Radiation Protection in Radiotherapy

1. Radiation Protection inRadiotherapy IAEA Training Material on Radiation Protection in Radiotherapy Part 18 Organization and Implementation of a Radiation Protection Programme

2. IAEA Basic Safety Standards Each Licensee must develop Safety Objectives in conformity with BSS requirements Radiation Protection Programme to achieve these objectives Commensurate with nature and extent of risks Sufficient to ensure compliance Part 18: Organization of radiation protection program

3. Responsible employer has a responsibility to ensure that a radiation safety programme is set up, in accordance with any local regulatory requirements, and/or the BSS • Every radiation user in medicine also has responsibilities • Everyone should be aware of this... Part 18: Organization of radiation protection program

4. Objectives • To be familiar with the basic structure of a radiation protection programme • To understand the components of an effective radiation protection programme in the context of radiotherapy • To understand the role of a radiation safety officer and a radiation safety committee • To appreciate the importance of education and training for radiation safety Part 18: Organization of radiation protection program

5. Contents 1. Radiation Protection Programme 2. Organizational structure 3. The role of the Radiation Safety Officer (and other professionals) 4. The role of committees 5. Education and training Part 18: Organization of radiation protection program

6. 1. Radiation Protection Programme • Determine measures and resources required to meet objectives and ensure they are provided • Review measures and resources regularly • Identify failures and shortcomings and take steps to prevent them • Establish consultation and co-operation of all parties • Maintain records of activities Part 18: Organization of radiation protection program

7. Typical elements of a RPP • Assignment of responsibilities • The Radiation Protection Officer • Designation of radiation areas • Local rules • Education and training • Planning for accidents and emergencies • Health surveillance and monitoring • Review and audit • System of recording and reporting Part 18: Organization of radiation protection program

8. Radiation Protection Programme in Radiotherapy • Many aspects covered in other parts of the course • Based on IAEA BSS (1996) • More details in IAEA TECDOC 1040 Part 18: Organization of radiation protection program

9. 2. Organisational Structure Regulatory Authority Authorization and Inspection Licensee Overall responsibility for application of BSS Employer Overall responsibility for application of BSS and/or Radiotherapy Facility Part 18: Organization of radiation protection program

10. Licensee Overall responsibility for application of BSS Employer Overall responsibility for application of BSS and/or Staff Patients Public External Experts Ethical Review Committee Suppliers Regulatory Authority Authorization and Inspection Radiation Protection Officer and /or Medical Physicist Radiation Oncologist Radiation Safety Committee Engineers, Technicians Part 18: Organization of radiation protection program

11. Local Rules • Local rules are intended to provide adequate levels of protection and safety through the establishment of common work procedures and other systems to be followed by all workers in the area • They should include all information required for work in the area, and be made known to all workers Part 18: Organization of radiation protection program

12. Local Rules Set down in writing : person(s) responsible for supervising the work description of controlled and supervised areas general radiation safety measures dose investigation levels emergency plans Part 18: Organization of radiation protection program

13. Radiation Safety Manual • The RSM is ideally a local reference book, and made available to (and possibly mandatory reading for) all radiation workers • An effective aid to training, and a valuable tool in itself is a Radiation Safety Manual • This now is required practice in many countries Radiation Safety Manual Part 18: Organization of radiation protection program

14. Radiation Safety Manual • The RSM should include sections on : • basics of radiation safety • sources, risks and effects of radiation • local radiation safety organization • national/state regulations • personnel monitoring • emergency procedures Part 18: Organization of radiation protection program

15. Radiation Safety Manual should contain: • Sections covering local rules in radiation-user departments including radiotherapy • Death procedures (patients containing radioactive materials) • Radiation and pregnancy (for radiation workers, but also including information relating to pregnant patients) • Incident/accident procedures • Research and radiation Part 18: Organization of radiation protection program

16. System of Recording and Reporting • In each radiation facility there should be a system instituted where all relevant information relating to radiation work is recorded, documented and when necessary, reported to management • This is a key factor in control of exposures and maintenance of a safe working environment Part 18: Organization of radiation protection program

17. Reports are not a one way street • Acknowledgement of reports • Additional questioning • Feedback very important ??? Part 18: Organization of radiation protection program

18. External reporting • May depend on national regulations • In general the following should be reported to the regulatory authority: • any proposed changes to license conditions • any proposed new buildings or building modifications relevant for radiation safety • radiation accidents Part 18: Organization of radiation protection program

19. External reporting • Shall be done within a specified time period • Shall include all relevant information • Is typically done via the licensee/registrant • ...may also be useful to professional organisations where information can be disseminated Part 18: Organization of radiation protection program

20. Responsibilities • BSS 1.6: The registrant/licensee or (if different from this) the employer has a responsibility to ensure that a radiation safety programme is set up • The registrant/licensee is the legal person responsible for radiation protection and compliance with BSS and local standards (as applicable) • Some responsibilities can be delegated Part 18: Organization of radiation protection program

21. Responsibility of the Radiation Oncologist (Medical User) • The medical practitioner has the obligation of ensuring overall protection and safety in the prescription and delivery of medical exposure (BSS II.1.(b)) • This obviously includes the patient, but also staff and public Part 18: Organization of radiation protection program

22. Some Responsibilities for Radiation Protection • …may be delegated • The Radiation Protection Officer is typically the key person responsible for the radiation protection programme and its implementation Part 18: Organization of radiation protection program

23. 3. Radiation Protection Officer • A person technically competent to provide advice and oversight of the local radiation safety programme - often (but not necessarily) a radiation oncology physicist • The RPO is a crucial component of the programme, and should be given the resources and authority necessary Part 18: Organization of radiation protection program

24. Radiation Protection Officer • The RPO will often need further training specific to radiation protection (or radiotherapy depending on her/his background), which is not necessarily available in all countries • The IAEA runs a number of training programs and Fellowships for persons wishing to work professionally in radiation safety Part 18: Organization of radiation protection program

25. Radiation Protection Officer • The role of the RPO is determined locally, but typically would include : • responsibility for designation of controlled and supervised areas • responsibility for ensuring preparation of local rules • training of new staff in safe radiation work practices • liaison with the regulatory authority on radiation protection matters Part 18: Organization of radiation protection program

26. Other tasks of the RPO: • supervision of the personnel monitoring programme • maintenance of records, especially worker radiation histories • routine surveillance of radiation areas • responding to and investigating radiation accidents • provision of radiation dosimetry • general advice to management and staff regarding radiation safety Part 18: Organization of radiation protection program

27. Qualified Experts • Licensees/employers/registrants shall have access to the advice of a qualified expert in radiation oncology physics • BSS: Appendix II: MEDICAL EXPOSURE: RESPONSIBILITIES - II.1. Registrants and licensees shall ensure that: (d) for therapeutic uses of radiation (including teletherapy and brachytherapy), the calibration, dosimetry and quality assurance requirements of the Standards be conducted by or under the supervision of a qualified expert in radiotherapy physics; Part 18: Organization of radiation protection program

28. Qualified Experts • Training, competencies and certification of experts is a national matter • Professional organisations may be involved in the definition and certification • Typically the expert is a medical physicist Part 18: Organization of radiation protection program

29. Qualified expert in radiotherapy physics (medical physics) -IAEA “An individual who, by virtue of certification by appropriate boards or societies, professional licences or academic qualifications and experience, is recognised as having experience in medical physics.” from IAEA Working Material, March 1999, “Regulatory Guidance, Radiation Protection and Safety in Radiotherapy.” Part 18: Organization of radiation protection program

30. Requires a thorough knowledge of: radiation physics radiation generation radiation dosimetry treatment planning radiation protection Desirable knowledge Human anatomy Physiology Radiobiology Radiation oncology Certification of an adequate level of competence Medical physicist (ICRP 44, 1984):“A physicist with training in the medical application of radiation.” Part 18: Organization of radiation protection program

31. Medical physicist • Special knowledge in radiotherapy physics is required • Responsible for commissioning of radiation equipment • Shall certify that a treatment unit is fit for use on patients • Often responsible for treatment planning • Often responsible for the technical aspects of QA in radiotherapy Part 18: Organization of radiation protection program

32. Other professionals in a radiotherapy department • Radiotherapy Technician: • a.k.a. therapy radiographer or radiation therapist • responsible for precise delivery of the treatment • the person typically closest to the patient • should be capable to determine changes in patient condition due to radiation • sometimes also responsible for treatment planning (potentially referred to as dosimetrist) Part 18: Organization of radiation protection program

33. Other professionals in a radiotherapy department • Maintenance/service engineers and technicians: • responsible for maintenance of treatment units • require special training • should be capable to determine machine parameters which could cause changes in the radiation beam • must report all problems or repairs which could affect the beam to the qualified expert in radiotherapy physics. Part 18: Organization of radiation protection program

34. Outside persons with responsibility for radiation protection in radiotherapy • Manufacturers and/or suppliers of radiotherapy equipment • Service engineers • Hospital civil engineer/architect • Regulators... Part 18: Organization of radiation protection program

35. Quick discussion What potential role could a hospital engineer play for radiation protection in radiotherapy?

36. 4. The role of committees • General: • Facilitate information sharing and decision making • Provide documentation (TOR, minutes) • Specific: Radiation Safety Committee • Members often are: • the RSO (usually chair of the RSC) • representatives of radiation-users (head clinician) • representatives of management (decision making) • representative of nursing • the institutional occupational health person • others as appropriate Part 18: Organization of radiation protection program

37. Radiation Safety Committee • Typical roles of the RSC are to: • oversee the institutional radiation safety programme • advise and review local rules relevant for radiation protection • review radiation exposures to staff, and to investigate abnormal exposures • review new, and research applications of radiation • review and investigate radiation incidents and accidents • ensure appropriate reporting of accidents • advise management on radiation protection matters • Members may require special training Part 18: Organization of radiation protection program

38. Other committees of relevance to radiation protection • Occupational Health and Safety:staff radiation protection (compare module 8) • Quality Assurance within department of radiation oncology • medical: review of patient charts and incidences • technical: review of radiation surveys and other technical matters which could affect radiation protection of the patient Part 18: Organization of radiation protection program

39. 5. Education and Trainingare essential for a radiation protection programme • As part of a the implementation of a Radiation Protection Programme (IAEA TECDOC 1040, 2.2.1): “Early in the process a decision should be made about additional training required for the hospital staff…” • The relevant plan should include who, where and when shall be trained. Part 18: Organization of radiation protection program

40. Responsibility of the licensee • BSS 2.30.: “Provision shall be made for reducing as far as practicable the contribution of human error to accidents and other events that could give rise to exposures, by ensuring that: (a) all personnel on whom protection and safety depend be appropriately trained and qualified so that they understand their responsibilities and perform their duties with appropriate judgement and according to defined procedures;” Part 18: Organization of radiation protection program

41. In practice training is required for both: • Staff on whom radiation protection depends - typically radiotherapy professionals and service staff • Persons who could be subject to irradiation: staff (module 8), patients (module 9) and public (module 17) - in the latter case the education may be limited to information sheets and/or warning signs Part 18: Organization of radiation protection program

42. Education • All staff in radiotherapy must have appropriate education to perform their duties… • For radiation protection purposes this affects particularly: • Radiation Protection Officer • Physician • Qualified Expert (Medical Physicist) • Radiotherapy Technician • Maintenance staff Part 18: Organization of radiation protection program

43. IAEA-TECDOC-1040... • …provides specific information on the role of the physician (3.2.2.1) and medical physicist (3.2.2.2) - the skills and competencies identified there determine the education and training requirements. Part 18: Organization of radiation protection program

44. A note of qualifications of others • There should also be a process in place which ensures that outside contractors on whom radiation protection may depend (e.g. service engineers) are appropriately trained and qualified. This is typically reflected in a license of the contractor of which a copy should be available in the radiotherapy facility. Part 18: Organization of radiation protection program

45. BSS: Education is part of Management Requirements • Qualified radiation safety experts • Licensee shall arrange for qualified radiation safety experts to provide observance to the Regulations • The qualifications of the radiation safety experts shall include appropriate academic knowledge and professional experience In radiotherapy, these requirements will be fulfilled by the requirement for a qualified expert in radiotherapy physics. Part 18: Organization of radiation protection program

46. Regulations – Management requirements Continuous education and training in radiation protection shall be provided to meet with changes in equipment, instrumentation, practice, monitoring methods, recommendations and regulations A transition period should be provided for those already involved in the delivery of radiation exposure in order to meet the requirements of training Part 18: Organization of radiation protection program

47. Continuing Education • Technology in radiation therapy is fast developing • It is essential for all staff to have regular updates on radiation protection aspects (e.g. consider the introduction of HDR brachytherapy) • Continuing education must be documented Part 18: Organization of radiation protection program

48. BSS: There is also a role for the regulatory authority • The Regulatory Authority should encourage medical authorities, universities and professional organizations to design and implement training programmes in radiation protection for: • radiation oncologists • qualified experts in radiotherapy physics • radiotherapy technologists • dosimetrists • maintenance personnel Part 18: Organization of radiation protection program

49. Education & Training • The Regulatory Authority should establish training curricula for (for example) : • RPOs • members of the RSC • relevant physicians • medical physicists • laboratory staff Part 18: Organization of radiation protection program

50. Education and Training (cont) • Nurses working with radioactive patients • maintenance staff • radiation technologists • other relevant staff e.g. cardiologists who need to use X Rays Part 18: Organization of radiation protection program