State of Connecticut Radiation Professional
Volunteer Program (CT-RPVP)
LESSON 1
Principles of Radiation and Radiation Protection
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1
Objectives
• Describe the two forms of radiation and give examples of each
• Distinguish between radiation exposure and radioactive
contamination
• Describe the relationships between radiation exposure,
radiation absorbed dose, and dose equivalent
• Understand how time, distance and shielding are used to
minimize radiation exposure
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2
Photon and Particle Radiation
• Radiation, as the term is used in this course, consists of:
Photon
‒ photons
and
‒ subatomic particles
Radiation
Radioactive
Atom
Particle
• Radiation is emitted from the nuclei of radioactive atoms (or
radioisotopes) and is capable of causing the ionization of
atoms. For this reason, this type of radiation is often referred
to as “ionizing radiation”
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3
Photon Radiation
• X- and gamma rays are released
from the nuclei of a radioactive
atoms as packets of energy, or
photons
• X rays are similar to gamma but
have lower energy
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4
Subatomic Particle Radiation
• Alpha, and beta radiations are subatomic particles ejected from the nuclei
of atoms undergoing radioactive decay
• Neutron radiation consists of free neutrons produced during nuclear
fission, a reaction which takes place in reactors of nuclear power plants
and atomic bombs following detonation
++
(N)
Alpha (α)
Beta (β)
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Neutron (N)
5
Test Your knowledge
• Which of the following can be used to in place of “radioactive
atom”
A) Radiation
B) Radioisotope
C) Photon
D) Subatomic Particle
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6
Sources of Radiation
• Man-Made, such as x-rays generated
from a medical x-ray machine, and
gamma rays from radiation therapy
equipment
or
• Naturally-Occurring, such as cosmic rays
from space, and gamma radiation from
radon gas
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7
Shielding from Radiation
• Protective shielding varies with the type of radiation
α
[Alpha]
Skin, paper, 1 to 4 inches of air
β
Less than ¼ inch metal, glass, concrete,
1 to 18 feet air
[Beta]
X, γ and n
[X-, Gamma
rays and
Neutrons]
2 to 12 inches lead, 3 to 18 inches
steel, 1 to 6 feet of concrete, tens to
hundreds of yards in air
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8
Radiation Detection
Cannot be seen
Cannot be smelled
Cannot be felt
Cannot be tasted
But, can be
easily detected by
instruments
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9
Exposure vs. Contamination
• Exposure to radiation occurs after
entering an area in which there is a
radiation source
• After leaving the area, the exposure
no longer happens
• Contamination occurs when
radioactive material is on the body
surface (external contamination) or is
in the body (internal contamination)
• Decontamination of external areas is
accomplished by removing clothing
and washing the affected areas
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10
Measuring Radiation
• Exposure to radiation results in the absorption of a radiation dose
– The unit for exposure is the roentgens (R)
– The unit for absorbed dose is the Radiation Absorbed Dose (rad)
– The unit for dose equivalent is the Roentgen equivalent man (rem)
• For practical purposes, 1 R (exposure) = 1 rad (absorbed dose) = 1 rem or
1000 mrem (dose equivalent)
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Daily sources of radiation
Normal annual exposure from natural radiation
Approx. 0.3 rem/yr
•
•
•
•
Radon gas
Human body
Rocks, soil
Cosmic rays
0.165 rem
0.03 rem
0.02 rem
0.02 rem
Normal annual exposure from man-made radiation
Between 0.030 - 0.070 rem/yr
•
•
•
•
•
1 chest X-ray
Consumer products
Air travel round trip (NY-LA)
Watching color TV
Nuclear industry
0.010 rem
0.010 rem
0.005 rem
0.001 rem
< 0.001 rem
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12
Test You knowledge
Radon gas can enter homes from surrounding soil. Radon cannot be seen and has
no odor, but at elevated levels, radon in homes presents a serious health risks.
Radiation emitted by radon in homes is an example of:
A) Man-made radiation
B) Naturally occurring radiation
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13
Minimizing Radiation Doses - ALARA
• ALARA stands for As Low As is Reasonably Achievable
• The purpose of ALARA is to minimize risk as a result of
exposure to radiation or radioactive material to a level that is
As Low As is Reasonably Achievable
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Mitigating External Radiation Doses
Minimize Time
Maximize Distance
Maximize Shielding
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Dose Limits for Responders Performing Emergency Services
Dose Limit (rem)
Activity
5
All
10
Protecting valuable
property
lower dose not practicable
25
Life-saving or
protection of large
populations
lower dose not practicable
> 25
Life-saving or
protection of large
populations
Only on a voluntary basis
to persons fully aware of
the risks involved
ICRP (1991), NCRP Report No. 116 and NCRP Report No. 138, DHS (2007)
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Condition
Summary
•
Radiation is composed of subatomic particles or high-energy photons
•
Contamination results form the presence of radioactive material on or in the body,
whereas radiation exposure results form being in the presence of a radiation
source
•
R, rad and rem are units used to measure radiation exposure, absorbed dose and
dose equivalent
•
ALARA is a radiation safety principle for minimizing radiation doses and releases of
radioactive materials by employing all reasonable methods
•
Three basic rules of thumb for minimizing radiation exposure are time, distance
and shielding
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State of Connecticut Radiation Professional
Volunteer Program (CT-RPVP)
Lesson 2
Radiation and Nuclear Threats and Vulnerabilities
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18
Objectives
• Describe the radiological and nuclear threats faced by the U.S.
• Understand the risks of contamination and exposure to
volunteers when screening individuals involved in a
radiological or nuclear incident
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19
Intentional Nuclear/Radiological Threats to the US
“Dirty” Conventional Bomb (RDD)
•
Improvised Nuclear Device (IND)
•
1kT “Suitcase Nuke”
•
Ballistic Missile Attack
•
250 kT Nuclear Weapon – “City Killer”
More
•
Impact/Damage
Radiation Emission Device (RED)
Dirty Bomb
RED
Less
•
Nuclear Weapon, IND
Less
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Likelihood
More
20
Possible Terrorist-Related Scenario
• Radiation Emission Device (RED) - concealed at high-traffic area: ~
60 to 250 deaths and ~ 130 cases of radiation sickness requiring
public health follow-up for 30 years; psychological trauma

Community recovery timeline: Months to years
Source: Tofani A, Bartolozzi M. Ranking nuclear and radiological terrorism scenarios: The Italian case. Risk Analysis 2008;28(Oct):1431-44.
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Possible Terrorist-Related Scenario
• Radiation Dispersal Device (RDD) - explodes at busy street corner: ~ 30 to
180 deaths
• Few in any radiation-related injuries
• Decontamination efforts for people and objects
• Significant financial cost for decontamination of property in the affected
area
Source: Tofani A, Bartolozzi M. Ranking nuclear and radiological terrorism scenarios: The Italian case. Risk Analysis
2008;28(Oct):1431-44.
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22
Possible Terrorist-Related Scenario
•
Improvised nuclear device (IND) - explosion of 10 kilotons,
in center of a city, such as Coleman Dock, Seattle, WA
•
Approximately 50,000 deaths
•
Infrastructure damage out to 1 mile
•
Contamination ~3,000 sq. miles
•
$100+ billion in costs
•
Community recovery time: Years
Source: Tofani A, Bartolozzi M. Ranking nuclear and radiological terrorism scenarios: The Italian case. Risk Analysis 2008;28(Oct):1431-44.
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23
Risk to Volunteers from Screening Individuals of a
Radiological or Nuclear Incident
• What is the risk of exposure or contamination to volunteers performing
radiological surveys of people involved in a radiological or nuclear event?
•
•
Depends on the nature of the event:
Contamination for RED: None


•
Exposure only (such as in an RED incident)
Acute radiation syndrome in exposed individuals
No risk of exposure or contamination to volunteers
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Risk to Volunteers from Screening Individuals of a
Radiological or Nuclear Incident
Contamination (Radiation Dispersal Device )
• Individual’s person, articles of clothing, other belongings may be contaminated
• Removing contaminated clothing will eliminate 80 - 90% of contamination
• Individuals may be internally contaminated
• Individuals with minor injuries may self-refer to screening centers
• Relatively low risk for contamination to volunteers; very low level exposures
possible (varies with degree of individuals’ levels of contamination)
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25
Risk to Volunteers from Screening Individuals of a
Radiological or Nuclear Incident
Contamination (Nuclear Power Plant Incident)
• Individual’s person, articles of clothing, other belongings may be contaminated
• Individuals may be internally contaminated
• Relatively low risk for contamination to volunteers; very low level exposures
possible (varies with degree of individuals’ levels of contamination)
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26
Risk to Volunteers from Screening Individuals of a
Radiological or Nuclear Incident
Contamination from Fall-Out, and High-Level Exposures (Nuclear detonation)
• Individuals’ persons, articles of clothing, and other belongings may be contaminated
• Individuals may be internally contaminated
• Individuals may incur radiation doses up to several hundred rads are possible (acute radiation
syndrome)
• Individuals with minor injuries may self-refer
• Relatively low risk for contamination to volunteers; very low level exposures possible (varies with
degree of individuals’ levels of contamination)
• Incident-related psychological stress/trauma among volunteers
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27
Test your knowledge
Which of the following are the most likely terrorist-related threats to
the U.S are:
A) 250 kT nuclear weapon and an IND detonation
B) Ballistic missile attack and an IND detonation
C) Dirty bomb detonation and deployment of an RED
D) Detonation of a RDD and IND
E) No threat
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28
Test your knowledge
Which of the following is true:
A) The impact of an IND is greater than that of a 250 kT bomb
B) With respect to a terrorist attack, the probability of an RDD
detonation is greater than that of a IND detonation
C) A dirty bomb detonation is likely to cause radiation
injury, deaths and contamination of a small area
D) The risk of radiation exposure and contamination to volunteers who may
be called upon to screen victims of an RED is zero
E) The risk of radiation exposure and contamination to volunteers who may
be called upon to screen victims of an RDD is zero
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Summary
• Threats to the U.S. involving the release of radiation and
radioactive materials are the use of REDs, RDDs, INDs, and
nuclear weapons with yields varying from 1 – 250 kT
• Volunteers screening individuals impacted by an RDD have no
risk of exposure or contamination
• Volunteers screening individuals impacted by a dirty bomb or
a nuclear weapon, including an IND, have a low risk of
contamination, or radiation exposure
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State of Connecticut Radiation Professional
Volunteer Program (CT-RPVP)
Lesson 3
Biological and Clinical features of Radiation injuries
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31
Objectives
• Distinguish between acute and chronic radiation exposure
• State three types of DNA changes resulting from radiation
exposure
• Identify symptoms of acute radiation syndrome
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Acute Radiation Exposure
• Acute radiation exposure is
exposure to a large, single dose of
radiation, over a short period of
time (seconds)
• A large acute exposure to radiation
may result in immediate clinical
effects (e.g., acute radiation
syndrome) as well as long-term
effects (e.g., cancer)
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Chronic Radiation Exposure
• Chronic radiation exposure involves
exposure to low levels of radiation over a
long period of time (months – years)
• Chronic radiation exposure may result in
increased risk of developing cancer
• Exposure to radiation emitted by radon gas
present in many homes is an example of
chronic radiation exposure
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34
Test your knowledge
True or False: Unlike acute radiation exposure, chronic
radiation exposure may result in the development of cancer
A) True
B) False
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35
Test your knowledge
Of the following, which is a example of acute radiation
exposure
A) Radiation incurred on a round-trip flight from New York City to Los
Angles
B) Radiation incurred from a one-time chest x-ray
C) Eating foods over one’s lifetime that contain high levels of
potassium-40 (radioactive isotope)
D) Living in high-altitude areas
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Radiation Targets All Cellular Components
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Types of DNA Damage Caused by Radiation
Deoxyribonucleic Acid -
Radiation can damage DNA
resulting in:
 DNA mutations and DNA
breaks
 Gross structural
rearrangements or
chromosomal aberrations,
to the DNA can also occur
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Janice Brock
University RPO
DNA Damage Caused By Radiation
Deoxyribonucleic Acid -
Radiation damages DNA may result in:
 DNA mutations may not kill the cell; however over time, these
mutations may transform the cell into a cancerous cell
 This transformation is random (stochastic) and take place
over several years
 The higher the radiation dose, the greater the chance of
developing cancer
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Janice Brock
University RPO
DNA is the most important Target of Radiation
Deoxyribonucleic Acid -
Radiation damages DNA which result in:
•
Unrepaired DNA breaks and gross structural changes to the DNA almost
always lead to cell death
•
High radiation doses, delivered quickly (seconds) and to a large area of the
body, result in widespread cell death, causing:
o Tissue and organ failure which manifest as acute radiation
syndrome (ASR)
•
The occurrence of these biological events and clinical manifestations are
predictable (or non-stochastic) and take place relatively quickly
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Janice Brock
University RPO
Effects of Acute Radiation Exposure (High Dose, High Dose Rate)
25 – 50 rads 100 rads
WBC
650 rads
250 rads
1000 rads
Severe Vomiting (100%)
Diarrhea
Cramps
Bleeding - mouth, kidneys
Nausea
Vomiting
WBC
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Test your knowledge
Which is true of acute radiation syndrome:
A. Affects more males than females
B. Varies in severity according to the absorbed dose of
radiation
C. Can be treated with potassium iodide
D. All of the above
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Summary
• Acute radiation exposure is exposure to a large, single dose of radiation,
over a short period of time
• Chronic radiation exposure involves exposure to low levels of radiation
over a long period of time
• Both, acute and chronic radiation exposures can result in cancer
• The most important cellular target of radiation is DNA. Radiation-induced
damage to DNA include DNA mutations and chromosomal aberrations
• The severity of ARS is directly proportional to dose
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43
State of Connecticut Radiation Professional
Volunteer Program (CT-RPVP)
Lesson 3
External Decontamination
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44
Objectives of this Section
• Describe the purpose and goal of decontamination
• List some key concepts of decontamination
• Provide an overview of the decontamination process for
removing radioactive contaminants present on body surfaces,
including hair
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Decontamination Concepts
• The purpose of the external
decontamination is to remove or reduce
radioactive contaminants from the
surfaces of individuals and pets
– Skin
– Hair
•
Goal is < 2 times background or 2
decontamination attempts
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Decontamination Concepts for Reception Centers
• Decontamination, if required or advisable, follows
immediately after the screening process
• If survey readings are:
 > 2 - 3x background, decontamination is advisable (EPA/NCRP)
 > 20- 30x background, decontamination is required (EPA/NCRP)
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Test your knowledge
• Decontamination of individuals should continue until survey
readings indicate levels below 2 times background
A. True
B. False
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Decontamination Concepts for Reception Centers
• Individuals (and pets) with contamination
levels > 2x background, as per GM survey
• Decontamination is repeated until survey
readings are < 2x background or until
additional rounds of decontamination do
not reduce contamination levels by more
than 10% (CDC)
• After each round of decontamination,
individuals are resurveyed
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Decontamination Process for Reception Centers
• All contaminated clothing and
valuables are placed in a plastic bag

Removing clothing will eliminate
80 – 90% of contamination
• Items that cannot be decontaminated
(e.g., porous materials) should be
discarded in waste bins for
contaminated items
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Decontamination Process for Local Surface Contamination
• If contamination is limited to a small
body surface (e.g., hand, face) it
may be possible to decontaminate
the area without showering
• Cover wounds with bandages
• Wash with warm water
• Begin with the least aggressive
techniques and mildest agents (e.g.,
soap and water)
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Decontamination Process for Local Surface Contamination
• Use the mechanical action of flushing or
friction of cloth, sponge, or soft brush
• Keep materials out of eyes, nose, and
mouth,
• Avoid causing mechanical, chemical, or
thermal damage to skin
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Decontamination Process for Extensive Body Contamination
• If contamination is present on the majority of the body surface
contamination may be removed by showering
• Shower with warm water and mild
soap
• Begin with the head, bending it
forward to direct wash-water away
from body
• Keep water out of eyes, nose,
mouth, and wounds
• Use mechanical action of a cloth or
sponge but avoid abrading the skin
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Considerations for Decontamination Process
• Separate male and female decontamination showers
• If possible, parent(s) should assist children with washing
• Keep families together
• Decontaminate pets in an area separate
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Considerations for Decontamination Process
• Have on-hand replacement clothing or disposable gowns
• For large-scale events, it may not be feasible to collect
contamination from runoff
• Provide for the security of items of personal value
• Individuals with medical dependencies or with other special needs,
older adults and children will require additional help with
decontamination
• Medical care for life-threatening injuries must not be delayed in
favor of decontamination
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Test your Knowledge
All of the following statements are true except:
a. Radioactive contamination may be removed, or
reduced to acceptable levels simply by washing
the contaminated areas with warm water and mild soap
b. Removing a contaminated individual’s clothing
eliminates 80 – 90% of radioactive contamination
c. Treatment of minor cuts or abrasions should never
be delayed in favor of decontaminated
d. To the extent possible, family members should not
be separated during the decontamination process
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Summary
• The goal of the decontamination process is to reduce or
remove contamination from body surfaces
• Ideally decontamination is performed until survey readings
indicate levels below those of 2 times background
• Removing clothing eliminates 80 – 90% of contamination
• It may not be possible to decontaminate all personal
belongings
• External contamination may be removed by washing with
warm water and mild soap
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Summary
• Do not abrading skin, and avoid internalizing water runoff
during showering
• Do not separate families, particularly, children from parents
• Make provisions to assist individuals with medical
dependencies or other special needs as well as older adults
with decontamination
• Never delay the delivery of emergency care in favor of
decontamination
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State of Connecticut Radiation Professional
Volunteer Program (CT-RPVP)
Lesson 4
Behavioral Responses to Radiological/Nuclear Incidents
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59
Objectives
• Define psychological stress
• Present the range of psychological
responses elicited by radiation and
nuclear incidents
• Describe elements for managing
psychological stress produced by radiation
and nuclear incidents
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What is Psychological Stress?
• For this lesson, psychological stress is the individual's response
when demands go beyond coping resources to deal with a
radiological or nuclear incident
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Reactions Following Radiation Incidents
• Radiation and nuclear incidents may cause psychological
stress, with both short and long-term effects
• Extend beyond the individuals directly affected
• Situations with a high degree of uncertainty, regarding
potential future health effects, may be more
psychologically traumatic than others
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Fear Is the Initial Response
• Tasteless
• Odorless
• Colorless
• Association to malignant disease
• Visuals of Hiroshima and Nagasaki
Osteosarcoma in a radium dial
factory worker (circa 1920)
Hiroshima: A boy who received
radiation burns on his whole
body following the atomic bomb
explosion
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Reactions Following Radiation Incidents
“When people are confused about their actual
health risks, some will assume incorrectly that they
have been exposed and will develop physical
reactions.”
National Child Traumatic Stress Network (NCTSN) 2010
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Stress Reactions Mimic Physical Injury or Illness
Goiania, Brazil (1987)
• A Cesium-137 capsule was stolen from a discarded
radiation therapy instrument and opened
• 250 people came in contact with Cs-137
– Fear caused 112,000 people to request screening
for contamination
– Of the first 60,000 screened, 5,000 individuals had
psychosomatic symptoms that mimicked those of
radiological exposure
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Lack of Accurate Information Fuels Fear
Inaccurate or insufficient
information
Knowledge
Fear
Facts
Myths
Accurate information at a local level


Fear and anxiety of radiation exposure are as debilitating as the actual physical health effects
One role of population monitoring volunteers is to reassure individuals by providing accurate information
about radiation
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66
Test Your Knowledge
Which fact about radiation contributes to its fear?
A. Causes severe sunburns and other skin rashes
B. Damages cellphones
C. Cannot be detected by the human senses
D. Leads to birth defects such as two-headed cows
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Responders’ Concerns to Radiation Incidents
Responders’ Concerns and Emotional Reactions
Medical professionals, First Responders and Volunteers
• Have limited experience in managing casualties from radiation events
• May experience fear, shock, anger, helplessness and worry
• May be concerned about exposing family/friends
Psychological support services, education and training may mitigate the
psychological stress exhibited by emergency responders
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Range of Psychological Stress
Emotional
Cognitive
Behavioral
indecisiveness,
distrust, conflict,
shock, fear, grief,
worry, confusion,
work/school problems,
anger, guilt, shame,
reduced attention span,
irritability, loss of
feeling helpless,
trouble concentrating
intimacy,
feeling numb,
feeling abandoned,
sadness
withdrawn
Spiritual
Physical
tension, fatigue,
edginess, insomnia,
bodily aches pain,
startling easily, racing
heartbeat, nausea,
change in appetite
changes in one’s
belief in God,
changes in
assumptions
about good and evil
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Managing the Psychological Responses to a radiological or Nuclear Incident
• Prompt, safe and dignified provision of assistance
– Medical care
– Screening and decontamination of affected individuals
• Clear and credible information pertinent to:
– Incident status
– Protective actions
• Public health follow-up
– Tracking of chronic health effects
– Education on health risks
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70
Test Your Knowledge
Which of these is not a strategy for mitigating psychological
stress during a radiological or nuclear incident?
A. Provide clear and credible information about the
incident
B. Minimize the incident as not to worry the
community
C. Provide education on the health risk of
radiation
D. Provide medical assistance to those affected by
the incident
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Summary
• Radiological and nuclear incidents cause psychological stress to people
directly and indirectly affected by the incidents.
• Fear is the first psychological response to a radiological or nuclear
incidents, and perhaps the debilitating of the psychological reactions
• Fear may cause individuals to exhibit symptoms which resemble those of
radiation exposure, and act in extreme and sometimes irrational ways to
avoid the perceived or real threat
• Medical professionals, first responders and volunteers may also experience
the same psychological stresses as those experienced by the general public
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Summary
• Individuals impacted by radiological or nuclear incidents may exhibit
alterations in emotional, cognitive behavioral, physical and spiritual
reactions
• Strategies for managing psychological stress in the after math of a
radiological or nuclear incident are to provide prompt assistance to the
affected population, disseminate clear information by credible sources
about the status of the situation and instructions for protecting the public,
and ensure that governmental agencies establish a means for tracking the
effects of the event and provide health risk management information.
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State of Connecticut Radiation Professional
Volunteer Program (CT-RPVP)
Lesson 5
Roles and Responsibility of Local, State and Federal
Agencies
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• SETH TO DEVELOP
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