1. 09/02/20161 First FRCR Examination in Clinical Radiology Statutory Requirements and Non-Statutory Recommendations Ionising Radiations Regulations 1999 John Saunderson Radiation Protection Adviser

2. The route to regulations ICRP 60 (1990) BSS 1996, etc. IRR 1999, etc. ICRP 103 (2007) BSS 2014 “IRR 2018”, etc. 09/02/20162

3. 3 Relevant Radiation Legislation Ionising Radiations Regulations 1999 –staff, public, equipment (IRR99) Ionising Radiation (Medical Exposure) Regs 2000 –patients, research subjects (IRMER) Environmental Permitting Regulations 2010 –keeping & disposing of radioactive materials (EPR2010) The Carriage of Dangerous Goods and Use of Transportable Pressure Equipment Regulations 2009 Medicines (Administration of Radioactive Substances) Regulations 1978 –nuclear medicine, brachytherapy (ARSAC)

4. 09/02/20164 Guidance Approved Code of Practice (ACOP) Guidance Notes odd HSE guidance etc. IPEM, NRPB, RCR, BIR, etc. stuff.

5. 09/02/20165 Ionising Radiations Regulations 1999 Responsibility for radiation safety Local rules and procedures Role of radiation protection adviser and radiation protection supervisor Classified workers Restriction of exposure (through design, systems of work and ppe) Dose limits Equipment used for medical exposures Notification of incidents Dose constraints for comforters and carers Routine inspection and testing of equipment Notification of incidents.

6. 6 Responsibility for radiation safety Radiation employer - i.e. an NHS Trust, private dentist, etc. –Authorisation of practices –Required for x-rays used for industrial radiography, processing of products, research or exposure of persons for medical treatment –HSE issued generic authorisations, with conditions –Notification to HSE –28 days in advance of first use –Forthwith of any material changes –Prior risk assessments –PRIOR to any new activity (e.g....) –Must consult an RPA on plans for new installations, etc.

7. 09/02/20167 Responsibility for radiation safety Employee must –not knowingly expose himself greater than necessary –use personal protective equipment provided –report equipment defects –look after PPE –(extra duties for classified persons)

8. Prior risk assessment a)sources of radiation b)estimated dose rates c)contamination risk d)the results of monitoring e)manufacturer advice f)engineering control measures and design features g)any planned systems of work; h)estimated levels of contamination likely i)personal protective equipment (PPE) j)unrestricted access where significant dose rates or contamination k)possible accident scenarios l)possible failures of control measures m)steps to prevent identified accidents situations, or limit their consequences. 8

9. 09/02/20169 Local rules and procedures Controlled areas Supervised areas Local Rules.

10. 10 Controlled area any area where it is necessary to follow special procedures to restrict significant exposure, or any area where > 6 mSv/y, or 3 / 10 th dose limit is likely also ACOP says if –> 7.5 uSv/h averaged over 8 h working day –> 75 uSv/h to hands averaged over 8 h working day –contamination risk –need to keep non-radiation workers out or > 7.5 uSv/h averaged over 1 minute and –site radiography, or

11. 11 Controlled area any area where it is necessary to follow special procedures to restrict significant exposure, or any area where > 6 mSv/y, or 3 / 10 th dose limit is likely also ACOP says if –> 7.5 uSv/h averaged over 8 h working day –> 75 uSv/h to hands averaged over 8 h working day –contamination risk –need to keep non-radiation workers out or > 7.5 uSv/h averaged over 1 minute and –site radiography, or –employees untrained in radiation protection enter area (unless radioactivity is dispersed inside a person).

12. 09/02/201612 Supervised area any area where it is necessary to keep conditions under review, or any area where > 1 mSv in a year, or 1/10th dose limit is likely.

13. 09/02/201613 Local Rules How to work safely in that area Must contain –Dose investigation levels –contingencies for foreseeable accidents –RPS (radiation protection supervisor) name –describe area covered –work instructions for unclassified workers.

14. 09/02/201614 Local Rules Could also contain –management and supervision of work –testing and maintenance of safety features –radiation and contamination monitoring –testing of monitors –personal dosimetry –arrangements for pregnant and breast feeding staff –risk assessments –programme to review ALARA –RPA contact.

15. 09/02/201615 Local Rules Usually get new employees to read Local Rules and sign to say they have understood them.

16. 09/02/201616 Role of radiation protection adviser and radiation protection supervisor

17. Radiation Protection Adviser R.P.A. Must have qualification approved by HSE (e.g. RPA2000 certificate) Must be appointed in writing Must be consulted on –controlled and supervised areas. –prior examination of plans –regular calibration of dose monitoring equipment –periodic testing of safety features and warning devices –risk assessment of new radiation work. –incidents where more then 6 mSv has been received. –critical examination of safety features of new radiation equipment.

18. 09/02/201618 R.P.A. need not be appointed if only Very, small amounts of radioactive material (below specified levels) Very low dose (< 1uSv/h @ 10 cm) x-ray units of a design approved by HSE VDUs with < 1uSv/h @ 10 cm < 30 kV and < 1uSv/h @ 10 cm.

19. 09/02/201619 Radiation Protection Supervisor R.P.S. Must be appointed “for the purpose of securing compliance with these Regulations” in controlled or supervised areas Name must be in Local Rules It is recommended that –know & understand regs. and local rules –command sufficient authority –understand necessary precautions –know what to do in an emergency.

20. 09/02/201620 Classified person Anyone who may exceed 6 mSv effective dose per year, or 3 / 10 th of a dose limit (e.g. 150 mSv hand dose, or 45 mSv lens dose) Must be informed (!) Must be 18 or over Must be certified fit to work with radiation by a suitable doctor Dose monitored and recorded for 50 years with an HSE Approved Dosimetry Service - results to HSE Radiation passbook for “outside workers” Adequate (at least yearly) medical surveillance - record for 50 y.

21. Here on 15 th Oct 2015 09/02/201621

22. 22 Restriction of exposure (through design, systems of work and ppe) Restrict exposure 1. By engineering 2. By systems of work 3. By personal protective equipment Controlled areas - demarcate and sign Non-classified workers can only enter under written system of work Must demonstrate by personal dose monitoring or other means that doses are restricted

23. 09/02/201623 Dose Limits Schedule 4 Part 1

24. 09/02/201624 Employees  18 –20 mSv/y effective dose –150 mSv/y equivalent dose to lens of eye –500 mSv/y equivalent dose over 1 cm 2 skin –500 mSv/y equivalent dose to hands, forearms, feet and ankles Trainee < 18 –6 mSv/y effective dose –50 mSv/y lens of eye –150 mSv/y over 1 cm 2 skin –150 mSv/y hands, forearms, feet and ankles.

25. 09/02/201625 Abdomen of women of reproductive capacity at work –13 mSv / 3 months equivalent dose Not employee or trainee, or a “comforter or carer” or undergoing a medical exposure –1 mSv effective dose, unless dose the result of a medical exposure of another, then 5 mSv / 5 y –15 mSv/y lens of eye –50 mSv/y over 1 cm 2 skin –50 mSv/y hands, forearms, feet and ankles.

26. 09/02/201626 Reg. 11(2) (2) Where an employer is able to demonstrate in respect of any employee that the dose limit specified in paragraph 1 of Part I of Schedule 4 is impracticable having regard to the nature of the work undertaken by that employee, the employer may in respect of that employee apply the dose limits set out in paragraphs 9 to 11 of that Schedule and in such case the provisions of Part II of the Schedule shall have effect.

27. 09/02/201627 Employees  18 –100 mSv / 5y and 50 mSv/y effective dose –150 mSv/y equivalent dose to lens of eye –500 mSv/y equivalent dose over 1 cm 2 skin –500 mSv/y equivalent dose to hands, forearms, feet and ankles Not allowed for Trainees < 18 Abdomen of women of reproductive capacity at work –13 mSv / 3 months equivalent dose. Part II Dose Limits

28. 09/02/201628 To use Part II must... Consult RPA inform employee ADS in writing give 28 days notice to HSE if > 20 mSv given in a year –undertake investigation –notify HSE Review every 5 years.

29. 09/02/201629 Dose Limits Note, not like a speed limit. Doses must be as low as is reasonably practicable (ALARP) Dose constraints used in design –e.g. 0.3 mSv for members of public, –5 mSv for comforters and carers (1mSv if pregnant) Foetus limit: 1 mSv from notification of pregnancy by employee Need formal investigation levels for staff Do not apply to medical exposures.

30. 09/02/201630 For HEY Trust the DIL’s are

31. 09/02/201631 Radiation Protection Adviser Hull & East Yorkshire Hospitals’ dose investigation levels

32. 09/02/201632 HSE Nov. 01 “There has been a number of reported cases where employees have failed to take good care of their dosemeters. Many of these cases involve employees in the Health Services, some of whom have been senior clinicians. “ Non-Classified employees who have been provided with a dosemeter by their employer to ensure compliance with reg 18(2)(b)(ii) of the IRR99 have a duty to look after that dosemeter and return it for processing as required. Provided the employer has informed the employees of that duty and is exercising the appropriate level of supervision, employees who persistently fail to wear, look after or return their dosemeters promptly are liable to enforcement action by inspectors up to and including prosecution under Section 7 of the HSW Act 1974. Employers may find statement of this fact useful when dealing with 'errant' staff.”

33. 09/02/201633 Equipment used for medical exposures Design, construct, install, maintain to keep doses ALARP Display indication of dose (e.g. DAP meter, mAs meter, etc.) Equipment quality assurance programme –IPEM91 –Must test before first clinical use –Must test at appropriate intervals –Must test after major maintenance.

34. 09/02/201634 Routine inspection and testing of equipment Follow IPEM 91 –Test, e.g kV accuracy –Expertise, e.g. A = radiographer, B = medical physics –Frequency, e.g. annual for B general –Remedial level, e.g. +/- 10% for kV –Suspension level, e.g. +/- 20% for kV

35. Notification of incidents Must report to HSE where dose to patient is “much greater than intended” due to equipment fault.

36. 09/02/201636 Patient Doses Much Greater Than Intended [HSE PM77 (3 rd )] x 20 - extremities, skull, chest, dentition, shoulder, chest, elbow, knee and nuclear medicine where intend <=0.5mSv x 1.5 – Interventional radiology, use of contrast, CT, nuclear medicine where intend >5mSv x10 – other imaging.

37. 09/02/201637 Patient Doses Much Greater Than Intended [HSE PM77 (3 rd )] x 1.1 – whole course of radiotherapy x 1.2 – single fraction of radiotherapy, or unsealed radionuclide therapy.

38. 09/02/201638 Incidents Any untoward occurrence which may result in excess radiation to staff or patients must be referred to the Radiation Protection Supervisor and the Radiation Protection Adviser, who will estimate the dose and liase with management, HSE, DoH, HCC, EA, etc. as appropriate Suspect equipment must be withdrawn from service and labelled according.

39. 09/02/201639 Investigation  establishing what happened  identifying the failure  deciding on remedial action to minimise the chance of a similar failure  estimating the doses involved  decide whether patient informed (usually yes).

40. Here on 22 nd Oct 09/02/201640

41. 09/02/201641 Comforters and Carers "individuals who (other than as part of their profession) knowingly and willingly incur an exposure to ionising radiation in the support or comfort of another person who is undergoing, or has undergone a medical exposure" Dose constraint required.

42. 09/02/201642 Comforters and Carers e.g. parent holding a child being X-rayed not a nurse, care assistant, etc. if < 1 mSv public dose limit, not “C&C” 5 mSv dose constraint if pregnant 1 mSv dose constraint must be aware of the risk.

43. 09/02/201643

44. 09/02/201644 Reference Book List Advice on Exposure to Ionising Radiation during Pregnancy Guidance Notes IPEM 91