Radiation Safety - Things You Need to Know

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1 Radiation Safety - Things You Need to Know Michael Casey Ph.D. Phlebotomy Autumn Seminar 13 th October 2012

2 Radiation is a form of energy transport What is Radiation? It is caused by electrical disturbances It behaves like a wave system It can have a wide range of frequencies.

3 Categories of Radiation. There are two broad categories of radiation - Ionising and Non-ionising. Examples of Non-Ionising radiation are Radiowaves, Microwaves, Infra-red, Visible light. Non-Ionising radiation can cause heating when it is absorbed by matter. Examples of Ionising radiation are X-rays and Gamma rays. Ionising radiation can liberate electrons in matter when they are absorbed. The liberated electrons can then cause damage to the absorbing matter.

4 Ionising Radiation Interaction in Cells

5 Units of Radiation Measurement The detrimental effects of radiation are related to the amount of energy deposited in the tissue The amount of energy per unit mass of tissue determines the likely damage. The units of radiation dose are MICROSIEVERTS or MILLISIEVERTS A chest X-ray gives a dose of 20 microsieverts..

6 Natural Background Radiation Everyone is exposed to background radiation. In addition to external sources of radiation we have naturally occurring radioactive substances ( e.g. Potassium 40) in our bodies. Background radiation levels vary depending on location.

7 Average population radiation dose The average dose from natural radiation in Ireland is 3500 microsieverts.

8 Cosmic radiation variation with altitude Background radiation levels vary depending on location. Average background radiation levels in Ireland are approximately 10 microsieverts per day. Airline flight adds to the background radiation dose. ( Dublin Paris = 5 microsieverts)

9 Zero tolerance not an option. ICRP 60 Many billion ion pairs are created in the total mass of DNA in a human being each year by exposure to natural sources of ionising radiation. Clearly the process of passing from creation of an ion pair in the DNA to detrimental effect is very rarely completed. There is some evidence that radiation can act to stimulate a variety of cellular functions, including proliferation and repair

10 Radiation Effects. Radiation dose is related to the amount of energy the radiation deposits in tissue. There are two categories of effect in tissue. Deterministic effects skin burns, cataracts, sterility etc occur above a dose threshold and the severity increases with dose. Stochastic effects cancer, genetic effects, etc have no dose threshold and the probability of occurrence increases with dose. Both effects have a latency period that is dependent on the type of effect. Both effects are related to cumulative dose.

11 Radiation Effects Different organ systems have different sensitivities to radiation damage. Breast and bone marrow are more sensitive than skin and bone surface. The fetus is more sensitive to radiation damage than the adult. There is some evidence that this sensitivity is related to gestational age, being greater in the first trimester. Radiation does not induce effects that do not occur spontaneously.

12 Radiation Effects in Phlebotomy. The threshold radiation dose levels needed to induce Deterministic Effects are such that they could not be encountered in Phlebotomy. The normal radiation dose levels encountered in Phlebotomy are low and hence the risk of inducing Stochastic Effects is very low. However the possibility cannot be excluded. Because of the risks of Stochastic Effects radiation levels must be kept As Low As Reasonably Achievable. ( ALARA) Deterministic Effect

13 Artificial Sources of Radiation in Hospitals X-Rays X-ray machines : An electrical current in the X-ray tube generates X- rays. The radiation exists only while the tube is activated. Flash Radiography generates X-rays for fractions of a second. The vast bulk of the X-ray exposures are performed in specially designed X-ray rooms in the X-ray Department. On occasions it is necessary to perform X-ray examinations using a mobile X-ray machine on the wards or in theatre. Unless you are in the immediate vicinity of the X-ray machine during the exposure you will not be affected by radiation..

14 Artificial Sources of Radiation in Hospitals Nuclear Medicine / PET. Patients who go to the Nuclear Medicine Department for diagnostic imaging are injected with a radiopharmaceutical. After the radiopharmaceutical injection the patient is emitting radiation. This radiation is used to generate the nuclear medicine image. After the imaging process is complete the patient will continue to emit radiation for a period that is determined by the characteristics of the radiopharmaceutical. Radiopharmaceuticals levels in the body are reduced by radioactive decay and by biological elimination. It is important to note that patients may be sent to outside hospitals for nuclear medicine /PET procedures.

15 Radioactive Decay.

16 Useful Parameters. The most frequently used product in Nuclear Medicine is Technetium-99m. It has a half-life of 6 hours. The most frequently used product in PET is Fluorine-18. It has a halflife of just under 2 hours. The radiation from Flourine -18 is much more penetrating than that from Technetium-99m. Both will also be removed from the body by biological excretion.

17 Radioactivity

18 Nuclear Medicine / PET Patients The risks associated with Nuclear medicine patients are twofold 1. External Exposure. 2. Contamination with radioactivity.

19 External Exposure Control. Time: Prepare for the procedure before the exposure starts. Ensure that all the required items are at hand before approaching the patient. Distance: Very small increases in distance from a source dramatically reduce the external exposure. [ Inverse-Square law] Shielding : All materials reduce exposure to some extent. However lead is a very effective shield and is incorporated in PPE ( Lead rubber aprons).

20 Mobile X-ray Unit

21 Scattered Radiation Levels in the vicinity of a Mobile X-ray Machine. In general low dose procedures, like Chest X-rays, are performed using mobile X-ray equipment For a standard Chest X-ray examination the scattered radiation dose is ~ 0.3 microsieverts at two metres from the side of the patient bed. At four metres the radiation dose is ~ 0.08 microsieverts Standard concrete walls reduce the radiation levels by a factor of 1000.

22 Radiation Exposure levels associated with Nuclear Medicine/ PET Patients. The dose rate from a nuclear medicine patient who has had a bone scan is of the order of 6 microsieverts per hour. The dose rate from a PET patient after the procedure is completed is about 20 microsieverts per hour. The dose rate from blood samples taken from Nuclear Medicine / PET patients idoes not represent a radiation hazard to staff.

23 Personal Shielding X-ray departments have a range of shielding equipment Lead rubber aprons can reduce X-ray exposure by over 90% Lead rubber aprons reduce the radiation levels from Technetium used in Nuclear Medicine by ~ 50% but are ineffective against PET agents.

24 Contamination. The normal methods used in infection control are effective preventing contamination. Surgical gloves are a very effective barrier. Care must be exercised when removing the gloves to ensure that there is no spread of the contamination. Intact skin is also an effective barrier. Make sure any cuts are covered with waterproof dressing. Internal contamination can be prevented by not consuming products/applying makeup that could be contaminated. Any spillage of potentially contaminated product should be cleaned up carefully.

25 Decontamination. Warm soapy water is very effective at removing contamination on the skin. Alcohol wipes are also very effective. Care should be exercised to ensure that the contamination is not spread to uncontaminated areas. Cuts or needle-stick injuries should be cleaned, initially, by bleeding and covered with waterproof plaster. Any contaminated cleaning materials should be bagged and stored in a sluice room or toilet. Medical Physics personnel have detectors and cleaning products that are useful if there is a contamination incident.

26 Decontamination Sin

27 First Month

28 Pregnant Staff. A risk evaluation should be performed to identify the hazards involved in the work practices. The dose to the foetus should be kept as low as reasonably achievable (ALARA), taking social and economic factors into account. The maximum permitted dose to the foetus is 1000 microsieverts. This limit applies from the declaration of the pregnancy.

29 Radiation and Pregnancy What is of concern is radiation exposure to the uterus. The overlying maternal tissue reduces the fetal exposure by a factor of two for X-rays and Technetium-99m The risk of radiation induced cancer is of the order of 1 in 17,000,000 for 20 minutes exposure to a Nuclear Medicine patient 1 metre). The spontaneous risk of childhood cancer is of the order of 1 in 650. The risk of heritable disease, after foetal exposure of the same nature is of the order of 1 in 200,000,000. The spontaneous risk of heritable disease is of the order of 1 to 6 in a 100.

30 Theraputic use of Radiopharmaceuticals. Special precautions are required when patients are administered radiopharmaceuticals for therapeutic purposes. [ For example Radioactive Iodine is used to treat thyroid cancer.] Rigorous risk estimates are performed to identify the hazards involved in the procedures. In general the radiation levels are higher than those used for imaging. For a certain period after the treatment phlebotomy would only be performed in an emergency and only under the supervision of a medical physicist.

31 Legislative Provisions. Statutory Instrument 125 of Radiation protection of workers and members of the public. Statutory Instrument 478 of Radiation protection of patients.

32 SI 125 of 2000 Protection of Workers and Members of the Public Equipment and practices must be licensed by the Radiological Protection Institute of Ireland (RPII). The Licence requires that a Radiation Safety Committee be appointed in the hospital and it must meet at least twice a year. A Radiation Protection Adviser must be appointed. Equipment must be subject to quality control programmes. A comprehensive risk assessment must be performed prior to any new practices Radiation Safety Procedures must be in place for existing practices. Workers must be given information on the risks involved in the practices.

33 Radiation Safety Procedures relevant to Phlebotomy. The Radiographer should always alert personnel in the vicinity that an X-ray exposure is about to performed on the ward. Nuclear Medicine patients should be identifyable while they are emitting radiation. The active period usually ends on the morning after the imaging injection. On the day of an imaging procedure phlebotomy should be performed before the imaging injection. On the day of imaging treat all body fluids as potential sources of contamination. If, in the case of an emergency, phlebotomy has to be performed while the patient is active use strict infection control procedures and restrict the time spent in close contact with the patient. If in doubt contact staff in Nuclear Medicine for clarification on any concerns in regard to radiation.

34 Radiation Protection Structure in Licensed Facilities. The CEO has ultimate responsibility for radiation protection in the hospital. The responsibility for radiation protection in each department resides with the Head of Department. The Radiation Protection Adviser (RPA) gives advice on radiation protection matters to the CEO through the Radiation Safety Committee. The RPA also advises Heads of Departments on best practice and legislative requirements in relation to radiation protection. Operational matters in relation to radiation protection are usually handled by Radiation Safety Officers (RSO).

35 Conclusion Human beings have been exposed to naturally occurring radiation since life began. The bodies repair mechanisms are sufficiently robust to ensure that there are no long-term effects from moderate amounts of exposure Since their discovery X-rays ( 1895) and radioactivity ( 1896) have had a major impact on medical practice. Medical practice does result in some radiation exposure to workers. Exposure to workers should be kept as low as reasonably achievable. Strict adherence to radiation safety procedures should ensure that the risk is from radiation is negligible.

36 The dose is the poison

37

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