Radiation Safety Human Use (Nursing)

Radiation Safety
General Nursing Orientation
Max Amurao, PhD, MBA
Director of Radiation Safety for Clinical Programs
601 W 168th Street – Apt. 53
telephone: 212.305.0307
[email protected]
Radiation, Lasers and Magnets at Orientation?
Radiation, Lasers and Magnets are essential in modern patient care
• Diagnosis of disease and injury
– X-rays, Nuclear Medicine, CT
– MRI, Ultrasound, Lasers
• Treatment
– Lasers in Surgery
– Nuclear Medicine (unsealed sources)
– Radiation Oncology (external beams, sealed sources)
Where Radiation, Lasers and strong Magnets are used
Recognize the Caution Signs
Who to Contact
Radiation use in the hospital
• Radiology / IR
• Emergency (ER)
• Surgery (OR)
• Critical Care (ICU’s)
• Cardiology
• Patient Rooms
• Nuclear Medicine
• GI Labs
• Radiation Oncology
• Speech Pathology
Laser use in the hospital
Magnet use in the hospital
MRI Magnet Safety – Main Concerns
Projectiles
Damage
Tissue Heating
Contrast Reactions
Laser Safety
Primary Concerns
Laser Warning Signs
Class 2, 2M and 3R lasers
Class 3B and 4 lasers
Outline
• Common Sources of Radiation Exposure
• Potential Hazards Associated with Radiation
• Personnel Dosimetry
• ALARA and Radiation Safety Basics
• New York City and Various State Regulations
• Radiation Protection Guidelines
• Obligations of CUMC and NYP Employees
• Question and Answers
Radiation Safety
Radiation Safety
Common Sources of
Radiation Exposure
• Everybody on the planet is exposed to radiation.
• Radiation occurs naturally in the atmosphere, in building
materials, even in our own bodies.
• Individuals are also exposed to man-made sources of radiation.
• Naturally occurring background (baseline) radiation levels in
the United States averages approximately 3 mSv per year.
• The baseline radiation is not included in dosimeter reports.
• Exposure versus Contamination
- Radioactive Materials – Contamination & Exposure
- X-ray Devices – Exposure. A person receiving an x-ray is
exposed to radiation but is not contaminated.
Potential Radiation Hazards
• Most of the energy deposited by radiation is manifested as
heat and does not result in chemical changes.
• Radiation-induced injury begins with chemical changes at
the atomic and molecular level.
• Radiation changes induced in molecules, cells, tissues and
organs are not unique.
• Radiation-induced changes apparent after a latency period.
• Human cells have the ability to repair damage caused by low
doses of radiation.
Potential Radiation Hazards
Factors affecting the biologic response to radiation
•
•
•
•
dose and dose rate
type of radiation – particulate vs. electromagnetic
energy of radiation
type of cell/tissue – actively dividing → more radiosensitive
Radiation Effects
Stochastic
• ↑Exposure → ↑Probability
• Includes cancer formation and
genetic effects.
• Principal risk from low dose
exposures.
Deterministic
• ↑Exposure → ↑Severity
• Includes radiation skin burns, hair
loss, sterility, cataract formation.
• Unlikely for medical occupational
exposure levels.
Caution Radiation Signs
Any Clinician, Employee or Student who works in an area
posted with these signs must receive specialized training.
Personnel Dosimetry
EXTERNAL RADIATION
EXPOSURE MONITORING
Optically Stimulated
Luminescent Detector
ThermoLuminescent
Detector
ref: http://www.landauerinc.com/
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Personnel Dosimetry
If you are issued a single body
dosimeter, you can wear it either
attached at the collar/chest level
or at the waist.
CUMC and NYP issues
personal radiation dosimeters
to any individual likely to
receive at least 10% of the
annual occupational radiation
dose limit (5 mSv).
Personnel Dosimetry
Workers wearing
protective lead aprons
and issued a single
dosimeter (HN ) must
wear the dosimeter at
the collar outside the Pb
apron
HE = 0.3 x HN
Personnel Dosimetry
HNeck dosimeter worn at
collar outside Pb apron
HWaist dosimeter worn
at waist under Pb apron
For Workers wearing protective
lead aprons and issued two
dosimeters
HE = (1.5 x HWaist + 0.04 x Hneck)
Personnel Dosimetry
EXTERNAL RADIATION EXPOSURE MONITORING
Whole Body Badges
• An individual monitoring device used for monitoring the dose
to the whole body shall be worn at the unshielded location of
the whole body likely to receive the highest exposure. When a
protective apron is worn, the location of the individual
monitoring device is typically at the neck (collar).
Extremity Badges
• Wear underneath gloves to prevent contamination of the
dosimeter.
Personnel Dosimetry
Dosimeters must
• not be removed from the CUMC and NYP campus.
• only be worn by the individual whose name appears on it.
• be returned promptly once the new dosimeter is received.
- Do not return the dosimeter holder.
- The new dosimeter snaps into the same holder.
Pregnant Workers
• The embryo and fetus have a heightened sensitivity to radiation.
• CUMC and NYP provide a voluntary program for workers who are pregnant.
The program provides for enhanced monitoring of the unborn child.
• All individuals interested in the program must set up a confidential
consultation with the Radiation Safety Officer (305-0303) .
Pregnant Radiation Workers
• Pregnant workers are allowed to work around
radiation.
• Pregnant radiation workers have the right to
declare their pregnancy, and thereby work
under lower radiation dose limits.
• A Pregnancy Declaration must be made in
writing to the Radiation Safety Officer. Just
telling your supervisor is not adequate.
• Note: even if an employee is visibly pregnant,
lower dose limits will not apply until the
employee has voluntarily initiated this policy.
• Pregnancy Declarations are confidential.
Federal Regulations
Personnel Category
Annual Dose Limit
Occupational Exposure
5,000 mrem / whole body
15,000 mrem / lens of eye
50,000 mrem / skin
50,000 mrem / extremity
Declared Pregnant Worker
500 mrem / entire pregnancy
50 mrem / any month of pregnancy
Workers < 18 years of age
500 mrem
Members of the General
Public
100 mrem
Personnel Dosimetry
ALARA I
• At CUMC/NYPH, the quarterly ALARA I alert level
• 125 mrem for the whole body deep dose equivalent,
• 375 mrem for the lens dose equivalent,
• 1250 mrem for the shallow dose equivalent.
ALARA II
• At CUMC/NYPH, the quarterly ALARA I alert level
• 375 mrem for the whole body deep dose equivalent,
• 1125 mrem for the lens dose equivalent,
• 3750 mrem for the shallow dose equivalent.
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Whole-Body Radiation Dose Limits
Radiation Workers
• Members of Public
•
5,000 mrem/year
100 mrem/year
The ALARA Philosophy
Keep excess exposure (above background radiation)
As Low As Reasonably Achievable
Principles of Radiation Protection
• Time
• Shielding
EXTERNAL
RADIATION
INTERNAL
RADIATION
• Distance
• Control Contamination
Time
Distance
Shielding
Control
Contamination
The ALARA Philosophy
EXTERNAL RADIATION – TIME
• Less time spent in a radiation area reduces exposure.
• Work with RAM in a quick but systematic manner as
rushing increases the likelihood of a spill.
(Radiation) Dose = Dose Rate × Time
Allowed Dose
Stay Time =
Dose Rate
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The ALARA Philosophy
EXTERNAL RADIATION – DISTANCE
• The amount of radiation an individual receives will also
depend on how close the body and/or hands are to the
radioactive source.
• Inverse Square Law.
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The ALARA Philosophy
EXTERNAL RADIATION – SHIELDING
• Shielding material placed between the
radiation source and the person will
reduce radiation exposure.
• Wear a lead apron during fluoroscopy.
Hang/Store PPE properly (tested annually)
• Use protective goggles & thyroid shields.
• Stand behind radiation shields.
• Report equipment malfunctions and
image quality problems.
The ALARA Philosophy
SHIELDING
• Lead aprons reduce x-ray
radiation exposure to 5% of
incident strength.
• Hanging lead aprons on
hangers/hooks prevents the
lead from cracking.
• Lead aprons are annually
inspected for cracks / holes.
The ALARA Philosophy
EXTERNAL RADIATION – SHIELDING
• Shielding material placed between the radiation
source and the personnel will reduce the radiation
intensity (hence the exposure) via attenuation.
• Attenuation: process by which a beam of radiation is
reduced in intensity by absorption or scatter in the
medium.
The ALARA Philosophy
EXTERNAL RADIATION – CONTAMINATION
Use butterfly to establish entry into vein.
The ALARA Philosophy
EXTERNAL RADIATION – CONTAMINATION
The following activities are prohibited in
areas where the radioactive material sign
is posted.
No Eating
No Drinking
No Smoking
No Cosmetics
The ALARA Philosophy
EXTERNAL RADIATION – CONTAMINATION
• Daily Ambient Survey of
RAM Use Areas with a
survey meter.
• Ambient Surveys must be
documented.
• Weekly Surveys for Removable
Contamination (Wipe Tests) of RAM Use
Areas for monitoring.
• Removable Surveys must be
documented.
Access and Security
• Radioactive materials are stored in rooms with
a “Caution Radioactive Materials” sign. These
rooms must remain locked.
• Remember to close and/or lock the door
behind you when leaving these areas.
• Limiting access to radiation sources means less
exposure to others.
Spills and Incidents
• Report the following to the Radiation Safety Officer ASAP
– Abandoned containers or boxes with Radioactive Materials
– Unsafe or unusual working conditions involving radiation
– Major Spills involving Radioactive Materials
• Cordon off the area. Contact Radiation Safety.
Emergency Procedures
Spill / Decontamination Kit
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•
•
•
•
•
•
•
•
•
•
•
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Disposable gloves and housekeeping gloves
Disposable lab coats, head coverings and shoe covers
Roll of absorbent paper with plastic backing
Masking tape
Plastic trash bags with twist ties
“Radioactive Material” labeling tape
Marking pen
Pre-strung “Radioactive Material” labeling tags
Contamination wipes
Instructions for “Emergency Procedures
Clipboard with copy of Radioactive Spill Report Form
Pencil
Appropriate survey instruments, including batteries
Radiation Protection
Radiation Protection Best Practices
• Know when the x-ray beam is on.
• The main source of radiation is the x-ray tube.
• The second largest source of x-rays is scatter
from the patient .
• Stand on the same side of the image receptor (II)
whenever possible during fluoroscopy.
• Use a lead drape during fluoroscopy.
• Use mobile lead shields when available.
• Use 30 cm SSD spacer cone for C-arms.
Radiation Protection Best Practices
• Scatter is responsible for most occupational exposure.
• Scatter radiation does not linger in the room. It is only present
when the x-ray beam is on. (i.e. foot pedal or hand switch.)
• The patient is the main source of scatter.
• Radiography exposure time < 1 second.
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Radiation Protection Best Practices
Fluoroscopy beam-on times usually < 5 minutes.
Fluoroscopic systems have an audible alarm.
Beam will NOT cut off at 5 minutes.
Only physicians or licensed x-ray technologists may
- turn the beam on.
- silence the 5 min audible alarm.
• Scatter radiation intensity is lower on the image
receptor side compared to the x-ray tube side.
• For lateral and oblique projections – position the
x-ray tube on the opposite side of the patient from
where you are standing.
•
•
•
•
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Radiation Protection Best Practices
Stand on side of patient closest
to the image receptor.
Try to stand further away
from the x-ray tube.
image receptor
Position the x-ray tube under the
patient to decrease the amount of
scatter radiation that reaches you.
Radiation Protection Best Practices
Collimating tightly to the area of interest:
Positioning the image receptor as close as
possible to the patient.
 Decreases patient and operator dose.
 Improves image quality.
 Reduces the patient’s total entrance
skin exposure.
 Improves image contrast.
 Reduces scatter radiation.
New York City Regulations
• The safe use of radiation is governed by Article 175 of the Rules
of the City of New York.
• CUMC and NYPH use radiation under licenses and permits
issued by the New York City Department of Health.
• Applicable regulations, radioactive materials licenses, x-ray
registrations, conditions, information notices, bulletins,
instrument calibration, relevant records, etc. are available for
review by any CUMC and NYP employee by contacting Radiation
Safety at 305-0303 or by e-mailing [email protected]
State Specific Regulations
http://www.crcpd.org/Map/RCPs_more.aspx
Obligations of CUMC / NYP
Clinicians, Employees, and Students
• Each employee and student has an obligation to report
unsafe radiation-use conditions to the Radiation Safety
Office.
• Each employee and student has the right to be
informed of occupational radiation safety exposure
and bioassay results.
• Each employee has an obligation to return personal
radiation dosimeters to the Radiation Safety Office in a
timely manner.
Radiation Safety – Clinical Programs
MAIN POINTS
T-D-S-CC
Signs
Regulations
Contacts
Geño Silvestrini, CNMT
Daniela Nicoletti, MA
Kostas Georgiou, MS
Kassia Kelly, MS, MS
Director – Max Amurao, PhD, MBA
(cell - 917 576 4795 || office - 212 305 0303)
Thank You