Safety Culture in Handling Radioactive Materials for Radiation Practitioners: A Review

This paper reviews the safety culture in handling radioactive sources. Safety culture refers to how safety is addressed and communicated in the workplace. It encompasses the attitudes, beliefs, perceptions, and values of all employees in an organization in relation to safety. A good safety culture can be promoted by management through commitment to safety, realistic practices for handling hazards, continuous organizational learning and concern for hazards shared across the workforce. The radioactive substances used should comply with the following characteristics where radiotoxicity must be as low as possible, short-living isotopes are preferred than long-living ones and the amounts used must be kept to a minimum. Therefore, the ‘As Low As Reasonably Achievable’ (ALARA) principle was applied that based on the minimization of radiation doses and limiting the release of radioactive materials into the environment by employing all reasonable methods. Besides that, the ALARA principle is an integral part of all activities that involve the use of radiation or radioactive materials and can help prevent unnecessary exposure as well as overexposure. The three major ALARA principles to assist with maintaining doses are time, distance and shielding. It takes a whole team effort to successfully implement the ALARA in safety culture while doing routine element of working in handling radioactive materials.

Development of measurement methods and dose evaluating algorithms for electronic personal dosimeter

For personal radiation dose monitoring, electronic personal dosimeters (EPD), also known as active personal dosimeter (APD), using silicon diode detector have the advantage capability of measuring and displaying directly the exposure results of gamma, beta and neutron radiations in real time. They are mainly considered as good complement to passive dosimeters to satisfy ALARA principle in the radiation protection. In this paper, the meansurement methods and algorithms for evaluating personal dose equivalents such as Hp(10) and Hp(0.07) from air-kerma are studied and developed in two directions: the first, named energy correction method based on incident energy determined by the ratio of two detector responses with the different filter configurations; the second new method is carried out in the way that matching the shape of a detector’s energy response curve to the kerma-to-personal dose equivalent conversion function provides an approximate means of determining the dose equivalent without the need to resolve the actual incident energies. The algorithm has also been experimentally verified at Secondary Standards Dosimetry Laboratory (SSDL) of INST by the beam of radiation defined in ISO 4037-1. The obtained results of personal dose equivalents with errors almost less than 30% in energy range from 20 keV to 1.5 MeV are partially met the EPD design requirements according to the IEC 61526 Standard. The work and results of described in this paper are important basics for design and construction of completed electronic personal dosimeter.

Pulsed fluoroscopy in retrograde urethrograms

Objectives: Retrograde urethrogram (RUG) is one of the corner stones for the reconstructive urologist. With hundreds of RUGs being performed yearly in busy reconstructive center, the concern for radiation exposure to the patient and the medical personnel becomes important. We propose the use of pulsed fluoroscopy to decrease the radiation exposure for patient and medical personnel. Methods: Patients presenting to our center with urethral strictures between March 2016 and March 2019 were included in our study. The fluoroscopy machine was set for pulsed fluoroscopy at a setting of 4 pulses per second. Patient information including demographics, pre-operative diagnosis, Intra-op findings, and fluoroscopy time were recorded. RUG was performed to localize the stricture pre-operatively and post-operatively. Results: A total of 185 RUG were performed between March 2016 and March 2019. The median age was 63 (14-81). The remaining 154 RUG had 77 performed pre-operatively and 77 performed post-operatively. Pathology was identified in 77 patients. Intra-operative confirmation of pre-operative finding was found in 76 patients (98.7%). Median fluoroscopy time was found to be 2.43 seconds (0.5 sec- 6.5 sec). Conclusions: Pulsed fluoroscopy reduces the radiation exposure in RUG without a reduction in the diagnostic capacity of the test. Reduction of fluoroscopy can have beneficial cumulative effect as per the ALARA principle for patients and medical personnel. Further studies with randomized control trials could be of great benefit.

The role of PoCUS in the assessment of COVID-19 patients

The Coronavirus disease 19 (COVID-19) pandemic has increased the burden of stress on the global healthcare system in 2020. Point of care ultrasound (PoCUS) is used effectively in the management of pulmonary, cardiac and vascular pathologies. POCUS is the use of traditional ultrasound imaging techniques in a focused binary manner to answer a specific set of clinical questions. This is an imaging technique that delivers no radiation, is inexpensive, ultraportable and provides results instantaneously to the physician operator at the bedside. In regard to the pandemic, PoCUS has played a significant adjunctive role in the diagnosis and management of co-morbidities associated with COVID-19. PoCUS also offers an alternative method to image obstetric patients and the pediatric population safely in accordance with the ALARA principle. Finally, there have been numerous PoCUS protocols describing the effective use of this technology during the COVID-19 pandemic.

Paradigma baru konsep proteksi radiasi dalam pemeriksaan radiologi kedokteran gigi: dari ALARA menjadi ALADAIP

Objectives: This article is aimed to widely share information and discuss further about the emerging transformation theories of the traditional radiation protection concept of ALARA into some more modern proposed concepts, particularly in dentomaxillofacial radiology. Literature Review: The concept of radiation protection in the use of X-ray modalities in the medical field has developed along with the development of science over past decades. The concept of ALARA which has been widely known for a long time and is used as a basic of theory or main reference in radiation protection policies in several countries or at the international level now becomes a traditional, conservative and invalid principle to apply. There are several emerging theories which are considered to be more valid and representative to replace the ALARA principle. Conclusion: Newer concepts of radiation protection that have developed, ALADAIP, are considered to be more precise and specific to be the main principle of radiation protection at this time, especially in the field of dentomaxillofacial radiology.

MEASUREMENT OF OPERATIONAL DOSIMETRY QUANTITIES FOR NUCLEAR MEDICINE STAFF

According to the ALARA principle, exposure to radiation should be reduced as low as reasonably achievable. This principle is very important in nuclear medicine (NM), and different investigations have been performed by establishing protocols and standards for staff protection. This study aims to measure the operational quantities, personal dose equivalent, Hp (10), Hp (0.07) and Hp (3) for NM staff in Shiraz hospitals, and comparison with dose limits. Two types of dosimeters, TLD-100 and GR-200, were used in this study. In the first step, the calibration of dosimeters was performed using different phantoms. Then, a group of dosimeters was prepared and used for 1 month on the heads, wrists and chests of the staff for measurement of Hp (3), Hp (0.07) and Hp (10), respectively. The obtained values of Hp (10) were compared with the results of their personal dosimetry, film badge. The results of this study show good consistency in the measurements using the two dosimeters.

Radiation protection practice of medical doctors of surgical and interventional specialties in Saudi Arabia

This study aimed to evaluate the radiation protection practices of medical doctors of surgical and interventional specialties in different healthcare sectors of Saudi Arabia. A cross-sectional study of medical doctors in Saudi Arabia who utilize radiation to perform interventional procedures and surgical operations was conducted. Data were gathered about the basic demographic background of the respondents, their daily application of radiation protection, and variations among different specialties and institutions regarding radiation protection practices. A total of 182 responses were received from different specialties, including interventional radiology (22%), interventional cardiology (16.5%), orthopedic surgery (14.8%), urology (14.3%), and diagnostic radiology (12.1%). Responses were received from different healthcare sectors, including the Ministry of Health (47%), private sector (26%), and university hospitals (18%). Only 59% of the respondents reported applying the As Low As Reasonably Achievable (ALARA) principle of radiation protection. The specialties with the highest reported lack of the ALARA principle application were orthopedic surgery (89%), urology (69%) and endoscopy (57%). The highest reported non-adherence to the ALARA principle was in the Ministry of Defense hospitals (50%), private hospitals (44%) and Ministry of Health hospitals (43%). The use of a personal dosimeter was reported by 58% of the respondents and only 42% reported having training in radiation protection. The respondents reported a lack of regular checking of x-ray machines (28%) and protection aprons (40%), non-availability of radiation protection guidelines (48%), and a lack of policies for radiation dose monitoring (27%) in their institutions. It was concluded that the compliance with radiation protection practices was variable and generally poor among different specialties and healthcare sectors in Saudi Arabia. Similar poor practices were reported in the international literature of different countries. The concerned authorities worldwide are advised to take further actions in this regard.

Summary of SFRP-IRPA workshops on the reasonableness in the practical implementation of the ALARA principle

The practical implementation of the principle of optimisation of radiological protection (i.e., ALARA principle) was the subject of two workshops organised in Paris (France) in February 2017 and October 2018 at the initiative of SFRP within the framework of IRPA. The article summarizes the discussions and conclusions of these two workshops. The search for reasonableness was examined in three sectors: nuclear industry, medical practices and existing exposure situations. In all sectors, the optimisation remains a challenge and experience shows that this is implemented through a deliberative process to achieve a reasonable compromise with all informed parties. This issue was further investigated by three working groups − one for each sector – on the basis of cases studies. It emerges that, in complement to the use of classical tools such as cost-benefit analysis, the implementation of the optimisation principle implies a clear identification of the challenges to be met in order to achieve the best protection in the prevailing circumstances. These challenges may be specific to a type of exposure situation and in some cases to a given situation. The process should also well identify the relevant stakeholders and decision-makers to be involved and determine how they will be involved. A proactive process including development of awareness, empowerment and/or training may be needed. This reflexion deserves to be further developed.