principles from the aorn guideline for radiation safety copyright © 2015 aorn, inc. all rights...

Principles from the AORN Guideline for Radiation Safety

Copyright © 2015 AORN, Inc. All rights reserved. Used or adapted with permission.

Byron Burlingame has been a senior perioperative nursing specialist in the AORN Nursing Department for 10 years. Byron serves as the lead author for various guidelines and as the staff liaison to many task forces. He also serves as an AORN representative on the Healthcare Guidelines Revision Committee and on the FDA Surgical Fires Group. Before coming to AORN, Byron was the director of surgical services at a hospital with 13 operating rooms. In addition to surgery, he managed the endoscopy department, sterile processing, day surgery, and the postanesthesia care unit. For seven years prior to this, he worked as a perioperative manager in a 50-bed hospital. He spent the five preceding years as a surgical services staff nurse in a 350-bed facility with 10 ORs.

His other experiences include being the director of nursing in a 22-bed hospital and more than 10 years as a charge and staff nurse in three different intensive care units. Byron’s education started with a diploma from St. Lukes Hospital School of Nursing in Fargo, ND, followed by a Bachelor’s degree in nursing from Moorhead State University in Moorhead, MN. His Master of Science with an emphasis on Rural Health Nursing Administration was gained at the University of North Dakota in Grand Forks, ND. In 1995, he sat for and successfully completed the CNOR exam, and he has renewed his CNOR credential four times since then.

Developed and originally presented by Byron L. Burlingame, MS, BSN, RN, CNOR

These slides taken from the webinar Principles of Radiation Safety found in the AORN Guidelines, presented May 13, 2015. To listen to the webinar, visit https://www.aorn.org/Events/Webinars/Previously_Recorded_Webinars.aspx. These slides are made available for educational use. Slides may be personalized for your facility and presentation. HOWEVER, THE VIEWS EXPRESSED IN THESE SLIDES ARE THOSE OF THE PRESENTERS AND DO NOT NECESSARILY REPRESENT THE VIEWS OF, AND SHOULD NOT BE ATTRIBUTED TO AORN.

• Describe the actions to take when applying the principles of radiation safety to the patient, including the pregnant patient.• Describe the actions to take when applying the principles of

radiation safety to the health care worker, including the pregnant worker.• State the recommendations for caring for radiation personnel

shielding devices.

Objectives


• Primary radiation • Leakage radiation• Scatter radiation

Exposure Sources


• Patient positioning• Image magnification• Fluoroscopy duration• Maintenance of a single beam angle• Use of high-intensity mode• Dose monitoring• X-ray beam angulation• Mechanical defects in the radiation source

Factors Affecting the Radiation Dose


Responsibilities • Create and maintain the radiation safety program• Determine qualifications for the equipment operator for each

type of radiologic device• Evaluate and select new radiology equipment• Determine the unit of measure to be used for monitoring the

radiation dose and the peak value for notifying the operator

Interprofessional Team


MUST include• List of the approved equipment operators • Documentation and record retention requirements • List of measures for protecting patients and personnel from

unnecessary exposure to ionizing radiation • Procedures for handling and disposing of body fluids and tissue

that may be radioactive • Requirements for using radiation monitoring devices (eg,

dosimeters)

Radiation Safety Program


SHOULD include• Processes and requirements for the selection of equipment at

the time of purchase • Requirements for personnel education and competency

assessment • Quality assurance and improvement program • Frequency of and processes for testing of protective devices • Requirements for patient education • Processes for sterilization of radiation seeds when seed

sterilization is required

Radiation Safety Program


• Oversees the radiation safety program• Monitors compliance with Nuclear Regulatory Commission regulations • Assists in creating and enforcing policies and procedures• Determines methods for monitoring and recording occupational exposure• Determines which individuals require monitoring devices • Identifies radiation safety problems• Stops unsafe practices• Initiates, recommends, provides, and verifies implementation of

corrective actions• Is present before and during radionuclide therapy• Controls and maintains the radionuclide surveillance program

Radiation Safety Officer


Radiation Safety for Patients


• Move extraneous body parts out of the path of the radiation beam• Collaborate regarding the use and placement of

shielding• Assess the pregnancy status of all premenopausal

patients• Place shielding between the fetus and the source of

radiation

Patient Safety


Patient Safety

Reprinted with permission from Guidelines for Perioperative Practice. Copyright © 2015, AORN, Inc, 2170 S. Parker Road, Suite 400, Denver, CO 80231. All rights reserved


A perioperative team member (eg, radiation technologist, nurse, other designated person) should• Monitor the radiation dose received by the patient • Inform the operator when the peak value for

notification has been reached • Use the values recorded by the fluoroscopy unit and

not only fluoroscopy time for peak values

Patient Safety


Radiation Safety for Staff


Should you leave the OR when radiation is being used?A: Yes B: No

Question


•Time•Distance •Shielding

Staff Safety


Staff Safety Distance & Time

Reprinted with permission from Guidelines for Perioperative Practice. Copyright © 2015, AORN, Inc, 2170 S. Parker Road, Suite 400, Denver, CO 80231. All rights reserved


• Radiation equipment operator should alert personnel present in the treatment room before activating the source• Use slings, traction devices, sandbags to maintain the patient’s position during radiation exposure• Use cassette holders to secure films• No need to leave the OR

Photo by Byron L. Burlingame

Staff Safety Distance & Time


Which of the following roles is it safe for the pregnant worker to perform?A. CirculatorB. Scrub personC. First assistantD. Anesthesia care providerE. All of the aboveF. None of the aboveG. A & D

Question


• Follow standard radiation protection techniques• Declare the pregnancy to the radiation safety officer or through

other appropriate facility channels• Wear radiation monitors at the waist under shielding during

times of exposure to radiation

Pregnant Staff Safety


Pregnant Staff Safety

Photos by Byron L. Burlingame


Shielding Devices


• Architectural (ie, fixed) shielding• Equipment-mounted or mobile shields • Personal protective devices • Composed of :– Lead – Lead-equivalent material (eg, tungsten antimony, bismuth antimony)

Shielding Devices


Equipment-mounted and mobile shields • Suspended personal radiation protection systems• Mobile hanging shields• Under-table skirts • Table-mounted side shields • Rolling shields• Sterile drape shields

Shielding Devices


Personal protective devices • Aprons • Thyroid shields • Leaded eye protection • Protective gloves• Sterile radiation shield drapes • Protective caps

Shielding Devices


Combine the devices

Shielding Devices


Protective devices should be • Visually inspected – At the time of purchase– Before use • X-rayed – At the time of purchase– At least annually for defects related to wear – Whenever damage is suspected• Labeled with the last test date

Shielding Devices


Photos by Byron L. Burlingame

Shielding Devices


Shielding Devices

• Clean and disinfect protective devices according to the manufacturer’s instructions for use• Frequency determined by an interprofessional

team


Monitoring Devices

•Wear as prescribed by regulatory requirements•Wear in a consistent location (eg, one inside

and one outside the apron)• Finger dosimeters• Store in a radiation free location•Dosimeter reports

Photo by Byron L. Burlingame


•Handling of source•Use under supervision•Counting of seeds•Sterilization processes•Disposal

Therapeutic Radiation


Perioperative Team• Minimizing exposure to radiation (ie, as low as reasonably

achievable [ALARA]) • Dosimeter use and monitoring• Care of patients receiving radioactive nuclides • Handling radioactive nuclides• Controlling and providing security for the material (ie,

constant surveillance)• Emergency response to spills

Radiation Exposure Education


Patients • Collaborate with the physician • Advise the patient to– Stay away from crowded places, such as movie theaters– Double flush urine and stool–Wipe up spills of body fluids immediately–Wear protective clothing (eg, shorts, breast shields)

• Advise female patients not to breastfeed for 1 week after treatment• Advise family members, caregivers, and visitors to stay a distance of

3 ft (1 m) from the patient • Timeframe for precautions

Radiation Exposure Education


Guideline for radiation safety. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2015.

Reference


principles from the aorn guideline for radiation safety copyright © 2015 aorn, inc. all rights...

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