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"Tujuan: menilai prevalensi katarak terinduksi radiasi, serta menghubungkannyadengan dosis paparan radiasi dan penggunaan perlengkapan proteksi radiasi.Metode: Studi potong lintang dan studi kasus-kontrol. Seratus delapan puluh subyekberpartisipasi dalam penelitian. Prevalensi katarak terinduksi radiasi dinilaimenggunakan analisis Scheimpflug pada alat Pentacam®-Oculus. Dosis paparanradiasi kumulatif dan penggunaan perlengkapan proteksi radiasi pada subyekdiidentifikasi melalui kuesioner dan personal dosimeter.Hasil: Prevalensi katarak terinduksi radiasi sebanyak 16.7%. Median dosis radiasikumulatif berdasarkan kuesioner menunjukkan median 0,8 (0.1- 35.6) Gy. Hubungankorelasi positif didapatkan antara dosis radiasi kumulatif dengan densitas lensa (RSpearman= 0.64). Sebanyak 83.9% subyek menggunakan tabir pada 71-100% masakerjanya, tetapi mayoritas subyek penelitian (40.6%), tidak menggunakan kacamatapelindung. Peningkatan risiko katarak terinduksi radiasi meningkat secara bermaknaseiring dengan kepatuhan penggunaan proteksi radiasi yang kurang. Subyek denganproteksi tabir radiasi 31-50% dari masa kerjanya meningkatkan risiko katarak 10.80kali lipat (IK 95% 1.05-111.49, p=0.044). Sementara itu, kelompok proteksi tabirradiasi 51-70% meningkatkan risiko katarak 8.64 kali lipat (p=0.001). Subyek yangtidak memakai kacamata pelindung memiliki OR 164.3 (IK 95% 19.81-1363)dibandingkan dengan kelompok pengguna kacamata pelindung.Kesimpulan: Katarak terinduksi radiasi pada pekerja radiasi bidang kardiologiintervensi tergantung pada dosis paparan radiasi dan penggunaan proteksi radiasi.Oleh karena itu, kepatuhan pekerja radiasi perlu ditingkatkan sesuai ketentuanproteksi radiasi.

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Objectives: to determine the prevalence of radiation-induced cataract and correlatewith radiation exposure dose and radiation protection use among radiation workers ofinterventional cardiology.Methods: A cross-sectional and retrospective case-control study. One hundred andeighty subjects were included. Prevalence of radiation-induced cataract was assessedusing Scheimpflug analysis on the Pentacam®-Oculus. Individual cumulativeradiation exposure dose and radiation protection use of subjects were identified fromquestionnaire and personal dosimeter.Results: The prevalence of radiation-induced cataract was 16.7%. Median cumulativeradiation dose was 0.8 (0.1-35.6) Gy. A positive correlation was found betweencumulative radiation dose and lens density (RSpearman=0.64). This study showed that83.9% of subjects used ceiling-suspended shield in 71-100% of their working period,however the majority of subjects (40.6%) did not wear protective eyewear.Statistically significant increasing risk of cataract was found along with unresponsiveuse of radiation protection. The subjects using ceiling-suspended shield in 31-50% oftheir working period were increasing their cataract risk by 10.80 times (95% CI 1.05-111.49, p=0.044). Meanwhile, the subjects using protective eyewear in 51-70% oftheir working period were increasing their cataract risk by 8.64 times (p=0.001).Subjects who did not wear protective eyewear had an OR 164.3 (95% CI 19.81-1363)compared to those who wore protective eyewear.Conclusion: Radiation-induced cataract among radiation workers of interventionalcardiology was depend on radiation exposure dose and radiation protection.Therefore, the compliance of radiation safety recommendation should be improved."

"Tujuan: menilai prevalensi katarak terinduksi radiasi, serta menghubungkannya dengan dosis paparan radiasi dan penggunaan perlengkapan proteksi radiasi.Metode: Studi potong lintang dan studi kasus-kontrol. Seratus delapan puluh subyekberpartisipasi dalam penelitian. Prevalensi katarak terinduksi radiasi dinilai menggunakan analisis Scheimpflug pada alat Pentacam® Oculus. Dosis paparan radiasi kumulatif dan penggunaan perlengkapan proteksi radiasi pada subyek diidentifikasi melalui kuesioner dan personal dosimeter"

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Rute pulmonal merupakan rute penghantaran zat aktif yang menjanjikan untuk pengobatan lokal dan sistemik, karena memungkinkan untuk mengadministrasikan obat dengan dosis minimum dan konsentrasi tinggi langsung pada situs terapi, non-invasif, dan tidak melalui metabolisme lintas pertama. Pemilihan eksipien yang tepat dapat menghasilkan sediaan inhalasi dengan karakteristik yang sesuai untuk penghantaran zat aktif sesuai dengan tujuan penggunaannya. Bahan alam Indonesia yang berasal dari laut (seperti kitosan, alginat, gelatin ikan) dan bahan nabati (modifikasi pati, gum alam dan xyloglucan) telah dikembangkan sebagai eksipien pada sejumlah sediaan farmasi. Namun bahan alam tersebut belum banyak dimanfaatkan sebagai eksipien sediaan inhalasi. Oleh karena itu, penulisan artikel ini bertujuan untuk mengidentifikasi karakteristik bahan alam Indonesia yang prospektif untuk dikembangkan sebagai eksipien untuk sediaan inhalasi, serta menganalisa tantangan dalam proses pengembangannya. Metode yang digunakan adalah literature review dengan pencarian artikel penelitian di sciencedirect, PubMed dan google scholar dengan kata kunci natural, excipient dan inhalation. Bahan alam Indonesia yang berasal dari laut (seperti kitosan, alginat, gelatin ikan) dan bahan nabati (modifikasi pati, gum alam dan xyloglucan) menunjukkan karakteristik yang prospektif untuk penghantaran zat aktif ke paru-paru. Pengembangan bahan alam untuk sediaan inhalasi perlu dilakukan dengan mempertimbangkan sifat fungsional eksipien yang sesuai untuk tujuan pengobatan yang diinginkan dan proses produksi yang efisien, serta kompatibilitas dan keamanan eksipien tersebut terhadap sel dan jaringan paru-paru.

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Pulmonary route is a prospective delivery route for active substances for local and systemic therapy due to its possibility to administer drugs with minimum doses and high concentrations directly at the therapeutic site, non-invasive method, and avoid the first-pass metabolism. Selecting suitable excipients can produce inhalation dosage forms with appropriate characteristic to deliver API according to their intended use. Natural excipients from Indonesia which are derived from the sea (such as chitosan, alginate, fish gelatin) and from plants (modified starch, natural gum and xyloglucan) have been developed as excipients in several pharmaceutical dosage forms. However, this natural material has not been widely used as excipient in inhalation dosage form. Therefore, this article aimed to identify characteristics of natural resources which are prospective to be developed as excipients for inhalation dosage form, as well as analyze the challenges in its development. The literature review has been performed to explore research articles in sciencedirect, PubMed and google scholar with key words of natural, excipient dan inhalation. Natural excipients from Indonesia which are derived from the sea (such as chitosan, alginate, fish gelatin) and from plants (modified starch, natural gum and xyloglucan) exhibit prospective characteristics for delivering API to the lungs. Furthermore, several considerations should be performed in developing these natural materials for inhalation dosages form, including the functional properties of the excipient required for targeted therapy and efficient production processes, as well as the compatibility and safety of the excipient toward cells and lung tissue.

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"To analyze the relationship between exposure to xylene as organic solvents and neurotoxic symptoms as affect of xylene exposure between paint manufacture workers. Fourty-five male workers completed a symptom questionnaire 18 Germany version. Fourteen workers underwent the positive neurotoxic symptoms from the questionnaire results. In chi-square tests, confounding variables for working period, smoking habits, exercise habits, duration of xylene exposure, usage of respiratory protection, and historical disease were found a not significant relation with the symptoms of neurotoxic with affect of xylene exposure. The relation between level of exposure and age factor, in both correlation and linier regression analysis were poor relation with the symptoms of neurotoxic with affect of xylene exposure.The results suggest that a symptom and some behavioral changes shows the neurotoxic effects to low levels of xylene exposure. However, no consistent pattern was observed in regard to the effects of xylene exposure on neurobehavioral dysfunction, in regards with the confounding factors that studied.

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Untuk menganalisis hubungan antara pajanan xylene sebagai pelarut organik dan gejala neurotoksik yang diakibatkan pajanan xylene pada pekerja pembuatan cat di PT. X tahun 2012. Empat puluh lima pekerja laki-laki menyelesaikan kuesioner Q18 versi Jerman. Empat belas pekerja mengalami gejala neurotoksik positif dari hasil kuesioner. Dalam uji chi-square, variabel confounding untuk masa kerja, kebiasaan merokok, kebiasaan olahraga, lama pajanan per minggu, penggunaan perlindungan pernapasan, dan riwayat penyakit ditemukan tidak berhubungan signifikan dengan gejala neurotoksik akibat pajanan xylene. Hubungan antara tingkat pajanan xylene dan faktor usia, baik lewat uji korelasi dan analisis regresi linier menunjukkan hubungan yang lemah dengan gejala neurotoksik akibat pajanan xylene.Hasil penelitian menunjukkan bahwa gejala neurotoksik dan beberapa perubahan perilaku terjadi pada pajanan xylene tingkat rendah. Namun, tidak ada gambaran yang menunjukkan pola yang linier yang diamati sehubungan dengan efek pajanan xylene pada gangguan neurobehavioral, berkaitan dengan faktor-faktor pengganggu yang dipelajari."

"Radiografer secara umum mempunyai tugas dan tanggung jawab untuk melakukan pemeriksaan pasien secara radiografi meliputi pemeriksaan untuk radiodiagnostik termasuk kedokteran nuklir dan ultrasonografi (USG) dan melakukan tindakan proteksi radiasi dalam mengoperasikan peralatan radiologi. Penelitian ini bertujuan memprakirakan risiko pajanan radiasi sinar-X pada pekerja radiasi di Departemen Radiologi RSUPN Cipto Mangunkusumo. Dalam perhitungan prakiraan risiko pajanan radiasi sinar-X, dosis pajanan radiasi sianr-X radiografer diperoleh dari hasil pengukuran film badge. Data pola aktifitas (lama kerja, frekuensi pajanan dan masa kerja) diperoleh berdasarkan hasil wawancara pada 35 radiografer di Departemen Radiologi RSUPN Cipto Mangunkusumo. Berdasarkan perhitungan yang dilakukan, nilai rata-rata Excess Cancer Risk (ECR) lifetime (4,8E-2) dan realtime (1,9E-2). Karena secara teoretis karsinogenisitas tidak mempunyai nilai ambang atau non threshold, maka prakiraan risiko dinyatakan unacceptable (dosis tidak dapat diterima) bila ECR < E4. Kisaran angka E-4 diperoleh dari nilai default karsinogenistas yang digunakan oleh US-EPA (1990). Berdasarkan perhitungan ECR lifetime dan ECR realtime diperoleh gambaran prakiraan risiko efek karsinogenik yang terjadi pada radiografer di Departemen Radiologi RSUPN CM, dinyatakan aceptable pada risiko kanker baik pada ECR lifetime maupun realtime.

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Radiographer in general have a duty and responsibility to audit includes examined patients for radiodiagnostic including nuclear medicine and ultrasonography (USG), and radiation protection in radiology and operating equipment. This study aims to estimated the risk of X-ray radiation exposure to radiographer in the Department of Radiology RSUPN Cipto Mangunkusumo using Environmental Health Risk Analysis (ARKL). In calculating the estimated risk forecasts ARKL, risk of X-ray radiation exposure dose radiographer obtained from measurements of the film badge. Data patterns of activity (duration of work, frequency of exposure and years of work) obtained based on the results of a survey of 35 radiographers in the Department of Radiology RSUPN Cipto Mangunkusumo.

Based on the calculations performed, the average value of Excess Cancer lifetime Risk (ELCR) is 4,8E-2 and the value of Excess Real-time Cancer Risk (ERRC) the average is 1,9E-2. Because theoretically carcinogenicity has non-threshold value, then the forecast is declared unacceptable when ECR < E-4. Range of numbers obtained from the E-4, carcinogenicity default values used by the US-EPA (1990). Based on the calculation of the ELCR and ERCR forecasts illustrate the risk of carcinogenic effects that occur in the radiographers in the Department of Radiology RSUPN CM, acceptable on cancer risk both in the ELCR and ERRC."

"Pendahuluan. WHO menyatakan bahwa kanker adalah salah satu penyebab utama kematian di seluruh dunia. Radiasi dapat menyebabkan leukemia, kanker payudara, dan kanker tiroid. Untuk kondisi yang lebih spesifik, radiasi pada masa kanak-kanak meningkatkan risiko kanker tiroid dan peningkatan risiko kanker payudara telah diamati setelah radiasi pada wanita pra-menopause. Berdasarkan data kanker Organisasi Kesehatan Dunia (WHO) pada tahun 2020, kanker tiroid termasuk dalam 10 besar penyakit keganasan di Indonesia. Pekerja radiasi medis terpapar radiasi di tempat kerjanya dan pekerja tersebut pasti mempunyai kompetensi profesional/sertifikat terkait pengetahuan paparan radiasi, sehingga paparan radiasi harus dikendalikan dan Serendah yang Dapat Dicapai (ALARA). Sejauh ini hanya sedikit yang diketahui tentang etiologi kanker tiroid; paparan radiasi pengion (terutama selama masa kanak-kanak) adalah salah satu dari sedikit faktor risiko karsinoma tiroid. Meskipun International Agency for Research on Cancer (IARC) telah menyatakan bahwa radiasi bersifat karsinogenik pada kanker tiroid, pengetahuan terkini mengenai radiasi dan kanker tiroid didasarkan pada penelitian terhadap paparan akut tunggal (penyintas bom atom). Namun, dampak paparan radiasi di tempat kerja yang berkepanjangan dan berdosis rendah terhadap petugas layanan kesehatan masih belum jelas. Tujuan dari makalah ini adalah untuk mengevaluasi hubungan antara petugas kesehatan yang terpapar dan tidak terpapar radiasi dengan risiko kanker tiroid. Metode. Pencarian literatur dilakukan melalui PubMed dan ProQuest dan juga dilengkapi dengan pencarian tangan. Kriteria inklusi adalah tinjauan sistematis, kohort dan kontrol kasus, melibatkan petugas kesehatan, artikel teks lengkap tersedia, dan dalam bahasa Inggris. Kriteria eksklusi adalah artikel yang tidak dapat diakses dan tidak relevan. Artikel-artikel yang dipilih dari pencarian online dinilai secara kritis untuk mengevaluasi apakah penelitian tersebut memenuhi aspek validitas, kepentingan dan penerapan pada pasien menggunakan kriteria yang relevan untuk studi etiologi oleh Oxford Centre for Evidence-based Medicine. Hasil. Terdapat tiga artikel terpilih yang sesuai kriteria inklusi dan eksklusi, semuanya merupakan penelitian kohort. Salah satunya dilakukan di Norwegia pada perawat Norwegia yang tidak menunjukkan hubungan yang jelas antara paparan radiasi pengion di tempat kerja dan risiko kanker tiroid. Penelitian lain dilakukan di Finlandia pada dokter yang bekerja dengan radiasi dibandingkan dengan dokter yang tidak terpapar radiasi. Rasio risiko kanker tiroid adalah 1,5 (0,4-6,3) untuk dokter yang dimonitor radiasi dibandingkan dengan dokter yang tidak dimonitor radiasi. Artikel terakhir dilakukan di Tiongkok pada pekerja rontgen diagnostik medis yang dibandingkan dengan spesialis medis lainnya. Tidak terdapat peningkatan risiko paparan radiasi terhadap kanker tiroid secara signifikan [Risiko Rasio 1,6 95% CI (0,9 - 2,6)]. Kesimpulan. Bukti saat ini menunjukkan bahwa, jika dibandingkan dengan kelompok yang tidak terpajan,pekerja medis dengan paparan radiasi di tempat kerja tidak mengalami peningkatan risiko kanker tiroid. Kesimpulan ini dibuat dari tiga studi kohort (bukti tingkat 2b).

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Introduction. WHO stated that cancer is one of the leading causes of death worldwide Radiation could cause leukaemia, breast cancer, and thyroid cancer. For more specific conditions, radiation during childhood increase the risk of thyroid cancer and increase in breast cancer risk has been observed after irradiation of pre-menopausal women. Based on cancer data from World Health Organization (WHO) in 2020, thyroid cancer included in the top 10 malignancies in Indonesia. Medical radiation workers exposed to radiation in workplace and these workers definitely have professional competences / certificates related to radiation exposure knowledge, so the radiation exposure should be controlled and As Low As Reasonably Achievable (ALARA). Little is known about thyroid cancer etiology so far; exposure to ionizing radiation (especially during childhood) is one of few well-established risk factors for thyroid carcinomas. Despite of International Agency for Research on Cancer (IARC) had stated that radiation as carcinogenic for thyroid cancer, the current knowledge of radiation and thyroid cancer are based on studies of single acute exposures (A-bomb survivors). However, the effects of protracted and low dose occupational radiation exposure in healthcare workers remains unclear. The purpose of this paper is to evaluate the associations between exposed and non-exposed radiation of healthcare workers and the risk of thyroid cancer. Method. Literature search was conducted through PubMed and ProQuest and also complemented with the hand searching. The inclusion criteria were systematic review, cohort and case control, involving healthcare workers, full text article available, and in English. The exclusion criteria were inaccessible and irrelevant articles. The selected articles from online search were critically appraised to evaluate whether the study meet the aspect of validity, importance and applicability to the patient using relevant criteria for etiological study by the Oxford Center for Evidence-based Medicine. Result. There were three selected articles that fit the inclusion and exclusion criteria, all of them are cohort studies. One was conducted in Norway among Norwegian nurses which showed no clear association between nurses’s occupational exposure to ionizing radiation and risk of cancers of thyroid. Another one was conducted in Finland among physicians working with radiation was compared to that of unexposed physicians. The risk ratio for thyroid cancer was 1.5 (0.4-6.3) for physicians monitored for radiation compared to physicians not monitored for radiation. Last article was conducted in China among medical diagnostic x-ray workers who are compared with other medical specialists. There was no significant increase of radiation exposure risk to thyroid cancer [Risk Ratio 1.6 95% CI (0.9 - 2.6)]. Conclusion. The current evidences show that, when compared with the unexposed group, medical workers with occupational radiation exposure was not in an increased risk of thyroid cancer. The conclusion was made from three cohort studies (evidence level 2b)."

"Paparan radiasi pengion dosis rendah (<0,5 Gy) dapat menyebabkan gangguan sirkulasi. Namun, belum diketahui apakah paparan radiasi pengion dosis rendah dapat menyebabkan hipertensi. Seorang petugas radiologi berjenis kelamin laki-laki yang berusia 27 tahun menanyakan tentang hasil pemeriksaan berkalanya dimana hasilnya menyatakan ia mengidap hipertensi. Dia juga menyebutkan bahwa pada tahun sebelumnya, hasil pemeriksaan EKG-nya tidak baik, tetapi dia tidak dapat mengingat apa yang dikatakan oleh dokter spesialis jantung. Apakah hipertensi pada pekerja radiologi disebabkan oleh paparan radiasi pengion di tempat kerja? Pencarian literatur dilakukan melalui PubMed, Scopus dan Cochrane. Didapatkan sebuah artikel yang relevan, yang memenuhi kriteria inklusi. Sebuah studi kohort oleh Preetha R, et al (2015) menunjukkan bahwa terdapat hubungan antara risiko hipertensi dan paparan FGIP. Penelitian ini valid dan dapat diterapkan pada pasien saya karena metodenya sesuai dan cukup baik. Selain itu, populasi dalam penelitian ini memiliki kemiripan dengan pasien saya. Namun, hanya ada satu artikel yang ditemukan. Hal ini mungkin dikarenakan kurangnya penelitian mengenai hal ini. Oleh karena itu, hubungan sebab akibat masih belum dapat dibuktikan. Dianjurkan untuk melakukan penelitian lebih lanjut dengan menggunakan pengukuran paparan dan hasil yang lebih baik.

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Exposure to low dose ionising radiation (<0.5 Gy) can cause circulation disorders. It is not yet known whether exposure to low dose ionising radiation can cause hypertension. A 27-year-old male radiologist asked about the result of his periodic examinations in which written hypertension. He also said that in the previous year, his ECG examination resulted in no good, but he couldn’t remember what the cardiologist said. Does hypertension in radiology workers due to exposure to ionising radiation at work? The literature searches were conducted through PubMed, Scopus and Cochrane. A relevant article, which fitted the inclusion criteria, was found. A cohort study by Preetha R, et al (2015) suggested that there is a relationship between the risk of hypertension and FGIP exposure. This study is valid and applicable to my patient because the method is quite good and suitable. Also, the population in the study is similar to my patient. However, there was only one article found which might be due to the lack of research on this subject. Hence, the causal relationship still cannot be proven. Further research is recommended with a better measurement of exposure and outcome."

"This book summarizes the advances achieved by these research groups after more than ten years of studies on radiation damage in biomolecular systems.An extensive Part I deals with recent experimental and theoretical findings on radiation induced damage at the molecular level. It includes many contributions on electron and positron collisions with biologically relevant molecules. X-ray and ion interactions are also covered. Part II addresses different approaches to radiation damage modelling. In Part III biomedical aspects of radiation effects are treated on different scales. After the physics-oriented focus of the previous parts, there is a gradual transition to biology and medicine with the increasing size of the object studied. Finally, Part IV is dedicated to current trends and novel techniques in radiation reserach and the applications hence arising. It includes new developments in radiotherapy and related cancer therapies, as well as technical optimizations of accelerators and totally new equipment designs, giving a glimpse of the near future of radiation-based medical treatments. "

"This book aimed to bring the reader up to date on contemporary issues associated with exposure to methylmercury, from its effects on stem cells and neurons to population studies."

"Skripsi ini membahas tentang implementasi PP No.33 tahun 2007 tentang keselamatan radiasi pengion di instalasi radiologi Pusat Jantung Nasional Harapan Kita tahun 2013. Penelitian ini menggunakan metode kualitatif Cross Sectional, dengan melakukan wawancara mendalam dengan purposing informan yang mengacu pada prinsip kesesuaian dan kecukupan guna mendapatkan hasil yang akurat. Tujuan penelitian ini adalah untuk mengetahui bagaimana pengimplementasian PP No.33 tahun 2007 tentang keselamatan radiasi pengion. Manfaat penelitian ini bagi rumah sakit yang dijadikan tempat penelitian adalah sebagai bahan evaluasi atas implementasi keselamatan radiasi pengion yang telah dilakukan dan masukan atas hal- hal yang belum dilaksanakan dari hasil penelitian menunjukan bahwa pengimplementasian PP No.33 tahun 2007 tentang Keselamatan Radiasi Pengion di Instalasi Radiologi Pusat Jantung Nasional Harapan Kita sudah baik namun memiliki beberapa kekurangan dalam pelaksanaannya. Diantaranya: Pada Persyaratan Manajemen, Tenaga ahli dengan pendidikan yang sesuai belum ada (S2 fisika medis), pelaksanaan tugas masing- masing anggota PPR belum maksimal. Hal ini dikarenakan adanya tumpang tindih peran, dimana Tenaga ahli juga merupakan anggota PPR dan Radiografer. Dan jenis pemeriksaan kesehatan khusus dan pemeriksaan rutin selama bekerja belum maksimal. Pada Persyaratan Proteksi Radiasi belum diketahuinya tentang pembatasan dosis, belum adanya pembagian daerah kerja secara tertulis,dan belum adanya pengadaan alat ukur dosis personal bagi pasien dan pendamping pasien. Pada verifikasi keselamatan belum dilaksanakannya pengukuran paparan radiasi pada alat yang mengalami perbaikan dan pengukuran paparan radiasi secara rutin.

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This research discusses the implementation of Goverment Regulation Number 33 of 2007 on Ionizing Radiation Safety at Radiology Department National Cardiovascular Centre Harapan Kita in 2013. This study used a cross sectional qualitative methods, by conducting in-depth interviews with informants purposing which refers to the principle of suitability and adequacy in order to obtain accurate results. The purpose of this study is to investigate the implementation of Government Regulation Number 33 of 2007 on ionizing radiation safety. The benefits of this research for the hospital where the study was used as an evaluation of the implementation of the safety of ionizing radiation that has been done and input on matters that have not been implemented. From the results of the study showed that the implementation of Government Regulation Number 33 of 2007 on Ionizing Radiation Safety at Radiology Department National Cardiovascular Center Harapan Kita has been good but has some shortcomings in implementation. Among them: In the Requirements Management, experts with appropriate education unmet (medical physics S2), the implementation of tasks of each member of the PPR is not maximized. This is due to the overlap of roles, where the expert is also a member of the PPR and Radiografer. And a kind of special medical examination and routine check has not been carreid out. On Radiation Protection requirements not already know about the dose limitation, the lack of regional division of labor in writing, and the lack of provision of personal dose measurement tool for patients and patient attendants. And yet the implementation of measurement of radiation exposure to the tools and the improved measurement of radiation exposure on a regular basis."