Radiation Safety Training

What is Radiation?Radiation is energy in the form of particles or electromagnetic waves.

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What is Ionizing Radiation?Ionizing radiation is defined as radiation consisting of particles, X-rays, or gamma rays with sufficient energy to cause ionization in the medium through which it passes.

RadioactivityThe process by which unstable atoms spontaneously transform to new atoms* and in the process emit radiation.

*The new atom may be the same atom in a lower energy state.

Naturally Occurring Radiation in your BodyNuclide Activity . Uranium 30 pCi (1.1 Bq) Thorium 3 pCi (0.11 Bq) Potassium 40 120 nCi (4.4 kBq) Radium 30 pCi (1.1 Bq) Carbon 14 0.4 Ci (15 kBq) Tritium 0.6 nCi (23 Bq) Polonium 1 nCi (37 Bq)

Radiation DefinitionsExposure R (roentgen): Amount of charge produced per unit mass of air from x-rays and gamma rays. Absorbed Dose rad: Amount of Energy deposited per unit mass of material. 1Gy = 100 rad. Dose Equivalent rem: Risk adjusted absorbed dose. The absorbed dose is weighted by the radiation type and tissue susceptibility to biological damage. 1 Sv = 100 rem.Radiation weighting factors: alpha(20), beta(1), n(10).Tissue weighting factors: lung(0.12), thyroid(0.03), and gonads(0.25).

* Helium Nucleus Very massive and doubly ionized* Only a hazard via ingestion or inhalation of alpha emitter* Not usually an external radiation hazard* Stopped by paper and dead layer of skin* Uranium, Thorium, Radon and radon daughters

Alpha Decay

Energetic electron singly ionizedExternal hazard to skin and eyesInternal hazard via ingestion or inhalation of beta emitterProduces bremsstrahlung radiationA 1 MeV beta can travel up to 12 feet in air and 1 cm in plasticPhosphorus, Tritium, Carbon, Sulfur

BETA DECAY

Gamma Decay

* X-rays and gamma rays are photons no charge* External radiation hazard to deep organs and tissues* Internal hazard via ingestion or inhalation of gamma emitter* Lead (high electron density) is good for shielding x and gamma rays* Iodine 125 gammas (30 keV) can be easily stopped with 1/8 inch of lead

Bremsstrahlung x-ray intensity increases with increasing atomic number of absorber, and the average x-ray energy increases with increasing electron energy. (activity of the source is also a factor)

x-raye-

Interactions with Matter

* Photoelectric Effect* Compton Effect * Pair Production

Photoelectric Effect All photon energy is given upPart of the energy is used in removing the electron from the atomThe rest of the energy is carried off as the kinetic energy of the electron Important when the energy of the photon is low (less than 200 keV) More likely to occur in materials with a high atomic number ZLead has a Z of 82 and copper has a 29

Compton Effect an increase in wavelength of X-rays or gamma rays that occurs when they are scattered.The change in wavelength of the scattered radiation does not depend upon the energy of the incident photon.The Compton Effect is important for gamma-ray energies between 200 keV and 5 MeV in most light elements. The Compton Effect decreases with increasing gamma energy but not as quickly as the photoelectric effect. Compton scattering is predominant in substances of intermediate Z.

Pair Production The process in which a photon of sufficient energy gives up all its energy and forms two particles, an electron and positron, is called a pair productionOccurs near the nucleus of an atomEnergy is beyond MeV Both positron and electron lose kinetic energy through ionization of atoms in the substance Positron eventually interacts with an electron in the substance in a process called annihilation.

The Three Processes Photoelectric and Compton Effect decrease with an increase of gamma energy.Pair Production increases with gamma energy.In radiation safety, we are concerned with the absorption of radiation by matter so that we can protect people from these rays. The three processes produce electrons, which then ionize the absorbing matter.

Half Value Layer

Common Units RadioactivityExposureAbsorbed DoseDose Equivalent

Radioactivity Rate of Decay / Potential to Decay StrengthCurie (Ci) - 1 gram of radium disintegrates 3.7 X 1010 disintegration/second (dps)Becquerel (Bq) = 1 disintegration/second (dps)1 mCi = 37 MBq

Exposure Radioactivity is measured in Roentgens (R) Charge produced in air from ionization by gamma and x-rays ONLY for photons in airRather infrequently used unitA measure of what is emitted

Absorbed Dose Energy deposited by any form of ionizing radiation in a unit mass of materialRoentgen Absorbed Dose (rad)Gray (Gy)1 Gy = 100 rad

Dose EquivalentScale for equating relative hazards of various types of ionization in terms of equivalent riskDamage in tissue measured in rem(Roentgen Equivalent Man) Q:risk of biological injury rem = Q * radSievert (Sv)1 Sv = 100 rem

What do we really need to know about dose and why?1 R 1 rad = 1 remFor gammas & betas*1 rad 1 remFor alphas, neutrons & protons1 rem = 1 rad * Q Dosage and dosimetry are measured and reported in rems. All the Federal and State regulations are written in rems.The regulators must be placated with reports in rems.

Whole Body Effects of Radiation Acute or NonstochasticOccur when the radiation dose is large enough to cause extensive biological damage to cells so that large numbers of cells die off.Evident hours to a few months after exposure (Early).Late or Stochastic (Delayed)Exhibit themselves over years after acute exposure.GeneticSomaticTeratogenic

Biological Effects of Radiation Radiation passing through living cells will ionize or excite atoms and molecules in the cell structure. These changes affect the forces which bind the atoms together into molecules. If the molecule breaks up, some of the parts will be charged. These fragments are called radicals and ions and are not chemically stable. Further effects are produced when the radicals and ions interact with other cell material. In this way, damage is caused in a direct and indirect manner. These changes are called mutations and can then affect either the daughter call or future cells.

Most and Least Sensitive Cells to Radiation

Effects to the UnbornEffects on the embryo depend upon the dose as well as the age of the fetus. The younger the fetus, the more it will be affected. The unborn human is the most radiosensitive since its organs are rapidly developing and very susceptible to damage.

So how do we protect ourselves and our patients from unnecessary radiation exposure??

ALARA

As Low As Reasonably Achievable

TimeLess time = Less radiation exposureShorten exposure times whenever possible However, increasing exposure in order to decrease time is not the answer. Sometimes more time is necessary to obtain an optimal image.

DistanceEffective & EasyInverse Square LawDoubling distance from source, decreases dose by factor of four Tripling it decreases dose nine-fold More Distance = Less Radiation Exposure

ShieldingMaterials absorb radiationProper shielding = Less Radiation Exposure

MEDcare Sheilding It is the policy of MEDcare to shield all patients whenever possible. This means that we should shield for every exam as long as the quality of the exam is not compromised by the shielding. Lead shields of different sizes and shapes are located in each clinic for this purpose.

Other Indications of Radiation Wall Signs

Performance Evaluations are performed annually on both x-ray and CT machines to ensure that they are functioning properly

We work with medical physicists to ensure that our CT protocols are in accordance with ACR regulations and standards. They also work with us to create pediatric protocols based on weight to keep the child dose as low as reasonably achievable. These protocols are located in the Pediatric tab on the CT monitor. We follow the standards put forth through both Image Wisely and Image Gently

Personnel Monitoring Devices

At MEDcare, we use Mirion Technlogies Thermoluscent film badges. The TLDs respond accurately to beta, gamma, X-ray and neutron radiation. The response of each element is corrected by the application of its own unique element correction factor. These TLDs allow for the reporting of deep, lens of eye and shallow doses. They are changed out and reported on every 3 months. They are worn at the collar level and should be left at the center each day. These reports are available for all radiation staff in the Radiology QA binder located in the radiology department. Fetal badges are available once a radiation worker declares themselves as pregnant to the Radiation Safety Officer. These are worn at the waist level. See Policy for Pregnant Radiation Workers.

Annual Occupational Dose Limits *Declared Pregnant Women

Pregnant PatientsIt is the policy of MEDcare to perform a urine pregnancy test for each female patient within child bearing age that will receive an X-ray or CT exam. This test should be performed and resulted prior to the study being performed. If a patient is pregnant and the benefits of a radiation exam outweigh the risks, the physician can instruct the technologist to proceed with the exam. However, the patient should be shielded over the abdominal and reproductive areas whenever possible. The patient should also sign the pregnancy waiver indicating that they are aware of the potential risks and choose to proceed with the exam. This should be scanned into their chart. See policy on Radiation Protection of Pregnant and Nursing patients.

Pregnant PatientsEach patient has the right to decline a pregnancy test. If a patient declines the test, this should be documented in the EMR. You should ask the patient (whether they have a pregnancy test or not) if there is any chance of pregnancy. The response of this question and the patients last menstrual cycle should be documented in the EMR as well. The patient should be shielded appropriately for the exam.

Nursing MothersAlthough there is no indication that IV contrast is harmful to a nursing child through the mothers breast milk, it is the policy of MEDcare to instruct the mother to pump and dump for 48 hours after an IV contrast administration before nursing their child again. See radiology policy for Nursing Mothers.

Patient HoldingRadiologic Technologists are prohibited from holding patients during radiographic examinations. If a patient requires holding, a family member or guardian of the patient is the first choice to do so. This person, as well as the patient, must be shielded. You must also document in the EMR the person that held the patient. If a family member is not available to help hold, a MEDcare employee who does not work in radiation can help hold the patient. This employee holding should be documented in the EMR as well as documentation of the shielding that took place. See radiology policy on Patient Holding.

IV Contrast AdministrationPhysician must be on site when a tech administers IV contrast.Patient must be asked about any allergies to contrast in the past.Creatinine level must be obtained for all patients over the age of 50, all diabetics and any patient with known renal disease prior to administration of IV Contrast. Creatinine levels of 1.4 or above must be discussed with the ordering physician before moving forward with the Contrast Administration.All Diabetics should be instructed to refrain from their oral medications for 48 hours after an IV contrast administration. (Only Oral Meds, Not Insulin Injections) If a patient on dialysis receives IV contrast, they should be instructed to receive their dialysis treatment within 48 hours after administration of IV contrast.

Pediatric Patients For anyone 16 and under, C-Spine and L-Spine radiographic exams should be 3 views instead of 5 views. Lead shielding will be utilized whenever possible.Decreased dose by decreasing technical factors on both CT and Radiologic Exams. CT Protocols based on weight of the child to ensure smallest dose administered. (See pediatric tab on CT machine) Limit multi-phase contrasted CT scans. Radiographic imaging of long bones can be obtained.

Other Facts to Consider We are exposed to radiation each day in the form of background radiation. This can come from our environment, within our body, foods we eat and products we buy.

Just RememberMedical imaging has revolutionized healthcare over the past 30 years. It helps detect and diagnose disease at its earliest stages when most treatable. Imaging reduces the need for invasive procedures by catching these diseases early, therefore saving the patient money. Due to radiologic advancements, exploratory surgery is almost obsolete. Medical imaging is an extraordinary tool and when used appropriately and safely, has endless benefits.

Just RememberRadiation is not something to be feared, but should be respected. We are exposed on a daily basis to all types of radiation. Those exposures serve no purpose. Medical imaging has a great purpose in the world of medicine. If someone is apprehensive about an exam, you should be comfortable explaining the risks but also the benefits of the exam. At MEDcare, our exams are very low risk with high diagnostic benefits. As long as the proper history is obtained and the proper pre-exam testing performed, all patients are safe.This is why it is so important to know and understand the radiology polices in place.

Policies and Procedures Please be sure to read your radiology policies and procedures. These are found in the X-Ray QA binders located in each radiology department as well as the clinic Policy and Procedure binder under the Radiology tab. These polices are also located at the end of this training module for you to print if you wish. If you have any questions or concerns in regards to radiation safety or policies and procedures, please contact your Radiation Safety Officer, Crystal Wise 843-708-1606

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