The history of radiation protection begins at the turn of the 19th and 20th centuries with the realization that ionizing radiation from natural and artificial sources can have harmful effects on living organisms. As a result, the study of radiation damage also became a part of this history. While radioactive materials and X-rays were once handled carelessly, increasing awareness of the dangers of radiation in the 20th century led to the implementation of various preventive measures worldwide, resulting in the establishment of radiation protection regulations. Although radiologists were the first victims, they also played a crucial role in advancing radiological progress and their sacrifices will always be remembered. Radiation damage caused many people to suffer amputations or die of cancer. The use of radioactive substances in everyday life was once fashionable, but over time, the health effects became known. Investigations into the causes of these effects have led to increased awareness of protective measures. The dropping of atomic bombs during World War II brought about a drastic change in attitudes towards radiation. The effects of natural cosmic radiation, radioactive substances such as radon and radium found in the environment, and the potential health hazards of non-ionizing radiation are well-recognized. Protective measures have been developed and implemented worldwide, monitoring devices have been created, and radiation protection laws and regulations have been enacted. In the 21st century, regulations are becoming even stricter. The permissible limits for ionizing radiation intensity are consistently being revised downward. The concept of radiation protection now includes regulations for the handling of non-ionizing radiation. In the Federal Republic of Germany, radiation protection regulations are developed and issued by the Federal Ministry for the Environment, Nature Conservation, Nuclear Safety and Consumer Protection (BMUV). The Federal Office for Radiation Protection is involved in the technical work. In Switzerland, the Radiation Protection Division of the Federal Office of Public Health is responsible, and in Austria, the Ministry of Climate Action and Energy.
X-rays
Early radiation consequences The discovery of X-rays by Wilhelm Conrad Röntgen (1845-1923) in 1895 led to extensive experimentation by scientists, physicians, and inventors. The first X-ray machines produced extremely unfavorable radiation spectra for imaging with extremely high skin doses. In February 1896, John Daniel and William Lofland Dudley (1859–1914) of Vanderbilt University conducted an experiment in which Dudley's head was X-rayed, resulting in hair loss. Herbert D. Hawks, a graduate of Columbia University, suffered severe burns on his hands and chest during demonstration experiments with X-rays. Burns and hair loss were reported in scientific journals. Nikola Tesla (1856–1943) was one of the first researchers to explicitly warn of the potential dangers of X-rays in the Electrical Review on May 5, 1897 - after initially claiming them to be completely harmless. He suffered massive radiation damage after his experiments. Nevertheless, some doctors at the time still claimed that X-rays had no effect on humans. Until the 1940s, X-ray machines were operated without any protective safeguards. Röntgen himself was spared the fate of the other X-ray users by habit. He always carried the unexposed photographic plates in his pockets and found that they were exposed if he remained in the same room during the exposure. So he regularly left the room when he took X-rays.
The use of X-rays for diagnostic purposes in dentistry was made possible by the pioneering work of C. Edmund Kells (1856-1928), a New Orleans dentist who demonstrated them to dentists in Asheville, North Carolina, in July 1896. Kells committed suicide after suffering from radiation-induced cancer for many years. He had been amputated one finger at a time, later his entire hand, followed by his forearm and then his entire arm. Otto Walkhoff (1860-1934), one of the most important German dentists in history, took X-rays of himself in 1896 and is considered a pioneer in dental radiology. He described the required exposure time of 25 minutes as an "ordeal". Braunschweig's medical community later commissioned him to set up and supervise a central X-ray facility. In 1898, the year radium was discovered, he also tested the use of radium in medicine in a self-experiment using an amount of 0.2 grams of radium bromide. Walkhoff observed that cancerous mice exposed to radium radiation died significantly later than a control group of untreated mice. He thus initiated the development of radiation research for the treatment of tumors.
The Armenian-American radiologist Mihran Krikor Kassabian (1870-1910), vice president of the American Roentgen Ray Society (ARRS), was concerned about the irritating effects of X-rays. In a publication, he mentioned his increasing problems with his hands. Although Kassabian recognized X-rays as the cause, he avoided making this reference so as not to hinder the progress of radiology. In 1902, he suffered a severe radiation burn on his hand. Six years later, the hand became necrotic and two fingers of his left hand were amputated. Kassabian kept a diary and photographed his hands as the tissue damage progressed. He died of cancer in 1910.
Many of the early X-ray and radioactivity researchers went down in history as "martyrs for science." In her article, The Miracle and the Martyrs, Sarah Zobel of the University of Vermont tells of a 1920 banquet held to honor many of the pioneers of X-rays. Chicken was served for dinner: "Shortly after the meal was served, it could be seen that some of the participants were unable to enjoy the meal. After years of working with X-rays, many of the participants had lost fingers or hands due to radiation exposure and were unable to cut the meat themselves". The first American to die from radiation exposure was Clarence Madison Dally (1845-1904), an assistant to Thomas Alva Edison (1847-1931). Edison began studying X-rays almost immediately after Röntgen's discovery and delegated the task to Dally. Over time, Dally underwent more than 100 skin operations due to radiation damage. Eventually, both of his arms had to be amputated. His death led Edison to abandon all further X-ray research in 1904. One of the pioneers was the Austrian Gustav Kaiser (1871-1954), who in 1896 succeeded in photographing a double toe with an exposure time of 1½-2 hours. Due to the limited knowledge at the time, he also suffered severe radiation damage to his hands, losing several fingers and his right metacarpal. His work was the basis for, among other things, the construction of lead rubber aprons. Heinrich Albers-Schönberg (1865-1921), the world's first professor of radiology, recommended gonadal protection for testicles and ovaries in 1903. He was one of the first to protect germ cells not only from acute radiation damage but also from small doses of radiation that could accumulate over time and cause late damage. Albers-Schönberg died at the age of 56 from radiation damage, as did Guido Holzknecht and Elizabeth Fleischman. Since April 4, 1936, a radiology memorial in the garden of Hamburg's St. Georg Hospital has commemorated the 359 victims from 23 countries who were among the first medical users of X-rays.
Initial warnings
In 1896, the engineer Wolfram Fuchs, based on his experience with numerous X-ray examinations, recommended keeping the exposure time as short as possible, staying away from the tube, and covering the skin with Vaseline. In 1897, Chicago doctors William Fuchs and Otto Schmidt became the first users to have to pay compensation to a patient for radiation damage. In 1901, dentist William Herbert Rollins (1852-1929) called for using lead-glass goggles when working with X-rays, for the X-ray tube to be encased in lead, and for all areas of the body to be covered with lead aprons. He published over 200 articles on the potential dangers of X-rays, but his suggestions were long ignored. A year later, Rollins wrote in despair that his warnings about the dangers of X-rays were not being heeded by either the industry or his colleagues. By this time, Rollins had demonstrated that X-rays could kill laboratory animals and induce miscarriages in guinea pigs. Rollins' achievements were not recognized until later. Since then, he has gone down in the history of radiology as the "father of radiation protection". He became a member of the Radiological Society of North America and its first treasurer. Radiation protection continued to develop with the invention of new measuring devices such as the chromoradiometer by Guido Holzknecht (1872-1931) in 1902, the radiometer by Raymond Sabouraud (1864-1938) and Henri Noiré (1878–1937) in 1904/05, and the quantimeter by Robert Kienböck (1873-1951) in 1905, which made it possible to determine maximum doses at which there was a high probability that no skin changes would occur. Radium was also included by the British Roentgen Society, which published its first memorandum on radium protection in 1921.
Unnecessary applications
Pedoscope
Since the 1920s, pedoscopes have been installed in many shoe stores in North America and Europe, more than 10,000 in the U.S. alone, following the invention of Jacob Lowe, a Boston physicist. They were X-ray machines used to check the fit of shoes and to promote sales, especially to children. Children were particularly fascinated by the sight of their footbones. X-rays were often taken several times daily to evaluate the fit of different shoes. Most were available in shoe stores until the early 1970s. The energy dose absorbed by the customer was up to 116 rads, or 1.16 grays. In the 1950s, when medical knowledge of the health risks was already available, pedoscopes came with warnings that shoe-buyers should not be scanned more than three times a day and twelve times a year. By the early 1950s, several professional organizations issued warnings against the continued use of shoe-mounted fluoroscopes, including the American Conference of Governmental Industrial Hygienists, the American College of Surgeons, the New York Academy of Medicine, and the American College of Radiology. At the same time, the District of Columbia enacted regulations requiring that shoe-mounted fluoroscopes be operated only by a licensed physical therapist. A few years later, the state of Massachusetts passed regulations stating that these machines could only be operated by a licensed physician. In 1957, the use of shoe-mounted fluoroscopes was banned by court order in Pennsylvania. By 1960, these measures and pressure from insurance companies led to the disappearance of the shoe-mounted fluoroscope, at least in the United States. In Switzerland, there were 1,500 shoe-mounted fluoroscopes in use, 850 were required to be inspected by the Swiss Electrotechnical Association by a decree of the Federal Department of Home Affairs on October 7, 1963. The last one was decommissioned in 1990. In Germany, the machines were not banned until 1976. The fluoroscopy machine emitted uncontrolled X-rays, which continuously exposed children, parents, and sales staff. The all-wood cabinet of the machine did not prevent the X-rays from passing through, resulting in particularly high cumulative radiation levels for the cashier when the pedoscope was placed near the cash register. It is clear that the machine was not designed with proper safety measures in place, leading to dangerous levels of radiation exposure. The well-established long-term effects of X-rays, including genetic damage and carcinogenicity, suggest that the use of pedoscopes worldwide over several decades may have contributed to health effects. However, it cannot be definitively proven that they were the sole cause. For example, a direct link has been discussed in the case of basal cell carcinoma of the foot. In 1950, a case was published in which a shoe model had to have a leg amputated as a result.
Radiotherapy
In 1896, Viennese dermatologist Leopold Freund (1868-1943) used X-rays to treat patients for the first time. He successfully irradiated the hairy nevus of a young girl. In 1897, Hermann Gocht (1869–1931) published the treatment of trigeminal neuralgia with X-rays, and Alexei Petrovich Sokolov (1854-1928) wrote about radiotherapy for arthritis in the oldest radiology journal, Advances in the field of X-rays (RöFo). In 1922, X-rays were recommended as safe for many diseases and for diagnostic purposes. Radiation protection was limited to recommending doses that would not cause erythema (reddening of the skin). For example, X-rays were promoted as an alternative to tonsillectomy. It was also boasted that in 80% of cases of diphtheria carriers, Corynebacterium diphtheriae was no longer detectable within two to four days. In the 1930s, Günther von Pannewitz (1900–1966), a radiologist from Freiburg, Germany, perfected what he called X-ray stimulation radiation for degenerative diseases. Low-dose radiation reduces the inflammatory response of tissues. Until about 1960, children with diseases such as ankylosing spondylitis or favus (head fungus) were irradiated, which was effective but led to increased cancer rates among patients decades later. In 1926, the American pathologist James Ewing (1866-1943) was the first to observe bone changes as a result of radiotherapy, which he described as radiation osteitis (now Osteoradionecrosis). In 1983, Robert E. Marx stated that osteoradionecrosis is radiation-induced aseptic bone necrosis. The acute and chronic inflammatory processes of osteoradionecrosis are prevented by the administration of steroidal anti-inflammatory drugs. In addition, the administration of pentoxifylline and antioxidant treatments, such as superoxide dismutase and tocopherol (vitamin E) are recommended.
Radiation protection during X-ray examinations
Preliminary observation
Sonography (ultrasound diagnostics) is a versatile and widely used imaging modality in medical diagnostics. Ultrasound is also used in therapy. However, it uses mechanical waves and no ionizing or non-ionizing radiation. Patient safety is ensured if the recommended limits for avoiding cavitation and overheating are observed, see also Safety Aspects of Sonography. Even devices that use alternating magnetic fields in the radiofrequency range, such as magnetic resonance imaging (MRI), do not use ionizing radiation. MRI was developed as an imaging technique in 1973 by Paul Christian Lauterbur (1929-2007) with significant contributions from Sir Peter Mansfield (1933-2017). Jewelry or piercings can become very hot; on the other hand, a high tensile force is exerted on the jewelry, which in the worst case can cause it to be torn out. To avoid pain and injury, jewelry containing ferromagnetic metals should be removed beforehand. Pacemakers, defibrillator systems, and large tattoos in the examination area that contain metallic color pigments may heat up or cause second-degree burns or malfunction of the implants.
Photoacoustic Tomography (PAT) is a hybrid imaging modality that utilizes the photoacoustic effect without the use of ionizing radiation. It works without contact with very fast laser pulses that generate ultrasound in the tissue under examination. The local absorption of the light leads to sudden local heating and the resulting thermal expansion. The result is broadband acoustic waves. The original distribution of absorbed energy can be reconstructed by measuring the outgoing ultrasound waves with appropriate ultrasound transducers.
Radiation exposure detection
In order to better assess radiation protection, the number of X-ray examinations, including the dose, has been recorded annually in Germany since 2007. However, the Federal Statistical Office does not have complete data for conventional X-ray examinations. In 2014, the total number of X-ray examinations in Germany was estimated to be about 135 million, of which about 55 million were dental X-ray examinations. The average effective dose from x-ray examinations per inhabitant in Germany in 2014 was about 1.55 mSv (about 1.7 x-ray examinations per inhabitant per year). The proportion of dental X-rays is 41%, but accounts for only 0.4% of the collective effective dose. In Germany, Section 28 of the X-ray Ordinance (RöV) has required since 2002 that the attending physician must have an X-ray pass available for X-ray examinations and offer it to the patient. The pass contains information about the patient's X-rays to avoid unnecessary examinations and to allow comparison with previous images. With the entry into force of the new Radiation Protection Ordinance on December 31, 2018, this obligation no longer applies. In Austria and Switzerland, x-ray passports have so far been available voluntarily. In principle, there must always be both a justifiable indication for the use of X-rays and the informed consent of the patient. In the context of medical treatment, informed consent refers to the patient's agreement to all types of interventions and other medical measures. § 630d Act of (in German)
Radiation reduction Over the years, there have been increasing efforts to reduce radiation exposure to therapists and patients.
Radiation protective clothing
Following Rollins' discovery in 1920 that lead aprons protected against X-rays, lead aprons with a lead thickness of 0.5 mm were introduced. Due to their weight, lead-free and lead-reduced aprons were subsequently developed. In 2005, it was recognized that in some cases the protection was significantly less than wearing lead aprons. The lead-free aprons contain tin, antimony and barium, which have the property of producing intense radiation (X-ray fluorescence radiation) when irradiated. In Germany, the Radiology Standards Committee has taken up the issue and introduced a German standard (DIN 6857-1) in 2009. The international standard IEC 61331-3:2014 was finally published in 2014. Protective aprons that do not comply with DIN 6857-1 of 2009 or the new IEC 61331-1 of 2014 may result in higher exposures. There are two classes of lead equivalency classes: 0.25 mm and 0.35 mm. The manufacturer must specify the area weight in kg/m2 at which the protective effect of a pure lead apron of 0.25 or 0.35 mm Pb is achieved. The protective effect of an apron shall be appropriate to the energy range used, up to 110 kV for low energy aprons and up to 150 kV for high energy aprons. If necessary, lead glass panels must also be used, with the front panels having a lead equivalent of 0.5-1.0 mm, depending on the application, and the side shields having a lead equivalent of 0.5-0.75 mm. Outside the useful beam, radiation exposure is primarily caused by scattered radiation from the tissue being scanned. During examinations of the head and torso, this scattered radiation can spread throughout the body and is difficult to shield with radiation protective clothing. Fears that a lead apron will prevent radiation from leaving the body are unfounded, however, because lead absorbs radiation rather than scattering it. When preparing an orthopantomogram (OPG) for a dental overview radiograph, it is sometimes recommended not to wear a lead apron, as it does little to shield scattered radiation from the jaw area, but may hinder the rotation of the imaging device. However, according to the 2018 X-ray regulation, it is still mandatory to wear a lead apron when taking an OPG.
X-ray intensifier foils In the same year as the discovery of X-rays, Mihajlo Idvorski Pupin (1858-1935) invented the method of placing a sheet of paper coated with fluorescent substances on the photographic plate, drastically reducing the exposure time and thus the radiation exposure. 95% of the film was blackened by the intensifying film and only the remaining 5% was directly blackened by the X-rays. Thomas Alva Edison identified the blue-emitting calcium tungstate (CaWO4) as a suitable phosphor, which quickly became the standard for X-ray intensifying film. In the 1970s, calcium tungstate was replaced by even better and finer intensifying films with rare earth-based phosphors (terbium-activated lanthanum oxybromide, gadolinium oxysulfide). The use of intensifying films in dental film production did not become widespread because of the loss of image quality. The combination with high-sensitivity films further reduced radiation exposure.
Anti-scatter grid An anti-scatter grid is a device in X-ray technology that is placed in front of the image receiver (screen, detector, or film) and reduces the incidence of diffuse radiation on it. The first diffusion radiation grid was developed in 1913 by Gustav Peter Bucky (1880-1963). The US radiologist Hollis Elmer Potter (1880-1964) improved it in 1917 by adding a moving device. The radiation dose must be increased when using scattered radiation grids. For this reason, the use of scattered radiation equipment should not be used on children. In digital radiography, a grid may be omitted under certain conditions to reduce radiation exposure to the patient.
Radiation protection splint
Radiation protection measures may also be necessary against scattered radiation, which occurs during tumor irradiation of the head and neck on metal parts of the dentition (dental fillings, bridges, etc.). Since the 1990s, soft tissue retractors known as radiation protection splints have been used to prevent or reduce mucositis, an inflammation of the mucous membranes. It is the most significant adverse acute side effect of radiation. The radiation protection splint is a spacer that keeps the mucosa away from the teeth and reduces the amount of scattered radiation that hits the mucosa according to the square law of distance. Mucositis, which is extremely painful, is one of the most significant detriments to a patient's quality of life and often limits radiation therapy, thereby reducing the chances of tumor cure. The splint reduces oral mucosal reactions that typically occur in the second and third third of a radiation series and are irreversible.
Panoramic X-ray machine
The Japanese Hisatugu Numata developed the first panoramic radiograph in 1933/34. This was followed by the development of intraoral panoramic X-ray units, in which the X-ray tube is placed intraorally (inside the mouth) and the X-ray film extraorally (outside the mouth). At the same time, Horst Beger from Dresden in 1943 and the Swiss dentist Walter Ott in 1946 worked on the Panoramix (Koch & Sterzel), Status X (Siemens) and Oralix (Philips). Intraoral panoramic devices were discontinued at the end of the 1980s because the radiation exposure was too high in direct contact with the tongue and oral mucosa due to the intraoral tube.
Digital X-ray Eastman Kodak filed the first patent for digital radiography in 1973. The first commercial CR (Computed Radiology) solution was offered by Fujifilm in Japan in 1983 under the device name CR-101. X-ray imaging plates are used in X-ray diagnostics to record the shadow image of X-rays. The first commercial digital X-ray system for use in dentistry was introduced in 1986 by Trophy Radiology (France) under the name Radiovisiography. Digital x-ray systems help reduce radiation exposure. Instead of film, the machines contain a scintillator that converts the incident X-ray photons either into visible light or directly into electrical impulses.
Computer tomography In 1972, the first commercial CT scanner for clinical use went into operation at Atkinsons Morley Hospital in London. Its inventor was the English engineer Godfrey Newbold Hounsfield (1919-2004), who shared the 1979 Nobel Prize in Medicine with Allan McLeod Cormack (1924-1998) for his pioneering work in the field of computed tomography. The first steps toward dose reduction were taken in 1989 in the era of single-slice spiral CT. The introduction of multi-slice spiral computed tomography in 1998 and its continuous development made it possible to reduce the dose by means of dose modulation. The tube current is adjusted, for example by reducing the power for images of the lungs compared to the abdomen. The tube current is modulated during rotation. Because the human body has an approximately oval cross-section, radiation intensity is reduced when radiation is delivered from the front or back, and is increased when radiation is delivered from the side. This dose control also depends on the body mass index. For example, the use of dose modulation in the head and neck region reduces total exposure and organ doses to the thyroid and eye lens by up to 50% without significantly compromising diagnostic image quality. The Computed Tomography Dose Index (CTDI) is used to measure radiation exposure during a CT scan. The CTDI was first defined by the Food and Drug Administration (FDA) in 1981. The unit of measurement for the CTDI is the mGy (milli-Gray). Multiplying the CTDI by the length of the examination volume yields the dose-length product (DLP), which quantifies the total radiation exposure to the patient during a CT scan.
Structural protective measures
An X-ray room must be shielded on all sides with 1 mm lead equivalent shielding. Calcium silicate or solid brick masonry is recommended. A steel jamb should be used, not only because of the weight of the heavy shielding door but also because of the shielding; wooden frames must be shielded separately. The shielding door must be covered with a 1 mm thick lead foil and a lead glass window must be installed as a visual connection. A keyhole shall be avoided. All installations (sanitary or electrical), that interrupt the radiation protection, must be leaded ( § 20 § 20 Röntgenverordnung (röv_1987) [§ 20 X-ray Ordinance] (in German) and § Annex+2 Annex 2 (to § 8 para. 1 sentence 1 RöV) (röv_1987) (in German) Depending on the application, nuclear medicine requires even more extensive protective measures, up to and including concrete walls several meters thick. In addition, from December 31, 2018, when the latest amendments to Section 14 (1) No. 2b of the Radiation Protection Act § 14 Strahlenschutzgesetz – StrlSchG [Radiation Protection Act (StrlSchG)] (in German) come into force, an expert in medical physics for X-ray diagnostics and therapy must be consulted for the optimization and quality assurance of the application and for advice on radiation protection issues.
Certificate of competence
Each facility operating an x-ray unit shall have sufficient personnel with appropriate expertise. The person responsible for radiation protection or one or more Radiation Safety Officers shall have appropriate qualifications, which shall be regularly updated. X-ray examinations may be technically performed by any other staff member of a medical or dental practice if they are under the direct supervision and responsibility of the person responsible and if they have knowledge of radiation protection. This knowledge of radiation protection has been required since the amendment of the X-ray Ordinance in 1987; medical and dental assistants (then called medical assistants or dental assistants) received this additional training in 1990. The regulations for the specialty of radiology were tightened by the Radiation Protection Act, which came into force on October 1, 2017. The handling of radioactive substances and ionizing radiation (if not covered by the X-ray Ordinance) is regulated by the Radiation Protection Ordinance (StrlSchV). Section 30 StrlSchV § 30 StrlSchV (in German) defines the "Required expertise and knowledge in radiation protection".
Radiation protection associations The Association of German Radiation Protection Physicians (VDSÄ) was formed in the late 1950s from a working group of radiation protection physicians of the German Red Cross and was founded in 1964. It was dedicated to the promotion of radiation protection and the representation of medical, dental, and veterinary radiation protection concerns to the public and the health care system. In 2017, it was merged into the Professional Association for Radiation Protection. The Austrian Association for Radiation Protection (ÖVS), founded in 1966, pursues the same goals as the Association for Medical Radiation Protection in Austria. The Professional Association for Radiation Protection for Germany and Switzerland is networked worldwide.
Radiation protection in radiotherapy In radiotherapy, radiation protection is often overlooked in favor of structural safeguards and therapist protection. The benefit/risk assessment should prioritize both the therapeutic goal of treating the patient's cancer and the safety of all involved. However, it is crucial to ensure that radiation is delivered only where it is needed through appropriate treatment planning. By employing strong radiation protection measures, we can confidently provide effective treatment while minimizing potential risks. Linear accelerators replaced cobalt and caesium emitters in routine therapy due to their superior technical characteristics and risk profile. They have been available since about 1970. The presence of a medical physicist responsible for technical quality control is required for linear accelerators, unlike X-rays and telecurie systems. It is important to note that radiation necrosis is the necrosis of cells in an organism caused by the effects of ionizing radiation. Radionecrosis is a serious complication of radiosurgical treatment that becomes clinically apparent months or years after irradiation. Radiation therapy has significantly reduced the incidence of radionecrosis since its early days. Modern radiation techniques prioritize the sparing of healthy tissue while irradiating as much of the area around the tumor as possible to prevent recurrence. It is important to note that patients undergoing radiotherapy face a certain level of radiation risk.
Radiation protection and radiation damage in veterinary medicine
While there is limited literature on radiation injury to animals, there is no evidence of other types of radiation injury. Diagnostic radiation has been shown to cause local burns in animals, typically resulting from prolonged exposure of body parts or sparks from old x-ray tubes. It is important to note that the frequency of injury to veterinary staff and veterinarians is significantly lower than that in human medicine, highlighting the safety of diagnostic radiation in veterinary practice. In veterinary medicine, fewer images are taken compared to human medicine, particularly fewer CT scans. However, due to the manual restraint of animals to avoid anesthesia, at least one person is present in the control area, resulting in significantly higher radiation exposure than that of human medical staff. It is important to note that since the 1970s, dosimeters have been used to measure the radiation exposure of veterinary personnel, ensuring their safety. Feline hyperthyroidism (overactive thyroid) is a common disease in older cats. Radioiodine therapy is considered by many authors to be the treatment of choice. Following the administration of radioactive iodine, cats are kept in an isolation pen. The cat's radioactivity is measured to determine the time of discharge, which is typically 14 days after the start of therapy. The therapy requires significant radiation protection measures and is currently only offered at two veterinary facilities in Germany (as of 2010). After the start of treatment, cats must be kept indoors for four weeks, and contact with pregnant women and children under the age of 16 must be avoided due to residual radioactivity. Just like a medical practice, any veterinary practice operating an X-ray machine must have sufficient staff with the appropriate expertise, as required by Section 18 of the X-Ray Ordinance 2002. The corresponding training for paraveterinary workers (then called veterinary nurses) took place in 1990. In 2017, Linsengericht (Hesse) opened Europe's first clinic for horses with cancer. Radiation therapy is administered in a treatment room that is eight meters wide, on a specially designed table that can withstand heavyweight. The surrounding area is protected from radiation by three-meter thick walls. Mobile equipment is used to irradiate tumors in small animals at various locations.
Radioactive substances
Radon
Radon is a naturally occurring radioactive noble gas discovered in 1900 by Friedrich Ernst Dorn (1848-1916) and is considered carcinogenic. Radon is increasingly found in areas with high levels of uranium and thorium in the soil. These are mainly areas with high granitic rock deposits. According to studies by the World Health Organization, the incidence of lung cancer increases significantly at radiation levels of 100-200 Bq per cubic meter of indoor air. The likelihood of developing lung cancer increases by 10% with each additional 100 Bq/m3 of indoor air.
Elevated radon levels have been measured in numerous areas in Germany, particularly in southern Germany, Austria and Switzerland.
Germany The Federal Office for Radiation Protection has developed a radon map of Germany. The EU Directive 2013/59/Euratom (Radiation Protection Basic Standards Directive) introduced reference levels and the possibility for workers to have their workplace tested for radon exposure. In Germany, it was implemented in the Radiation Protection Act (Chapter 2 or Sections 124-132 StrlSchG) § 124-132 StrlSchG (in German) and the amended Radiation Protection Ordinance (Part 4 Chapter 1, Sections 153-158 StrlSchV). § 153-158 Act of (in German) The new radon protection regulations for workplaces and new residential buildings have been binding since January 2019. Extensive radon contamination and radon precautionary areas have been determined by the ministries of the environment of the federal states (as of June 15, 2021).
Austria The highest radon concentrations in Austria were measured in 1991 in the municipality of Umhausen in Tyrol. Umhausen has about 2300 inhabitants and is located in the Ötztal valley. Some of the houses there were built on a bedrock of granite gneiss. From this porous subsoil, the radon present in the rock seeped freely into the unsealed cellars, which were contaminated with up to 60,000 Becquerels of radon per cubic meter of air. Radon levels in the apartments in Umhausen have been systematically monitored since 1992. Since then, extensive radon mitigation measures have been implemented in the buildings: New buildings, sealing of cellar floors, forced ventilation of cellars or relocation. Queries in the Austrian Health Information System (ÖGIS) have shown that the incidence of new cases of lung cancer has declined sharply since then. The Austrian National Radon Project (ÖNRAP) has studied radon exposure throughout the country. Austria also has a Radiation Protection Act as a legal basis. Indoor limits were set in 2008 The Austrian Ministry of the Environment states that
"Precautionary measures in radiation protection use the generally accepted model that the risk of lung cancer increases uniformly (linearly) with radon concentration. This means that an increased risk of lung cancer does not only occur above a certain value, but that a guideline or limit value only adjusts the magnitude of the risk in a meaningful way to other existing risks. Achieving a guideline or limit therefore means taking a risk that is still (socially) acceptable. It therefore makes perfect sense to take simple measures to reduce radon levels, even if they are below the guideline values." In Austria, the Radon Protection Ordinance in its version of September 10, 2021 is currently in force, which also defines the radon protection areas and radon precautionary areas.
Switzerland The aim of the Radon Action Plan 2012-2020 in Switzerland was to incorporate the new international recommendations into the Swiss strategy for protection against radon and thus reduce the number of lung cancer cases attributable to radon in buildings. On 1 January 2018, the limit value of 1000 Bq/m3 was replaced by a reference value of 300 becquerels per cubic meter (Bq/m3) for the radon gas concentration averaged over a year in "rooms in which people regularly spend several hours a day". Subsequently, on May 11, 2020, the Federal Office of Public Health FOPH issued the Radon Action Plan 2021-2030. The provisions on radon protection are primarily laid down in the Radiation Protection Ordinance (RPO).
Radiation sickness among miners
In 1879, Walther Hesse (1846-1911) and Friedrich Hugo Härting published the study "Lung Cancer, the Miners' Disease in the Schneeberg Mines". Hesse, a pathologist, was shocked by the poor health and young age of the miners. This particular form of bronchial carcinoma was given the name Schneeberg disease because it occurred among miners in the Schneeberg mines (Saxon Erz Mountains). When Hesse's report was published, radioactive radiation and the existence of radon were unknown. It was not until 1898 that Marie Curie-Skłodowska (1867-1934) and her husband Pierre Curie (1859-1906) discovered radium and created the concept of radioactivity. Beginning in the fall of 1898, Marie Curie suffered from inflammation of the fingertips, the first known symptoms of radiation sickness. In the Jáchymov mines, where silver and non-ferrous metals were mined from the 16th to the 19th century, uranium ore was mined in abundance in the 20th century. It was only during the Second World War that restrictions were imposed on ore mining in the Schneeberg and Jáchymov mines. After World War II, uranium mining was accelerated for the Soviet atomic bomb project and the emerging Soviet nuclear industry. Forced labor was used. Initially, these were German prisoners of war and displaced persons, and after the February Revolution of 1948, political prisoners were imprisoned by the Communist Party regime in Czechoslovakia, as well as conscripted civilian workers. Several "Czechoslovak gulags" were established in the area to house these workers. In all, about 100,000 political prisoners and more than 250,000 forced laborers passed through the camps. About half of them probably did not survive the mining work. Uranium mining ceased in 1964. We can only speculate about other victims who died as a result of radiation. Radon-bearing springs discovered during the mining in the early 20th century established a spa industry that is still important today, as well as the town's status as the oldest radium brine spa in the world.
Wismut AG The approximately 200,000 uranium miners employed by Wismut AG in the former Soviet occupation zone of East Germany were exposed to very high levels of radiation, particularly between 1946 and 1955, but also in later years. This exposure was caused by the inhalation of radon and its radioactive by-products, which were deposited to a considerable extent in the inhaled dust. Radiation exposure was expressed in the historical unit of working level month (WLM). This unit of measurement was introduced in the 1950s specifically for occupational safety in uranium mines in the U.S. to record radiation exposure resulting from radioactive exposure to radon and its decay products in the air we breathe. Approximately 9000 workers at Wismut AG have been diagnosed with lung cancer.
Radium
Until the 1930s, radium compounds were not only considered relatively harmless, but also beneficial to health, and were advertised as medicines for a variety of ailments or used in products that glowed in the dark. Processing took place without any safeguards.
Until the 1960s, radioactivity was often handled naively and carelessly. From 1940 to 1945, the Berlin-based Auergesellschaft, founded by Carl Auer von Welsbach (1858-1929, Osram), produced a radioactive toothpaste called Doramad that contained thorium-X and was sold internationally. It was advertised with