Commentary No. 9 (1994) seeks to (1) draw special attention to the problems in protection of the embryo, fetus and nursing child that might result from the use of radiation in the medical diagnosis and treatment of the mother, and (2) assist the Nuclear Regulatory Commission in developing requirements appropriate to dealing with the unintended exposure of the embryo, fetus or nursing child as a result of such procedures. The Commentary highlights the fact that physicians must be constantly alert for the patient who may be pregnant or breast feeding. Commentary No. 9 summarizes the doses to the embryo, fetus or nursing child that might result from radiological procedures, brachytherapy to the mother, teletherapy to the mother, and the administration of radiopharmaceuticals to the mother. The Commentary then goes on to treat the risks attributable to these radiation exposures including those for deterministic effects and stochastic effects. Finally, the Commentary sets out recommendations and conclusions aimed at the specification of requirements for action after radiation exposure of the embryo, fetus or nursing child.
Commentary No. 09 – Considerations Regarding the Unintended Radiation Exposure of the Embryo, Fetus or Nursing Child (1994)
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Commentary No. 12 (1995) explores radiation protection considerations associated with high-altitude flight at an altitude of 65,000 feet (20,000 m) or so. It addresses relevant considerations such as dose rates at different altitudes, dose rates from solar flares, biological effects of ionizing radiation at these altitudes, and the associated radiation risk estimates. Estimates of radiation risk for flight crew, passengers, frequent travelers, and conventional travelers are made. The Commentary concludes with comments on aspects of radiation protection philosophy and measurements that need to be addressed to operate commercial aircraft at these altitudes.
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Table of Contents Preface
Commentary No. 13 (1995) discusses the concept of efficacy as it applies to the use of radiation in diagnostic radiology and nuclear medicine and describes the interrelationships of efficacy with cost-effectiveness and cost-benefit analysis, including consideration of potential radiation detriment, as well as with outcome research and technology assessment. Inherent in the decision to use radiation as a tool in diagnosis is the understanding that every radiation exposure needs to be justified. Since it is only through the development of medical decision-making concepts such as efficacy that decisions concerning justification can be made, NCRP finds the evaluation of radiation exposure involved in a practice or procedure an essential part of evaluating efficacy. The Commentary presents a general hierarchical model to classify efficacy studies. This hierarchy extends from basic laws of physics, through clinical use, to more general patient outcome and societal issues. Discussion of this hierarchy is followed by a discussion of the applications of efficacy concepts to the assessment and emergence of a new technology. Next, the relations of outcome research, technology assessment, and efficacy are explored. The final section summarizes the logical relationships of efficacy levels and the use of imaging efficacy concepts in clinical decision making.
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Table of Contents Preface
It can be stated that no radiologic examination should be carried out unless there is a significant medical need for such examination at that time. It may also be stated that no radiological examination for which there is a significant medical need should be denied a patient, even if she is pregnant, for the risk to the patient of not having an indicated examination is also an indirect health risk to the embryo-fetus. However, there may be exceptions to this general thesis. The need for radiological examinations covers the entire spectrum of necessity, and health practitioners may, and often do, disagree as to the importance of a given examination in a given situation. There is presumably a radiation dose level below which most experts would agree that the risk of any radiation injury from a radiological examination (such as a routine chest x ray) is so small that it would be offset by any slight medical benefit. There is also a level, presumably, above which the risk of the radiological procedure is so great that it should not be carried out except to counteract a life-threatening situation (such as the radiation treatment of cancer). Individual experts will differ if asked to numerically define these levels, and they may draw different conclusions in trying to compare the risks with the benefits in a given situation because both are so often nonquantifiable or at least illdefined. NCRP recognizes that any general recommendation it makes regarding the medical radiation exposure of women having child-bearing capacity can serve only as a guide that may be modified in specific instances according to the judgment of the patient's physician and the consulting expert.
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Report No. 92 is the first of a series of reports providing detailed information on population exposures as summarized in NCRP Report No. 93. The Report presents estimates of exposures arising from the entire light water reactor nuclear fuel cycle. Dose estimates are calculated for individuals in the general population who may receive the maximum exposure and for the population within 80 km of facilities that are typical of those in operation in the nuclear fuel cycle. Each process in the cycle is presented in sufficient detail to provide an understanding of the sources and magnitudes of radiations and radionculides involved. Annual release rates of radionuclides to air and water and the resulting radiation doses are given for exposures arising from mining, milling and refining, uranium hexafloride production, enrichment, fuel fabrication, power generation, fuel reprocessing, low-level waste, spent fuel storage, high-level waste, and transportation.