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Medical Imaging > Radiation Protection - Legislation > Flashcards

Radiation Protection - Legislation Flashcards

1
Q

Principles of RP

A

Justification, Optimisation, Limitation

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2
Q

What was the ionising radiations regulations 2017 made under?

A

health and safety at work act 1974

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3
Q

What does IRR 2017 apply to?

A

work with ionising radiations:
- radioactive materials
- generators over 5kV
- includes training

  • naturally occurring radionuclides
  • Radon >300Bq.m-3
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4
Q

Who has responsibilities under IRR 2017

A
  • employer
  • employees
  • self employed
  • manufacturer/supplier - equipment must be fit for purpose and compliant
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5
Q

What should be completed before starting work?

A
  • appoint RPA/RPS
  • HSE - notification, registration or consent
  • designate supervised/controlled areas
  • consider classification of staff
  • staff and area monitoring
  • instruct and train employees
  • PPE
  • contingency plans and RA
  • arrangements for outside workers
  • critical examination of installed equipment
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6
Q

Conditions for notification

A

Work with very small quantities of radioactive material
Work in an area where radon > 300Bq.m-3

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7
Q

Conditions for registration

A

work with radiation generators or radioactive materials

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8
Q

conditions for consent

A

administration of radioactive material to people
addition of radioactivity to products
operation of an accelerator
use of a high activity sealed source

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9
Q

Why is a radiation risk assessment carried out?

A

identify radiation hazards to which employees or other people might be exposed
assess nature and magnitude of risks associated with hazards

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10
Q

Who carries out a radiation risk assessment?

A

employer who carries out work with ionising radiation

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11
Q

When should a radiation risk assessment be carried out?

A

before commencing a new activity with ionising radiation for which there is no previous risk assessment

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12
Q

Content of Risk Assessment

A

1) nature of source inc. accumulation of radon in working environment
2) estimated radiation doses
3) likelihood of contamination
4) results of previous personal or area dosimetry
5) advice re. equipment from manufacturer/supplier
6) engineering control measures/design features
7) planned systems of work
8) est. levels of airborne and surface contamination
9) effectiveness and suitability of PPE
10) extent of unrestricted access to areas with sig. dose rate/contamination
11) reasonably foreseeable accidents, likelihood and severity
12) consequence of reasonably foreseeable failure of control measures
13) steps to prevent possible accidents/limit consequence

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13
Q

Outcomes of Risk Assessment

A

1) actions to keep doses ALARP
2) need for engineering controls and PPE
3) arrangements for pregnant staff
4) need to designate areas and staff
5) contingency for foreseeable accident scenarios
6) need for assessment of doses
7) system for monitoring and auditing

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14
Q

What is the dose limit when exposed as a result of medical exposure to another person (not comforter or carer) ?

A

effective dose 5mSv in 5 years

special circumstances - employee effective dose can be averages over 5 years

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15
Q

When is a designated controlled area required?

A

special procedures necessary to restrict significant exposure or prevent/limit accidents
person likely to receive E> 6mSv or lens dose > 15mSv or skin or extremity dose > 150mSv

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16
Q

What should controlled areas have?

A
  • physically demarcated/delineated areas
  • signs to warn of designation, nature of hazard/risk
  • control over entry - classified workers, systems of work to restrict exposure
  • dose monitoring
  • washing facilities, no eating, contamination monitoring
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17
Q

When is a designated supervised area required?

A

areas where conditions need to be kept under review
person likely to receive E> 1mSv, lens dose > 5mSv, skin or extremity dose >50mSv

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18
Q

What should supervised areas have?

A

signs to warn of designation, hazard, risk

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19
Q

What dose is possible for classified employees to have?

A

E>6mSv, lens dose > 15mSv, skin or extremity dose > 150 mSv

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20
Q

What conditions/procedures should be in place for classified workers?

A

-certified fit annually by an appointed doctor
- doses assessed and recorded by HSE approved dosimetry services
- keep records for 30 years or til 75 years old

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21
Q

Likely classified workers in healthcare?

A
  • radiopharmacy (fingers)
  • interventional radiologists (eye, extremity)
  • nuclear medicine/ PET
  • brachytherapy
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22
Q

What are local rules and what are their purposes ?

A

local rules are written rules required for work in controlled and possibly supervised areas

they identify key work instructions to restrict exposure, and enable work to be carried out in accordance with IRR2017

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23
Q

What responsibilities do people have with local rules?

A

employer - provide
employee - read, understand and comply

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24
Q

Essential content of local rules

A

1) dose investigation level
2) contingency arrangements for reasonably foreseeable incidents
3) names of radiation protection supervisors
4) description of areas covered including designation
5) summary of work instructions including instructions for non-classified workers in controlled areas

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25
Optional extras for local rules
- testing and maintenance of controls and warning devices - examination and testing of monitoring equipment - radiation and contamination monitoring - personal dosimetry - arrangements for pregnant and breastfeeding staff - significant findings of risk assessment - review process for procedures to ensure doses are ALARP - initiation of investigations - RPA contact procedures
26
Role of radiation protection adviser
Advises employer on application of IRR2017 1) requirements for supervised and controlled areas 2) examination of plans, designs, safety measures and restrictions for new or modified radiation facilities 3) maintenance and calibration of monitoring equipment 4) periodic examination and testing of controls, design features, warning devices and systems of work 5) risk assessments and contingency plans 6) content of local rules 7) training 8) incident investigation 9) critical examination and QA of equipment 10) selection and use of PPE and dosimeters
27
Role of Radiation Protection Supervisor
necessary to supervise work in areas local rules are required know what to do in an emergency possess authority know where to go for information and advice have enough time and resources
28
What training do radiation protection supervisors have?
Specific RPS training - nature of radiation and its effect - principles of restriction of exposure - quantities used - measurement techniques - requirements of regulations and local rules - principles of radiation protection - local knowledge
29
Radiation protection supervisor in practice
- usually a superintendent radiographer or lab manager - reports to head of department - attends radiation protection committee - first point of contact for employees - usually directly in contact with RPA's
30
How is exposure restricted?
- design - dose constraints - systems of work - PPE - training - additional restrictions for pregnant/ breastfeeding people
31
Shielding methods in design
lead in walls and doors lead glass screens syringe shields
32
Equipment features to reduce exposures
collimation filtration dose saving features e.g., pulsed fluoro
33
Design features to reduce exposure
- shielding - equipment features - emergency stop buttons - room layouts - warning signs - access to proper equipment (e.g, remote handling tools)
34
What are dose constraints?
planning tool not a dose limit
35
How are dose constraints set?
1) identify potential exposed groups 2) set a dose constraint for each group (<0.3 mSv per annum) 3) design facility so this constraint will not be exceeded 4) audit once running
36
What is the purpose of systems of work?
keep doses alarp and below classification levels
37
What do systems of work restrict?
- amount of radiation - duration of exposure - number of people exposed
38
examples of systems of work
use of dose saving features on x-ray equipment keeping away from patient table in interventional radiology unless necessary use of shielded areas lipped worktrays when working with open sources use of PPE and dosimeters
39
What should PPE be?
adequate, suitable, RPA advises, quality assured
40
Examples of PPE
ceiling suspended lead glass shields shields on wheels lead aprons lead specs lab coat and gloves
41
What does radiation safety training cover?
nature and hazard of radiation legal requirements use of design controls use of procedural controls and local rules selection and use of PPE use of monitors significance of warning devices RPS training is appropriate to level of use of radiation
42
Conditions for pregnant workers?
employer restrict so foetal dose ALARP, unlikely to exceed 1mSv for rest of pregnancy risk assessment required -> leading to work restriction, change of duties, suspension on full pay foetal dose of 1mSv is approx 2mSv to abdomen
43
Conditions for breastfeeding workers?
restrict exposure to prevent significant bodily contamination risk assessment required breastfeeding > 6 months - good idea to inform employer
44
Conditions for breastfeeding workers?
restrict exposure to prevent significant bodily contamination risk assessment required breastfeeding > 6 months - good idea to inform employer
45
Definition of outside worker
any person carrying out activities in a controlled or supervised area without an individual contract of employment with the employer for that area
46
Definition of multi-employed worker
any person who works in a controlled or supervised area for more than one employer
47
Duties of multi-employed workers
cooperate and share information regarding employee classification status and dose records
48
Duties of outside worker employers
cooperate over working requirements and conditions and dosimetry
49
What should be monitored?
designated areas to ensure control is appropriate staff to ensure adequate restriction of exposure dose investigation levels records of monitoring
50
General duties for manufacturer and installer of any equipment
designed erected and installed to restrict exposure safety features and warning devices critical examination of safety feature operation and protection of persons from exposure adequate information on use, testing and maintenance
51
What incidents should HSE be notified of?
dose exceeding dose limit loss or theft of source release or spillage leading to significant contamination intention to work with ionising radiation
52
What incidents should be internally reported?
dose exceeding investigation level failure to follow work instructions and local rules near misses
53
Scope of IRMER 2017 (ionising radiation medical exposure regulation)
- patients - health screening programmes - research - carers and comforters - asymptomatic individuals - individuals undergoing non medical imaging with medical equipment (e.g., legal cases, pre-emigration xray, customs)
54
Responsible persons under IRMER 2017
referrer practitioner operator employer medical physics expert
55
Role of a practitioner
registered HCP entitled to take responsibility for an individual medical exposure responsible for the justification of each individual exposure
56
Entitlement is a ____ decision
local involve other HCPS can restrict who can be a practitioner and for what must be adequately trained
57
Role of an operator
a person who is entitled to carry out any practical aspect associated with the procedure of a medical exposure MPE is an operator must be adequately trained
58
What does "practical aspect" of a medical exposure refer to?
physical conduct of the exposure calibration & maintenance of equipment assessment of doses preparation & administration of radiopharmaceuticals Processing of images and other data Computer planning Preparation of results
59
Role of an employer
a person who has legal responsibility for a radiological installation responsible for radiation protection framework via SOP's, written procedures and diagnostic reference levels contractual arrangements required if 3rd party involved
60
Role of a medical physics expert
experienced in the application of physics to diagnostic and therapeutic uses of ionising radiation involved in every exposure advise on compliance
61
Define Medical Physics Expert
individual who has the knowledge, training and experience to act or give advice on matters relating to radiation physics applied to medical exposure, whose competence in this respect is recognised by a national body
62
Who provides justification and authorisation?
justification - practitioner authorisation - practitioner or operator acting under written guidelines
63
Define diagnostic reference level
a dose level or amount of radioactivity used in a diagnostic procedure for typical examinations
64
Who establishes DRL's?
employer, should also establish how to be used
65
DRL are a requirement under ______
IRMER2017 under duties of employer
66
DRLs are a tool for ______
optimisation and comparing equipment and protocols
67
How is the LDRL set?
perform dose area product audit across several x-ray installations median DAP for a particular exam on each x-ray unit calculated average median DAP across all units used to set the LDRL
68
Define carers and comforters
individuals knowingly and willingly incurring an exposure to ionising radiation by helping, other than as part of their occupation, in the support and comfort of individual undergoing or having undergone medical exposures
69
Dose constraint for carers and comforters
less than 5mSv per event
70
Responsibilities for employers using medical equipment
specify acceptable performance criteria measures to improve inadequate performance implement and maintain a QA programme Include assessment of dose a person may be exposed to during ordinary operation of the equipment inventory of radiation equipment
71
Guidelines for notification to regulators under IRMER 2017
accidental and unintended exposures accidental above 3mSv in adults and 1mSv in children report to CQC in england all accidental in rest of UK
72
Accidental exposure
exposure to anyone who was not supposed to have the exposure at all
73
How should patient identification be carried out?
3 forms of identifiers - name DOB address pause and checked - 6steps active response from patient make clear who is responsible for identification
74
How should clinical evaluations be carried out?
recorded and for every exposure include dose delivered no specification on who does it
75
Who is the licensing authority for radioactive materials?
ARSAC administration of radioactive substances advisory commitee
76
ARSAC guidance notes
data for dose reduction guidance for protection of children conception, pregnancy and breastfeeding routine procedures - DRL's, effective dose and uterus dose radiation dose calculation
77
Purpose of EPR permit
limits the type, number and activity of sources which can be held
78
____ records of open sources are required.
daily, what you have and where the source is.
79
who should loss, theft or spills be reported to?
RPS
80
How long are records held for?
your records are needed for a monthly and annual record held by your hospital and an annual return by the hospital to the environmental agency
81
What does an EPR permit specify in terms of radioactive waste?
identification of waste category: organic liquid, solid, aqueous liquid, or gas limits in terms of activity and volume what can be stored and how specifies acceptable disposal routes
82
Best available techniques (waste disposal) should be used to minimise ______
activity and volume of radioactive waste activity of waste disposed of environmental impact of disposal
83
Waste management techniques
decay store short half-life solid waste aqueous waste goes directly to sewer organic and solid waste incinerated some very low level waste goes to landfill
84
What is and what are the conditions for the Exemption Regime?
hospital is exempt from registering radioactive sources provided: - <1GBq Tc-99m - <100MBq all others except <20MBq iodines - patient excreta NOT EXEMPT if the premises hold other EPR permits

Medical Imaging (3 decks)

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