Medical Radiation Safety

Lesson 1: Objectives

In this course you will learn about the:

 Different sources of radiation used in medical facilities;

 The health effects of ionizing radiation;

 And steps you can take to minimize your exposure.

the exposure.

Lesson 2: Radiation Basics

Radiation is the process of producing invisible energy in the form of waves and

particles. Radiation occurs naturally or is man-made. Naturally-occurring radiation

comes from radioactive materials that exist in nature, such as from outer space, rocks

and soil, and the human body, and accounts for about half of a person’s annual

exposure. The other half comes from man-made radiation sources, primarily medical

procedures.

Radioactive materials are materials that are unstable. They emit ionizing radiation in

an attempt to become stable, non-radioactive materials. Precautions need to be taken

to minimize or prevent exposure to the radiation emitted and to prevent the spread of

radioactive contamination on a person or throughout a facility.

Since ionizing radiation can change living cells, it creates some health risk. That is why

your organization addresses the issue of safety and maintains a radiation-friendly

environment.

Quiz Question:

Lesson 3: Sources of Radiation at Medical Facilities

Sources of radiation include diagnostic radiology, nuclear medicine and radiation

therapy.

Diagnostic radiology refers to the use of ionizing radiation to create images of the

human body for clinical purposes. At your organization, personnel may work near

radiation sources such as:

 X-Rays

 Fluoroscopy

straight line at the speed of light and cannot be seen, tasted, smelled or felt. It can also

be produced at different levels of energy. A small amount of radiation scatters in other

directions. If you are near one of these sources at the time of exposure, you may be

asked to wear a lead apron or stand behind some equipment for shielding.

When used within a Radiology Department or another fixed location, these sources are

typically enclosed within lead walls and access is restricted to keep out non-radiation

personnel, except when medically necessary. Some of the sources are portable (or

mobile) however and may be used outside of the Radiology Department, such as in the

Emergency Department, Operating Room or patient room. When using portable

A small amount of radiation can scatter from the straight line and put others in the area

at risk.

Lesson 4: Sources of Radiation – Diagnostic Nuclear Medicine

(NOTE: This lesson may be removed from the course for your organization)

medicine scan because of the natural process of radioactive decay. These individuals

do not require special precautions for staff safety because the amount of radioactive

material administered is low and therefore the radiation dose to others is minimal.

Your organization may perform diagnostic nuclear medicine procedures such as:

 Myocardial Perfusion Scanning

 Positron Emission Tomography (PET)

 Thyroid Scan and Uptake

Lesson 5: Sources of Radiation – Therapeutic Nuclear Medicine

(NOTE: This lesson may be removed from the course for your organization)

In therapeutic nuclear medicine procedures, radioactive substances are administered to

individual intravenously or orally to treat disease. In doing so, these

“radiopharmaceuticals” mix with the individual’s body fluid, making the blood, urine,

saliva and perspiration radioactive. Some facilities choose to treat the individuals in-

house until the level of radioactive material in their body is low enough to send them

home. Because of the higher amount of radioactive material used in therapeutic

Quiz Question:

During therapeutic nuclear medicine procedures the individual’s body fluids are

radioactive.

Lesson 6: Sources of Radiation – Radiation Therapy

(NOTE: This lesson may be removed from the course for your organization)

than is possible with external radiation treatment. The radioactive material is enclosed

and implanted within or next to the tumor. While the implant is in place, there is a large

amount of radioactive material in the individual. When the implant is removed, all

radioactive material is gone. For these procedures, the individual remains in the facility

until the radioactive source is removed. Your organization may perform internal

radiation therapy such as brachytherapy.

External radiation therapy is a procedure in which a source of radiation outside the body

is used to treat cancer cells or a tumor. A beam of radiation leaves the source and

irradiates the tumor. The individual does not become radioactive with this type of

An individual with an internal radiation implant has a large amount of radioactive

material in their body.

Lesson 7: Steps to Minimize Your Exposure to Ionizing Radiation While at Work

While radiation is used to help diagnose and treat disease, exposure to high levels can

be harmful. The effects of exposure to ionizing radiation depend on how much radiation

Standard precautions refer to the practice of avoiding contact with an individual’s bodily

fluids by means of wearing personal protective equipment such as gloves, lab coats or

other disposable garments. Standard precautions should be followed with all individuals,

not just those receiving radiation.

Quiz Question:

Standard precautions should only be used with individuals receiving radiation.

(NOTE: This lesson may be removed from the course for your organization)

Radioactive substances or radiopharmaceuticals used for diagnostic and therapeutic

nuclear medicine procedures may be accidentally internally deposited in your body

through inhalation, ingestion and absorption. These exposures can occur when

radioactive substances are inhaled and absorbed by the lungs; are present in

contaminated food or drink; or are spilled onto the skin or enters through cuts or

scratches. Internal deposition may also result from contaminated hands with

subsequent eating or rubbing of the eyes. Precautions should be taken to avoid each of

these means of internal exposure to radioactive substances. Wearing protective

Lesson 10: External Exposure Precautions

There are three major ways to minimize your external exposure to radiation:

1. Distance – Increase the distance between the radioactive source and yourself.

As radiation travels from the source, it spreads out becoming less intense.

2. Time – Spend less time around radiation sources to limit your exposure.

sources, and properly shield yourself.

Lesson 11: ALARA

ALARA is an acronym for As Low As Reasonably Achievable. All organizations and

personnel are responsible for taking steps to keep radiation doses to all people ALARA.

Your organization follows this radiation safety principle by establishing procedures

personnel are to follow and utilizing reasonable methods that minimize radiation doses

Lesson 12: Monitoring for Radiation Exposure

Individual monitoring equipment is used to detect and measure radiation to which you

may have been exposed. It is the most important monitor to determine your risk from

radiation on the job. There are different types of monitoring devices available. Personnel

who are likely to be exposed to radiation may wear monitoring equipment. The millirem

(mrem) is a unit of radiation dose. The annual allowable limit is 5,000 millirems whole

body radiation dose for occupationally exposed radiation workers.

The following personnel may wear monitoring equipment in your organization:

 Clinical Equipment engineers

 Staff caring for the Iodine-131 therapy patient

Quiz Question:

Which of the following measures the amount of radiation you have been exposed to on

the job?

a. ALARA

b. *Individual monitoring equipment

A radiation “caution” sign will tell you when radiation precautions are in effect. Do not

enter rooms containing radiation generating equipment or radioactive substances

without authorization. If you must be in an area where radiation is being generated

follow the directions of the appropriate personnel for personal protection procedures.

Lesson 14: Radiation Safety Concerns and Pregnant Workers

Exposure to radiation while pregnant can involve exposure to the embryo or fetus. The

maximum permissible exposure to the embryo or fetus of a declared pregnant worker

during the gestation period is 500 mrem. Declaring the pregnancy to your employer is

voluntary. The pregnant worker must notify appropriate personnel in writing in order for

the prenatal exposure limits to take effect. Pregnant personnel working within areas in

which radiation or radioactive materials are used may be assigned additional monitoring

equipment.

Lesson 15: Radioactive Contamination Concerns

(NOTE: You may wish to add-on your organization’s policy regarding radioactive spills,

including proper notification of appropriate personnel)

(NOTE: This lesson may be removed from the course for your organization)

Contamination occurs when material that contains radioactive atoms is deposited on

materials, skin, clothing, or any place where it is not desired. A person contaminated

with radioactive material will receive radiation exposure until the source of radiation is

removed. A person is externally contaminated if radioactive material is on the skin or

Quiz Question:

A person contaminated with radioactive material will receive radiation exposure until the

source of radiation is removed.

*True or False

Lesson 16: Magnetic Resonance Imaging

(NOTE: This lesson may be removed from the course for your organization)

 Projectiles: As a result of the very high strength of the magnetic field needed

to produce scans there are several safety issues. Missile-effects accidents,

where magnetic objects are attracted to the center of the magnet, have

resulted in injury and death. It is for this reason that magnetic objects and

devices are prohibited in proximity to the MRI scanner, with non magnetic

versions of many of these objects typically retained by the scanning facility.

Only use equipment that has been approved for use during MRI scans. The

magnetic field remains a permanent hazard – the superconductive MRI

magnet retains its magnetic field at all times. Never attempt to run a cardio-

pulmonary arrest code or resuscitation within the MR magnet room itself.

oxygen and, therefore, risk of asphyxiation. Spontaneous quenches are

uncommon, but can occur at any time.

Quiz Question:

The magnets in the MRI scanner are always “on”.

problems identified, are documented. If your organization provides fluoroscopic

services, the cumulative-air kerma or kerma-area product are documented in a

retrievable format. For equipment that cannot display or provide cumulative-air kerma or

kerma-area product, fluoroscopy time and number of images acquired are documented

in a retrievable format. Your organization has also identified radiation exposure and skin

dose threshold levels, that if exceeded, trigger further review, analysis and evaluation to

assess for adverse radiation effects on the individual. If your organization provides

diagnostic CT imaging, the organization has established and adopted protocols based

on current standards of practice.

Your organization has designated an individual to serve as the radiation safety officer.

This individual is responsible for ensuring radiologic services are provided in

accordance with law, regulation, and organizational policy.

Lesson 18: Conclusion

(NOTE: You may wish to display contact information for the appropriate personnel to

contact within your organization.)

materials, contact the appropriate personnel within your organization for guidance and

assistance.

Reducing the risk of adverse health effects from radiation exposure greatly depends on

you. Together, everyone can keep the workplace safe.

Lesson 4: Oral Medications

sublingual and buccal medications, syrups, elixirs, suspensions, and sustained and

the patient/resident. Do not warm refrigerated medications unless specifically instructed

to do so.

Allow the patient/resident to take oral medications independently when able. Encourage

patients/residents to swallow tablets, caplets, and capsules whole. Enteric coated,

sustained and extended-release medications must not be crushed. Shake all

suspensions and syrups thoroughly. Determine if an elixir can be mixed with water or

juice to alter or improve the taste. With children, consider the use of medication cups

and sipping syringes. Allow a parent or caregiver to administer the medication with your

supervision or assistance. Insert liquids into the side of the mouth to reduce the amount

of medication the child may spit out. Any medications administered through a feeding

*should not be removed from individually labeled packages until you are with the

patient/resident and ready to administer

should be warmed if refrigerated prior to administration

*should be taken independently by the patient/resident when able

such as enteric coated, sustained and extended-release medications must be crushed

*administered through a feeding tube should be in liquid form whenever possible

Lesson 5: Injectable Medications

Types of injectable medications include intramuscular, subcutaneous, and intradermal.

Injectable medications should be left in pre-filled labeled syringes whenever possible.

When syringes are prepared, they must be labeled with patient/resident identification

Determine the appropriate injection site based on the age and size of the

patient/resident, his/her preference, and the type and amount of medication being

administered.

Determine the appropriate method for preparing the site for the injection.

Following administration apply a dressing or band-aid only if there is bleeding at the

site. Wiping the site with alcohol is not required after an injection and can cause local

skin irritation and burning.

Vaccines are regulated by the local health department and require special techniques

and considerations. There may be additional documentation requirements as well.

Types of intravenous (IV) medications include intravenous solutions, premixed

evidence in peer-reviewed biomedical literature, or in accordance with approved

institutional guidelines. Dilution of medications prior to IV push administration should

occur in the pharmacy before dispensing the medication. If dilution of a medication is

necessary outside of the pharmacy, your organization will take steps to provide ready

access to the proper diluent and instructions for dilution to support safe practice. A

saline flush may need to be prepared. IV push medication is kept in its original package

unless it is mixed with a diluent in a larger syringe. Most IVPB medication is kept in a

refrigerator until about 30 minutes prior to use. All medications must be labeled

according to your organization’s policy.

Prior to administering an IV medication, evaluate the location of the IV site and the size

of the blood vessel. For IV solutions, determine the infusion rate. If a IVPB or IV push

the compatibility of the medication with the solution.

Phlebitis is the inflammation of a vein and can be evidenced by localized redness, heat

and swelling, which can track further along the length of the vein, eventually leading to

induration (or hardness) and a “palpable venous cord”. Phlebitis is precipitated by

mechanical, chemical, or infective causes. If a patient/resident with a peripheral venous

catheter develops signs of phlebitis, remove the catheter, elevate the extremity, and

apply a warm compress as directed.

The unintentional leakage of vesicant (or blistering) fluids or medications from a vein

into the surrounding tissues, called extravasation, can be evidenced by swelling and

may have formed within the catheter. Do not flush the catheter forcefully because this

can dislodge a clot into circulation.

If the catheter is a central line, notify the LIP as soon as possible and avoid using the

catheter.

Quiz Question:

All of the following are treatments for phlebitis except:

a. Removal of catheter

b. Application of a warm compress

c. Elevation of extremity

Follow your organization’s policy regarding documentation requirements for medication

administration. For example, you may be required to document the date and time the

assessment of the IV site accessed for the administration of an IV medication. You may

The patient/resident should be educated on the purpose of the medication, intended

effects and possible or expected side effects, how to respond to side effects, the

medication name and its qualities, instructions such as whether the medication should

how to respond to and monitor a patient/resident in the event of an ADR, LIP and/or

prescriber notification, documentation, and reporting requirements.

Quiz Question:

An adverse drug reaction is an unwanted or harmful reaction experienced following the

administration of a medication or combination of medications under normal conditions of

patient/resident wearing an incorrect allergy band or no band, failure to clarify a written

order that is incomplete, illegible, or unclear, failure to verify a verbal or telephone order,

or sound alike, medical abbreviations, and failure to use drug information resources.

Quiz Question:

e. Medications that look alike or sound alike

c. Right Route

every 4 hours and the usual dosing is every 8-12 hours?

d. Viscosity of the medication

patient/resident and route of medication administration.

10. Oral medications must never be taken independently by the patient/resident.

11. Enteric coated, sustained and extended-release medications must be crushed.

12. Medications administered through a feeding tube should be in liquid form whenever

possible.

13. Oral medications should not be removed from individually labeled packages until you

14. Injectable medications should be administered at the refrigerated temperature

because the coolness makes the medication hurt less.

15. Medications removed from a multidose container should be placed in a clearly

medication use or harm while the medication is in the control of the health care

professional or patient/resident.