MCCCD Official Course Competencies:

DMI268  2008 Summer I – 2009 Summer II

Nuclear Medicine Theory II

1.

Explain the role of regulatory agencies, their records and reporting in Nuclear Medicine. (I, XII)

2.

Define the terms associated with dose and exposure limit recommendations and regulations, occupational and public dose, unrestricted and restricted areas. (II)

3.

Describe surveys and monitoring, including requirements, equipment, and conditions requiring monitoring. (II, XII)

4.

Discuss the control of exposure form external sources in a restricted area. (II, XII)

5.

Discuss the regulations pertinent to the possession of detection and monitoring equipment an regulations concerning personnel monitoring. (III)

6.

Discuss the regulations associated with sealed sources, including inventory and leak tests. (IV)

7.

Explain the quality management program to include radionuclides covered by the program, written directives, patient identification, following directives, recordable and reportable events, program review, and records. (V)

8.

Discuss the general safety rules and regulations for both technologists and patients, associated with working with specific radioactive materials. (VI, VII)

9.

Explain the protocols and regulations associated with receipt and shipping of radioactive material packages, waste disposal, decay in storage, and release into sanitary sewerage including minor and major spills. (VIII, IX, X, XII)

10.

Explain the procedures associated with therapeutic dose administration including patient identification, written directives, and informed consent, release and isolation criteria and limited restrictions. (XI)

11.

Describe the measurement of exposure rates including surveys of restricted and unrestricted areas, safe distance markers, and calculated nursing time. (XI)

12.

Discuss procedures in case of death, autopsy, or emergency surgery. (XI)

13.

Explain respiratory protection and the controls used to restrict internal exposure in restricted areas. (XII)

14.

Design a plan for the purpose and implementation of a radiation protection program, including the as low as reasonably achievable (ALARA) concept. (XII)

15.

List the regulations found in Title 10 CFR Parts 19, 20 and 35. (XII)

16.

Describe the regulations associated with the possession, use, calibration, and quality control requirements for dose calibrators. (XII)

17.

Classify regulations pertinent to mobile and therapeutic nuclear medicine. (XII)

MCCCD Official Course Outline:

DMI268  2008 Summer I – 2009 Summer II

Nuclear Medicine Theory II

I. Regulation of Radiation Exposure and Use of Radioactive Materials

A. Agencies

1. Nuclear Regulatory Commission (NRC)

2. Department of Transportation (DOP)

3. Food and Drug Administration (FDA)

4. Environmental Protection Agency (EPA)

B. Licensing

1. Federal and state

2. Institutional licenses

C. Introduction to regulatory documents

1. NRC, Title 10CFR20

2. NRC, Title 10CFR35

3. NRC, Title 10CFR71

4. DOT, Title 49CFR170

D. State regulations

II. Dose and Exposure Limit Recommendations and Regulations

A. Definitions

1. Effective dose equivalent (EDE)

2. Total effective dose equivalent (TEDE)

3. Deep-dose equivalent (DDE)

4. Committed effective dose equivalent (SDE)

5. Shallow-eye equivalent (LDE)

6. Eye dose equivalent (LDE)

7. Derived air concentration (DAC)

8. Annual limit on intake (ALI)

9. Occupational dose

10. Public dose

11. Restricted area

12. Unrestricted area

B. Occupational limits

1. Whole body total effective dose equivalent (TEDE)

2. Individual organs, except lens of eye

3. Lens of eye

4. Skin or any extremity

5. Summation of internal and external exposures

6. Planned special exposures

7. Minors

8. Embryo/fetus of occupationally exposed worker

9. Emergency exposures

C. Limits for individuals members of the public

1. Principles

2. Recommended levels

D. Radiation protection programs - Title 10 CFR Part 20

E. Restricted and unrestricted areas

1. Exposure rates

2. Access

3. Signage

III. Personnel Monitoring

A. Regulations

B. Bioassay following use of radioiodine

C. Personnel exposure records

1. Report interpretation

2. Notification of exposure levels

3. Prior exposures

IV. Possession of Radioactive Materials

A. Licensed materials

1. Radioactive materials for use in humans

2. Controlled reference sources

3. Exempt sources

B. Activity inventory limits

C. Sealed sources

1. Regulations

2. Inventory

3. Leak tests

D. Lost sources

V. Institutional Oversight - NRC regulations

A. Radiation Safety Officer (RSO)

1. Responsibilities

2. Training requirements

3. Delegation of authority

B. Radiation safety committee (RSC)

1. Responsibilities

2. Composition

3. Frequency of meetings

4. Records

C. Quality management program (QMP)

1. Covered radionuclides

2. Written directives

3. Patient identification

4. Following directives

5. Recordable & reportable events

6. Program review

7. Records

VI. Radiation Safety Procedures

A. Worker protection

1. Regulations

2. Posting notices

3. Radiation safety education

4. Notification and reports to workers

5. Workers' rights

6. Declaration of pregnancy

B. General safety rules when working with unsealed radioactive sources

C. Use of shields and labels

1. Regulations

2. Syringes

3. Vials

VII. Protection of the Patient

A. Measurement of dose to be administered

1. Regulations

2. Calibration requirements

3. Instrument requirements

4. Instrument quality control

B. Labeling of patient doses to be administered

1. Regulations

2. Definitions

3. Procedures

VIII. Radioactive Material Packages

A. Receipt

1. Regulations

2. Procedures

B. Shipping

1. Regulations

2. Procedures

3. Labels

IX. Waste Disposal Procedures and Regulation

A. Waste exempt form disposal regulations

B. Decay-in-storage

C. Discharge into sewer system

D. Discharge into atmosphere

E. Transfer to authorized recipient

X. Contamination

A. Ambient dose rate survey

1. Regulations

2. Survey instrument requirements

3. Survey instrument quality

4. Survey instrument control

5. Action and trigger levels

B. Removable contamination survey

1. Regulations

2. Procedures

3. Action and trigger levels

C. Decontamination of minor spill

1. Definition

2. Procedures

D. Decontamination of major spill

1. Definition

2. Procedures

XI. Radionuclide Therapy

A. Regulations

B. Responsibilities of RSO and authorized user

C. Dose administration

1. Patient identification

2. Written directives

3. Informed consent

4. Procedure

D. Release and isolation criteria

1. No restrictions

2. Limited restrictions

3. Isolation requirements

E. Limited restrictions

1. Restrictions

2. Instructions to patient

F. Safety precautions involving patients in radiation-based isolation

1. Nursing instructions

2. Instructions to patient

3. Room preparation and sign postings

4. Contamination control

5. Room decontamination upon discharge

6. Disposal of waste

7. Patient care and control

8. Visitor control

9. Personnel monitoring

10. Nursing precautions and restrictions

11. Bioassay of personnel

G. Measurement of exposure rates

1. Surveys of restricted and unrestricted areas

2. Safe distance markers

3. Calculated nursing time

H. Procedures in case of death, autopsy, or emergency surgery

XII. NRC Rules and Regulations

A. Title 10 CFR Part 19

1. Posting of notices to workers

a. documents

b. location

2. Instructions to workers

3. Notification and reports to individuals

4. Request for inspections

a. right

b. request

c. employee protection

B. Title 10 CFR Part 20

1. Radiation protection programs

2. Occupational dose limits

3. Radiation dose limits for individual members of the public

4. Surveys and monitoring

a. General requirements for surveys

b. Survey equipment

c. Monitoring of external and internal occupational doses

5. Control of exposure from external sources in restricted areas

6. Respiratory protection/controls to restrict internal exposure in restricted areas

7. Storage and control of licensed material

a. Security of stored material

b. Control of materials not in storage

8. Precautionary procedures

a. Caution signs

b. Posting requirements

c. Exceptions to posting requirements

9. Labeling containers

10. Exceptions to labeling containers

11. Procedures for receiving and opening packages

12. Waste disposal

a. General requirement.

b. Decay in storage

13. Release into sanitary sewerage

14. Transfer for disposal

15. Records

a. Surveys

b. Prior occupational dose

16. Individual monitoring results

17. Dose to individual members of the public

18. Waste disposal

19. Form of records

20. Reports

a. Reports of theft or loss of licensed material

b. Notification of incidents

c. Reports of excess exposure

21. Reports of individual monitoring

C. Title 10 CFR Part 35

1. As Low As Reasonably Achievable (ALARA) program

a. Model program

b. Management commitment

c. Radiation Safety Officer

d. Investigational levels I and II

e. Methods to meet ALARA goals

2. Radiation Safety Officer (RSO)

a. Responsibilities

b. Training requirements

c. Delegation of authority

3. Radiation safety committee (RSC)

a. Responsibilities

b. Composition

c. Frequency of meetings

d. Records

4. Quality management program (QMP)

a. Covered radionuclides

b. Written directives

c. Patient identification

d. Following directives

e. Recordable & reportable events

f. Records

5. Misadministration

a. Definitions

(1). Recordable event

(2). Reportable event

b. Verbal and written reports

c. Who is informed

d. Records

6. Possession, use, calibration, and check of dose calibrators

a. Requirement for possession and use

b. Constancy check

(1). Sources

(2). Corrections

(3). Records

c. Accuracy test

(1). Sources

(2). Corrections

(3). Records

d. Linearity test

(1). Range

(2). Corrections

(3). Records

e. Test for geometry dependence

(1). Range

(2). Corrections

(3). Records

7. Calibration and check of survey instruments

a. Frequency

b. Calibration procedure

c. Daily operational check

d. Records

8. Measurement of radiopharmaceutical doses

a. Requ irements

b. Records

9. Authorization of calibration and reference sources

a. Controlled sources

b. Exempt sources

10. Syringe shields and labels

a. Use of shields

b. Labeling of doses to be administered

11. Vials shields and labels

a. Use of shields

b. Labeling requirements

12. Mobile nuclear medicine service

a. Administrative requirements

b. Doses

c. Waste

d. Security of byproduct material

e. Survey meters and dose calibrators

f. Records

13. Storage of volatiles and gases

14. Decay-in-storage

15. Permissible molybdenum-99 concentration

a. Limits

b. Measurements

c. Records

16. Control of aerosols and gases

a. Room concentration limits

b. Negative pressure requirements

c. Calculation of room ventilation time

d. Postings and records

17. Use of radiopharmaceuticals for therapy