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Radiation Protection in Radiotherapy

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Radiation oncology. Certification of an adequate level of competence ... Quality Assurance within department of radiation oncology ... – PowerPoint PPT presentation

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Title: Radiation Protection in Radiotherapy


1
Radiation Protection inRadiotherapy
IAEA Training Material on Radiation Protection in
Radiotherapy
  • Part 18
  • Organization and Implementation
  • of a Radiation Protection Programme

2
IAEA Basic Safety Standards
Each Licensee must develop Safety Objectives in
conformity with BSS requirements
Radiation Protection Programme to achieve these
objectives
Commensurate with nature and extent of risks
Sufficient to ensure compliance
3
Responsible employer has a responsibility to
ensure that a radiation safety programme is set
up, in accordance with any local regulatory
requirements, and/or the BSS
  • Every radiation user in medicine also has
    responsibilities
  • Everyone should be aware of this...

4
Objectives
  • To be familiar with the basic structure of a
    radiation protection programme
  • To understand the components of an effective
    radiation protection programme in the context of
    radiotherapy
  • To understand the role of a radiation safety
    officer and a radiation safety committee
  • To appreciate the importance of education and
    training for radiation safety

5
Contents
  • 1. Radiation Protection Programme
  • 2. Organizational structure
  • 3. The role of the Radiation Safety Officer (and
    other professionals)
  • 4. The role of committees
  • 5. Education and training

6
1. Radiation Protection Programme
  • Determine measures and resources required to meet
    objectives and ensure they are provided
  • Review measures and resources regularly
  • Identify failures and shortcomings and take steps
    to prevent them
  • Establish consultation and co-operation of all
    parties
  • Maintain records of activities

7
Typical elements of a RPP
  • Assignment of responsibilities
  • The Radiation Protection Officer
  • Designation of radiation areas
  • Local rules
  • Education and training
  • Planning for accidents and emergencies
  • Health surveillance and monitoring
  • Review and audit
  • System of recording and reporting

8
Radiation Protection Programme in Radiotherapy
  • Many aspects covered in other parts of the course
  • Based on IAEA BSS (1996)
  • More details in IAEA TECDOC 1040

9
2. Organisational Structure
Regulatory Authority Authorization and Inspection
Licensee Overall responsibility for application
of BSS
Employer Overall responsibility for application
of BSS
and/or
Radiotherapy Facility
10
Regulatory Authority Authorization and Inspection
Radiation Protection Officer and /or Medical
Physicist
Radiation Oncologist
Radiation Safety Committee
Engineers, Technicians
11
Local Rules
  • Local rules are intended to provide adequate
    levels of protection and safety through the
    establishment of common work procedures and other
    systems to be followed by all workers in the area
  • They should include all information required for
    work in the area, and be made known to all
    workers

12
Local Rules
  • Set down in writing
  • person(s) responsible for supervising the work
  • description of controlled and supervised areas
  • general radiation safety measures
  • dose investigation levels
  • emergency plans

13
Radiation Safety Manual
  • The RSM is ideally a local reference book, and
    made available to (and possibly mandatory reading
    for) all radiation workers
  • An effective aid to training, and a valuable tool
    in itself is a Radiation Safety Manual
  • This now is required practice in many countries

Radiation Safety Manual
14
Radiation Safety Manual
  • The RSM should include sections on
  • basics of radiation safety
  • sources, risks and effects of radiation
  • local radiation safety organization
  • national/state regulations
  • personnel monitoring
  • emergency procedures

15
Radiation Safety Manual should contain
  • Sections covering local rules in radiation-user
    departments including radiotherapy
  • Death procedures (patients containing radioactive
    materials)
  • Radiation and pregnancy (for radiation workers,
    but also including information relating to
    pregnant patients)
  • Incident/accident procedures
  • Research and radiation

16
System of Recording and Reporting
  • In each radiation facility there should be a
    system instituted where all relevant information
    relating to radiation work is recorded,
    documented and when necessary, reported to
    management
  • This is a key factor in control of exposures and
    maintenance of a safe working environment

17
Reports are not a one way street
  • Acknowledgement of reports
  • Additional questioning
  • Feedback very important

???
18
External reporting
  • May depend on national regulations
  • In general the following should be reported to
    the regulatory authority
  • any proposed changes to license conditions
  • any proposed new buildings or building
    modifications relevant for radiation safety
  • radiation accidents

19
External reporting
  • Shall be done within a specified time period
  • Shall include all relevant information
  • Is typically done via the licensee/registrant
  • ...may also be useful to professional
    organisations where information can be
    disseminated

20
Responsibilities
  • BSS 1.6 The registrant/licensee or (if different
    from this) the employer has a responsibility to
    ensure that a radiation safety programme is set
    up
  • The registrant/licensee is the legal person
    responsible for radiation protection and
    compliance with BSS and local standards (as
    applicable)
  • Some responsibilities can be delegated

21
Responsibility of the Radiation Oncologist
(Medical User)
  • The medical practitioner has the obligation of
    ensuring overall protection and safety in the
    prescription and delivery of medical exposure
    (BSS II.1.(b))
  • This obviously includes the patient, but also
    staff and public

22
Some Responsibilities for Radiation Protection
  • may be delegated
  • The Radiation Protection Officer is typically the
    key person responsible for the radiation
    protection programme and its implementation

23
3. Radiation Protection Officer
  • A person technically competent to provide advice
    and oversight of the local radiation safety
    programme - often (but not necessarily) a
    radiation oncology physicist
  • The RPO is a crucial component of the programme,
    and should be given the resources and authority
    necessary

24
Radiation Protection Officer
  • The RPO will often need further training specific
    to radiation protection (or radiotherapy
    depending on her/his background), which is not
    necessarily available in all countries
  • The IAEA runs a number of training programs and
    Fellowships for persons wishing to work
    professionally in radiation safety

25
Radiation Protection Officer
  • The role of the RPO is determined locally, but
    typically would include
  • responsibility for designation of controlled and
    supervised areas
  • responsibility for ensuring preparation of local
    rules
  • training of new staff in safe radiation work
    practices
  • liaison with the regulatory authority on
    radiation protection matters

26
Other tasks of the RPO
  • supervision of the personnel monitoring programme
  • maintenance of records, especially worker
    radiation histories
  • routine surveillance of radiation areas
  • responding to and investigating radiation
    accidents
  • provision of radiation dosimetry
  • general advice to management and staff regarding
    radiation safety

27
Qualified Experts
  • Licensees/employers/registrants shall have access
    to the advice of a qualified expert in radiation
    oncology physics
  • BSS Appendix II MEDICAL EXPOSURE
    RESPONSIBILITIES - II.1. Registrants and
    licensees shall ensure that
  • (d) for therapeutic uses of radiation (including
    teletherapy and brachytherapy), the calibration,
    dosimetry and quality assurance requirements of
    the Standards be conducted by or under the
    supervision of a qualified expert in radiotherapy
    physics

28
Qualified Experts
  • Training, competencies and certification of
    experts is a national matter
  • Professional organisations may be involved in the
    definition and certification
  • Typically the expert is a medical physicist

29
Qualified expert in radiotherapy physics (medical
physics) -IAEA
  • An individual who, by virtue of certification by
    appropriate boards or societies, professional
    licences or academic qualifications and
    experience, is recognised as having experience in
    medical physics. from IAEA Working Material,
    March 1999, Regulatory Guidance, Radiation
    Protection and Safety in Radiotherapy.

30
Medical physicist (ICRP 44, 1984) A physicist
with training in the medical application of
radiation.
  • Requires a thorough knowledge of
  • radiation physics
  • radiation generation
  • radiation dosimetry
  • treatment planning
  • radiation protection
  • Desirable knowledge
  • Human anatomy
  • Physiology
  • Radiobiology
  • Radiation oncology
  • Certification of an adequate level of competence

31
Medical physicist
  • Special knowledge in radiotherapy physics is
    required
  • Responsible for commissioning of radiation
    equipment
  • Shall certify that a treatment unit is fit for
    use on patients
  • Often responsible for treatment planning
  • Often responsible for the technical aspects of QA
    in radiotherapy

32
Other professionals in a radiotherapy department
  • Radiotherapy Technician
  • a.k.a. therapy radiographer or radiation
    therapist
  • responsible for precise delivery of the treatment
  • the person typically closest to the patient
  • should be capable to determine changes in patient
    condition due to radiation
  • sometimes also responsible for treatment planning
    (potentially referred to as dosimetrist)

33
Other professionals in a radiotherapy department
  • Maintenance/service engineers and technicians
  • responsible for maintenance of treatment units
  • require special training
  • should be capable to determine machine parameters
    which could cause changes in the radiation beam
  • must report all problems or repairs which could
    affect the beam to the qualified expert in
    radiotherapy physics.

34
Outside persons with responsibility for radiation
protection in radiotherapy
  • Manufacturers and/or suppliers of radiotherapy
    equipment
  • Service engineers
  • Hospital civil engineer/architect
  • Regulators...

35
Quick discussion
  • What potential role could a hospital engineer
    play for radiation protection in radiotherapy?

36
4. The role of committees
  • General
  • Facilitate information sharing and decision
    making
  • Provide documentation (TOR, minutes)
  • Specific Radiation Safety Committee
  • Members often are
  • the RSO (usually chair of the RSC)
  • representatives of radiation-users (head
    clinician)
  • representatives of management (decision making)
  • representative of nursing
  • the institutional occupational health person
  • others as appropriate

37
Radiation Safety Committee
  • Typical roles of the RSC are to
  • oversee the institutional radiation safety
    programme
  • advise and review local rules relevant for
    radiation protection
  • review radiation exposures to staff, and to
    investigate abnormal exposures
  • review new, and research applications of
    radiation
  • review and investigate radiation incidents and
    accidents
  • ensure appropriate reporting of accidents
  • advise management on radiation protection matters
  • Members may require special training

38
Other committees of relevance to radiation
protection
  • Occupational Health and Safety staff radiation
    protection (compare module 8)
  • Quality Assurance within department of radiation
    oncology
  • medical review of patient charts and incidences
  • technical review of radiation surveys and other
    technical matters which could affect radiation
    protection of the patient

39
5. Education and Training are essential for a
radiation protection programme
  • As part of a the implementation of a Radiation
    Protection Programme (IAEA TECDOC 1040, 2.2.1)
    Early in the process a decision should be made
    about additional training required for the
    hospital staff
  • The relevant plan should include who, where and
    when shall be trained.

40
Responsibility of the licensee
  • BSS 2.30. Provision shall be made for reducing
    as far as practicable the contribution of human
    error to accidents and other events that could
    give rise to exposures, by ensuring that
  • (a) all personnel on whom protection and safety
    depend be appropriately trained and qualified so
    that they understand their responsibilities and
    perform their duties with appropriate judgement
    and according to defined procedures

41
In practice training is required for both
  • Staff on whom radiation protection depends -
    typically radiotherapy professionals and service
    staff
  • Persons who could be subject to irradiation
    staff (module 8), patients (module 9) and public
    (module 17) - in the latter case the education
    may be limited to information sheets and/or
    warning signs

42
Education
  • All staff in radiotherapy must have appropriate
    education to perform their duties
  • For radiation protection purposes this affects
    particularly
  • Radiation Protection Officer
  • Physician
  • Qualified Expert (Medical Physicist)
  • Radiotherapy Technician
  • Maintenance staff

43
IAEA-TECDOC-1040...
  • provides specific information on the role of the
    physician (3.2.2.1) and medical physicist
    (3.2.2.2) - the skills and competencies
    identified there determine the education and
    training requirements.

44
A note of qualifications of others
  • There should also be a process in place which
    ensures that outside contractors on whom
    radiation protection may depend (e.g. service
    engineers) are appropriately trained and
    qualified. This is typically reflected in a
    license of the contractor of which a copy should
    be available in the radiotherapy facility.

45
BSS Education is part of Management
Requirements
  • Qualified radiation safety experts
  • Licensee shall arrange for qualified radiation
    safety experts to provide observance to the
    Regulations
  • The qualifications of the radiation safety
    experts shall include appropriate academic
    knowledge and professional experience

In radiotherapy, these requirements will be
fulfilled by the requirement for a qualified
expert in radiotherapy physics.
46
Regulations Management requirements
  • Continuous education and training in radiation
    protection shall be provided to meet with changes
    in equipment, instrumentation, practice,
    monitoring methods, recommendations and
    regulations
  • A transition period should be provided for those
    already involved in the delivery of radiation
    exposure in order to meet the requirements of
    training

47
Continuing Education
  • Technology in radiation therapy is fast
    developing
  • It is essential for all staff to have regular
    updates on radiation protection aspects (e.g.
    consider the introduction of HDR brachytherapy)
  • Continuing education must be documented

48
BSS There is also a role for the regulatory
authority
  • The Regulatory Authority should encourage medical
    authorities, universities and professional
    organizations to design and implement training
    programmes in radiation protection for
  • radiation oncologists
  • qualified experts in radiotherapy physics
  • radiotherapy technologists
  • dosimetrists
  • maintenance personnel

49
Education Training
  • The Regulatory Authority should establish
    training curricula for (for example)
  • RPOs
  • members of the RSC
  • relevant physicians
  • medical physicists
  • laboratory staff

50
Education and Training (cont)
  • Nurses working with radioactive patients
  • maintenance staff
  • radiation technologists
  • other relevant staff e.g. cardiologists who need
    to use X Rays

51
Syllabus
  • Training in radiation protection for radiotherapy
    should cover
  • radiation modalities
  • facility design
  • characteristics of safety features of sources and
    source realeted equipment
  • dosimetry and instrument calibration
  • treatment planning
  • radiactive waste disposal
  • accident prevention and emergency procedures (
    lessons learned from past accidents)

52
Education and Training
  • As well as ensuring that specialist radiation
    workers (e.g. radiographers) have the necessary
    training, the employer should also provide local
    training
  • This could be basic safety training for new
    employees such as nurses and lab. staff
  • Training should include the local rules

53
Education and Training
  • The Regulatory Authority should also have an
    audit system to ensure that training is of an
    appropriate standard
  • The use of licenses to use radiation is one
    method of ensuring compliance

54
Education and Training
  • If the number of professionals is too small to
    justify setting up a training course, then
    international co-operation programs may be used
  • Distance learning programs may be useful
  • A course such as the present may play an
    important role...

55
Summary
  • A radiation protection programme is an essential
    requirement for every radiotherapy facility
  • The radiation protection officer and the
    radiation safety committee plays an important
    role in the implementation of the programme
  • Education and training of staff and all other
    persons who may be in contact with radiation is
    essential

56
Typical elements of a RPP
  • Assignment of responsibilities
  • The Radiation Protection Officer
  • Designation of radiation areas
  • Local rules
  • Education and training
  • Planning for accidents and emergencies
  • Health surveillance and monitoring
  • Review and audit
  • System of recording and reporting

57
Any questions?
58
Question
  • Please draft the terms of reference for a
    radiation protection committee in your facility
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