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Medical Imaging > Radiation Protection - Legislation > Flashcards

Radiation Protection - Legislation Flashcards

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USMLE® Step 1 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
Q

Optional extras for local rules

A
  • 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
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26
Q

Role of radiation protection adviser

A

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

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27
Q

Role of Radiation Protection Supervisor

A

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

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28
Q

What training do radiation protection supervisors have?

A

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

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29
Q

Radiation protection supervisor in practice

A
  • 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
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30
Q

How is exposure restricted?

A
  • design
  • dose constraints
  • systems of work
  • PPE
  • training
  • additional restrictions for pregnant/ breastfeeding people
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31
Q

Shielding methods in design

A

lead in walls and doors
lead glass screens
syringe shields

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32
Q

Equipment features to reduce exposures

A

collimation
filtration
dose saving features e.g., pulsed fluoro

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33
Q

Design features to reduce exposure

A
  • shielding
  • equipment features
  • emergency stop buttons
  • room layouts
  • warning signs
  • access to proper equipment (e.g, remote handling tools)
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34
Q

What are dose constraints?

A

planning tool not a dose limit

35
Q

How are dose constraints set?

A

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
Q

What is the purpose of systems of work?

A

keep doses alarp and below classification levels

37
Q

What do systems of work restrict?

A
  • amount of radiation
  • duration of exposure
  • number of people exposed
38
Q

examples of systems of work

A

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
Q

What should PPE be?

A

adequate, suitable, RPA advises, quality assured

40
Q

Examples of PPE

A

ceiling suspended lead glass shields

shields on wheels

lead aprons

lead specs

lab coat and gloves

41
Q

What does radiation safety training cover?

A

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
Q

Conditions for pregnant workers?

A

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
Q

Conditions for breastfeeding workers?

A

restrict exposure to prevent significant bodily contamination

risk assessment required

breastfeeding > 6 months - good idea to inform employer

44
Q

Conditions for breastfeeding workers?

A

restrict exposure to prevent significant bodily contamination

risk assessment required

breastfeeding > 6 months - good idea to inform employer

45
Q

Definition of outside worker

A

any person carrying out activities in a controlled or supervised area without an individual contract of employment with the employer for that area

46
Q

Definition of multi-employed worker

A

any person who works in a controlled or supervised area for more than one employer

47
Q

Duties of multi-employed workers

A

cooperate and share information regarding employee classification status and dose records

48
Q

Duties of outside worker employers

A

cooperate over working requirements and conditions and dosimetry

49
Q

What should be monitored?

A

designated areas to ensure control is appropriate

staff to ensure adequate restriction of exposure

dose investigation levels

records of monitoring

50
Q

General duties for manufacturer and installer of any equipment

A

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
Q

What incidents should HSE be notified of?

A

dose exceeding dose limit

loss or theft of source

release or spillage leading to significant contamination

intention to work with ionising radiation

52
Q

What incidents should be internally reported?

A

dose exceeding investigation level

failure to follow work instructions and local rules

near misses

53
Q

Scope of IRMER 2017 (ionising radiation medical exposure regulation)

A
  • 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
Q

Responsible persons under IRMER 2017

A

referrer
practitioner
operator
employer
medical physics expert

55
Q

Role of a practitioner

A

registered HCP entitled to take responsibility for an individual medical exposure

responsible for the justification of each individual exposure

56
Q

Entitlement is a ____ decision

A

local

involve other HCPS
can restrict who can be a practitioner and for what

must be adequately trained

57
Q

Role of an operator

A

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
Q

What does “practical aspect” of a medical exposure refer to?

A

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
Q

Role of an employer

A

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
Q

Role of a medical physics expert

A

experienced in the application of physics to diagnostic and therapeutic uses of ionising radiation

involved in every exposure

advise on compliance

61
Q

Define Medical Physics Expert

A

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
Q

Who provides justification and authorisation?

A

justification - practitioner
authorisation - practitioner or operator acting under written guidelines

63
Q

Define diagnostic reference level

A

a dose level or amount of radioactivity used in a diagnostic procedure for typical examinations

64
Q

Who establishes DRL’s?

A

employer, should also establish how to be used

65
Q

DRL are a requirement under ______

A

IRMER2017 under duties of employer

66
Q

DRLs are a tool for ______

A

optimisation and comparing equipment and protocols

67
Q

How is the LDRL set?

A

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
Q

Define carers and comforters

A

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
Q

Dose constraint for carers and comforters

A

less than 5mSv per event

70
Q

Responsibilities for employers using medical equipment

A

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
Q

Guidelines for notification to regulators under IRMER 2017

A

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
Q

Accidental exposure

A

exposure to anyone who was not supposed to have the exposure at all

73
Q

How should patient identification be carried out?

A

3 forms of identifiers - name DOB address
pause and checked - 6steps
active response from patient
make clear who is responsible for identification

74
Q

How should clinical evaluations be carried out?

A

recorded and for every exposure

include dose delivered

no specification on who does it

75
Q

Who is the licensing authority for radioactive materials?

A

ARSAC
administration of radioactive substances advisory commitee

76
Q

ARSAC guidance notes

A

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
Q

Purpose of EPR permit

A

limits the type, number and activity of sources which can be held

78
Q

____ records of open sources are required.

A

daily, what you have and where the source is.

79
Q

who should loss, theft or spills be reported to?

A

RPS

80
Q

How long are records held for?

A

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
Q

What does an EPR permit specify in terms of radioactive waste?

A

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
Q

Best available techniques (waste disposal) should be used to minimise ______

A

activity and volume of radioactive waste

activity of waste disposed of

environmental impact of disposal

83
Q

Waste management techniques

A

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
Q

What is and what are the conditions for the Exemption Regime?

A

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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