IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology

RADIATION PROTECTION IN
DIAGNOSTIC AND
INTERVENTIONAL RADIOLOGY

L13.2: Occupational exposure -

Radioprotection measures

IAEA
International Atomic Energy Agency
Introduction

Subject matter: occupational exposure and

regulatory aspects
The monitoring procedures
Investigation and follow up protocols

IAEA 13.2: Occupational exposure - Radioprotection measures 2

Topics

Personal protective equipment

Individual monitoring and exposure
assessment
Investigation and follow up
Health surveillance
Records

IAEA 13.2: Occupational exposure - Radioprotection measures 3

Overview

To become familiar with the BSS detailed

requirement for radiation protection of
workers in diagnostic radiology.

IAEA 13.2: Occupational exposure - Radioprotection measures 4

IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology

Part 13.2: Occupational exposure

Topic 1: Personal protective equipment

IAEA
International Atomic Energy Agency
Personal protective equipment

Registrants and licensees shall ensure that

workers are provided with suitable and
adequate personal protective equipment
which meets any relevant regulations or
standards (BSS 3.76).
Protective equipment includes lead aprons,
thyroid protectors, protective eye-wear and
gloves. The need for these protective
devices should be established by the RPO

IAEA 13.2: Occupational exposure - Radioprotection measures 6

Protective clothing:

Gowns, aprons and thyroid protectors made

of a material (such as vinyl) which contains
lead or other high Z material
Aprons should be equivalent to at least 0.25
mm Pb if the X Ray equipment operates up
to 100 kV and 0.35 mm Pb if it operates
above 100 kV
Aprons may be of the style which is open, or
contains less lead, at the back, due to the
extra weight of lead required - this assumes,
however, that the wearer is always facing
the radiation source
Heavy, leaded gloves have limited value
because they are difficult to use

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Protective devices

SCREEN CURTAIN
AND
GOGGLES

IAEA 13.2: Occupational exposure - Radioprotection measures 8

Personal protective equipment

Additional protective devices should be

available in fluoroscopy and interventional
radiology rooms which include:
Ceiling suspended protective screens.
Protective lead curtains mounted on the patient
table.
Protective lead curtains for the operator if the X
Ray tube is placed in an over couch geometry
and if the radiologist must stand near the patient

IAEA 13.2: Occupational exposure - Radioprotection measures 9

IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology

Part 13.2: Occupational exposure

Topic 2: Individual monitoring and exposure

assessment

IAEA
International Atomic Energy Agency
Individual monitoring and exposure
assessment (I)

Individual dose monitoring shall be

undertaken for workers who are normally
exposed to radiation in controlled areas:
radiologists, medical physicists, the RPO,
radiographers and nurses
Other frequent users of X Ray systems such as
endoscopists, anaesthetists, cardiologists,
surgeons etc., as well as ancillary workers who
work in controlled areas, shall also be
monitored.

IAEA 13.2: Occupational exposure - Radioprotection measures 11

Individual monitoring and exposure
assessment (II)

Individual external doses should be determined by

using individual monitoring devices:
Thermoluminescent or optically stimulated luminescence
Film badges
Electronic dosimeters
Worn at breast level, between the shoulders and
the waist
The monitoring period should be one month,
and shall not exceed three months.
The exchange of dosimeters and report receipt
should not exceed three months
IAEA 13.2: Occupational exposure - Radioprotection measures 12
Personal dosimetry

Several
personal
dosimeters are
recommended

From: Avoidance of radiation injuries from interventional procedures. ICRP Publication 85

IAEA 13.2: Occupational exposure - Radioprotection measures 13

Different types of personal dosimeters

film
termoluminescence (TLD) and optically
stimulated luminescence (OSL) dosimeters
electronic dosimeters

IAEA 13.2: Occupational exposure - Radioprotection measures 14

Film badge

plastic filter metal filters open windows

open window
detects beta, gamma, X Ray
IAEA 13.2: Occupational exposure - Radioprotection measures 15
TLD

IAEA 13.2: Occupational exposure - Radioprotection measures 16

TLDs

whole body extremity

IAEA 13.2: Occupational exposure - Radioprotection measures 17
OSL

1 cm
IAEA 13.2: Occupational exposure - Radioprotection measures 18
Individual monitoring and exposure
assessment (III)

Evaluation of dose is an important aspect of

radiation protection
It is important that workers return dosimeters
on time for processing
Delays in the evaluation of a dosimeter can
result in the loss of the stored information
Licensees should make every effort to
recover any missing dosimeters

IAEA 13.2: Occupational exposure - Radioprotection measures 19

Individual monitoring
when a lead apron is used (I)

The dosimeter should be worn under the apron for

estimating the effective dose
The other body areas not protected by the apron
will receive higher dose
One dosimeter worn under the apron will yield a
reasonable estimate of effective dose for most
instances
In case of high workload (interventional radiology)
an additional dosimeter outside the apron should
be considered by the RPO

IAEA 13.2: Occupational exposure - Radioprotection measures 20

Individual monitoring
when a lead apron is used (II)
When expected doses are high, two dosimeters are required:
1 under the apron at waist level
1 over the apron at collar level
The effective dose E is given by:
E = 0.5 Hw + 0.025 Hn
where:
Hw : dose at waist level under the apron
Hn : dose recorded by a dosimeter worn at neck level over
the apron
Note: The thyroid shielding allows 50% reduction of the E
The dosimeter worn over the apron at collar level gives also an
estimation of thyroid and eye lens doses

IAEA 13.2: Occupational exposure - Radioprotection measures 21

Individual monitoring and exposure
assessment (IV)
In some facilities and for some individuals with a low level
of exposure (e.g.: general dental practitioners), area
dosimetry to estimate the level of dose per procedure can
be an acceptable alternative.
Some X Ray systems for dental radiography, or others
used in surgical theatres which use X Rays on a limited
number of occasions a month may not require individual
dosimetry for all staff involved although fluoroscopy in
surgical theatres may lead to high dose in short time if not
properly conducted
In these cases, area dosimetry or some other individual
dose evaluation per procedure could allow the RPO to
estimate the typical level of risk
IAEA 13.2: Occupational exposure - Radioprotection measures 22
Special aspects of individual
monitoring

In case of loss of a dosimeter, the dose estimation

may be carried out from:
recent dose history,
co-workers dose
or, workplace dosimetry
Individual monitoring devices should be calibrated
Laboratory performing personnel dosimetry should
be approved by the regulatory authority

IAEA 13.2: Occupational exposure - Radioprotection measures 23

Monitoring of the workplace (I)

Registrant and licensees shall develop

programmes for monitoring of the workplace:
All survey meters used for workplace monitoring shall be
calibrated and this calibration shall be traceable to a
standards dosimetry laboratory
Initial monitoring should be conducted immediately after
the installation of new radiology equipment and shall
include measurements of radiation leakage from
equipment, and area monitoring of useable space
around radiology rooms

IAEA 13.2: Occupational exposure - Radioprotection measures 24

Monitoring of the workplace (II)

Annual area surveys should be performed

All radiation monitors shall be calibrated,
and their warning devices and operability
should be checked prior to each day of use
(BSS 3.76)

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IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology

Part 13.2: Occupational exposure

Topic 3: Investigation and follow up

IAEA
International Atomic Energy Agency
Investigation levels (I)

Employers, registrants and licensees shall,

in consultation with workers or through their
representatives, include in the local rules
and procedures the values of any relevant
investigation level, and the procedure to be
followed in the event that any such value is
exceeded.

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Investigation levels (II)

A suitable quantity for use as investigation

level is the monthly individual effective dose.
The dose measured outside the lead apron
(at collar or shoulder level) and the dose to
the hands can also be used as a quantity for
an investigation level for staff in
interventional radiology.

IAEA 13.2: Occupational exposure - Radioprotection measures 28

Investigation levels (III)

Monthly values higher than 0.5 mSv (for the

dosimeter worn under the lead apron)
should be investigated.
Values higher than 5 mSv per month in the
over apron dosimeter or in the hand or finger
dosimeters should also be investigated with
a view to optimization.

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Investigation levels (IV)

The licensee shall conduct formal

investigations, as required by the Regulatory
Authority, whenever (BSS 3.46):
an individual effective dose exceeds
investigation levels
any of the operational parameters related to
protection or safety are out of the normal range
established for operational conditions

IAEA 13.2: Occupational exposure - Radioprotection measures 30

Investigation levels (V)

any equipment failure, severe accident or error

takes place, which causes, or has the potential to
cause, a dose in excess of annual dose limit
any other event or unusual circumstance that
causes, or has the potential to cause a dose in
excess of the annual dose limits or the operational
restrictions imposed on the installation (e.g., the
significant change in workload or operating
conditions of radiology equipment)

IAEA 13.2: Occupational exposure - Radioprotection measures 31

Investigation levels (VI)

The investigation shall be initiated as soon as

possible following discovery of the event, and a
written report shall be prepared concerning its
cause (determination or verification of any doses
received, corrective actions, and instructions or
recommendations to avoid recurrence)
The report shall be submitted to the Regulatory
Authority and other concerned bodies as required,
as soon as possible after the investigation, or as
otherwise specified and kept for a specified period.
IAEA 13.2: Occupational exposure - Radioprotection measures 32
IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology

Part 13.2: Occupational exposure

Topic 4: Health surveillance

IAEA
International Atomic Energy Agency
Health surveillance (I)

Primary purpose is to assess the initial and

continuing fitness of employees for their intended
tasks
Medical surveillance (medical examinations) to
workers as specified by the Regulatory Authority.
Counselling should be provided for women who
are or may be pregnant
This is especially relevant in interventional
radiology.

IAEA 13.2: Occupational exposure - Radioprotection measures 34

Health surveillance (II)

Under normal working conditions, the doses

incurred in a radiology department are lower
than the dose limits.
No specific radiation-related medical
examinations are normally required for
persons who are occupationally exposed to
ionizing radiation, as there are no diagnostic
tests which yield information relevant to
exposures that are close to or below dose
limits.
IAEA 13.2: Occupational exposure - Radioprotection measures 35
Health surveillance (III)

It is therefore rare for the radiation component of

the working environment of a radiology department
to significantly influence the decision about the
fitness of a worker to undertake work with radiation
or the influence the general conditions of service
However in the case of accidental exposure to high
doses (of the order of magnitude of 0.2 - 0.5 Sv or
higher), specific radiation-related medical
investigation are necessary

IAEA 13.2: Occupational exposure - Radioprotection measures 36

IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology

Part 13.2: Occupational exposure

Topic 5: Records

IAEA
International Atomic Energy Agency
Records (I)

The registrant or licensee should maintain:

exposure records
medical records for each worker
results from workplace monitoring

IAEA 13.2: Occupational exposure - Radioprotection measures 38

Record (II)

Other records to be maintained:

The authorization or registration documents
Training provided (initial and refresher):
Name of the person who delivered the training
Name of the person who received the training
Date and length of the training
List of the topics addressed
Copy of the certificates of training

IAEA 13.2: Occupational exposure - Radioprotection measures 39

Record (III)

Other records to be maintained:

Results from acceptance and commissioning
tests of radiology equipment
Audits and reviews
Installation, maintenance and repair work
Facility modification
Incident and accident investigation reports

IAEA 13.2: Occupational exposure - Radioprotection measures 40

Summary

Different technical approaches can be

followed to monitor the occupational
exposure as well as to optimize the radiation
protection
Several operating rules can be used to
investigate the radiation dose level occurring
at the different working area

IAEA 13.2: Occupational exposure - Radioprotection measures 41

Where to Get More Information

Radiation Protection and Safety of Radiation

Sources: International Basic Safety Standards,
Revision of IAEA Safety Series No. 115, IAEA,
Vienna Austria, 2011
The 2007 Recommendations of the International
Commission on Radiological Protection, ICRP 103,
Annals of the ICRP 37(2-4):1-332 (2007)
International Atomic Energy Agency, Safety Report
on Methodology for Investigation of Accidents
involving Sources of Ionizing Radiation, IAEA,
Vienna (in press).
IAEA 13.2: Occupational exposure - Radioprotection measures 42