Sudan Academy of Science Atomic Energy Council

Institute of Radiation Safety

Evaluation of radiation protection In X Rays Room Design In Diagnostic Radiography Department In

Omdurman locality

A research submitted for partial fulfillment of M. Sc. degree in Radiation protection and

environmental

Prepared by:Ahmed Y usif Abdelrahman Adam

Supervised b y :Dr. Eltayeb Abdalla Haj Musa

MARCHX2013

Sudan Academy of Sciences

Atomic Energy Council

Evaluation of Radiation Protection in X- ray rooms design In

Diagnostic Radiological Department in Omdurman Locality

By:

Ahmed Y usif Abdelrahman Adam

Examination committee:

Title Name Signature

Supervisor Mr. Eltayeb Abdalla Haj Musa

External Examiner Prof. Mohamed Osman Sid Ahmed •• r ) . 0 \ . — — - A

4 4 4 • • • 4 4 4 * . 4 * ♦

Dedication

To my Mother

To my Father

To my Brothers and Sisters

To my Daughters

To all my friends

II

A cknowledgement

First and foremost, I would like to express my deepest gratitude to

Dr. Eltayeb Abdulla Haj Musa for his support and guidance.

Without his help this work couldn’t have been accomplished. My

thanks go to staff of military emergency and radiation center

department, Omdurman teaching, albuga specialized, Omdurman

children, Blue Nile, Yestabsheroon, Asia, Tuga, Abusied health

center, and specially my collage Ali hider and murtada Shasta for

their help and support. Finally, I would like to sincerely thank my

family and my friends for their consistent mental support.

AbstractThe purpose o f this study is conducted in order to evaluate the application o f radiation

protection in x-ray rooms design in diagnosis radiology department , evaluate personal

monitoring devices , to assess primary scatter and leakage radiation dose, to assess

monitoring devices if available, in period from March 2013 to august 2013 .The design data

included room size ,control room size, manufacture of equipment, building material,

personnel monitoring , environmental monitoring dose measuring, room surrounding areas,

workload of all equipment rooms, type of x-ray equipment, radiation workers' in all hospital,

number of patient in each shift, structural material and shielding, Kvp and mAs used in x-ray

room department during examination testing. The results of this study show that there is x-ay

room design, the design of x-ray equipments is accepted according to the Radiation Safety

Institute team of quality control. Also the study shows that the radiation protection devices

are available and in a good condition and enough in number. The study shows that there are

not personal monitoring devices and services, the radiological technologist are well trained .

Also the study investigation the radiation protection in x-ray room in diagnostic department

in Omdurman locality. Finally the study shows that there is compactable to ICRP

recommended and National quality control in Sudan Atomic energy council exception .

Alwedad, Abusied and Blue Nile there are have not control room concludes that there is

only in relationship hospital have a window without shield.

IV

Contents

D edication

A ck n o w led g em en t

Abstract (E n g lish )

Abstract (A ra b ic )

Contents

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A bbreviations .VIII

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A • J , *A Introduction

. • * » * - - * - *

1.2. D e fin it io n o f X - ra y s rad ia tion

1.3. Prim ary ra d ia tio n

1.4. S econ d ary ra d ia tio n - sca tter and lea k a g e

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1.6. Standard barriers

1.6.2. S eco n d a ry x -r a y barriers

1.7. A n a c c e p ta b le se c o n d a r y barrier

1.8. M aterials

1.9. Structural o f x -r a y r o o m sh ie ld in g d e s ig n♦ f t ♦ t o f t « a ♦ f t f t f t ♦ * f t f t i » ♦ ♦ a a

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1.9.2. U se F a cto r U

1.10. G eneral g u id e lin e s w ith regard to th e d e s ig n o f x -ra y ro o m

1.10.1 g en era l ra d io g ra p h ic r o o m s s iz e

1 .10 .2 . f lu o r o sc o p y r o o m s s iz e

1.10.3. d o o rs an d w a llsf t * f t

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1.10.9. R a d ia tio n w a r n in g n o t ic e sr

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99 V»♦ ♦ •aCHAPTER TWO

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n .

Literature Review% %

2 .2 .Io n iz in g rad ia tion

2.3. S o u rces o f I o n iz in g R a d ia tio n

2 .4 .B a sic R a d ia tio n P ro tec tio n

2.5. D e s ig n and la y o u t o f r a d io lo g y fa c ilit ie s

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« * 4 ^ 4 « •

2 .5 .1 . R a d io lo g y r o o m ty p e s♦ ♦

2 .5 .2 . R a d io g ra p h ic eq u ip m en t

2 .5 .3 . F lu o r o sc o p y

2 .5 .4 . C o m p u ted T o m o g r a p h y (C T )

2 .5 .5 . Shared fu n c tio n r o o m s

2.6 . S o m e g en era l c o m m e n ts o n sh ie ld in g

2.7 . R a d io g ra p h y r o o m s

2.7.1 G en era l x -r a y r o o m

2.7 .2 D e d ic a te d c h e s t ro o m

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13-14

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14-16

17-18

18

19

VII

2.7.3 M am m ograp h y r o o m» « * # # # *

2.7 .4 D ual en erg y X -r a y a b so rp tio m etry (D X A ) room* 4 H m

2.7.5 F a c ilit ie s fo r d en ta l rad iograp h y (in tra-ora l and p a n o ra m ic)

2.8. F lu o ro sco p y r o o m s

2.8.1 F lu o ro sco p y r o o m (g e n e r a l) 2 5 -2 6

2.8 .2 F lu o ro sco p y (s p e c ia l & in terv en tio n a l r a d io lo g y and c a r d io lo g y )

2.8.3 C om p u ted T o m o g r a p h y (C T ) ro o m» « ♦ ♦ • • • ♦ ♦

Shared fu n c tio n r o o m s

2.9.1 A c c id en t an d E m e r g e n c y d ep artm en ts (A and E )

2.9.3 O p eratin g th ea tres an d r e c o v e r y areas

2 .9 .4 IC U /C C U , h ig h d e p e n d e n c y u n its /n eo n a ta l u n its an d g en era l

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3.2. M ateria ls

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3.2 .3 . R ad ia tion M o n ito r in g d e v ic e s a v a ila b le in x -r a y d ep artm en t

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3 .2 .8 R ad ia tion W o rk ers an d p a tien ts in e a c h s if t o n x -r a y r o o m

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Structural and shielding materials

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VIII

D IS C U T IO N O F R E S U L T S 4 2 -4 5

C O N C L U S IO N A N D R E C O M M E N D A T IO N S

5.1 C o n c lu sio n

5.2 R eco m m en d a tio n s

R eferences

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List o f table

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1 T a b le 3 .1 :X -R a y M a c h in e In fo rm a tio n 33 i$

2 T a b le 3 .2 : R a d io lo g ic X -R a y D ia g n o s t ic R o o m In H o sp ita l U n d e r Study:

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3 T a b le 3 .3 : X -R a y R o o m s S iz e 3 5 !t

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4 T a b le :3 .4 . Structural A n d S h ie ld in g M a ter ia ls 3 6l

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5 T a b le :3 .5 .R a d ia tio n P ro tec tio n D e v ic e s : 3 7«

6 T a b le 3 .6 : X -R a y R o o m s L e a k a g e R a d ia tio n A ro u n d 3 8•

T h e D o o r A n d C o n tro l R o o m D o se s :•

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8 T a b le 3 .8 : W o rk lo a d F actors In X -R a y R o o m s: jt

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9 3 .9 . O c c u p a n c y F a cto r (T ) L o c a tio n A n d Surround A r e a A t X -R a y R oom :

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X

Abbreviations:CT: Computed Tomography.

DXA: Dual Energy x-ray Absorptiometry.

IAEA: International Atomic Energy Agency.

ICRP: International Commission on Radiological Protection.

Kvp: Kilovolt peak.

mAs: miliambir per second.

mSv/h: milisiver per hours

PDM: Personal Dose Meter

QA: Quality Assurance.

QC: Quality Control.

RPA: Radiation Protection Adviser.

RPO: Radiation Protection Officer.

RSC: Radiation Safety Committee.

WHO: World Health Organization.

TLD: Thermolumenscence Dosimeter.

UK: United Kingdom.

USA: United State of America.

XI

CHAPTER ONE

1. INTRODUCTION:

1.1. Definition o f X - rays radiation:

The x- rays are short-wavelength electromagnetic radiations that can undergo various interactions with matter, x- rays are ionizing radiation that can cause adverse biological effects such as cancer and leukemia. While a brief exposure to the hands in the primary beam of analytical x-ray equipment may not present any clinically observable effects over a short- or long-term period in some individuals, the effect in other individuals may result in mild skin discoloration, which subsequently could develop into a burn, dermatitis and possiblx progress to a cancer. [ 1 ]

1.2. Primary radiation:

A barrier is required to attenuate the primary beam to a level that complies with the dose constraint. Primary barriers arc typically required in general radiographic rooms, dedicated chest rooms and rooms where there is a combination of radiograph) and lluoroseop\. f or mammography, fluoroscopy, CT and DXA the entire primary beam is normally incident on the face of the image detector which acts as a primary beam stop. [2).

1.3. Secondary radiation scatter and leakage:

Secondary radiation is, in practice, the most ubiquitous radiation type for which shielding >s provided. It is a combination of scattered radiation (generally from the patient) and leakage (from the tube housing). The former is frequently the dominant component. For shielding calculations, the patient may be regarded as the source of scattered radiation. The amount ol scatter increases with the field size and the thickness of the part o f the patient irradiated. It is also dependent on the spectrum of the primary beam and the scattering angle. The scattered radiation is generally present throughout the room and decreases with the distance from its source. |2|.

1.4. Radiology room location:

Structural design and equipment layout of x-ray rooms must be carefully considered from a radiation protection perspective. This is easier when x-ray facilities are not designed as stand­alone rooms and are planned as part of an integrated radiology/imaging department with its supporting areas and services. Planning the room layouts should start as earl) as possible in the design process and be based on inputs from a team including architects, engineers, hospital management, radiologists, radiographers, the RPA. other consultant medical stall such as cardiologists or vascular surgeons where relevant, and once identified, the equipment suppliers. The practical requirements for radiation protection depend on the clinical functions the room is designed for as well as the workload and adjacent occupancy. For simplicity, at this point, rooms will be divided into four broad categories:

1

i. Radiography (e.g. general, chest, dental, mammography, etc.).

ii. Fluoroscopy (e.g. general or interventional applications).

iii. Computed Tomography (CT).

iv. Shared function rooms x-ray rooms should be of a size that allows unimpeded access and ease of movement around the equipment, the patient table and the operator's consolc.|3|

Radiation Shielding typical room layout showing in fig (1:1). The location and orientation of the X Ray unit is very important. Distances are measured from the equipment (inverse square law will affect dose). The directions of primary x-ay beam will be used depend onthe position and orientation.

CorridorA* + + A

X-Ray Room

Corridor+ C

• Fig: 1.1. Standard Typical x-ray rooms layout

• A to G are points used to calculate shiclding[6|

2

1.5. Standard barriers :

1.6.1. Primary x-ray barriers:

All primary barriers in standard diagnostic x -ray facilities shall have alead equivalence of 2.0 mm with an allowable tolerance of ± 10%. The primary barrier shall extend at least 300 mm beyond each boundary of the area normally exposed to the primary x-ray beam . The lead equivalence stated shall be applicable for all the kilo voltages applied to the x -ray tube or tubes in the x -ray room. The shielding shall be uniform throughout the barrier and be effective over all openings and penetrations in the barrier. [4] All primary barriers in standard diagnostic x-ray facilities shall have lead equivalence o f 2.0 mm whit an allowable tolerance of ± 10% .[4] Primary barriers. An acceptable primary barrier may be one of the following:

i. Lead sheet of nominal total thickness 2 mm. The lead sheet may be used as such, sandwiched between two layers of plywood ("Plymax"), or bonded to decorative laminate board.

ii. Double thickness of barium plasterboard (plasterboard incorporating barytes). Each thickness shall have a lead equivalence of 1 mm ± 0.1 mm at 100 kVp.

iii. Concrete, solid concrete block or concrete block filled with grout or sand, and having atotal thickness of not less than 150 mm.

iv. Double thickness o f standard solid building bricks , having a total thickness of not less than 150 mm.

v. Any other building material whose thickness used in the construction leads to a lead equivalence o f 2 mm ± 0.2 mm. [4]

1.6.2. Secondary x-ray barriers:

All secondary barriers in standard diagnostic x -ray facilities shall have a lead equivalence of 1.0 mm with an allowable tolerance of ± 10%. The lead equivalence stated shall be applicable for all the kilovoltages applied to the x -ray tube or tubes in the x -ray room.

The shielding shall be uniform throughout the barrier and be effective over all openings and penetrations in the barrier. [4] All secondary barriers in standard diagnostic x-ray facilities shall have a lead equivalence of 1.0 mm with an allowable tolerance of ± 10%.[6]. An acceptable secondary barrier for general diagnostic radiology may be one of the following:

i. Any primary barrier.

ii. Lead sheet o f thickness not less than 1 mm.

iii. Barium plasterboard of 1 mm lead equivalence.

3

iv. Any building material, such as brick or concrete whose use in construction leads to a thickness having a lead equivalence of 1 mm ±0.1 mm.

v. Lead glass or lead acrylic of 1 mm lead equivalence.

vi. Plain glass of 1 mm lead equivalence (typically a thickness of at least 100 mm of glass).

1.7. An acceptable secondary barrier:

For mammography may be one of the following:

i. Two thicknesses of gypsum plasterboard, each no less than 9 mm thick.

ii. Aluminum of thickness not less than 2 mm.«

1.8. Materials:

which offer a limited absorption of x-rays and are not to be regarded as shielding materials, except possibly for mammography facilities, include plaster boards based on calcium compounds, "gibraltar" board and similar boards based on calcium compounds and pumice, hardboards, decorative .wallboards, laminated plastics boards, fiber -reinforced cement boards, timber linings. A qualified health physicist shall be consulted to establish the acceptability or not of non -standard building materials.

The entrance of the x -ray room shall be marked with a sign containing cither a recognized symbol together with appropriate wording or appropriate, wording to warn of the possibility of x-ray exposures. All entrances to x -ray rooms should have a light that is illuminated when the x -ray machine is in the "preparation" mode or when fluoroscopy is in progress. The warning sign and warning light may be combined.[4]

1.9. Structural of x-ray room shielding design:

Factors to be considered in :

1 .Shielding: The maximum kilo-voltage (KV) of the tube.

2. The maximum milliampere (mA) of the current beam.

3. The workload per week (W) which is calculated by mA.min / week .

4. The use factor (U) which is the fraction of the workload that is directed towards the location of interest.

5 .The occupancy factor (T).

Shielding Material: There are several materials that could be used for radiation shielding, and if employed in a thickness sufficient enough, will attenuate the radiation by the

4

required degree. The materials mostly used for shielding are: brick, concrete and lead. In selecting shielding material, the following factors should be considered!5 1.

Protective barriers are designed to ensure that the dose equivalent reeeived b> any individual does not exceed the applicable maximum permissible value. The areas surrounding the room are designated as controlled or non-control led area. For protective calculation the maximum permissible dose equivalent is assumed to be 1.0 mSv/year respectively .protection is required against three types o f radiation .. the primary radiation . scattered radiation and leakage radiation through the source housing. Useful beam protective required degree is called the primary barrier. The required barrier against stray radiation (leakage and scatter) is called secondary barrier. The following factor enter into calculation o f barrier thickness:

1.9.1. Workload W:For x-ray equipment operating below 500 Kvp the workload is usually express in

milliampere minutes per week, which can be computed by multiply ing the maximum m.\

with approximate minutes/week o f the beam on time. For mega voltage machines the

workload is usually started in terms o f weekly dose delivered at 1.0 meter from the source.f t f t

This can be estimated by multiplying the number o f patients treated per week with the dose

delivered per patient at 1.0 m. W is expressed in cGv/week at 1.0 m.

1.9.2. Use Factor U:Fraction of operating time during which the radiation under consideration is directed towards

particular barrier. Although the use factor vary depending upon the techniques used. Typical

use factor for primary protective barriers. The location has use factor floor 1 walls 14 and

ceiling 12-1/4 depending on equipment and techniques.

1.9.3. Occupancy factor T:Fraction of time as particular place is occupied by staff, patients or public. Has to be

s to 0.06 for toilets.conservative. Ranges from I for all work

1.10. General guidelines with regard to the design of x-ray room :

1.10.1 General radiographic rooms size:

Should be approximately 16 n r . there should be sufficient space for permanently build

protective cubicle.

1.10.2.Fluoroscopy rooms size:

Should be approximately 25 n r . special procedure rooms should be considering individually.

5

1.10.3. Doors and walls:

A clearing of 1.5 m is recommended. The overlap should be 10 cm each side. The doors

should be with lead sheet of 2 mm thickness. The walls should be 230 mm clay brick or 2

mm lead sheet sandwiched between partitioning or 115 mm brick with 6 mm barium plaster,

walls should be protected up to a height of 2.2 meter.

1.10.4. Lead equivalence:230 mm brick = 2 mm lead (at 150 Kv ), 2.4 mm lead (at 100 Kv). 115 mm brick I mm

lead (at 150 Kv), 0.9 mm lead (at 100 Kv). 6 mm barium plaster 1 mm lead(at 100 Kv).

0.55 mm lead (at 150 Kv).

1.10.5. barium plaster mix:

Has consistent 1 part of coarse barium sulphate. 1 part fine barium sulphate andl part

cement.

1.10.6. Ceiling and floors:

The x-ray rooms should preferably be sited on the ground floor of a building. If the x-ray

room is above ground level the solid concrete slab of density 2.35g/cm3 must be of 150 mm

thickness. Thickness of ceiling slabs, if space above is occupied, should not be less than 100

mm. single story buildings do not require ceiling slab.

1.10.7. Window and air conditioning:

should be sited at lead 2 m above the floor. Alternatively access near the window must be

prevented effectively. Windows of upper floor x-ray rooms can be of normal height.

1.10.8. Protective cubicle:

A protective cubicle allowing space for the control as well as the operator should be

constructed in the x-ray room. The cubicle should be located such that unattenuated direct

scatter originating on the examination tabic or the erect bucky do not reach the operator in

the cubicle. The x-ray control for the system should be fixed within the cubicle which is

nearest to the examination table. The cubicle should have at least on viewing window, which

will be so placed, that the operator could view the patient during the exposure. The size of

the window should be at least 35 cm x 35 cm . the lead equivalence of the wall or panel as

6

well as the protective glass should be at least 2 mm, i.e. { 230 mm brick or 115 mm barium

plastered (6mm) or 2 mm lead sheet}. The lead glass protective material must overlap each

other by at least 25 mm. access door into the x-ray room must be lockable from the x-ray

room site to prevent entrance during radiation exposures.

1.10.9. Radiation warning notices:

The warning lights are required at the entrances to fluoroscopy and CT rooms. This light

must be connected to the generator in such a way that it will illuminate during activation of

the tube. A radiation warning notice must be displayed at all entrance to x-ray room.

1.10.10. Special procedure computed tomography room:

Doors-lined with 0.5 mm lead sheet. Walls -1155 mm brick or 0.5 mm lead sheet. Protective

class- 36 mm plate glass or 0.5 mm lead glass. Gantry to be grater then 3 m from control

panel. [6]

1.11. Study Problems:

> Some of x ray room size in compatible to standards of radiation protection .

> The location o f x ray room department and surrounded areas.

> The type, highest and thickness of shielding material.

> The quality and efficiency of protective devices.

> The number o f worker in x ray room capacity or load working.

> Site of control panel and darkroom from away primary x ray beam.

> If there are personal monitoring .

7

1.12. Objectives:

1.12.1. General Objectives:

> To evaluate radiation protection in x ray room diagnostic radiological department in Omdurman area.

1.12.2. Specific Objectives:

> To evaluate x ray room (size operator area), thickness of wall door floor .adjacent room .

> To evaluate building material and sketch of room .

'r To evaluate radiation protection program.

> To evaluate staff radiation protection facilities.

> To evaluate protection of patients and public from unnecessary radiation .

> To evaluate radiation protection monitoring.

r To evaluate factor to minimize radiation dose to patient staff and environment.

1.13. Methodology:

1.13.1. Study Population:

The study population is the working staff of hospital under study.

1.13.2.Study area:

Omdurman locality x-ray department

1.13.3.Study Sample:

-designof x-ray room and measurement of radiation in control area and supervised area around the room in Omdurman locality x-ray departments.

1.13.4.Tools of data collections

-By questionnaire.

-By check list.

-By tests (Survey meter- TLD-Pocket Dosimeter) if available.

-By observation.8

1.13.5.Data analysis:

Method of data analysis will be done manually and by using computer for check and

management using SPSS.

1.13.6.Study durations:

3-6 month

1.13.7.Thesis outlines:

Thesis study will consist of five chapters .chapters one will deal with introduction which include problems of the study and objectives . chapter two will highlight the literature review .chapter three will show the methodology .chapter four will deal with result of data analysis . chapter five will discuss the result, conclusion recommendations and the list of references and appendices.

9

CHAPTER TWO

Literature Review

2.1. Ionizing radiation:

Ionizing radiation is special type of radiation that include x-ray Ionizing radiation is any kind

of radiation capable o f removing an orbital electron from an atom with which it interacts .

Ionization occurs when incident ionizing - radiation, on passing through matter, passes close

enough to an orbital electron of a target atom to transfer sufficient energy to the electron to

remove it from a tom. The ionizing radiation may interact with and ionize additional atoms.

The orbital electron and the atom from which it was separated are called an ion pair: the

electron is a negative ion, and the remaining atom is appositive ion.

Thus any type of energy or matter - energy combination capable of ionizing matter is known

as ionizing radiation .x-rays and gamma rays are the only electromagnetic radiation with

sufficient energy to ionize matter .examples of particle-type ionizing radiation arc alpha and

beta particles. Although alpha and beta radiations are sometimes called rays, such designation

is a misnomer because they are particles.[l |

2.2. Sources of Ionizing Radiation:

Many types of radiation are harmless, but ionizing radiation can severely injure humans. We are exposed to many types o f ionizing radiation .One source is a natural environmental radiation ,which results in annual dose of approximately 100 mrad(lmGy).an mrad (milliard) is 0.001 of rad. The rad is the unit of absorbed dose ; it is used to express the quantit} of radiation absorbed by humans The approximate annual dose resulting from medical applications of ionizing radiation is 93mrad(0.93Gy).Unlike the natural radiation dose .this levels takes into account those persons not receiving an x-ray examination and those receiving several within period of year The medical radiation exposure lor some segments id' our population will be zero ,but for others it may be quite high. Although this average level s is comparable to natural radiation levels, it is actually a rather small amount of radiation.onc could question, therefore, why it is necessary to be concerned with radiation control and radiation safety in radiology.| 1]

10

2.3.Basic Radiation Protection:

Minimizing radiation exposure to technologist and patient is easy if the radiographic and

fluoroscopic devices designed for this purpose arc recognized and understood.

I. Filtration: Metal filters, usually aluminum, are inserted in x-ray tube housing so that

the low energy x-rays emitted by tube are observed before they can reach the patient.

These x-rays have little diagnostic value.

II. Collimation: Collimators take many different forms. Blade-type diaphragms,

adjustable light-localizing collimators, and cones are the most frequently employ ed

collimating devices. Collimation restricts the useful x-ray beam to that part of the

body requiring examination and thereby spares adjacent tissues from unnecessary

exposure.

III. Intensifying screens: Today most x-ray films are exposed in a cassette with

intensifying screens on either side of the film. Examinations conducted with

intensifying screens reduce the exposure of the patient to x-rays by more than 95%

compared with the examinations conducted without intensifying screens.

IV. Protective apparel: lead-impregnated leather or vinyl is used to make aprons and

gloves worn by radiologist and technologist during fluoroscopy and some

radiographic procedures.

V. Gonadal shielding: the same lead-impregnated material used in aprons and gloves is

used to fabricate gonadal shields. Gonadal shields should be employed with all

persons of childbearing age when their gonads are in the useful x-ray beam and when

use of such shielding will not interfere with the diagnostic value of the examination.

VI. Protective barriers: The radiographic control console is always located behind a

protective barrier. Often the barrier is equipped with a leaded glass window. Under

normal circumstances the barrier should not be violated.

There are also certain procedures that should be followed. Abdominal Aims of expectant

mothers should never be taken to ensure that the examination will not have to be repeated

because of technical error. Repeat examinations subject the patient to twice as much radiation

as necessary. When selecting patient for x-ray examination, one should consider the medical

11

management of the patient. In general, examination of asymptomatic patients is not indicated.

Patient who requires assistance during examination should never be held by x-ray personnel.

Usually it is best for a member of patient's family to provide assistance. This

person should be given protective apparel and should be carefully instructed before each

exposure.

Many aspects of radiation protection will be considered in more details later. For the time

being, the following list should serve as a summary and ready reference of the more

important aspects of radiation protection in diagnostic radiology.|6|

2.4. Design and layout of radiology facilities:

2.4.1. Radiology room types

The location, structural design and equipment layout of XBIray rooms must be carefully

considered from aradiation protection perspective. This is easier when Xl?lray facilities are not

designed as stand-alone rooms and are planned as part of an integrated radiology/imaging

department with its supporting areas and services. Planning the room layouts should start as

early as possible in the design process and be based on inputs from a team including

architects, engineers, hospital management, radiologists, radiographers, the

RPA, other consultant medical staff such as cardiologists or vascular surgeons where

relevant, and once identified, the equipment supplier.

The practical requirements for radiation protection depend on the clinical functions the room

is designed for as well as the workload and adjacent occupancy. For simplicity, at this point,

rooms will be divided into four

broad categories:

1) Radiography (e.g. general, chest, dental, mammography, etc.).

2) Fluoroscopy (e.g. general or interventional applications).

3) Computed Tomography (CT).

4) Shared function rooms (e.g. operating theatres or emergency departments where mobile or

fixed X-ray equipment may be used).

X-ray rooms should be o f a size that allows unimpeded access and ease of movement around

the equipment, the patient table and the operator’s console. The size of the room will vary

greatly depending on the modality and the cost of space. There are no absolute norms, but it

may be helpful to bear in mind some examples from the UK National Health Service which

12

recommends that general rooms, complex interventional suites and mammography rooms be

33,50 and 15 m2 respectively (NHS, 2001).

General X-ray rooms with ceiling-mounted X-ray tubes must have a minimum height of 3.1

m between the floor level and the underside of the ceiling support grid (normally concealed

by a suspended ceiling). A conventional ceiling height of 2.4 m should be adequate for dental

and dual energy X-ray absorptiometry (DXA) rooms (NHS, 2001, NHS, 2002).

2.4.2. Radiographic equipment:

Radiography equipment provides a single two-dimensional ‘snap-shot’ image, which is.

essentially, a partially penetrated projected shadow. Staff are not normally required to be in

the vicinity of the patient during the procedure. These rooms generally include a fixed screen

to protect the operator console area. It is necessary to be able to see and communicate with

the patient from this area. In addition, the rooms should be sufficiently large to reduce

radiation intensity at the operator’s screen and boundaries.

2.4.3. Fluoroscopy:

Fluoroscopy allows for continuous real-time imaging and tends to be used in complex

investigations and treatments requiring some staff to be in close contact with the patient

during all or part o f the procedure. Others who do not need to be in the vicinity of the patient

. the radiographer, take up position behind a console as described above. The procedures may

be long and can involve high doses in the vicinity of the patient. Thus additional protective

measures at the table are generally provided.

2.4.4. Computed Tomography (CT):

CT allows cross sectional imaging which was traditionally of the single 'snap-shot' form of

the head or body. Modem CT systems produce multiple slices, enable faster three-

dimensional imaging, and allow for real-time tracking of events as in fluoroscopy. These

systems have greatly enhanced the clinical value of CT and also allow for much more rapid

patient scanning. For both reasons the workload in CT rooms has increased and the radiation

levels in the vicinity o f a CT scanner are possibly higher than for any other imaging modality.

Staff are not generally expected to be in the vicinity of the patient during procedures, so the

mechanisms of radiation protection include the operator screen and the room size approaches

already mentioned. However, the functions accommodated in the operator area are greatly-

expanded and often include direction and analysis of the examination by the radiologist as it

happens, and observation of the results by the referringclinical team. Thus the operator's

13

4

cubicle in effect acquires a consultation, reporting and analysis function and occupies a

considerable area. There is normally a panoramic window and a door from this area to the C l

room.

2.4.5. Shared function rooms:

There are an increasing number of situations involving rooms with shared functions, one of

which has a radiological component. At the extreme upper level of this range are operating

theatres for vascular procedures which also have full permanent fixed radiological equipment

installed. However, more commonly, these applications involve low-dose lluoroscopx for

short time periods - e.g. during or following orthopedicsprocedures. By comparison with

conventional radiological practice, a large number of staff may be present in the room at the

time. Because of the relatively low doses, radiation protection requirements are generally less

demanding than in the other facilities described above. However the large number of staff

not all of whom will be trained in radiation protection, presents special problems. In practice

a combination of mobile shields, staff withdrawing from the immediate area and limited

structural shielding can usually provide a good solution. However, the design of these areas is

generally approached on a case by case basis. In addition, the number and type of these areas

is increasing, and now routinely includes the Intensive Care, High Dependency. Theatre, and

Emergency Medicine environments.

2.5. Some general comments on shielding:

From the point of view of providing shielding at the room boundaries, it is important to

weigh up whether it is more economical to maximise space or install more structural

shielding. For example, it may be possible to designate a relatively large space for an Xblray

room, and as a result of the increased distances to the occupants of nearby areas the shielding

requirements can be significantly reduced. The cost and practical implications of distance

versus shielding should be considered in optimizing the design solution. This will be

considered further in Chapter 5 and may be particularly important with some newer

techniques with very demanding shielding requirements. From the point of view of providing

for those who must work within the controlled or supervised areas that coincide with the

room boundaries, there are three approaches to providing protection that impact on room

design or equipment specification. These are:

1. Fixed screen: This is a screen which attenuates radiation and behind which the operator

console and any other necessary operator control systems (e.g. emergency stop switch) are

located. Where the design allows, the screen should be positioned so that it protects the stall'14

entry door and staff can enter and leave the room without risk to themselves or persons in the

corridor outside. Normally the screen is composed of lead and lead glass. It extends to at least

2 m in height and is of sufficient length to provide full body protection for the operator) s)

from scattered radiation. The screen should allow the operator panoramic view of the room to

include the patient table, the chest stand (if present) and all doors. Showing Iig2.1

Fig.2.1. fixed operator screen.2. Room size and equipment positioning: Where possible the imaging equipment should he

placed in the room so as to maximize the distance to the more critical boundaries. A room

which has considerable space around the imaging equipment reduces radiation risks b\

allowing staff to stand well back from the patient except when they are specifically required

to be near. In addition a large room generally increases the distance between the operator

screen and the patient table thereby reducing the radiation intensity in the operator console

area.

3. Partial body shielding: This is used to protect staff who are required to be near the patient

during X-ray exposures. The shielding may be broadly divided into two types: that used to

protect the upper body and that for the lower body. Upper body shielding is common in

interventional rooms; the focus is on head

and neck protection, and particularly on eye shielding. This is normally made of lead glass or

lead acrylic and mounted on the ceiling at the end of a moveable arm. In the case of general

fluoroscopy rooms and some interventional rooms using under couch tube systems, upper

body shielding is provided in the form

15

of a lead skirt that hangs from the image detector down to the table. Lower both shielding i-

often provided for under couch fluoroscopy tubes: this is achieved by means of a lead skirl

hanging from the table (the norm tor interventional systems) or lead panels below the suveii

(fig.2.2).

Fig.2.2:IntcrventionaI x-ray room with partial body shielding devices.

16

2.6. Radiography rooms2.6.1 General x-ray room

♦

- .* * # • 4

v%

► ♦ ♦ ♦ 0

t•* *^ ♦ *r

* ♦ < \ 4

% t "

Figure 2.3: General x-ray room with chest stand

A good layout for a radiographic room based on the two-corridor design is shown in Fig. 2.3.

The room is designed for general X-ray radiography with the facility to use either the patient

table or the chest stand/ vertical Bucky. An area of 33 m2 has been suggested for general

X-ray systems (BIR, 2000).

The boundaries to all occupied areas (walls, doors, doorframes, floor, ceiling, windows,

window frames and the protective viewing screen) must be shielded appropriately. General 1\

this requirement will be met by 2 mm of lead, or its equivalent with other material. As noted

in Section 6.1.1, in practice it is preferable to specify the actual British Standard Code of lead

sheet required, to avoid errors arising from inappropriate rounding up or down later. In this

case, Code 5 lead sheet (2.24 mm thickness) would be appropriate. Workload, distances and

occupancy in adjoining areas may serve to reduce this requirement. However, a policy of

shielding to the 2.24 mm (Code 5) level may reduce problems that may arise with future

change of use and occupancy in the areas adjacent to the room. Notwithstanding this it is

important to assess each room on an individual basis in consultation with an RPA. Also walls

should be marked with the lead equivalent thickness for future reference.

17

The 2.24 mm (Code 5) shielding is adequate to deal with secondary or scattered radiation and

assumes the boundaries will not normally be exposed to the primary beam. Where this ma\

happen additional shielding is required, for example an additional lead beam blocker ma\ he

required behind a chest stand or vertical Bucky. This additional shielding should extend over

the range of possible tube movements when it is directed towards the wall.

The room has been designed with a number of features in mind. There is good access through

the patient doors, to allow patients on trolleys to be brought into the room and ensure case of

access to the table. The staff entrance is placed so that the door to the corridor is behind the

protective barrier. This protects both staff entering this area and the corridor if the door is

inadvertently opened. The protective barrier is composed of a lead-ply or equivalent lower

section and a lead glass upper section which allows a panoramic view of the room.

A protective screen length of 2-2.5 m with a 0.6-1.0 m wing is normally adequate. 1 lowever.

how this fits with the general room design must be considered. The chest stand, in this

example, has been positioned to minimize the amount of scattered radiation that can enter the

operator’s console area.

Patient changing facilities must be provided and should be close to a general X ray room.

Cubicles may be designed as individual changing rooms, which open directly into the X ra>

room. This will allow for changing arrangements consistent with good radiation protection

practice, greater privacy, security and perhaps fasterpatient throughput.'The main alternative

is to group the cubicles together close to the X ray room but notadjoining it. and allow for a

sub-waiting area from which the changed patients are escorted to the X ray room

( NHS. 2001). The advantage of this design is that there are less access points into the X ray

room.

Cubicle doors leading into the X ray room must provide adequate radiation protection and

the lock should be controlled from the X-ray room to prevent inadvertent access. These

considerations on cubicles apply to many of the other room types dealt w ith in this section.

General X-ray rooms are occasionally designed with two tables, for example. IVP rooms.

Protective arrangements between the tables are necessary and the RPA must advise on this

and on the specification of the equipment to avoid inadvertent exposures! 6 1.

18

2.6.2 Dedicated chest room:A layout for a dedicated chest room is shown in Fig. 2.4. Chest X rays are one of the most

common examinations and hence rooms for this purpose must facilitate a rapid throughput.

The room has many features in common with the general radiographic room shown in Fig.

as there is no patient table. The provision of changing cubicles and arrangements that

facilitate throughput are particularly important. The chest stand has again been positioned to

minimize the amount of scattered radiation that can enter the operator's console, and an

additional lead primary beam attenuator may be required behind the chest stand.

2.6.3 Mammography room:A layout for a Mammography room is shown in Fig. 2.5. Mammography rooms may be

smaller in sizethan other X-ray rooms, and the shielding requirements are less due to the low

X-ray energy used.

Because of this, normal building materials such as gypsum wallboard may provide sufficient

attenuation.However, if this approach is used, it is important to remember that in the event of

a change of use of the room to some other radiological purpose complete re-shielding may be

required.

When assessing shielding requirements, only scattered radiation needs to be considered as

mammography equipment is generally designed so that all of the primary beam will be

. 1-

Figurc 2.4: Dedicated chest room

19

intercepted by the image receptor. When laying out the room, a practical shielding solution

may be to position the equipment so that the door to the room will be in the wall behind the

patient, as virtually all of the radiation will be absorbed by the patient (BIR, 2000). This

arrangement also facilitates privacy.

Figure 2.5: Mammography X-ray room«

2.6.4 Dual energy X-ray absorptiometry (DXA) room:

DXA (or DEXA) rooms are often located outside of the radiology department, e.g. in the

outpatient or medicine for the elderly facilities o f a hospital, in a G.P. surgery or sports

medicine clinic. A room size of 15-20 m2 may be required, depending on the design of the

equipment. If limited space is available, 10 m2 may suffice for a compact pencil beam DXA

system. (NHS, 2002). An example of a DXA room layout is shown in Fig. 2.6. The patient

table is normally located close to a wall to maximise the functional space in the room. When

this is so, the wall closest to the table may need to be shielded, and the RPA should adviseon

this. A protective shield for the operator’s console may be required, depending on design of

scanner, room size and workload, but the protective shield need not be as heavily attenuating

as that in a general X-ray room. Where more space is available, the tabic should be placed so

as to maximise distance to the important boundaries from a shielding point of view. Where

the walls are 2 m or more from the DXA scanner (1 m will suffice for pencil beam scanners),

shielding is unlikely to be required for workloads of up to 100 cases per week, however the

20

RPA should always be consulted. Shielding requirements for ceilings and floors depends on

the factors mentioned above and whether the system uses an over or under-couch X ray tube.

f t ,

*• «

- * *l~.*.4* - « % . . .

j • * * . - * . , * * * .. * *«- k}'. (. . * » i%

* > ♦9

Figure 2.6: DXA room

2.6.5 Facilities for dental radiography (intra-oral and panoramic)Intra-oral X-ray equipment:

Intra-oral dental X-ray equipment may be installed in a dedicated X ray room or in a

surgery. In the latter situation the surgery may not be used for other purposes, or as a

passageway, while a radiograph is in progress. The surgery accommodating the equipment

must be designed in consultation with the RPA to provide a safe environment.

A surgery containing an intra-oral X-ray unit is shown in Fig. 2.7a. The primary beam in

intra-oral radiography should always be intercepted by the patient. The equipment should be

installed and used so that the useful beam is not directed towards wooden lloors. unshielded

doors or windows if the space immediately beyond them is occupied (RPII, 1996).

The unit must be provided with a long cable for the exposure hand-switch or a separately

located hand switch to allow the operator to stand at a distance greater than 2 m from the

patient’s head/X ray tube. During adental exposure, the area defined by all points within 2 m

of the patient’s head is referred to as the controlled area. This is illustrated in Fig. 2.7a. The

RPA should check that all boundaries (doors, windows, walls, etc.) within 2 m of the

patient’s head during an X-ray examination provide adequate shielding to meet with the

design dose constraints. The RPA’s shielding assessment should take account of the projected21

workloads, distances to boundaries, beam directions, boundary materials and occupancy ol

adjoining areas, including above and below the surgery. No structural shielding is required in

the surgery if the workload is 20

films per week or less and the distance between the patient and the wall or other boundary is

at least 2 m (BIR, 2000).

Where possible the operator exposure controls should be within the surgery but outside the

controlled area.

Where the operator exposure controls are located outside the room in a public area, they

should be installed in a lockable box to prevent unintended exposures being made by an

unauthorized person.[6]

Figure 2.7.a: A n in tra -o ra l d e n ta l u n it in sta lled in a su rg e ry

Extra-oral X-ray equipment and combined equipment suites

For new build, extra-oral X-ray equipment must be located in a dedicated X ray room. An

indicative area of 12 m2 has been suggested for panoramic/orthopantomographic (OKI)

22

units. A slightly larger area will comfortably accommodate the widely used combination ol

panoramic and intra-oral equipment (Fig 2.7b).

* t ♦

# |

« • 4

Figure (F ig 2 .7b): A d e n ta l ra d io g ra p h y su ite w ith sev e ra l item s o f

equipm ent

A shielded operator's console shown in Fig. 2.7b may be required depending on the

workload. It is preferable that it is located within the room, especially if young children and

special needs patients are involved.

Due to the restricted size of many dental facilities, it may not be practical to install a

protective operator screen. An alternative solution is to locate the exposure hand switch

outside the X-ray room door and install a shielded lead glass viewing panel in the door. The

hand switch should be installed in a lockable box for security reasons and each switch clearly

labeled to indicate the unit it operates. It is advisable not to have two or more control panels

located close to one another. A screen of 1 mm lead equivalence will often suffice (NIIS.

2002). However, this and the overall level of shielding must be determined in consultation

with the RPA and will depend on the workload, room geometry and use/occupancy of

adjoining areas.

23

2.7. Fluoroscopy rooms2.7.1 Fluoroscopy room (general)

4\

r f

v* t

t

f 4 * ♦« I

*

t

1> { ♦* . «

tt

4

to4

A A

V

* »

t n

*

• r «

« . * «

« - • '4 *

Figure 2.8: Fluoroscopy roo used for general screening purposes

A layout for a general-purpose fluoroscopy room based on the two-corridor design is show si

in Fig. 2.8. The room has similar features to the general radiographic room. However, the

operator's protective screen is longer as there may be more staff in the room for these

procedures; a screen length of 2.5-3 m with a 1 m wing is typical, but this is dependent on the

room size and use.

Fluoroscopy systems may have overcouch or undercouch X-ray tubes. Ovcrcouch tubes w ill

have higher levels of scattered radiation and are generally operated by remote control from

behind the protective screen, and make heavy demands on this area. Fluoroscopy remote

control units may require a larger control area and a smaller examination room area (NHS.

2001). Undercouch tube systems have lower levels of effective dose to staff from scatter, and

are generally associated with more staff working in the room. There is generally an exposure

control foot switch at the tableside - which should be guarded. There should be clear audible

and visual indicators when the X-ray beam is on, so as to avoid inadvertent staff or patient

exposure. A ceiling-mounted TV display is normally located in the controlled area so that the

operator can view live x-ray images when working close to the patient. A combination of

24

mobile shielding (e.g. ceiling mounted mobile lead screens, table mounted lead skirts) should

be installed as part of the building or equipping project as appropriate. Suitable storage for

personal protective equipment (lead aprons and thyroid collars.etc.) should be provided and

easily accessed in the controlled area.

There should be a direct access toilet for patients following examinations, particular!) for

rooms used for barium procedures. It is recommended that changing facilities are grouped

close together.

Radiation shielding calculations for fluoroscopy systems need only take account of scattered

radiation as the primary beam is generally completely intercepted by the image receptor in

modem equipment. However, fluoroscopy rooms often have an additional overeoueh general

tube installed, which may be used, for example, to take lateral radiographic views in barium

studies. In such cases, the room must also be considered as a general room and primal)

radiation shielding will need to be considered.

2.7.2 Fluoroscopy (special & interventional radiology and cardiology):The layout for an interventional fluoroscopy room is shown in Fig. 2.9. This is general!) part

of a suite with preparation, recovery and other areas as appropriate. Suites of this type are

now commonly used in Radiology. Cardiology, Vascular Surgery and other disciplines. The

suites that support interventional procedures should be designed, as far as possible, to meet

operating theatre standards, in terms of hygiene and suite design. Most of these rooms use

complex ceiling suspended X ray equipment, often having a C-arm configuration.

Sometimes two such installations are incorporated in a room providing "biplane" X ra\

imaging facilities.

Dual-table cardiac "swing-labs’* may also be designed, which may require additional

protection between tables, often in the form of vertical lead blinds. In addition large numbers

of staff are frequently involved and need to access the room, the patient or the console area.

The console area also often doubles as a tcaching/consultation area. This involves considered

application of dose constraints. Thus room size should be large and a range spanning 38 to 50

m2 has been recommended (B1R, 2000, NHS, 2001).

The console area normally occupies the length of one wall with lead glass shielding providing

a panoramic view. A combination of mobile shielding (e.g. ceiling mounted mobile lead

screens, table mounted lead skirts) should be installed as part of the building or equipping

project as appropriate. This is absolutely essential in this type of facility, and it must be fitted

25

in a fashion well adapted to the procedures envisaged for the room. Suitable storage for

personal protective equipment (lead aprons and thyroid collars, etc.) should be provided and

easily accessed in the controlled area.

. . *

# •

#

« <

»

»

. • • t i •

• t

•« r ♦« < •* I ** I •* fc •* • y

*4

to»

Figure 2.9: Fluoroscopy roo (designed for special and interventionalradiology procedures)

An interventional room will require direct access to patient preparation/an aesthetie/rceovery

area(s). Many interventional examinations will require sedation and some will involve

general an aesthetic hence the need for a recovery room/ward and more space in the X ra\

room for ancillary patient monitoring equipment. Staff changing facilities, patient changing

cubicles and toilet facilities should be provided nearby. The scattered radiation is normally

exceptionally high in interventional rooms due to the long fluoroscopy times, long

fluorography acquisitions and high patient doses. Shielding requirements may exceed Code 5

(2.24 mm) lead in some cases. Thus individual shielding assessments arc essential for these

facilities and should be undertaken in consultation with the RPA.

2.7.3. Computed Tomography (CT) room:A CT room layout based on the two-corridor model is shown in Fig. 2.9. It is easy to adapt to

a single corridor approach by switching the staff entrance to the opposite wall. CT rooms arc

generally part of a suite with patient waiting, changing cubicles, and toilets. As with

interventional rooms, large numbers of staff are frequently involved and need access to the

26

room, the patient and the console area. The console area also often serves as image

proeessing/reporting/teaching and consultation areas and again this must he borne in mind

when selecting the dose constraints to be used. It normally occupies the length of one wall

with lead glass shielding providing a panoramic

view. In addition, it may be expanded to serve two CT rooms, or a CT and MR I room, one

each side of the operator area. An intercom must be used for communication with the patient

as the door between the CT and console area must remain closed during exposures. Within

the CT room, the oblique alignment of the scanner allows observation of the patient from

thcoperator's area for the duration of the examination. It also facilitates easy movement of

patients, wheelchairs, trolleys and staff in the room. Facilities suitable lor storage of personal

protective equipment (lead aprons, etc.) should be provided and easily accessed.

There are large variations in the shielding requirements for different CT systems. The

increased patient throughput facilitated by modern multi-slice and spiral CT sy stems can

result in very high levels of scattered radiation in the room and therefore greater levels ol

shielding are required.

F ig u re 2 .10: C o m p u ted T o m o g rap h y (C T ) room

Unlike interventional rooms the distribution of scattered radiation in the CT' room is well

defined and fixed, as the position of the gantry is fixed and the X ray lube follows the same

rotation path for each exposure. Is dose curves for each are normal Iv av ailable from27

the manufacturer and these should be used to determine shielding requirements taking due

account of local technique. As a general guide, the shielding requirements for new multi-slice

CT systems are between 3-4 mm lead (NIIS. 2001). However, individual shielding

assessments based on actual workloads, room dimensions and occupancy of adjoining areas

are essential for these facilities and should be undertaken by the RPA.|6|

2.8. Shared function rooms:2.8.1 Accident and Emergency departments:Many A&H departments have dedicated x ray facilities (e.g. general. OPCi. CT) and some

have a dedicated x-ray room located immediately adjoining the resuscitation room, flic

shielding of dedicated x ray rooms in this area should be based on advice from the RPA. but

will generally be similar to that applying elsewhere. As an alternative to a dedicated \ ra\

room, some A and E departments have a ceiling suspended x ray tube located in the

resuscitation room, for use in several dedicated areas or bays (lig.2.10). The external

boundaries of the resuscitation room may be fully or partially shielded, depending on the

workload and occupancy and on the RPA's advice.

Fig. 2.11: Resuscitation room in an (A) and ( E) department

28

In such an area, consideration should be given to including a fixed operator's protective

screen which allows good visibility of all the bays. Protective half-length partitioned walls,

fixed screens, blinds or curtains are generally required between bays. Lead partitions and

fixed screens are robust but may restrict the workflow and visibility within the room. Lead

curtains or blinds have the advantage that they may be retracted when not in use. but may

have a limited lead equivalence and may become damaged over time. The dimensionsand

lead equivalence of the protective barrier between bays will vary with the workload and the

distance from the bed to the barrier. The dimensions must be sufficient to contain the primary

beam for lateral examinations. Unless the lead protection is adjacent to the patient trolley, it

is recommended that the screen extends by at least 0.5 m beyond both the head and the foot

of the bed, if the workload includes lateral skull examinations for example.

Alternatively, a mobile X-ray unit may be used in A and E departments. In this case the

shielding requirements for all boundaries within the A and E department must be determined

by the RPA on the basis of the workload, occupancy of adjacent areas, etc. A secure place

must be provided for storage of the mobile unit.

Endoscopic retrograde cholangiopancreatography (ERCP) facilities are normally associated

with endoscopy suites and use a mobile C-arm or a fixed fluoroscopic system. Cardiac pacing

rooms are frequently situated near the CCU, and these procedures generally require a mobile

C-arm. Fixed fluoroscopic systems for lithotripsy applications may be sited in the Urologv

department. The boundary shielding of these rooms must be assessed by the RPA as part of

the room design. If a fixed fluoroscopic system is provided, the room must contain a shielded

operator console.[6]

2.8.3 Operating theatres and recovery areas:Some surgical procedures, particularly in orthopedics and vascular surgery, require mobile C-

arm and/or mobile X-ray exposures. The theatre must be large enough to allow staff to stand

well back from the X-ray tube and the patient; theatre areas of 40 m2 (BIR. 2000) and 55 m2

(NHS. 2001) have been recommended. The boundaries will require shielding to a level

advised by the RPA, and this would normally be Code 3 lead equivalent, but may be greater

for interventional procedures or less for low workloads or for applications such as intra­

operative dental work. It may be feasible to install X-ray warning lights outside the theatre

door. When building a suite of theatres, it may be pragmatic to shield them all to the same

level of shielding as their usage may change over time. Dedicated theatres used for

29

interventional X-ray procedures will require significant protection as these generally involve

fixed equipment with higher power output. The boundaries will generally need to be shielded

as for an X-ray room. A shielded operating console should be included, and X ray warning

lights must be installed outside the door.

The use of mobile X-ray units is often required in the recovery area. Examinations will often

involve chest X-rays, and thus the considerations listed below for ICU/CCU/IIDIJ apph. and

special consideration must be given to the need for shielding the floor and the boundan

behind the head of the trolley.

Lateral X-rays are often required after orthopedic surgery, and thus a shielded trolley ba\

may be required.

This situation is similar to that discussed previously for multi-bay resuscitation room in A&K.

The Theatre area also needs to include a secure storage place for mobile x ray units and

mobile C-arms.

2.8.4 ICU/CCU, high dependency units/neonatal units and general wards:In situations where it is not possible or advisable to move patients to the x ray department.

mobile x-ray equipment is required. This occurs in neonatal units, intensive or coronary care

units, and high dependency units. Shielding will often be required to contain the primarx

beam. Since the majority of exposures involve chest x-rays with the patient lying supine.

semi-supine or sitting upright, shielding is often required for the floor and at the back of the

bed.

The RPA must assess the shielding requirements. Consideration should be given to the

location of the bed. In new developments, beds are often positioned in front of window s,

where shielding may be required.

Generally, Code 3 lead equivalence is sufficient in these situations. Figures 2.10(a) and

2.11(b) illustrate the issues involved. If the bed backs onto a solid concrete wall, additional

lead shielding is not normally required. However the need for shielding of the floor area must

be assessed.

door. When building a suite o f theatres, it may be pragmatic to shield them all to the same

level o f shielding as their usage may change over time. Dedicated theatres used for

30

Occasionally mobile X-rays will be required in general wards, and the above considerations

will also apply. A risk assessment must be carried out to determine if structural shielding is

required.

>

4

Figure 2.12(a): Window shielding not required, as primary x-ray beam does not impact on window

0 0 4 m m \ 4

Figure 2.103(b): Window shielding may be required depending on occupancy outside window. [6]

31

CHAPTER THREE Methodology

3.1. Introduction:

The study was performed in some of x-ray diagnostic departments in Omdurman locality (

Military hospital (emergency and Central X-ray rooms) , Wedad specialized hospital .Asia

specialized hospital , Yestabsheroon specialized hospital,Tuga specialized hospital.

Friendships' hospital, Emergency children hospital,Abusied health centre. Blue Nile

specialized hospital and Albuga specialized hospital )by questionnaire and chick list. The

data has collected at the period from March to August 2013.

32

3.2. Materials3.2.1. X-ray Machine:

The main X-ray machines in these departments were general, such as chest, dental, mammography Fluoroscopy and Computed Tomography).

Table 3.1:X-ray machine information:

hospital

Army hospital

Central X-ray

RoomNo.1

2* * ♦ «

J1

Wadedspecialized

Asia specialized

Yestabsheroonspecialized

Tuga specialized Friendships* hospital

• t o t o ft

Emergencychildren

Abusied health centre( 1)

Bluespecialized

> + « ^ ^ B 0 * « * f t * + . * 4

Nile

2

4

2

134

51

21

1♦

1

x-ray equipment

Radiography• • • • ♦

• • • •

C.T Scanning Mammography

Fluoroscopy(screen)RadiographyMammography

f t f t ^ q

Radiography

Dental machine C.T

4 0 f t f t * f t ♦ f t ^ ^ ^ f t + ^ f t « « f t « * « « t o ♦ f t f t ^ ^ ^ t o f t f t f t f t t * f t ^ t o f t f t ♦ « f t * f t

Screen( Fluoroscopy)

MammographyScreen( Fluoroscopy)

C.T

2-radiography

RadiographyRadiographyRadiography

Mammography__Radiography

Radiography

Dental____Radiography

manufacture Serial No.

tToshiba November * 41.299 2004 |Toshiba 2004 41.293Toshiba 2004

♦ • « * * ♦ * ♦ * *

IAF.Viafilai53

\SPA I 601.007

• • •

Toshiba 2004Toshiba June 2011

f t 4 f t f t * f t » * *

Siemens

9

X%%A

J4A1153565 11F698

788♦ ♦ ♦ « • • * « f t

NemotoOPHRAJanuary 2012

• * # • • • f t f t t o f t f t t o f t * f t ♦ ♦ * * f t * ♦ ♦ •

Performa

1-006-24252A020732458

♦ 4 \

Communication and AM 5I24G: power industries _Communication and power industries

f t * ♦ ♦ ♦ * • «

December Toshiba Dong fang

* • « • • « f t * * m 9 ♦ ♦

2004 4m833f

F92-1 jh 12201-19

Toshiba November ! BI.0539 2008

i

September 1993 February 2006 shimadzu

to ft ft ft ftft • • ♦ ♦ ♦ ♦

July 2003» * « + f t f t « f t « ♦ ♦ ♦ ♦ ♦ ♦ f t *

April 2oo6

• • •

93002560052

043-1220061219

• ♦ ♦

hainuo♦ ♦ ♦ ♦ * « f t * « f t f t f t + « * * f t ♦ f t f t ♦ « • • ♦ f t

Shimadzu October * 83986 2008

4 ♦

33

3.2.2. Radiation protection devices in x-ray department

There were lead aprons used now in all hospital a good condition .There were neck

shield(thyroid) in Military Hospital. There Were no lead goggles for eye protection used..

There were a lead glass with control room shielded in the working position.

T able3 .2 . :R a d ia tio n p ro tec tio n devices:Hospital x-ray machine Lead

apron! Army hospital Radiographyi emergency

c . r

'central X-ray• ft ft ♦♦ * * * * * ^ t o f t

radiography

fluoroscopy

^ t o t o f t f t ^ f t ♦ ♦ ♦ i m i i t m > m > t o f t *

jWedad ! specializedL » * * t o * ♦ ♦ ♦ ♦ * 9 9

I Asia specialized

Radiography

♦ * f t ♦ ft ♦ ♦ * «fttoft* ♦ •

Radiography

CT Andfluoroscopy

Yestabsheroon fluoroscopy ! specialized

I’lugaI specialized dentali f t * * ♦ * t o « f t t o t o f t ^ B f t t o f t * « M ^ ^ t o f t ^ f t f t ♦ * f t f t f t ^ t o t o * * f t « » ^ ^ t o M f t f t f t f t * t o » t o t o

j Friendships' i hospital rEmergencychildrenAbuseid health centre(1)

^ f t f t f t « « f t t o ♦ f t f t * * « f t * * * ^ * « f t . <

j Blue; specialized

f t * t o * * * ♦ f t f t f # # f t M f t t o * * *

| Albuga . Specialized

c . r> « f t * « * ♦ ♦ * ^ f t * * • * * • * f t * * f t * « * «

Radiography and

Radiography and mammography Radiography

Radiography and dental

* f t * « • « * * « ^ ♦ t o ^ * f t « * «

Radiography

fluoroscopy

« » * ^ t o * * « •

✓

V

♦ ♦ •

✓

V

Gonad

♦ t o f t * * * * * • « * q

f t * t

• • • •

X

* * ♦ *

X

f t t o f t * t o « f t ♦ f t * t o * f t *

X

X

toft ♦ *•♦ ftft* ftft

X

♦ ♦ ♦

X

f t *

X

X

X

X

X

breast

x

• • •

x

X

X

X

X

X

« • * t o f t ♦ « * « • • « ♦ * ♦

♦ ♦ ♦

X

X

X

X

♦ f t

X

X

X

X

goggles

X

X

X

X

X

X

X

X

X

X

X

TLD

to

\

X

X

X

X

X

X

X

X

X

X

X

X

X

Gloves

x

x

x

x

x

✓

X

X

X

X

X

X

34

-There were no personal monitoring devices available in all hospitals. But we used

environmental survey meter ( Radose .type RDS200 ).

X-Ray M a c h in e Rooms and Control rooms Size:Table 3.3: X -R ay R oom s a n d C o n tro l ro o m s Size :

3.2.3. Radiation Monitoring devices available in x-ray department:

I lospital Room No. Room Size (Meter)2

5x4

4 4 4 « 4 ^ ♦ ♦ « « • 4 4 « 4 « • « * 4 • • « » ♦

5x4^ 4 4 4 « 4 « « * 4 4 * 4 4 m » « « 4 « « 4 4 4 4 « 4

5x44x2

4 f t « « » 4 « « ♦ ♦ 4 ♦

5x54 4 «

5x5• ♦ « M 4 4 » 4 ^ M 4 » « f t f t f t « 4 4 « » « « «

5x5

Army Hospital Emergency

Mammography

Radiographyi

Central X-Ray•

Radiography4 * 4 * ^ 0 * ♦ * « « 4 * 4 « « « « « « «

MammographyRadiography

4 4 4 # * 4 1 * # ♦ * ♦ 4 4 « # 4 « ♦ « ♦ « ♦ .

Radiography« 4 * * * * 9 • ♦ ♦ ♦ • ♦ ♦ ♦ ♦ f t * f t « f t « * 4 ♦ 4 4 4 4 * 4 4 * * « • 4 ^ * « 4 4

FluoroscopyWaded Specialized C.T 5x3.5Asia Specialized Radiography And

Mammography.5x4

4 4 ♦ n f i , M i 4 I 4 « f t * « * ♦ 4 * * 4

5x4« « « « « *

5x3.50♦ * 4 4 « « 4 « « «

6x5

* 4 * * * 4 4 « « ♦ ♦ « ^ 4 « « *

6x54x5

*« • « * < # « * ♦ ♦ ♦ ♦ ♦ # ♦ ♦ * « 4 4 4 « 4 4 * ♦ ♦ ♦ ♦ ♦ ♦ • 4 «

}

Yestabsherooni

Specialized

Tuga Specialized

Fluoroscopy^ ^ 4 « « 4 « 4 * ^ 4 « m ♦ ♦ * * • ♦ ♦ ^ • « « « « « * * * ♦ « • *

1 C.T* m * ♦ ♦ * « 4 4 * 4 ♦ # 4 4 4 * • « • • « « * « « « « 4 4 ^ 4

Fluoroscopy

4 f t 4 4 4 4 4 4 4 4 4 4 4 * « * ^ 4 « • 4 4 4 4 4 4 ^ ^ ^ ^ ^ 4 4 4 4 « 4 ^ 4 4 4 4 4 4 * « « •

C.TRadiography And Dental

Friendships’ Hospital

4

• ♦ * * ^ ^ ^ ^ 4 ^ 4 ^ 4 4 • 4 ♦ ♦ ♦ ♦ 4 4 4 # 4 * m m * 4 # 4 ♦ ♦ # 4 ♦ ♦ 4 « • 4 * 4 4 ^ 4

Radiography AndFluoroscopyRadiography

• ♦ 4 4 « 4 « f t 4 4 * 4 A 4 W 4 4 ^ M 4 4 4 4 ^ ^ M 4 * * 4 4 M 4 4 4 q # 4 * i * ♦ 4 ♦ « 4 4 4 4 • 4

Radiography1 4 1 4 * 4 4 ♦ ♦ ♦ ♦ ♦ ♦ ^ 4 4 * 4 « * m ^ M ^ « 4 1 ■ ! > 1 « 4 4 > 4 4 ♦ ♦ ♦

Radiography

6x6

9 * 4 4 4 4 4 4 « * f t « • 4 « 4 f t 4 « • • 4 m * * 4 « * 4 « «

5x35x5

« « « « « 4 « « « « « « f t

5x3k ^ M 4 * m # 4 4 4 4 4 4 4 « « 4 « + ^ 4 4 * ^ 4 4 • 4 4 * * 4 •

5x34 4 4 « 4 « m • « « 4 m « A 4 « m * « * * 4 4 ^ ^ v * * * « ♦ 4 * 4 4 4 * * ♦

4x4

4.5x4.5

» 4 4 ft 4 4 4 * * 4 4 # * • « « 4 « 4 4 ^ 4 « • « « « 4 * ♦ ♦

5x45x5

« ♦ ♦ * « « 4 4 4 4 4 « 4 4 « « » *

MammographyEmergency Children Radiography And

MobileAbusied Health Centre( 1)

Radiography Mobile And Dental

Blue Nile Specialized Albuga specialized

Radiography« 4 4 » 4 * * 4 « 4 4 * 4 4 * * « 4 ♦ ♦ ♦ ' ■ « « « ■ ^ * 4 4 ^ ^ ^ ^ 4 4 ^ 4 # ^ 4 i M l | » 4 * 4 4 * * * ♦ ♦ ♦ * * *

Fluoroscopy and mobile radiography

4 4 4 ( ^ 4 4 * 4 M W 4 4 A * 4 ^ M A 4 4 4 4 « 4 ^ ^ M 4 ^ ^ 4 4 4 4 4 4 * * 4 # 4 0 9 4 « 4 « 4 4 4 * 4 4 4 4 4 4 4 « 4 * « « « • « • 4 » «

Control Si/.c( Meter)2I X I

lxl5x4

' 2x2j 1.5x3

1.5x31x3

Room

2.80x4.40

60x90

No Control

4x2 Dark Room

35

3.2.5Shiclding

Thickness of shielding is 2mm of lead rubber applied to walls of rooms. Height of shielding

is 2.5 meter from the floor all department in hospital.- There is lead glass in control room of

2mm thickness and 35x35cm on military hospital department see 'fable (4). There is lead on

the door of 2mm thickness and 55x25 cm his size.

3.2.8 Radiation Workers and patients in each sift on x-ray room department.:

There are(96) radiation workers in Omdurman locality radiological in diagnostic-

department and(673 )patients in each shift in X-ray rooms in Omdurman locality in

diagnostic department.

Table 3.4.: Radiologic X-Ray Diagnostic Room In Hospital Under Study:

36

This table (3.5). It is shown Structural and shielding materials used for design and protection.

Table:3.5. Structural and shielding materials:

window

No

No

No

No

No

No

No

No

No

No

No

No

Y cs no shield Yes no shield No

No

No

37

Leakage: This table (3.6) it's showing X-ray rooms leakage radiation around the door andcontrol room doses

T able 3 .6: X -ra y ro o m s leak ag e ra d ia tio n a ro u n d th e d o o r a n d co n tro l room doses:

Hospitals Room equipments No.

Control rooms microsiver (psv\h)

« • «m » * « * «•++ ♦ ♦ ♦ * « m # « ♦•% # ♦♦ # 4

Door microsiver!•

i

(psv\h) I, A . M A AA J. A.A .M * ♦ f

Friendships 1 0.00 0 .0 0 !!2 0.5 0 0.00 !13 "ToToo '

♦ ♦ * •* ♦ 1

0.00 IA AM A . J . A • .A 4 M A A AgA .A * 4

4 0.001 — — — A A A ^^a . . . -- --- A — _ a . —

* . a . . . * * * * . a ***** * *. * * a0.00

A * 4—. . A * 4

5v 4 tt# v 4*4w ^^b * p4* 4 9 ^ 4 ♦ 4

0.0044“ Bw* ■

0.00$

. A A A _ A .^BM. A* A^Bg. .A* B a

Emergency military 1 90 .00 7.00^|A4AA_. A A . A A A A A A A * 4 4 f

2 7.00 A& A A . . . A

1 .00* ^«*44m*«M 4* 4# ^ ^# * « *«44 J

3 9.00 0.8 0 !4

AAM4M4 a « • • 4 « + # • « « ^

Central military 1 0.00 o.oo !•

. 4 4 M 4

2 0.5• *♦ |

0.2 0 j> # M **4 * # 4 4 ♦ M* + ♦♦ * #♦ J

3 0.8 0.2 044 ♦ *44^ ♦ ♦ * #44 « # #

4 6.00' 0.5 0mm# ♦ * 4mm* * * * * * * 4

Wedad 1 0.00 0.00 !^ a — - _ a 4* * * M a a . «a- + + « * • * *♦ m A 44* « A J

Children emergency 1 0.00. * * a * . * . * * . . .***.*. . . . . . . . a

0.00#++• # * # 4 * #* m ♦ + «# ♦ « * * #♦ 4

A busied 1 0.00 o.oo !^nMafr»«A^» a m a «4# a « +«• 4 ^ * 4 4 * « ♦ ♦ J

Blue Nile 1 0.00 0.00 1•

^^^bAa A a a aa a * MM* * 4M^^ 4

Yestabsheroon 1 0.7 0.00 Ia A A a am m 4 4

2 0.9**4 * * * 4 4 J « * * • 4 m* m *^+ «

0.00 I♦ ♦ * 4

Asia 1 9.00 0.3 0• 4 *

2 0.00 0.9 0A A A * i

3 0.00♦ ♦ ♦ J

0.00Omdurman 1 0.00 0 .0 0 ” “ 1

emergency %4

Albuga 1 4.00 0.00 !•

A^A a a ♦ A A Z

Tuga 1 0.00 0.00 1•

H . . i

Abusied health centre 1

1 0.00 0 .0 0 i!♦ ♦ * * ^

38

T ab le 3.7. M a x im u m K v p a n d ex am in a tio n te s tin g :

As used in x-ray room department during

Hospital_______________Army Hospital Emergency

Central X-Ray

Wedad Specialized Asia Specialized

Yestabsheroon Specialized

Friendships' Hospital

Emergency Children

Abusied Health Centre( 1)

Blue Nile Specialized

mAs« • ♦

1616

39

T ab le 3.8: W o rk lo a d F a c to rs In X -R ay R oom s:Hospital Equipment Weekly Workload mA-min per

week744.8Army Hospital

EmergencyradiographyCT 2688

Central X-Ray radiography 7844 **mm*« ^+m «# + m * * «4« m *• ♦ * 4ftft« ^4 ♦«• ♦ ♦ ♦ ft ft

56*+ «#4**4^V ♦ ♦ « « * *• « * « * « « «

105« ^ ft* * ♦ « ++ft 4 4 ^ * ft m ^« * « « «• mm ♦ ♦ * * 4 4 « * « « ♦ *

49- 1260”

*4«##ft*« * * * «^ 4^^«ft #** «*♦ 4* «

210A A A A —_A A A J A - A A A A AA AA—_ AA A ft . A

fluoroscopyWedad Specialized Asia Specialized

radiographyradiographyCTfluoroscopy

YestabsheroonSpecialized

CT 630fluoroscopy 105

Tuga Specialized radiography 68.25Friendships' Hospital Emergency Children

radiographyradiography

m»* * * • • • ♦ ♦ • •♦*♦*••• 44 m** ♦ 4* ♦

147♦ ♦ ■ m 4 ♦ « • « * ♦ « m **« ♦ «4 ^ » * « * * ♦ * ♦ • *•*♦♦ « ♦ « « ♦ ♦ * • • ♦ «*

31.5«•« mm* ♦ « • m« *m* « « * « « ♦♦ ♦ *•• « ♦ « «

6.125

^^M »*444 *4»« ***** ^ *4 »« «• *♦ ♦ ♦ ♦ * « «

10556

Abusied Health Centre( 1)

radiography

Blue Nile Specialized radiographyAlbuga specialized fluoroscopyOmdurman emergency radiography 672

40

3.9. Occupancy factor (T) location and surround area at x-ray room:

ArmyEmergency

HospitalRoom No. Location And Surrounding Rooms1,2, Full occupancy, receptionist area, access, patient

waiting, administrative offices, control room, outdoor area,

♦ I H H » 4 ^ 0 + 0 0 4 f t ♦

3, Corridor, maize generator, vault doors, control room, outdoor area, partial occupancy

Central X-Ray 1,2,3,4 Attended holding area, adjacent mammography room(l), access, administrative offices, toilets, corridor, control room, outdoor area, partial occupancy

Wedad Specialized 1, Waiting treatment room, corridor, control room, outdoor area, partial occupancy

Asia Specialized 1, Receptionist area, dark room, administrative offices, attended patient holding area, corridor, control room, outdoor area, partial occupancy

» ♦ ♦ ♦ « + ♦ » 0 4 f " m t * 4 4 ♦ ♦ ♦♦

2,3 attended patient holding area, receptionist area, corridor, control room, outdoor area, partial occupancy

♦ ♦

YestabsheroonSpecialized

1, attended patient holding area, unattendedadministrative offices, outdoor area with waiting, corridor, partial occupancy

• • *4 ^ ^ 0 • % m ...................

2, outdoor area with seating, MR examination room adjacent to shielded wall, corridor, control room, outdoor area, partial occupancy

Tuga Specialized 1, attended administrative offices, dark room, corridor, control room, outdoor area, partial occupancy

Friendships' Hospital 1,2.3,4,5 attended administrative offices, dark room, corridor control room, outdoor area, partial occupancy

♦ ♦ 44 4 4409 99900

Emergency Children attended administrative offices, toilets, attended patient holding area, control room, outdoor area, partial occupancy

Abusied Centre( 1)

Health Treatment room, corridor, dark room, control room, outdoor area, partial occupancy

Blue Nile Specialized Dark and control share rooms, outdoor area.. Administrative share offices, corridor, partialoccupancy

•499 44 ♦ «

control room, outdoor area, patient holding area.adjacent receptionist area, corridor, partial occupancy

0 0 0 4 9 0 ♦ «

41

3.3 M ethods:

Evaluation o f X-ray rooms in hospitals in terms o f the design o f the room, area o f shielding in the room, building materials used in the room, equipment inside the room and operator system forthe X-ray machine.

Measuring the radiation levels out o f the X-ray room that affect on workers in radiographic department, using (Radose) in the control room, the door o f the X-ray room and the areas adjacent to the room to see the quality o f the design o f the room where the prevention o f

radiation.

42

CHAPTER FOUR

D i s c u s s i o n :The X-ray room design equipment were presented in Table (3.1) by comparing results with

«

the recommended in NCRP49 it can be seen that all the x-ray machines used in this study passed a verification performed. The figure in appendix (A) present performed in the 12 hospitals in Omdurman locality, x-ray departments has 30 x-ray machine, radiation workers in each hospital and number of patient on each shift .The shielding and building material used on all hospital was 2 mm lead sheet thickness the discussion and the assessments of the result were:

F ir st: M ilita ry E m e r g e n c y Hospital: Radiography rooms (1,2) design of X-ray roomsand C.T room conform to the specification standard. The leakage radiation around the door and control room about 90 psv\h to 7 psv\h . the exposure measuring arc seen in the table (3.6). The Workload factors there were in radiography room about 744.8 mA-min per week .and for C.T about 2688 mA-min per week seen table (3.8). The Location and surrounding areas for radiography are Full occupancy, receptionist area, access, patient waiting, administrative offices, control room and outdoor area. Fluoroscopy Location and surrounding areas Corridor, maize generator, vault doors, control room, outdoor area and partial occupancy. Seen table (3.9) which were acceptable values according to NCRP49

S e c o n d :M ilita r y C entra l: The X-Ray radiography room (2,3) design of X-ray rooms, mammography room (1) and fluoroscopy room(4) there were confirm to the specificationstandard. The leakage radiation around the door and control room abut 6 psv\h to 0.5 psv\h. the exposure measuring are seen in the table (3.6). There were share control room between the rooms (2,3) design. The workload factor there were in radiography about 784 mA-min per week and for Fluoroscopy 56 mA-min per week. The Location and surrounding areas are Attended holding area, adjacent mammography room(l), access, administrative otfices. toilets, corridor, control room, outdoor area and partial occupancy Seen table (3.9) There were have cooling system and ventilation fan, and these results were extremely low (no action need)F o u r th : A s ia S p e c ia liz e d : The X-Ray radiography room (1) design Fluoroscopy(2)room and C.T room (4) confirm to the specification standard. The leakage radiation around the door and control room about 9 psv\h to 0.9 psv\h . the exposure measuring arc seen in the table (3.6). The Workload Factors there were in radiography 49 mA-min perweek, for Fluoroscopy 210 mA-min per week and C.T 1260 mA-min per week. The Location and surrounding areas in radiography room (1) Receptionist area, dark room, administrative offices, attended patient holding area, corridor, control room, outdoor area and partial occupancy. Room (2,3) attended patient holding area, receptionist area, corridor, control room, outdoor area and partial occupancy.F ifth : Y e s ta b sh e r o o n S p e c ia liz e d : The Fluoroscopy (l)room and C.T room (2) confirm to the specification standard. The leakage radiation around the door and control room abut

43

0.7 |isv\h to 0.9 |isv\h . the exposure measuring are seen in the table (3.6). The Workload Factors there were in radiography 630 mA-min per week. Fluoroscopy 105 mA-min per weekand C.T 1260 mA-min per week. The Location and surrounding areas in Fluoroscopy room attended patient holding area, unattended administrative offices, outdoor area with waiting, corridor and partial occupancy. C.T room outdoor area with seating, MR examination room adjacent to shielded wall, corridor, control room, outdoor area and partial occupancy.S ix th : T u g a S p e c ia liz e d : The X-Ray general room and dental x-ray (1) design confirmto the specification standard. The leakage radiation around the door and control room abut 0.00 |isv\h to 0.00 psv\h . the exposure measuring are seen in the table (3.6). The Workload Factors are 68.25 mA-min per week. The Location and surrounding areas attended administrative offices, dark room, corridor, control room, outdoor area, partial occupancy.There were share General x-ray and Dental room. There were share general x-ray and dentalroom.S e v e n th : F r ien d sh ip s H o sp ita l: The X-Ray radiography room (1.2.3.4) andmammography room design are confirm to the specification standard. The leakage radiation around the door and control room abut 10 psv\h to 0.5 psv\h . the exposure measuring arc seen in the table (3.6). The Workload Factors are 147 mA-min per week. The Location and surrounding areas rooms (1,2,3,4.5) attended administrative offices, dark room, corridor, control room, outdoor areas and partial occupancy. There were windows in the wall on the rooms.E ig h th : E m e r g e n c y C h ild ren : The X-Ray radiography room (I) design confirm to thespecification standard. The leakage radiation around the door and control room abut 0.00 gsv\h to 0.00 (isv\h . the exposure measuring are seen in the table (3.6). The Workload Factors are 31.5 mA-min per week. The Location and surrounding areas attended administrative offices, toilets, attended patient holding area, control room, outdoor area andpartial occupancy. There were share General x-ray and mobile x-ray room.N in th : A b u s ie d H ea lth C e n tr e ( l) : The X-Ray radiography room (1) design confirm tothe specification standard. The leakage radiation around the door and control room abut 0.00 psv\h to 0.00 psv\h . the exposure measuring are seen in the table (3.6). The WorkloadFactors are 6.125 mA-min per week. The Location and surrounding areas. There were nocontrol penal room. There were share General x-ray and Dental room.T e n th : B lu e N i le S p e c ia liz e d : The X-Ray radiography room (1) design confirm to thespecification standard. The leakage radiation around the door and control room abut 0.00 |isv\h to 0.00 psv\h . the exposure measuring are seen in the table (3.6). The Workload Factors are 68.25 mA-min per week. The Location and surrounding areasE le v e n th : A lb u g a sp e c ia liz e d : The X-Ray fluoroscopy and mobile room (I) designconfirm to the specification standard. The leakage radiation around the door and control room abut 0.00 psv\h to 0.00 psv\h . the exposure measuring are seen in the tabic (3.6). The Workload Factors are 68.25 mA-min per week. The Location and surrounding areas Treatment room, corridor, dark room, control room, outdoor area and partial occupancy.

44

There were no control room in the room. There were share General x-ray and Dental room. There were share fluoroscopy x-ray and mobile room.T w elfth : O m durm an Em ergency : The X-Ray radiography room (1,2) design conformto the specification standard, room( 2) is out the services. The leakage radiation around the door and control room about 0.00 psv\h to 0.00 psv\h . the exposure measuring are seen in the table (3.6). The Workload Factors are 672 mA-min per week. The Location andsurrounding areas corridor, dark room, control room, outdoor area and partial occupancy.

45

CHAPTER FIVE

Conclusion And Recommendations

5.1 Conclusion:

This study was performed to evaluate the design of x-ray room in Omdurman locality. And it

concluded that in friend ship hospital there was windows inside x-ray room and this was not

in the recommendation of ICRP for design of x-ray room. In Abusied Centre. Al-wedad

Specialized Hospital and Blue Nile Hospital they have no control area and this also was not

in the recommendation of ICRP for design of x-ray room. In Military Hospital (seven x-ray

room ), Omdurman Teaching Hospital (two rooms), Omdurman Children Hospital(one room

and two machines), Albuga Hospital (one room and two machines), Ycstabshcroon hospital!

two rooms), Asia specialized hospital (three rooms and four machines), Tuga specialized

hospital(one room and two machines): all of them are compatible to ICRP recommendations

for the design.

5.2 Recommendations:❖ In friend ship hospital must close the windows of the room.

❖ In Abusied Centre, Al-wedad Specialized Hospital and Blue Nile Hospital, they must

performed control room for each x-ray room.

❖ Provide all hospitals with personal monitoring devices like TLDs.

❖ Prepare and set the following registrations:

• Registration of maintenance and follow up services.

• Registration of radiation protection program follow up.

• Registration of local rules of hospital work.

• Registration of worker training and work improvement.

• Registration of radiation emergency situations.

❖ Selection of protocols for individual patients and for laboratories needs to be determined from an ALARA approach.

❖ Warning signs must be placed at all entrances to x-ray rooms there was not placed at any rooms.

46

4t

Appendix

1. Fig: Of X-Ray Room design In Abusied Health Center Block One

: * * * » « *

, . * * • * * # * . * » " I K * *

i9 .\. f v t z + * ♦♦♦/♦

' 9 • •

••♦*

Door withIm H ffbcc

■5♦V*>

> ♦. • • U r n . * . . . , * * « * * < : . * y . - O I I I K l r » - ,

x K » . - *

iI 2. Fig: of x-ray room design of C.T and fluoroscopy in AsiaDepartment:

48

3. Fig: of general x-ray room in Asia department

offices

Reception

►

access

offices

\

Dark room

And control roo

50

*

+0

5. Fig: Children Emergency x-ray room design

!t!!

«* 4 /♦ 3 . C A

• ♦ ♦ # TTTTiT Tt 111 ♦ W Z * * t . * r ♦

£:.%> - -:f - ■ % . . .

... .. . . ♦ . « « . « ♦ . . . . . . «• ♦ • « . • « ♦ ♦ > « . » » . . • « : * • « • - - 9 9 m

51

6. Fig: X-Ray Room Design In Friendship Hospital :

tffc.I'i'w ftffW Eiiim w w fw itiiiiiiLV

52

V*

. B

Friendships hospital

Dark roomwindow

> ftftft#ftftft ♦♦♦♦••*)%•}}*• ♦♦♦♦••♦♦#

Leadglass

window

window

;<*»r♦ ♦V

tube•-V-,%f t f t #

♦ ♦♦♦ft

door door♦Cft -

offices Control rooLeadglass

WV5 * « * :

♦ V

A Mftft

A A ft ft ft ftftftftftftftftftft##♦ ^ft^ft^ tft ft ♦♦♦♦ ♦♦♦♦♦♦♦♦«♦♦

2v #

*•

v - . * •

. * • » >• r * *

y tube♦♦♦♦♦♦♦♦♦• ♦ __♦♦♦♦ ♦ •♦

Classwindow

Control room

window window. * *

Nwindow

t

7.Fig: Albuga specialized hospital:

I

Waiting area

i

8.Fig: Omdurman emergency hospital:

55

9. Fig: Military Emergency hospital department

access

. . . ***f ♦♦

door

cooline

10. Fig illtary Radiation center department:

Waiting room

1

ii

57

11.Fig: Tuga Specialized Hospital:

58

12.Fig: X-Ray Room Design In Yestabsheroon Department

References:[1] Jerrold T. Bushberg,J.Anthony Seibert, Edwinm. Leidholdt. Jr.. Johnm. Boone. Second

Edition (2002)- The Essential Physics Of Medical

[2] National Radiation Laboratory - Minstry Of Health -New Zlealand . January (1994)

Revised June (2010) -Code Of Safe Practice For The Use Of X-Rays In Medical Diagnosis-

christchurch new Zealand- issn 0110-9316-bag 26

[3] A Code Of Practice Issued By The Radiological Protection Institute Of Ireland-

Radiological Protection Institute Of Ireland. June (2009). The Design Of Diagnostic

Medical Facilities-Where Ionizing Radiation Is Used Where Ionizing Radiation Is Used -

[4] B.E.Keane- -K.B. Tikhonov Health Organization Geneva 1975. Manual On Radiation

Protection In Hospetals Physicist, Medical Physics Department And General Practcc-

Volume 3 X-Ray Diagnosis- Principal, Royal Sussex County Hospital Brighton Hngland

Central Research Institute For Rontgenology Leningrad , Ussr,

[5] Dorria Salem Prof. January (2011). Standard Specifications For Basic Diagnostic-

Radiology Department. The Purpose Of This Document. Of Radiology Cairo University-

Advisor Of He Minister Of Health Esrp Manager To Assist In Planning New Radiology

Departments And To Assist In Rehabilitating The Existing Radiology Departments.

Distribution / Target Group. Health System Planners, Radiologists, Governmental

Hospitals, Engineers.

[6] IAEA Post Grande Educational Course In Radiation Protection And Safety Use Of

Radiation Sources.

[71 Leonie Munro / Artist Line Diagram's- World Health Organization-(2004). Merle

Conway Creative Basic Of Radiation Protection For Every Day Used -How To Achieve

ALARA: Working Tips And Guidelines / Editors-Harald Ostensen- Gudrun Ingolfsdottir -/

Author / Digital Imaging -Fiona Walters

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