10/21/2013. Pakistan A quick primer. Pakistan. Pakistan. Pakistan

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1 A quick primer A country of varied landscapes, high mountains, lush plains, beautiful coastline, rich history Million: 6th largest Nation of the World 3 Karachi: 20 Million people 4 Objectives Improve the personnel radiation monitoring system Improve radiation safety At Aga Khan University Hospital (AKUH), Karachi, 9th in the world for English as the official language 7th largest pool of scientists and Engineers in the World Moin Ali Nawazish making a World Record with 22 A s in A level Exams 5 Talk : A7c-2223, Monday, , ISQua s 30th International Conference-Edinburgh 2013, Harris Room 6 1

2 Safety The potential of the ionizing radiation being carcinogenetic which expresses itself as a late somatic effect signifies the need of radiation monitoring Regulatory: Nuclear Regulatory Authority Regulation Exposure levels are well defined Occupational Exposure 20 msv per year - PAK-904 Radiation monitoring ensure that the safe practices are followed and protection is in place and intact Radiation Worker anyone working in the Control Area An environment which has potential to deliver more than 6 msv exposure per year PAK 904 Responsibilities Wear Personal Radiation Monitor Health Surveillance Protect Themselves Fellow workers Patients Others Department Number Bio-Medical Eng. 9 Cath Lab 45 Lithotripsy 4 Medicine 39 Nuclear Cardiology 4 Operating Rooms 35 Radiation Oncology 50 Radiology & Nuclear Medicine 166 RIA (Clinical Lab) 6 Total 358 Talk : A7c-2223, Monday, , ISQua s 30th International Conference-Edinburgh 2013, Harris Room 7 Talk : A7c-2223, Monday, , ISQua s 30th International Conference-Edinburgh 2013, Harris Room 8 Aga Khan University Hospital Karachi (AKUH) is complying with the regulations of Nuclear Regulatory Authority (PNRA) The personnel radiation monitoring is done through inhouse OSL facility Film Badges PINSTECH, PAEC, Islamabad Thermo- Luminescent Devices (TLD) KIRAN, PAEC, Karachi, 2012 to date Optically Stimulated Luminescence (OSL) In-house at Aga Khan University Hospital, Karachi, Talk : A7c-2223, Monday, , ISQua s 30th International Conference-Edinburgh 2013, Harris Room 9 Talk : A7c-2223, Monday, , ISQua s 30th International Conference-Edinburgh 2013, Harris Room 10 FACTS Radiation Monitoring is in place and meet the regulatory requirements Thermo-Luminescent Devices -TLD badges- are used Crystals are read by authorized service from PNRA Defined frequency of 3 months for collecting the badges not followed due to external constraints. No radiation worker had exposure of more than the maximum permissible dose (20 msv per year) to date. Issues Accuracy and timelines Limited service The TLD service providers switched to a new system. The change required a major investment as one extra badge was needed for each of the 400 radiation workers totaling to around $40,000 Low cost of the service. Service available locally and easily Advantages accessible In-house System Talk : A7c-2223, Monday, , ISQua s 30th International Conference-Edinburgh 2013, Harris Room 11 Talk : A7c-2223, Monday, , ISQua s 30th International Conference-Edinburgh 2013, Harris Room 12 2

3 Justification No alternate facility available locally High amount needed to be spent to continue with the existing facility with compromises The institutional leadership realized the need Advantages Overcome the delays Accountability Reliability, Consistency & Accuracy Market Leader Another option for the radiation users countrywide Wider scope OSL system was identified as it s the emerging technology replacing TLD world wide. OSL system acquired by the end of the year 2011 Talk : A7c-2223, Monday, , ISQua s 30th International Conference-Edinburgh 2013, Harris Room 13 Talk : A7c-2223, Monday, , ISQua s 30th International Conference-Edinburgh 2013, Harris Room 14 Optically stimulated luminescence, OSL Advantages Most recent technology High accuracy High levels of sensitivity and a wide range Research opportunities Easy handling The leadership realized the importance of the recommendation for OSL Provided the resources to acquire the system Human Resource development Services started in the 1 st quarter, 2012 Talk : A7c-2223, Monday, , ISQua s 30th International Conference-Edinburgh 2013, Harris Room 15 Talk : A7c-2223, Monday, , ISQua s 30th International Conference-Edinburgh 2013, Harris Room 16 The system was installed and calibrated. The calibration was verified by the manufacturer. Collection of TLD for submission to the facility for reading Reminders to those who have not submitted the badges Prepare list of collected badges The collected crystals delivered to the reading facility Permission to establish in-house radiation dosimetry facility was also taken from PNRA. For personnel radiation dosimetry, OSL badges were distributed to radiation workers hospital wide. Evaluation of the Results provided by the reading facility Date of providing the KIRAN provides the annealed crystals for issuing to the workers The reading facility is contacted and PNRA is informed about the issue YES Error in NO Results distributed Talk : A7c-2223, Monday, , ISQua s 30th International Conference-Edinburgh 2013, Harris Room 17 Talk : A7c-2223, Monday, , ISQua s 30th International Conference-Edinburgh 2013, Harris Room 18 3

4 Collection of OSL for reading on pre-defined date Reminders to those who have not submitted the badges within due date Prepare list of collected badges The collected badges are read in-house A special set of detectors, Nanodots, was used for the radiation dosimetry for Total Body Irradiation in patients in Radiation Oncology department. Next badge collection and reading date set and communicated in advance to all users Results distributed Talk : A7c-2223, Monday, , ISQua s 30th International Conference-Edinburgh 2013, Harris Room 19 Talk : A7c-2223, Monday, , ISQua s 30th International Conference-Edinburgh 2013, Harris Room 20 Personnel Dosimetry The OSL badges were received in a timely manner from all over the hospital as per fixed schedule. The system s reproducibility and linearity was also checked and found within acceptable range of 5%. Increased confidence on the reliability of Radiation exposure of all the workers. Patient Dosimetry The Nanodots also showed the beam distribution and verified the dose distribution during Total Body Irradiation procedure. Nanodot S/N Counts after annealing Counts after exposure Real counts Normalized to average value DN C DN DN R DN P DN DN M DN U DN E DN DN Y DN Talk : A7c-2223, Monday, , ISQua s 30th International Conference-Edinburgh 2013, Harris Room 21 Talk : A7c-2223, Monday, , ISQua s 30th International Conference-Edinburgh 2013, Harris Room Talk : A7c-2223, Monday, , ISQua s 30th International Conference-Edinburgh 2013, Harris Room 23 Talk : A7c-2223, Monday, , ISQua s 30th International Conference-Edinburgh 2013, Harris Room 24 4

5 The in-house dosimetry system: has empowered AKUH with timely, consistent, accurate & accountable personnel radiation monitoring facility significant Quality Improvement in radiation monitoring improved radiation safety is a resource to perform radiation dosimetry for patients undergoing diagnostic radiology, radiation oncology and nuclear medicine procedures Talk : A7c-2223, Monday, , ISQua s 30th International Conference-Edinburgh 2013, Harris Room 25 Talk : A7c-2223, Monday, , ISQua s 30th International Conference-Edinburgh 2013, Harris Room 26 Timely Personnel Radiation Monitoring leading to improved radiation safety Accurate and reliable Significant reduction in process timings Research opportunities Talk : A7c-2223, Monday, , ISQua s 30th International Conference-Edinburgh 2013, Harris Room 27 5