current. These supplements contain the pamphlets prepared by the Medical Internal Radiation Dose Committee (MIRD). They include decay schemes and the beta and photon contributions of internal emitters. 6. Gross G. McCullough EC: Exposure values around an x-ray scanning transaxial tomograph (EMI Scanner). Med Phys 2:282, 1975. Measurements of exposures around a scanner averaged over a long period of clinical operation. X.
Benefit-Risk Evaluation 1. NCRP Report 39 on Basic Radiation Protection
July 1976
Criteria. Washington, NCRP, 1971. A comprehensive review of scientific evidence, philosophical considerations, benefit-risk analysis, and the radiation protection criteria established by the committee. 2. Ionizing Radiation: Levels and Effects. New York, United Nations Scientific Committee on the Effects of Atomic Radiation, 1972. Evidence and models for estimates of genetic and carcinogenic risks from radiation exposure in man. 3. The Effects on Population of Exposure to Low Levels of Ionizing Radiation. Washington, National Academy of Sciences-National Research Council, 1972. A summary and analysis of current knowledge of the risks from exposure to ionizing radiation. 4. NCRP Report 43: Review of the Current State of Radiation Protection Philosophy. Washington, National Council on Radiation Protection and Measurements, 1975. A position statement on issues raised by publication of the NAS-BEIR Committee Report and the UNSCEAR Report subsequent to publication [Report 30 of the NCRP (see reference abovej] . Department of Radiology Aultman Hospital
2600 6th St. S.W. Canton, Ohio 44710
Special Report
RSNA Syllabus for Radiation Biology in Diagnostic Radiology Residency Training 1 Willard J. Howland, M.D., Marvin L. Baker, Ph.D., Donald J. Pizzarello, Ph.D., Eric J. Hall, Ph.D., Melvyn H. Schreiber, M.D., Robert J. Schulz, Ph.D., Dale E. Starchman, Ph.D., and Raymond L. Tanner, Ph.D. A guide for radiation biology program directors is presented, with an annotated bibliography. INDEX TERMS: Radiobiology. Radiological Society of North America. Radiology and radiologists • Special reports
Radiology 120:233-236, July 1976
•
• V.
In this guide for diagnostic radiology program directors, every effort has been made to ensure that practical clinical material is well represented. Basic research topics have been avoided unless they have a direct bearing on pragmatic considerations. The resident is assumed to have a moderate background in radiation physics. The annotated bibliography is a basic source of references to aid the instructors in the presentation of reasonably uniform material. It is a basic list, intended to be neither exhaustive nor exclusive. I.
Mechanisms of action Latent period Leukemia Skin cancer Thyroid tumors Other neoplasms Dose-response relationship and risk estimates Life shortening in mammalian populations
REVIEW OF RADIATION INTERACTIONS WITH MATTER
VI.
Excitation and Ionization Free radical production Chain of events between absorption of energy and expression of biological effects II.
Interphase death and reproductive death Cell cycle Cell survival curves Factors affecting radiation response Sublethal damage and repair
VII.
EFFECTS ON THE DEVELOPING EMBRYO AND FETUS
Radiosensitive periods during development Malformations; spontaneous and radiation induced Lethality; spontaneous and radiation induced Carcinogenesis and leukemeogenesis Therapeutic abortion and elective booking
TISSUE RADIOSENSITIVITY
Rapidly renewing populations (e.g., gut, hematopoetic) Slowly or nonrenewing populations (nerve tissue)
VIII. IV.
GENETIC EFFECTS
Gene mutation Chromosomal changes Extrapolation of data to humans The doubling dose for spontaneous mutations Dose protraction and genetic effects The concept of genetically significant dose
MAMMALIAN CELLULAR RADIOSENSITIVITY
III.
CARCINOGENSIS AND NONSPECIFIC LIFE SHORTENING
ACUTE RADIATION EFFECTS (Whole Body)
CNS syndrome GI syndrome HEM syndrome Immunology suppression Reproductive
COMPARISON OF NATURAL AND MAN-MADE RADIATION LEVELS
Natural background radiation Diagnosttc procedures Radiotherapy Occupation exposure Other man-made sources
1 From a special report of the Radiological Society of North America task force appointed by Dr. Raymond L. Tanner as Chairman of the Associated Science Committee. Accepted for publication in March, 1976. ss
233
234
SPECIAL REPORT
IX.
SOURCES OF PATIENT AND PERSONNEL EXPOSURE
Fluoroscopic procedures Radiographic procedures Special procedures and new modalities Nuclear medicine procedures X.
BENEFIT-RISK EVALUATIONS
Limiting patient exposure Evolution of maximum permissible dose concept Radiation risks compared with other hazards in society XI.
REGULATIONS AND RECOMMENDATIONS
Basic radiation protection criteria NCRP 33,34,37,39 State and Federal regulations
July 1976
and in vivo. Radiat Res 16:822-832, 1962. A survival curve for colony-forming units in the mouse hemopoietic system. 7. Pizzarello OJ, Witcofski RL: Basic Radiation Biology. Philadelphia, Lea-Febiger, 1967, ch 18, pp 216-221. The relative sensitivity of the nucleus and cytoplasm. 8. Puck TT, Markus PI: Action of x-rays on mammalian cells. J Exp Med 103:653-666, May 1956. The first in vitro survival curve. 9. Sinclair WK: Dependence of radiosensitivity upon cell age. [In] BNL Report 50203 (C-57): Proceedings of the Carmel Conference on Time and Dose Relationships in Radiation Biology as Applied to Radiotherapy, 1969, pp 97- 10 1. Cell sensitivity as a function of age in the mitotic cycle. 10. Sinclair WK, Morton RA: X-ray sensitivity during the cell generation cycle of cultured Chinese hamster cells. Radiat Res 29:450-474, 1966. Cell sensitivity as a function of age in the mitotic cycle.
ANNOTATED BIBLIOGRAPHY
I.
Review of Radiation Interactions with Matter 1. Johns HE, Cunningham JR: The Physics of Radiology. Springfield, III, Thomas, 3d ed, 1969, ch V, ch XVIII. V: the mechanisms by which x rays interact and transfer energy to matter; XVIII (18.01-18.03): microscopic aspects of ionizing radiation, linear energy transfer, and radical production. 2. Lea DE: Actions of Radiations on Living Cells. New York, Cambridge, 1962. A classic text of interest to the instructor; chapters I and II: ionization, excitation, dosimetry, chemical effects, mechanisms for biological action.
III.
Tissue Radiosensitivity 1. Andrews JR: The Radiobiology of Human Cancer Radiotherapy. Philadelphia, Saunders, 1968, pp 95-105. The radiation response of organs and tissues. 2. Hall EJ, ed: Radiobiology for the Radiologist. Hagerstown, Md, Harper, 1973, ch 10, pp 187-197. Sensitivity of tissues. 3. Rubin P, Casarett GW: Clinical Radiation Pathology. Philadelphia, Saunders, 1968, vol I. Classification of tissues according to radiosensitivity. IV.
Mammalian Cellular Radiosensitivity 1. Andrews JR: The Radiobiology of Human Cancer Radiotherapy. Philadelphia, Saunders, 1968, ch 3, pp 25-50. Cellular radiosensitivity and the cell cycle. 2. Elkind MM, Sutton H: Radiation response of mammalian cells grown in culture. I. Repair of x-ray damage in surviving Chinese hamster cells. Radiat Res 13:556-593, Oct 1960. Repair of sublethal damage. 3. Hall EJ: Radiation dose-rate: a factor of importance in radiobiology and radiotherapy. Br J Radial 45: 81-97, Feb 1972. Dose-rate effects. 4. Hall EJ, ed: Radiobiology for the Radiologist. Hagerstown, Md, Harper, 1973, ch 2, pp 13-49. Reproductive death, cell survival curves, and cellular sensitivity. Ch 5, pp 79-95: the cell cycle and variation of radiosensitivity with cell age; ch 6, pp 95-133: repair of sublethal damage; ch 7, pp 133-145: sensitizers and protectors. 5. Hewitt HB, Wilson CW: The effect of tissue oxygen tension on the radiosensitivity of leukaemia cells irradiated in situ in the livers of leukaemic mice. Br J Cancer 13: 675-684, Dec 1959. The dilution assay technique and the first in vivo survival curve. 6. McCulloch EA, Till JE: The sensitivity of cells from normal mouse bone marrow to gamma radiation in vitro II.
Acute Radiation Effects 1. Bond VP, Fliedner TM, Archambeau JO: Mammalian Radiation Lethaly. New York, Academic, 1965. This classic text reviews in detail mammalian response to whole body irradiation, including basic cellular radiobiology and the kinetics of cell proliferation in both the irradiated and unirradiated animal. The syndromes are reviewed in detail. The bibliography, though dated, is extensive. 2. Fabrikant JI: Radiobiology. Chicago, Yearbook, 1972, pp 187-207,286-317. Immunobiology and reproductive biology in relation to radiation exposure; good reference list. 3. Key CR: Studies on the acute effects of the atomic bomb. Hum Pathol 2:475-484, Dec 1971. Symposium pathology study at the Atomic Bomb Casualty Commission; numerical data on the pathology of the bomb casualties. 4. Ohkita T: Acute effects. Radiat Res 16 (Suppl): 49-66, 1975. The supplement, and particularly this article, provide a current summary of the studies involving Japanese bomb victims. Details of the radiation syndromes, some of their underlying pathology, organ effect, and dose-rate data are provided; protection and recovery are included. Extensive bibliography. 5. Upton AC: Radiation Injury: Effect Principles and Perspectives. Chicago, Univ of Chicago, 1969, pp 1-31. This short work provides a brief and readable description
Vol. 120
SPECIAL REPORT
of the syndromes and some of their underlying pathology. Organ effect information, dose-rate data, protection, and recovery are included. 6. Prasad KN, ed: Human Radiation Biology. Hagerstown, Md, Harper, 1974, pp 149-318. An extensive description of the acute radiation syndromes. Modifications of the syndromes and patient management; some case history data and considerable organ system data. Effects of radiation on the reproductive system are extensively covered; good bib;liographies with each chapter. V.
Carcinogenesis and Nonspecific Life Shortening 1. Hall EJ,ed: Radiobiology for the Radiologist. Hagerstown, Md, Harper, 1973, ch 12, pp 213-220. Nonspecific life shortening and radiation carcinogenesis. 2. Upton AC: Radiation carcinogenesis. [In] Dalrymple GV, Gaulden ME, Kollmorgen GM, et ai, eds.: Medical Radiation Biology. Philadelphia, Saunders, 1973, ch 10. 3. Mole RM: Ionizing radiation as a carcinogen: practical questions and academic pursuits. Br J Radiol 48: 157, 1975. VI.
Genetic Effects 1. The Effects on Population of Exposure to Low Levels of Ionizing Radiation, ch 5. Washington, National Academy of Sciences-National Research Council, 1972. A comprehensive treatment of genetic effects, including fundamental data, mechanisms, sources, benefit-risk analysis, and an extensive list of references (94). 2. Hall EJ, ed: Radiobiology for the Radiologist. Hagerstown, Md, Harper, 1973, ch 12, pp 220-228. Genetic abnormalities, radiation-produced genetic effects, experimental data, and the genetic dose concept. Comprehensive list of references. VII. Effects on the Developing Embryo and Fetus 1. Rugh R: X-ray induced teratogenesis in the mouse and its possible significance to man. Radiology 99: 433-443, May 1971. Data at different gestational ages and extrapolation to ages of man. 2. Hall EJ: Effects on the embryo and fetus. [In] Hall EJ, ed: Radiobiology for the Radiologist. Hagerstown, Md, Harper, 1973, ch 13, pp 231-237. The incidences of lethal and teratogenetic effects of radiation in the mouse relative to number of days post-conception; extrapolation to comparable developmental ages in the human embryo. 3. Rugh R: Radiobiology and the human embryo and fetus. [In] Dalrymple GV, Gaulden ME, Kollmorgan GM, et ai, eds: Medical Radiation Biology. Philadelphia, Saunders, 1973, ch 5, pp 83-96. 4. VanCleave CD: Long term effects of prenatal irradiation. [In] VanCleave CD, ed: Late Somatic Effects of Ionizing Radiation. USAEC Division of Technical Information TID-24310, 1969, ch 6, pp 188-195. The effects of prenatal irradiation in terms of functional changes other than carcinogenic which may be expressed in later life:
235
Special Report
general growth retardation, gonadal hypoplasia, and degrees of arrest in the lung, heart, and kidney. 5. Prasad KN: Radiation hazards to the human fetus. [In] Prasad, KN, ed: Human Radiation Biology. Hagerstown, Md, Harper, 1974, ch 16, pp 319-339. The evidence of carcinogenic and leukogenic effects of in utero irradiation in humans. 6. Greim ML: The effects of radiation on the fetus. [In] Dalrymple GV, Gaulden ME, Kollmorgen GM, et ai, eds: Medical Radiation Biology. Philadelphia, Saunders, 1973, ch 5, pp 97-99. The rationale for therapeutic abortion; dose levels from diagnostic procedures expected to cause abnormalities in man; the "1 O-day" rule. 7. Bennett R: Some aspects of radiation protection in a diagnostic department. Emphasizing elective examination of females of reproductive age. Australas Radiol 13:224-229, 1969. This and the following reference define elective examination and give examples of the procedures used in instituting such a plan. 8. Dalrymple GV, Barnhard HJ: Protection of potentially pregnant women. Appendix II. [In] Dalrymple GV, Gaulden ME, Koltmorgan GM, et ai, eds: Medical Radiation Biology. Philadelphia, Saunders, 1973, pp. 301-304. VIII. Comparison of Natural and Man-Made Radiation Levels 1. Prasad KN: Maximum permissible dose. [In] Prasad KN, ed: Human Radiation Biology. Hagerstown, Md, Harper, 1974, ch 23, pp 452-453. External and internal sources of background radiation. 2. Hall EJ: Late effects of radiation. [In] Hall EJ, ed: Radiobiology for the Radiologist. Hagerstown, Md, Harper, 1973, ch 12, pp 213-228. Tables compare the levels of radiation contributed by diagnostic radiology, radiotherapy, nuclear medicine, occupational exposure, and other man-made sources to the levels of natural background radiation. Exposures are considered in terms of GSD. 3. Population exposure to x rays, U.S. 1970. [In] DHEW Publication (FDA) 73-8047: A Report on the Public Health Service X-Rays Exposure Study, Nov 1973. Principle findings and summary of highlights, ch 5 and 6, pp 27 -55. Estimates of mean surface exposure intergral values for radiographic films for the U.S. in 1970. IX.
Sources of Patient and Personnel Exposure 1. Johns HE, Cunningham JR: The Physics of Radiology. Springfield, III, Thomas, 3d ed, 1969, ch XVI-sect 16.12. Patient exposure in diagnostic radiology: typical radiographic factors, skin exposure, transmission, gonadal dose, doses to other organs, and methods of reducing dose. Ch XVII: radiation protection for both external and internal sources. 2. Hendee WR: Medical Radiation Physics. Chicago, New York Medical, 1970, ch XVI-XVIII. Internal dosimetry techniques and principles of radiation safety including licensing and development of a protection program for use of radio-pharmaceuticals.
236
SPECIAL REPORT
3. Wagner HN Jr, ed: Principles of Nuclear Medicine. Philadelphia, Saunders, 1968, ch XVI-XVIII. Internal dosimetry techniques and principles of radiation safety, including licensing and development of a protection program for use of radio-pharmaceuticals. 4. Report of Committee II on Permissible Dose for Internal Radiation. Recommendation of the International Commission on Radiation Protection, Pergammon, 1959. Basic principles of internal dosimeters and values of maximum permissible body burden of radionuclides; maximum permissible concentration of these nuclides in air and in water (or food). 5. Journal of Nuclear Medicine: Supplements 1current. These supplements contain the pamphlets prepared by the Medical Internal Radiation Dose Committee (MIRD). They include decay schemes and the beta and photon contributions of internal emitters. 6. Gross G. McCullough EC: Exposure values around an x-ray scanning transaxial tomograph (EMI Scanner). Med Phys 2:282, 1975. Measurements of exposures around a scanner averaged over a long period of clinical operation. X.
Benefit-Risk Evaluation 1. NCRP Report 39 on Basic Radiation Protection
July 1976
Criteria. Washington, NCRP, 1971. A comprehensive review of scientific evidence, philosophical considerations, benefit-risk analysis, and the radiation protection criteria established by the committee. 2. Ionizing Radiation: Levels and Effects. New York, United Nations Scientific Committee on the Effects of Atomic Radiation, 1972. Evidence and models for estimates of genetic and carcinogenic risks from radiation exposure in man. 3. The Effects on Population of Exposure to Low Levels of Ionizing Radiation. Washington, National Academy of Sciences-National Research Council, 1972. A summary and analysis of current knowledge of the risks from exposure to ionizing radiation. 4. NCRP Report 43: Review of the Current State of Radiation Protection Philosophy. Washington, National Council on Radiation Protection and Measurements, 1975. A position statement on issues raised by publication of the NAS-BEIR Committee Report and the UNSCEAR Report subsequent to publication [Report 30 of the NCRP (see reference abovej] . Department of Radiology Aultman Hospital
2600 6th St. S.W. Canton, Ohio 44710
