Safe Care of Radiation Patients Annual Radiation Safety Training Surgery-7 Staff

1. Safe Care of Radiation Patients Annual Radiation Safety Training Surgery-7 Staff Andrés Sinisterra Assistant Radiation Safety Officer for Medicine

2. Yet Another Radiation Safety Session Eh… Mes Amis !!!!!! Brought to you by your neighborhood radiation safety professionals Dedicated to the Health, Safety and Welfare of our Community

3. Radiation Vs. Radioactivity • Radiation - energy in transit in the form of high speed particles and electromagnetic waves. • Ionizing radiation - radiation with enough energy so that during an interaction with an atom, it can remove tightly bound electrons from their orbits, causing the atom to become charged or ionized. • Radioactivity - spontaneous transformation of an unstable atom and often results in the emission of radiation. This process is referred to as a transformation, a decay or a disintegration of an atom.

4. Its Only a Wave !!

7. Beta Decay

8. X-RAYS GAMMA RAYS Gamma Decay γ

9. External vs. Internal Radiation Exposure • External Exposure– X-rays, Diagnostic Procedures. • Internal Deposition– Contamination from nuclear medicine patient undergoing a diagnostic or therapeutic procedure resulting in an ingestion of radioactive materials by the staff.

10. Radiation Exposure Limits Rem Per Year 5 or 5,000 mrems 50 or 50,000 mrems 15 or 15,000 mrems 50 or 50,000 mrems Type of Exposure Total Effective Dose Equivalent (TEDE) which is the sum of the Deep-Dose Equivalent (for external exposures) and the Committed Effective Dose Equivalent (for internal exposures) for the whole body Sum of the Deep-Dose Equivalent and the Committed Dose Equivalent to any individual organ or tissue other than the lens of the eye Eye Dose Equivalent (lens of the eye) Shallow Dose Equivalent to the skin or to any extremity

11. 1.25 18.75 7.5 (1,250 mrem) (18,750 mrem) (7,500 mrem) Radiation Exposure Limits (State of Connecticut Administrative Regulations Sect. 19-24-5) Whole body; head and trunk; active blood-forming organs; lens of eyes, or gonads. Hands and forearms; feet and ankles. Skin of whole body. Type of Exposure Rem Per Calendar Quarter

12. Roentgen Measure of electrical charge produced in air 1,000 mr = 1R Fluoro @ SSD ~3-10 R/min Measure of energy absorbed, usually in tissue or bone. 200 rad = transient erythema 1 Gray = 100 Rad Rad (Gray) Units of Radiation Exposure

13. Rem (Sievert) Measure of occupational risk (cancer) from radiation exposure 1,000 mrem = 1 Rem 1 Sievert = 100 Rem 5 Rem/yr maximum limit 1 R = 1 Rad = 1 Rem Diagnostic & Fluoro X-Rays +-20% Units of Radiation Exposure

14. Time Distance Shielding Contamination Control Basic Radiation Safety Principles

15. g g g g g - gamma radiation g g g g g g g g Brachytherapy137cs 192ir 125I • Temporary Implant • Interstitial or Intracavitary • Sealed – Encapsulated Sources • No Contamination Concern Unless Encapsulation is Compromised

16. Cesium-137 GYN Intracavitary Radiation Implant

17. Never Touch Sources With Hands 137Cs Radioactive Brachytherapy Sealed Sources

18. Never Touch Sources With Hands Iridium-192 Interstitial Radiation Implant

19. Iridium-192 Interstitial Radiation Implant

20. Iridium-192 Interstitial Radiation Implant

21. g - gamma radiation g g g g g 10,000 2,500 g g 1 cm 2 cm 400 5 cm g 10 cm 100 g g 20 cm 25 g g Inverse Square Law(137Cs 192Ir) • For a point source, the intensity varies inversely as the square of the distance from the source.

22. Radiopharmaceutical Therapies131 I 153 Sm 32 P • Unsealed Radioactive Liquid or Radioactive Capsule (IV or PO) • Extreme Contamination Concern • All Body Fluids Will Be “Contaminated”

23. Phosphorus-32 Synovectomy

24. Iodine-131 Therapy

25. For Contamination Control Procedures Radiation Badge (must be worn by all staff while attending patient) Gloves Gown Shoe Covers Clean Step off Area

26. Door Warning Signs

27. Door Warning Signs

28. Iodine-131 Therapy

29. Iodine-131 Therapy

30. Iodine-131 Therapy

31. Iodine-131 Therapy (contamination control)

34. 100 mR/hr 25 mR/hr

35. Nuclear Medicine Diagnostic Procedures • Radionuclides With Short Half Lives (e.g., 99mTc @ 6 hrs) • No Significant External Radiation Exposure Hazard To Staff or Family • Contamination Precautions and Universal Precautions Should Always Be Followed

36. Bladder

37. Pregnancy Declaration • NRC requires a signed declaration of pregnancy for occupational workers to limit exposures to 500 mrem/9months or 50 mrem in any one month.

38. Source of Exposure Sources and Doses of RadiationRadiation Dose Received from Various Sources of Natural Background Radiation

39. Source of Exposure Radiation Dose Received From Other Sources of Radiation

40. Radiation Exposures from Consumer Products 1 1Adapted from NCRP 95

41. Radiation Exposures from Consumer Products 1 1 Adapted from NCRP 95 2BEDE = Bronchial Epithelial Dose Equivalent; WB = Whole Body; IDF = Ingestion Dose from Foods BMDE = Bronchial Mucosa Dose Equivalent; CGDE = Corneal Germinal Dose Equivalent; SODE = Selected Organ Dose Equivalent

42. Smoking a pack and a half of cigarettes a day will add about 1,300 mrem/year to one's effective dose Flying from New York to London results in the absorption of an extra 2-3 mrem of cosmic radiation 6-8 mrem from NY to Japan Radiation Exposures From ?

43. For Astronauts ~ 17,000 mrem / yr From Cosmic Radiation

44. Radiation Biology

45. So, you think radiation poses a risk?

46. Not all things are as bad as they seem

47. And simple things can be…..

48. Radiosensitive Radioresistant Breast tissue Heart tissue Bone marrow cells Large arteries Mucosa lining of small intestines Large veins Sebaceous (fat) glands of skin Mature blood cells Immune response cells Neurons All stem cell populations Muscle cells Lymphocytes Various degrees of sensitivity to radiation exist due to the type of tissue which receives the exposure

49. Risk of contracting cancer increased 0.09% 1,000 mrem Temporary blood count change 25,000 mrem Permanent sterilization in men 100.000 mrem Permanent sterilization in women 250.000 mrem Skin Erythema 300,000 mrem Cataract formation (20 slices) 600,000 mrem Biologically Significant Radiation Exposures(Absorbed/Acute Exposure)

50. One Coast to Coast Flight 3 mrem Natural Background Radiation in the U.S. 150 - 300 mrem/year Chest Radiograph, A/P view 15 - 25 mrem/view Chest Radiograph, Lateral view 50 - 65 mrem/view Screening Mammography (film/screen combination) 60 - 135 mrem/view Computerized Tomography of Body (20 slices) 3000 - 6000 mrem Common Radiation Exposures(Natural Sources and Human Made)