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Health Physics Feb 2019Radiation protection in brachytherapy entails protecting members of the public, radiation professionals, and the patient from unnecessary radiation, as well as making...
Radiation protection in brachytherapy entails protecting members of the public, radiation professionals, and the patient from unnecessary radiation, as well as making sure that the radiation used in the patient's treatment is placed correctly with the correct dose distribution. Protecting members of the public from radiation emanating from brachytherapy sources implanted in a patient was an issue several decades ago, but with modern brachytherapy, the problem has mostly disappeared. The most frequent treatments are either low-dose-rate permanent implants for prostate cancer, or high-dose-rate procedures for gynecological, breast, or skin cancers. Almost all current permanent implants use low-energy photon sources that are shielded by the patient. Similarly, some temporary implants, such as eye plaques that also use low-energy photon sources, incorporate a metallic shield into the applicator. All high-dose-rate brachytherapy takes place in a treatment vault, in a manner similar to external-beam radiotherapy, thus eliminating exposure to members of the public, in the absence of some terrible error or mistake. Modern brachytherapy techniques either eliminate or greatly reduce radiation exposures to the brachytherapy staff also. As noted above, high-dose-rate treatments take place in a heavily shielded vault, and staff remain outside the vault when the source is out of its shielded housing. For low-energy permanent implants, facilities often order the sources loaded into the implant needles by the vendor, reducing the time the procedure staff is exposed to the source. Often, the loaded needles can be shielded while awaiting implantation. Alternatively, individual sources may be placed using a special applicator that shields the staff. Radiation protection of the patient in many respects differs little from how it was decades ago except for greatly increased precision. Assaying the strength of a source of any kind is still essential. As important as verifying the source strength is ensuring that the source will be in the correct location for the desired time. Imaging serves as the main mechanism to guide the implantation and verify source or applicator position. Modern imaging has unveiled anatomy exquisitely and often permits definition of target disease and neighboring normal structures sufficiently to allow very conformal dose distributions. Despite these great advances and capabilities, errors and mistakes (together called failures) still occur. Failures in health care overall are the third leading cause of death in the United States. Most treatment failures result not from equipment problems but from procedures gone wrong. Attention to comprehensive commissioning of both equipment and procedures and risk-based development of quality management procedures helps protect the patient. Patient safety organizations, established by the Agency for Healthcare Research and Quality, work with client facilities to help identify weaknesses in both treatment procedures and quality management and to develop improvements to enhance protection.
Topics: Brachytherapy; Humans; Patient Safety; Quality of Health Care; Radiation Protection
PubMed: 30585963
DOI: 10.1097/HP.0000000000001005 -
Archivos de Cardiologia de Mexico 2015INTERVENTIONAL: cardiology progress makes each year a greater number of procedures and increasing complexity with a very good success rate. The problem is that this... (Review)
Review
INTERVENTIONAL: cardiology progress makes each year a greater number of procedures and increasing complexity with a very good success rate. The problem is that this progress brings greater dose of radiation not only for the patient but to occupationally exposed workers as well. Simple methods for reducing or minimizing occupational radiation dose include: minimizing fluoroscopy time and the number of acquired images; using available patient dose reduction technologies; using good imaging-chain geometry; collimating; avoiding high-scatter areas; using protective shielding; using imaging equipment whose performance is controlled through a quality assurance programme; and wearing personal dosimeters so that you know your dose. Effective use of these methods requires both appropriate education and training in radiation protection for all interventional cardiology personnel, and the availability and use of appropriate protective tools and equipment. Regular review and investigation of personnel monitoring results, accompanied as appropriate by changes in how procedures are performed and equipment used, will ensure continual improvement in the practice of radiation protection in the interventional suite.
Topics: Cardiac Catheterization; Humans; Practice Guidelines as Topic; Radiation Protection; Radiography, Interventional
PubMed: 26169040
DOI: 10.1016/j.acmx.2015.05.005 -
Seminars in Nuclear Medicine May 2014As authorized users of radioactive material, nuclear medicine (NM) physicians play a leading role in the use and management of these agents. Regarding patient... (Review)
Review
As authorized users of radioactive material, nuclear medicine (NM) physicians play a leading role in the use and management of these agents. Regarding patient management, NM physicians are responsible for ensuring both the appropriateness of exams and the associated patient doses. Along with radiologists, NM physicians are the ones developing and implementing processes that provide guidance to and dialog with referring physicians to ensure that patients receive the most appropriate type of imaging exams. Regarding regulatory compliance, in collaboration with radiation safety officers, NM physicians are the ones educating their staff about principles of radiation protection and radiation safety with adherence to regulations from agencies such as the Nuclear Regulatory Commission, the Department of Transportation, the Environmental Protection Agency, and the Food and Drug Administration. On occasion, these regulations and standards can be difficult to comprehend. This article is intended to serve as a condensed guide for NM physicians who are in the process of applying for a radioactive materials license, establishing a new radiation protection program, or want to ensure continued compliance and maintenance of safety and security of licensed materials in the clinical or research settings.
Topics: Environmental Exposure; Humans; Nuclear Medicine; Physicians; Radiation Protection; Social Control, Formal
PubMed: 24832587
DOI: 10.1053/j.semnuclmed.2014.03.005 -
Annals of the ICRP Oct 2018The use of proton therapy as a treatment modality is becoming more widespread in conventional radiation therapy practice. Commercialisation and introduction of compact... (Review)
Review
The use of proton therapy as a treatment modality is becoming more widespread in conventional radiation therapy practice. Commercialisation and introduction of compact systems has led to embedding of proton therapy facilities in existing hospital environments. In addition, technologically, proton therapy is currently undergoing an important evolution, moving from passive scattering delivery techniques to active pencil beam scanning, adopting image guidance techniques from conventional radiotherapy and introducing various range verification techniques in the clinic. An overview is given of today's technological evolution of proton therapy in clinical environments, and its impact on aspects of radiation protection.
Topics: Humans; Proton Therapy; Radiation Protection
PubMed: 29714076
DOI: 10.1177/0146645318756252 -
Radiation Protection Dosimetry Oct 2014The present system of radiation protection for neutrons is reviewed with particular reference to the development of the protection quantities and their relationships... (Review)
Review
The present system of radiation protection for neutrons is reviewed with particular reference to the development of the protection quantities and their relationships with the operational quantities. Some of the shortcomings of the system are outlined, and the difficulties of measuring the operational quantities. Suggestions are made for future developments.
Topics: Humans; Neutrons; Radiation Dosage; Radiation Monitoring; Radiation Protection; Radiation, Ionizing; Radiometry; Risk
PubMed: 24336117
DOI: 10.1093/rpd/nct303 -
Radiation Protection Dosimetry Sep 2011When planning good management of ionising radiation in medicine, key factors such as ensuring that health professionals work together and convincing them that radiation... (Review)
Review
When planning good management of ionising radiation in medicine, key factors such as ensuring that health professionals work together and convincing them that radiation protection (RP) represents a substantial part of the quality management system in their clinical practice are of utmost importance. The United Nations Scientific Committee on the Effects of Atomic Radiation has decided that one of the thematic priorities will be medical radiation exposure of patients. The International Commission on Radiological Protection has recently updated the report on RP in medicine and continues to work on focused documents centred on specific areas where advice is needed. The roles of the International Atomic Energy Agency, World Health Organization and the European Commission, in the area of RP in medicine, are described in the present document. The industry, the standardisation organisations as well as many scientific and professional societies are also dedicating significant effort to radiation safety aspects in medicine. Some of the efforts and priorities contemplated in RP in medicine over the coming years are suggested. The best outcome will be accomplished when all the actors, i.e. medical doctors, other health professionals, regulators, health authorities and the industry manage to work together.
Topics: Humans; International Agencies; Medicine; Radiation Injuries; Radiation Protection
PubMed: 21725079
DOI: 10.1093/rpd/ncr265 -
Der Radiologe Jul 2017In Germany, persons who are to be exposed to radiation for medical research purposes are protected by a licensing requirement. However, there are considerable... (Review)
Review
BACKGROUND
In Germany, persons who are to be exposed to radiation for medical research purposes are protected by a licensing requirement. However, there are considerable uncertainties on the part of the applicants as to whether licensing by the competent Federal Office for Radiation Protection is necessary, and regarding the choice of application procedure.
AIM
The article provides explanatory notes and practical assistance for applicants and an outlook on the forthcoming new regulations concerning the law on radiation protection of persons in the field of medical research.
MATERIALS AND METHODS
Questions and typical mistakes in the application process were identified and evaluated.
RESULTS AND DISCUSSION
The qualified physicians involved in a study are responsible for deciding whether a license is required for the intended application of radiation. The decision can be guided by answering the key question whether the study participants would undergo the same exposures regarding type and extent if they had not taken part in the study. When physicians are still unsure about their decision, they can seek the advisory service provided by the professional medical societies. Certain groups of people are particularly protected through the prohibition or restriction of radiation exposure. A simplified licensing procedure is used for a proportion of diagnostic procedures involving radiation when all related requirements are met; otherwise, the regular licensing procedure should be used. The new radiation protection law, which will enter into force on the 31st of december 2018, provides a notification procedure in addition to deadlines for both the notification and the licensing procedures. In the article, the authors consider how eligible studies involving applications of radiation that are legally not admissible at present may be feasible in the future, while still ensuring a high protection level for study participants.
Topics: Biomedical Research; Decision Making; Germany; Humans; Licensure; Radiation Exposure; Radiation Protection; Societies, Medical
PubMed: 28660297
DOI: 10.1007/s00117-017-0264-5 -
Physica Medica : PM : An International... Aug 2018The International Atomic Energy Agency (IAEA) organized the 3rd international conference on radiation protection (RP) of patients in December 2017. This paper presents... (Review)
Review
INTRODUCTION
The International Atomic Energy Agency (IAEA) organized the 3rd international conference on radiation protection (RP) of patients in December 2017. This paper presents the conclusions on the interventional procedures (IP) session.
MATERIAL AND METHODS
The IAEA conference was conducted as a series of plenary sessions followed by various thematic sessions. "Radiation protection of patients and staff in interventional procedures" session keynote speakers presented information on: 1) Risk management of skin injuries, 2) Occupational radiation risks and 3) RP for paediatric patients. Then, a summary of the session-related papers was presented by a rapporteur, followed by an open question-and-answer discussion.
RESULTS
Sixty-seven percent (67%) of papers came from Europe. Forty-four percent (44%) were patient studies, 44% were occupational and 12% were combined studies. Occupational studies were mostly on eye lens dosimetry. The rest were on scattered radiation measurements and dose tracking. The majority of patient studies related to patient exposure with only one study on paediatric patients. Automatic patient dose reporting is considered as a first step for dose optimization. Despite efforts, paediatric IP radiation dose data are still scarce. The keynote speakers outlined recent achievements but also challenges in the field. Forecasting technology, task-specific targeted education from educators familiar with the clinical situation, more accurate estimation of lens doses and improved identification of high-risk professional groups are some of the areas they focused on.
CONCLUSIONS
Manufacturers play an important role in making patients safer. Low dose technologies are still expensive and manufacturers should make these affordable in less resourced countries. Automatic patient dose reporting and real-time skin dose map are important for dose optimization. Clinical audit and better QA processes together with more studies on the impact of lens opacities in clinical practice and on paediatric patients are needed.
Topics: Humans; Occupational Exposure; Patient Safety; Radiation Protection
PubMed: 30139610
DOI: 10.1016/j.ejmp.2018.06.634 -
Radiation Protection Dosimetry 2004Aircraft crew and frequent flyers are exposed to elevated levels of cosmic radiation of galactic and solar origin and secondary radiation produced in the atmosphere, the... (Review)
Review
Aircraft crew and frequent flyers are exposed to elevated levels of cosmic radiation of galactic and solar origin and secondary radiation produced in the atmosphere, the aircraft structure and its contents. Following recommendations of the International Commission on Radiological Protection in Publication 60, the European Union introduced a revised Basic Safety Standards Directive, which included exposure to natural sources of ionising radiation, including cosmic radiation, as occupational exposure. The revised Directive has been incorporated into laws and regulations in the European Union Member States. Where the assessment of the occupational exposure of aircraft crew is necessary, the preferred approach to monitoring is by the recording of staff flying times and calculated route doses. Route doses are to be validated by measurements. This paper gives the general background, and considers the radiation protection aspects of the cosmic radiation exposure of aircraft crew, with the focus on the situation in Europe.
Topics: Aircraft; Calibration; Cosmic Radiation; Humans; Occupational Exposure; Radiation Protection; Radiometry
PubMed: 15273353
DOI: 10.1093/rpd/nch311 -
The British Journal of Radiology Aug 1959
Topics: Equipment and Supplies; Radiation Protection
PubMed: 13851378
DOI: 10.1259/0007-1285-32-380-557