Rationale for Radiation Protection Policies:

1. It is imperative that students are aware of radiation protection policies. The radiation protection policies and procedures contained herein comply with the Nuclear Regulatory Commission (NRC) regulations and state laws as applicable. The National Council on Radiation Protection and Measurements (NCRP) and the International Commission of Radiological Protection (ICRP) have also developed dose limits, guidelines and regulations for radiation protection and these are accepted by all regulatory agencies. Students must adhere to all guidelines and regulations of the EPA, OSHA and NCRP at federal, state, and local levels.
2. The radiation protection policies ensure keeping occupational and non-occupational absorbed doses below allowable maximum levels. This is achieved through the employment of proper radiation control procedures.
3. Students are always expected to exercise sound radiation protection practices. Students should never participate in a procedure that violates safe radiation protection procedures.

Clinical and Laboratory Policies:

1. Students must adhere to the radiation protection practices of ALARA (As Low As Reasonably Achievable). ALARA was developed to create an awareness of radiation safely in the workplace. Adhering to ALARA protocols should be the goal for all radiation workers. The following is a list of ALARA practices:
   • Never hold patient or image receptor during an exposure
   • Always wear a radiator dosimeter
   • Wear dosimeter at the front collar level (outside of lead apron) and, if pregnancy is declared, wear an additional dosimeter at the front waist level (under/behind the lead apron)
   • Do not leave dosimeter in an exam room
   • Do not wear dosimeter during personal medical or dental radiographs
   • Wear lead apron when performing mobile or fluoroscopic procedures
   • Stand behind lead barrier when making an exposure
   • User proper collimation
   • Never make an exposure when the door to the radiographic room is open
   • Never enter a radiographic room without first knocking
   • Properly shield patients and others in the x-ray room during all exposures
   • Follow all rules for radiation safety at each clinical site and in the school laboratory
2. During clinical or laboratory training, all students using x-ray equipment will always practice safe radiation protection measures. All x-ray procedures in the clinical setting must be conducted under the following supervision parameter required by the JRCERT:

Assures that medical imaging procedures are performed under the direct supervision of a qualified radiographer until a student achieves competency.

Explanation:

Direct supervision assures patient safety and proper educational practices. The JRCERT defines direct supervision as student supervision by a qualified radiographer who:

• • Reviews the procedure in relation to the student’s achievement,
  • Evaluates the condition of the patient in relation to the student’s knowledge,
  • Is physically present during the conduct of the procedure, and
  • Reviews and approves the procedure and/or image.

Students must be directly supervised until competency is achieved.

Assures that medical imaging procedures are performed under the indirect supervision of a qualified radiographer after a student achieves competency.

Explanation:

Indirect supervision promotes patient safety and proper educational practices. The JRCERT defines indirect supervision as that supervision provided by a qualified radiographer immediately available to assist students regardless of the level of student achievement. **“Immediately available” is interpreted as the physical presence of a qualified radiographer adjacent to the room or location where a radiographic procedure is being performed. This availability applies to all areas where ionizing radiation equipment is in use on patients.

** Note: Use of electronic communication in any form to contact a qualified radiographer (e.g., phone, texting, pager, intercom, etc.) is NOT considered “immediately available.”

Assures that students are directly supervised by a qualified radiographer when repeating unsatisfactory images.

Explanation:

The presence of a qualified radiographer during the repeat of an unsatisfactory image assures patient safety and proper educational practices. A qualified radiographer must be physically present during the conduct of a repeat image and must approve the student’s procedure prior to re-exposure.

Note: Students not adhering to these supervision policies are subject to dismissal.

Note: The student to clinical staff ration is 1:1 always, regardless of student competency.

Dosimeter Badges:

1. 1. A dosimeter badge will be issued to each student monthly to monitor their radiation exposure during laboratory and clinical education.
   2. All students must always wear a radiation dosimeter badge at the front collar level during clinical or laboratory training (outside of the lead apron when used) to measure radiation exposure. No student will be permitted to enter a clinical site. For declared pregnant students, a second dosimeter badge must be worn at the front waist level and under the lead apron when used.
   3. Dosimeters will be replaced each month. The old dosimeter must be returned to the Clinical Coordinator. Students receiving new dosimeters must sign a sheet indicating that they have received the new dosimeter. Each student must be also review and initial their monthly exposure report.
   4. The dosimeter readings will be reported either monthly in writing to the Program Director by the dosimeter badge company and, in turn, provided to the students within 30 days of receipt.
   5. A protective lead apron must be worn during fluoroscopy, mobile radiography, or special radiographic procedures. The dosimeter must be worn outside the apron at the front collar level. For declared pregnant students, a second badge must be worn under/behind the lead apron at the front waist level.
   6. Loss of a dosimeter badge must be reported to the Clinical Coordinator immediately.

Radiation Exposure Incident:

If a student is accidentally exposed to ionizing radiation, it must be reported to the Clinical Coordinator immediately.

Protocol for Exceeded Dose Limits:

To assure a standard response to student Radiation badge readings that are higher than normal, all RT programs will adhere to the following procedure which is based on the ALARA (As Low As Reasonably Achievable) protocols suggested by the NRCP. The following ALARA protocols and the corresponding actions will be followed to assure ALARA compliance by all students:

1. 1. Radiation Badge Reading: 175mrem to 374mrem per quarter
      • The student will be notified and will be asked about the behaviors that might have led to the higher than usual badge reading.
      • The Program Director will reinforce basic radiation safety procedures and make suggestions to the student regarding measures to reduce radiation in the workplace.
      • The badge reading will be signed to acknowledge the student’s awareness of the reading.
      • The meeting with the student will be documented in writing with the student’s signature.
   2. Radiation Badge Reading: 375mrem to 749mrem per quarter
      • The student will be required to provide a reason in writing why the reading was high and what they intend to do to reduce their radiation exposures.
      • The student will be required to write a paper on radiation safety measures that can be taken to reduce radiation to themselves, patients, and others.
      • The badge report will be signed to assure student awareness of the reading.
      • The meeting with the student will be documented in writing with the student’s signature.
      • The dosimeter provider will be asked for a second reading to see if the reading was a result of **static exposure (i.e., the badge being left in the room and not being worn during the exposure).
   3. Radiation Badge Reading: 750mrem or greater per quarter
      • Follow steps in items 1 and 2.
      • The badge provider will be asked for a second reading to see if the reading was a result of a ***static exposure (i.e., badge being left in the radiation area and not being worn during the exposure).
   4. Radiation Badge Reading: 1250mrem in one quarter
      • Follow steps in the items 1 and 2.
      • This reading will require that the Program Director consult with a Radiological Physicist for recommendations regarding further action.
   5. ** Radiation Badge Reading Due to Static Exposure:
      • Any badge reading that is determined to be the result of static exposure (meaning that the badge was left in a radiation area and not being worn during the exposure) may be removed from the student’s permanent record by having the student write a letter to the badge provider requesting that the reading be removed.
      • The reading will be replaced by an average of the student’s monthly readings.