17.4 Medical Care for Admitted Patients
207
Patients in the Emergency Department are likely to remain for only a relatively
short period of time and, while there will be a need to exercise caution with patients
who are contaminated or who have embedded radioactive fragments, there are
different concerns in the Emergency Department compared to the concerns regarding
working on a patient who is admitted for what might be an extended period of time.
Much of good radiological work practices revolves around controlling radiation
exposure and controlling the spread of contamination. Each of these will be addressed
in turn.
Health Physicist Strom [32] published The Ten Principles and Ten Commandments
of Radiation Protection. While not all of Strom’s principles apply in a medical setting,
there are a number that do:
• Time—minimize the amount of time spent working in the highest-dose radiation
fields and do not enter such areas unless necessary. When working in any radiation
area, work quickly (although not hastily) and leave as soon as the necessary work
is finished. Have conversations and make radio or telephone calls in areas that
have low dose rates if possible. When examining or treating a patient, minimize
the amount of time spent in close proximity to the patient.
• Distance—because of the inverse square law radiation dose rates drop off quickly
with distance; doubling the distance to a radiation source will reduce the dose by
a factor of four. This is true at close distances as well as on larger scales. For
example, when attending to a heavily contaminated patient, a patient with an
intake of radioactivity, or a patient with embedded source fragments, standing at
arms’ length instead of immediately next to the patient can reduce exposure. If
the patient is known to have radioactive material in a specific location (e.g. I-131
in the thyroid, source fragments embedded in the leg, etc.) try to stand away from
that part of the body—stand near the head of a patient with fragments embedded
in the calf, stand at the foot of the bed for patients with an I-131 intake.
• Shielding—interposing radiation shielding between the caregiver and the radiation source will also help to reduce exposure. Many hospitals with radiation
oncology programs, for example, will have rolling or mobile shields that can be
used for patients with embedded source fragments.
• Source reduction—flushing wounds with saline solution or a chelating agent
(e.g. DTPA) not only reduces intake but will also reduce the amount of radioactivity to which personnel are exposed. This would include removing embedded
source fragments (if any), which should then be placed into shielded containers
(shielding) or moved to a radioactive material storage area (distance) until they
can be sent for disposal.
• Surveys—to help identify areas with elevated levels of radiation, radioactive
sources, and areas with contamination. This should include hand and foot surveys
for everyone leaving the room of a contaminated patient as well as using step-off
pads and performing contamination surveys of the floor outside their rooms.
• Decorporation (if appropriate)—treating those with an intake of radioactivity
will reduce their exposure.
207
Patients in the Emergency Department are likely to remain for only a relatively
short period of time and, while there will be a need to exercise caution with patients
who are contaminated or who have embedded radioactive fragments, there are
different concerns in the Emergency Department compared to the concerns regarding
working on a patient who is admitted for what might be an extended period of time.
Much of good radiological work practices revolves around controlling radiation
exposure and controlling the spread of contamination. Each of these will be addressed
in turn.
Health Physicist Strom [32] published The Ten Principles and Ten Commandments
of Radiation Protection. While not all of Strom’s principles apply in a medical setting,
there are a number that do:
• Time—minimize the amount of time spent working in the highest-dose radiation
fields and do not enter such areas unless necessary. When working in any radiation
area, work quickly (although not hastily) and leave as soon as the necessary work
is finished. Have conversations and make radio or telephone calls in areas that
have low dose rates if possible. When examining or treating a patient, minimize
the amount of time spent in close proximity to the patient.
• Distance—because of the inverse square law radiation dose rates drop off quickly
with distance; doubling the distance to a radiation source will reduce the dose by
a factor of four. This is true at close distances as well as on larger scales. For
example, when attending to a heavily contaminated patient, a patient with an
intake of radioactivity, or a patient with embedded source fragments, standing at
arms’ length instead of immediately next to the patient can reduce exposure. If
the patient is known to have radioactive material in a specific location (e.g. I-131
in the thyroid, source fragments embedded in the leg, etc.) try to stand away from
that part of the body—stand near the head of a patient with fragments embedded
in the calf, stand at the foot of the bed for patients with an I-131 intake.
• Shielding—interposing radiation shielding between the caregiver and the radiation source will also help to reduce exposure. Many hospitals with radiation
oncology programs, for example, will have rolling or mobile shields that can be
used for patients with embedded source fragments.
• Source reduction—flushing wounds with saline solution or a chelating agent
(e.g. DTPA) not only reduces intake but will also reduce the amount of radioactivity to which personnel are exposed. This would include removing embedded
source fragments (if any), which should then be placed into shielded containers
(shielding) or moved to a radioactive material storage area (distance) until they
can be sent for disposal.
• Surveys—to help identify areas with elevated levels of radiation, radioactive
sources, and areas with contamination. This should include hand and foot surveys
for everyone leaving the room of a contaminated patient as well as using step-off
pads and performing contamination surveys of the floor outside their rooms.
• Decorporation (if appropriate)—treating those with an intake of radioactivity
will reduce their exposure.