Overview of Medical Occupational Exposure Issues in the European Countries

1. Overview of Medical Occupational Exposure Issues in the European Countries Christian Lefuare John Croft CEPN NRPB

2. Broad Strands Well established technology and professions • radiologists, radiographers, nurses etc Cutting edge technology • equipment • procedures • widening scope of disciplines

3. Broad Strands Well established technology and professions • radiologists, radiographers, nurses etc Cutting edge technology • equipment • procedures • widening scope of disciplines HOW DO WE PERFORM?

4. Occupational Exposure Review ( UNSCEAR ) 1975-79 0.8 2500 1980-84 1985-89 1990-94 2000 0.6 Average annual individual dose, mSv Monitored workers, x 103 1500 0.4 1000 0.2 500 0 0

5. Average Annual Individual Doses to “Measurably Exposed Workers” Medical 1.4 mSv Education/Veterinary 1.0 mSv Industrial 2.2 mSv Nuclear fuel cycle 3.1 mSv

6. Medical Sector Dose Data E and SE Asia Monitored E Europe Indian sub continent Latin America OECD (except USA) Measurably exposed USA Other Total 0 1 2 3 4 5 UNSCEAR Average annual individual doses, mSv

7. European Study of Occupational Exposure (ESOREX) • EU MS + Iceland, Norway & Switzerland • systems to register doses • numbers exposed & dose distributions • potential for harmonisation • ESOREX East: applicant countries • Bulgaria, Estonia, Hungary, Latvia, Lithuania, Poland & Slovak Republic

8. General Education, industry Research, Safety inspection Occupationally Radiation Exposed Workers 1995 - Norway 80 Nos. of workers Total 12,158 60 Collective doses Total 3.6 man Sv % 40 20 0 Nuclear Medicine

9. General Education, industry Research, Safety inspection Occupationally Radiation Exposed Workers 1995 - Germany 80 Nos. of workers Total 337,613 Collective doses Total 94.43 man Sv 60 % 40 20 0 Nuclear Medicine Others 24188

10. General Education, industry Research, Safety inspection Occupationally Radiation Exposed Workers 1995 - Spain 80 Nos. of workers Total 67,836 60 Collective doses Total 47.76 man Sv % 40 20 0 Nuclear Medicine

11. General Education, Natural industry Research, radioactivity Safety inspection Occupationally Radiation Exposed Workers 1995 - UK 60 Nos. of workers Total 48,502 Collective doses Total 38.62 man Sv 40 % 20 0 Nuclear Medicine Others

12. UK Anomaly “Classified workers” • likely to receive >6 mSv • dose records, health surveillance • Central Index of Dose Information (CIDI) “Non-classified workers” • large volume monitored and records kept

13. Occupational Exposure in Medicine, 1995 Measurably exposed No. in dose range, mSv 5-10 10-15 15-20 20-50 >50 Finland Germany Greece Norway Spain 2.32 1.02 2.48 1.60 0.55 46 338 74 75 279 13 62 25 27 55 5 18 9 14 36 8 10 20 14 27 3 8 1 0 6 ESOREX, 1998

14. Survey of Occupational Exposure in Medicine in the UK Category No. in dose range, mSv Average annual dose, mSv 0-5 5-10 10-15 15-20 >20 Diagnostic Radiotherapy Nuclear med. Survey UK total 10,619 2,916 883 14,418 39,950 4 3 0 7 <50 2 0 0 2 <10 2 0 0 2 <10 2 3 0 5 <10 0.08 0.08 0.33 0.09 0.1 ESOREX, 1998

15. UK Survey of Occupational Exposure in Diagnostic Radiology Departments Category No. in dose range, mSv Average annual dose, mSv 0-5 5-10 10-15 15-20 >20 Radiologists Cardiologists Other clinicians Radiographers Nurses Scientists/ technicians Other staff Total 999 458 656 5,024 2,276 631 575 10,619 2 1 0 1 0 0 0 4 0 1 0 0 0 1 0 2 0 1 0 0 0 1 0 2 1 0 0 0 1 0 0 2 0.19 0.26 0.04 0.05 0.07 0.07 0.04 0.08 ESOREX, 1998

16. UK Survey of Occupational Exposure in Radiotherapy Departments Category No. in dose range, mSv Average annual dose, mSv 0-5 5-10 10-15 15-20 >20 Beam radiographers Radiotherapists Nurses - Theatre Source technicians Scientists/ technicians Other staff Total 864 242 481 646 64 16 251 352 2,916 0 0 0 1 0 0 2 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 3 0.06 0.23 0.05 0.10 0.10 0.15 0.10 0.01 0.08 Ward Other ESOREX, 1998

17. UK Survey of Occupational Exposure in Nuclear Medicine Departments Category No. in dose range, mSv Average annual dose, mSv 0-5 5-10 >10 Pharmacists Radiographers Scientists/ technicians Clinicians Nurses Other staff Research workers Total 168 262 86 54 73 109 131 883 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.35 0.53 0.29 0.18 0.61 0.06 0.07 0.33 ESOREX, 1998

18. Occupational Exposure in Non-nuclear Industry - France, 1999 Category No. in dose range, mSv <1 1-6 6-20 20-50 >50 Radiology Radiotherapy Nuclear medicine Non in vitro Dental Veterinary Non-nuclear industry Occupation and PH Others Total 86,207 7,621 3,614 3,572 25,412 2,637 18,763 5,366 13,752 166,944 1,189 259 400 23 208 27 2,639 33 90 4,868 294 35 39 0 48 2 1,299 3 24 1,744 48 7 0 0 3 1 60 1 1 121 17 0 1 0 1 10 6 1 0 25 ESOREX, 1998

19. IAEA: Protecting Workers Against Exposure to Ionising Radiation • Generally well controlled • Problem of new areas • particularly interventional radiology • post graduate education • raising awareness • participation of Health Physicists

20. Format of Workshop • Focussed sessions • Working Groups • 2 sessions • some suggested issues • Report back in final session • recommendations to EC etc.

21. Issues (1) New technologies and procedures provide radiation protection challenges: are there issues where co-operative research would be useful ?

22. Issues (2) Data suggests varying levels of achievement: Do Qualified experts and Radiation Protection Supervisors have a high enough profile within medical establishments both large and small ?

23. Issues (2) Data suggests varying levels of achievement: Do Qualified experts and Radiation Protection Supervisors have a high enough profile within medical establishments both large and small ? If not; what can be done to improve matters ?

24. Issues (3) There is often a link between the standard of control of patient exposure and occupational exposure. Is that link widely recognised and if not, what initiatives to improve safety culture can be identified ?

25. Issues (4) Training at al levels is a fundamental building block Is RP covered to a sufficient extent in the professional training of mainstream medical occupations ? If not, how can this be improved ?

26. Issues (4) Training at al levels is a fundamental building block New technologies etc. can lead to professions that are unfamiliar with RP becoming new users: Are there adequate training arrangements ?

27. Issues (4) Training at al levels is a fundamental building block Update and refresher training is important: are there sufficient facilities for this and could we make more use of e-technology to improve accessibility and availability ?

28. Issues (5) How can we improve the feedback process so that we learn lessons from accidents and incidents ? How can we make information available to the direct users, who may spread across diverse establishments ?

29. Issues (6) Are there concerted actions that could improve the monitoring and control of extremity doses ?

30. Issues (7) The production and distribution of radiopharmaceuticals involves a series of employers and provides the potential for doses that are a significant fraction of the dose limit. Is there scope for improvement, and if so how should efforts be focussed ?