临床医学]ICRP辐射防护体系的道德伦理基础.ppt

,The ICRP System of Radiation Protection: Moral and Ethical Foundation,Abel J. Gonzlez (*) ICRP Vice-Chairman Av. del Libertador 8250, (1429)Buenos Aires, Argentina; +54 1163231306; agonzalezarn.gob.ar (*) Member United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) Member Commission on Safety Standards of the International Atomic Energy Agency Senior Adviser of the Argentine Nuclear Regulatory Authority,ICRP Main Commission Meeting Symposium of the Chinese Radiation Protection Society Pan Pacific Hotel Suzhou, China; Friday April 16, 2010,ICRP放射防护体系:道德伦理基础 The ICRP System of Radiation Protection: Moral and Ethical Foundation,Abel J. Gonzlez (*) ICRP 副主席 Av. del Libertador 8250, (1429)Buenos Aires, Argentina; +54 1163231306; agonzalezarn.gob.ar (*) Member United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) Member Commission on Safety Standards of the International Atomic Energy Agency Senior Adviser of the Argentine Nuclear Regulatory Authority,ICRP主要委员会会议 - 中国辐射防护学会研讨会 Meeting of the Main Commission of ICRP- Symposium of the Chinese Radiation Protection Society 泛太平洋大酒店，苏州，中国; 星期五, 2010年4月16 Pan Pacific Hotel, Suzhou , China; Friday April 16, 2010,国际放射防护委员会2007年建议书 国际放射防护委员会第103号出版物,The 2007 Recommendations of the International Commission on Radiological Protection ICRP Publication 103,放射防护的生物学方面 - 确定效应（有害的组织反应）的诱发 - 随机效应的诱发 - 判断和不确定性,Biological Aspects of Radiological Protection - The induction of deterministic effects (harmful tissue reactions) - The induction of stochastic effects - Judgements and uncertainties,;,Dose (Sv),Likelihood of health effects,100% (certainty),0,1,Approx. lower bound of pathological knowledge, 5% (UNSCEAR estimate),1,10,Tissue reactions Clinical diagnosis (individual pathology),Approx. lower bound of epidemiological knowledge,Cytogenetic exposure indicators,radiation syndromes and death, 10%, 1%,General radiobiological information,Increase incidence of malignancies Statistical estimates (epidemiology of populations),Frequentist (Bernoullian) estimation,Subjective (Bayesian) estimation,Estimated likelihood of cancer,;,Dose (Sv),Likelihood of health effects,100% (certainty),0,1,Approx. lower bound of pathological knowledge, 5% (UNSCEAR estimate),1,10,Approx. lower bound of epidemiological knowledge,Increased syndromes and death, 10%, 1%,Typical Background,Estimated likelihood of cancer,Region of individual attribution of effects,Region of inference of radiation risks,Region of collective attribution of effects,;,Dose (Gy),Likelihood of health effects,100% (certainty),0,1,Approx. lower bound of pathological knowledge, 5% (UNSCEAR estimate),1,10,Approx. lower bound of epidemiological knowledge,Increased syndromes and death, 10%, 1%,Typical Background,Estimated likelihood of cancer,Region of individual attribution of effects,Region of inference of radiation risks,Region of collective attribution of effects,;,Total background incidence of effects,Background annual dose (average 2.4, typical 10 mSv y-1),Postulated likelihood of health effects,Dose,Radiation-unrelated background incidence,Presumed radiation-related background incidence,Nominal incremental likelihood of health effects,Incremental dose,0.005%/mSv,辐射防护中使用的量,Quantities Used in Radiological Protection,活度 (Activity)，A,吸收剂量 (absorbed dose), D,注量 (Fluence)，,吸收剂量 (absorbed dose), D,辐射权重因数 (Radiation weighting factor), wR,当量剂量 (Equivalent dose), HT,当量剂量 (Equivalent dose), HT,组织权重因数 (Tissue Weighting factor), wT,有效剂量 (Effective dose), E,照射情况类型 Types of exposure situations,照射情况类型 Types of exposure situations,现存照射情况 Existing exposure situations 计划照射情况 Planned exposure situations 应急照射情况 Emergency exposure situations,计划照射情况, Planned exposure situations,是指计划引入或操作辐射源的情况（这类照射情况包括以前分类为实践的情况）。 which are situations involving the planned introduction and operation of sources. (This type of exposure situation includes situations that were previously categorised as practices.),S,3 April, 2019,16,天然本底 natural background,有效剂量 (Effective dose),实践 practice,监管控制 regulatory control,计划照射情况, Planned exposure situations,应急照射情况， Emergency exposure situations,是指在计划照射情况的运行过程中可能发生，或由恶意行为引起的，并需要采取应急措施的意外情况。 which are unexpected situations such as those that may occur during the operation of a planned situation, or from a malicious act, requiring urgent attention.,现存照射情况， Existing exposure situations,是指在决定必须采取控制措施时照射已经存在的情况，如天然本底辐射引起的照射。 which are exposure situations that already exist when a decision on control has to be taken, such as those caused by natural background radiation.,2009 WNU-Summer InstituteS,3 April, 2019,19,可防止的剂量 (Averted dose),监管控制 regulatory control,有效剂量 (Effective dose),应急照射情况 Emergency exposure situations,2009 WNU-Summer Institute,现存照射情况 Existing exposure situations,放射防护原则,The principles of radiological protection,放射防护原则 The principles of radiological protection,正当性原则 The Principle of Justification 防护最优化原则 The Principle of Optimization of Protection 剂量限值的应用原则 The Principle of Application of Dose Limits 保护当代和后代原则 The Principle of Protection of Present and Future Generations,正当性原则 The Principle of Justification,任何改变照射情况的决定都应当是利大于弊。 Any decision that alters the radiation exposure situation should do more good than harm.,正当性 Justification,利弊,好 (good) 坏 (bad),电力 (electricity) 好 (good),好 (good) 坏 (bad),放射性排放 (radioactive discharges) 坏 (bad),防护最优化原则 The Principle of Optimization of Protection,在考虑了经济和社会因素后，遭受照射的可能性、受照射人员数量以及个人所受剂量的大小均需控制在可合理达到的尽量低水平。 The likelihood of incurring exposure, the number of people exposed, and the magnitude of their individual doses should all be kept as low as reasonably achievable, taking into account economic and societal factors.,危害 Detriment 对受照射人群组和他们的后代产生的总健康损害。,社会成本 Social cost,危害 + 社会成本 Detriment +Social cost,辐射防护水平 RP level,最佳 optimal,剂量限值的应用原则 The Principle of Application of Dose Limits,除患者的医疗照射之外，任何个人受到来自受监管源的计划照射剂量之和不应超过委员会确定的相应限值。 The total dose to any individual from regulated sources in planned exposure situations other than medical exposure of patients should not exceed the appropriate limits specified by the Commission.,S,3 April, 2019,28,天然本底 natural background,有效剂量 (Effective dose),实践 practice,剂量限值 (Dose limit) 剂量约束 (Dose constraint),计划照射情况, Planned exposure situations,S,剂量限值 (Dose limit),在有计划照射情况下对个人产生的有效剂量或当量剂量不得超过的数值。 The value of the effective dose or the equivalent dose to individuals from planned exposure situations that shall not be exceeded.,S,3 April, 2019,30,Industry,剂量限值 (Dose limit),S,剂量约束 (Dose constraint),来自某一个源的预期的和源相关的个人剂量限制，对来自某个源的最高被照射个人提供一个基本防护水平，用作源防护最优化的剂量上限。 A prospective and source-related restriction on the individual dose from a source, which provides a basic level of protection for the most highly exposed individuals from a source, and serves as an upper bound on the dose in optimization of protection for that source.,S,3 April, 2019,32,剂量约束 (Dose constraint),2009 WNU-Summer InstituteS,3 April, 2019,33,可防止的剂量 (Averted dose),参考水平 (Reference Level),有效剂量 (Effective dose),应急照射情况 Emergency exposure situations,2009 WNU-Summer Institute,现存照射情况 Existing exposure situations,2009 WNU-Summer InstituteS,可防止的剂量 (Averted dose),采取防护措施或制定防护措施防止或避免的剂量，即如果不采取防护措施的预期剂量和预计剩余剂量之差。 The dose prevented or avoided by the application of a protective measure or set of protective measures, i.e., the difference between the projected dose if the protective measure(s) had not been applied and the expected residual dose .,2009 WNU-Summer InstituteS,参考水平 (Reference Level),在应急或现存的可控制照射情况下，参考水平表示这样的剂量或危险水平，对于计划准许存在的照射高于这一水平时认为是不恰当的，在这一水平之下应进行防护最优化。 参考水平值的选择取决于所考虑照射的主要情况 In emergency or existing controllable exposure situations, this represents the level of dose or risk, above which it is judged to be inappropriate to plan to allow exposures to occur, and below which optimization of protection should be implemented. The chosen value for a reference level will depend upon the prevailing circumstances of the exposure under consideration.,保护当代和后代原则 The principle of protection of present and future generations,必须保护当前和今后的人类和环境免于辐射危险。 People and the environment, present and future, must be protected against radiation risks.,委员会的确赞成全球为保持生物的多样性，确保物种的保护，保护自然栖息地、群落和生态系统的健康与现状的需求和努力。,The Commission does subscribe to the global needs and efforts required to maintain biological diversity, to ensure the conservation of species, and to protect the health and status of natural habitats, communities, and ecosystems.,照射的分类 Categories of exposure,职业照射 (Occupational exposure) 公众照射 (Public exposure) 医疗照射 (Medical exposure),职业照射 (Occupational exposure),指工作人员因从事他们的工作所受到的所有照射，下述情况除外， 1)排除的照射，和包含辐射的豁免活动或豁免源产生的照射； 2)任何医疗照射；以及 3)正常地区天然本底辐射。 This refers to all exposure incurred by workers in the course of their work, with the exception of 1) excluded exposures and exposures from exempt activities involving radiation or exempt sources; 2) any medical exposure; and 3) the normal local natural background radiation.,公众照射 (Public exposure),辐射源对公众成员产生的照射，不包括任何职业或医疗照射，以及正常地区本底辐射。 Exposure incurred by members of the public from radiation sources, excluding any occupational or medical exposure and the normal local natural background radiation.,医疗照射 (Medical exposure),患者因作为他们自己医疗或牙科诊断或治疗的组成部分而受到的照射；除了职业性受照射人员之外的其他人，这些人对辐射照射有清楚的了解，在支持和安抚患者方面自愿进行帮助时而受到的照射；以及在涉及照射的生物医学研究计划中自愿者所受到的照射。 Exposure incurred by patients as part of their own medical or dental diagnosis or treatment; by persons, other than those occupationally exposed, knowingly, while voluntarily helping in the support and comfort of patients; and by volunteers in a programme of biomedical research involving their exposure.,源相关剂量约束和参考水平的框架 所有受控照射情况下占主导作用的单一辐射源对工作人员和公众的剂量约束举例,道德伦理基础,Moral and Ethical Foundation,倫理學,Ethics,道德学说 Theories on Ethics,目的论伦理观 (后果 ) Teolological ethics (consequences) 功利主义伦理观 (效用) Utilitarian ethics (effectiveness, utility) 义务论伦理学 (个人责任 ) Deontological ethics (personal duty) 美德伦理 (道德智慧) Areatic virtue ethics (moral wisdom),目的论伦理观 (后果 ) Teolological ethics (consequences),警句: “目的正当手段” Epigram: “The ends justify the means”,功利主义伦理观 (效用) Utilitarian ethics (effectiveness, utility),警句: “做最好的来满足多数人” Epigram: “Do the best for the majority of people”,义务论伦理学 (个人责任) Deontological ethics (personal duty),警句: “怎样对待别人， 因为他们应该对他们做” Epigram: “do unto others as they would one should have done unto them”,美德伦理 (道德智慧) Areatic virtue ethics (moral wisdom),警句: “有道德的，明智和审的， 始终着眼于人类” “be virtuous, wise and prudent, and always aim at humanity” “做什么是诚实/慈善， 不要做的事情不诚实/无情” Do what is honest/charitable; do not do what is dishonest/uncharitable.“,放射防护原则 The principles of radiological protection,正当性原则 The Principle of Justification 防护最优化原则 The Principle of Optimization of Protection 剂量限值的应用原则 The