Clinical Radiation Safety.pdf

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    CLINICAL RADIATION SAFETY

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    PATIENT HANDLING AND

    PROTECTION STANDARDS  

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    1. A patient has just undergone an oralradiotherapy and will be staying in the hospital for 2 days. How can the hospital safely transfer the patient to his/her room?

     What should be the precautions of the hospital to prevent contamination?

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    HOW TO SAFELY TRANSPORT THE PATIENT ?

     

    •  Transport the patient by the most direct route.

    •  The patient shall not be left in public waiting areas or corridors. If necessary the transporter shall

    remain in the area to keep other people at least 6feet from the patient.

    •   When transporting the patient, do not share elevators with other staff or patients. 

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    PRECAUTIONS TO PREVENT CONTAMINATION   •

     

    The patient is restricted to his/her room where the walls have proper shielding.  

    •  The patient must use disposable eating utensils. These utensils should be placead in the special waste container after use.

    •  

    The patient should flush the toilet two or three times after each use. This will insure that all radioactive urine is washed from the toilet bowl.

    •  Both male and female patients must sit down on the toilet to

    prevent urine splatter. •   Adult family visitors are encouraged but avoid physical contact

     with visitors.

    •  The floor should be covered with plastic.  

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    2. A patient was implanted with 192Ir and  will be staying in the hospital for one night after the operation. What are the protection standards that the nurses and

    hospital staff should observe?  

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    PROTECTION STANDARDS TO BE OBSERVED

     

    •  

    The nurses should not stay at the patient’s room after doing necessary care to to the patient.

     

    •  There should be a specific “stay times” posted at the patient’s door. 

    • 

    Housekeeping can only enter the room when escorted by anurse. 

    •  The laundry should be placed in a linen bag and be saved until surveyed and released by the radiation oncologist.  

    •   Visitors should be above 18 years old and should not be pregnant.

     

    •   Visitors should be 6 feet away from the patient and should not stay for more than 2 hours.  

    •   A radiation survey must be performed before the patient is

    discharged.  

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    OPTIMIZATION OF RADIATION

    THERAPY

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    3. Head-and –Neck Cancer was the case of one

    patient in the hospital, treatment planning came with the Neurosurgeons, Radiation Oncologist, and medical Physicist. What is their objective in creating a treatment plan?  

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    GOAL IN DESIGNING A TREATMENT PLAN

     

    The objective is simply to deliver a prescribed dose to targets while sparing, to the greatest extent possible, critical structures.

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    4. A study had eight cases of head and neck cancer. Two beam arrangements were placed in the treatment planning system, the B/L and the A-P fields. The DVH’s for the cord does were recorded and compared

    in both plans with a standard fraction size of 200cGy/ fraction. The results showed that in the A-P arrangement 168.06cGy was the mean dose to the spinal cord whereas only 133.75cGy only in the B/L

    arrangement. What are the possible effects for such doses? What can you conclude given the results?

     

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    •  Delivering a high dose to the spinal cord is the same thing as cutting it down

    •  The A-P field arrangement delivered a higher dose

    compared to the B/L hence, there is a need to sparethe cord at an earlier dose limit.

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    RADIATION THERAPY

    •  External-Beam Radiation Therapy

    •  Intensity-modulated radiation therapy (IMRT)  

    •  Image-guided radiation therapy  

    • 

    Tomotherapy •  Stereotactic radiosurgery  

    •  Stereotactic body radiation therapy  

    •  Proton therapy  

    •  

    Other charged particle beams  

    •  Internal Radiation Therapy (Brachytherapy)  

    •  Systemic Radiation Therapy

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    5.  

     A patient comes in and complains of a sore throat

    that has been on for 4 weeks, and is experiencing pain when swallowing. After evaluating the patient’s medical history, physical examination and tests have been run, the doctor diagnoses the patient as having

    Oropharyngeal cancer. Radiation Oncologists, Medical Physicists, Medical Dosimetrists convene for the patient’s treatment planning. What are considerations in such planning and what does optimization have to do with the treatment planning?

     

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     WHEN A RADIOTHERAPY TREATMENT IS CREATED

     

    •  Physician provides prescription dose  

    •  Treatment planner chooses incident beam directions  

    •  Determines radiation fields  

    •  Calculates final dose distribution  

    •  

    Physician reviews/approves the plan  

    Treatment plans can be of different strengths of weaknesses and it is the physician’s goal to choose the best possible treatment that will provide the needed dose to the tissue/organ whilst sparing other healthy tissues and

    organs around it’s vicinity.

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    MEDICAL EQUIPMENT MAINTENANCE

     

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    6. A radiation technician is about to commence

    a linearity test for their dose calibrator using a 50 mCi Tc-99m source (half life is 6 hours). The technician started at 8am, and recorded the readings in regular intervals. The recorded

    activity was plotted against time, but the graph looked scattered and not linear at all. What possible reasons could explain this?

     

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     WHAT COULD’VE HAPPENED?  

    •  Loss of battery voltage on the chamber 

    •  Pressure leak from the chamber  

    •  Temperature changes in the chamber due to

    environmental conditions (change in heat or air- conditioning systems)

     

    •  Operator / human error  

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    7. A radiation technician forgot to set-up the

    collimators for their clinic’s gamma camera. He failed to notice this and continued to use the gamma camera on a patient for diagnostic purposes. What would happen?

     

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     WHAT WOULD HAPPEN?  

    The Images will be blurry.  

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    TREATMENT VENUE

    SPECIFICATIONS & STRATEGIES  

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    8. A female patient was treated for thyroid carcinoma. After a few hours of radioiodine administration, it was found that she was 3 weeks pregnant. What can

    happen? What should be done?

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    The dose will endanger the development of the fetus. To reduce the risks, advise the patient to

    drink lots of water and urinate frequently.

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    9. After performing the daily warm-up routines

    for their linear accelerator, a radiation therapist prepares the treatment for a breast cancer patient. What should be done if the patient has a history of twitching and restlessness?

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     A mold should be prepared for the patient so that she will stay still during treatment.

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    REFERENCES

    •  

    https://rpop.iaea.org/RPOP/RPoP/Content/SpecialGroups/ 1_PregnantWomen/PregnancyNuclearMedicine.htm

     

    •  

    https://www.mskcc.org/cancer-care/patient-education/radiation- therapy-breast-chest-wall

     

    •  

    http://www.nuclearfields.com/collimators-nuclear-medicince.htm  

    •  

    http://www.biodex.com/sites/default/files/documents/tips/tip-dose- calibrator-linearity-testing-14194.pdf  

    •  

    http://web.stanford.edu/dept/EHS/prod/researc