Author: Versant Physics

01 Jun 2022
diagnostic imaging procedure

Diagnostic Medical Physics in Medicine: Why It’s Important

Many are unfamiliar with the important role that diagnostic medical physics plays in medicine, particularly in the diagnosis and treatment of diseases like cancer.

At Versant Physics, we provide a wide range of diagnostic medical physics services that help healthcare facilities safely and effectively execute procedures for the health and well-being of their patients. Our goal is to help facilities ensure their patients are protected from excessive levels of radiation and that diagnostic equipment is working appropriately, all while maintaining compliance with state and federal regulations.

In this blog post, we’ll break down what diagnostic imaging is, how and why physics principles are applied to diagnostic medicine, and the various roles of a diagnostic medical physicist to help clarify the importance of this profession.

What is Diagnostic Imaging?

Diagnostic Imaging is a range of techniques and equipment used to look inside the body. The purpose of this is to help physicians identify injuries and illnesses, and to help make an accurate diagnosis and treatment plan. This can include a variety of procedures, from simple X-rays for broken bones to more complex procedures involving the brain, heart, or lungs.

Diagnostic imaging procedures are usually painless and noninvasive. However, depending on the test being performed, some patients may be exposed to small amounts of radiation.

diagnostic medical physics

CT scans are a common example of a diagnostic imaging test that emits radiation. In a CT scan, the patient is exposed to a series of X-rays from a variety of angles which are then processed via a computer. The computer creates cross-sectional images of the inside of the body. CT scans are higher-quality images than a normal X-ray and allow physicians to view both hard and soft tissues in the body. They can check for stroke, internal bleeding, chest abnormalities, enlarged lymph nodes, abdominal or pelvic pain, tumors, and more. It is also used to monitor existing diseases such as heart disease and cancer. 

Other common diagnostic imaging procedures include mammography, which helps detect and diagnose breast cancer, fluoroscopy, magnetic resonance imaging (MRI), and ultrasounds.  

Diagnostic Physics and Medicine

Medical physics as a field is divided into five categories, including:

  • nuclear medicine
  • therapeutic medical physics,
  • medical health physics,
  • magnetic resonance imaging physics, and
  • diagnostic imaging.

Diagnostic medical physicists are responsible for ensuring the safe and effective application of radiation used in medical treatments. Specifically, radiology procedures. They work as a member of a patient’s care team, which typically includes physicians, dosimetrists, and radiologic technologists among others.

Equipment Evaluation and Compliance

One of the main roles of a diagnostic medical physicist is to ensure the safe operation of radiation-producing machines and diagnostic radiation detectors. This can include developing imaging equipment specifications, measuring the radiation produced by a piece of equipment prior to clinical use, and proving that the equipment is compliant with regulatory and accreditation requirements.

This also includes assessing all the software, algorithms, data, and computer systems associated with the radiation-producing equipment for accuracy and performance.

Acceptance Testing

Any unit that is used in a diagnostic setting must be periodically reviewed to ensure not only that the image quality is maintained, but that the unit is operating in compliance with the manufacturer’s specifications.

Most states require that a newly installed piece of diagnostic imaging equipment, whether it is brand new or used, be tested by a qualified medical physicist prior to first clinical use. This extremely thorough survey confirms that the unit was installed and set up correctly and ensures that it meets vendor and industry performance standards. It is also an opportunity to identify any potential issues with the unit before it is used on patients.

mammography unit

Typical units that require acceptance testing include fluoroscopic x-rays, radiographic x-rays, PET and PET/CT units, mammography equipment, C-arms, CTs, SPECT cameras, and PACS workstations.

Commissioning

The commissioning process for diagnostic radiation therapy machines such as Linear Accelerators involves testing the unit’s functionality and verifying that dose calculation algorithms work appropriately to produce measured dose calculations.  

Radiation-producing equipment like a LINAC is highly technical and specific. There are many requirements and protocols that detail how this unit should work, from how much energy it produces to the shape and direction of the beam. Diagnostic medical physicists are trained to measure, assess, and implement the optimal baseline values for a unit during the commissioning process.

Patient safety is the end goal of all diagnostic physics commissioning work.

Shielding

Another important aspect of diagnostic physics includes the planning and placement of shielding in areas that use radiation. In the United States, 35+ states require specific shielding designs in any room that houses radiation-producing equipment.

A diagnostic medical physicist can evaluate any shielding that is installed to determine if it will adequately protect workers, patients, and the public from the radiation outside of the scope of a specific treatment. This includes planning for material thickness as well as appropriate placement.

Versant Physics physicists are experienced with a range of equipment shielding requirements, including dental units, Cone-beam CTs, mobile c-arms, high-energy LINACS, Proton Therapy units, and Cyclotrons.

Our team is also experienced with different types of shielding materials, including non-lead materials, which are guaranteed to meet regulatory guidelines and ALARA principles.

Patient Dose & Treatment

Part of a diagnostic physicist’s job is also to ensure the safety of medical imaging modalities being applied in the treatment of individual patients.

They are responsible for determining the exact radiation dose a patient will receive in accordance with the radiation oncologist’s prescription before the patient begins treatment. Creating this therapy plan can take a few hours or multiple days, depending on the complexity of the illness. They also ensure radiation protection guidelines are in place, develop QA tools that ensure optimal image quality, and make sure that all operators are trained in the use of the best imaging techniques.

A diagnostic medical physicist may also monitor the dose of the patient throughout the course of their treatment.

Patients rarely interact directly with the medical physicist on their care team; however, they are a vital part of a safe and effective treatment process.

Versant Physics Diagnostic Support

Our board-certified physicists are able to handle diagnostic physics support for a variety of facilities, including hospitals, clinics, dental offices, and university health systems. With decades of experience, top-of-the-line equipment, and a passion for patient safety, our team is the best choice to assist with your diagnostic medical physics needs.

Contact us for a quote or to learn more about our medical physics support services.

20 May 2022
dental x-ray

X-Rays and Radiation Safety Principles in Dentistry

Dental x-rays are important for maintaining an individual’s optimal oral health. Like with any x-ray procedure, there are radiation safety principles that have been put in place to protect both patients and dentistry professionals.

Why are Dental X-rays Important?

Dental x-rays are an essential part of maintaining a healthy jaw and teeth. This diagnostic tool allows dentists to take a more in-depth look at what’s going on inside a patient’s mouth. Some dental problems affecting the roots of a tooth or that exist below the gum line cannot be diagnosed through a simple visual exam.

What Can a Dental X-ray Be Used for?

Dentists use dental x-rays to diagnose a variety of dental conditions, including:

  • Gum disease
  • Cavities and tooth decay
  • Impacted teeth
  • Cysts
  • Abscesses
  • Jaw disorders
  • Sinus issues
  • Bone loss

These x-rays are also beneficial for individuals who smoke, have a history of restorative dental work, or drink an excessive number of sugary drinks like pop or juice.

Radiation Safety for Patients During Dental X-rays

Most patients will undergo at least one of two different types of dental x-rays during their annual or bi-annual visit to the dentist.  Each has its own radiation protection requirements to limit the patient’s radiation dose.

Bitewing X-rays

Bitewing x-rays are a type of intraoral x-ray. During a bitewing x-ray, the patient is required to bite down on a small tab attached to an x-ray film. There are usually 4 images taken to help dentists visualize all sides of the mouth.

Patients are usually required to wear a lead vest during a bitewing x-ray. Thyroid collars and leaded glasses can also be used to protect the eyes and sensitive areas of the throat.

Panoramic X-rays

Panoramic x-rays are extraoral x-rays used to diagnose dental problems in the jaw and skull. This 2D digital x-ray captures a single image of the entire mouth.

dental x-ray

The machine has two sides. One side houses the x-ray tube, and the other houses the x-ray detector or x-ray film. The x-ray rotates around the patient’s head during this procedure to take the full image. A lead apron or thyroid protective collar may also be worn during this procedure as a safety precaution; however, it is not required.

Miscellaneous Dental X-rays

Other types of dental x-rays a patient may experience include a dental cone beam CT scan (3D image of the teeth and jaw) or a cephalometric projection (image of the entire head). These x-rays are not likely to occur during a routine visit.

Are Dental X-rays Safe?

Patients are exposed to extremely minimal radiation doses during dental x-ray procedures. A patient who undergoes a bitewing x-ray procedure will receive a radiation dose of 0.4 mrem, while a panoramic x-ray radiation dose exposure is approximately 0.7 mrem.  

For comparison, the average U.S. citizen receives an annual radiation dose of 620 mrem. The sources of this radiation come from naturally occurring cosmic, internal, and terrestrial radiation, medical procedures like CT scans and conventional radiography procedures, and consumer products like tobacco, fertilizer, or welding rods.  

As mentioned above, there are numerous protective measures put in place to help limit overall radiation exposure. Protective measures for patients during a dental x-ray include:

  • Using protective lead aprons and thyroid collars
  • Using modern x-ray equipment and up to date imaging techniques
  • Limiting the number of images taken in a year

The American Dental Association recommends that healthy patients receive x-rays once every 2 to 3 years to limit the amount of radiation exposure they receive.

Like any diagnostic procedure, the benefits of a dental x-ray far outweigh the low radiation dose a patient will receive. Dental x-rays can not only identify existing issues, but they can also identify potential problems that, if left untreated, could turn into serious or even life-threatening issues.

Radiation Safety for Dental Professionals

Radiation safety and radiation protection guidelines are especially important for dental professionals. The NRC regulates the amount of radiation exposure for adults who work with radioactive materials. Occupational exposure limits are limited to 5,000 mrem per year.

Dental professionals including hygienists, oral surgeons, and orthodontists, are required to adhere to these exposure limits. This profession receives less ionizing radiation exposure than other healthcare professionals on average. However, basic protective measures help limit their occupational radiation exposure and keep up with ALARA standards.

Personal Dosimeter

Dental professionals should wear a personal dosimeter when operating x-ray equipment to record their dose.

Instadose+ Dosimeter

The Instadose+ dosimeter is an affordable personal dosimeter option that provides dentists and dental professionals with accurate, long-term exposure tracking. The device wirelessly captures, transmits, measures, and analyzes radiation dose exposure. Dental professionals can access their read history on-demand and in real-time thanks to the device’s Bluetooth and SmartMonitoring technology.

Unlike traditional film badges, the Instadose+ dosimeter does not need to be collected and processed off-site.

Time, Distance, and Shielding

The standard guidelines for minimizing dental professionals’ exposure are time, distance, and shielding. This means limiting the amount of time spent around a radiation source, maintaining a safe distance away from the source of radiation, and standing behind protective barriers during a procedure.

During a routine dental visit, hygienists are often the ones who prepare and take the dental x-ray. To limit their exposure from taking these images multiple times a day, hygienists will usually leave the room to increase their distance from the x-ray tube. They may also stand behind a lead wall or partition while the image is being taken.

The Takeaway

Dental x-rays are a necessary part of maintaining good oral health. Radiation safety guidelines like wearing lead vests and thyroid collars are important for limiting patient exposure during routine checkups. Wearing a personal dosimeter and following time, distance, and shielding guidelines are also necessary for limiting occupational exposure.

28 Apr 2022
Radiation Protection Survey of Package with Pancake Probe

A Beginner’s Guide to Radiation Protection Surveys

The purpose of a radiation protection survey is to identify higher-than-normal doses of radiation in medical environments, labs, and anywhere radiation-emitting machines or radioactive materials (RAM) are used. They are required by state and federal regulations to be performed regularly to ensure the safety of technicians, technologists, nurses, doctors, researchers, and patients.

In this brief guide we’ll talk about what a radiation protection survey is, why it is important, and the type of equipment required to perform a radiation protection survey.

What is a radiation protection survey?

Radiation protection surveys are a way to directly measure radiation levels and identify potential leakage through breaks or voids in shielding.

Surveys are performed on:

  • Diagnostic fluoroscopic and radiographic equipment
  • Non-medical industrial equipment such as those found in veterinary offices
  • CT and CBCT machines
  • Particle accelerators
  • Irradiators
  • Bone mineral densitometers
  • Cabinet x-ray machines
  • Areas that use sealed sources of RAM
  • Packages containing RAM

The Different Types of Radiation Surveys

Not all radiation surveys are created equal. Let’s talk about some of the different surveys you may encounter a need for in your radiation safety program.

Radiation Emitting Device Survey

X-ray machines and other radiation-emitting devices require regular surveys to be performed to confirm that the machine is operating as expected. Radiation producing machines are surveyed for:

  • Timer accuracy
  • Radiation output
  • Focal spot size
  • kVp and mA
  • Beam limitation accuracy
  • Filtration
  • Skin entrance exposure / rate of exposure
  • Scatter radiation measurements
  • Photo-timer operation
  • Proper signage, labels, and postings

If high or unexpected dose rates are measured during a survey, the machine should be turned off and undergo appropriate maintenance.

Area Survey

Area surveys are required anywhere a radiation device is in use and the potential for receiving a higher-than-normal radiation dose is present. These surveys are typically measured in milliRoentgen per hour (mR/hr). The Roentgen is a measure of the amount of ionization in the air from the radiation.

Anytime you have an area survey performed, you are required to keep the official records of the survey results for 3 years.

Contamination Wipe Test

A contamination wipe test, also known as an indirect or swipe survey, is used to identify radioactive material contamination on surfaces, equipment, and clothing such as those found in a lab. This type of survey can identify non-fixed radiation left behind from radioactive solids, liquids, or gasses.

Lab tech performing a wipe test

Wipe tests are recommended to be performed frequently, especially if you are a HAZMAT employee that receives or ships RAM packages. A wipe test involves wiping at least 300cm2 of the package’s surfaces using an absorbent material. Afterward, the activity on the swipe is measured assuming a removal efficiency of 0.1 unless the actual efficiency is known.

Users in lab settings typically survey their work areas after an experiment or when a minor spill is suspected.

Radioactive Sealed Source

A radioactive sealed source is a source of special form RAM that has been contained or encapsulated to prevent contamination. These sources can only be opened by destruction. Semi-annual surveys of these sources are required to check for leakage.

Bioassay Survey

Internal exposure monitoring, or a bioassay survey, is performed on individuals that use unsealed radioactive materials. The survey estimates the internal organ dose to determine if any RAM has entered the body. It can also help determine if RAM is present in the air.

Bioassay surveys are performed by analyzing blood, tissue, or urine samples or by carefully monitoring the presence and/or quality of isotopes present in the organ of concern.

How often do I need to have a survey performed?

The frequency of a radiation protection survey depends on several factors, most of which depend on different state and federal regulations.

  • When a new or used x-ray equipment is installed
  • When existing x-ray equipment has been moved
  • If shielding has been modified
  • After the equipment has undergone significant repairs
  • If a potential problem is indicated

Who performs these surveys?

In general, surveys on radiation-producing equipment are conducted by health physicists and medical physicists.

Is special equipment required for a survey?

Special equipment is required to detect ionizing radiation. Most equipment is hand-held measurement instruments called survey meters. This equipment is required to be calibrated annually to maintain accuracy and to ensure that reliable measurements are recorded.

Survey meters consist of:

  • A probe which produces electrical signals when it is exposed to radiation
  • A control panel readout with an electronic meter that gauges the amount of radiation exposure
  • A speaker which provides an audible indication of the radiation exposure

There are several different kinds of survey meters physicists use to perform radiation surveys.

Geiger-Mueller Pancake Probe

One of the more commonly used survey meters is the Geiger-Mueller Pancake Detector. Although there is no “universal” radiation detector, the G-M Pancake Probe comes pretty close. This is because the probe can detect alpha, beta, and gamma radiation, although they are generally used for detecting Beta Emitters. These probes come in a variety of models and configurations.

Surveying open package with pancake probe

The probe detects radiation by collecting counting gas within the tube. The counting gas is ionized when a photon or particle interacts with a released electron. When the voltage is high, radiation that interacts with the counting gas produces an electronic pulse that is measured with a separate counting instrument.

A pancake probe has a thin layer of mica on the active face of the detector, which allows most alpha and beta particles to interact with the counting gas inside the tube.

G-M Pancake Probes are frequently used to detect C-14, Ca-45, P-32, P-33, and S-35.

Scintillation Survey Meter

A scintillation survey meter is used to detect low-energy Gamma Emitters and x-rays. The scintillator, or sensor, is made of a transparent crystal or liquid which shines when it interacts with ionizing radiation. The scintillator is attached to a photosensor like a photomultiplier tube which detects the generated light.

This survey meter detects I-125 and Cr-51. They are an ideal equipment choice for surveying electron microscopes and x-ray diffractometers.

Diagnostic Physics Support and Radiation Surveys by Versant Physics

When it comes to hiring a consultant to perform radiation protection or QA surveys for your equipment, you want to make sure you’re working with the best. People who are experts in state and federal regulations regarding radiation machines and RAM, have access to top-of-the-line survey equipment and understand the importance of adhering to ALARA standards.

Versant Physics’ proactive and transparent diagnostic physics support process minimizes safety concerns and reduces the likelihood of compliance violations. We support our clients by sharing our knowledge of best practices in advanced technologies, and by utilizing a team-based approach we feel enables our clients to focus on maximizing the quality of patient care.

Contact our team for a free 30-minute consultation to learn more about our diagnostic physics and radiation survey expertise.


20 Apr 2022
Nurse standing behind radiation shielding

The Basics of Radiation Shielding in Medicine

Basic radiation protection guidelines can be summed up in three simple concepts: time, distance, and shielding. While both limiting the time spent and increasing the proximity to an ionizing radiation source is something that lies within the power of the individual, shielding and X-ray room design require careful planning and execution by the facility or Radiation Safety Officer.

What is radiation shielding?

Radiation shielding is simply a barrier placed between a source of radiation and the area or person that needs to be protected. The purpose of radiation shielding is to limit, control, or modify the radiation exposure rate at a set point.

Shielding is based on attenuation or the gradual reduction in the intensity of energy through a specific medium. X-ray radiation that passes through certain materials decrease and are absorbed, thereby reducing the exposure to the other side of the barrier.

Without shielding, the public, radiation workers (including dentists and veterinarians), and even nearby office workers could be exposed to levels of radiation outside regulated exposure limits, which can potentially lead to negative health effects. Although it is impossible to completely avoid exposure to radiation, shielding is a critical consideration in any medical facility that greatly reduces unnecessary exposure.

Shielding Materials

There are several different materials that provide protection from penetrating radiation. Concrete, water, special plastic shields, air stops, and lead are all barriers that stop different types of rays and particles, reducing the overall dose a person receives.

In medical environments, the most common shielding materials used include lead, lead-free shielding, and lead composites.

Lead

Lead is one of the most used and most effective shielding materials. It is a highly dense material with a high atomic number and a high number of electrons which make it ideal for shielding in most medical radiation environments. This is because the type and energy of radiation in a medical environment that passes through lead are absorbed or scattered by the electrons present in the material.

Vet team wearing shielding garments during exam

Lead is also cheap and easy to process. It can be mixed with other materials like glass, or binders like vinyl, which allows it to be used as construction materials in X-ray rooms or worn as shielding garments.

Lead-Free Shielding

Technological advances have allowed for the creation of non-toxic, lead-free shielding materials as well. Other attenuating materials such as antimony (Sb), tungsten (W), and tin (Sn) are used in place of lead and combined with additives and binders to create wearable protective garments or materials. They offer equal protection from scatter radiation.

Lead-free shielding has several benefits, including being both recyclable and non-toxic. Lead-free shielding materials can also be lighter which makes them easier for personnel to wear during longer procedures.  

Lead Composite

Lead composite shielding is a long-lasting mixture of lead and lighter materials that attenuate radiation just as successfully as traditional lead shielding barriers.

Because of lead’s weight, it can be cumbersome to use and wear for long periods of time, limiting the efficacy of a radiation worker. Lead composites solve this problem. They are made with blends of tin, vinyl, and rubber and create a shielding barrier that can be up to 25% lighter than traditional shielding without sacrificing their ability to block penetrating radiation.

Shielding and Scatter Radiation

In some diagnostic X-ray procedures, medical personnel such as operators, radiologists, and technologists are required to remain in the room with the patient. This proximity frequently exposes them to something called scatter radiation or radiation that bounces off a patient’s body during a procedure.

To limit this exposure, some medical personnel are required to wear frontal or full wrap-around style lead aprons, thyroid shields, and lead glasses/gloves. These protective garments can attenuate roughly 93% of photons at typically scattered energies.

Lead apron and thyroid collar on hangar

Shielding Products and Design

There are several different ways radiation shielding can be applied or designed to protect healthcare workers.

Room Shielding

Shielding may be required in the floor, ceiling, doors, or any wall of any X-ray or radioactive material use room.  Shielding is used to protect workers, patients, or the public that may be in the adjacent areas/rooms.

During a room’s construction, special shielding materials are installed where their need has been determined. These materials can include lead-lined windows and doors, lead-lined drywall or plywood, lead sheets for floors and ceilings, pipe shielding, and more.

X-ray room shielding requirements vary from state to state. It is important to consult with a qualified expert familiar with these regulations as well as work with an architect experienced in constructing X-ray suites before building a new room.

Leaded Glass and Curtains

In some cases, it isn’t possible for a facility to build shielding into the physical structure of a building.

Leaded glass barriers are a barrier used by techs and doctors which allow them to safely view a patient during an imaging procedure. This type of glass is ideal for radiation-producing equipment in the 80-300 kV range thanks to its high lead content.

Lead curtains are also used to shield radiation workers, particularly in large animal hospitals or operating rooms. These curtains are leaded rubber or vinyl sheets that are ideal for protection against low-level or secondary radiation. They make for room-saving partitions that can be open or closed as needed and typically offer protection from 0.5mm to 2.00mm lead equivalency.

Mobile Shielding Barriers

In some cases, additional barriers are needed to protect doctors and techs during radiology, nuclear medicine, cath lab, or diagnostic imaging procedure. These barriers are lead-lined partitions on wheels, often with a protected window to allow for patient observation.

Mobile radiation barriers come in a variety of shapes, sizes, and lead equivalencies. They are ideal for maintaining flexibility and ease of movement in a procedure room while successfully minimizing the scattered radiation dose to workers in the room.

Versant Physics Shielding Services

Understanding the detailed shielding requirements for your state or facility can be a time-consuming challenge. If executed incorrectly, there can be serious consequences to the health and safety of radiation workers, patients, and building staff as well as potential regulatory compliance fines.

That’s why it is important to have a radiation safety consultant like Versant Physics on your side. Whether you’re constructing a new X-ray room, remodeling or repairing an existing shielding setup, or looking to upgrade your current shielding equipment, our team of expert health and medical physicists can assist.

We provide radiation shielding calculations, evaluation, and design for facilities of all kinds, including hospitals, clinics, dentist offices, chiropractor offices, and veterinary clinics. Our range of expertise includes:

  • Radiography
  • Fluoroscopy
  • Computed Tomography (CT)
  • Nuclear Medicine/PET
  • Mammography
  • Dental/Veterinary X-ray

Not sure what materials or type of shielding is right for your facility? Contact our regulatory experts for a free 30-minute consultation.

25 Feb 2022
CT radiation medical event

What are Radiation Medical Events and How to Prevent Them

The use of radiation in medicine via radiology, nuclear medicine, and radiotherapy helps detect and treat a variety of medical conditions in humans. It is a commonly used practice, with over 10 million procedures performed in the United States each year and thousands of lives saved as a result.

When radiation is administered improperly it is classified as a radiation medical event. A radiation medical event can occur when certain forms of radioactive sources are applied differently from what was intended or prescribed.

Although a radiation medical event does not necessarily result in harm to the patient, it does indicate that there is a potential problem in the medical facility’s use of radioactive sources (materials or equipment). An investigation into the event is required as soon as a medical event is suspected, typically by a clinical health physicist, as well as a written report documenting their findings.

What is a Radiation Medical Event?

The NRC defines an incident as a radiation medical event when (10 CFR 35.3045) the administration of byproduct material or radiation from byproduct material for, except permanent implant brachytherapy, results in—

  1. A dose that differs from the prescribed dose or dose that would have resulted from the prescribed dosage by more than 0.05 Sv (5 rem) effective dose equivalent, 0.5 Sv (50 rem) to an organ or tissue, or 0.5 Sv (50 rem) shallow dose equivalent to the skin; and
    1. The total dose delivered differs from the prescribed dose by 20 percent or more; or
    1. The total dosage delivered differs from the prescribed dosage by 20 percent or more or falls outside the prescribed dosage range; or
    1. The fractionated dose delivered differs from the prescribed dose for a single fraction, by 50 percent or more.
  2. A dose that exceeds 0.05 Sv (5 rem) effective dose equivalent, 0.5 Sv (50 rem) to an organ or tissue, or 0.5 Sv (50 rem) shallow dose equivalent to the skin from any of the following—
    1. An administration of a wrong radioactive drug containing byproduct material or the wrong radionuclide for a brachytherapy procedure;
    1. An administration of a radioactive drug containing byproduct material by the wrong route of administration;
    1.  An administration of a dose or dosage to the wrong individual or human research subject;
    1. An administration of a dose or dosage delivered by the wrong mode of treatment; or
    1. A leaking sealed source.
  3. A dose to the skin or an organ or tissue other than the treatment site that exceeds by:
    1. 0.5 Sv (50 rem) or more the expected dose to that site from the procedure if the administration had been given in accordance with the written directive prepared or revised before administration; and
    1. 50 percent or more the expected dose to that site from the procedure if the administration had been given in accordance with the written directive prepared or revised before administration.
  4. For permanent implant brachytherapy, the administration of byproduct material or radiation from byproduct material (excluding sources that were implanted in the correct site but migrated outside the treatment site) that results in—
    1. The total source strength administered differing by 20 percent or more from the total source strength documented in the post-implantation portion of the written directive;
    1. The total source strength administered outside of the treatment site exceeding 20 percent of the total source strength documented in the post-implantation portion of the written directive; or
    1. An administration that includes any of the following:
      1. The wrong radionuclide;
      1. The wrong individual or human research subject;
      1. Sealed source(s) implanted directly into a location discontiguous from the treatment site, as documented in the post-implantation portion of the written directive; or
      1. A leaking sealed source resulting in a dose that exceeds 0.5 Sv (50 rem) to an organ or tissue.
  5. Intervention of a patient or human research subject in which the administration of byproduct material or radiation from byproduct material results or will result in unintended permanent functional damage to an organ or a physiological system, as determined by a physician.

Radiation Medical Event Reports

Any of these medical events must be reported by telephone to the appropriate regulatory agency (i.e., Nuclear Regulatory Commission or Agreement State agency) no later than the next calendar day after discovery. A detailed written report, as described in 10 CFR 35.3045, must be submitted within 15 days after the discovery of the event. Such reports do not include information that could identify the affected patient as these reports are made available to the public.

medical event report

While medical events are accidental, it should be noted that a radiation medical event and a radiation accident are not the same things. Radiation accidents are defined as an event that “has led to significant consequences to people, the environment, or the facility,” such as a nuclear reactor core melt.

The purpose of medical event reporting is to initiate a process that will: (i) determine the root cause(s) and contributing cause(s); (ii) implement immediate corrective actions as may be necessary; (iii) identify preventative actions necessary to prevent a reoccurrence, and (iv) ensure appropriate notification of the patient and referring physician has occurred.  Additionally, the event may trigger the regulatory agency to alert other licensees to a potential problem that should be addressed.   

A medical event may indicate that there are problems within a facility that needs to be addressed. Communication problems, improper labeling, lack of training, and basic human error are all possible explanations.

An investigation into the technical aspects of the procedure, overall quality assurance practices (i.e., audits), and treatment delivery are required. A physician may also need to provide a separate analysis of potential injury or inadequate treatment to determine if any harm came to the patient because of the medical event.

Other medical event reports include:

  1. Report and notification of a dose to an embryo/fetus or a nursing child (10 CFR 35.3047) This includes an unintended dose to an embryo/fetus or a nursing child greater than 5 rem resulting from administration of a byproduct material to the mother/breast feeding individual. No report is required if the dose to the embryo/fetus was approved by the authorized user; or
  2. Report of a leaking sealed source (10 CFR 35.3067). The written report should include the model number, serial number, the radionuclide and its estimated activity, the date and results of the leak test, and the action taken.

How Are Patients Notified of a Medical Event?

NRC regulations state that it is the licensee’s responsibility to notify the exposed individual and their referring physician of the medical event within 24 hours of its discovery. If the notice is made verbally, the patient can request a written notification as well as access to the full report.

Severe events are rare, and harm is unlikely to befall a patient involved with a radiation medical event. However, it is important that the individual receive the appropriate medical care as soon as possible if needed.

Radiation Medical Events Can Be Prevented

With proper continuing education training, regular machine and technology upkeep, a working standard operating procedure, and efficient reporting systems, radiation medical events can be prevented.

It also helps to have a third-party consultant who can identify potential problems in your radiation safety program.

The team at Versant Physics is trained and equipped to help radiology departments and medical facilities prevent radiation medical events. Our board-certified medical and health physicists can help by performing acceptance testing of radiation-producing machines, conducting regulatory compliance audits, performing shielding evaluation and design calculations, and leading training opportunities.

Contact our regulatory team to discuss your radiation safety program needs.

Further Reading:

07 Feb 2022
Dosimetry management

How to Increase Dosimetry Compliance Rates with Versant Physics Proven Management Process 

One of the many responsibilities of a Radiation Safety Officer is to manage their facility’s personnel dosimetry program and monitor the exposures of the radiation workers employed there. This may seem like a simple task; however, it can be a challenge to get workers to wear and exchange/read their dosimeters in accordance with state and federal regulations. This leads many RSOs to wonder if it is possible to improve dosimetry compliance rates, particularly in large programs that have hundreds of occupationally exposed individuals to monitor. 

With the right dosimeter and the right management process, improving dosimetry compliance rates is very possible, regardless of the size of your dosimetry program.

Below we explain the common problems associated with traditional methods of personnel dosimetry program management, as well as offer a solution for improving your dosimetry compliance rates without increasing costs or workload for your staff.

The Problem with Traditional Methods of Dosimetry Management

Dosimetry is one of the key elements of a radiation safety program, but it can also be one of the biggest headaches for Radiation Safety Officers and Environmental, Health, and Safety managers. There are several problems with traditional methods of dosimetry management that managers often encounter, including:

  • A time-consuming badge collection and redistribution process
  • High costs of running a badge monitoring program
  • Time between when an exposure or anomaly is received and when an individual is made aware of the exposure
  • Keeping track of historical dose reads and measurements
  • Efficient communication with wearers regarding read reminders, exceeding dose limits, and more

These problems can make an RSO feel as though they’re herding cats at worst and like they’re constantly one step behind at best. Juggling these many tasks within just one aspect of a radiation safety program, along with a variety of other responsibilities, it’s not hard to see why dosimetry compliance rates can be rather low.  

Versant Physics Personnel Dosimetry Management

Versant Physics manages personnel dosimetry programs a bit differently. In addition to using top-of-the-line electronic dosimeters that utilize the latest monitoring technology, our team of badge specialists and physicists combines customer service, technical support, and quality administration tactics to manage everything your program needs to run successfully. From ordering new badges to ensuring wearers read their badges promptly, our team’s management process is proven and effective.

Versant Physics also utilizes their proprietary radiation safety software Odyssey to manage the personnel dosimetry programs of their clients.

Personnel Dosimetry Management Module

Odyssey is a cloud-based software that features an entire module devoted to personnel dosimetry management. The module includes useful tools like a query builder for compiling data records and a Form Generator for easy management of Form-5s. The module also features a series of customizable widgets that allow users to visualize pre-set metrics in their program, including a User Watch List for wearers likely to exceed internal or annual dose limits, Read Activity, and Badges Communicated.

Instadose+ by Mirion Technologies

Personnel dosimetry programs managed by Versant Physics also utilize the Instadose+ dosimeter. These small, lightweight badges combine Bluetooth technology, Direct Ion Storage (DIS), and SmartMonitoring to wirelessly and remotely transmit radiation dose data. Mobile devices, such as a smartphone or tablet, as well as PCs or hotspot stations, assist with this process.

Instadose+ Dosimeter

Each dosimeter has a built-in memory chip with a unique serial code that is assigned to the specific wearer. The badges are assigned long-term, meaning they do not need to be sent in for processing at the end of a monitoring period. Instead, wearers are responsible for reading their badges per the monitoring period set up by their radiation safety program.

Reading the badge is easy and takes less than a minute to complete from start to finish. Wearers typically read their badge by opening the Instadose+ app on their mobile device and holding down the button on the back of the dosimeter for 5 seconds, or until the light on the top of the badge turns green. Readings are then stored within their secure account.

The Instadose+ allows for unlimited, on-demand dose reads, so wearers can complete this process as often as they desire. Not only is this useful from a dose history standpoint, but it also gives wearers the power to view their current and historical dose reads from their online account anytime they want. If they have a question or a concern, the answers are already at their fingertips.

Overall, the Instadose+ simplifies dose reads and makes them more accessible to the individual worker and radiation safety officer. This allows for improved dosimetry compliance across the board.

Its user-friendly read process, historical dose transparency, and accurate, reliable readings are some of the reasons why it is a key player in Versant Physics’ badge management process.  

Badge Administration

Our experienced technical support specialists are equipped to handle the entire badge management process. This includes ordering badges from the manufacturer to removing wearers from the program. They also handle:

  • Remote and/or in-person badge training
  • Initialization of badges
  • Vendor credentialing and attestation
  • On-site event support

Compliance Administration

Versant Physics assigns a physicist to each client to help drive program compliance. The physicist works with the program RSO to develop an effective plan for making sure wearers read their badges. In the event there is no program RSO, Versant Physics’ physicists can serve as in-house RSOs as well.

Together with the badge team, they are also responsible for: 

  • Regular communication with wearers (weekly, monthly, or quarterly)
  • Read-day reminders
  • Non-communicated follow-up reminders
  • Comprehensive monthly compliance reports
  • Dose monitoring
  • High dose alerts
  • Dose discussions with RSOs/workers

Consistent communication with wearers is a necessary part of improving overall dosimetry compliance rates. Depending on the monitoring period set by the program RSO, Versant Physics sends out scheduled read-day reminder emails. They also send follow-up emails to those that have not read their badge.

Furthermore, RSOs and program leadership are always kept in the loop as to where their program currently stands. This is done through the use of a comprehensive monthly report.

Versant Physics monthly report displays badges that have not submitted a reading during the monitoring period. It also lists duplicate badges, lost and defective badges, as well as any new badges that were assigned in that month. The report provides status updates on mid-month follow-up with wearers, an active wearer list organized by location, and high dose reports as well.

This report paints a clear picture of program compliance month over month and helps pinpoint areas of concern. It also addresses program elements that could be improved upon in the following months.

Customer Service and Technical Support

When issues arise or wearers experience problems with their badges, Versant Physics’ team of technical support specialists are trained and ready to handle them promptly. They will help with:

  • Badge troubleshooting
  • Issuing replacement badges
  • Phone and email support

Additionally, wearers have access to the Versant Physics support desk, where they can submit questions or concerns with their badges 24/7. All requests submitted by wearers and program personnel receive a response within 24-hours.

A Note on Radiation Dose Limits

Versant Physics clients can set their own dose limits for their employees (within the regulatory limits) depending on what works best for their program.

For example, some clients prefer to set specific limits for single doses. Others have more lenient thresholds that are measured quarterly. Whatever your program’s monitoring preferences are, Versant Physics is prepared to help you implement and manage them.

The Takeaway

Versant Physics badge specialists, physicists, and technical support teams provide efficient badge management catered to the needs of your program. With the help of the Instadose+ dosimeter, Odyssey radiation safety software, and years of experience managing dosimetry programs of all sizes, we can work with you to help improve dosimetry compliance rates in your program.

Contact our team to learn more about our badge management process and pricing.

Versant Physics logo

Forum Article "Radiopharmaceutical Extravasation: Pragmatic Radiation Protection" published ahead of print

An article written by Versant team members Dr. Darrell R. Fisher, Ph.D. and Misty Liverett, M.S., CNMT was recently published ahead of print in Health Physics. The article provides an unbiased, scientific assessment of pragmatic and reasonable health physics actions that should be taken in response to inadvertent extravasation events. Click the link below to view the article.

Permits

THE PERMISSION SYSTEM FOR INVENTORY TRACKING, MACHINE MANAGEMENT & EQUIPMENT CATALOG MODULES

Permit Profile

Each permit has a dedicated profile of information that includes authorized personnel, radioactive material, machines, and devices. Permit conditions, completed audits, and forms are also found on this profile.

Authorized Condition Database

Create and view authorized conditions included on permits. Previously created authorized conditions are listed with their code, category, and description.

Permit Enforcement

Information specified on a permit not only serves as a record of that permit, but also controls what can be added to other modules. The location, owner and type of radioactive materials, machines, and equipment can be enforced by permits.

Permit Audits

Perform permit audits, mail the results to relevant personnel, and track responses to non-compliances.