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Radiation Safety Review for Radiation Oncology Staff


Radiation Safety Review for Radiation Oncology Staff MARCUS JEANNETTE RADIATION SAFETY OFFICER 744-2070 * * * * * * * * Highlights of NCRPAR 15A NCAC 11 .1600 ... – PowerPoint PPT presentation

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Title: Radiation Safety Review for Radiation Oncology Staff

Radiation Safety Review for Radiation Oncology
  • 744-2070

Office of Radiation Safety Responsibilities
  • Comply with regulations, laws, and guidelines
    regarding the safe use of radioactive material
    and radiation producing devices.
  • Protect employees, students, and the general
    public from overexposure to radiation at East
    Carolina University.

Regulatory Environment
  • There are a number of factors involved and during
    the process of this training session you should
    gain a larger understanding of the reason.
  • We will first look at where the regulations
    originate from and what agencies govern our
    operational use of radiation producing machines
    and radioactive materials.

This training is mandated by regulation, but why?
Scientific Community
International Commission on Radiation
Protection ICRP
  • The ICRP and NCRP are advisory bodies that
    collect and analyze data regarding ionizing
    radiation and put forth recommendations on
    radiation protection.
  • The regulatory groups utilize these
    recommendations when developing regulations.

National Council on Radiation Protection and
Measurements NCRP
Federal Regulatory Groups
  • Many Federal agencies have regulations that deal
    with radiation protection.
  • Each agency regulates a different aspect as it
    pertains to their particular program area.

NRC Nuclear Regulatory Commission FDA Food
Drug Administration FEMA Federal Emergency
Management Agency OSHA Occupational Safety and
Health Administration DOT Department of
Transportation EPA Environmental Protection
Agency USPS United States Postal Service
State Regulatory Groups
  • In North Carolina, the Radiation Protection
    Section regulates the safe use of ionizing
    radiation (electronic product or radioactive
    materials) used at our facility.
  • We are authorized to use these sources of
    ionizing radiation via licensure (radioactive
    materials and accelerators) and registration
    (diagnostic x-ray equipment). Our facility has a
    radiation protection program that must meet the
    requirements set forth by the State in order to
    maintain these authorizations.

Licenses and Radiation Safety Committees
Current Licenses Managed By ECU
  • 074-296-1, Broad Academic License
  • 074-296-A1, Physics Linear Accelerator
  • 074-296-A2, LJCC Accelerators
  • 074-296-7, ECHI Nuclear Cardiology

ECU Radiation Safety Committees
  • Basic Sciences-Radiation Safety Committee
  • -Academic Research
  • -Physics Linear Accelerator
  • Clinical Radiation Safety Committee
  • -Therapy Accelerators
  • -High Dose Rate Applicator

Committee Responsibilities
  • Develop policies and procedures for the safe use
    of radioactive materials and radiation producing
  • Approve authorized users.
  • Provide technical advice to the RSO.
  • Review all instances of alleged infractions of
    the use of ionizing radiations or safety rules
    with the RSO and responsible personnel and take
    corrective actions.
  • Review periodic reports from the RSO.

Basic Radiation Physics
Ionizing vs. Non-IonizingRadiations
  • Ionizing Radiation
  • A radiation that has sufficient energy to remove
    electrons from atoms or molecules as it passes
    through matter.
  • Examples x-rays, gamma rays, beta particles,
    and alpha particles
  • Non-Ionizing Radiation
  • A radiation that is not as energetic as ionizing
    radiation and cannot remove electrons from atoms
    or molecules.
  • Examples light, lasers, heat, microwaves, and

  • Whether we talk about ionizing or non-ionizing
    radiation, its genesis is either within or very
    close to the exterior of the atom. The following
    is a brief review the atomic structure.

The atom is comprised of a nucleus, which is made
up of positively charged protons and electrically
neutral (no charge) neutrons, surrounded by
negatively charged electrons.
In an electrically neutral atom, the number of
positively charged protons and negatively charged
electrons are equal.
Radiation Origins
  • Ionizing radiation (hereafter, referred only as
    radiation) can be generated by electronic means
    (x-ray units) or radioactive materials.
  • When electronic-product radiation is produced,
    the source is turned on and off like a light
    switch. Once the unit is off, the radiation
    exposure is over. The x-ray unit does not
    continue to radiate or become radioactive.
  • With radioactive materials, there is a little
    more involved. The source is always on until it
    decays away.

Next A review of both types of ionizing
radiation generators X-rays and Radioactive
Radioactive MaterialTypes of Radiations
  • Gamma rays and X-rays are essentially the same,
    except for where they originate. Gamma rays
    originate from the nucleus, and X-rays originate
    outside the nucleus of an atom.
  • These rays have no mass or no charge, and are
    very penetrating.
  • These rays are the same as light (electromagnetic
    radiation), only much more energetic.
  • Considered more of an external hazard than
  • Both rays are great for imaging patients.

Generally, stopped by lead.
Sources include naturally occurring radioactive
materials and cosmic radiation.
Medical imaging
FYI As discussed earlier, x-rays can be
produced by radioactive decay or electronic
production. Both originate outside the nucleus
of the atom.
X-ray GenerationReview
  • X-rays as produced by an x-ray unit are also know
    as Bremsstrahlung. It is a German word for
    braking radiation.
  • As depicted in the diagram, when the electron
    slows very fast (brakes) as it gets close to the
    atom of the target nucleus, x-rays (radiation)
    are formed.
  • X-rays are emitted in all directions therefore,
    the structure housing the x-ray tube is shielded
    except for a port where the x-rays escape and can
    be used for diagnostic purposes.

FYI If youve ever had an x-ray, when the x-ray
technologists takes your picture, it is over.
The x-ray unit does not continue to produce
radiation after the exposure is complete.
Radiation Units
Now that you have a little understanding of the
physics behind ionizing radiation, how do we
measure or quantify radiation? Here are a few
units of measure that are used (often
interchangeably) in radiation protection
  • Exposure
  • A measure of ionization produced in air by X or
    gamma radiation.
  • Highly specific in that the unit specifies the
    matter being exposed and radiation producing the
  • Unit roentgen (R)
  • 1 R 1000 mR
  • Absorbed Dose
  • A measure of energy deposition per unit mass
  • Considers all radiations imparting energy to all
    types of matter.
  • Unit rad
  • 1 rad 1000 mrad
  • SI Units gray (Gy)
  • 1 Gy 100 rad
  • Dose Equivalent
  • It is numerically equal to the absorbed dose by a
    quality factor
  • Dose equivalent is needed because the biological
    effect from a given absorbed dose is dependent
    upon the type of radiation producing the absorbed
  • Unit rem
  • 1 rem 1000 mrem
  • SI Units sievert (Sv)
  • 1 Sv 100 rem

Radiation UnitsDose Equivalent
  • The unit of measure, dose equivalent, was
    instituted to take into account the relative
    biological effectiveness of the differing types
    of radiations.
  • Some radiations like alpha particles are densely
    ionizing therefore, as they pass through tissue,
    they are able to strip more electrons than beta
    particles or x-rays or gamma rays20 times
    greater. In short, alpha particles are better at
    producing damage.
  • Absorbed dose merely documents how much energy is
    being deposited per unit mass, it does not
    consider how effective each radiation is at
    producing damage in a biological system.
  • The more densely ionizing, the more damage is

FYI If you wear a badge, your dose in reported
in mrem.
Biological EffectsandRadiological Risk
Biological Effects
  • Acute Effects
  • Generally occurring in the individual receiving
    the radiation dose.
  • A threshold dose must be exceeded before
  • Example Radiation Sickness
  • Delayed Effects
  • Can occur in the individual receiving the
    radiation dose or the offspring.
  • Probabilistic effect, whereby the increase in
    dose increases the probability that the effect
  • Example Cancer or genetic mutation
  • Who cares about electrons being stripped from
  • Electrons are essential in creating molecular
    bonds. When radiation breaks those bonds, the
    molecule ceases to function properly.
  • Research has shown that the body has great repair
    mechanisms, but when overwhelmed the repair may
    be incomplete or incorrect.
  • If enough damage to a region occurs, the result
    may be cell death.
  • Damage may manifest as delayed or acute

Biological Effects
  • Epidemiological studies of these groups have
    shown that following significant radiation doses,
    effects were observed.
  • The effects were both acute and delayed.
  • What we know about the effects of radiation come
    from a number of different exposed populations
  • Atomic bomb survivors
  • Accident victims
  • Radium watch dial painters
  • Radiation therapy patients
  • Early experimenters with radiation

Dose versus Effect
  • Nobody knows for sure what radiation dose does to
    us below the shaded region. There may be a
    threshold where there is no effect from radiation
    below a certain dose.
  • In Radiation Protection, as a protective measure,
    it is assumed that all dose carries some risk,
    this is represented by the straight red line on
    the diagram.

FYI There are other theories regarding the
effects of radiation dose (as represented by the
other lines blue and gray), to include
radiation hormesis. Radiation hormesis is a
theory that chronic low doses of radiation is
good for the body.
Radiation Risk
  • Understanding the different types of effects,
    regulatory agencies impose radiation dose limits
    that eliminate the likelihood of acute effects
    and reduce the likelihood of delayed, or
    risk-based, effects.
  • Regulatory groups are concerned with fatal risk
  • The current regulatory limit for an
    occupationally exposed worker is 5,000 mrem per
  • When initially instituted, the radiation dose
    limit represented a risk that was equal to that
    of other safe industries.
  • Given that the regulatory limits are risk-based,
    and that increasing ones dose increases ones
    chance that an effect may occur, the law also
    requires radiation workers to employ the
    philosophy of ALARA, or keeping your radiation
    dose As Low As Reasonably Achievable.

Putting Radiation in Perspective!
  • Everyone on Earth is being exposed to radiation!
  • The average North Carolinian receives
    approximately 360 mrem of radiation dose per
  • Background radiation dose is affected by
    altitude, soil type and other factors. There is
    a wide variation of natural backgrounds in the
  • Some places have annual background radiation
    levels greater than the US dose limits for
    radiation workerswith no excess cancer

Did you know some of the foods you eat contain
naturally occurring radioactive material?
Bananas contain low quantities of Potassium-40.
PracticalRadiation Safety
Protecting Ourselves from External Exposure
  • Adhere to the three cardinal rules of external
    radiation protection
  • TIME

TIME Less Time Less Exposure
DISTANCE Greater Distance Less Exposure
SHIELDING More Shielding Less Exposure
External Radiation ProtectionConsider This
Exposure to a source of ionizing radiation is
very similar to the exposure from a light bulb
(i.e. light and heat).
The closer you are to the source, the more
intense the light and heat are. Likewise, if you
move away, the intensity decreases.
The longer you are close to the light bulb, you
begin to feel the warming effects of the light.
If however, you move quickly to and from the
light, youll not likely feel the warming effect.
If you put something opaque between you and the
light bulb, you effectively eliminate the light.
Exposure and Contamination
A difficult concept to understand is the
difference between exposure and contamination
when we talk about radioactive materials. To
illustrate the difference, consider a burning
  • If you stand away from the candle, you are
    being exposed to the candles light. If you
    leave the room, your are no longer exposed to the
    candles light.
  • If you walk up to the candle, you are being
    exposed to the candles light. If you then
    reached out and grabbed the candle, you would get
    hot wax on your hand. If you left the room, you
    are no longer exposed to the light, but the wax
    on your hand (i.e. contamination) remains. If
    the wax were radioactive, the contamination
    would continue to expose your hand until you
    washed it off.

Remember Being exposed by a radioactive source
does not contaminate you. You must have
interacted with the source to get some of the
source on you. Once on you, the contamination
will expose you until it is removed.
General Safety Guides for Use of Radiation
Producing Equipment
  • X-ray equipment should not be left unattended
    while in operating mode.
  • When in fixed radiographic rooms, operators shall
    remain behind the protective barrier.
  • If required to be in a room during a diagnostic
    x-ray exposure (e.g. fluoroscopy), wear a lead
    apron or stand behind a protective barrier.
  • Where your dosimetry, if applicable.
  • Follow established procedures when unsure, stop
    and notify your supervisor or the RSO.
  • Keys MUST not be left in portable x-ray equipment.

Radiation Symbols
  • Caution Radioactive Materials
  • Caution Radiation Area
  • Caution Radiation Area when X-ray Energized

North Carolina Regulations for the Protection
Against Radiation (NCRPAR)
NC Regulations for the Protection Against
  • This is the LAW.
  • Web location http//www.ncradiation.net/documents

Highlights of NCRPAR
  • 15A NCAC 11 .1600, Standards for the Protection
    Against Radiation.
  • 15A NCAC 11 .0300, Licensing of Radioactive
  • 15A NCAC 11 .0600, X-rays in the Healing Arts
    (Not included in this Presentation).
  • 15A NCAC 11 .0900, Requirements for Particle
    Accelerators (Not Included in this Presentation)

.1600, Standards for the Protection Against
  • .1603, Radiation Protection Program
  • .1604, Occupational Dose Limits for Adults
  • .1610, Dose Equivalent to an Embryo Fetus
  • .1611, Dose Limits for Individual Members of the

Radiation Protection Program (.1603)
  • The Licensee or registrant must develop, document
    a radiation protection program commensurate with
    the scope and extent of licensed activities.
  • Program must insure compliance with the
    provisions outlined in .1600
  • For example compliance with occupational dose
    limits, record keeping, dose limits for members
    of the public, radiological area surveys, annual
    program review, etc.

Occupational Dose Limits (.1604)
  • The occupational dose limits for workers in North
    Carolina and the US are as follows
  • Whole Body (WB) 5,000 mrem/yr
  • Extremities/Skin 50,000 mrem/yr
  • Lens of the Eye 15,000 mrem/yr
  • Minor WB (lt 18 years old) 500 mrem/year
  • Declared Pregnant Worker 500 mrem/gestation
  • By regulation, the institutional radiation
    protection program shall monitor individuals
    exposure/dose if they are likely to receive 10
    of the limit, or in the case of declared pregnant
    workers and minors the threshold is 100 mrem.

Personnel Monitoring Methods(Dosimetry)
  • Monitoring Required Monitoring Method
  • Whole Body TLD or OSL Badge
  • Extremity Finger Ring TLD
  • Internal Contamination Urinalysis or

Ring Badge
Whole Body Badge
Thyroid Bioassay
General Rules for Use of Dosimetry
  • Wear your own badge.
  • Wear your whole body (WB) badge whenever working
    with radiation sources
  • Notify the RSO immediately when a badge is lost.
  • Wear ring badges under gloves.
  • Store badges in designated areas at the end of
    each day of work.

Personnel Dosimetry - FYI
  • Dosimetry does not protect you from radiation.
  • Dosimetry is not a warning device (i.e. it will
    not alarm, beep or change color)
  • Dosimetry documents the radiation dose an
    individual receives when working with radiation
  • It is ILLEGAL to intentionally expose an
    individuals dosimeter.

Personnel Dosimetry Review
  • Each monitoring period dose report is reviewed by
    the Radiation Safety Officer
  • The report is compared against the institutions
    investigational levels
  • gt200 mrem/monitoring period to whole body
  • gt 2000 mrem/monitoring period to extremities
  • gt 800 mrem/monitoring period to the skin
  • Action Required Written notification from RSO
    to worker and investigation

Dose Equivalent to an Embryo/fetus (.1610)
  • Occupational exposure to the fetus of a declared
    pregnant woman shall not exceed 500 millirem
    during the 9 month pregnancy.
  • Declare pregnancy as soon as possible

Declared Pregnant Workers
  • Available for those radiation workers who are
    pregnant or planning a pregnancy.
  • Purely VOLUNTARY!
  • To be apart of the program, you must DECLARE your
    pregnancy in writing to your supervisor and
    provide the estimated date of conception. The
    RSO must be notified immediately upon
  • The declared pregnant worker may be provided with
    a dosimeter that will be worn at the waist level.
    If lead is worn, the fetal badge shall always
    be worn under the lead.

Dose Limits for Individual Members of the Public
  • The total effective dose equivalent shall not
    exceed 100 millirem within one year.
  • The dose in any unrestricted area from external
    sources of radiation , exclusive of the dose
    contribution from patients administered
    radioactive material and released in accordance
    with the regulations, does not exceed 2 millirem
    in any one hour.
  • This is basically 2 millirem per week for a 50
    week work period.
  • Patients recieving medical care are exempted from
    this rule!

How do we comply with the Dose Limits for Members
of the Public?
  • Radiation Safety Policies and Procedures
  • Radiological Area Surveys
  • Contamination surveys
  • External Radiation surveys
  • Environmental Monitoring
  • Landauer OSL Environmental monitors
  • Standard OSL monitors

Geiger Mueller Detector
  • Geiger counters are portable devices that detect
    and measure radioactivity.
  • Can be used to detect beta, gamma and X-ray
  • Geiger-Muller tube is filled with an inert gas
    that will conduct electricity when ionized. The
    tube amplifies this conduction by a cascade
    effect and outputs a current pulse, which is
    displayed by a needle or audible clicks.

Licensing of Radioactive Material (.300)
  • .0350, Records and Reports of Misadministration
  • .0356, Procedures for Administration Requiring a
    Written Directive
  • .0364, Medical Events
  • .0365, Report and Notification of a Dose to an
    Embryo/Fetus or Nursing Child

Records and Reports of Misadministration (.0350)
  • Repealed as of November 1, 2007
  • Changed to Medical Event, .0361

Written Directives
  • The prescription or order given by a physician
    that is documented in the patient chart or
    electronic charting system (Lantis).
  • A written prescription must be completed by the
    authorized Physician.
  • Treatment summary will be completed by the chief
    radiation therapist and medical physics staff
    upon completion of treatment
  • The patients identity will be verified before
    each and each administrations written directive.

The Written Directive will Include
  • Volume (site) to be treated
  • Radiation modality
  • Dose per fraction
  • Total number of fractions
  • Treatment Pattern
  • Prescription point or isodose
  • Technique used

Medical Events (.0364)
  • Medical Event is the administration of
    radioactive material or radiation that results
  • 1. A dose that differs from the prescribed dose
    by 5 rem effective dose equivalent, 50 rem to
    an organ or tissue.
  • 2. The total dose delivered differs from the
    prescribed dose by 20 or more..
  • 3. An administration of the wrong radioactive
    drug containing radioactive material.
  • 4. An administration of a radiopharmaceutical by
    the wrong route of administration.
  • 5. An administration to the wrong patient.

Reporting a Medical Event
  • Notify the RSO Immediately
  • Call DENR, RPS within 24 hours of event
  • 919-571-4141
  • Give the following information
  • Callers Name
  • Licensee East Carolina University School of
  • Date of Medical Event
  • Date of discovery
  • License Number 074-296-A2
  • Brief Description of Event

Reporting a Medical Event
  • ECHI will submit a written report to DENR within
    15 days.
  • The report should include the following
  • 1. The licensees name
  • 2. The name of the prescribing physician
  • 3. Brief description of the event
  • 4. Why the event occurred
  • 5. The effect on the individual(s) who received
    the administration
  • 6. Corrective Actions
  • 7. Certification that we notified the
    individual involved
  • The Medical Event reporting form is available on
    the web at www.ncradiation.net

Accelerator Safety
  • Maintenance should only be performed by a
    qualified expert with the proper training. Before
    entering the treatment room for any reason,
    always verify that LINAC or Cyberknife is in a
    beam off condition. Notify the operator before
  • Before rotating the gantry, always verify that
    the treatment couch is positioned and the
    patient restrained so a collision cannot occur.
  • Notify your supervisor of any abnormal occurences
    with the LINAC/Cyberknife..
  • Do not continue operation of the LINAC/Cyberknife
    or attempt to deliver a treatment if there is
    any indication of a malfunction of any kind.
  • Always remove the console keys and deposit them
    in a secure area when the LINAC/Cyberknife is
    unattended. The keys should always be removed at
    night and on the weekend.

Accelerator Safety
  • If a power failure or emergency stop should shut
    down the LINAC/Cyberknife during treatment,
    always remove the patient and have a maintenance
    check of the unit before completing treatment.
  • Emergency procedures are posted at all three
    shielded vaults. Emergency contacts are also
  • Quality Assurance checks should be performed
    daily, monthly and annually. Review the Radiation
    Oncology policies and procedures regarding the
    the type of checks that are to be performed
  • No one except the patient under treatment shall
    be in the accelerator room when the beam (x-ray
    or electron) is energized. When a patient must be
    held in position for radiation therapy,
    mechanical supporting or restraining shall be
  • This is a North Carolina Regulation for the
    Protection Against Radiation, 15A NCAC 11
  • Absolutely NO exceptions to this rule.

LINAC Emergency Procedure
  • In the event of any malfunction of the treatment
    unit(s) (mechanical, electrical, or
    otherwise) which may prove hazardous to the
    patient, therapist or the any member of the
  • 1. Press any emergency off button.
  • 2. Remove patient and other personnel from
  • 3. Close accelerator door.
  • 4. Call the Radiation Safety Officer AND the
    Medical Physicist listed below.
  • 5. Remain at the console and prevent entry of
    personnel into vault until problem has been
    resolved, if possible.

Emergency Call List
  • Medical Physicist
  • Melodee Wolfe
  • Beeper 754-3422 Home 524-5720
  • Claudio Sibata
  • Beeper 561-9445 Home412-2875
  • Radiation Safety Officer
  • Marcus Jeannette
  • Beeper 757-5056 Home 258-8005

One Last Thought to Remember!
  • Radiation protection is not just the
    responsibility of management, the Radiation
    Safety Committee, the Radiation Safety Officer or
    co-workers, it is all of our responsibility.

  • The North Carolina Regulations for the Against
    Radiation May be found at the following Website
  • http//ncradiation.net/documents/15ANCAC11_1107.pd
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