IRPA Questionnaire of Task Group on Tissue Reactions
This questionnaire is distributed to all the IRPA associated societies (ASs) to collate points of interest ontissue reactions and promote a wide exchange of knowledge and points of view at an international level. It
considers updates about the progress in relation to dedicated research on tissue reactions relating to gaining
a better understanding of the impact of radiation on the disease processes. It also seeks the view of professionalsof the IRPA ASs about wider issues relating to tissue reactions to contribute to creating awareness aboutearly and late effects of radiation, including the effects of ionizing radiation on diseases of the circulatory
system (DCS) including cerebrovascular diseases (CeVD) and ischemic heart disease (IHD).
Main activities to be carried out:
- To focus on literature and related views of the ASs on radiation tissue reactions within the tissues andorgans of interest with particular emphasis on the circulatory system.
- To analyze the pertinent application of workers’ dosimetry in different sectors from medicine, nuclear
and industrial radiology, as well as evaluation of doses for exposed patients, in relation to tissuereactions.
- To collate the view of the ASs in considering the use of absorbed dose for the dose limits of tissues andorgans, and on the justification of different limits for workers and members of the public, as for skinand lens of the eye.
- To collate and share information on eye dosimeters being developed and introduced in different
countries and related publications for an improved exchange of knowledge.
- To collate information from studies of the effectiveness of devices for protection of the eye lens andprepare and share advice concerning on-going improvement.
Chair: Marie Claire Cantone (AIRP, Italy); Vice Chairs: Colin J. Martin (SRP, United Kingdom); Merce
Ginjaume (SEPR, Spain)
Nominated members from Associated Societies of the different geographical areas: Africa, North and SouthAmerica, Asia, Australia, and Europe: Michelin Severino (SAR, Argentina); George McGill (ARPS,Australia), Zoe Brady (ARPS, Australia); Jean-Marc Bordy (SFRP, France); Nobuyuki Hamada (JHPS,Japan); Sumi Yokoyama (JHPS, Japan); Mark C. Okeji (NigSRP, Nigeria); Lawrence Dauer (HPS, UnitedStates); Timothy Sebeela (SARPA, South Africa).
This questionnaire is distributed to all the IRPA ASs with the objective to collect and report the evaluation of
the IRPA community about: the best applied methods for monitoring dose to the lens of the eye; the methodsof protection and the ongoing path toward the implementation of recommendations at a legislative level inthe different countries. At the same time this is an opportunity to learn the views of professionals of the IRPA
ASs on the wider generic issue of tissue reactions.
This Task Group has the opportunity to assess whether professionals of the IRPA ASs are informed about
tissue reactions in a radiation protection context and if any of them are involved in this field, as well as theirperspectives on the evolution of this topic.
The issue of Tissue Reactions is complex. Tissues are affected in different ways through different mechanisms,
many of which are not as yet properly understood. Evidence for effects on the lens of the eye has been built
up over many years with a dose limit set to prevent cataracts. Evidence for effects on other tissues within thebody and the dose levels at which such effects may occur, particularly in relation to cardiovascular disease,
have not yet been established. These effects are of particular interest in the medical field, where doses to thetissues affected may be significant and benefit-risk ratios are important for patient management. Therefore, aseparate section on this has been created at the end of the questionnaire.

Q1. Within your Association is there an open discussion about Tissue Reactions? Is your organization involved
in reviewing or writing documents or papers on this topic? Are there other organizations within your country
carrying out such reviews and preparing reports? Please provide details if your response is yes to any of these.
Q2. Has the theme of Tissue Reactions been included in recent events or conferences organized by yourAssociation? What is the opinion about the evolution of knowledge and understanding on the topic?
Q3. Are you aware of any initiative to review the possible effects of ionizing radiation on diseases specificallyof the circulatory system, the dose levels at which these might occur, and the population groups that might beaffected?
Q4. Do you have insight regarding factors that could contribute to inter-individual variations in response toionising radiation, e.g. in relating to radiation cataracts factors such as age at exposure, attained age, genetic
factors, and individual response?
Q5. Are professionals within your Association aware that effects currently classified as tissue reactions (e.g.
effects on the lens of the eye) may have a stochastic component?
Q6. Is the term ‘deterministic effects’, still used in legislation or other official documents in your country or
has it been replaced by the term ‘tissue reactions’ as is the case in ICRP reports?
Q7. In the next set of fundamental recommendations from ICRP the dose limit quantity equivalent dose in Sv
will be changed to mean absorbed dose in Gy when applied to tissue reactions. What is the view amongradiation protection professionals in your country of the proposed change in which the radiation weighting
factor will no longer be applied for tissue reactions? Is the change already being implemented in radiation
research studies in your country?
Q8. Do you consider that the professional opinions within each sector on the importance of tissue reactions
vary significantly? If so, would sharing perspectives from different sectors of radiation protection be anadvantage?
Q9. The ICRP established a new absorbed dose threshold for circulatory disease of 0.5 Gy for the heart andbrain. Are radiation protection practitioners aware of this and do you know if there have been any changes in
the optimization of procedures, risk assessment or dose monitoring for exposed staff related to the newthreshold? If yes provide details.
Q10. Has your country included the 20 mSv dose limit for the lens of the eye and if so, when was this done?
How strictly are occupational dose limits for tissue reactions in the eye and skin enforced? Have steps beentaken to reduce doses relating to tissue reactions through education and training programmes?
Occupational exposure
Q11. Have there been any reports of tissue reactions resulting from occupational exposure of which you areaware in your country, e.g. eye lens opacities, skin injury, or other effects? If so, what effects have been
observed? What occupational groups have been affected? How many individuals have been affected?
Q12. Are professionals who may be at greater risk of eye lens exposure (especially radiological medicalpractitioners) aware of the risk for developing eye lens opacities from eye exposure and methods required fortheir reduction?
Q13. Are there groups of radiological medical practitioners considered to be at particular risk of eye lens
exposure identified and if so, are their eye lens doses monitored in most hospitals in your country?
Q14. If dosimeters for monitoring eye lens dose are worn, what type of dosimeters are used most frequently
for this? Please give types of dosimeters, e.g. head band with dosimeter on forehead, headband with dosimeteradjacent to the eye, collar dosimeter, etc., together with manufacturer.

Q15. Is there any specific guidance about how to reduce eye lens exposure for radiological medicalpractitioners? Please provide references or details of guidance.
Q16. What shielding devices do radiological medical practitioners use most frequently for protecting theireyes: Ceiling suspended screens, protective eyewear, etc.? If protective eyewear is used, describe the maintypes, and the lead equivalence, together with manufacturer, and comment on their effectiveness.
Q17. What are the best designs of protective eyewear available, of which you are aware? What is the leadequivalence and what are the dimensions of the lenses? Are there any issues relating to availability of suitable
protective eyewear?
Q18. Are any groups of staff considered to be at risk of receiving doses to the extremities that might exceed
the occupational dose limit? If so, what methods are used to optimize protection and is staff extremity dosemonitored regularly?
Q19. What types of dosimeters are used for monitoring finger doses? The most exposed part of the hand isusually the finger tip, if ring dosimeters are used, what method is employed to estimate doses to the finger tips.
Medical exposures
Radiotherapy
Q20. Are radiological and medical professionals aware of reports of raised incidences of cardiovasculardisease among radiotherapy patients? If so, give examples of treatments and effects that have been observed.
Q21. Are radiation doses to the heart and other relevant tissues, which are considered to have an associatedrisk for induction of Cardiovascular Diseases (CVD), considered when planning radiotherapy treatments?
Q22. Have any additional special measures been taken with patients being treated with radiotherapy
procedures that can give significant exposure of the heart, circulatory system or brain during radiotherapy
either to reduce dose levels to the affected organs or follow-up progress of any disease?
Q23. Are radiotherapy treatments and follow-up arrangements modified for patients with preexisting
cardiovascular conditions, which may place them at greater risk of CVD? If yes, please provide details andany references describing recommended arrangements.
Interventional and diagnostic imaging
Q24. Are you aware of any reports of skin erythema or hair loss among patients in your country. If so, what
effects have been observed and what procedures were involved? Please consider both fluroscopically guided
procedures and nuclear medicine, e.g. doses from extravasation of radiopharmaceutical.
Q25. Do radiological medical practitioners take account of the risk of tissue reactions such as skin injuries orcardiovascular effects when performing interventional procedures? Have particular medical radiologicalprocedures that could involve unwanted tissue reactions been identified? What are these procedures, which
tissue are at risk, and what are the possible dose levels?
Q26. Is there any specific guidance, regarding the identification of patients’ having a risk of exposure during
treatments or diagnostics high enough to cause skin injury? Please provide references.
Q27. Are there any documents or studies that would show examples where tissue radiation risks for patients
could be preventable if the procedures were optimized and performed by skilled personnel?
Q28. Are systems in place to follow-up patients who may receive skin doses high enough to cause tissue
reactions in hospitals in your country? If so, to your knowledge, are these applied widely throughout yourcountry?

Q29. Is there a legal requirement in your country for any tissue reactions observed or any dose delivered topatients that are likely to cause tissue reactions to be reported to the regulatory authority? If so, give details of
the requirements including the dose levels, and if not, provide information about any other arrangement forcolling data relating the tissue reactions that is utilised?
Q30. Is the evaluation of radiation risks for patients always viewed in the context of the overall health risks,
including underlying factors such as the patient’s medical condition and age?