The paucity of data institutional compliance to internationally recognized and accepted radiation protection protocols elicited the interest that gave rise to the decision to carry out an independent external audit assessment of radiation protection compliance in the Nuclear Medicine Department in East Tennessee Hospital.
Objective: To determine the extent of institutional and professional compliance to standardized criteria, procedures and the use of protection equipment as prescribed in the institutionalized radiation safety protocol. Second, to assess the level of knowledge of junior workers in the Nuclear Medicine Department and third, to propose a study to expand on safety procedures that are currently in practice.
Methods: Two safety measures: adherence to personal safety devices, and participation in the establishment, implementation and operation of the Radiation Protection rules in the hospital were taken through the study to determine the consistency of compliance. To establish the level of knowledge of radiation and radiation protection measures, the study administered questionnaires whose findings were correlated to the data derived from personal dose measurements derived from a series of thin layer ultra sensitive MCP-Ns dosimeters that were attached together with individual protection devices.
Results: Consistency for adherence to personal safety devices was extremely high(76%), while the latter was extremely low(35%). 60% of NM Department were in possession of valuable but basic knowledge on particles of atom, the emission of energy, and basic radiation protection devices.
Conclusion: There was an appreciably high level of compliance to institutionalized criteria and procedures for radiation protection in the Nuclear Medicine Department.
Radiation is basically classified as either non ionizing or ionizing. This classification is dependent on the radiations ability to ionize matter. Ionizing radiations can either ionize matter directly of indirectly. Directly ionizing radiations are sometimes called charged particles. They include; protons, electronics, alpha particles and heavy ions. These particles deposit energy in mediums through direct Coulomb interactions between the orbital; atoms contained in the medium and the directly charged particle. Indirectly ionizing radiations or neutral particles include photons such as x-rays and gamma rays, and neutrons. Unlike the directly charged particles, these photons and neutrons deposit energy into the medium in line with a two step process. The first step involves the release of the particle into the medium followed by a second step that involves the deposition of energy into the target medium through direct Coulomb interactions.
These interactions define the importance of radiations in the treatment of diseases in nuclear medicine. The safety of these interactions can only be determined when radiation detection devices and measurements are used to assess the quantities of radiation energy deposited in the medium; usually, cells, tissues or organs in nuclear medicine. These dosimetric measurements are presented as levels of exposure, absorbed dose or equivalent dose, or kerma. These measurements and the calculations of the response of a medium radiation doses, define the safety standards for radiation exposure to health professionals and patients in the delivery of nuclear medicine.
These safety measurements seek to prevent the occurrence of the biological effects of therapeutic radiation as these factors are predominantly dependent on the nature of ionizing radiation, dose, dose rate, administration route and the types of radiation exposure in addition to factors like the age, health status and gender of the patient. Such an assessment also serves in ensuring that high accuracy is achieved to produce the desired results and the complications thereof be in agreement with acceptable levels (Noz et al 2007).
Hospitals with the capacity to offer nuclear medicine interventions usually ensure that radiation safety protocols are complied by in accordance to internal control systems which are either adoptions or slight modifications of the internationally recognized and accepted radiation protection protocols. These internal control systems are basically standardized criteria, procedures and protection equipment. To assess the level of compliance to these internal control systems, a study was carried out in the Nuclear Medicine Department; East Tennessee hospital.
Two safety measures: adherence to personal safety devices, and participation in the establishment, implementation and operation of the Radiation Protection rules in the hospital were taken through the study to determine the consistency of compliance. An estimate of attendance to the bi-weekly program was done through a follow up of attendance capacity in addition to a retrospective study of past attendance records.
To establish the effect of the level of knowledge on adherence to standard safety protocols, Nuclear Medicine workers were issued with a questionnaire detailing basic knowledge on particles of atom, the emission of energy, and basic radiation protection devices. The questionnaire also sought to collect and collect opinions of whether the Department was doing enough to ensure that occupational exposure to radiation was minimized. Data from these questionnaires were correlated to the data derived from personal dose measurements derived from a series of thin layer ultra sensitive MCP-Ns dosimeters that were attached together with individual protection devices.
Results and Conclusion
Consistency was not achieved for all the three safety techniques taken through the observational study. Consistency for adherence to personal safety devices was extremely high(76%), while attendance in the bi weekly Radiation Protection Program aimed at the encouragement of participation in the establishment, implementation and operation of the Radiation Protection rules in the hospital was extremely low(35%). This may have been lack of collaborative discussions and consequently team decision making the lower cadres of employees in the Nuclear Medicine Department unwilling to contribute their views on safety.
Of the 15 Nuclear Medicine Department employees enshrined in the study, 60% were in possession of relevant knowledge on particles of atom, the emission of energy, and basic radiation protection devices. The remaining 40% were barely in possession of such information and only adhered to the stringent radiation protection protocols only as a way of routine. When analyzed to the other fraction, these workers had extremely high levels of radiation absorption as shown by a comparison of dosimetric meters. However, this correlation is not conclusive and is subject to additional complex study since there are so many factors that influence the level of exposure to radiations.
Given the low level of compliance to the safety measures , there is need of an inclusion of an external assessment body that is independent from the professional quality management systems that carry out compliance assessments in hospitals. Such a study would develop novel methods for assessing the response to quality improvement strategies in the hospital. Such a model would also serve as a tool for comparable assessments of radiation standard protection between hospitals. This on site assessment for an appreciable period of time will not only take into account the structural variabilities between hospital facilities and their effect on compliance but also the effect of structural variabilities on the levels of radiations dosage within the hospital establishment.
Noz, E. Marilyn., Maguire, Q. Gerald., & Maguire, Q. Gerald Jr. (2007). Radiation Protection in the Health Sciences: (with Problem Solutions Manual).Edition: 2, World Scientific