WORLD HFALTH ORGANIZATION R ' g i o n a l O f f i c e f o r the Eastern ~edfteranean
WEPI. RAD. PROT. /22 EM/RAD/'+7 EIvlRO 0070/~ N o v e m b e r 1970
mom ON
SEMINAR ON RADIATION PROTECTION
KUWAIT, 28 FmARY - 5 MARCH 1970
WHO m o
1. Opening Session 2. Election of Officers 3. Adoption of Agenda and P r o g m e
I1 RADIATION PROTECI'ION IN COUNTRIES OF THE RE!GION
I11 PROBLEMS ASSOCIATEI) WITH RADIATION HEALTH
Current trends in atomic energy a.nd expectation for the future
Ionizing radiation and sources of exposure Radiation effects on man, health hazards Maximum permissible doses from external soumes of radiation
Maximum permissible doses from internal sources of radiation
Medical use of X-rays Radiation protection in hospitals Techniques for measuring stray radiation The nature of radioactivity, its uses; methods of measurements
Uses ofradiamtivematerials in medicine; safety considerations
Relative importance of health hazards associated with various radiation activities
Radiation accidents & public health planning IAEA postal dose intercomparison programme Planning and development of radiological facilities Radiation protection legislation
IV TRAINING OF MEDICAL AND PARAMEDICAL PERSONNEL
V RECOMMENDrnONS
VI CLOSING SESSION AND A C X N O ~ ~
ANNEXES
ANNEX I AGENDA OF THE MEKTING ANNEX I1 FINK LIST OF PAF2ICIPANTS ANNM 111 PROGR4iWE OF THE iQEM3G ANNM IV LIST OF BASIC & BACKGROUND DXWlEPF.7
The Seminar on iladiation Protection took place at the Radiotherapy
and Radioisotopes Centre, AlSabah Hospital, Kuwait, from 28 February to
5 March 1970.
1. Opening Session
H.E. M r Abdul Aziz Al-Neij, Minister of Puhlia,Health, representing
the Government of Kuwait, opened the Seminar in the presence of Mr Y.J. Hijji,
Under-Secretary of Health, Dr A.R. Al-Yusuf, Director of Curative Services,
Dr A.H. Taba, Director, World Health Organization Eastern Mediterranean
Region, the Representative of the International Atomic Energy Agency,
participants representing fifteen countries from the Eastern Mediterranean
Region. namely: Afghanistan, Cyprus, Iran, Iraq, Jordan, Kuwait, Lebanon,
Pakistan, Qatar, Southern Yemen, Sudan, Syrian Arab Republic, Tunisia,
United Arab Republic, and Yemen Arab Republic, as well as WIX) staff and
consultants.
The ceremony, which started at 9.45 a.m. on 28 February 1970, took
place at the auditorium of the Nursing College in the grounds of the
Al-Sabah Hospital.
H.E. The Minister of Health, welcomed the guests as messengers of
welfare to human beings and representatives of the World Health Organization
which is devoted to the protection of hwnanity from the dangers of disease.
Kuwait was chosen f o r the discussion of means and ways t o protect mankind
against t h e harmf'ul effects of radiation. He reviewed the accomplishments
of the S ta te of Kuwait i n this f i e l d since the appointment of radiation
spec ia l i s t s i n 1963, and pointed out t h a t a high committee f o r the
protection against radiat ion was entrusted i n 1967 w i t h the responsibi l i ty
of arranging the use of radiation i n both Goverxunental and Private sectors .
Radiation i s used i n Kuwait not only i n medicine but i n research, agriculture,
prospecting, e tc . He referred t o the creation, i n 1969, of the
Radiotherapy and Radioisotopes Centre a t Al-Sabah Hospital, which can
be considered the most modern of i ts kind i n the region. Finally, he
conveyed t o the guests the cordial welcome of H.H. the A m i r , Sheikh Sabah
Al-Salim Al-Sabah.
I n reply, D r A.H. Taba, Director, World Health Organization, Eastern
Mediterranean Region, speaking on behalf of +&e World Health Organization,
expressed h i s grat i tude t o the Government of Kuwait for t h e i r kind
inv i ta t ion t o hold the Seminar on Radiation i 'rotection a t the Radiotherapy
and ~ i o i s o t o p e s Centre. After welcoming the par t ic ipants t o the Seminar,
the Representative of the International Atomic Ehergy Agency and the WHO
consultants, Dr Taba referred t o the deleterious somatic and genetic
effects of ionizing radiat ion and stressed t'nat the greatest contribution
t o the somatic and genetic dose received by the population a r i s e s from the
diagnostic use of X-rays. Dr Taba s t ressed the ro le and responsibi l i ty
of WHO i n the control of radiat ion hazards and revealed t h a t i n a survey
of medical x-ray equipment conducted by WHO i n the Eastern Mediterranean
Region, s ixty-f ive per cent of the X-ray uni t s surveyed were found t o be
lacking one or more essential radiological safety features. He further
added that i n order t o meet th i s problem, the Eastern Mediterranean Office
of the World Health Organization i s encouraging the ministries of health
t o establish radiation health units and to enact legislation on radiation
protection.
The electior. of officers and adoption of the agenda, as well as a l l
subsequent working sessions of the Seminar were held a t the auditorium of
the Radiotherapy and Radioisotopes Centre.
2. Election of Officers
The Regional Director opened the f i r s t working session and the
following offic.ers were elected by the participants (see ANNFX 11).
D r Youssef T. Omar,
Head, Radiotherapy ernd Radioisotopes Centre,
Al-Sabah Hospital, Kuwait, as Chairman
D r A l i Al-Hindawl,
Director, Ins t i tu te of Nuclear Medicine, and
Radiation, Baghdad, Iraq, as Vice-Chairman
D r H. Manzoor Zaidi,
Head of Department, Ins t i tu te of Radiotherapy,
Jinnah Post-Graduate Medical Centre,
Karachi, Pakistan, as Vice-Chairman
D r Ahmed Gherab,
Head of Department, National Cancer Ins t i t u t e ,
Tunis, as Vice-chairman
D r Mohamed Fouad Ibrahim,
Head, Radiology Division,
Ministry of Public Health, Cairo,
United Arab Fiepublic, as Vice-chairman
D r Aristides Costeas,
Senior Physicist, Radiotherapy Department,
Nicosia General Hospital,
Nicosia, Cyprus, as Rapporteur
PBre F. &pr6 l a Tour,
Professor of Biophysics9
French Faculty of Meaicme,
Beirut, Lebanon, as Rapporteur
3. @option of Agenda and Programme
The provisional agenda was adopted without amendments (ANNM I).
Two minor changes were introduced i n the provisional programme
(ANNM 111) :
t o s h i f t t o Monday afternoon, 2 March 1970, the demonstration
scheduled f o r Tuesday, 3 March on:
WHO mR0
a. planning and dosimetry of radiation therapy and,
b. the detection and measurement of radioact ivi ty i n a
medical radioisotope laboratory.
t o allow f ive minutes fo r questions at the end of each paper.
A s m a l l s c i en t i f i c exhibit displaying photographs representing,
s tep by step, a radiological health survey of an X-ray diagnostic
department, planning and delivery of Cobalt-60 teletherapy and handling
and application of radiun,was presented.
A large bu l l e t in board displayed c i rcu lar l e t t e r s and questionnaires
inv i t ing the par t ic ipat ion of radiat ion centres i n the WHO film-badge
service, i n the IAE@IHO mail dosimetry service f o r Cobalt-60 teletherapy
uni t s and questionnaires requesting information on the f a c i l i t i e s
available i n radiotherapy centres and on the r e su l t s of the existing
film-badge services.
I1 RADIATION PROTMTmON I N COlJKEUES OF THE REGION
On the f i r s t morning of the sc i en t i f i c sessions, D r Gomez-Crespo
spoke of public health respons ib i l i t i es i n radiat ion protection. He
emphasized the f ac t t h a t radiation protection is primarily a public health
responsibi l i ty although other agencies may be involved.
He mentioned par t icu lar ly the imvortance of the genetic e f fec ts of
radiation, which const i tutes a hazard t o cornunity ra ther than t o the
individual, a most important aspect is t h a t of prevention. It is believed
EM/SEM. WD. TROT ./22 page 6
t h a t exposure no matter how s m a l l , may be harmful. It i s most important
t h a t the use of diagnostic X-rays be controlled with careful balancing
of the advantages against the r isks . It has been found that the
correction of deficiency i n X-ray equipment and i t s use is simple and
cheap.
There are four elements of control:
I. Ident i f icat ion and measurement of a l l sources.
2. Evaluation of hazards.
3 . Development and application of control methods.
4 Professional and public information and education.
The organization of services was outlined with the possible in t e r -
relationship of various government agencies and t h e i r responsibi l i t ies .
Preference was shown f o r a new radiat ion control unit , co-ordinating with
other agencies.
The usefulness of the film-badge programme fo r both personnel
monitoring and s t ruc tura l shielding checks. The most effect ive means
of reducing radiation exposure i s by the improvement of medical and dental
X-ray use.
The next speaker, M r Ernborg, WHC Technical Officer i n Medical X-rays,
gave the r e su l t s of h i s survey of 334 X-ray in s t a l l a t ions i n 154 in s t i t u t ions
of ten countries i n the Eastern Mediterranean ilegion. These included 744
sessions of instruct ion and demonstration.
E M / S E M . R A D . P ~ . / ~ ~ page 7
He told of the shortage of radiologists and health physicists. There
are four X-ray technician training schools in the Region with another
starting soon. It is believed that there are mmy X-ray examinations
without sufficient reason partly because public patients are demanding
to be examined. A few highly dangerous installations were found and it
was recommended that their use be discontinued. In forty per cent of
the installations, the electrical current was not stable, causing fluctuation
in operations. Forty to fifty per cent of the dark rooms were
considered inadequate.
Mr Ernborg expressed the opinion that much additional training was
needed for radiologists, technicians, physicists,repair- en and safety
inspectors. There is also need for legislation, registration, inspection
and survey in the field of X-rays and isotspes.
I11 PROBIZNS ASSOCIATED WlTH RADIATTON HEALTH
1. Current Trends in Atomic Energy and Expectations for the Future
The next speaker, Dr Daw, IAEA, spoke about current trends in atomic
energy and expectations for the future. He mentioned the rapidly
increasing need for power. Increased power production would result in
increased pollution. In developing countries there are economic restraints
and difficulty in obtaining nuclear fuel. He predicted that in the
year 2000 the United States power production would be fifty per cent nuclear.
WHO EMRO
The subject of nuclear desalt ing of water and its cost was discussed
i n d e t a i l with a comparison with conventional desalt ing as used i n Kuv-ait.
There i s a large nuclear desalt ing plant under const i tut ion i n the USSR.
He next spoke of isotope power generators which produce steady power
fo r a long period of time. They are useful i n remote points including
space exploration and i n inaccessible par t s of the ear th but present
problems i n recovery and disposal. They also present internat ional
control problems. Their shielding i s only p a r t i a l l y effective.
There have been several recent medical applications such as i n hear t
pacemakers.
The speaker then gave estimates of future nuclear power waste
accwiulations indicating t h a t i n the year 2000, the radioactive wastes
and t h e i r volumes would be increased by factors of hundreds.
He warned against the increased use of isotopes i n consumer a r t i c l e s
such as s t a t i c eliminators and f i r e alarms. These uses should be reviewed
and compared with other methods t o jus t i fy t h e i r widespread use.
2. Ionizing Radiation and Sources of Exposure
On the morning of 1 March, Trofessor Blatz spoke about the nature of
ionizing radiation and sourceso-exposure. He described the difference
between electro-magnetic radiat ion and par t icu la te radiat ion describing
how both may be produced by both radioactive materials and e l ec t r i ca l
machinery, such as X-ray machines and pa r t i c l e accelerators. A description
was given of the mechanism of ionization with a br ie f description of its
ef fec t on human t issues . He mentioned tha t there had been a recent
increased in t e re s t i n cer ta in non-ionizing radiat ion such as l a s e r beams
and micro-waves. There has a l so been concern about the production of
X-rays from televis ion se t s . Brief mention vras made of wide variety
of radiat ion sources i n medicine, research and industry. A l l of these
a re t o be covered with gi.eater d e t a i l i n fu'mre sessions.
After the f i r s t presentation, a film was shown en t i t l ed "The Light
i n the Shadows". It demonstrated the use of radiation i n diagnostic
radiology and nuclear medicine and was prepared by the Dv.pvmt Film Company.
3. Radiation Effects - on M a n , Health Hazards
The next t a lk was given by S i r Brian Windeyer on the subject of
radiat ion e f fec ts on man, health hazards. He to ld how X-rays were f i r s t
used i n t rea t ing almost every known disease. The effects were mostly
ineffect ive but with a few beneficial resu l t s . It was f i r s t believed
t h a t radiat ion had a stimulating e f fec t but experience has shown t h a t it
has e i the r an inhibitory, damaging o r 3estructive effect , depending on
the s ize of the dose. Various c e l l s and organs have re la t ive resistance
o r s ens i t i v i ty t o radiation. The cause of c e l l death i s a s yet unlmown,
although it i s known tha t act ively dividing c e l l s and c e l l s t h a t are
mdifferent ia ted, fo r a par t icu lar function, are more sensi t ive.
The speaker described i n d e t a i l the various biological e f fec ts of
radiation on the skin, the tes tes , sperm ce l l s , ovaries, blood and blood-
forming organs. He gave several anecdotes regarding ear ly experience
with radiat ion damage.
He said that radiation effects are generally classified as either
somatic or genetic although some people mistakenly consider damage to
the foetus as a genetic effect. In describing some of the somatic effects,
he stated that these may be classified as acute-local, acute-generd,
chronic-local and chronic-general. Among the acute-local effects he
described those on the skin, glands and bona. Acute-general includes:
nausea, haematological, gross enterological and neurological effects.
These have been caused by atomic explosions and serious nuclear accidents.
Among the chronic-local effects are fibrosis, late necrosis, cataracts and
cancer, among many others. Chronic-general includes anaemia, leukaemia
and again cancer.
He mentioned the great sensitivity of the foetus, particularly
during the early stage of pregnancy. Malformations and leukaemia among
off-spring have been attributed to exposure to radiation of pregnant
women. It has, therefore, been recommended that except in case of urgency,
women in the child-bearing age should be X-rayed only during the first ten
days of the menstrual period, when it is certain that no pregnancy exists.
He then showed several slides of severe radiation damage resulting
from large doses of X-rays. In one case it was accidental, resulting
from the omission of a filter, in another case it was deliberate irradiation
that was employed to save a patient's life.
In the afternoon, he continued his morning lecture by discussing some
of the genetic hazards of radiation.
He pointedout t h a t t h i s involves the i r rad ia t ion of germ plasma rather
than of the foetus. It can r e su l t i n damage t o the chromosomes causing
breaks and misunions. It has been found t h a t there are a greater number
of chromosome abnormalities frem irradiated persons. Some of the r e su l t s
could be mongolism o r myeloid leukaemia Ionizing radiation however, i s
not the only agent known t o be a genetic hazard. Radiation can also
a l t e r the chemical composition of genes themselves. I-Ie gave several
examples of abnormal. conditions induced by single gene damage including
a cer ta in type of dwarfism and haemophilia. Although heat, coffee and
other agents are believed t o cause genetic damage, ionizing radiation i s
believed t o be the most potent.
It i s believed t h a t an exposure of between f i f t een and t h i r t y rads
of radiation, spread over the population i s needed t o double the genetic
mutation r a t e i n humans. Several examples were given of the great
increase i n cer ta in diseases tha t would r e su l t from such a doubling of
the m ~ t a t i o n r a t e .
He described the r e s u l t of t heea r lyuse of radioactive drinking water
fo r ap th r i t i s . He a l so described t h a t theearlyexperience with radium
watch-dial painters and the damage, resul t ing i n necrosis and bone
sarcoma, has served a s a yardstick i n establishing the maximum permissible
radium ingestion. He a l so to ld of the experience of the miners i n
Schneeberg. The extensive bronchial sarcoma experienced there, has
helped i n establishing permissible radon concentrations i n air. Problems
of excessive radon concentrations s t i l l e x i s t among the uranium miners
i n Colorado, USA.
EM/SEM.MD.PXQ./22 page 12
WHO Em0
He also described the experience with Iodine-131, Caesium-137
Strontium-90 exposure and its effects .
He then proceeded t o discuss the necessary procedures and management
of radiation accidents. There a re many considerations; what organs
a re affected, what i s the ha l f - l i f e and a t what r a t e i s the radioactive
material eliminated? Mention was made of the value of measuring neutron
activation, par t icu lar ly of the blood.
Persons involved i n an accident should be sorted i n t o three groups:
those most affected, those with some exposure and those with t r i v i a l o r
no exposure, and each handled different ly . Consideration should be
given t o the mode of entry in to the body. It may be through i n t a c t
skin, it may be through fractures o r wounds, by ingestion o r inhalation.
Therapy max be by loca l removal, chelation treatment, physiological
treatment o r by l imitat ion of absorption o r uptake. Details of each
method of treatment were given.
He gave several examples of each circumstance cf radiation accident
that might be expected t o occur.
4. Maximum Permissible Doses from Extei-nal sources of Radiation
The next subject was t h a t of m a x i m u m permissible doses from external
sources of radiation, presented by Professor Blatz. He expressed the
opinion t h a t a f u l l understanding of the philosophy and reasons underlying
the exposure l i m i t s being currently used required a knowledge of the
h is tory of radiat ion exposure experience.
The severe skin reactions of some of the ear ly workers resulted i n
precautions taken t o avoid acute e f fec ts of exposure. It took many
years t o appreciate t h a t even i f acute reactions were not evident, fur ther
reductions were needed t o prevent damage t o the blood-forming organs.
Later another reduction i n permissible exposure was needed t o avoid
leukaemia and other malignant diseases. Finally, another sham
reduction was recommended because of new bowledge about deleterious
genetic effects . It was pointed out t h a t e f fo r t s t o es tab l i sh exposure
l i m i t s were handicapped u n t i l about 1931, because of inadequate methods
of measuring ionization i n te rns of repi-oducible uni t s of measurement.
This was overcome by the establishment of the universally accepted unit ,
the roentgen.
He then presented the following tab le t o show the his tory of
changing standards:
Reason
Acute e f fec ts
Blood changes
Malignancies
Increasing Evi-
dence of Damage*
Genetic Effect
Years
1900-1.920
1920-1936
1976-1950
1950-1957
1957-1970
Permissible Dose Limit
(R per ear) Approx. 2 006 t o 5 000
Approx. 50
20
15
5*
* also the greatly increased number of exposed workers because of the new
acute atomic energy industry and growing evidence of genetic effects.
** including a distinction between radiation workers and the general
population with the exposure of the l a t t e r limited t o 0.5 R per year.
Professor Blatz then sunanarized the major external sources of radiation
with a consideration of available mans of controlling human exposure
from each.
5. Maxim Permissible Doses from Internal Sources of Radiation
The next speaker was Dr H. Daw, who discussed maxirmun permissible dose
from internal sources of radiation; i.e., radioactive materials that have
been taken into the body by inhalation, ingestion or other means.
He stated that there were basic docwnents that gave much of the
important information. One is the International Commission on Eladiological
Protection Committee 11 report, the other i s the report entitled "Dose
Evaluation from Internal Sources" (ICRP Report 10). Another valuable
source i s the IAEA safety series.
Three separate categories of persons must be considered; those
occupationally exposed, individual members of the general public and the
whole population. In arriving a t the m a x i m u m permissible dose for large
segments of the population, the percentage of persons exposed must be
considered i n the calculations, for example, if ten per cent of the
population is exposed, the m a x i m average dose should be 0.17 ran per
year, but no individual's exposure should exceed 0.5 rein per year.
EN/SEM. RAD. PROT . /22 page 15
Dr Daw described the considerations taken i n arr iving a t m a x i m u m
permissible exposures. The m a x i m body burden must f i r s t be determined
with the influence of ha l f - l i f e and equilibrium considered. The body
burden may sometimes be determined by external counting. Emretion
r a t e s and bioassays a re a l so helpful. From t h i s information maxim
permissible intake r a t e s and all permissible concentrations i n a i r and
water may be arrived a t . It has been learned t h a t inhalation i s a most
common means of depositing radioactive materials within t h e body.
The speaker gave examples of many s teps taken i n the calculation
of permissible exposure and concentrations.
6 . Medical Use of X-rays
The next lec ture was given by D r Y.T. Omar on the medical use of
X-rays. He related b r i e f l y the his tory of the discovery of X-rays and
of radioactivity, t e l l i n g about i t s rapPd adoption by the medical
profession f o r diagnosis and therapy. He also t o l d of some of the
harmful e f fec ts experienced by the ear ly workers. The development rf
permissible leve ls and general pract ice i n radiation protection was
described.
Dr Omar s ta ted tha t c lear d i s t inc t ion was f i r s t made between
diagnostic and therapeutic radiology i n 19jOs by the issuance of separate
diplomas. He spoke of the development of diagnostic radiology employing
fluoroscopy and radiography including the development of grids,
intensifying screens, high kilovoltage and high milliamperage techniques,
image in t ens i f i e r s and contrast media.
EN/[email protected]./22 page 16
He described in detail simple radiography and many special techniques
that have been developed over the years. He expressed the opinion that
there should be a distinct separation of diagnostic and therapeutic
radiology and that combined certificates should no longer be given.
Er Omar next covered the subject of therapeutic radiology, describing
the high energy accelerators and computers that are now being used. He
mentioned the revision of old concepts regarding dose-time relationships.
He also told how certain materials aided in modern radiotherapy including
certain chemicals and oxygen. He described many of the reasons for
arriving at optimum dosage. A description was given of the many
considerations necessary to localise the radiation properly, including
minimum beam size and improved depth dose distribution. He also pointed
out the importance of reducing the overall integral dose. Mention was
made of the reduction of the use of radiotherapy for benign conditions
and the reasons, although it is sometimes used for some cases; such as
ankylosing spondylitis.
It was recommended that diagnosis and planning should be done by teams
of specialists. The importance of radiotherapy in cancer management
was also emphasized.
D r Omar pointed out the importance of treatment planning and the
need for well trained physicists. He spoke of the use of a simulator
for localisation. He stated that surgery was found preferable to
radiation in many cases, but some inoperable, "so-called" radio-resistant
EM/SEM.RAD.PECT./22 page 17
tmours have been cured with radiation. He mentioned t h e re la t ive
value of cobalt equipment and l i nea r accelerators but warned against
tbe maintenance problems with the accelerators.
He emphasized the importance of complete treatment records i n which
the Internat ional Commission on Radiological Units and Measurements
u11ifom terminology should be used. He concluded h i s lec ture by displaying
many in te res t ing s l ides .
7. Radiation Protectior? i n Hospitals
The next lec ture on the subject of radiation protection i n hospi ta ls
was presented by Professor Blatz. He c lass i f ied the areas of i n t e re s t
as. ( a ) X-rays diagnosis 'medical and dental) , (b) radiation t e l e -
therapy (x-ray, gamma emitting radionuclides and par t i c l e accelerators),
(c) brachytherapy (radium and gamma radionuclides) and, (d) nuclear
medicine i n diagnosis and therapy (except fo r teletlierapy). Each
presents different problems and solutions.
F i r s t a t ten t ion must be given i n the hospi ta l planning stage f o r
housing, including room layout and equipment arrangement, shielding.
vent i la t ion and e l e c t r i c a l wiring, not neglecting apparatus, such as
bedside X-ray uni ts , t h a t must be taken t o wards and pat ients ' rooms.
Then the careful selection of equipment, i t s in s t a l l a t ion and maintenance
f a c i l i t i e s must be considered. A l l of t h i s should be a co-operative
e f f o r t of the radiologis t jo in t ly with an arcll i tect , physicist , and
engineer.. It i s important f o r efficiency, which i s closely related t o
radiat ion protection.
WHO EMRO
In the use of any radiation equipment or materials in a hospital,
there should be a clear designation of authority, responsibility and
supervision. The training and experience qualifications of all members
of the staff is most important.
The speaker then covered many of the elements that serve to assure
the efficient and radiologically safe operation of hospital radiation
activities. They include: training, supervision, personnel monitoring
and periodic radiation calibrations and surveys. The designation of a
Radiation Safzty Committee and a Radiation Safety Officer is advisable,
the latter should be a regular member of the staff who is always readily
available for assistaqce and consultation Among his responsibilities,
are several of those items previously mentioned and the desimation of
controlled and non-controlled areas, the posting oT Radiation Area warning
signs, hazard labels, exc.
An effective radiation protection programme requires constant
vigilance to avoid accidents and over-exposures. An important aspect
is a continuing effort to reduce the exposure of patients by improved
techniques and equipment.
A film entitled "Radiation: Physician and Patient" was then shown.
It is a film prepared specifically to illustrate dramatically the means
available for reducing the radiation exposure of patients in radiology.
8. Techniques f o r Measdring Stray Radiation
During the afternoon, Professor Blatz and M r EArnborg gave the first
of four demonstrations showing various techniques f o r measuring s t ray
radiation during X-ray diagnostic procedures. There was a general
review of methods used t o check compliance with ICW safety Fecommendations
f o r diagnostic X-ray ins ta l la t ions . These include the arrangement of
eauipment and controls, protective accessories and s t ruc tura l shielding.
The use of several types of radiation survey instruments w a s demonstrated.
Some of them have been spec i f ica l ly designed fo r mut ine medical X-ray
safety inspections They include a twin dosimeter s e t , similar t o
personnel pocket self-reading dosimeters, t o measure simultaneously
the X-ray outplut r a t e a id half-value-layer of e i t h e r a fluoroscopic o r
radiographic X-ray tube, and also a self-contained s t r ay radiation
ionization chamber instrument, capable of measuring as l i t t l e as ten
microroentgens (0.OlmR) of X-ray s t ray radiation i n a room adjacent t o
an X-ray room during a single radiographic exposure. These instruments
a re s m a l l , light-weight, rugged and re la t ive ly inexpensive, being designed
fo r surveyors who must t rave l extensively.
I n t h e Radiotherapy and Radioisotope Centre, the par t ic ipants were
given three demonstrations arranged by D r Omar and h i s s t a f f .
The f i r s t was a demonstration of treatment planning f o r teletherapy
and brachytherapy. System analysis and the use of computers for treatment
planning were described. Calibration of the Theratron-80, using a
EN/SEM.RAJI.PROT./22 page 20
Baldwin Farmer sub-stmaad dosimeters and an International Commission
on Radiological Units and Measurements recommended water phantom were
demonstrated. The check of.the Baldwin Famer dosimeter using a Sr-90
reference source was shawn.
During this demonstration, the following equipment was shown; the
The-retron-80, a TEN Cobtaltron, A Siemens' Pendulum Unit, a Siemens'
Delmopan, an AEX Low ?oltage Unit, and a Siemens' Simulator. The
system of immobilization of patients with various mould techniques and
the use of the vacuum forming machine was presented:
The second demonstration was at the radioisotope Laboratories which
were shown. The use of the following Nuclear-Chicago equipment was
demonstrated; the calibration of the Thyrad using the internationally
recommended thyroid phantom, Pho-Dot Scanner, Renaltron IV, Automatic
Gamma Changer with computerised printing system, and the Toko , the
large volume counter.
The last exhibit was that of the hot and cold isotope laboratories
where the following demonstrations and equipment were shown; Panta-safe,
handling of radium sources, preparation of ovoids and tubes for gynaeco-
logical intracavitary applications and their transport. The sewage
monitoring system for waste water disposal and the management of open
radioactive so~!rces, their measurement and disposal and the v.se of various
survey instruments were demonst~ated
WHO EMRO EM/SEM. RAD. PR(Tr./22 page 21
9. The Nature of Radioactivity; i t s uses: Methods of Measurements
On the morning of 3 March the p m g r m e was started by a presentation
by Dip1 Engineer P. Houdek on the subject of "The Nature of Radioactivity;
Its Uses; Methods of Measurements". H i s ta lk was primarily concerned
with nuclear structure, natural radioactivity, a r t i f i c i a l radioactivity,
desintegration and methods of measurements. To i l lus t ra te nuclear
structure, he described the meson and central f i e ld models. Nature
radioactivity was presented by radioactive series. Art i f ic ia l radio-
activity was described with the use of certain types of nuclear reactions
i n accelerators and nuclear reactors. Then the different types of
desintegration, alpha, beta (plus and minus), internal conversion, isomeric
transition and K-capture were discussed.
In the second part of h i s lecture the methods of measurements
with the use of an ionization chamber a GM counter and a photomultiplier
were illustrated. The basic scheme f o r calorimetric and chemical
dosimetry were also shown.
10. Uses of Radioactive Materials in Medicine Safety Considerations
D r Y.T. Omar spoke on the subject, "Uses of Radioactive Materials
in Medicine; Safety Considerations".
He referred t o the extensive use of radioactive isotopes in therapy,
d i a s o s i s and research and t o the development of a new discipline: nuclear
medicine.
There is no agreement on whether the various act iv i t ies in nuclear
medicine should be carried out a t a centralised laboratory or whether
separate radioisotope laboratories should be attached t o the different
specialized clinics.
WHO Em0
specialised clinics.. For a developing country he was i n favour of
having a cent ra l i sed labora tory which can afford be t t e r equipment and
well trained personnel.
The need fo r collaboration between physicians, surgeons, biochemists,
physiologists,- b io logis t s and physicists was stressed by the speakeF.
Dr Y.T. Omar Presented a h i s to r i ca l sketcli of the use of radioisotopes
i n therapy and indicated the present modalities of t he i r use: i . e .
- External gamma-X-ray beam therapy
- External beta-ray therapy
- I n t e r s t i t i a l radiotherapy (Brachytherapg)
- Intracavi tary
- Systemic
- In t r a -a r t e r i a l
Radioactive yttrium-90 and radioactive tantblum wires are a lso
used i n therapy. Radium is s t i l l being used i n the treatment of the
carcinoma of the uterus, cobalt beads i n the treatment of oesophageal
carcinoma, solutions of radioactive sodium and bromine i n the papillomata
of the bladder and col loidal gold i n the treatment of malignant seri,0uS
effusions
Regarding the systemic use of radioisotopes, D r Y T Omar described
124 the use of various isotopes of iodine, i n par t icu lar 113' and 1 , for
t rea t ing the fuiictioning carcinoma of the thyroid and t h a t of radioactive
phosphorus f o r the treatment of polycythaemia vera and chronic leukaemia.
WHO EMRO
Regional treatment by intrdymphatic inject ions, i nmf la t ions of
radioactive isotopes i n the bronchial t r e e and -the use of radioactive
microspheres injected intra-arte1;ially was also described.
D? Y T Omar l i s t e d the multiple diagnostic applications of
radioactive isotopes s t ress ing tha t previously unobtainable d e t a l l s of
the s t ructure and functions of the organs can now be obtained by using
radioisotope t racers .
After an h i s to r i ca l introduction, he referred t o the progress made
i n the detection of radioactive isotopes from the Geiger-Muller counter
t o the c rys t a l and l iqu id sc i en t i l l a t ion detectors. The progress i n
the production of radio-pharmaceuticals, the ava i l ab i l i t y of countless
label led compounds and the poss ib i l i ty of labe l l ing l iv ing c e l l s has
multiplied our research and diagnostic capabi l i t i es greatly.
Then he revie.led i n d e t a i l the study of the function of the thyroid
gland using iodine isotopes, i ron metabolism and ferrokinetics, using
i ron radioisotopes. He a l so described the study of the blood using
phosphorus-32, chromium-51 and radioiodinated albumin. The study of
the circulat ion, the s b d y of the body water and electrolytes and the
use of vitamin B12 i n malabsorption s tudies were a l so described.
He ~ e f e r r e d t o the scanningtechniaues f o r map9ing such organs of
the thyroid gland, heart, bone marrow, l i ve r , spleen, e t c . .
Safety considerations referred t o the handling of sealed and unsealed
sovrces, used fo r diagnosis and 'herapy. The storage and handling of
radioisotopes as well as pat ient management were described.
E2Q'SEM.FAD.PROT./22 page 24
Following D r O m a r ' s lecture there was a film on, "Radiation
Protection i n Nuclear Medicine" which showed graphically many of the
points the speaker had covered
11 -cive Inporzance of Eeal::? Hazards associated wit:? - - - . - - - - - - - -1a.j ous Radiation Ac:ii.i ; i e s - Professor Blatz next spoke on the subject of the re la t ive
importance of the health hazards associated with various radiation
ac t iv5 t ies . He f i r s t entunerated all of the common sources of radiation,
with par t icu lar a t tent ion t o those about which the public has often
expressed feelings of concern: such as, radioactive f a l lou t from
nuclear weapons tes t ing . Some exposure sources concern primarily
radiat ion workers while others might involve e i t h e r individual members
of the public or en t i r e population.
He emphasized the f ac t t h a t except fo r accidents and gross
carelessness, there' should be no suf f ic ien t ly large exposures t o cause
somatic damage among workers o r the public from normal radiation
a c t i v i t i e s today. Care and vigilance should guard against radioactive
contamir1ation o f - a i r water and food and the use of radioactive
materials i n consumer pr,oducts should be careful ly controlled. Whenever
the r i sk of exposix-e i s considered, it is always important t o estimate
the numbers of i n d i v i d a l s i n the child bearing ages and younger who
might be exposed
When a l l of the possible sources of exposure t h a t have o r might
occur, excluding the eventuality of nuclear war o r a major nuclear
disaster , the one tha t stands out as con$t?ibuting the greatest genetic
r i s k t o the population i s t h a t of the widespread diagnostic use of X-rays.
This fac t , combined with the knowledge tha t the unnecessarily high X-ray
exposures so frequently observed can eas i ly be reduced, means t h a t the
major e f f o r t should be directed at medical X-ray exposure reduction.
12. Radiation Accidents and Public Health Planning
D r H. Caw next discussed the subject of radiat ion accidents and
public health planning. He said t h a t public agencies have t o prepare
i n advance, plans and procedures f o r being able t o handle radiation
accident s i tuat ions, partic'g.larly fo r reactors
T'ne competen'r av-thority o r au thor i t ies must be ident i f ied and
known t o all Appropriate channels of communication and request fo r
additional help should be well ident i f ied. Qualified experts capable
of assessing the s i tua t ion and being i n a posit ion t o reach policy
decisions as well a s the necessary executive machinery t o implement them
must be well prepared and available. Alternates t o key personnel should
be available. There should be a cent ra l point of contact t o co-ordinate
act ion between the various agencies and authori t ies involved, e.g. f i r e
brigades, c i v i l defence, e tc .
WSEM. FAD. PRCT . /Z page 26
The speaker said t h a t advanced planning t o deal with radiat ion
accidents which might involve the general public r e s t s on the a b i l i t y
t o provide information and a c t on it, t o be able t o furnish confirmation
fo r surveil lance and monitoring, prediction of the outcome of exposure,
and evaluation of the available counter measures and co-ordination ard
ident i f ica t ion of t he various responsible au thor i t i es .
Training is a l so an important aspect of plaqning. Adequate
t ra ining and ins t ruc t ion of all those who might be cal led upon t o
par t ic ipa te i n handling an emergency must be conducted, together with
rehea-sals from time t o time, Plans must be reviewed per iodical ly and
improvements included i n tne l i g h t of new knowledge and experience.
D r Daw said t ha t the prevention o r minimization of accidents car^
be la-gely a t ta ined by carefill s i t e select ion f o r major nuclear
i n s t a l l a t i o n s For such in s t a l l a t i ons , the design, se lect ion and
fabr icat ion of eqi~ipment and construction is a l so important. Qual i ty
control of the components i s important t o prevent those component f a i l u re s
which may lead t o accidental release. Plant t e s t p r io r t o operation t o
demonstrate compliance with design and safety specif icat ions should be
made.
Following D r Daw's lecture , there was a fi lm presentation on:
"Personnel Monitoring".
1 . IAEA Postal Dose Intercomparison Programme
The next l ec tu re r was D r W. Moos, who described the ImA postal
dose intercomparison progmmne. He sa id t h a t da t aco l l ec t ed f o r a
number of years by t h e agency has shown t h a t the dosimetry fo r
therapeutic radiat ion eq~lipment i s not carr ied out t o the degree which
present knowledge and instrumentation permits. This r e su l t s i n under-
o r over-exposure i n radiat ion cancer treatment more frequently than
i s usually expected A recent survey by agency s t a f f has shown t h a t
about t h i r t y per cent of the surveyed in s t i t u t ions i n over for ty
countries, had infrequently cal ibrated dosimeters o r none at a l l .
D r Moos said t h a t t o remedy t h i s s i tuat ion, the agency hrrs
developed a dose intercomparison system by mail and a f t e r checking out
the procedures, is offering t h i s service t o member s t a t e s i n co-operation
wit;? WHO. The system consists of Lithium Fluoride powder, the
thermoluminescence of which is measured a f t e r the return of capsules
containing the LiF powder t o the agency. The par t ic ipat ing in s t i t u t ions
expose the capsules under cer ta in conditions t o t h e i r Co-60 source
before shipping them back fo r evaluation. The r e s u l t w i l l be made
known t o each i n s t i t u t e but are kept confidential otherwise.
Fxperience so f a r has shown t h a t deviations of over t en per cent
from the reference value a re surprisingly frequent. Thus t h i s service
serves a dual purpose; namely that it has an educational value a s
well a s seeing t o it that the accuracy of CO-60 teletherapy treatments
is fur ther improved.
WHO EMRO
14. Planning and Development of Radiological Fac i l i t i e s -- . - - .- - S i r Brian Windeyer next presented a lec ture on the planning and
development of radiological f a c i l i t i e s . He said t h a t the two main
branches of radiology, diagnosis and therapy, though a l l i e d i n the
consideration of problems of PI-otection, should be considered separately.
Diagnostic radiology, he pointed out, has become the most important
single method of c l in i ca l diagnosis and the hub of the modern hospi ta l .
It is a? essent ia l service which should be conducted by spec ia l i s t s
and trained doctors, who should be employed f u l l time i n t h e i r special i ty .
They should be helped by radiographers who a lso should have t ra in ing
t o enable then t o ca~?-y0u.t the dut ies e f f ic ien t ly . The radiographer
should have l imited responsibi l i ty and should not be l e f t without
supervision.
I f therapeutic radiology i s t o be conducted e f f i c i en t ly and if
cancer pa t ien ts are t o derive appropriate benefit , the organization
required is a substant ia l one. I n the i n i t i a l planning, the responsible
au thor i t ies must determine whether national p r i o r i t i e s need a cancer
service with adequate radiotherapy. The provision of one machine with
inadeauate s~l~pport w i l l only r e su l t i n inef f ic ien t t r e a t m t , and it
would be be t t e r t o send pa t ien ts abroad fo r treatment.
He expressed the opinion tha t e f f i c i en t radiotherapy demands the
employment of full-t ime trained radiotherapists wno are c l in ic ians and
versed i n the problem of cancer. Radiographers with appropriate t ra ining
are essent ia l t o help the radiotherapist They should have l imited
responsibi l i ty and should not be l e f t t o carry out treatment without
the supervision of the radiotherapist , The collaboration of a physicist ,
special ly t ra ined i n c l i c i c a l problems, is necessary 'or the proper
planning of treatment and dose measurements The physicist w i l l need
technical help a l so
The actual plaming of a department and i t s equipment i s a job
f o r spec ia l i s t advisors. Assistance i s now readi ly available from
archi tec ts and engineers who have special experience.
The s i ze and capabi l i ty of the in s t a l l a t ion mast be equated with
the foreseeable c l i n i c a l needs and the s t a f f available. Elaborate
in s t a l l a t ions with inadequate pa t ien t loads can be a great waste of
precious f a c i l i t i e s and must not be b u i l t f o r prestige. There must
a l so be adequate medical and radiographic staff t o take advantage of the
in s t a l l a t ion planned.
Inadeq~wte f a c i l i t i e s and machinery i n a department w i l l be
f rus t ra t ing t o any well-trained workers and they w i l l tend t o leave and
go elsewhere. Par t icu lar note should be made of the necessity of
providinga reasonable appointment with adequate prospects f o r people
on t h e i r return f r o m t ra in ing abroad.
The c l in i ca l use of radioisotopes may be organized i n a var ie ty
of ways I n some la rge centres there a re spec ia l i s t s whose whole time
is devoted t o t h i s work I n other cenkes , it is appropriate t h a t the
diagnostic o r therapeutic radiologis t should be i n charge. I n others,
it may be a laboratory worker such as pathologist. The advantages and
disadvantages were discussed.
There i s a need f o r special ly designed premises and f o r equipment
appropriate t o the expected pa t ien t ward. There i s a l so here a need
for appropriately trained s t a f f . A l l radiology is a c l in i ca l subject
and must be closely embedded i n the hospi ta l f a c i l i t i e s fo r t rea t ing
pa t ien ts and must have close collaboration with other c l inicians.
15. Radiation Protection Legislation
On 5 Mar,ch, D-c G , Gomez-C~espo opened the session with a discussion
on radiation protection leg is la t ion . He s ta ted tha t requests f o r
assistance i n the drawin;; v.p of fadiat ion healtn leg is la t ion a re being
increasingly received by internat ional organizations i n par t icu lar WHO,
IAEA and IU,.
Radiation protection legis la t ion, l i k e all other leg is la t ion , can
be effect ive only i f it is accepted and recognized a s necessary by the
overwhelming majority of those who w i l l be affected by it.
Certain pre-requisites have first t o be sa t i s f ied , such as ava i l ab i l i t y
of su i tab ly trained personnel, necessary equipment and premises, and
adequate b~~.dgetary provision
Perhaps -t%e bes t approach i s the introduction of a simple basic
enabling law empowering the authori ty competent f o r public health t o
draw up and enforce regulations. These regulations can make specific
reference to certain existing international recommendations or codes
of practice such as in the publications of the I C E and the IAEA.
Of the many pessible uses of ionizing radiation, the medical use
of X-rays will almost certainly be the most important one. Therefore,
priority should be given to the drafting of legislation applicable to
such sources.
However, radiation health legislation should apply to all radiation
sources irrespective of the organization owning them.
Since more than one agency or ministry may be concerned with one
or more aspects of the use of ionia ?g radiation, all authorities involved
should be consulted. A co-ordlnating commlttee may be set up with
representatives of all authorities concerned.
The first step must be to require the registration of all
radiation sources. Registration can be followed by licensing. Registration
and/or licensing imply the need for some form of inspection or supervision
and in the ultimate of penalties of some kind.
Radiologists and other users of radiation sources are persons
occupationally exposed to radiation and, therefore, subject to the
provisions as to the maximum permissible doses established by the ICW.
Although there are no established maximum permissible doses for
patients, the exposure limit for each procedure should be the minimum
radiation necessary to obtain the required information or effect.
EN/SEM.RAD.PROT./~~ page 32
WHO EMRO
D r G. Gomez-Crespo referred t o the Helsinki Declaration (5 November 1968)
which spe l l s out the basic pr inciple s ta ted above i n regard t o the
protection of the pat ients .
After D r G. Gomez-Crespo's general review of the prmblem of radiat ion
protection legis la t ion, Professor Blatz continued the subject by outlining
some of the d e t a i l s t h a t are generally included i n legis la t ion.
It i s always necessary t o f i x responsibi l i ty and authority i n a
s ingle agency mr t o designate the l imitat ions on authority if other
agencies share the authority. I n such cases, each such agency generally
has i t s own laws and regulations.
A basic pa r t of a code, which may e i t h e r be an in tegra l pa r t of the
law, o r an administrative authorized by an enabling law, :s a c l ea r
def in i t ion of maximum permissible doses and concentrations. These should
be i n basic agreement with ICRP recommendations. A system of e i t h e r
l icensing o r reg is t ra t ion should be exp l i c i t l y expressed. Each has
i t s advantages and disadvantages. The l icensing i s generally of
individuals o r organizations, whereas, reg is t ra t ion is usually of machines,
materials o r ins ta l la t ions .
The speaker pointed out t h e importance of specifying c lear ly w h a t
const i tutes a radiat ion sourcesubject t o control, and t h a t radioactive
materials i n very s m a l l specified quant i t ies and inoperable radiat ion
machinery should be exempted f r o m control.
It is common to fix responsibility for radiation protection by
requiring the designation of a person for that purpose by any
registration on license applicant. The person's responsibilities
are usually specified in the code. They should include surveying
periodically, maintaining a personnel monitoring programme under specified
criteria, posting warning signs and labels and supervising the storage
of radioactive materials and the disposal of wastes. Specified record-
keeping, and the reporting of accidents, overexposures or losses to the
regulatory authority, are usually required.
m e law or code usually desigaates by whom or under whose supervision
radiation may be applied to humans for diagnostic or therapeutic purposes
and limits its application for experimental purposes.
IV OF MEDICAL AND PARACEDEAJA PPERSOfiTNEL
A panel consisting of Professor B. Windeyer, Professor L. Banks,
Professor H. Blatz, D r G. Gomez-Crespo and Mr D.R.E. Emborg, was
assembled to discuss the subject of the training of medical and paramedical
personnel in radiology, radiotherapy, nuclear medicine and medical physics.
V EIECOMMEXDATIONS
Adequate legislation should be enacted to enable the ministries of
health in the Region to discharge the following duties:
WHO mo
1. Appoint a well-qualified person as a head of the Radiation Health
Unit of the Ministry of Health.
2. Select the technical s t a f f required f o r regis t ra t ion, inspection,
cal ibrat ion and survey of radiation sources and possibly for operations
a film-badge service, and establish, co-ordinate and supervise a film-
badge monitoring service for radiation users i n par t icu lar the medical ones.
3. To establ ish a system of reg is t ra t ion and l icensing of X-ray,
radioisotope teletherapy and unsealed radioisotope sources and t h e i r
users (medical, industr ia l , research, e tc . ) .
4. To conduct systematic inspections and radiological surveys - (using
adequate instrumentation) - of a l l medical, indus t r ia l etc. , sources and
premises, where ionizing radiations a re used.
5. To conduct an educational p r o g r m e f o r medical and paramedical
personnel aimed a t reducing the individual radiat ion doses from medical
o r occupational exposures.
6 . To disseminate t o the public fac tua l informatian and in te rpre ta t ion
on the impact of radiat ion on mankind, so t h a t people have suf f ic ien t
knowledge t o dispel public anxlety.
7. Control of the transportation of radioactive substances.
8. Participation of the radiation health officers of the Ministry of
Health in,the siting of nuclear reactors, and in the ecological survey
of the sites. (In collaboration with the atomic energy authorities).
9. Surveillance for radionuclides in the environment (areas of high
natural risdioactivity, ground, air, water, foodstuffs, reactor
effluents, etc.)
10. Planning for and dealing with emergencies created by radiation
incidents and accidents.
Most of these activities can only be carried out in close co-operation
with the users of radiation sources and with the other ministerial
departments concerned with the various aspects of the use of ionizing
radiation, e.g., Labour, Industry, Atomic Energy, Agriculture, Civil
Defense, Transport, etc.
However, it is the responsibility of the health ministry to provide
a single focal point for evaluation of the total health impact of all
sources of radiation and to ensure that adequate measures for health
protection are taken.
EM/SEM.RAD.PROT./22 page 36
WHO EMRO
V I CLOSING SESSION AND ACKNOWLEDGEMENT
During the closing session, the draft report and the recammendations
were reviewed and adopted by the participants. The participants expressed
their gratitude to the Government of Kuwait and to the authorities of the
Al-Sabah Hospital for the excellent arrangements made, which contributed
greatly to the success of the meeting. They alsa thanked the Warld Health
Organization Regional Office for the Eastern Mediterranean for having
sponsared the meeting.
WHO EMRO
VTI
VTII
M
AGENDA OF THE MEhTING
Opening of the Seminar
Election of Officers and adoption of the Agenda
Introduction Radiation pratection in countries of the Region
E M / S E E . R A D . P ~ . / ~ ~
Annex I page i
The nature of ionizing radiation and its effects on man
The medical use of X-rays: Radiation protection aspects
The nature of radioactivity and the medical use of radioactive materials: Safety considerations
Radiation hazards in perspective
Radiation protection legislation
Public health programmes in radiation protection: experience with existing progrananes
Planning and development of radiological facilities
Training of medical and auxiliary personnel in the medical use of ionizing radiations
Eemonstration of radiation measurements and practical protection procedures in medical. X-ray departments and radioisotope laboratories
Field visits
XTV Surrnnary report and recommendations
W ~ . R A D . P W Y P . / ~ ~ Annex I1
AFGHANISTAN
CYPRUS
FINAL ILST O F PARITCIPANTS AND ODSERVERS
D r Mohammed Akbar Saha k i e f X-ray Ins t i t u t ion Ministry of Public Health Kabul
D r Aristides Costeas Senior Medical Physicist Radiotherapy Department Nicosia General Hospital Nicosia
Engineer Vahab Baba Zadeh Deputy Director
General Dept. Environmental Health & Director
Indus t r ia l mgiene and A i r Pollution Dept. Ministry of Public Health Teheran
Dr Mehdi Mommi Director Pathology and Isotope Section Firouzgar Hospital Teheran
Dr A l i Al-Hindawi Director I n s t i t u t e of Nuclear Medicine and Radiation Baghdad
D r Mohammed Abu Al-Tabikh Expert i n Radiology and Radiotherapy I n s t i t u t e of Nuclear Medicine and Radiation Bwmad
ET./SFM. RAD . PRO'?. /22 Annex 11
WHO m page ii
JORDAN
KUWAIT
D r Hassan Abdo Head Radiology Department Ministry of Health Amman
D r Youssef T. Omar Head Radiotherapy Centre Al-Sabah Hospital Kuwait
D r I. Fikry Head X-ray Departrne~t A m i r i Hospital Kuwait
D r A. Attiya Head X-ray Department Al-Sabah Hospital Kuwait
Dip1 Engineer P. Houdek Senior Physicist Radiotherapy & Radio3sotope Centre Al-Sabah Hospital Kuwait
M r M. Tarakanath Physicist Radiotherapy & Radioisotope Centre Al-Sabah Hospital Kuwait
M r J. A 1 Mudaires Physicist Radiotherapy & Radioisotope Centre Al-Sabah Hospital Kuwait
WHO m o EX/SEN.RAD.PROT./~~ Annex II page iii
PBre F. Dupr6 l a Tour Professor of Biophysics French Faculty of Medicine Beirut
D r S.H. Manzoor Zaidi Head of Department I n s t i t u t e of Radiotherapy Jinnah Post-Graduate Medical Centre Xaraohi
Dr M.D. Abul Khair Associate Professor of Radiotherapy Rajshahi Medical College Iiospital Ra j shahi East Pakistan
D r Mohammed Aziz Abdel Gawad Radiologist Medical & Public Health Semrices Dept. k h a -
Dr Ahmed A l i Hamed Albar Medical Officer Al-Jamhouria Hospital Aden -
D r Abdel Rahman Mohammed El Ledir Radiologist Khartoum Hospital Khartoum
M r Abdel Samad Mohmed Saleh Senior X-ray Instructor Khartom Hospital Khartoum
SYrCrPN ARAB PZFUBLIC Dr 2. Kari Radiologist Damascus Hospital Damascus
EM/S~.RAD.PROT./~~ Annex LC page iv
SYIiIAN ARAB REPUBLIC Dr G. Awad (cont'd. ) Director
Health Institute Damascus
Dr Ahrned Gherab Head of Department National Cancer Institute Tunis
lJNTED ARAB RE-C Dr Mohammed Fouad Ibrahlm Head Radiology Division Ministry of Public Health Cairo --
M r Zakaria Aziz Zakhari Health Physicist Executive Office for Radiation Protection Ministry of Public Health Cairo
YENEN ARAB REPUBLIC Dr Ismail Abbas El-Moayed Radiologist X-ray Section Republican Hospital Sana' a
Dr Abdel Mogbny Mohammed Aghbari Radiologist X-ray Section Republican Hospital Taiz -
INTERNATIONAL ATOMIC ENERGY AGENCY
Dr Hussein T. Daw Representative of IAEA Division of Health, Safety and Waste Managment, Vienna, Austria
Dr W. Moos Guest Speaker, IPEA Head of Dosimetric Section, Vienna, Austria
m/sm. RAD . PFWT ./22 Annex I1 page v
NATIONAL PPJPARATOEPS COMMTTTEE
D r Youssef T. O m a r Chairman of the Committee Dr Ibrahim F ik r i Head, X-ray Department, A m i r i Hospital DT A t i f Att iya Head, X-ray Department, Al-Sabah Hospital M r Paul Houdek Spec ia l i s t i n Radiotherapy D r Hassan Abu Ghazaleh Head, Health Education and Guidance M r Naif M. Al-Mousherji Head, Public Health Relations Office M r Mohammed M. Al-Anbaei Head, Internat ional Health Relations Office
WHO SECRETWT
D r A.H. Taba Director WHO-Regional Office fo r the Eastern .Mediterranean
Professor A.L. Banks Consultant, Medical and WHC Regional Office fo r Paramedical Education the Eastern Mediterranean
Acting Fublic Health Administrator i n - Education & Training
Dr G. Gomez Crespo Adviser on Radiation and WHC Regional Office fo r Isotopes the Eastern Mediterranean
Secretary of the Seminar
Professor Hanson Blatz Consultant Director, Dept. of Health, Office of Radiation Control, New York, USA
S i r B. Windeyer Temporary Adviser Director, Meyerstein I n s t i t u t e of Radiotherapy, The Middlesex Hospital, London, United Kingdom
M r D.R.E. Ernborg Technical Officer i n WHO Regional Office f o r Medical X-rays the Eastern Mediterranean
Miss C. Cartoudis Conference Off icer IrlHC Regional Office fo r the Eastern Mediterranean
WHO EMRO El\I/SEM. RAD .PrWr ./22 Annex 111 page i
FINAL PROGIiAMME OF THE SENINAR -
CATJRDAY 28 FEBRUARY 1970
NURSING COUEGE
9.00 a . m . - 9.25 a.m. Registration of par t ic ipants
* 9.30 a.m. - 10.00 a.m. OPlXtNG SESSION
Inauguration by H.E. M r Abdel Aziz E l Feleig, Minister of Public Health, Kuwait
Address by D r A.H. Taba, Director Wig) Regional Office fo r the Eastern Mediterranean
AT,-SABAH HOSPITAL - Auditorium of the Radiotherapy and Radioisotope Centre
10.30 a.m. - 11.00 a.m. Election of Officers and adoption of the Agenda
11.00 a.m. - 11.33 a.m. Public health respons ib i l i t i es i n D r G. Gomez-Crew0 radiat ion protection:intrcduction
11.3 a.m. - 12.00 noon Medical radiat ion protection i n M r D.R.E. Ernborg the Eastern Mediterrznean Region
12 noon - 12.45 p.m. Current trends i n atomic energy D r H. n a w and expectations f o r the future: radiat ion protection aspects
12.45 p.m. - 1.15 p.m. Discussion
* 3.00 p.m. - 4 . 3 p.m. Public health progrananes i n Participants radiat ion protection: experience with exis t ing programmes
4.45 p.m. - 6.00 p.m. Discussion
* Break
EN/SEM. RAD . PROF. /22 Annex I11 page ii
9.00 a.m. - 9.45 a.m. Nature of ionizing radiation: Prof. H. Blatz sources of exposure
9.45a.m. -1O.OOa.m. Film - T h e L i g h t i n t h e S h a d o w s
* 10.00 a.m. - 10.45 a.m. Radiation e f f ec t s on m a n : Prof. S i r Brian
heal th hazards Windeyer
11.15 a.m. - 12.00 noon Discussion
2.00 p.m. - 2.45 p.m. Radiation i n j u r j : radioactive Prof. S i r Brian poisoning Windeyer
Discussion K
2.45 p.m. - 3.30 p.m. Radiation protection maximum permissible doses:
a ) Fmm external sources
b) From in t e rna l radioactive substances
Prof. H. Blatz
D r H. Daw
4.00 p.m. - 5.00 p.m. Discussion
M O W 2 MARCH 1970
9.00 a.m. - 9.45 a.m. The medical use of X-rays Dr Y.T. Omar
+6 9.45 a.m. - 10.30 a.m. Radiation protection i n hospi ta ls Prof. H. Blatz
11.00 a.m. - 11.45 a.m. Film - Radiation: physician and pa t ien t
11.45 a.m. - 12.00 noon Discussion
AT THE ~ODIAGNOSTIC DEP- AL-SA?3AH HOSPITffi --
2.00 p.m. - 5.00 p.m. DEMONSTRATION of rad ia t ion Prof. H. Blatz measurements and p rac t i ca l protec- & t i o n procedures i n a hosp i ta l X-ray M r D.R.E. Ernborg department
WHO EMRO wSEM.RAD.PROT./22 Amex 111 page iii
PIONDAY 2 MAXCH 1970 (cont'd.)
AT THE RADIOTHERAPY AND RADIOISOTOPES -- CENTRF DEMONSTRATIONS:
a) Planning and dosimetry of ( Dr Y.T. Omar radiation therapy ( Dip1 Ebg. P. Houdek
b) The detection and measurement ( Mr M. Tarakanath of radioactivity in a medical ( Mr J. El Mudaires radioisotope laboratory ( Mr J. Lawrence
11.45 a.m. - 12.00 noon 12.00 noon - 12.33 p.m.
The nature of radioactivity: Dip1 h@;. P. Houdek methods of measurement
Uses of radioactive materials in Dr Y.T. Omar medicine: safety considerations
Film - Facliation Protection in Nuclear Medicine
Discussion
Relative importance of the health Pmf. H. Blatz hazards associated with various radiation activities
Radiation accidents: public health Dr H. Daw planning
Film - Personnel monitoring IPEA mail dosimetry service
Planning and development of radiological facilities:
(X-ray diagnostic (X-ray and radioisotope tele- ( therapy (Dosimetry (Radioisotopes
Dr W. Moos
Prof. Sir Brian Wandeyer
Y
Break
EN/SED1. R4D. PROT. /22 Annex I11 page iv
WHO mo
WEDNESDAY 4 MARCH 1970 Field visit - Kuwait Oil Co. - Ahmadi
THURSDAY 5 MARCH 1970
9.00 a.m. - 10.3 a.m. Radiation protection legislation: a) Introduction Dr G. Gomez-Crespo
b) Special aspects Prof. H. Blatz
AT THE AUDITORIUM OF THE W I N G COLLEGE
11.00 a.m. - 1.00 p.m. Training of medical and paramedical (prof. Sir Brian personnel in: Windeyer Radiology (Prof. L.A. Banks Radiotherapy& (Prof. H. Blatz Nuclear Medicine (DT G. Gomez-Crespo Medical Physics ( M ~ D.R.E. Ernborg
1.00 p.m. - 1.20 p.m. Summary report and recommendations
1.30 p.m. Closure of the Seminar
EM/SEM.RAIXTRR~. 122 Arinex IV page i
ANNEX IV
LIST OF BASIC DOCUMEi'lCS ----
Previsional Agenda .......................... EM/SEM.RAD.PROT./I
Provisional Programme ........................ Elv$/SF,M.FiAD.PRGT,/2 ~ i s t of ParticLpants ......................... EM/SEM.RAD. PROT./3 PUBLIC W T H RESPONSIBILITIES IN RADIATION PROTECTION - Sg Dr G. Gomez-Crespo, WHO Regional Adviser on Radiation and Isotopes . EM/SEM.RAD.PRGT./~ A
MEDICAL RADIATION. PROTECTION IN THE EASTERN MEDITERRANEAN RI.:CION - by Dr G. C-omsz-Crespo, WIIO Regional Adviser on Radiation and Isrtopes .......... EM/[email protected].?RCT./~ B
R4DIATION PRCYI'ECTION LEGLSLATION compiled by Dr G. Gomez-Crespo, WHO Regior-1 Adviser on Radiation and Isotopes . EM/SEM.RA~).PROT./~ A,B
LIST OF BACLC-ROUND rommms -- Public Eealth Responsibilities in Radiation Protectic~n -- WHO/T.R.S. Ns. 254
Conference on the Public Health Aspects of Protection against Ionizing Radiation (Dt'sseldorf 1962) -- VniO/n%O 234
Public Health and Medical Use of Ionizing Radiation - WH0,'T.R.S. No. 3 6
Ionizing Radiation and Eealth -- WHO P.H. Paper No. 6
Radiation Hazards in Perssective - WHO/T.R.S. No. 2m
Minimizing Radiological Hazara to Patients
Collimation in Chest Radiography
Radiation Protection in Diagnostic X-rays
Code of Practice of the Medical Use of X-rays
EM,&EKRAD. PRCT . /22 Annex IV page ii
10) Medical Supervision in Radiation Wnrk - WHO/T.R.S. No. 196
11) Planning of Radiotherapy Facilities - WHO/T.R.S. No. 328
12) Mental Health Aspects of the Peaceful Uses of Atomic Energy - WHO/T.R.S. No. 151
3 Radiological Hazards to Patients, Interim Report, 1959
1 ) Radiological Hazards to Patients, Second Report, 1960
15) Routine Surveillance for Radionuclides in Air and Water, WHO, 1969
16) Effect af Radiation on Human Heredity - WHO/T.R.S. No. 166
17) Ionizing Radiations and Health, WHO Chronicle Volume 15, No. 12, December 1961
18) Introduction of Radiation Medicine into the Undergraduate Medical Curriculum - WHO/T.R.S. No. 155
I91 Medical Radiation Physics - WHO/T.R.S. NO. 390
20) Inspectors Portable Kit
21) Technical Data on Model 666 Fluoroscopic Survey Meter
22) Some Views on Filrn Dosimetry - EMRO/TIB/l
23) Medical X-ray Protection - EMRO/TlE/2 24) Recommendations Relatives h la Protection en Radiodiagnostic - EMRO/TlB/3 25) Facts about Safe Use of X-ray Equipment- EMRO/TIB/~ (English)
Voici Comment Utiliser llEquipment Radiologique - EMRo/TIB/~ (French)
t / 3 f a - -1 - - -"y ;*b cSf"h~ ~ b $ i l ,JA QLhp
(Facts about Safe Use of X-ray Equipment - EMRO/TIB/&) (Arabic)
26) Selected Bibliography on Radiation Protection
