Radiation Safety

Recently there has been considerable news media coverage regarding high levels of ionizing radiation associated with CT scans.(1)  The radiation doses quoted in this paper are not those recommended by the American College of Radiology or the Society of Pediatric Radiology (2-4) however; these articles have heightened awareness and fear regarding ionizing radiation.

The following report discusses basic policies and procedures employed to assure safety and security of patients undergoing imaging examination/procedures and for the employees providing these services.  These policies and procedures are part of the safety assurances patients can count on when having imaging examinations in an accredited hospital.  Explanations of various available imaging techniques, including MR and US which do not use ionizing radiation to produce an image are described along with the risks associated with contrast agents occasionally used with imaging studies.  The intent is to inform patients and employees and improve communication in order to reassure that safety is a priority. The administrative roles and responsibilities for oversight are also briefly outlined.  Patients and employees of the institution can use this information to quell the concerns of patients and other providers regarding the safety of various medical imaging procedures.

Part I & II: Proactive measures to Assure Safety and Security for Patients, (Part I) Employees and Visitors, (Part II).

Part III: Administrative oversight and maintenance policies for equipment, education, employee safety measures with regard to assuring safety associated with medical imaging including interventional procedures performed under image guidance

Part IV:  Summary

Part V:  References

TABLE OF CONTENTS

                                    
I. PATIENT SAFETY

• GENERAL

• Patient identification
  
  
• Patient privacy/dignity 

• Patient responsibilities

B.  VARIOUS IMAGING MODALITIES – DEFINITIONS RISKS AND SAFETY      MEASURES FOR EACH MODALITY

• Ionizing Radiation (Radiology) Modalities

         Conventional x-ray
         Fluoroscopy
         Computed Tomography (CT)
         Nuclear Medicine
                 

• Non-Ionizing Imaging Modalities

         Ultrasound (US)
         Magnetic Resonance Imaging (MRI)

• Interventional Radiology (IR)

         Radiographic/Imaging Contrast Agents

II. EMPLOYEES AND VISITORS SAFETY MEASURES

A.  GENERAL

• Employee Safety Responsibility
  
  
• Occurrence reporting

B. SAFETY WITH REGARD TO EQUIPMENT USE & MONITORING

•  Ionizing Radiation Protection

   Equipment Safety
   Personnel Safety
   Occupational Dose Program
   Radiation Safety of Pregnant Radiation Workers
   Radiation Safety Rules for Portable Radiography CT & in OR

• Non-Ionizing Radiation

   Ultrasound (US)
   Magnetic Resonance Imaging (MRI)

III. ADMINISTRATION

            A.  RADIOLOGY QUALITY ASSURANCE COMMITTEE

            B.  RADIATION SAFETY COMMITTEE

• Membership
• Responsibilities
  

C. RADIATION SAFETY OFFICER

• Responsibilities of authorized users of ionizing radiation

D. POLICIES & PROCEDURES RE: IONIZING RADIOLOGY

•  Radioactivity testing & controls

Leak Testing
Radiation Surveys
Preparation & Administration of Radionuclides
Radioactive waste disposal policy & monitoring

• Nursing Care of Patients who received Radioactive Material

Occurrence Report Form

• Management of Radiation Emergencies

IV. SUMMARY

V.  REFERENCES

Safety & Security Procedures within the Dept of Radiology & Imaging

The Department of Radiology & Imaging provides for the safety and security of all patients, employees and visitors in regard to medical imaging including interventional procedures performed under imaging guidance and use of contrast agents for enhanced imaging outcomes.  At our institution, administrative controls and oversight are in place to establish policies and procedures which assure safety and security.

I.  PATIENT SAFETY

A. GENERAL

• Patient identification

            Each patient is required to have written orders from their physician
            identifying the requested imaging exam and/or interventional procedure. 
            Custom order forms are generated by the Department and are offered to each referring             MD and are encouraged to be used to improve efficiency and decrease the possibility of             communication errors.

           Correct patient identification is ensured by using two approved specific
           identifiers, Patients must: spell their name and give their date of birth.   
                                                                            

• Patient Privacy and Dignity

Information regarding imaging examinations and/or procedures is available on the hospital and Department of Radiology website for patients to review.

            Each patient is given an individual dressing room. Private restroom facilities
            are adjacent to the radiographic rooms.

• Patient Responsibilities

   The patient must provide, to the best of his/her knowledge, accurate and complete information regarding all matters relating to their health care, including:

                     Nature of present complaint
                     A brief medical history pertinent to the particular exam is requested from the                            patient by the technologist and/or radiologist.
                     Past illnesses/hospitalizations
                     Unexpected changes in condition since last examination or visit to referring physician.
                     If scheduled for a procedure, medications prescribed and over the counter

A patient is responsible to make known whether or not he/she clearly understands the reason for the examination/procedure and their role in that process.  The patient is also responsible to follow established rules and regulations especially as they affect patient care.  This responsibility includes consideration for the rights and respect for the property of other patients and personnel, and assistance in the hospital's efforts to limit noise, smoking, and the behavior and number of the persons accompanying them.

All female patients of child bearing age scheduled for a conventional x-ray,
CT, fluoroscopy, MR or non-US image guided interventional procedure are asked if they are or think they might be pregnant.   If the possibility of pregnancy exists, the patient is informed of options, risks and alternatives.  If pregnant, the patient is informed of the risks and the patient’s obstetrician is consulted.

• VARIOUS IMAGING MODALITIES - DEFINITIONS RISKS & SAFETY MEASURES FOR EACH MODALITY

• Ionizing Radiation (Radiology) Modalities

• Conventional x-rays

Definition: Conventional x-rays use invisible electromagnetic energy-ionizing radiation to produce images of the body, including bones, joints, and soft tissue.

Risks:
Ionizing radiation is a risk to sensitive tissues, e.g. bone marrow, gonads and thyroid.

Radiation during pregnancy has the potential of producing birth defects so it is
important to avoid ionizing radiation if there is a suspicion or actuality of being
pregnant.  Particular caution should be exercised during the first trimester.  A patient
who is pregnant or suspects there is a possibility of being pregnant will not be examined without the recommendation of a radiologist and consultation with the attending gynecologist/obstetrician. 

Safety Measures:
Every effort is made to keep radiation exposure as low as practicable.   Dosage utilized is according to ALARA (individual and collective doses must be As Low As is Reasonably Achievable).

Radiation dosages for diagnostic imaging examinations are described in terms of mRems and can be presented as entrance dose, skin dose, organ dose, total body dose or “effective dose”.  
The “effective dose” is the most usually used terminology.  The “effective” dose is a calculation which estimates what dose, if given to the entire body, might produce approximately the same amount of risk as would the real dose actually received by the irradiated area.  The “effective dose” for a specific examination can be compared to background received just by living in a specific area, such as 200 mRem. received annually in New York City.

Collimation is a major factor to reduce ionizing radiation exposure; it limits the field of exposure to the area of interest.

All patients receive gonadal shielding provided the shielding does not infringe upon the area of primary diagnostic interest.  The department has wraparound, full and half aprons, breast shields, male and female gonadal shields.

• Fluoroscopy

Definition:  Fluoroscopy provides real-time X-ray imaging and is used to study moving body structures via a continuous x-ray beam producing a generated image. The image is transmitted to a TV-like monitor so that the body part and its motion can be seen in detail. Fluoroscopy is used for guiding diagnostic and therapeutic interventional procedures including image-guided anesthetic injections into joints or the spine, and also to help locate radiopaque foreign bodies.

Risks:
The risks of ionizing radiation are discussed under conventional x-ray.
        
Safety Measures:
All fluoroscopic procedures performed in the Department of Radiology & Imaging
are by a radiologist, a physician with subspecialized training and assisted by a 
technologist both trained in the safe use of ionizing radiation including collimation,
ionizing scatter &  pulsed radiation techniques to guide interventional procedures. Patient exposures are logged and monitored to be within safety standards. 

• Computed Tomography (CT)

     
Definition: Computed Tomography (CT) uses ionizing radiation to capture thin section
axial images and  computer processing to create cross-sectional images of  bones, joints,
and soft tissues.  These axial images are reformatted for multiplanar views.

CT provides highly detailed information of the spine, joints, soft tissues, including
soft tissue calcifications, in addition to abnormalities of the abdomen, pelvis or head. CT
is usually obtained after myelograms, discograms, and after selected types of arthrograms. Special protocols are used to visualize each area of the musculoskeletal system. CT is also used to guide procedures such as diagnostic and therapeutic interventional    procedures including, facet joint injections, nerve blocks as well as biopsies.

Risks and Safety Measures
Risks and Safety measures are the same as described under conventional x-ray and every effort is made to minimize dosage.  Exposure factors appropriate to patient body size and thickness to minimize dose while optimizing image quality are utilized.  Specific pediatric imaging protocols for infants and children are used and based on patient size and weight.

• Nuclear Medicine

Definition: Nuclear Medicine studies use injected and/or inhaled radioisotope tracer to
detect abnormalities in the bones and joints as well as to identify clots (thrombi) in the
lung vasculature.

Risks:
As with conventional x-rays, the Nuclear Medicine Division follows the ALARA program.

Safety Measures:
Radiation safety with regard to clinical usage of radioisotopes requires each patient
to have written orders from their physician regarding medical necessity and the required radiopharmaceutical.  The Radiologist reviews the requested order for appropriateness.
The dose of radioactive isotope tracer is prepared by the nuclear medicine technologist             
per procedure and patient weight and age.
           
In all cases involving in-patients who have had radioactive material, a note is placed in
their chart and a radioactive symbol sticker is adhered to the chart as to the dosage and
type of radioisotope administered.  Patient records of specific radioactive isotope and
dosage are maintained.

• Non-Ionizing Imaging Modalities

• Ultrasound

Definition: Ultrasound or sonogram (US) uses high frequency sound waves to image soft tissues e.g. tendon, ligaments, neuromas, bursas etc. and blood flow.  US is also used to
guide both diagnostic and therapeutic interventional procedures.

Risks:
No ionizing radiation is involved, Ultrasound is very safe,

Safety measures:
Precautions are mainly for instrument and field sterilityand physical safety.

• Magnetic Resonance Imaging

Definition: Magnetic Resonance Imaging (MRI) uses high strength magnets and radio waves to send and receive signals to a specific body part and a computer converts these signals into images. High resolution MR imaging is used to demonstrate fine detail of articular cartilage, tendons, peripheral nerve, and other soft tissue structures, which are not typically demonstrated on routine MR exams.

Risks:
Because ionizing radiation is not used. MRI is safe in the majority of patients;
however, certain patients may not be able to have an MRI.   Patients who are at
risk for an MRI examination include people who get nervous in small spaces (claustrophobic); people with implanted medical devices such as aneurysm in the brain, heart pacemakers and cochlear (inner ear) implants; people with pieces of metal close to or in an important organ (e.g. the eye); any patient who is pregnant or suspects there is a possibility of being pregnant will not be scanned or enter the restricted magnetic field area without the recommendation of a radiologist and consultation with the attending gynecologist/obstetrician.  As with ionizing radiation, particular caution should be exercised during the first trimester.

Safety Measure
Patient’s specific areas of discomfort/pain are requested to verify that the procedure ordered
is appropriate for the patient's condition.

To insure that MRI incompatible clothing or jewelry are not present in the MRI field
the following precautions are taken:

All patients wear examining gowns, are given a locker and instructed to remove all clothing, jewelry and MRI incompatible items.  Metal objects like watches, credit cards, hair pins, writing pens, etc. which may be damaged by the MRI scanner or may be pulled into the MRI are removed.  A comprehensive patient intake form is used to screen for magnetic safety and identification.  Previous experiences and/or conditions which could be harmful to the patient and/or equipment during an MR scan are part of the intake form.
  
The MRI technologist reviews intake form with the patient to insure magnetic safety and
verify the patient's symptoms with the scanning protocol to be performed.  Patients and Relatives, caregivers and other persons accompanying the patient during the MRI exam are also screened and required to fill out an MRI safety questionnaire. 

   Sample MRI Intake Questions:
                  What does your doctor think is wrong?
                  Have you ever been a machinist, welder, or metal worker?
                  Have you ever been hit in the face or eye with a piece of metal?
                  (including shavings, slivers, bullets or BBs)?
                  Have you ever had a piece of metal removed from your eye?
                  Are you pregnant or breastfeeding?
                  Do you have claustrophobia?                     
                  Do you have any of the following in your body: infusion pump, or medication pump of any kind?  Pacemaker? Brain/aneurysm clip? etc,

• Interventional Radiology (IR)

Definition:  Interventional radiology (IR) is a subspecialty within the field of radiology and implies the use of various imaging techniques (e.g. X-ray, Fluoroscopy, CT, and Ultrasound) to guide diagnostic examinations and therapeutic procedures.  Interventional Radiologists are board certified physicians who have special training in minimally invasive, targeted diagnostic examinations and treatments performed using imaging for guidance.
                 
Risks:
Interventional procedures have less risk, less pain and less recovery time compared to surgery.  Risks include potential of infection or bleeding and in inexperienced hands, risks of exposure to ionizing radiation.
  
Safety Measures:
The Radiologist reviews the order for the procedure and makes other recommendations to the referring physician, if required.  Once the procedure is deemed appropriate and necessary, the following protocol is followed:

            Pre-procedure verification  involves the following:

Within 4 hours of scheduling, an interventional radiologist nurse makes a pre-procedure phone call to begin the assessment process, provide patient education, and respond to any concerns.  Assessment includes but is not limited to: Patient identification as previously described, Height & weight, medical history, allergies, current medications, surgical history, contact information including patient’s phone number where they can be reached the day before the procedure.  Patient is provided with a phone number to call in case they have questions.

The day before the procedure thescheduling staff contacts the patient to confirm their appointment date, provide their arrival time, and confirm with the                             patient whether theystill need to speak with a nurse.  If needed, a nurse performsfinal pre-procedure call.
        
Relevant documents are verified:
MD orders, applicable radiological studiesand lab reports.  Confirmation that they have been reviewed and are consistent with each other and with the patients’ expectationsand with the team’s understanding of the intended patient, intended procedure,intended site, etc.
Missing information or discrepancies areaddressed before starting the procedure.

            Day of procedure

          All Procedures are performed under supervision of Radiologists.

Admission to IR Unit occurs at least 30 minutes to one (1) hour prior to the procedure.

Each patient is given an identification bracelet (name, DOB and medical record #) during the registration process.  To ensure correct patient identification using the two previously identified -approved identifiers, the patient is asked to spell their name and give their date of birth.

Medication Reconciliation Safety Tool is a formal process for creating the most complete and accurate list of new medication orders or changes in medication for each patient. Patients, families and available record/documents are required to develop an accurate list of current home medications. 

Consents and Confidentiality

A written consent form for the patient to sign, with an explanation of the procedure, is given to the patient with an opportunity for the patient to ask questions at this time. All applicable hospital policies and departmental standards regarding confidentiality of patient information are followed.

The consent form is very specific as to the procedure and site.  The words “RIGHT” or “LEFT” or “BILATERAL” are spelled out on the MD orders, schedule and the consent form.

When digits (fingers, toes) are involved, the procedure consent form and customized Radiology diagram form: “Patient Verification of Side and Site for Interventional Procedure” must be completed.

Conscious sedation
Conscious sedation or intravenous sedation at out institution is administered by an anesthetist designated by the Anesthesiology Department who is responsible for monitoring and drug administration, adhering to the protocol for the care of patients under conscious sedation.

The JCAHO “Universal Protocol” for preventing wrong site, wrong procedure and wrong person surgery is applied to all Interventional Radiology Procedures. Marking the procedure site is a mandatory part of the process and is intended to identify unambiguously the intended site of injection/procedure. The general level of the procedure (cervical, thoracic or lumbar), right or left or bilateral will be marked with the Radiologist’s designee’s initials. Exception for procedure site marking with practitioner initials is permitted when the practitioner doing the procedure is in continuous attendance with the patient from the time of decision to do the procedure and patient consent from the patient to the performance of the procedure. If the patient refuses to have the site signed, importance of site marking will be explained.

“Time Out” is conducted immediately before starting the procedure and includes a final verification of the correct patient, procedure and site. “Time Out” is performed in the procedure room immediately before starting the procedure (prior to skin prep). Active communication is utilized to perform “time out” either by the radiologist, technologist or nurse and it is to include: correct patient identity, correct side and site, agreement on the procedure to be done, verify
x-ray/imaging studies congruence with procedure site.

Discharge from Unit

Patients are discharged from the unit shortly after conclusion of the procedure, when, the site is dressed, pain scale is lower than on admission, neurovascular status is intact, they are alert, able to ambulate safely, understand their discharge instruction, and feel comfortable to leave. An information sheet is given to the patient which includes post-procedural care outlines as well as the contact details of the radiology fellow on call in case of emergency. A complete list of medication is provided to the patient at time of discharge. Relevant information is clearly posted in the charts of inpatients.

Before the patient leaves the department, they are assessed by the radiologist/fellow to ensure stability, pain level and state of mind. If the patient feels in any way unwell or in pain, they are encouraged to stay in the department at least until the feeling subsides.

Exception: IV Sedation patients are transferred to Post Anesthesia Care
Unit for monitoring and discharged to home when discharge criteria are met.

Conversion to Inpatient status occurs only if there is an unanticipated response e.g. severe pain. The reasons for admission and the proposed treatment plan will be documented in the patient’s record. The Admitting Department is notified and all relevant “hand off” communications completed. The patient is assigned a medical doctor as per hospital policy.

Post Procedure Follow Up Call: The day after their procedure, patients are contacted by the IR nurse to ascertain their status, reinforce discharge instructions, and ensure contact with the physician if there is any concern.

• Radiographic/Imaging Contrast Agents

Definition: Radiographic/Imaging Contrast Agents are used to increase sensitivity and specificity of diagnostic accuracy and to help guide and confirm location of diagnostic and therapeutic procedures.

Radiographic x-ray contrast agents usually contain barium or iodine.
MR contrast agents contain gadolinium.
US contrast agents contain microbubbles.

Risks:

Allergic Reaction to iodine or gadolinium

Extravasation

Safety Measures:
Pre-contrast Questionnaires:

In order for a patient to receive contrast, a written order is required. Contrast Assessment and IV Contrast Agent form is completed by the radiologist/fellow. A power injector, used in CT for the delivery of IV contrast media, is operated by a trained healthcare professional.

Contraindications
No intravenous access
Hemolytic anemia
Severely impaired renal function as evidenced by GFR < 30. Any impairment of kidney function when accompanied by chronic liver disease where the patient is immediately about to undergo or has recently undergone liver transplantation

Specific Gadolinium Safety Measure: Re: USAGE OF GADOLINIUM CONTRAST AGENT - Gadolinium is labeled for use for magnetic resonance imaging (MRI). A strict policy regarding the use of gadolinium is used. MRI contrast agents that currently contain gadolinium are Magnevist, MultiHance, Omniscan, OptiMARK, and ProHance.

Although published information provides support for the use of gadolinium as an alternative to iodinated contrast agent in non-MRI examinations, such as CT angiography and for certain interventional procedures, gadolinium is not recommended to be used for an outpatient and/or for a non-emergent scan in a patient with a history of allergy to iodinated contrast agent. In this instance, the patient should be pre-treated with the usual preventive antihistamine and corticosteroid therapy 24 hours prior to the administration of iodinated contrast for the examination.

Gadolinium contrast agent may be used for emergency procedures where the patient has an absolute or relative contraindication to the administration of traditional iodinated contrast agent. Emergent procedures include but are not limited to: A CTA examination to diagnose Pulmonary Embolus or DVT.

Use of Gadolinium by Non-Radiologists

If gadolinium is used on a patient by a non-radiologist and an MRI is subsequently ordered within 48 hours of the administration of the gadolinium, the physician must include on the order form for the MRI both the reason for the MRI exam and specific information.

Patients receiving contrast are monitored for:
           
Allergies:

Mild to severe allergic reactions e.g. headaches, flush, allergic skin reaction, severe anaphylactic reaction or convulsive attack.  Individuals with a history of prior severe
contrast reaction will either have the exam performed without contrast or in certain cases
will have it performed with contrast after a course of premedication with steroids and
antihistamine. Patients with known history of contrast allergy are assessed and pre-
medicated per departmental policy. The premedication is started a day or so before the
exam.

At the first suspicion of anaphylaxis, the MD is contacted and the airway, breathing
and circulation are assessed.  If systemic anaphylaxis (severe allergic reaction) is suspected in adults, EpiPen auto-injector is appropriate for intramuscular injection.

Extravasation - Guidelines for Treatment of Extravasated Contrast Media

The site of swelling from the extravasated contrast will be circled with a marker Patient
is given care instructions of this site.  Most patients improve over 24-36 hours.  If after
36-48 hours there is continued improvement, the likelihood of any subsequent problems
are very low. 

Surgical treatment is only reserved for patients who experience necrosis and skin sloughing which would be evident by this time.

II. EMPLOYEE AND VISITORS SAFETY MEASURES

Safety procedures provide confidence that the department maintains a safe environment for patients, visitors, physicians, and employees to prevent accidents or injuries.

A. GENERAL

• Employee Safety Responsibility

The employee is responsible for patient, visitor and fellow employees’ personnel safety and is expected to practice safe work procedures in accordance with the Radiology Department safety policy.  Personnel are expected to:  Maintain good personal hygiene.  Hand washing is expected before and after contact with patients; before going on breaks and at mealtime; after using restrooms, etc.   Personnel should be free from communicable disease. Safety hazards are to be reported to their immediate supervisor including, but not limited to: observations of unsafe acts or conditions and defective/malfunctioning equipment.  Employees should perform their job function in such a manner that will not cause injury to themselves and/or others or that will cause property damage.  They must obey all warning signs, tags and notices and move cautiously when pushing portables and carts of any kind, especially when approaching a blind corner.  It is expected that they follow proper procedures and specific methods when handling/moving patients,  particularly as they relate to back care and report injuries to supervisor as soon as feasibly possible after an incident. .
     
Occurrence Report Form is completed if there is any injury or incident.

B. SAFETY WITH REGARD TO EQUIPMENT USE & MONITORING
                                               
All diagnostic x-ray equipment is used under the direction and/or supervision of a diagnostic radiologist.  Only trained persons licensed by the NYS Dept. of Health shall be authorized to make radiographic exposures of a patient.

• Ionizing Radiation Protection

○   Equipment Safety

All diagnostic radiologic equipment (fixed and mobile) is calibrated by a qualified physicist, at least every year and have scheduled preventative maintenance checks
by service engineers.  Technologists check the equipment before each patient use.

The exposure switch of each fixed x-ray diagnostic unit (x-ray room) has an electrical connection with the door, such that an exposure cannot be made unless the x-ray room door is closed.

Equipment malfunction of any kind requires the patient to be transferred to another x-ray
room for completion of the exam.  Any malfunction of equipment is to be communicated
to department personnel responsible for equipment service.

○   Personnel Safety

Whenever possible, mechanical devices only (e.g. tape, velcro straps, etc.) shall be utilized to immobilize patients during radiology procedures.  Employees are not to hold children.  No Radiological (x-ray or nuclear) Technologist or female in the procreating age shall hold a patient. A family member who is not pregnant will hold the child.

The location of the crash carts and other emergency carts are known by all department employees.

New personnel are oriented to Radiation Safety practices
e.g. Maximize the distance and minimize the time at the radiation source; wear protective apparel,  i.e. lead aprons, gloves and; use proper collimation.  Semi-Annual Radiation Safety In-service with documentation of staff attendance is required.

Lead aprons must be worn by all personnel present during a fluoroscopic examination. 
All lead gloves, aprons, and gonadal shields are inspected regularly for safety defects.
Employees when using x-ray equipment are in an enclosed control booth behind lead glass.

○   Occupational Dose Program 

Film badges must be worn at collar level by all radiation workers at all times.  Distribution and collection of the film badges for routine processing will be the responsibility of the Radiation Safety Officer.  Results of radiation dose monitoring are reviewed monthly by the Radiation Physicist, and are available for review upon request.

At no time will a film badge be exposed to radiation unless worn by the individual
to whom it is issued.  Any infraction of this rule may result in the loss of that
person's privilege to work with radioactive material and/or ionizing radiation.     

Flagrant violations of this policy may result in reprimand, suspension, or termination.
The personnel who are subjected to radiation exposure due to radioactive
material will be furnished a thermo luminescent dosimeter, to be worn at the
collar and extremity (ring) badge to be worn on the hand most likely to receive the
most radiation exposure.  The records of exposure reported on these dosimeters will
be kept by the Radiation Safety Officer on forms which are in compliance with
Article 175.

○   Radiation Safety of Pregnant Radiation Workers

A female radiation worker who becomes pregnant during employment automatically becomes treated as a non-radiation worker in regard to her Maximum Permissible Dose (MPD). The employee is responsible to inform the department in writing of her pregnancy. 

A separate fetal monitoring badge is provided and worn at abdomen behind a lead shield. Risks associated with exposure to the fetus are reviewed with the employee.  Periodically, working conditions for the employee are reviewed by the Radiation Safety Officer and Health physicist.

○   Radiation Safety Rules for Portable Radiography CT & in OR

Only persons whose presence is needed during portable radiography procedures are to be in the patient room.  All unnecessary personnel are cleared from the area when an X-ray/fluoroscopy is being used in the area.

• Non-Ionizing Radiation Protection

• Ultrasound (US)

Preventive maintenance on a regular basis and performed by authorized service engineer
is required on all Ultrasound equipment.

• Magnetic Resonance Imaging (MRI)

Scheduled preventive maintenance on the MRI scanner is performed by contracted service personnel.
           
Restricted Magnetic Field Area:  To insure safety of both personnel and the magnet, access to the area around the magnet is controlled.  This area includes the magnet room, the control room, the computer room, and all other adjacent rooms within the immediate area. The MRI technologist is responsible for all equipment and personnel entering this area.  Because of the effects of the static magnetic field, all personnel and visitors are thoroughly screened for contraindications to MRI before entering the magnetic field area or magnet room. No one with a pacemaker or other implanted device    is allowed to enter the restricted magnetic field area. 

No metal objects are permitted to be in or on a person when entering the restricted magnetic field.

Guidelines to insure the safety of housekeeping personnel when performing their responsibilities, as well as to insure the protection of the magnet are enforce.  A plan to correctly handle emergency situations in the magnet room to avoid injury to patients and personnel, as well as damage to the magnet is in force.

ADMINISTRATION

A.  RADIATION QUALITY ASSURANCE COMMITTEE meets quarterly to monitor the safety program and to make recommendations for ensuring a safe work environment.  The members conduct monthly walk through inspection tours and develop programs for the ongoing training of employees.  In-service education is given on a regular basis within the department.

• RADIATION SAFETY COMMITTEE is a standing subcommittee of the Radiology Department's Quality Assurance Committee which meets quarterly. 

• Members include the following representatives

Radiologist -in- Chief , Physician
Chief of Nuclear Medicine, Radiation Safety Officer, Physician
Radiation Physicist
Associate Radiation Safety Officer, Clinical
Associate Radiation Safety Officer, Research
Vice President, Administration
Associate Vice President, Administration
Associate Director, Radiology
Assistant Director, Radiology
Director PACU

• Responsibilities

Review/Recommend policies regarding ionizing radiation safety and implement to
the Board of Trustees, through the Medical Board.

Provide technical advice to the Radiation Safety Officer on matters regarding
radiation safety.

Receive, review and act on all applications for the use of machines capable of
producing ionizing radiation and use of radioactive materials in humans .

Review all incidents of alleged infractions of use and safety rules with the Radiation
Safety Officer and the Responsible User, and if necessary, the Committee has the
authority from the Board of Trustees, through the Medical Board, to stop or restrict the us
of radioactive materials by the user until the infraction is corrected.

C. RADIATION SAFETY OFFICER is responsible to observe that the policies and procedures adopted by the Radiation Safety Committee are followed by all of those whose work involves the use of radioactive material and/or ionizing radiation.  The Radiation Safety Officer is available for consultation to all persons using ionizing radiations and will supervise decontamination procedures and advise investigators of the necessity for decontamination in an area. 

• Responsibility of authorized users of ionizing radiation

The authorized user will be responsible for insuring compliance with these procedures
in areas under his/her jurisdiction and that new personnel will be instructed as to the
hazards and safety precautions attendant to their work and course of action in emergencies. 

D. POLICIES AND PROCEDURES RE: IONIZING RADIOLOGY 

• Radioactivity testing & controls

○   Leak Testing - All sealed sources of radioactive material are tested for leakage at intervals not to exceed six months, except that sources designed to emit alpha particles
shall be tested at intervals not to exceed three months. 

○   Radiation Surveys – Surveys are conducted by the Radiation Safety Officer or a qualified Radiation Physicist prior to scheduling routine use, to determine that no hazard
will exist to operators or other persons in the area. 

○   Preparation & Administration of Radionuclides - are performed under the authority
of the Radiation Safety Officer.  Exact measurement is recorded with the patient’s name and time of administration on the accompanied label.  A label with the same information is attached to the patient’s requisition for review by the radiologist. 

○   Radioactive Waste Disposal Policy& Monitoring - Radioactive waste materials are disposed of in compliance with Article 175, New York City Department of Health. Radioactive waste is placed in storage for decay and then final disposal to normal trash.  All waste leaving the hospital facility is monitored for radioactive contamination every day by Nuclear Medicine Personnel.

• Nursing Care of Patients who have had Radioactive Material

○   A note is placed in the patient's chart regarding the procedure and radioactive material. A radioactive symbol sticker is adhered to the chart as to the dosage and type of radioisotope administered, to alert those caring for the patient. 

○   Occurrence Report Form - provides a tool for documentation and investigation of
 all potentially hazardous conditions.

• Management of Radiation Emergencies

A radiation emergency is defined as an unforeseen occurrence, either actual or suspected.  It involves exposure of, or contamination on or within, humans, the environment or both, by a hazardous amount of ionizing radiation or radioactive material.  All radiation emergencies are reported immediately to the Radiation Safety Officer or any member of the Radiation Safety Committee   The Radiation Safety Officer determines what constitutes a hazardous amount of ionizing radiation or radioactive material, call the Radiation Safety Officer.

SUMMARY:

At a licensed and accredited institution, imaging equipment is tested by the city and state Department of Health for safety.  Radiologists, as the equipment operators, are specifically trained to assure ultimate safety in the operation of the equipment and in the recognition and treatment of possible adverse reaction.  Radiology technologists are also licensed professionals trained in radiation safety and proper use of the equipment and protective gear.  Patients are encouraged to research their imaging examinations and ask questions of their imaging providers.  The more comfortable a patient is the better the outcome. 

REFERENCES:

• Brenner DJ, Ph.D., D.Sc. and Hall EJ, D. Phil., D.Sc. Computed Tomography An Increasing Source of Radiation Exposure.  The New England Journal of Medicine. November 29, 2007; 357:2277-2284.
• Boone JM, Geraghty EM, Seibert JA, Wootton-Gorges SL. Dose reduction in   pediatric CT: a rational approach. Radiology. 2003;228:352-360.
• Cody DD, Moxley DM, Krugh KT, O'Daniel JC, Wagner LK, Eftekhari F. Strategies for formulating appropriate MDCT techniques when imaging the chest, abdomen, and pelvis in pediatric patients. AJR Am J Roentgenol. 2004;182:849-859.
• American College of Radiology Appropriateness Criteria: conventional and reduced radiation-dose techniques. Radiology. 2003;229:575-580