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Radiation safety manual

Since the first application of diagnostic X-ray in the early 1900s, several studies on the subject have been made, most of which have resulted in considerable improvement in the process’ applicability and safety. Although safety has never stopped being a major concern, subsequent developments had led to a drop in radiation hazards, something that has inspired the increased application of diagnostic X-rays. Regulations and proper applications in different protocols regarding radiation use and exposure in the medical field is an important need for various reasons.

Firstly, the risks of exposure to radiation have long-term and debilitating effects on the health of those in direct or indirect contact with ionizing radiation. Second, using radiation for diagnosis requires details that must be carried out in a way that minimizes the doses of radiation, hence there should be complete understanding about the hazards of radiation and the methods and procedures that must be followed in order to ensure maximum safety to the patients, staff and the general public.

Third, the setup must address the various potential challenges that may arise. Finally, there should be complete knowledge about the management of patients with special needs regarding radiation exposure and dosage. The radiation safety procedure manual has been designed to address to the specific needs of the radiation department. The manual will include the various policies and procedures that are required for carrying out various radiation procedures, their dosages, policies for special procedures, and structural barriers used to minimize radiation.

In addition, the manual will include in-service education for staff, the laboratory requirements, the setup of the department and the different concerns relating to radiation exposure. Therefore, safety can be assured from unnecessary exposure to radiation if procedures and methods are followed properly. In order words, the objective of these radiology safety procedures should be geared towards keeping exposures of persons, including the patients undergoing the radiology process, to a minimum level.

While this may seem like a simple straight forward objective and a matter of personal responsibility, there is a need for safety precautions to be put down in clear and explicit terms at Raphael’s Clinic to minimize radiation exposure to the patients, staff, and the general public. There is an inclusion of the principle, As Low As Reasonably Achievable (ALARA). This, being a fairly-subjective concept, has to be dealt with on a case-to-case basis. Therefore, the concept application must be done under the guidance of a committee of experts who may be consulted from time to time.

Machine equipment’s quality control has also been included with the understanding that faulty equipment will lead to excessive use of X-rays. Instructively, the manual has tried to be as detailed as possible, but it is worth noting that safety is mainly a matter of personal responsibility, hence all are encouraged to take personal initiatives towards general safety for our patients, employees and the general public. MISSION STATEMENT OF RADIOLOGIC DEPARTMENT: The Radiology Department of Raphael Clinic is devoted to provide the best diagnostic radiology services to our patients.

Our mission in this clinic is to be the healthcare facility of choice for everyone regardless of religion, nationality, age, race and socio-economic status. Pursuant to its social responsibility function amongst other values, the clinic endeavors to make all those within its facilities safe from harmful exposure to ionizing radiation. The clinic recognizes that while personal health is an individual responsibility, the institution has an obligation to ensure that all those within its premises receive proper guidance on how to carry themselves in the most appropriate manner to ensure maximum safety.

In addition, radiation protection should be designed so as to conform to the suggestions presented by Radiologic Technologist’s Guide to Radiation Protection of 2002. OBJECTIVES: • Value for human life: Protection and preservation of human life shall take precedence over everything else. • Human dignity: The uniqueness of an individual is an inherent quality of human life and must be respected at all times. • Total Quality Management (TQM): The hospital shall endeavor to refine all its procedures and resources to ensure that its clients receive the best care.

• Social responsibility: The hospital shall accord all its stakeholders their rights as may be practically possible. • Collaboration: The hospital shall seek strategic partnerships with like-minded organizations in the interest of improving healthcare provision. • To create guidelines and procedures which are in accordance with the State and Federal regulations. • To create guidelines that are in accordance with the various safety needs as laid down by the relevant health department or authority.

• The assessment and changes that are needed in order to comply with the environmental and technological changes constantly taking place. • The creation of the manual to address the various issues pertaining to the different types of radiation procedures and dealing issues related to it, such as equipment and radiation dosages • To create a manual that ensures staff safety and minimal radiation dosage exposure levels. Also, an aim to create guidelines regarding how different patients with needs must be handled according to their specific condition. FACILITY DESIGN:

Raphael Clinic opened in January 28, 2001 to the community after 3 years of under construction. The facility was designed to help people who are unable to afford X-ray services when they needed to, and these people are elderly patients with Medicare and low class income with medicate. Furthermore, the department was carefully designed by our engineers and ALARA was our main priority. Our goal is to have the best and the latest equipments for the facility while providing maximum radiation protection from ionizing radiation for the general public, our patients and our employees. Raphael’s Clinic has been very successful.

• Two of the rooms are Computed Radiography X-ray rooms with the remaining one being a digital radiography room. • Each of the rooms has a sink for hygiene purposes. • The area is served by three elevators; one for the in-patients, another for the general public, and lastly, one for the staff. • The console is located in each of the rooms to enable better provision of instructions to the patients, with windows in each of the consoles having windows positioned at a 900 angle. • The reception area is strategically located not far from the main elevator to provide easy access for the out-patients when they enter the facility.

• The employee locker room is located adjacent to the staff elevator to prevent interruption between the patients flow and the employees flow. • The largest room within the facility is our patient lounge room which consists of a 40-inch flat-screen TV, Whirlpool Silver 21. 7 cu. feet side-by-side refrigerator with water filtration, comfortable sofas and recliners, and nice wooden tables to provide the best comfort for our technologists and radiologists. • The department has 7 bathrooms to accommodate the patients and employees. STRUTURAL BARIERS TO MINIMIZE RADIATION:

Objectives This section is meant to define the primary and secondary barriers that will be used in the reduction of exposure to x-ray by patients, staff and members of the general public. Protective barriers are very critical when building an x-ray facility because it helps minimize radiation exposure to ionizing radiation. Structural barriers serve as shields placed between the radiation source and the patients to minimize exposure. The barriers act as a shield not only for the patient but also for other personnel and members of the public who are at risk of exposure.

The x-ray rooms in Raphael Clinic facilitate protective barriers that are designed to control primary radiation, leakage radiation and scatter radiation. Primary radiation is the useful beam that comes from the x-ray tube during an exam; scatter radiation is emitted by the patients; and leakage radiation is the radiation that is emitted by the x-ray tube housing in all directions. Bushong (2008) stated that there are three factors that affect barrier thickness of an x-ray room. These are the distance between the source of the radiation and the barrier, the time of occupancy factor and the controlled area.

Our goal is to provide the maximum radiation protection to our patients, staffs and members of the general public. Primary Barriers According to Sherer, Visconti, & Ritenour (2006), “the primary protective barriers are located perpendicular to the undeflected line of travel beam”. The primary barriers usually consist of 1/16 inch of lead and measuring 7 feet high from the floor to the ceiling. Secondary Barriers Secondary barriers protect the patients from leakage radiation and scatter radiation. According to the NRCP, the secondary protective barriers have to overlap the primary barriers by ? inch.

The secondary barriers consist of 1/32 inch of lead. Controlled and Uncontrolled Areas Bushong (2008) stated that “an uncontrolled area can be occupied by anyone; therefore, the maximum exposure rate allowed is based on the recommended dose limit for the public of 100 mrem/year(1 msv/yr)”. In addition, an individual should not receive more than 2. 5 mrem in a single year based on the protective barrier. Uncontrolled areas are areas that are adjacent to radiation sources such as bathrooms, hallways, and waiting and receptionist’s area. A controlled area is where the radiology personnel and patients are stationary.

According to Bushong (2008), “the design limits for controlled area are based on the recommended occupational dose limits; therefore, the barrier is required to reduce the exposure to the worker in the area to less than mrem per week (1 msv/wk)”. • The controlled booth is a primary barrier because it is inside the x-ray room. • The window in the controlled booth that the radiographer uses to view the patients is made up of 1. 6 mm of lead. • The walls inside the x-ray rooms are made up of 1. 6 mm of lead from the floor to the ceiling.

• Controlled areas are made up of 1. 6 mm of lead to ensure maximum safety for our patients and employees. • An uncontrolled area is considered to be a secondary barrier which is made up of 1/32 inch of lead to provide maximum safety for other staffs, patients, and the general public. SAFETY PRECAUTIONS AND PROCEDURES FOR THE DEPARTMENT: Objectives: 1. The department is dedicated to provide the best radiographs needed for diagnosing pathologies while keeping the working environment safe for the patients and employees. 2. The department must follow all the rules and regulations that will prevent future biological effects to our patients and staffs.

The department is devoted to provide the best radiographic image to solve any pathology while making ALARA (As Low As Reasonably Achievable) and which also referred to as, ORP (Optimization for Radiation Protection) first priority in the department, as stated by Sherer, Visconti, & Ritenour (2006). Sherer, Visconti, & Ritenour (2006) further stated, “It is the responsibility of the employer to implement an effective radiation safety program by providing necessary resources and appropriate environment in which execute an ALARA program”. It is very important that our employees are committed to practice ALARA for our patients and themselves.

According to Sherer, Visconti, & Ritenour (2006), “when radiation safety is safely and prudently used in imaging of patients, the benefit of the exposure can be maximized while the potential risk of biologic damage can be minimized”. • Use of all equipment designed to produce x-rays shall be under the jurisdiction of relevantly trained medical officer. • All staff operating radiology equipment must undergo continuous training as may be designed and prescribed by the facility. • For purposes of implementing ALARA, the facility has committee made of experts whose role is to review dosage limits for patients, staff and members of the public.

• The objective is to levels that with time, the limits of exposure shall be lowered to levels below those provided by NRCP. • In accordance with this principle, all members of staffs at risk of exposure to radiation have to be provided with dosimeters. • All processes including equipment quality check, staff training and optimization of the radiation process are done in order to keep the levels of radiation exposure low, which means that all of them to be done in pursuance of ALARA. POLOCIES FOR SPECIAL PROCEDURES:

ALARA is the acronym for As Low As Reasonably Achievable. ALARA provides the guiding principle in dealing with radiation doses. Every employee at Raphael Clinic must understand and apply the policies and if they fail to do so, the employee concerned may be subject to suspension or termination. Application of x-ray to the following groups of persons shall be considered special and treated as such; • Geriatrics • Pediatrics • Pregnancy Geriatrics For purposes of this manual, geriatrics will be taken to include medical procedures done on elderly people above the age of 65.

This group of citizens has increased chances of contracting diseases due to their reduced immunity and cell activity. It is therefore important to ensure that their exposure to radiation is minimized. Although older people are generally considered to face lower risks of developing complications from radiations, they still face an inherent risk as a result of their vulnerability due to age. The general guidelines for carrying out radiation for older people are as outlined below; • Patient history should be inquired.

The risk of adverse radiation effects increases with the number of x-ray on a person. • Must explain the procedures and speak loud and clear for the patient. • Personnel must help patient who are not able to move into proper position for the radiograph. • Ask the patient when they stand do they feels dizzy or feels like falling. • Use a full pad for geriatric patents because laying the radiographic table may be painful for them. • Give the patients’ additional blanket to provide the best comfort because the radiography rooms sometimes could be extremely cold.

• Collimate to the size of the interested area. • Use low mAs and high Kvp. • The patient’s bones and body are very sensitive so touch them gentle and firm to prevent bruises and further damage to their painful body. • Employees must shield every patient regardless of their age or diagnose. Pediatric Pediatric patients start from infant to the age of 15. According to Torres, Dutton & Linn-Watson, “children in this broadly defined group require special care, depending on their age and ability to comprehend the radiographic procedures.

In order to be both sensitive and effective in performing the imaging procedure, radiographers must use age-appropriate methods of communication and execution of the required procedure according to a child’s age”. Children will generally require less radiation dosage in comparison to adults. Our goal in Raphael Clinic is to care and provide maximum safety for the children while achieving high quality radiography. • Every child must be shielded with 0. 25 mm of lead during any x-ray procedure. • One parent or guardian should be allowed in the radiation area.

However, the allowed parent should not be a pregnant woman. In cases wherein the parent is a single mother and pregnant, then the parent has the liberty of picking another adult to stay in the room on her behalf and that person that is restricting the child should be provided with appropriate shielding and a pocket ionization chamber for instant radiation reading. • The technologist must wear scrubs with cartoon characters and have a positive attitude when dealing with children. • Collimate the area that is required to prevent unwanted exposure to pediatric patients.

• Use Pigg-O-Stat when taking a chest radiograph to immobilize babies to prevent repeats. Pregnant Patients Radiation procedures for women of child-bearing age shall take into consideration the possibility of pregnancy. Whenever a female of child-bearing age is having an x-ray examination, it very important to ask them questions about possibility of pregnancy and must ask the patients their last day of menstrual period. Raphael Clinic requires all technologists to shield all child-bearing age patients and use Gonadal shields when the uterus and ovaries are within the x-ray field Sherer, Visconti & Ritenour (2006).

Seeram (2001) states that the NRCP report 54 recommends, “The risk (of abnormality) is considered to be negligible at 5 rad (50 mGy) or less when compared to other risks of pregnancy, and the risks of malformations is substantially increased above control levels only at doses above 15 rad (150 mGy). Therefore, exposure of the fetus to radiation arising from diagnostic procedures would very rarely be cause by itself, for terminating a pregnancy (NRCP). ” • Technologists must always ask patients if they are pregnant and have it properly documented if they are not pregnant. •

A visible signage such as, ARE YOU PREGNANT, must be posted in every examination room in order for the patients to declare their pregnancies. • Use low mAs and high Kvp techniques. • Collimate the area of interest to reduce exposure to the other surrounding tissues. • A consent form will be giving and signed by the patients if they are pregnant and need to be irradiated. • If a patient is pregnant please notify the technologist’s supervisor and the Radiologist for extra precaution. • Follow the 10 day rule. • Pregnancy exam must be given to every child-bearing age patient before any x-ray examination. Pregnant employee

Because ionizing radiation could do serious damage to a fetus, our pregnant employees must follow the radiation protection regulations and guidelines. In Raphael Clinic, we will consider the right to privacy, dose limits, and maternity policies Seeram (2001). According to Seeram (2001), “employer policies for pregnant workers should be available and should focus on the job expectations so as to eliminate any notion of special treatment that may subject pregnant workers to job discrimination”. Sherer, Visconti & Ritenour (2006) cites the NRCP report No. 116, which states that the employees’ dose limits should not exceed 5 mSv or 0.5 rem for the entire gestation, or 0. 5 mSv or 0. 05 rem in any given month.

Policies and procedures for pregnant workers are as follow: • Personnel that are pregnant will be required to wear two dosimeters; one at collar level (worn regularly) and the second one under a lead apron at abdominal level. • Discrimination on pregnancy at Raphael Clinic is zero tolerance. • Our facility will provide with counseling and in-service classes on fetal exposure and the mother. • Pregnant employees must not switch the two dosimeters. • If pregnant personnel do not declare pregnancy, they will follow the 50 mSv or 5 rem regulations.

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