handout 2166- college on medical physics. digital imaging...
TRANSCRIPT
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2166-Handout
College on Medical Physics. Digital Imaging Science and Technology to Enhance Healthcare in the Developing Countries
Cornelius LEWIS
13 September - 1 October, 2010
King’s College Hospital
United Kingdom
Radiation Protection Audit
London
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ICTP Summer School 2010
Radiation Protection Audit
Dr Cornelius LewisKing’s College Hospital
London, UK
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ICTP Summer School 2010
Why Audit?
• Best practice• Legal compliance • Quality system (ISO 9000)
requirement
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ICTP Summer School 2010
Advisory Bodies
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ICTP Summer School 2010
• Recommendations form basis of RP internationally
• Main commission and four standing committees– Effects, Doses, Protection in
Medicine, Application of Recommendations
• Ad Hoc Task Groups and Working Parties
• Annals of the ICRP
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ICTP Summer School 2010
International Commission on Non-Ionising Radiation Protection
• All non-ionising• Established 1977 by ICRP• Four standing committees
– Epidemiology, Biology, Physics and Engineering, Optical Radiation
• Produce exposure guidelines, practical guides etc
• Publish in Health Physics & net
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ICTP Summer School 2010
• Measurements and Units• Up to 20 report committees• Publish own reports
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ICTP Summer School 2010
• Linked to United Nations• One concern is Protection of the
Human Environment• Undertakes studies of environmental
impact– Chernobyl– Depleted Uranium
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ICTP Summer School 2010
United Nations Scientific Committeeon the Effects of Atomic Radiations
• UNSCEAR• Established by UN General
Assembly• Assesses and reports on
exposures to ionising radiation in general
• Latest report UNSCEAR 2008
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ICTP Summer School 2010
Radiation Effects Research Foundation
• Formerly the Atomic Bomb Casualty Commission (ABCC)
• Laboratories in Hiroshima and Nagasaki
• Funded jointly by Japan and USA• Epidemiological research • Major publications on A-bomb
dosimetry (T65D and DS86)
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ICTP Summer School 2010
• US version of NRPB• National meetings
organised• Publications include;
– Reports, Commentaries, Reviews etc
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ICTP Summer School 2010
• Established to– advance knowledge of radiation protection– provide information
• Publications– “At-a-glance”; Bulletin; Reports; Documents of
the NRPB, Software• Provides RP services
Health Protection Agency
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ICTP Summer School 2010
• Established to– advance knowledge of
radiation protection– provide information
• Publications– “At-a-glance”; Bulletin;
Reports; Documents of the NRPB, Software
• Provides RP services
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ICTP Summer School 2010
E-Mail Lists• (UK) Medical-Physics-Engineering• (UK) Radiation Protection• (US) MedPhys• (US) Health Physics
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ICTP Summer School 2010
Why Audit?
• Best practice• Legal compliance • Quality system (ISO 9000)
requirement
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ICTP Summer School 2010
How Are Laws Made?
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ICTP Summer School 2010
ICRP Framework for Radiation Protection
Source
Individual
Practices Natural
Dose Constraints Intervention
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ICTP Summer School 2010
ICRP 103 FrameworkFor PRACTICES :
• Justification• Optimisation
– dose constraints• Limitation
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ICTP Summer School 2010
ICRP 103 FrameworkFor INTERVENTIONS:
• Justification• Optimisation
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ICTP Summer School 2010
EU Legislative Process
Commission
Council
Regulation,
Directive,
Judgement,
Recommendation
ECOSOC
European
Parliament
Impetus for legislation
Expert Group
National Interest Group
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ICTP Summer School 2010
EU Legislative Process - Basic Safety Standards
ECOSOC
European
Parliament
Commission
Council
Directive 96/29/Euratom
ICRP, IAEA, etc
Article 31
Group
Atomic
Questions
Group
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ICTP Summer School 2010
UK Legislative Process - Ionising Radiations Regulations
EU Directive
Dep. Trade and Industry
Parliament
Topic Groups
HSE HSE
Consultation
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ICTP Summer School 2010
IRR99
Ionising Radiations
Regulations 1999, Approved Code of
Practice and Statutory Guidance
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ICTP Summer School 2010
Governmental Bodies
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ICTP Summer School 2010
Compliance with Regulations• Inspectorate• Warrant cards• Powers of enforcement
– improvement notice– prohibition notice– prosecution
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ICTP Summer School 2010
Why Audit?• Best practice • Legal compliance • Quality system (ISO 9000)
requirement
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ICTP Summer School 2010
The Audit Process• Arrange time for visit
– allow sufficient time– ensure all responsible persons available
• Follow systematic protocol (audit checklist)• Provide written report• Follow up on action points
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ICTP Summer School 2010
Audit checklist categories• Follow up of previous recommendations• General questions• Records• Modality-specific questions
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ICTP Summer School 2010
General questions• Current workload• Staff issues• Follow up of visits from external agencies• Awareness of latest
information/documentation/regulation
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ICTP Summer School 2010
RecordsGeneral
• Personnel monitoring• Staff training
X-ray• QA• Equipment maintenance• PPE checks
Unsealed Sources• Contamination• Storage and Waste disposal
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ICTP Summer School 2010
Specific issues : X-ray examples
• Warning lights• Warning signs• Room shielding• Film reject analysis• Gonad protection
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ICTP Summer School 2010
Tube Assembly• Beam limiting
devices• Filtration
– Minimum flitration
– Filtration combinations
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ICTP Summer School 2010
Exposure Control• Use of AEC• Hand and foot switches• Emergency shut-off
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ICTP Summer School 2010
Fluoroscopy• Automatic brightness
control• Last image hold• Pulsed fluoroscopy
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ICTP Summer School 2010
Design features
• Low attenuation materials
• Dose monitoring equipment
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ICTP Summer School 2010
Testing and Maintenance• Regular servicing• Approved service agent• Regular QA
– Frequent baseline QA– QA after servicing
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ICTP Summer School 2010
Specific issues : Unsealed sources
• Adequacy of facilities– floor covering, sinks, drainpipes
• Storage of radioisotopes• Accumulation/disposal of
radioactive waste• Availability of spill kit• Contamination monitor(s)
condition/calibration
Radioactive MaterialRadioactive Material Radioactive Material Radioactive Material
XXX X X
COUNTER
STORE
PARTITION
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ICTP Summer School 2010
Training• Practitioner and Operator• Theoretical and practical
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ICTP Summer School 2010
Inspectors’ Comments
BSS IRR99Health and Safety Executive
BSS RSA93Environment Agency
MED IR(ME)R2000Care Quality Commission
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ICTP Summer School 2010
IRR99 (BSS)
• Poor Supervision and Training • Inadequate Local Rules/SoW
– some too long, some too short• RPS not of sufficient standing• Inadequate QA• Poor understanding of radiation dose
concepts• Poor control of external engineers
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ICTP Summer School 2010
RSA93 (BSS)
• Records not up to date• Records inaccurate• Certificates not displayed• Storage areas inadequate• Facilities in disrepair
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ICTP Summer School 2010
IR(ME)R2000 (MED)• Responsibilities not clarified• Prescribers (Referrers) not properly
identified• Referral guidelines not available/not
disseminated• Poor procedures for
– identification of patient– determining pregnancy