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Program for Training Individuals Occupationally Exposed to
Ionizing Radiation

This procedure establishes guidelines for training individuals occupationally exposed to ionizing radiation

The Program for Training Individuals Occupationally Exposed to Ionizing Radiation applies to all individuals at Columbia University Medical Center, New York Presbyterian Hospital, New York State Psychiatric Institute and Allen Hospital who are occupationally exposed to ionizing radiation.  The program provides topics for training, based on the experience, duties, and previous training of individuals.  The topics chosen will depend on the purpose of the training,  the audience, and the state of learning (background knowledge) of the audience.  The program may also be useful to identify topics for annual refresher training.  Refresher training should include topics with which the individual is not involved frequently and topics that require reaffirmation.  Topics for refresher training need not include review of procedures or basic knowledge that the trainee routinely uses.  The program also includes training for Authorized   Medical Physicists (AMPs) and Medical Authorized Users (AUs) who engage in certain specialized practices.

Individuals will receive radiation safety instruction before assuming duties with, or in the vicinity of, radioactive materials or radiation-producing equipment.  Individuals will also receive radiation safety instruction during annual refresher training, and whenever there is a significant  change in duties, regulations, terms of the license / permit, or type of radioactive material or  therapy device used.  Records of worker training will be maintained for at least 3 years.  The   training records will include the date of the instruction or training and the name(s) of the  attendee(s) and instructor(s).

A.  Training for Individuals Involved in the Medical Usage of Radioactive Material or Radiation-Producing Equipment

Training for professional staff that provide or are involved in the care of patients during diagnostic or therapeutic procedures (e.g., AU, AMP, Authorized Nuclear Pharmacist (ANP), Radiation Safety Officer (RSO), nurse, dosimetrist, technologist, and therapist) should contain the following elements, commensurate with their duties :

    1. Basic radiation biology (e.g., interaction of ionizing radiation with cells and tissues);
    2. Basic radiation protection to include concepts of time, distance, and shielding;
    3. Concept of maintaining exposure ALARA;
    4. Risk estimates, including comparison with other health risks;
    5. Posting requirements;
    6. Proper use of personnel dosimetry (when applicable);
    7. Access control procedures;
    8. Proper use of radiation shielding, if used;
    9. Patient release procedures;
    10. Instruction in procedures for notification of the Radiation Safety Officer and Authorized User, when responding to patient emergencies or death, to ensure that radiation protection issues are identified and addressed in a timely manner. The intent of these procedures should in no way interfere with or be in lieu of appropriate patient care;
    11. Occupational dose limits and their significance
    12. Dose limits to the embryo/fetus, including instruction on declaration of pregnancy
    13. Individuals right to be informed of occupational radiation exposure;
    14. Each individual’s obligation to report unsafe conditions to the RSO;
    15. Applicable regulations, license conditions, information notices, bulletins, etc.
    16. Where copies of the applicable regulations, the NRC license, and its application are posted or made available for examination;
    17. Recordkeeping requirements;
    18. Appropriate surveys to be conducted;
    19. Proper calibration of required survey instruments;
    20. Emergency procedures;
    21. Decontamination and release of facilities and equipment;
    22. Dose to individual members of the public; and
    23. Licensee’s operating procedures (e.g., survey requirements, instrument calibration, waste management, sealed-source leak testing

B.  Training for Individuals Involved in Nonmedical Usage of Radioactive Material or Radiation-Producing Equipment

Training of individuals working with radioactive material or radiation-producing equipment for nonmedical uses or animals containing radioactive material may include, as appropriate, the elements that are listed above for medical uses. All training should be commensurate with the individual’s duties.

C. Training for Individuals Directly Involved in Administration to or Care of Patients Administered Radioactive Material for which a Written Directive Is Required (Including Greater-than-30 microcuries of I-131), or Therapeutic Treatment Planning
In addition to the topics identified above, the following topics may be included in instruction for staff involved in the therapy treatment of patients (e.g., nursing, RSO, AMP, AU, and dosimetrist), commensurate with their duties :

1.   Leak testing of sealed sources;
2.   Emergency procedures (including emergency response drills);
3.   Operating instructions;
4.   Computerized treatment planning system;
5.   Dosimetry protocol;
6.   Detailed pretreatment quality assurance checks;
7.   Safe handling (when applicable) of the patient’s dishes, linens, excretions (saliva, urine,  feces), and surgical dressings that are potentially contaminated or that may contain radioactive sources;
8.   Patient control procedures;
9.   Visitor control procedures, such as visitors’ stay times and safe lines in radiation control areas (patient’s room);
10  Written Directive (WD) Procedures, to ensure that each administration is in accordance with the WD, patient identity is verified, and where applicable, attention is paid to correct positioning of sources and applicators to ensure that treatment is to the correct site (or, for Gamma Stereotactic Surgery (GSR), correct positioning of the helmet);
11. Proper use of safety devices and shielding to include safe handling and shielding of dislodged sources (or, in the case of remote afterloaders, disconnected sources);
12. Size and appearance of different types of sources and applicators;
13. Previous incidents, events, and/or accidents; and
14. For remote afterloaders, teletherapy units, and GSR units, initial training provided by the device manufacturer or by individuals certified by the device manufacturer that is device model-specific and includes:

a.   Design, use, and function of the device, including safety systems and interpretation of various error codes and conditions, displays, indicators, and alarms;
b.   Hands-on training in actual operation of the device under the direct supervision of an experienced user, including “dry runs” (using dummy sources) of routine patient setup and treatment and implementation of the licensee’s emergency procedures;
c.   A method, such as practical examinations, to determine each trainee’s competency to use the device for each type of proposed use.

D.  Additional Training for Authorized Medical Physicists (AMPs)
Certain tasks requiring special training should ensure that the AMP is trained in the activities (e.g. remote afterloader therapy, teletherapy, GSR therapy, the use of the treatment planning systems, as well as the calculation of activity of Sr-90 sources used for opthalmic treatments.)  Medical physicists must also have training for the type(s) of use for which   authorization is sought that includes hands-on device operation, safety procedures, clinical use, and the operation of a treatment planning system

E.  Additional Training for Authorized Users for Medical Uses of Radioactive Materials for Which a Written Directive Is Required
Authorized Users should carefully consider the type of radiation therapy that is contemplated.  In addition to the training and experience requirements described above, attention should be focused on additional training and experience necessary for treatment planning and quality control systems, and clinical procedures associated with specialized uses of     radiation.

F.   Training for Ancillary Staff

For the purposes of this section, ancillary staff includes personnel engaged in janitorial and/housekeeping duties, dietary, laboratory, security, and life-safety services. The training program for ancillary staff performing duties that are likely to result in a dose in excess of 1 mSv (100 mrem) will include instruction commensurate with potential radiological health protection problems present in the work place. Alternatively, prohibitions on entry into controlled or restricted areas may be applied to ancillary personnel unless escorted by trained personnel. Topics of instruction may include the following:

1.   Storage, transfer, or use of radiation and/or radioactive material;
2.   Potential biological effects associated with exposure to radiation and/or radioactive material, precautions or procedures to minimize exposure, and the purposes and functions of protective devices (e.g., basic radiation protection concepts of time, distance, and shielding);
3.   The applicable provisions of regulations, licenses and permits for the protection of personnel from exposure to radiation and/or radioactive material (e.g., posting and labeling of radioactive material);
4.   Responsibility to report promptly to the licensee any condition that may lead to or cause a violation of NRC regulations and licenses or unnecessary exposure to radiation and/or radioactive material (e.g., notification of the RSO regarding radiation protection issues);
5.   Appropriate response to warnings made in the event of any unusual occurrence or malfunction that may involve exposure to radiation and/or radioactive material;
6.   Radiation exposure reports that workers may request.