Radiation Protection Review

Hi. So in this lecture we'll have a review of the radiation protection. All the necessary information that you need to learn about radiation protection, the principles and standards and the regulatory compliance here in the Philippines. Okay? Some of which we've already discussed, some of which I've added. No, so that you'll have strong foundation of radiation protection. So radiation protection is not about avoiding radiation completely. Okay. It is being able to use radiation and cause very minimum damage to the living tissue. So as we know you have two uses of your radiation. It can be diagnostic or therapeutic and we should use it following your um high standards of justification, optimization and those limitation. Okay. So why do we need radiation protection? Because ionizing radiation has uh enough energy to remove electrons creating ions and these ions may damage DNA. Okay. cell tissues and organs biologic effect. So what are those types of of effects? Okay, you can identify it by its probability to who it will occur and when it will occur. So when we say probability, you have deterministic and stoastic. Okay, deterministic is that there is certain threshold para mag occur effect. Okay, for stochastic there is no threshold but there is increase in probability. Somatic is the effect will happen to the one who is exposed. All right. And genetic or heritable is that the effect will happen to the offspring or to the next generation hit radiation. And when it comes to when it will occur, you have the acute effect where it will happen shortly after exposure. You know that in your radiation biology, the acute radiation syndrome, the different types of radiation syndrome and the chronic effect wherein the effect could happen after uh a long period after your irradiation or exposure. Okay. So key point since radiation can cause both immediate and long-term harm radiation protection is a must and is established with principles and regulatory standards. So your core principles for radiation protection justification optimization which is the use of ara and your dose limitation. Okay. Guidelines followed in radiation protection. We start from the international standards to Philippine regulations. Okay. So for international you have the IAEA safety standards in the part three of your general safety. Okay. And is specific to scientific evidence on radiation exposure and effects. Okay. And WH is focused on public health and patient safety. in medical radiation. How about national guidelines? Okay, so s national guidelines for X-ray machines and radiation devices, you have the FDA center for device. Okay, which is entitled radiation protection and safety of radiation sources international basic safety standards. This is one of the most important international references for radiation protection. It provides requirements for protecting patients, workers, the publics and the environment from the harmful effects of radiation. What are the key concepts? Okay, I will be sending you this file, right? So, please keep in mind to concepts under the GSR part three. Of course, we have the ICRP recommendations short for International Commission on Radiological Protection. And these are your key principles for ICRP justification, optimization, and those limitation. ICRP emphasizes the radiation protection is based on balancing benefit, risk, and those reduction. We also have the world the world health organization and the anskear regulation on radiation health and research under do and you have your radioactive materials and nuclear sources with the PNRI and the department of science and technology. Okay. So code of PNR regulations or the CPR. Okay. Code of PNRI regulation CPR part three is entitled standards for protection against radiation. Okay. Establishes standards for protection against ionizing radiation for activities under PNRI licenses. It covers the responsibility of licenses limits occupational exposure, medical exposure, public exposure monitoring and optimization. um PNRI is mostly for radioactive substances and devices. Okay. So eto para s nuclear medicine because they have radioarmaceuticals also for radiation therapy they use cobalt 60 for bracket therapy. So they are the one responsible for regulating such practices and devices. So PNRI also follows this CPR. No CPR part three also follows this those limits. Yeah. Now we go to uh administrative order 202035. So this one we'll be discussing just now. So eto is more on the registration of radiation facilities. No, which uses the use of radiation devices. What do they issue? They issue LTO CFR. They're the one to authorize and they're the one to inspect. Okay. So under FDA CCD RR to Yang administrative order for the licensing of um m facilities. Okay. Key point administrative order 202035 is mainly about licensing and registration of radiation facilities using radiation devices. nam 2022-000022 which we've already discussed is the radiation protection uh radiation protection and safety standards on the use of ionizing radiation. So the use of it okay um to concept uh it's a planned exposure situation. There is what you call a radiation protection program. your key principles. Okay. How do we protect our patients, the public and the use of quality assurance so that the to make sure that the equipments and procedures are regularly checked. Okay. So these are your connected framework of radiation protection guidelines from the international to national level. Okay. So please study these and if you read all these guidelines no you will have a very strong understanding of radiation protections stands for United Nations scientific committee on the effects of atomic radiation. So from their evidence on radiation effects, okay, ICRP develops radiation protection recommendations. Okay. Then the IAEA converts this into international standards such as GSR part 3. The Philippines adopt this principles which is in the PNRICPR part 3 and still also the basis for administrative order 202035 and 202200022 and in the facility level there should be a radiation protection anchored on those guidelines. Of course, we have your allar. We monitor the dose. We control the quality. Okay. There is a shielding, documentation, and incident reporting. So, radiation protection begins with international scientific evidence and safety standards, but it becomes enforcable only when translated into national regulations. in the Philippines. This means the rad tech must not only understand all dose limit shielding and patient protection but must also comply with CPR part three FDA administrative orders and national laws governing radiation safety. Okay. Later on we'll also cover ano ba talaga penalty no if if you don't follow this guidelines and regulations. So we now understand um radiation and how do we measure them. So exposure, absorb dose, equivalent dose and effective dose. Please note that in equivalent dose you only consider the radiation waiting factor. Okay. For the effective dose you consider both the radiation waiting factor and the tissue waiting factor. Okay. So what are the difference? Absorb dose is the dose in tissue. You know the deposit s tissue mismo equivalent dose is the absorb dose and the radiation waiting factor which only accounts for the type of radiation and for the effective dose it accounts for organ sensitivity. Okay. So absorb dose how much energy is deposited in a tissue in equivalent dose radiation effective dose which organ was exposed no and how would it affect it biologically. So for the dose limits code code of PNRI regulations part three. Okay. Anchored in all your international guidelines, you have a 20 millise shiver per year average over 5 years. Okay? Per year and average over 5 years. It should be just 20 mill shiver and not more than 50 milliver in any single year. 20 mill shiver per year for the lens of the eye and skin hands and feet 500 mill shiver per year for declared pregnant workers you have one mill shiver during the entire pregnancy. Now we go to hierarchy of controls in radiation protection. The hierarchy of controls is important because it tells us which protective measure should be prioritized first. So to control no important s radiation protection you start with elimination substitution engineering controls administrative controls and the use of um PPE. So elimination of course substitution if we can use other modality like MRI and ultrasound. Okay, that is already a strong uh control for erration protection. But since we always do the X-ray or procedures because the benefit outweighs the risk. No. Um radiation procedure then the strongest the strongest control is the engineering control. Okay. shielded walls, dead barriers, interlocks and cimators is part of your engineering controls. Next, you have the administrative control to you mga SOP and the warning sign and the training and rotation. Okay, that is next to engineering control. And lastly, the use of your protective devices. Okay. Lead apron, thyroid shield, leadless and gloves. So the first priority is elimination of course, but in radiology where exposure is often necessary, engineering controls are stronger than administrative controls and PPE. Let's not forget our three basic protective methods. Time, distance, and shielding. NTO. So pan protect patient no when they do have the procedure. So before procedure we should verify patient identity we ask for their their birthday no or middle name procedure. Of course, we confirm the physician request by asking them uh ano yung sake. Okay. Bakit ng papa x-ray yan. Check pregnancy status when appropriate. So pinto ginagawa. When was your last menstrual period? No. And the 10-day rule says that the procedure should be done within the 10 days after the LMP because that's the time that the childbearing age is safe from getting pregnant. Okay. Review previous imaging. We ask if they already have such examination. And of course, Huh? And then request K. This is left. No. And the request was right. So you really have to confirm because X-ray. So you have to be able to do the correct examination. And during exposure, of course, you use the correct positioning. You have to do proper cimation. That's why um isang visit there was a problem with cim cimation. So how can they do this practice missator okay? Because cimation should be done um only limited to the part of interest. Use appropriate factors KVP and MAS. And of course we want to avoid repeat examination. We immobilize when needed. So immobilize never po as much as possible not you. But if there is no choice then you have to wear your protective gear. Okay. And communicate breathing instructions clearly. If you've noticed, if you've visited the departments, no before the actual instruction ahead of time patients, mom sir instruct especially know if older or then we want to practice ahead of time before we actually do the procedure. para um clear on instructions. How about after exposure? Of course, we want to evaluate image before they leave. Okay. Make sure nang problemma. Okay. Record exposure data if required and report incidents or unintended exposure. Okay. So immediately you have to check in with your supervisors. No. Um no overexpose agree. No that is for proper documentation. The common causes of unnecessary patient dose is the wrong patient, wrong procedure, wrong side or sight repeat exposure, poor positioning and incorrect exposure factors and the failure to cimate. Now how about the radiation protection for workers? The licency responsible for worker protection compliance with regulations optimization policies equipment health surveillance monitoring devices PPE training and those records CPR party specifically requires policies procedures monitoring equipment PPE calibration maintenance training retraining and adequate records. So your responsibility is not just to take X-rays. Okay. But actually train, record, monitor. No, if my training calibration to maintenance um is still part of our job as a radiologic technologist. Okay. So you have your requirements over here. Okay. What what um devices we use to protect ourselves. Okay. Quality control ensure safe equipment performance. So you calibration monitoring. No. Um sometimes or in in bigger hospitals we really have medical physicists who do this regularly. Okay. So yeah, check the radiation protection pro program in your um facilities. What are the different types of personnel decimters? Okay, so please do study about your personal dimeters film badge, TLD, OSL packet decimeters, the electronic type and the ion chamber type. So you also have here the advantage of each theimeters. Okay. And the limitations or you can disadvantage controlled and supervised areas. When we say it is a controlled area, no, these are the areas where specific protection measures are needed like your X-ray room, fluoscopy suites procedure. You call that the controlled area. The super supervised area or where exposure conditions are kept under review s um procedure room no to monitor if meron bang um higher levels of normal dose. No. So we call that supervised area. So you mga controlled area those have the highest um monitoring. Okay. How do we control? We put warning signs. We we have access restriction, shielding, area monitoring and radition survey. Quality control and equipment safety. Okay. Your addition protection is not only about wearing lead. It also includes machine safety. Okay. Make sure that your columators are working properly. Your KVP is accurate. Timer correct. No, MA is sin set is same bad output. Reproducibility meaning um the amount of radiation is the same every time if you put up the same um factors. Okay. Half value layer checks beam filtration. Leakage radiation test. AEC testing. What is uh automatic exposure control to y um that immediately ends the exposure or stops the exposure when it hits uh dun detectors. Okay. And repeat analysis identifies causes of unnecessary dose. So bucket no repeat. Um for example if procedures why why why does why do you take repeats positioning problem tech problem machine problem factors? So um there is record keeping to be able to track ano angapati correct. Okay. Now we go to enforcement and penalty provisions for radiation protection in the Philippines. So both administrative order 202035 and 202200022 and penalty is naka stipulates sorry public act 9711 which says that there could be suspension or revocation of LTO or CFR fine of not less than 50,000 but not more than 500,000 additional fine of up to 1,000 per day for continuing violations. Um there could be closure of the facility and the seizure, destruction or disposition of regulated devices. So this can be your penalty when you don't abide by the guidelines. Okay. The proper yong lead thickness. Okay. You don't report when your uh badge or your TLD has reached higher than the dose limit. Okay, this could be your penalties for nuclear and radioactive materials. We have the Republic Act 12305 which has stronger penalties. For example, imprisonment of up to 5 years or fine of at least 5 million or both for specified violations. You could be imprisoned up to two years or fined at at least 1 million. Administrative penalties such as notice of violation, fine, suspension, modic modification, seize and decease order and ci civil monetary fines from 50,000 to 100 million with additional daily fines for continuing violations. Okay. Republic Act 5207 which is the older Atomic Energy Legatory and Liability Act also penalize willful violations with imprisonment and fines. Okay. So understanding the penalty provisions in radiation protection is essential for ensuring compliance with both administrative and legal requirements in radiologic practice. Regulations governing radiation devices and radioactive materials are not merely procedural but are enforcable standards designed to protect patients, health workers and the public from unnecessary exposure. This does this just shows no there is weight in our responsibilities as rad no as licenses for those who own facilities to make sure that we protect the patients the workers and the public or if not you could be penalized or even be imprisoned. So ganun heavy responsibilities. So what are examples when radiation protection is not followed? Okay. Repeating due to poor positioning. Malo nagawang x-ray patient pregnant patient was exposed without screening. Okay. Worker holds patient patient during exposure without apron. Yeah. So these are situations wherein you you don't follow the radiation protection. Okay. Mega regulatory violation when the unlicensed X-ray facility operates. Okay. Of course they need to secure authorization proper UC testing. Okay. So pooration orangimation administrative order no that could penalize these facilities and the responsible person. So here is your um summary and key concepts for radiation protection and I hope that all of you have learned from this subject okay and will apply especially when you already become registered radiologic technologist. So I will see you when I see you and thank you very much for um listening and participating in all our classes. So congratulations and see you around. Bye.