Radiation Protection in Radiotherapy

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Radiation Protection inRadiotherapy
IAEA Training Material on Radiation Protection in
Radiotherapy

• Part 18
• Organization and Implementation
• of a Radiation Protection Programme

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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
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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...

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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

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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

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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

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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

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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

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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
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Regulatory Authority Authorization and Inspection
Radiation Protection Officer and /or Medical
Physicist
Radiation Oncologist
Radiation Safety Committee
Engineers, Technicians
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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

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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

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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
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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

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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

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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

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Reports are not a one way street

• Acknowledgement of reports
• Additional questioning
• Feedback very important

???
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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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.

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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

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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

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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)

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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.

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Outside persons with responsibility for radiation
protection in radiotherapy

• Manufacturers and/or suppliers of radiotherapy
  equipment
• Service engineers
• Hospital civil engineer/architect
• Regulators...

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Quick discussion

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

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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

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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

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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

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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.

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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

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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

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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

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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.

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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.

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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.
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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

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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

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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

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Education Training

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

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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

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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)

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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

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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

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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...

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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

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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

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Any questions?
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Question

• Please draft the terms of reference for a
  radiation protection committee in your facility