Radiation Safety in Nuclear Medicine, Second Edition

by Lombardi; Max H.

• ISBN13: 9780849381683
• ISBN10: 0849381681
• Edition: 2nd
• Format: Hardcover
• Copyright: 2006-10-20
• Publisher: CRC Press

Summary

Recent advances in the field of nuclear medicine (NM) are expanding the role and responsibilities of the nuclear medicine technologist (NMT) to include more complex and detailed tasks. New technologies are making the diagnosis, management, and treatment of illnesses more sensitive, more specific, more accurate, and ultimately safer for both the patient and the technologist.Radiation Safety in Nuclear Medicine, Second Edition provides the latest technological advances and expanded responsibilities of today's NMT while laying a solid foundation for understanding the basic physics behind the technology. As with the original, this edition teaches the units of radioactivity, exposure, and dosimetry, along with the principles of instrumentation needed for detection and measurement. Focusing on the issues of safety, this volume devotes considerable attention to the science and practice of safety techniques and includes information on rules and regulations.In keeping with the expanding nature of the field, the second edition incorporates many updates and additions such as,· Recent modifications to the U.S. Code of Federal Regulations specific to the use of radiopharmaceuticals in medicine· The growing popularity of metabolic imaging with positron emissions tomography (PET)· The benefits of merging two modalities, namely, the images of PET and computerized tomography (CT) into one short scanning procedure· The new role of therapeutic radiopharmaceuticals that use molecular targeting as a method of localizationProviding a basic understanding of nuclear medicine, its scientific basis, diagnostic and therapeutic applications, safety practices and regulations, and future directions, Radiation Safety in Nuclear Medicine, Second Edition is the comprehensive reference for technologists, students, researchers, and other professionals in the Nuclear Medicine.

Table of Contents

Chapter 1 Principles of Radiation Physics	1	(28)
I. Rationale	1	(1)
II. Brief History of Radiation Science	1	(3)
A. The Nature of Matter	1	(1)
B. Atoms and Molecules	2	(1)
C. X-Rays and Natural Radioactivity	2	(1)
D. Relativity	3	(1)
E. Quantum Physics	3	(1)
F. Radiation Physics	4	(1)
III. Matter and Energy	4	(2)
A. Nature of Matter	4	(1)
B. Laws of Thermodynamics	4	(1)
C. Some Basic Units	5	(1)
1. Mass	5	(1)
2. Distance	5	(1)
3. Time	6	(1)
4. Energy	6	(1)
5. Speed of Light (c)	6	(1)
6. Mass–Energy Equivalence (E = mc²)	6	(1)
7. Electrical Charge	6	(1)
IV. Atomic Structure and Radioactivity	6	(13)
A. Basic Structure	6	(1)
B. Nuclear Stability	7	(1)
C. Radioactive Decay	8	(2)
D. Modes of Radioactive Decay	10	(6)
1. Alpha Decay	10	(1)
2. Negatron Decay	11	(2)
3. Positron Decay	13	(1)
4. Electron Capture	14	(1)
5. Gamma Decay	15	(1)
6. Isomeric Transition (IT)	15	(1)
E. Electromagnetic (EM) Radiations	16	(3)
1. The EM Spectrum	18	(1)
V. Particle Interactions	19	(2)
A. General Considerations	19	(1)
1. Electrical Charge	19	(1)
2. Momentum	19	(1)
3. Impulse	19	(1)
B. Alpha Interactions	19	(1)
1. Trajectory	19	(1)
2. Range	20	(1)
3. Specific Ionization (S)	20	(1)
C. Beta Interactions (Positrons and Negatrons)	20	(1)
1. Trajectory	20	(1)
2. Range	20	(1)
3. Bremsstrahlung (Braking Radiation)	21	(1)
4. Backscatter	21	(1)
5. Annihilation Radiation	21	(1)
VI. Gamma Ray Interactions	21	(3)
A. General Considerations	21	(1)
B. Photoelectric Effect (τ)	21	(1)
C. Compton Effect (σ)	22	(1)
D. Pair Production (kappa)	23	(1)
E. Internal Conversion (IC)	24	(1)
VII. Gamma Ray Interactions with Lead and Water	24	(2)
A. Some Properties of Lead	24	(1)
B. Some Properties of Water	24	(1)
C. Gamma Ray Attenuation	25	(1)
D. In Lead	25	(1)
E. In Water or Soft Tissue	26	(1)
Problems	26	(1)
References	26	(3)
Chapter 2 Units of Radiation Exposure and Dose	29	(12)
I. Rationale	29	(1)
II. Basic Concepts	29	(5)
A. Activity (A)	30	(1)
1. Relative Standardization	30	(1)
2. Absolute Standardization	31	(1)
B. Exposure (X)	31	(1)
C. Absorbed Dose (D)	32	(1)
D. Equivalent Dose (HT,R)	32	(1)
E. Effective Dose (E)	33	(1)
F. Relative Biological Effectiveness (RBE)	34	(1)
III. Other Concepts	34	(3)
A. Specific Ionization	34	(1)
B. The W Value	35	(1)
C. Linear Energy Transfer (LET)	35	(1)
D. Range of Beta Particles	35	(1)
E. The f Value (rad/R)	35	(2)
IV. Specific Gamma Constant (F)	37	(1)
V. About S.I. Units	38	(1)
Problems	39	(1)
References	39	(2)
Chapter 3 Guidelines for Radiation Protection	41	(16)
I. Rationale	41	(1)
II. National and International Agencies	41	(5)
A. The Big Picture	41	(1)
B. National Council on Radiation Protection and Measurement	42	(1)
C. International Commission on Radiation Protection (ICRP)	42	(1)
D. International Commission on Radiation Units and Measurements	43	(1)
E. Nuclear Regulatory Commission (NRC)	43	(1)
F. Environmental Protection Agency (EPA)	43	(1)
G. Food and Drug Administration (FDA)	43	(1)
H. Department of Transportation (DOT)	44	(1)
I. Joint Commission on Accreditation of Health Organizations	45	(1)
J. Other Consulting Organizations	45	(1)
III. Radiation Safety and the Law	46	(2)
A. Objective	46	(1)
B. Philosophy	46	(1)
C. The Concept of Risk	47	(1)
D. The ALARA Policy	47	(1)
E. Method	47	(1)
F. Licensing (10CFR19.3)	48	(1)
1. General Licenses	48	(1)
2. Specific Licenses	48	(1)
IV. Types of Radiation Effects	48	(1)
A. Acute and Chronic Exposures	48	(1)
B. Deterministic Effects	48	(1)
C. Stochastic Effects	49	(1)
V. Other Concepts in Dosimetry	49	(2)
A. Committed Equivalent Dose, HT(τ)	49	(1)
B. Committed Effective Dose, E(τ)	49	(1)
C. Annual Limit on Intake (ALI)	50	(1)
D. Derived Air Concentrations (DACs)	50	(1)
E. Deep Dose (Hd)	50	(1)
F. Shallow Dose (Hs)	50	(1)
G. Lens Dose (LD)	51	(1)
VI. Recommended Dose Limits	51	(1)
A. Occupational Dose Limits (10CFR20.1201)	51	(1)
B. General Public Dose Limits (10CFR20.1301)	51	(1)
C. Comments	51	(1)
VII. Radiation Safety Practice	52	(2)
A. Radiation Safety Officer (RSO)	52	(1)
B. Radiation Safety Committee (RSC)	52	(1)
C. Radiation Safety Program (RSP)	52	(1)
D. Quality Management Program (QMP)	52	(1)
E. The ALARA Program	52	(1)
F. Radiation Warning Signs	53	(1)
Problems	54	(1)
References	54	(3)
Chapter 4 Radiation Detection and Measurement	57	(24)
I. Rationale	57	(1)
II. Fundamentals	57	(2)
A. Principles	57	(1)
B. Detection	58	(1)
C. Radioactive Contamination	58	(1)
D. Measurement	58	(1)
E. Radiation Survey Instruments	58	(1)
1. Gas Detectors	58	(1)
2. Personal Exposure Monitors	59	(1)
3. Scintillation Detectors	59	(1)
F. Interpretation	59	(1)
III. Gas Detectors	59	(6)
A. Basic Design	59	(2)
1. Components	59	(1)
2. Ions Collected and Voltage	59	(2)
B. GM Survey Meters	61	(1)
1. Design	61	(1)
2. Scales	61	(1)
3. Wall Thickness	61	(1)
4. Gases	61	(1)
5. Error of Detection	61	(1)
6. Time Constant	62	(1)
7. Disadvantage	62	(1)
C. Calibration of GM Survey Meters	62	(1)
1. Sealed Source	62	(1)
2. Regulation	62	(1)
3. Correction Factor	62	(1)
D. Wipe-Test Counters	63	(1)
1. Design	63	(1)
2. Positive Wipes	63	(1)
E. Portable Ionization Chambers	63	(1)
1. Properties	63	(1)
2. Accuracy	63	(1)
3. Scales	63	(1)
F. Dose Calibrators	63	(1)
1. Accurate Assays	63	(1)
2. Safety	64	(1)
G. Pocket Dosimeters	64	(1)
1. Design	64	(1)
2. Operation	64	(1)
3. Applications	64	(1)
4. Advantage	64	(1)
H. Summary of Gas Detectors	65	(1)
IV. Scintillation Detectors	65	(2)
A. Basic Design	65	(1)
1. The Na(Tl) Detector	65	(1)
2. Principle	66	(1)
B. Associated Electronics	66	(1)
1. Single-Channel Analyzer (SCA)	66	(1)
2. The Window	67	(1)
3. Applications	67	(1)
4. Other Scintillation Detectors	67	(1)
V. Imaging Instrumentation	67	(3)
A. Conventional Imaging	68	(1)
1. Planar Imaging	68	(1)
2. SPECT	68	(1)
B. Pet Imaging	68	(1)
1. Metabolic Tracers	68	(1)
2. The PET Scanner	69	(1)
C. The Merging of PET and CT	69	(1)
1. Computerized Tomography (CT)	69	(1)
2. Coverage	69	(1)
3. The PET/CT Scanner	70	(1)
4. Applications	70	(1)
VI. Statistics of Counting	70	(4)
A. Types of Errors	70	(1)
1. Systematic Errors	70	(1)
2. Random Errors	70	(1)
3. Blunders	70	(1)
B. Statistical Distributions	70	(1)
1. Poisson Distribution	70	(1)
2. Gaussian Distribution	71	(1)
C. The Normal Distribution	71	(3)
1. Sample	71	(1)
2. Ranges of Confidence	71	(1)
3. The Meaning of σs	72	(1)
4. Practical Rules	72	(1)
5. Background Radiation	72	(1)
6. Coefficient of Variation (CV)	73	(1)
7. Standard Deviation of the Mean, σx	73	(1)
8. Total Counts Collected (N)	73	(1)
9. Reliability	73	(1)
10. Rejection of Data	74	(1)
VII. Making Decisions	74	(1)
A. Relative Error (τ)	74	(2)
1. Detector Performance	74	(1)
2. Is There Contamination?	75	(1)
VIII. Minimum Detectable Activity (MDA)	75	(1)
IX. Quality Assurance of Radiation Counters	76	(2)
A. Reliability	76	(1)
B. QA Tests	76	(6)
1. The Relative Error (τ)	76	(1)
2. The Reliability Factor (RF)	76	(1)
3. The Chi-Squared Test (χ²)	77	(1)
Problems	78	(1)
References	78	(3)
Chapter 5 Radiation Safety in the Nuclear Medicine Department	81	(22)
I. Rationale	81	(1)
II. Design of the NM Department	82	(1)
A. Cold Areas	82	(1)
B. Lukewarm Areas	82	(1)
C. Warm Areas	83	(1)
D. Hot Areas	83	(1)
III. Description of Some Areas	83	(3)
A. Waiting Room and Reception	83	(1)
B. Nonimaging Procedures Room	83	(1)
1. Radioimmunoassays (RIAs)	84	(1)
2. Thyroid Uptake of Radioiodide	84	(1)
3. Schilling Test	84	(1)
4. Blood Volume Test	84	(1)
C. Control Room	84	(1)
D. Imaging Rooms	84	(1)
E. Radiopharmacy (Hot Lab)	85	(1)
IV. Molecular Medicine	86	(3)
V. The Radiation Safety Program (RSP)	89	(1)
A. General Considerations	89	(1)
B. Contents	90	(1)
VI. Radiation Safety Committee (RSC)	90	(1)
VII. Radiation Safety Officer (RSO)	90	(1)
VIII. Radioactive Materials License	91	(1)
IX. Quality Management Program (QMP)	91	(1)
A. Definition	91	(1)
B. Misadministrations	92	(1)
C. Recordable Events	92	(1)
D. Reportable Events	92	(1)
X. The ALARA Program	92	(1)
A. Objective	92	(1)
1. Inclusion	93	(1)
XI. The Practice of Radiation Safety	93	(6)
A. Authorized Users	93	(1)
B. Training of Personnel	93	(1)
C. Personnel Exposures	93	(1)
D. Record Keeping	93	(1)
E. Inspections (10CFR19.14, 10CFR30.52)	94	(1)
F. Reception of Radioactive Packages	94	(1)
G. Radiopharmaceuticals	95	(1)
H. Dose Calibrators	95	(1)
I. Laboratory Rules	96	(1)
J. Use of Radioactive Materials	96	(1)
K. Radioactive Waste Disposal	96	(2)
L. Laboratory Surveys	98	(1)
M. Sealed Sources	98	(1)
N. Radionuclide Therapy	98	(1)
O. Radiation Emergencies	98	(1)
Problems	99	(1)
References	100	(3)
Chapter 6 Safe Handling of Radioactivity	103	(20)
I. Rationale	103	(1)
II. Minimizing External Exposures	103	(7)
A. Principles	103	(7)
1. Quantity of Radioactivity Used	103	(1)
2. Time of Exposure	104	(1)
3. Effect of Distance	105	(1)
4. Effect of Shielding	106	(4)
III. Preventing Internal Contamination	110	(2)
A. Ingestion	110	(1)
B. Inhalation	110	(1)
C. Percutaneous Absorption	111	(1)
D. Accidental Injection	112	(1)
IV. Laboratory Rules	112	(1)
V. Radiation Hazards	113	(4)
A. Alpha Emitters	113	(1)
B. Negatron Emitters	114	(1)
C. Positron Emitters	115	(1)
D. Gamma Emitters	116	(1)
E. Neutrons	116	(1)
VI. Radionuclide Therapy	117	(2)
A. Radioiodine Therapy	117	(1)
1. Imaging of Metastases	117	(1)
2. Hyperthyroidism	117	(1)
3. Thyroid Ablation	117	(1)
B. Thyroid Ablation	118	(1)
C. Release of Patients	119	(1)
D. Room Decontamination	119	(1)
VII. Other Radionuclide Therapies	119	(2)
A. Phosphorus-32	119	(1)
B. Strontium-89 Chloride and 153Sm-EDTMP	120	(1)
C. Yttrium-90	120	(1)
D. Iodine-125	120	(1)
E. Iodine-131	120	(1)
Problems	121	(1)
References	121	(2)
Chapter 7 Radiation Surveys and Waste Disposal	123	(16)
I. Rationale	123	(1)
II. Radiation Surveys	123	(3)
A. Preparation	123	(1)
B. Survey Practices	124	(1)
C. Selection of a Survey Instrument	124	(1)
D. Proper Operation	124	(1)
E. Surveying of Working Areas	125	(1)
F. Methods	125	(1)
III. Survey Instruments	126	(2)
A. GM Survey Meters	126	(1)
B. Alarm Monitors	126	(1)
C. Ionization Chambers	126	(1)
D. Surface Monitors	127	(1)
IV. Monitoring	128	(2)
A. Map of the Department	128	(1)
B. Method	128	(1)
C. Hot-Lab Housekeeping	129	(1)
D. Wipe-Test Monitoring	129	(1)
V. Accidental Contamination	130	(2)
A. Radioactive Spills	130	(1)
B. Decontamination	130	(2)
1. Minor Spills	130	(1)
2. Major Spills	130	(1)
3. Procedure	131	(1)
C. Release of ¹³³Xe	132	(1)
VI. Radioactive Wastes	132	(2)
A. Classes of Radioactive Wastes	132	(1)
B. Nuclear Medicine Wastes	133	(1)
1. Solid Wastes	133	(1)
2. Liquid Wastes	133	(1)
3. Radioactive Gases	133	(1)
C. Radiotoxicity	133	(1)
VII. Disposal of Radioactive Wastes	134	(2)
A. Disposal of Solid Wastes	134	(1)
1. Management of Wastes (10CFR20.2001)	134	(1)
2. Segregation by Half-Life	134	(1)
3. Biohazards	134	(1)
4. Radiopharmaceutical Remnants	134	(1)
5. Nuclide Generators	134	(1)
6. Labeling	135	(1)
7. Records	135	(1)
B. Liquid Wastes Disposal	135	(1)
C. Gases, Aerosols, and Volatile Radioiodine	135	(1)
D. Transportation of Wastes	136	(1)
VIII. Occupational Exposures	136	(1)
A. Occupational Exposure to ¹³¹I	136	(1)
B. Occupational Exposure to ¹³³Xe	136	(1)
IX. The Environmental Protection Agency (EPA)	136	(1)
Problems	137	(1)
References	137	(2)
Chapter 8 Monitoring of Personnel Exposures	139	(14)
I. Rationale	139	(1)
II. Monitoring of Occupational Exposures	140	(1)
A. Dose Limits	140	(1)
B. Requirements	140	(1)
III. Reminder of Dose Limits	140	(1)
A. Occupational Dose Limits (10CFR20.1201)	140	(1)
B. Nonoccupational Dose Limits (10CFR20.1301)	140	(1)
IV. Monitoring Methods	141	(8)
A. Acceptable Methods	141	(1)
B. Film Badge Dosimetry	141	(4)
1. The Service	141	(1)
2. The Badge Case	141	(1)
3. The Film	142	(1)
4. The Emulsion	142	(1)
5. The Theory	143	(1)
6. Film Processing	143	(1)
7. Density	143	(1)
8. Calibration Curve	144	(1)
9. Advantages	145	(1)
10. Disadvantages	145	(1)
C. Thermoluminescence Dosimetry (TLD)	145	(1)
1. The Principle	145	(1)
2. The Theory	145	(1)
3. Quantification	145	(1)
4. The Service	146	(1)
5. Advantages of TLD	146	(1)
6. Disadvantages of TLD	146	(1)
D. Pocket Dosimeters	146	(2)
1. Description	146	(2)
2. Advantages	148	(1)
3. Disadvantages	148	(1)
E. Personal Alarm Monitors (Bleepers)	148	(1)
1. Description	148	(1)
2. Advantages	148	(1)
3. Disadvantages	148	(1)
F. OSL Dosimetry	148	(1)
1. Advantages	149	(1)
2. Disadvantages	149	(1)
V. Records of Personnel Dosimetry	149	(1)
A. Personnel Doses	149	(1)
B. Previous Records	149	(1)
C. Committed Dose	149	(1)
D. Other Records	149	(1)
VI. Reports	149	(1)
A. Lost or Stolen Radioactive Sources	149	(1)
B. Incident Reports (10CFR20.2202)	150	(1)
1. Immediate Notification	150	(1)
2. Twenty-Four-Hour Notification	150	(1)
VII. Reportable Events	150	(1)
A. Incidents	150	(1)
B. The EPA	150	(1)
C. Reports to Individuals	150	(1)
D. Files	150	(1)
Problems	151	(1)
References	151	(2)
Chapter 9 Internal Dosimetry and Bioassays	153	(18)
I. Rationale	153	(1)
II. Historical Review	153	(7)
A. General Considerations	153	(1)
B. Methods	154	(1)
C. The ICRP Method	154	(2)
1. Assumptions	154	(1)
2. "Standard Man"	154	(1)
3. The Snyder–Fisher Phantom	154	(1)
4. The Marinelli Equations	155	(1)
5. Effective Half-Life (Te)	155	(1)
D. The MIRD Method	156	(3)
1. MIRD Assumptions	156	(1)
2. The MIRD Equations	157	(1)
3. Cumulative Activities (Ã)	157	(1)
4. Equilibrium Dose Constants (Δi)	157	(1)
5. Absorbed Fraction (φ)	157	(1)
6. Effective Absorbed Energies (EAE)	158	(1)
7. Mean Absorbed Doses (S)	158	(1)
8. Internal Doses According to MIRD	159	(1)
E. The Radar Web Site	159	(1)
III. Internal Doses from Radiopharmaceuticals	160	(2)
A. Package Inserts	160	(1)
1. Requirement	160	(1)
B. Diagnostic RPs	160	(2)
1. Conventional Imaging Procedures	160	(1)
2. Dosimetry of '8F-FDG	160	(1)
3. Dosimetry of Radionuclide Therapy	160	(2)
4. Diagnostic Whole-Body and Fetal Doses	162	(1)
IV. Bioassay of Radioactivity	162	(4)
A. Definitions	162	(1)
B. Requirements	163	(1)
C. Airborne Medical Radionuclides	163	(1)
D. Bioassays of Iodine-131	163	(1)
1. Alert and Action Levels for ¹³¹I	163	(1)
2. Action Levels	164	(1)
E. Biological Models	164	(2)
1. Highly Diffusible Radionuclides	164	(1)
2. High-Organ-Uptake Radionuclides	165	(1)
V. Biological Half-Times	166	(1)
A. Exponential Removal	166	(1)
Problems	167	(1)
References	168	(3)
Chapter 10 Introduction to Radiobiology	171	(32)
I. Rationale	171	(1)
II. Review of Basic Concepts	171	(5)
A. Living Organisms	171	(1)
B. Properties of Living Organisms	171	(1)
C. Energy Flow	172	(1)
D. Cellular Respiration	173	(1)
E. Cell Division	174	(1)
F. Mitosis	174	(1)
G. The Cell Cycle	175	(1)
H. Defense Mechanisms	175	(1)
III. The Study of Radiobiology	176	(2)
A. The General Scheme	176	(1)
B. Sources of Radiation	176	(1)
C. The Biological System	177	(1)
IV. Types of Exposure	178	(1)
A. Acute Exposure	178	(1)
B. Chronic Exposure	179	(1)
C. Experimental Levels of Exposure	179	(1)
V. Theories of Radiation Injury	179	(3)
A. Introduction	179	(1)
B. Target Theory	180	(1)
C. Indirect Theory	181	(1)
VI. DNA: The Most Sensitive Target	182	(2)
A. Lesions in DNA	182	(1)
B. Role of DNA	183	(1)
VII. Quantitative Radiobiology	184	(1)
A. Survival Curves	184	(1)
B. Microscopic Autoradiography	184	(1)
C. Other Methods	184	(1)
VIII. Survival Curves	184	(2)
A. Definition	184	(1)
B. Equations	185	(1)
C. The Shoulder	185	(1)
IX. Tissue Sensitivities	186	(1)
A. Cells	186	(1)
B. Cell Populations	186	(1)
C. The Law of Bergonie and Tribondeau	186	(1)
X. Types of Damage	186	(1)
A. Sublethal Damage (SLD)	186	(1)
B. Potentially Lethal Damage (PLD)	187	(1)
XI. Radiation Injury Modifiers	187	(2)
A. Physical Modifiers	187	(1)
B. Chemical Modifiers	187	(1)
C. Biological Modifiers	188	(1)
D. The Overkill Effect	188	(1)
E. Dose Fractionation	189	(1)
XII. Acute Radiation Syndrome (ARS)	189	(3)
A. Whole-Body Exposure	189	(1)
B. The Bone Marrow Syndrome	190	(1)
C. GI Syndrome	190	(1)
D. CNS Syndrome	191	(1)
E. Radiation Dispersion Device (RDD)	191	(1)
XIII. Late Effects of Radiation	192	(5)
A. Types of Late Effects	192	(1)
B. The Human Experience	192	(1)
C. Hypotheses for Late Effects	193	(1)
D. Radiation Hormesis	194	(1)
E. The Concept of Risk	194	(2)
F. Life-Span Shortening	196	(1)
G. Other Late Effects	196	(1)
XIV. Genetic Effects	197	(1)
A. Basic Concepts	197	(1)
B. Background Radiation	198	(1)
C. Mutations in Drosophila	198	(1)
D. The Megamouse Project	198	(1)
XV. Effects of Prenatal Irradiation	198	(1)
A. Experiments with Mice	198	(1)
B. Observations in Humans	199	(1)
C. Recommendations	199	(1)
Problems	199	(1)
References	200	(3)
Appendix A Properties of Medical Radionuclides	203	(2)
A. Negatron Emitters	203	(1)
B. Gamma (X-Rays) Emitters	203	(1)
C. Positron Emitters (Annihilation Radiation)	204	(1)
Appendix B Symbols and Abbreviations	205	(6)
Appendix C Interconversion of Units	211	(2)
Appendix D Answers to Problems	213	(6)
Chapter 1	213	(1)
Chapter 2	213	(1)
Chapter 3	214	(1)
Chapter 4	215	(1)
Chapter 5	215	(1)
Chapter 6	216	(1)
Chapter 7	216	(1)
Chapter 8	217	(1)
Chapter 9	217	(1)
Chapter 10	218	(1)
Index	219