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February 2013 academy radiation safety handouts

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The document appears to be a presentation on radiation safety given by Sandy Wolff. The presentation covers basic principles of radiation, handling radioactive materials in clinical and pathology laboratories, and regulatory agencies that oversee use of radioactive materials. It discusses common units used to measure radioactivity and radiation exposure. Finally, it lists some common unsealed and sealed radioactive sources used in nuclear medicine and radiation oncology.

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Slide 1 ___________________________________ ___________________________________ ___________________________________ Sandy Wolff, MS, CHP, DABR Radiation Safety Officer, ___________________________________ Sentara Healthcare Norfolk, VA ___________________________________ ___________________________________ ___________________________________ Slide 2 ___________________________________ Objectives: ___________________________________ 1. Understand the basic principles of radiation and how it can affect staff. 2. Discuss the handling of radioactive material in the clinical and anatomic pathology laboratory ___________________________________ settings. 3. Review laboratory procedures and processes related to radiation safety. ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 3 ___________________________________ Polling Question ___________________________________ Do you use radioactive materials as part of a lab procedure to label specimens or perform other procedures? ___________________________________  Yes  No  Not Sure ___________________________________ ___________________________________ ___________________________________ ___________________________________
Slide 4 ___________________________________ Regulatory Agencies ► NRC: Nuclear Regulatory Commission ___________________________________  Jurisdiction over all use of nuclear reactor byproduct material in USA  Agreement 38 State status states have signed agreements with ___________________________________ the NRC to regulate their own states’ radioactive materials users Use equivalent regulations to NRC ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 5 ___________________________________ Regulatory Agencies  NRC Agreement States – 38/50 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 6 ___________________________________ State Regulatory Agencies ___________________________________  Health or Environmental Division o Radiation Health Section or o Radiological Control Bureau o Regulates: ___________________________________ o Ionizing x-ray equipment o Linear accelerators o Naturally occurring and cyclotron-produced ___________________________________ radioactive material o Nuclear byproduct material also if agreement state ___________________________________ ___________________________________ ___________________________________
Slide 7 ___________________________________ Radioactivity Units 1 millicurie (mCi) = 3.7 x 107 disintegration per second (dps) (clicks on the Geiger ___________________________________ counter) ___________________________________  New SI unit is becquerel (Bq) = 1 disintegration per second (dps) o ( 1 click on the Geiger counter) ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 8 ___________________________________ Radiation Units 1 Roentgen = 1 rad = 1 rem ___________________________________ (in most cases)  New SI units:  grays (Gy)  sieverts (Sv) ___________________________________  Most of us in the field still converse in rad and rem o although the journals have moved to gray and sievert… ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 9 ___________________________________ Common Unsealed Radionuclides These isotopes are used in nuclear medicine and radiation oncology to diagnose and treat various conditions. Most are excreted in the urine. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
Slide 10 ___________________________________ Common Sealed Sources These seeds are implanted in tissue and remain unless surgically removed – no blood or urine contamination. ___________________________________ ___________________________________ ___________________________________ * Aft er t en half lives, consider ed essent ially decayed t o zer o. ___________________________________ ___________________________________ ___________________________________ Slide 11 ___________________________________ Prostate Therapy Seed Implant ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 12 ___________________________________ Breast Tissue Specimen With Seed in Place  New use of seeds to localize breast tumors ___________________________________  Low activity seed and only one or two are used ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
Slide 13 ___________________________________ GM survey meter – used to survey for contamination ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 14 ___________________________________ Acronyms  ALARA - As Low as Reasonably Achievable ___________________________________  RSC - Radiation Safety Committee  Review occupational radiation exposure and ALARA issues, Approve radiation safety policies and procedures, investigate Medical Events. ___________________________________  RSO - Radiation Safety Officer Legally responsible for ensuring compliance ___________________________________ o with federal and state radiation safety regulations. ___________________________________ ___________________________________ ___________________________________ Slide 15 ___________________________________ Principles of Radiation Protection (TDS) ___________________________________ Time: Minimize Time ___________________________________  Exposure is proportional to time  Work quickly and efficiently  Have all materials at hand prior to start ___________________________________ ___________________________________ ___________________________________ ___________________________________
Slide 16 ___________________________________ Principles of Radiation Protection (TDS) ___________________________________  Distance:Maximize distance  Inverse Square Law  Double your distance, quarter your dose  Lean back ___________________________________  Step back  Exposure drops off quickly with distance ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 17 ___________________________________ Principles of Radiation Protection (TDS) ___________________________________  Shielding - lead is the best for radiation  Shielded vials for transporting seeds and doses  Lead bricks in hot labs for storage of large amounts ___________________________________  Lead aprons not appropriate for isotope shielding ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 18 ___________________________________ Film and Ring Badges Film and ring badges ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
Slide 19 ___________________________________ Annual Occupational Dose Limits  Whole body - effective dose ___________________________________  50 mSv  (5000 mrem)  (5 rem) ___________________________________  Monitoring required at 10% of this limit  Most nuclear medicine staff do not reach this level ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 20 ___________________________________ Annual Occupational Dose Limits ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 21 ___________________________________ Annual Dose Limits General Public (those who are not trained and not monitored) ___________________________________ 1 mSv (100 mrem) • Our use of radioactive material may not result in any member of the general public being exposed to 100 millirem per year ___________________________________ • Considered a negligible dose by regulatory bodies • Staff who are not radiation workers • Also must be considered and calculated when highly radioactive patients go home to their ___________________________________ families ___________________________________ ___________________________________ ___________________________________
Slide 22 ___________________________________ Declared Pregnancy Dose Limit ___________________________________ Unborn child exposure 5 mSv (500 mrem) (entire gestation) ___________________________________ 0.5 mSv (50 mrem) per month ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 23 ___________________________________ Patient Handling ___________________________________  Phlebotomy/Other Procedures  Patients who receive radioactive substances for treatment are not hazardous to healthcare ___________________________________ workers.  Radiation may be present, but there are ways to protect yourself. ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 24 ___________________________________ Patient Handling ___________________________________  Utilize Standard Precautions for all collection procedures.  Follow any instructions listed for the patient (i.e. ___________________________________ instructions posted in room)  Limitduration of time in close contact with patient. ___________________________________ ___________________________________ ___________________________________ ___________________________________
Slide 25 ___________________________________ Patient Handling  Precautions for radiation therapy patients are similar to those for patients isolated for other reasons ___________________________________  Use PPE as instructed via postings.  Foot covers, gowns, lab coats, gloves  DiscardPPE into containers for radioactive waste ___________________________________ inside patient room or in ante-room. Perform hand hygiene before exiting room. ___________________________________ Pregnant staff should avoid caring for patient. ___________________________________ ___________________________________ ___________________________________ Slide 26 ___________________________________ Polling Question Are you notified if/when you ___________________________________ are given radioactive specimens from other departments (blood/urine) ? ___________________________________  Yes  No ___________________________________  Sometimes ___________________________________ ___________________________________ ___________________________________ Slide 27 ___________________________________ Sample Handling ___________________________________ Have not detected radiation from blood, urine or body fluids of most radiation patients. ___________________________________ Do not normally perform urine testing on I-131 patients, but it would be radioactive! ___________________________________ ___________________________________ ___________________________________ ___________________________________
Slide 28 ___________________________________ Sample Handling ___________________________________  No special measures need to be taken for clinical specimen transport .  BottomLine: Use Standard Precautions to ___________________________________ handle radioactive specimens unless otherwise directed.  Questions? Officer. Contact your Radiation Safety ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 29 ___________________________________ Sample Handling ___________________________________  Process blood and urine samples as usual.  OK to run samples on lab analyzers.  Becareful not to generate aerosols with radioactive specimens. ___________________________________  Allow centrifuges to come to a complete stop, wait three minutes before opening. Cap specimens for vortexing. ___________________________________  ___________________________________ ___________________________________ ___________________________________ Slide 30 ___________________________________ Sample Handling ___________________________________  Other handling safety tips:  Prevent punctures  Protect  Never against glass breakage recap needles ___________________________________  Prevent ingestion  No food or drink in lab areas  Prevent absorption  Wear gloves, lab coats, face protection ___________________________________ ___________________________________ ___________________________________ ___________________________________
Slide 31 ___________________________________ Polling Question Does your laboratory use ___________________________________ radiation detectors?  Yes ___________________________________  No ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 32 ___________________________________ Sample Handling ___________________________________  Disposal of Clinical Specimens  Blood and urine can be disposed of per routine laboratory procedure. Treat these as usual regulated medical waste. ___________________________________  Some sites recommend disposing of known radioactive samples immediately to minimize exposure to staff. ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 33 ___________________________________ Sample Handling ___________________________________  Disposal of Pathology Specimens and Seeds Contact the Radiation Safety Officer for specific ___________________________________  instructions.  Contact Nuclear Medicine department for pick up if that is an option.  Store separately from other samples. ___________________________________ ___________________________________ ___________________________________ ___________________________________
Slide 34 ___________________________________ Lab Procedures Involving ___________________________________ Radioactivity ___________________________________  Prostate Seeds  Sentinel Node Biopsy  Radioactive Tissue Biopsy  Breast Seeds ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 35 ___________________________________ Prostate Seeds ___________________________________  Usually permanently implanted I-125 seeds  Seeds arrive in lab embedded in prostate tissue ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 36 ___________________________________ Prostate Seeds ___________________________________  Seeds are removed using forceps  Place seeds in tin foil, place foil into lead container ___________________________________  Contact Radiation Safety Officer for removal/disposal process ___________________________________ ___________________________________ ___________________________________ ___________________________________
Slide 37 ___________________________________ Sentinel Node Biopsies ___________________________________  Sentinel Node Lymph Biopsy  Gamma radiation ___________________________________  No risk to transport personnel, processors  Minimal risk to pathologists  Use standard precautions to handle ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 38 ___________________________________ Tissue Biopsies ___________________________________  Very rare that known radioactive tissue would be removed for biopsy  Removal of tissue after treatment with ___________________________________ radioactive iodine ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 39 ___________________________________ Breast Implant Seeds ___________________________________  New procedure  Seeds are removed and counted  Place into lead containers  Check area for radioactivity ___________________________________  Store if necessary  Return for disposal ___________________________________ ___________________________________ ___________________________________ ___________________________________
Slide 40 ___________________________________ Lab Radiation Safety ___________________________________  CLSIGuidelines: GP-17 A3, Clinical Laboratory Safety  Appendix A: Radiation Safety ___________________________________  Guidance for good practices as well as meet NRC and state regulations ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 41 ___________________________________ CLSI General Radiation Safety ___________________________________  Radioactive material must be secured from unauthorized access  Radioactive waste ___________________________________  Radioactive samples  Radioactive reagents ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 42 ___________________________________ CLSI Signs  and Labels “Caution (or Danger), Radioactive Materials.” ___________________________________  Refrigerators, other containers Radiation Survey  Wipe tests ___________________________________  Sealed sources Necessary Equipment ___________________________________ ___________________________________ ___________________________________ ___________________________________
Slide 43 ___________________________________ CLSI Safe Work Practices ___________________________________  PPE  Personnel Monitoring ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 44 ___________________________________ CLSI Radioactive Material Spills ___________________________________ S = Secure the area, inform others P = Protect yourself (PPE) I = Inspect the Spill L = Lay down a barrier ___________________________________ L = Lay down absorbents E = Extract the mess D = Dispose of waste properly ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 45 ___________________________________ CLSI Extra precautions ___________________________________  Wipe inward toward center of spill to localize contamination  Use a disinfectant if a biological agent is involved  Remove gloves, shoes and lab coats ___________________________________ before leaving the area, treat as radioactive waste  If skin is contaminated, wash as soon as possible ___________________________________ ___________________________________ ___________________________________ ___________________________________
Slide 46 ___________________________________ CLSI Basic Rules ___________________________________ Do not mix radioactive and non- radioactive waste Package dry and liquid waste separately and by isotope Never keep waste in public or ___________________________________ unsecured areas Get permission from RSO for sink disposal Ensure disinfectants do not liberate ___________________________________ volatile radionuclides ___________________________________ ___________________________________ ___________________________________ Slide 47 ___________________________________ CAP  Gen.20374: The laboratory has a policy for ensuring compliance with applicable state and ___________________________________ local laws and regulations. ___________________________________  The note states that this includes “handling radioactive materials.” ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 48 ___________________________________ CAP ___________________________________ Gen.54400: Personnel files include records of radiation exposure where applicable. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
Slide 49 ___________________________________ CAP ___________________________________ Gen.60150: There is adequate space for radionuclide storage, as applicable. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 50 ___________________________________ CAP ___________________________________ Gen.77000: Policies and procedures are documented and adequate for radiation safety. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 51 ___________________________________ CAP ___________________________________  Gen.77100: There are specific policies and procedures for the safe handling of tissues that may contain radioactive material (e.g. sentinel lymph nodes, breast biopsies, prostate "seeds", etc.). ___________________________________  ANP.11275 for those labs that perform anatomic pathology on site. ___________________________________ ___________________________________ ___________________________________ ___________________________________
Slide 52 ___________________________________ CAP  Gen.77100 ___________________________________  NOTE: These procedures should be developed in conjunction with the institutional radiation safety officer, and must comply with any state regulations for the safe handling of tissues ___________________________________ containing radionuclides. The policy should distinguish between low radioactivity specimens such as sentinel lymphadenectomy and implant devices with higher radiation levels. ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 53 ___________________________________ CAP ANP. The 11275 note states: The pathology ___________________________________ department may wish to monitor (potentially radioactive) specimens for radioactivity, with safe storage of specimens until sufficient decaying ___________________________________ has occurred, before proceeding with processing in the histology laboratory. ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 54 ___________________________________ Polling Question Do you have radiation safety ___________________________________ policies or procedures in your laboratory?  Yes ___________________________________  No ___________________________________ ___________________________________ ___________________________________ ___________________________________
Slide 55 ___________________________________ Lab Procedures  Handling of Prostate Seeds: ___________________________________ Utilize Standard Precautions for all specimens Obtain lead container Use forceps to pick up seed(s) and wrap seeds in aluminum foil Place foil-wrapped seed in lead container and replace cap ___________________________________ Disinfect forceps with a 10% bleach solution. Page Radiation Safety Officer Turn lead container over to nuclear medicine staff ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 56 ___________________________________ Lab Procedures ___________________________________  Handling Specimens From Known Radioactive Patients: ___________________________________ Utilize Standard Precautions for all specimens Minimize time spent working with known radioactive samples Maximize distance from known radioactive samples Run samples on instruments as usual Page Radiation Safety Officer for instructions prior to disposal ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 57 ___________________________________ Lab Procedures ___________________________________  Isolation of Radioactive Breast Seeds: Use scintillation meter as needed to locate seed in specimen. Remove seed from tissue. Place seed in glass vial inside lead container . ___________________________________ Note date and number of seeds on rad sticker. Survey work area AND specimen with meter to ensure no contamination remains. ___________________________________ ___________________________________ ___________________________________ ___________________________________
Slide 58 ___________________________________ Lab Procedures ___________________________________  Isolation of Radioactive Breast Seeds: Note: If seed compromise (lost seed, cutting of seed) occurs in the laboratory, complete the following steps: Obtain lead container to collect seed. ___________________________________ Locate and contain actual seed using Scintillation detector if necessary. Place seed inside lead container. ___________________________________ Survey area of suspected contamination. Contact Radiation Safety Officer for further guidance. Complete proper reports. ___________________________________ ___________________________________ ___________________________________ Slide 59 ___________________________________ Lab Procedures ___________________________________  Isolation of Radioactive Breast Seeds: Example Radiation Survey Log: Background Tissue Area Reading # seeds Pathology ___________________________________ Date Time Case MRN Reading Reading Initials # counts/sec counts/sec counts/sec isolated ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 60 ___________________________________ Lab Procedures ___________________________________  Remember:  Radiation precautions are the same as for other laboratory Standard Precautions ___________________________________  Radioactive in-patients are treated as other isolation patients  Time, distance, and shielding are the 3 special tools used for radiation safety ___________________________________ ___________________________________ ___________________________________ ___________________________________
Slide 61 ___________________________________ Now It’s Your Turn to Ask The Experts ___________________________________ Sandy Wolff, MS, CHP, DABR Radiation Safety Officer, Sentara Healthcare Norfolk, VA ___________________________________ Thank you! For more information, contact me at: samaritan@cox,net Facebook.com/danthelabsafetyman ___________________________________ ___________________________________ ___________________________________ ___________________________________

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February 2013 academy radiation safety handouts

  • 1. Slide 1 ___________________________________ ___________________________________ ___________________________________ Sandy Wolff, MS, CHP, DABR Radiation Safety Officer, ___________________________________ Sentara Healthcare Norfolk, VA ___________________________________ ___________________________________ ___________________________________ Slide 2 ___________________________________ Objectives: ___________________________________ 1. Understand the basic principles of radiation and how it can affect staff. 2. Discuss the handling of radioactive material in the clinical and anatomic pathology laboratory ___________________________________ settings. 3. Review laboratory procedures and processes related to radiation safety. ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 3 ___________________________________ Polling Question ___________________________________ Do you use radioactive materials as part of a lab procedure to label specimens or perform other procedures? ___________________________________  Yes  No  Not Sure ___________________________________ ___________________________________ ___________________________________ ___________________________________
  • 2. Slide 4 ___________________________________ Regulatory Agencies ► NRC: Nuclear Regulatory Commission ___________________________________  Jurisdiction over all use of nuclear reactor byproduct material in USA  Agreement 38 State status states have signed agreements with ___________________________________ the NRC to regulate their own states’ radioactive materials users Use equivalent regulations to NRC ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 5 ___________________________________ Regulatory Agencies  NRC Agreement States – 38/50 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 6 ___________________________________ State Regulatory Agencies ___________________________________  Health or Environmental Division o Radiation Health Section or o Radiological Control Bureau o Regulates: ___________________________________ o Ionizing x-ray equipment o Linear accelerators o Naturally occurring and cyclotron-produced ___________________________________ radioactive material o Nuclear byproduct material also if agreement state ___________________________________ ___________________________________ ___________________________________
  • 3. Slide 7 ___________________________________ Radioactivity Units 1 millicurie (mCi) = 3.7 x 107 disintegration per second (dps) (clicks on the Geiger ___________________________________ counter) ___________________________________  New SI unit is becquerel (Bq) = 1 disintegration per second (dps) o ( 1 click on the Geiger counter) ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 8 ___________________________________ Radiation Units 1 Roentgen = 1 rad = 1 rem ___________________________________ (in most cases)  New SI units:  grays (Gy)  sieverts (Sv) ___________________________________  Most of us in the field still converse in rad and rem o although the journals have moved to gray and sievert… ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 9 ___________________________________ Common Unsealed Radionuclides These isotopes are used in nuclear medicine and radiation oncology to diagnose and treat various conditions. Most are excreted in the urine. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
  • 4. Slide 10 ___________________________________ Common Sealed Sources These seeds are implanted in tissue and remain unless surgically removed – no blood or urine contamination. ___________________________________ ___________________________________ ___________________________________ * Aft er t en half lives, consider ed essent ially decayed t o zer o. ___________________________________ ___________________________________ ___________________________________ Slide 11 ___________________________________ Prostate Therapy Seed Implant ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 12 ___________________________________ Breast Tissue Specimen With Seed in Place  New use of seeds to localize breast tumors ___________________________________  Low activity seed and only one or two are used ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
  • 5. Slide 13 ___________________________________ GM survey meter – used to survey for contamination ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 14 ___________________________________ Acronyms  ALARA - As Low as Reasonably Achievable ___________________________________  RSC - Radiation Safety Committee  Review occupational radiation exposure and ALARA issues, Approve radiation safety policies and procedures, investigate Medical Events. ___________________________________  RSO - Radiation Safety Officer Legally responsible for ensuring compliance ___________________________________ o with federal and state radiation safety regulations. ___________________________________ ___________________________________ ___________________________________ Slide 15 ___________________________________ Principles of Radiation Protection (TDS) ___________________________________ Time: Minimize Time ___________________________________  Exposure is proportional to time  Work quickly and efficiently  Have all materials at hand prior to start ___________________________________ ___________________________________ ___________________________________ ___________________________________
  • 6. Slide 16 ___________________________________ Principles of Radiation Protection (TDS) ___________________________________  Distance:Maximize distance  Inverse Square Law  Double your distance, quarter your dose  Lean back ___________________________________  Step back  Exposure drops off quickly with distance ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 17 ___________________________________ Principles of Radiation Protection (TDS) ___________________________________  Shielding - lead is the best for radiation  Shielded vials for transporting seeds and doses  Lead bricks in hot labs for storage of large amounts ___________________________________  Lead aprons not appropriate for isotope shielding ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 18 ___________________________________ Film and Ring Badges Film and ring badges ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
  • 7. Slide 19 ___________________________________ Annual Occupational Dose Limits  Whole body - effective dose ___________________________________  50 mSv  (5000 mrem)  (5 rem) ___________________________________  Monitoring required at 10% of this limit  Most nuclear medicine staff do not reach this level ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 20 ___________________________________ Annual Occupational Dose Limits ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 21 ___________________________________ Annual Dose Limits General Public (those who are not trained and not monitored) ___________________________________ 1 mSv (100 mrem) • Our use of radioactive material may not result in any member of the general public being exposed to 100 millirem per year ___________________________________ • Considered a negligible dose by regulatory bodies • Staff who are not radiation workers • Also must be considered and calculated when highly radioactive patients go home to their ___________________________________ families ___________________________________ ___________________________________ ___________________________________
  • 8. Slide 22 ___________________________________ Declared Pregnancy Dose Limit ___________________________________ Unborn child exposure 5 mSv (500 mrem) (entire gestation) ___________________________________ 0.5 mSv (50 mrem) per month ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 23 ___________________________________ Patient Handling ___________________________________  Phlebotomy/Other Procedures  Patients who receive radioactive substances for treatment are not hazardous to healthcare ___________________________________ workers.  Radiation may be present, but there are ways to protect yourself. ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 24 ___________________________________ Patient Handling ___________________________________  Utilize Standard Precautions for all collection procedures.  Follow any instructions listed for the patient (i.e. ___________________________________ instructions posted in room)  Limitduration of time in close contact with patient. ___________________________________ ___________________________________ ___________________________________ ___________________________________
  • 9. Slide 25 ___________________________________ Patient Handling  Precautions for radiation therapy patients are similar to those for patients isolated for other reasons ___________________________________  Use PPE as instructed via postings.  Foot covers, gowns, lab coats, gloves  DiscardPPE into containers for radioactive waste ___________________________________ inside patient room or in ante-room. Perform hand hygiene before exiting room. ___________________________________ Pregnant staff should avoid caring for patient. ___________________________________ ___________________________________ ___________________________________ Slide 26 ___________________________________ Polling Question Are you notified if/when you ___________________________________ are given radioactive specimens from other departments (blood/urine) ? ___________________________________  Yes  No ___________________________________  Sometimes ___________________________________ ___________________________________ ___________________________________ Slide 27 ___________________________________ Sample Handling ___________________________________ Have not detected radiation from blood, urine or body fluids of most radiation patients. ___________________________________ Do not normally perform urine testing on I-131 patients, but it would be radioactive! ___________________________________ ___________________________________ ___________________________________ ___________________________________
  • 10. Slide 28 ___________________________________ Sample Handling ___________________________________  No special measures need to be taken for clinical specimen transport .  BottomLine: Use Standard Precautions to ___________________________________ handle radioactive specimens unless otherwise directed.  Questions? Officer. Contact your Radiation Safety ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 29 ___________________________________ Sample Handling ___________________________________  Process blood and urine samples as usual.  OK to run samples on lab analyzers.  Becareful not to generate aerosols with radioactive specimens. ___________________________________  Allow centrifuges to come to a complete stop, wait three minutes before opening. Cap specimens for vortexing. ___________________________________  ___________________________________ ___________________________________ ___________________________________ Slide 30 ___________________________________ Sample Handling ___________________________________  Other handling safety tips:  Prevent punctures  Protect  Never against glass breakage recap needles ___________________________________  Prevent ingestion  No food or drink in lab areas  Prevent absorption  Wear gloves, lab coats, face protection ___________________________________ ___________________________________ ___________________________________ ___________________________________
  • 11. Slide 31 ___________________________________ Polling Question Does your laboratory use ___________________________________ radiation detectors?  Yes ___________________________________  No ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 32 ___________________________________ Sample Handling ___________________________________  Disposal of Clinical Specimens  Blood and urine can be disposed of per routine laboratory procedure. Treat these as usual regulated medical waste. ___________________________________  Some sites recommend disposing of known radioactive samples immediately to minimize exposure to staff. ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 33 ___________________________________ Sample Handling ___________________________________  Disposal of Pathology Specimens and Seeds Contact the Radiation Safety Officer for specific ___________________________________  instructions.  Contact Nuclear Medicine department for pick up if that is an option.  Store separately from other samples. ___________________________________ ___________________________________ ___________________________________ ___________________________________
  • 12. Slide 34 ___________________________________ Lab Procedures Involving ___________________________________ Radioactivity ___________________________________  Prostate Seeds  Sentinel Node Biopsy  Radioactive Tissue Biopsy  Breast Seeds ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 35 ___________________________________ Prostate Seeds ___________________________________  Usually permanently implanted I-125 seeds  Seeds arrive in lab embedded in prostate tissue ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 36 ___________________________________ Prostate Seeds ___________________________________  Seeds are removed using forceps  Place seeds in tin foil, place foil into lead container ___________________________________  Contact Radiation Safety Officer for removal/disposal process ___________________________________ ___________________________________ ___________________________________ ___________________________________
  • 13. Slide 37 ___________________________________ Sentinel Node Biopsies ___________________________________  Sentinel Node Lymph Biopsy  Gamma radiation ___________________________________  No risk to transport personnel, processors  Minimal risk to pathologists  Use standard precautions to handle ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 38 ___________________________________ Tissue Biopsies ___________________________________  Very rare that known radioactive tissue would be removed for biopsy  Removal of tissue after treatment with ___________________________________ radioactive iodine ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 39 ___________________________________ Breast Implant Seeds ___________________________________  New procedure  Seeds are removed and counted  Place into lead containers  Check area for radioactivity ___________________________________  Store if necessary  Return for disposal ___________________________________ ___________________________________ ___________________________________ ___________________________________
  • 14. Slide 40 ___________________________________ Lab Radiation Safety ___________________________________  CLSIGuidelines: GP-17 A3, Clinical Laboratory Safety  Appendix A: Radiation Safety ___________________________________  Guidance for good practices as well as meet NRC and state regulations ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 41 ___________________________________ CLSI General Radiation Safety ___________________________________  Radioactive material must be secured from unauthorized access  Radioactive waste ___________________________________  Radioactive samples  Radioactive reagents ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 42 ___________________________________ CLSI Signs  and Labels “Caution (or Danger), Radioactive Materials.” ___________________________________  Refrigerators, other containers Radiation Survey  Wipe tests ___________________________________  Sealed sources Necessary Equipment ___________________________________ ___________________________________ ___________________________________ ___________________________________
  • 15. Slide 43 ___________________________________ CLSI Safe Work Practices ___________________________________  PPE  Personnel Monitoring ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 44 ___________________________________ CLSI Radioactive Material Spills ___________________________________ S = Secure the area, inform others P = Protect yourself (PPE) I = Inspect the Spill L = Lay down a barrier ___________________________________ L = Lay down absorbents E = Extract the mess D = Dispose of waste properly ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 45 ___________________________________ CLSI Extra precautions ___________________________________  Wipe inward toward center of spill to localize contamination  Use a disinfectant if a biological agent is involved  Remove gloves, shoes and lab coats ___________________________________ before leaving the area, treat as radioactive waste  If skin is contaminated, wash as soon as possible ___________________________________ ___________________________________ ___________________________________ ___________________________________
  • 16. Slide 46 ___________________________________ CLSI Basic Rules ___________________________________ Do not mix radioactive and non- radioactive waste Package dry and liquid waste separately and by isotope Never keep waste in public or ___________________________________ unsecured areas Get permission from RSO for sink disposal Ensure disinfectants do not liberate ___________________________________ volatile radionuclides ___________________________________ ___________________________________ ___________________________________ Slide 47 ___________________________________ CAP  Gen.20374: The laboratory has a policy for ensuring compliance with applicable state and ___________________________________ local laws and regulations. ___________________________________  The note states that this includes “handling radioactive materials.” ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 48 ___________________________________ CAP ___________________________________ Gen.54400: Personnel files include records of radiation exposure where applicable. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
  • 17. Slide 49 ___________________________________ CAP ___________________________________ Gen.60150: There is adequate space for radionuclide storage, as applicable. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 50 ___________________________________ CAP ___________________________________ Gen.77000: Policies and procedures are documented and adequate for radiation safety. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 51 ___________________________________ CAP ___________________________________  Gen.77100: There are specific policies and procedures for the safe handling of tissues that may contain radioactive material (e.g. sentinel lymph nodes, breast biopsies, prostate "seeds", etc.). ___________________________________  ANP.11275 for those labs that perform anatomic pathology on site. ___________________________________ ___________________________________ ___________________________________ ___________________________________
  • 18. Slide 52 ___________________________________ CAP  Gen.77100 ___________________________________  NOTE: These procedures should be developed in conjunction with the institutional radiation safety officer, and must comply with any state regulations for the safe handling of tissues ___________________________________ containing radionuclides. The policy should distinguish between low radioactivity specimens such as sentinel lymphadenectomy and implant devices with higher radiation levels. ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 53 ___________________________________ CAP ANP. The 11275 note states: The pathology ___________________________________ department may wish to monitor (potentially radioactive) specimens for radioactivity, with safe storage of specimens until sufficient decaying ___________________________________ has occurred, before proceeding with processing in the histology laboratory. ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 54 ___________________________________ Polling Question Do you have radiation safety ___________________________________ policies or procedures in your laboratory?  Yes ___________________________________  No ___________________________________ ___________________________________ ___________________________________ ___________________________________
  • 19. Slide 55 ___________________________________ Lab Procedures  Handling of Prostate Seeds: ___________________________________ Utilize Standard Precautions for all specimens Obtain lead container Use forceps to pick up seed(s) and wrap seeds in aluminum foil Place foil-wrapped seed in lead container and replace cap ___________________________________ Disinfect forceps with a 10% bleach solution. Page Radiation Safety Officer Turn lead container over to nuclear medicine staff ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 56 ___________________________________ Lab Procedures ___________________________________  Handling Specimens From Known Radioactive Patients: ___________________________________ Utilize Standard Precautions for all specimens Minimize time spent working with known radioactive samples Maximize distance from known radioactive samples Run samples on instruments as usual Page Radiation Safety Officer for instructions prior to disposal ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 57 ___________________________________ Lab Procedures ___________________________________  Isolation of Radioactive Breast Seeds: Use scintillation meter as needed to locate seed in specimen. Remove seed from tissue. Place seed in glass vial inside lead container . ___________________________________ Note date and number of seeds on rad sticker. Survey work area AND specimen with meter to ensure no contamination remains. ___________________________________ ___________________________________ ___________________________________ ___________________________________
  • 20. Slide 58 ___________________________________ Lab Procedures ___________________________________  Isolation of Radioactive Breast Seeds: Note: If seed compromise (lost seed, cutting of seed) occurs in the laboratory, complete the following steps: Obtain lead container to collect seed. ___________________________________ Locate and contain actual seed using Scintillation detector if necessary. Place seed inside lead container. ___________________________________ Survey area of suspected contamination. Contact Radiation Safety Officer for further guidance. Complete proper reports. ___________________________________ ___________________________________ ___________________________________ Slide 59 ___________________________________ Lab Procedures ___________________________________  Isolation of Radioactive Breast Seeds: Example Radiation Survey Log: Background Tissue Area Reading # seeds Pathology ___________________________________ Date Time Case MRN Reading Reading Initials # counts/sec counts/sec counts/sec isolated ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 60 ___________________________________ Lab Procedures ___________________________________  Remember:  Radiation precautions are the same as for other laboratory Standard Precautions ___________________________________  Radioactive in-patients are treated as other isolation patients  Time, distance, and shielding are the 3 special tools used for radiation safety ___________________________________ ___________________________________ ___________________________________ ___________________________________
  • 21. Slide 61 ___________________________________ Now It’s Your Turn to Ask The Experts ___________________________________ Sandy Wolff, MS, CHP, DABR Radiation Safety Officer, Sentara Healthcare Norfolk, VA ___________________________________ Thank you! For more information, contact me at: samaritan@cox,net Facebook.com/danthelabsafetyman ___________________________________ ___________________________________ ___________________________________ ___________________________________