Radiation Safety Professionals Research Articles

Clinical Best Practices for Radiation Safety During Lutetium-177 Therapy.

177 Lu therapy as part of theranostic treatment for cancer is expanding but it can be a challenge for sites with limited radiation protection staff to implement the radiation safety program required for therapeutic nuclear medicine. To increase the adoption of 177 Lu therapy, especially in smaller centers and clinics, by providing a collection of radiation safety best practices and operational experience. To provide a resource for radiation safety officers supporting the implementation of a 177 Lu therapy program. A panel of 11 radiation safety professionals representing sites across Canada and the United States with experience delivering 177 Lu therapy was assembled and discussed their responses to a list of questions focused on the following radiation safety topics: facility layout and design; radiation safety program; and drug management and patient care. A comprehensive set of best practice guidelines for clinical radiation safety during 177 Lu therapy has been developed based on the collective operational experience of a group of radiation safety professionals. Significant findings included that 177 Lu therapy is often safely administered in unshielded rooms, that staff radiation exposure associated with 177 Lu therapy is minimal relative to other nuclear medicine programs, and that some relatively simple preparation in advance including papering of common surfaces and planning for incontinence can effectively control contamination during therapy. The guidance contained in this paper will assist radiation safety professionals in the implementation of safe, effective 177 Lu therapy programs, even at smaller sites with limited to no experience in therapeutic nuclear medicine.

Considerations for Radiation Safety Professionals to Prepare and Respond to the Next Pandemic.

The Health Physics Society's stated mission is "excellence in the science and practice of radiation safety." Why, then, should we discuss disease outbreaks, epidemics, and pandemics with radiation safety professionals? The answer is simple: all workers are impacted by infectious diseases-and, as safety professionals, we will inevitably be called upon to prepare for and respond to these events. The COVID-19 pandemic has disrupted every facet of life, including home, school, work, and leisure. Moreover, virtually all radiation safety professionals have been impacted by the pandemic either personally, academically, or professionally. Even if radiation safety professionals were not involved directly with COVID-19 response, they were impacted by school closures, remote schooling and work, testing regimes, temperature screenings, vaccination programs, and so forth. However, many radiation safety professionals have been intimately involved in COVID-19 response through activities such as the deployment of personal protective equipment, directional airflow verification for isolation areas, disinfection and decontamination efforts, the design and layout of testing and vaccine centers, and in many other ways. Yet, it is likely that many radiation safety professionals have not received formal training in epidemiology, disease control, or other related topics, and thus may not be attuned to the key aspects to consider when the next pandemic emerges-and it will.

The role of radiation protection professionals in the landscape of low dose radiation

Radiation protection professionals benefit from using and applying a robust system of radiological protection that has evolved and matured through decades of research and experience. Nevertheless, uncertainties in potential health effects from low doses and low dose rates of radiation continue to remain. This uncertainty, coupled with complex jargon and nuances, has created an environment where the system of radiological protection can be misrepresented, even by radiation safety professionals, and by extension, misunderstood by the public. While it is universally agreed that the linear-no-threshold model cannot adequately explain or predict health effects of low dose radiation for all cancers, all individuals, or all exposure situations, the recommendation of authoritative scientific bodies to use this model for managing risks of radiation exposure is unequivocal. The role of individual radiation protection professionals in communicating radiation health and risk information is critical and consistent with the primary objective of professional organisations that represent them, mainly to promote best science and practice of radiation protection. If radiation protection professionals provide advice contrary to the recommendations and advice of regulatory and authoritative scientific bodies, it can erode public confidence in the system of radiological protection and harm the credibility of our profession.

To Mitigate The Lnt Model's Unintended Consequences-A Proposed Stopping Point For As Low As Reasonably Achievable.

While the debate over the linear no-threshold model continues, there's a relatively straightforward step that can be taken to mitigate the unintended consequences of the linear no-threshold model and the application of the as low as reasonably achievable principle-enact a stopping point for as low as reasonably achievable. The National Council on Radiation Protection and Measurements defined the negligible individual dose in 1993 as having a value of 0.01 mSv y. Radiation safety professionals overwhelmingly agree that applying the as low as reasonably achievable principle at very low doses, such as those consistent with background radiation levels, is not improving radiation safety of the public or radiation workers. To the contrary, this practice has significant financial and social consequences, and it severely inhibits public communication of radiation risks. To move forward, the National Council on Radiation Protection and Measurements should increase the negligible individual dose to a more practical value of 0.1 mSv y-the new as low as reasonably achievable stopping point. While radiation research in radiation biology and epidemiology are needed to better understand low-dose health effects below 100 mSv, in the meantime we should apply what we know-i.e., that radiation protection should not include trying to protect people from radiation doses that are consistent with variations in background radiation.

A Pilot Examination of the Methods Used to Counteract Insider Threat Security Risks Associated with the Use of Radioactive Materials in the Research and Clinical Setting.

While many organizations maintain multiple layers of security control methodologies to prevent outsiders from gaining unauthorized access, persons such as employees or contractors who have been granted legitimate access can represent an "insider threat" risk. Interestingly, some of the most notable radiological events involving the purposeful contamination or exposure of individuals appear to have been perpetrated by insiders. In the academic and medical settings, radiation safety professionals focus their security efforts on (1) ensuring controls are in place to prevent unauthorized access or removal of sources, and (2) increasing security controls for the unescorted accessing of large sources of radioactivity (known as "quantities of concern"). But these controls may not completely address the threat insiders represent when radioactive materials below these quantities are present. The goal of this research project was to characterize the methodologies currently employed to counteract the insider security threat for the misuse or purposeful divergence of radioactive materials used in the academic and medical settings. A web-based survey was used to assess how practicing radiation safety professionals in academic and medical settings anticipate, evaluate, and control insider threat security risks within their institutions. While all respondents indicated that radioactive sources are being used in amounts below quantities of concern, only 6 % consider insider threat security issues as part of the protocol review for the use of general radioactive materials. The results of this survey identify several opportunities for improvement for institutions to address security gaps.

Improvements in Radiation Monitoring Trending.

One of the main goals for Radiation Safety Professionals is to help maintain radiation worker doses below administrative control levels. In the radiation safety field there is an increasing recognition of the value of dosimetry-related data that can be used to enhance safety programs and regulatory compliance. Mining radiation dosimetry data and rendering results in the form of dashboards provides insights for the Radiation Safety Professionals that could help improve the radiological protection programs effectiveness, enhances quality, and reduces cost. Quite often the professionals spend more time assembling data than analyzing for trends and acting to improve the radiation safety program. Data analysis tools were developed allowing the radiation safety professionals to perform surveillance on key parameters in the dosimetry program that can help identifying risks and insure early intervention. More than 2,200 institutions chosen from different industries were surveyed for more than 2 years after the implementation of this tool. Four indicators: dose per participant, collective dose, dosimeter return compliance, and number of workers exceeding ALARA levels were chosen as meaningful parameters in characterizing the health of the program. These parameters were tracked, analyzed, and compared to benchmarks developed based on more than 1 million monitored workers.

Strategies for Navigating Common Ethical Dilemmas Encountered by Operational Radiation Safety Professionals.

Because operational radiation safety professionals can encounter ethical dilemmas in the course of their work, codes of ethics and professional standards of conduct are maintained by the Health Physics Society (HPS) and the American Academy of Health Physics (AAHP). While these works provide valuable guidance, they do not operationalize the types of ethical dilemmas radiation safety practitioners might encounter. For example, consider the ethical conundrum of “dual loyalty,” defined as the situation in which an individual holds simultaneous obligations to two or more parties. In the case of radiation safety, practicing professionals hold obligations to the workers being protected and to the leaders of the organization. If these obligations are in conflict, serious difficulties can arise. The conundrum of dual loyalty is described and a strategy for reducing its effect is discussed. Two other common ethical issues; “confidentiality” and “organizational dissent” are similarly presented. A foundation from which to launch an ongoing dialogue about ethical issues within the radiation safety profession is also proposed.

An approach to radiation safety department benchmarking in academic and medical facilities.

Based on anecdotal evidence and networking with colleagues at other facilities, it has become evident that some radiation safety departments are not adequately staffed and radiation safety professionals need to increase their staffing levels. Discussions with management regarding radiation safety department staffing often lead to similar conclusions. Management acknowledges the Radiation Safety Officer (RSO) or Director of Radiation Safety's concern but asks the RSO to provide benchmarking and justification for additional full-time equivalents (FTEs). The RSO must determine a method to benchmark and justify additional staffing needs while struggling to maintain a safe and compliant radiation safety program. Benchmarking and justification are extremely important tools that are commonly used to demonstrate the need for increased staffing in other disciplines and are tools that can be used by radiation safety professionals. Parameters that most RSOs would expect to be positive predictors of radiation safety staff size generally are and can be emphasized in benchmarking and justification report summaries. Facilities with large radiation safety departments tend to have large numbers of authorized users, be broad-scope programs, be subject to increased controls regulations, have large clinical operations, have significant numbers of academic radiation-producing machines, and have laser safety responsibilities.

Delivering a radiation protection dividend: systemic capacity-building for the radiation safety profession in Africa

Many African countries planning to enter the nuclear energy “family” have little or no experience of meeting associated radiation safety demands, whether operational or regulatory. Uses of radiation in medicine in the continent, whether for diagnostic or clinical purposes, are rapidly growing while the costs of equipment, and hence of access to services, are falling fast. In consequence, many patients and healthcare workers are facing a wide array of unfamiliar challenges, both operational and ethical, without any formal regulatory or professional framework for managing them safely. This, combined with heighted awareness of safety issues post Fukushima, means the already intense pressure on radiation safety professionals in such domains as NORM industries and security threatens to reach breaking point. A systematic competency-based capacity-building programme for RP professionals in Africa is required (Resolution of the Third AFRIRPA13 Regional Conference, Nairobi, September 2010). The goal is to meet recruitment and HR needs in the rapidly emerging radiation safety sector, while also addressing stakeholder concerns in respect of promoting and meeting professional and ethical standards. The desired outcome is an RP “dividend” to society as a whole. A curriculum model is presented, aligned to safety procedures and best practices such as Safety Integrity Level and Layer of Protection analysis; it emphasizes proactive risk communication both with direct and indirect stakeholders; and it outlines disciplinary options and procedures for managers and responsible persons for dealing with unsafe or dangerous behavior at work. This paper reports on progress to date. It presents a five-tier development pathway starting from a generic foundation course, suitable for all RP professionals, accompanied by specialist courses by domain, activity or industry. Delivery options are discussed. Part of the content has already been developed and delivered as MiLoRAD, based on extensive experience training radiation safety personnel in the United States.

Fostering Communication Between Physicians and Patients

Imagine what it must be like to have a child with a condition that calls for treatment involving multiple interventional radiology procedures that result in upwards of one hour of fluoroscopy time and/or digital subtraction angiography to portions of the scalp and face. Depending on the operating parameters of the fluoroscopy device, the dose to the skin will range from approximately 0.02–0.04 Gy min−1. Therefore, under some circumstances, the 2 Gy threshold dose for temporary epilation is surpassed during one procedure. Now imagine the horror that both an underage patient and his or her parents experience when, two to three weeks after the procedure, significant clumps of hair fall from the child's head. It is inexcusable yet fairly common for interventional radiologists and other medical practitioners involved in these types of procedures to fail to take a few minutes to prepare patients and their families for this possibility. All health physicists working in medical facilities as well as other radiation safety professionals with access to physicians who use radiation-generating devices should be proactive in stressing to these physicians the importance of notifying their patients about acute radiation health effects when such effects are possible.

News and Notices

Health Physics, first published in 1958, provides the latest research to a wide variety of radiation safety professionals including health physicists, nuclear chemists, medical physicists, and radiation safety officers with interests in nuclear and radiation science. The Journal allows professionals in these and other disciplines in science and engineering to stay on the cutting edge of scientific and technological advances in the field of radiation safety. The Journal publishes original papers, technical notes, articles on advances in practical applications, editorials, and correspondence. Journal articles report on the latest findings in theoretical, practical, and applied disciplines of epidemiology and radiation effects, radiation biology and radiation science, radiation ecology, and related fields. Official Journal of the Health Physics Society

WE‐B‐213A‐01: Medical Response to a Radiological/Nuclear Event

Planning for and exercising the medical response to potential mass casualty radiological and nuclear (rad/nuc) events from accidents or terrorism are very new responsibilities for most physicians, nurses, emergency medical technicians/paramedics and other healthcare professionals. Many medical professional societies are attempting to define the essential knowledge base and performance skills needed to certify readiness and competence in this area of disaster medicine.Medical physicists and the entire spectrum of radiation safety professionals have critical expertise needed for event preparedness. They can• Help educate medical personnel to understand radiation issues and gain comfort with techniques and procedures needed to perform effectively and safely• Help develop appropriate response plans if plans are non‐existent or inadequate, and assist with iterative plan improvement and assessment in formal exercises• Identify, procure, store, and maintain required response equipmentDuring events they will help protect first responders, victim transport personnel, and first receivers in hospitals and other medical facilities along the entire continuum of the medical response. Radiation safety professionals may be asked to• Assist event managers and security personnel in establishing safe response zones• Supervise or perform radiation surveys of victims and responders• Assist with estimates of absorbed dose received by both victims and responders,• Support the implementation of appropriate protective actions• Participate in the collection and transport of radiation bioassays for contamination• Supervise decontamination of victims and responders• Assist with short and long term tracking of both victims and respondersThreat analysis has identified a list of isotopes of potential concern for mass casualty events. Selected medical countermeasures will be recommended for victims with certain levels of contamination and/or exposure.For physics professionals planning to assist in rad/nuc mass casualty responses, knowledge about existing Federal, State, and local medical response plans in your area is crucial. Implementation of the Hospital Incident Command System will integrate medical activities with other response activities, including public information, forensics, and security.This lecture will provide an overview of• The kinds of mass casualty rad/nuc events that have received the most attention from homeland security and medical planners• The isotopes of concern for mass casualty events• Available radiation countermeasures for exposure and contamination• Some of the issues surrounding the assessment of contamination and performance of decontamination in mass casualty events• The “radiation response zones” likely to be established during certain events• Suggestions for initiating and equipping rad/nuc medical response teams in your hospital• How to volunteer to be on rad/nuc response teams• A bibliography of useful publications and web sitesLearning objectives: After attending this lecture, students will be able to1. Describe the radiological and nuclear events of greatest concern to US government response planners2. Identify isotopes of concern and medical countermeasures likely to be associated with various kinds of events3. Identify the radiation zones likely to be associated with managing the response to a nuclear detonation

A Security Vulnerabilities Assessment Tool for Interim Storage Facilities of Low-Level Radioactive Wastes

Limited permanent low-level radioactive waste (LLRW) disposal capacity and correspondingly high disposal costs have resulted in the creation of numerous interim storage facilities for either decay-in-storage operations or longer term accumulation efforts. These facilities, which may be near the site of waste generation or in distal locations, often were not originally designed for the purpose of LLRW storage, particularly with regard to security. Facility security has become particularly important in light of the domestic terrorist acts of 2001, wherein LLRW, along with many other sources of radioactivity, became recognized commodities to those wishing to create disruption through the purposeful dissemination of radioactive materials. Since some LLRW materials may be in facilities that may exhibit varying degrees of security control sophistication, a security vulnerabilities assessment tool grounded in accepted criminal justice theory and security practice has been developed. The tool, which includes dedicated sections on general security, target hardening, criminalization benefits, and the presence of guardians, can be used by those not formally schooled in the security profession to assess the level of protection afforded to their respective facilities. The tool equips radiation safety practitioners with the ability to methodically and systematically assess the presence or relative status of various facility security aspects, many of which may not be considered by individuals from outside the security profession. For example, radiation safety professionals might not ordinarily consider facility lighting aspects, which is a staple for the security profession since it is widely known that crime disproportionately occurs more frequently at night or in poorly lit circumstances. Likewise, the means and associated time dimensions for detecting inventory discrepancies may not be commonly considered. The tool provides a simple means for radiation safety professionals to assess, and perhaps enhance in a reasonable fashion, the security of their interim storage operations. Aspects of the assessment tool can also be applied to other activities involving the protection of sources of radiation as well.

ATE Evolution: Becoming Your Resource

The Health Physics Society (HPS) Web site was created in 1996 to further the HPS mission of promoting communication among people who conduct radiation safety activities; to encourage scientific, professional, and public education; and to disseminate sound scientific information. In 1999, a new feature called "Ask the Experts" (ATE) was added allowing individuals from around the world to pose questions concerning radiological protection. With the help of four editors, 20 topic editors, and 125 subject experts, nearly 5,000 questions have been answered. Response to questions submitted is rapid with the topic editor corresponding directly with the questioner. Most responses involve only one interaction although there may be follow-up interactions to fully resolve issues in the questioner's mind. Experts must provide prompt, valuable, and sound scientific answers in an easy-to-understand manner. The ATE feature is the most popular on the HPS Web site. With a current average of three questions submitted each day (including weekends), it became increasingly difficult for a person browsing the Web site to find information among the many posted questions and answers. Because of this difficulty, some questions were being asked repeatedly. It was decided to redesign the ATE feature to make the process of finding information easier. Answer categories were merged, eliminated, added, or reduced in size. "Frequently Asked Questions" (FAQs) or information sheets were developed. As a result, 36 categories became 25, and 18 FAQs, 22 information sheets, and 8 reference sheets were created to provide useful information resources for HPS members, radiation safety professionals, and the public.

Risk-Informed, Performance-Based Inspections at Medical Facilities

During the past couple of years, radiation safety professionals have observed a significant change with regard to the inspection philosophy of regulators. The NRC and many Agreement State agencies have implemented a performance-based, risk-informed approach for inspecting medical Radiation Safety Programs. This new, less prescriptive approach originates from the necessity to produce safety benefits commensurate with their cost to the industry and still maintain health and safety performance. While compliance with regulatory requirements is important, regulatory agencies have been focusing on areas that provide greater safety benefit, such as protecting the radiation worker, members of the general public and the environment. This paper discusses simple and practical measures that may assist licensees in preparing for performance-based, risk informed inspections.

Preventing Improper Disposal of Healthcare Facility Waste Containing RAM

Non-hazardous waste management facilities, which are not authorized to receive licensable radioactive material (RAM), periodically find contaminated waste in shipments from local healthcare facilities. As a consequence, many healthcare facilities are cited each year for losing control and/or improperly disposing of RAM at unauthorized disposal sites. Healthcare radiation safety professionals must ensure that effective measures are in place at their facilities to prevent RAM from inadvertently being included with non-radioactive waste shipments. The objective of this article is to assist in developing and implementing procedures to properly monitor and dispose of waste containing RAM. This article discusses, among other topics, the installation of portal monitors containing both visual and audible alarms to screen medical waste, instruction to individuals handling medical waste and emergency response procedures.

Radiation safety precautions for sentinel lymph node procedures.

Radiation safety professionals need guidelines for controlling occupational radiation doses and handling generated contaminated tissues from sentinel lymph node procedures involving 99mTc. Many healthcare facilities do not have formal controls in place, or they adopt policies that may be too restrictive or impractical. During accreditation inspections at healthcare facilities, agencies such as the College of American Pathology and the Joint Commission on the Accreditation of Healthcare Organizations occasionally raise questions about these issues. Inspectors expect to find formal policies to ensure these procedures are performed safely. The objective of this article is to review the basic radiation safety controls needed during sentinel lymph node procedures and to propose guidelines that may be used to control occupational radiation doses and handling of SLN contaminated tissues.

Radiation safety compliance issues at affiliated institutions.

"Affiliation" may be defined as a collaborative interaction between two (or more) organizations in a spirit of mutual benefit through an equitable contribution of resources. Across the United States, hundreds of medical schools and healthcare organizations affiliate with one another for the enhancement of patient care, education, and research. Oftentimes, both parties in the affiliation have active clinical and research programs that involve the use of radioactive material (RAM). The combination of this close affiliation and use of radioactive material presents a number of challenging radiation safety compliance issues. It is important for radiation safety professionals (RSPs) employed by each affiliate to work together to ensure compliance with applicable regulatory requirements.

Radiation safety considerations with therapeutic 90Y Zevalin.

ABSTRACT Radioimmunotherapy with the 90Y-labeled Zevalin radioimmunoconjugate is a new and promising modality in cancer treatment that combines the targeting power of monoclonal antibodies with the cytotoxicity of localized radiation. 90Y is a pure beta emitter, with different physical characteristics than traditional therapeutic radionuclides such as 131I. It is important that radiation safety professionals understand the characteristics of this radionuclide so that effective radiation safety procedures can be implemented with the Zevalin regimen. Because 90Y is a pure beta emitter, the Zevalin regimen is routinely administered as an outpatient procedure and is administered by using plastic shielding. Once the radioimmunoconjugate has been administered, the risk of radiation exposure to healthcare workers and family members is minimal. The primary route of biologic elimination of 90Y Zevalin is through the urinary system, with approximately 7% of the total activity administered eliminated over the course of 1 wk. Standard universal precautions, which should already be in place in healthcare facilities, should be sufficient to prevent radiation exposure to personnel working with patients who have been treated with Zevalin. Written radiation safety instructions for patients are not required, but basic instructions to the patient and his or her family may help further minimize the risk of radiation exposure and help alleviate patient and family concerns.

Restructuring nuclear regulations.

Nuclear regulations are a subset of social regulations (laws to control activities that may negatively impact the environment, health, and safety) that concern control of ionizing radiation from radiation-producing equipment and from radioactive materials. The impressive safety record among nuclear technologies is due, in no small part, to the work of radiation safety professionals and to a protection system that has kept pace with the rapid technologic advancements in electric power generation, engineering, and medicine. The price of success, however, has led to a regulatory organization and philosophy characterized by complexity, confusion, public fear, and increasing economic costs. Over the past 20 years, regulatory costs in the nuclear sector have increased more than 250% in constant 1995 U.S. dollars. Costs of regulatory compliance can be reduced sharply, particularly when health and environmental benefits of risk reduction are questionable. Three key regulatory areas should be closely examined and modified to improve regulatory effectiveness and efficiency: a) radiation protection should be changed from a risk-based to dose-based system; b) the U.S. government should adopt the modern metric system (International System of Units), and radiation quantities and units should be simplified to facilitate international communication and public understanding; and c) a single, independent office is needed to coordinate nuclear regulations established by U.S. federal agencies and departments.