RadiationSafetyReviewfor

RadiationOncologyStaff
MARCUSJEANNETTE
RADIATIONSAFETYOFFICER
7442070

OfficeofRadiationSafety
Responsibilities
Complywithregulations,laws,andguidelinesregarding
thesafeuseofradioactivematerialandradiation
producingdevices.
Protectemployees,students,andthegeneralpublicfrom
overexposuretoradiationatEastCarolinaUniversity.

Regulatory
Environment

Regulatory Environment
Thistrainingis
mandatedby
regulation,but
why?

There are a number of

factors involved and during
the process of this training
session you should gain a
larger understanding of the
reason.
We will first look at where the
regulations originate from
and what agencies govern
our operational use of
radiation producing
machines and radioactive
materials.

Scientific Community
International Commission on
Radiation Protection
ICRP

National Council on Radiation

Protection and Measurements
NCRP

The ICRP and NCRP are

advisory bodies that
collect and analyze data
regarding ionizing
radiation and put forth
recommendations on
radiation protection.
The regulatory groups utilize
these recommendations
when developing
regulations.

Federal Regulatory Groups

Many Federal agencies have
regulations that deal with
radiation protection.
Each agency regulates a
different aspect as it
pertains to their particular
program area.
NRC Nuclear Regulatory Commission
FDA Food & Drug Administration
FEMA Federal Emergency Management Agency
OSHA Occupational Safety and Health Administration
DOT Department of Transportation
EPA Environmental Protection Agency
USPS United States Postal Service

State Regulatory Groups

In North Carolina, the Radiation Protection Section
regulates the safe use of ionizing radiation
(electronic product or radioactive materials) used
at our facility.
We are authorized to use these sources of ionizing
radiation via licensure (radioactive materials and
accelerators) and registration (diagnostic x-ray
equipment). Our facility has a radiation protection
program that must meet the requirements set forth
by the State in order to maintain these
authorizations.

LicensesandRadiationSafety
Committees

CurrentLicensesManagedByECU
0742961,BroadAcademicLicense

074296A1,PhysicsLinearAccelerator
074296A2,LJCCAccelerators
0742967,ECHINuclearCardiology

ECURadiationSafety
Committees

BasicSciencesRadiationSafetyCommittee
AcademicResearch
PhysicsLinearAccelerator
ClinicalRadiationSafetyCommittee
TherapyAccelerators
HighDoseRateApplicator

CommitteeResponsibilities
Developpoliciesandproceduresforthesafeuseof
radioactivematerialsandradiationproducing
equipment.
Approveauthorizedusers.
ProvidetechnicaladvicetotheRSO.
Reviewallinstancesofallegedinfractionsoftheuse
ofionizingradiationsorsafetyruleswiththeRSO
andresponsiblepersonnelandtakecorrectiveactions.
ReviewperiodicreportsfromtheRSO.

BasicRadiationPhysics

Ionizing vs. Non-Ionizing

Radiations
Ionizing Radiation
A radiation that has
sufficient energy to
remove electrons from
atoms or molecules as it
passes through matter.
Examples: x-rays,
gamma rays, beta
particles, and alpha
particles

Non-Ionizing Radiation
A radiation that is not as
energetic as ionizing
radiation and cannot
remove electrons from
atoms or molecules.
Examples: light, lasers,
heat, microwaves, and
radar

Atom
Whether we talk about ionizing or non-ionizing
radiation, its genesis is either within or very
close to the exterior of the atom. The
following is a brief review the atomic structure.
The atom is comprised
of a nucleus, which is
made up of positively
charged protons and
electrically neutral (no
charge) neutrons,
surrounded by
negatively charged
electrons.

In an electrically
neutral atom, the
number of positively
charged protons and
negatively charged
electrons are equal.

Radiation Origins
Ionizing radiation (hereafter, referred only as
radiation) can be generated by electronic means (xray units) or radioactive materials.
When electronic-product radiation is produced, the
source is turned on and off like a light switch. Once
the unit is off, the radiation exposure is over. The xray unit does not continue to radiate or become
radioactive.
With radioactive materials, there is a little more
involved. The source is always on until it decays
away.
Next: A review of both types of ionizing radiation
generators X-rays and Radioactive Materials.

Radioactive Material
Types of Radiations
GAMMA AND X-RADIATION

Generally, stopped by lead.

Sources include naturally
occurring radioactive materials
and cosmic radiation.

Medical imaging

FYI: As discussed earlier, x-rays can be

produced by radioactive decay or
electronic production. Both originate
outside the nucleus of the atom.

Gamma rays and X-rays are

essentially the same, except for
where they originate. Gamma rays
originate from the nucleus, and Xrays originate outside the nucleus
of an atom.
These rays have no mass or no
charge, and are very penetrating.
These rays are the same as light
(electromagnetic radiation), only
much more energetic.
Considered more of an external
hazard than internal.
Both rays are great for imaging
patients.

X-ray Generation
Review

FYI: If youve ever had an x-ray,

when the x-ray technologists takes
your picture, it is over. The x-ray
unit does not continue to produce
radiation after the exposure is
complete.

X-rays as produced by an x-ray

unit are also know as
Bremsstrahlung. It is a
German word for braking
radiation.
As depicted in the diagram, when
the electron slows very fast
(brakes) as it gets close to the
atom of the target nucleus, x-rays
(radiation) are formed.
X-rays are emitted in all
directions; therefore, the structure
housing the x-ray tube is shielded
except for a port where the x-rays
escape and can be used for
diagnostic purposes.

Radiation Units
Now that you have a little understanding of the physics behind ionizing
radiation, how do we measure or quantify radiation? Here are a few units of
measure that are used (often interchangeably) in radiation protection:
Absorbed Dose

Exposure
A measure of ionization
produced in air by X or
gamma radiation.
Highly specific in that
the unit specifies the
matter being exposed
and radiation producing
the ionizations.
Unit: roentgen (R)
1 R = 1000 mR

A measure of energy
deposition per unit
mass irradiated.
Considers all
radiations imparting
energy to all types of
matter.
Unit: rad
1 rad = 1000 mrad
SI Units: gray (Gy)
1 Gy = 100 rad

Dose Equivalent

It is numerically equal to
the absorbed dose by a
quality factor
Dose equivalent is
needed because the
biological effect from a
given absorbed dose is
dependent upon the type
of radiation producing the
absorbed dose.
Unit: rem
1 rem = 1000 mrem
SI Units: sievert (Sv)
1 Sv = 100 rem

Radiation Units
Dose Equivalent
The unit of measure, dose equivalent, was instituted to take into
account the relative biological effectiveness of the differing types of
radiations.
Some radiations like alpha particles are densely ionizing; therefore,
as they pass through tissue, they are able to strip more electrons
than beta particles or x-rays or gamma rays20 times greater. In
short, alpha particles are better at producing damage.
Absorbed dose merely documents how much energy is being
deposited per unit mass, it does not consider how effective each
radiation is at producing damage in a biological system.
The more densely ionizing, the more damage is done.

FYI: If you wear a badge, your dose in reported in mrem.

Biological Effects
and
Radiological Risk

BiologicalAcute
Effects
Effects:

Who cares about electrons being

stripped from atoms?
Electrons are essential in creating
molecular bonds. When radiation
breaks those bonds, the molecule
ceases to function properly.
Research has shown that the body
has great repair mechanisms, but
when overwhelmed the repair may
be incomplete or incorrect.
If enough damage to a region occurs,
the result may be cell death.
Damage may manifest as delayed
or acute effects.

Generally occurring in the

individual receiving the radiation
dose.
A threshold dose must be
exceeded before symptomatic.
Example: Radiation Sickness

Delayed Effects:

Can occur in the individual

receiving the radiation dose or the
offspring.

Probabilistic effect, whereby the

increase in dose increases the
probability that the effect occurs.

Example: Cancer or genetic

mutation

Biological Effects
What we know about
the effects of radiation
come from a number
of different exposed
populations:
Atomic bomb survivors
Accident victims
Radium watch dial painters
Radiation therapy patients
Early experimenters with
radiation

Epidemiological
studies of these
groups have shown
that following
significant radiation
doses, effects were
observed.
The effects were both
acute and delayed.

Dose versus Effect

Nobody knows for sure
what radiation dose does to
us below the shaded
region. There may be a
threshold where there is no
effect from radiation below
a certain dose.
In Radiation Protection, as
a protective measure, it is
assumed that all dose
carries some risk, this is
represented by the straight
red line on the diagram .

FYI: There are other theories regarding

the effects of radiation dose (as
represented by the other lines blue and
gray), to include radiation hormesis.
Radiation hormesis is a theory that
chronic low doses of radiation is good for
the body.

Radiation Risk
Understanding the different types of
effects, regulatory agencies impose
radiation dose limits that eliminate
the likelihood of acute effects and
reduce the likelihood of delayed, or
risk-based, effects.
Regulatory groups are concerned
with fatal risk estimates.
The current regulatory limit for an
occupationally exposed worker is
5,000 mrem per year.
When initially instituted, the
radiation dose limit represented a
risk that was equal to that of other
safe industries.

Given that the regulatory limits

are risk-based, and that
increasing ones dose increases
ones chance that an effect may
occur, the law also requires
radiation workers to employ the
philosophy of ALARA, or
keeping your radiation dose As
Low As Reasonably
Achievable.

Putting Radiation in
Perspective!
Everyone on Earth is being
exposed to radiation!
The average North Carolinian
receives approximately 360
mrem of radiation dose per year.
Background radiation dose is
affected by altitude, soil type and
other factors. There is a wide
variation of natural backgrounds
in the world.
Some places have annual
background radiation levels
greater than the US dose limits
for radiation workerswith no
excess cancer mortality!

Did you know some of the foods

you eat contain naturally occurring
radioactive material?
Bananas contain low
quantities of Potassium-40.

Practical
Radiation Safety

Protecting Ourselves from

External Exposure
Adhere to the three
cardinal rules of
external radiation
protection:
TIME
DISTANCE
SHIELDING

TIME
Less Time = Less Exposure

DISTANCE
Greater Distance = Less Exposure

SHIELDING
More Shielding = Less Exposure

External Radiation Protection

Consider This
Exposure to a source of ionizing radiation is very similar to
the exposure from a light bulb (i.e. light and heat).
The closer you are
to the source, the
more intense the
light and heat are.
Likewise, if you
move away, the
intensity decreases.
If you put something
opaque between
you and the light
bulb, you effectively
eliminate the light.

The longer you are

close to the light
bulb, you begin to
feel the warming
effects of the light.
If however, you
move quickly to and
from the light, youll
not likely feel the
warming effect.

Exposure and Contamination

A difficult concept to understand is the difference between
exposure and contamination when we talk about radioactive
materials.
To illustrate the difference, consider a burning candle.
If you stand away from the candle, you
are being exposed to the candles light. If
you leave the room, your are no longer
exposed to the candles light.
If you walk up to the candle, you are
being exposed to the candles light. If you
then reached out and grabbed the candle,
you would get hot wax on your hand. If
you left the room, you are no longer
exposed to the light, but the wax on your
hand (i.e. contamination) remains. If the
wax were radioactive, the contamination
would continue to expose your hand until
you washed it off.

Remember: Being
exposed by a
radioactive source
does not
contaminate you.
You must have
interacted with the
source to get some
of the source on
you. Once on you,
the contamination
will expose you until
it is removed.

General Safety Guides for Use of

Radiation Producing Equipment
X-ray equipment should not be left unattended while in
operating mode.
When in fixed radiographic rooms, operators shall
remain behind the protective barrier.
If required to be in a room during a diagnostic x-ray
exposure (e.g. fluoroscopy), wear a lead apron or
stand behind a protective barrier.
Where your dosimetry, if applicable.
Follow established procedures; when unsure, stop and
notify your supervisor or the RSO.
Keys MUST not be left in portable x-ray equipment.

RadiationSymbols
CautionRadioactive
Materials
CautionRadiation
Area
CautionRadiation
AreawhenXray
Energized

NorthCarolinaRegulationsfor
theProtectionAgainstRadiation
(NCRPAR)

NCRegulationsforthe
ProtectionAgainstRadiation
ThisistheLAW.
Weblocation:
http://www.ncradiation.net/documents/15A
NCAC11_1107.pdf

HighlightsofNCRPAR
15ANCAC11.1600,Standardsforthe
ProtectionAgainstRadiation.
15ANCAC11.0300,Licensingof
RadioactiveMaterial.
15ANCAC11.0600,XraysintheHealing
Arts(NotincludedinthisPresentation).
15ANCAC11.0900,Requirementsfor
ParticleAccelerators(NotIncludedinthis
Presentation)

.1600,Standardsforthe
ProtectionAgainstRadiation

.1603,RadiationProtectionProgram
.1604,OccupationalDoseLimitsforAdults
.1610,DoseEquivalenttoanEmbryoFetus
.1611,DoseLimitsforIndividualMembers
ofthePublic.

RadiationProtectionProgram
(.1603)
TheLicenseeorregistrantmustdevelop,document
aradiationprotectionprogramcommensuratewith
thescopeandextentoflicensedactivities.
Programmustinsurecompliancewiththe
provisionsoutlinedin.1600
Forexamplecompliancewithoccupationaldose
limits,recordkeeping,doselimitsformembersof
thepublic,radiologicalareasurveys,annual
programreview,etc.

Occupational Dose Limits

(.1604)
The occupational dose limits for workers in North Carolina and the
US are as follows:
Whole Body (WB)
5,000 mrem/yr
Extremities/Skin
50,000 mrem/yr
Lens of the Eye
15,000 mrem/yr
Minor WB (< 18 years old)
500 mrem/year
Declared Pregnant Worker
500 mrem/gestation
By regulation, the institutional radiation protection program shall
monitor individuals exposure/dose if they are likely to receive
10% of the limit, or in the case of declared pregnant workers and
minors the threshold is 100 mrem.

Personnel Monitoring Methods

(Dosimetry)
Monitoring Required
Whole Body
Extremity
Internal Contamination

Whole
Body
Badge

Monitoring Method
TLD or OSL Badge
Finger Ring TLD
Urinalysis or
Bioassay

Ring
Badge
Thyroid
Bioassay

General Rules for Use of

Dosimetry
Wear your own badge.
Wear your whole body
(WB) badge whenever
working with radiation
sources
Notify the RSO
immediately when a
badge is lost.

Wear ring badges under

gloves.
Store badges in
designated areas at the
end of each day of work.

Personnel Dosimetry - FYI

Dosimetry does not protect
you from radiation.
Dosimetry is not a warning
device (i.e. it will not alarm,
beep or change color)
Dosimetry documents the
radiation dose an individual
receives when working with
radiation sources.
It is ILLEGAL to intentionally
expose an individuals
dosimeter.

Personnel Dosimetry Review

Each monitoring period dose report is reviewed by the Radiation
Safety Officer
The report is compared against the institutions investigational
levels:
>200 mrem/monitoring period to whole body
> 2000 mrem/monitoring period to extremities
> 800 mrem/monitoring period to the skin
Action Required: Written notification from RSO to worker and
investigation

DoseEquivalenttoan
Embryo/fetus(.1610)
Occupationalexposuretothefetusofa
declaredpregnantwomanshallnotexceed
500milliremduringthe9month
pregnancy.
Declarepregnancyassoonaspossible

Declared Pregnant Workers

Available for those radiation workers who are pregnant or
planning a pregnancy.
Purely VOLUNTARY!
To be apart of the program, you must DECLARE your pregnancy
in writing to your supervisor and provide the estimated date of
conception. The RSO must be notified immediately upon
declaration.
The declared pregnant worker may be provided with a dosimeter
that will be worn at the waist level. If lead is worn, the fetal
badge shall always be worn under the lead.

DoseLimitsforIndividual
MembersofthePublic(.1611)
Thetotaleffectivedoseequivalentshallnotexceed100
milliremwithinoneyear.
Thedoseinanyunrestrictedareafromexternalsourcesof
radiation,exclusiveofthedosecontributionfrompatients
administeredradioactivematerialandreleasedin
accordancewiththeregulations,doesnotexceed2
millireminanyonehour.
Thisisbasically2milliremperweekfora50weekwork
period.
Patientsrecievingmedicalcareareexemptedfromthis
rule!

Howdowecomplywiththe
DoseLimitsforMembersofthe
Public?
RadiationSafetyPoliciesandProcedures
RadiologicalAreaSurveys
Contaminationsurveys
ExternalRadiationsurveys

EnvironmentalMonitoring
LandauerOSLEnvironmentalmonitors
StandardOSLmonitors

GeigerMuellerDetector

Geigercountersareportable
devicesthatdetectandmeasure
radioactivity.

Canbeusedtodetectbeta,
gammaandXrayradiation.

GeigerMullertubeisfilled
withaninertgasthatwill
conductelectricitywhen
ionized.Thetubeamplifies
thisconductionbyacascade
effectandoutputsacurrent
pulse,whichisdisplayedbya
needleoraudibleclicks.

LicensingofRadioactive
Material(.300)
.0350,RecordsandReportsofMisadministration
.0356,ProceduresforAdministrationRequiringaWritten
Directive
.0364,MedicalEvents
.0365,ReportandNotificationofaDosetoan
Embryo/FetusorNursingChild

RecordsandReportsof
Misadministration(.0350)
RepealedasofNovember1,2007
ChangedtoMedicalEvent,.0361

WrittenDirectives
Theprescriptionorordergivenbyaphysicianthat
isdocumentedinthepatientchartorelectronic
chartingsystem(Lantis).
Awrittenprescriptionmustbecompletedbythe
authorizedPhysician.
Treatmentsummarywillbecompletedbythechief
radiationtherapistandmedicalphysicsstaffupon
completionoftreatment
Thepatientsidentitywillbeverifiedbeforeeach
andeachadministrationswrittendirective.

TheWrittenDirectivewill
Include:

Volume(site)tobetreated
Radiationmodality
Doseperfraction
Totalnumberoffractions
TreatmentPattern
Prescriptionpointorisodose
Techniqueused

MedicalEvents(.0364)
MedicalEventistheadministrationofradioactivematerialor
radiationthatresultsin:
1.Adosethatdiffersfromtheprescribeddoseby5remeffective
doseequivalent,50remtoanorganortissue.
2.Thetotaldosedelivereddiffersfromtheprescribeddoseby
20%ormore..
3.Anadministrationofthewrongradioactivedrugcontaining
radioactivematerial.
4.Anadministrationofaradiopharmaceuticalbythewrong
routeofadministration.
5.Anadministrationtothewrongpatient.

ReportingaMedicalEvent
NotifytheRSOImmediately
CallDENR,RPSwithin24hoursofevent
9195714141
Givethefollowinginformation:

CallersName
Licensee:EastCarolinaUniversitySchoolofMedicine
DateofMedicalEvent
Dateofdiscovery
LicenseNumber:074296A2
BriefDescriptionofEvent

ReportingaMedicalEvent
ECHIwillsubmitawrittenreporttoDENRwithin15days.
Thereportshouldincludethefollowing:
1.Thelicenseesname

2.Thenameoftheprescribingphysician
3.Briefdescriptionoftheevent
4.Whytheeventoccurred
5.Theeffectontheindividual(s)whoreceivedtheadministration
6.CorrectiveActions
7.Certificationthatwenotifiedtheindividualinvolved

TheMedicalEventreportingformisavailableontheweb
at:www.ncradiation.net

AcceleratorSafety

Maintenanceshouldonlybeperformedbyaqualifiedexpertwiththepropertraining.
Beforeenteringthetreatmentroomforanyreason,alwaysverifythatLINACor
Cyberknifeisinabeamoffcondition.Notifytheoperatorbeforeentering.

Beforerotatingthegantry,alwaysverifythatthetreatmentcouchispositionedandthe
patientrestrainedsoacollisioncannotoccur.

NotifyyoursupervisorofanyabnormaloccurenceswiththeLINAC/Cyberknife..

DonotcontinueoperationoftheLINAC/Cyberknifeorattempttodeliveratreatmentif
thereisanyindicationofamalfunctionofanykind.

Alwaysremovetheconsolekeysanddeposittheminasecureareawhenthe
LINAC/Cyberknifeisunattended.Thekeysshouldalwaysberemovedatnightandon
theweekend.

AcceleratorSafety

IfapowerfailureoremergencystopshouldshutdowntheLINAC/Cyberknifeduring
treatment,alwaysremovethepatientandhaveamaintenancecheckoftheunitbefore
completingtreatment.

Emergencyproceduresarepostedatallthreeshieldedvaults.Emergencycontactsarealso
listed.

QualityAssurancechecksshouldbeperformeddaily,monthlyandannually.Reviewthe
RadiationOncologypoliciesandproceduresregardingthethetypeofchecksthataretobe
performed

Nooneexceptthepatientundertreatmentshallbeintheacceleratorroomwhenthebeam(x
rayorelectron)isenergized.Whenapatientmustbeheldinpositionforradiationtherapy,
mechanicalsupportingorrestrainingshallbeused.
ThisisaNorthCarolinaRegulationfortheProtectionAgainstRadiation,15ANCAC
11.0609(e)(2).
AbsolutelyNOexceptionstothisrule.

LINACEmergencyProcedure
In the event of any malfunction of the treatment
unit(s) (mechanical, electrical, or otherwise) which
may prove hazardous to the patient, therapist or the
any member of the public:
1.
Press any emergency off button.
2.
Remove patient and other personnel from vault.
3.
Close accelerator door.
4.
Call the Radiation Safety Officer AND the Medical
Physicist listed below.
5.
Remain at the console and prevent entry of personnel
into vault until problem has been resolved, if possible.

EmergencyCallList
MedicalPhysicist:
MelodeeWolfe
Beeper:7543422

Home:5245720

ClaudioSibata
Beeper:5619445

Home:4122875

RadiationSafetyOfficer:
MarcusJeannette
Beeper:7575056

Home:2588005

One Last Thought to

Remember!
Radiation protection is not just the responsibility
of management, the Radiation Safety
Committee, the Radiation Safety Officer or coworkers, it is all of our responsibility.

References
TheNorthCarolinaRegulationsforthe
AgainstRadiationMaybefoundatthe
followingWebsite:
http://ncradiation.net/documents/15ANCA
C11_1107.pdf