Radioactive Material Incidents Tutorial

Question 1

What advice might be given in regards to an incontinent patient urinating in a hospital canteen after receiving 600 MBq Tc-99m injection (myocardial perfusion study)? Consider good practice and regulations in England.

Answer 1

• Support the patient, maintaining their privacy and dignity. This may involve asking other members of the public for space.
• Do not mention the word “radiation” initially so as to not cause alarm.
• Prevent the spread of contamination by ensuring the patient and any other potentially contaminated individuals remain where they are.
• Call for help from nuclear medicine department. Ask for medical physicist and technologist to attend with wheelchair, incontinence pads, radiation contamination monitor and decontamination kit (should contain PPE, clinical waste bags, surface decontaminant, cotton wool balls etc.).
• To prevent the spread of contamination, don PPE (gloves, aprons, overshoes etc.). Prevent spread by placing absorbent incontinence pads of visibly contaminated areas. Line wheelchair with incontinence pads and ask patient to sit in it.
• Place absorbent materials in clinical waste bags and continue to remove visible contamination.
• Use a hard surface surfactant to decontaminate further.
• Decontaminate and monitor canteen chair and remove to for decay storage if contamination remains.
• Use a radiation monitor in silent mode to ensure all hard surfaces are decontaminated and only fixed contamination remains. If contamination levels below that permitted in a public area, the canteen can be released for public use. If not, determine the surface dose rate with a dose rate meter. Cover the contaminated area by taping lead sheets to reduce the dose rate. Consideration of dose rates with advice from IRR17 radiation specialist to be sought on whether area needs to be controlled until contamination has sufficiently decayed. Area to be re-monitored and released as soon as possible.
• All staff to be monitored before leaving the incident scene.
• After moving to nuclear medicine department, patient clothed removed, bagged and placed in contamination store. Alternative clothing (e.g. scrubs) provided.
• Skin decontamination performed.
• Provide patient with incontinence pads for next 24 hours.
• Patient imaging completed at appropriate time.
• Bagged patient clothing returned with advice to wash once home.
• All radioactive waste to be logged into the solid waste stream.
• Record incident and actions taken in the relevant departmental record (requirement of IRR17 and EPR16) and the trust incident system.
• Ensure appropriate role holders have been informed, as per contingency plans (requirement of IRR17 and EPR16). Seek advice for regulatory compliance from MPE/RPA.
• Review existing risk assessments, protocols and contingency plans to determine if update is required.
• Consider need to provide training - could this scenario be used to practice contingency plans (a requirement of IRR17 and EPR16)?

Question 2

What action may be taken if it was discovered a category 5, security level D radioactive source was missing from its storage location? Consider good practice and regulations in England.

Answer 2

• IRR17: Check departmental log (i.e. sign out/sign in of sealed sources from storage locations). Seek the source if it has been signed out to a different location on the premises.
• Inform/discuss with the relevant competent person charged with supervision of permitted sealed sources, as per EPR16. Inform/discuss with other role holders in accordance with the local contingency plan for loss/theft of a sealed source (IRR17 RPA/RPS, EPR16 RWA). Agree best course of action.
• IRR17/EPR16: Start a search for the source with appropriate assistance. Check usual locations, use radiation monitors etc.
• IRR17/EPR16: If source not found, check contingency plan, contact all likely source users to initiate search in their area and prevent removal/disposal of any solid waste without prior check for presence of the source.
• IRR17/EPR16: Consider the possibility that source has been stolen; Discuss with staff to find last known source location, determine if any evidence of unusual activity, discuss with organisation security (review CCTV?), contact local counter terrorism security advisor (CTSA) regarding potential terrorist activity.
• Ensure the required reporting/notification by the appropriate role holder is completed: Check EPR16 permit (will require notification to EA incident hotline and police), IRR17 will require notification to HSE if above notification limits, report through organisations incident reporting system.
• Notify chief executive officer due to potential for adverse publicity.
• Consider need for training. Could this be used as a scenario for exercising contingency plans (a requirement of IRR17 and EPR16).

Question 3

What action would be required if a doctor was found by security trying to leave the hospital with I-131 capsules? Consider good practice and regulations in England.

Answer 3

• Advise security that the doctor should not leave the hospital with the I-131 capsules and they should be held for police/CTSA investigation. Make it clear the incident should be treat as a possible terrorist incident.
• Contact any senior/key role holders for the department to explain the situation and seek attendance to take custody of the sources, make safe and be available for any initial police enquiries.
• Attending key role holders should:
  
  • Ensure police and CTSA have been informed.
  • Check the integrity of the I-131 capsules and return to storage.
  • Undertake contamination of all individuals who may have been in contact with the sources and decontaminate if necessary.
  • Check source holding and ensure all sources are accounted for.
  • Inform police/CTSA if any sources are missing as well as the EA incident hotline (EPR16) and determine if HSE need to be notified under IRR17 (i.e. if above notification levels).
  • Ensure physical security measures are appropriate to prevent another incident (e.g. change door lock codes).
  • Inform chief executive officer and trust communications.
• Next working day:
  
  • Review security arrangements in conjunction with CTSA officer and implement any changes required.
  • Record incident in local incident reporting system.
  • Cooperate with police and count terrorism investigations.
  • Direct press enquiries to trust communications lead.
• Could similar incident scenario be used for exercising contingency plans (a requirement of IRR17 and EPR16)?

Question 4

What action would be required if mortuary assistant was informed patient undergoing post-mortem had has radiation therapy prior to death. Consider good practice and regulations in England.

Answer 4

• Advise staff to stop post-mortem.
• Obtain patient details.
• Inform key role holders with local responsibility (e.g. MPE nuclear medicine, RPA etc.).
• MPE should do following:
  
  • Attend mortuary with dose rate meters, contamination monitor, radionuclide identifier, decontamination kit and colleague.
  • Undertake dose rate measurements and identify radionuclide if appropriate.
  • If any radiation is detected, undertake contamination monitoring and decontaminate.
  • Deal with any radioactive waste (EPR16).
  • Make area safe and prevent post-mortem until nature of radionuclide therapy has been determined and risk assessment completed.
  • Obtain information (therapy type, date, activity etc.) regarding patient radionuclide therapy (medical records, attend hospital department, speak to next of kin etc.).
• Risk assessment should consider risks associated with; post-mortem, embalming, burial, cremation etc.
• Deal with any RAW (EPR16) and any pathological sample issues (IRR17, EPR16 and potentially CDG09).
• Record incident in local records and trust incident reporting system.
• Similar incident used for exercising contingency plans?