Rad T 110

1. Rad T 110 State Syllabus for Radiation Protection

2. The syllabus is published by the State as a reference for issues regarding radiation. There are different syllabi for various aspects of radiology, i.e. radiography, fluoroscopy, mammography, nuclear medicine, etc. State laws pertinent to radiology are enacted by the Legislature on recommendations from various groups including, the Radiologic Technology Certification Committee(RTCC).

3. The syllabus consists of chapters covering most aspects of radiation exposure. These are the abridged version of the laws. The actual laws are found in Title 17 of the California Code of Regulations.

4. Chapter 1Radiation Utilization • 15 – 29 y/o (the genetically significant cohort) receive 600 exam/ 1000 people annually. • Average # of exams per person imaged was 1.6 at 2.2 films/exam • Nationally 43% of the population receive medical x-ray exams while 22% receive dental x-ray exams.

5. Breakdown of exams by type • Chest 50% • Abdomen 25% • Extremities 17% • Head and neck 8%

6. Chapter 2Factors Influencing Patient Dose • Topics in this section we have already covered. • Gonadal shields are required to have 0.5 mm Pb eq. This stops 92% of the primary beam. • Technique charts are required in all x-ray rooms.

7. Tech controlled dose factors • Collimation • Gonadal shielding • Proper technique • Correct positioning • Using grids • Proper film handling

8. When to Shield • Patient is of reproductive age • Shield will not interfere with the exam • Gonads are within 5 cm of the primary beam

9. Chapter 3Repeat Films • 2 categories for repeats • Equipment failure • Technologist error • Experienced techs have a <2% repeat rate • Inexperienced tech/students can be >10% • 50% of retakes are due to technique errors • Positioning errors account for 25% of repeats • Ongoing repeat analysis is required. • Various abdominal films account for 40% of repeats but only 25% of acquired films

10. Chapter 4Pediatric Radiography • Shielding • Clothing • Phototiming • Collimation • Immobilization

11. Chapter 5Computed Tomography • A high-dose modality • Brain exams 1-4 rads • Body exams 2-12 rads • Essentially no dose to the tech.

12. Chapter 6Mobile Radiographic Equipment • Switch has to be a dead-man type • The cord for the exposure switch has to be at least 6 ft. • Source to skin distance has to be at least 12 inches (30 cm). • Personnel monitoring is required

13. Aprons need to be available with mobile units • ‘Exposure rules’ • Anyone in the room needs to be outside the primary beam and away from the patient • Everyone in the room needs an apron • Everyone in the room wear a personnel monitor

14. Chapter 7 Health Effects of Low-level Radiation Exposure • Somatic Dose Indicators • Injuries to skin • Induction of cancer • Fertility problems, cataracts • Injuries to fetus/embryo • Most somatic dose indicators are location specific • i.e. cataracts come from eye exposure

15. Bone marrow • Hematological depression • High marrow dose exams • LSP, IVP, Abdominal angio, GI, chest tomos • Thyroid and skin • Skin dose is often used as organ dose for adjacent organs

16. Genetically significant dose (GSD) • Based on future child expectancy, exam rate, gonadal dose/exam • In 1970, the GSD was estimated to be 20 mRad annually. • Abdominal exams contribute 70% of the GSD.

17. Chapter 8Biologic Effects and Significance of Radiation Dose • Biologic effects are influenced by • Dose rate • Total dose • Type of cell irradiated

18. Radiobiological Injury • Cellular amplification • Gross cellular effects • Latent period

19. Determinants of Biologic Effect • Dose effect curve • Area exposed and shielding • Cell sensitivity

20. Cell Sensitivity(most to least) • Lymphocytes or WBC • Erythrocytes or RBC • Epithelial cells • Endothelial cells • Connective tissue cells

21. Cell Sensitivity Cont • Bone cells • Muscle cells • Nerve cells • Brain cells

22. Chapter 9Personnel Radiation Protection • Types of effects • Stochastic – probability of the effect occurring (cancer) • Non-stochastic – severity increases with dose - threshold • Tech is required by law to stand behind a protective barrier • 99.87% reduction in exposure at 100 kVp • Aprons, thyroid shields, gloves, glasses – required to have 0.25 mm Pb eq • 97% effective against scatter • Pts should only beheld in emergencies. • No one should routinely hold pts.

23. Chapter 10Personnel Monitoring • Record whole body exposure unless specified • Example • Film badge • TLD • Pocket ionization chamber • Overexposure is considered valid until proven otherwise

24. MPD • Occupational • Whole body • 5 REM or 5000 mRem or 0.05Sv • Skin and extremities • 50 REM or 0.5 Sv • Eyes • 15 REM or 0.15 Sv

25. MPD • Public • Whole body • 100 mRem or 0.1 rem or 0.001 Sv (1mSv) annually • 0.002 rem or 2 mrem per hour

26. Radiation Areas • High radiation area • 100 mRem/hr at 30 cm • Fluoroscopy and CT • Radiation area • 5 mRem/hr at 30 cm • Monitoring devices have to be worn be individuals doing mobile exams and in high radiation areas.

27. Chapter 11Supervision and Use of X-rays on Humans • Supervisors are licentiates of the healing arts. They have the ultimate responsibility for ensuring compliance.

28. Technologist Restrictions • Taking films without adequate supervision • Exposing pts without an order • Operating equipment without training • Using a unit without repeat policies • Exposing the gonads without shielding if appropriate • Interpreting or diagnosing films

29. Tech restrictions • Reporting diagnoses to the pt • Performing procedures without being certified • Taking films without having your certificate posted • Taking films with an expired certificate • Using a title indicating the right to practice medicine

30. Display of Documents • Certificates are required to be displayed • Cal. Rad Control Regs need to be displayed • Notice to Employees needs to be displayed