Radiation Safety: What Practice Managers Need to Know
Radiography is a vital tool in diagnosis and treatment of patients. However, equally vital is a practice's radiation safety program — the procedures and policies put in place to keep team members and patients safe by reducing their exposure to radiation.
State or OSHA?
Certain states (Ala., Ariz., Ark., Calif., Colo., Fla., Ga., Idaho, Kan., Ky., La., Md., Miss., Nev., N.H., N.Y., N.C., N.D., Ore., S.C., Tenn., Texas, and Wash.) have OSHA-approved state radiation protection programs; all other states' regulations are enforced by OSHA. If you're unsure whether to follow OSHA or state guidelines, pick the guidelines that are most stringent and stick with those. Let's examine some ways you can ensure your radiation safety culture is adequate.
Protection Is Key
To begin, let's clear up a common misconception: Digital radiography (DR) and Computed Radiography (CR) are just as risky as traditional radiography. While the exposure needed to capture the image is lower than with traditional radiography, this does not mean your team can forego the use of personal protective equipment (PPE). OSHA and all states with a radiation protection culture require the use of aprons, thyroid shields, and gloves when restraining a pet for a radiograph.
Tips for Reducing Exposure
- Use appropriate PPE: Most staff members are accustomed to wearing an apron, but remind them that OSHA requires the use of gloves and insist that they use thyroid collars as well. PPE must be worn when taking dental radiographs also, unless the operator is behind a protective shield (a barrier that cannot be penetrated by radiation).
- Collimate the beam: By reducing the size of the beam to expose only the area of interest, you reduce the amount of radiation the patient is exposed to, and narrow the field from which scatter radiation will be produced.
- Use sedation: When a patient is not cooperative and will not lie still during the radiograph, use light sedation to achieve the desired results. This will reduce the number of retakes that are necessary and prevent staff from having to stand too close to the patient in order to effectively restrain them.
- Adjust radiation dose: Adjustments should be made based on requirements of the imaging system, patient size and anatomy, and the ability of image processing software to enhance the image to achieve optimal diagnostic image quality.
Maintaining Equipment Standards
As important as reducing exposure is ensuring that your machines and PPE are in good working order. Keeping equipment up to code is a crucial part of maintaining your facility. All machines should be inspected annually (unless otherwise noted by state regulations) and PPE should be inspected every 6 months. To ensure PPE is adequate, simply radiograph each piece in its entirety. If there are cracks or other indications of exposure, dispose of those pieces and order new ones right away. Do not continue using damaged equipment or PPE. Keep a radiation safety log where inspection dates and results are recorded. Assign a radiation safety officer to be accountable for ensuring that equipment and PPE are in good working order and inspected appropriately.
All team members who may be called on to assist with a radiograph should be assigned a dosimeter badge. This badge monitors the level of radiation exposure to individuals. Badges should be stored away from the radiation area and should never be worn outside, as exposure to the sun can falsely elevate the reading. The control badge should be kept in the manager's office. Badges are mailed to a monitoring facility quarterly and new badges are issued. You are required to keep the exposure reports received from the monitoring facility indefinitely.
Make It Official Policy
Create a written radiation safety policy and have all team members sign it, even those who don't expect to be involved with radiographs. All new hires should sign the policy as part of their onboarding and all team members should sign again annually. It should be clear that failure to adhere to safety protocols is grounds for immediate termination.