Radiation Safety

Overview

Western Health is committed to ensuring that comprehensive systems of control are in place at all times to protect users, employees, contractors, patients, and the general public from exposure to radiation arising from radiation practices conducted at Western Health. In order to ensure the highest level of protection, Western Health has appointed a Radiation Safety Officer (RSO) to oversee all levels of radiation protection and compliance.

Radiation Safety Documents

Western Health has an overarching radiation safety policy, and a number of procedures related to radiation safety.

Related policy and procedure can be accessed via the Policies and Procedures tab on the intranet - or use the search function with keyword such as 'radiation'.

In addition these local policies and procedures, Western Health has a Radiation Management Plan.

The Radiation Safety Officer

The Radiation Safety Officer (RSO) is responsible for the safe use of ionising and non-ionising radiation equipment and substances in Western Health. The RSO is responsible for management of radiation incidents which may affect Western Health. The Radiation Safety Officer is responsible for radiation safety functions within Western Health, provides training and performs periodic safety inspections. Western Health emphasizes safety education and training as a priority. The RSO provides training to staff to ensure appropriate levels of awareness and competence in Radiation Safety.

Please contact the RSO to arrange radiation safety training for individuals or groups, in the case of radiation related incident, or radiation equipment safety information and inspection.

Radiation Safety Officer: Leah Biffin

Contact: (office) 8345 7010

Email: leah.biffin@wh.org.au

Radiation Incidents

Any incident that involves the exposure or potential exposure of a patient or staff member to ionising radiation, where it was not part of planned care, must be reported. Please use Riskman to report the incident, and ensure that a radiation exposure category is chosen. In addition to Riskman, please contact the RSO directly if a radiation incident has occurred. If you are unsure if an incident is a radiation incident, please also contact the RSO to discuss.

The unnecessary exposure of persons to radiation is treated seriously in Victoria. The Victorian Department of Health and Human Services monitors incidents and unnecessary exposures. Incidents within the medical context include incorrectly prescribed examinations, repeat examinations, incorrect patient exposures and occasionally accidental staff exposures. Western Health endeavours to minimise radiation incidents wherever possible. In order to do this, radiation related incidents must be appropriately reported.

Incidents that involved the actual exposure of staff or patients to an unnecessary radiation procedure are reviewed internally by the Western Health Radiation Safety Committee, in addition to all other risk and incident review steps. The RSO conducts individual dose estimates and reports for every radiation incident. Where the dose has been in excess of 1 mSv for an adult, or any inappropriate dose to a child, the incident is reported to the Victorian Department of Health and Human Services.

Lead Gowns

Lead aprons / gowns are required for use in many areas where fluoroscopy equipment is used. These are protective items that require special care in use and storage.

The WH procedure outlining the use, maintenance and specifications for lead gowns and lead protective items may be found here: Lead Protective Items.docx

When wearing a lead gown, choose one of the appropriate size.

· A gown too big or too small can leave some parts of the body exposed unnecessarily.

· Ensure a gown that crosses over at the front is able to fully close / cross.

· Ensure gown reaches to above the knee – protecting the femur.

· Ensure the arm holes of gowns are not too large, leaving breast tissue and torso exposed from the side.

· Always choose a gown with a back – do not use drop off or apron style leads.

· Always use a thyroid collar, secured appropriately to cover the thyroid at the base of the neck.

When storing lead gowns, hang on hangers provided.

· NEVER fold gowns. Folds in gowns quickly develop cracks and reduce protection.

· NEVER place gowns in laundry. To clean gowns, wipe surface with water & soap – do not use chemicals. Exposure to heat and chemicals will destroy gowns.

· Check gowns for damage to surface, Velcro, penetrations, fraying, etc. Serious damage may reduce gown protection. Contact RSO for inspection of gown if damage is suspected.

Lead glass screens

At all times the radiographer has supervision of radiation safety and may make directions to staff members re the use of lead screens or lead gowns in theatre. A radiographer my direct a staff member to cease using a lead screen and put on a lead gown.

Mobile lead screens available in Theatres must only be used for limited, low dose and low screening procedures as per lead screen guidelines in above procedure. This includes only lap chole and neuro level check type procedures.

Staff members utilising mobile lead screens for these procedures only do not require the use of a lead gown

Personal Radiation monitors (TLDs) must be worn by users of screens (when TLD has been allocated to staff members)

Only one staff member may use each screen at a time. Lead screens are not suitable for protecting two or more persons at once.

Overhead lead glass screens available in Fluoroscopy, Cath Lab and Angiography laboratories should be utilitised whenever possible, but do not obviate the requirement for lead gown use in these areas.

Radiation Use License

The operation of ionising radiation apparatus is conducted under license at both a management and individual level. Any individual wishing to operate an ionising radiation apparatus MUST hold a current Radiation Use License from the Department of Health.

Unlicensed individuals are not permitted to operate radiation producing equipment at any time at Western Health. Unlicensed operation of equipment can result in heavy fines.

Please contact the RSO if you wish to operate equipment or for more information on Radiation Use License.

License application forms and information are available at:

http://www.health.vic.gov.au/radiation/

Radiation Use License may be issued to persons in the following categories.

Radiographer - holding current Australian registration to practice Radiography

Radiologist - holding current Australian registration to practice

Cardiologist - holding current Australian registration to practice

Surgeon - Must complete Fluoroscopy Radiation Safety Course, can only operate limited output mobile fluoroscopy device

Dentist - holding current Australian registration to practice, can only operate limited X-ray device for dentistry

Nurses, technicians, other physicians, etc., are NOT able to apply for a license at this time.

Please contact the Department of Health Radiation Safety Section for any information on Radiation Use License.

Paediatric Patients

Where possible, radiation exposure for children should be minimised.

In most diagnostic and therapeutic applications of radiation, the radiation exposure can be adjusted for paediatric patients.

Wherever possible, Western Health endeavours to reduce radiation dose to paediatric patients.

This includes utilising paediatric optimised protocols Dose Reference Levels in CT, optimising techniques in X-ray and fluoroscopy and other techniques for minimising radiation dose.

For more information about radiation exposure for children please see the following links:

1. RANZCR Inside Radiology

http://www.insideradiology.com.au/pages/list_index.php

2. International Atomic Energy Agency ‘Radiation Protection of Patients’

https://rpop.iaea.org/RPOP/RPoP/Content/InformationFor/Patients/patient-information-pregnancy-children/

3. Image Gently campaign

http://www.pedrad.org/associations/5364/ig/?page=595

Pregnancy brochure for patients WH - 2023.pdf

Pregnant Patients

Where possible, radiation exposure of a foetus should be avoided. However, many diagnostic radiation procedures can be carried out with minimal radiation exposure to the fetus.

Where possible, please discuss radiation procedures for pregnant patients and suitable imaging alternatives with a radiologist.

For pregnancy related risk information, please see the following links:

1. RANZCR Inside Radiology
http://www.insideradiology.com.au/pages/view.php?T_id=96&ref_info

2. International Atomic Energy Agency ‘Radiation Protection of Patients’
https://rpop.iaea.org/RPOP/RPoP/Content/SpecialGroups/1_PregnantWomen/PregnancyAndRadiology.htm

Pregnant / Occupationally Exposed Staff Members

Staff members who are regularly or irregularly exposed to radiation during their normal occupation may continue their work while pregnant. Pregnancy should not prevent staff working with ionising radiation provided that safe work practices are followed. The Western Health Radiation Safety Officer can be contacted for further advice.

Radiation risks to a foetus of an occupationally exposed worker are usually minimal. In most cases, no changes to work practices are necessary due to radiation exposure.

• Among pregnant Western Health occupationally exposed workers, when normal safety practices are followed:

– there is no risk of malformation or developmental defects in a foetus,

– there is minimal risk of childhood cancer in a foetus,

– there is no grounds for termination of a pregnancy due to radiation dose.

• Information and advice is available from the Western Health RSO at any time, and any consultation is confidential.

Staff Radiation Dose

Occupational radiation exposure is monitored at Western Health by the Radiation Safety Officer (RSO). Any staff member who may potentially exceed the annual limit of exposure for members of the public (1 mSv) is monitored using a personal radiation monitor.

Dose levels for all staff at Western Health rarely exceed 1 mSv, and are not likely to exceed the annual limit of exposure for occupationally exposed persons (20 mSv).

Staff who receive monitoring are typically Radiographers, Radiologists, nurses working in Radiology and Cardiac Cath Lab and Nuclear Medicine Technicians.

The RSO closely monitors the results of the personal radiation badges to ensure that no staff member is receiving excessive radiation exposure.

Information on individual radiation dose is available from the RSO. Radiation dose reports are not publically published for privacy reasons.

The Personal Radiation Monitoring badge

Where staff members do wear personal radiation monitoring badges, the proper care and use of these badges is important. The badges do not provide any form of protection or real-time feed-back about radiation exposure. Rather, these badges are a record of exposure over time.

Radiation monitoring badges must not be tampered with, exposed to high levels of heat and especially not submerged or wetted. These badges should be protected from going through the laundry or similar situations. Where possible, badges should be stored at work and not taken home.

Badges should be worn either in the centre of the torso, or as close as possible (i.e. on a lanyard or similar). Where this is not possible, at the waistline is preferable. Badges must be worn with the label side facing away from the body. Badges must always be worn underneath the lead gown or similar protections, unless specifically directed otherwise.

Badges are issued for a recurring period of either three months or one month. At the conclusion of each period badges must be returned for readout and re-use. If badges are not returned, no radiation dose can be recorded for that period. There is an additional cost to the hospital for late and not-returned badges.

Lost badges should be reported to the RSO as soon as possible so a new badge may be provided.