ML20126A491

Radiation Protection Training for Personnel Employed in Medical Facilities

ML20126A491
Person / Time
Issue date:	05/31/1985
From:	Brodsky A, Mcelroy N NRC OFFICE OF NUCLEAR REGULATORY RESEARCH (RES)
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References
NUREG-1134, NUDOCS 8506130363
Download: ML20126A491 (61)

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NUREG-1134-Radiation Protection Training for Personnel Employed in Medical Facilities U.S. Nuclear Regulatory Commission

-Offica of Nuclear Regulatory Research N. L. McElroy, A. Brodsky p+" "%

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8506130363 850531

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r i-c NOTICE Availability of Reference Materials Cited in NRC Publications Most documents cited in N RC publications will be available from one of the following sources:

1. The NRC Public Document Room,1717 H Street, N.W. <

Washington, DC 20555 2, .The Superintendent of Documents, U.S. Government Printing Office, Post Office Box 37082, Washington, DC 20013-7982

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- American National Standards institute,1430 Broadway New York, NY 10018.

NUREG-1134

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i Rad.t.ia ion Protect. ion Tra. .ining l for Personnel Employed in '

Medical Facilities

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N. L. McElroy, A. Brodsky Divi:isn of Radiation Programs and Earth Sciences Offica of Nuclear Regulatory Research U.S. Nuclear Regulatory Commission Wrhington, D.C. 20666

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Abstract This report provides information useful for planning and conducting radiation safety training in medical facilities to keep exposures as low as reasonably achievable, and to meet other regulatory, safety and loss prevention require-ments in today's hospitals. A brief discussion of the elements and basic considerations of radiation safety training programs is followed by a short bibliography of selected references and sample lecture (or session) outlines for various job categories. This information is intended for use by a profes-sional who is thoroughly acquainted with the science and practice of radiation protection as well as the specific procedures and circumstances of the parti-cular hospital's operations. Topics can be added or substracted, amplified or condensed as appropriate.

This document does not set forth specific training program requirements for any particular hospital or type of medical institution or group of employees.

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TABLE OF CONTENTS Chapter Page Abstract.............................................................. iii 1.

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INTRODUCTION..................................................... 1 SELECTION AND SCHEDULING OF TRAINEES............................. 2 2.1 -Who Should Receive Radiation Protection Training............ 2 2.2 When Training Should 0ccur.................................. 3

-2.3 How Trainees Should Be Evaluated............................ 3 2.4 What Records of Training Should Be Maintained............... 3

3. RADIATION PROTECTION TRAINING PR0 GRAM............................ 3 3.1 Objectives of a Training Program............................ 3 3.2 Content of Training Programs................................ 4

4. RADIATION SAFETY STAFF........................................... 4 BIBLIOGRAPHY.......................................................... 5 Appendix I - Suggested Lecture Outlines.............................. 7 Diagnostic Nuclear Medicine Personne1................................. 7 Therapeutic Nuclear Medicine Personne1................................ 11 Teletherapy Personne1................................................. 14 Brachytherapy Personne1............................................... 17 Nurses, Orderlies, and Technicians (Survey Lecture).................................................... 19 Nurses and Orderlies (Brachytherapy Lecture).......................... 22 Nurses and Orderlies (I-131 Therapy Lecture). . . . . . . . . . . . . . . . . . . . . . . . . . 25 Administrators........................................................

Security Personne1....................................................

28 31 Physical Plant Personne1.............................................. 34 Secretarial and Clerical Personne1.................................... 37 Housekeeping Personne1................................................ 40 La b o ra to ry U s e r s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Animal Caretakers..................................................... 47 Appendix II - The Radiation Sca1e..................................... 50 Table II The Radiation Sca1e...................................... 51 v

1. INTRODUCTION S:ction 19.12, " Instructions to Workers," of 10 CFR Part 19, " Notices, Instruc-tions and Reports to Workers; Inspections," requires that individuals be given instruction in radiation protection commensurate with the potential radiation protection problems they may encounter in restricted areas as defined in para-graph 19.3(e) of 10 CFR Part 19. Paragraph 20.1(c) of 10 CFR Part 20 " Standards fcr Protection Against Radiation," states that occupational radiation exposure should be kept as low as is reasonably achievable (ALARA). Appropriate training is'an essential aspect _of an ALARA program. This report provides radiation safety training outlines that can be adapted for training individuals who work with or in the vicinity of radioactive material. Regulatory Guide 8.18, "Infor-

'mation Relevant to Ensuring that Occupational Radiation Exposures at Medical Institutions Will Be As Low As Reasonably Achievable," Regulatory Guide 8.23,

" Radiation Safety Surveys at Medical Institutions," and the other references in the Bibliography, provide a basic source of information, together with this r port, that may be used in any given hospital for planning suitable training s:ssions for specific groups of employees.

.This information, including the topical outlines, is intended only for use by h2 spital radiation safety staff in determining who requires training, how often, and-in-tailoring the degree of coverage of specific topics listed to particular hospital and job needs.

This report by itself can not, and is not intended to, impose any specific training requirerents on any particular hospital or group of employees.

Every job entails the acceptance of some risk. Many of these risks are obvious and easily recognized. Other hazards are more subtle and may not be recognized l

cr. appreciated without specific instruction. Radiation exposure is one of the t subtle hazards. A person may be exposed to significant levels of radiation or to radioactive materials without realizing it because human senses will not  ;

d:tect ionizing radiation until exposure levels greatly exceed regulatory limits.  !

For these reasons, instruction in radiation safety and occupational risks is  !

assential for personnel in medical facilities that use radioactive material for  !

human use.  ;

It is not necessary for all personnel to become experts in radiation protection.

However, it is important for controlling loss prevention as well as meeting

. applicable regulations that each individual's training be commensurate with his

' duties and responsibilities. Sample lecture outlines are provided in Appendix I, but these are only topical lists'that must be revised by the hospital's radia-tion safety professional to meet the needs of the particular institution.

Appendix II lists some levels of radiation that are commonly encountered, recom-mended maximum permissible doses,-and the amounts of radiation that may cause biological effects. This brief list together with information in the references may be helpful as a handout that puts radiation risks and the radiation safety program in proper perspective.

Each individual's duties and responsibilities should be carefully considered in

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l determining appropriate radiation safety training for that individual. In most cases, training for' ancillary. personnel can be accomplished in a short lecture session that includes opportunities for questions and answers. Such lectures 1

. . _ . . - . ~ . , . - - . _ _ ._- _- -- - -

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i should be provided by qualified personnel whose knowledge of the subject exceeds that to be expected of the trainee and who will be able to answer general radia-tion safety questions and put the radiation risks and safety procedures in pro-per perspective. For some individuals, such as housekeepers who may only occa-sionally be called upon to help clean areas with minor contamination, a formal lecture may be inappropriate. Often in cases like this the employee can best be trained by an informal briefing while preparing to assist a member of the nursing staff or the radiation safety officer.

' For full-time radiation workers, training should ordinarily include both lectures and demonstrations of safe work procedures. Although allowance may be made for applicable training received during formal education or during previous employ-  ;

l ment, facility-specific training is also essential. This may be most practical i as a single session lasting an entire day or as short topical sessions throughout  !

the year. The topics listed in this document may be covered as briefly and l simply, or as comprehensively, as appropriate for the purpose and audience of

, the training session.

! The training program should be conducted under the supervision of the Radiation i Safety Officer ~(RS0)* or a safety training professional qualified in radiation protection, with the cooperation of authorized users and management. It should be reviewed at least once every two years and updated as necessary. The program should be changed promptly to reflect changes in operations.

I Anyone interested in copying Appendix II or any of the sample lecture outlines may do so.in whole or in part without specific NRC permission.

2. SELECTION AND SCHEDULING OF TRAINEES I 2.1 Who Should Receive Radiation Protection Training Section 19.12 requires that all personnel, including supervisors, who work in

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or frequent a restricted area where licensed radioactive materials are used receive radiation protection training. This should also include:

1. Ancillary personnel who work in restricted areas on an occasional basis, and

,. 2. Ancillary personnel who work with patients who have received radiophar-maceuticals or who contain brachytherapy sources.

In addition, the licensee should consider radiation safety training for other groups of employees such as housekeeping, maintenance and secretarial staff, even if it~is not required by the regulations. A selection of the types of employees who might need training is indicated by the job-specific outlines in 4

Appendix I.

• The title " Radiation Safety Officer," used by many medical licensees, is used in'this report to designate the qualified individual who is responsible for carrying out the licensee's radiation safety program and who is listed as the Radiation Safety Officer on the application for the license.

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2.2 When Training Should Occur Personnel who work in or frequent a restricted area should be trained before they enter the restricted area. Ancillary personnel who are occasionally exposed should be trained during their new employee orientation, during regu-larly scheduled continuing education sessions, or during general safety educa-tion sessions.

The training program should include periodic refresher training. This is neces-sary to maintain awareness of the need for maintaining exposures ALARA and to remind individuals of appropriate safety procedures. Operating procedures,

. levels of usage, and areas of use also change from time to time. The refresher training can provide a time for an updated description of the entire byproduct material program. The refresher training should be given at least once per year for those personnel who continue to work in areas where they might receive more than 25 percent of applicable limits of 10 CFR Part 20, or where training would help maintain their exposures ALARA.

2.3 How Trainees should Be Evaluated In most cases, it is unnecessary to conduct a formal written or oral testing program for ancillary personnel; however, this may be prudent for hospital loss prevention.in some cases. If such personnel will be working in a restricted area for an extended period of time, additional personal instruction or per-sonal supervision should be considered.

For personnel regularly working in a restricted area, written testing, on-the-

-job observation of work habits, and attendance at training sessions can be important aspects of a hospital's loss prevention, regulatory compliance, and safety programs.

2.4 What Records of Training Should Be Maintained NRC regulations do not generally require that records of training be kept. How-ever, for administrative and loss prevention program purposes, recordkeeping may be essential. In most cases, an attendance sheet should be kept including the name and department (or, for nursing staff, the ward) of each individual in attendance, the date of the training session, the lecture outline number or title, and the name of the individual who conducted the training session. Atten-dees.should sign this roster at training sessions so that a record of their attendance can be retained.

3. RADIATION PROTECTION TRAINING PROGRAM In meeting the requirements of 10 CFR Part 19, the training program should pro-vide general information that must be available to all individuals who work with or frequent areas where byproduct' radioactive material is used, and also address potential radiation hazards specific to each facility.

3.1 Objectives of a Training Program e A training program's objectives should include:

1. Informing all personnel of management's commitment to employee safety and specifically in keeping radiation exposures ALARA; 3

2. Providing an overview of the use of byproduct material in the institution and the requirements governing its use;

3. Providing instructions about the biological effects of radiation and its

! relative risks in the workplace, especially in perspective with other health risks;

'4. Providing instructions in safety measures that individuals can use to mini-mize their radiation exposure; and

5. Identifying the Radiation Safety Office as a source of services and further information and assistance in radiation safety matters.

3.2 Content of Training Programs Sample lecture outlines for various occupational groups are given in Appendix I.

In order to indicate some of the information that should be presented, the out-lines were prepared to reflect common practices at-large medical institutions where byproduct material is handled in every conventional fashion. The licensee should edit each outline to reflect the byproduct material program,. practices, and recommendations specific to the licensee's facility. Other radiation safety information, for example, x-ray safety measures, may be incorporated. The depth of a presentation will depend on the educational background and the job respon-sibilities of the audience. For some audiences, the discussion of a topic may be only a briefing that lasts few minutes; frequently a sentence will suffice.

4. RADIATION SAFETY STAFF The members of the radiation safety or professional training staff who give the lectures should be thoroughly conversant with the material in the lecture out-lines. Their knowledge should be of sufficient depth to qualify them to con-duct training sessions. Furthermore, .these individuals should be thoroughly familiar with the type and magnitude of radiation safety problems associated with each area where byproduct material is used.

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BIBLIOGRAPHY NRC DOCUMENTS Regulatory Guides 8.13 Instruction Concerning Prenatal Radiation Exposure 8.18 Information Relevant to Ensuring That Occupational Radiation Exposures at Medical Institutions Will Be As Low As Reasonably Achievable 8.23 Radiation Safety Surveys at Medical Institutions 8.29 Instruction Concerning Risks from Occupational Radiation Exposure Report NUREG- Principles and Practices for Keeping Occupational Radiation Exposures 0267 at Medical Institutions As Low As Reasonably Achievable REPORTS OF THE NATIONAL COUNCIL ON RADIATION PROTECTION AND MEASUREMENTS

• No. 32 Radiation Protection in Educational Institutions (1966)

No. 37 Precautions in the Management of Patients Who Have Received Thera-peutic Amounts of Radionuclides (1970)

No. 39 Basic Radiation Protection Criteria (1971)

No. 40 Protection Against Radiation from Brachytherapy Sources (1972)

No. 48 Radiation Protection for Medical and Allied Health Personnel (1976)

No. 53 Review of NCRP Radiation Dose Limit for Embryo and Fetus in Occupationally-Exposed Women (1977)

No. 54 Medical Radiation Exposure of Pregnant and Potentially Pregnant Women (1977)

No. 71 Operational Radiation Safety--Training (1983)

• Copies are available from the National Council on Radiation Protection and Measurements, 7910 Woodmont Avenue, Suite 1016, Bethesda, Maryland 20814.

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Other References l C. A. Kelsey, " Comparison of Relative Risk from Radiation Exposure and Other Common Hazards," Health Phys. 35, 428-430, 1978.

Radiation Education Notebook, Educational Service) Office, Atomic Industrial Forum, Inc., 7101 Wisconsin Avenue, Bethesda, MD 10814.

J. B. Revelle, Safety Training Methods, John Wiley and Sons, Inc., Somerset, NJ, 1980, 248 pp.

P. Slovic, " Images of Disaster: Perceptions and Acceptance of Nuclear Power,"

in Perceptions of Risk, proceedings of the 15th Annual Meeting of the NCRP, March 14-15, 1979.

P. Slovic, B. Fischhoff and S. Lichtenstein, " Rating the Risks," Environment 21, No. 3, pp. 14-39, 1979.

R. Johnson, "Public Understanding of Radiation," in Proceedings of a Public Meeting to Address a Proposed Federal Radiation Research Agenda, National Cancer Institute, Bethesda, MD, March 1980.

S. M. Brahmavar, " Radiation Safety: Employee Manual," available from Director, Medical Physics and Radiation Safety, Baystate Medical Center, Springfield, MA 01199, 1984.

Society of Nuclear Medicine, Inc., " Low-Level Radiation Effects: A Fact Book,"

The Society of Nuclear Medicine, Inc., 1982.

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APPENDIX I Suggested Lecture Outlines

• Lccture No.  : Diagnostic Nuclear Medicine Personnel A. Potential risks of radiation exposure

1. Prompt somatic

a. Examples: temporary change in blood count or dermatitis

b. Observed following large dose over a short time period

c. Not observed for exposures within regulatory limits

2. Delayed somatic

a. Example: cancer

b. Increase in risk is about 0.0001 per rem of exposure

3. Genetic

a. Definition: abnormality observed in offspring due to previous irradiation of a parent's reproductive system

b. Increase in risk with any exposure

c. Not observed for exposures within regulatory limits

4. Teratogenic

a. Definition: abnormality observed in offspring due to irradiation in utero

b. Increase in risk above 10 rem

c. Not observed for exposures within regulatory limits

5. Placing risks in perspective (appropriately summarize from Regulatory Guide 8.29)

B. The ALARA concept C. Procedures usino radioactive material

1. In vitro laboratory (or pathology) f i a. Test tube work

b. Microcuries of I-125, Co-57, and C-14 CThese outlines are designed to present an ordered list of topics that might be pertinent for each respective job category. The selection or addition of topics, depth of coverage, and time for presentation should be tailored to meet the needs of the specific employees.

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A

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2. Diagnostic nuclear medicine

a. Injections for internal imaging

b. Usually 5-30 mci of Tc-99m

c. Xe-133 imaging and exposure control

3. Therapeutic nuclear medicine

a. Oral administration for benign and malignant disease

b. Up to 200 mci of I-131

c. P-32 for malignant effusions l

4. Brachytherapy

a. Temporary implant of sealed radioactive sources

b. 50 mci of Cs-137 or Ir-192 for two days

c. Implants or injections of short-lived radioactive materials such as Au-198 (used to treat prostatic cancer) may produce high dose rates at bedside. Weekly dose allowance may be received in one hour near bedside.

5. Diagnost.ic sealed sources

a. Similar to conventional x-ray procedure

b. 200 mci of I-125

6. Teletherapy

a. External administration of radiation for therapeutic purposes

b. 5000 Ci of Co-60 D. Contact RSO

1. For personal exposure data

2. For regulations, license, amendments, inspection reports

3. If pregnant

4. If problems are suspected

5. If there are questions E. Personnel dosimeter procedures and precautions 4 1. Wear at collar level outside protective aprons

2. Leave at work in the specified location at the end of each day

3. Use only to monitor personal radiation exposure at work. Do not use to test home television or microwave oven or durirg personal medical or dental exposure

4. Do not share with another person

5. Handle carefully

a. Dosimeters are affected by temperature, humidity, and chemicals

b. Accidental mistreatment should be reported to RSO 8

6. Site-specific radiation exposure levels, investigational levels

7. Procedures for signing out at termination of employment F. General safety measures

1. Time: exposure is proportional to time

2. Distance: exposure decreases rapidly with distance

3. Shielding: plastic for beta, lead for gamma; for Tc-99m (external exposure rate of 0.7 R-cm2/ mci-hr), HVL is about 0.3 mm lead

4. Housekeeping: cleanliness reduces internal and skin contamination

5. Instructions for visitors: maintain distance from patient, limit contact G. Specific Safety Measures

1. Do not smoke, eat, drink, or apply cosmetics

2. Do not store food near radioactive materials

3. Demonstrate proper use of syringe and vial shields

4. Use a cart or wheelchair to transport doses, flood fields, waste

5. Maximize personal distance from patient consistent with good care

6. Use patient restraint devices consistent with good care

7. Use disposable gloves and change them frequently

8. Define misadministration

9. Double-check patient, syringe, and request

10. Notify chief technologist or physician immediately if any equipment is not working properly H. End-of-day safety measures

1. Demonstrate hand check for contamination with a camera or crystal ratemeter

2. Demonstrate GM survey of pharmacy, clinic, and storage areas I. Waste-handling procedures

1. Low-activity waste includes syringes, needles, cotton swabs, gauze, and absorbent paper

2. High-activity waste includes spent generators, radiopharmaceuticals that were not administered, and materials used to clean spills

3. Do not mix nonradioactive waste with radioactive waste

4. Separate short-half-life and long-half-life waste

5. Obliterate labels unless waste is to be transferred

6. Follow packaging procedures

a. Seal

b. Date

c. Initial

d. Deliver to storage area J. Emergencies

1. Spill procedures (See Regulatory Guide 10.8)

2. Personnel decontamination by gentle wash and induced perspiration )

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e K. Safety measures in the pharmacy

1. Check dose calibrator for constancy

2. Work over a countertop or tray..with absorbent paper

3. Wear double gloves; change the outer gloves frequently L. Use of radioactive cases and aerosols

1. Proper checks and use of specialized equipment

2. ' Briefing to ensure patient's cooperation

3. Special spill procedures 1

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Lecture No.  : Therapeutic Nuclear Medicine Personnel (I-131 Radiopharmaceutical Therapy)

A. Potential-risks of radiation exposure

1. Prompt somatic

a. Examples: temporary change in blood count or dermatitis

b. Observed following large dose over a short time period

c. Not observed for exposures within regulatory limits

2. Delayed somatic

a. Example: cancer

b. Increase in risk is about 0.0001 per rem of exposure

3. Genetic-

a. Definition: abnormality observed in offspring due to previous irradiation of a parent's reproductive system

b. Increase in risk with any exposure

c. Not observed for exposures within regulatory limits

4. Teratogenic

a. Definition: abnormality observed.in offspring due to irradiation in utero

b. Increase in risk above 10 rem

c. Not observed for exposures within regulatory limits

5. Placing risks in perspective (appropriately summarize from

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Regulatory Guide 8.29)

B. The ALARA concept (A more complete (but conceptually simple) review of appropriate material in NCRP' Reports 37 and 40 is also necessary for these personnel.)

C. Procedures using radioactive material

1. In vitro laboratory

a. Test tube work

b. Microcuries of I-125, Co-57, and C-14

-2. Diagnostic nuclear medicine

a. Injections for internal imaging

b. Usually 5-30 mci of Tc-99m

3. Therapeutic nuclear medicine

a. Oral administration for benign and malignant disease

b. Up to 200 mci of I-131 11

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4. Brachytherapy'

a. Temporary implant of sealed radioactive sources

'b. 50 mci of Cs-137-or Ir-192 for two days

c. Implants or injections of short-lived radioactive materials d

such as Au-198 (used to treat prostatic cancer) may produce high dose l'ates at bedside. Weekly dose allowance may be received in one hour near bedside.

5. Diagnostic sealed sources

a. Similar to conventional x-ray procedure f~ b. 200 mC1 of I-125

6. Teletherapy

a. External administration of radiation for therapeutic purposes

b. 5000 Ci of Co-60 D. Contact RSO i

1. For personal exposure data

2. For regulations, license, amendments, inspection reports

, 3. .If pregnant e 4. If problems are suspected

5. If there are questions f

E. Personnel dosimeter procedures and precautions

1. Wear at collar level outside protective aprons

2. Leave at work in the specified location at the end of each day

3. Use only to monitor personal radiation exposure at work. Do not use to test a home television or microwave oven or during personal medical or dental exposure

4. Do not share with another person

5. Handle carefully

a. Dosimeters are affected by temperature, humidity, and chemicals

b. Accidental mistreatment should be reported to RSO

6. Procedures for signing out at termination of employment

F. Radiation hazards of I-131 3-

1. ' Volatility during dose administration and from urine 2.: Contamination of tableware, personal effects, linen, furniture

3. External exposure rate of 2.2 R-cm2 / mci-hr; HVL for I-131 is about 3 mm lead G. Precautions

1. Define therapeutic misadministration

2. Practice the administration beforehand with a cold solution 12

3. Prepare the patient's room (see Regulatory Guide 10.8)

4. Brief the patient prior to dose administration to ensure cooperation

5. Brief the patient (and escort, if applicable) prior to release to follow safety instructions at home H. Energencies

1. For spills or emesis, use mild washing and induce perspiration

2. Spill procedures (see Regulatory Guide 10.8)

3. Notify RSO in case of accidents, acute illness, or death and prior to release I. Monitorino

1. Use personnel dosimeters provided for external exposure

2. Assay personnel for thyroid burden one day after administration

3. Post exposure rates and stay times as recommended in NCRP 37, as part of Item G.3 i

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Lecture No.  : Teletherapy Personnel A. Potential risks of radiation exposure

1. Prompt somatic

a. Examples: temporary change in blood count or dermatitis

b. Observed following large dose over a short time period

c. Not observed for exposures within regulatory limits

2. Delayed somatic

a. Example: cancer

b. Increase in risk is about 0.0001 per rem of exposure

3. Genetic

a. Definition: abnormality observed in offspring due to previous irradiation of a parent's reproductive system

b. Increase in risk with any exposure

c. Not observed for exposures within regulatory limits

4. Teratogenic

a. Definition: abnormality observed in offspring due to irradiation in utero

b. Increase in risk with any exposure

c. Not observed for exposures within regulatory limits

5. Placing risks in perspective (appropriately summarize from Regulatory Guide 8.29)

.B. The ALARA concept C. Procedures using radioactive material

1. In vitro laboratory

a. Test tube work

b. Microcuries of I-125, Co-57, and C-14

2. Diagnostic nuclear medicine

a. Injections for internal imaging

b. Usually 5-30 mci of Tc-99m

3. Therapeutic nuclear medicine

a. Oral administration for benign and malignant disease

b. Up to 200 mci of I-131 14

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4. Grach/ therapy

a. Temporcry implant of sealed radioactive sources

b. 50 mci of Cs-137 or Ir-192 for two days

c. Implants or injections of short-lived radioactive materials such as Au-198 (used to treat prostatic cancer) may produce high dose rates at bedside. Weekly dose allowance may be received in one hour near bedside.

5. Diagnostic sealed sources

a. Similar to conventional x-ray procedure

b. 200 mci of I-125

6. Teletherapy

a. External administration of radiation for therapeutic purposes

b. 5000 Ci of Co-60 D. Contact RSO

1. For personal exposure data

2. For regulations, license, amendments, inspection reports

3. If pregnant

4. If problems are suspected

5. If there are questions E. Personnel dosimeter procedures and precautions

1. Wear at collar level outside protective aprons

2. Leave at work in the specified location at the end of each day

3. Use only to monitor personal radiation exposure at work. Do not use to test home television or microwave oven or during personal medical or dental exposure

4. Do not share with another person

5. Handle carefully

a. Dosimeters are affected by temperature, humidity, and chemicals

b. Accidental mistreatment should be reported to RSO

6. Procedures for signing out at termination of employment F. Use of the beam-condition room monitor

1. . Check it each morning

2. Look at it each time you enter the room

3. Notify the RSO immediately if it is not working G. Door interlock check

1. Beam should not go on if door is open

2. Opening door should turn beam off

3. Closing door should not turn beam on

) 4. Notify the RSO immediately if interlocks are not working l

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H. Safety measures

1. Define therapeutic misadministration

2. Do not try to work too fast

3. Check to be sure only the patient is in the room prior to each beam on I. Site-specific radiation exposure levels

1. Entrance door

2. Console J. Emergencies

1. Discuss use of survey meter

2. Walk through emergency evacuation of ambulatory patient

a. Tell patient to leave the room

b. Secure the room

c. Contact the RSO immediately

d. Do not attempt to retract the source

3. Walk through emergency removal of nonambulatory patient

a. Enter the room, avoiding the primary beam

b. Close the collimators or direct the beam away from yourself and the patient

c. Remove the patient from the room

d. Secure the room

e. Contact the RSO immediately

f. Do not attempt to retract the source 16

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- Lecture No.  : Brachytherapy Personnel A. Potential risks of radiation exposure

1. Prompt somatic

a. Examples: temporary change in blood count or dermatitis

b. Observed following large dose over a short time period

c. Not observed for exposures within regulatory limits

2. Delayed somatic

a. Example: cancer

b. Increase in risk is about 0.0001 per rem of exposure

3. Genetic

a. Definition: abnormality observed in offspring due to previous irradiation of a parent's reproductive system

b. Increase in risk with any exposure

c. Not observed for exposures within regulatory limits

4. Teratogenic

a. Definition: abnormality observed in offspring due to irradiation in utero

b. Increase in risk above 10 rem

c. Not observed for exposures within regulatory limits f

5. Placing risks in perspective (appropriately summarize from Regulatory Guide 8.29)

B. The ALARA concept (A more complete (but conceptually simple) review of appropriate material in NCRP Reports 37 and 40 is also necessary for these personnel.)

C. Procedures using radioactive material 4

1. In vitro laboratory

a. Test tube work

b. Microcuries of I-125, Co-57, and C-14

2. Diagnostic nuclear medicine

a. Injections for internal imaging

b. Usually 5-30 mci of Tc-99m

3. Therapeutic nuclear medicine

a. Oral administration for benign and malignant disease

b. Up to 200 mci of I-131 17

4. Brachytherapy

a. Temporary implant of sealed radioactive sources

b. 50 mci of Cs-137 or Ir-192 for two days

c. Implants or injections of short-lived radioactive materials such'as Au-198 (used to treat prostatic cancer) may produce high dose rates at bedside. Weekly dose allowance may be received in one hour near bedside.

5. Diagnostic sealed sources i

a. Similar to conventional x-ray procedure

b. 200 mci of I-125 6.- Teletherapy j

a. External administration of radiation for therapeutic purposes 1

b. 5000 Ci of Co-60 D. Contact RSO

1. For personal exposure data

2. For regulations, license, amendments, inspection reports

3. If pregnant '

4. If problems are suspected

5. If there are questions E. Personnel dosimeter procedures and precautions

1. Wear. at collar level outside protective aprons

2. Leave at work in the specified location at the end of each day  ;

3. Use only to monitor personal radiation exposure at work. Do not use to test home television or microwave oven or during persona 1' medical or dental exposure

4. Do not share with another person

5. Handle carefully ,

a. Dosimeters are affected by temperature, humidity, and chemicals

b. Accidental mistreatment should be reported to RSO ,

6. Procedures for signing out at termination of employment F. Safety measures

1. Define therapeutic misadministration

2. Use remote handling tools for preparation, insertion, removal, and transport g 3. Use transport device 4 4. Use L-block during preparation

5. Count seeds and survey patient prior to release from facility l 6. Perform quarterly inventory check j 7. Instructions for visitors: maintain 2 meter distance from patient, limit stay to 1/2 hour or as advised by signs (see NCRP 37 and 40) f

{ 18

i i

Lecture No _

Nurses, Orderlies, and Technicians (Survey Lecture) '

Potential risks of radiation exposure

( A.

l- 1. Prompt somatic l a. . Examples: temporary change in blood count or dermatitis

! b. Observed following large dose over a short time period l c. Not observed for exposures within regulatory limits 2.. Delayed somatic  ;

1 l a. Example: cancer i l b. Increase in risk is about 0.0001 per ren of exposure i

3. Genetic

a. Definition: abnormality observed in offspring due to previous irradiation of a parent's reproductive system

b. ' Increase in risk with any exposure

c. Not observed for exposures within regulatory limits  ;

4. Teratogenic

- a. Definition

abnormality observed in offspring due to irradiation i

in utero l b. Increase in risk above 10 rem

c. Not observed for exposures within regulatory limits l 5. Placing risks in perspective (appropriately summarize from '

Regulatory Guide 8.29)

8. The ALARA concept C. Procedures usina radioactive material f

, 1. In vitro laboratory  ;

l-

! a. Test tube work i j b. Microcuries of I-125, Co-57, and C-14 l

i

2. Diagnostic nuclear medicine  ;

a. Injections for internal imaging b, Usually 5-30 mci of Tc-99m

3. Therapeutic nuclear medicine

a. Oral administration for benign and malignant disease

b. Up to 200 mCl of I-131 2

4. Brachytherapy a.- Temporary implant of sealed radioactive sources

, b. 50 mC1 of Cs-137 or Ir-192-for two days 19

, . . . . . ~ _ , . , , . . _ . ~ . _ . , _ , . ..,..-_---,_._,.,_,.,-_..__..._,_.._,.__,,,,_-.,.....,-,,_,_,.-,_.._,.m.-,.-,

c. Implants or injections of short-lived radioactive materials such as Au-198 (used to treat prostatic cancer) may produce high -

dose rates at bedside. Weekly dose allowance may be received in one hour near bedside.

5. Diagnostic sealed sources

a. Similar to conventional x-ray procedure

b. 200 mci of I-125

6. Teletherapy 1

a. External administration of radiation for therapeutic purposes

b. 5000 Ci of Co-60

, D. Contact RSO

1. For personal exposure data

2. For regulations, license, amendments, inspection reports

3. If pregnant

4. If problems are suspected

5. If there are questions E. Personnel dosimeter procedures and precautions

1. Wear at collar level outside protective aprons

2. Leave at work in the specified location at the end of each day

3. Use only to monitor personal radiation exposure at work. Do not use to test home television or microwave oven or during personal medical or dental exposure

, 4. Do not share with another person

5. Handle carefully

a. Dosimeters are affected by temperature, humidity, and chemicals

b. Accidental mistreatment should be reported to RSO l 6. Procedures for signing out at termination of employment F. Sources of ionizing radiation i

i 1. X-ray machines

2. Television sets

3. Radioactive materials i 4. Teletherapy units

5. Natural radioactivity in the earth and your body

6. Cosmic radiation 4 G. What are not sources of ionizing radiation i 1. Microwave ovens

2. X-ray machines that are turned off

3. X-ray and teletherapy patients

! 4. Nuclear medicine imaging and counting equipment I

20

H. Potential sources of ionizing radiation at this institution

1. Diagnostic nuclear medicine patients l

2. Therapeutic nuclear medicine patients

3. Portable x-ray machines

4. . Brachytherapy patients

5. Laboratory areas

6. Teletherapy room  ;

I; General safety measures

1. Time: exposure is proportional to time

2. Distance: exposure decreases rapidly with distance

3. Shielding: lead aprons are frequently used in x-ray; most are not thick enough to help significantly in nuclear medicine or brachy-therapy

4. Housekeeping: cleanliness reduces internal and skin contamination J. Specific safety measures

1. For diagnostic nuclear medicine patients

a. Minimal exposure to ancillary personnel, negligible after 24 hours2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br />

b. Urine, saliva, or perspiration may have contamination

c. Use disposable gloves if handling patient or urine

d. Minimize personal time around patient consistent with good care

e. Maximize personal distance from patient consistent with good care

2. For therapeutic nuclear medicine patients or brachytherapy patients there will be special precautions A

,o M

9 s

21

Lecture No.  : Nurses and Orderlies (Brachytherapy Lecture)

A. Potential risks of radiation exposure

1. Prompt somatic

a. Examples: temporary change in blood count or. dermatitis

b. Observed following large dose over a short time period

c. Not observed for exposures within regulatory limits

2. Delayed somatic

a. Example: cancer

b. Increase in risk is about 0.0001 per rem of exposure

3. Genetic

a. Definition: abnormality observed in offspring due to previous irradiation of a parent's reproductive system

b. Increase in risk with any exposure

c. Not observed for exposures within regulatory limits

4. Teratogenic

a. Definition: abnormality observed in offspring due to irradiation in utero

b. Increase in risk above 10 rem

c. Not observed for exposures within regulatory limits

5. Placing ritks in perspective (appropriately summarize from Regulatory Juid- 8.29)

B. The ALARA concept (A more complete (but conceptually simple) review of appropriate material in NCRP Reports 37 and 40 is necessary for staff attending brachytherapy patients.)

C. Procedures using radioactive material

1. In vitro laboratory

a. Test tube work

b. Microcuries of I-125, Co-57, and C-14

2. Diagnostic nuclear medicine

a. Injections for internal imaging

b. Usually 5-30 mci of Tc-99m

3. Therapeutic nuclear medicine

a. Oral administration for benign and malignant disease

b. Up to 200 mci of I-131 22

4. Brachytherapy

a. Temporary implant of sealed radioactive sources

b. 50 mci of Cs-137 or Ir-192 for two days

c. Implants or injections of short-lived radioactive materials such as Au-198 (used to treat prostatic cancer) may produce high dose rates at bedside. Weekly dose allowance may be received in one hour near bedside.

5. Diagnostic sealed sources

a. Similar to conventional x-ray procedure

b. 200 mci of I-125

6. Teletherapy

a. External administration of radiation for therapeutic purposes

b. 5000 Ci of Co-60 D. Contact RSO

1. For personal exposure data

2. For regulations, license, amendments, inspection reports

3. If pregnant

4. If problems are suspected

5. If there are questions E. Personnel dosimeter procedures and precautions

1. Wear at collar level outside protective aprons

2. Leave at work in the specified location at the end of each day

3. Use only to monitor personal radiation exposure at work. Do not use to test home television or microwave oven or during personal medical or dental exposure

4. Do not share with another person

5. Handle carefully

a. Dosimeters are affected by temperature, humidity, and chemicals

b. Accidental mistreatment should be reported to RSO

6. Procedures for signing out at termination of employment F. The procedure

1. Number and appearance of sources used

2. Duration G. Potential hazards

1. External exposure rates

2. No contamination hazard

3. Lost source i

23

H. Safety measures

1. Pregnant personnel should not care for the patient

2. Housekeeping personnel should not enter the room

3. Limit personal time in the room consistent with good care

4. Maximize personal distance from the patient consistent with good care I. Visitor control

1. Visitors who are pregnant or under 18 years old should not be allowed ,

in the room (

2. Each visitor should be limited to 30 minutes each day

3. Visitors should stay behind a " safe line" marked on the floor J. Emergency procedures Call attending physician and RSO if

1. Death or cardiac arrest occurs

2. Patient must be moved i

3. A dislodged implant is suspected l

24

. . =. . _ - -

Lecture No.  : ' Nurses 'and Orderlies (I-131 Therapy Lecture)

A. Potential risks of radiation exposure 4

1. Prompt somatic

a. Examples: temporary change in blood count or dermatitis

b. Observed-following large dose over a short time period

c. Not observed for exposures within regulatory limits

2. Delayed somatic

a. Example: cancer

b. Increase in risk is about 0.0001 per rem of exposure

3. Genetic

a. Definition: abnormality observed in offspring due to previous irradiation of a parent's reproductive system

b. Increase in risk with any exposure

c. Not observed for exposures within regulatory limits

4. Teratogenic

a. . Definition: abnormality observed in offspring due to irradiation in utero

b. Increase in risk above 10 rem

c. Not observed for exposures within regulatory limits

5. Placing risks in perspective (appropriately summarize from Regulatory Guide 8.29)

B. The ALARA concept (Provide also an elementary review of appropriate material in NCRP Report 37)

'C. Procedures using radioactive material l 1. In vitro laboratory

a. Test tube work

b. Microcuries of I-125, Co-57, and C-14

2. Diagnostic nuclear medicine

a. Injections for internal imaging

b. Usually 5-30 mci of Tc-99m

3. Therapeutic nuclear medicine j

a. Oral administration for benign and malignant disease i

b. Up to 200 mci of I-131 l

25 l

_ _ , _ , , -4 ~

W "" '

4. Brachytherapy

a. Temporary implant of sealed radioactive sources

b. 50 mci of Cs-137 or Ir-192 for two days

c. Implants or injections of short-lived radioactive materials such as Au-198 (used to treat prostatic cancer) may produce high dose rates at bedside. Weekly dose allowance may be received

.in one hour near bedside.

5. Diagnostic sealed sources

a. Similar to conventional x-ray procedure

b. 200 mci of I-125 1

6. Teletherapy

a. External administration of radiation for therapeutic purposes

b. 5000 Ci of Co-60 D. Contact RSO

1. For personal exposure data

2. For regulations, license, amendments, inspection reports

3. If pregnant

4. If problems are suspected

5. If there are questions E. Personnel dosimeter procedures and precautions

1. Wear at collar level outside protective aprons

2. Leave at work in the specified location at the end of each day

3. Use only to monitor personal radiation exposure at work. Do not use to test home television or microwave oven or during personal medical or dental exposure

4. Do not share with another person

5. Handle carefully

a. Dosimeters are affected by temperature, humidity, and chemicals

b. Accidental mistreatment should be reported to RSO

6. Procedures for signing out at termination of employment F. The procedure

1. Radiopharmaceutical and its route through the body

2. Activity administered

3. Estimated retention at various times G. Potential hazards

1. External exposure rates from patients and specimens (see NCRP Report l

No. 37, Table 3)

2. Contamination 26

[

l

l H. Safety Measures

1. Pregnant personnel should not care for the patient

2. Housekeeping personnel should not enter the room

3. Limit personal time in the room consistent with good patient care

- 4. Maximize personal distance from the patient consistent with good care

5. Wear disposable gloves in the room, wash your hands after leaving

6. Hold, linen and tableware for RSO

7. Follow prescribed urine collection or disposal procedures

8. Follow other prescribed waste collection and disposal procedures I. Visitor control

1. Visitors _who are pregnant or under 18 years old should not be allowed in the room

2. Visitors should stay behind a " safe line" marked on the floor

3. Each visitor should be limited to 30 minutes each day J. Emergency procedures Call attending physician and RSO if

1. Death or cardiac arrest occurs

2. Patient must be moved

3. There is an emesis or' spill of urine l

27

Lecture No. _: Administrators A. Potential risks of radiation exposure

1. Prompt somatic

a. Examples: temporary change in blood count or dermatitis

b. Observed following large dose over a short time period l

c. Not observed for exposures within regulatory limits

2. Delayed somatic

a. Example: cancer

b. Increase in risk is about 0.0001 per rem of exposure

3. Genetic

a. Definition: abnormality observed in offspring due to previous irradiation of a parent's reproductive system

b. Increase in risk with any exposure ,

c. Not observed for exposures within regulatory limits l

4. Teratogenic

a. Definition: abnormality observed in offspring due to irradiation in utero

b. Increase in risk above 10 rem

c. Not observed for exposures within regulatory limits

5. Placing risks in perspective (appropriately summarize from Regulatory Guide 8.29)

B. The ALARA concept C. Procedures using radioactive material

1. In vitro laboratory

a. Test tube work

b. Microcuries of I-125, Co-57, and C-14

2. Diagnostic nuclear medicine

a. Injections for internal imaging

b. Usually 5-30 mci of Tc-99m

3. Therapeutic nuclear medicine

a. Oral administration for benign and malignant disease

b. Up to 200 mci of I-131 I

28 i

4. Brachytherapy

a. Temporary implant of sealed radioactive sources

b. 50 mci of Cs-137 or Ir-192 for two days

c. Implants or injections of short-lived radioactive materials such as Au-198 (used to treat prostatic cancer) may produce high dose rates at bedside. Weekly dose allowance may be received in one hour near bedside.

5. Diagnostic sealed soerces

a. Similar to conventi c al x-ray procedure

b. 200 mci of I-125

6. Teletherapy

a. External administration of radiation for therapeutic purposes

b. 5000 Ci of Co-60

7. Number of occupationally exposed individuals in each area l

l 8. Relative hazard in each area l

D. Rights of Workers

1. Access to personal exposure data i

2. Access to regulations, license, amendments, inspection reports 1

3. Notify RSO if pregnant

4. Notify RSO if problems are suspected E. Legislative and regulatory jurisdictions

1. Byproduct material

2. NARM (natural and accelerator produced radioactive material)

3. X-rays F. Radiation Safety Committee

1. Membership

2. . Charge

3. Authority

~

G. Current radiation safety program I

1. Areas where material is being used safely {

2. Areas where there are unresolved safety deficiencies '

3. Past incidents and inspection reports

4. Budget needs

5. Equipment needs

6. Space needs

7. Staff needs

8. Visitor control measures I

H. Questions for the future 1.' Proposed changes in regulations

2. Changes in program size or direction I.- Results of-the Radiation Safety Committee annual audit .

1. Need for the audit

2. Form for sample audit (see NUREG-0267)

I s

h t

1 30

. Lecture No. _: Security Personnel A. Potential risks of radiation exposure i l

1. Prompt soma' tic

a. Examples: temporary change in blood count or dermatitis

b. 0bserved following large dose over a short time period

c. Not observed for exposures within regulatory limits

2. Delayed somatic

a. Example: cancer

b. Increase in risk is about 0.0001 per rem of exposure

3. Genetic

a. Definition: abnormality observed in offspring due to previous irradiation of a parent's reproductive system

b. Increase in risk with any exposure

c. Not observed for exposures within regulatory limits

4. Teratogenic

a. Definition: abnormality observed in offspring due to irradiation in utero

b. Increase in risk above 10 rem

c. Not observed for exposures within regulatory limits

5. Placing risks in perspective (appropriately summarize from Regulatory Guide 8.29)

B. The ALARA concept C. Procedures using radioactive material

1. In vitro laboratory

a. Test tube work

b. Microcuries of I-125, Co-57, and C-14

2. Diagnostic nuclear medicine

a. Injections for internal imaging

b. Usually 5-30 mci of Tc-99m

3. Therapeutic nuclear medicine

a. Oral administration for benign and malignant disease

b. Up to 200 mci of I-131 f'

31 l

.4. Brachytherapy

a. Temporary implant of sealed radioactive sources b.

50 mci of Cs-137 or Ir-192 for two days

c. Implants or injections of short-lived radioactive materials such as.Au-198 (used to treat prostatic cancer) may produce high dose rates at-bedside. Weekly dose allowance may be received in one hour near bedside.

~ 5. Disgnostic sealed sources

a. Similar to conventional x-ray procedure

b. 200 mci of I-125

6. Teletherapy j

a. External administration of radiation for therapeutic purposes l

b. 5000 Ci of Co-60 l D. Contact RSO

1. For personal exposure data

2. For regulations, license, amendments, inspection reports

3. If pregnant

4. If problems are suspected )

. 5. If there are questions E. Personnel dosimeter procedures and precautions

1. Wear at collar level outside protective aprons

2. Leave at work in the specifed location at the end of each day

3. Use only to monitor personal radiation exposure at work. Do not use to' test home television or microwave oven or during personal medical or dental exposure

-4. Do not share with another person

5. Handle carefully

a. Dosimeters are affected by temperature, humidity, and chemicals-

b. Accidental mistreatment should be reported to RSO

6. . Procedures for signing out at termination of employment F. Sources of radiation

1. X-ray machines

2. Sealed sources

3. Teletherapy machines

4. Radiopharmaceuticals G. Potential for radiation hazards

-1. Areas

a. X-ray: low-level radiation when machine is being used 32 4

. - _ . - _ _. ---. - . , . - . , , - , , - , . - - , ,~ , - , , , - - . , , , - - - , - - - - - , - . . - , -

b. Cobalt teletherapy: high-level radiation when machine is being used; low-level radiation at all other times

c. Nuclear medicine: low-level radiation and contamination l

d. Laboratories: low-level radiation and contamination

2. Patients

a. X-ray: none

b. Teletherapy: none

c. Nuclear medicine: low-level radiation and contamination

d. Brachytherapy: low-level radiation; high-level radiation from displaced source H. The radiation symbol

1. Door signs

2. Work areas

3. Package labels I. In case of emergency, contact user and RSO for instructions for

1. Fire

2. Flood

3. Explosion

4. Unsecured room

5. Theft or vandalism J. Package receipt protocol

1. If leaking or damaged, call RSO. Ask carrier to stay for contamination check

2. Otherwise, place on wheelchair or cart, transport to room 33

Lecture No. __:. Physical Plant Personnel A. Potential risks of radiation exposure 1.- Prompt somatic

a. Examples: temporary change in blood count or dermatitis

. . b'. Observed following large dose over a short time period

c. Not observed for exposures within regulatory limits

2. Delayed somatic

a. Example: cancer

b. Increase in risk is about 0.0001 per rem of exposure

3. Genetic

a. Definition: abnormality observed in offspring due to previous )

irradiation of a parent's reproductive system

. b. Increase in risk with any exposure ,

c. Not observed for exposures within regulatory limits l

4. Teratogenic

a. Definition: abnormality observed in offspring due to irradiation in utero

b. Increase in risk above 10 rem.

c. Not observed for exposures within regulatory limits

5. Placing risks in perspective (appropriately summarize from Regulatory Guide 8.29)

8. The ALARA concept C. ' Procedures using radioactive material

1. In vitro laboratory

a. Test tube work

b. Microcuries of I-125, Co-57, and C-14

2. Diagnostic nuclear medicine i a. Injections for internal imaging

[ b. Usually 5-30 mci of Tc-99m 3 .' ' Therapeutic nuclear medicine

! a. Oral administration for benign and malignant disease

b. Up to 200 mci of I-131 34

t

4. Brachytherapy

a. Temporary implant of sealed radioactive sources

b. - 50 mci of Cs-137 or Ir-192 for two days

c. - Implants or injections of short-lived radioactive materials such as Au-198 (used to treat prostatic cancer) may produce high ,

I dose rates at bedside. Weekly dose allowance may be received j

-in one hour near bedside.

l

5. Diagnostic sealed sources

~

4

'a. Similar to conventional x-ray procedure

b. 200 mci of I-125

. 6. Teletherapy

a. External' administration of radiation for therapeutic purposes

b. 5000 Ci of Co-60

7. Ventilation Requirements - Xenon Use Areas

a. The need to perform air flow checks in these areas

b. The precaution that air flow in these areas NOT be altered or terminated without the prior knowledge of the RSO

c. Rationale for a. and b.

D. Contact RSO

1. For personal exposure data

2. For regulations, license, amendments, inspection reports

3. If pregnant-

4. If problems are suspected 5 .- If there are questions E. Personnel dosimeter procedures and precautions

1. Wear at collar level outside protective aprons

2. Leave at work in the specified location at the end of each day

3. Use only to monitor personal radiation exposure at work. Do not use i to test home television or microwave oven or during personal medical or dental exposure 4 .- Do not share with another person

5. Handle carefully

a. Dosimeters are affected by temperature, humidity, and chemicals

b. Accidental mistreatment should be reported to RSO

6. Proce'ures d for signing out at termination of employment F. Sources of radiation

- 1. X-ray machines

2. Sealed sources s

a-35 i

--w,,,g- e , , ,y m- <te----, m

-.. > - + * -----w- w ,,, _ _ _ , , , _ , , ,-+ 4 . , -,,,. , , y ,_y _,-

3. Teletherapy machines

4. Radiopharmaceuticals G. Potential for radiation hazards l

1. Areas

a. X-ray: low-level radiation when machine is being used

b. Cobalt teletherapy: high-level radiation when machine is being used; low-level radiation at all other times

c. Nuclear medicine: low-level radiation and contamination i

d. Laboratories: low-level radiation and contamination

2. Patients

a. X-ray: none

b. Teletherapy: none

c. Nuclear medicine: low-level radiation and contamination

d. Brachytherapy: low-level radiation; high-level radiation from displaced source H. The radiation symbol

1. Door signs

2. Work areas

3. Package labels I. Good practice when working

1. Look for the radiation symbol

2. Get user permission before working in an area

3. Beware of hoods, sinks, and storage areas J. Safety measures

1. Time: exposure is proportional to time

2. Distance: exposure decreases rapidly with distance

3. Shielding: lead aprons are frequently used in x-ray; most are not thick enough to help significantly in nuclear medicine or brachytherapy

4. Housekeeping: cleanliness reduces internal and skin contamination K. In case of emergency, contact user and RSO

1. Fire

2. Flood

3. Explosion I

l l

36 l

Lecture No.  : Secretarial and Clerical Personnel I A. Potential risks of radiation exposure

1. Prompt somatic

a. Examples: temporary change in blood count or dermatitis

b. Observed following large dose over a short time period

c. Not observed for exposures within regulatory limits

2. Delayed somatic

a. Example: cancer

b. Increase in risk is about 0.0001 per rem of exposure

3. Genetic

a. Definition: abnormality observed in offspring due to previous irradiation of a parent's reproductive system

b. _ Increase in risk with any exposure

c. Not observed for exposures within regulatory limits

4. Teratogenic a.' Definition: abnormality observed in offspring due to irradiation in utero

b. Increase in risk above 10 rem

c. Not observed for exposures within regulatory limits

5. Placing risks in perspective (appropriately summarize from Regulatory Guide 8.29)

8. The ALARA concept C. Procedures using radioactive material

1. In vitro laboratory ~

a. Test tube work

b. Microcuries of I-125, Co-57, and C-14

'2. Diagnostic nuclear medicine

a. Injections for internal imaging  ;

b. Usually 5-30 mci of Tc-99m l

3. Therapeutic' nuclear medicine

a. Oral administration for benign and malignant disease

b. Up to 200 mci of I-131 37

4. Brachytherapy

a. Temporary implant of sealed radioactive sources

b. 50 mci of Cs-137 or Ir-192 for two days ,

c. Implants or injections of short-lived radioactive materials such as Au-198 (used to treat prostatic cancer) may produce high dose rates at bedside. Weekly dose allowance may be received in one hour near bedside.

5. Diagnostic sealed sources

a. Similar to conventional x-ray procedure

b. 200 mci of I-125

6. Teletherapy

a. External administration of radiation for therapeutic purposes

b. 5000 Ci of Co-60 D. Contact RSO

1. For personal exposure data

2. For regulations, license, amendments, inspection reports

3. If pregnant

4. If problems are suspected

5. If there are questions E. Sources of ionizing radiation

1. X-ray machines

2. Radioactive materials

3. Teletherapy units

4. Natural radioactivity.in the earth and your body

5. Cosmic radiation

6. Television sets .

F. What are not sources of ionizing radiation

1. Microwave ovens

2. X-ray. machines that are turned off

3. X-ray and teletherapy patients

4. Nuclear medicine imaging and counting equipment-G. Potential sources of ionizing radiation at this institution

1. Diagnostic nuclear medicine patients

2. Therapeutic nuclear medicine patients

3. Portable x-ray machines

4. Brachytherapy patients

> 5. Laboratory areas

6. Teletherapy room 38 1

H. Radiation Area Signs I- 1. Observe radiation warning signs

a. Door signs

b. Work areas

2. Do not tarry in radiation areas

3. Notify RSO in case of suspected problems or if there are questions I

39

Lecture No. _: -Housekeeping Personnel A. Potential risks of radiation exposure

1. Prompt somatic

a. Examples: temporary change in blood count or dermatitis

b. Observed following large dose over a short time period

c. Not observed for exposures'within regulatory limits

2. . Delayed somatic

a. Example: cancer

b. Increase in risk is about 0.0001 per rem of exposure

3. Genetic

a. Definition: abnormality observed in offspring due to previous irradiation of a parent's reproductive system

b. Increase in risk with any exposure

c. Not observed for exposures within regulatory limits

4. Teratogenic

a. Definition: abnormality observed in offspring due to irradiation in utero

b. Increase in risk above 10 rem

c. Not observed for exposures within regulatory limits

5. Placing risks in perspective (appropriately summarize from Regulatory Guide 8.29)

8. The ALARA concept C. Procedures using radioactive material

1. In vitro laboratory

a. Test tube work

b. Microcuries of I-125, Co-57, and C-14

2. Diagnostic nuclear medicine

a. Injections for internal imaging

b. Usually 5-30 mci of Tc-99m

3. Therapeutic nuclear medicine

a. Oral administration for benign and malignant disease

b. Up to 200 mci of I-131 l

l l

40 l

i

4. Brachytherapy

a. Temporary implant of sealed radioactive sources

b. 50 mci of Cs-137 or Ir-192 for two days

c. Implants or injections of short-lived radioactive materials such as Au-198 (used to treat prostatic cancer) may produce high dose rates at bedside. Weekly dose allowance may be received in one hour near bedside.

5. Diagnostic sealed sources

a. Similar to conventional x-ray procedure

b. 200 mci of I-125

6. Teletherapy

a. External administration of radiation for therapeutic purposes

b. 5000 Ci of Co-60 D. Contact RSO

1. For personal exposure data

2. For regulations, license, amendments, inspection reports

3. If pregnant

4. If problems are suspected "

5. If there are questions E. Personnel dosimeter procedures and precautions

1. Wear at collar level outside protective aprons

2. Leave at work in the specified location at the end of each day

3. Use only to monitor personal radiation exposure at work. Do not use to test home television or microwave oven or during personal medical or dental exposure

4. .Do not share with another person

5. Handle carefully

a. Dosimeters are affected by temperature, humidity, and chemicals.

b. Accidental mistreatment should be reported to RSO

6. Procedures for signing out at termination of employment F. Sources of ionizing radiation

1. X-ray machines

2. . Radioactive materials

3. Teletherapy units

4. Natural radioactivity in the earth and your body

5. Cosmic radiation 6 .- Television sets 41

l i

1 G. Whct are not sources of ionizing radiation )

i

1. Microwave ovens

2. X-ray machines that are turned off l

3. X-ray and teletherapy patients

4. Nuclear medicine imaging and counting equipment H. -Potential sources of ionizing radiation at this institution

1. Diagnostic nuclear medicine patients ,

2. Therapeutic nuclear medicine patients

3. Portable x-ray machines

4. Brachytherapy patients

5. Laboratory areas

6. Teletherapy room I. Good practice when working

1. Look for the radiation symbol

a. Door sign

b. Work areas

c. Waste cans

d. Packages

, 2. Get user permission and instructions from Radiation Safety Offices before cleaning spills of radioactive material

3. Do not clean countertops, hoods, refrigerators, or sinks in areas where radiation signs are posted unless specially requested and instructed by the area supervisor or Radiation Safety Office staff.

4. Do not remove bedclothes, dishes, trash or other items from rooms posted with radiation signs, unless specifically instructed by the charge nurse or a member of the Radiation Safety staff l

l l

i l

42

Lecture No. __: Laboratory Users A. Potential risks of radiation exposure

1. Prompt somatic

a. Examples: temporary change in blood count or dermatitis ,

b. Observed following large dose over a short time period I

c. Not observed for exposures within regulatory limits

2. Delayed somatic

a. Example: cancer

b. Increase in risk is about 0.0001 per rem of exposure

3. Genetic

a. Definition: abnormality observed in offspring due to previous irradiation of a parent's reproductive system

b. -Increase in risk with any exposure

c. Not observed for exposures within regulatory limits

4. Teratogenic

a. Definition: abnormality observed in offspring due to irradiation in utero

b. Increase in risk above 10 rem

c. Not observed for exposures within regulatory limits

5. Placing risks.in perspective (appropriately summarize from Regulatory Guide 8.29)

B. The ALARA concept C. Procedures using radioactive material

1. In vitro laboratory

a. Test tube work

b. Microcuries of I-125, Co-57, and C-14

2. Diagnostic nuclear medicine i

a. Injections for internal imaging

b. Usually 5-30 mci of Tc-99m

3. Therapeutic nuclear medicine

a. Oral administration for benign and malignant disease l b.

Up to 200 mci of I-131 43

4. Brachytherapy

-j

'a. . Temporary implant of sealed radioactive sources j

b. l50 mci of Cs-137 or Ir-192 for two-days

c. Implants or injections of short-lived radioactive materials such as Au-198 (used to. treat prostatic cancer) may produce high dose rates at bedside. Weekly dose allowance may be received l

-in one hour near bedside.

]1

5. Diagnostic sealed sources.  ;

J

a. Similar to conventional x-ray procedure

b. 200 mci of I-125 L

6. Teletherapy.

a. . External administration of radiation for therapeutic purposes

b. -5000 Ci of Co-60 D. Contact RSO

1. For personal exposure data

2. For. regulations, license, amendments,-inspection reports

3. If: pregnant-

4. If problems.are suspected

5. If there are questions E. Personnel dosimeter procedures and precautions

1. Wear at collar level outside protective aprons

~

2. Leave at work in the specified location at the end of each day

3. Use only to monitor personal. radiation exposure at work. Do not use to test home television or. microwave oven or during personal medical or dental exposure-

- 4. !Do not share with another person

, 5. Handle carefully '

- a'. Dosimeters are affected by temperature, humidity, and chemicals

'b. Accidental mistreatment should be reported to RSO

6. Procedures for signing out at termination'of employment'

-F. . Radiation safety program

' 1. Radiation' Safety Officer duties i 2. Radiation Safety Committee duties

3. Authorized user duties-

x G. ALARA program H. General safety measures

1. Time: exposure is proportional to time

2. . Distance: exposure decreases rapidly with distance 44 L

3. Shielding: ' plastic for beta, lead for gamma; HVL for I-125 is about

.02 mm lead

4. Housekeeping: cleanliness reduces internal and skin contamination

.I. Minor spill procedure J. Periodic radiation surveys

1. Procedures

a. Removal of contamination

b. Use of survey meters

2. Documentation K. General rules for the safe use of radioactive material L. The radiation symbol

1. Door signs

2. Work areas

3. Waste cans

4. Packages M. Inventory requirements

1. Frequency

2. Method N. Ordering material

1. Authorized limits

2. Appropriate forms and routing of request )

3. Receipt and opening of material I

4. Proper storage

0. The radiation scale and site-specific radiation levels 1

P. Waste handling

1. Do not mix radioactive waste and nonradioactive waste

2. Obliterate radiation labels on empty, clean, and decay-in-storage vials

3. Do not mix short-lived and long-lived material-

4. label each container with user name, date, estimated mC1, and isotope before transporting to RSO S. Sanitary sewer disposal

6. Decay-in-storage disposal 7.' Handling liquid scintillation counting waste

8. Proper packaging for disposal by transfer

a. Dry

b. Liquid

c. Carcasses 45

t Q. Bioassay requirements l l

1. -For I-125 users, see Regulatory Guide 8.20 l

2. For H-3 users', see NUREG-0938, "Information for Establishing Bioassay l Measurements-and Evaluations of-Tritium Exposure," and draft '

Regulatory Guide OP 713-4, " Applications of Bioassay.for Tritium" R. Appropriate use of available instrumentation i

1. Well counters-

2. Liquid scintillation counters

3. GM survey meters

4. Ionization chamber survey meters 46

Lecture No. __: Animal Caretakers A. Potential risks of radiation exposure

1. Prompt somatic

a. Examples: temporary change in blood count or dermatitis

b. Observed following large dose over a short time period

c. Not observed for exposures within regulatory limits

2. Delayed somatic

a. Example: cancer

b. Increase in risk is about 0.0001 per rem of exposure

3. Genetic

a. Definition: abnormality observed in offspring due to previous irradiation of a parent's reproductive system

b. Increase in risk with any exposure

c. Not observed for exposures within regulatory limits

! 4. Teratogenic

a. Definition: abnormality observed in offspring due to irradiation in utero

b. Increase in risk above 10 rem

c. Not observed for exposures within regulatory limits

5. Placing risks'in perspective (appropriately summarize from Regulatory Guide 8.29)

B. The ALARA concept C. Procedures using radioactive material

1. In vitro laboratory

a. Test tube work

b. Microcuries of I-125, Co-57, and C-14

2. Diagnostic nuclear medicine

a. Injections for internal imaging Usually 5-30 mci of Tc-99m b.

3. Therapeutic nuclear medicine

a. Oral administration for benign and malignant disease

b. Up to 200 mci of I-131 47 l

l

. 4. Brachytherapy

a. Temporary implant of sealed radioactive sources j

b. 50 mci of Cs-137 or Ir-192 for two days

c. Implants or injections of short-lived radioactive materials such as Au-198 (used to treat prostatic cancer) may produce high

- dose rates at bedside. Weekly dose allowance may be received in one hour near bedside.

5. Diagnostic sealed sources

a. Similar to conventional x-ray procedure

b. 200' mci of I-125

6. Tele' therapy

a. External administration of radiation for therapeutic purposes

b. 5000 Ci of Co-60 D. Contact RSO

1. For personal exposure data

2. For regulations, license, amendments, inspection reports

3. If pregnant

4. If problems are suspected

5. If there are questions E. Personnel dosimeter procedures and precautions i

1. Wear at collar level outside protective aprons -

2. Leave at work in the specified location at the end of each day

3. Use only to monitor personal radiation exposure at work. Do not use to test home television or microwave oven or during personal medical or dental exposure

4. Do not share with another person

5. Handle carefully

a. Dosimeters are affected by temperature, humidity, and chemicals

b. Accidental mistreatment should be reported to RSO

< 6. Procedures for signing out at termination of employment F. , Sources of ionizing radiation

. 1. X-ray machines

2. Radioactive materials as chemicals or administered to animals

3. Natural radioactivity in the earth and your body

4. Cosmic radiation

5. Television sets l

G. What are not sources of ionizing radiation

1. - Microwave ovens

2. X-ray machines that are turned off I'

l 48 i

W -^*=-

Tm -y --

~~'

i a

3. [X-ray and teletherapy patients

4. Nuclear medicine imaging and counting equipment H. Potentialhaza$ds

1. External exposure

2. Internal exposure I. Safety Measu*y .

~

1. Wear gloves, aprons,, goggles, and boots

2. Wash well after working

3. Do not smoke, eat, drink, or apply cosmetics in work areas

4. Follow procedures to handle and discard droppings

5. Follow procedures to handle and discard carcasses n s-

.t

/

D*

9 i

49 i

i

i l

APPENDIX II The Radiation Scale Some individuals who are exposed to radiation on the job have no concept of orders of magnitude of radiation exposure. They may tend to simply divide the workplace into two areas: rooms with radiation and rooms without radiation.

Table II-1 showing representative quantities of radiation dose has been con-structed from several sources. If there are ranges within or among referenced sources, the range of reported values is generally given. It should be emphasized to the audience that the values are " order of magnitude indicators" and not legal limits or ideal goals.

The table has three sections. The first section identifies commonly encountered radiation doses. The second section presents examplet of some recommended maximum permissible doses. The third section identifies radiation doses that have the potential for biological effects on humans. The table does not address genetic effects of radiation. For a more complete discussion of the effects of radiation, refer to Regulatory Guide 8.29, " Instruction Concerning Risks from Occupational Radiation Exposure."

a l

l l

50

Table 11-1 The Radiation Scale Dose Whole body Information in rem or local source

• Some Commonly Encountered Radiation Doses:

One transcontinental airline flight 0.003 WB 1 Standing beside'a diagnostic nuclear medicine 0.0001 .008 WB 2, 3 patient for one hour

'Living in a brick house for one year, add to 0.013 WB 4 your natural background exposure One diagnostic nuclear medicine study 0.01-2.2 WB 5 One chest radiograph 0.03-0.05 L 6,7,8,9 Natural background in the United States 0.08-0.15 WB 1, 6, 10 at sea level for one year Natural background in Denver for one year 0.12 WB 1 One abdominal radiograph 0.5-1 L 6,7,9 Annual occupational dose to a nuclear medicine 0.3-1 WB 11, 12 technician One CT series of the brain 2 L 9, 13 Recommended Maximum Permissible Doses:

Recommended maximum permissible dose for 0.5 WB 14, 15 cne year for-individuals not exposed cccupationally Recommended maximum permissible dose for one 5 & WB 15 year for occupationally exposed individuals Recommended maximum permissible planned special e10 WB 15 dose Maximum permissible dose for one year to 75 L 14 hands of occupationally exposed individuals Potential Biological Effects from Radiation Doses:

Risk of contracting cancer increased 0.01% 1 WB 16 Temporary change in blood count 25 WB 10 Cataract formation 600-1500 L 6, 15 Permanent sterilization in men 100-300 L 17 Permanent sterilization in women 250-800 L 17 Lethal single exposure 500 WB 18 Therapeutic dose for malignancy 6000 L 10

• See following pages.

51

Information Sources for Table 11-1

1. National Council on Radiation Protection and Measurements, " Natural Background Radiation in the United States," NCRP Report No. 45, Washington, DC, 1975.

2. L. Brateman, T. H. Shawker, and D. M. Conca, " Potential Hazard to Ultra-sonographers from Previously Administered Radionuclides," Radiology, Vol. 134, No. 2, pp. 479-482, February 1980.

3. I. B. Syed et al., " Radiation Exposure in Nuclear Cardiovascular Studies,"

Health Physics, Vol. 42, No. 2, pp. 159-163, February, 1982.

4. National Council on Radiation Protection and Measurements, " Radiation Exposure from Consumer Products and Miscellaneous Sources," Report No. 56, Washington, DC, 1977.

5. R. Chandra, Introductory Physics of Nuclear Medicine, Lea and Febiger, Philadelphia, p. 79, 1976.

6. J. Shapiro, Radiation Protection, Harvard University Press, Cambridge,

p. 54, 1972.

7. " Radiation Protection Guidance to Federal Agencies," Federal Register, Vol. 43, No. 22, February 1, 1978.

8. U.S. Nuclear Regulatory Commission, " Instruction Concerning Prenatal Radiation Exposure," Regulatory Guide 8.13, p. 4.

9. K. L. Mossman, " Analysis of Risk in Computerized Tomography and Other Diagnostic Radiology Procedures," Computerized Radiology, Vol. 60, pp. 251-256, 1982.

10. N. Frigerio, "Your Body and Radiation," U.S. Atmomic Energy Commission, Office of Information Services, 1967.

11. G. A. Lis, S. M. Zubi, and S. M. Brahmavar, " Fingertip and Whole Body Exposure to Nuclear Medicine Personnel," Journal of Nuclear Medicine Technology, Vol. 9, No. 2, pp. 91-97, 1982.

12. " Requirements for an Effective National Ionizing Radiation Measurements Program," National Bureau of Standards Special Publication 603, p. 3, March 19, 1981.

13. T. Villafana et al., " Health Physics Aspects of the EMI Computerized Tomography Brain Scanner, " Health Physics, Vol. 34, No.1, pp. 71-82, January 1978.

14. Code of Federal Regulations, Title 10, Part 20 (10 CFR Part 20),

" Standards for Protection Against Radiation," U.S. Government Printing Office, Washington, DC.

52

15. International Commission on Radiological Protection, " Recommendations of the International Commission on Radiological Protection," ICRP Publica-tion 26, Pergamon Press, Oxford, 1977.

16. Committee on the Biological Effects of Ionizing Radiation of the National Research Council, "The Effects on Populations of Exposure to Low Levels of Ionizing Radiation: 1980," National Academy Press, Washington, DC, 1980.

17. P. Ash, "The Influence of Radiation on Fertility in Man," British Journal of Radiology, Vol. 53, pp. 271-278, April 1980.

18. " Interagency Task Force on the Health Effects of Ionizing Radiation:

Report of the Work Group on Science," U.S. Department of Health, Education and Welfare, Washington, DC, June 1979.

l 53

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'E.'" W' BI:LIOHRAPHIC DATA SHEET

-E iN.1 uctioN.o 1, E .E.E. E NURE-H34

3. TITLE AND SueTITLE 3 LE Avt BLANE Radiation Protection Training for Personnel Bnployed in ,

Medical Facilities l 4 DATE REPORT COMPLETED MONTH WEAR

. Aui Oam April 1985 4 DATE REPORT iS$uED Noman L. McElroy and Allen Brodsky "

May l 1985

7. PE ,OMuiNG ORGANt2 AllON NAME AND M A LING ADDRESS tracaverle C.et 8 PROJECTITASE/ WORK uNii NUU9ER i OP-212-4 Division of Radiation Programs and Earth Sciences ePNOaGaANTNuM.Ea Office of Nuclear Regulatory Research U. S. Nuclear Regulatory Commission W rhington. DC 20555

10. SPONSOmiNG ORGANi2 ATiON NAME AND M AILING ADDRES$ ttars v ar le Coser II. TYPE O. REPORT Same as 7 above. Tec M eal Repod D PERIOD COVERED flac8ers.oe s esost 12 SUPPLEMENTARY NOTES

13. AS$ TRACT (J00 ereres .r seses This report provides information useful for planning and conducting radiation safety training in medical facilities to keep exposures as low as reasonably achievable, and to meet other regulatory, safety and loss prevention requirements in today's hospitals. A brief discussion of the elements and basic considerations of radiation safety training programs is followed by a short bibliography of selected references and sample lecture (or session) outlines for various job categories. This information is intended for use by a professional who is thoroughly acquainted with the science and practice of radiation protection as well as the specific procedures and circumstances of the particular hospital's operations. Topics can be added or subtracted, amplified or condensed as appropriate.

This document does not set forth specific training program requirements for any particular hospital or type of medical institution or group of employees.

is oOCuMENT ANALvsi . kev onDscotsCa.PTOas iuTv in Av,A rcdiation protection training Unlimited 16 SECumirv CLAS$1FICArlON Irne o.pos m ioENvi,iE=wE= ENoto rt.M. Unclassified

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