L12 health surveillance-jb

1. 5th BAERA Training Course on Radiation Protection for
Radiation Control Officers (RCOs) of Industrial Practices
Bangladesh Atomic Energy Regulatory Authority
Agargaon, Dhaka
06-09 October 2017
L-12: Health Surveillance of Radiation Workers

2. 1. Introduction
Radiation : Radiation may be considered as energy travelling in
the form of electromagnetic waves or a stream of particles.
Electromagnetic radiation is a form of energy without mass or
electrical charge and is propagated as a wave. Example light,
infrared radiation, X-rays and gamma rays. Radiation is energy
capable of propagating through space and/ or matter
Ionizing Radiation : is radiation composed of particles that
individually carry enough kinetic energy to liberate an electron
from an atom or molecule, ionizing it. X-ray or gamma ray
photons carry enough energy to ionize atoms and disrupt
molecular bonds. This makes it a type of ionizing radiation and
thereby harmful to living tissue.

3. 1. Introduction
 All types of ionizing radiation are harmful to human beings
 Various attempts have been taken to reduce the exposure to the
persons engaged in radiation works and as also the public around
the radiation installation
 Employees should be medical examined prior to employment
involving work with ionizing radiations, and thereafter their medical
fitness should be reviewed at periodic intervals
 The nature of the periodic reviews will depend on the type of work
that is undertaken.

4. The control of sources is facilitated by formal designation of the
workplaces containing them. The BSS employ two such
designations :
Controlled Areas
Any area in which specific protection measures and safety
provisions are or could be required for :
(a) Controlling normal exposure or preventing the spread of
contamination during normal working conditions and
(b) Preventing or limiting the extent of potential exposure
Supervised Areas
Any area not designated as a controlled area but for which
occupational exposure conditions are kept under review even
though specific protective measures and safety provisions are
not normally needed.

5. 2. Nuclear Safety & Radiation Control Rules - 1997
 Rules 58: Personnel Monitoring in Controlled Area
The licensee shall carry out personnel monitoring of all workers
in a controlled area and shall measure routinely the doses
received by each person working in controlled area from external
and internal exposure as per applicable standard. The licensee
shall conduct immediate assessment if it appears that a worker
received sudden or accidental exposure or intakes radioactive
material or prescribed substance as an outcome of an accident.

6.  Rules 59: Exposure Record
 59.1: Exposure Record of a Worker
The licensee, in case of exposure record of a worker, shall –
(a) collect the exposure record of a worker while appointing him as a radiation
worker and in such cases the former employer shall supply the exposure
record of the worker upon requested by the licensee; and
(b) Record doses received by a worker during normal operation, planned special
exposure and accidental and emergency exposure together but these shall
be distinguishable
 59.2: Record-Keeping Procedure
The Commission may provide record-keeping procedure for keeping records
of exposure of workers who work in controlled area under different licensees.

7.  The exposure records shall include:
(a) information on the general nature of the work involving
occupational exposure;
(b) information on doses, exposures and intakes at or above the
relevant recording levels and the data upon which the dose
assessments have been based
( c ) when a worker is or has been occupationally exposed while
in the employ of more than one employer, information on the
dates of employment with each employer and the doses ,
exposures and intakes in each such employment; and
(d) records of any doses, exposures or intakes due to emergency
interventions or accidents, which shall be distinguished from
doses exposures or intakes during normal work and which shall
include references to reports of any relevant investigations.

8.  Rules 66: General Health Surveillance
The licensee shall ensure that an approved registered medical practitioner is
given access to the working premises and to any information which such
approved registered medical practitioner may require in order to ascertain the
state of health of the worker under surveillance
 Rules 67: Periodic Review of Health
The licensee shall ensure that health of a worker is reviewed in every two
years to determine whether such worker remains fit to perform his duties. The
frequency of the periodic reviews of health shall depend on type and extent of
exposure to radiation and on the individual worker’s state of health. The
licensee shall make arrangement to review the state of health of a worker at
least once in five years for a worker in a supervised area, once in two years
for a worker in a controlled area and more frequently if the worker’s exposure
conditions and the state of health so require.

9.  Rules 68: Medical Examination at Termination of Employment or
Retirement
The licensee shall make arrangement for medical examination of
every worker at the termination of employment or retirement and
such medical examination shall be carried out by an approved
registered medical practitioner who shall indicate, based on his
examination of the worker, whether the medical surveillance of
the worker is required to be continued after the termination of
employment or retirement. The licensee shall continue, as deem
necessary, the surveillance of a worker after the termination of
employment or retirement as per the result of the medical
examination in order to safeguard the health of the concerned
worker.

10.  Rules 69: Medical Supervision
The licensee, where occupationally related radiation induced
diseases of a worker is suspected, shall provide medical
supervision as appropriate
 Rules 72: Special Medical Examination
The licensee shall provide special medical examination for the
workers who have received doses exceeding the limits stated in
the rules.

11. 3. Medical Monitoring During the Period of Occupation
All employees working in radiation must be under medical
surveillance irrespective of the dose of exposure
Recommended procedure for monitoring is as follows:
 In case where the exposure is less than or equivalent to maximum
limit, full medical examination should be done every year and at the
end of the occupational
 If the periodic exposure is more than permissible limit and total
exposure in one year remain within the permissible limit, then
examination of blood picture should be done within two weeks of the
high exposure and then every 6 months till the end of the
occupation

12. 3. Medical Monitoring During the Period of Occupation
 If the occasional at exposure exceeds 50 mSv, the person should be transferred
to non-radioactive work. Full examination of blood should be done within 2
weeks of exposure and this should be repeated every six months and in case of
any unusual illness, the particular person should be advised to contact the
medical monitoring centre if there is any unusual complain after the end of
occupation and may be related to radiation
 If the exposure is 50-250 mSv, the subject should be admitted in the special
hospital. Total examination of blood is needed immediately and this should be
repeated every fortnight for 6 months and than every six month for 10-15 years.
After then there should be monitoring for late effect of radiation throughout the
life. If there is vomiting, nausea and diarrhea there should be fluid and
electrolyte replacement. In case of anemia and blood loss proper medication
should be done. If there is immunity loss, infection should be prevented as per
as possible

13.  If the exposure excceds 250 mSv due to accident, the subject will
show all the signs of acute radiation exposure and intensive measures
should be taken for saving the life. After survival the subject should be
under observation through the life for any late effect of radiation .
According to our Nuclear Safety and Radiation Control Rules-1997
(RUle-66 & 67) each licensee shall ensure that health of each
occupational worker is reviewed in every two years to determine
whether such worker remains fit to perform his duties.
3. Medical Monitoring During the Period of Occupation

14. Responsibilities of the regulatory body to occupational exposure
Requirement 19: BSS (2011)
The government or regulatory body shall establish and
enforce requirements to ensure that protection and safety is
optimized, and the regulatory body shall enforce compliance
with dose limits for occupational exposure.

15. Responsibilities of the regulatory body to occupational exposure
Requirement 19: BSS (2011)
3.69. The government or regulatory body shall establish the
responsibilities of employers, registrants and licensees with
regard to application of the requirements for occupational
exposure in planned exposure situations.
3.70. The government or regulatory body shall establish and
enforce requirements to ensure that protection and safety is
optimized for occupational exposure.
3.71. The government or regulatory body shall establish and the
regulatory body shall enforce compliance with the dose limits
specified in Schedule III for occupational exposure.

16. Responsibilities of the regulatory body to occupational exposure
Requirement 19: BSS (2011)
3.72. Before authorization of a new or modified practice, the
regulatory body shall require, as appropriate, and review
supporting documents from the responsible parties that state:
(a) design criteria and design features relating to the
exposure and potential exposure of workers in all
operational states and accident conditions;
(b) design criteria and design features of the appropriate
systems and programmes for monitoring of workers for
occupational exposure in all operational states and accident
conditions.

17. Module 5.5. Personal Protective Equipment
IAEA Training Material on Radiation Protection
Part 5. Occupational Exposure Protection of the Worker

18. “3.95. Employers, registrants and licensees shall ensure that:
(a) Workers are provided with suitable and adequate personal protective equipment that
meets relevant standards or specifications, including as appropriate:
(i) protective clothing;
………..
(iii) protective aprons and gloves and organ shields;
………..
(d) All personal protective equipment, including equipment for use in an emergency, is
maintained in proper condition and, if appropriate, is tested at regular intervals;
Personal Protective Equipment

19. Protective Clothing
Appropriate clothing should as a minimum include
lab coat and gloves.National regulations may require
more.

20. Safety equipment needed depends on the type
of work
Safety equipment:
•protective clothing
•contamination monitor
•shields
•forceps, tongs
Example unpacking:
•check for damage
•check for contamination
•check the content
•check the activity

21. Module 5.8. Health Surveillance
IAEA Training Material on Radiation Protection
Part 5. Occupational Exposure Protection of the Worker

22. Health Surveillance
3.108. Health surveillance programmes shall be:
(a) Shall be based on the general principles of occupational health;
(b) Shall be designed to assess the initial fitnessand continuing
fitness of workers for their intended tasks.

23. Health Surveillance
 3.109. If one or more workers are to be engaged in work in
which they are or could be exposed to radiation from a source
that is not under the control of their employer, the registrant or
licensee responsible for the source shall, as a precondition for
the engagement of such workers, make any special
arrangements for workers’ health surveillance with the employer
that are needed to comply with the rules established by the
regulatory body or other relevant authority.

24. Health Surveillance
The following three situations may need to be considered
in the initial medical examination and in the subsequent
Reviews:
The fitness of a worker for wearing protective devices such
as respiratory protection devices, lead aprons etc.
The fitness of a worker with a skin disease, such as eczema
or psoriasis
The fitness of a worker known to have a psychological
disorder for work with radiation sources

25. Health Surveillance
Health surveillance records should be confidential and preserved
in a manner approved by the Regulatory Authority. The minimum
period of record keeping should be the lifetime of the worker
concerned. Longer preservation may be advisable.

26. Annex-I
Medical Examination of Radiation Workers
A. General Health Investigations
a) Name of the worker :
b) Age :
c) Sex :
d) Date of birth :
e) Home address :

27. ANNEX-I
(f) Date of examination :
(g) Height (Feet-Inch) :
(h) Weight (Kg) :
(i) Pulse :
(j) Blood pressure :
(k) ECG :

28. ANNEX-I
B. Laboratory investigations:
 Blood group:
Blood picture:
TC-
Polymorph-
Lymphocyte-
Monocyte-
Basophil-
Esonophil-
RBC-
WBC-
Hb%-
ESR-
Platelet Count-

29. Thank You
For
Your Kind Attention