Radiation protection - 16/10

Why does radiation protection matter?

Because it is the law, training is provided to staff to ensure general public is kept safe.

What two laws mention radiation protection in the workplace ?

The Ionising Radiation Regulations 2017 - rules applying to radiation in all workplaces eg. Hospitals, airports etc, predominantly in health, safety and wellbeing. It is regulated by the HSE.

The Ionising Radiation (Medical Exposure) Regulations 2017 - apply to medical specific radiation and concerned with reducing number of unnecessary radiation exposure. It is regulated by the CQC

What are the four roles of IR(ME)R 2017 ?

Employer - they have the ultimate responsibility for implementing this law throughout imaging processes and set frameworks for all exposures

Referrer - must provide sufficient information to ensure exposure is justified. They must have the skills to be able to refer under a scope of practice

Practitioner eg. radiologist - responsible for the justification of medical exposure, may be apart of a group of other practitioners. If there’s a query about the image request, they can ask referrer for more information in order to make a judgement

Operator eg. Radiographer - carry out justification for procedure on behalf of the practitioner approved guidance and are entitled to carry out said procedure

How can we use the “Justification” principle from the IR(ME)R in practice ?

1. Is the correct examination being performed ?

2. Has it been authorised and justified by a practitioner ?

3. Sufficient net benefit for the patient ?

How can we use the “Optimisation” principle from the IR(ME)R in practice ?

Achieving diagnostic quality with the lowest reasonable dose.

ALARP - As Low As Reasonably Possible

—> making the dose too low that an X ray image cannot be seen clearly and having to redo the scan, risks putting the patient under too much radiation.

Why do we need radiographic legislation ?

• ensures safety of staff and service users

• Prevent known deterministic and stochastic effects of radiation

• Protection is needed even at a small dose eg. Someone who is unknowingly pregnant and accidentally exposing foetus to radiation can be extremely dangerous to their growth as they are very radiographic sensitive

Pregnancy enquiry’s

If someone is of a child bearing potential, they should be asked if they are or could be pregnant to reduce risk of unintended radiation exposure to foetus.

Ensuring that service users are not discriminated against and asking ALL patients if they are possibly pregnant as we may not know what organs people have. this is a HCPC requirement

What is the Inclusive Pregnancy Status form ?

Introduced by SoR to be given to all patients aged 12-55 years before imaging.

If someone may be pregnant, justification of the exam may need to be reviewed again by a Radiologist.

What is the absorbed dose?

How much radiation is emitted / is absorbed by the patient

What’s the equivalent dose and what is it measured in ?

How much radiation absorption a body tissue or organ is receiving

Measured in sieverts (Sv) or millisieverts (mSv)

What’s the effective dose ?

What are the long term effects on your body from receiving the dose of radiation

How can radiation doses be limited in an X ray room ?

• professionals sit in a controlled area

• Lock / secure door

• Lead shielding aprons

• If family carers are present, they can stand behind a screen / wear a lead coat

• Diagnostic reference levels (DRLs) - dose levels for typical exams for groups is standard sized patients for certain equipments

What happens if a patient received too much radiation ?

1. Firstly should be reported as radiographers have a legal requirement to report it. It can be dealt with internally

2. If patient has received accidental exposure radiation exceeding references from IR(ME)R then it can be reported to the CQC who will investigate

How is dose limitation achieved in a CT room ?

• scatter radiation is CT is high so anyone in the room should wear a lead coat and be as far away from the gantry as possible

• Radiographers should not leave dose badges in the room

• Always pause and check to look for colleagues on the room to limit exposing them to unnecessary radiation

How is dose limitation achieved in a portable X ray ?

• Wear a lead coat

• Stand at least 2 metres away from the x-ray tube

• Call out “X-rays” prior to exposure

• Clear unnecessary personnel from scatter area

• Reassure staff about safe distances

How can you protect yourself using the Inverse square law ?

• intensity of the radiation reduces with distance

• If you have to be in the room, stand as far away as possible from source of radiation and ensure you wear a lead coat

How is dose limitation achieved in an Operating theatre ?

• ensure everyone in the room is wearing lead

• Warn people coming in that the operating room is now a controlled area

• Ensure radiation warning signs are placed on doors

• Give verbal response when asked for an X ray by surgeon.

How is dose limitation achieved in a fluoroscopy room ?

• wear a lead coat

• Wear dose badge

• Collimate !!

  Fluro rooms require the operator to be within a high scatter field so protection is crucial

How is dose limitation achieved in an Interventional suite ?

• wear lead apron and BAT shield

• Wear a thyroid shield

• Protect your eyes with lens protection

• Always use lead shields and close the gap to reduce scatter and distance with machine