Transcript Radiation - Kilo Curie?

First FRCR Examination in Clinical Radiology
Statutory Requirements and
Non-Statutory Recommendations
Ionising Radiations Regulations 1999
John Saunderson
Radiation Protection Adviser
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Relevant Radiation Legislation
• Ionising Radiations Regulations 1999
– staff, public, equipment (IRR99)
• Ionising Radiation (Medical Exposure) Regs 2000
– patients, research subjects (IRMER)
• Environmental Permitting Regulations 2010
– keeping & disposing of radioactive materials (EPR2010)
• The Carriage of Dangerous Goods and Use of Transportable
Pressure Equipment Regulations 2009
• Medicines (Administration of Radioactive Substances)
Regulations 1978
– nuclear medicine, brachytherapy (ARSAC)
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Guidance
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Approved Code of Practice (ACOP)
Guidance Notes
DoT guidance
odd HSE guidance
etc.
IPEM, NRPB, RCR, BIR, etc. stuff.
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Ionising Radiations Regulations 1999
•Responsibility for radiation safety
•Local rules and procedures
•Role of radiation protection adviser and radiation protection
supervisor
•Classified workers
•Restriction of exposure (through design, systems of work and ppe)
•Dose limits
•Equipment used for medical exposures
•Notification of incidents
•Dose constraints for comforters and carers
•Routine inspection and testing of equipment
•Notification of incidents .
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Responsibility for radiation safety
•Radiation employer - i.e. an NHS Trust, private dentist, etc.
–Authorised practices
–Notification to HSE
–Prior risk assessments
•Employee must
–not knowingly expose himself greater than necessary
–use personal protective equipment provided
–report equipment defects
–look after PPE
–(extra duties for classified persons)
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Local rules and procedures
•Controlled areas
•Supervised areas
•Local Rules.
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Controlled area
• any area where it is necessary to follow special procedures to
restrict significant exposure, or
• any area where > 6 mSv/y, or 3/10th dose limit is likely
• also ACOP says if
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> 7.5 uSv/h averaged over 8 h working day
> 75 uSv/h to hands averaged over 8 h working day
contamination risk
need to keep non-radiation workers out
• or > 7.5 uSv/h averaged over 1 minute and
– site radiography, or
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Controlled area
• any area where it is necessary to follow special procedures to
restrict significant exposure, or
• any area where > 6 mSv/y, or 3/10th dose limit is likely
• also ACOP says if
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> 7.5 uSv/h averaged over 8 h working day
> 75 uSv/h to hands averaged over 8 h working day
contamination risk
need to keep non-radiation workers out
• or > 7.5 uSv/h averaged over 1 minute and
– site radiography, or
– employees untrained in radiation protection enter area (unless
radioactivity is dispersed inside a person).
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Supervised area
• any area where it is necessary to keep conditions under
review, or
• any area where > 1 mSv in a year, or 1/10th dose limit is
likely.
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Local Rules
• How to work safely in that area
• Must contain
– Dose investigation levels
– contingencies for foreseeable accidents
– RPS (radiation protection supervisor) name
– describe area covered
– work instructions for unclassified workers.
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Local Rules
• Could also contain
– management and supervision of work
– testing and maintenance of safety features
– radiation and contamination monitoring
– testing of monitors
– personal dosimetry
– arrangements for pregnant and breast feeding staff
– risk assessments
– programme to review ALARA
– RPA contact.
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Local Rules
• Usually get new employees to read Local Rules and
sign to say they have understood them.
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Role of
radiation protection adviser
and
radiation protection supervisor
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Radiation Protection Adviser
R.P.A.
•Must have qualification approved by HSE (e.g. RPA2000
certificate)
•Must be appointed in writing
•Must be consulted on
–controlled and supervised areas.
–prior examination of plans
–regular calibration of dose monitoring equipment
–periodic testing of safety features and warning devices
–risk assessment of new radiation work.
–incidents where more then 6 mSv has been received.
–critical examination of safety features of new radiation equipment.
R.P.A. need not be appointed if only
• Very, small amounts of radioactive material (below
specified levels)
• Very low dose (< 1uSv/h @ 10 cm) x-ray units of a design
approved by HSE
• VDUs with < 1uSv/h @ 10 cm
• < 30 kV and < 1uSv/h @ 10 cm.
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Radiation Protection Supervisor
R.P.S.
• Must be appointed “for the purpose of securing
compliance with these Regulations” in controlled or
supervised areas
• Name must be in Local Rules
• It is recommended that
– know & understand regs. and local rules
– command sufficient authority
– understand necessary precautions
– know what to do in an emergency.
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Here on 4th Nov 2014
Classified workers
•Anyone who may exceed 6 mSv effective dose per year, or
3/ th of a dose limit (e.g. 150 mSv hand dose, or 45 mSv lens dose)
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•Must be informed (!)
•Must be 18 or over
•Must be certified fit to work with radiation by a suitable doctor
•Dose monitored and recorded for 50 years with an HSE
Approved Dosimetry Service - results to HSE
•Radiation passbook for “outside workers”
•Adequate (at least yearly) medical surveillance - record for 50 y.
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Restriction of exposure (through design,
systems of work and ppe)
•Restrict exposure
1. By engineering
2. By systems of work
3. By personal protective equipment
•Controlled areas - demarcate and sign
•Non-classified workers can only enter under written system
of work
•Must demonstrate by personal dose monitoring or other
means that doses are restricted
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Dose Limits
Schedule 4 Part 1
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• Employees  18
– 20 mSv/y effective dose
– 150 mSv/y equivalent dose to lens of eye
– 500 mSv/y equivalent dose over 1 cm2 skin
– 500 mSv/y equivalent dose to hands, forearms, feet and
ankles
• Trainee < 18
– 6 mSv/y effective dose
– 50 mSv/y lens of eye
– 150 mSv/y over 1 cm2 skin
– 150 mSv/y hands, forearms, feet and ankles .
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• Abdomen of women of reproductive capacity
at work
– 13 mSv / 3 months equivalent dose
• Not employee or trainee, or a “comforter or carer” or
undergoing a medical exposure
– 1 mSv effective dose, unless dose the result of a medical
exposure of another, then 5 mSv / 5 y
– 15 mSv/y lens of eye
– 50 mSv/y over 1 cm2 skin
– 50 mSv/y hands, forearms, feet and ankles .
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Reg. 11(2)
(2) Where an employer is able to demonstrate in
respect of any employee that the dose limit specified
in paragraph 1 of Part I of Schedule 4 is impracticable
having regard to the nature of the work undertaken by
that employee, the employer may in respect of that
employee apply the dose limits set out in paragraphs 9
to 11 of that Schedule and in such case the provisions
of Part II of the Schedule shall have effect.
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Part II Dose Limits
• Employees  18
– 100 mSv / 5y and 50 mSv/y effective dose
– 150 mSv/y equivalent dose to lens of eye
– 500 mSv/y equivalent dose over 1 cm2 skin
– 500 mSv/y equivalent dose to hands, forearms, feet and
ankles
• Not allowed for Trainees < 18
• Abdomen of women of reproductive capacity
at work
– 13 mSv / 3 months equivalent dose .
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To use Part II must . . .
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Consult RPA
inform employee ADS in writing
give 28 days notice to HSE
if > 20 mSv given in a year
– undertake investigation
– notify HSE
• Review every 5 years.
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Dose Limits
• Note, not like a speed limit. Doses must be as low as is
reasonably practicable (ALARP)
• Dose constraints used in design
– e.g. 0.3 mSv for members of public,
– 5 mSv for comforters and carers (1mSv if pregnant)
• Foetus limit: 1 mSv from notification of pregnancy by
employee
• Need formal investigation levels for staff
• Do not apply to medical exposures.
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For HEY Trust the DIL’s are
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Hull & East Yorkshire Hospitals’
dose investigation levels
Radiation Protection Adviser
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HSE Nov. 01
“There has been a number of reported cases where employees have failed to
take good care of their dosemeters. Many of these cases involve employees in
the Health Services, some of whom have been senior clinicians.
“Non-Classified employees who have been provided with a dosemeter by their employer to
ensure compliance with reg 18(2)(b)(ii) of the IRR99 have a duty to look after that dosemeter
and return it for processing as required. Provided the employer has informed the employees of
that duty and is exercising the appropriate level of supervision, employees who
persistently fail to wear, look after or return their dosemeters promptly are
liable to enforcement action by inspectors up to and including prosecution
under Section 7 of the HSW Act 1974. Employers may find statement of this fact useful
when dealing with 'errant' staff.”
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Equipment used for medical exposures
•Design, construct, install, maintain to keep doses ALARP
•Display indication of dose (e.g. DAP meter, mAs meter, etc.)
•Equipment quality assurance programme
–IPEM91
–Must test before first clinical use
–Must test at appropriate intervals
–Must test after major maintenance.
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Routine inspection and testing of equipment
•Follow IPEM 91
–Test, e.g kV accuracy
–Expertise, e.g. A = radiographer, B = medical physics
–Frequency, e.g. annual for B general
–Remedial level, e.g. +/- 10% for kV
–Suspension level, e.g. +/- 20% for kV
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Notification of incidents
Must report to HSE where dose to patient is “much greater
than intended” due to equipment fault.
Patient Doses
Much Greater Than Intended
[HSE PM77 (3rd)]
• x 20 - extremities, skull, chest, dentition, shoulder,
chest, elbow, knee and nuclear medicine where
intend <=0.5mSv
• x 1.5 – Interventional radiology, use of contrast, CT,
nuclear medicine where intend >5mSv
• x10 – other imaging.
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Patient Doses
Much Greater Than Intended
[HSE PM77 (3rd)]
• x 1.1 – whole course of radiotherapy
• x 1.2 – single fraction of radiotherapy, or unsealed
radionuclide therapy.
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Incidents
•Any untoward occurrence which may result in excess
radiation to staff or patients must be referred to the
Radiation Protection Supervisor and the Radiation
Protection Adviser, who will estimate the dose and
liase with management, HSE, DoH, HCC, EA, etc. as
appropriate
•Suspect equipment must be withdrawn from service
and labelled according.
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Investigation
 establishing what happened
 identifying the failure
 deciding on remedial action to minimise the
chance of a similar failure
 estimating the doses involved
 decide whether patient informed (usually yes).
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Comforters and Carers
"individuals who (other than as part of their
profession) knowingly and willingly incur an
exposure to ionising radiation in the support or
comfort of another person who is undergoing, or
has undergone a medical exposure"
Dose constraint required.
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Comforters and Carers
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e.g. parent holding a child being X-rayed
not a nurse, care assistant, etc.
if < 1 mSv public dose limit, not “C&C”
5 mSv dose constraint
if pregnant 1 mSv dose constraint
must be aware of the risk.
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Reference Book List
• Advice on Exposure to Ionising Radiation during
Pregnancy
• Guidance Notes
• IPEM 91
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Here on 6th Nov 2014??
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