Radiation Protection and Measurement

**3**

**Chapter 1**

**1. Introduction**

*Otolorin Adelaja Osibote*

or increase with increase altitude [1].

tion of food, milk and water or by inhalation.

and medical purposes.

function and may lead to death [2].

Introductory Chapter: Radiation

Radiation sources are known to be basically of two origins, that is, the natural or background radiation and artificial or man-made radiation. Natural or background radiation sources are grouped as those from cosmic; these are radiation from the space. The dose from cosmic source of radiation could vary from one location to another, i.e., the dose values vary in different parts of the world and also change with altitude. The exposure also decreases in intensity with depth in the atmosphere

Other natural source group is the terrestrial radiation, which is from soil, water and vegetation. These are radionuclides such as 238U, 234Th and 40K, and they contribute mostly to the external dose to human body. Radon is another example of naturally occurring radionuclide which is found in rock formations and can release

The third source of natural radiation is the internal radiation, and these are 40K, 14C and 210Pb inside the body. These radionuclides enter the body through the inges-

The artificial or man-made radiations are those that originate from various activities of man such as in consumer products, examples which include building materials, television receivers and tobacco products. Other activities are nuclear power plants for electricity/power generation, testing and using of nuclear bombs, decommissioning of radioactive waste, and industrial activities such as mining, security inspection systems use in cargo scanners and personnel security systems

Also radiation can be categorized into types; they are ionizing and nonionizing radiation. Nonionizing radiation is the type of electromagnetic radiation with no enough energy to ionize atom, while ionizing radiation is radiation that carries enough energy to detach electrons from atoms causing the atom to become charged or ionized. Ionizing radiation has more energy than nonionizing radiation, that is, enough to cause chemical changes, and thereby causing damage to tissue. The ionizing radiation is further categorized into four types: alpha particles, beta particles, gamma rays and X-rays. The effects of ionizing radiation at high-dose levels are well known, while the effects of ionizing radiation at low doses are not yet clear. Ionizing radiation is used for diagnostic and therapeutic medical purposes, and there are advantages and disadvantages attached to the use of ionizing radiation for this purpose; the advantage lies in being able to diagnose and treat diseases; however, it can damage human cells and cause harm. Radiation doses of about 10 Sv and above received in a short period can cause the organs and tissues in the body to cease to

higher levels of radiation that can pose health risks particularly lung cancer.

Exposure, Dose and Protection

### **Chapter 1**

## Introductory Chapter: Radiation Exposure, Dose and Protection

*Otolorin Adelaja Osibote*

### **1. Introduction**

Radiation sources are known to be basically of two origins, that is, the natural or background radiation and artificial or man-made radiation. Natural or background radiation sources are grouped as those from cosmic; these are radiation from the space. The dose from cosmic source of radiation could vary from one location to another, i.e., the dose values vary in different parts of the world and also change with altitude. The exposure also decreases in intensity with depth in the atmosphere or increase with increase altitude [1].

Other natural source group is the terrestrial radiation, which is from soil, water and vegetation. These are radionuclides such as 238U, 234Th and 40K, and they contribute mostly to the external dose to human body. Radon is another example of naturally occurring radionuclide which is found in rock formations and can release higher levels of radiation that can pose health risks particularly lung cancer.

The third source of natural radiation is the internal radiation, and these are 40K, 14C and 210Pb inside the body. These radionuclides enter the body through the ingestion of food, milk and water or by inhalation.

The artificial or man-made radiations are those that originate from various activities of man such as in consumer products, examples which include building materials, television receivers and tobacco products. Other activities are nuclear power plants for electricity/power generation, testing and using of nuclear bombs, decommissioning of radioactive waste, and industrial activities such as mining, security inspection systems use in cargo scanners and personnel security systems and medical purposes.

Also radiation can be categorized into types; they are ionizing and nonionizing radiation. Nonionizing radiation is the type of electromagnetic radiation with no enough energy to ionize atom, while ionizing radiation is radiation that carries enough energy to detach electrons from atoms causing the atom to become charged or ionized. Ionizing radiation has more energy than nonionizing radiation, that is, enough to cause chemical changes, and thereby causing damage to tissue. The ionizing radiation is further categorized into four types: alpha particles, beta particles, gamma rays and X-rays. The effects of ionizing radiation at high-dose levels are well known, while the effects of ionizing radiation at low doses are not yet clear. Ionizing radiation is used for diagnostic and therapeutic medical purposes, and there are advantages and disadvantages attached to the use of ionizing radiation for this purpose; the advantage lies in being able to diagnose and treat diseases; however, it can damage human cells and cause harm. Radiation doses of about 10 Sv and above received in a short period can cause the organs and tissues in the body to cease to function and may lead to death [2].

These two categories of radiation, ionizing and nonionizing, can cause damage to humans. Ionizing radiation can cause cancer, heart and brain problems, while nonionizing radiation can cause burning of retinas, skin cancer as a result of long exposure to the sun [3].

Examples of natural sources of ionizing radiation include metal mining, radon exposure, cosmic rays from the sun and radioactive rocks and soils, while examples of artificial sources of ionizing radiation includes nuclear reactors, medical equipment such as X-rays. Sources of natural nonionizing radiation are sunlight and thermal radiation, while man-made sources of nonionizing radiation are microwave oven, cell phones and power lines.

Most of the man-made exposure to radiation is from medical procedures. This can be shown from the NCRP Report No. 93, 1987, on the ionizing radiation exposure of the population of the United States. Natural sources of radiation accounted for 82%, and medical sources are responsible for 11% of the remaining and 18% from man-made radiation (NCRP Report No. 160), and most of the exposure is from diagnostic X-rays such as examinations of computed tomography, conventional radiography and fluoroscopy and interventional fluoroscopy. The average dose from the use of radiation for treatment purposes is much less than that from diagnostic purposes even though quite a number of exposures may be used in certain treatments such as cancer; only a small number of people are involved, and exposures are limited to small areas where treatment is necessary [4].

Medical use of radiation is known to be the greatest artificial source of doses to human beings at large. Following the improvement in technology and healthcare, this has led to an increase in the usage of radiation; this can be measured by the frequency of procedures and by the levels of individual and collective doses. Medical X-rays are responsible, in Western countries, for at least some 300 man Sv per million inhabitants, representing approximately 90% of man-made source. The common sources of radiation exposure to the population are the natural sources and medical irradiation [5].

The risk of radiation exposure from X-ray such as malignancy, skin damage and cataract is high with increasing number of examination performed. There is an increase in the number of procedures performed and the possibility of more complicated procedures such as interventional procedures that can lead to higher doses to patients and staff. The increasing number of computed tomography (CT) procedures performed also can lead to increase in the collective dose.

Since the diagnostic X-rays take the highest portion of the medical use of radiation or in which human are exposed apart from the natural sources, it is therefore necessary that people or the population are protected which therefore necessitate the need for a radiation protection to be considered in order to eliminate the damage from unnecessary exposure. Even though, the doses from diagnostic radiology are much less than in the treatment of diseases, there is a need to monitor that the dose to the patient is not too low or too high for a particular procedure. According to the International Commission on Radiation Protection (ICRP), radiation protection involves the use of three techniques, and these are justification of practices, optimization of protection and the use of dose limits/levels. Since dose limits do not apply to medical exposure, optimization and justification are therefore important in patients using radiation for medical purposes.

The European Union Council Directive 97/43/Euratom (the Council of the European Union, 1997) also laid emphasis on the need of these two principles of justification and optimization. The principle of justification implies that the advantages to the patient and the society during a radiological procedure must be more than the risks for the patient and the need to consider alternative techniques that do not involve medical radiation exposure [6].

**5**

*Introductory Chapter: Radiation Exposure, Dose and Protection*

The principle of optimization is to keep the dose 'as low as reasonably achievable' (ALARA principle) economic and social factors being taken into consideration (ICRP 60) [7]. Also ICRP in its recommendation in Publication 73 (ICRP 73) introduced the need for establishment and use of diagnostic reference levels (DRLs) to ensure that implementation guidance is available. The purpose of DRLs is not to be used when considering the dose to individual patients but to prevent delivery of unnecessary high doses as well as to be used in estimating radiation doses as a form

The International Commission on Radiological Protection (ICRP) defined DRL as 'a form of investigation level, applied to an easily measured quantity, usually the absorbed dose in air, or tissue-equivalent material at the surface of a simple phantom or a representative patient,' while the Council of the European Union defined DRL as 'dose levels in medical radiodiagnostic practices or, in case of radiopharmaceuticals, levels of activity, for typical examinations for groups of standard-sized

DRLs settings for diagnostic radiology should not be based on patient's doses measured from only well-equipped hospitals but in all types of different hospitals, clinics and practices. DRL values are to be established by using the 75th percentile, taking into account of values that are too low or too high. DRLs are to be set locally, regionally or nationally and recorded on regular basis to allow for comparison over some time and also for the purpose of establishing database. According to Vassileva and Rehani [8], DRLs are indicators for a typical practice in a country or in a region, and since equipment and procedures can vary between different facilities in countries or regions, it is therefore a good practice to establish national or regional DRLS. DRLs should be reviewed wherever DRLs are constantly exceeded

In most countries with established National Diagnostic Reference Levels (nDRLs), the responsibility lies with the government national authorities and institutes responsible for radiological protection and nuclear safety. They perform the function of collecting data from different hospitals or clinics with medical imaging facilities, analysis of the data and then give update on the DRL values. The established DRL values are reviewed periodically, and recommendations are made

From the article on historical background on DRLs, Wall and Shrimpton [9] reported that national surveys of patient doses on X-ray examinations conducted in Europe and the USA in the 1950s showed high variations in doses from different hospitals which came about the need for quantitative guidance on patient exposure. It was reported that in the late 1980s, the dose guidelines started first in the USA and then in the UK and then followed in Europe, and the reference doses were incorporated into working documents giving *Quality Criteria for Diagnostic Radiographic Images* for adult and pediatric by European countries study groups of

In 1997, the need to develop the DRLs then followed, (Council Directive 97/43/ EURATOM, 1997) which is defined as dose levels in diagnostic radiology to patients of standard-sized groups or standard phantoms, for particular examinations and as well considering different types of equipment [6]. The DRL values should not be exceeded for standard procedures when good and normal practice is applied. The main aim of a DRL is to serve as a control in using radiation for diagnostic purposes and by avoiding unnecessary exposure to radiation. In 1989, national reference

patients or standard phantoms for broadly defined types of equipment.'

and that corrective actions are taken when appropriate.

*DOI: http://dx.doi.org/10.5772/intechopen.89041*

of quality assurance [7].

based on the findings.

**2. Reason for DRLs**

radiologists and physicists.

### *Introductory Chapter: Radiation Exposure, Dose and Protection DOI: http://dx.doi.org/10.5772/intechopen.89041*

*Ionizing and Non-ionizing Radiation*

oven, cell phones and power lines.

exposure to the sun [3].

medical irradiation [5].

These two categories of radiation, ionizing and nonionizing, can cause damage to humans. Ionizing radiation can cause cancer, heart and brain problems, while nonionizing radiation can cause burning of retinas, skin cancer as a result of long

Examples of natural sources of ionizing radiation include metal mining, radon exposure, cosmic rays from the sun and radioactive rocks and soils, while examples of artificial sources of ionizing radiation includes nuclear reactors, medical equipment such as X-rays. Sources of natural nonionizing radiation are sunlight and thermal radiation, while man-made sources of nonionizing radiation are microwave

Most of the man-made exposure to radiation is from medical procedures. This can be shown from the NCRP Report No. 93, 1987, on the ionizing radiation exposure of the population of the United States. Natural sources of radiation accounted for 82%, and medical sources are responsible for 11% of the remaining and 18% from man-made radiation (NCRP Report No. 160), and most of the exposure is from diagnostic X-rays such as examinations of computed tomography, conventional radiography and fluoroscopy and interventional fluoroscopy. The average dose from the use of radiation for treatment purposes is much less than that from diagnostic purposes even though quite a number of exposures may be used in certain treatments such as cancer; only a small number of people are involved, and

Medical use of radiation is known to be the greatest artificial source of doses to human beings at large. Following the improvement in technology and healthcare, this has led to an increase in the usage of radiation; this can be measured by the frequency of procedures and by the levels of individual and collective doses. Medical X-rays are responsible, in Western countries, for at least some 300 man Sv per million inhabitants, representing approximately 90% of man-made source. The common sources of radiation exposure to the population are the natural sources and

The risk of radiation exposure from X-ray such as malignancy, skin damage and cataract is high with increasing number of examination performed. There is an increase in the number of procedures performed and the possibility of more complicated procedures such as interventional procedures that can lead to higher doses to patients and staff. The increasing number of computed tomography (CT)

Since the diagnostic X-rays take the highest portion of the medical use of radiation or in which human are exposed apart from the natural sources, it is therefore necessary that people or the population are protected which therefore necessitate the need for a radiation protection to be considered in order to eliminate the damage from unnecessary exposure. Even though, the doses from diagnostic radiology are much less than in the treatment of diseases, there is a need to monitor that the dose to the patient is not too low or too high for a particular procedure. According to the International Commission on Radiation Protection (ICRP), radiation protection involves the use of three techniques, and these are justification of practices, optimization of protection and the use of dose limits/levels. Since dose limits do not apply to medical exposure, optimization and justification are therefore important in

The European Union Council Directive 97/43/Euratom (the Council of the European Union, 1997) also laid emphasis on the need of these two principles of justification and optimization. The principle of justification implies that the advantages to the patient and the society during a radiological procedure must be more than the risks for the patient and the need to consider alternative techniques that do

exposures are limited to small areas where treatment is necessary [4].

procedures performed also can lead to increase in the collective dose.

patients using radiation for medical purposes.

not involve medical radiation exposure [6].

**4**

The principle of optimization is to keep the dose 'as low as reasonably achievable' (ALARA principle) economic and social factors being taken into consideration (ICRP 60) [7]. Also ICRP in its recommendation in Publication 73 (ICRP 73) introduced the need for establishment and use of diagnostic reference levels (DRLs) to ensure that implementation guidance is available. The purpose of DRLs is not to be used when considering the dose to individual patients but to prevent delivery of unnecessary high doses as well as to be used in estimating radiation doses as a form of quality assurance [7].

The International Commission on Radiological Protection (ICRP) defined DRL as 'a form of investigation level, applied to an easily measured quantity, usually the absorbed dose in air, or tissue-equivalent material at the surface of a simple phantom or a representative patient,' while the Council of the European Union defined DRL as 'dose levels in medical radiodiagnostic practices or, in case of radiopharmaceuticals, levels of activity, for typical examinations for groups of standard-sized patients or standard phantoms for broadly defined types of equipment.'

DRLs settings for diagnostic radiology should not be based on patient's doses measured from only well-equipped hospitals but in all types of different hospitals, clinics and practices. DRL values are to be established by using the 75th percentile, taking into account of values that are too low or too high. DRLs are to be set locally, regionally or nationally and recorded on regular basis to allow for comparison over some time and also for the purpose of establishing database. According to Vassileva and Rehani [8], DRLs are indicators for a typical practice in a country or in a region, and since equipment and procedures can vary between different facilities in countries or regions, it is therefore a good practice to establish national or regional DRLS. DRLs should be reviewed wherever DRLs are constantly exceeded and that corrective actions are taken when appropriate.

In most countries with established National Diagnostic Reference Levels (nDRLs), the responsibility lies with the government national authorities and institutes responsible for radiological protection and nuclear safety. They perform the function of collecting data from different hospitals or clinics with medical imaging facilities, analysis of the data and then give update on the DRL values. The established DRL values are reviewed periodically, and recommendations are made based on the findings.

### **2. Reason for DRLs**

From the article on historical background on DRLs, Wall and Shrimpton [9] reported that national surveys of patient doses on X-ray examinations conducted in Europe and the USA in the 1950s showed high variations in doses from different hospitals which came about the need for quantitative guidance on patient exposure. It was reported that in the late 1980s, the dose guidelines started first in the USA and then in the UK and then followed in Europe, and the reference doses were incorporated into working documents giving *Quality Criteria for Diagnostic Radiographic Images* for adult and pediatric by European countries study groups of radiologists and physicists.

In 1997, the need to develop the DRLs then followed, (Council Directive 97/43/ EURATOM, 1997) which is defined as dose levels in diagnostic radiology to patients of standard-sized groups or standard phantoms, for particular examinations and as well considering different types of equipment [6]. The DRL values should not be exceeded for standard procedures when good and normal practice is applied. The main aim of a DRL is to serve as a control in using radiation for diagnostic purposes and by avoiding unnecessary exposure to radiation. In 1989, national reference

doses were first suggested for some radiographic examinations. This was followed by the investigation in the levels in patient doses by ICRP in 1990 and further developed into development of DRLs in ICRP Publication 73.

The list of medical exposure according to the United Kingdom nDRLs required by the Ionizing Radiation Regulations in 2000 include adult and pediatric computer tomography examinations, general radiography and fluoroscopy which include diagnostic examinations on adult and pediatrics and interventional procedures on adult and dental radiography.

### **3. Regulatory bodies on the use of ionizing radiation and DRLs**

The regulatory bodies on the use of radiation include the following organizations:

### **3.1 United Nations Scientific Committee on the Effects of Atomic Radiation, UNSCEAR**

UNSCEAR, which was established in 1955 with the mandate to undertake broad assessments of the sources of ionizing radiation and its effects on human health and the environment, provides the service of assessing global levels and effects of ionizing radiation as well as providing scientific basis for radiation protection. The use of radiation for medical purposes could be of positive applications; it is a reality that X-rays can cause biological harm or injury to humans [10]. Reports from developed countries indicated that the use of ionizing radiation for diagnostic purpose is estimated to be about 1 mSv per capital annual. At this dose level, the estimated annual additional cancer mortality is 0.5 per 10,000 persons of a general population basing on the additive risk model of the United Nations Scientific Committee on the Effect of Atomic Radiation (UNSCEAR). In its report in 2008, UNSCEAR Report No. 1 reported an increase in the total number of diagnostic medical examinations from 2.4 to 3.6 billion; this is an increase of almost 50% from its previous study in 1991–1996. The use of high-dose X-ray techniques such as the computed tomography scanning is leading to growth in the annual number of procedures in many countries thereby increasing the collective dose. It is estimated that the total collective effective dose from medical diagnostic examinations have increased by 1.7 million man Sv, that is, it rises from about 2.3 million to about 4 million man Sv, which gives an increase of about 70% [11].

### **3.2 International Atomic Energy Agency (IAEA)**

IAEA develops safety standards to protect the health and minimize the danger to people's life and property associated with the use of ionizing radiation in medicine, etc. IAEA focuses on ensuring that radiation doses to patients commensurate with the medical purpose, thereby preventing patients from being exposed to unnecessary and unintended radiation. To ensure that radiation protection and safety of radiation sources in medical uses of ionizing radiation, the IAEA Safety Guide on Radiation Protection and Safety in Medical Uses of Ionizing Radiation (2018) was published to provide recommendations and guidance on fulfilling the requirements of IAEA Safety Standards series No GSR Part 3 [12].

According to the report from the IAEA office of Public Information and Communication, DRLs is a tool for comparing diagnostic imaging procedures in a country which include adults and children of different ages and weights in examinations in X-rays, CT, image-guided interventional procedures or nuclear medicine procedure. Each facility needs to set their DRL and then compare with

**7**

*Introductory Chapter: Radiation Exposure, Dose and Protection*

diagnostic quality. As well as prevent unnecessary exposures.

local, national or regional doses. The newsletter report also mentioned the need to track radiation dose data to improve practice and reduce doses without loss of

**3.3 The International Commission on Radiological Protection (ICRP)**

limiting the beneficial practices giving rise to radiation exposure' [13].

mendations through legislation appropriate for their own country.

International Organizations of Medical Sciences [19] and WHO [20].

**3.4 World Health Organization (WHO)**

International Atomic Energy Agency also states that DRLs should be set locally, regionally or even nationally. IAEA also agreed to set the nDRLs at the third quartile values, and they could not be considered as optimum dose but in identifying unusual practices. According to IAEA, the government is responsible for the establishment of DRLs and to involve health authority, the professional bodies and the regulatory body. IAEA also identifies DRLs as a tool in radiation protection of the patients.

The primary aim of radiological protection, as stated in ICRP Publication 60, is 'to provide an appropriate standard of protection for mankind without unduly

According to the International Commission on Radiological Protection (ICRP)

in its international recommendations, ICRP 60, (ICRP 19), the focus is on the principles of justification and optimization of all radiation exposures in diagnostic radiology. Another recommendation, which is the ICRP 85, [14], focused on the risk of skin damage from interventional radiology. In 2007 in its publication (ICRP Publication 103), ICRP presented the revised recommendations for radiological protection followed by ICRP Publication 118 (2012) published on deterministic effects of ionizing radiation. ICRP makes recommendations only, and it is the responsibility of government of individual countries to implement those recom-

According to the World Health Organization (WHO), there are established relevant guidelines that have to be considered in each type of diagnostic procedure [15–17]. Human exposure to radiation for medical research is considered as not justified unless it is in accordance with the provisions of the Helsinki Declaration [18] and follows the guidelines for its application prepared by the Council for

The WHO in 2008 launched a Global Initiative on Radiation Safety in Health Care Settings (GIRSHCS), thereby facilitating the adoption and applications of regulations, in the evaluation of radiation medicine and medical imaging procedures. WHO also facilitates training on the use of appropriate technologies as well as publishing and disseminating guidance tools and technical documents. In 2012, the WHO presented report of its Radiation Risk Communication in pediatric imaging workshop on the need to develop and implement a risk communication tool in order to create the awareness of radiation risks and exposure in pediatric procedures [21].

**3.5 National Council on Radiation Protection and Measurements (NCRP)**

the optimization of protection should follow [22, 23].

National Council on Radiation Protection and Measurements Report No. 160 (1993) focused on the biological effects of ionizing radiation such as cancer, cardiovascular disease and cataracts, while its Report No. 180 focused on the management of exposure to ionizing radiation and expressed radiation protection principles as justification, optimization of protection and numeric protection criteria, i.e., the management of dose to an individual. This means that the protection criteria is the first objective when there is a numeric protection for a specific exposure; then

*DOI: http://dx.doi.org/10.5772/intechopen.89041*

*Ionizing and Non-ionizing Radiation*

adult and dental radiography.

organizations:

**UNSCEAR**

doses were first suggested for some radiographic examinations. This was followed by the investigation in the levels in patient doses by ICRP in 1990 and further

The list of medical exposure according to the United Kingdom nDRLs required by the Ionizing Radiation Regulations in 2000 include adult and pediatric computer tomography examinations, general radiography and fluoroscopy which include diagnostic examinations on adult and pediatrics and interventional procedures on

developed into development of DRLs in ICRP Publication 73.

**3.2 International Atomic Energy Agency (IAEA)**

of IAEA Safety Standards series No GSR Part 3 [12].

**3. Regulatory bodies on the use of ionizing radiation and DRLs**

The regulatory bodies on the use of radiation include the following

**3.1 United Nations Scientific Committee on the Effects of Atomic Radiation,** 

UNSCEAR, which was established in 1955 with the mandate to undertake broad assessments of the sources of ionizing radiation and its effects on human health and the environment, provides the service of assessing global levels and effects of ionizing radiation as well as providing scientific basis for radiation protection. The use of radiation for medical purposes could be of positive applications; it is a reality that X-rays can cause biological harm or injury to humans [10]. Reports from developed countries indicated that the use of ionizing radiation for diagnostic purpose is estimated to be about 1 mSv per capital annual. At this dose level, the estimated annual additional cancer mortality is 0.5 per 10,000 persons of a general population basing on the additive risk model of the United Nations Scientific Committee on the Effect of Atomic Radiation (UNSCEAR). In its report in 2008, UNSCEAR Report No. 1 reported an increase in the total number of diagnostic medical examinations from 2.4 to 3.6 billion; this is an increase of almost 50% from its previous study in 1991–1996. The use of high-dose X-ray techniques such as the computed tomography scanning is leading to growth in the annual number of procedures in many countries thereby increasing the collective dose. It is estimated that the total collective effective dose from medical diagnostic examinations have increased by 1.7 million man Sv, that is, it rises from about 2.3 million to about 4 million man Sv, which gives an increase of about 70% [11].

IAEA develops safety standards to protect the health and minimize the danger to people's life and property associated with the use of ionizing radiation in medicine, etc. IAEA focuses on ensuring that radiation doses to patients commensurate with the medical purpose, thereby preventing patients from being exposed to unnecessary and unintended radiation. To ensure that radiation protection and safety of radiation sources in medical uses of ionizing radiation, the IAEA Safety Guide on Radiation Protection and Safety in Medical Uses of Ionizing Radiation (2018) was published to provide recommendations and guidance on fulfilling the requirements

According to the report from the IAEA office of Public Information and Communication, DRLs is a tool for comparing diagnostic imaging procedures in a country which include adults and children of different ages and weights in examinations in X-rays, CT, image-guided interventional procedures or nuclear medicine procedure. Each facility needs to set their DRL and then compare with

**6**

local, national or regional doses. The newsletter report also mentioned the need to track radiation dose data to improve practice and reduce doses without loss of diagnostic quality. As well as prevent unnecessary exposures.

International Atomic Energy Agency also states that DRLs should be set locally, regionally or even nationally. IAEA also agreed to set the nDRLs at the third quartile values, and they could not be considered as optimum dose but in identifying unusual practices. According to IAEA, the government is responsible for the establishment of DRLs and to involve health authority, the professional bodies and the regulatory body. IAEA also identifies DRLs as a tool in radiation protection of the patients.

### **3.3 The International Commission on Radiological Protection (ICRP)**

The primary aim of radiological protection, as stated in ICRP Publication 60, is 'to provide an appropriate standard of protection for mankind without unduly limiting the beneficial practices giving rise to radiation exposure' [13].

According to the International Commission on Radiological Protection (ICRP) in its international recommendations, ICRP 60, (ICRP 19), the focus is on the principles of justification and optimization of all radiation exposures in diagnostic radiology. Another recommendation, which is the ICRP 85, [14], focused on the risk of skin damage from interventional radiology. In 2007 in its publication (ICRP Publication 103), ICRP presented the revised recommendations for radiological protection followed by ICRP Publication 118 (2012) published on deterministic effects of ionizing radiation. ICRP makes recommendations only, and it is the responsibility of government of individual countries to implement those recommendations through legislation appropriate for their own country.

### **3.4 World Health Organization (WHO)**

According to the World Health Organization (WHO), there are established relevant guidelines that have to be considered in each type of diagnostic procedure [15–17]. Human exposure to radiation for medical research is considered as not justified unless it is in accordance with the provisions of the Helsinki Declaration [18] and follows the guidelines for its application prepared by the Council for International Organizations of Medical Sciences [19] and WHO [20].

The WHO in 2008 launched a Global Initiative on Radiation Safety in Health Care Settings (GIRSHCS), thereby facilitating the adoption and applications of regulations, in the evaluation of radiation medicine and medical imaging procedures. WHO also facilitates training on the use of appropriate technologies as well as publishing and disseminating guidance tools and technical documents. In 2012, the WHO presented report of its Radiation Risk Communication in pediatric imaging workshop on the need to develop and implement a risk communication tool in order to create the awareness of radiation risks and exposure in pediatric procedures [21].

### **3.5 National Council on Radiation Protection and Measurements (NCRP)**

National Council on Radiation Protection and Measurements Report No. 160 (1993) focused on the biological effects of ionizing radiation such as cancer, cardiovascular disease and cataracts, while its Report No. 180 focused on the management of exposure to ionizing radiation and expressed radiation protection principles as justification, optimization of protection and numeric protection criteria, i.e., the management of dose to an individual. This means that the protection criteria is the first objective when there is a numeric protection for a specific exposure; then the optimization of protection should follow [22, 23].

### **4. Conclusion**

The use and exposure of humans to ionizing and nonionizing form of radiation is of various purposes. Radiation exposure cannot be entirely avoided on this planet, taking into account how much radiation people receive from natural sources. The proper use of radiation can be of immense benefits. The sources and categories of radiation exposure, the various use of ionizing radiation and the principles of radiation protection to avoid unnecessary exposure to high level of radiation dose from the use of ionizing radiation have been discussed in this chapter.

### **Author details**

Otolorin Adelaja Osibote Department of Mathematics and Physics, Cape Peninsula University of Technology, Cape Town, South Africa

\*Address all correspondence to: osibotea@cput.ac.za

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

**9**

*Introductory Chapter: Radiation Exposure, Dose and Protection*

Radiation Protection Dosimetry.

[10] United Nations Scientific Committee on the Effects of Atomic Radiation. UNSCEAR 1993 Report to the General Assembly. Sources and Effects of Ionizing Radiation

[11] United Nations Scientific Committee on the Effects of Atomic Radiation. UNSCEAR 2008, Report No. 1. Report to the General Assembly.

Sources and Effects of Ionizing

[12] International Atomic Energy Agency Safety Standards: Radiation Protection and Safety in Medical Uses of Ionizing Radiation. Specific Safety

[13] ICRP. 1990 Recommendations of the International Commission on Radiological Protection. ICRP Publication 60. Annals of the ICRP.

[14] ICRP. Avoidance of Radiation Injuries from Medical Interventional Procedures. ICRP Publication 85. Annals

[15] World Health Organization (WHO). A rational approach to radiodiagnostic investigations. Technical Report Series

[16] World Health Organization (WHO). Effective choices for diagnostic imaging in clinical practices. Technical Report Series No. 795. Geneva: WHO; 1990

[17] World Health Organization (WHO). Rational use of diagnostic imaging in paediatrics. Technical Report Series No.

[18] Helsinki Declaration 1964. Adopted by the 18th World Medical Assembly and as amended by the 29th World

Guide No SSG-48. 2018

of the ICRP. 2000;**30**(2)

No. 689. Geneva: WHO; 1983

757. Geneva: WHO; 1987

Radiation

1991;**21**(1-3)

1998;**80**(1-3):15-20

*DOI: http://dx.doi.org/10.5772/intechopen.89041*

[1] United States Environmental Protection Agency. Radiation sources and doses. Available from: https://www.epa.gov/radiation/ radiation-sources-and-doses

[2] Australian radiation protection and Nuclear Safety- Health Effects of Ionizing Radiation. Available from: https://www.arpansa.gov. au/understanding-radiation/whatis-radiation/ionising-radiation/

[3] EMF Academy. Difference Between Ionizing and Non-Ionizing Radiation Written by Christian. 2018. Available from: https://emfacademy.com/ difference-ionizing-non-ionizing-

[4] National Council on Radiation Protection and Measurement NCRP Report No. 93. Ionizing Radiation Exposure of the Population of the

[5] Centers for Disease Control and Prevention (CDC). The Electromagnetic Spectrum: Ionizing Radiation. 2015. Available from: https://www.cdc.gov/ nceh/radiation/ionizing\_radiation.html

[6] European Commission. Council Directive 97/43/EURATOM of 30 June 1997 on health protection of individuals against the danger of ionizing radiation in relation to medical exposure. Official Journal of the European Commission. 180

[7] ICRP. Radiological protection and safety in medicine. ICRP Publication 73.

[8] Vassileva J, Rehani M. Diagnostic reference levels. American Journal of Roentgenology 2015;**204**:W1-W3

Annals of the ICRP. 1996;**26**(2)

[9] Wall BF, Shrimpton PC. The historical development of reference doses in diagnostic radiology.

**References**

health-effects

radiation/

United States

*Introductory Chapter: Radiation Exposure, Dose and Protection DOI: http://dx.doi.org/10.5772/intechopen.89041*

### **References**

*Ionizing and Non-ionizing Radiation*

**4. Conclusion**

**8**

**Author details**

Otolorin Adelaja Osibote

Cape Town, South Africa

\*Address all correspondence to: osibotea@cput.ac.za

provided the original work is properly cited.

Department of Mathematics and Physics, Cape Peninsula University of Technology,

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

The use and exposure of humans to ionizing and nonionizing form of radiation is of various purposes. Radiation exposure cannot be entirely avoided on this planet, taking into account how much radiation people receive from natural sources. The proper use of radiation can be of immense benefits. The sources and categories of radiation exposure, the various use of ionizing radiation and the principles of radiation protection to avoid unnecessary exposure to high level of radiation dose from

the use of ionizing radiation have been discussed in this chapter.

[1] United States Environmental Protection Agency. Radiation sources and doses. Available from: https://www.epa.gov/radiation/ radiation-sources-and-doses

[2] Australian radiation protection and Nuclear Safety- Health Effects of Ionizing Radiation. Available from: https://www.arpansa.gov. au/understanding-radiation/whatis-radiation/ionising-radiation/ health-effects

[3] EMF Academy. Difference Between Ionizing and Non-Ionizing Radiation Written by Christian. 2018. Available from: https://emfacademy.com/ difference-ionizing-non-ionizingradiation/

[4] National Council on Radiation Protection and Measurement NCRP Report No. 93. Ionizing Radiation Exposure of the Population of the United States

[5] Centers for Disease Control and Prevention (CDC). The Electromagnetic Spectrum: Ionizing Radiation. 2015. Available from: https://www.cdc.gov/ nceh/radiation/ionizing\_radiation.html

[6] European Commission. Council Directive 97/43/EURATOM of 30 June 1997 on health protection of individuals against the danger of ionizing radiation in relation to medical exposure. Official Journal of the European Commission. 180

[7] ICRP. Radiological protection and safety in medicine. ICRP Publication 73. Annals of the ICRP. 1996;**26**(2)

[8] Vassileva J, Rehani M. Diagnostic reference levels. American Journal of Roentgenology 2015;**204**:W1-W3

[9] Wall BF, Shrimpton PC. The historical development of reference doses in diagnostic radiology.

Radiation Protection Dosimetry. 1998;**80**(1-3):15-20

[10] United Nations Scientific Committee on the Effects of Atomic Radiation. UNSCEAR 1993 Report to the General Assembly. Sources and Effects of Ionizing Radiation

[11] United Nations Scientific Committee on the Effects of Atomic Radiation. UNSCEAR 2008, Report No. 1. Report to the General Assembly. Sources and Effects of Ionizing Radiation

[12] International Atomic Energy Agency Safety Standards: Radiation Protection and Safety in Medical Uses of Ionizing Radiation. Specific Safety Guide No SSG-48. 2018

[13] ICRP. 1990 Recommendations of the International Commission on Radiological Protection. ICRP Publication 60. Annals of the ICRP. 1991;**21**(1-3)

[14] ICRP. Avoidance of Radiation Injuries from Medical Interventional Procedures. ICRP Publication 85. Annals of the ICRP. 2000;**30**(2)

[15] World Health Organization (WHO). A rational approach to radiodiagnostic investigations. Technical Report Series No. 689. Geneva: WHO; 1983

[16] World Health Organization (WHO). Effective choices for diagnostic imaging in clinical practices. Technical Report Series No. 795. Geneva: WHO; 1990

[17] World Health Organization (WHO). Rational use of diagnostic imaging in paediatrics. Technical Report Series No. 757. Geneva: WHO; 1987

[18] Helsinki Declaration 1964. Adopted by the 18th World Medical Assembly and as amended by the 29th World

Medical Assembly, Tokyo, 1975, the 35th World Medical Assembly, Venice, 1983, and the 41st World Medical Assembly, Hong Kong

[19] Council for International Organizations of Medical Sciences (CIOMS), in collaboration with World Health Organization. International Ethical Guidelines for Biomedical Research Involving Human Subjects. Geneva; 1993

[20] World Health Organization (WHO). Use of ionizing radiation and radionuclides on human beings for medical research, training and nonmedical purposes. Technical Report Series No. 611. Geneva: WHO; 1977

[21] World Health Organization. Radiation risk communication in paediatric imaging. Global initiative on radiation safety in health care settings workshop report. 2012

[22] National Council on Radiation Protection (NCRP) Report No. 180— Management of Exposure to Ionizing Radiation: Radiation Protection Guidance for the United States; 2018

[23] NCRP Report No. 160. Ionizing Radiation Exposure of the Population of the United States

**11**

**1. Introduction**

**Chapter 2**

**Abstract**

The Effect of Repeated

Electromagnetic Fields

Stimulation in Biological Systems

*Cristina N. Perez Chumbiauca and Maher Rizkalla*

*Felipe P. Perez, James Rizkalla, Matthew Jeffers, Paul Salama,* 

The effects of electromagnetic fields on living organs have been explored with

the use of both biological experimentation and computer simulations. In this paper we will examine the effects of the repeated electromagnetic field stimulation (REMFS) on cell cultures, mouse models, and computer simulations for diagnostic purposes. In our biological experiments we used 50 MHz and 64 MHz since this is approved in MRI systems. REMFS upregulated pathways that control the aging process such as proteostasis. REMFS delayed and reversed cellular senescence in mouse and human cell cultures. More recently we determined that REMFS decreases toxic protein beta amyloid levels, which is the cause of Alzheimer's disease (AD), in human neuronal cultures. The mechanism of these effects is the reactivation of the heat shock factor 1 (HSF1). HSF1 activation is a quantum effect of the EMFoscillations on the water that surrounds a long non-coding RNA, allowing it to then bind and activate the HSF1. We also performed electromagnetic (EM) computer simulations of virtual prototypes of bone cancer, femur fracture, and diabetic foot ulcers utilizing different frequencies and power applications to build an accurate differential diagnosis. These applications indicate the feasibility of subsequent

practical models for diagnosing and treating human diseases.

**Keywords:** electromagnetic, aging, Alzheimer's, simulation, diagnosis, treatment

Living organisms interact with and adapt to the EMF environment. This discovery has ignited interest in the analysis of the EMF-biological systems [1–4]. Researchers imagine that precise tuning of experimental and clinical REMFS exposure could lead to favorable health results including the development of treatment and diagnostic devices [5, 6]. REMFS exposures produce the activation of multiple biological pathways, including changes in Ca2+ regulation [7, 8], channel activity [9], enzyme activity [10], RNA and DNA synthesis [11–13], expression of microRNA [14–16], free radical processes in the genetic effects of EMF [17–19], decreasing oxidative stress [20–24], activation of the heat shock response [25], activation of the heat shock factor 1 (HSF1) [26], cytoprotecting [27], growth behavior [11, 28], activation of the ubiquitin-proteasome [29–31], autophagy-lysosome systems [32],

### **Chapter 2**

*Ionizing and Non-ionizing Radiation*

[19] Council for International Organizations of Medical Sciences (CIOMS), in collaboration with World Health Organization. International Ethical Guidelines for Biomedical Research Involving Human Subjects.

[20] World Health Organization (WHO). Use of ionizing radiation and radionuclides on human beings for medical research, training and nonmedical purposes. Technical Report Series No. 611. Geneva: WHO; 1977

[21] World Health Organization. Radiation risk communication in paediatric imaging. Global initiative on radiation safety in health care settings

[22] National Council on Radiation Protection (NCRP) Report No. 180— Management of Exposure to Ionizing Radiation: Radiation Protection Guidance for the United States; 2018

[23] NCRP Report No. 160. Ionizing Radiation Exposure of the Population of

workshop report. 2012

the United States

Hong Kong

Geneva; 1993

Medical Assembly, Tokyo, 1975, the 35th World Medical Assembly, Venice, 1983, and the 41st World Medical Assembly,

**10**

## The Effect of Repeated Electromagnetic Fields Stimulation in Biological Systems

*Felipe P. Perez, James Rizkalla, Matthew Jeffers, Paul Salama, Cristina N. Perez Chumbiauca and Maher Rizkalla*

### **Abstract**

The effects of electromagnetic fields on living organs have been explored with the use of both biological experimentation and computer simulations. In this paper we will examine the effects of the repeated electromagnetic field stimulation (REMFS) on cell cultures, mouse models, and computer simulations for diagnostic purposes. In our biological experiments we used 50 MHz and 64 MHz since this is approved in MRI systems. REMFS upregulated pathways that control the aging process such as proteostasis. REMFS delayed and reversed cellular senescence in mouse and human cell cultures. More recently we determined that REMFS decreases toxic protein beta amyloid levels, which is the cause of Alzheimer's disease (AD), in human neuronal cultures. The mechanism of these effects is the reactivation of the heat shock factor 1 (HSF1). HSF1 activation is a quantum effect of the EMFoscillations on the water that surrounds a long non-coding RNA, allowing it to then bind and activate the HSF1. We also performed electromagnetic (EM) computer simulations of virtual prototypes of bone cancer, femur fracture, and diabetic foot ulcers utilizing different frequencies and power applications to build an accurate differential diagnosis. These applications indicate the feasibility of subsequent practical models for diagnosing and treating human diseases.

**Keywords:** electromagnetic, aging, Alzheimer's, simulation, diagnosis, treatment

### **1. Introduction**

Living organisms interact with and adapt to the EMF environment. This discovery has ignited interest in the analysis of the EMF-biological systems [1–4]. Researchers imagine that precise tuning of experimental and clinical REMFS exposure could lead to favorable health results including the development of treatment and diagnostic devices [5, 6]. REMFS exposures produce the activation of multiple biological pathways, including changes in Ca2+ regulation [7, 8], channel activity [9], enzyme activity [10], RNA and DNA synthesis [11–13], expression of microRNA [14–16], free radical processes in the genetic effects of EMF [17–19], decreasing oxidative stress [20–24], activation of the heat shock response [25], activation of the heat shock factor 1 (HSF1) [26], cytoprotecting [27], growth behavior [11, 28], activation of the ubiquitin-proteasome [29–31], autophagy-lysosome systems [32],

inflammation [33–35], mitochondrial enhancement [36], neuronal activity [37], and a reduction in β-secretase activity [38].

Here, we will focus on studies performed on the REMFS spectrum (50–918 MHz) to explain the mechanism by which non-ionizing, non-thermal, non-modulated, continuous waves cause biological effects. We will use our and other researchers' recent results on human cell cultures and mouse AD models to explain this interaction. Initially, the frequency used in our REMFS experiments was 50 MHz with a specific absorption rate (SAR) of 0.5 W/kg. We found that these exposures upregulated the heat shock factor-1 (HSF1) in human lymphocytes and mouse fibroblasts [39]. HSF1 upregulation increased 70-kDa heat shock protein (HSP70) levels and delayed cellular senescence and death in these cell cultures [39]. Our recent data [40] demonstrated that cultures treated with REMFS at 64 MHz, with a SAR of 0.6 W/kg for 1 h daily for 21 days, had significantly reduced (p = 0.001) levels of Aβ40 peptide, compared to untreated cultures [40]. We also demonstrated a quantitative reduction of Aβ levels in primary human neuron cultures after different times and power protocols. There are further therapeutic implications of REMFS based on the improved cognitive function noted by lowering of Aβ levels in several AD mouse model studies performed by other investigators using 918 MHz exposures [36–38, 41].

The aforementioned biological effects demonstrate that REMFS is a multitarget strategy with potentially therapeutic implications on human diseases. In fact, among the biological effects observed, results of our experiments promote the capacity of REMFS to influence various networks of physiological functions that are dysregulated in the aging process and in Late Onset Alzheimer's disease (LOAD) [39, 40, 42].

### **2. Quantum mechanism of REMFS**

The low energy (2–37 eV<sup>−</sup><sup>7</sup> ) of the REMFS exposures is not able to cause any chemical change under the provision of classical physics, since the atoms or molecules pass through a potential barrier that they theoretically cannot overcome [43]. Our main challenge is to explain the mechanism of the REMFS-biological system interaction. There is a disparity between the low energy carried by the REMFS perturbation and the response of the biological system. The REMFS biological system interaction is a paradox from the classical point of view as it enables elementary particles and atoms to penetrate an energetic barrier without the need for sufficient energy to overcome it. To solve this paradox we have to look into the quantum scale and examine non-classical physical phenomenon such as wave-particle duality and quantum tunneling [44].

Despite this difficulty here we will describe a plausible sequence of events and a mathematical model for the REMFS-interaction. First we need to consider the REMFS perturbation as a time dependent adiabatic perturbation of water (the most likely receptor for REMFS), specifically the H bond network of the interfacial water [45]. REMFS subjects the quantum system, in the form of the H bond, to gradually changing external conditions giving the quantum system sufficient time for the functional form to adapt [46]. The probabilities of quantum transitions of the adiabatic change in the frequency of the quantum system have been calculated previously on the example of the harmonic oscillator [47].

The reason for the REMFS biological effects rests on the difference between the man-made EMF, and the natural EMF [48]. Man-made EMF waves are produced by parallel EMF oscillating circuits, whereas natural electromagnetic radiation is produced by atomic events such as nuclear fusion from the sun releasing infrared,

**13**

REMFS:

*The Effect of Repeated Electromagnetic Fields Stimulation in Biological Systems*

heat shock proteins and chaperones including HSP70 [39].

from Piilo et al. to find the amplitude change under REMFS:

periodic force, and ħ is the reduced Planck's constant.

We developed a mathematical model of the REMFS and biological systems interaction at the quantum level. We hypothesized the quantum effects of REMFS that explain how a low energy exposure is able to produce biochemical changes. For

Stage 1. The oscillating REMFS energy causes a time dependent adiabatic perturbation on the first layer of the interfacial water (FLIFW). REMFS perturbs the HB from FLIFW to the oxygen (O) of the "Guanine of the RNA" (GRNA). Under REMFS the H bond of the FLIFW acts as a driven quantum harmonic oscillator increasing the amplitude of the HB vibrations. The following equation estimates the increase in the amplitude of HB vibration when it acts as a driven quantum harmonic oscillator system under REMFS [59]. See following time dependent equation

> F(t)= <sup>A</sup> cos (ω<sup>t</sup> <sup>+</sup> <sup>φ</sup>) \_\_\_\_\_\_\_\_\_\_\_ √

We will obtain the change in the amplitude of the H bond vibration under

A = F (t) √

\_

2mħ ω0

\_

2mħ ω0 \_\_\_\_\_\_\_\_\_\_\_ cos (ωt + φ)

Where A describes the amplitude and ω the oscillation frequency of the periodic force, ω0 is the frequency of the oscillator, m is the mass of the oscillator, φ is the phase of the driving field, t is the time of the exposure, F(t) is the time dependent

Stage 2. The increased HB vibration amplitude induced by REMFS triggers shortening of the HB of the FLIFW to O of the GRNA. The calculated distance

(1.1)

(1.2)

clarity, we divided them into 3 stages with the consequent three equations

**3. REMFS mathematical model**

(see **Figure 1**).

visible, ultraviolet, X-rays [48]. For this reason, man-made RF-EMF vibrations occur in a single plane, so they are polarized in contrast to the multi plane vibrations from the natural EMF waves. This polarization would explain the differences in the biological effects of man-made versus natural RF-EMF. The polarized RF-EMF exposure has the ability to force all charged/polar molecules and chemical bonds to oscillate on parallel planes, and in phase with the applied polarized field [48, 49]. This external excitatory oscillation forces the exposed physical or chemical system to vibrate at the excitatory frequency changing the frequency of the system to the excitatory frequency [50, 51]. One of the targets of this driven oscillation is the hydrogen bond (HB) network of the first layer of the interfacial water (FLIFW) that surrounds an RNA which in the case of REMFS is a long non-coding RNA (HSR1) [52, 53]. The REMFS oscillations are absorbed by the HB which then acts as a driven quantum harmonic oscillator [54]. This HB responds to REMFS increasing its vibration amplitude [55] with the consequent decreased distance in the direction of the nucleic acid [56]. Since the tunnel probability is proportional to the square of the amplitude, the tunneling probability is increased. REMFS induced quantum tunneling allows proton transfer from the interfacial water to the nucleic acids of RNA [57]. The protonation of the nucleic acid results in tautomeric interconversions [58] with the consequent conformational changes. In the case of the REMFS, a long non-coding RNA called Heat shock RNA (HSR1) changes from a close to an open structure [53] able to bind and activate HSF1 to initiate the expression of several

*DOI: http://dx.doi.org/10.5772/intechopen.89668*

*The Effect of Repeated Electromagnetic Fields Stimulation in Biological Systems DOI: http://dx.doi.org/10.5772/intechopen.89668*

visible, ultraviolet, X-rays [48]. For this reason, man-made RF-EMF vibrations occur in a single plane, so they are polarized in contrast to the multi plane vibrations from the natural EMF waves. This polarization would explain the differences in the biological effects of man-made versus natural RF-EMF. The polarized RF-EMF exposure has the ability to force all charged/polar molecules and chemical bonds to oscillate on parallel planes, and in phase with the applied polarized field [48, 49]. This external excitatory oscillation forces the exposed physical or chemical system to vibrate at the excitatory frequency changing the frequency of the system to the excitatory frequency [50, 51]. One of the targets of this driven oscillation is the hydrogen bond (HB) network of the first layer of the interfacial water (FLIFW) that surrounds an RNA which in the case of REMFS is a long non-coding RNA (HSR1) [52, 53]. The REMFS oscillations are absorbed by the HB which then acts as a driven quantum harmonic oscillator [54]. This HB responds to REMFS increasing its vibration amplitude [55] with the consequent decreased distance in the direction of the nucleic acid [56]. Since the tunnel probability is proportional to the square of the amplitude, the tunneling probability is increased. REMFS induced quantum tunneling allows proton transfer from the interfacial water to the nucleic acids of RNA [57]. The protonation of the nucleic acid results in tautomeric interconversions [58] with the consequent conformational changes. In the case of the REMFS, a long non-coding RNA called Heat shock RNA (HSR1) changes from a close to an open structure [53] able to bind and activate HSF1 to initiate the expression of several heat shock proteins and chaperones including HSP70 [39].

### **3. REMFS mathematical model**

*Ionizing and Non-ionizing Radiation*

a reduction in β-secretase activity [38].

tors using 918 MHz exposures [36–38, 41].

**2. Quantum mechanism of REMFS**

The low energy (2–37 eV<sup>−</sup><sup>7</sup>

quantum tunneling [44].

(LOAD) [39, 40, 42].

inflammation [33–35], mitochondrial enhancement [36], neuronal activity [37], and

The aforementioned biological effects demonstrate that REMFS is a multitarget strategy with potentially therapeutic implications on human diseases. In fact, among the biological effects observed, results of our experiments promote the capacity of REMFS to influence various networks of physiological functions that are dysregulated in the aging process and in Late Onset Alzheimer's disease

chemical change under the provision of classical physics, since the atoms or molecules pass through a potential barrier that they theoretically cannot overcome [43]. Our main challenge is to explain the mechanism of the REMFS-biological system interaction. There is a disparity between the low energy carried by the REMFS perturbation and the response of the biological system. The REMFS biological system interaction is a paradox from the classical point of view as it enables elementary particles and atoms to penetrate an energetic barrier without the need for sufficient energy to overcome it. To solve this paradox we have to look into the quantum scale and examine non-classical physical phenomenon such as wave-particle duality and

Despite this difficulty here we will describe a plausible sequence of events and a mathematical model for the REMFS-interaction. First we need to consider the REMFS perturbation as a time dependent adiabatic perturbation of water (the most likely receptor for REMFS), specifically the H bond network of the interfacial water [45]. REMFS subjects the quantum system, in the form of the H bond, to gradually changing external conditions giving the quantum system sufficient time for the functional form to adapt [46]. The probabilities of quantum transitions of the adiabatic change in the frequency of the quantum system have been calculated

The reason for the REMFS biological effects rests on the difference between the man-made EMF, and the natural EMF [48]. Man-made EMF waves are produced by parallel EMF oscillating circuits, whereas natural electromagnetic radiation is produced by atomic events such as nuclear fusion from the sun releasing infrared,

previously on the example of the harmonic oscillator [47].

) of the REMFS exposures is not able to cause any

Here, we will focus on studies performed on the REMFS spectrum (50–918 MHz) to explain the mechanism by which non-ionizing, non-thermal, non-modulated, continuous waves cause biological effects. We will use our and other researchers' recent results on human cell cultures and mouse AD models to explain this interaction. Initially, the frequency used in our REMFS experiments was 50 MHz with a specific absorption rate (SAR) of 0.5 W/kg. We found that these exposures upregulated the heat shock factor-1 (HSF1) in human lymphocytes and mouse fibroblasts [39]. HSF1 upregulation increased 70-kDa heat shock protein (HSP70) levels and delayed cellular senescence and death in these cell cultures [39]. Our recent data [40] demonstrated that cultures treated with REMFS at 64 MHz, with a SAR of 0.6 W/kg for 1 h daily for 21 days, had significantly reduced (p = 0.001) levels of Aβ40 peptide, compared to untreated cultures [40]. We also demonstrated a quantitative reduction of Aβ levels in primary human neuron cultures after different times and power protocols. There are further therapeutic implications of REMFS based on the improved cognitive function noted by lowering of Aβ levels in several AD mouse model studies performed by other investiga-

**12**

We developed a mathematical model of the REMFS and biological systems interaction at the quantum level. We hypothesized the quantum effects of REMFS that explain how a low energy exposure is able to produce biochemical changes. For clarity, we divided them into 3 stages with the consequent three equations (see **Figure 1**).

Stage 1. The oscillating REMFS energy causes a time dependent adiabatic perturbation on the first layer of the interfacial water (FLIFW). REMFS perturbs the HB from FLIFW to the oxygen (O) of the "Guanine of the RNA" (GRNA). Under REMFS the H bond of the FLIFW acts as a driven quantum harmonic oscillator increasing the amplitude of the HB vibrations. The following equation estimates the increase in the amplitude of HB vibration when it acts as a driven quantum harmonic oscillator system under REMFS [59]. See following time dependent equation from Piilo et al. to find the amplitude change under REMFS:

\*\*EMFS\*\* [59]. See following time dependent equation (tude change under REMFS:

$$\mathbf{F}(\mathbf{t}) = \frac{\mathbf{A}\cos(\mathbf{\hat{u}t} + \boldsymbol{\varrho})}{\sqrt{2\mathbf{m}\hbar\omega\_0}}\tag{1.1}$$

We will obtain the change in the amplitude of the H bond vibration under REMFS: \_

$$\mathbf{A} = \frac{\mathbf{F} \text{ (t)} \sqrt{2 \mathbf{m} \hbar \omega\_0}}{\cos \text{(out} + \text{\textquotedblleft}\text{)}} \tag{1.2}$$

Where A describes the amplitude and ω the oscillation frequency of the periodic force, ω0 is the frequency of the oscillator, m is the mass of the oscillator, φ is the phase of the driving field, t is the time of the exposure, F(t) is the time dependent periodic force, and ħ is the reduced Planck's constant.

Stage 2. The increased HB vibration amplitude induced by REMFS triggers shortening of the HB of the FLIFW to O of the GRNA. The calculated distance

**Figure 1.**

*REMFS quantum effects on the first layer of the interfacial water of the RNA. REMFS (repeated electromagnetic field stimulation).*

between the H from the first layer of the interfacial water and the Oxygen of the RNA Oxygen is 1.85 Å [60]. This value is very short, predisposing the H for quantum tunneling. The following equation estimates the change in HB shortening as a function of the amplitude of the oscillation [61].

To find the variation of the HB distance we will use the equation from Samdal et al. using the average over the inter-nuclear configurations of the interfacial water and the RNA nucleic acids (ra exp) which is given as:

$$\mathbf{r\_a^{exp} = \langle \mathbf{r} \rangle = \int \mathbf{F\_r(q)} \ P(q) d \ \mathbf{q} \tag{2.1}$$

Fr(q) = variation of bond distance; P(q) = probability function. The equation of P(q) in the classical Boltzmann approximation is:

the classical Boltzmann approximation is:

$$
\mathbf{P}(q) = \mathbf{1}/Nf \exp\left(-\frac{V(q)}{RT}\right)dq\tag{2.2}
$$

This equation predicts the shortening of the HB of the interfacial water under the time dependent perturbation caused by REMFS.

Stage 3. Shortening of the H bond decreases distance from the H from the FLIFW to the O from the GRNA. This will increase the probability of proton tunneling. The following equation estimates the quantum tunneling probability when barrier thickness or distance decreases [43]. \_ \_

$$-\frac{\hbar^2}{2m}\frac{d^2\Psi(\infty)}{d\boldsymbol{x}^2} = \left(\boldsymbol{E} - \boldsymbol{U}\_0\right)\Psi(\infty)\tag{3}$$

**15**

*The Effect of Repeated Electromagnetic Fields Stimulation in Biological Systems*

Multiple studies have found that repeated mild heat-shock (RMHS) produce beneficial effects on human fibroblasts experiencing in vitro senescence [62]. This prompted our laboratory to study the effects of a similar electromagnetic stimuli but instead applying lower frequency energy and therefore less risk of producing heat damage (430 THz vs. 64 MHz). The fact that the energy of the REMFS exposures are several orders of magnitude lower energy that heat exposure, yet both heat and REMFS are able to activate the HSR, makes REMFS a more suitable and safer strategy to activate this biological pathway to prevent and treat age-related diseases. We hypothesized that these exposures would produce anti-aging changes such as delay of in vitro senescence, would also lead to retardation of progressive cell enlargement, prevention of development of abnormal proteins, increased glutathione, and decrease in age-dependent glycosylation [63], as well as maintenance of youthful morphology, increased proteasome activity, increased levels of various heat shock proteins (HSP's), increased resistance against oxidative abilities, and UV-A irradiation similar to repeated mild heat shock [64]. Interestingly many of these anti-aging effects are produce by the heat shock response (HSR) elements [65]. In fact, attenuation in the HSR during senescence is the earliest event in the aging process, and is characterized by loss of proteostasis [66] that comes as a result of decreased heat shock factor-1 (HSF1)

Originally our laboratory utilized a frequency of 50 MHz, a power of 0.5 W, and a specific absorption rate (SAR) of 0.6 W/kg to expose different types of cell cultures applying different dose regimes [39]. REMFS treated cell cultures showed anti-aging effects. The proposed mechanism is the activation of HSF1 when REMFS releases HSF1 from its repressor Hsp90 to activate it. This study suggests that EMF exposure directly interacts with the HSF1-Hsp90 complex, releasing HSF1 for activation preparing it for following injuries. Our experiments also revealed that REMFS increased the population doublings number and changed the morphology of the cells to youthful appearance near the end of their replicative life in wild type, but not in the knockout HSF1 cell cultures. REMSF also decreased cell mortality in human T-cells. Remarkably, REMFS also increased HSF1 phosphorylation, enhanced HSF1-DNA binding, and improved HSP70 expression relative to non-

We hypothesized a mechanism in which REMFS oscillation produces increase amplitude of the hydrogen bond of the interfacial water, therefore increasing the probability of proton tunneling. This proton transfer between the hydrogen bond of the interfacial water and the oxygen of the adjacent nucleic acids of the heat-shock-RNA1 (HSR1) will protonate the nucleic acid to form tautomers [58] that will cause conformational changes in this long non-coding RNA [68]. This secondary structure would be able to bind HSF1 and activate it by dissociation from the repressor chaperone HSP90 [39]. Then, activated HSF1 enters the nucleus and binds DNA to induce expression of beneficial chaperones and, ultimately, the promotion of antiaging and proteostasis effects [69]. The REMSF exposure utilized here is a potential new strategy to treat age-related diseases such as Alzheimer's. We will examine the experiments from REMFS exposures in human neuronal cultures [40] and the

studies from other investigators in AD mouse models [41].

*DOI: http://dx.doi.org/10.5772/intechopen.89668*

**4.1 REMFS effects in aging and age-related diseases**

**4. REMFS biological effects**

DNA-binding [67].

treated cells [39].

*4.1.1 REMFS delays cellular senescence*

Ψ = *A e* −*x* , where α = √ \_ 2*m*(*U*<sup>0</sup> − *E*) ℏ2.

Where E is a particle of energy, U0 is the height of the barrier, and E < U0. Also where m is the mass, d is the thickness of the barrier, α is the attenuation factor.

These three equations formed the mathematical model that is able to predict how the time dependent perturbation caused by REMFS affects the HB network of the first layer of the interfacial water. This HB acts as a quantum harmonic oscillator to produce proton tunneling and the protonation of the nucleic acids of the surrounding RNA to produce biological effects.

### **4. REMFS biological effects**

*Ionizing and Non-ionizing Radiation*

between the H from the first layer of the interfacial water and the Oxygen of the RNA Oxygen is 1.85 Å [60]. This value is very short, predisposing the H for quantum tunneling. The following equation estimates the change in HB shortening as a

*REMFS quantum effects on the first layer of the interfacial water of the RNA. REMFS (repeated electromagnetic* 

To find the variation of the HB distance we will use the equation from Samdal et al. using the average over the inter-nuclear configurations of the interfacial water

> (− \_ *V*(*q*)

This equation predicts the shortening of the HB of the interfacial water under

Stage 3. Shortening of the H bond decreases distance from the H from the FLIFW to the O from the GRNA. This will increase the probability of proton tunneling. The following equation estimates the quantum tunneling probability when

Where E is a particle of energy, U0 is the height of the barrier, and E < U0. Also where m is the mass, d is the thickness of the barrier, α is the attenuation

These three equations formed the mathematical model that is able to predict how the time dependent perturbation caused by REMFS affects the HB network of the first layer of the interfacial water. This HB acts as a quantum harmonic oscillator to produce proton tunneling and the protonation of the nucleic acids of the sur-

exp = 〈r〉 = ∫ Fr(q) P(q)d q (2.1)

*RT* )*dq* (2.2)

= (*E* − *U*0)Ψ(*x*) (3)

exp) which is given as:

function of the amplitude of the oscillation [61].

ra

the time dependent perturbation caused by REMFS.

− ℏ2 \_ 2*m d*2 \_ Ψ(*x*) *d x*<sup>2</sup>

\_ \_ 2*m*(*U*<sup>0</sup> − *E*) ℏ2.

barrier thickness or distance decreases [43].

, where α = √

rounding RNA to produce biological effects.

Fr(q) = variation of bond distance; P(q) = probability function. The equation of P(q) in the classical Boltzmann approximation is:

P(*q*) = 1/*N*∫exp

and the RNA nucleic acids (ra

**Figure 1.**

*field stimulation).*

**14**

Ψ = *A e*

factor.

−*x*

### **4.1 REMFS effects in aging and age-related diseases**

Multiple studies have found that repeated mild heat-shock (RMHS) produce beneficial effects on human fibroblasts experiencing in vitro senescence [62]. This prompted our laboratory to study the effects of a similar electromagnetic stimuli but instead applying lower frequency energy and therefore less risk of producing heat damage (430 THz vs. 64 MHz). The fact that the energy of the REMFS exposures are several orders of magnitude lower energy that heat exposure, yet both heat and REMFS are able to activate the HSR, makes REMFS a more suitable and safer strategy to activate this biological pathway to prevent and treat age-related diseases. We hypothesized that these exposures would produce anti-aging changes such as delay of in vitro senescence, would also lead to retardation of progressive cell enlargement, prevention of development of abnormal proteins, increased glutathione, and decrease in age-dependent glycosylation [63], as well as maintenance of youthful morphology, increased proteasome activity, increased levels of various heat shock proteins (HSP's), increased resistance against oxidative abilities, and UV-A irradiation similar to repeated mild heat shock [64]. Interestingly many of these anti-aging effects are produce by the heat shock response (HSR) elements [65]. In fact, attenuation in the HSR during senescence is the earliest event in the aging process, and is characterized by loss of proteostasis [66] that comes as a result of decreased heat shock factor-1 (HSF1) DNA-binding [67].

### *4.1.1 REMFS delays cellular senescence*

Originally our laboratory utilized a frequency of 50 MHz, a power of 0.5 W, and a specific absorption rate (SAR) of 0.6 W/kg to expose different types of cell cultures applying different dose regimes [39]. REMFS treated cell cultures showed anti-aging effects. The proposed mechanism is the activation of HSF1 when REMFS releases HSF1 from its repressor Hsp90 to activate it. This study suggests that EMF exposure directly interacts with the HSF1-Hsp90 complex, releasing HSF1 for activation preparing it for following injuries. Our experiments also revealed that REMFS increased the population doublings number and changed the morphology of the cells to youthful appearance near the end of their replicative life in wild type, but not in the knockout HSF1 cell cultures. REMSF also decreased cell mortality in human T-cells. Remarkably, REMFS also increased HSF1 phosphorylation, enhanced HSF1-DNA binding, and improved HSP70 expression relative to nontreated cells [39].

We hypothesized a mechanism in which REMFS oscillation produces increase amplitude of the hydrogen bond of the interfacial water, therefore increasing the probability of proton tunneling. This proton transfer between the hydrogen bond of the interfacial water and the oxygen of the adjacent nucleic acids of the heat-shock-RNA1 (HSR1) will protonate the nucleic acid to form tautomers [58] that will cause conformational changes in this long non-coding RNA [68]. This secondary structure would be able to bind HSF1 and activate it by dissociation from the repressor chaperone HSP90 [39]. Then, activated HSF1 enters the nucleus and binds DNA to induce expression of beneficial chaperones and, ultimately, the promotion of antiaging and proteostasis effects [69]. The REMSF exposure utilized here is a potential new strategy to treat age-related diseases such as Alzheimer's. We will examine the experiments from REMFS exposures in human neuronal cultures [40] and the studies from other investigators in AD mouse models [41].

### *4.1.2 REMFS in human neurons*

One of the hallmarks of the aging process is the decrease of the proteostasis due to attenuation of the HSF1 which produce protein aggregation [42]. Alzheimer's is the most common protein deposition disease, it is caused by beta amyloid (Aβ) aggregation. Our recent study showed that REMFS decreased Aβ levels in human neuronal cultures [40]. REMFS decreased Aβ 1–40 and Aβ 1–42 levels. Importantly, it did not cause any toxicity in the neuronal cultures. We tested several REMFS parameters such as time of exposure, frequency, etc. to define any change in the levels of Aβ. Initially we used REMFS treatments at 64 MHz with a SAR of 0.6 W/ kg daily for 1 h for 21 days. Results showed a decrease of 58.3% in Aβ 1–40 levels. We also found that these treatments did not cause any toxicity to the cultures compared to control, non-treated cells as measured by LDH levels, cell morphology, cell attachment, cell number, or neurite extension. Subsequently, we decided to determine if 14 days of REMFS at 64 or 100 MHz with a lower SAR of 0.4 W/kg also decreased the Aβ 1–42 levels. We found that there was a similar significant difference in the Aβ 1–42 levels when we increased the exposure time from 1 to 2 h or when we put the chamber outside the incubator. When we increased the frequency from 64 to 100 MHz; we found a similar beneficial effect in Aβ 1–42 levels. This suggest that REMFS at 64 MHz with a SAR of 0.4 W/kg for 1 h could be the minimal energy required to induce reduction of the Aβ peptides levels, these results are important for future clinical trials. All these suggest that the decrease of Aβ levels in cell cultures were mediated by the activation of the proteostasis master regulator HSF1 [39], this activated HSF1 would increase the expression of chaperones to induce Aβ degradation.

### *4.1.3 REMFS in AD mouse models*

The first REMFS study that prevented cognitive impairment in a transgenic (Tg) AD mouse model "Transgene with human APP gene bearing the Swedish mutation" (AβPPsw) was performed with a pulsed/modulated RF-EMF at 918 MHz which produced a SAR of 0.25–1.05 W/kg over a 7–9 month period [41]. Non-treated Tg mice showed cognitive impairment in memory tests, on the other hand treated Tg mice preserved memory after 6–7 months of REMFS treatment. A more recent REMFS experiment applying daily exposures for a two-month period in older Tg mice (21–27 months) showed improvement in the Y-maze task (memory test), though did not show improvement in more complex tests after 2 months of REMFS [36]. Also the old non-treated Tg had very high levels of Aβ deposition in most areas of the brain. Conversely, the EMF-treated Tg mice exhibited an impressive 24–30% removal of Aβ deposits, suggesting a disaggregation of pre-existing Aβ deposits following 2 months of daily EMF treatment. More importantly, these long-term (daily for up to 9 months) exposure schedules were found to be very safe because they did not demonstrate any harmful effects including, no effects on brain oxidative stress or abnormal brain histology, no significant brain heating, no damage to DNA in circulating blood cells, and no gross changes to peripheral tissues. Another study performed at a higher frequency (1950 MHz, SAR 5 W/kg, 2 h/day, 5 days/week) was also found to ameliorate AD pathology in Tg-5xFAD and wild type (WT) mice exposed to REMFS for 8 months [38]. Remarkably, long-term REMFS significantly decreased not only Aβ plaques, APP, and APP carboxyl-terminal fragments in whole brain (including hippocampus and entorhinal cortex), but also inhibited the parenchymal expression of beta-amyloid precursor protein cleaving enzyme 1 (BACE1) and neuro-inflammation. Additionally, REMFS recovered memory impairment in

**17**

head.

*The Effect of Repeated Electromagnetic Fields Stimulation in Biological Systems*

AD mice. Furthermore, treated Tg showed expression of 5 genes (Tshz2, Gm12695, St 3 gal1, Isx and Tll1), which are associated with Aβ metabolism. We found that these genes are significantly altered inTg-5xFAD mice, showing diverse responses to the treatments in the hippocampus of wild control and transgenic mice. Treatment in wild type mice showed no difference than control Tg. Conversely, REMFS-treated Tg group showed contrasting gene expression arrays. All these findings suggest REMFS treatments positively alter Aβ deposition and metabolism in AD, but not in

Together, human neurons and AD model mouse experiments suggest that REMFS exposures decrease Aβ at the extra and intra cellular levels. Different from the clinical trials with active and passive immunization, REMFS did not cause encephalitis or inflammation. REMFS has important effects in preventing and decreasing brain Aβ deposition, therefore making REMFS a potential therapeutic strategy in the treatment of advanced AD patients who have massive Aβ aggregation

Considering the REMFS effects in Tg AD mice, the results on primary neuronal cultures are very promising as the REMFS parameters such as frequency and SAR we applied creates an appropriate and safe potential new therapeutic strategy for human exposures. However, before we exposed humans to this type of RF radiation, we need to recognize that extrapolating effects of mice exposure to effects of human exposure is complex. The mouse's geometry, size, tissue penetration, tissue dielectric properties are significantly different from that of a human and therefore the external fields produced during the 915 MHz exposure would result in quite different internal fields. Internal fields are the electromagnetic fields inside the object, and not the electromagnetic fields incident upon the object. The energy absorbed by an object is directly related to its internal field. Consequently, it is imperative to determine what type of external fields could yield the same internal fields in mouse and human. An important EMF parameter to contemplate is tissue penetration; we should consider that tissue penetration is inversely proportional to the EMF frequency. For example, 918 MHz (frequency used in mouse experiments and cell phone) has a skin penetration of less than 4 cm in a human head, while it is a whole-body exposure for a mouse. Human head thickness for an adult male is around 19.4 cm, so to irradiate the center of a human head the exposure should have a skin penetration of minimum of 9.7 cm. This demonstrates that the 918 MHz frequency is not able to reach important deep brain areas such as the hippocampus. Additionally, 918 MHz produced a greater energy than REMFS, so rising the thermal injury risk. Instead, REMFS exposure (64 MHz) has a skin penetration of 13.49 cm, similar to the 14.5 width of a human head making it suitable for a human

Using similarities in dosimetry between cell cultures, animal exposure, human phantom exposure, and computer simulation it is possible to adjust conditions for human exposure [70]. Thus, we used frequencies more suitable for human expo-

1.MRI machines has been used 64 MHz for several decades giving a safe exposure that is similar to the 50 and 64 MHz used in our previous experiments [39].

2.It is similar to the human whole body resonant frequency (75 MHz), [71] at this frequency the body absorbs up to 10 times as much as power as when it is not in

sures (50–75 MHz). The basis for these frequencies was:

*DOI: http://dx.doi.org/10.5772/intechopen.89668*

*4.1.4 REMFS potential therapeutic strategy*

wild type mice [38].

in the brain.

### *The Effect of Repeated Electromagnetic Fields Stimulation in Biological Systems DOI: http://dx.doi.org/10.5772/intechopen.89668*

AD mice. Furthermore, treated Tg showed expression of 5 genes (Tshz2, Gm12695, St 3 gal1, Isx and Tll1), which are associated with Aβ metabolism. We found that these genes are significantly altered inTg-5xFAD mice, showing diverse responses to the treatments in the hippocampus of wild control and transgenic mice. Treatment in wild type mice showed no difference than control Tg. Conversely, REMFS-treated Tg group showed contrasting gene expression arrays. All these findings suggest REMFS treatments positively alter Aβ deposition and metabolism in AD, but not in wild type mice [38].

Together, human neurons and AD model mouse experiments suggest that REMFS exposures decrease Aβ at the extra and intra cellular levels. Different from the clinical trials with active and passive immunization, REMFS did not cause encephalitis or inflammation. REMFS has important effects in preventing and decreasing brain Aβ deposition, therefore making REMFS a potential therapeutic strategy in the treatment of advanced AD patients who have massive Aβ aggregation in the brain.

### *4.1.4 REMFS potential therapeutic strategy*

*Ionizing and Non-ionizing Radiation*

*4.1.2 REMFS in human neurons*

induce Aβ degradation.

*4.1.3 REMFS in AD mouse models*

One of the hallmarks of the aging process is the decrease of the proteostasis due to attenuation of the HSF1 which produce protein aggregation [42]. Alzheimer's is the most common protein deposition disease, it is caused by beta amyloid (Aβ) aggregation. Our recent study showed that REMFS decreased Aβ levels in human neuronal cultures [40]. REMFS decreased Aβ 1–40 and Aβ 1–42 levels. Importantly, it did not cause any toxicity in the neuronal cultures. We tested several REMFS parameters such as time of exposure, frequency, etc. to define any change in the levels of Aβ. Initially we used REMFS treatments at 64 MHz with a SAR of 0.6 W/ kg daily for 1 h for 21 days. Results showed a decrease of 58.3% in Aβ 1–40 levels. We also found that these treatments did not cause any toxicity to the cultures compared to control, non-treated cells as measured by LDH levels, cell morphology, cell attachment, cell number, or neurite extension. Subsequently, we decided to determine if 14 days of REMFS at 64 or 100 MHz with a lower SAR of 0.4 W/kg also decreased the Aβ 1–42 levels. We found that there was a similar significant difference in the Aβ 1–42 levels when we increased the exposure time from 1 to 2 h or when we put the chamber outside the incubator. When we increased the frequency from 64 to 100 MHz; we found a similar beneficial effect in Aβ 1–42 levels. This suggest that REMFS at 64 MHz with a SAR of 0.4 W/kg for 1 h could be the minimal energy required to induce reduction of the Aβ peptides levels, these results are important for future clinical trials. All these suggest that the decrease of Aβ levels in cell cultures were mediated by the activation of the proteostasis master regulator HSF1 [39], this activated HSF1 would increase the expression of chaperones to

The first REMFS study that prevented cognitive impairment in a transgenic (Tg) AD mouse model "Transgene with human APP gene bearing the Swedish mutation" (AβPPsw) was performed with a pulsed/modulated RF-EMF at 918 MHz which produced a SAR of 0.25–1.05 W/kg over a 7–9 month period [41]. Non-treated Tg mice showed cognitive impairment in memory tests, on the other hand treated Tg mice preserved memory after 6–7 months of REMFS treatment. A more recent REMFS experiment applying daily exposures for a two-month period in older Tg mice (21–27 months) showed improvement in the Y-maze task (memory test), though did not show improvement in more complex tests after 2 months of REMFS [36]. Also the old non-treated Tg had very high levels of Aβ deposition in most areas of the brain. Conversely, the EMF-treated Tg mice exhibited an impressive 24–30% removal of Aβ deposits, suggesting a disaggregation of pre-existing Aβ deposits following 2 months of daily EMF treatment. More importantly, these long-term (daily for up to 9 months) exposure schedules were found to be very safe because they did not demonstrate any harmful effects including, no effects on brain oxidative stress or abnormal brain histology, no significant brain heating, no damage to DNA in circulating blood cells, and no gross changes to peripheral tissues. Another study performed at a higher frequency (1950 MHz, SAR 5 W/kg, 2 h/day, 5 days/week) was also found to ameliorate AD pathology in Tg-5xFAD and wild type (WT) mice exposed to REMFS for 8 months [38]. Remarkably, long-term REMFS significantly decreased not only Aβ plaques, APP, and APP carboxyl-terminal fragments in whole brain (including hippocampus and entorhinal cortex), but also inhibited the parenchymal expression of beta-amyloid precursor protein cleaving enzyme 1 (BACE1) and neuro-inflammation. Additionally, REMFS recovered memory impairment in

**16**

Considering the REMFS effects in Tg AD mice, the results on primary neuronal cultures are very promising as the REMFS parameters such as frequency and SAR we applied creates an appropriate and safe potential new therapeutic strategy for human exposures. However, before we exposed humans to this type of RF radiation, we need to recognize that extrapolating effects of mice exposure to effects of human exposure is complex. The mouse's geometry, size, tissue penetration, tissue dielectric properties are significantly different from that of a human and therefore the external fields produced during the 915 MHz exposure would result in quite different internal fields. Internal fields are the electromagnetic fields inside the object, and not the electromagnetic fields incident upon the object. The energy absorbed by an object is directly related to its internal field. Consequently, it is imperative to determine what type of external fields could yield the same internal fields in mouse and human. An important EMF parameter to contemplate is tissue penetration; we should consider that tissue penetration is inversely proportional to the EMF frequency. For example, 918 MHz (frequency used in mouse experiments and cell phone) has a skin penetration of less than 4 cm in a human head, while it is a whole-body exposure for a mouse. Human head thickness for an adult male is around 19.4 cm, so to irradiate the center of a human head the exposure should have a skin penetration of minimum of 9.7 cm. This demonstrates that the 918 MHz frequency is not able to reach important deep brain areas such as the hippocampus. Additionally, 918 MHz produced a greater energy than REMFS, so rising the thermal injury risk. Instead, REMFS exposure (64 MHz) has a skin penetration of 13.49 cm, similar to the 14.5 width of a human head making it suitable for a human head.

Using similarities in dosimetry between cell cultures, animal exposure, human phantom exposure, and computer simulation it is possible to adjust conditions for human exposure [70]. Thus, we used frequencies more suitable for human exposures (50–75 MHz). The basis for these frequencies was:


resonance [72]. Consequently, we would need to apply less power and achieve the minimum SAR that could achieve biological effect, a safer exposure compared to high energy fields. This would decrease the complexity of the EMF-biological system interaction decreasing the heat production from the exposure.

The physical and biological conditions of the exposed target would affect the EMF parameters of the exposures concerning the case under study [73].

3.Our REMFS exposures produced a SAR (0.4–0.9 W/kg) well below the value limits values of 2 W/kg set by the Institute of Electrical and Electronics Engineers (IEEE) [40], so offering a safe framework for clinical trials [39]. The REMFS parameter for human exposures will range from daily to twice weekly, with a length extending from 30 min to 1 h for several months founded on human neurons and AD mouse studies [36, 37, 39–41].

### *4.1.4.1 REMFS anti-aging effects*

In our previous studies, we determined that REMFS enhanced the HSF1-DNA and delayed the aging process. Taking into consideration that the decline in proteostasis is the earliest event in the aging process and that it is caused by attenuation of the HSF1-DNA binding [66, 74], this makes REMFS a potential therapeutic strategy to treat age-related diseases.

Nevertheless, we should take into consideration other pathway imbalances that cause the pathomolecular mechanism of age-related diseases. Take, for example, the Forehead box protein (FoxO) pathways whose dysregulation results in accelerating the aging process [75]. This suggests that delaying the aging process may be achieved by reactivation of both HSF1 and FoxO pathways (longevity pathways). The combination of the treatments for these two pathways such as HSF1 enhancers (REMFS) in combination with caloric restriction mimetics such as resveratrol (RV) would be an appropriate therapeutic strategy [69, 76]. Enhancing these two pathways that control an array of different processes, including metabolism, cognition, stress response, and brain plasticity demands close monitoring to prevent hyperstimulation of either pathway, thus controlling side effects [69]. For this reason, we suggest using REMFS because 64 MHz affords a safe framework for human treatments [77]. Our previous studies utilized a non-ionizing EMF radiation of 50 MHz allowed safe exposures comparable to our recent study in human neurons with 64 MHz [39]. We should take into consideration that 918 MHz has less skin penetration and therefore the energy carried by the exposure is absorbed adjacent to the skin. In an interest study the RF exposure during 30 min with a 2.7–4 W/kg SAR, versus a 16 min with 6 W/kg both caused a noteworthy temperature change (0.1–0.4°C), as well as other physiological changes in heart rate, localized sweating, and blood flow [78], thus, we suggest lower and effective SAR values (0.4–0.9 W/kg) to prevent these side effects. REMFS can be applied through different exposure systems such as antennas in anechoic chambers or large TEM chambers, these chambers would likely about 10 m in length, 6 m in height, and 6 m in width and utilized frequencies between 50 and 64 MHz [79, 80]. The Institute of Electrical and Electronics Engineers (IEEE) recommend maximum permissible exposure (MPE) values of less than 1 W/kg [81]. Our REMFS treatment produce SAR's under this limit, so suggesting that this is a safe exposure for human treatments. An important aspect to consider is the homocysteinylation of the HSF1 which could be the cause of the age-related attenuation of the HSF1-DNA binding. Therefore, decreasing plasma homocysteine levels by dietary interventions is recommended to prevent the HSF1-DNA binding [82].

**19**

this new potential therapeutic strategy.

**5. Future diagnostic procedures**

*The Effect of Repeated Electromagnetic Fields Stimulation in Biological Systems*

monitor neuro-degeneration and protein deposition load [69, 85].

*4.1.4.2 REMFS in Alzheimer's disease and other protein aggregation diseases*

While REMFS might affect the organism in a whole-body basis, we also consider that more focused exposures, individual body targets may be selected. Any organ that shows functional decline, including the brain, kidneys, joints, liver, or heart, may benefit from engineered REMFS to induce protein disaggregation by activation of the HSF1 pathway. Therefore, we will initiate human head exposure to treat the most common cause of dementia (Alzheimer's disease). Before clinical trials are considered we have to determine the best electromagnetic settings for human exposures such as power output, power deposition, far field, antenna type, distance from antenna, electric field, magnetic field, etc. that will produce uniform internal fields similar to our previous studies when applied to a human brain with a target SAR of 0.4–0.9 W/kg [40]. Initially, we determined by mathematical and computer modeling that the REMFS exposures in our biological studies delivered a safe thermal and SAR measurements [70]. With these results we developed a virtual exposure system by numerical model and computer simulation. We designed a virtual antenna that delivers a SAR of around 0.6 W/kg to a simulated phantom of a human brain. With these simulations we found the REMFS parameters that would deliver a uniform radiation to a human skull in clinical trials [86]. In the near future, we will experimentally confirm these results using an appropriate antenna to expose a Specific Anthropomorphic Mannequin (SAM) human head phantom [87] with internal and external probes oriented vertically to determine the EMF parameters that will provide an effective and safe SAR for future Alzheimer's treatment. Data suggest that the ideal environment for these treatments should be an anechoic chamber to prevent RF wave reflections and provide a uniform exposure to the subjects. The final step will be to initiate phase 1 clinical trials in patient with early Alzheimer's disease to determine safety and efficacy of

We performed several computer modeling and simulation to create visual representations of the interior of the human body for diagnostic analysis, as well as visual representation of the function of some organs or tissues. We utilized

Likewise, FoxO activation is a very crucial part of the combination therapy to delay the aging process and age-related diseases. RV is one of the most effective FoxO activators; it has few side effects and it is easy to administer. RV also activates the mTOR, and SK1N pathways [83]. RV has effects on multiple pathways such as antioxidant, vasodilating, inflammation, cell growth, atherosclerosis, anticoagulant, and beneficial for the cardiac rhythm. Notably, RV decreases mortality and metabolic syndrome in high-calorie and high-fat diets in mice experiments [84]. For these reasons RV is a potentially a new therapeutic strategy to prevent and treat metabolic syndrome and diabetes mellitus type II. One disadvantage is that RV bioavailability is poor as a consequence of metabolic alterations in the plasma. Hypothetically, REMFS combines with RV as soon as a decline in any of these two pathways is detected. One of the methods to determine if the HSF1 pathway is failing would be monitoring the T lymphocyte HSF-1 DNA binding [69]. The method to detect a decline in the FoxO pathway includes testing the FoxO3a binding to DNA. An important part of the evaluation is to determine the aggregation of beta amyloid (Aβ), Tau, or α-synuclein proteins in the human brain using Positron-emission tomography (PET) scanning to

*DOI: http://dx.doi.org/10.5772/intechopen.89668*

### *The Effect of Repeated Electromagnetic Fields Stimulation in Biological Systems DOI: http://dx.doi.org/10.5772/intechopen.89668*

Likewise, FoxO activation is a very crucial part of the combination therapy to delay the aging process and age-related diseases. RV is one of the most effective FoxO activators; it has few side effects and it is easy to administer. RV also activates the mTOR, and SK1N pathways [83]. RV has effects on multiple pathways such as antioxidant, vasodilating, inflammation, cell growth, atherosclerosis, anticoagulant, and beneficial for the cardiac rhythm. Notably, RV decreases mortality and metabolic syndrome in high-calorie and high-fat diets in mice experiments [84]. For these reasons RV is a potentially a new therapeutic strategy to prevent and treat metabolic syndrome and diabetes mellitus type II. One disadvantage is that RV bioavailability is poor as a consequence of metabolic alterations in the plasma. Hypothetically, REMFS combines with RV as soon as a decline in any of these two pathways is detected. One of the methods to determine if the HSF1 pathway is failing would be monitoring the T lymphocyte HSF-1 DNA binding [69]. The method to detect a decline in the FoxO pathway includes testing the FoxO3a binding to DNA. An important part of the evaluation is to determine the aggregation of beta amyloid (Aβ), Tau, or α-synuclein proteins in the human brain using Positron-emission tomography (PET) scanning to monitor neuro-degeneration and protein deposition load [69, 85].

### *4.1.4.2 REMFS in Alzheimer's disease and other protein aggregation diseases*

While REMFS might affect the organism in a whole-body basis, we also consider that more focused exposures, individual body targets may be selected. Any organ that shows functional decline, including the brain, kidneys, joints, liver, or heart, may benefit from engineered REMFS to induce protein disaggregation by activation of the HSF1 pathway. Therefore, we will initiate human head exposure to treat the most common cause of dementia (Alzheimer's disease). Before clinical trials are considered we have to determine the best electromagnetic settings for human exposures such as power output, power deposition, far field, antenna type, distance from antenna, electric field, magnetic field, etc. that will produce uniform internal fields similar to our previous studies when applied to a human brain with a target SAR of 0.4–0.9 W/kg [40]. Initially, we determined by mathematical and computer modeling that the REMFS exposures in our biological studies delivered a safe thermal and SAR measurements [70]. With these results we developed a virtual exposure system by numerical model and computer simulation. We designed a virtual antenna that delivers a SAR of around 0.6 W/kg to a simulated phantom of a human brain. With these simulations we found the REMFS parameters that would deliver a uniform radiation to a human skull in clinical trials [86]. In the near future, we will experimentally confirm these results using an appropriate antenna to expose a Specific Anthropomorphic Mannequin (SAM) human head phantom [87] with internal and external probes oriented vertically to determine the EMF parameters that will provide an effective and safe SAR for future Alzheimer's treatment. Data suggest that the ideal environment for these treatments should be an anechoic chamber to prevent RF wave reflections and provide a uniform exposure to the subjects. The final step will be to initiate phase 1 clinical trials in patient with early Alzheimer's disease to determine safety and efficacy of this new potential therapeutic strategy.

### **5. Future diagnostic procedures**

We performed several computer modeling and simulation to create visual representations of the interior of the human body for diagnostic analysis, as well as visual representation of the function of some organs or tissues. We utilized

*Ionizing and Non-ionizing Radiation*

*4.1.4.1 REMFS anti-aging effects*

to treat age-related diseases.

resonance [72]. Consequently, we would need to apply less power and achieve the minimum SAR that could achieve biological effect, a safer exposure compared to high energy fields. This would decrease the complexity of the EMF-biological system interaction decreasing the heat production from the exposure. The physical and biological conditions of the exposed target would affect the EMF param-

3.Our REMFS exposures produced a SAR (0.4–0.9 W/kg) well below the value limits values of 2 W/kg set by the Institute of Electrical and Electronics Engineers (IEEE) [40], so offering a safe framework for clinical trials [39]. The REMFS parameter for human exposures will range from daily to twice weekly, with a length extending from 30 min to 1 h for several months founded on hu-

In our previous studies, we determined that REMFS enhanced the HSF1-DNA and delayed the aging process. Taking into consideration that the decline in proteostasis is the earliest event in the aging process and that it is caused by attenuation of the HSF1-DNA binding [66, 74], this makes REMFS a potential therapeutic strategy

Nevertheless, we should take into consideration other pathway imbalances that cause the pathomolecular mechanism of age-related diseases. Take, for example, the Forehead box protein (FoxO) pathways whose dysregulation results in accelerating the aging process [75]. This suggests that delaying the aging process may be achieved by reactivation of both HSF1 and FoxO pathways (longevity pathways). The combination of the treatments for these two pathways such as HSF1 enhancers (REMFS) in combination with caloric restriction mimetics such as resveratrol (RV) would be an appropriate therapeutic strategy [69, 76]. Enhancing these two pathways that control an array of different processes, including metabolism, cognition, stress response, and brain plasticity demands close monitoring to prevent hyperstimulation of either pathway, thus controlling side effects [69]. For this reason, we suggest using REMFS because 64 MHz affords a safe framework for human treatments [77]. Our previous studies utilized a non-ionizing EMF radiation of 50 MHz allowed safe exposures comparable to our recent study in human neurons with 64 MHz [39]. We should take into consideration that 918 MHz has less skin penetration and therefore the energy carried by the exposure is absorbed adjacent to the skin. In an interest study the RF exposure during 30 min with a 2.7–4 W/kg SAR, versus a 16 min with 6 W/kg both caused a noteworthy temperature change (0.1–0.4°C), as well as other physiological changes in heart rate, localized sweating, and blood flow [78], thus, we suggest lower and effective SAR values (0.4–0.9 W/kg) to prevent these side effects. REMFS can be applied through different exposure systems such as antennas in anechoic chambers or large TEM chambers, these chambers would likely about 10 m in length, 6 m in height, and 6 m in width and utilized frequencies between 50 and 64 MHz [79, 80]. The Institute of Electrical and Electronics Engineers (IEEE) recommend maximum permissible exposure (MPE) values of less than 1 W/kg [81]. Our REMFS treatment produce SAR's under this limit, so suggesting that this is a safe exposure for human treatments. An important aspect to consider is the homocysteinylation of the HSF1 which could be the cause of the age-related attenuation of the HSF1-DNA binding. Therefore, decreasing plasma homocysteine levels by dietary interven-

eters of the exposures concerning the case under study [73].

man neurons and AD mouse studies [36, 37, 39–41].

tions is recommended to prevent the HSF1-DNA binding [82].

**18**

EMF of different frequencies up to 5 GHz because they are commonly used in medicine for diagnosis. Here, we show several future non-invasive EMF diagnostic procedures.

### **5.1 Pathological bone**

We performed microwave and thermal simulation of human bone. The results showed differential power dissipation over the bone materials with different temperatures within 2–4° change for various frequencies [88]. This simulation also showed the distinction between normal and abnormal bone tissues, indicating that this is an effective method for diagnosing normal bone and pathological bone including bone cancer, fractures and infection.

### **5.2 Femoral neck vasculature**

We also performed simulations of the vasculature of the femoral bone [89]. Disruption of the blood supply to the femoral neck is a well-recognized source of morbidity and mortality, often resulting in avascular necrosis of the femoral head. EM simulations of femoral neck fractures were presented as examples. Electric fields were generated in a fashion that exploited disruptions within the vasculature of the femoral neck. Simulated blood vessels were developed in two-dimensions: the phi direction (the circular), and the z-direction. Two different frequencies, 3 and 5 GHz were considered, with 100-J energy pulses within blood vessels of 2.54 mm in diameter. The fat surrounding the bone was simulated, we also developed an additional model with layered fat and skin above the vessels. We were able to visualize the femoral neck's blood vessels. This research validated the technique of detecting and diagnosing pathology of the circulation of femur bone in humans. The approach using the characteristics of the RF response of the reflected power at various frequencies as determined from the finite element simulation was appropriate, and it fits well with the practical model if implemented via MEMS (micro-electro-mechanical systems). Magnetic sensors may be built on flexible substrates in order to shape up the sensors and make them suitable for measuring various sizes. The COMSOL models were made close to the anatomical model seen in **Figure 2**. It shows the head, neck, and leg of the femur. The exploitation of electric field indicates the feasibility of a subsequent practical model to diagnose femur vasculature pathology including avascular necrosis of the femoral neck and other human bones.

### **5.3 Arteriosclerosis disease**

We lastly performed simulations to detect arteriosclerosis of human blood vessels which is associated with coronary artery and peripheral vascular disease. Our laboratory developed a new non-invasive EMF approach for the diagnosis of stenosis/arteriosclerosis disease. A simulated human foot was analyzed using COMSOL multi-physics software in attempt to visualize, analyze, and quantify the degree of peripheral vascular disease, which plays a pivotal role in the development of diabetic foot ulcers. The simulation results served as a proof of concept for predicting and stratifying certain degrees of occlusion within the peripheral vasculature. Although this study was based on computer modeling with simulation results in nature, the research parameters shows promise for practical models for future diagnosis of the peripheral vasculature via EM parameters. The study shows promises for the practical implementation of the device. Current technologies with MEMS/NEMS can serve as hardware systems

**21**

*The Effect of Repeated Electromagnetic Fields Stimulation in Biological Systems*

proper for this diagnosis process designed for detecting EM parameters needed for the diagnostic tool for the early detection of peripheral vascular disease, and

*(a) The computerized model of the femur (b) The anatomical femur with components and blood vessels: blood* 

Since the discovery of electromagnetic fields, the beneficial health effects and their potential applications toward the treatment and diagnostic of age-related diseases has been eagerly sought with promising results. The effect of non-thermal, non-ionizing REMFS has been examined in our laboratory for its ability to induce cytoprotecting effect via the heat shock factor-1. Results suggest anti-aging effects occurred as a direct consequence of a biological systems-REMFS interaction, and herein we have proposed a quantum tunneling-based mechanism mediated by the interfacial water to explain it. Our pioneering studies have also demonstrated safe REMFS decreases toxic Aβ levels in primary human brain cell cultures; an outcome likely resulting from increased Aβ degradation. When considered in parallel with several transgenic AD mouse model studies that have demonstrated the efficacy and safety of REMFS in-vivo to induce removal/disaggregation of pre-existing Aβ deposits and prevent or reverse cognitive impairment, the potential application of REMFS toward the treatment of AD and age-related protein deposition diseases is certainly encouraging. Furthermore, the simultaneous modulation of longevity pathways through HSF1 enhancers (e.g., REMFS) and FoxO pathway up-regulators (caloric restriction mimetics, such as resveratrol) suggest complementary strategies could act synergistically to balance and preserve cellular defense and repair systems. As REMFS targets the most important pathways affected in Alzheimer's disease and other age-related pathologies, HSF1 modulation and enhancement by REMFS could potentially restore a variety of damaged signaling networks associated with the aging process, additionally, diagnostic EMF devices could prove to be a fast, non-invasive, and painless tool that will avoid incisions into the body and the

*DOI: http://dx.doi.org/10.5772/intechopen.89668*

ultimately, diabetic foot ulcers [90].

*vessels showing rupture in the femur vasculature.*

removal of tissue for diagnosis of a multitude of diseases.

**6. Conclusion**

**Figure 2.**

*The Effect of Repeated Electromagnetic Fields Stimulation in Biological Systems DOI: http://dx.doi.org/10.5772/intechopen.89668*

**Figure 2.**

*Ionizing and Non-ionizing Radiation*

including bone cancer, fractures and infection.

procedures.

**5.1 Pathological bone**

**5.2 Femoral neck vasculature**

other human bones.

**5.3 Arteriosclerosis disease**

EMF of different frequencies up to 5 GHz because they are commonly used in medicine for diagnosis. Here, we show several future non-invasive EMF diagnostic

We performed microwave and thermal simulation of human bone. The results

We also performed simulations of the vasculature of the femoral bone [89]. Disruption of the blood supply to the femoral neck is a well-recognized source of morbidity and mortality, often resulting in avascular necrosis of the femoral head. EM simulations of femoral neck fractures were presented as examples. Electric fields were generated in a fashion that exploited disruptions within the vasculature of the femoral neck. Simulated blood vessels were developed in two-dimensions: the phi direction (the circular), and the z-direction. Two different frequencies, 3 and 5 GHz were considered, with 100-J energy pulses within blood vessels of 2.54 mm in diameter. The fat surrounding the bone was simulated, we also developed an additional model with layered fat and skin above the vessels. We were able to visualize the femoral neck's blood vessels. This research validated the technique of detecting and diagnosing pathology of the circulation of femur bone in humans. The approach using the characteristics of the RF response of the reflected power at various frequencies as determined from the finite element simulation was appropriate, and it fits well with the practical model if implemented via MEMS (micro-electro-mechanical systems). Magnetic sensors may be built on flexible substrates in order to shape up the sensors and make them suitable for measuring various sizes. The COMSOL models were made close to the anatomical model seen in **Figure 2**. It shows the head, neck, and leg of the femur. The exploitation of electric field indicates the feasibility of a subsequent practical model to diagnose femur vasculature pathology including avascular necrosis of the femoral neck and

We lastly performed simulations to detect arteriosclerosis of human blood vessels which is associated with coronary artery and peripheral vascular disease. Our laboratory developed a new non-invasive EMF approach for the diagnosis of stenosis/arteriosclerosis disease. A simulated human foot was analyzed using COMSOL multi-physics software in attempt to visualize, analyze, and quantify the degree of peripheral vascular disease, which plays a pivotal role in the development of diabetic foot ulcers. The simulation results served as a proof of concept for predicting and stratifying certain degrees of occlusion within the peripheral vasculature. Although this study was based on computer modeling with simulation results in nature, the research parameters shows promise for practical models for future diagnosis of the peripheral vasculature via EM parameters. The study shows promises for the practical implementation of the device. Current technologies with MEMS/NEMS can serve as hardware systems

showed differential power dissipation over the bone materials with different temperatures within 2–4° change for various frequencies [88]. This simulation also showed the distinction between normal and abnormal bone tissues, indicating that this is an effective method for diagnosing normal bone and pathological bone

**20**

*(a) The computerized model of the femur (b) The anatomical femur with components and blood vessels: blood vessels showing rupture in the femur vasculature.*

proper for this diagnosis process designed for detecting EM parameters needed for the diagnostic tool for the early detection of peripheral vascular disease, and ultimately, diabetic foot ulcers [90].

### **6. Conclusion**

Since the discovery of electromagnetic fields, the beneficial health effects and their potential applications toward the treatment and diagnostic of age-related diseases has been eagerly sought with promising results. The effect of non-thermal, non-ionizing REMFS has been examined in our laboratory for its ability to induce cytoprotecting effect via the heat shock factor-1. Results suggest anti-aging effects occurred as a direct consequence of a biological systems-REMFS interaction, and herein we have proposed a quantum tunneling-based mechanism mediated by the interfacial water to explain it. Our pioneering studies have also demonstrated safe REMFS decreases toxic Aβ levels in primary human brain cell cultures; an outcome likely resulting from increased Aβ degradation. When considered in parallel with several transgenic AD mouse model studies that have demonstrated the efficacy and safety of REMFS in-vivo to induce removal/disaggregation of pre-existing Aβ deposits and prevent or reverse cognitive impairment, the potential application of REMFS toward the treatment of AD and age-related protein deposition diseases is certainly encouraging. Furthermore, the simultaneous modulation of longevity pathways through HSF1 enhancers (e.g., REMFS) and FoxO pathway up-regulators (caloric restriction mimetics, such as resveratrol) suggest complementary strategies could act synergistically to balance and preserve cellular defense and repair systems. As REMFS targets the most important pathways affected in Alzheimer's disease and other age-related pathologies, HSF1 modulation and enhancement by REMFS could potentially restore a variety of damaged signaling networks associated with the aging process, additionally, diagnostic EMF devices could prove to be a fast, non-invasive, and painless tool that will avoid incisions into the body and the removal of tissue for diagnosis of a multitude of diseases.

### **Acronyms**


### **Author details**

Felipe P. Perez1 , James Rizkalla2 , Matthew Jeffers3 , Paul Salama3 , Cristina N. Perez Chumbiauca1 and Maher Rizkalla3,4\*

1 Indiana University School of Medicine, Indianapolis, Indiana, United States

2 Baylor University Medical Center, Dallas, Texas, United States

3 Department of Electrical and Computer Engineering, Indiana University Purdue University Indianapolis (IUPUI), Indiana, United States

4 Integrated Nanotechnology Development Institute (INDI), IUPUI, Indianapolis, Indiana, United States

\*Address all correspondence to: mrizkall@iu.edu

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

**23**

1987;**8**(6):413-427

*The Effect of Repeated Electromagnetic Fields Stimulation in Biological Systems*

[9] Fesenko EE, Geletyuk VI, Kazachenko VN, Chemeris NK. Preliminary microwave irradiation of

water solutions changes their channel-modifying activity. FEBS

[10] Byus CV, Pieper SE, Adey WR. The

[11] Goodman R, Henderson AS. In: SpringerLink, editor. Mechanistic Approaches to Interactions of Electric and Electromagnetic Fields with Living Systems. New York: Plenum Press; 1987

[12] Liboff AR, Williams T Jr, Strong DM, Wistar R Jr. Timevarying magnetic fields: Effect on DNA synthesis. Science. 1984;**223**(4638):818-820

[13] Grundler W, Abmayr W. Differential inactivation analysis of diploid yeast exposed to radiation of various LET. I. Computerized single-cell observation and preliminary application to X-raytreated *Saccharomyces cerevisiae*.

Radiation Research. 1983;**94**(3):464-479

[14] Capelli E, Torrisi F, Venturini L, Granato M, Fassina L, Lupo GFD, et al. Low-frequency pulsed electromagnetic field is able to modulate miRNAs in an experimental cell model of Alzheimer's

disease. Journal of Healthcare Engineering. 2017;**2017**:10

[15] Liu Y, Liu WB, Liu KJ, Ao L, Cao J, Zhong JL, et al. Extremely lowfrequency electromagnetic fields affect the miRNA-mediated regulation of signaling pathways in the GC-2 cell line. PLoS One. 2015;**10**(10):e0139949

[16] Dasdag S, Akdag MZ, Erdal ME, Erdal N, Ay OI, Ay ME, et al. Effects

Letters. 1995;**366**(1):49-52

effects of low-energy 60-Hz environmental electromagnetic fields upon the growth-related enzyme ornithine decarboxylase. Carcinogenesis. 1987;**8**(10):1385-1389

*DOI: http://dx.doi.org/10.5772/intechopen.89668*

[1] Rosen A, Stuchly MA, Vorst AV. Applications of RF/microwaves in medicine. IEEE Transactions on Microwave Theory and Techniques.

[2] Michaelson SM. Health implications

microwave energies. British Journal of Industrial Medicine. 1982;**39**(2):105-119

[4] Hardell L, Sage C. Biological effects from electromagnetic field exposure and public exposure standards. Biomedicine & Pharmacotherapy = Biomedecine & Pharmacotherapie.

of exposure to radiofrequency/

[3] Singh S, Kapoor N. Health implications of electromagnetic fields, mechanisms of action, and research needs. Advances in Biology.

**References**

2002;**50**(3):963-974

2014;**2014**:24

2008;**62**(2):104-109

2014;**15**(4):5366-5387

[6] Perez FP, Morisaki JJ,

[5] Gherardini L, Ciuti G,

Tognarelli S, Cinti C. Searching for the perfect wave: The effect of radiofrequency electromagnetic fields on cells. International Journal of Molecular Sciences.

Bandeira JP. Repeated electromagnetic field stimulation in aging and health. In: The Science of Hormesis in Health and Longevity. Cambridge, Massachusetts, USA: Elsevier; 2019. pp. 189-197

[7] Conti P, Gigante GE, Alesse E, Cifone MG, Fieschi C, Reale M, et al. A role for Ca2+ in the effect of very low frequency electromagnetic field on the blastogenesis of human lymphocytes. FEBS Letters. 1985;**181**(1):28-32

[8] Rozek RJ, Sherman ML, Liboff AR, McLeod BR, Smith SD. Nifedipine is an antagonist to cyclotron resonance enhancement of 45Ca incorporation in human lymphocytes. Cell Calcium.

*The Effect of Repeated Electromagnetic Fields Stimulation in Biological Systems DOI: http://dx.doi.org/10.5772/intechopen.89668*

### **References**

*Ionizing and Non-ionizing Radiation*

EMF electromagnetic fields

SAR specific absorption rate HSF1 heat shock factor 1 HB hydrogen bond

GRNA guanine of the RNA

HSP heat shock proteins HSR1 heat shock RNA RV resveratrol

FoxO Forkhead box protein

, James Rizkalla2

Cristina N. Perez Chumbiauca1

, Matthew Jeffers3

1 Indiana University School of Medicine, Indianapolis, Indiana, United States

2 Baylor University Medical Center, Dallas, Texas, United States

University Indianapolis (IUPUI), Indiana, United States

\*Address all correspondence to: mrizkall@iu.edu

provided the original work is properly cited.

and Maher Rizkalla3,4\*

3 Department of Electrical and Computer Engineering, Indiana University Purdue

4 Integrated Nanotechnology Development Institute (INDI), IUPUI, Indianapolis,

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

, Paul Salama3

,

Aβ amyloid beta AD Alzheimer's disease SOD superoxide dismutase

WT wild type Tg transgenic

**Author details**

Felipe P. Perez1

Indiana, United States

O oxygen

FLIFW first layer of the interfacial water

REMFS repeated electromagnetic fields stimulation

**Acronyms**

**22**

[1] Rosen A, Stuchly MA, Vorst AV. Applications of RF/microwaves in medicine. IEEE Transactions on Microwave Theory and Techniques. 2002;**50**(3):963-974

[2] Michaelson SM. Health implications of exposure to radiofrequency/ microwave energies. British Journal of Industrial Medicine. 1982;**39**(2):105-119

[3] Singh S, Kapoor N. Health implications of electromagnetic fields, mechanisms of action, and research needs. Advances in Biology. 2014;**2014**:24

[4] Hardell L, Sage C. Biological effects from electromagnetic field exposure and public exposure standards. Biomedicine & Pharmacotherapy = Biomedecine & Pharmacotherapie. 2008;**62**(2):104-109

[5] Gherardini L, Ciuti G, Tognarelli S, Cinti C. Searching for the perfect wave: The effect of radiofrequency electromagnetic fields on cells. International Journal of Molecular Sciences. 2014;**15**(4):5366-5387

[6] Perez FP, Morisaki JJ, Bandeira JP. Repeated electromagnetic field stimulation in aging and health. In: The Science of Hormesis in Health and Longevity. Cambridge, Massachusetts, USA: Elsevier; 2019. pp. 189-197

[7] Conti P, Gigante GE, Alesse E, Cifone MG, Fieschi C, Reale M, et al. A role for Ca2+ in the effect of very low frequency electromagnetic field on the blastogenesis of human lymphocytes. FEBS Letters. 1985;**181**(1):28-32

[8] Rozek RJ, Sherman ML, Liboff AR, McLeod BR, Smith SD. Nifedipine is an antagonist to cyclotron resonance enhancement of 45Ca incorporation in human lymphocytes. Cell Calcium. 1987;**8**(6):413-427

[9] Fesenko EE, Geletyuk VI, Kazachenko VN, Chemeris NK. Preliminary microwave irradiation of water solutions changes their channel-modifying activity. FEBS Letters. 1995;**366**(1):49-52

[10] Byus CV, Pieper SE, Adey WR. The effects of low-energy 60-Hz environmental electromagnetic fields upon the growth-related enzyme ornithine decarboxylase. Carcinogenesis. 1987;**8**(10):1385-1389

[11] Goodman R, Henderson AS. In: SpringerLink, editor. Mechanistic Approaches to Interactions of Electric and Electromagnetic Fields with Living Systems. New York: Plenum Press; 1987

[12] Liboff AR, Williams T Jr, Strong DM, Wistar R Jr. Timevarying magnetic fields: Effect on DNA synthesis. Science. 1984;**223**(4638):818-820

[13] Grundler W, Abmayr W. Differential inactivation analysis of diploid yeast exposed to radiation of various LET. I. Computerized single-cell observation and preliminary application to X-raytreated *Saccharomyces cerevisiae*. Radiation Research. 1983;**94**(3):464-479

[14] Capelli E, Torrisi F, Venturini L, Granato M, Fassina L, Lupo GFD, et al. Low-frequency pulsed electromagnetic field is able to modulate miRNAs in an experimental cell model of Alzheimer's disease. Journal of Healthcare Engineering. 2017;**2017**:10

[15] Liu Y, Liu WB, Liu KJ, Ao L, Cao J, Zhong JL, et al. Extremely lowfrequency electromagnetic fields affect the miRNA-mediated regulation of signaling pathways in the GC-2 cell line. PLoS One. 2015;**10**(10):e0139949

[16] Dasdag S, Akdag MZ, Erdal ME, Erdal N, Ay OI, Ay ME, et al. Effects of 2.4 GHz radiofrequency radiation emitted from Wi-Fi equipment on microRNA expression in brain tissue. International Journal of Radiation Biology. 2015;**91**(7):555-561

[17] Luukkonen J, Liimatainen A, Juutilainen J, Naarala J. Induction of genomic instability, oxidative processes, and mitochondrial activity by 50Hz magnetic fields in human SH-SY5Y neuroblastoma cells. Mutation Research. 2014;**760**:33-41

[18] Jouni FJ, Abdolmaleki P, Ghanati F. Oxidative stress in broad bean (*Vicia faba* L.) induced by static magnetic field under natural radioactivity. Mutation Research. 2012;**741**(1-2):116-121

[19] Campisi A, Gulino M, Acquaviva R, Bellia P, Raciti G, Grasso R, et al. Reactive oxygen species levels and DNA fragmentation on astrocytes in primary culture after acute exposure to low intensity microwave electromagnetic field. Neuroscience Letters. 2010;**473**(1):52-55

[20] Hajnorouzi A, Vaezzadeh M, Ghanati F, Jamnezhad H, Nahidian B. Growth promotion and a decrease of oxidative stress in maize seedlings by a combination of geomagnetic and weak electromagnetic fields. Journal of Plant Physiology. 2011;**168**(10):1123-1128

[21] Maaroufi K, Had-Aissouni L, Melon C, Sakly M, Abdelmelek H, Poucet B, et al. Spatial learning, monoamines and oxidative stress in rats exposed to 900 MHz electromagnetic field in combination with iron overload. Behavioural Brain Research. 2014;**258**:80-89

[22] Osera C, Amadio M, Falone S, Fassina L, Magenes G, Amicarelli F, et al. Pre-exposure of neuroblastoma cell line to pulsed electromagnetic field prevents H2O2-induced ROS production by increasing MnSOD

activity. Bioelectromagnetics. 2015;**36**(3):219-232

[23] Di Carlo AL, White NC, Litovitz TA. Mechanical and electromagnetic induction of protection against oxidative stress. Bioelectrochemistry. 2001;**53**(1):87-95

[24] Osera C, Fassina L, Amadio M, Venturini L, Buoso E, Magenes G, et al. Cytoprotective response induced by electromagnetic stimulation on SH-SY5Y human neuroblastoma cell line. Tissue Engineering Parts A. 2011;**17**(19-20):2573-2582

[25] Goodman R, Blank M. Magnetic field stress induces expression of hsp70. Cell Stress & Chaperones. 1998;**3**(2):79-88

[26] Lin H, Opler M, Head M, Blank M, Goodman R. Electromagnetic field exposure induces rapid, transitory heat shock factor activation in human cells. Journal of Cellular Biochemistry. 1997;**66**(4):482-488

[27] Carmody S, Wu XL, Lin H, Blank M, Skopicki H, Goodman R. Cytoprotection by electromagnetic field-induced hsp70: A model for clinical application. Journal of Cellular Biochemistry. 2000;**79**(3):453-459

[28] Blank M, Goodman R. DNA is a fractal antenna in electromagnetic fields. International Journal of Radiation Biology. 2011;**87**(4):409-415

[29] Eleuteri AM, Amici M, Bonfili L, Cecarini V, Cuccioloni M, Grimaldi S, et al. 50 Hz extremely low frequency electromagnetic fields enhance protein carbonyl groups content in cancer cells: Effects on proteasomal systems. Journal of Biomedicine and Biotechnology. 2009;**2009**:834239

[30] Caraglia M, Marra M, Mancinelli F, D'Ambrosio G, Massa R, Giordano A, et al. Electromagnetic fields at mobile

**25**

*The Effect of Repeated Electromagnetic Fields Stimulation in Biological Systems*

to old Alzheimer's mice reverses beta-amyloid deposition, modifies cerebral blood flow, and provides selected cognitive benefit. PLoS One.

[37] Arendash GW. Transcranial electromagnetic treatment against Alzheimer's disease: Why it has the potential to trump Alzheimer's disease drug development. Journal of Alzheimer's Disease: JAD.

[38] Jeong YJ, Kang GY, Kwon JH, Choi HD, Pack JK, Kim N, et al. 1950 MHz electromagnetic fields ameliorate Abeta pathology in Alzheimer's disease mice. Current Alzheimer Research. 2015;**12**(5):481-492

Morisaki J, Jurivich D. Electromagnetic field therapy delays cellular senescence and death by enhancement of the heat shock response. Experimental Gerontology. 2008;**43**(4):307-316

[40] Perez FP, Bandeira JP, Bailey JA,

[41] Arendash GW, Sanchez-Ramos J, Mori T, Mamcarz M, Lin X, Runfeldt M, et al. Electromagnetic field treatment protects against and reverses cognitive impairment in Alzheimer's disease mice. Journal of Alzheimer's Disease: JAD.

[42] Perez FP, Bose D, Maloney B, Nho K, Shah K, Lahiri DK. Late-onset Alzheimer's disease, heating up and foxed by several proteins: Pathomolecular effects of the aging process. Journal of Alzheimer's Disease:

Potential noninvasive approach for Alzheimer's disease: Repeated electromagnetic field stimulation lowers beta-amyloid protein levels in primary human neuronal cultures. Journal of the American Geriatrics Society.

2012;**7**(4):e35751

2012;**32**(2):243-266

[39] Perez FP, Zhou X,

Morisaki JJ, Lahiri DK.

2017;**65**(S1):S119-SS20

2010;**19**(1):191-210

JAD. 2014;**40**(1):1-17

*DOI: http://dx.doi.org/10.5772/intechopen.89668*

phone frequency induce apoptosis and inactivation of the multi-chaperone complex in human epidermoid cancer cells. Journal of Cellular Physiology.

Ogura M, Sng JC, Yoneda Y. Stimulation of ubiquitin-proteasome pathway

[32] Marchesi N, Osera C, Fassina L, Amadio M, Angeletti F, Morini M, et al. Autophagy is modulated in human neuroblastoma cells through direct exposition to low frequency electromagnetic fields.

Journal of Cellular Physiology. 2014;**229**(11):1776-1786

[33] Pena-Philippides JC, Yang Y, Bragina O, Hagberg S, Nemoto E, Roitbak T. Effect of pulsed

Research. 2014;**5**(4):491-500

of pulsed electromagnetic field treatment on programmed resolution of inflammation pathway markers in human cells in culture. Journal of Inflammation Research. 2015;**8**:59-69

[35] Rohde CH, Taylor EM,

[36] Arendash GW, Mori T, Dorsey M, Gonzalez R, Tajiri N,

Borlongan C. Electromagnetic treatment

Alonso A, Ascherman JA, Hardy KL, Pilla AA. Pulsed electromagnetic fields reduce postoperative interleukin-1beta, pain, and inflammation: A doubleblind, placebo-controlled study in TRAM flap breast reconstruction patients. Plastic and Reconstructive Surgery. 2015;**135**(5):808e-817e

electromagnetic field (PEMF) on infarct size and inflammation after cerebral ischemia in mice. Translational Stroke

[34] Kubat NJ, Moffett J, Fray LM. Effect

2005;**204**(2):539-548

[31] Hirai T, Taniura H, Goto Y,

through the expression of amidohydrolase for N-terminal asparagine (Ntan1) in cultured rat hippocampal neurons exposed to static magnetism. Journal of Neurochemistry.

2006;**96**(6):1519-1530

*The Effect of Repeated Electromagnetic Fields Stimulation in Biological Systems DOI: http://dx.doi.org/10.5772/intechopen.89668*

phone frequency induce apoptosis and inactivation of the multi-chaperone complex in human epidermoid cancer cells. Journal of Cellular Physiology. 2005;**204**(2):539-548

*Ionizing and Non-ionizing Radiation*

of 2.4 GHz radiofrequency radiation emitted from Wi-Fi equipment on microRNA expression in brain tissue. International Journal of Radiation Biology. 2015;**91**(7):555-561

activity. Bioelectromagnetics.

Mechanical and electromagnetic induction of protection against oxidative stress. Bioelectrochemistry.

[24] Osera C, Fassina L, Amadio M, Venturini L, Buoso E, Magenes G, et al. Cytoprotective response induced by electromagnetic stimulation on SH-SY5Y human neuroblastoma cell line. Tissue Engineering Parts A. 2011;**17**(19-20):2573-2582

[25] Goodman R, Blank M. Magnetic field stress induces expression of hsp70. Cell Stress & Chaperones.

[26] Lin H, Opler M, Head M, Blank M, Goodman R. Electromagnetic field exposure induces rapid, transitory heat shock factor activation in human cells. Journal of Cellular Biochemistry.

[27] Carmody S, Wu XL, Lin H, Blank M, Skopicki H, Goodman R. Cytoprotection by electromagnetic field-induced hsp70: A model for clinical application. Journal of Cellular Biochemistry.

[28] Blank M, Goodman R. DNA is a fractal antenna in electromagnetic fields. International Journal of Radiation

[29] Eleuteri AM, Amici M, Bonfili L, Cecarini V, Cuccioloni M, Grimaldi S, et al. 50 Hz extremely low frequency electromagnetic fields enhance protein carbonyl groups content in cancer cells: Effects on proteasomal systems. Journal of Biomedicine and Biotechnology.

[30] Caraglia M, Marra M, Mancinelli F, D'Ambrosio G, Massa R, Giordano A, et al. Electromagnetic fields at mobile

Biology. 2011;**87**(4):409-415

[23] Di Carlo AL, White NC, Litovitz TA.

2015;**36**(3):219-232

2001;**53**(1):87-95

1998;**3**(2):79-88

1997;**66**(4):482-488

2000;**79**(3):453-459

2009;**2009**:834239

[17] Luukkonen J, Liimatainen A, Juutilainen J, Naarala J. Induction of genomic instability, oxidative processes, and mitochondrial activity by 50Hz magnetic fields in human SH-SY5Y neuroblastoma cells. Mutation Research.

[18] Jouni FJ, Abdolmaleki P,

2012;**741**(1-2):116-121

[19] Campisi A, Gulino M, Acquaviva R, Bellia P, Raciti G,

Letters. 2010;**473**(1):52-55

[20] Hajnorouzi A, Vaezzadeh M, Ghanati F, Jamnezhad H, Nahidian B. Growth promotion and a decrease of oxidative stress in maize seedlings by a combination of geomagnetic and weak electromagnetic fields. Journal of Plant Physiology. 2011;**168**(10):1123-1128

[21] Maaroufi K, Had-Aissouni L, Melon C, Sakly M, Abdelmelek H, Poucet B, et al. Spatial learning,

monoamines and oxidative stress in rats exposed to 900 MHz electromagnetic field in combination with iron

overload. Behavioural Brain Research.

[22] Osera C, Amadio M, Falone S, Fassina L, Magenes G, Amicarelli F, et al. Pre-exposure of neuroblastoma cell line to pulsed electromagnetic field prevents H2O2-induced ROS production by increasing MnSOD

Ghanati F. Oxidative stress in broad bean (*Vicia faba* L.) induced by static magnetic field under natural radioactivity. Mutation Research.

Grasso R, et al. Reactive oxygen species levels and DNA fragmentation on astrocytes in primary culture after acute exposure to low intensity microwave electromagnetic field. Neuroscience

2014;**760**:33-41

**24**

2014;**258**:80-89

[31] Hirai T, Taniura H, Goto Y, Ogura M, Sng JC, Yoneda Y. Stimulation of ubiquitin-proteasome pathway through the expression of amidohydrolase for N-terminal asparagine (Ntan1) in cultured rat hippocampal neurons exposed to static magnetism. Journal of Neurochemistry. 2006;**96**(6):1519-1530

[32] Marchesi N, Osera C, Fassina L, Amadio M, Angeletti F, Morini M, et al. Autophagy is modulated in human neuroblastoma cells through direct exposition to low frequency electromagnetic fields. Journal of Cellular Physiology. 2014;**229**(11):1776-1786

[33] Pena-Philippides JC, Yang Y, Bragina O, Hagberg S, Nemoto E, Roitbak T. Effect of pulsed electromagnetic field (PEMF) on infarct size and inflammation after cerebral ischemia in mice. Translational Stroke Research. 2014;**5**(4):491-500

[34] Kubat NJ, Moffett J, Fray LM. Effect of pulsed electromagnetic field treatment on programmed resolution of inflammation pathway markers in human cells in culture. Journal of Inflammation Research. 2015;**8**:59-69

[35] Rohde CH, Taylor EM, Alonso A, Ascherman JA, Hardy KL, Pilla AA. Pulsed electromagnetic fields reduce postoperative interleukin-1beta, pain, and inflammation: A doubleblind, placebo-controlled study in TRAM flap breast reconstruction patients. Plastic and Reconstructive Surgery. 2015;**135**(5):808e-817e

[36] Arendash GW, Mori T, Dorsey M, Gonzalez R, Tajiri N, Borlongan C. Electromagnetic treatment to old Alzheimer's mice reverses beta-amyloid deposition, modifies cerebral blood flow, and provides selected cognitive benefit. PLoS One. 2012;**7**(4):e35751

[37] Arendash GW. Transcranial electromagnetic treatment against Alzheimer's disease: Why it has the potential to trump Alzheimer's disease drug development. Journal of Alzheimer's Disease: JAD. 2012;**32**(2):243-266

[38] Jeong YJ, Kang GY, Kwon JH, Choi HD, Pack JK, Kim N, et al. 1950 MHz electromagnetic fields ameliorate Abeta pathology in Alzheimer's disease mice. Current Alzheimer Research. 2015;**12**(5):481-492

[39] Perez FP, Zhou X, Morisaki J, Jurivich D. Electromagnetic field therapy delays cellular senescence and death by enhancement of the heat shock response. Experimental Gerontology. 2008;**43**(4):307-316

[40] Perez FP, Bandeira JP, Bailey JA, Morisaki JJ, Lahiri DK. Potential noninvasive approach for Alzheimer's disease: Repeated electromagnetic field stimulation lowers beta-amyloid protein levels in primary human neuronal cultures. Journal of the American Geriatrics Society. 2017;**65**(S1):S119-SS20

[41] Arendash GW, Sanchez-Ramos J, Mori T, Mamcarz M, Lin X, Runfeldt M, et al. Electromagnetic field treatment protects against and reverses cognitive impairment in Alzheimer's disease mice. Journal of Alzheimer's Disease: JAD. 2010;**19**(1):191-210

[42] Perez FP, Bose D, Maloney B, Nho K, Shah K, Lahiri DK. Late-onset Alzheimer's disease, heating up and foxed by several proteins: Pathomolecular effects of the aging process. Journal of Alzheimer's Disease: JAD. 2014;**40**(1):1-17

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[52] Leung K, Rempe SB. Ab initio molecular dynamics study of glycine intramolecular proton transfer in water. The Journal of Chemical Physics. 2005;**122**(18):184506

[53] Shamovsky I, Nudler E. New insights into the mechanism of heat shock response activation. Cellular and Molecular Life Sciences: CMLS. 2008;**65**(6):855-861

[54] Almlöf J. Hydrogen bond studies. 71. Ab initio calculation of the vibrational structure and equilibrium geometry in HF-2 and DF-2. Chemical Physics Letters. 1972;**17**(1):49-52

[55] Cassone G. Ab Initio Molecular Dynamics Simulations of H-Bonded Systems under an Electric Field. Université Pierre et Marie Curie-Paris VI; 2016

[56] Goryainov S. A model of phase transitions in double-well Morse potential: Application to hydrogen bond. Physica B: Condensed Matter. 2012;**407**(21):4233-4237

[57] Cerón-Carrasco JP, Jacquemin D. Electric field induced DNA damage: An open door for selective mutations. Chemical Communications. 2013;**49**(69):7578-7580

[58] Singh V, Fedeles BI, Essigmann JM. Role of tautomerism in RNA biochemistry. RNA. 2015;**21**(1):1-13

[59] Piilo J, Maniscalco S. Driven harmonic oscillator as a quantum simulator for open systems. Physical Review A. 2006;**74**(3):032303

[60] Chandra AK, Nguyen MT, Uchimaru T, Zeegers-Huyskens T. Protonation and deprotonation enthalpies of guanine and adenine and implications for the structure and energy of their complexes with water: Comparison with uracil, thymine, and cytosine. The Journal of Physical Chemistry A. 1999;**103**(44): 8853-8860

**27**

*The Effect of Repeated Electromagnetic Fields Stimulation in Biological Systems*

[69] Perez FP, Moinuddin SS, ul ain Shamim Q , Joseph DJ, Morisaki J, Zhou X. Longevity pathways: HSF1 and FoxO pathways, a new therapeutic

[70] Perez F, Millholland G, Peddinti SV, Thella AK, Rizkalla J, Salama P, et al. Electromagnetic and thermal simulations of human neurons for SAR applications. Journal of Biomedical Science and Engineering.

Islanker MF. Radiofrequency Radiation Dosimetry Handbook. 4th ed. Brooks Air Force Base, TX: USAF School of Aerospace Medicine, Aerospace Medical

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[71] Durney CH, Massoudi H,

[72] Huttunen P, Hanninen O, Myllyla R. FM-radio and TV tower signals can cause spontaneous hand movements near moving RF reflector. Pathophysiology. 2009;**16**(2-3):201-204

[73] Sefidbakht Y, Moosavi-Movahedi AA, Hosseinkhani S, Khodagholi F, Torkzadeh-Mahani M, Foolad F, et al. Effects of 940 MHz EMF on bioluminescence and

oxidative response of stable luciferase producing HEK cells. Photochemical & Photobiological Sciences: Official Journal of the European Photochemistry Association and the European Society for Photobiology. 2014;**13**(7):1082-1092

[74] Rao DV, Watson K, Jones GL. Agerelated attenuation in the expression of the major heat shock proteins in human peripheral lymphocytes. Mechanisms

of Ageing and Development.

[75] Hsu A-L, Murphy CT, Kenyon C. Regulation of aging and age-related disease by DAF-16 and heat-shock factor. Science. 2003;**300**(5622):1142-1145

1999;**107**(1):105-118

*DOI: http://dx.doi.org/10.5772/intechopen.89668*

[62] Rattan SI. Hormesis in aging. Ageing Research Reviews. 2008;**7**(1):63-78

[64] Miura Y, Abe K, Urano S, Furuse T, Noda Y, Tatsumi K, et al. Adaptive response and the influence of ageing: Effects of low-dose irradiation on cell growth of cultured glial cells. International Journal of Radiation Biology. 2002;**78**(10):913-921

[65] Rattan SI. Mechanisms of hormesis through mild heat stress on human cells. Annals of the New York Academy of Sciences. 2004;**1019**(1):554-558

[66] Ben-Zvi A, Miller EA, Morimoto RI. Collapse of proteostasis represents an early molecular event in *Caenorhabditis elegans* aging. Proceedings of the National Academy of Sciences of the United States of America. 2009;**106**(35):14914-14919

[67] Udelsman R, Blake MJ, Stagg CA, Holbrook NJ. Endocrine control of stress-induced heat shock protein 70 expression in vivo. Surgery.

[68] Shamovsky I, Ivannikov M, Kandel ES, Gershon D, Nudler E. RNA-mediated response to heat shock in mammalian cells. Nature.

2006;**440**(7083):556-560

1994;**115**(5):611-616

[63] Rattan SI. Repeated mild heat shock delays ageing in cultured human skin fibroblasts. IUBMB Life.

[61] Samdal S. The effect of large amplitude motion on the comparison of bond distances from ab initio calculations and experimentally determined bond distances, and on root-mean-square amplitudes of vibration, shrinkage, asymmetry constants, symmetry constraints, and inclusion of rotational constants using the electron diffraction method. Journal of Molecular Structure.

1994;**318**:133-141

1998;**45**(4):753-759

*The Effect of Repeated Electromagnetic Fields Stimulation in Biological Systems DOI: http://dx.doi.org/10.5772/intechopen.89668*

[61] Samdal S. The effect of large amplitude motion on the comparison of bond distances from ab initio calculations and experimentally determined bond distances, and on root-mean-square amplitudes of vibration, shrinkage, asymmetry constants, symmetry constraints, and inclusion of rotational constants using the electron diffraction method. Journal of Molecular Structure. 1994;**318**:133-141

*Ionizing and Non-ionizing Radiation*

2007. pp. 1-5

[43] Ankerhold J. Introduction. In: Quantum Tunneling in Complex Systems. Berlin, Germany: Springer; intramolecular proton transfer in water. The Journal of Chemical Physics.

[53] Shamovsky I, Nudler E. New insights into the mechanism of heat shock response activation. Cellular and Molecular Life Sciences: CMLS.

[54] Almlöf J. Hydrogen bond studies. 71. Ab initio calculation of the

vibrational structure and equilibrium geometry in HF-2 and DF-2. Chemical Physics Letters. 1972;**17**(1):49-52

[55] Cassone G. Ab Initio Molecular Dynamics Simulations of H-Bonded Systems under an Electric Field. Université Pierre et Marie Curie-Paris VI; 2016

[56] Goryainov S. A model of phase transitions in double-well Morse potential: Application to hydrogen bond. Physica B: Condensed Matter.

[57] Cerón-Carrasco JP, Jacquemin D. Electric field induced DNA damage: An open door for selective mutations.

Essigmann JM. Role of tautomerism

2012;**407**(21):4233-4237

Chemical Communications. 2013;**49**(69):7578-7580

in RNA biochemistry. RNA.

[59] Piilo J, Maniscalco S. Driven harmonic oscillator as a quantum simulator for open systems. Physical Review A. 2006;**74**(3):032303

[60] Chandra AK, Nguyen MT, Uchimaru T, Zeegers-Huyskens T. Protonation and deprotonation enthalpies of guanine and adenine and implications for the structure and energy of their complexes with water: Comparison with uracil, thymine, and cytosine. The Journal of Physical

Chemistry A. 1999;**103**(44):

8853-8860

[58] Singh V, Fedeles BI,

2015;**21**(1):1-13

2005;**122**(18):184506

2008;**65**(6):855-861

[44] Schmitz KS. Physical Chemistry: Concepts and Theory. Cambridge, Massachusetts, USA: Elsevier; 2016

electromagnetic fields of low intensity. Electromagnetic Biology and Medicine.

[46] Teufel S. Adiabatic Perturbation Theory in Quantum Dynamics. Berlin,

[47] Dykhne A. Quantum transitions in the adiabatic approximation. Soviet

[48] Panagopoulos DJ, Johansson O, Carlo GL. Polarization: A key difference

[49] Sowlati-Hashjin S, Matta CF. The chemical bond in external electric fields: Energies, geometries, and vibrational stark shifts of diatomic molecules. The Journal of Chemical Physics.

[50] Panagopoulos DJ, Messini N, Karabarbounis A, Philippetis AL, Margaritis LH. A mechanism for action of oscillating electric fields on cells. Biochemical and Biophysical Research Communications. 2000;**272**(3):634-640

[51] Panagopoulos DJ, Margaritis LH. Theoretical considerations for the biological effects of electromagnetic fields. In: Biological Effects of

Electromagnetic Fields. Springer; 2003.

[52] Leung K, Rempe SB. Ab initio molecular dynamics study of glycine

between man-made and natural electromagnetic fields, in regard to biological activity. Scientific Reports.

[45] Lobyshev V. Water is a sensor to weak forces including

2005;**24**(3):449-461

Germany: Springer; 2003

Physics—JETP. 1960;**11**:411

2015;**5**:14914

2013;**139**(14):144101

**26**

pp. 5-33

[62] Rattan SI. Hormesis in aging. Ageing Research Reviews. 2008;**7**(1):63-78

[63] Rattan SI. Repeated mild heat shock delays ageing in cultured human skin fibroblasts. IUBMB Life. 1998;**45**(4):753-759

[64] Miura Y, Abe K, Urano S, Furuse T, Noda Y, Tatsumi K, et al. Adaptive response and the influence of ageing: Effects of low-dose irradiation on cell growth of cultured glial cells. International Journal of Radiation Biology. 2002;**78**(10):913-921

[65] Rattan SI. Mechanisms of hormesis through mild heat stress on human cells. Annals of the New York Academy of Sciences. 2004;**1019**(1):554-558

[66] Ben-Zvi A, Miller EA, Morimoto RI. Collapse of proteostasis represents an early molecular event in *Caenorhabditis elegans* aging. Proceedings of the National Academy of Sciences of the United States of America. 2009;**106**(35):14914-14919

[67] Udelsman R, Blake MJ, Stagg CA, Holbrook NJ. Endocrine control of stress-induced heat shock protein 70 expression in vivo. Surgery. 1994;**115**(5):611-616

[68] Shamovsky I, Ivannikov M, Kandel ES, Gershon D, Nudler E. RNA-mediated response to heat shock in mammalian cells. Nature. 2006;**440**(7083):556-560

[69] Perez FP, Moinuddin SS, ul ain Shamim Q , Joseph DJ, Morisaki J, Zhou X. Longevity pathways: HSF1 and FoxO pathways, a new therapeutic target to prevent age-related diseases. Current Aging Science. 2012;**5**(2):87-95

[70] Perez F, Millholland G, Peddinti SV, Thella AK, Rizkalla J, Salama P, et al. Electromagnetic and thermal simulations of human neurons for SAR applications. Journal of Biomedical Science and Engineering. 2016;**9**(9):437-444

[71] Durney CH, Massoudi H, Islanker MF. Radiofrequency Radiation Dosimetry Handbook. 4th ed. Brooks Air Force Base, TX: USAF School of Aerospace Medicine, Aerospace Medical Division (AFSC); 1986

[72] Huttunen P, Hanninen O, Myllyla R. FM-radio and TV tower signals can cause spontaneous hand movements near moving RF reflector. Pathophysiology. 2009;**16**(2-3):201-204

[73] Sefidbakht Y, Moosavi-Movahedi AA, Hosseinkhani S, Khodagholi F, Torkzadeh-Mahani M, Foolad F, et al. Effects of 940 MHz EMF on bioluminescence and oxidative response of stable luciferase producing HEK cells. Photochemical & Photobiological Sciences: Official Journal of the European Photochemistry Association and the European Society for Photobiology. 2014;**13**(7):1082-1092

[74] Rao DV, Watson K, Jones GL. Agerelated attenuation in the expression of the major heat shock proteins in human peripheral lymphocytes. Mechanisms of Ageing and Development. 1999;**107**(1):105-118

[75] Hsu A-L, Murphy CT, Kenyon C. Regulation of aging and age-related disease by DAF-16 and heat-shock factor. Science. 2003;**300**(5622):1142-1145

[76] Cohen E, Bieschke J, Perciavalle RM, Kelly JW, Dillin A. Opposing activities protect against age-onset proteotoxicity. Science. 2006;**313**(5793):1604-1610

[77] Perez FP, Zhou X, Morisaki J, Ilie J, James T, Jurivich DA. Engineered repeated electromagnetic field shock therapy for cellular senescence and agerelated diseases. Rejuvenation Research. 2008;**11**(6):1049-1057

[78] Shellock FG, Bierman H. The safety of MRI. Journal of the American Medical Association. 1989;**261**(23):3412

[79] Hill D. Human whole-body radiofrequency absorption studies using a TEM-cell exposure system. IEEE Transactions on Microwave Theory and Techniques. 1982;**30**(11):1847-1854

[80] Allen SJ. Measurements of power absorption by human phantoms immersed in radio-frequency fields. Annals of the New York Academy of Sciences. 1975;**247**(1):494-498

[81] Lin JC. A new IEEE standard for safety levels with respect to human exposure to radio-frequency radiation. IEEE Antennas and Propagation Magazine. 2006;**48**(1):157-159

[82] Perez FP, Ilie JI, Zhou X, Feinstein D, Jurivich DA. Pathomolecular effects of homocysteine on the aging process: A new theory of aging. Medical Hypotheses. 2007;**69**(1):149-160

[83] Park D, Jeong H, Lee MN, Koh A, Kwon O, Yang YR, et al. Resveratrol induces autophagy by directly inhibiting mTOR through ATP competition. Scientific Reports. 2016;**6**:21772

[84] Baur JA, Pearson KJ, Price NL, Jamieson HA, Lerin C, Kalra A, et al. Resveratrol improves health and survival of mice on a high-calorie diet. Nature. 2006;**444**(7117):337

[85] Small GW, Kepe V, Ercoli LM, Siddarth P, Bookheimer SY, Miller KJ, et al. PET of brain amyloid and tau in mild cognitive impairment. New England Journal of Medicine. 2006;**355**(25):2652-2663

Chapter 3

Abstract

in Argentine

probabilities to explain their condition.

1.1 The characteristics of a normal radiation

cellular telephony

1. Introduction

in an open environment.

29

Study of Non-predictive

Patterns of Non-Ionizing

Radiation in the City of Salta

Mario Marcelo Figueroa de la Cruz and Roberto Daniel Breslin

Non-ionizing radiation (NIR) is a subject of continuous debate despite having been regulated internationally and at the level of organizations in all countries. This debate is focused on the level of population exposure to non-ionizing radiation density, since there is no certain evidence of the level of safety of the values adopted ranging from 0.2 mW/cm<sup>2</sup> to 0.2 uW/cm<sup>2</sup> according to the regulations of each state. The radiation precisions are made with models that evolve to take into account most of the factors that can attenuate the radiation emitted from an antenna from free space to models that take reflection and diffraction as attenuation factors. However, our work deepens in a phenomenon that is verified in measurement campaigns that is one of the values that do not fit with predictive models and that, on the contrary instead of showing attenuation, have higher values than expected. This work shows the results of observation campaigns of these points and

their relationship with environmental conditions, which present diverse

A normal non-ionizing radiation (NIR) is that which is produced from a radiation mechanism based on electromagnetic propagation and its propagation components; that is, it follows a radiation mechanism where the electromagnetic wave encounters a discontinuity in its path waveguide, being forced to change the shape of longitudinal propagation within a closed environment to a spread radiation

transforming it into a directional radiation is the element called antenna.

The typical discontinuity that is used for the radiation to be efficient and allows controlling to some degree the propagation of an essentially isotropic radiation and

An antenna, in essence, transforms an ideal isotropic radiation into a radiation that concentrates, in a certain direction, in the energy coming from a source of

Keywords: non-ionizing radiation, population exposure, antennas,

[86] Perez FP, Bandeira JP, Morisaki JJ, Peddinti SVK, Salama P, Rizkalla J, et al. Antenna design and SAR analysis on human head phantom simulation for future clinical applications. Journal of Biomedical Science and Engineering. 2017;**10**(9):421-430

[87] Christ A, Chavannes N, Nikoloski N, Gerber HU, Pokovic K, Kuster N. A numerical and experimental comparison of human head phantoms for compliance testing of mobile telephone equipment. Bioelectromagnetics. 2005;**26**(2):125-137

[88] Suryadevara VK, Patil S, Rizkalla J, Helmy A, Salama P, Rizkalla M. Microwave/thermal analyses for human bone characterization. Journal of Biomedical Science and Engineering. 2016;**9**(02):101

[89] Rizkalla J, Jeffers M, Salama P, Rizkalla M. Electromagnetic simulation for diagnosing damage to femoral neck vasculature: A feasibility study. Journal of Orthopaedics. 2018;**15**(4):997-1003

[90] Borkar R, Rizkalla J, Kwon Y, Salama P, Rizkalla M. Electromagnetic simulation of non-invasive approach for the diagnosis of diabetic foot ulcers. Journal of Orthopaedics. 2018;**15**(2):514-521

### Chapter 3

*Ionizing and Non-ionizing Radiation*

[77] Perez FP, Zhou X, Morisaki J, Ilie J, James T, Jurivich DA. Engineered repeated electromagnetic field shock therapy for cellular senescence and agerelated diseases. Rejuvenation Research.

2008;**11**(6):1049-1057

1989;**261**(23):3412

1982;**30**(11):1847-1854

[78] Shellock FG, Bierman H. The safety of MRI. Journal of the American Medical Association.

[79] Hill D. Human whole-body radiofrequency absorption

studies using a TEM-cell exposure system. IEEE Transactions on Microwave Theory and Techniques.

[80] Allen SJ. Measurements of power absorption by human phantoms immersed in radio-frequency fields. Annals of the New York Academy of Sciences. 1975;**247**(1):494-498

[81] Lin JC. A new IEEE standard for safety levels with respect to human exposure to radio-frequency radiation. IEEE Antennas and Propagation Magazine. 2006;**48**(1):157-159

[82] Perez FP, Ilie JI, Zhou X, Feinstein D, Jurivich DA. Pathomolecular effects of homocysteine on the aging process: A new theory of aging. Medical Hypotheses. 2007;**69**(1):149-160

[83] Park D, Jeong H, Lee MN, Koh A, Kwon O, Yang YR, et al. Resveratrol induces autophagy by directly inhibiting mTOR through ATP competition. Scientific Reports. 2016;**6**:21772

[84] Baur JA, Pearson KJ, Price NL, Jamieson HA, Lerin C, Kalra A, et al. Resveratrol improves health and survival of mice on a high-calorie diet.

Nature. 2006;**444**(7117):337

[76] Cohen E, Bieschke J, Perciavalle RM, Kelly JW, Dillin A. Opposing activities protect against age-onset proteotoxicity. Science. 2006;**313**(5793):1604-1610

[85] Small GW, Kepe V, Ercoli LM, Siddarth P, Bookheimer SY, Miller KJ, et al. PET of brain amyloid and tau in mild cognitive impairment. New England Journal of Medicine. 2006;**355**(25):2652-2663

[86] Perez FP, Bandeira JP, Morisaki JJ, Peddinti SVK, Salama P, Rizkalla J, et al. Antenna design and SAR analysis on human head phantom simulation for future clinical applications. Journal of Biomedical Science and Engineering.

[87] Christ A, Chavannes N, Nikoloski N, Gerber HU, Pokovic K, Kuster N. A numerical and experimental comparison

compliance testing of mobile telephone equipment. Bioelectromagnetics.

Rizkalla J, Helmy A, Salama P, Rizkalla M. Microwave/thermal analyses for human bone characterization. Journal of Biomedical Science and Engineering.

[89] Rizkalla J, Jeffers M, Salama P, Rizkalla M. Electromagnetic simulation for diagnosing damage to femoral neck vasculature: A feasibility study. Journal of Orthopaedics. 2018;**15**(4):997-1003

[90] Borkar R, Rizkalla J, Kwon Y, Salama P, Rizkalla M. Electromagnetic simulation of non-invasive approach for the diagnosis of diabetic foot ulcers. Journal of Orthopaedics.

of human head phantoms for

[88] Suryadevara VK, Patil S,

2017;**10**(9):421-430

2005;**26**(2):125-137

2016;**9**(02):101

2018;**15**(2):514-521

**28**

## Study of Non-predictive Patterns of Non-Ionizing Radiation in the City of Salta in Argentine

Mario Marcelo Figueroa de la Cruz and Roberto Daniel Breslin

### Abstract

Non-ionizing radiation (NIR) is a subject of continuous debate despite having been regulated internationally and at the level of organizations in all countries. This debate is focused on the level of population exposure to non-ionizing radiation density, since there is no certain evidence of the level of safety of the values adopted ranging from 0.2 mW/cm<sup>2</sup> to 0.2 uW/cm<sup>2</sup> according to the regulations of each state. The radiation precisions are made with models that evolve to take into account most of the factors that can attenuate the radiation emitted from an antenna from free space to models that take reflection and diffraction as attenuation factors. However, our work deepens in a phenomenon that is verified in measurement campaigns that is one of the values that do not fit with predictive models and that, on the contrary instead of showing attenuation, have higher values than expected. This work shows the results of observation campaigns of these points and their relationship with environmental conditions, which present diverse probabilities to explain their condition.

Keywords: non-ionizing radiation, population exposure, antennas, cellular telephony

### 1. Introduction

### 1.1 The characteristics of a normal radiation

A normal non-ionizing radiation (NIR) is that which is produced from a radiation mechanism based on electromagnetic propagation and its propagation components; that is, it follows a radiation mechanism where the electromagnetic wave encounters a discontinuity in its path waveguide, being forced to change the shape of longitudinal propagation within a closed environment to a spread radiation in an open environment.

The typical discontinuity that is used for the radiation to be efficient and allows controlling to some degree the propagation of an essentially isotropic radiation and transforming it into a directional radiation is the element called antenna.

An antenna, in essence, transforms an ideal isotropic radiation into a radiation that concentrates, in a certain direction, in the energy coming from a source of

electromagnetic radiation. In this chapter, we analyze the characteristics of the normal radiations that generate predictive patterns based on the propagation characteristics and those of the antennas with respect to non-predictive patterns. To verify this alteration of the patterns, measurement points with discordant values were obtained in a specific campaign.

### 2. Elements of radiation

### 2.1 The antenna and its gain

The energy radiated by an antenna will be distributed uniformly in all directions and with divergent direction of the source, which in this case is the antenna, this case is also ideal since the radiation cannot be precise considering that the antenna does not it is more than a discontinuous prolongation of a transmission line and therefore has a feature of balanced line or balanced lines, this implies the existence of two elements or arms and therefore an antenna is basically a dipole.

This implies that, in essence, the radiation will have zero in the directions axial to the axis of that dipole.

In this way, if the dipole is placed with alignment to the Z axis, that is to say in a vertical position, the radiation null will be at �90 of the dipole antenna itself.

In the case that the antenna is aligned with the axis y or x, the minimum radiation will be aligned with the corresponding axis.

However, the generality for broadcasting or cell phone transmission dipole antennas has an orientation on the Z axis in such a way that the main polarization is the so-called vertical polarization.

This means that the electric field vector has the same direction as the originating antenna, i.e., vertical (aligned with the Z axis), and that the magnetic field vector is of horizontal orientation since it will always be perpendicular to the vector of magnetic field enunciated in Maxwell's equations.

Radiation emitted by a dipole is conditioned by two factors that are not directly related to propagation or radiation and if the electrical characteristics of the circuit between a transmitting device and an antenna are:


The adaptation efficiency depends on the adaptation of impedances between the transmission line and the antenna, where what is sought is that the impedance of the antenna constitutes the conjugate transpose of the impedance of the transmission line in which case the adaptation is perfect (Figure 1).

$$
\mathbf{R}\_{\mathfrak{e}} + \mathbf{R}\_{\mathfrak{e}\mathfrak{e}} = \mathbf{R}\_{\mathfrak{e}} \tag{1}
$$

electrical element of resistance equal to zero, so that 100% of the energy delivered is radiated, this being an unrealizable situation; however, a part of the energy delivered is transformed into heat by Joule effect and is conditioned by the quality of the

Study of Non-predictive Patterns of Non-Ionizing Radiation in the City of Salta in Argentine

Therefore, the gain is conditioned by two efficiencies in such a way that the gain must be affected by the relationship between the impedance of the line and the antenna and the relationship between the ohmic and radiation resistances.

However, these considerations are not the only ones to be carried out for wireless communication and in particular for cellular telephony due to two factors:

ð3Þ

ð4Þ

ð5Þ

physical components of the antenna.

Thevenin model of transmission of an antenna.

DOI: http://dx.doi.org/10.5772/intechopen.84717

Figure 1.

• Limitation on profit

• Unequal coverage

31

$$\mathbf{X\_A} = -\mathbf{X\_i} \tag{2}$$

The radiation efficiency is specified by the relation between the totality of the energy that is delivered by the transmission line to the antenna and the energy actually radiated by it. The ideal situation is for the antenna to behave as an

Study of Non-predictive Patterns of Non-Ionizing Radiation in the City of Salta in Argentine DOI: http://dx.doi.org/10.5772/intechopen.84717

Figure 1. Thevenin model of transmission of an antenna.

electrical element of resistance equal to zero, so that 100% of the energy delivered is radiated, this being an unrealizable situation; however, a part of the energy delivered is transformed into heat by Joule effect and is conditioned by the quality of the physical components of the antenna.

Therefore, the gain is conditioned by two efficiencies in such a way that the gain must be affected by the relationship between the impedance of the line and the antenna and the relationship between the ohmic and radiation resistances.

$$\eta\_{\mathbf{r}} = \frac{\mathbf{R}\_{\mathbf{r}}}{\mathbf{R}\_{\mathbf{r}} + \mathbf{R}\_{\alpha}} \tag{3}$$

$$\text{Ca}\_{\text{T}} = \frac{\text{P}\_{\text{A}}}{\text{P}\_{\text{A}\text{MAX}}} = 1 - \left| \rho \right|^{2} = 1 - \left| \frac{\text{ROE} - 1}{\text{ROE} + 1} \right|^{2} \tag{4}$$

$$\rho = \frac{Z\_L - Z\_\bullet}{Z\_L + Z\_\bullet} \tag{5}$$

However, these considerations are not the only ones to be carried out for wireless communication and in particular for cellular telephony due to two factors:


electromagnetic radiation. In this chapter, we analyze the characteristics of the normal radiations that generate predictive patterns based on the propagation characteristics and those of the antennas with respect to non-predictive patterns. To verify this alteration of the patterns, measurement points with discordant values

The energy radiated by an antenna will be distributed uniformly in all directions and with divergent direction of the source, which in this case is the antenna, this case is also ideal since the radiation cannot be precise considering that the antenna does not it is more than a discontinuous prolongation of a transmission line and therefore has a feature of balanced line or balanced lines, this implies the existence

This implies that, in essence, the radiation will have zero in the directions axial

In this way, if the dipole is placed with alignment to the Z axis, that is to say in a

This means that the electric field vector has the same direction as the originating antenna, i.e., vertical (aligned with the Z axis), and that the magnetic field vector is of horizontal orientation since it will always be perpendicular to the vector of

Radiation emitted by a dipole is conditioned by two factors that are not directly related to propagation or radiation and if the electrical characteristics of the circuit

The adaptation efficiency depends on the adaptation of impedances between the transmission line and the antenna, where what is sought is that the impedance of the antenna constitutes the conjugate transpose of the impedance of the transmis-

The radiation efficiency is specified by the relation between the totality of the energy that is delivered by the transmission line to the antenna and the energy actually radiated by it. The ideal situation is for the antenna to behave as an

ð1Þ

ð2Þ

vertical position, the radiation null will be at �90 of the dipole antenna itself. In the case that the antenna is aligned with the axis y or x, the minimum

However, the generality for broadcasting or cell phone transmission dipole antennas has an orientation on the Z axis in such a way that the main polarization is

of two elements or arms and therefore an antenna is basically a dipole.

radiation will be aligned with the corresponding axis.

magnetic field enunciated in Maxwell's equations.

between a transmitting device and an antenna are:

sion line in which case the adaptation is perfect (Figure 1).

were obtained in a specific campaign.

Ionizing and Non-ionizing Radiation

2. Elements of radiation

2.1 The antenna and its gain

to the axis of that dipole.

the so-called vertical polarization.

• Adaptation efficiency

• Radiation efficiency

30

### 2.2 The limitation of profit

The gain of an antenna is defined based on a factor called directivity.

The directivity is a factor that is given by the deformation of the radiation lobe that has a dipolar antenna and is measured as a relationship between a totally isotropic radiation and the radiation of a lobe that has an angular aperture bounded by a certain value less than that of isotropic radiation that has a 360-degree lobe.

2.3 Uneven coverage

DOI: http://dx.doi.org/10.5772/intechopen.84717

antenna that is used to radiate.

strong that the coverage it has is very deficient.

receiving device.

information.

directivity are used.

antenna.

Figure 3.

33

Huawei Dual Band Panel Radiation Diagram ADU4518R3 [1].

antennas with 60° openings.

or directivity that the antenna has.

Coverage is the geographical area in which the energy radiated by a radiator element such as an antenna has such a value that it can be exploited by an electronic

Study of Non-predictive Patterns of Non-Ionizing Radiation in the City of Salta in Argentine

That is, it is the area where the signal has a suitable value so that the receiving electronic equipment can adequately transform the electromagnetic signal into an electrical signal with an adequate signal-to-noise ratio in order to be intelligible

Depending on the type of coverage required, it will be the characteristic of the

If what is required is an omnidirectional radiation, a dipole antenna is more than enough; however, it is precisely this antenna that has the lowest gain and, therefore, although it achieves an omnidirectional coverage, the attenuation it suffers is so

That is why, for the omnidirectional coverage, antennas with a characteristic in

the horizontal lobe of high aperture and in the vertical radiation lobe of high

A generic situation is to achieve the 360° coverage by antennas that have a horizontal lobe opening of 120° placing in this case three antennas or even placing 6

As far as the coverage in distance is concerned, it depends on the vertical lobe opening and how it is required to achieve the widest possible coverage. It is required that the effects of the attenuation in the free space be compensated by the high gain

For this, antenna panels with apertures smaller than 20° are used (Figure 3). This coverage is usually referred to as the footprint of the antenna and the situation generates that in the areas closest to the antenna there is more radiation in the case that the center of the radiation lobe is aimed at the point closest to the

The directivity can be defined as the lobe whose opening is limited by the angles that limit radiation with a drop of 3 decibels with respect to the maximum.

So the lobe will have a maximum of radiation in some direction and will have a smaller amount of radiation in directions with different angles from the maximum, that angle where it is verified that falls 3 decibels with respect to the maximum constitutes the limit of the radiation lobe or half power points. In short, the angle of opening will be twice the angle between the direction of the main lobe and the direction of the points of half power.

Obviously, the energy is not dispersed but is concentrated within the radiation lobe, i.e., the Poynting vector of the radiation lobe will have its maximum in the main direction of it and will decrease in different directions to that of the main lobe (Figure 2).

Figure 2. Directivity of an antenna.

The gain of the antenna as previously expressed depends directly on the directivity so that the lower the opening of the lobe, the greater the verified directivity and, consequently, the greater the gain allocated to the antenna.

As a consequence, the Poynting vector has a much higher value in the main direction of the radiation lobe, where the greater part of the radiated energy is concentrated, so that to have greater radiated energy, a greater directivity is needed.

That is why what is sought in an antenna, in most cases, is the directivity, since having more energy in the center of the lobe, the attenuation will have a lesser effect and you can have a communication that arrives with good energy level at a greater distance.

The design of an antenna is based on the fundamental premise that the radiation lobe, both vertically and horizontally, is calculated for the electric field of the radiated wave.

However, the search in wireless communications is based on achieving the maximum use of radiated energy to achieve propagation distances as long as possible, which are why the gain of the antenna is the main factor in the efficiency of telecommunications.

Study of Non-predictive Patterns of Non-Ionizing Radiation in the City of Salta in Argentine DOI: http://dx.doi.org/10.5772/intechopen.84717

### 2.3 Uneven coverage

2.2 The limitation of profit

Ionizing and Non-ionizing Radiation

direction of the points of half power.

(Figure 2).

Figure 2.

Directivity of an antenna.

greater distance.

radiated wave.

32

telecommunications.

The gain of an antenna is defined based on a factor called directivity.

that has a dipolar antenna and is measured as a relationship between a totally isotropic radiation and the radiation of a lobe that has an angular aperture bounded by a certain value less than that of isotropic radiation that has a 360-degree lobe. The directivity can be defined as the lobe whose opening is limited by the angles

that limit radiation with a drop of 3 decibels with respect to the maximum.

The directivity is a factor that is given by the deformation of the radiation lobe

So the lobe will have a maximum of radiation in some direction and will have a smaller amount of radiation in directions with different angles from the maximum, that angle where it is verified that falls 3 decibels with respect to the maximum constitutes the limit of the radiation lobe or half power points. In short, the angle of opening will be twice the angle between the direction of the main lobe and the

Obviously, the energy is not dispersed but is concentrated within the radiation lobe, i.e., the Poynting vector of the radiation lobe will have its maximum in the main direction of it and will decrease in different directions to that of the main lobe

The gain of the antenna as previously expressed depends directly on the directivity so that the lower the opening of the lobe, the greater the verified directivity

As a consequence, the Poynting vector has a much higher value in the main direction of the radiation lobe, where the greater part of the radiated energy is concentrated, so that to have greater radiated energy, a greater directivity is needed. That is why what is sought in an antenna, in most cases, is the directivity, since

having more energy in the center of the lobe, the attenuation will have a lesser effect and you can have a communication that arrives with good energy level at a

lobe, both vertically and horizontally, is calculated for the electric field of the

However, the search in wireless communications is based on achieving the maximum use of radiated energy to achieve propagation distances as long as possible, which are why the gain of the antenna is the main factor in the efficiency of

The design of an antenna is based on the fundamental premise that the radiation

and, consequently, the greater the gain allocated to the antenna.

Coverage is the geographical area in which the energy radiated by a radiator element such as an antenna has such a value that it can be exploited by an electronic receiving device.

That is, it is the area where the signal has a suitable value so that the receiving electronic equipment can adequately transform the electromagnetic signal into an electrical signal with an adequate signal-to-noise ratio in order to be intelligible information.

Depending on the type of coverage required, it will be the characteristic of the antenna that is used to radiate.

If what is required is an omnidirectional radiation, a dipole antenna is more than enough; however, it is precisely this antenna that has the lowest gain and, therefore, although it achieves an omnidirectional coverage, the attenuation it suffers is so strong that the coverage it has is very deficient.

That is why, for the omnidirectional coverage, antennas with a characteristic in the horizontal lobe of high aperture and in the vertical radiation lobe of high directivity are used.

A generic situation is to achieve the 360° coverage by antennas that have a horizontal lobe opening of 120° placing in this case three antennas or even placing 6 antennas with 60° openings.

As far as the coverage in distance is concerned, it depends on the vertical lobe opening and how it is required to achieve the widest possible coverage. It is required that the effects of the attenuation in the free space be compensated by the high gain or directivity that the antenna has.

For this, antenna panels with apertures smaller than 20° are used (Figure 3).

This coverage is usually referred to as the footprint of the antenna and the situation generates that in the areas closest to the antenna there is more radiation in the case that the center of the radiation lobe is aimed at the point closest to the antenna.

Figure 3. Huawei Dual Band Panel Radiation Diagram ADU4518R3 [1].

What is required, for a good coverage, is that all users have reasonably the same level of signal. It is customary to make the center of the radiation lobe point toward the most extreme point, so that the signal level at the most extreme point coincides with the maximum of the radiation lobe. In the same way, those points that coincide with the minimum values of the radiation ovule, i.e., the 3 decibel points, are those that have less attenuation by distance.

density value of the order of 0.2 W/cm<sup>2</sup>

DOI: http://dx.doi.org/10.5772/intechopen.84717

in the values of 700 megahertz at 2.3 GHz

of cellular equipment.

(back, bottom, and top).

where they are located.

erable gain.

35

in a panel (Figure 7).

2.5 Calculation of normal radiation

• The power with which the antenna is fed

• The attenuations of the connections

to do with the emitting antennas.

2.4 The antennas

. This value is very important to take into

account in the study of electromagnetic emission, derived from the radiation of a cell phone installation, characterizing the emission in the exclusive values of the frequency spectrum used by this application, for which the considered emission is

Study of Non-predictive Patterns of Non-Ionizing Radiation in the City of Salta in Argentine

These values are directly related to the tread and with the radiated power from

Therefore, the signal level will directly affect the speed of the internal modems

Another aspect that has to be taken into account is what is normal radiation has

The mobile telephone antennas are characterized by being bi-directional (emission or reception) of low power. In addition to producing RF radiation, they are mounted on poles, transmission towers, or the roofs of tall buildings, since they

In a typical mobile telephone antenna, the radio emission is made toward the front and horizontally, in the form of a substantially flat beam, and covers a sector between 60 and 120°. Emissions are almost non-existent in the other directions

The characteristics of the antennas and the conditions in which they are usually installed make the emission levels in terms of radiation density very low in the place

These panels, in fact, are an array of 4 or 5 antennas whose separation between each other within the panel and the different paths that run through the signal in the waveguides that feed them provide an additional tilt (called an electric tilt). The angle of inclination of the main lobe is the sum of the mechanical TILT (conditioned by mobile supports) and the electric TILT given by the regulation of the paths (phase delays) of the power supply of each antenna of the array installed

Normal radiation follows a predictive pattern in which there are components

that allow to know what is the power density value in the surface based on:

The flat panel antennas, as the name suggests, are a square- or rectangularshaped panel. And they are configured in a patch-type format. Flat panel antennas are very directional since most of their radiated power is a single direction in either the horizontal or the vertical plane. In the elevation pattern (Figure 5) and in the azimuth pattern (Figure 6) [3], you can see the directivity of the flat panel antenna. The flat panel antennas can be manufactured in different directivity values according to their construction. This can provide excellent directivity and consid-

Mobile cellular equipment in turn will change its data reception system depending on the signal level in such a way that when receiving a signal lower than this value, it will automatically change to Enhanced Data Rates for GSM Evolution

the radio bases and correspond to an average value of 79 decibels.

(EDGE) or General Packet Radio Service (GPRS) mode.

need to be at a certain height in order to have a wider coverage.

In this way, the radiation lobe will tilt such that the level of radiation that will suffer the least attenuation by distance will fall at the point of coverage closest to the antenna and that the center of the radiation lobe having the highest power will suffer the greater attenuation in such a way that the coverage is equalized between both extremes and the users do not feel the decrease of the signal given by the attenuation in the free space (Figure 4).

### Figure 4. Coverage method by downtilt [2].

It is evident that the height of the tower on which the antenna is located has a direct influence on the coverage area; however, there is a limitation that has to do with the attenuation in the free space so that the height of the tower has a practical limit that has to do with coverage and attenuation.

$$\frac{\textit{Inner}\,\textit{Rardius}}{\textit{Distance}} = \frac{\textit{Wtan}\,\textit{W} + \frac{\textit{ROV}}{2}}{\textit{S2RO}}\tag{6}$$

$$\underbrace{\text{Outer\ Radian}}\_{\text{Distance}} = \frac{\text{H}\top\text{An}\left(\mathbb{A} - \frac{\text{BW}}{2}\right)}{5280} \tag{7}$$

where A is the downtilt angle of the main beam, H is the height of the antenna relative to the ground, and BW is the angle of opening of the lobe for 3 dB of fall with respect to the main lobe.

These trigonometric equations give us the rule that the largest distance will depend on the angle of inclination that is the lowest, possibly and logically, and will also depend on the height of the tower as it has a direct proportionality.

It is very evident that if the value of the bandwidth of the beam width is 15° half of it will be 7° and the minimum distance of radiation from the base of the antenna would be corresponding to 7°. However, this would imply that it is directly pointing down. (A = 90°), which is not feasible or economically acceptable.

Considering that the Poynting vector analyzed practically how radiation density per unit area is 100 watts over square centimeters, a normal tread has a radiation

Study of Non-predictive Patterns of Non-Ionizing Radiation in the City of Salta in Argentine DOI: http://dx.doi.org/10.5772/intechopen.84717

density value of the order of 0.2 W/cm<sup>2</sup> . This value is very important to take into account in the study of electromagnetic emission, derived from the radiation of a cell phone installation, characterizing the emission in the exclusive values of the frequency spectrum used by this application, for which the considered emission is in the values of 700 megahertz at 2.3 GHz

These values are directly related to the tread and with the radiated power from the radio bases and correspond to an average value of 79 decibels.

Mobile cellular equipment in turn will change its data reception system depending on the signal level in such a way that when receiving a signal lower than this value, it will automatically change to Enhanced Data Rates for GSM Evolution (EDGE) or General Packet Radio Service (GPRS) mode.

Therefore, the signal level will directly affect the speed of the internal modems of cellular equipment.

### 2.4 The antennas

What is required, for a good coverage, is that all users have reasonably the same level of signal. It is customary to make the center of the radiation lobe point toward the most extreme point, so that the signal level at the most extreme point coincides with the maximum of the radiation lobe. In the same way, those points that coincide with the minimum values of the radiation ovule, i.e., the 3 decibel points, are those

In this way, the radiation lobe will tilt such that the level of radiation that will suffer the least attenuation by distance will fall at the point of coverage closest to the antenna and that the center of the radiation lobe having the highest power will suffer the greater attenuation in such a way that the coverage is equalized between both extremes and the users do not feel the decrease of the signal given by the

It is evident that the height of the tower on which the antenna is located has a direct influence on the coverage area; however, there is a limitation that has to do with the attenuation in the free space so that the height of the tower has a practical

where A is the downtilt angle of the main beam, H is the height of the antenna relative to the ground, and BW is the angle of opening of the lobe for 3 dB of fall

It is very evident that if the value of the bandwidth of the beam width is 15° half of it will be 7° and the minimum distance of radiation from the base of the antenna would be corresponding to 7°. However, this would imply that it is directly pointing

Considering that the Poynting vector analyzed practically how radiation density per unit area is 100 watts over square centimeters, a normal tread has a radiation

These trigonometric equations give us the rule that the largest distance will depend on the angle of inclination that is the lowest, possibly and logically, and will

also depend on the height of the tower as it has a direct proportionality.

down. (A = 90°), which is not feasible or economically acceptable.

ð6Þ

ð7Þ

that have less attenuation by distance.

Ionizing and Non-ionizing Radiation

attenuation in the free space (Figure 4).

limit that has to do with coverage and attenuation.

with respect to the main lobe.

Figure 4.

34

Coverage method by downtilt [2].

Another aspect that has to be taken into account is what is normal radiation has to do with the emitting antennas.

The mobile telephone antennas are characterized by being bi-directional (emission or reception) of low power. In addition to producing RF radiation, they are mounted on poles, transmission towers, or the roofs of tall buildings, since they need to be at a certain height in order to have a wider coverage.

In a typical mobile telephone antenna, the radio emission is made toward the front and horizontally, in the form of a substantially flat beam, and covers a sector between 60 and 120°. Emissions are almost non-existent in the other directions (back, bottom, and top).

The characteristics of the antennas and the conditions in which they are usually installed make the emission levels in terms of radiation density very low in the place where they are located.

The flat panel antennas, as the name suggests, are a square- or rectangularshaped panel. And they are configured in a patch-type format. Flat panel antennas are very directional since most of their radiated power is a single direction in either the horizontal or the vertical plane. In the elevation pattern (Figure 5) and in the azimuth pattern (Figure 6) [3], you can see the directivity of the flat panel antenna.

The flat panel antennas can be manufactured in different directivity values according to their construction. This can provide excellent directivity and considerable gain.

These panels, in fact, are an array of 4 or 5 antennas whose separation between each other within the panel and the different paths that run through the signal in the waveguides that feed them provide an additional tilt (called an electric tilt).

The angle of inclination of the main lobe is the sum of the mechanical TILT (conditioned by mobile supports) and the electric TILT given by the regulation of the paths (phase delays) of the power supply of each antenna of the array installed in a panel (Figure 7).

### 2.5 Calculation of normal radiation

Normal radiation follows a predictive pattern in which there are components that allow to know what is the power density value in the surface based on:


The resulting value can still be added to a variety of attenuations produced by

Study of Non-predictive Patterns of Non-Ionizing Radiation in the City of Salta in Argentine

These attenuation parameters have been contemplated in various models such as

This model is used to predict the power of the signal when there is a clear line

which is separated from the transmitting antenna by a distance d, is given by the

Where Pt is the transmitted power, Pr is the received power that is a function of the Tx-Rx separation (transmitter-receiver), Gt is the transmit antenna gain, Gr is the gain of the receiving antenna, D is the separation distance of Tx-Rx given in meters, λ is the wavelength given in meters, and L depends on the obstacles, line of

The equation shows that the power of the received signal is attenuated to form the square of the distance between the transmitter and the receiver, which implies

The Okumura model [5] is one of the most widely used for signal prediction in urban areas. This model is applicable for frequencies in the range of 150–1920 MHz,

Pr dð Þ¼ PtGtGr λ2=ð Þ 4 π 2 d2 L (8)

of sight between the transmitter and the receiver. Satellite communication systems and microwave links can be modeled as free space propagation. The free

space model predicts that the received power decays as a function of the separation distance between the transmitter and receiver raised to some power. The power received in the free space by a receiving antenna,

the surrounding environment that can be characterized as:

Angle of an array of antennas caused by different phases [4].

DOI: http://dx.doi.org/10.5772/intechopen.84717

• High density urban

• Urban low density

2.5.1 Propagation model in free space

• Suburban

• Rural

Figure 7.

the following:

equation.

sight is = 1.

37

that 20 dB /decade decays.

2.5.2 Okumura model

Figure 5. Flat elevation pattern high gain panel [3].

### Figure 6. Azimuth flat high gain panel pattern [3].


Study of Non-predictive Patterns of Non-Ionizing Radiation in the City of Salta in Argentine DOI: http://dx.doi.org/10.5772/intechopen.84717

Figure 7.

Angle of an array of antennas caused by different phases [4].

The resulting value can still be added to a variety of attenuations produced by the surrounding environment that can be characterized as:


These attenuation parameters have been contemplated in various models such as the following:

### 2.5.1 Propagation model in free space

This model is used to predict the power of the signal when there is a clear line of sight between the transmitter and the receiver. Satellite communication systems and microwave links can be modeled as free space propagation. The free space model predicts that the received power decays as a function of the separation distance between the transmitter and receiver raised to some power. The power received in the free space by a receiving antenna, which is separated from the transmitting antenna by a distance d, is given by the equation.

$$\Pr\left(\mathbf{d}\right) = \Pr \mathbf{GtGr} \,\lambda 2 / (4\,\pi) 2 \,\mathrm{d}2 \,\mathrm{L} \tag{8}$$

Where Pt is the transmitted power, Pr is the received power that is a function of the Tx-Rx separation (transmitter-receiver), Gt is the transmit antenna gain, Gr is the gain of the receiving antenna, D is the separation distance of Tx-Rx given in meters, λ is the wavelength given in meters, and L depends on the obstacles, line of sight is = 1.

The equation shows that the power of the received signal is attenuated to form the square of the distance between the transmitter and the receiver, which implies that 20 dB /decade decays.

### 2.5.2 Okumura model

The Okumura model [5] is one of the most widely used for signal prediction in urban areas. This model is applicable for frequencies in the range of 150–1920 MHz,

• The antenna gain affected by the coupling coefficients and radiation loss

coefficient

Figure 6.

36

Figure 5.

Flat elevation pattern high gain panel [3].

Ionizing and Non-ionizing Radiation

• The attenuation in free space

Azimuth flat high gain panel pattern [3].

that is, it comprises the VHF and UHF band (however, it is typically extrapolated for frequencies above 3000 MHz entering the SHF band) and distances of 1 Km to 100 Km. It can be used for antenna heights of the base station in the range of 30– 1000 m.

The model can be expressed as:

$$\text{L50 (dB)} = \text{LF} + \text{Amu (f, d)} - \text{G (hte)} - \text{G (hre)} - \text{GAREA} \tag{9}$$

For large cities:

DOI: http://dx.doi.org/10.5772/intechopen.84717

For rural areas:

expressed as:

the distance.

39

attenuation for urban areas is made.

2.5.4 Model cost 231 (extension of the Hata model)

equations presented in the previous topic (Hata Model).

2.5.5 Calculations based on normative resolution N° 3690/04

It is also defined in the following range:

resolution number 3690 of 2004 [6].

f: 1500–2000 MHz Th: 30–200 m hre: 1–10 m d: 1–20 km

a hre ð Þ¼ 8:29 log 1 ð Þ :54hre 2 � 1:1 dB for fc < 300 MHz (12) a hre ð Þ¼ 3:2 log 11 ð Þ :75hre 2 � 4:97 dB for fc>300 MHz (13)

L dB ð Þ¼ L50 urban ð Þ� 2 log fc ½ � ð Þ =28 2 � 5:4 (14)

<sup>þ</sup> ð Þ <sup>44</sup>:<sup>9</sup> � <sup>6</sup>:55 log hte log d <sup>þ</sup> CM (16)

The following is the formula that can be used in a suburban environment:

Study of Non-predictive Patterns of Non-Ionizing Radiation in the City of Salta in Argentine

L dB ð Þ¼ L50 urban ð Þ� 4:78 log fc ð Þ 2 þ 18:33 log fc � 40:94 (15)

This model adapts very well for the design of large-scale systems, but not for PCS systems, which have cells of the order of 1 km radius. For this purpose, a numerical-empirical formulation of the graphical data provided by Okumura of

The European Cooperative for Scientific and Technical Research (EURO-

L50 urban ð Þ¼ 46:3 þ 33:9 log fc � 13:82 log hte � a hre ð Þ

One of the contributions of this model is to consider dispersion losses.

Although the above are mitigation calculations, the regulations applied in Argentina are those issued by CNC (National Communications Commission) under

In the aforementioned, reference is made to the fact that prior to any measurement, a predictive calculation based on attenuation in space must be made, which takes into account the antenna power to calculate the radiation density in relation to

ð17Þ

where CM is a correction factor to adapt the model by extending the frequency range for which the Hata model operates, CM is 0 dB for medium-sized cities and suburban areas, CM is 3 dB for metropolitan centers, and a (hre) corresponds to the

COST) [5] developed the COST 231 model, in which it extends the Hata model up to the 2 GHz range covering the VHF and UHF bands. The model is

where L50 (dB) is the median attenuation per trajectory, LF is the free space attenuation, Amu (f, d) is the average relative attenuation (curves), G (htx) is the height gain of the Tx antenna, G (hrx) is the height gain of the Rx antenna, and GAREA is the gain due to the type of environment.

Okumura found that G (hte) varies at an index of 20 dB/decade and G (hre) varies at an index of 10 dB/decade for heights less than 3 m.

G (hte) = 20log (hte/200) for 30 m < hte < 1000 m

G (hre) = 10log (hre/3) for hre < 3 m

G (hre) = 20log (hre/3) for 3 m < the <10 m

It is one of the simplest and most suitable models for attenuation predictions.

### 2.5.3 Hata model (Okumura-Hata)

It is an empirical formulation of the propagation loss data provided by Okumura and is valid in the frequency range of VHF and UHF, from 150 to 1500 MHz. Although Hata [5] presented the losses within an urban area as a standard formula:

$$\begin{aligned} \text{L50 (urban) (dB)} &= 69.55 + 26.16 \log \text{fc} - 13.82 \log \text{hte} - \text{a (hre)}\\ &+ (44.9 - 6.55 \log \text{hte}) \log \text{d} \end{aligned} \tag{10}$$

Taking into account that: 150 MHz < fc <1500 MHz 30 m < hte <200 m 1 m < hre <10 m

It should be considered that the definitions are the same as for the Okumura model, including:


As can be seen, it involves a new variable that is the correction factor of the mobile antenna and is defined according to the size of the city:

For small- and medium-sized cities:

$$\mathbf{a} \ (\text{hre}) = (\mathbf{1.1} \ \log \text{ fc} - \mathbf{0.7}) \ \text{hre} - (\mathbf{1.56} \ \log \text{ fc} - \mathbf{0.8}) \ \text{dB} \tag{11}$$

Study of Non-predictive Patterns of Non-Ionizing Radiation in the City of Salta in Argentine DOI: http://dx.doi.org/10.5772/intechopen.84717

For large cities:

that is, it comprises the VHF and UHF band (however, it is typically extrapolated for frequencies above 3000 MHz entering the SHF band) and distances of 1 Km to 100 Km. It can be used for antenna heights of the base station in the range of 30–

where L50 (dB) is the median attenuation per trajectory, LF is the free space attenuation, Amu (f, d) is the average relative attenuation (curves), G (htx) is the height gain of the Tx antenna, G (hrx) is the height gain of the Rx antenna, and

Okumura found that G (hte) varies at an index of 20 dB/decade and G (hre)

It is one of the simplest and most suitable models for attenuation predictions.

It is an empirical formulation of the propagation loss data provided by Okumura

<sup>þ</sup> ð Þ <sup>44</sup>:<sup>9</sup> � <sup>6</sup>:55 log hte log d (10)

and is valid in the frequency range of VHF and UHF, from 150 to 1500 MHz. Although Hata [5] presented the losses within an urban area as a standard formula:

L50 urban ð Þ ð Þ¼ dB 69:55 þ 26:16 log fc � 13:82 log hte � a hre ð Þ

It should be considered that the definitions are the same as for the Okumura

• the height of the transmitting antenna in [m] in the range from 30 to

• hre: receiving antenna height in [m] in the range from 1 to 10 meters.

• a (hre): correction factor for the effective height of the mobile antenna that is

As can be seen, it involves a new variable that is the correction factor of the

a hre ð Þ¼ ð Þ 1:1 log fc � 0:7 hre � ð Þ 1:56 log fc � 0:8 dB (11)

L50 dB ð Þ¼ LF þ Amu fð Þ� ; d G hte ð Þ� G hre ð Þ� GAREA (9)

1000 m.

The model can be expressed as:

Ionizing and Non-ionizing Radiation

GAREA is the gain due to the type of environment.

G (hre) = 20log (hre/3) for 3 m < the <10 m

G (hre) = 10log (hre/3) for hre < 3 m

2.5.3 Hata model (Okumura-Hata)

Taking into account that: 150 MHz < fc <1500 MHz 30 m < hte <200 m 1 m < hre <10 m

• fc: carrier frequency [MHz].

function of the type of service area.

For small- and medium-sized cities:

• d: distance between transmitter and receiver [km].

mobile antenna and is defined according to the size of the city:

model, including:

200 meters.

38

varies at an index of 10 dB/decade for heights less than 3 m. G (hte) = 20log (hte/200) for 30 m < hte < 1000 m

$$\mathbf{a} \ (\text{hre}) = 8.29 \ (\log \ 1.54 \text{hre}) \ 2 - 1.1 \text{ dB for fc} \times \text{300 MHz} \tag{12}$$

$$\mathbf{a} \ (\text{hre}) = \mathbf{3.2} \ (\text{log } \mathbf{11.75} \text{hre}) \ 2-4.97 \text{ dB for fc-}\mathbf{300 MHz} \tag{13}$$

The following is the formula that can be used in a suburban environment:

$$\text{L (dB)} = \text{L50 (urban)} - 2\left[\log\left(\text{fc/28}\right)\right]2 - 5.4 \tag{14}$$

For rural areas:

$$\text{L (dB)} = \text{L50 (urban)} - 4.78 \left(\log \text{fc}\right) \text{2} + 18.33 \log \text{fc} - 40.94 \tag{15}$$

This model adapts very well for the design of large-scale systems, but not for PCS systems, which have cells of the order of 1 km radius. For this purpose, a numerical-empirical formulation of the graphical data provided by Okumura of attenuation for urban areas is made.

### 2.5.4 Model cost 231 (extension of the Hata model)

The European Cooperative for Scientific and Technical Research (EURO-COST) [5] developed the COST 231 model, in which it extends the Hata model up to the 2 GHz range covering the VHF and UHF bands. The model is expressed as:

$$\begin{aligned} \text{L50 (urban)} &= 46.3 + 33.9 \text{ log fc} - 13.82 \text{ log hte} - \text{a (hre)}\\ &+ (44.9 - 6.55 \text{ log hte)} \text{ log d} + \text{CM} \end{aligned} \tag{16}$$

where CM is a correction factor to adapt the model by extending the frequency range for which the Hata model operates, CM is 0 dB for medium-sized cities and suburban areas, CM is 3 dB for metropolitan centers, and a (hre) corresponds to the equations presented in the previous topic (Hata Model).

One of the contributions of this model is to consider dispersion losses. It is also defined in the following range: f: 1500–2000 MHz Th: 30–200 m hre: 1–10 m d: 1–20 km

### 2.5.5 Calculations based on normative resolution N° 3690/04

Although the above are mitigation calculations, the regulations applied in Argentina are those issued by CNC (National Communications Commission) under resolution number 3690 of 2004 [6].

In the aforementioned, reference is made to the fact that prior to any measurement, a predictive calculation based on attenuation in space must be made, which takes into account the antenna power to calculate the radiation density in relation to the distance.

$$\mathcal{S} = \frac{\text{PRA.1,64.2,56.F}^2}{4.\pi \text{r}^2} \tag{17}$$

where S is the power density in <sup>W</sup> <sup>m</sup>2:, PRA is the antenna power in W, F is the attenuation at times of radiation at a certain angle of incidence in the vertical plane if it is unknown to adopt 1, 2.56 is an empirical reflection factor that takes into account the possibility that fields reflected in phase can be added to the direct incident field, and R is the distance from the antenna in meters.

3.1.2 Instruments used

correspond (unless specific indication) to TES-92. The characteristics of the instrument are:

• Directional characteristic: isotropic, three-dimensional

�1.0 dB (50 MHz–1.9 GHz), �2.4 dB (1.9–35 GHz)

• Error of use (@ 1 V/m and 50 MHz): � 1.0 dB

• The noise deviation: Type. �1.0 dB f > 50 MHz

• Measuring range (signal >50 MHz): 20 mV/m up to 108.0 V/m

• Frequency response (taking into account the number Factor CAL Factor:

The Miguel Ortiz site is an area centered on a monopost and located in the northern area of the city of Salta. It is characterized for being a suburban and quasirural location, since two of the panels partially cover areas corresponding to the field. It also covers an area of the Bolivian avenue that is an urban continuation of the highway of the same name. That is why in the path marked according to the regulations, there are rough areas of absolute clearance and line of sight

Some deviations (attributed to motorway conditions) can be seen, although the

This site is relevant because the first 150 ms of separation from the antenna are in free space due to the presence of a clear field; here, the installation is of a self-

A correction by footprint is made linearly from the point of �3 dB not taking into account the real lobe but an approximation that does not take secondary lobes

K ¼ 0:707 þ ð Þ 1 � 0:707 =ð Þ 198 � 108 :ð Þ Distance � 108 (18)

• Sensor type: electric field (E)

DOI: http://dx.doi.org/10.5772/intechopen.84717

• Frequency range: 50–3.5 GHz

• Load limit: 4.2 W/m2 (40 V/m)

3.1.3 Normal measurement site Miguel Ortiz

trend of the curve follows a predictive pattern

supporting tower 40 meters high (Figures 10 and 11).

3.1.4 Normal measurement site Castañares

3.1.4.1. Linear correction factor

into account.

41

(Figures 8 and 9).

In all cases, the instruments used were a TES-92 and TM-190 (TENMARS); previously, a contrast of measurements was made with an NARDA �550 that was taken as a calibration standard in a total of 25 measurements, the dispersion of results of 10% for TES-92 and 22% for TM-190, so the measurements presented

Study of Non-predictive Patterns of Non-Ionizing Radiation in the City of Salta in Argentine

### 3. Background on normal RNI measurements

Measurements of non-ionizing radiation are clearly developed not only with a number of works on the subject, only to exemplify the work of Azpurua et al. [7], the thesis work of Br. Jorge Juan Eduardo Ríos Solar [8], or the work that preceded it [9] and the relevant regulations in Argentina. In all these works and even regulations, measurements are made or measurements based on the theoretical radiation lobes are standardized of the installations taken as a reference for the emission of non-ionizing radiation.

### 3.1 Normal measurements made

This research developed a plan of field measurements, which focused on areas already studied in the project "Analysis of Measurements of Non-Ionizing Radiation in the City of Salta from the UCASAL" [9]. It was extended for 2 months in the areas studied and new areas.

The methodology emanating from RES N ° 3690/04 was used because the following stipulations were applied:

### 3.1.1 Selection criteria for measuring points


Factors that influence the response of the instruments: The following should be taken into account when making measurements:


The influence of these factors can be reduced by maintaining a separation greater than 20 cm or three times the size of the probe, whichever is greater, with respect to the source of re-irradiation field. That is why it is recommended that the antennas and/or probes are installed on tripods of non-conductive material.

Study of Non-predictive Patterns of Non-Ionizing Radiation in the City of Salta in Argentine DOI: http://dx.doi.org/10.5772/intechopen.84717

### 3.1.2 Instruments used

where S is the power density in <sup>W</sup>

Ionizing and Non-ionizing Radiation

non-ionizing radiation.

3.1 Normal measurements made

areas studied and new areas.

system.

surfaces

40

following stipulations were applied:

predictive calculations".

wavelength of the emitter.

3.1.1 Selection criteria for measuring points

<sup>m</sup>2:, PRA is the antenna power in W, F is the

attenuation at times of radiation at a certain angle of incidence in the vertical plane if it is unknown to adopt 1, 2.56 is an empirical reflection factor that takes into account the possibility that fields reflected in phase can be added to the direct

Measurements of non-ionizing radiation are clearly developed not only with a number of works on the subject, only to exemplify the work of Azpurua et al. [7], the thesis work of Br. Jorge Juan Eduardo Ríos Solar [8], or the work that preceded it [9] and the relevant regulations in Argentina. In all these works and even regulations, measurements are made or measurements based on the theoretical radiation lobes are standardized of the installations taken as a reference for the emission of

This research developed a plan of field measurements, which focused on areas already studied in the project "Analysis of Measurements of Non-Ionizing Radiation in the City of Salta from the UCASAL" [9]. It was extended for 2 months in the

• The measurement points will be chosen according to the characteristics of the

• For omnidirectional systems, at least 16 points should be selected, conveniently located on the ground, whose separation from the station is a function of the

• Variation of the impedance of antennas or probes in the vicinity of conductive

• Irradiation and the wavelength of the emissions, where "applicable a the

The following should be taken into account when making measurements:

• Capacitive coupling between the probe and the field radiation source

antennas and/or probes are installed on tripods of non-conductive material.

The influence of these factors can be reduced by maintaining a separation greater than 20 cm or three times the size of the probe, whichever is greater, with respect to the source of re-irradiation field. That is why it is recommended that the

The methodology emanating from RES N ° 3690/04 was used because the

• The measurement must be made at accessible points by the public.

Factors that influence the response of the instruments:

incident field, and R is the distance from the antenna in meters.

3. Background on normal RNI measurements

In all cases, the instruments used were a TES-92 and TM-190 (TENMARS); previously, a contrast of measurements was made with an NARDA �550 that was taken as a calibration standard in a total of 25 measurements, the dispersion of results of 10% for TES-92 and 22% for TM-190, so the measurements presented correspond (unless specific indication) to TES-92.

The characteristics of the instrument are:


### 3.1.3 Normal measurement site Miguel Ortiz

The Miguel Ortiz site is an area centered on a monopost and located in the northern area of the city of Salta. It is characterized for being a suburban and quasirural location, since two of the panels partially cover areas corresponding to the field. It also covers an area of the Bolivian avenue that is an urban continuation of the highway of the same name. That is why in the path marked according to the regulations, there are rough areas of absolute clearance and line of sight (Figures 8 and 9).

Some deviations (attributed to motorway conditions) can be seen, although the trend of the curve follows a predictive pattern

### 3.1.4 Normal measurement site Castañares

This site is relevant because the first 150 ms of separation from the antenna are in free space due to the presence of a clear field; here, the installation is of a selfsupporting tower 40 meters high (Figures 10 and 11).

### 3.1.4.1. Linear correction factor

A correction by footprint is made linearly from the point of �3 dB not taking into account the real lobe but an approximation that does not take secondary lobes into account.

$$\mathbf{K} = \mathbf{0}.707 + (\mathbf{1} - \mathbf{0}.707)/(198 - \mathbf{108}). (\text{Distance} - \mathbf{108})\tag{18}$$

3.1.5 Conclusions of normal measurements

DOI: http://dx.doi.org/10.5772/intechopen.84717

account the theoretical tread.

4. Non-predictive patterns

4.1 History of discordant measurements

signage with a minimum height of 3 meters.

coverage.

Figure 11.

increases.

4.1.1 Aeroclub Salta site

4.1.2 Guayacanes Site

43

In both cases, it can be observed that there is a clearance at least in the first section of the measurement and that it responds to the calculation trend taking into

Study of Non-predictive Patterns of Non-Ionizing Radiation in the City of Salta in Argentine

Graph of radiation density measurements and predictive patterns. Castañares site.

The uniformity in density values along the tread is also denoted, which is a desirable effect and compatible with an expected behavior for mobile telephony

During the measurement process referred to in the work "Analysis of Measurements of Non-Ionizing Radiation in the City of Salta from the UCASAL" [10], a series of random measurements were taken and also values were found that do not respond to a predictive pattern within urban trajectories and in trajectories in suburban environments but with sufficient clearance to be considered with little incidence of buildings; however, it was observed that there are phenomena that cannot be predicted with the stated models since they correspond to the attenuation

The cases that are listed show sites where, in the level of radiation density, not only does it not follow a predictive pattern, but also the level of radiation density

The measurement in the Aeroclub Salta site constitutes the first measurement parameter discordant with the applied theory from the point of view of both the attenuation in the free space and the correction by tread (Figures 12 and 13).

The point located at 200 meters and the point located at 180 meters completely change the predictivity of the measurement; although the scope of measurement is free space in most of the path, the jarring factor is given in a point close to metal

This is a completely suburban site in the Tres Cerritos neighborhood of the City

of Salta. It is a self-supporting tower 65 meters high and has a large number of panels as it is used by three telephone companies to provide service in the area.

in the free space and this is added in all cases of additional attenuations.

Figure 8. Miguel Ortiz site measurement area.

Figure 9. Graph of radiation density measurements and predictive patterns. Miguel ortiz site.

Figure 10. Castañares site measurement route.

Study of Non-predictive Patterns of Non-Ionizing Radiation in the City of Salta in Argentine DOI: http://dx.doi.org/10.5772/intechopen.84717

### Figure 11.

Graph of radiation density measurements and predictive patterns. Castañares site.

### 3.1.5 Conclusions of normal measurements

In both cases, it can be observed that there is a clearance at least in the first section of the measurement and that it responds to the calculation trend taking into account the theoretical tread.

The uniformity in density values along the tread is also denoted, which is a desirable effect and compatible with an expected behavior for mobile telephony coverage.

### 4. Non-predictive patterns

During the measurement process referred to in the work "Analysis of Measurements of Non-Ionizing Radiation in the City of Salta from the UCASAL" [10], a series of random measurements were taken and also values were found that do not respond to a predictive pattern within urban trajectories and in trajectories in suburban environments but with sufficient clearance to be considered with little incidence of buildings; however, it was observed that there are phenomena that cannot be predicted with the stated models since they correspond to the attenuation in the free space and this is added in all cases of additional attenuations.

The cases that are listed show sites where, in the level of radiation density, not only does it not follow a predictive pattern, but also the level of radiation density increases.

### 4.1 History of discordant measurements

### 4.1.1 Aeroclub Salta site

The measurement in the Aeroclub Salta site constitutes the first measurement parameter discordant with the applied theory from the point of view of both the attenuation in the free space and the correction by tread (Figures 12 and 13).

The point located at 200 meters and the point located at 180 meters completely change the predictivity of the measurement; although the scope of measurement is free space in most of the path, the jarring factor is given in a point close to metal signage with a minimum height of 3 meters.

### 4.1.2 Guayacanes Site

This is a completely suburban site in the Tres Cerritos neighborhood of the City of Salta. It is a self-supporting tower 65 meters high and has a large number of panels as it is used by three telephone companies to provide service in the area.

Figure 10.

42

Figure 9.

Figure 8.

Miguel Ortiz site measurement area.

Ionizing and Non-ionizing Radiation

Castañares site measurement route.

Graph of radiation density measurements and predictive patterns. Miguel ortiz site.

Figure 12. Measurement trajectory and discordant points. Aeroclub Salta site.

4.1.3 Considerations regarding low-frequency radiation

DOI: http://dx.doi.org/10.5772/intechopen.84717

Graph of radiation density measurements and predictive patterns. Guayacanes site.

instruments are.

Figure 15.

4.1.3.1 Definition of Immission

energy or radioactive particles."

sum is a vector sum of these fields.

certain high-frequency measurements.

bility of a concentration.

measured by RNI sensors.

5.1 Work methodology

45

The aerial lines of low- and medium-voltage lines are in some cases considered as causing a probability of increase in the radiation density by radiofrequency, which is why it is worth considering what the applicable concept of immission is and what the ranges of measurement of the immission sensors used by the

Study of Non-predictive Patterns of Non-Ionizing Radiation in the City of Salta in Argentine

As can be inferred from [11], "this term refers (in law) to an attack, aggression or attack of environmental type or also to a concentration, agglutination or conglomeration of pollution or the transfer of pollutants in a place or site and at a specific moment, more in common in the air and in general to an electromagnetic

The analysis of the definition is very useful because the agglutination does not imply a sum necessarily (it is an essentially biological concept) [12] and the possi-

In the case of electromagnetic immission, it must be considered that the sensors used for measurement are made in the three electric field vectors (x and z) and the

However, the sensed fields start from frequencies from 100 Khz. If we consider the harmonic spectrum of an electrical network, this would correspond to a harmonic of order 2000, considering 50 Hz as fundamental frequency, so it cannot be considered to the radiation of electric lines as a member of the emission that can be

Such is the case that there are no sensors with such a large bandwidth to detect RF radiation with values below 100 KHz [13], and in fact the detectors are based on Schottky diodes with bounded bandwidths, hence the need to change the probe for

5. Measurements of points that do not respond to predictive patterns

In the research project "Analysis of non-predictive patterns of non-ionizing radiation in a sector of the northern area of the City of Salta" approved by the

### Figure 13.

Graph of radiation density measurements and predictive patterns. Aeroclub Salta site.

Measurements followed a path in a street (Las Acacias) that provides a line of sight of good quality and there is even a square with ample clearance (Figures 14 and 15).

The values measured in this area are much higher than the trend, and additionally, they are punctual since, as the advance of the planned measurement path continues, they return to their normal value.

It can be seen that in a high clearance area there are highly discordant points

Figure 14. Measurement trajectory and discordant points. Guayacanes site.

Study of Non-predictive Patterns of Non-Ionizing Radiation in the City of Salta in Argentine DOI: http://dx.doi.org/10.5772/intechopen.84717

Figure 15.

Measurements followed a path in a street (Las Acacias) that provides a line of sight of good quality and there is even a square with ample clearance (Figures 14 and 15). The values measured in this area are much higher than the trend, and addition-

It can be seen that in a high clearance area there are highly discordant points

ally, they are punctual since, as the advance of the planned measurement path

Graph of radiation density measurements and predictive patterns. Aeroclub Salta site.

continues, they return to their normal value.

Measurement trajectory and discordant points. Guayacanes site.

Measurement trajectory and discordant points. Aeroclub Salta site.

Ionizing and Non-ionizing Radiation

Figure 12.

Figure 13.

Figure 14.

44

Graph of radiation density measurements and predictive patterns. Guayacanes site.

### 4.1.3 Considerations regarding low-frequency radiation

The aerial lines of low- and medium-voltage lines are in some cases considered as causing a probability of increase in the radiation density by radiofrequency, which is why it is worth considering what the applicable concept of immission is and what the ranges of measurement of the immission sensors used by the instruments are.

### 4.1.3.1 Definition of Immission

As can be inferred from [11], "this term refers (in law) to an attack, aggression or attack of environmental type or also to a concentration, agglutination or conglomeration of pollution or the transfer of pollutants in a place or site and at a specific moment, more in common in the air and in general to an electromagnetic energy or radioactive particles."

The analysis of the definition is very useful because the agglutination does not imply a sum necessarily (it is an essentially biological concept) [12] and the possibility of a concentration.

In the case of electromagnetic immission, it must be considered that the sensors used for measurement are made in the three electric field vectors (x and z) and the sum is a vector sum of these fields.

However, the sensed fields start from frequencies from 100 Khz. If we consider the harmonic spectrum of an electrical network, this would correspond to a harmonic of order 2000, considering 50 Hz as fundamental frequency, so it cannot be considered to the radiation of electric lines as a member of the emission that can be measured by RNI sensors.

Such is the case that there are no sensors with such a large bandwidth to detect RF radiation with values below 100 KHz [13], and in fact the detectors are based on Schottky diodes with bounded bandwidths, hence the need to change the probe for certain high-frequency measurements.

### 5. Measurements of points that do not respond to predictive patterns

### 5.1 Work methodology

In the research project "Analysis of non-predictive patterns of non-ionizing radiation in a sector of the northern area of the City of Salta" approved by the

research council of the UCASAL a plan of measurements inside and outside lobe trajectories is planned of radiation, a work methodology and a measurement protocol were implemented in accordance with the objective of identifying and characterizing points where the radiation value exceeds the normal value of the area. Offtrajectory measurements were also made from radiation lobes centered on radio bases with the sole purpose of verifying the possible existence of other points of discordance, not with a radiation pattern but with their close environment.

to the incident electromagnetic wave. These structures can focus, redirect, or divide

reveals that molecules adsorbed on specially prepared silver surfaces produce a Raman spectrum that is sometimes a million times more intense than expected. This effect was called improved surface Raman scattering (SERS). Since then, the effect has been demonstrated with many molecules and with several metals, including Cu,

Study of Non-predictive Patterns of Non-Ionizing Radiation in the City of Salta in Argentine

In this sense, Martin Moskovits in his work Surface-Enhanced Spectroscopy [16]

Another factor that could be the cause of non-predictive patterns is stated in the work of Francisco J. Rodríguez-Fortuño, Giuseppe Marino, Pavel Ginzburg, Daniel O'Connor, Alejandro Martínez, and Gregory A. W, Near-Field Interference for the Unidirectional Excitation of Electromagnetic Guided Modes [17], where they postulate that wave interference is a fundamental manifestation of the superposition principle with numerous applications. Although in conventional optics, the interference between waves that experience different phase advances during propagation, the vector structure of the near field of an emitter is essential to control its radiation, since it interferes with the interaction with a mediating object. Then, the near-field interference of a circularly polarized dipole results in the unidirectional excitation of the electromagnetic modes guided in the near field, without a pre-

With these studies, it can be postulated that in the vicinity of certain surfaces there may be abnormal concentrations of radiation with respect to a prediction based on the propagation models from a source based on an antenna and that there is a dependence of the characteristics of this abnormality with the polarization that occurs in the near field of the source, so not all antennas could produce constructive

Under this hypothesis is that a campaign of measurements focused on the probability of finding hot spots of radiation density in certain environmental conditions, in particular, metallic reflective surfaces or with reflective paints, is required.

It is a possibility that these points are the consequence of antennas or panels that have circular polarization characteristics, that is, discarding the linear polarization

Although the emission should not be related to power lines, it is no less true that the process of transforming voltage with high power levels could generate harmonics that contribute to the emission, whose value could be a significant analysis of the presence of transformers in the vicinity of points of high radiation

Resolution ITU No P526-11 is a methodology that includes a series of predictive patterns taking into account a variety of effects of buildings on the radiation pattern by diffraction [18] and most other propagation models also take into account reflection effects. It is necessary to identify the presence of buildings with a differential height with respect to the normal level of buildings; in this sense, it will take into account only the buildings very close to the points of differential radiation of

For these purposes, a non-predictive non-ionizing radiation measurements

incident light

interferences.

dipoles.

density.

47

electromagnetic density.

protocol was designed.

Ag, Au, Li, Na, K, In, Pt, and Rh.

DOI: http://dx.doi.org/10.5772/intechopen.84717

ferred far-field radiation direction.

5.3.2 Electric distribution transformers

5.3.3 Buildings of 2 or 3 floors that could produce reflections

Thus, random routes were generated with a permanent measurement methodology with configurable alarm instrument, and it was particularized in density levels higher than 1 uW/cm<sup>2</sup> .

For the field measurements, both the TES-92 meter (which exclusively measures the emission in a range of 300 KHz–2.5 GHz) and the TM-190 meter that measures a range of 50 MHz–3.5 GHz of RNI were used. And additionally, it measures electromagnetic and electric field radiation separately in the frequency of 50 to 60 exclusively. The objective of this double measurement was to contrast the presence of abnormal values of electric fields in conditions of electromagnetic fields relevant to this study.

### 5.2 Background of "hot" points

In informal measurements prior to the launch of the measurement campaign, 4 points were found where the level greatly exceeds the level of 1 uW/cm<sup>2</sup> , reaching values of 2.75 uW/cm<sup>2</sup> . That measurement campaign was launched with the aim of finding other points and analyzing the environmental conditions in order to establish a prediction pattern.

### 5.3 Work hypothesis

### 5.3.1 Metallic surfaces

As a consequence of the aforementioned antecedents, the possibility arises that there are specific locations, or small areas where phenomena of increase in the level of radiation density are manifested that are not a consequence of the emission produced by antenna radiation, but of other factors which are related to the environment of the point in question.

There is sufficient evidence of the increase in light radiation at infrared frequencies and visible by the effects of the surfaces on which they affect, such as the case of Raman scattering. [14] When light interacts with matter, it can disperse inelastically from vibrational quantum states. During this process, the photons can lose energy, or gain it from vibratory excitations, and it can also produce a concomitant change in the scattered frequency. The phenomenon, called the Raman effect, was discovered experimentally in 1928 by C. V. Raman and K. S. Krishnan in India and, independently, by Leonid Mandelstam and Grigory Landsberg in the former Soviet Union.

Oldenburg SJ, Hale GD, Jackson JB, and Halas NJ postulate in their work Light scattering from dipole and quadrupole nanoshell antennas [15] that metal nanoshells are nanoscale optical components that allow the controllable redirection of electromagnetic radiation through a careful engineering of its multilayer structures. By varying the size of the core and the thickness of the shell of these nanoparticles, nanoscale "antennas" are constructed that can be selectively driven in a dipolar or quadrupole oscillation pattern. With spaced transverse sections many times larger than their physical cross-section, these antennas are efficiently coupled Study of Non-predictive Patterns of Non-Ionizing Radiation in the City of Salta in Argentine DOI: http://dx.doi.org/10.5772/intechopen.84717

to the incident electromagnetic wave. These structures can focus, redirect, or divide incident light

In this sense, Martin Moskovits in his work Surface-Enhanced Spectroscopy [16] reveals that molecules adsorbed on specially prepared silver surfaces produce a Raman spectrum that is sometimes a million times more intense than expected. This effect was called improved surface Raman scattering (SERS). Since then, the effect has been demonstrated with many molecules and with several metals, including Cu, Ag, Au, Li, Na, K, In, Pt, and Rh.

Another factor that could be the cause of non-predictive patterns is stated in the work of Francisco J. Rodríguez-Fortuño, Giuseppe Marino, Pavel Ginzburg, Daniel O'Connor, Alejandro Martínez, and Gregory A. W, Near-Field Interference for the Unidirectional Excitation of Electromagnetic Guided Modes [17], where they postulate that wave interference is a fundamental manifestation of the superposition principle with numerous applications. Although in conventional optics, the interference between waves that experience different phase advances during propagation, the vector structure of the near field of an emitter is essential to control its radiation, since it interferes with the interaction with a mediating object. Then, the near-field interference of a circularly polarized dipole results in the unidirectional excitation of the electromagnetic modes guided in the near field, without a preferred far-field radiation direction.

With these studies, it can be postulated that in the vicinity of certain surfaces there may be abnormal concentrations of radiation with respect to a prediction based on the propagation models from a source based on an antenna and that there is a dependence of the characteristics of this abnormality with the polarization that occurs in the near field of the source, so not all antennas could produce constructive interferences.

Under this hypothesis is that a campaign of measurements focused on the probability of finding hot spots of radiation density in certain environmental conditions, in particular, metallic reflective surfaces or with reflective paints, is required.

It is a possibility that these points are the consequence of antennas or panels that have circular polarization characteristics, that is, discarding the linear polarization dipoles.

### 5.3.2 Electric distribution transformers

Although the emission should not be related to power lines, it is no less true that the process of transforming voltage with high power levels could generate harmonics that contribute to the emission, whose value could be a significant analysis of the presence of transformers in the vicinity of points of high radiation density.

### 5.3.3 Buildings of 2 or 3 floors that could produce reflections

Resolution ITU No P526-11 is a methodology that includes a series of predictive patterns taking into account a variety of effects of buildings on the radiation pattern by diffraction [18] and most other propagation models also take into account reflection effects. It is necessary to identify the presence of buildings with a differential height with respect to the normal level of buildings; in this sense, it will take into account only the buildings very close to the points of differential radiation of electromagnetic density.

For these purposes, a non-predictive non-ionizing radiation measurements protocol was designed.

research council of the UCASAL a plan of measurements inside and outside lobe trajectories is planned of radiation, a work methodology and a measurement protocol were implemented in accordance with the objective of identifying and characterizing points where the radiation value exceeds the normal value of the area. Offtrajectory measurements were also made from radiation lobes centered on radio bases with the sole purpose of verifying the possible existence of other points of discordance, not with a radiation pattern but with their close environment.

Thus, random routes were generated with a permanent measurement methodology with configurable alarm instrument, and it was particularized in density

For the field measurements, both the TES-92 meter (which exclusively measures the emission in a range of 300 KHz–2.5 GHz) and the TM-190 meter that measures a range of 50 MHz–3.5 GHz of RNI were used. And additionally, it measures electromagnetic and electric field radiation separately in the frequency of 50 to 60 exclusively. The objective of this double measurement was to contrast the presence of abnormal values of electric fields in conditions of electromagnetic fields relevant

In informal measurements prior to the launch of the measurement campaign, 4

finding other points and analyzing the environmental conditions in order to estab-

As a consequence of the aforementioned antecedents, the possibility arises that there are specific locations, or small areas where phenomena of increase in the level of radiation density are manifested that are not a consequence of the emission produced by antenna radiation, but of other factors which are related to the envi-

There is sufficient evidence of the increase in light radiation at infrared frequencies and visible by the effects of the surfaces on which they affect, such as the case of Raman scattering. [14] When light interacts with matter, it can disperse inelastically from vibrational quantum states. During this process, the photons can lose energy, or gain it from vibratory excitations, and it can also produce a concomitant change in the scattered frequency. The phenomenon, called the Raman effect, was discovered experimentally in 1928 by C. V. Raman and K. S. Krishnan in India and, independently, by Leonid Mandelstam and Grigory Landsberg in the

Oldenburg SJ, Hale GD, Jackson JB, and Halas NJ postulate in their work Light

nanoshells are nanoscale optical components that allow the controllable redirection

scattering from dipole and quadrupole nanoshell antennas [15] that metal

of electromagnetic radiation through a careful engineering of its multilayer structures. By varying the size of the core and the thickness of the shell of these nanoparticles, nanoscale "antennas" are constructed that can be selectively driven in a dipolar or quadrupole oscillation pattern. With spaced transverse sections many times larger than their physical cross-section, these antennas are efficiently coupled

. That measurement campaign was launched with the aim of

, reaching

points were found where the level greatly exceeds the level of 1 uW/cm<sup>2</sup>

levels higher than 1 uW/cm<sup>2</sup>

Ionizing and Non-ionizing Radiation

5.2 Background of "hot" points

ronment of the point in question.

values of 2.75 uW/cm<sup>2</sup>

lish a prediction pattern.

5.3 Work hypothesis

5.3.1 Metallic surfaces

former Soviet Union.

46

to this study.

.

### 6. Protocol of measurement of RNI under non-predictive patterns

In order to systematize the analysis of the environmental conditions that could eventually generate points with differential RNI levels, a working protocol was established based on the hypothesis that certain elements or constructive characteristics could be generating the points with radiation differentials with respect to normal radiation in the area.

v. Vehicles parked in the vicinity (in this case, check again when the

vii. Presence of obvious radiation sources (such as antennas, transformers, welding machines, electric motors in operation, generators, etc.).

d. He will photograph the surrounding environment and place particular focus

vi. Painted surfaces with some type of metallic or shiny paint.

Study of Non-predictive Patterns of Non-Ionizing Radiation in the City of Salta in Argentine

7. Results of measurements under protocol of measurement of RNI

and the value of its environment, obtaining the differential value. The table is

From the analysis of Table 1, the following conclusions can be obtained:

• The radius of a point of high differential radiation is variable and does not

• The radiation differential between the maximum and the normal level is not

7.2 Analysis of the relationship between points of high level of radiation and

Table 2 is shown in order to determine the possible relationship between the proximity to the emission source and the points with the highest differential value

7.2.1 Conclusions of analysis of the relationship between points of high level of radiation

From Table 2 and Figure 16, it can be seen that there is no relationship between the increase in the differential of radiation and the distance to the most probable source of radiation since, for example, for a distance to the site of most likely emission of 100 meters, radiation differential values as different as 16.95 uW/cm<sup>2</sup>

Table 1 shows the values found taking into account the value of the point found

viii. Any other aspect of the environment that is relevant.

on the constructions or elements listed.

6.Continue the journey under the rules stated.

ordered in descending order with respect to the differential.

directly related to the maximum level of radiation.

of radiation density with respect to the normal values of the site.

.

7.1 Analysis of sites with non-predictive values of radiation level

under non-predictive patterns

depend on the center's RNI level.

• The observed average radius is 1.81 mts.

distance to the most likely site of emission

and distance to the most likely site of emission

cm2 are appreciated as 0.81 uW/cm<sup>2</sup>

uW

49

vehicle is not).

DOI: http://dx.doi.org/10.5772/intechopen.84717

### 6.1 Measurement protocol of non-predictive patterns

	- a. The field analyst will stop or start a scan in the detailed area looking for the point where the maximum radiation is detected.
	- b. At that point, he will proceed to do the following:
		- i. Record the exact coordinates of the site.
		- ii. Photograph the meter at that point.
		- iii. Take the meter to a nearby point where the radiation level is significantly lower.
		- iv. Record the coordinates of this point.
		- v. Photograph the meter in the foreground and in the background the place where the significant level was verified.
		- vi. Return to the point where the significance was verified.
	- c. He will make an observation of the physical/constructive characteristics of the place, emphasizing the following aspects:
		- i. Constructions or parts of metal buildings both solid and grilled.
		- ii. Metal signage nearby.
		- iii. Surfaces that can be identified as reflective.
		- iv. Metal gates.

Study of Non-predictive Patterns of Non-Ionizing Radiation in the City of Salta in Argentine DOI: http://dx.doi.org/10.5772/intechopen.84717


### 7. Results of measurements under protocol of measurement of RNI under non-predictive patterns

Table 1 shows the values found taking into account the value of the point found and the value of its environment, obtaining the differential value. The table is ordered in descending order with respect to the differential.

### 7.1 Analysis of sites with non-predictive values of radiation level

From the analysis of Table 1, the following conclusions can be obtained:


### 7.2 Analysis of the relationship between points of high level of radiation and distance to the most likely site of emission

Table 2 is shown in order to determine the possible relationship between the proximity to the emission source and the points with the highest differential value of radiation density with respect to the normal values of the site.

### 7.2.1 Conclusions of analysis of the relationship between points of high level of radiation and distance to the most likely site of emission

From Table 2 and Figure 16, it can be seen that there is no relationship between the increase in the differential of radiation and the distance to the most probable source of radiation since, for example, for a distance to the site of most likely emission of 100 meters, radiation differential values as different as 16.95 uW/cm<sup>2</sup> uW cm2 are appreciated as 0.81 uW/cm<sup>2</sup> .

6. Protocol of measurement of RNI under non-predictive patterns

6.1 Measurement protocol of non-predictive patterns

normal radiation in the area.

Ionizing and Non-ionizing Radiation

deactivated.

or more.

In order to systematize the analysis of the environmental conditions that could eventually generate points with differential RNI levels, a working protocol was established based on the hypothesis that certain elements or constructive characteristics could be generating the points with radiation differentials with respect to

1. A known radiation source of omnidirectional radiation must be determined in the UHF or higher bands whose radiation model is omnidirectional. To this end, the application Cell Network Info lite or similar should be used in an Android phone to locate the antenna on which the route will be based.

2. An analysis grid will be drawn identifying the route to be carried out. For this purpose, radial routes to the location of the tower should be prioritized.

3. A walking tour will be started by holding the TES 92 meter or similar in a hand at an approximate height of 1.60 meters above ground level, your own cell phone or any other device that can emit radiation (e.g., Bluetooth) must be

4.The field analyst must observe the radiation indicator At all times looking for radiation patterns that exceed the normal nominal values of the area by 100%

a. The field analyst will stop or start a scan in the detailed area looking for the

5. Upon the detection of a value such as stated above, proceed as follows:

iii. Take the meter to a nearby point where the radiation level is

v. Photograph the meter in the foreground and in the background the

c. He will make an observation of the physical/constructive characteristics of

i. Constructions or parts of metal buildings both solid and grilled.

point where the maximum radiation is detected. b. At that point, he will proceed to do the following: i. Record the exact coordinates of the site.

ii. Photograph the meter at that point.

iv. Record the coordinates of this point.

place where the significant level was verified.

the place, emphasizing the following aspects:

iii. Surfaces that can be identified as reflective.

vi. Return to the point where the significance was verified.

significantly lower.

ii. Metal signage nearby.

iv. Metal gates.

48


7.3 Analysis of the incidence of the proximity of transformers of electrical distribution with respect to the differential of radiation density

7.3.1 Conclusions of the analysis of the incidence of the proximity of transformers of electrical distribution with respect to the differential of radiation density

7.4 Analysis of the incidence of the proximity of billboards, gates, or metal

7.4.1 Analysis of the incidence of the proximity of signage, gates, or metal fences with

According to working hypothesis 4.3, the analysis of metal surfaces near points

fences with respect to the differential of radiation density

of high differential level of radiation density is of particular interest.

respect to the differential of radiation density

ID site Coordinates Dif real-

65.4012

Study of Non-predictive Patterns of Non-Ionizing Radiation in the City of Salta in Argentine

65.40427

65.4012

24.76664, 65.39294

65.40224

65.3905

24.80825, 65.40466

65.39797

65.39803

65.40427

65.39652

65.39652

Results of samples under non-predictive pattern measurement protocol.

Avda. Uruguay 751 24.78087,

DOI: http://dx.doi.org/10.5772/intechopen.84717

Vicente López 1075 24.77694,

6-Rioja 710 24.78087,

21-Mendoza "Paseo" 24.79544,

1-Santa Fe 698 24.76403,

17-Avda. Independencia 1360 24.80827,

Av. Reyes Católicos 1617 24.76743,

3-Rioja Esq. Catamarca 24.77694,

Los Ombúes 95 24.76449,

10-Jujuy 804 24.76449,

Los Jazmines y Los Mandarinos

13-Avda. Independencia y

calle Pucha

Table 1.

normal

Level l uW cm<sup>2</sup>

0.663 0.955 0.292 2

0.621 0.934 0.313 2

0.601 1.141 0.54 0.5 a 1

0.587 0.6 0.013 10

0.511 1.523 1.012 2

0.421 1.071 0.65 1 a 1.5

0.4 0.7 0.3 1

0.3 0.5 0.2 2

0.294 0.535 0.241 1

0.129 0.226 0.097 3

0.21 0.89 0.68 0.3 a 0.7

0.06 0.61 0.55 0.4 a 0.8

Normal level uW cm<sup>2</sup> Radius (mts)

the total of events.

51

From Table 3 and Figure 17, it can be concluded that the presence of electrical distribution transformers does not constitute a conditioning factor for the point increase in the level of differential radiation density. However, the lack of influence in the specific increase cannot be guaranteed since they have an incidence of 27% in


Study of Non-predictive Patterns of Non-Ionizing Radiation in the City of Salta in Argentine DOI: http://dx.doi.org/10.5772/intechopen.84717

### Table 1.

ID site Coordinates Dif real-

65.39294

65.39923

65.40314

24.80575, 65.4197

65.39889

65.40111

65.40431

65.40132

65.40111

24.79541, 65.4028

65.39829

65.40314

65.41483

65.4045

65.39803

65.40302

65.40132

24.77307, 65.41625

65.40344

65.41455

65.40431

24.77309, 65.41596

65.42133

65.3905

9-Rioja 880 24.76664,

Ionizing and Non-ionizing Radiation

14-Avda. Independencia 1286 24.80827,

8-Rioja 862 24.77988,

15-Avda. Independencia 1290 24.80828,

7-Rioja 842 24.7813,

4-Florida y San Luis 24.77664,

5-Florida 602 24.7796,

Avda. Uruguay 735 24.7813,

16-Avda. Independencia 1326 24.80825,

Avda. del Bicentenario 800 24.77988,

25-Sarmiento y 12 de Octubre 24.77378,

18-Santa Fe y Mendoza 24.79534,

2-Santa Esq. Rioja 24.76743,

19-Mendoza 2 24.79551,

Avda. Uruguay 895 24.7796,

22-San Martin Y Lavalle 24.79374,

26-Sarmiento y 12 de Octubre 24.77416,

Vicente López 1000 24.77664,

11-Lamadrid y Lola mora 24.80426,

Los Jazmines 840 24.76403,

23-Aniceto Latorre y A.

24-Aniceto Latorre y A.

Güemes

Güemes

50

12-Avda. Paraguay y J Castellanos

20-Mendoza "Lago del

Parque"

normal

Level l uW cm<sup>2</sup>

Normal level uW cm<sup>2</sup>

16.95 20.15 3.2 0.5 a 1

16.14 17.64 1.5 4

4.134 5.058 0.924 2

4.05 5.25 1.2 3

2.859 3.599 0.74 0.9 a 1.5

2.772 4.011 1.239 0.4 a 1

2.609 3.223 0.614 0.3 a 07

2.026 3 0.537 4

1.602 3.152 1.55 2

1.26 2.06 0.8 2

1.19 2 0.33 5

1.161 1.791 0.63 1

1.138 1.738 0.6 2

1.067 2.533 1.466 0.5 a 1

0.935 1.735 0.8 3

0.9 1 0.253 1

0.883 1.57 0.687 1

0.85 1.45 0.6 3

0.811 1.261 0.45 2

0.81 1 0.22 4

0.719 1.029 0.31 1

0.7 1.3 0.6 1

0.667 0.777 0.11 3

7.71 8.51 0.8 0.4 a 0.9

Radius (mts)

Results of samples under non-predictive pattern measurement protocol.

### 7.3 Analysis of the incidence of the proximity of transformers of electrical distribution with respect to the differential of radiation density

### 7.3.1 Conclusions of the analysis of the incidence of the proximity of transformers of electrical distribution with respect to the differential of radiation density

From Table 3 and Figure 17, it can be concluded that the presence of electrical distribution transformers does not constitute a conditioning factor for the point increase in the level of differential radiation density. However, the lack of influence in the specific increase cannot be guaranteed since they have an incidence of 27% in the total of events.

### 7.4 Analysis of the incidence of the proximity of billboards, gates, or metal fences with respect to the differential of radiation density

### 7.4.1 Analysis of the incidence of the proximity of signage, gates, or metal fences with respect to the differential of radiation density

According to working hypothesis 4.3, the analysis of metal surfaces near points of high differential level of radiation density is of particular interest.


From Table 4, the following can be concluded:

DOI: http://dx.doi.org/10.5772/intechopen.84717

Differential radiation density as a function of distance to probable source.

with radiation density differential (Figure 19).

From Table 5, the following can be concluded:

The probability increases by 30% if there is more than one metal surface in the

Having some type of metallic surface, there is an 89% chance of finding a point

7.5 Analysis of the relationship between nearby buildings and the radiation

Study of Non-predictive Patterns of Non-Ionizing Radiation in the City of Salta in Argentine

7.5.1 Analysis of the relationship between nearby buildings and the radiation level

In 84% of the cases of differential increase in radiation density, there is a building with 2 or more floors nearby, although the presence of these two types of

The following additional factors have been taken into account as a probable

• Some surface 89%

• Metal posters 27%

• Metal gates 57%

• Fences 68%

Figure 16.

vicinity (Figure 18).

level differential

• Some building 84%

7.6 Other factors analyzed

factor of point increase:

• Metallic ceilings

• Electrical wiring

• Pavement

53

• Buildings of 2 floors 73%

• Buildings of 3 floors or more 22%

• Influence of vegetation and trees

• High density of parked vehicles

buildings only increases the possibility by 0.06%.

differential

Table 2. Differential radiation density values as a function of distance to probable source. Study of Non-predictive Patterns of Non-Ionizing Radiation in the City of Salta in Argentine DOI: http://dx.doi.org/10.5772/intechopen.84717

Figure 16.

Real-normal dif of S in uW

Ionizing and Non-ionizing Radiation

Table 2.

52

Differential radiation density values as a function of distance to probable source.

cm<sup>2</sup> x 100 Theoretical radiation source (mts)

Differential radiation density as a function of distance to probable source.

From Table 4, the following can be concluded:


The probability increases by 30% if there is more than one metal surface in the vicinity (Figure 18).

Having some type of metallic surface, there is an 89% chance of finding a point with radiation density differential (Figure 19).

### 7.5 Analysis of the relationship between nearby buildings and the radiation level differential

7.5.1 Analysis of the relationship between nearby buildings and the radiation level differential

From Table 5, the following can be concluded:


In 84% of the cases of differential increase in radiation density, there is a building with 2 or more floors nearby, although the presence of these two types of buildings only increases the possibility by 0.06%.

### 7.6 Other factors analyzed

The following additional factors have been taken into account as a probable factor of point increase:



### Table 3.

Presence of distribution transformers in relation to differential level of radiation density.

7.6.1 Analysis of the influence of other factors on the differential and on the point value of

Distribution of probability of increase of differential level of radiation density according to the amount of metal

Cases of presence of distribution transformers in relation to differential level of radiation density (y axis).

Study of Non-predictive Patterns of Non-Ionizing Radiation in the City of Salta in Argentine

DOI: http://dx.doi.org/10.5772/intechopen.84717

Incidence of the number of cases of metallic surfaces with respect to the differential of radiation density.

In this analysis, it is possible to deepen the point radiation according to its value.

From the analysis of Table 6, the following can be concluded:

radiation density

Figure 17.

Figure 18.

Figure 19.

55

surfaces nearby.

Study of Non-predictive Patterns of Non-Ionizing Radiation in the City of Salta in Argentine DOI: http://dx.doi.org/10.5772/intechopen.84717

### Figure 17.

Real-normal differential uW

Ionizing and Non-ionizing Radiation

Table 3.

54

cm<sup>2</sup> Proximity of transformers (mts)

16.95 1 16.14 0 7.71 1 4.134 0 4.05 0 2.859 1 2.772 0 2.609 0 2.026 0 1.602 0 1.26 1 1.19 1 1.161 0 1.138 0 1.067 0 0.935 0 0.9 0 0.883 0 0.85 0 0.811 0 0.81 0 0.719 0 0.7 1 0.667 0 0.663 0 0.621 0 0.601 0 0.587 0 0.511 0 0.421 0 0.4 0 0.3 1 0.294 0 0.21 1 0.129 1 0.06 1

Presence of distribution transformers in relation to differential level of radiation density.

Cases of presence of distribution transformers in relation to differential level of radiation density (y axis).

Figure 18.

Incidence of the number of cases of metallic surfaces with respect to the differential of radiation density.

### Figure 19.

Distribution of probability of increase of differential level of radiation density according to the amount of metal surfaces nearby.

### 7.6.1 Analysis of the influence of other factors on the differential and on the point value of radiation density

In this analysis, it is possible to deepen the point radiation according to its value. From the analysis of Table 6, the following can be concluded:

### Ionizing and Non-ionizing Radiation


Real-normal differential

DOI: http://dx.doi.org/10.5772/intechopen.84717

Table 5.

57

Relationship between nearby buildings and the radiation level differential.

2-floor buildings Buildings of 3 or more floors Amount Amount > 0

Study of Non-predictive Patterns of Non-Ionizing Radiation in the City of Salta in Argentine

### Table 4.

Closeness of billboard, gates, or metal fences with respect to the differential of radiation density.


Study of Non-predictive Patterns of Non-Ionizing Radiation in the City of Salta in Argentine DOI: http://dx.doi.org/10.5772/intechopen.84717

### Table 5.

Differential realnormal uW cm<sup>2</sup>

Ionizing and Non-ionizing Radiation

Table 4.

56

High metal signage cases

Metal gates cases

Closeness of billboard, gates, or metal fences with respect to the differential of radiation density.

Metal fences/wiring cases

Number of cases

Relationship between nearby buildings and the radiation level differential.

### Ionizing and Non-ionizing Radiation


High levels:

DOI: http://dx.doi.org/10.5772/intechopen.84717

• 63% cars

• 63% plants

• 38% roofs

Low levels:

• 34% cars

• 10% plants

• 24% ceilings

conditions.

8. Conclusions

The presence of cars parked in the vicinity, plants or trees on the measurement area, and to lesser extent metal roofs have a strong influence on the point value,

It is also observed that at the highest levels there is the presence of two of these

There is no doubt that electromagnetic radiation has a number of variables whose study is constantly evolving, at the same time as technology evolves. New radiation patterns are incorporated to make the calculation more accurate and the

In this work, it is demonstrated by field exploration in urban and suburban environments that there are points of high concentration of radiation, that these points have locations not related to the distance to the source, which are only points and not extensive areas with smaller radii than 4 meters, and that you can evaluate possibilities of existence of these points based on the surrounding environment, taking into account metallic surfaces at level and above ground level, constructions of more than one plant nearby, and to a lesser extent other factors, but in some cases, they are definitive in the location of what can be called hot spots of differen-

The authors wish to express their gratitude to the Research Council of the Catholic University of Salta (UCASAL) for their support in the development of the

factors is verified. On the other hand, in low radiation values, there are no such conditions. Therefore, it can be concluded that vehicles and some types of plants contribute to the possibility of an increase in the level of radiation density.

Study of Non-predictive Patterns of Non-Ionizing Radiation in the City of Salta in Argentine

, the presence of these

such that in the values above the average of 2.12 uW/cm<sup>2</sup>

behavior of electromagnetic waves more predictive.

tial density of non-ionizing radiation.

Acknowledgements

research.

59

### Table 6.

Influence of other factors on the increase in the difference in radiation density.

Study of Non-predictive Patterns of Non-Ionizing Radiation in the City of Salta in Argentine DOI: http://dx.doi.org/10.5772/intechopen.84717

High levels:

• 63% cars

Real-normal differential

Ionizing and Non-ionizing Radiation

Table 6.

58

Influence of other factors on the increase in the difference in radiation density.

High-density electrical wiring High-density parked vehicles

Site under plants

Metal ceilings nearby


Low levels:


The presence of cars parked in the vicinity, plants or trees on the measurement area, and to lesser extent metal roofs have a strong influence on the point value, such that in the values above the average of 2.12 uW/cm<sup>2</sup> , the presence of these factors is verified. On the other hand, in low radiation values, there are no such conditions. Therefore, it can be concluded that vehicles and some types of plants contribute to the possibility of an increase in the level of radiation density.

It is also observed that at the highest levels there is the presence of two of these conditions.

### 8. Conclusions

There is no doubt that electromagnetic radiation has a number of variables whose study is constantly evolving, at the same time as technology evolves. New radiation patterns are incorporated to make the calculation more accurate and the behavior of electromagnetic waves more predictive.

In this work, it is demonstrated by field exploration in urban and suburban environments that there are points of high concentration of radiation, that these points have locations not related to the distance to the source, which are only points and not extensive areas with smaller radii than 4 meters, and that you can evaluate possibilities of existence of these points based on the surrounding environment, taking into account metallic surfaces at level and above ground level, constructions of more than one plant nearby, and to a lesser extent other factors, but in some cases, they are definitive in the location of what can be called hot spots of differential density of non-ionizing radiation.

### Acknowledgements

The authors wish to express their gratitude to the Research Council of the Catholic University of Salta (UCASAL) for their support in the development of the research.

### Conflict of interest

The authors declare that there is no potential conflict of interest related to the article.

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15-10-2018]

15-18, 2011

61

[1] ADU4518R3. DXX-790-960/ 1710-2180-65/65-16.5i/18.5i-M/M-R. EasyRET Dual-Band Antenna with 2 Integrated RCUs. Electrical. Frequency range (MHz). Available from: https:// www.huawei.com/ucmf/groups/public/ documents/attachments/hw\_316934.pdf

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Study of Non-predictive Patterns of Non-Ionizing Radiation in the City of Salta in Argentine

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### Author details

Mario Marcelo Figueroa de la Cruz1,2\* and Roberto Daniel Breslin1


\*Address all correspondence to: mfiguero@gmail.com

<sup>© 2019</sup> The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Study of Non-predictive Patterns of Non-Ionizing Radiation in the City of Salta in Argentine DOI: http://dx.doi.org/10.5772/intechopen.84717

### References

Conflict of interest

Ionizing and Non-ionizing Radiation

Author details

60

Mario Marcelo Figueroa de la Cruz1,2\* and Roberto Daniel Breslin1

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

1 Catholic University of Salta (UCASAL), Salta, Argentina

2 National Technological University, Tucuman, Argentina

\*Address all correspondence to: mfiguero@gmail.com

provided the original work is properly cited.

article.

The authors declare that there is no potential conflict of interest related to the

[1] ADU4518R3. DXX-790-960/ 1710-2180-65/65-16.5i/18.5i-M/M-R. EasyRET Dual-Band Antenna with 2 Integrated RCUs. Electrical. Frequency range (MHz). Available from: https:// www.huawei.com/ucmf/groups/public/ documents/attachments/hw\_316934.pdf [Accessed: 05-01-2019]

[2] Wireless Calculators. Available from: http://www.terabeam.com/support/ calculations/index.php [Accessed: 05-01-2019]

[3] WNI Mexico Types of Antennas and Operation. Available from: https:// www.wni.mx/index.php?option=com\_ content&view=article&id=62: antenassoporte&catid=31:general& Itemid=79 [Accessed: 05-01-2019]

[4] Reuse of the Mobile Telephone System. Basic Antennas. Available from: http://antenasupv.blogspot.com/2008/ 07/reutilizacin-del-sitema-de-telefonia. html [Accessed: 15-10-2018]

[5] Chapter 5 Propagation Models. Available from: http://catarina.udlap. mx/u\_dl\_a/tales/documentos/lem/ trevino\_c\_jt/capitulo5.pdf [Accessed: 15-10-2018]

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[8] Rios Solar J. Study of non-ionizing radiations for a base station Gsm 850

Mhz located in the Private University Antenor Orrego De Trujillo [thesis]. Trujillo: Perú Private University Antenor Orrego—UPAO; 2011

[9] Figueroa de la Cruz M, Breslin R, Narváez P. Measurements of nonionizing radiations. In: Proceedings of the VI Working Meeting on Information Processing and Control; Salta Argentina; November 17 and 18, 2016

[10] Figueroa de la Cruz M, Narvaez P, Breslin R, Den Herder T. Analysis of measurements of non-ionizing radiation in the city of Salta from the UCASAL. No. of project 123/14 [thesis]. Salta Argentina Catholic University of Salta; 2016

[11] Definition—Definition and Etymology of Words. Available from: https://definiciona.com/inmision [Accessed: 27-10-2018]

[12] Oxford Dictionary. Available from: https://es.oxforddictionaries.com/ definicion/aglutinacion [Accessed: 27-10-2018]

[13] Linear Technology—LTC5533 Schottky Peak Detector. Available from: https://www.analog.com/media/en/ technical-documentation/data-sheets/ 5534fc.pdf [Accessed: 17-10-2018]

[14] Katrin K. Surface-enhanced Raman scattering. Physics Today. 2007. DOI: 10.1007/11663898

[15] Oldenburg SJ, Hale GD, Jackson JB, Halas NJ. Light scattering from dipole and quadrupole nanoshell antennas. Applied Physics Letters. 1999;75:1063. DOI: 10.1063/1.124597

[16] Martin M. Surface-enhanced spectroscopy. Reviews of Modern Physics. 1985;57:783. DOI: 10.1007/ 3-540-33567-6\_1

### Ionizing and Non-ionizing Radiation

[17] Rodriguez-Fortuño F, Marino G, Ginzburg P, O'Connor D, Martinez A, Gregory A. Near-field interference for the unidirectional excitation of electromagnetic guided modes. Science. 2013;340(6130):328-330. DOI: 10.1126/ science.1233739

[18] RECOMMENDATION ITU-R P.526-11 Available from: https://www. itu.int/dms\_pubrec/itu-r/rec/p/R-REC-P.526-11-200910-S!!PDF-S.pdf [Accessed: 27-10-2018]

**63**

vaccine.

genetically attenuated sporozoites

**1. Introduction: basic malaria biology**

**Chapter 4**

Infection

*Sarat Kumar Dalai*

**Abstract**

Application of Radiation

Immunity against Malaria

Technology: A Novel Vaccine

Approach to Induce Protective

*Nikunj Tandel, Devang Trivedi, Aditi Mohan Krishnan and* 

Among the numerous infectious diseases, malaria remains a major health challenge. Despite the various approaches adopted for the vector control and availability of antimalarial drugs, the success of malaria eradication is dampened by the spread of drug and insecticide resistance, unavailability of proper diagnostic treatment and successful vaccine. Among the various approaches, vaccination with the aim of developing protective immunity is the most suited, safe and reliable approach for the entire mankind. Numerous approaches are in use for vaccine development; however, they suffer from the drawbacks that immunity developed is short lived and are both species- and stage-specific. Of late, radiation sterilization has drawn the attention in the vaccine development due to its advantages over the conventional methods, and successful clinical trials of irradiated vaccines against the pathogens and tumor. Recently, a novel approach of genetically attenuated sporozoites (PfRAS, PfSPZ, PFSPZ-GA1 sporozoites vaccines) has shown promising results by generating protective immunity against the homologous and heterogenous infection in the clinical trials. Radiation techniques have also been beneficial in controlling the insects by sterility technique. In this chapter, we have recapitulated the role of radiation biology in the malaria vaccine development with its current status and future challenges associated with the development of radiation attenuated parasite

**Keywords:** malaria, infectious disease, vaccine, radiation technology, immunity,

Malaria, an ancient disease has been found recorded in several historical documents and the word malaria comes from the Italian mal'aria meaning spoiled air [1].

### **Chapter 4**

[17] Rodriguez-Fortuño F, Marino G, Ginzburg P, O'Connor D, Martinez A, Gregory A. Near-field interference for the unidirectional excitation of

Ionizing and Non-ionizing Radiation

electromagnetic guided modes. Science. 2013;340(6130):328-330. DOI: 10.1126/

[18] RECOMMENDATION ITU-R P.526-11 Available from: https://www. itu.int/dms\_pubrec/itu-r/rec/p/R-REC-

P.526-11-200910-S!!PDF-S.pdf [Accessed: 27-10-2018]

science.1233739

62

## Application of Radiation Technology: A Novel Vaccine Approach to Induce Protective Immunity against Malaria Infection

*Nikunj Tandel, Devang Trivedi, Aditi Mohan Krishnan and Sarat Kumar Dalai*

### **Abstract**

Among the numerous infectious diseases, malaria remains a major health challenge. Despite the various approaches adopted for the vector control and availability of antimalarial drugs, the success of malaria eradication is dampened by the spread of drug and insecticide resistance, unavailability of proper diagnostic treatment and successful vaccine. Among the various approaches, vaccination with the aim of developing protective immunity is the most suited, safe and reliable approach for the entire mankind. Numerous approaches are in use for vaccine development; however, they suffer from the drawbacks that immunity developed is short lived and are both species- and stage-specific. Of late, radiation sterilization has drawn the attention in the vaccine development due to its advantages over the conventional methods, and successful clinical trials of irradiated vaccines against the pathogens and tumor. Recently, a novel approach of genetically attenuated sporozoites (PfRAS, PfSPZ, PFSPZ-GA1 sporozoites vaccines) has shown promising results by generating protective immunity against the homologous and heterogenous infection in the clinical trials. Radiation techniques have also been beneficial in controlling the insects by sterility technique. In this chapter, we have recapitulated the role of radiation biology in the malaria vaccine development with its current status and future challenges associated with the development of radiation attenuated parasite vaccine.

**Keywords:** malaria, infectious disease, vaccine, radiation technology, immunity, genetically attenuated sporozoites

### **1. Introduction: basic malaria biology**

Malaria, an ancient disease has been found recorded in several historical documents and the word malaria comes from the Italian mal'aria meaning spoiled air [1]. It is a vector born disease caused by the parasite, belonging to genus *Plasmodium* and out of five different species, the burden of malaria leads by *Plasmodium falciparum* followed by *Plasmodium vivax* in humans [2]. 219 million cases of malaria were reported in 2017 with the death toll of 4,35,000 and the latest world malaria report suggest the stalled in the progression of the reduction in malaria elimination across the globe [3].

Almost half of the world population is at the risk of malaria, with more than 85% cases in sub-Saharan Africa followed by South-East Asia, West Pacific and others [3]. The population groups are at higher risk of malaria, and developing fatal severity include infants, children under 5 years of age, pregnant women, immunocompromised patients, non-immune migrants, mobile populations and travelers [4, 5]. In areas where malaria transmission rate is high, among these, children under 5 years are particularly receptive to infection, Illness, and death; more than 2/3 (70%) of all malaria deaths occur in this age group [4]. The number of under age of 5 years for malaria deaths has declined from 4,40,000 in 2010 to 2,85,000 in 2016, nevertheless, it remains as a leading reason for the death under 5 years children, taking the life of a child every 2 minutes [3].

### **1.1 Malaria life cycle**

*Plasmodium spp*., a Causative parasite for malaria exhibits a complex life cycle that switches between *Anopheles* mosquitoes (vector), and invertebrate hosts that form unique zoite formation to evade different cell types at specific stages [6, 7]. It comprises of three different types, two of these (asexual stage) in vertebrate which are exo-erythrocytic cycle (liver/asymptomatic stage) and erythrocytic cycle (blood/symptomatic stage). And the third phase (sexual stage) is in the mosquito that is sporogenic cycle (infective stage) [7].

During the probing for the blood meal using its proboscis on the host, the infected female mosquito injects sporozoites (SPZs) within its saliva into dermis of uninfected human [8, 9] which contains vasodilators and anticoagulants that facilitate the ingestion of blood [10]. Most of the parasites reside in the skin between 1 and 6 hours [7, 8]. Many fail to migrate to the lymph nodes (LNs) and approximately 20% of them migrate directly into the skin-draining LNs through the lymph [11, 12]. It triggers the induction or modulation of the host immune system followed by an antiparasitic immune response [13, 14]. On the other hand, a small proportion of SPZs randomly transverse to the nearest blood vessel [12]. After crossing the endothelial barrier of the skin, the SPZs enter to the circulation and reached to the liver which is critical for the infection cycle as the development of merozoites occurs [15–18].

The traversal activity of SPZs through different host cells and molecular events that underpin the transformation of SPZs into merozoites via erythrocyte invasion involves the expression of thousands of proteins [7]. These SPZs migrate via blood flow to the liver retained by hepatic stellate cells (HSC) and glide, further using the Kupffer cells as a shield, traverse the liver sinusoidal endothelial cells (LESC) barrier in a sinusoids [8]. It has been moving in several hepatocytes through the space of Disse by the thrombospondin related anonymous protein (TRAP) and circumsporozoite protein (CSP) interactions before actually infecting one of them to form a parasitophorous vacuole, that aids in protecting from the host's immune system and provides nutrients for the SPZs to replicate and differentiate into merozoites [8, 10]. The healthy or successful sporozoites release up to 10,000 to more than 30 to 40,000 merozoites per hepatocyte into the bloodstream within parasite-filled vesicles called

**65**

**Figure 1.**

*The basic malaria life cycle of Plasmodium falciparum (adapted from [20] with permission).*

*Application of Radiation Technology: A Novel Vaccine Approach to Induce Protective Immunity…*

merosomes through a process of budding which use the host-cell membrane to

The merozoites release in the hepatic circulation that invades erythrocytes in a short duration via dynamic and multi-step process that includes pre-invasion, active invasion, and echinocytosis [21] through the involvement of proteins named merozoite surface protein (MSP) [7]. The blood stage is symptomatic stage that develops once the erythrocytic cycle produces a parasitemia above a certain threshold approximately 50–100 parasites/μL (microscopy). The merozoites released into the blood reinvade the new red blood cells (RBCs) and continue to replicate or in some instance, they differentiate into male and female gametocytes [22, 23]. Mature gametocytes travel throughout the body and deposited mainly in skin capillaries from which they are taken up by the mosquito for the next blood meal. Once they reach to the mosquito gut, male gametocyte produces eight microgametes with three rounds of mitosis, meanwhile female gametocyte mature in macrogametes in the gut of the mosquito [24]. The fusion of the male and female gametocyte forms a diploid zygote that elongates into an ookinete; which exits the epithelium through the lumen of the gut as an oocyst and undergoes cycles of replication and forms sporozoites. It moves from the abdomen and resides into the

*DOI: http://dx.doi.org/10.5772/intechopen.85491*

escape the host immune system (**Figure 1**) [19].

*Application of Radiation Technology: A Novel Vaccine Approach to Induce Protective Immunity… DOI: http://dx.doi.org/10.5772/intechopen.85491*

merosomes through a process of budding which use the host-cell membrane to escape the host immune system (**Figure 1**) [19].

The merozoites release in the hepatic circulation that invades erythrocytes in a short duration via dynamic and multi-step process that includes pre-invasion, active invasion, and echinocytosis [21] through the involvement of proteins named merozoite surface protein (MSP) [7]. The blood stage is symptomatic stage that develops once the erythrocytic cycle produces a parasitemia above a certain threshold approximately 50–100 parasites/μL (microscopy). The merozoites released into the blood reinvade the new red blood cells (RBCs) and continue to replicate or in some instance, they differentiate into male and female gametocytes [22, 23]. Mature gametocytes travel throughout the body and deposited mainly in skin capillaries from which they are taken up by the mosquito for the next blood meal. Once they reach to the mosquito gut, male gametocyte produces eight microgametes with three rounds of mitosis, meanwhile female gametocyte mature in macrogametes in the gut of the mosquito [24]. The fusion of the male and female gametocyte forms a diploid zygote that elongates into an ookinete; which exits the epithelium through the lumen of the gut as an oocyst and undergoes cycles of replication and forms sporozoites. It moves from the abdomen and resides into the

**Figure 1.** *The basic malaria life cycle of Plasmodium falciparum (adapted from [20] with permission).*

*Ionizing and Non-ionizing Radiation*

across the globe [3].

child every 2 minutes [3].

that is sporogenic cycle (infective stage) [7].

**1.1 Malaria life cycle**

occurs [15–18].

It is a vector born disease caused by the parasite, belonging to genus *Plasmodium* and out of five different species, the burden of malaria leads by *Plasmodium falciparum* followed by *Plasmodium vivax* in humans [2]. 219 million cases of malaria were reported in 2017 with the death toll of 4,35,000 and the latest world malaria report suggest the stalled in the progression of the reduction in malaria elimination

Almost half of the world population is at the risk of malaria, with more than 85% cases in sub-Saharan Africa followed by South-East Asia, West Pacific and others [3]. The population groups are at higher risk of malaria, and developing fatal severity include infants, children under 5 years of age, pregnant women, immunocompromised patients, non-immune migrants, mobile populations and travelers [4, 5]. In areas where malaria transmission rate is high, among these, children under 5 years are particularly receptive to infection, Illness, and death; more than 2/3 (70%) of all malaria deaths occur in this age group [4]. The number of under age of 5 years for malaria deaths has declined from 4,40,000 in 2010 to 2,85,000 in 2016, nevertheless, it remains as a leading reason for the death under 5 years children, taking the life of a

*Plasmodium spp*., a Causative parasite for malaria exhibits a complex life cycle that switches between *Anopheles* mosquitoes (vector), and invertebrate hosts that form unique zoite formation to evade different cell types at specific stages [6, 7]. It comprises of three different types, two of these (asexual stage) in vertebrate which are exo-erythrocytic cycle (liver/asymptomatic stage) and erythrocytic cycle (blood/symptomatic stage). And the third phase (sexual stage) is in the mosquito

During the probing for the blood meal using its proboscis on the host, the infected female mosquito injects sporozoites (SPZs) within its saliva into dermis of uninfected human [8, 9] which contains vasodilators and anticoagulants that facilitate the ingestion of blood [10]. Most of the parasites reside in the skin between 1 and 6 hours [7, 8]. Many fail to migrate to the lymph nodes (LNs) and approximately 20% of them migrate directly into the skin-draining LNs through the lymph [11, 12]. It triggers the induction or modulation of the host immune system followed by an antiparasitic immune response [13, 14]. On the other hand, a small proportion of SPZs randomly transverse to the nearest blood vessel [12]. After crossing the endothelial barrier of the skin, the SPZs enter to the circulation and reached to the liver which is critical for the infection cycle as the development of merozoites

The traversal activity of SPZs through different host cells and molecular events that underpin the transformation of SPZs into merozoites via erythrocyte invasion involves the expression of thousands of proteins [7]. These SPZs migrate via blood flow to the liver retained by hepatic stellate cells (HSC) and glide, further using the Kupffer cells as a shield, traverse the liver sinusoidal endothelial cells (LESC) barrier in a sinusoids [8]. It has been moving in several hepatocytes through the space of Disse by the thrombospondin related anonymous protein (TRAP) and circumsporozoite protein (CSP) interactions before actually infecting one of them to form a parasitophorous vacuole, that aids in protecting from the host's immune system and provides nutrients for the SPZs to replicate and differentiate into merozoites [8, 10]. The healthy or successful sporozoites release up to 10,000 to more than 30 to 40,000 merozoites per hepatocyte into the bloodstream within parasite-filled vesicles called

**64**

salivary gland followed by the next blood meal of mosquito during which it will inject the sporozoites to the healthy host [24].

### **1.2 The liver stage infection of malaria parasites: yet hold promises**

The liver is the most important organ and known for its role in blood purification, detoxification of chemicals and metabolizes of drugs, role in the immune system and homeostasis [25]. This unique architecture of liver favors the interaction between leukocytes and hepatic cells and intra-hepatic recruitment of T cells which recognize their cognate antigen within their vicinity [26]. Among the multi-stage life cycle, liver/exoerythrocytic stage of the malaria parasite is least known due to several reasons, however recent developments of humanized mice have revealed the importance of liver stage [2]. All the same, liver stage parasites in murine and humans evade the immune clearance despite the presence of antigen presenting cells (APCs) [8]. Cytotoxic T cell (CD 8+ T cell) requires to kill the intracellular parasite infected cell as they are intracellular organism reside in the hepatocytes. Therefore long lasting immunity, reduce/remove the parasitic load in asymptomatic exoerythrocytic stage and to prevent their liver to blood stage transitions are the main concern for any malarial parasitologist to develop and improve the vaccine strategies.

### **1.3 Current status of antimalarial therapy and standing of vaccine initiative**

To prevent and eradicate malaria, prophylaxis that has no adverse effect and versatile for all is an urgent requirement. Till now various antimalarial therapy of drugs, insecticide-treated bed nets and different diagnostic tests [27] are in use, however the success of malaria infection halted by the insecticide [28, 29] and parasite resistance [28, 30, 31]. This life-threatening condition needs the novel antimalarial therapy that can control parasite at different stages of its life cycle (**Figure 2**).

### **Figure 2.**

*Schematic diagram of intra-erythrocytic trophozoite showing targets of novel antimalarial drugs (red color indicates the drugs under the pipeline/clinical trials and green color for the drugs currently available) (adapted and modified from [32]).*

**67**

*Application of Radiation Technology: A Novel Vaccine Approach to Induce Protective Immunity…*

Nowadays, a novel approach of combinational drug therapies are in use such as Artemisinin based combinatorial therapy (ACT) and others though, the success rate is low or restricted to the area due to the diversity among the parasite [33]. Despite the availability of drugs from natural resources or synthetic compound, the parasite still surpasses and escape the host immune system as well as dampen the effect of the drugs [34]. Also, the recent finding has alarmingly shown that parasite has been gaining resistance against artemisinin and its derivatives [31, 35]. In this bleak condition, the malaria vaccine is urgent and indeed. Different approaches are in practice for the development of malaria vaccine based on immunogenic peptides, usage of mosquito and/or parasite antigens, usage of adjutants, radiation or genetically modified sporozoites and so on [36]. Different experimental evidences shed the light on the importance of novel vaccine approaches (attenuated whole sporozoites) which strongly confirms the role of APCs resides in the liver capable to recruit CD 8+ T cells together with the cytokines (IFN-γ and TNF-α) required for the sterile protection [21, 37–43]. Despite the sterile immunity last longs for the 6–9 months, a recent study confirmed the usage of the intermittent challenge of radiation attenuated sporozoites in mice stay long lasting up to 18 months and give rise to sterile immunity [44]. The approach of radiation for protective immunity has gained attention in the scientific community to eradicate the morbidity and mortal-

Radiation is a form of energy which travels and transmits or emits from its source as a wave (ionization radiation) or in the form of electron particles (nonionizing radiation) [45]. The broad range of electromagnetic spectrum consists of harmless radio and microwaves, sunlight includes longer (infrared) and shorter (ultraviolet) wavelength and finally the higher energy specific wavelength of X-rays and gamma rays which exist the electrons from the atoms through the ionization process [45, 46]. During the process of radioactive decay there are mainly three types of ionizing radiation emitted; alpha, beta and gamma rays. Other than this, X-rays can be occurred naturally or produced by machines [47]. The major difference between this ionizing radiation (X-rays and gamma rays) is the photon's energy of individual rather than the energy of the total dose of the radiation

As the entire world is in the vicinity of the radioactive environment, we all, more or less, are exposed to a certain level of background radiation [49]. It has been reported that more than 80% of human-radiation doses are uncontrolled which are mainly consist of the natural sources, terrestrial and exposure through inhalation or

There are more than 60 natural radionuclides are found in the environment and no place on the earth is without spontaneous radiation activity. It is mainly observed in the soils and rocks (uranium and thorium decay), in water sources such as naturally occurred lacks, rivers and oceans and Human-made buildings and homes [51]. Also, the effect of gamma radiation on natural radioactivity and their associated exposures mainly depends upon the geological and geographical location together with their appearance at different levels in the soil of the respective the region [50]. Overall, we received an average dose of 2.4 mSv/year (mSv stands for millisieverts, one-thousandth part of a sievert, an SI unit and currently used in the radiation protection standards) from the background radiation which may vary from 1 to 10 mSv/year and rely on the location of the region; however it

*DOI: http://dx.doi.org/10.5772/intechopen.85491*

ity of malaria infection.

**2. Radiation and its impact on health**

alongside their source of origin [48].

intake of the radiation (mainly through medication) [50].

*Application of Radiation Technology: A Novel Vaccine Approach to Induce Protective Immunity… DOI: http://dx.doi.org/10.5772/intechopen.85491*

Nowadays, a novel approach of combinational drug therapies are in use such as Artemisinin based combinatorial therapy (ACT) and others though, the success rate is low or restricted to the area due to the diversity among the parasite [33]. Despite the availability of drugs from natural resources or synthetic compound, the parasite still surpasses and escape the host immune system as well as dampen the effect of the drugs [34]. Also, the recent finding has alarmingly shown that parasite has been gaining resistance against artemisinin and its derivatives [31, 35]. In this bleak condition, the malaria vaccine is urgent and indeed. Different approaches are in practice for the development of malaria vaccine based on immunogenic peptides, usage of mosquito and/or parasite antigens, usage of adjutants, radiation or genetically modified sporozoites and so on [36]. Different experimental evidences shed the light on the importance of novel vaccine approaches (attenuated whole sporozoites) which strongly confirms the role of APCs resides in the liver capable to recruit CD 8+ T cells together with the cytokines (IFN-γ and TNF-α) required for the sterile protection [21, 37–43]. Despite the sterile immunity last longs for the 6–9 months, a recent study confirmed the usage of the intermittent challenge of radiation attenuated sporozoites in mice stay long lasting up to 18 months and give rise to sterile immunity [44]. The approach of radiation for protective immunity has gained attention in the scientific community to eradicate the morbidity and mortality of malaria infection.

### **2. Radiation and its impact on health**

Radiation is a form of energy which travels and transmits or emits from its source as a wave (ionization radiation) or in the form of electron particles (nonionizing radiation) [45]. The broad range of electromagnetic spectrum consists of harmless radio and microwaves, sunlight includes longer (infrared) and shorter (ultraviolet) wavelength and finally the higher energy specific wavelength of X-rays and gamma rays which exist the electrons from the atoms through the ionization process [45, 46]. During the process of radioactive decay there are mainly three types of ionizing radiation emitted; alpha, beta and gamma rays. Other than this, X-rays can be occurred naturally or produced by machines [47]. The major difference between this ionizing radiation (X-rays and gamma rays) is the photon's energy of individual rather than the energy of the total dose of the radiation alongside their source of origin [48].

As the entire world is in the vicinity of the radioactive environment, we all, more or less, are exposed to a certain level of background radiation [49]. It has been reported that more than 80% of human-radiation doses are uncontrolled which are mainly consist of the natural sources, terrestrial and exposure through inhalation or intake of the radiation (mainly through medication) [50].

There are more than 60 natural radionuclides are found in the environment and no place on the earth is without spontaneous radiation activity. It is mainly observed in the soils and rocks (uranium and thorium decay), in water sources such as naturally occurred lacks, rivers and oceans and Human-made buildings and homes [51]. Also, the effect of gamma radiation on natural radioactivity and their associated exposures mainly depends upon the geological and geographical location together with their appearance at different levels in the soil of the respective the region [50]. Overall, we received an average dose of 2.4 mSv/year (mSv stands for millisieverts, one-thousandth part of a sievert, an SI unit and currently used in the radiation protection standards) from the background radiation which may vary from 1 to 10 mSv/year and rely on the location of the region; however it

*Ionizing and Non-ionizing Radiation*

strategies.

inject the sporozoites to the healthy host [24].

salivary gland followed by the next blood meal of mosquito during which it will

The liver is the most important organ and known for its role in blood purification, detoxification of chemicals and metabolizes of drugs, role in the immune system and homeostasis [25]. This unique architecture of liver favors the interaction between leukocytes and hepatic cells and intra-hepatic recruitment of T cells which recognize their cognate antigen within their vicinity [26]. Among the multi-stage life cycle, liver/exoerythrocytic stage of the malaria parasite is least known due to several reasons, however recent developments of humanized mice have revealed the importance of liver stage [2]. All the same, liver stage parasites in murine and humans evade the immune clearance despite the presence of antigen presenting cells (APCs) [8]. Cytotoxic T cell (CD 8+ T cell) requires to kill the intracellular parasite infected cell as they are intracellular organism reside in the hepatocytes. Therefore long lasting immunity, reduce/remove the parasitic load in asymptomatic exoerythrocytic stage and to prevent their liver to blood stage transitions are the main concern for any malarial parasitologist to develop and improve the vaccine

**1.3 Current status of antimalarial therapy and standing of vaccine initiative**

To prevent and eradicate malaria, prophylaxis that has no adverse effect and versatile for all is an urgent requirement. Till now various antimalarial therapy of drugs, insecticide-treated bed nets and different diagnostic tests [27] are in use, however the success of malaria infection halted by the insecticide [28, 29] and parasite resistance [28, 30, 31]. This life-threatening condition needs the novel antimalarial therapy that can control parasite at different stages of its life cycle (**Figure 2**).

*Schematic diagram of intra-erythrocytic trophozoite showing targets of novel antimalarial drugs (red color indicates the drugs under the pipeline/clinical trials and green color for the drugs currently available) (adapted* 

**1.2 The liver stage infection of malaria parasites: yet hold promises**

**66**

**Figure 2.**

*and modified from [32]).*

can exceed above the 50 mSv/year. Therefore, if an average of 2 mSv/year of the radiation dose exposed to an individual, the person at the age of 80 years will be accumulated almost 160 mSv radiation originated from the natural sources [50].

### **2.1 Radiation biology**

The term radiation biology came across into the picture during 1963 when Bergonie and Tribondeau assumed and stated that the immature, undifferentiated and continuously dividing cells are more prone towards the radiation with compare to the cells which are fully matured, differentiated and not actively participated in the cell division process [52]. Therefore, the radiosensitive cells such as stem cells, the stratum basal of the skin and stomach mucosa; continuously experiencing cell division (mitosis) and exhibits certain effects after the exposure towards the ionizing radiation resulting into the cell death or cell injury. Contradictory, the radioresistant cells such as neurons which never divides or do it very slowly show less inclined towards the cell injury or death after the radiation exposure [53]. The experiments carried out on fruit flies and mice have shown the effects of radiation as mutation was occurred however, it was notified that all the mutation were similar to the spontaneously generated one. Also, it was linked to the dose and exposure rate of the respective ionizing radiation [54].

### *2.1.1 Interaction between radiation and human cells*

The interaction of human cells and radiation is just the likelihood and therefore, any permanent damage occurs to the tissues is not due to the facing off them each other during the cellular repair mechanism [53]. The processes of energy deposition have not any signature pattern (very rapid, 10<sup>−</sup>18 s) and the interaction takes place at the cellular level affect the organ as well as the entire system [45]. Alongside, there is no established cellular damage associated with the radiation, and heat, chemical or physical damage is also accounted for the same. The destruction occurs as a result of radiation towards the cells has the latent period followed by observable responses. The latent period remains for a prolonged time in case of low radiation whereas, it accounts for minutes to hours for the higher dose of radiation and the radiation biology entirely rely on these basic principles [53, 55].

The interaction of ionizing radiation with the cells, possibly occur through any of the two ways; direct interaction within the cells hit the macromolecules (proteins and DNA) resulting into the death of the cells or the mutation of the DNA. This mechanism can happen during the higher doses of the radiation as the cellular repair mechanism is tightly regulated [53]. Another one is the indirect pathway where the radiation energy is trapped inside the cellular compartment and interacts with the water rather than macromolecules followed by hydrolysis of water produced the free radicals inside the cells [53, 56]. This will lead to the loss of the important enzymes resulting in the cell death or the mutation. As the result of an interaction, there are mainly three types of cellular injury arises: (1) delayed division, (2) failure of the reproduction and (3) death during the interphase of the cell cycle [53].

The intensity of the damage occurs inside the cells rely upon various parameters including the types and its source, duration, doses, exposure and its energy [57]. The knowledge about the risk of the radiation has been studied, documented and referred well from the survivor of the atomic bombs at Hiroshima and Nagasaki in the Japan during the Second World War. Also, the additional inputs are given by the studies conducted on the radiation industry workers [45].

**69**

**Figure 3.**

*therapeutics (adapted from [62] with permission).*

*Application of Radiation Technology: A Novel Vaccine Approach to Induce Protective Immunity…*

It was during the 1895, when Wilhem Roentgen has invented the X-rays to see the things visibly inside the body without surgery. This historic discovery has transformed the medical field and currently, it has been widely used to diagnose the injuries and diseases [45]. At present, more than 50% of our exposure contributed to the medical sources lead by X-rays and CT scan. Nowadays, understanding the radiation risk and their effects at molecular, cellular and organ level is mainly

*Radiation therapy and their different consequences can be used for antitumor combination therapy for cancer* 

*DOI: http://dx.doi.org/10.5772/intechopen.85491*

**2.2 Radiation therapy: application in medical research**

*Application of Radiation Technology: A Novel Vaccine Approach to Induce Protective Immunity… DOI: http://dx.doi.org/10.5772/intechopen.85491*

### **2.2 Radiation therapy: application in medical research**

*Ionizing and Non-ionizing Radiation*

rate of the respective ionizing radiation [54].

*2.1.1 Interaction between radiation and human cells*

**2.1 Radiation biology**

basic principles [53, 55].

can exceed above the 50 mSv/year. Therefore, if an average of 2 mSv/year of the radiation dose exposed to an individual, the person at the age of 80 years will be accumulated almost 160 mSv radiation originated from the natural sources [50].

The term radiation biology came across into the picture during 1963 when Bergonie and Tribondeau assumed and stated that the immature, undifferentiated and continuously dividing cells are more prone towards the radiation with compare to the cells which are fully matured, differentiated and not actively participated in the cell division process [52]. Therefore, the radiosensitive cells such as stem cells, the stratum basal of the skin and stomach mucosa; continuously experiencing cell division (mitosis) and exhibits certain effects after the exposure towards the ionizing radiation resulting into the cell death or cell injury. Contradictory, the radioresistant cells such as neurons which never divides or do it very slowly show less inclined towards the cell injury or death after the radiation exposure [53]. The experiments carried out on fruit flies and mice have shown the effects of radiation as mutation was occurred however, it was notified that all the mutation were similar to the spontaneously generated one. Also, it was linked to the dose and exposure

The interaction of human cells and radiation is just the likelihood and therefore, any permanent damage occurs to the tissues is not due to the facing off them each other during the cellular repair mechanism [53]. The processes of energy deposition have not any signature pattern (very rapid, 10<sup>−</sup>18 s) and the interaction takes place at the cellular level affect the organ as well as the entire system [45]. Alongside, there is no established cellular damage associated with the radiation, and heat, chemical or physical damage is also accounted for the same. The destruction occurs as a result of radiation towards the cells has the latent period followed by observable responses. The latent period remains for a prolonged time in case of low radiation whereas, it accounts for minutes to hours for the higher dose of radiation and the radiation biology entirely rely on these

The interaction of ionizing radiation with the cells, possibly occur through any of the two ways; direct interaction within the cells hit the macromolecules (proteins and DNA) resulting into the death of the cells or the mutation of the DNA. This mechanism can happen during the higher doses of the radiation as the cellular repair mechanism is tightly regulated [53]. Another one is the indirect pathway where the radiation energy is trapped inside the cellular compartment and interacts with the water rather than macromolecules followed by hydrolysis of water produced the free radicals inside the cells [53, 56]. This will lead to the loss of the important enzymes resulting in the cell death or the mutation. As the result of an interaction, there are mainly three types of cellular injury arises: (1) delayed division, (2) failure of the reproduction and (3) death during the interphase of the

The intensity of the damage occurs inside the cells rely upon various parameters including the types and its source, duration, doses, exposure and its energy [57]. The knowledge about the risk of the radiation has been studied, documented and referred well from the survivor of the atomic bombs at Hiroshima and Nagasaki in the Japan during the Second World War. Also, the additional inputs are given by the

studies conducted on the radiation industry workers [45].

**68**

cell cycle [53].

It was during the 1895, when Wilhem Roentgen has invented the X-rays to see the things visibly inside the body without surgery. This historic discovery has transformed the medical field and currently, it has been widely used to diagnose the injuries and diseases [45]. At present, more than 50% of our exposure contributed to the medical sources lead by X-rays and CT scan. Nowadays, understanding the radiation risk and their effects at molecular, cellular and organ level is mainly

### **Figure 3.**

*Radiation therapy and their different consequences can be used for antitumor combination therapy for cancer therapeutics (adapted from [62] with permission).*

studied for the diseases. This will bridge the gap and guide the health physicist to determine the safety level of the radiation to use in the medical, industrial and scientific world for the betterment of the mankind [45, 49, 58].

Despite the hazardous effects of radiation on the cells, if the cell death mechanism is instinct or properly targeted then it will be the achievement in the medical field for the cancer patients where it is using as radiation therapy [59]. It still remains as the preliminary cancer treatment and more than 50% of all the cancer patients received radiation therapy and stands for 40% of the curative treatment [60]. It is believed that it can evoke the tumor-specific immune response to destroy the tumor cells as well also travel to the site of the disease [61].

Recent research confirms the potential usage of radiation therapy in cancer therapeutics by converting tumor to favorable condition and makes them immunostimulatory milieu [62]. Experiential data suggest that the combination of radiotherapy alongside the immunotherapeutic agents can produce the synergistic effects (**Figure 3**) [61, 62]. From all the above-stated information, it has become clear that recent developments in radiation therapy [61, 63, 64] may have proven to be the most critical part in the successful development of cancer vaccine.

### *2.2.1 Radiation and vaccine development*

Usage of chemical and physical methods to develop a stable and safe vaccine is the gold standard method through which the pathogen will be converting into the inactive form. Despite the successful application in various medical conditions to eradicate the disease or to develop the sterile immunity; the fast, reliable and rapidly generated vaccine is required [58]. Recently, radiation sterilization is been under the process for the vaccine development which surpasses the chemical or other types of contamination. Also, it destroys the nucleic acid of the respective pathogens through penetration without disturbing the cell surface antigens. It is been in under the clinical trials for the various types of cancers [65–67] however, due to the issues of safety and other regulatory affairs it is under development at industrial level [58]. On the other side, results of current clinical trials of using the various irritated vaccines for numerous pathogens and tumors has attracted the researcher and scientific world towards the preparation of various radiationbased vaccine for various infected and non-infected diseases [61, 62, 64, 68]. The ongoing effective development of irradiated vaccines for malaria and influenza have exhibited the attainability of this approach, and have shown the promising results alongside the advantages of the radiation therapy by overcoming the limitation of existing facilities without using any sophisticated technological approach [69, 70].

### **3. Role of radiation therapy in malaria vaccine: developments and challenges**

Malaria vaccine development is an active research area with enormous challenges. An effective vaccine for *P. falciparum* is needed in malaria-endemic populations; however, none of the licensed malaria vaccines and candidates consistently produced long-lived protection [71, 72]. The malarial parasite undergoes continuous morphological changes and displays antigenic variations during the entire life cycle in both the host [73]. As a result, parasite evades the protective immune responses of the host and long-term protective immunity is not observed in malaria-infected individuals [74, 75].

**71**

date vaccine [99].

*Application of Radiation Technology: A Novel Vaccine Approach to Induce Protective Immunity…*

*Plasmodium falciparum* has a multi-stage life cycle and a large 23 Mb genome expressing 5268 putative proteins. Many of these proteins exhibit allelic variation between species or antigenic polymorphism typically at sites recognized by antibody or T cell responses [76]. To date, only a handful of the nearly 5300 potential target antigens expressed by *P. falciparum*, representing less than 0.3 percent of the genome, have been pursued as vaccine targets [76, 77]. From the host perspective, malaria is a chronic infection and the *Plasmodium* parasite is capable of evading or modulating the host immune response. Based on the life cycle of the malaria parasite and the process of infection, malaria vaccines are divided into four potential target groups; interruption of human to mosquito transmission (parasite sexual and mosquito stages), inhibition of clinical consequences (asexual blood stage), prevention of mosquito to human transmission, and pre-erythrocytic infections (sporozoite [SPZ]/liver stages) [78]. As per the recent advancement in the malaria vaccine development mainly three types of vaccine candidate targeting different stages of malaria parasite have been intensively investigated named as pre-erythrocytic vaccines, blood-stage vaccines and

The pre-erythrocytic stage does not cause clinical disease, and there is no convincing evidence for naturally acquired protective immunity to this stage in individuals living in malaria-endemic areas [81]. Thus, this stage would appear to be an unattractive vaccine target. Nonetheless, the most advanced vaccine in development is a protein expressed at this stage that covers the parasite surface, the circumsporozoite protein (CSP). One of the most advanced anti-malaria vaccines at a clinical level is the RTS,S/AS01, a subunit vaccine consisting of the *P. falciparum* CSP fused with the hepatitis B surface antigen (HBsAg) [82–85]. Although this vaccine did not appear to elicit a CD8<sup>+</sup> T cell response, CSP-HBsAg induced a

by which RTS,S confers protection against the blood-stage disease remains poorly understood. It seems that RTS,S induces protection against clinical malaria by temporarily reducing the number of merozoites emerging from the liver [69]. This may allow prolonged exposure to subclinical levels of asexual blood-stage para-

Blood-stage vaccines work on the principle of anti-invasion and anti-disease responses by blocking the invasion of erythrocytes by merozoites and preventing malarial disease [88]. The extensive genetic diversity of the parasite and the selective pressure are factors to be considered in the development of effective blood-stage vaccines. At present, several blood-stage antigens are in clinical trials: apical membrane antigen 1 (AMA1) [89], erythrocyte-binding antigen-175 (EBA-175) [90], glutamate-rich protein (GLURP) [91, 92], merozoite surface protein (MSP) 1 [93], MSP2 [94], MSP3 [95–97] and serine repeat antigen 5 (SERA5) [98]. All these antigens are highly expressed on the surface of merozoites. During the blood-stage vaccine development various assay such as ELISA, western blot and immunofluorescence assay, invasion inhibitory assay, antibody-dependent cellular inhibition (ADCI) assay, phagocytosis/opsonization assay, T cell-based assay and other antibody-based assays are in use for their screening of the candi-

sites, therefore boosting the naturally acquired blood-stage immunity.

T cell response targeting the whole SPZs [86, 87]. The mechanism

*DOI: http://dx.doi.org/10.5772/intechopen.85491*

transmission-blocking vaccines [79, 80].

**3.1 Pre-erythrocytic vaccines**

specific CD4<sup>+</sup>

**3.2 Blood stage vaccines**

*Application of Radiation Technology: A Novel Vaccine Approach to Induce Protective Immunity… DOI: http://dx.doi.org/10.5772/intechopen.85491*

*Plasmodium falciparum* has a multi-stage life cycle and a large 23 Mb genome expressing 5268 putative proteins. Many of these proteins exhibit allelic variation between species or antigenic polymorphism typically at sites recognized by antibody or T cell responses [76]. To date, only a handful of the nearly 5300 potential target antigens expressed by *P. falciparum*, representing less than 0.3 percent of the genome, have been pursued as vaccine targets [76, 77]. From the host perspective, malaria is a chronic infection and the *Plasmodium* parasite is capable of evading or modulating the host immune response. Based on the life cycle of the malaria parasite and the process of infection, malaria vaccines are divided into four potential target groups; interruption of human to mosquito transmission (parasite sexual and mosquito stages), inhibition of clinical consequences (asexual blood stage), prevention of mosquito to human transmission, and pre-erythrocytic infections (sporozoite [SPZ]/liver stages) [78]. As per the recent advancement in the malaria vaccine development mainly three types of vaccine candidate targeting different stages of malaria parasite have been intensively investigated named as pre-erythrocytic vaccines, blood-stage vaccines and transmission-blocking vaccines [79, 80].

### **3.1 Pre-erythrocytic vaccines**

*Ionizing and Non-ionizing Radiation*

studied for the diseases. This will bridge the gap and guide the health physicist to determine the safety level of the radiation to use in the medical, industrial and

Despite the hazardous effects of radiation on the cells, if the cell death mechanism is instinct or properly targeted then it will be the achievement in the medical field for the cancer patients where it is using as radiation therapy [59]. It still remains as the preliminary cancer treatment and more than 50% of all the cancer patients received radiation therapy and stands for 40% of the curative treatment [60]. It is believed that it can evoke the tumor-specific immune response to destroy the tumor

Recent research confirms the potential usage of radiation therapy in cancer therapeutics by converting tumor to favorable condition and makes them immunostimulatory milieu [62]. Experiential data suggest that the combination of radiotherapy alongside the immunotherapeutic agents can produce the synergistic effects (**Figure 3**) [61, 62]. From all the above-stated information, it has become clear that recent developments in radiation therapy [61, 63, 64] may have proven to be the

Usage of chemical and physical methods to develop a stable and safe vaccine is the gold standard method through which the pathogen will be converting into the inactive form. Despite the successful application in various medical conditions to eradicate the disease or to develop the sterile immunity; the fast, reliable and rapidly generated vaccine is required [58]. Recently, radiation sterilization is been under the process for the vaccine development which surpasses the chemical or other types of contamination. Also, it destroys the nucleic acid of the respective pathogens through penetration without disturbing the cell surface antigens. It is been in under the clinical trials for the various types of cancers [65–67] however, due to the issues of safety and other regulatory affairs it is under development at industrial level [58]. On the other side, results of current clinical trials of using the various irritated vaccines for numerous pathogens and tumors has attracted the researcher and scientific world towards the preparation of various radiationbased vaccine for various infected and non-infected diseases [61, 62, 64, 68]. The ongoing effective development of irradiated vaccines for malaria and influenza have exhibited the attainability of this approach, and have shown the promising results alongside the advantages of the radiation therapy by overcoming the limitation of existing facilities without using any sophisticated technological

**3. Role of radiation therapy in malaria vaccine: developments and** 

Malaria vaccine development is an active research area with enormous challenges. An effective vaccine for *P. falciparum* is needed in malaria-endemic populations; however, none of the licensed malaria vaccines and candidates consistently produced long-lived protection [71, 72]. The malarial parasite undergoes continuous morphological changes and displays antigenic variations during the entire life cycle in both the host [73]. As a result, parasite evades the protective immune responses of the host and long-term protective immunity is not observed in

scientific world for the betterment of the mankind [45, 49, 58].

most critical part in the successful development of cancer vaccine.

cells as well also travel to the site of the disease [61].

*2.2.1 Radiation and vaccine development*

**70**

approach [69, 70].

**challenges**

malaria-infected individuals [74, 75].

The pre-erythrocytic stage does not cause clinical disease, and there is no convincing evidence for naturally acquired protective immunity to this stage in individuals living in malaria-endemic areas [81]. Thus, this stage would appear to be an unattractive vaccine target. Nonetheless, the most advanced vaccine in development is a protein expressed at this stage that covers the parasite surface, the circumsporozoite protein (CSP). One of the most advanced anti-malaria vaccines at a clinical level is the RTS,S/AS01, a subunit vaccine consisting of the *P. falciparum* CSP fused with the hepatitis B surface antigen (HBsAg) [82–85]. Although this vaccine did not appear to elicit a CD8<sup>+</sup> T cell response, CSP-HBsAg induced a specific CD4<sup>+</sup> T cell response targeting the whole SPZs [86, 87]. The mechanism by which RTS,S confers protection against the blood-stage disease remains poorly understood. It seems that RTS,S induces protection against clinical malaria by temporarily reducing the number of merozoites emerging from the liver [69]. This may allow prolonged exposure to subclinical levels of asexual blood-stage parasites, therefore boosting the naturally acquired blood-stage immunity.

### **3.2 Blood stage vaccines**

Blood-stage vaccines work on the principle of anti-invasion and anti-disease responses by blocking the invasion of erythrocytes by merozoites and preventing malarial disease [88]. The extensive genetic diversity of the parasite and the selective pressure are factors to be considered in the development of effective blood-stage vaccines. At present, several blood-stage antigens are in clinical trials: apical membrane antigen 1 (AMA1) [89], erythrocyte-binding antigen-175 (EBA-175) [90], glutamate-rich protein (GLURP) [91, 92], merozoite surface protein (MSP) 1 [93], MSP2 [94], MSP3 [95–97] and serine repeat antigen 5 (SERA5) [98]. All these antigens are highly expressed on the surface of merozoites. During the blood-stage vaccine development various assay such as ELISA, western blot and immunofluorescence assay, invasion inhibitory assay, antibody-dependent cellular inhibition (ADCI) assay, phagocytosis/opsonization assay, T cell-based assay and other antibody-based assays are in use for their screening of the candidate vaccine [99].

### **3.3 Transmission-blocking vaccines**

Transmission-blocking vaccines (TBV) target antigens on gametes, zygotes and ookinetes to prevent parasite development in the mosquito midgut [88, 100]. The aim of these vaccines is to induce antibodies against the sexual-stage antigens to block the ookinete-to-oocyst transition to stop the subsequent generation of infectious sporozoites thereby acting as important tools for protection against epidemics [101, 102]. The leading vaccine candidates in this group include the *P. falciparum* ookinete surface antigens Pfs25 and Pfs28 and their *P. vivax* homologs Pvs25 and Pvs28. To improve the immunogenicity, Pfs25 was expressed as a recombinant protein that was chemically cross-linked to Exoprotein A and delivered as nanoparticles [103]. This enhanced the immunogenicity of the vaccine in mice, and it is currently undergoing Phase I trials in humans. Because the antigens are never naturally presented to the human immune system, one of the potential limitations of the TBV approach is that the absence of natural boosting following immunization might limit efficacy [88]. The vaccine would confer no protection to the vaccinated individual unless combined with an effective pre-erythrocytic or erythrocytic vaccine. Nevertheless, TBVs could be important tools for a malaria elimination and eradication program, for prevention of transmission of the disease [88].

### **3.4 Novel usages of radiation attenuated sporozoites (RAS) and effects on the host immunity**

A recent landmark finding that set the standards for immunological protection against malaria infection was established by immunization with irradiated sporozoites [82, 104]. Because the parasite undergoes morphological changes and displays antigenic variation at each stage of infection, whole parasite vaccines have an advantage [105–107]. In the early 1940s, Russell and Mohan [104] first demonstrated that inactivated *P. gallinaceum* SPZs provided protection against challenge with infectious *P. gallinaceum*. In 1967, Nussenzweig et al. [82] reported that a killed *P. berghei* sporozoites (SPZs) vaccine was unsuccessful, but that an X-ray irradiated SPZ vaccine provided significant protection in an SPZ-challenge mouse model.

In the 1970s, researchers showed that immunizing human volunteers with bites from irradiated mosquitoes carrying *P. falciparum* SPZS (PfSPZ) or *P. vivax* SPZ (PvSPZs) provided protection against challenges with infectious SPZ [108–112]. Because infected mosquitoes cannot be used for immunizing large numbers of individuals, a team at the Vaccine Research Center, NIH developed an injectable and cryo-preserved irradiated PfSPZ vaccine that met the vaccine regulatory standards [58, 113]. The group succeeded in raising mosquitoes on an industrial scale to good manufacturing practice (GMP) levels and harvested large amounts of PfSPZ from the mosquito salivary glands. Although studies provided proof of concept that sporozoites could induce high-level immunity, as a vaccine for human use, PfRAS immunization was deemed impractical for many decades due to the complexity of administering a vaccine through natural way of mosquito bite, the requirement for a secure vivarium and a laboratory for maintaining *P. falciparum* in culture, and the perceived need for five or more immunization sessions to achieve a sufficient number of bites. Recently, it has been demonstrated that the Sanaria PfSPZ vaccine is safe, well tolerated, easily administered by syringe using a variety of routes, and can induce 100% protective efficacy against controlled human malaria infection (CHMI) when administered intravenously [109, 114].

**73**

*Application of Radiation Technology: A Novel Vaccine Approach to Induce Protective Immunity…*

The sterile immunity induced by RAS appears to be mediated primarily by

subunit vaccines suggests that a better understanding of RAS-induced protective mechanisms may provide a rationale to develop alternative or improved subunit strategies using newly discovered antigens or more potently inducing cell-mediated immunity. Despite all difficulties, the most convincing evidence that vaccination against malaria is feasible has come from experimental studies in rodents, monkeys and human subjects in which attenuated sporozoites induced sterile protective

**3.5 Current status and future development: role of radiation in malaria vaccine** 

The first whole sporozoites vaccine (WSV) studied in both rodents and humans were RAS and also the first to confer protection in humans when administered by mosquito bites. A major advance for vaccine development was the ability to isolate a purified, aseptic, and cryo-preserved product of RAS for clinical trials (PfSPZ vaccine). A subsequent scientific advance showed that intravenous (IV) administration of PfSPZ vaccine was required for inducing potent immunity in humans [109]. These studies provided the first evidence for using IV administration of a preventive vaccine in humans. More recent results with PfSPZ vaccine from sub-Saharan Africa reported that PfSPZ vaccine was well tolerated, safe, and easy to administer by direct venous inoculation (DVI) of healthy volunteers in the clinical trial setting. The proportion of participants with any infection from 28 days after the fifth vaccination to the end of the malaria season (20 weeks) was lower in the vaccinated group than in the control group [126]. These data suggest that WSV can provide some protection against malaria infection during intense transmission (93% infection rate among placebos) [79]. Recent progress in manufacturing whole organism vaccines has prompted several vaccinology questions: (1) Can whole sporozoite vaccines be improved? (2) What are the optimal doses, routes of administration, and adjuvants that confer sterilizing immunity? (3) Can other antigens be included? (4) Are we exploring all protective immune mechanisms? (5) Does efficacy differ in populations from endemic versus non-endemic areas? (6) What is the impact of

The future lies in improving dosing strategy, immunogenicity enhancement, and/ or alternative vaccine approach for populations in malaria-endemic regions. To halt the spreading of the malaria infection is not only the development of the vaccine against it, however; the mosquito biology equally holds the importance in understanding the malaria pathophysiology and parasite biology which may be understand more in detailed by radiation biology [127]. Combination of different approaches based on attenuated whole organism sporozoites may be a valuable tool that would help unearth

sporozoites and liver-stage parasites [115–118]. Antibodies also appear to contribute to protection. Studies in mice and humans show that immunization with RAS induces sporozoite-neutralizing antibodies that recognize the CSP, an abundant protein forming the surface coat of the sporozoites [109, 119, 120]. This finding led to the cloning of *P. falciparum* CSP and the formulation of several CSP-based sub-unit vaccines designed to induce protective antibodies [121, 122]. Although efficacy was low, subsequent development of CSP using a particle-based approach has led to the currently most advanced malaria sub-unit vaccine, RTS, S/AS01, that elicits 30% protection in young children [123] primarily mediated by anti-CSP

T cell-dependent mechanisms targeting antigens expressed by

T cells [124, 125]. The partial efficacy of these first generation

*DOI: http://dx.doi.org/10.5772/intechopen.85491*

CD8+

and CD4+

antibodies and CD4+

**development**

antigen polymorphisms? [80].

immunity.

*Application of Radiation Technology: A Novel Vaccine Approach to Induce Protective Immunity… DOI: http://dx.doi.org/10.5772/intechopen.85491*

The sterile immunity induced by RAS appears to be mediated primarily by CD8+ and CD4+ T cell-dependent mechanisms targeting antigens expressed by sporozoites and liver-stage parasites [115–118]. Antibodies also appear to contribute to protection. Studies in mice and humans show that immunization with RAS induces sporozoite-neutralizing antibodies that recognize the CSP, an abundant protein forming the surface coat of the sporozoites [109, 119, 120]. This finding led to the cloning of *P. falciparum* CSP and the formulation of several CSP-based sub-unit vaccines designed to induce protective antibodies [121, 122]. Although efficacy was low, subsequent development of CSP using a particle-based approach has led to the currently most advanced malaria sub-unit vaccine, RTS, S/AS01, that elicits 30% protection in young children [123] primarily mediated by anti-CSP antibodies and CD4+ T cells [124, 125]. The partial efficacy of these first generation subunit vaccines suggests that a better understanding of RAS-induced protective mechanisms may provide a rationale to develop alternative or improved subunit strategies using newly discovered antigens or more potently inducing cell-mediated immunity. Despite all difficulties, the most convincing evidence that vaccination against malaria is feasible has come from experimental studies in rodents, monkeys and human subjects in which attenuated sporozoites induced sterile protective immunity.

### **3.5 Current status and future development: role of radiation in malaria vaccine development**

The first whole sporozoites vaccine (WSV) studied in both rodents and humans were RAS and also the first to confer protection in humans when administered by mosquito bites. A major advance for vaccine development was the ability to isolate a purified, aseptic, and cryo-preserved product of RAS for clinical trials (PfSPZ vaccine). A subsequent scientific advance showed that intravenous (IV) administration of PfSPZ vaccine was required for inducing potent immunity in humans [109]. These studies provided the first evidence for using IV administration of a preventive vaccine in humans. More recent results with PfSPZ vaccine from sub-Saharan Africa reported that PfSPZ vaccine was well tolerated, safe, and easy to administer by direct venous inoculation (DVI) of healthy volunteers in the clinical trial setting. The proportion of participants with any infection from 28 days after the fifth vaccination to the end of the malaria season (20 weeks) was lower in the vaccinated group than in the control group [126]. These data suggest that WSV can provide some protection against malaria infection during intense transmission (93% infection rate among placebos) [79]. Recent progress in manufacturing whole organism vaccines has prompted several vaccinology questions: (1) Can whole sporozoite vaccines be improved? (2) What are the optimal doses, routes of administration, and adjuvants that confer sterilizing immunity? (3) Can other antigens be included? (4) Are we exploring all protective immune mechanisms? (5) Does efficacy differ in populations from endemic versus non-endemic areas? (6) What is the impact of antigen polymorphisms? [80].

The future lies in improving dosing strategy, immunogenicity enhancement, and/ or alternative vaccine approach for populations in malaria-endemic regions. To halt the spreading of the malaria infection is not only the development of the vaccine against it, however; the mosquito biology equally holds the importance in understanding the malaria pathophysiology and parasite biology which may be understand more in detailed by radiation biology [127]. Combination of different approaches based on attenuated whole organism sporozoites may be a valuable tool that would help unearth

*Ionizing and Non-ionizing Radiation*

**host immunity**

model.

**3.3 Transmission-blocking vaccines**

Transmission-blocking vaccines (TBV) target antigens on gametes, zygotes and ookinetes to prevent parasite development in the mosquito midgut [88, 100]. The aim of these vaccines is to induce antibodies against the sexual-stage antigens to block the ookinete-to-oocyst transition to stop the subsequent generation of infectious sporozoites thereby acting as important tools for protection against epidemics [101, 102]. The leading vaccine candidates in this group include the *P. falciparum* ookinete surface antigens Pfs25 and Pfs28 and their *P. vivax* homologs Pvs25 and Pvs28. To improve the immunogenicity, Pfs25 was expressed as a recombinant protein that was chemically cross-linked to Exoprotein A and delivered as nanoparticles [103]. This enhanced the immunogenicity of the vaccine in mice, and it is currently undergoing Phase I trials in humans. Because the antigens are never naturally presented to the human immune system, one of the potential limitations of the TBV approach is that the absence of natural boosting following immunization might limit efficacy [88]. The vaccine would confer no protection to the vaccinated individual unless combined with an effective pre-erythrocytic or erythrocytic vaccine. Nevertheless, TBVs could be important tools for a malaria elimination and

eradication program, for prevention of transmission of the disease [88].

**3.4 Novel usages of radiation attenuated sporozoites (RAS) and effects on the** 

A recent landmark finding that set the standards for immunological protection against malaria infection was established by immunization with irradiated sporozoites [82, 104]. Because the parasite undergoes morphological changes and displays antigenic variation at each stage of infection, whole parasite vaccines have an advantage [105–107]. In the early 1940s, Russell and Mohan [104] first demonstrated that inactivated *P. gallinaceum* SPZs provided protection against challenge with infectious *P. gallinaceum*. In 1967, Nussenzweig et al. [82] reported that a killed *P. berghei* sporozoites (SPZs) vaccine was unsuccessful, but that an X-ray irradiated SPZ vaccine provided significant protection in an SPZ-challenge mouse

In the 1970s, researchers showed that immunizing human volunteers with bites from irradiated mosquitoes carrying *P. falciparum* SPZS (PfSPZ) or *P. vivax* SPZ (PvSPZs) provided protection against challenges with infectious SPZ [108–112]. Because infected mosquitoes cannot be used for immunizing large numbers of individuals, a team at the Vaccine Research Center, NIH developed an injectable and cryo-preserved irradiated PfSPZ vaccine that met the vaccine regulatory standards [58, 113]. The group succeeded in raising mosquitoes on an industrial scale to good manufacturing practice (GMP) levels and harvested large amounts of PfSPZ from the mosquito salivary glands. Although studies provided proof of concept that sporozoites could induce high-level immunity, as a vaccine for human use, PfRAS immunization was deemed impractical for many decades due to the complexity of administering a vaccine through natural way of mosquito bite, the requirement for a secure vivarium and a laboratory for maintaining *P. falciparum* in culture, and the perceived need for five or more immunization sessions to achieve a sufficient number of bites. Recently, it has been demonstrated that the Sanaria PfSPZ vaccine is safe, well tolerated, easily administered by syringe using a variety of routes, and can induce 100% protective efficacy against controlled human malaria infection (CHMI) when administered

**72**

intravenously [109, 114].

host mechanisms of protection as well as surrogate measures of immune protection for malaria, thus providing crucial leads towards discovery of long-awaited vaccine [128].

### **4. Conclusion**

Malaria is one of the most fatal diseases in the world related to humans in terms of morbidity and mortality. The asexual blood stage *P. falciparum* culture *in vitro* was successfully achieved in the early 1980s. However, various aspects related to their life cycle are unclear. The technological advancements in the field of epidemiology and entomology supported the research not only in reducing the burden but also allow scientists to go one step further in malaria parasitology by the staining the different stages of the parasites. The reports of the emergence of drug resistance in last decade against the various *Plasmodia* strains resulted in the serious condition to find out the causes. Given this bleak situation, the need to develop additional control measures, such as the malaria vaccine, is indeed. Understanding the mechanism of protective immunity to natural infection is critical in engineering an effective vaccine. The usage of radiation therapy in various medical fields has gained the attention of the malarial biologist to make the next generation vaccines for the long-lasting immunity. Various approaches through whole sporozoites vaccines may prove to be the better vaccine candidates, however, the obstacles related to their manufacturing, formulation, and availability to mankind needs further experimental validation.

### **Acknowledgement**

Authors would like to thank the Department of Science & Technology (DST-SERB; grant number: EMR/2014/000543) and Department of Biotechnology (DBT; grant number: BT/PR7857/BRB/10/1215/2013), Govt. of India for providing financial support to SKD, and the Council of Scientific and Industrial Research (CSIR), New Delhi, Govt. of India for providing fellowship (CSIR-SRF HRDG No.: 09/1048(0009)/2018-EMR-I) to Mr. Nikunj Tandel.

### **Conflict of interest**

The authors declare that they have no competing interests.

### **Author details**

Nikunj Tandel, Devang Trivedi, Aditi Mohan Krishnan and Sarat Kumar Dalai\* Institute of Science, Nirma University, Ahmedabad, Gujarat, India

\*Address all correspondence to: sarat.dalai@nirmauni.ac.in

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

**75**

*Application of Radiation Technology: A Novel Vaccine Approach to Induce Protective Immunity…*

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[12] Sidjanski S, Vanderberg JP. Delayed migration of plasmodium sporozoites from the mosquito bite site to the blood. The American Journal of Tropical Medicine and Hygiene.

[13] Yamauchi LM, Coppi A, Snounou G, Sinnis P. Plasmodium sporozoites trickle out of the injection site. Cellular Microbiology. 2007;**9**(5):1215-1222

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*Application of Radiation Technology: A Novel Vaccine Approach to Induce Protective Immunity… DOI: http://dx.doi.org/10.5772/intechopen.85491*

### **References**

*Ionizing and Non-ionizing Radiation*

**4. Conclusion**

**74**

**Author details**

**Acknowledgement**

**Conflict of interest**

Nikunj Tandel, Devang Trivedi, Aditi Mohan Krishnan and Sarat Kumar Dalai\*

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

Authors would like to thank the Department of Science & Technology (DST-SERB; grant number: EMR/2014/000543) and Department of Biotechnology (DBT; grant number: BT/PR7857/BRB/10/1215/2013), Govt. of India for providing financial support to SKD, and the Council of Scientific and Industrial Research (CSIR), New Delhi, Govt. of India for providing fellowship (CSIR-SRF HRDG No.:

host mechanisms of protection as well as surrogate measures of immune protection for malaria, thus providing crucial leads towards discovery of long-awaited vaccine [128].

Malaria is one of the most fatal diseases in the world related to humans in terms of morbidity and mortality. The asexual blood stage *P. falciparum* culture *in vitro* was successfully achieved in the early 1980s. However, various aspects related to their life cycle are unclear. The technological advancements in the field of epidemiology and entomology supported the research not only in reducing the burden but also allow scientists to go one step further in malaria parasitology by the staining the different stages of the parasites. The reports of the emergence of drug resistance in last decade against the various *Plasmodia* strains resulted in the serious condition to find out the causes. Given this bleak situation, the need to develop additional control measures, such as the malaria vaccine, is indeed. Understanding the mechanism of protective immunity to natural infection is critical in engineering an effective vaccine. The usage of radiation therapy in various medical fields has gained the attention of the malarial biologist to make the next generation vaccines for the long-lasting immunity. Various approaches through whole sporozoites vaccines may prove to be the better vaccine candidates, however, the obstacles related to their manufacturing, formulation, and availability to mankind needs further experimental validation.

Institute of Science, Nirma University, Ahmedabad, Gujarat, India

The authors declare that they have no competing interests.

\*Address all correspondence to: sarat.dalai@nirmauni.ac.in

provided the original work is properly cited.

09/1048(0009)/2018-EMR-I) to Mr. Nikunj Tandel.

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*Application of Radiation Technology: A Novel Vaccine Approach to Induce Protective Immunity…*

by intravenous immunization with a nonreplicating sporozoite vaccine. Science. 2013;**341**(6152):1359-1365

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[112] Epstein JE, Tewari K, Lyke K, Sim B, Billingsley P, Laurens M, et al. Live attenuated malaria vaccine designed to protect through hepatic CD8+ T cell immunity. Science. 2011;**334**(6055):475-480

[113] Luke TC, Hoffman SL. Rationale and plans for developing a nonreplicating, metabolically active, radiation-attenuated *Plasmodium falciparum* sporozoite vaccine. Journal of Experimental Biology.

[114] Richie TL, Billingsley PF, Sim BKL, James ER, Chakravarty S, Epstein JE, et al. Progress with *Plasmodium falciparum* sporozoite (PfSPZ) based malaria vaccines. Vaccine.

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[116] Wizel B, Houghten R, Church P, Tine JA, Lanar DE, Gordon DM, et al. HLA-A2-restricted cytotoxic T lymphocyte responses to multiple *Plasmodium falciparum* sporozoite

2003;**206**(21):3803-3808

2015;**33**(52):7452-7461

1991;**88**(8):3300-3304

2013;**26**(5):420-428

*DOI: http://dx.doi.org/10.5772/intechopen.85491*

*P. falciparum* in endemic populations.

[103] Scaria PV, Chen B, Rowe CG, Jones DS, Barnafo E, Fischer ER, et al. Protein-protein conjugate nanoparticles

for malaria antigen delivery and enhanced immunogenicity. PLoS One.

[104] Russell PF, Mohan B. The immunization of fowls against mosquito-borne *Plasmodium* 

*gallinaceum* by injections of serum and of inactivated homologous sporozoites. Journal of Experimental Medicine.

[105] Hoffman SL, Goh LM, Luke TC, Schneider I, Le TP, Doolan DL, et al. Protection of humans against malaria by immunization with radiationattenuated *Plasmodium falciparum* sporozoites. The Journal of Infectious Diseases. 2002;**185**(8):1155-1164

[106] Roestenberg M, McCall M, Hopman J, Wiersma J, Luty AJ, van Gemert GJ, et al. Protection against a malaria challenge by sporozoite inoculation. New England Journal of Medicine. 2009;**361**(5):468-477

[107] Roestenberg M, Teirlinck AC, McCall MB, Teelen K, Makamdop KN, Wiersma J, et al. Long-term protection against malaria after experimental sporozoite inoculation: An openlabel follow-up study. The Lancet.

[108] Laurens MB, Billingsley P, Richman A, Eappen AG, Adams M, Li T, et al. Successful human infection with *P. falciparum* using three aseptic *Anopheles stephensi* mosquitoes: A new model for controlled human malaria infection.

2011;**377**(9779):1770-1776

PLoS One. 2013;**8**(7):e68969

[109] Seder RA, Chang L-J, Enama ME, Zephir KL, Sarwar UN, Gordon IJ, et al. Protection against malaria

Current Molecular Medicine.

2006;**6**(2):223-229

2017;**12**(12):e0190312

1942;**76**(5):477-495

*Application of Radiation Technology: A Novel Vaccine Approach to Induce Protective Immunity… DOI: http://dx.doi.org/10.5772/intechopen.85491*

*P. falciparum* in endemic populations. Current Molecular Medicine. 2006;**6**(2):223-229

*Ionizing and Non-ionizing Radiation*

2017;**13**(9):2098-2101

2010;**120**(12):4168-4178

alternative development plan. Human Vaccines and Immunotherapeutics.

parasite populations in a phase 1-2b trial in Papua New Guinea. The Journal of Infectious Diseases. 2002;**185**(6):820-827

[95] Audran R, Cachat M, Lurati F, Soe S, Leroy O, Corradin G, et al. Phase I malaria vaccine trial with a long synthetic peptide derived from the merozoite surface protein 3 antigen. Infection and Immunity. 2005;**73**(12):8017-8026

[96] Sirima SB, Tiono AB, Ouédraogo A, Diarra A, Ouédraogo AL, Yaro JB, et al. Safety and immunogenicity of the malaria vaccine candidate MSP3 long synthetic peptide in 12-24 monthsold Burkinabe children. PLoS One.

[97] Druilhe P, Spertini F, Soesoe D, Corradin G, Mejia P, Singh S, et al. A malaria vaccine that elicits in humans antibodies able to kill

[98] Horii T, Shirai H, Jie L, Ishii KJ, Palacpac NQ, Tougan T, et al. Evidences of protection against blood-stage infection of *Plasmodium falciparum* by the novel protein vaccine SE36. Parasitology International.

*Plasmodium falciparum*. PLoS Medicine.

[99] Miura K. Progress and prospects for blood-stage malaria vaccines. Expert Review of Vaccines. 2016;**15**(6):765-781

[100] Carter R, Mendis KN, Miller LH, Molineaux L, Saul A. Malaria transmission-blocking vaccines—How can their development be supported? Nature Medicine. 2000;**6**(3):241

[101] Graves PM, Carters R, Burkot TR, Quakyi IA, Kumar N. Antibodies to *Plasmodium falciparum* gamete surface antigens in Papua New Guinea sera. Parasite Immunology.

[102] Bousema J, Drakeley C, Sauerwein R. Sexual-stage antibody responses to

2009;**4**(10):e7549

2005;**2**(11):e344

2010;**59**(3):380-386

1988;**10**(2):209-218

[88] Crompton PD, Pierce SK, Miller LH. Advances and challenges in malaria vaccine development. The Journal of Clinical Investigation.

[89] Sagara I, Dicko A, Ellis RD, Fay MP, Diawara SI, Assadou MH, et al. A randomized controlled phase 2 trial of the blood stage AMA1-C1/Alhydrogel malaria vaccine in children in Mali. Vaccine. 2009;**27**(23):3090-3098

[90] El Sahly H, Patel S, Atmar R, Lanford T, Dube T, Thompson D, et al. The safety and immunogenicity of recombinant EBA 175-RII NG malaria vaccine in healthy adults living in a non-endemic area. Clinical and Vaccine Immunology. 2010;**17**(10):1552-1559

[91] Esen M, Kremsner PG, Schleucher R, Gässler M, Imoukhuede EB, Imbault N, et al. Safety and immunogenicity of GMZ2—A MSP3–GLURP fusion protein malaria vaccine candidate. Vaccine.

[92] Hermsen CC, Verhage DF, Telgt DS, Teelen K, Bousema JT, Roestenberg M, et al. Glutamate-rich protein (GLURP) induces antibodies that inhibit in vitro growth of *Plasmodium falciparum* in a phase 1 malaria vaccine trial. Vaccine.

[93] Ogutu BR, Apollo OJ, McKinney D, Okoth W, Siangla J, Dubovsky F, et al. Blood stage malaria vaccine eliciting high antigen-specific antibody concentrations confers no protection to young children in Western Kenya. PLoS

[94] Genton B, Betuela I, Felger I, Al-Yaman F, Anders RF, Saul A, et al. A recombinant blood-stage malaria vaccine reduces *Plasmodium falciparum* density and exerts selective pressure on

2009;**27**(49):6862-6868

2007;**25**(15):2930-2940

One. 2009;**4**(3):e4708

**80**

[103] Scaria PV, Chen B, Rowe CG, Jones DS, Barnafo E, Fischer ER, et al. Protein-protein conjugate nanoparticles for malaria antigen delivery and enhanced immunogenicity. PLoS One. 2017;**12**(12):e0190312

[104] Russell PF, Mohan B. The immunization of fowls against mosquito-borne *Plasmodium gallinaceum* by injections of serum and of inactivated homologous sporozoites. Journal of Experimental Medicine. 1942;**76**(5):477-495

[105] Hoffman SL, Goh LM, Luke TC, Schneider I, Le TP, Doolan DL, et al. Protection of humans against malaria by immunization with radiationattenuated *Plasmodium falciparum* sporozoites. The Journal of Infectious Diseases. 2002;**185**(8):1155-1164

[106] Roestenberg M, McCall M, Hopman J, Wiersma J, Luty AJ, van Gemert GJ, et al. Protection against a malaria challenge by sporozoite inoculation. New England Journal of Medicine. 2009;**361**(5):468-477

[107] Roestenberg M, Teirlinck AC, McCall MB, Teelen K, Makamdop KN, Wiersma J, et al. Long-term protection against malaria after experimental sporozoite inoculation: An openlabel follow-up study. The Lancet. 2011;**377**(9779):1770-1776

[108] Laurens MB, Billingsley P, Richman A, Eappen AG, Adams M, Li T, et al. Successful human infection with *P. falciparum* using three aseptic *Anopheles stephensi* mosquitoes: A new model for controlled human malaria infection. PLoS One. 2013;**8**(7):e68969

[109] Seder RA, Chang L-J, Enama ME, Zephir KL, Sarwar UN, Gordon IJ, et al. Protection against malaria

by intravenous immunization with a nonreplicating sporozoite vaccine. Science. 2013;**341**(6152):1359-1365

[110] Epstein JE, Richie TL. The whole parasite, pre-erythrocytic stage approach to malaria vaccine development: A review. Current Opinion in Infectious Diseases. 2013;**26**(5):420-428

[111] Hoffman SL, Billingsley PF, James E, Richman A, Loyevsky M, Li T, et al. Development of a metabolically active, non-replicating sporozoite vaccine to prevent *Plasmodium falciparum* malaria. Human Vaccines. 2010;**6**(1):97-106

[112] Epstein JE, Tewari K, Lyke K, Sim B, Billingsley P, Laurens M, et al. Live attenuated malaria vaccine designed to protect through hepatic CD8+ T cell immunity. Science. 2011;**334**(6055):475-480

[113] Luke TC, Hoffman SL. Rationale and plans for developing a nonreplicating, metabolically active, radiation-attenuated *Plasmodium falciparum* sporozoite vaccine. Journal of Experimental Biology. 2003;**206**(21):3803-3808

[114] Richie TL, Billingsley PF, Sim BKL, James ER, Chakravarty S, Epstein JE, et al. Progress with *Plasmodium falciparum* sporozoite (PfSPZ) based malaria vaccines. Vaccine. 2015;**33**(52):7452-7461

[115] Malik A, Egan JE, Houghten RA, Sadoff JC, Hoffman SL. Human cytotoxic T lymphocytes against the *Plasmodium falciparum* circumsporozoite protein. Proceedings of the National Academy of Sciences. 1991;**88**(8):3300-3304

[116] Wizel B, Houghten R, Church P, Tine JA, Lanar DE, Gordon DM, et al. HLA-A2-restricted cytotoxic T lymphocyte responses to multiple *Plasmodium falciparum* sporozoite

surface protein 2 epitopes in sporozoiteimmunized volunteers. The Journal of Immunology. 1995;**155**(2):766-775

[117] Krzych U, Lyon JA, Jareed T, Schneider I, Hollingdale MR, Gordon DM, et al. T lymphocytes from volunteers immunized with irradiated *Plasmodium falciparum* sporozoites recognize liver and blood stage malaria antigens. The Journal of Immunology. 1995;**155**(8):4072-4077

[118] Nardin EH, Herrington DA, Davis J, Levine M, Stuber D, Takacs B, et al. Conserved repetitive epitope recognized by CD4+ clones from a malaria-immunized volunteer. Science. 1989;**246**(4937):1603-1606

[119] Gwadz R, Cochrane A, Nussenzweig V, Nussenzweig R. Preliminary studies on vaccination of rhesus monkeys with irradiated sporozoites of *Plasmodium knowlesi* and characterization of surface antigens of these parasites. Bulletin of the World Health Organization. 1979;**57**(Suppl):165-173

[120] Egan JE, Hoffman SL, Haynes JD, Sadoff JC, Schneider I, Grau GE, et al. *Humoral immune responses in volunteers immunized with irradiated Plasmodium falciparum sporozoites*. The American Journal of Tropical Medicine and Hygiene. 1993;**49**(2):166-173

[121] Zavala F, Tam JP, Hollingdale MR, Cochrane AH, Quakyi I, Nussenzweig RS, et al. Rationale for development of a synthetic vaccine against *Plasmodium falciparum* malaria. Science. 1985;**228**(4706):1436-1440

[122] Ballou WR, Sherwood JA, Neva FA, Gordon DM, Wirtz RA, Wasserman GF, et al. Safety and efficacy of a recombinant DNA *Plasmodium falciparum* sporozoite vaccine. Bethesda, MD: Naval Medical Research Institute; 1987

[123] Olotu A, Fegan G, Wambua J, Nyangweso G, Awuondo KO, Leach A, et al. Four-year efficacy of RTS, S/AS01E and its interaction with malaria exposure. New England Journal of Medicine. 2013;**368**(12):1111-1120

[124] White MT, Bejon P, Olotu A, Griffin JT, Bojang K, Lusingu J, et al. A combined analysis of immunogenicity, antibody kinetics and vaccine efficacy from phase 2 trials of the RTS, S malaria vaccine. BMC Medicine. 2014;**12**(1):117

[125] Moorthy VS, Ballou WR. Immunological mechanisms underlying protection mediated by RTS, S: A review of the available data. Malaria Journal. 2009;**8**(1):312

[126] Sissoko MS, Healy SA, Katile A, Omaswa F, Zaidi I, Gabriel EE, et al. Safety and efficacy of PfSPZ vaccine against *Plasmodium falciparum* via direct venous inoculation in healthy malariaexposed adults in Mali: A randomised, double-blind phase 1 trial. The Lancet Infectious Diseases. 2017;**17**(5):498-509

[127] Sinden R. The cell biology of malaria infection of mosquito: Advances and opportunities. Cellular Microbiology. 2015;**17**(4):451-466

[128] Karanja J, Kiboi N. Current milestones towards development of a fully deployable anti-malaria vaccinefuture hope for malaria-free world: A review. Journal of Vaccines and Vaccination. 2016;**7**(332):2

**83**

**Chapter 5**

**Abstract**

*Chandra R. Makanjee*

these chains of events and beyond.

collective decision-making

**1. Introduction**

Diagnostic Imaging Safety

and Protection: A Collective

an Effective Health Outcome

Interaction and Decision-Making

Processes and Procedures toward

This chapter will focus on the safety and protection in utilization of radiation and nonradiation imaging modalities within a medical encounter in health institutional context. The challenges of ease of access on the one hand regarding a referral versus accessing of these imaging services. The roles and responsibilities of the diverse range of professionals in the medical encounter are in ensuring that an effective decision-making is made at each point in time. The importance of communication, coordination, collaboration, and alignment is in ensuring that the care and safety of the patient is not compromised. Thus, the chore essence of provider is patient-centered care, that is, from the point of the initiation of the referral to the outcomes of an effective medical treatment and management plan. The role of the imaging investigation and its value is outweighing the risks versus harm through

**Keywords:** safety, interrelated, interdependent, distributed roles and responsibilities,

Modern medicine is highly dependent upon high technological scientific equipment and practices [1] of which medical imaging, often referred to as a diagnostic test, is part of. The advances in medical imaging technology with enhanced image quality open the door for detecting previously unseen abnormalities of unknown relevance. According to Webster [2], imaging from surface anatomy to intrabody physiology enables the "medical gaze" to move deeper and deeper into body structures. Digitally acquired images also promote ease of access for the referrer [3]. However, technology has professional, social, and individual implications, as the availability of the latest diagnostic equipment is like a diagnostic invitation that could lead to the belief in the "gift" of knowing that would enable health-care professionals to make an informed decision [4]. Unfortunately, according to modern medicine and Smith [1], at times, the patient as a person can be lost from the clinician's gaze and advancement in patient care is not necessarily guaranteed [5].

### **Chapter 5**

*Ionizing and Non-ionizing Radiation*

[117] Krzych U, Lyon JA, Jareed T, Schneider I, Hollingdale MR, Gordon DM, et al. T lymphocytes from volunteers immunized with irradiated *Plasmodium falciparum* sporozoites recognize liver and blood stage malaria antigens. The Journal of Immunology.

[118] Nardin EH, Herrington DA, Davis J, Levine M, Stuber D, Takacs B, et al. Conserved repetitive epitope recognized by CD4+ clones from a malaria-immunized volunteer. Science.

[119] Gwadz R, Cochrane A, Nussenzweig V, Nussenzweig R. Preliminary studies on vaccination of rhesus monkeys with irradiated sporozoites of *Plasmodium knowlesi* and characterization of surface antigens of these parasites. Bulletin of the World Health Organization.

1995;**155**(8):4072-4077

1989;**246**(4937):1603-1606

1979;**57**(Suppl):165-173

1993;**49**(2):166-173

[120] Egan JE, Hoffman SL, Haynes JD, Sadoff JC, Schneider I, Grau GE, et al. *Humoral immune responses* 

[121] Zavala F, Tam JP, Hollingdale MR, Cochrane AH, Quakyi I, Nussenzweig RS, et al. Rationale for development of a synthetic vaccine against

*Plasmodium falciparum* malaria. Science.

[122] Ballou WR, Sherwood JA, Neva FA, Gordon DM, Wirtz RA, Wasserman

Bethesda, MD: Naval Medical Research

GF, et al. Safety and efficacy of a recombinant DNA *Plasmodium falciparum* sporozoite vaccine.

*in volunteers immunized with irradiated Plasmodium falciparum sporozoites*. The American Journal of Tropical Medicine and Hygiene.

1985;**228**(4706):1436-1440

surface protein 2 epitopes in sporozoiteimmunized volunteers. The Journal of Immunology. 1995;**155**(2):766-775

[123] Olotu A, Fegan G, Wambua J, Nyangweso G, Awuondo KO, Leach A, et al. Four-year efficacy of RTS, S/AS01E and its interaction with malaria exposure. New England Journal of Medicine. 2013;**368**(12):1111-1120

[124] White MT, Bejon P, Olotu A, Griffin JT, Bojang K, Lusingu J, et al. A combined analysis of

Medicine. 2014;**12**(1):117

[125] Moorthy VS, Ballou

WR. Immunological mechanisms underlying protection mediated by RTS, S: A review of the available data.

Malaria Journal. 2009;**8**(1):312

[127] Sinden R. The cell biology of malaria infection of mosquito: Advances and opportunities. Cellular Microbiology. 2015;**17**(4):451-466

[128] Karanja J, Kiboi N. Current milestones towards development of a fully deployable anti-malaria vaccinefuture hope for malaria-free world: A review. Journal of Vaccines and Vaccination. 2016;**7**(332):2

[126] Sissoko MS, Healy SA, Katile A, Omaswa F, Zaidi I, Gabriel EE, et al. Safety and efficacy of PfSPZ vaccine against *Plasmodium falciparum* via direct venous inoculation in healthy malariaexposed adults in Mali: A randomised, double-blind phase 1 trial. The Lancet Infectious Diseases. 2017;**17**(5):498-509

immunogenicity, antibody kinetics and vaccine efficacy from phase 2 trials of the RTS, S malaria vaccine. BMC

**82**

Institute; 1987

Diagnostic Imaging Safety and Protection: A Collective Interaction and Decision-Making Processes and Procedures toward an Effective Health Outcome

*Chandra R. Makanjee*

### **Abstract**

This chapter will focus on the safety and protection in utilization of radiation and nonradiation imaging modalities within a medical encounter in health institutional context. The challenges of ease of access on the one hand regarding a referral versus accessing of these imaging services. The roles and responsibilities of the diverse range of professionals in the medical encounter are in ensuring that an effective decision-making is made at each point in time. The importance of communication, coordination, collaboration, and alignment is in ensuring that the care and safety of the patient is not compromised. Thus, the chore essence of provider is patient-centered care, that is, from the point of the initiation of the referral to the outcomes of an effective medical treatment and management plan. The role of the imaging investigation and its value is outweighing the risks versus harm through these chains of events and beyond.

**Keywords:** safety, interrelated, interdependent, distributed roles and responsibilities, collective decision-making

### **1. Introduction**

Modern medicine is highly dependent upon high technological scientific equipment and practices [1] of which medical imaging, often referred to as a diagnostic test, is part of. The advances in medical imaging technology with enhanced image quality open the door for detecting previously unseen abnormalities of unknown relevance. According to Webster [2], imaging from surface anatomy to intrabody physiology enables the "medical gaze" to move deeper and deeper into body structures. Digitally acquired images also promote ease of access for the referrer [3]. However, technology has professional, social, and individual implications, as the availability of the latest diagnostic equipment is like a diagnostic invitation that could lead to the belief in the "gift" of knowing that would enable health-care professionals to make an informed decision [4]. Unfortunately, according to modern medicine and Smith [1], at times, the patient as a person can be lost from the clinician's gaze and advancement in patient care is not necessarily guaranteed [5].

Globally, an ongoing concern is about the effectiveness of radiation and nonradiation control measures. Increasing budgetary and financial constraints in health-care sectors and the growing consumerist movement demanding greater patient-initiated access to medical services are of special concern [6]. The justification for an imaging investigation referral or a nonreferral within in the chain of events leading to the ultimate diagnosis in managing the health outcomes lies beyond the traditional medical encounter. Whether the procedures involve exposure to ionizing radiation or nonionizing radiation, of importance is the benefit versus risks in conjunction with the clinical value of the referral, the justification of the imaging investigation requested and the actual conducting of the investigation and outcomes thereof in devising an effective management and treatment strategy that would benefit not only the health outcomes within a medical encounter but also the person.

The purpose of this chapter is to discuss the complexities of decision-making processes and procedures in imaging investigation utilization within the continuum of care processes and procedures to achieve a quality of health outcomes for the patient as a person. Where communication and interactions shaping the decisions are inherently distributed in nature. Apart from the temporary nature of the encounter, it is also integrated and intertwined within the biomedical, technological, and psychosocial dimensions. The assumption is to ensure the safety of the patient within the medical imaging context requiring a collective of decisions which are interrelated rather than isolated events that lead to a quality health outcome.

### **2. The health system and the timely access**

Within the health system, diagnostic imaging services form an important component in terms of delivering quality professional service to health-care professionals and patients as the direct or indirect beneficiaries from the referral. The use of diagnostic medical imaging can be defined as "timely access to and delivery of integrated and appropriate radiological studies and interventions in a safe and responsive facility and a prompt delivery of accurately interpreted reports by capable personnel in an efficient, effective, and sustainable manner" ([7], p. 457).

Accessibility to these medical imaging services depends highly on the level of services provided at the various institutions. The effectiveness of these services is shaped through interactions between skilled health-care professionals and the patient and between multiple skilled health-care professionals who either work as individuals or as a group to make decisions regarding intra- and interinstitutional pathways of the referral and treatment to be followed for each individual patient. Accessing a timely service to certain imaging modalities is not always a linear pathway. In some instances, it may entail building up evidence through a graded referral from the most basic to the most sophisticated modalities based on clinical decisions. It could entail moving from one level of care to the next, depending on the availability of medical specialists, technologies [8]. A common experience of all professionals and patients is the financial boundaries and constraints. This correspond with Gibson's [9] description of "first layered approach of access to health services" aimed at cost-effectiveness and rational usage of available resources. Khan et al.'s [10] view is that the more expensive imaging services are not necessarily the most appropriate for a given clinical situation. Often, a patient's condition necessitates referral to a better resourced health-care institution for further management [11]. Then, in the absence of a central record, keeping system which includes imaging investigations may result in a re-referral for duplication of a diagnostic imaging investigation at the receiving health-care institution [12]. Regarding quality of care, it is important that the continuum of care is maintained.

**85**

*Diagnostic Imaging Safety and Protection: A Collective Interaction and Decision-Making…*

The principles of justification and optimization that underpin medical practice also form the cornerstones of radiation protection [6]. On the one hand, according to Bernardy et al. [13], the quality of medical care brings value to both patient and provider when medical imaging investigation is justified and performed correctly. This investigation can be used for triaging to determine whether to refer a patient for further diagnostic tests [14]. If initial tests suggest the possibility of a condition, more costly or invasive tests may be ordered for confirmation on the basis of the

On the other hand, a failure of timely, appropriate clinical action following the test result can render the value of the entire process useless [7]. Medical practitioners are expected to employ the most efficient diagnostic strategies to prevent unnecessary referrals for diagnostic tests that could impact on time and resources [15]. A definitive diagnosis of a patient's condition is sometimes challenging and may require additional, unrewarding imaging examinations to improve the certainty of the diagnosis [16]. The use of radiological referral guidelines, an effective handoffs, and continuous

Despite the acknowledgement in the current literature that health professionalpatient interactions and decision-making processes regarding referral, diagnostic imaging investigations, interpretation, and communication of outcomes are complex phenomena, research in diagnostic investigations in general is distributed [8]. Effective control of ionizing or nonradiation exposure, inter alia by means of appropriate justification for every exposure, is a basic principle to be followed by all diagnostic imaging services. Each set of role players and each individual bring with them individual characteristics, skills, competencies, roles, and responsibilities. According to Webster [2], the medical gaze transcends not only at an individual level but also at a public, collective level of the regulation bodies. For instance, most health-care professionals belong to a central professional statutory regulatory body but are also governed by their institutional code of conduct and practice. An influencing or confounding factor is about financial incentives for the provider via payments by medical aids providing access to these services [9]. One way of overcoming these challenges is developing of practice-based case management. This is achieved by coordinated care management across the continuum of care by workflow mapping techniques and standardizing protocols and clinical pathways. And is followed by network interfaces between different subsystems (i.e., points of care). That is, an integrated case management platform is coordinated by clinicians

professional development programs are essential to bridge this gap [17, 18].

as the patient navigates through the health-care delivery network [19].

of the patient, hence the prominence given to patient-centered care.

**within a biotechnopsychosocial context**

**3. The interrelated interdependent medical imaging encounter: decisions** 

Decision-making in the health-care system—specifically with regard to diagnostic imaging investigations—occurs at multiple levels. Decision-making involves choosing a course of action to achieve specific outcomes and can occur at departmental and individual levels [17]. Within the ambit of diagnostic imaging, van Baalen et al. [20], in their study on the diagnosis and treatment of patients with pulmonary hypertension, refer to this kind of decision-making as being based on "distributed knowing." Distributed knowing implies a socially distributed process of shared meaning making among different health-care providers. Information is exchanged, collectively explored, and adjusted at the patient's different points of contact in a medical encounter. Within the health-care context, the ultimate predictor of the efficiency and effectiveness of the decision is measured by the well-being

*DOI: http://dx.doi.org/10.5772/intechopen.82844*

possible differential diagnoses.

### *Diagnostic Imaging Safety and Protection: A Collective Interaction and Decision-Making… DOI: http://dx.doi.org/10.5772/intechopen.82844*

The principles of justification and optimization that underpin medical practice also form the cornerstones of radiation protection [6]. On the one hand, according to Bernardy et al. [13], the quality of medical care brings value to both patient and provider when medical imaging investigation is justified and performed correctly. This investigation can be used for triaging to determine whether to refer a patient for further diagnostic tests [14]. If initial tests suggest the possibility of a condition, more costly or invasive tests may be ordered for confirmation on the basis of the possible differential diagnoses.

On the other hand, a failure of timely, appropriate clinical action following the test result can render the value of the entire process useless [7]. Medical practitioners are expected to employ the most efficient diagnostic strategies to prevent unnecessary referrals for diagnostic tests that could impact on time and resources [15]. A definitive diagnosis of a patient's condition is sometimes challenging and may require additional, unrewarding imaging examinations to improve the certainty of the diagnosis [16]. The use of radiological referral guidelines, an effective handoffs, and continuous professional development programs are essential to bridge this gap [17, 18].

Despite the acknowledgement in the current literature that health professionalpatient interactions and decision-making processes regarding referral, diagnostic imaging investigations, interpretation, and communication of outcomes are complex phenomena, research in diagnostic investigations in general is distributed [8]. Effective control of ionizing or nonradiation exposure, inter alia by means of appropriate justification for every exposure, is a basic principle to be followed by all diagnostic imaging services. Each set of role players and each individual bring with them individual characteristics, skills, competencies, roles, and responsibilities. According to Webster [2], the medical gaze transcends not only at an individual level but also at a public, collective level of the regulation bodies. For instance, most health-care professionals belong to a central professional statutory regulatory body but are also governed by their institutional code of conduct and practice. An influencing or confounding factor is about financial incentives for the provider via payments by medical aids providing access to these services [9]. One way of overcoming these challenges is developing of practice-based case management. This is achieved by coordinated care management across the continuum of care by workflow mapping techniques and standardizing protocols and clinical pathways. And is followed by network interfaces between different subsystems (i.e., points of care). That is, an integrated case management platform is coordinated by clinicians as the patient navigates through the health-care delivery network [19].

### **3. The interrelated interdependent medical imaging encounter: decisions within a biotechnopsychosocial context**

Decision-making in the health-care system—specifically with regard to diagnostic imaging investigations—occurs at multiple levels. Decision-making involves choosing a course of action to achieve specific outcomes and can occur at departmental and individual levels [17]. Within the ambit of diagnostic imaging, van Baalen et al. [20], in their study on the diagnosis and treatment of patients with pulmonary hypertension, refer to this kind of decision-making as being based on "distributed knowing." Distributed knowing implies a socially distributed process of shared meaning making among different health-care providers. Information is exchanged, collectively explored, and adjusted at the patient's different points of contact in a medical encounter. Within the health-care context, the ultimate predictor of the efficiency and effectiveness of the decision is measured by the well-being of the patient, hence the prominence given to patient-centered care.

*Ionizing and Non-ionizing Radiation*

Globally, an ongoing concern is about the effectiveness of radiation and nonradiation control measures. Increasing budgetary and financial constraints in health-care sectors and the growing consumerist movement demanding greater patient-initiated access to medical services are of special concern [6]. The justification for an imaging investigation referral or a nonreferral within in the chain of events leading to the ultimate diagnosis in managing the health outcomes lies beyond the traditional medical encounter. Whether the procedures involve exposure to ionizing radiation or nonionizing radiation, of importance is the benefit versus risks in conjunction with the clinical value of the referral, the justification of the imaging investigation requested and the actual conducting of the investigation and outcomes thereof in devising an effective management and treatment strategy that would benefit not

only the health outcomes within a medical encounter but also the person.

**2. The health system and the timely access**

it is important that the continuum of care is maintained.

The purpose of this chapter is to discuss the complexities of decision-making processes and procedures in imaging investigation utilization within the continuum of care processes and procedures to achieve a quality of health outcomes for the patient as a person. Where communication and interactions shaping the decisions are inherently distributed in nature. Apart from the temporary nature of the encounter, it is also integrated and intertwined within the biomedical, technological, and psychosocial dimensions. The assumption is to ensure the safety of the patient within the medical imaging context requiring a collective of decisions which are interrelated rather than isolated events that lead to a quality health outcome.

Within the health system, diagnostic imaging services form an important component in terms of delivering quality professional service to health-care professionals and patients as the direct or indirect beneficiaries from the referral. The use of diagnostic medical imaging can be defined as "timely access to and delivery of integrated and appropriate radiological studies and interventions in a safe and responsive facility and a prompt delivery of accurately interpreted reports by capable personnel in an efficient, effective, and sustainable manner" ([7], p. 457). Accessibility to these medical imaging services depends highly on the level of services provided at the various institutions. The effectiveness of these services is shaped through interactions between skilled health-care professionals and the patient and between multiple skilled health-care professionals who either work as individuals or as a group to make decisions regarding intra- and interinstitutional pathways of the referral and treatment to be followed for each individual patient. Accessing a timely service to certain imaging modalities is not always a linear pathway. In some instances, it may entail building up evidence through a graded referral from the most basic to the most sophisticated modalities based on clinical decisions. It could entail moving from one level of care to the next, depending on the availability of medical specialists, technologies [8]. A common experience of all professionals and patients is the financial boundaries and constraints. This correspond with Gibson's [9] description of "first layered approach of access to health services" aimed at cost-effectiveness and rational usage of available resources. Khan et al.'s [10] view is that the more expensive imaging services are not necessarily the most appropriate for a given clinical situation. Often, a patient's condition necessitates referral to a better resourced health-care institution for further management [11]. Then, in the absence of a central record, keeping system which includes imaging investigations may result in a re-referral for duplication of a diagnostic imaging investigation at the receiving health-care institution [12]. Regarding quality of care,

**84**

### **3.1 The medical encounter**

An illustration at an individual level during a medical encounter entails clinical decisions that are mostly governed by; either you have the disease or not, align with yes/no decisions. Often, these processes entail a series of interim decisions, guided at each stage to a diagnosis being present or not by minimizing uncertainty. This process still assumes there is an underlying dichotomous disease state (yes or no); this assumption could be inconclusive [21]. These interim decisions depending on the context of the encounter may be paternalistic, informed, shared, negotiated, and or a partnership process. However, these interactions should address the benefit versus risks in conjunction with the clinical value of the referral, aligning with the justification of the imaging investigation requested and the aligning of actual conducting of the investigation achieved through coordination by the medical imaging professional (competency) and cooperation by the patient mediated through text (patient records, quality of the order, and radiological report) and technology (optimally functioning equipment) to achieve an effective outcomes thereof in informing in the decision of devising an effective management and treatment strategy benefitting not only the health outcomes from a medical provider perspective but also the patient as a person.

Within the medical encounter regarding the diagnostic interaction revolves around how medical practitioners involve patients when collecting information. For example, according to Langalibalele et al., patients rely on referring doctors to provide information on the management aspect prior to the referral [12]. Not having records in this regard could lead to a decision of re-referral for duplication of investigation(s) at the receiving health-care institution. Physicians should encourage patients to describe their previous imaging examinations to help eliminate the duplication of imaging studies [16]. The dilemma is that the continuum of care is not disrupted. Often, a patient's condition necessitates referral to a better resourced health-care institution for further management [11]. If records are not centrally linked, it could lead to a re-referral for duplication of diagnostic imaging investigation at the receiving health-care institution [12, 22]. The electronic sharing of medical imaging data is an important element of modern health-care systems, but current infrastructure for cross-site image transfer depends on trust in third-party intermediaries [22, 23].

The referring doctor has the responsibility for the collection of all diagnostic information that justifies the requested radiological (radiography) examination, including information about previous exposures. Khan et al. [10] and others [24] state that in order to select imaging tests judiciously, the clinician must understand what each test can do and be fully knowledgeable about the limitations, also with regard to the available techniques. Malone et al. [6] and others [25] also refer to the use of referral guidelines or appropriateness criteria as a good practice in the process of justification. In the absence of written formal system, protocols related to the way in which diagnostic imaging investigation referrals intertwined with clinical pathways often result in what Croft et al. [21] like Croskerry [26] refers to the "gradient" of decision-making that parallels the degree of uncertainty associated with the wide variety of patient conditions, as well as to the challenge of the uncertainty about the diagnosis and the inability to stage the disease and make a choice on treatment and management.

Reasons for referrals vary, that is, to rule out a condition or to help the attending practitioner's referral decision-making. Primary care doctors commonly face the decision between ordering a test or adopting a period of "watchful waiting," requesting the patient to return later to follow the development of his or her symptoms [14, 21, 27]. To provide information to the secondary care specialist, or

**87**

*Diagnostic Imaging Safety and Protection: A Collective Interaction and Decision-Making…*

instance, refers to the use of radiographic investigation in triaging the referral to a secondary care specialist, whereas Gibson [9] refers to it as the medical legitimization of the institutionalization of the patient. Langalibalele et al. [12], highlight that the receiving doctor has to be well informed, otherwise there may be a need to "re-invent the wheel" through trial and error, which has an effect on cost and time. Confirmation of normality is often important in general practice to exclude or confirm a diagnosis. In this situation, a negative result may be as important as a

The quick-fix approaches and head-to-toe investigations were an easy way to diagnose and served as a form of reassurance that it was the right thing to do, a phenomenon that has also been reported in the international literature [29]. Then, the old paradigm of history taking, physical examination, and provisional clinical diagnosis is being replaced by imaging investigations [30]. Geneau et al. [8] refer to time management and patient overflow associated with less communication between patient and physician, which leads to medical uncertainty, and ultimately

Health-care professionals are also of the opinion that patients see the referral as a curative measure to the extent of a total healing of their illnesses. Perceptions like these could lead to the use of technology as a placebo for the so-called demanding patients to pacify the desire for a referral and at the same time as an incentive to prevent comebacks, instead of trying to convince patients on clinical grounds why a referral for a diagnostic imaging investigation was not necessary [31]. Murphy [32] states that myths that confuse patients and "blur the boundaries between facts and fiction" are widely disseminated because of patients' previous encounters with imaging examinations. Then, some practitioners feel they deserved an investigation, because an expectation had been created and it could affect the relationship if the patient was denied of a referral for the investigation. Therefore, it is important that when decisions are made for referral are the benefits versus harm and risks are carefully weighed against each other and in situations. It is beneficial by both the medical practitioner and the patient work together to determine how to best address the situation. The patient gets an opportunity to deliberate, clarify what is most

*DOI: http://dx.doi.org/10.5772/intechopen.82844*

positive one [28].

more referrals for investigations.

important to them and be guided [33].

previous records and guides on what you could do.

**3.2 The actual medical imaging investigation and outcomes thereof**

The diagnostic imaging investigation phase starts with the interpretation of the request order. An investigation can only be justified if sufficient relevant clinical information is provided on the request form [34, 35]. Information gathering is initiated by the medical imaging professional interpretation of the request form. The minimal information radiographers routinely receive about their patients prior to taking a radiographic image has also been a finding in a study by Halkett et al. [36]: the quality of the information on the request form; in the event of a mismatch between the investigation requested and the intended investigation; could result in an incorrect investigation conducted; and in some instances, the correct investigation by getting additional information from the patients themselves or by contacting the general practitioner [34]. The medical imaging professional makes the choice to accept or reject the request if needed or to modify it and continue with the investigation. The quality of the task to be performed is assessed against the quality of the request and whether the referring medical officer's question is answered [37]. The value of medical records in planning the task at hand is access to patients'

Prior to commencing this subsection, it is important to provide a brief overview on the image formation and production and the importance thereof in terms of the

### *Diagnostic Imaging Safety and Protection: A Collective Interaction and Decision-Making… DOI: http://dx.doi.org/10.5772/intechopen.82844*

instance, refers to the use of radiographic investigation in triaging the referral to a secondary care specialist, whereas Gibson [9] refers to it as the medical legitimization of the institutionalization of the patient. Langalibalele et al. [12], highlight that the receiving doctor has to be well informed, otherwise there may be a need to "re-invent the wheel" through trial and error, which has an effect on cost and time. Confirmation of normality is often important in general practice to exclude or confirm a diagnosis. In this situation, a negative result may be as important as a positive one [28].

The quick-fix approaches and head-to-toe investigations were an easy way to diagnose and served as a form of reassurance that it was the right thing to do, a phenomenon that has also been reported in the international literature [29]. Then, the old paradigm of history taking, physical examination, and provisional clinical diagnosis is being replaced by imaging investigations [30]. Geneau et al. [8] refer to time management and patient overflow associated with less communication between patient and physician, which leads to medical uncertainty, and ultimately more referrals for investigations.

Health-care professionals are also of the opinion that patients see the referral as a curative measure to the extent of a total healing of their illnesses. Perceptions like these could lead to the use of technology as a placebo for the so-called demanding patients to pacify the desire for a referral and at the same time as an incentive to prevent comebacks, instead of trying to convince patients on clinical grounds why a referral for a diagnostic imaging investigation was not necessary [31]. Murphy [32] states that myths that confuse patients and "blur the boundaries between facts and fiction" are widely disseminated because of patients' previous encounters with imaging examinations. Then, some practitioners feel they deserved an investigation, because an expectation had been created and it could affect the relationship if the patient was denied of a referral for the investigation. Therefore, it is important that when decisions are made for referral are the benefits versus harm and risks are carefully weighed against each other and in situations. It is beneficial by both the medical practitioner and the patient work together to determine how to best address the situation. The patient gets an opportunity to deliberate, clarify what is most important to them and be guided [33].

### **3.2 The actual medical imaging investigation and outcomes thereof**

The diagnostic imaging investigation phase starts with the interpretation of the request order. An investigation can only be justified if sufficient relevant clinical information is provided on the request form [34, 35]. Information gathering is initiated by the medical imaging professional interpretation of the request form. The minimal information radiographers routinely receive about their patients prior to taking a radiographic image has also been a finding in a study by Halkett et al. [36]: the quality of the information on the request form; in the event of a mismatch between the investigation requested and the intended investigation; could result in an incorrect investigation conducted; and in some instances, the correct investigation by getting additional information from the patients themselves or by contacting the general practitioner [34]. The medical imaging professional makes the choice to accept or reject the request if needed or to modify it and continue with the investigation. The quality of the task to be performed is assessed against the quality of the request and whether the referring medical officer's question is answered [37]. The value of medical records in planning the task at hand is access to patients' previous records and guides on what you could do.

Prior to commencing this subsection, it is important to provide a brief overview on the image formation and production and the importance thereof in terms of the

*Ionizing and Non-ionizing Radiation*

tive but also the patient as a person.

intermediaries [22, 23].

choice on treatment and management.

An illustration at an individual level during a medical encounter entails clinical decisions that are mostly governed by; either you have the disease or not, align with yes/no decisions. Often, these processes entail a series of interim decisions, guided at each stage to a diagnosis being present or not by minimizing uncertainty. This process still assumes there is an underlying dichotomous disease state (yes or no); this assumption could be inconclusive [21]. These interim decisions depending on the context of the encounter may be paternalistic, informed, shared, negotiated, and or a partnership process. However, these interactions should address the benefit versus risks in conjunction with the clinical value of the referral, aligning with the justification of the imaging investigation requested and the aligning of actual conducting of the investigation achieved through coordination by the medical imaging professional (competency) and cooperation by the patient mediated through text (patient records, quality of the order, and radiological report) and technology (optimally functioning equipment) to achieve an effective outcomes thereof in informing in the decision of devising an effective management and treatment strategy benefitting not only the health outcomes from a medical provider perspec-

Within the medical encounter regarding the diagnostic interaction revolves around how medical practitioners involve patients when collecting information. For example, according to Langalibalele et al., patients rely on referring doctors to provide information on the management aspect prior to the referral [12]. Not having records in this regard could lead to a decision of re-referral for duplication of investigation(s) at the receiving health-care institution. Physicians should encourage patients to describe their previous imaging examinations to help eliminate the duplication of imaging studies [16]. The dilemma is that the continuum of care is not disrupted. Often, a patient's condition necessitates referral to a better resourced health-care institution for further management [11]. If records are not centrally linked, it could lead to a re-referral for duplication of diagnostic imaging investigation at the receiving health-care institution [12, 22]. The electronic sharing of medical imaging data is an important element of modern health-care systems, but current infrastructure for cross-site image transfer depends on trust in third-party

The referring doctor has the responsibility for the collection of all diagnostic information that justifies the requested radiological (radiography) examination, including information about previous exposures. Khan et al. [10] and others [24] state that in order to select imaging tests judiciously, the clinician must understand what each test can do and be fully knowledgeable about the limitations, also with regard to the available techniques. Malone et al. [6] and others [25] also refer to the use of referral guidelines or appropriateness criteria as a good practice in the process of justification. In the absence of written formal system, protocols related to the way in which diagnostic imaging investigation referrals intertwined with clinical pathways often result in what Croft et al. [21] like Croskerry [26] refers to the "gradient" of decision-making that parallels the degree of uncertainty associated with the wide variety of patient conditions, as well as to the challenge of the uncertainty about the diagnosis and the inability to stage the disease and make a

Reasons for referrals vary, that is, to rule out a condition or to help the attending practitioner's referral decision-making. Primary care doctors commonly face the decision between ordering a test or adopting a period of "watchful waiting," requesting the patient to return later to follow the development of his or her symptoms [14, 21, 27]. To provide information to the secondary care specialist, or

**3.1 The medical encounter**

**86**

inherent risks or harm versus benefits. To produce images depends on the type of modality used to acquire an image. A suitable source is required to produce the different forms of energy, such as X-rays (high-energy radiation), ultrasound (high-energy sound waves), magnetic resonance imaging (strong magnetic fields, electric field gradients, and radio waves), and radioactive substances. Within planar imaging, it would be, for instance, the voltage, current, and time which is depended on the distance and type of receptor used. For ultrasound, it would be the type of transducer used which generates the sound pulses and detects the echoes. Whereas, with MRI, it entails selecting appropriate imaging parameters like T1 and T2 and the various software available to characterize the image. To produce an image requires a suitable medium to capture these attenuated energies and convert to an analogue or digital form of a visible image on a screen to make a diagnosis. All of these depend on the ability and the capability of the imaging equipment, the competency of the operator to make a sound decision on the completeness of the investigation using sound scientific knowledgebased approach without compromising the integrity of the quality of the examination.

For example, in the case of follow-up imaging investigation, it may be modified, so with establishing the exposure technique, some factors determine the quality of the image. In the case of pathology, sometimes, the exposure technique needs to be adapted is to be consistent of the quality standard of the image produced to compare with previous images. This is governed, among other factors (e.g., the focus to film distance and positioning of the patient), by the exposure technique over which the radiographer has most control [38–40]. Precautionary measures have a positive outcome on the possible risk of exposing the patient unnecessarily to radiation. Part of obtaining an optimal quality image is the investigation protocol and procedures including the imaging parameters [41]. Established departmental quality control and assurance guidelines are essential to avoid inconsistencies in practice which may result in suboptimal imaging investigation. The patient's physical condition and capacity to cooperate in the examination must be assessed and any shortcomings must be communicated to others in the health-care team [39, 42]. Radiographers often have trouble in acquiring the desired projection if the patient is either uncooperative or immobile. The investigation is measured against the time consumed and the worth in terms of anticipated normal versus abnormal findings.

The completeness of the information required to generate a radiological diagnostic report is depended on the quality of the completeness of the request, the patient, and the accuracy of investigation performed. According to Khan et al. [10], detailed case notes and a well-conceived, ordered list of differential diagnoses are the absolute minimum to include in any imaging request to ensure that the selected imaging is warranted and to improve the accuracy of reporting. Then, clinicians should not just read the radiological report, but ought to be able to interpret the image. Misreading of images has been shown to be the most common type of clinical error [28]. According to Hardy and Barrett [43], a referral for a diagnostic investigation stems from a clinical examination, based on the clinical signs and symptoms. The provisional diagnosis can be confirmed or refuted depending on the clinician's ability to interpret the images. Therefore, in all circumstances, the decision to do a radiographic investigation should be influenced by the ability to interpret the resultant image [27]. It is the responsibility of the treating clinician to determine whether the anatomic anomaly revealed by an imaging study is related to the patient's symptoms [10]. This could be since in clinical practice "to recognize pathology in a 'sea of normals'" is quite difficult and "[t]he prevalence of pathology can contribute to a 'context or prevalence bias' in decision making" [44]. It is recommended that collaborative radiologist-medical practitioner educational efforts to help enhancing medical practitioners' knowledge could be useful. Another option could be use of decision aids [45].

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*Diagnostic Imaging Safety and Protection: A Collective Interaction and Decision-Making…*

Patient-centered care puts the patient as partner and collaborator in the diagnosis and management of his or her own health conditions. Patient-centered care is intricately linked with notions of shared decision-making and the patient's active participation in all processes of the medical encounter, ranging from the provisional diagnosis to the choice of diagnostic investigations (including diagnostic imaging), the discussion of provisional findings, and the design of a management plan [46–53]. In the doctor-patient consultation, there has been a steady shift from paternalism toward a focus on the needs and the multiple voices of providers and the autonomy of the patient as being at the center of his or her own care [54]. When information is passed on, an individual's language preferences and level of literacy should be considered [50], including the ability to negotiate and coordinate care [47]. One way of potentially solving language discordance problems and reducing disparities in care is to provide language interpreters [55] for the patient to understand what is going on and could engage effectively [56] to bridge this gap by use of comprehensive language and modify some of the terminology through metaphors [57]. In communicating the events frequently, little or no mention is made of radiation risk [6, 58]. The argument is the complex and specialized nature of the units used to quantify radiation exposure, which is not conducive to effective communication with the public and even with health professionals. Patients have the right to know of the radiation risk and it is the duty of health professionals to inform them [6]. This contributes to empowering patients to make informed decisions especially in the case of high-dose procedures, where open discussion and shared decisionmaking would facilitate the process. Radiologists and their registrars had an expectation that it was the attending medical officers' responsibility to communicate risks and benefits. This type of consultation is also dependent on the institutional culture which promotes active participation or where patients are expected to behave like "good" patients and passively accept services and attention allocated to them [9]. Another important factor is the potential influence of consumer awareness and demand on the patterns of utilization of diagnostic imaging services. Patients may demand imaging procedures for various reasons: they may have acquired information from the print or electronic media or by word of mouth; or they could believe that they should receive specific imaging services for particular symptoms, based on their past experience. Most patients are not financially liable for imaging services received. If the physician is reluctant to refer them for diagnostic imaging, they may interpret it as insensitivity on the part of the physician who withholds procedures that they are entitled to. Furthermore, many patients have little understanding of indications for or benefits of imaging procedures and the cost involved. Radiation doses and their associated risks, and the protection procedures in place are also poorly understood [6, 8, 16, 59, 60]. One of the gaps in the current knowledge on the functioning of the health system is the extent to which patients are aware of their rights regarding participation in the planning of their treatment and diagnostic processes, including knowledge of radiation risks. According to Geneau et al. [8], patient demands influence physicians' behavior. Espeland and Baerheim [29] found that medical practitioners complied with strong wishes from patients in cases where the clinical indication for radiographic investigation was in doubt, little else could be done, the consultation was difficult, or time was scarce or out of moral obligation. This created a false sense hope that something could and had been done. A choice was made to refer the patient without the knowledge of what the patient's desires were in terms of monetary incentives. The types of misconceptions of passive demands or expectations may have been created as a result of the "quick fix" approach, for instance, like, let us rather do the X-ray, it is easier. Khan et al. [10] blame physicians for contributing to the idea

*DOI: http://dx.doi.org/10.5772/intechopen.82844*

**3.3 Patient autonomy**

*Diagnostic Imaging Safety and Protection: A Collective Interaction and Decision-Making… DOI: http://dx.doi.org/10.5772/intechopen.82844*

### **3.3 Patient autonomy**

*Ionizing and Non-ionizing Radiation*

inherent risks or harm versus benefits. To produce images depends on the type of modality used to acquire an image. A suitable source is required to produce the different forms of energy, such as X-rays (high-energy radiation), ultrasound (high-energy sound waves), magnetic resonance imaging (strong magnetic fields, electric field gradients, and radio waves), and radioactive substances. Within planar imaging, it would be, for instance, the voltage, current, and time which is depended on the distance and type of receptor used. For ultrasound, it would be the type of transducer used which generates the sound pulses and detects the echoes. Whereas, with MRI, it entails selecting appropriate imaging parameters like T1 and T2 and the various software available to characterize the image. To produce an image requires a suitable medium to capture these attenuated energies and convert to an analogue or digital form of a visible image on a screen to make a diagnosis. All of these depend on the ability and the capability of the imaging equipment, the competency of the operator to make a sound decision on the completeness of the investigation using sound scientific knowledgebased approach without compromising the integrity of the quality of the examination. For example, in the case of follow-up imaging investigation, it may be modified, so with establishing the exposure technique, some factors determine the quality of the image. In the case of pathology, sometimes, the exposure technique needs to be adapted is to be consistent of the quality standard of the image produced to compare with previous images. This is governed, among other factors (e.g., the focus to film distance and positioning of the patient), by the exposure technique over which the radiographer has most control [38–40]. Precautionary measures have a positive outcome on the possible risk of exposing the patient unnecessarily to radiation. Part of obtaining an optimal quality image is the investigation protocol and procedures including the imaging parameters [41]. Established departmental quality control and assurance guidelines are essential to avoid inconsistencies in practice which may result in suboptimal imaging investigation. The patient's physical condition and capacity to cooperate in the examination must be assessed and any shortcomings must be communicated to others in the health-care team [39, 42]. Radiographers often have trouble in acquiring the desired projection if the patient is either uncooperative or immobile. The investigation is measured against the time consumed and the worth in terms of anticipated normal versus abnormal findings. The completeness of the information required to generate a radiological diagnostic report is depended on the quality of the completeness of the request, the patient, and the accuracy of investigation performed. According to Khan et al. [10], detailed case notes and a well-conceived, ordered list of differential diagnoses are the absolute minimum to include in any imaging request to ensure that the selected imaging is warranted and to improve the accuracy of reporting. Then, clinicians should not just read the radiological report, but ought to be able to interpret the image. Misreading of images has been shown to be the most common type of clinical error [28]. According to Hardy and Barrett [43], a referral for a diagnostic investigation stems from a clinical examination, based on the clinical signs and symptoms. The provisional diagnosis can be confirmed or refuted depending on the clinician's ability to interpret the images. Therefore, in all circumstances, the decision to do a radiographic investigation should be influenced by the ability to interpret the resultant image [27]. It is the responsibility of the treating clinician to determine whether the anatomic anomaly revealed by an imaging study is related to the patient's symptoms [10]. This could be since in clinical practice "to recognize pathology in a 'sea of normals'" is quite difficult and "[t]he prevalence of pathology can contribute to a 'context or prevalence bias' in decision making" [44]. It is recommended that collaborative radiologist-medical practitioner educational efforts to help enhancing medical practitioners' knowledge could be useful. Another

**88**

option could be use of decision aids [45].

Patient-centered care puts the patient as partner and collaborator in the diagnosis and management of his or her own health conditions. Patient-centered care is intricately linked with notions of shared decision-making and the patient's active participation in all processes of the medical encounter, ranging from the provisional diagnosis to the choice of diagnostic investigations (including diagnostic imaging), the discussion of provisional findings, and the design of a management plan [46–53]. In the doctor-patient consultation, there has been a steady shift from paternalism toward a focus on the needs and the multiple voices of providers and the autonomy of the patient as being at the center of his or her own care [54]. When information is passed on, an individual's language preferences and level of literacy should be considered [50], including the ability to negotiate and coordinate care [47]. One way of potentially solving language discordance problems and reducing disparities in care is to provide language interpreters [55] for the patient to understand what is going on and could engage effectively [56] to bridge this gap by use of comprehensive language and modify some of the terminology through metaphors [57]. In communicating the events frequently, little or no mention is made of radiation risk [6, 58]. The argument is the complex and specialized nature of the units used to quantify radiation exposure, which is not conducive to effective communication with the public and even with health professionals. Patients have the right to know of the radiation risk and it is the duty of health professionals to inform them [6]. This contributes to empowering patients to make informed decisions especially in the case of high-dose procedures, where open discussion and shared decisionmaking would facilitate the process. Radiologists and their registrars had an expectation that it was the attending medical officers' responsibility to communicate risks and benefits. This type of consultation is also dependent on the institutional culture which promotes active participation or where patients are expected to behave like "good" patients and passively accept services and attention allocated to them [9].

Another important factor is the potential influence of consumer awareness and demand on the patterns of utilization of diagnostic imaging services. Patients may demand imaging procedures for various reasons: they may have acquired information from the print or electronic media or by word of mouth; or they could believe that they should receive specific imaging services for particular symptoms, based on their past experience. Most patients are not financially liable for imaging services received. If the physician is reluctant to refer them for diagnostic imaging, they may interpret it as insensitivity on the part of the physician who withholds procedures that they are entitled to. Furthermore, many patients have little understanding of indications for or benefits of imaging procedures and the cost involved. Radiation doses and their associated risks, and the protection procedures in place are also poorly understood [6, 8, 16, 59, 60]. One of the gaps in the current knowledge on the functioning of the health system is the extent to which patients are aware of their rights regarding participation in the planning of their treatment and diagnostic processes, including knowledge of radiation risks. According to Geneau et al. [8], patient demands influence physicians' behavior. Espeland and Baerheim [29] found that medical practitioners complied with strong wishes from patients in cases where the clinical indication for radiographic investigation was in doubt, little else could be done, the consultation was difficult, or time was scarce or out of moral obligation. This created a false sense hope that something could and had been done. A choice was made to refer the patient without the knowledge of what the patient's desires were in terms of monetary incentives. The types of misconceptions of passive demands or expectations may have been created as a result of the "quick fix" approach, for instance, like, let us rather do the X-ray, it is easier. Khan et al. [10] blame physicians for contributing to the idea

that an accurate diagnosis is only possible with the aid of an image. The above view corresponds with Balaqué and Cedraschi's [61] contention that "[p]atients tend to consider technological investigations as more trustworthy than the clinical examination." According to Borgen et al. [62], "normal findings will reassure the patient" (p. 197) and treatment, gives patients the feeling of being taken seriously.

### **4. The professional confined spaces yet inherently multiprofessional**

According to Mørk et al. [63], shared practice by its very nature creates boundaries (p. 14), and experiences may be modified and extended in the light of experiences in their discipline fields. For example, boundary blurring between practices of radiologists and surgeons necessarily evokes conflicts and that each group wants to claim ownership to the treatment and to the eligible patients [63]. Powell and Davies [65] describe professional territory as "the differences in professional identities and core beliefs" and the significant impact of professional identities and boundaries on how individual health-care providers from the same or different profession work with each other—something that has implications for the care that patients receive. They also refer to the radiology profession seeking to lay claim to particular fields of knowledge and to assert their jurisdiction over particular tasks. In a study by Johansen and Brodersen [66], the fear of losing demarcations with regard to resources and organizational quality is also a concern between medical specialist professionals and radiographers where tasks were taken over or shared. Similar to Stephens and Carmeli [64], Hilligoss [67] studied that existing personal relationships, differing levels of experience, formal power structures, and hierarchies have numerous effects on quality of care or services. Lack of information and understanding of professional roles and responsibilities, meaningful communication, and relationships are also reported in the literature [1, 47]. The radiographer's role in theater is confined to a task of taking images, but usually there is no direct cooperation between, for example, operation nurses and radiographers [63]. The power of relations in the hierarchies leaves very little space for radiographers to participate in decision-making processes dominated by other professions. Medical practitioners see the completion of the request form as a medium of instruction to perform a job. A radiologist should—before accepting an examination request—be aware of the clinical condition of the patient and the preceding examinations, to be able to make appropriate decisions [35] in the event of not having the full picture of the interactions that had taken place prior to the referral. They were respectful of the doctorpatient relationship and did not want to be the confounders, which could often result in conflict. Lewis et al. refer to unethical situations relating to the justification of radiographic examinations and radiographers' feelings of uncertainty regarding their legal and moral responsibilities [68]. Olivier et al. see radiographers as often being in the forefront where patients want to know from them what is wrong [69]. They emphasize the importance of finding the appropriate words that will keep them within their professional boundary. If the radiographer is not able to disclose results to patients, it does not afford them much professional autonomy in their working environment [50]. Often the patient is at risk of not been communicated too.

The biomedical and psychosocial worlds cannot be treated as isolated components [58]. These authors refer to the different languages and cultures of these worlds—different ways of knowing—that both contribute to the establishment of overall care of the patients, inter alia about efficient use of resources, the quality of services, and provider and patient satisfaction. These authors refer to the predictability existing in the biomedical world with its focus on anatomy and physiology with a view to diagnose and institute effective treatment to bring the human body

**91**

**Figure 1.**

*The biotechnopsychosocial network of interactions.*

*Diagnostic Imaging Safety and Protection: A Collective Interaction and Decision-Making…*

back to its "normal state." This is in contrast with the greater unpredictability and complexity inherent in the psychosocial nature where cognition, emotion, and behavior function more at a normative level needed for adaptability and flexibility. **Figure 1** represents an attempt to interpret the biopsychosocial interactions within "a bigger picture" [58] that portray the nonstatic nature of health-care provision with ever-changing and emerging ways of treatment and health management

There is also a growing body of knowledge on the interpretation of biotechno interactions in the ambit of medical technoscience; for example, relations between the analog and digital technological worlds of communication and interactive processes, and the fusion between diagnostic and therapeutic work [47, 63, 71]. **Figure 2** depicts the role of information and interpretation in diagnostic imaging decision-making. At each point of contact, four interrelating activities with the focus on information take place: information gathering, information verification, information processing, and information exchange. All these activities also play a role in the final transformation of information, that is, integration and interpretation needed for completing the assessment-treatment-expected outcome sequence [70]. This is a continuous cyclical circular process that plays itself out throughout

The decision-making and diagnosis processes are also characterized by information and knowledge inputs and outputs that contribute to an awareness of the bigger picture and which Wilson [72] considers as a basis for decision-making processes that could lead to improved operational, economic, or clinical benefit

*DOI: http://dx.doi.org/10.5772/intechopen.82844*

the patient's journey.

interaction with recent technological evidence [51].

### *Diagnostic Imaging Safety and Protection: A Collective Interaction and Decision-Making… DOI: http://dx.doi.org/10.5772/intechopen.82844*

back to its "normal state." This is in contrast with the greater unpredictability and complexity inherent in the psychosocial nature where cognition, emotion, and behavior function more at a normative level needed for adaptability and flexibility. **Figure 1** represents an attempt to interpret the biopsychosocial interactions within "a bigger picture" [58] that portray the nonstatic nature of health-care provision with ever-changing and emerging ways of treatment and health management interaction with recent technological evidence [51].

There is also a growing body of knowledge on the interpretation of biotechno interactions in the ambit of medical technoscience; for example, relations between the analog and digital technological worlds of communication and interactive processes, and the fusion between diagnostic and therapeutic work [47, 63, 71].

**Figure 2** depicts the role of information and interpretation in diagnostic imaging decision-making. At each point of contact, four interrelating activities with the focus on information take place: information gathering, information verification, information processing, and information exchange. All these activities also play a role in the final transformation of information, that is, integration and interpretation needed for completing the assessment-treatment-expected outcome sequence [70]. This is a continuous cyclical circular process that plays itself out throughout the patient's journey.

The decision-making and diagnosis processes are also characterized by information and knowledge inputs and outputs that contribute to an awareness of the bigger picture and which Wilson [72] considers as a basis for decision-making processes that could lead to improved operational, economic, or clinical benefit

**Figure 1.** *The biotechnopsychosocial network of interactions.*

*Ionizing and Non-ionizing Radiation*

that an accurate diagnosis is only possible with the aid of an image. The above view corresponds with Balaqué and Cedraschi's [61] contention that "[p]atients tend to consider technological investigations as more trustworthy than the clinical examination." According to Borgen et al. [62], "normal findings will reassure the patient"

(p. 197) and treatment, gives patients the feeling of being taken seriously.

**4. The professional confined spaces yet inherently multiprofessional**

According to Mørk et al. [63], shared practice by its very nature creates boundaries (p. 14), and experiences may be modified and extended in the light of experiences in their discipline fields. For example, boundary blurring between practices of radiologists and surgeons necessarily evokes conflicts and that each group wants to claim ownership to the treatment and to the eligible patients [63]. Powell and Davies [65] describe professional territory as "the differences in professional identities and core beliefs" and the significant impact of professional identities and boundaries on how individual health-care providers from the same or different profession work with each other—something that has implications for the care that patients receive. They also refer to the radiology profession seeking to lay claim to particular fields of knowledge and to assert their jurisdiction over particular tasks. In a study by Johansen and Brodersen [66], the fear of losing demarcations with regard to resources and organizational quality is also a concern between medical specialist professionals and radiographers where tasks were taken over or shared. Similar to Stephens and Carmeli [64], Hilligoss [67] studied that existing personal relationships, differing levels of experience, formal power structures, and hierarchies have numerous effects on quality of care or services. Lack of information and understanding of professional roles and responsibilities, meaningful communication, and relationships are also reported in the literature [1, 47]. The radiographer's role in theater is confined to a task of taking images, but usually there is no direct cooperation between, for example, operation nurses and radiographers [63]. The power of relations in the hierarchies leaves very little space for radiographers to participate in decision-making processes dominated by other professions. Medical practitioners see the completion of the request form as a medium of instruction to perform a job. A radiologist should—before accepting an examination request—be aware of the clinical condition of the patient and the preceding examinations, to be able to make appropriate decisions [35] in the event of not having the full picture of the interactions that had taken place prior to the referral. They were respectful of the doctorpatient relationship and did not want to be the confounders, which could often result in conflict. Lewis et al. refer to unethical situations relating to the justification of radiographic examinations and radiographers' feelings of uncertainty regarding their legal and moral responsibilities [68]. Olivier et al. see radiographers as often being in the forefront where patients want to know from them what is wrong [69]. They emphasize the importance of finding the appropriate words that will keep them within their professional boundary. If the radiographer is not able to disclose results to patients, it does not afford them much professional autonomy in their working environment [50]. Often the patient is at risk of not been communicated too. The biomedical and psychosocial worlds cannot be treated as isolated components [58]. These authors refer to the different languages and cultures of these worlds—different ways of knowing—that both contribute to the establishment of overall care of the patients, inter alia about efficient use of resources, the quality of services, and provider and patient satisfaction. These authors refer to the predictability existing in the biomedical world with its focus on anatomy and physiology with a view to diagnose and institute effective treatment to bring the human body

**90**

### **Figure 2.**

*The role of information and interpretation in diagnostic imaging decision-making.*

[73]. According to Paul and Reddy, interpretation draws on mediation tools and embedded contexts such as work practices, cultures, organization structures, and interpersonal relations [74].

To construct and reconstruct a diagnosis and management plan to improve patient outcomes, information in the form of empirical evidence—the "right" piece of information—needs to be gathered during a medical consultation and by means of diagnostic tests [75, 76]. Pivotal questions are "what information to gather?; which diagnostic test to perform?; how to interpret and integrate this information to draw diagnostic conclusions?" ([75], pp. 26–27).

Medical imaging procedures whether diagnostic or interventional, for instance, draw the following together: the system; diverse but interconnected communities of practice; the patient; technology; drugs; clinical interventions; and many other elements [77]. All of them are interconnected and interrelated, "yet each irreducible to the other."

Regarding diagnostic imaging, Murphy [78] distinguishes between "hard technology" (equipment) designed to diagnose and treat disease and "soft technology" that includes the social interactions of radiographers with patients and other health-care professionals. The radiographer acts as an interface between the patient and biomedical health, technology, and humane health care, referred to as "technology-in-practice" [79]. The coordinating power of health technologies is concerned with how technologies can bring together or break apart the pragmatic worlds as social actors navigate in our everyday lives [80]. Reeves and Decker [81] refer to the "technology-human dualism" with which the profession of radiography is faced because of the short encounter and once-off interactions with patients discouraging emotional investment. Within the imaging context entails an acknowledgement of the situation-specific encounter between individual patients and health-care professionals where patient needs and desires do not come to the forefront instead the anatomy and physiology [70].

Some of these combined terminologies referred to above are well described in the literature, whereas others need further exploration in future in terms of the feasibility of their application and their relations to quality of patient care, patient and provider satisfaction, and/or efficient use of resources [70]. The ever-shifting

**93**

provided the original work is properly cited.

the delivery of health-care services.

**Conflict of interest**

None.

**Author details**

Australia

Chandra R. Makanjee

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

Department of Medical Radiation Sciences, University of Canberra, Bruce, ACT,

\*Address all correspondence to: chandra.makanjee@canberra.edu.au

*Diagnostic Imaging Safety and Protection: A Collective Interaction and Decision-Making…*

boundaries between different worlds in which health-care providers and patients are situated and the interconnectedness between role players also has particular implications for the formation of professional boundaries, and identities illustrating the temporariness of encounters within the continuum of the care is the challenge

In conclusion, the building blocks for deciding on the most appropriate investigation of choice with minimal risk and optimal benefit in terms of management and treatment strategies are highly dependent on the organizational structure, its institutional members, the quality of the referral, the investigation itself, and the outcomes thereof. The process evolves as the events unfold, based on the actions that are taken and highly dependent on who is communicating with whom in that institution or with a referral institution and what is communicated with whom. The processes and interactions are also more dependent on what patients present with and how patients present their condition. It calls for a risk-centered approach to many syndromes and chronic conditions [6] and parallels proposals that public health should be organized around achievable outcomes rather than disease categories. Such a framework shifts the focus of clinical practice to improving outcomes for patients in their total biological, psychological, and social environment and away from an exclusive and narrow focus on underlying disease as the determinant of outcome. The underlying "disease" is often a continuous distribution of probability for future health states [21]. This encounter entails the patient together with a diverse range of health-care professionals to collectively align their decisions in ensuring that the safety and care of the patient as a person is not compromised in

*DOI: http://dx.doi.org/10.5772/intechopen.82844*

of ensuring the safety of the patient as a person.

**5. Conclusions**

*Diagnostic Imaging Safety and Protection: A Collective Interaction and Decision-Making… DOI: http://dx.doi.org/10.5772/intechopen.82844*

boundaries between different worlds in which health-care providers and patients are situated and the interconnectedness between role players also has particular implications for the formation of professional boundaries, and identities illustrating the temporariness of encounters within the continuum of the care is the challenge of ensuring the safety of the patient as a person.

### **5. Conclusions**

*Ionizing and Non-ionizing Radiation*

interpersonal relations [74].

**Figure 2.**

ible to the other."

to draw diagnostic conclusions?" ([75], pp. 26–27).

[73]. According to Paul and Reddy, interpretation draws on mediation tools and embedded contexts such as work practices, cultures, organization structures, and

*The role of information and interpretation in diagnostic imaging decision-making.*

To construct and reconstruct a diagnosis and management plan to improve patient outcomes, information in the form of empirical evidence—the "right" piece of information—needs to be gathered during a medical consultation and by means of diagnostic tests [75, 76]. Pivotal questions are "what information to gather?; which diagnostic test to perform?; how to interpret and integrate this information

Medical imaging procedures whether diagnostic or interventional, for instance, draw the following together: the system; diverse but interconnected communities of practice; the patient; technology; drugs; clinical interventions; and many other elements [77]. All of them are interconnected and interrelated, "yet each irreduc-

Regarding diagnostic imaging, Murphy [78] distinguishes between "hard technology" (equipment) designed to diagnose and treat disease and "soft technology" that includes the social interactions of radiographers with patients and other health-care professionals. The radiographer acts as an interface between the patient and biomedical health, technology, and humane health care, referred to as "technology-in-practice" [79]. The coordinating power of health technologies is concerned with how technologies can bring together or break apart the pragmatic worlds as social actors navigate in our everyday lives [80]. Reeves and Decker [81] refer to the "technology-human dualism" with which the profession of radiography is faced because of the short encounter and once-off interactions with patients discouraging emotional investment. Within the imaging context entails an acknowledgement of the situation-specific encounter between individual patients and health-care professionals where patient needs and desires do not come to the forefront instead the anatomy and physiology [70].

Some of these combined terminologies referred to above are well described in the literature, whereas others need further exploration in future in terms of the feasibility of their application and their relations to quality of patient care, patient and provider satisfaction, and/or efficient use of resources [70]. The ever-shifting

**92**

In conclusion, the building blocks for deciding on the most appropriate investigation of choice with minimal risk and optimal benefit in terms of management and treatment strategies are highly dependent on the organizational structure, its institutional members, the quality of the referral, the investigation itself, and the outcomes thereof. The process evolves as the events unfold, based on the actions that are taken and highly dependent on who is communicating with whom in that institution or with a referral institution and what is communicated with whom. The processes and interactions are also more dependent on what patients present with and how patients present their condition. It calls for a risk-centered approach to many syndromes and chronic conditions [6] and parallels proposals that public health should be organized around achievable outcomes rather than disease categories. Such a framework shifts the focus of clinical practice to improving outcomes for patients in their total biological, psychological, and social environment and away from an exclusive and narrow focus on underlying disease as the determinant of outcome. The underlying "disease" is often a continuous distribution of probability for future health states [21]. This encounter entails the patient together with a diverse range of health-care professionals to collectively align their decisions in ensuring that the safety and care of the patient as a person is not compromised in the delivery of health-care services.

### **Conflict of interest**

None.

### **Author details**

Chandra R. Makanjee Department of Medical Radiation Sciences, University of Canberra, Bruce, ACT, Australia

\*Address all correspondence to: chandra.makanjee@canberra.edu.au

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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[32] Murphy F. Understanding the humanistic interaction with medical imaging technology. Radiography.

Radiography. 2016:e40-e53. DOI:

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Radiology: Principles and Case Studies. 1st ed. Hoboken, NJ: John Wiley and

[41] Carlton RR, Adler AM. Principles of Radiographic Imaging: An Art and A Science. 5th ed. New York: Delmar,

[42] Egan I, Baird M. Optimising the diagnostic imaging process through clinical history documentation. The Radiographer. 2003;**50**(1):11-18

[43] Hardy M, Barret C. Interpretation of trauma radiographs by radiographers and nurses in the UK: A comparative study. The British Journal of Radiology.

[44] Pusic VC, Andrews JS, Kessler DO, Teng DC, Pecaric MR, Ruzal-Shapiro C, et al. Prevalence of abnormal cases in an image bank affects the learning of radiograph interpretation. Medical Education. 2012;**46**(3):289-298

[45] Spilseth B, Ghai S, Patel NU, Taneja SS, Margolis DJ, Rosenkrantz AB. A comparison of radiologists' and urologists' opinions regarding prostate MRI reporting: Results from a survey of specialty societies. American Journal of Roentgenology. 2018;**210**(1):101-107.

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2008;**26**(4):222-227

[46] Undeland M, Malterud K. Diagnostic interaction: The patient as a source of knowledge? Scandinavian Journal of Primary Health Care.

[47] Suter E, Arndt J, Arthur N,

of Interprofessional Care.

2009;**23**(1):41-45

Parboosingh J, Taylor E, Deutschlander S. Role understanding and effective communication as core competencies for collaborative practice. Journal

10.1016/j.radi.2015.07.001

Cengage Learning; 2013

2004;**77**(920):657-661

Sons; 2010

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2017;**92**(11):1612-1616. DOI: 10.1016/j.mayocp.2017.08.010 www.

mayoclinicproceedings.org

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[35] Triantopoulou C, Tsalafoutas I, Maniatis P, Papavdis D, Raios G, Siafas I, et al. Analysis of radiological

examination request forms in conjunction with justification of X-ray exposures. European Journal of Radiology. 2005;**53**(3):306-311

[36] Halkett GKB, McKay J, Shaw

of history taking. Radiography.

N. Use your good judgment— Radiographers' knowledge in image production work. Radiography.

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[39] Mc Inerney J, Baird B. Developing critical practitioners: A review of teaching methods in the bachelor of radiography and medical imaging.

2011;**17**(1):55-60

2009;**15**(3):11-21

T. Improving students' confidence levels in communicating with patients and introducing students to the importance

[37] Larsson W, Hillergård K, Lundberg

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2001;**7**(3):193-201

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[51] Makanjee CR, Bergh AM, Hoffmann WA. Healthcare provider and patient perspectives on diagnostic imaging investigations. African Journal of Primary Health Care and Family Medicine. 2015;**7**:1-10

[52] Cropley S. The relationshipbased care model: Evaluation of the impact on patient satisfaction, length of stay, and readmission rates. The Journal of Nursing Administration. 2012;**42**(6):333-339

[53] Dy SM, Purnell TS. Key concepts relevant to quality of complex and shared decision-making in health care: A literature review. Social Science & Medicine. 2012;**74**(4):582-587

[54] Elwyn G. Arriving at the postmodern medical consultation. Primary Care. 2005;**5**(12-13):287-291. Available from: http://www.primarycare.ch/docs/primarycare/archiv/ defr/2005/2005-12/2005-12-423.PDF [Retrieved: 5 January 2009

[55] Jayadevappa R, Chattre S. Patient centred care—A conceptual model and review of the state of art. The Open Health Services and Policy Journal. 2011;**4**:15-25

[56] Henderson A. Boundaries around the 'well-informed' patient: The contribution of Schutz to inform nurses' interactions. Journal of Clinical Nursing. 2006;**15**(1):4-10

[57] Van Ravesteijn H, Van Dijk I, Darmon D, Van Der Laar F, Lucassen P. The reassuring value of diagnostic tests: A systematic review. Patient Education and Counseling. 2012;**86**(1):3-8

[58] Makanjee CR, Engel-Hills P. Ethics in diagnostic radiography in South Africa: A complex temporary encounter mediated through text and technology. In: Nortjé N, De Jongh JC, Hoffmann W, editors. African Perspectives on Ethics for Healthcare Professionals. Advancing Global Bioethics. Vol. 13. Cham: Springer; 2018. pp. 201-204

[59] Chun-sing W, Bingshenga H, Ho-kwan S, Wai-lamb W, Ka-ling Y, Tiffany CYC. A questionnaire study assessing local physicians, radiologists and interns' knowledge and practice pertaining to radiation exposure related to radiological imaging. European Journal of Radiology. 2012;**81**(3):264-268

[60] Lin EC. Radiation risk from medical imaging. Mayo Clinic Proceedings. 2010;**85**(12):1142-1146. quiz 1146

[61] Balaqué F, Cedraschi C. Radiological examination in low back pain patients: Anxiety of the patient? Anxiety of the therapist? Joint, Bone, Spine. 2006;**73**(5):508-513

[62] Borgen L, Stranden E, Espeland A. Clinicians' justification of imaging: Do radiation issues play a role. Insights Imaging. 2010;**1**(3):193-200

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*Ionizing and Non-ionizing Radiation*

Elgar Publishing. 2017

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[66] Johansen LW, Brodersen J. Reading screening mammograms: Attitudes among radiologists and radiographers about skill mix. European Journal of Radiology. 2011;**80**(3):325-330

[67] Hilligoss PB. Patient handoffs between emergency department and inpatient physicians: A qualitative study to inform standardization of practice and organization theory [doctoral thesis]. Ann Arbor, Michigan, United States: University of Michigan; 2011. Available from: http://deepblue.lib. umich.edu/ bitstream/2027.42/86293/1/ bhilligo\_1.pdf [Retrieved: 7 May 2012]

[68] Lewis S, Heard R, Robinson J, White K, Poulos A. The ethical commitment of Australian radiographers: Does medical dominance create an influence?

Radiography. 2008;**14**(2):90-97

[69] Olivier L, Leclère J, Dolbeault S, Neuenschwander S. Doctor-patient relationship in oncologic radiology. Cancer Imaging. 2005;**11**(5):S83-S88

[70] Alfuth R, Barnard CP. Family physicians and family therapists: Understanding the interdependent synergism. Contemporary Family Therapy. 2000;**22**(3):253-277

[71] Nancarrow SA, Borthwick

2005;**27**(7):897-919

AL. Dynamic professional boundaries in the healthcare force workforce. Sociology of Health & Illness.

[64] Stephens JP, Carmeli A. Relational leadership and creativity: The effects of respectful engagement and caring on meaningfulness and creative work involvement. In: Hemlin S, Mumford MD, editors. Handbook of Research on Creativity and Leadership. Edward

[72] Wilson SJ. The myth of objectivity: Is medicine moving towards a social constructivist paradigm? Family Practice. 2000;**17**(2):203-209

[74] Paul SA, Reddy MC. Understanding together: Sensemaking in collaborative

[75] Everitt S. Clinical decision making in veterinary practice [doctoral thesis]. United Kingdom: University of Nottingham; 2011. Available from: http://etheses.nottingham.ac.uk/2051/

[76] Tatsioni A, Zarin DA, Aronson N, Samson DJ, Flamm CR, Schmid C, et al. Challenges in systematic reviews of diagnostic technologies. Annals of Internal Medicine. 2005;**142**(12, Part 2):

[77] Mol A, Elsman B. Detecting disease and designing treatment: Duplex and the diagnosis of diseased leg vessels. Sociology of Health and Illness.

[78] Murphy FJ. The paradox of imaging technology: A review of the literature. Radiography. 2006;**12**(2):169-174

[80] Moreira T, Rapley T. Understanding

[79] Timmermans S, Berg M. The practice of medical technology. Sociology of Health & Illness.

the shaping, incorporation and coordination of health technologies through qualitative research. In: Bourgeault I, Dingwall R, De Vries R, editors. The SAGE Handbook of

[73] Price P. Evidence-based laboratory medicine: Supporting decision-making. Clinical Chemistry.

information seeking. In: 2010 ACM Conference on Computer Supported Cooperative Work, CSCW 2010. 2010. pp. 321-330. DOI:

10.1145/1718918.1718976

[Retrieved: 7 October 2012]

1048-1055

1996;**18**(5):609-631

2003;**25**(3):97-114

2000;**46**(8):1041-1050

**98**

Chapter 6

Abstract

Vladimir Kutkov

Dosimetry for Use in Preparedness

Lessons learned from responses to past radiological and nuclear emergencies have shown that more guidance is needed for assessing doses to those who were affected in emergency exposure situation. The chapter introduces system of dosimetric quantities for use in emergency preparedness and response to nuclear or radiological emergency, which includes RBE-weighted absorbed dose in tissue or organ for evaluation of the risk of severe deterministic effects, equivalent dose in tissue or organ for evaluation of the risk of stochastic effects, and effective dose for evaluation of the detriment due to undetectable stochastic effects. The chapter also provides internationally proved criteria for protection of individual in emergency exposure situation and framework of dose and risk assessment in an emergency. The special attention has been put on evaluation of available sources of dosimetric

and Response to Radiological and

Nuclear Emergency

data needed for dose and risk assessment in an emergency.

emergency exposure situation and includes three parts:

event of nuclear or radiological emergency.

emergency exposure situation.

deterministic effects, stochastic effects

1. Introduction

101

Keywords: emergency, dosimetry, internal exposure, external exposure,

or would be received in emergency exposure situation, to be able to take an informed decision on protective and other response actions, including medical treatment of overexposed person as demanded in the IAEA General Safety

quantities, for use in emergency preparedness and response.

2. Criteria for assessment of doses received or expected to be received in

Requirements (GSR) Part 7 [1]. The chapter presents a basis for dose assessment in

1. Explanation of dosimetric quantities, such as basic, protection, and operational

3. Framework of estimation of protection quantities from monitoring results in

In event of nuclear or radiological emergency, uncontrolled exposure to ionizing radiation can cause fatal or threatening health effects. Dose received by individual determines the nature of such effects and their severity. To protect individual in emergency exposure situation, one needs to assess doses, which have been received,

### Chapter 6

## Dosimetry for Use in Preparedness and Response to Radiological and Nuclear Emergency

Vladimir Kutkov

### Abstract

Lessons learned from responses to past radiological and nuclear emergencies have shown that more guidance is needed for assessing doses to those who were affected in emergency exposure situation. The chapter introduces system of dosimetric quantities for use in emergency preparedness and response to nuclear or radiological emergency, which includes RBE-weighted absorbed dose in tissue or organ for evaluation of the risk of severe deterministic effects, equivalent dose in tissue or organ for evaluation of the risk of stochastic effects, and effective dose for evaluation of the detriment due to undetectable stochastic effects. The chapter also provides internationally proved criteria for protection of individual in emergency exposure situation and framework of dose and risk assessment in an emergency. The special attention has been put on evaluation of available sources of dosimetric data needed for dose and risk assessment in an emergency.

Keywords: emergency, dosimetry, internal exposure, external exposure, deterministic effects, stochastic effects

### 1. Introduction

In event of nuclear or radiological emergency, uncontrolled exposure to ionizing radiation can cause fatal or threatening health effects. Dose received by individual determines the nature of such effects and their severity. To protect individual in emergency exposure situation, one needs to assess doses, which have been received, or would be received in emergency exposure situation, to be able to take an informed decision on protective and other response actions, including medical treatment of overexposed person as demanded in the IAEA General Safety Requirements (GSR) Part 7 [1]. The chapter presents a basis for dose assessment in emergency exposure situation and includes three parts:


### 2. Dosimetric quantities

The International Commission on Radiation Units and Measurements (ICRU) in Report 30 [2] formulates a quantitative dosimetric concept in radiobiology as follows:

shall be evaluated on the basis of equivalent dose in tissue or organ. The detriment associated with the occurrence of stochastic effects in individuals in an exposed population shall be evaluated on the basis of the effective dose" (para. 4.28 of GSR Part 7 [1]). Dosimetric quantities of RBE-weighted absorbed dose in tissue or organ T, ADT; equivalent dose in tissue or organ T, HT; and effective dose E are defined in

The overall theory on the development of biological health effects is not yet developed. The protection quantities are essentially used for evaluation of consequences of human exposure to ionizing radiation in terms of developing deterministic and stochastic health effects separately as listed in Table 1. Figure 1 presents

Radiation protection quantities could not be measured directly. In particular irradiation conditions, they could be calculated by taking into account estimates of basic protection quantities (results of their measurement or calculation), geometry of irradiation, characteristics of irradiated person, etc. For radiation protection purposes, these quantities are defined for reference persons representing different groups of the public and workers in [6] and standard irradiation geometries for

Definitions of these quantities can be found in the GSR Part 3 [5], 2007 Recommendations of the International Commission on Radiological Protection (ICRP) [8],

The determination of RBE-weighted dose ADT in a tissue or organ T involves the

where DT,R is the average absorbed dose in the tissue or organ T for radiation R. Factor RBET,R depends on the quality of radiation and macroscopic distribution of energy of radiation imparted to matter of affected organ or tissue [9]. The role of such heterogeneity is significant in the case of internal exposure [9, 10]. The RBE-

DT,R � RBET,R, (1)

ADT Gy For evaluating deterministic effects induced as a result of exposure of an organ or tissue T

HT Sv For evaluating stochastic effects induced as a result of exposure of an organ or tissue T

stochastic effects in an exposed population

use of tissue-specific and radiation-specific factors RBET,R as a multiplier of absorbed dose for radiation R, to reflect the relative biological effectiveness of the

radiation in inducing severe deterministic effect in organ T at high doses:

weighted absorbed dose in tissue or organ is defined for use together with

Effective dose E Sv For evaluating detriment related to the occurrence of

Personal dose equivalent HPð Þ d Sv For monitoring external exposure of an individual Ambient dose equivalent <sup>H</sup><sup>∗</sup>ð Þ <sup>d</sup> Sv For monitoring a radiation field of the strongly

penetrating radiation

ð Þ d; Ω Sv For monitoring a radiation field of the weakly penetrating radiation

Dosimetric quantity Symbol Unit Purpose

ADT ¼ ∑ R

GSG-2 [4] and GSR Part 3 [5] and recommended for protection purposes.

Dosimetry for Use in Preparedness and Response to Radiological and Nuclear Emergency

DOI: http://dx.doi.org/10.5772/intechopen.83370

relationship between protection quantities and basic physical quantities.

external exposure in [7].

and EPR Publication [9].

Protection quantities RBE-weighted absorbed dose in tissue or organ T

organ T

Table 1.

103

Dosimetric quantities.

Equivalent dose in tissue or

Operational quantities

Directional dose equivalent H<sup>0</sup>


Dosimetric concept considers two-step assessment of a dose to characterize health consequences of exposure to ionizing radiation. On the first step, an energy of radiation absorbed in a tissue or organ has to be evaluated. On the next step, a human exposure has to be evaluated in term of protection quantities which could be used in models of developing radiation health effects to assess health consequences (risks) associated with irradiation. At this step, quality of radiation has to be considered taking into account its dependence on properties of radiation, properties of tissue or organ, and expected health effect.

### 2.1 Basic physical quantities

The basic dosimetric quantities include the particle fluence ΦR, the kerma KR, and the absorbed dose DR of radiation R. Basic quantities characterize the field of radiation and its interaction with a medium where the human body could be present:


The ICRU provides exact definition of these quantities in [3].

### 2.2 Protection quantities

Protection quantities are the dosimetric quantities, which characterize the irradiation of the human. GSR Part 7 [1] states that in response to emergency, "consideration shall be given to actions to be taken to avoid or to minimize severe deterministic effects and to reduce the risk of stochastic effects. Deterministic effects shall be evaluated on the basis of relative biological effectiveness (RBE) weighted absorbed dose in tissue or organ. Stochastic effects in a tissue or organ

### Dosimetry for Use in Preparedness and Response to Radiological and Nuclear Emergency DOI: http://dx.doi.org/10.5772/intechopen.83370

shall be evaluated on the basis of equivalent dose in tissue or organ. The detriment associated with the occurrence of stochastic effects in individuals in an exposed population shall be evaluated on the basis of the effective dose" (para. 4.28 of GSR Part 7 [1]). Dosimetric quantities of RBE-weighted absorbed dose in tissue or organ T, ADT; equivalent dose in tissue or organ T, HT; and effective dose E are defined in GSG-2 [4] and GSR Part 3 [5] and recommended for protection purposes.

The overall theory on the development of biological health effects is not yet developed. The protection quantities are essentially used for evaluation of consequences of human exposure to ionizing radiation in terms of developing deterministic and stochastic health effects separately as listed in Table 1. Figure 1 presents relationship between protection quantities and basic physical quantities.

Radiation protection quantities could not be measured directly. In particular irradiation conditions, they could be calculated by taking into account estimates of basic protection quantities (results of their measurement or calculation), geometry of irradiation, characteristics of irradiated person, etc. For radiation protection purposes, these quantities are defined for reference persons representing different groups of the public and workers in [6] and standard irradiation geometries for external exposure in [7].

Definitions of these quantities can be found in the GSR Part 3 [5], 2007 Recommendations of the International Commission on Radiological Protection (ICRP) [8], and EPR Publication [9].

The determination of RBE-weighted dose ADT in a tissue or organ T involves the use of tissue-specific and radiation-specific factors RBET,R as a multiplier of absorbed dose for radiation R, to reflect the relative biological effectiveness of the radiation in inducing severe deterministic effect in organ T at high doses:

$$AD\_T = \sum\_R D\_{T,R} \times RBE\_{T,R} \tag{1}$$

where DT,R is the average absorbed dose in the tissue or organ T for radiation R.

Factor RBET,R depends on the quality of radiation and macroscopic distribution of energy of radiation imparted to matter of affected organ or tissue [9]. The role of such heterogeneity is significant in the case of internal exposure [9, 10]. The RBEweighted absorbed dose in tissue or organ is defined for use together with


Table 1. Dosimetric quantities.

2. Dosimetric quantities

Ionizing and Non-ionizing Radiation

as follows:

The International Commission on Radiation Units and Measurements (ICRU) in Report 30 [2] formulates a quantitative dosimetric concept in radiobiology

1. Biological effects of radiation are correlated with the energy absorbed by

2. Biological effects of radiation are modified by microscopic spatial distribution

Dosimetric concept considers two-step assessment of a dose to characterize health consequences of exposure to ionizing radiation. On the first step, an energy of radiation absorbed in a tissue or organ has to be evaluated. On the next step, a human exposure has to be evaluated in term of protection quantities which could be used in models of developing radiation health effects to assess health consequences (risks) associated with irradiation. At this step, quality of radiation has to be considered taking into account its dependence on properties of radiation, properties of

The basic dosimetric quantities include the particle fluence ΦR, the kerma KR, and the absorbed dose DR of radiation R. Basic quantities characterize the field of radiation and its interaction with a medium where the human body could be

1. The fluence, ΦR, is the quotient of dNR by ds, where dNR is the number of particles R incident on a sphere of cross-sectional area ds. Unit of fluence

2. The kerma, KR, for ionizing uncharged particles R, is the quotient of dEtr by dm, where dEtr is the mean sum of the initial kinetic energies of all the charged particles liberated in a mass dm of a material by the uncharged particles incident on dm. Unit of kerma is J/kg. The special name for the unit of kerma is

3. The absorbed dose, DR, is the quotient of dε by dm, where dε is the mean energy imparted by ionizing radiation to matter of mass dm. Unit of absorbed dose is J/kg. The special name for the unit of absorbed dose is gray (Gy).

Protection quantities are the dosimetric quantities, which characterize the irradiation of the human. GSR Part 7 [1] states that in response to emergency, "consid-

eration shall be given to actions to be taken to avoid or to minimize severe deterministic effects and to reduce the risk of stochastic effects. Deterministic effects shall be evaluated on the basis of relative biological effectiveness (RBE) weighted absorbed dose in tissue or organ. Stochastic effects in a tissue or organ

The ICRU provides exact definition of these quantities in [3].

ionization and excitation in unit mass of tissue.

of energy of radiation imparted to matter.

tissue or organ, and expected health effect.

2.1 Basic physical quantities

present:

is m<sup>2</sup> .

gray (Gy).

2.2 Protection quantities

102

Figure 1. Dosimetric quantities.

radiobiological model for assessing the risk of developing severe deterministic effects in critical organs and tissues at high doses [9–12].

The determination of equivalent dose HT in a tissue or organ T involves the use of a radiation weighting factor wR as a multiplier of absorbed dose for radiation R, to reflect the relative biological effectiveness of the radiation in inducing stochastic effects at low doses:

$$H\_T = \sum\_R D\_{T,R} \times w\_R.\tag{2}$$

Recommendations of the ICRP state in para. (153) that the main and primary uses of effective dose in radiological protection for both occupational workers and the

Dosimetry for Use in Preparedness and Response to Radiological and Nuclear Emergency

• prospective dose assessment for planning and optimization of protection; and

• retrospective dose assessment for demonstrating compliance with dose limits,

In this regard, organ or tissue equivalent doses, not effective doses, are required

or for comparing with dose constraints or reference levels.

for assessing the probability of cancer induction in exposed individuals.

The recommended values of RBET,R, wR and wT are based on a review of published biological and epidemiological studies and are given in the definitions of

Since radiation protection quantities cannot be measured directly, the ICRU introduced operational quantities for practical use in radiation protection where exposure due to external sources is concerned. Definitions of these quantities can be found in [16–20] and in GSR Part 3 [5]. The operational quantities provide an estimate of effective or equivalent dose in tissue or organ in such a way that avoids overestimation in most radiation fields encountered in practice [7]. Radiation quality factor Q(L) is used in calculating the operational dose equivalent quantities used in monitoring [21]. The quality factor characterizes the biological effectiveness of the radiation type, based on the ionization density along the tracks of charged particles in tissue. Q is defined as a function of the unrestricted linear energy transfer, Lm (often denoted as L or linear energy transfer, LET), of charged particles in water. Detailed evaluation of the relationship between the physical, protection, and operational quantities was conducted by a joint task group of the ICRP and

Strongly penetrating radiation and weakly penetrating radiation are considered in radiation dosimetry and are differentiated as follows. For most practical purposes, it may be assumed that strongly penetrating radiation includes photons of energy above about 12 keV, electrons of energy more than about 2 MeV, and neutrons. It may be also assumed that weakly penetrating radiation includes photons of energy below about 12 keV, electrons of energy less than about 2 MeV, and

The operational quantity for individual monitoring is the personal dose equivalent HPð Þ d . Any statement of personal dose equivalent has to include a specification of the reference depth d. In order to simplify the notation, d is assumed to be

For strongly penetrating radiation, the reference depth for controlling the radiation detriment in planned exposure situation is 10 mm. Personal dose equivalent HPð Þ 10 provides a conservative estimate of effective dose to adult for strongly

For weakly penetrating radiation, the reference depth for controlling stochastic effects due to irradiation of the basal membrane of the skin is 0.07 mm, and the

For monitoring of the lens of the eye, a depth of 3 mm is recommended by the International Commission on Radiation Units and Measurements [3], so the operational quantity to be used is HPð Þ3 . In practice, however, the use of HPð Þ3 has not yet been implemented for routine individual monitoring. In specific cases, when

massive charged particles as protons and alpha particles [5].

deterministic effect in lens of the eye is 3 mm [15, 22, 23].

general public are:

protection quantities in GSR Part 3 [5].

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2.3 Operational quantities

ICRU [7].

expressed in millimeters.

penetrating radiation.

105

The equivalent dose in tissue or organ is defined for use together with radiobiological model for assessing the risk of developing stochastic effects in organs and tissues at low doses of external [13] and internal [14] exposure.

The determination of effective dose E involves the use of a tissue weighting factor wT as a multiplier of equivalent dose for tissue T, to account for the different sensitivities of different tissues or organs to the induction of stochastic effects and production of radiation detriment [8, 15]:

$$E = \sum\_{T} H\_{T} \times \mathcal{w}\_{T} = \sum\_{T,R} D\_{T,R} \times \mathcal{w}\_{R} \times \mathcal{w}\_{T}.\tag{3}$$

In accordance with the ICRP, the radiation detriment is the total harm to health experienced by an exposed group and its descendants as a result of the group's exposure to a radiation source. Detriment is a multidimensional concept. Its principal components are the stochastic quantities: probability of attributable fatal cancer, weighted probability of attributable nonfatal cancer, weighted probability of severe heritable effects, and length of life lost if the harm occurs [8]. The 2007

Recommendations of the ICRP state in para. (153) that the main and primary uses of effective dose in radiological protection for both occupational workers and the general public are:


In this regard, organ or tissue equivalent doses, not effective doses, are required for assessing the probability of cancer induction in exposed individuals.

The recommended values of RBET,R, wR and wT are based on a review of published biological and epidemiological studies and are given in the definitions of protection quantities in GSR Part 3 [5].

### 2.3 Operational quantities

Since radiation protection quantities cannot be measured directly, the ICRU introduced operational quantities for practical use in radiation protection where exposure due to external sources is concerned. Definitions of these quantities can be found in [16–20] and in GSR Part 3 [5]. The operational quantities provide an estimate of effective or equivalent dose in tissue or organ in such a way that avoids overestimation in most radiation fields encountered in practice [7]. Radiation quality factor Q(L) is used in calculating the operational dose equivalent quantities used in monitoring [21]. The quality factor characterizes the biological effectiveness of the radiation type, based on the ionization density along the tracks of charged particles in tissue. Q is defined as a function of the unrestricted linear energy transfer, Lm (often denoted as L or linear energy transfer, LET), of charged particles in water. Detailed evaluation of the relationship between the physical, protection, and operational quantities was conducted by a joint task group of the ICRP and ICRU [7].

Strongly penetrating radiation and weakly penetrating radiation are considered in radiation dosimetry and are differentiated as follows. For most practical purposes, it may be assumed that strongly penetrating radiation includes photons of energy above about 12 keV, electrons of energy more than about 2 MeV, and neutrons. It may be also assumed that weakly penetrating radiation includes photons of energy below about 12 keV, electrons of energy less than about 2 MeV, and massive charged particles as protons and alpha particles [5].

The operational quantity for individual monitoring is the personal dose equivalent HPð Þ d . Any statement of personal dose equivalent has to include a specification of the reference depth d. In order to simplify the notation, d is assumed to be expressed in millimeters.

For strongly penetrating radiation, the reference depth for controlling the radiation detriment in planned exposure situation is 10 mm. Personal dose equivalent HPð Þ 10 provides a conservative estimate of effective dose to adult for strongly penetrating radiation.

For weakly penetrating radiation, the reference depth for controlling stochastic effects due to irradiation of the basal membrane of the skin is 0.07 mm, and the deterministic effect in lens of the eye is 3 mm [15, 22, 23].

For monitoring of the lens of the eye, a depth of 3 mm is recommended by the International Commission on Radiation Units and Measurements [3], so the operational quantity to be used is HPð Þ3 . In practice, however, the use of HPð Þ3 has not yet been implemented for routine individual monitoring. In specific cases, when

radiobiological model for assessing the risk of developing severe deterministic

HT ¼ ∑ R

HT � wT ¼ ∑

heritable effects, and length of life lost if the harm occurs [8]. The 2007

tissues at low doses of external [13] and internal [14] exposure.

production of radiation detriment [8, 15]:

E ¼ ∑ T

The determination of equivalent dose HT in a tissue or organ T involves the use of a radiation weighting factor wR as a multiplier of absorbed dose for radiation R, to reflect the relative biological effectiveness of the radiation in inducing stochastic

The equivalent dose in tissue or organ is defined for use together with radiobiological model for assessing the risk of developing stochastic effects in organs and

The determination of effective dose E involves the use of a tissue weighting factor wT as a multiplier of equivalent dose for tissue T, to account for the different sensitivities of different tissues or organs to the induction of stochastic effects and

T, <sup>R</sup>

In accordance with the ICRP, the radiation detriment is the total harm to health

experienced by an exposed group and its descendants as a result of the group's exposure to a radiation source. Detriment is a multidimensional concept. Its principal components are the stochastic quantities: probability of attributable fatal cancer, weighted probability of attributable nonfatal cancer, weighted probability of severe

DT,R � wR: (2)

DT,R � wR � wT: (3)

effects in critical organs and tissues at high doses [9–12].

effects at low doses:

Figure 1.

104

Dosimetric quantities.

Ionizing and Non-ionizing Radiation

actual workplace radiation fields are known, monitoring of the eye through dosimeters calibrated for HPð Þ 0:07 could be acceptable. In [23], it is stated that HPð Þ 0:07 can be considered a good operational quantity for the lens of the eye for exposures to fields for which most of the dose is due to photons, including X radiation. In such cases, it has to be borne in mind that the uncertainty associated with the estimation of equivalent dose will be higher.

If the field is unidirectional, the direction Ω is specified as the angle between the

ð Þ d; 0 is

ð Þ d; Ω , the radiation fields have to be uniformed

radius opposing the incident field and the specified radius. When the specified radius is parallel to the radiation field (i.e., when Ω = 0°) the quantity H<sup>0</sup>

Dosimetry for Use in Preparedness and Response to Radiological and Nuclear Emergency

over the dimensions of the instrument, and the instrument has to have the appro-

When determining the possible health hazard, three dosimetric quantities must

2. The equivalent dose HT, which is used to evaluate the risk of stochastic effects

Protection quantities are applicable in certain dose ranges. Figure 3 provides an example of the applicable ranges for dosimetric quantities characterizing external penetrating radiation to evaluate risk of severe deterministic effects and stochastic effects, i.e., observable increase in the incidence of radiation-induced cancers. The ranges are not exactly defined because of competition of effects. For instance, both the risks of radiogenic cancers and severe deterministic effects have to be evaluated when whole-body absorbed dose is around 1 Gy. Below 100 mGy may not have any severe deterministic effects or an observable increase in the incidence of cancer, even in a very large exposed group. An increase in the cancer incidence rate due to

radiation-induced cases is uncertain and will not be detectable [10, 12, 24].

tional criteria that form the basis for decision-making in an emergency.

Probability of severe health effects as a function of absorbed dose for external penetrating radiation.

The system of protective actions and other response actions in an emergency includes numerical values of generic criteria as well as of the corresponding opera-

Table 2 presents levels of RBE-weighted absorbed dose in critical organs and tissues which if exceeded will give rise to severe deterministic effects in 5% of those

3. The effective dose E, which is used to evaluate the radiogenic detriment for

1. The RBE-weighted dose ADT, which is used to evaluate the risk of severe

equal to <sup>H</sup><sup>∗</sup>ð Þ <sup>d</sup> . When measuring <sup>H</sup><sup>0</sup>

DOI: http://dx.doi.org/10.5772/intechopen.83370

3. Generic dosimetric criteria

be considered as shown in Table 1:

purposes of radiation protection

deterministic effects

who are exposed.

Figure 3.

107

priate directional response.

The operational quantities recommended for workplace monitoring are defined in a phantom known as the ICRU sphere [18]. This is a sphere of 30 cm diameter made of tissue equivalent material with a density of 1 g/cm<sup>3</sup> and an elemental composition (by mass) of 76.2% oxygen, 11.1% carbon, 10.1% hydrogen, and 2.6% nitrogen.

The two quantities recommended by the International Commission on Radiation Units and Measurements for workplace monitoring [3] are the ambient dose equivalent <sup>H</sup><sup>∗</sup>ð Þ <sup>d</sup> and the directional dose equivalent <sup>H</sup><sup>0</sup> ð Þ d; Ω .

The ambient dose equivalent <sup>H</sup><sup>∗</sup>ð Þ <sup>d</sup> at a point in a radiation field is the dose equivalent that would be produced by the corresponding aligned and expanded field in the ICRU sphere, at a depth d on the radius opposing the direction of the aligned field.

The expanded field (see Figure 2(b)) is one in which the fluence and its angular and energy distribution are the same throughout the volume of interest as in the actual field at the point of reference (see Figure 2(a)). In the expanded and aligned field (see Figure 2(c)), the fluence and its energy distribution are the same as in the expanded field, but the fluence is unidirectional [12].

Any statement of ambient dose equivalent has to include a specification of the reference depth d. For strongly penetrating radiation, the recommended depth is 10 mm. When measuring <sup>H</sup><sup>∗</sup>ð Þ <sup>10</sup> , the radiation fields have to be uniformed over the sensitive volume of the instrument, and the instrument has to have an isotropic response.

The directional dose equivalent H<sup>0</sup> ð Þ d; Ω at a point in a radiation field is the dose equivalent that would be produced by the corresponding expanded field in the ICRU sphere, at a depth d on a radius in a specified direction Ω. Any statement of directional dose equivalent has to include a specification of the reference depth d and the direction Ω of the radiation. For strongly penetrating radiation and weakly penetrating radiation, the recommended depths are 10 mm and 0.07 mm, respectively.

Figure 2. Actual, expanded, and aligned radiation field.

Dosimetry for Use in Preparedness and Response to Radiological and Nuclear Emergency DOI: http://dx.doi.org/10.5772/intechopen.83370

If the field is unidirectional, the direction Ω is specified as the angle between the radius opposing the incident field and the specified radius. When the specified radius is parallel to the radiation field (i.e., when Ω = 0°) the quantity H<sup>0</sup> ð Þ d; 0 is equal to <sup>H</sup><sup>∗</sup>ð Þ <sup>d</sup> . When measuring <sup>H</sup><sup>0</sup> ð Þ d; Ω , the radiation fields have to be uniformed over the dimensions of the instrument, and the instrument has to have the appropriate directional response.

### 3. Generic dosimetric criteria

actual workplace radiation fields are known, monitoring of the eye through dosimeters calibrated for HPð Þ 0:07 could be acceptable. In [23], it is stated that HPð Þ 0:07 can be considered a good operational quantity for the lens of the eye for exposures to fields for which most of the dose is due to photons, including X radiation. In such cases, it has to be borne in mind that the uncertainty associated with the estimation

The operational quantities recommended for workplace monitoring are defined in a phantom known as the ICRU sphere [18]. This is a sphere of 30 cm diameter made of tissue equivalent material with a density of 1 g/cm<sup>3</sup> and an elemental composition (by mass) of 76.2% oxygen, 11.1% carbon, 10.1% hydrogen, and 2.6%

The two quantities recommended by the International Commission on Radiation Units and Measurements for workplace monitoring [3] are the ambient dose equiv-

The expanded field (see Figure 2(b)) is one in which the fluence and its angular and energy distribution are the same throughout the volume of interest as in the actual field at the point of reference (see Figure 2(a)). In the expanded and aligned field (see Figure 2(c)), the fluence and its energy distribution are the same as in the

Any statement of ambient dose equivalent has to include a specification of the reference depth d. For strongly penetrating radiation, the recommended depth is 10 mm. When measuring <sup>H</sup><sup>∗</sup>ð Þ <sup>10</sup> , the radiation fields have to be uniformed over the sensitive volume of the instrument, and the instrument has to have an isotropic

equivalent that would be produced by the corresponding expanded field in the ICRU sphere, at a depth d on a radius in a specified direction Ω. Any statement of directional dose equivalent has to include a specification of the reference depth d and the direction Ω of the radiation. For strongly penetrating radiation and weakly penetrating radiation, the recommended depths are 10 mm and 0.07 mm, respectively.

The ambient dose equivalent <sup>H</sup><sup>∗</sup>ð Þ <sup>d</sup> at a point in a radiation field is the dose equivalent that would be produced by the corresponding aligned and expanded field in the ICRU sphere, at a depth d on the radius opposing the direction of the

ð Þ d; Ω .

ð Þ d; Ω at a point in a radiation field is the dose

of equivalent dose will be higher.

Ionizing and Non-ionizing Radiation

alent <sup>H</sup><sup>∗</sup>ð Þ <sup>d</sup> and the directional dose equivalent <sup>H</sup><sup>0</sup>

expanded field, but the fluence is unidirectional [12].

The directional dose equivalent H<sup>0</sup>

nitrogen.

aligned field.

response.

Figure 2.

106

Actual, expanded, and aligned radiation field.

When determining the possible health hazard, three dosimetric quantities must be considered as shown in Table 1:


Protection quantities are applicable in certain dose ranges. Figure 3 provides an example of the applicable ranges for dosimetric quantities characterizing external penetrating radiation to evaluate risk of severe deterministic effects and stochastic effects, i.e., observable increase in the incidence of radiation-induced cancers. The ranges are not exactly defined because of competition of effects. For instance, both the risks of radiogenic cancers and severe deterministic effects have to be evaluated when whole-body absorbed dose is around 1 Gy. Below 100 mGy may not have any severe deterministic effects or an observable increase in the incidence of cancer, even in a very large exposed group. An increase in the cancer incidence rate due to radiation-induced cases is uncertain and will not be detectable [10, 12, 24].

The system of protective actions and other response actions in an emergency includes numerical values of generic criteria as well as of the corresponding operational criteria that form the basis for decision-making in an emergency.

Table 2 presents levels of RBE-weighted absorbed dose in critical organs and tissues which if exceeded will give rise to severe deterministic effects in 5% of those who are exposed.

Figure 3. Probability of severe health effects as a function of absorbed dose for external penetrating radiation.


HPð Þ 10 in Table 4 are used for planning and operational monitoring of the work's

Task Quantity and guidance level

Dosimetry for Use in Preparedness and Response to Radiological and Nuclear Emergency

Actions to avert a large collective dose 100 mSv 100 mSv 10% from

Note: (a)This value may be exceeded—with due consideration of the generic criteria in Table 2—under circumstances in which the expected benefits to others clearly outweigh the emergency worker's own health risks and the emergency

HPð Þ 10 E AD<sup>T</sup>

500 mSv 500 mSv 50% from

Table 2

Table 2

be estimated as early as possible in a nuclear or radiological emergency.

4. Estimation of protection quantities

Actions to prevent severe deterministic effects and actions to prevent the development of catastrophic conditions that could

worker volunteers to take the action and understands and accepts these health risks [1].

significantly affect people and the environment

DOI: http://dx.doi.org/10.5772/intechopen.83370

Criteria for assessing individual doses in emergency workers.

for estimation of protective quantities.

rotational; and ISO, isotropic.

109

and air kerma are proportional to fluence:

For non-monoenergetic radiation

To assure protection of the emergency workers, the total effective dose and the RBE-weighted absorbed dose in a tissue or organ via all exposure pathways need to

Protection quantities of ADT, HT and E characterize the exposure of an individual for purposes of implementation of protective actions and other actions to protect him or her in emergency exposure situation. The practical goal of radiation monitoring in emergency exposure situation is to provide the information required

4.1 Estimation of protection quantities characterizing an external exposure

anteroposterior; PA, posteroanterior; LLAT, left lateral; RLAT, right lateral; ROT,

As presented in Figure 4, the major characteristic of a field of radiation is a fluence of radiation ΦR. For monoenergetic radiation, an ambient dose equivalent

<sup>R</sup>ð Þ <sup>d</sup> <sup>=</sup>h<sup>∗</sup>

<sup>R</sup>ð Þ d : (4)

ΦRð Þ� ε<sup>R</sup> kað Þ ε<sup>R</sup> dεR, (5)

pions, and helium ions in six considered irradiation geometries: AP,

<sup>Φ</sup><sup>R</sup> <sup>¼</sup> Ka,R=ka,R <sup>¼</sup> <sup>H</sup><sup>∗</sup>

Ka ¼ ∑ R Z

Properties of external radiation entering the body of individual R, basic physical characteristics of radiation field, such as particle fluence ΦR, the kerma KR, and geometry of irradiation G, provide a basis for estimation of the protection quantities from external exposure. For idealized irradiation geometries, the ICRP in [7] presents the relationship between basic physical quantities and protection quantities for monoenergetic photons, electrons and positrons, neutrons, protons, muons,

exposure.

Table 4.

Lifesaving actions (a)

### Table 2.

Criteria for assessing the high doses from external and internal exposure.


### Table 3.

Criteria for assessing the intermediate doses from external and internal exposure.

Table 3 provides the dosimetric criteria used to define the radiological health hazard level used for taking a decision on implementation of protective and other response actions in emergency exposure situation. These criteria are based on Table 3 of [4], which provides the international generic criteria below which the risk of cancers and other health effects is too low to justify taking any protective or other response actions, such as a medical screening. The criteria were established for exposures at high-dose rates. For the lower-dose rates that will occur off the site following a release resulting from a severe emergency at a light-water reactor or its spent fuel pool, a comparable level of radiation-induced cancer risk would probably occur at a dose two or more times higher [8].

For restricting the exposure of emergency workers having assigned tasks in an emergency response, Table 4 provides guidance values in terms of personal dose equivalent HPð Þ 10 from external exposure to strongly penetrating radiation. The values for HPð Þ 10 in Table 4 assume that every effort has been made for protection against external exposure to weakly penetrating radiation and against exposure due to intakes or skin contamination (see para. 5.53 of GSR Part 7 [1]). The values of


Note: (a)This value may be exceeded—with due consideration of the generic criteria in Table 2—under circumstances in which the expected benefits to others clearly outweigh the emergency worker's own health risks and the emergency worker volunteers to take the action and understands and accepts these health risks [1].

### Table 4.

Criteria for assessing individual doses in emergency workers.

HPð Þ 10 in Table 4 are used for planning and operational monitoring of the work's exposure.

To assure protection of the emergency workers, the total effective dose and the RBE-weighted absorbed dose in a tissue or organ via all exposure pathways need to be estimated as early as possible in a nuclear or radiological emergency.

### 4. Estimation of protection quantities

Protection quantities of ADT, HT and E characterize the exposure of an individual for purposes of implementation of protective actions and other actions to protect him or her in emergency exposure situation. The practical goal of radiation monitoring in emergency exposure situation is to provide the information required for estimation of protective quantities.

### 4.1 Estimation of protection quantities characterizing an external exposure

Properties of external radiation entering the body of individual R, basic physical characteristics of radiation field, such as particle fluence ΦR, the kerma KR, and geometry of irradiation G, provide a basis for estimation of the protection quantities from external exposure. For idealized irradiation geometries, the ICRP in [7] presents the relationship between basic physical quantities and protection quantities for monoenergetic photons, electrons and positrons, neutrons, protons, muons, pions, and helium ions in six considered irradiation geometries: AP, anteroposterior; PA, posteroanterior; LLAT, left lateral; RLAT, right lateral; ROT, rotational; and ISO, isotropic.

As presented in Figure 4, the major characteristic of a field of radiation is a fluence of radiation ΦR. For monoenergetic radiation, an ambient dose equivalent and air kerma are proportional to fluence:

$$
\Phi\_R = K\_{a,R}/k\_{a,R} = H\_R^\*(d)/h\_R^\*(d). \tag{4}
$$

For non-monoenergetic radiation

$$K\_{a} = \sum\_{R} \int \Phi\_{R}(\varepsilon\_{R}) \times k\_{a}(\varepsilon\_{R}) d\varepsilon\_{R} \tag{5}$$

Table 3 provides the dosimetric criteria used to define the radiological health hazard level used for taking a decision on implementation of protective and other response actions in emergency exposure situation. These criteria are based on Table 3 of [4], which provides the international generic criteria below which the risk of cancers and other health effects is too low to justify taking any protective or other response actions, such as a medical screening. The criteria were established for exposures at high-dose rates. For the lower-dose rates that will occur off the site following a release resulting from a severe emergency at a light-water reactor or its spent fuel pool, a comparable level of radiation-induced cancer risk would probably

HThyroid 100 mSv in 1 year For intake of thyroid-seeking radionuclides

ADRed marrow 1 Gy ADRed marrow represents the RBE-weighted absorbed dose in internal tissues or

ADSoft tissue 25 Gy Dose delivered to 100 cm2 at a depth of 0.5 cm under the body surface in soft

ADSkn derma 10 Gy Dose delivered to the 100 cm<sup>2</sup> dermis (skin structures at a depth of 40 mg=cm<sup>2</sup> (or 0.4 mm) below the body surface) [1, 4]

2 Gy For intake of radionuclides with Z ≤ 89; Δ = 30 d [1, 4]

ADLungð Þ Δ 30 Gy For the purposes of these generic criteria, "lung" means the alveolar-interstitial region of the respiratory tract; Δ = 30 d [1, 4] ADColonð Þ Δ 20 Gy For the purposes of these generic criteria, "colon" presents upper and lower

tissue [1, 4]

Criteria for assessing the high doses from external and internal exposure.

E 100 mSv in 1 year No HFetus=Embryo 100 mSv in 1 year No

Quantity Level Comments

Criteria for assessing the intermediate doses from external and internal exposure.

ADRed marrowð Þ Δ 0.2 Gy For intake of radionuclides with Z > 90; Δ = 30 d [1, 4]

ADThyroidð Þ Δ 2 Gy For intake of thyroid-seeking radionuclides; Δ = 30 d [1, 4]

large intestine: Δ = 30 d [1, 4]

organs from exposure in a uniform field of strongly penetrating radiation [1, 4]

For this particular case, Δe means the period of in utero development [1, 4]

For restricting the exposure of emergency workers having assigned tasks in an emergency response, Table 4 provides guidance values in terms of personal dose equivalent HPð Þ 10 from external exposure to strongly penetrating radiation. The values for HPð Þ 10 in Table 4 assume that every effort has been made for protection against external exposure to weakly penetrating radiation and against exposure due to intakes or skin contamination (see para. 5.53 of GSR Part 7 [1]). The values of

occur at a dose two or more times higher [8].

Quantity Level Comments Acute external exposure (for less than 10 h)

Ionizing and Non-ionizing Radiation

ADFetus<sup>=</sup>Embryo 0.1 Gy No

Acute intake of radioactive substance

� � 0. 1 Gy

ADFetus<sup>=</sup>Embryo Δe

Table 2.

Table 3.

108

### Figure 4.

General scheme for assessment of individual external dose from monitoring.

$$H^\*(\mathbf{10}) = \sum\_{\mathcal{R}} \int \Phi\_{\mathcal{R}}(\varepsilon\_{\mathcal{R}}) \times h^\*(\mathbf{10}, \varepsilon\_{\mathcal{R}}) d\varepsilon\_{\mathcal{R}}.\tag{6}$$

The publication [27] presents a compendium of neutron spectra, which could be used for estimation of protection quantities in accordance with Eqs. (7)–(10). The estimates show that for fission neutrons scattered from the concrete walls of the facility, soil, or from the air surrounding the facility (skyshine), the value of AdTð Þ ε<sup>R</sup> <sup>G</sup> is numerically equal to 1/5 of hTð Þ ε<sup>R</sup> <sup>G</sup> when the same organ or tissue and irradiation geometry are considered. This linkage provide the possibility to use results of operational or routine monitoring of doses in workers for estimation of ADRed marrow in emergency exposure situation as required by GSR Part 7 and

Dosimetry for Use in Preparedness and Response to Radiological and Nuclear Emergency

As presented in [7], dose coefficients mentioned above are proportional to the photon energy in range of (0.1–6) MeV. Therefore, for the same irradiation

For mentioned range of photon' energy, the exposure is proportional to the kerma free-in-air (air kerma) or exposure. Thus, in the same point of field of photon radiation, exposure or kerma in air for an exposure of 100 R is 0.876 Gy [28]. This linkage provides the possibility to use old devices such as exposure meters (R-meters) in environmental monitoring for estimation of air kerma and protection

The protection quantities ADT, HT and E received from exposure due to external sources can be also estimated from the operational quantities by using the following

For strongly penetrating radiation, the critical organ for controlling the development of the severe deterministic effects in individual is the red marrow [1, 4]. The ICRU did not recommend depth for controlling the dose in the red marrow. For practical reasons, monitoring of the red marrow through dosimeters calibrated for HPð Þ 10 could be acceptable. The RBE-weighted absorbed dose in the red marrow received from exposure due to external sources can be estimated from the opera-

For weakly penetrating radiation and in emergency exposure situation, the reference depth for controlling severe deterministic effects due to irradiation of the derma of the skin is 0.4 mm and for controlling the severe deterministic effects due to irradiation of shallow soft tissue is 5 mm [1, 4, 9, 10]. The ICRU did not recommend operational quantity for controlling the dose in the skin derma or shallow soft tissue in emergency exposure situation. For practical reasons, monitoring of the skin derma and shallow soft tissue through dosimeters calibrated for HPð Þ 0:07 could be acceptable. The RBE-weighted absorbed dose in the skin derma or in shallow soft tissue received from exposure due to external sources can be conservatively estimated from

<sup>H</sup><sup>∗</sup>ð Þ� <sup>10</sup> <sup>ε</sup><sup>j</sup> h<sup>∗</sup> 10; ε<sup>j</sup> ffi

Ka � ε<sup>j</sup> ka ε<sup>j</sup>

E ffi HPð Þ 10 : (12) HSkin ffi HPð Þ 0:07 : (13) HLense of eye ffi HPð Þ 0:07 : (14)

ADRed Marrow ffi HPð Þ 10 : (15)

ADSkin derma ffi ð Þ 0:07 : (16)

…, (11)

HPð Þ 10 <sup>G</sup> � ε<sup>j</sup> hP 10; ε<sup>j</sup> G ffi

where ε<sup>j</sup> is any photon energy from range of (0.1–6) MeV.

presented in Table 4.

HT,G � ε<sup>j</sup> hT ε<sup>j</sup> G ffi

DOI: http://dx.doi.org/10.5772/intechopen.83370

quantities as given in Eq. (11).

tional quantities by using the following equation:

the operational quantities by using the following equations:

geometry

equations:

111

where ΦRð Þ ε<sup>R</sup> dε<sup>R</sup> is the fluence of radiation R with energy between ε<sup>R</sup> and ε<sup>R</sup> þ dεR, kað Þ ε<sup>R</sup> is the dose coefficient of air kerma of radiation R with energy εR, and h<sup>∗</sup> ð Þ 10; ε<sup>R</sup> is the dose coefficient of ambient dose equivalent of radiation R with energy εR.

For irradiation geometry G, one has

$$H\_P(\mathbf{10})\_G = \sum\_R \int \Phi\_R(\varepsilon\_R) \times h\_P(\mathbf{10}, \varepsilon\_R)\_G d\varepsilon\_R. \tag{7}$$

$$AD\_{T,G} = \sum\_{\mathbb{R}} \int \Phi\_{\mathbb{R}}(\varepsilon\_{\mathbb{R}}) \times Ad\_T(\mathbf{10}, \varepsilon\_{\mathbb{R}})\_G d\varepsilon\_{\mathbb{R}},\tag{8}$$

$$H\_{T,G} = \sum\_{R} \int \Phi\_R(\varepsilon\_R) \times h\_T(\varepsilon\_R)\_G d\varepsilon\_R,\tag{9}$$

$$E\_G = \sum\_R \int \Phi\_R(\varepsilon\_R) \times \mathfrak{e}(\varepsilon\_R)\_G d\varepsilon\_R \tag{10}$$

where kað Þ ε<sup>R</sup> is the dose coefficient of air kerma of radiation R with energy εR, hPð Þ 10; ε<sup>R</sup> <sup>G</sup> is the dose coefficient of personal dose equivalent of radiation R with energy ε<sup>R</sup> and irradiation geometry G, AdTð Þ ε<sup>R</sup> <sup>G</sup> is the dose coefficient of RBEweighted dose in organ T of radiation R with energy ε<sup>R</sup> and irradiation geometry G, hTð Þ ε<sup>R</sup> <sup>G</sup> is the dose coefficient of equivalent dose in organ T of radiation R with energy ε<sup>R</sup> and irradiation geometry G, and eð Þ ε<sup>R</sup> <sup>G</sup> is the dose coefficient of effective dose of radiation R with energy ε<sup>R</sup> and irradiation geometry G.

For photon radiation, values of AdTð Þ ε<sup>R</sup> <sup>G</sup> and hTð Þ ε<sup>R</sup> <sup>G</sup> are numerically equal when the same organ or tissue and irradiation geometry are considered.

The internet resource [25] provides tools for evaluation of absorbed dose in different organs from point or volumetric radioactive sources inside or outside the human body.

The publication [26] provides dose coefficients for exposure to bulk sources that are ground, water body and cloud containing radioactive material.

### Dosimetry for Use in Preparedness and Response to Radiological and Nuclear Emergency DOI: http://dx.doi.org/10.5772/intechopen.83370

The publication [27] presents a compendium of neutron spectra, which could be used for estimation of protection quantities in accordance with Eqs. (7)–(10). The estimates show that for fission neutrons scattered from the concrete walls of the facility, soil, or from the air surrounding the facility (skyshine), the value of AdTð Þ ε<sup>R</sup> <sup>G</sup> is numerically equal to 1/5 of hTð Þ ε<sup>R</sup> <sup>G</sup> when the same organ or tissue and irradiation geometry are considered. This linkage provide the possibility to use results of operational or routine monitoring of doses in workers for estimation of ADRed marrow in emergency exposure situation as required by GSR Part 7 and presented in Table 4.

As presented in [7], dose coefficients mentioned above are proportional to the photon energy in range of (0.1–6) MeV. Therefore, for the same irradiation geometry

$$\frac{H\_{T,G} \times \varepsilon\_{j}}{h\_{T}(\varepsilon\_{j})\_{G}} \cong \frac{H\_{P}(\mathbf{10})\_{G} \times \varepsilon\_{j}}{h\_{P}(\mathbf{10}, \varepsilon\_{j})\_{G}} \cong \frac{H^{\*}(\mathbf{10}) \times \varepsilon\_{j}}{h^{\*}(\mathbf{10}, \varepsilon\_{j})} \cong \frac{K\_{a} \times \varepsilon\_{j}}{k\_{a}(\varepsilon\_{j})} \dots \tag{11}$$

where ε<sup>j</sup> is any photon energy from range of (0.1–6) MeV.

For mentioned range of photon' energy, the exposure is proportional to the kerma free-in-air (air kerma) or exposure. Thus, in the same point of field of photon radiation, exposure or kerma in air for an exposure of 100 R is 0.876 Gy [28]. This linkage provides the possibility to use old devices such as exposure meters (R-meters) in environmental monitoring for estimation of air kerma and protection quantities as given in Eq. (11).

The protection quantities ADT, HT and E received from exposure due to external sources can be also estimated from the operational quantities by using the following equations:

$$E \cong H\_P(\mathbf{10}).\tag{12}$$

$$H\_{\text{Skin}} \cong H\_P(\mathbf{0}.\mathbf{0}7).\tag{13}$$

$$H\_{\text{Lensé of } \text{eye}} \cong H\_P(\mathbf{0}.\mathbf{0}7). \tag{14}$$

For strongly penetrating radiation, the critical organ for controlling the development of the severe deterministic effects in individual is the red marrow [1, 4]. The ICRU did not recommend depth for controlling the dose in the red marrow. For practical reasons, monitoring of the red marrow through dosimeters calibrated for HPð Þ 10 could be acceptable. The RBE-weighted absorbed dose in the red marrow received from exposure due to external sources can be estimated from the operational quantities by using the following equation:

$$AD\_{Red\ Mar rww} \cong H\_P(\mathbf{10}).\tag{15}$$

For weakly penetrating radiation and in emergency exposure situation, the reference depth for controlling severe deterministic effects due to irradiation of the derma of the skin is 0.4 mm and for controlling the severe deterministic effects due to irradiation of shallow soft tissue is 5 mm [1, 4, 9, 10]. The ICRU did not recommend operational quantity for controlling the dose in the skin derma or shallow soft tissue in emergency exposure situation. For practical reasons, monitoring of the skin derma and shallow soft tissue through dosimeters calibrated for HPð Þ 0:07 could be acceptable. The RBE-weighted absorbed dose in the skin derma or in shallow soft tissue received from exposure due to external sources can be conservatively estimated from the operational quantities by using the following equations:

$$AD\_{\text{Skin\\_derma}} \cong (\mathbf{0}.\mathbf{0}7).\tag{16}$$

<sup>H</sup><sup>∗</sup>ð Þ¼ <sup>10</sup> <sup>∑</sup>

General scheme for assessment of individual external dose from monitoring.

HPð Þ 10 <sup>G</sup> ¼ ∑

ADT,G ¼ ∑

For irradiation geometry G, one has

Ionizing and Non-ionizing Radiation

and h<sup>∗</sup>

Figure 4.

energy εR.

human body.

110

R Z

R Z

R Z

HT,G ¼ ∑ R Z

> EG ¼ ∑ R Z

dose of radiation R with energy ε<sup>R</sup> and irradiation geometry G.

when the same organ or tissue and irradiation geometry are considered.

are ground, water body and cloud containing radioactive material.

<sup>Φ</sup>Rð Þ� <sup>ε</sup><sup>R</sup> <sup>h</sup><sup>∗</sup>

ð Þ 10; ε<sup>R</sup> is the dose coefficient of ambient dose equivalent of radiation R with

where kað Þ ε<sup>R</sup> is the dose coefficient of air kerma of radiation R with energy εR, hPð Þ 10; ε<sup>R</sup> <sup>G</sup> is the dose coefficient of personal dose equivalent of radiation R with energy ε<sup>R</sup> and irradiation geometry G, AdTð Þ ε<sup>R</sup> <sup>G</sup> is the dose coefficient of RBEweighted dose in organ T of radiation R with energy ε<sup>R</sup> and irradiation geometry G, hTð Þ ε<sup>R</sup> <sup>G</sup> is the dose coefficient of equivalent dose in organ T of radiation R with energy ε<sup>R</sup> and irradiation geometry G, and eð Þ ε<sup>R</sup> <sup>G</sup> is the dose coefficient of effective

For photon radiation, values of AdTð Þ ε<sup>R</sup> <sup>G</sup> and hTð Þ ε<sup>R</sup> <sup>G</sup> are numerically equal

The internet resource [25] provides tools for evaluation of absorbed dose in different organs from point or volumetric radioactive sources inside or outside the

The publication [26] provides dose coefficients for exposure to bulk sources that

where ΦRð Þ ε<sup>R</sup> dε<sup>R</sup> is the fluence of radiation R with energy between ε<sup>R</sup> and ε<sup>R</sup> þ dεR, kað Þ ε<sup>R</sup> is the dose coefficient of air kerma of radiation R with energy εR,

ð Þ 10; ε<sup>R</sup> dεR, (6)

ΦRð Þ� ε<sup>R</sup> hPð Þ 10; ε<sup>R</sup> <sup>G</sup>dεR, (7)

ΦRð Þ� ε<sup>R</sup> AdTð Þ 10; ε<sup>R</sup> <sup>G</sup>dεR, (8)

ΦRð Þ� ε<sup>R</sup> hTð Þ ε<sup>R</sup> <sup>G</sup>dεR, (9)

ΦRð Þ� ε<sup>R</sup> eð Þ ε<sup>R</sup> <sup>G</sup>dεR, (10)

$$AD\_{\text{Soft tissue}} \cong H\_P(\mathfrak{Z}).\tag{17}$$

Based on the foregoing, individual monitoring in planned, emergency and existing exposure situations through individual dosimeters calibrated for HPð Þ 10 and HPð Þ 0:07 could be acceptable.

### 4.2 Estimation of protection quantities characterizing an internal exposure

Internal doses cannot be measured directly; they can only be calculated from intake of radioactive substance through particular route such as respiratory system in the case of inhalation, gastrointestinal tract in the case of ingestion or wound, and undamaged skin in the case of contamination. The individual intake also could not be directly measured and can only be inferred from individual measurements of other quantities, such as measurements of activity in the body or in excretion samples or activity concentration in foodstuff or the environment. In circumstances where individual monitoring is inappropriate, inadequate, or not feasible, the occupational exposure of workers may be assessed on the basis of workplace monitoring and other relevant information such as location and durations of exposure. Individual measurements include measurements made by both direct and indirect methods. Methods for the measurement of activity content in the body, such as whole-body, lung, or thyroid counting, are examples of direct methods. Measurements of activity in collected biological samples or measurements made using personal air sampling are examples of indirect methods.

The conceptual framework for the assessment of doses from individual or environmental measurements is illustrated in Figure 5.

Chemical and physical properties of radioactive substance S containing radionuclide, the route of intake into the human body P, and value of intake IS,P composite a base for estimation of the protection quantities from internal exposure.

The measurable characteristics of internal exposure are quantities of body content or excretion rate of radionuclide M and concentration of radioactive substance in the environmental media C tð ÞS.

According to the scheme in Figure 5, the value of the intake of radioactive substance S could be obtained by multiplying the integrated over time the measured concentration of radioactive substance in the environmental media C tð Þ<sup>S</sup> by the appropriate value of vPð Þg :

$$I(\mathbf{g})\_{\mathcal{S},P} = \boldsymbol{\nu}\_P(\mathbf{g}) \times \int\_0^t \mathbf{C}(\mathbf{x})\_{\mathcal{S}} d\mathbf{x},\tag{18}$$

Special attention has to be paid to the interpretation of bioassay measurements after the use of means for blocking the uptake of radionuclides or for enhancing their excretion, such as the administration of diuretics, laxatives, or blocking or chelating agents, as well as after the removal of contamination and/or surgical intervention at a wound site. These techniques influence and modify the biokinetic behavior of the incorporated radionuclides, thus invalidating the use of the standardized modeling approach for estimating intake and dose from the bioassay

Dosimetry for Use in Preparedness and Response to Radiological and Nuclear Emergency

DOI: http://dx.doi.org/10.5772/intechopen.83370

In such cases, alternative approaches have to be employed, such as discarding data on excretion for excretion samples collected during the period in which excretion rates may be assumed to have been influenced by the treatment or modifying the standard models in order to take into account the effect of the treatment. Examples of analyses performed after the administration of the chelating agent Ca-DTPA (a calcium salt of diethylenetriaminepentaacetic acid) in cases of accidental intakes of actinides can be found in [31–33]. Bioassay measurements for dose assessment purposes are performed after a certain time period, posttreatment with Ca-DTPA, until the excretion of the radionuclide stabilizes in urine samples. Influence of iodine thyroid blocking on biokinetic of iodine in human body is discussed in [34]. Influence of administration of Prussian blue {Fe4[Fe(CN)6]3} on biokinetic

The specific protection quantities of committed RBE-weighted organ dose ADTð Þ Δ; g , committed equivalent organ dose HTð Þ τ; g , and committed effective

I gð ÞS,P � AdTð Þ Δ; g S,P

I gð ÞS,P � hTð Þ τ; g S,P

I gð ÞS,P � eð Þ τ; g S,P

n o, (20)

n o, (21)

n o, (22)

dose Eð Þ τ; g are used for evaluation of dose in an internal dosimetry:

S, <sup>P</sup>

S, <sup>P</sup>

S, <sup>P</sup>

ADTð Þffi Δ; g ∑

General scheme for assessment of individual internal dose from monitoring.

HTð Þ¼ τ; g ∑

Eð Þ¼ τ; g ∑

measurements.

Figure 5.

of Cs is discussed in [35].

113

where vPð Þg is the consumption rate of an individual of age group g through route P and t is the period of consumption.

According to the scheme in Figure 5, the value of the intake of radioactive substance S is obtained by dividing the measured body content or excretion rate M by the appropriate value of m tð Þ ; g S,P:

$$I(\mathbf{g})\_{\mathbb{S},P} = \mathbf{M}/m(\mathbf{t}, \mathbf{g})\_{\mathbb{S},P} \tag{19}$$

where m tð Þ ; g S,P is the fraction of an intake that remains in the body (for direct methods) or that is being excreted from the body (for indirect methods) at time t after the intake. This fraction depends on the radionuclide, its chemical and physical form in substance S, the route of intake P, the age group of age g, and the time t [29, 30].

Dosimetry for Use in Preparedness and Response to Radiological and Nuclear Emergency DOI: http://dx.doi.org/10.5772/intechopen.83370

### Figure 5.

ADSoft tissue ffi HPð Þ3 : (17)

Based on the foregoing, individual monitoring in planned, emergency and existing exposure situations through individual dosimeters calibrated for HPð Þ 10

4.2 Estimation of protection quantities characterizing an internal exposure

ual measurements include measurements made by both direct and indirect methods. Methods for the measurement of activity content in the body, such as whole-body, lung, or thyroid counting, are examples of direct methods. Measurements of activity in collected biological samples or measurements made using

The conceptual framework for the assessment of doses from individual or envi-

Chemical and physical properties of radioactive substance S containing radionuclide, the route of intake into the human body P, and value of intake IS,P composite a base for estimation of the protection quantities from internal exposure. The measurable characteristics of internal exposure are quantities of body content or excretion rate of radionuclide M and concentration of radioactive substance

According to the scheme in Figure 5, the value of the intake of radioactive substance S could be obtained by multiplying the integrated over time the measured concentration of radioactive substance in the environmental media C tð Þ<sup>S</sup> by the

where vPð Þg is the consumption rate of an individual of age group g through

According to the scheme in Figure 5, the value of the intake of radioactive substance S is obtained by dividing the measured body content or excretion rate M

where m tð Þ ; g S,P is the fraction of an intake that remains in the body (for direct methods) or that is being excreted from the body (for indirect methods) at time t after the intake. This fraction depends on the radionuclide, its chemical and physical form in substance S, the route of intake P, the age group of age g, and the

Z <sup>t</sup> 0

C xð ÞSdx, (18)

I gð ÞS,P ¼ M=m tð Þ ; g S,P, (19)

I gð ÞS,P ¼ vPð Þ� g

personal air sampling are examples of indirect methods.

ronmental measurements is illustrated in Figure 5.

in the environmental media C tð ÞS.

route P and t is the period of consumption.

by the appropriate value of m tð Þ ; g S,P:

appropriate value of vPð Þg :

time t [29, 30].

112

Internal doses cannot be measured directly; they can only be calculated from intake of radioactive substance through particular route such as respiratory system in the case of inhalation, gastrointestinal tract in the case of ingestion or wound, and undamaged skin in the case of contamination. The individual intake also could not be directly measured and can only be inferred from individual measurements of other quantities, such as measurements of activity in the body or in excretion samples or activity concentration in foodstuff or the environment. In circumstances where individual monitoring is inappropriate, inadequate, or not feasible, the occupational exposure of workers may be assessed on the basis of workplace monitoring and other relevant information such as location and durations of exposure. Individ-

and HPð Þ 0:07 could be acceptable.

Ionizing and Non-ionizing Radiation

General scheme for assessment of individual internal dose from monitoring.

Special attention has to be paid to the interpretation of bioassay measurements after the use of means for blocking the uptake of radionuclides or for enhancing their excretion, such as the administration of diuretics, laxatives, or blocking or chelating agents, as well as after the removal of contamination and/or surgical intervention at a wound site. These techniques influence and modify the biokinetic behavior of the incorporated radionuclides, thus invalidating the use of the standardized modeling approach for estimating intake and dose from the bioassay measurements.

In such cases, alternative approaches have to be employed, such as discarding data on excretion for excretion samples collected during the period in which excretion rates may be assumed to have been influenced by the treatment or modifying the standard models in order to take into account the effect of the treatment. Examples of analyses performed after the administration of the chelating agent Ca-DTPA (a calcium salt of diethylenetriaminepentaacetic acid) in cases of accidental intakes of actinides can be found in [31–33]. Bioassay measurements for dose assessment purposes are performed after a certain time period, posttreatment with Ca-DTPA, until the excretion of the radionuclide stabilizes in urine samples. Influence of iodine thyroid blocking on biokinetic of iodine in human body is discussed in [34]. Influence of administration of Prussian blue {Fe4[Fe(CN)6]3} on biokinetic of Cs is discussed in [35].

The specific protection quantities of committed RBE-weighted organ dose ADTð Þ Δ; g , committed equivalent organ dose HTð Þ τ; g , and committed effective dose Eð Þ τ; g are used for evaluation of dose in an internal dosimetry:

$$AD\_T(\Delta, \mathbf{g}) \cong \sum\_{\mathbb{S}, P} \left\{ I(\mathbf{g})\_{\mathbb{S}, P} \times Ad\_T(\Delta, \mathbf{g})\_{\mathbb{S}, P} \right\},\tag{20}$$

$$H\_T(\mathfrak{r}, \mathfrak{g}) = \sum\_{\mathbb{S}, P} \left\{ I(\mathfrak{g})\_{\mathbb{S}, P} \times h\_T(\mathfrak{r}, \mathfrak{g})\_{\mathbb{S}, P} \right\},\tag{21}$$

$$E(\mathsf{r}, \mathsf{g}) = \sum\_{\mathsf{S}, P} \left\{ I(\mathsf{g})\_{\mathsf{S}, P} \times e(\mathsf{r}, \mathsf{g})\_{\mathsf{S}, P} \right\}, \tag{22}$$

### Ionizing and Non-ionizing Radiation

where AdTð Þ Δ; g S,P and hTð Þ τ; g S,P are respectively the committed RBE-weighted or equivalent dose in the organ or tissue T due to intake of 1 Bq of radionuclide substance S through pathway P, by the group of age g. These dose factors are the time integrals of the relevant dose rates:

$$\operatorname{Ad}\_T(\Delta, \mathbf{g})\_{\mathbf{S}, P} = \int\_0^{\Delta} \dot{\operatorname{Ad}}\_T(\mathbf{t}, \mathbf{g})\_{\mathbf{S}, P} \, d\mathbf{t}, \tag{23}$$

4.3 Estimation of protection quantities characterizing a total exposure

Dosimetry for Use in Preparedness and Response to Radiological and Nuclear Emergency

within the same time period.

DOI: http://dx.doi.org/10.5772/intechopen.83370

HTð Þ τ; g is assessed by Eq. (21).

using the following equation:

5. Conclusions

115

where Eð Þ τ; g is assessed by Eq. (22).

for dose assessment becomes available.

associated with protective actions.

through inhalation, ingestion, and contaminated wound.

The protection quantities E and HT relate to the sum of the effective doses or equivalent doses, respectively, received from exposure due to external sources within a given time period and the committed effective doses or committed equivalent doses, respectively, from exposure due to intakes of radionuclides occurring

The total equivalent dose in organ or tissue T received or committed during a

HTð Þffi g HPð Þþ 10 HTð Þ τ; g , (26)

E gð Þffi HPð Þþ 10 Eð Þ τ; g , (27)

given time period in individuals from age group g can be estimated from the

where HPð Þ 10 is the personal dose equivalent from external exposure and

The total effective dose E received or committed during a given time period in individuals from age group g can be estimated from the operational quantities by

In the calculation of the committed dose from specific radionuclides, allowance may need to be made for the characteristics of the material taken into the body

To characterize the emergency exposure situation in event of nuclear or radio-

The dose assessment has to be as realistic as possible, and in any case, doses for

situations in which persons might be in danger of being harmed are not to be underestimated. Overestimation also has to be avoided because there are risks

logical emergency, doses to the members of the public, workers, emergency workers, as well as patients and helpers, if applicable, have to be derived from source monitoring, environmental monitoring, or individual monitoring, or from a combination of these. Result of dose assessment needs to be expressed in terms of protection quantities defined in the IAEA General Safety Requirements (GSR) Part 7 [1] and GSR Part 3 [5]. Dose assessment has to be based on the best available monitoring data and has to be promptly updated if any new information relevant

operational quantities by using the following equation:

$$h\_T(\mathbf{r}, \mathbf{g})\_{\mathbf{S}, P} = \int\_0^\mathbf{\tilde{r}} \dot{h}\_T(\mathbf{t}, \mathbf{g})\_{\mathbf{S}, P} \, d\mathbf{t}, \tag{24}$$

$$e(\mathfrak{r}, \mathfrak{g})\_{\mathbb{S}, P} = \sum\_{T} \left\{ h\_{T}(\mathfrak{r}, \mathfrak{g})\_{\mathbb{S}, P} \times \mathfrak{w}\_{T} \right\},\tag{25}$$

where Ad\_ <sup>T</sup>ð Þ <sup>t</sup>; <sup>g</sup> S,P is the RBE-weighted dose rate in organ or tissue T due to intake of 1 Bq of radionuclide substance S through pathway P and \_ hTð Þ t; g S,P is the equivalent dose rate in organ or tissue T due to intake of 1 Bq of radionuclide substance S through pathway P. For estimation of committed RBE-weighted dose, Δ is taken to be 30 days. The τ is the integration time elapsed after an intake of radioactive substances. When τ is not specified, it will be taken to be 50 years for adults and the time to age 70 years for intakes by children and persons younger than 20.

Various biokinetic models for calculating the values of m tð Þ ; g S,P, AdTð Þ Δ; g S,P and hTð Þ τ; g S,P have been developed.

Values of m tð Þ ; g S,P at selected times for a subset of radionuclides have been reported by the ICRP in graphical and tabular form [36, 37]. A compilation of m tð Þ ; g S,P by workers in emergency and planned exposure situation is presented in various publications of the IAEA [29, 38]. The Internet resources containing the values of m tð Þ ; g S,P different radioactive substances are presented in [39].

Special attention has to be paid to the patterns of inhalation intake in nuclear emergency. Chemical form of radionuclides in aerosol particles and their behavior in the human respiratory tract could be very specific [40, 41] and significantly different from these observed in planned exposure situation and presented in Table II.2C of GSR Part 3 [5].

A compilation of dose coefficients AdTð Þ Δ; g S,P for intakes of radionuclides by adults is presented in publications of the IAEA [9, 29].

A compilation of dose coefficients eð Þ τ; g S,P for ingestion and inhalation intakes of radionuclides by workers is presented in ICRP Publication 119 [42]. A compilation of hTð Þ τ; g S,P and eð Þ τ; g S,P for workers and all age groups of members of the public can also be found in the ICRP database in [43]. Data for fetus or embryo due to inhalation or ingestion of radioactive substance by mother are presented in [44, 45] and for infant in [46, 47]. These dose coefficients are based on the calculation methods and parameters given in ICRP Publication 60 [15]. The current published values of eð Þ τ; g S,P will be superseded in due course by new values [6, 36, 42] based on updated biokinetic models and on the methods of calculation and the parameters given in ICRP Publication 103 [8]. A compilation of m tð Þ ; g S,Wond, hTð Þ τ; g S,Wound and eð Þ τ; g S,Wound for penetration of radioactive substance through wound is presented in [48, 49].

Dosimetry for Use in Preparedness and Response to Radiological and Nuclear Emergency DOI: http://dx.doi.org/10.5772/intechopen.83370

### 4.3 Estimation of protection quantities characterizing a total exposure

The protection quantities E and HT relate to the sum of the effective doses or equivalent doses, respectively, received from exposure due to external sources within a given time period and the committed effective doses or committed equivalent doses, respectively, from exposure due to intakes of radionuclides occurring within the same time period.

The total equivalent dose in organ or tissue T received or committed during a given time period in individuals from age group g can be estimated from the operational quantities by using the following equation:

$$H\_T(\mathbf{g}) \cong H\_P(\mathbf{10}) + H\_T(\mathbf{r}, \mathbf{g}),\tag{26}$$

where HPð Þ 10 is the personal dose equivalent from external exposure and HTð Þ τ; g is assessed by Eq. (21).

The total effective dose E received or committed during a given time period in individuals from age group g can be estimated from the operational quantities by using the following equation:

$$E(\mathbf{g}) \cong H\_P(\mathbf{10}) + E(\tau, \mathbf{g}),\tag{27}$$

where Eð Þ τ; g is assessed by Eq. (22).

In the calculation of the committed dose from specific radionuclides, allowance may need to be made for the characteristics of the material taken into the body through inhalation, ingestion, and contaminated wound.

### 5. Conclusions

where AdTð Þ Δ; g S,P and hTð Þ τ; g S,P are respectively the committed RBE-weighted

or equivalent dose in the organ or tissue T due to intake of 1 Bq of radionuclide substance S through pathway P, by the group of age g. These dose factors are the

> Z Δ

Ad\_ <sup>T</sup>ð Þ <sup>t</sup>; <sup>g</sup> S,P dt, (23)

hTð Þ t; g S,P dt, (24)

, (25)

hTð Þ t; g S,P is the

0

Zτ

\_

hTð Þ τ; g S,P � wT n o

0

where Ad\_ <sup>T</sup>ð Þ <sup>t</sup>; <sup>g</sup> S,P is the RBE-weighted dose rate in organ or tissue T due to

Various biokinetic models for calculating the values of m tð Þ ; g S,P, AdTð Þ Δ; g S,P

Special attention has to be paid to the patterns of inhalation intake in nuclear emergency. Chemical form of radionuclides in aerosol particles and their behavior in the human respiratory tract could be very specific [40, 41] and significantly different from these observed in planned exposure situation and presented in

A compilation of dose coefficients AdTð Þ Δ; g S,P for intakes of radionuclides by

A compilation of dose coefficients eð Þ τ; g S,P for ingestion and inhalation intakes of radionuclides by workers is presented in ICRP Publication 119 [42]. A compilation of hTð Þ τ; g S,P and eð Þ τ; g S,P for workers and all age groups of members of the public can also be found in the ICRP database in [43]. Data for fetus or embryo due to inhalation or ingestion of radioactive substance by mother are presented in [44, 45] and for infant in [46, 47]. These dose coefficients are based on the calculation methods and parameters given in ICRP Publication 60 [15]. The current published values of eð Þ τ; g S,P will be superseded in due course by new values [6, 36, 42] based on updated biokinetic models and on the methods of calculation and the parameters given in ICRP Publication 103 [8]. A compilation of m tð Þ ; g S,Wond, hTð Þ τ; g S,Wound and eð Þ τ; g S,Wound for penetration of radioactive substance through wound is presented in

Values of m tð Þ ; g S,P at selected times for a subset of radionuclides have been reported by the ICRP in graphical and tabular form [36, 37]. A compilation

of m tð Þ ; g S,P by workers in emergency and planned exposure situation is presented in various publications of the IAEA [29, 38]. The Internet resources containing the values of m tð Þ ; g S,P different radioactive substances are presented

T

equivalent dose rate in organ or tissue T due to intake of 1 Bq of radionuclide substance S through pathway P. For estimation of committed RBE-weighted dose, Δ is taken to be 30 days. The τ is the integration time elapsed after an intake of radioactive substances. When τ is not specified, it will be taken to be 50 years for adults and the time to age 70 years for intakes by children and persons younger

AdTð Þ Δ; g S,P ¼

hTð Þ τ; g S,P ¼

intake of 1 Bq of radionuclide substance S through pathway P and \_

eð Þ τ; g S,P ¼ ∑

time integrals of the relevant dose rates:

Ionizing and Non-ionizing Radiation

and hTð Þ τ; g S,P have been developed.

Table II.2C of GSR Part 3 [5].

adults is presented in publications of the IAEA [9, 29].

than 20.

in [39].

[48, 49].

114

To characterize the emergency exposure situation in event of nuclear or radiological emergency, doses to the members of the public, workers, emergency workers, as well as patients and helpers, if applicable, have to be derived from source monitoring, environmental monitoring, or individual monitoring, or from a combination of these. Result of dose assessment needs to be expressed in terms of protection quantities defined in the IAEA General Safety Requirements (GSR) Part 7 [1] and GSR Part 3 [5]. Dose assessment has to be based on the best available monitoring data and has to be promptly updated if any new information relevant for dose assessment becomes available.

The dose assessment has to be as realistic as possible, and in any case, doses for situations in which persons might be in danger of being harmed are not to be underestimated. Overestimation also has to be avoided because there are risks associated with protective actions.

Ionizing and Non-ionizing Radiation

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Dosimetry for Use in Preparedness and Response to Radiological and Nuclear Emergency

[10] Extended Framework of Emergency Response Criteria: Interim Report for Comments. IAEA-TECDOC Series 1432.

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### Author details

Vladimir Kutkov National Research Centre, Kurchatov Institute, Moscow, Russia

\*Address all correspondence to: v.kutkov@yandex.ru

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Dosimetry for Use in Preparedness and Response to Radiological and Nuclear Emergency DOI: http://dx.doi.org/10.5772/intechopen.83370

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[14] Cancer Risk Coefficients for Environmental Exposure to Radionuclides. Federal Guidance Report No.13. Washington DC: U.S. Environmental Protection Agency; 1999. p. 335

[15] ICRP Publication 60. 1990 Recommendations of the International Commission on Radiological Protection. Annals of the ICRP. 1991;21(1-3):199. Oxford: Pergamon Press

[16] Determination of Dose Equivalents from External Radiation Sources. ICRU Report 39. Bethesda, MD: ICRU; 1985. p. 14

[17] Determination of Dose Equivalents Resulting from External Radiation Sources Part 2. ICRU Report 43. Bethesda, MD: ICRU; 1988. p. 56

[18] Measurement of Dose Equivalents from External Photon and Electron

Author details

Ionizing and Non-ionizing Radiation

Vladimir Kutkov

116

National Research Centre, Kurchatov Institute, Moscow, Russia

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

\*Address all correspondence to: v.kutkov@yandex.ru

provided the original work is properly cited.

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[21] The Quality Factor in Radiation Protection. ICRU Report 40. Bethesda, MD: ICRU; 1986. p. 32

[22] Guidance on Radiation Dose Limits for the Lens of the Eye. NCRP Comments 26. Bethesda, MD: U.S. NCRP; 2016. p. 145

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[49] Toohey RE, Bertelli L, Sugarman SL, Wiley AL, Christensen DM. Dose

for Radionuclide-Contaminated Wounds and Procedures for Their Assessment, Dosimetry and Treatment. NCRP Report 156. Bethesda, MD:

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YuB, Skryabin AM, Pogodin RI.

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Environmental Impact of Radioactive Releases; 8-12 May 1995; Vienna: IAEA;

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Radiations. ICRU Report 47. Bethesda,

Ionizing and Non-ionizing Radiation

Technical Report Series No. 403. Vienna: IAEA; 2001. p. 276

Springer; 2016. p. 955

Vienna: IAEA; 2005. p. 296

Vienna: IAEA; 2018. p. 360

105:509-512

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[30] Occupational Radiation Protection. Safety Standards Series No. GSG-7.

[31] Bailey BR, Eckerman KF, Townsend LW. An analysis of a puncture wound case with medical intervention. Radiation Protection Dosimetry. 2003;

[32] Fritsch P, Grappin L, Guillermin AM, et al. Modelling of bioassay data from a Pu wound treated by repeated DTPA perfusions: Biokinetics and dosimetric approaches. Radiation Protection Dosimetry. 2007;127:120-124

[33] James AC, Sasser LB, Stuit DB, et al.

[34] Zanzonico PB, Becker DV. Effects of time of administration and dietary iodine levels on potassium iodide (KI) blockade of thyroid irradiation by 131I from radioactive fallout. Health Physics.

[35] Melo DR, Lipsztein JL, Oliveira CAN, Bertelli L. 137Cs internal contamination involving a Brazilian accident, and the efficacy of Prussian Blue treatment. Health Physics. 1994;

[36] ICRP Publication 134. Occupational intakes of radionuclides: Part 2. Annals

of the ICRP. 2016;45(3–4):349

USTUR whole body case 0269: Demonstrating effectiveness of I.V. Ca-DTPA for Pu. Radiation Protection

Dosimetry. 2007;127:449-455

2000;78:660-667

66:645-652

[19] Determination of operational dose equivalent quantities for neutrons. ICRU Report 66. Journal of the ICRU 1 (3). Ashford, Kent: Nuclear Technology

[20] Quantities and Units in Radiation Protection Dosimetry. ICRU Report 51. Bethesda, MD: ICRU; 1993. p. 19

[21] The Quality Factor in Radiation Protection. ICRU Report 40. Bethesda,

[22] Guidance on Radiation Dose Limits

for the Lens of the Eye. NCRP Comments 26. Bethesda, MD: U.S.

[23] Implications for Occupational Radiation Protection of the New Dose Limit for the Lens of the Eye, IAEA TECDOC Series 1731. Vienna: IAEA;

[24] Biological effects at low radiation doses. Sources and Effects of Ionizing Radiation. In: UNSCEAR 2000 Report to the General Assembly (with scientific annexes). Vol. II. Scientific Annex G. New York: United Nations; 2000.

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[26] External Exposure to radionuclides in air, water and soil. Federal Guidance Report No. 15. Washington DC: U.S. Environmental Protection Agency;

[27] Compendium of Neutron Spectra and Detector Responses for Radiation Protection Purposes. Supplement to Technical Reports Series No. 318.

MD: ICRU; 1992. p. 45

Publishing; 2001. 95 p

MD: ICRU; 1986. p. 32

NCRP; 2016. p. 145

2013. p. 48

pp. 73-176

2018]

2018. p. 342

118

[38] Methods for assessing occupational radiation doses due to intakes of radionuclides. Safety Reports Series No. 37. Vienna: IAEA; 2004. p. 124

[39] Graphs of Predicted Monitoring Data. Chiba: National Institute of Radiological Sciences. Available from: http://www.NIRS.qst.go.jp/db/anzendb/ RPD/gpmd.php [Accessed: 01-12-2018]

[40] Kutkov VA, Arefieva ZS, Muraviev YuB, Skryabin AM, Pogodin RI. Inhalation of the aerosol of nuclear fuel particles from the Chernobyl nuclear power plant by adult persons from the Gomel region of Belarus. Environmental impact of radioactive releases. In: Proceedings of the IAEA International Symposium on Environmental Impact of Radioactive Releases; 8–12 May 1995; Vienna: IAEA; 1995. pp. 107-115

[41] Kutkov VA, Arefieva ZS, Muraviev YuB, Komaritskaya OI. Unique form of airborne radioactivity: Nuclear fuel "hot" particles of the Chernobyl accident. In: Proceedings of the IAEA international Symposium on Environmental Impact of Radioactive Releases; 8-12 May 1995; Vienna: IAEA; 1995. pp. 625-630

[42] ICRP Publication 119. Compendium of dose coefficients based on ICRP Publication 60. Annals of the ICRP. 2013;42(4):130

[43] ICRP-Database of Dose Coefficients: Workers and Members of the Public. Ver. 3.0. ICRP CD1. Available from: http://www.icrp.org [Accessed: 01-12-2018]

[44] ICRP Publication 88. Corrected version of May 2002. Doses to the embryo and fetus from intakes of radionuclides by the mother. Annals of the ICRP. 2001;31(1-2):511

[45] ICRP-Database of Dose Coefficients: Embryo and Fetus. Ver. 2.0. ICRP CD2. Available from: http://www.icrp.org [Accessed: 01-12-2018]

[46] ICRP Publication 95. Doses to infants from radionuclides ingested in mothers' milk. Annals of the ICRP. 2004;34(3-4):287

[47] ICRP-Database of Dose Coefficients: Radionuclides in Mother's Milk. Ver. 2.0. ICRP CD3. Available from: http:// www.icrp.org [Accessed: 01-12-2018]

[48] Development of a Biokinetic Model for Radionuclide-Contaminated Wounds and Procedures for Their Assessment, Dosimetry and Treatment. NCRP Report 156. Bethesda, MD: NCRP; 2006. p. 428

[49] Toohey RE, Bertelli L, Sugarman SL, Wiley AL, Christensen DM. Dose Coefficients for Intakes of Radionuclides via Contaminated Wounds. Oak Ridge: ORISE; 2015. p. 628

**121**

Section 2

Radiation Therapy
