Comparison of Personal Dosimetry Practices in Healthcare in Europe

1
Comparison of Personal Dosimetry Practices in
Healthcare in Europe

• John Croft
• Deputy Director
• Emergency Response Division
• Health Protection Agency

2
Structure of Presentation

• United Nations Scientific Committee on the
  Effects of Atomic Radiation (UNSCEAR)
• European Study of Occupational Exposure (ESOREX)
• 6th European ALARA Network (EAN) Workshop on
  Occupational Exposure Optimisation in the
  Medical and Pharmaceutical Sectors
• Madrid, October 2002
• http//ean.cepn.asso.fr

3
Occupational Exposure Review ( UNSCEAR )
1975-79
2500
0.8
1980-84
1985-89
1990-94
2000
0.6
Average annual individual dose, mSv
Monitored workers, x 103
1500
0.4
1000
0.2
500
0
0
4
Average Annual Individual Doses to Measurably
Exposed Workers

• Medical 1.4 mSv
• Education/Veterinary 1.0 mSv
• Industrial 2.2 mSv
• Nuclear fuel cycle 3.1 mSv

5
Medical Sector Dose Data
E and SE Asia
E Europe
Indian sub continent
Latin America
OECD (except USA)
USA
Other
Total
5
0
10
15
20
25
Workers, x 105
UNSCEAR
6
Medical Sector Dose Data
E and SE Asia
Monitored
E Europe
Indian sub continent
Latin America
OECD (except USA)
Measurably exposed
USA
Other
Total
1
0
2
3
4
5
UNSCEAR
Average annual individual doses, mSv
7
Trends in Collective Effective Dose Normalised
to GDP for All Medical Uses
500
E and SE Asia E Europe Indian sub-continent Latin
America OECD (except USA) USA
Remainder World
400
300
man Sv per 1012 US
200
100
0
1975-79
1980-84
1985-89
1990-94
8
European Study of Occupational Exposure (ESOREX)

• EU MS Iceland, Norway Switzerland
• systems to register doses
• numbers exposed dose distributions
• potential for harmonisation
• ESOREX East (then) applicant countries
• Bulgaria, Estonia, Hungary, Latvia, Lithuania,
  Poland Slovak Republic

9
Occupationally Radiation Exposed Workers 1995 -
Norway
80
Nos. of workers Total 12,158
60
Collective doses Total 3.6 man Sv

40
20
0
Nuclear
Medicine
10
Occupationally Radiation Exposed Workers 1995 -
Germany
80
Nos. of workers Total 337,613
Collective doses Total 94.43 man Sv
60

40
20
0
Nuclear
Medicine
Others
24188
11
Occupationally Radiation Exposed Workers 1995 -
Spain
80
Nos. of workers Total 67,836
60
Collective doses Total 47.76 man Sv

40
20
0
Nuclear
Medicine
12
Occupationally Radiation Exposed Workers 1995 - UK
60
Nos. of workers Total 48,502
Collective doses Total 38.62 man Sv
40

20
0
Nuclear
Medicine
Others
13
UK Anomaly

• Classified workers
• likely to receive gt6 mSv
• dose records, health surveillance
• Central Index of Dose Information (CIDI)
• Non-classified workers
• large volume monitored and records kept

14
Occupational Exposure in Medicine, 1995
Measurably exposed
No. in dose range, mSv
gt50
5-10
10-15
15-20
20-50
Finland Germany Greece Norway Spain
13 62 25 27 55
46 338 74 75 279
2.32 1.02 2.48 1.60 0.55
5 18 9 14 36
8 10 20 14 27
3 8 1 0 6
ESOREX, 1998
15
Occupational Exposure in Medicine Europe - 1995
Denmark
Finland
Germany
Monitored
Greece
Measurably
exposed
Ireland
Luxembourg
Norway
Spain
Switzerland
0.5
0
1
2
2.5
1.5
Average annual individual dose, mSv
16
Survey of Occupational Exposure in Medicine in
the UK
Category
No. in dose range, mSv
Average annual dose, mSv
5-10
10-15
15-20
gt20
0-5
Diagnostic Radiotherapy Nuclear med. Survey UK
total
2 0 0 2 lt10
4 3 0 7 lt50
10,619 2,916 883 14,418 39,950
2 0 0 2 lt10
2 3 0 5 lt10
0.08 0.08 0.33 0.09 0.1
ESOREX, 1998
17
UK Survey of Occupational Exposure in Diagnostic
Radiology Departments
Category
No. in dose range, mSv
Average annual dose, mSv
5-10
10-15
15-20
gt20
0-5
Radiologists Cardiologists Other
clinicians Radiographers Nurses Scientists/
technicians Other staff Total
0 1 0 0 0 1 0 2
2 1 0 1 0 0 0 4
999 458 656 5,024 2,276 631 575 10,619
0 1 0 0 0 1 0 2
1 0 0 0 1 0 0 2
0.19 0.26 0.04 0.05 0.07 0.07 0.04 0.08
ESOREX, 1998
18
UK Survey of Occupational Exposure in
Radiotherapy Departments
Category
No. in dose range, mSv
Average annual dose, mSv
5-10
10-15
15-20
gt20
0-5
Beam radiographers Radiotherapists Nurses -
Theatre Source technicians Scientists/
technicians Other staff Total
0 0 0 0 0 0 0 0 0
0 0 0 1 0 0 2 0 3
864 242 481 646 64 16 251 352 2,916
0 0 0 0 0 0 0 0 0
1 1 0 1 0 0 0 0 3
0.06 0.23 0.05 0.10 0.10 0.15 0.10 0.01 0.08
Ward Other
ESOREX, 1998
19
UK Survey of Occupational Exposure in Nuclear
Medicine Departments
Category
No. in dose range, mSv
Average annual dose, mSv
5-10
gt10
0-5
Pharmacists Radiographers Scientists/
technicians Clinicians Nurses Other
staff Research workers Total
0 0 0 0 0 0 0 0
168 262 86 54 73 109 131 883
0 0 0 0 0 0 0 0
0.35 0.53 0.29 0.18 0.61 0.06 0.07 0.33
ESOREX, 1998
20
Occupational Exposure in Non-nuclear Industry -
France, 1999
Category
No. in dose range, mSv
6-20
gt50
1-6
20-50
lt1
Radiology Radiotherapy Nuclear medicine Non in
vitro Dental Veterinary Non-nuclear
industry Occupation and PH Others Total
48 7 0 0 3 1 60 1 1 121
86,207 7,621 3,614 3,572 25,412 2,637 18,763 5,36
6 13,752 166,944
17 0 1 0 1 10 6 1 0 25
1,189 259 400 23 208 27 2,639 33 90 4,868
294 35 39 0 48 2 1,299 3 24 1,744
ESOREX, 1998
21
IAEA Protecting Workers Against Exposure to
Ionising Radiation

• Generally well controlled
• Problem of new areas
• particularly interventional radiology
• post graduate education
• raising awareness
• participation of Health Physicists

22
Format of EAN Workshop

• Focussed sessions
• Exposure from new technologies in Nuclear
  Medicine
• Exposure from new technologies in Radiotherapy
  and Radiology
• Production, transport and distribution of
  radiopharmaceuticals
• Dose monitoring equipment and strategies
• How to encourage a positive safety culture
• Training and exchange of information

23
Format of EAN Workshop

• Focussed sessions
• Working Groups
• 2 sessions
• some suggested issues
• Report back in final session
• recommendations to EC etc.

24
Recommendation 1

• Average doses vary by up to factor of 10
• Significant variations in dose profiles
• Difficulty in comparisons
• Concerns over new technologies

25
Recommendation 1

• Average doses vary by up to factor of 10
• Significant variations in dose profiles
• Difficulty in comparisons
• Concerns over new technologies
• In order to avoid confounding factors and
  provide dose data that will be useful in
  identifying trends and areas of concern there
  would be value in harmonised guidance at a
  European level on personal monitoring protocols

26
Recommendation 2

• Regulatory and professional bodies should
  influence managers and others responsible for
  safety to systematically include consideration of
  radiological risks into prior risk assessments
  particularly where new technologies or procedures
  are being used.

27
Recommendation 3

• The way regulators encourage and/or enforce
  regulatory requirements can set the tone for
  safety cultures but also need to involve
• Management
• Workers (harness experience)
• Professional bodies
• Suppliers and manufacturers

28
Recommendation 4

• National Authorities, in consultation with
  professional bodies should
• Periodically review the content of professional
  training courses
• Give advice on the need for refresher training
  and CPD
• Ensure risk assessments address the training
  requirements for new procedures

29
Recommendation 5

• The Workshop recognised that the participation
  of appropriately Qualified Experts in the
  development and implementation of radiological
  protection programmes was crucial. The EC should
  request the Article 31 Working Group to give
  priority to clarifying advice on
• (a) the role of QEs, and
• (b) training and qualifications required.

30
Recommendation 6

• In order to provide a focus and a means of
  avoiding groups re-inventing the wheel, the EAN
  should make arrangements to have a section of its
  website devoted to listing (and providing links
  to) existing guidance documents in the medical
  sector.

31
Recommendation 7

• Professional bodies, national authorities and
  international bodies should liaise to ensure that
  there are appropriate mechanisms in place for the
  reporting of accidents and incidents, and the
  dissemination of lessons learned.

32
Recommendation 8

• The EU and national authorities should support
  research into the development and use of
  electronic dosimetry systems.

33
Recommendation 9

• The EU could provide a useful focus for
  developing and implementing appropriate
  methodologies for internal dose assessments.

34
Recommendation 10

• The EU and national authorities should take
  measures to encourage the development of
  Reference Doses for new procedures.

35
Recommendation 11

• There would be value in international
  organisations developing harmonised approaches to
• (a) dosimetric assessment of doses to the
  embryo/foetus
• (b) practical criteria for identifying work
  activities that pregnant women should not
  undertake
• (c) administrative procedures for the
  declaration of pregnancy.
•  

36
Conclusions

• Confounding factors in dose data need to be
  clarified
• However, dose profiles do indicate differences in
  level of RP
• Key role of Qualified Experts
• Challenge provided by new technology