The Management of Radiation Protection in Diagnostic Radiology

1
The Management of Radiation Protection in
Diagnostic Radiology

• Colin J Martin
• Health Physics
• Gartnavel Royal Hospital
• Glasgow

2
The Management of Radiation Protection in
Diagnostic Radiology

• Commitment of senior management
• Organisation framework for management
• Documented procedures
• Establishment of controls
  (e.g. on use of X-ray equipment)
• Input of advice from RPA and MPE

3
Radiation Safety Policy

• Defines the attitude of the organisation
• Management gives firm documented pledge
• Identifies managers responsible for
  implementation and review of protection programme
• Must define responsibility for all aspects of
  safety
• Should be prepared in consultation with staff
• All staff groups should be aware of its content

4
Radiation Protection Personnel

• Radiation Protection Supervisor (RPS)
• Supervise safety aspects of work in each
  department
• Not responsible for management
• Radiation Protection Adviser (RPA)
• Inform management of requirements and
  responsibilities
• Liase with Managers and RPSs on implementation of
  programme
• Radiation Protection physicists and technicians
• Provide aspects of radiation protection service
• Medical Physics Expert (MPE) in diagnostic
  radiology
• Provide advice on use of X-ray equipment

5
Radiation Safety Committee

• Focal point for organisation of protection
  programme
• Committee should meet regularly

Membership Representative of senior
management RPSs Staff members RPA MPE
6
Radiation Safety CommitteeTopics which may be
covered

• Radiation safety issues
• Reports from RPA reviews
• RPS reports
• Incident reports
• Setting Diagnostic Reference Levels
• Adverse results from patient dose studies
• Equipment replacement priorities

7
Radiation Protection Framework
Hospital Senior Management
Radiation Safety Committee
Clinical Director of Radiology
RPA
Imaging Services Manager / Superintendent
Radiographer
RPS
End user
8
Documented Procedures

• Ionising Radiation Regulations 1999
• Radiation Safety Policy
• Local Rules
• Systems of Work
• Ionis. Rad. (Medical Exposure) Regs. 2000
• IRMER procedures
• IRMER referral criteria
• Examination protocols

9
Effective Communication

• Rules and procedures available to staff
• Individuals should follow rules for system to
  work
• System to ensure that staff are familiar with
  documents
• Hospital wide information networks suitable for
  dissemination of information Documents subject to
  regular review
• Advice relating to change in legislation or
  guidance

10
Training under IRR 99

• Professional qualifications
• Training of MPEs in diagnostic radiology physics
• Certification of RPAs
• External courses on radiation safety for RPSs
• Update or refresher courses may be given
  locally
• Training of staff groups in radiation safety by
  RPS and RPA

11
Tackling non-compliance
Hospital Senior Management
Radiation Safety Committee
RPA
Imaging Services Manager / Superintendent
Radiographer
RPS
Non-compliance
12
Radiation Incidents

• Ensure contingency plans are in local rules
• Staff know what steps to take
• Record information and data for dose assessment
• Effective system for reporting incidents
• Notify RPS, managers, clinician, RPA
• Determine whether statutory authorities informed
• Investigate to determine how incident occurred
• Decide whether procedures need to be revised,
  equipment replaced or staff given more training

13
Audit and Review - RPA

• Evaluate radiation protection programme
• Review with RPS and management
• Review of documentary records
• Review of staff and patient doses
• Analysis of incidents
• Review of risk assessments
• Identify shortcomings and remedial action to
  rectify
• Loop must be close and action taken
• Radiation Safety Committee can provide useful
  forum for follow up
• Results should be documented
• Reviews should take place at regular intervals

14
Five steps in risk assessment

• Identify the hazard
• Identify who might be harmed and how
• Evaluate the risk and decide whether existing
  precautions are adequate
• Record the findings of the evaluation
• Review the assessment and revise if necessary
  periodically

15
Proposals for Uses of Radiation

• Planning an new X-ray facility
• For protection to be optimised, practices must be
  planned
• Risk assessment must be carried out
• Outcome of risk assessment must be taken into
  account
• Implement control measures recommended in design
• Controls on X-ray equipment

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The Initial Plan
Radiology Department
Determine Key features likely to contribute to
dose Workload Associated exposure factors to
determine radiation levels
Establish Basic requirements Preliminary
design Room layout
Evaluate Alternative layouts and other options
Specifications for X-ray equipment
RPA input
Medical Physics Expert
17
Risk assessment and safety features
Risk assessment Establish dose criteria Assess
radiation levels Quantitative analysis Determine
controls
Evaluate Alternative layouts and other options
Radiology Department

• Decisions on
• Engineering controls
• Shielding
• Warning signs
• Procedural controls
• Local rules

RPA input
The RPA must have a role within the planning team
in specification of protection requirements
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Construction and preparing procedures

• Engineering controls
• Shielding
• Warning signs

Facility construction and X-ray equipment
installation
RPA input
Procedural controls Prepare local rules
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Planning a new X-ray room
Risk assessment Establish dose criteria Assess
radiation levels Quantitative analysis Determine
controls
Establish Basic requirements Preliminary
design Room layout
Radiology Department
Evaluate Alternative layouts and other options
Determine Key features likely to contribute to
dose Nos. of procedures Associated exposure
factors to determine radiation levels

• Decision 1 -Engineering controls
• Shielding
• Warning signs

Radiology Department
RPA input
Facility construction and X-ray equipment
installation
Specifications for X-ray equipment
Decision 2 - Procedural controls Prepare local
rules
Medical Physics Expert
20
Proposals for Uses of Radiation

• Planning an new X-ray facility
• Controls on X-ray equipment
• Testing of equipment for safety and performance
• Training in equipment use and procedures
• Optimisation of medical exposures

21
Acceptance for clinical use (IRR 99)
RPA input
Critical examination to check safety features
Acceptance checks to assess equipment performance
relative to specification
X-ray equipment
Commissioning to establish baseline values for
performance
MPE input
22
Training under IRMER 2000

• Professional qualifications
• Training of MPEs in diagnostic radiology physics
• Training of radiographers in operation of new
  equipment
• Training of radiologists in interpretation of
  images obtained with new technique
• Training of other clinical staff who may operate
  X-ray equipment or act as the practitioner
• All training must be documented effectively

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Introduction into clinical service
Operator training
Critical examination to check safety features
Techniques for operation of equipment
Acceptance checks to assess equipment performance
relative to specification
Clinical applications
X-ray equipment
Commissioning to establish baseline values for
performance
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X-ray equipment QA and maintenance
X-ray equipment
Clinical applications
Routine performance checks compared to baseline
values Medical Physics 1-2 y intervals Radiograp
hers 1 d 3 m intervals
Commissioning to establish baseline values for
performance
Routine maintenance
MPE input
25
Procedures for return of equipment to clinical use

• Handover form including question to check whether
  any change made which will affect patient dose
• Completed by X-ray engineer
• Competent representative of the employer should
  confirm that equipment left in a state fit for
  use
• Arrangements to carry out QA checks if changes
  have been made
• Arrangements to consult RPA / Medical Physics
  Expert if any change in dose level

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Equipment Handover Form

• Statement by person handing equipment over
• Equipment in a satisfactory condition for medical
  exposures
• Safety features and warning devices are
  functioning
• No alterations been carried out which may
  adversely affect patient dose.
• Or information on any points are outstanding

• Statement by staff member accepting equipment
• Confirmed that equipment in satisfactory
  condition
• Whether any QC tests carried out

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Patient dose surveys

• Assessments carried out at least every 3 years
• Surveys of dose results for set of individual
  patients
• In terms of measurable dose quantities-
• Entrance surface dose for radiography
• Dose-area product for fluoroscopy and radiography
• CTDI and dose-length product for CT
• Mean glandular tissue dose for mammography
• Compared to Diagnostic Reference Level (DRL)

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Patient Dose and Optimisation
Patient dose surveys
Medical Physics Expert
Techniques for operation of equipment
Equipment replacement programme priorities
Clinical applications
X-ray equipment
Routine performance checks compared to baseline
values Medical Physics 1-2 y intervals Radiograp
hers 1 d 3 m intervals
Medical Physics Expert
Routine maintenance
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Ageing X-ray equipment Factors to consider in
deciding when equipment should be condemned and
prioritising replacement

• If patient doses are greater than Diagnostic
  Reference Levels
• Comparison of equipment performance with remedial
  and suspension levels
• Number of patients and type (e.g. age) affected
  by continued use of the equipment

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X-ray Equipment
RPA input
Patient dose surveys
Operator training
MPE input
Critical examination to check safety features
Techniques for operation of equipment
Equipment replacement programme priorities
Acceptance checks to assess equipment performance
relative to specification
X-ray equipment
Clinical applications
Routine performance checks compared to baseline
values Medical Physics 1-2 y intervals Radiograp
hers 1 d 3 m intervals
Commissioning to establish baseline values for
performance
Routine maintenance
MPE input
31
X-ray Equipment
Medical Physics Expert
RPA input
Patient dose surveys
Operator training
Incident investigation
Critical examination to check safety features
Techniques for operation of equipment
Equipment replacement programme priorities
Acceptance checks to assess equipment performance
relative to specification
X-ray equipment
Clinical applications
Routine performance checks compared to baseline
values Medical Physics 1-2 y intervals Radiograp
hers 1 d 3 m intervals
Routine maintenance
Commissioning to establish baseline values for
performance
Medical Physics Expert
32
Summary

• Radiation Safety Policy setting out individual
  responsibilities
• Management framework with effective communication
• Radiation Safety Committee to consider RP issues
• Regular audit and review processes
• Risk assessments for new and existing facilities
• Engineering and procedural controls based on
  assessments
• Staff training in X-ray equipment use and
  protection
• QA programme and maintenance for X-ray equipment
• Effective system for reporting and investigating
  incidents