Radiation Surveys and Documentation in Radiology (AKORN)

1.General Survey Procedures

1.1 Qualified Experts:
- Health Physicist: Specializes in the application of physics principles
to protect workers, the public, and the environment from ionizing
radiation. They conduct radiation surveys, develop safety programs,
and ensure regulatory compliance.
- Medical Physicist: Works in healthcare, applying physics knowledge
to medical radiation treatments, devices, and technologies. They
ensure equipment safety and effectiveness and are often involved in
patient diagnosis and treatment, radiation safety, and product
development.
- Radiation Safety Officer (RSO): Assesses potentially hazardous
situations to improve the safety and health of individuals. They handle
hazardous materials to minimize radioactive exposure, manage the
Radiation Protection Program (RPP), and ensure regulatory compliance.
1.2 Records:
Accurate records of radiation surveys are crucial for:
- Regulatory Compliance: Meeting legal requirements and
demonstrating adherence to safety standards.
- Trend Analysis: Identifying patterns in radiation exposure levels to
assess effectiveness of protection measures.
- Verification of Radiation Protection Measures: Confirming that
safety practices are effective and meeting intended goals.
1.2.2 Standard Documentation Requirements in Radiology:
Proper documentation is essential for:
o Patient Safety: Ensuring appropriate procedures and
minimizing risks.
o Regulatory Compliance: Meeting legal requirements for
record-keeping.
o Quality Control: Maintaining standards for image quality and
patient care.
o Efficient Workflow Management: Streamlining processes and
facilitating communication.
1.2.2.1 Patient and Exam Information:
- Full patient identification, including name, date of birth, medical record
number (MRN), and contact details.
- Referring physician details, including name and credentials.
- Clinical indications, outlining the reason for the imaging procedure.
- Imaging modality, specifying the type of equipment used.
- Procedure details, including date, time, and site of imaging.

1.2.2.2 Radiology Report:

- Exam findings, detailing observations based on image interpretation.
- Comparisons (if applicable), mentioning previous imaging for
comparison.
- Impressions/Conclusions: Summarizing findings and suggesting
diagnoses.
- Recommendations: Follow-up imaging, additional tests, or specialist
referrals.
- Radiologist’s signature and credentials: Legally required authentication
of the report.
1.2.2.3 Imaging and Technical Data:
- Radiation dose records, tracking patient exposure levels.
- Contrast agent documentation (if applicable), specifying type, volume,
concentration, and route of administration.
- Adverse reactions and management, documenting any complications.
- Image quality and repeat exposures, including image acquisition
parameters (kVp, mA, exposure time).
- Reasons for repeat imaging and corrective actions taken.
1.2.2.4 Equipment and Maintenance Logs:
- Daily/Weekly Quality Control (QC) Checks: Calibration and
performance testing records, phantom test results for image quality
assessment.
- Preventive Maintenance Reports: Regular servicing logs by
biomedical engineers, equipment malfunction reports, and corrective
actions.
1.2.2.5 Radiation Safety and Compliance Records:
- Radiation exposure monitoring, including personnel dosimetry reports,
badge readings, and occupational exposure records.
- Lead shielding and protective equipment checks, ensuring proper
function and maintenance.
- Regulatory compliance documentation (e.g., FDA), demonstrating
adherence to legal standards.
1.2.2.6 Incident Reports and Adverse Event Documentation:
- Contrast reaction reports, detailing mild/moderate/severe allergic
reactions.
- Radiation overdose incidents, documenting any deviation from
standard dose levels and corrective measures.
 - Equipment malfunctions affecting patient care, documenting machine
failures and impact on imaging quality.

1.2.2.7 Billing and Administrative Documentation:

- Procedure coding and billing records, using CPT (Current Procedural
Terminology) and ICD-10 codes for insurance claims.
- Consent forms, documenting patient agreement for the procedure.
Patient Communication Logs: Tracking follow-up calls, report
delivery confirmations, and patient inquiries.
2. Dose Reporting:
Conditions: Dose reporting is required when radiation exposure
exceeds established thresholds or when personnel are working in high-
radiation environments.
2.2 Radiographic and Fluoroscopic Equipment:
- Radiation dose assessments must include evaluations of radiographic
and fluoroscopic equipment to ensure that exposure levels remain
within safety limits.
3. Area Survey:
3.1 Controlled/Uncontrolled Areas:
o Controlled areas are designated spaces where radiation exposure
is monitored and limited.
o Uncontrolled areas are accessible to the general public and must
have lower exposure levels.
3.2 Conditions: Surveys assess radiation levels, shielding
effectiveness, and compliance with exposure limits in both controlled
and uncontrolled areas.
3.3 Recommendations: Survey results lead to recommendations for
improving radiation safety, including shielding adjustments, procedural
modifications, and equipment maintenance.
3.4 “Radiation Area” Sign Posting: Radiation areas must be clearly
marked with appropriate signage to warn personnel and the public
about potential exposure risks.
3.5 Monitors: Radiation monitors, such as Geiger-Muller counters and
ionization chambers, are used to assess radiation levels and ensure
compliance with safety standards.
Radiation Surveys and Documentation(III-Surveys)
1.What is a Survey?
- A survey is a thorough evaluation of work areas, instruments, and
equipment for the presence of radioactive contamination.
- This includes checking surfaces like floors, sinks, faucet handles,
drawer fronts, doorknobs, telephones, light switches, refrigerators, etc.

Two main types of surveys are performed:

- Radiation Field Survey: Measures radiation levels in the
environment.
- Contamination (Wipe) Survey: Checks for radioactive material on
surfaces.

2.When to Perform Surveys?

- Surveys are required to ensure the safety of laboratory personnel and
the environment.
- “As used” or “daily basis”: Individuals are required to survey
themselves and their work areas frequently.
- After each day of radioactive material usage/experimentation.
- After transfer of radioactive material from stock solutions.
- After each experimental run if there is a possibility of a change in
radiation levels or contamination.
- After a minor radioactive spill clean up or emergency.

Survey Types Based on Radioactive Material

The type of survey performed depends on the type of radioactive material
being used:
o Radiation Emitting Device (e.g., X-ray machine): General
Radiation Field Survey should be conducted periodically during
machine operations to verify proper function.
o Sealed Source: These sources are encapsulated to prevent
contamination. They should be checked for radioactive material
leakage semiannually by the Radiation Safety Office. Users
should also perform periodic General Radiation Field Surveys.
o Radioactive Material (solid, liquid, gas): Both contamination
surveys and radiation field surveys are required due to potential
contamination risks.
Importance of Standardized Dose Reporting
- Dose Reduction: Standardized dose reporting can help reduce
radiation exposure for patients.
 - Variability Reduction: There is still a lot of variability in radiation
doses for many procedures.
- Information for Referring Physicians: Dictating radiation dose into
radiologic reports provides referring physicians with the option of
knowing a patient’s radiation dose history and whether an additional
radiologic procedure is advisable.

Personal Radiation Monitoring: History, Devices, and Safety

1. Radiation Protection History:
- Ionizing Radiation: Ionizing radiation causes neutral atoms or
molecules to acquire an electrical charge. It includes alpha, beta,
gamma, X, and neutron rays.
- Direct vs. Indirect Ionization: Charged particles (alpha, beta)
directly ionize, while neutral radiation (X, gamma, neutron) indirectly
ionizes by creating charged particles.
- Early Detection: Tools like the gold leaf electroscope, photography,
and the cloud chamber helped in detecting radiation, but the discovery
of X-rays by Roentgen and uranium radiation by Becquerel in the late
19th century revolutionized the field.
- The International Commission on Radiological Protection
(ICRP): Founded in 1928, the ICRP is a leading body in establishing
radiation safety principles. Its recommendations are adopted by
national regulatory bodies to protect workers and the public.
- Post-War Evolution: The increased use of radioactive substances in
military and civil nuclear programs led to the expansion of radiation
protection efforts. The ICRP has continued to evolve its
recommendations and committee structure to address new challenges.
2. Personal Radiation Monitoring Devices: Features and Safety
Issues
- National Regulations: Regulations determine whether healthcare
providers require radiation monitoring. In some countries, it’s
mandatory for all radiation-exposed personnel to wear dose-monitoring
badges.
- Pregnant Workers: Special precautions are necessary for pregnant
workers to minimize fetal exposure to radiation.
2.1 Film Badges:
 - Purpose: Keep a detailed record of quarterly, annual, and lifetime
radiation doses received.
- How It Works: Film badges contain radiation-sensitive film that is
exposed and developed to measure exposure.
- Advantages: Provides a permanent record and is relatively
inexpensive.
- Disadvantages: Requires a processor for development, results are
not instant, and may give inaccurate results at high temperatures.
- Accuracy: Film badges must be worn properly, stored away from
radiation sources, and investigated if overexposure is detected.

2.2 Thermoluminescent Dosimeters (TLDs):

- How It Works: TLDs consist of a phosphor-containing crystal
structure. The phosphor interacts with ionizing radiation, releasing light
proportional to the exposure.
- Advantages: More accurate than film badges, higher low-dose
sensitivity, reusable.
- Disadvantages: Results are not instant, cannot store permanent
records, and are not re-readable.
- Applications: Monitoring both personal and environmental radiation
exposure.
2.3 Optically Stimulated Luminescence Dosimeter (OSLD):
- How It Works: OSLDs use pre-irradiated aluminum oxide, which
emits light when stimulated with specific wavelengths. The light
intensity is proportional to the absorbed dose.
- Advantages: Very sensitive, can determine radiation type and
energy.
- Disadvantages: Must be worn with the dosimeter facing the radiation
source.
- Luxel Dosimeter: A common type of OSLD considered the most
sensitive.
2.3 Pocket Dosimeter:
- How It Works: Provides an immediate reading of radiation exposure.
Types:
- Direct Read Pocket Dosimeter: Reusable and provides instant
readings.
 - Digital Electronic Dosimeter: Uses Geiger-Müller counters to detect
dose rate.
- Advantages: Provides immediate readings.
- Disadvantages: Cannot store permanent records, limited range,
prone to data loss.
3.International Commission on Radiation Units and Measurements
(ICRU):
- Purpose: Develops concepts, definitions, and recommendations for
ionizing radiation units and measurements.
- Relationship to ICRP: The ICRU defines the units, while the ICRP
recommends their application in radiation protection.
4.Radiation Quantities:
- Units: The ICRU has defined various radiation quantities using SI and
non-SI units.

5.Total Effective Dose Equivalent (TEDE):

- Definition: A radiation dosimetry quantity used to monitor and
control human exposure to ionizing radiation.
- Components: Sum of effective dose equivalent from external
exposure and committed effective dose equivalent from internal
exposure.
- Regulatory Limits: TEDE limits are imposed on occupationally
exposed individuals and the general public.
6.Fetal Effects of Radiation Dosage:
- Stochastic Effects: Radiation-induced cancer and heritable effects.
- Deterministic Effects: Tissue reactions following high doses.
- Fetal Sensitivity: Fetuses are more vulnerable to radiation due to
cell growth and longer lifespan for cancer development.
- Intellectual Deficit: Estimated to be about 25 IQ-points per 1,000
mGy at 10 to 17 weeks of gestation.