RADIATION PROTECTION PROGRAMME

RADIATION PROTECTION PROGRAMME HOSPITAL SULTANAH AMINAH, JOHOR BAHRU

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Document No: Version 1

Effective Date: 01.01.2019 Review Date: 01.01.2019

Approval To Execute

Completion of the following signature block signifies the approver has read, understands,

and agrees with the content of this document & approves its execution.

Sign as Radiation Protection Supervisor

Signs as Radiation Protection Officer

Signs as Person Responsible for Licence


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Table of Contents

1.0 INTRODUCTION 4

1.1 Objective ....................................................................................................................................... 4

1.2 Policy ............................................................................................................................................ 4

1.3 Scope ............................................................................................................................................ 5

1.4 Terms and Definitions .................................................................................................................. 5

1.5 Facility Description – Scope of Activities .................................................................................... 6

2.0 ADMINISTRATIVE ORGANISATIONS 7

2.1 Radiation Protection Committee ................................................................................................... 7

2.2 Term of References....................................................................................................................... 8

2.3 Appointed officers ........................................................................................................................ 9

2.4 Responsibilities of RPO ................................................................................................................ 9

2.5 Responsibilities of Radiation Workers ....................................................................................... 10

2.6 Medical Surveillance .................................................................................................................. 10

2.7 Radiation Safety Contact ............................................................................................................ 11

2.8 Radiation Protection Organization Chart .................................................................................... 12

2.9 Visitor ......................................................................................................................................... 13

3.0 RADIATION SAFETY GENERAL PRINCIPLES 14

3.1 Dose Minimisation...................................................................................................................... 14

3.1.1 Control of Dose from External Sources 14

3.1.2 Control of Dose from Internal Sources 15

3.2 Occupational Dose ...................................................................................................................... 16

3.2.1 Declared Pregnant Worker 16

3.2.2 Public Dose 16

3.2.3 Handling Radioactive Materials 17

4.0 CLASSIFICATION OF AREAS 19

4.1 Controlled Areas ......................................................................................................................... 19

4.1.1 Rules for Working in Controlled Areas: 19

4.2 Supervised Area .......................................................................................................................... 19

4.2.1 Rules for Working in Supervised Areas 20

4.3 Clean Area .................................................................................................................................. 20

5.0 MONITORING OF INDIVIDUAL DOSES 21

5.1 Internal Radiation Dosimetry ..................................................................................................... 22

6.0 WORKPLACE MONITORING 24

6.1 Radiation Detector Calibration Requirements ............................................................................ 24

6.2 Guidelines for Using Radiation Detectors .................................................................................. 24


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7.0 TRAINING 26

8.0 DISPOSAL OF RADIOACTIVE WASTE 27

8.1 General Requirements and Responsibilities ............................................................................... 27

8.2 General Disposal Way of Radioactive waste .............................................................................. 28

8.3 Procedure for Decommissioning of Radiation Produce Machine............................................... 28

8.4 Leak Test for Sealed Radioactive Material ................................................................................. 28

8.5 Equipment Releases .................................................................................................................... 29

9.0 RADIOLOGICAL EMERGENCY MANAGEMENT 30

9.1 Notifications, Reports and Records of Reportable Events Procedure ........................................ 30

9.2 Defining Incidents and Emergencies .......................................................................................... 31

9.3 Fire Emergencies ........................................................................................................................ 32

9.4 Minor Spills ................................................................................................................................ 32

9.5 Major Spillage ............................................................................................................................ 33

10.0 RECORD KEEPING 34

10.1 General Requirements ................................................................................................................ 34

10.2 Transfer of Radioactive Material ................................................................................................ 34

10.3 Shipment of Radioactive Material .............................................................................................. 34

ANNEX 35

APPENDIX 37


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1.0 INTRODUCTION

This document contains general guidelines on safe use of ionising radiation to all staff working at

Hospital Sultanah Aminah, Johor Bahru (HSAJB). It is the duty for the staff to be aware of these rules

and to follow them at all times.

1.1 Objective

The main objective of this programme is to ensure the safety and radiation protection at the HSAJB is

at an optimal level and all sources of ionizing radiation are safe to use for diagnostic and therapeutic

purposes.

1.2 Policy

The policy adopted by all employees, patients, visitors and the public to deal directly with the HSAJB

for the purpose of diagnostics, treatment, research, teaching or any activity that uses ionizing radiation

sources.

i. In accordance with Act 304 and the regulations, standards and guidelines provided by the

Ministry of Health (MOH), HSAJB is committed to safety management and the use of

ionizing radiation apparatus in ensuring workplace safety regulation and radiation protection

regulations are complied with.

ii. It is the responsibility of all radiation workers using radiation sources for diagnostic or

treatment purposes with the right technique and at the right time. Accordingly, the

management of each department will be to ensure that all radiation workers practice the

principle of As Low As Reasonably Achievable (ALARA) and regulations are complied with,

such as the HSAJB Radiation Protection Program.

iii. RPO of HSAJB is responsible for implementing and managing all departments of Radiation

Protection Program that handles ionising radiation source. RPO fully authorized by the

HSAJB to terminate or suspend the operation of the use of ionizing radiation sources which

he thought could threaten the safety of workers, patients and the public.

iv. The management of every department who handle ionizing radiation sources to report on all

activities involving radiation protection primarily radiation incident to the HSAJB Radiation

Protection Committee (RPC). The Committee is responsible for providing advice and check

the radiation safety department policy from time to time.


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1.3 Scope

The Radiation Protection Programme relates in details most of the requirements for radiation safety

programme for HSAJB under the Atomic Energy Licensing Act (Act 304) and its subsidiary

regulations such as Basic Safety Radiation Protection 2010 (BSRP 2010).

These requirements provide a safe system of work development for activities related to the use of

ionizing radiation in HSAJB. The programme covers all activities pertaining to the use of ionizing

radiation in medical and activities in emergency situations.

1.4 Terms and Definitions

i. Person Responsible for Licence (PRFL)

A technically competent person appointed by the licensee and approved by the appropriate

authority to supervise the application of appropriate radiation protection regulations, measures

and procedures;

ii. Radiation Protection Officer (RPO)



and procedures;

iii. Radiation Protection Supervisor (RPS)



and procedures

iv. Radiation worker

Any person working under the instruction of the licensee, whether or not employed by the

licensee, in the handling or use of irradiating apparatus or who will come into contact with

any radioactive material, nuclear material or prescribed substance.

v. Radiation Source

An apparatus or material capable of emitting ionizing radiation;

vi. Ionizing radiation

An electromagnetic radiation or corpuscular radiation capable of producing ionization in its

passage through matter;

vii. Radioactive material

Any nuclear fuel, radioactive product or radioactive waste;

viii. Licensee

Holder of license issued under Atomic Energy Licensing Act 304, 1984


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1.5 Facility Description – Scope of Activities

HSAJB is a medical institution to provide diagnostic, curative , rehabilitative , and health promotion

services that are appropriate , adequate , comfortable , efficient , effective and of the highest quality

care to patients / client in order to preserve lives , reduce sufferings and achieve early and maximal

recovery. Below is the list of major facility or equipment available in this institution.

Facilities Services Equipments

Radiology Facilities

Radiology

General Radiography-2

General Radiography-2 (Poly)

CT Scanner-1

Angiography (Bi-plane)-1

Mobile radiography-15

Mammography-1

DEXA

OPG

Orthopedics Fluoroscopy (Mobile C-Arm)-2

A&E General Radiography-1

Cardiology Angiography (Bi-plane)-2

Neurosurgery Mobile CT Scanner (Ceratom)-1

CT Scanner (Brainsuite)-1

Urology Fluoroscopy (Lithotripter)-1

Fluoroscopy (Mobile C-Arm)-1

Dental Intra oral-5

Nuclear Medicine

Nuclear Medicine services

Gamma Camera-1 (SPECT)

Gamma Camera-1 (Cardiac)

Radioiodine Therapy-1 (Therapy)


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2.0 ADMINISTRATIVE ORGANISATIONS

These Radiation Protection Programme are issued by the Hospital and are intended to ensure that

unsealed radioactive sources are used safely and in accordance with the requirements of The Atomic

Energy Licensing Act 1984 (Act 304).

2.1 Radiation Protection Committee

Radiation Protection Committee Members are consist of

PRFL : HSAJB Director

RPO : Medical Physicist

Supervisor : Head of Radiology Department

: Head of Nuclear Medicine Department

Secretary : Medical Physicist

Committee Members : Head of Orthopedics Department

: Head of Pediatric Dental Department

: Head of General Surgical Department

: Head of Anestesiology Department

: Head of Cardiology department

: Head of Urology department

: Head of Emergency department

: Head of Oral Surgery department

: Head of Neurosurgery department

: Chief Physicist (Diagnostic Imaging)

: Chief Physicist (Nuclear Medicine)

: Chief Radiographer (Radiology)

: Matron General Operation Theatre


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2.2 Term of References

Hospital Sultanah Aminah shall establish a Radiation Protection Committee to oversee the medical

use of ionizing radiation.

The committee shall:

i. Monitor the institutional programme to maintain individual and collective doses as low as

reasonably achievable;

ii. Review on the basis of safety and approve or disapprove each proposed method of use of

radioactive material and irradiating apparatus;

iii. Submit to HSAJB Director the procedures and radiation protection program, that have been

reviewed by the committee;

iv. Ensure semiannually review of the records of individuals monitoring results of all individuals

for whom monitoring was required pursuant to the relevant regulations;

v. Ensure semiannually review of all recordable and reportable events & incidents involving

radioactive material and irradiation apparatus with respect to cause and subsequent action

taken;

vi. Review at least once a year the radiation protection program;

vii. To investigate overexposure or accidental exposure of ionizing radiation;

viii. To plan and oversee training needs and programs on radiation protection and safety in the

hospital;

a. Use of personnel and patients protective devices

b. Procedures to minimize patients and occupational doses

c. Use of individual monitoring devices

iv. The committee shall meet the following administrative requirements;

a. Membership shall consists of at least five individuals and shall include an authorized

user of each disciplined who are involved with the used of irradiating apparatus in the

department or outside their department;

b. The chairman shall be the HSAJB Director;

c. The committee shall meet at least once every 6 months;

d. The quorum shall be at least two third of the members of the committee inclusive the

director of the hospital and radiation protection officer.

v. HSAJB director shall appoint a RPO who is responsible for implementing the radiation protection

program.

The director of the HSAJB through the RPO shall ensure that radiation protection activities are being


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performed in accordance with the license provisions and regulatory requirements.

2.3 Appointed officers

The HSAJB Director was appointed as PRFL and his/her roles as a license holder for hospital to the

observance of the relevant regulations and as to other matters in connection with ionizing radiation.

Licensee shall appoint person who have a good knowledge with radiation safety as RPO to manage

ionizing activities in HSAJB. Radiation Workers is referred to all staff working full time with ionizing

radiation source.

2.4 Responsibilities of RPO

He shall administer the Local Rules, the requirements of the Regulations and Approved Code of

Practice and shall report to the PRFL. The duties may be summarized as follows:

i. Investigate overexposures, accidents, recordable and reportable events, losses, thefts,

unauthorised receipts, unauthorised uses, unauthorised transfers, unauthorised disposals and

other deviations from radiation protection practices approved by the appropriate authority and

implement corrective actions as necessary.

ii. Implement written policy and procedures for:

a. keeping an inventory record of radiation generated equipment;

b. using radiation generated equipment safely;

c. performing radiation surveys;

d. performing operability checks of survey instruments and other safety equipment;

e. providing or supervising the provision of radiation safety training to personnel who

are involved in radiation activities;

f. keep copies of all records, reports and written policies and procedures required

thereunder.

iii. Assist the Radiation Protection Committee in the performance of its duties.

iv. Maintain for a period of 10 years, records of all radiation workers. These records should

include:

a. the name of the individual;

b. a list of all duties and departmental responsibilities;

c. the date upon which the individual starts working;

d. occupational radiation exposure;

e. the signature of the radiation worker; and

f. the signature of the RPO.

v. To ensure that the recommendations of the Chairman Health & Safety Committee and the

rules contained in the Atomic Energy Licensing (Basic Safety Radiation Protection)

Regulations 2010 and the associated Codes of Practice are carried out within HSAJB.


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vi. To keep a register of all radioactive sources within HSAJB and of all disposals of radioactive

waste. In this respect it is particularly important that the conditions contained in the

Certificates of Registration and Authorization issued under the Atomic Energy Licensing

(Radioactive Waste Management) Regulation 2011 should not be violated.

2.5 Responsibilities of Radiation Workers

Registered Radiation Workers is referred to all staff working full time with ionizing radiation source.

The RPO must be informed before commencing work with ionizing radiation source. Job scopes of

radiation worker;

i. The work carried out must adhere to the Radiation Protection Programme, Atomic Energy

Licencing Act 1984 (Act 304), Atomic Energy Licensing (Basic Safety Radiation Protection)

Regulations 2010, Atomic Energy Licensing (Radioactive Waste Management) Regulations

2011, Regulations on Radiation Protection (Transport) 1989 and subsidiaries.

ii. Follow all instructions, rules and procedures and refrain from careless or reckless practices

that could result in unnecessary exposures.

iii. Use all facilities, devices and personnel protective equipment (PPE) as instructed.

iv. Use the approved personnel monitoring devices.

v. Not interfere with, remove place/ displace or alter any safety equipment; to take all reasonable

precautions to prevent damage to such equipment, and immediately report any damage or

malfunction of any safety equipment to immediate supervisor or RPO.

vi. Immediately report all accidental exposures or any suspected exposures to immediate

supervisor or RPO.

vii. Report pregnancy status, for female workers.

viii. Report unsafe working conditions to immediate supervisor or RPO.

2.6 Medical Surveillance

Radiation worker’s health status should be reviewed at least once in every three (3) year and more

frequent depends on exposure factor and worker health status if necessary. Special medical

examination shall be provided for workers who have received doses exceeding the annual dose limits.

Medical surveillance is mandatory for all radiation workers. The medical surveillance shall include

the following:

i. Pre-employment medical examination;


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ii. General health surveillance;

iii. Periodic reviews of health; and

iv. Termination of employment and retirement

2.7 Radiation Safety Contact

In case of an emergency involving ionising radiation or radioactive materials or areas where

radioactive materials are stored and/or used, the supervisor and/or the RPO shall be contacted

promptly.

Person Responsible For License (PRFL): Dr Aman bin Rabu

(07-225 7000 ext 2801)

Radiation Protection Officer (RPO): Husain bin Murat

(07-225 7000 ext 2003)

Radiation Protection Supervisor (RPS): Fatan Hamimah binti Jamal

(07-225 7000 ext 2060)

Radiation Protection Supervisor (RPS): Syarul Iman bin Saufi

(07-225 7000 ext 2060)

Radiation Protection Supervisor (RPS): Anita Natasya bt Abdul Talib

(07-225 7000 ext 2040)


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2.8 Radiation Protection Organization Chart

RADIATION PROTECTION SUPERVISOR

(Anita Natasya bt Abdul Talib) Medical Physicist

RADIATION WORKERS

PERSON RESPONSIBLE FOR LICENSE (Dr Aman bin Rabu)

Hospital Director

RADIATION PROTECTION OFFICER (Husain Murat)

Senior Medical Physicist


(Fatan Hamimah bt Jamal) Senior Medical Physicist


(Syarul Iman bin Saufi) Senior Medical Physicist

SUPERVISOR FOR LICENCES (1. Dr Hjh Khatijah binti Abu Bakar - Radiologist) (2. Dr Ng Chen Siew - Nuc.Med. Specialist)

MED.PHYSICIST (Noor Ameelia A.Majid)

MED.PHYSICIST (Norhazlina Hassan)

MED.PHYSICIST (Nurul Diyana Sharif)


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2.9 Visitor

It is current policy to allow persons not regularly associated with HSAJB to view the facility and its

operation. The following procedures are established for the purpose of permitting these visits with

maximum safety and minimum delay.

Area will comply with the following procedures:

i. The presence of children below the age of 13 is discouraged at all times because radiation

tolerances are much lower in children than in adults and the derivable benefits from such a

visit are questionable; however, when the benefits merit such a visit, permission may be

requested from a RPO;

ii. Each invited guest will sign his or her name and address in the Visitor’s Log. This log is

maintained by the receptionist. Visitors may be issued a pocket dosimeter, if a dosimeter is

used, the dosimeter numbers are entered beside the names in the log:

iii. At the conclusion of the visit, the guest will return the dosimeter to the receptionist and sign

out in the log.

iv. Visitors who are not guests of the staff (for example, high school science classes) will make

arrangements with the receptionist for a guided tour. Such tours will be scheduled for

Mondays. To ensure proper control and safety of these visitors, the following procedures will

be followed:

v. The presence of children below the age of 13 is discouraged but may be arranged through a

RPO under special circumstances;

vi. All visitors entering the Radiation Control Area must be accompanied by a member of the

Hospital staff who has been trained in supervising a tour;

vii. The visitors will be organized into groups normally not exceeding 10 persons;

viii. Each visitor will enter his or her name and address in the Visitor’s Log which is maintained

by the receptionist. Visitors may be issued a pocket dosimeter, if so, the number will be

entered in the log beside the name. Each tour guide must wear his/her assigned personal

dosimeter badge and shall wear a pocket dosimeter at the discretion of the PRPO. Personnel

dosimeter may not be issued to every tour member;

ix. RPO will be notified when a group is ready to enter the Radiation Control Area. He will

inform the tour escort of any areas where hazardous conditions may exist and which are off-

limits to visitors;

x. Normally not more than two groups of 10 persons each will be allowed in the Radiation

Control Area at the same time;

xi. A member of the Hospital radiation protection staff will read daily the pocket dosimeters and

record each individual’s reading in the Visitor’s Log.


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3.0 RADIATION SAFETY GENERAL PRINCIPLES

As Low As Reasonably Achievable (ALARA) has become an integral, functioning part of radiation

protection programs. Radiation safety programs have traditionally been most conservative in

minimizing radiation exposure to workers, and ALARA is simply a more formal commitment to this

basic principle of radiation protection. The ALARA action Level at this hospital is defined as 25% of

any applicable occupational limit.

Mainly the radiation hazard in HSAJB are from the ionizing radiation sources used is from external

radiation by photon rays. This hazard can be minimized by:

i. Keeping radiation sources behind adequate lead shielding as much as possible;

ii. Keeping radiation sources as far away from people as possible; and

iii. Spending as little time as possible in the vicinity of radiation sources.

A secondary hazard from the use of unsealed radioactive sources is that of internal radiation if any

radioactivity should be deposited on or ingested by any personnel. This hazard can be minimized by:

i. Keeping radioactive material within closed containers as far as possible;

ii. Taking steps to ensure that, in the event of an accident, radioactive material are not spread

around; and

iii. Avoiding accidental ingestion or inhalation of radioactive material into the body.

The annual radiation dose to members of the staff or the public must not exceed the dose limits

specified by Atomic Energy Licensing (Basic Safety Radiation Protection) Regulations 2010.

3.1 Dose Minimisation

i. In accordance with the ALARA principle, all procedures, protocols, examinations, and

tutorials shall be conducted in a manner which minimizes the radiation dose to radiation

workers and the general public.

ii. There is no dose limit for patients undergoing diagnostic investigations or therapeutic

procedure, but any dose received must be justified by the potential benefits to be gained.

iii. In all circumstances the radiation dose to patients, radiation worker and public must be kept

as low as reasonably achievable.

3.1.1 Control of Dose from External Sources

Procedures and policies should be in place to administratively control external radiation exposure.

i. Time - Decreasing “exposure time” reduces personnel dose linearly.


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ii. Distance - Increasing the distance between personnel and the radiation source is an

effective means of reducing dose. The radiation dose rate follows the “inverse square law”.

iii. Shielding - Shielding a source of radiation generally reduces the radiation levels around the

radioactive source.

3.1.2 Control of Dose from Internal Sources

The control methods outlined above do not readily apply when considering minimization efforts for

internally-deposited radionuclide. The primary control method for internal deposition is prevention.

Preventing the inhalation and ingestion of radionuclide is the recommended method for internal dose

control.

The four major pathways of internal deposition of radionuclide’s are:

i. Inhalation - Inhaling airborne radioactive material.

ii. Ingestion - Consuming a contaminated radioactive material in liquid or solid form.

iii. Absorption - Skin contamination may result in absorption of radioactive material into the

blood though the capillary system.

iv. Injection - Direct puncture or piercing of the protective layer of the skin.

The following guidelines should be used to minimize internal dose to personnel:

i. Fume Hoods - A chemical fume hood suitable for radioactive materials shall be used when

using high activities of volatile radioactive material.

ii. No Smoking, Eating, or Drinking in Laboratories - To minimize the risk of intake of

radioactive materials through the ingestion pathway, consumption in a laboratory area where

radioactive materials (excluding sealed sources) are used is prohibited. This includes

smoking, chewing tobacco, eating, and drinking.

iii. Use of Personnel Protective Equipment - Personal protective equipment furnishes an initial

barrier in protecting against the absorption and injection pathways. This equipment may take

the form of disposable gloves, laboratory jackets, long pants, closed-toe footwear, and face

shield.

iv. Proper Handling of Contaminated Sharps - Sharp objects which are contaminated with

radioactive material present an injection hazard. Therefore, personnel should minimize the

handling of sharps. Do not recap syringes after completion of the injection.

v. Respiratory Protective Equipment - Commitment to use respiratory protection cannot be

taken lightly. It is generally advantageous to spend a little more time and money in the design


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and planning of experimental work in order to eliminate or minimize airborne radioactivity

than to rely upon respiratory protection to control worker intake.

3.2 Occupational Dose

Dose limits are provided in Table 1 and 2 shall not be exceeded, except for planned special exposures

and emergency exposures.

3.2.1 Declared Pregnant Worker

For a declared pregnant worker, the following limits apply:

i. The dose limit for the embryo/fetus from conception to birth (entire gestation period) is 1

mSv.

ii. If the dose to the embryo/foetus is determined to have already exceeded 1mSv when a

radiation worker notifies her employer of her pregnancy, the worker shall not be assigned to

tasks where additional occupational radiation exposure is likely during the remainder of the

gestation period.

3.2.2 Public Dose

The dose limits for individual members of the public are described in the Radiation Protection (Basic

Safety Standards) Regulations 2010. The regulation states that each licensee will limit operations such

that:

i. The total effective dose equivalent to members of the public does not exceed 1 mSv in a year

ii. The limit on equivalent dose to the lens of the eye of a member of the public shall be 15 mSv

in a calendar year from exposure to radiation machines does not exceed 50mSv per year; and

iii. The limit on equivalent dose to the skin of a member of the public shall be 50 mSv in a

calendar year, averaged over an area of one square centimetre, regardless of the area exposed.

iv. The limit on effective dose for a person below the age of sixteen years visiting a patient

undergoing treatment or diagnostic examination involving radioactive material shall not

exceed 1 mSv during the period of the treatment or examination of the patient

v. The limit on effective dose for a person who knowingly assists in the support of a patient shall

not exceed 5 mSv during the period of diagnostic examination or treatment of the patient.

vi. Women of Childbearing Potential

a. All procedures during pregnancy that involve ionizing radiation should be postponed till

after delivery, unless it is essential.

b. For all female patients in the reproductive age group, the last menstrual period (LMP)/


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status of pregnancy shall be clearly indicated on the request form. The examination shall

then be carried out according to the 10/28-day rule.

c. Any radiological examination to be performed during pregnancy shall be justified on

strong clinical ground. If examination is mandatory, the patient shall be :

Informed about the risk and benefit, then written consent shall be taken by the

attending specialist prior to examination. Medical Officer may be allowed to take

consent after consultation with attending specialist. However, in life threatening

situation, the examination may proceed with a clear documentation in the patient

records.

The abdomen shall be protected by lead equivalent or appropriate protective

clothing where applicable.

The examination shall be modified accordingly in order to minimize the radiation

dose without compromising diagnostic value.

3.2.3 Handling Radioactive Materials

The following guidelines provide information on the safe handling of radioactive material. They are

based on the relevant legislation and on the Code of Practice for Handling Radioactive material.

3.2.3.1 Handling Unsealed Radioactive Materials

General rules of practice for work with radioactive materials;

i. Work in the glove box or a fume hood.

ii. Cover the working surface.

iii. Use gloves and lab coat.

iv. Dispose of or decontaminate glassware after use.

v. Do not smoke, eat, or drink in a radioactive material handling area.

vi. Use radioactive waste containers for solid waste.

vii. Use small plastic containers for liquid waste and label appropriately.

viii. Have the area surveyed by RPO after completion of the work.

ix. Make sure that all radioactive materials are properly labelled.


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3.2.3.2 Handling Irradiating Apparatus

General rules of handling irradiating apparatus:

i. Ensure areas in which irradiating apparatus are located shall be posted with signage informing

those entering that irradiating apparatus is present.

ii. The operator of the irradiating apparatus shall be responsible for the operations associated

with the equipment, including radiation safety.

iii. All operators must be trained in radiation safety and have their training document in the log

book.

iv. Radiation exposure will be in line with As Low As is Reasonably Achievable (ALARA).

v. Personnel shall not expose any part of their bodies to the primary x-ray beam.

vi. All personnel shall be familiar with safety procedures as they apply to each device.

vii. Wear personnel monitoring devices at all time.

viii. Equipment will be secured so it will not be used or approached by unauthorized personnel.

Never assume that the x-ray unit was left in a safe working condition by the previous user.

Check the shielding and interlocks before turning the device on.

ix. Do not bypass any safety device on any irradiating apparatus. When any safety system is

defective, inform the immediate supervisor or RPO.

x. Know what you are doing and where to expect problems. Be aware of the dangers. Do not

work in a hurry or allow yourself to become distracted.


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4.0 CLASSIFICATION OF AREAS

4.1 Controlled Areas

Any area in which specific protection measures and safety provisions are required for controlling

normal exposures or preventing the spread of contamination during normal working conditions and

preventing or limiting the extent of potential exposures.

4.1.1 Rules for Working in Controlled Areas:

i. Access to controlled areas must be limited to essential staff, patients and other personnel as

may be authorized by the RPO. Anyone entering a controlled area must follow these rules.

ii. All staff who regularly works in controlled areas will be issued a personnel monitoring badge

of which must be worn whenever they enter a controlled area.

iii. The occasional entry to a controlled area of any other person not wearing a personnel

monitoring badge (e.g. patients' relatives or escorts) may be permitted if they remain under

the supervision of an authorized member of staff who is wearing a personal dosimeter.

iv. Other people who need to enter a controlled area on an occasional basis at times when they

are not under the supervision of an authorized member of staff (e.g. maintenance worker or

contractors working outside normal hours) must be issued with a 'Permit to enter a controlled

area'.

v. To minimize the hazard from external radiation:

a. Sources must be kept within suitable lead shielding when not in use. Vials of activity

should only be removed from their lead pots when this is necessary (e.g. to place in the

ionization chamber);

b. Unshielded vials of activity should only be manipulated with long handled tongs;

c. Syringes containing radioactivity should be fitted with lead syringe shields whenever

possible;

d. Patient doses should be kept in the shielded storage area until required. Unused doses

should be returned to the radionuclide laboratory at the end of each session; and

e. Personnel should keep as far away as possible from all sources and organize work to

minimize the time spent in close proximity to large sources, (e.g. stand back while the 99m

Tc generator is eluting).

4.2 Supervised Area

Areas for which occupational exposure are kept under review even though specific protection and

safety provision are not normally needed.


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4.2.1 Rules for Working in Supervised Areas

i. No administrations of radioactive substances or other work with unsealed sources is permitted

in supervised areas.

ii. Deliveries of radioactive parcels should be taken to the radionuclide laboratory as soon as

possible.

iii. Before eating or drinking, hands must be washed.

4.3 Clean Area

An area where the annual dose received by a worker is not likely to exceed the dose limit for a

member of the public.


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5.0 MONITORING OF INDIVIDUAL DOSES

All staff who regularly works in controlled areas will be issued with personal dosimeters to monitor

the radiation dose that they receive.

i. This must always be worn at the front between waist level and shoulder level when working

with radiation sources.

ii. When not being worn the personal dosimeter should be kept away from all sources of ionizing

radiation.

iii. The personal dosimeter should not be worn at times when staff receives ionizing radiation

exposure as part of their own medical investigation or treatment.

iv. The dosimeter must be returned promptly for processing at monthly basis. A record of the

doses received by all staff will be kept by the RPO.

v. If changes in working practice are made which might significantly alter the distribution of

radiation dose received, additional means of monitoring personnel radiation dose may be used

for some staff at certain times. This could include the issuing of extremities dose monitors.

vi. Any incident which could result in a serious underestimate or overestimate of the dose

recorded on an individual's personal dosimeter badge must be reported to the radiation

protection supervisor who will inform the RPO.

vii. Any female member of staff who pregnant must inform her immediate supervisor as soon as

possible so that the advisability to minimize radiation dose can be practiced.

viii. The ALARA investigation level at the hospital is defined as 25% of any applicable

occupational limit. To this end, a dosimeter measurement in a monitoring period exceeding

this ALARA level should be investigated by the RPO. This investigation will examine

workload and protocol changes, dosimeter placement variations, or possible methods of dose

minimization for future protocols.

ix. Radiation dosimeters shall not be deceptively exposed. These devices are an integral safety

component and must accurately reflect the worker’s true exposure scenario. If a situation

arises, please contact the RPO for resolution.

x. Under no circumstances should a dosimeter assigned to one person be worn by another

person.

xi. Dosimeters should not be exposed to high heat, chemical, or physical insults, including the

washing machine.

xii. The Radiation Workers should inform the RPO upon discovery of any misrepresentative

dosimeter information.

xiii. Location and use of individual monitoring devices:


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22

a. An individual monitoring device used for monitoring the dose to the whole body shall be

worn at the unshielded location of the whole body likely to receive the highest exposure.

When a protective apron is worn, the location of the individual monitoring device is

typically between waist level and shoulder level, inside the apron.

b. If an additional individual monitoring device is used for monitoring the dose to an

embryo/foetus of a declared pregnant worker, it should be located at the waist under any

protective apron being worn.

c. An individual monitoring device used for monitoring the eye dose equivalent should be

located at the neck or a location closer to the eye, outside any protective apron being

worn by the monitored individual.

d. An individual monitoring device used for monitoring the dose to the extremities should

be worn on the extremity likely to receive the highest dose. Each individual monitoring

device, to the extent practicable, should be oriented to measure the highest dose to the

extremity being monitored.

xiv. The assigned deep dose equivalent and shallow dose equivalent shall be for the portion of the

body receiving the highest dose.

xv. The deep dose equivalent, eye dose equivalent, and shallow dose equivalent may be assessed

from surveys, use factors, exposure time calculations or other measurements for the purpose

of demonstrating compliance with the occupational dose limits, if the monitoring device was

mishandled, destroyed, or lost.

5.1 Internal Radiation Dosimetry

The RPO shall monitor occupational exposure to radiation and shall provide and require the use of

internal radiation dose assessments for:

i. Adult radiation workers likely to receive, in one year, an intake in excess of 25% of the

applicable Annual Limit on Intake in the Radiation Protection (Basic Safety Standards)

Regulations 2010.

ii. Minors and declared pregnant workers likely to receive, in one year, a committed effective

dose equivalent in excess of 0.5 mSv.

iii. For purposes of assessing committed effective dose equivalent, the RPO utilize the following

measurements:

a. Concentrations of radioactive materials in the air or water in the work zone

b. Quantities of radioactive materials in the body; or

c. Quantities of radioactive materials excreted from the body; or

d. Any combination of these measurements.

iv. In the absence of respiratory protective equipment and intake assessment bioassay

measurements, the time-weighted average of the airborne radioactive material concentration

should be used as the inhaled radioactive material concentration for the exposure duration.


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23

v. When specific information on the physical and bio kinetic properties of the radionuclide taken

into the body or the behaviour of the material in an individual is known, the following may

occur:

a. This information may be used to calculate the committed effective dose equivalent, and,

if used, shall be documented in the individual’s record; and

b. With prior approval from the Biological Research Centre (BRC), adjust the Derived Air

Concentration (DAC) or Annual Limit Intake (ALI) values to reflect the physical and

chemical characteristics of the airborne radioactive material (e.g. particle size

distribution and other applicable correction factors); and

c. Separately assess the fractional contribution of Class D, W, or Y compounds of a given

radionuclides to the committed effective dose equivalent.

d. RPO should ensure that personnel performing radioactive material protocols obtain

internal dose assessments when warranted.

e. The result of internal dosimetry assessment will be informed to the respective radiation

workers by RPO.


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6.0 WORKPLACE MONITORING

i. When there has been a significant change in working practice, a survey of the dose rates in

the department, including non-designated areas, shall be made periodically in order to ensure

that established working practices are satisfactory for restricting radiation exposure and that

all areas remain correctly designated.

ii. If the radioactive contamination levels are found to exceed the limit as shown in Table 3,

steps must be taken to remove the contamination. If the contamination cannot be reduced

below the stated action level the RPO must be informed.

iii. Records of the results of the monitoring as well as the leak testing must be kept.

iv. All records will be checked by the RPO once a year.

6.1 Radiation Detector Calibration Requirements

i. Radiation detectors used for quantitative measurements shall be calibrated at intervals not

to exceed 12 months by approved authority.

ii. Radiation detectors may be calibrated by the third party, the instrument manufacturer, or a

licensed or registered calibration service provider.

iii. Quantitative radiation detectors which are serviced or repaired shall be recalibrated

following the repair. Recalibration is not essential for minor changes which will not affect

the instrument response characteristics (e.g. battery replacement).

iv. Radiation detectors used for quantitative measurements shall be calibrated for the type of

radiation encountered and the energies appropriate for use based on manufacture

recommendation.

6.2 Guidelines for Using Radiation Detectors

i. Radiation detectors shall be used in accordance with manufacturer specifications or

standard procedures. Failure to adequately follow these guidelines may result in erroneous

readings.

ii. Before using a radiation detector in the field, the detector should be checked for operability

and the detector response should be evaluated.

iii. Thin or open window probes should be operated in a manner which prevents contamination

of the detector face.

iv. High radiation fields may not be accurately detected with GM probes due to electronic

effects. Use with caution when evaluating radiation fields with a GM probe. Use suitable


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25

detector for different types of radiation sources. Contact the RPO for additional

information.

v. Low-energy beta-emitting radionuclides are not efficiently detected using a portable

radiation detector. In general, this class of radionuclide should be evaluated using a liquid

scintillation counter.

vi. Low-energy x-ray sources (e.g. 125

I) are most efficiently detected using a thin-window NaI

scintillation probe. The RPO should be contacted for further details.


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26

7.0 TRAINING

i. New Radiation Workers or transferred Radiation Workers from other institution shall attend

basic radiation safety in ionizing radiation briefing conducted by RPO before working with

ionizing radiations sources.

ii. No one shall be permitted to work unsupervised with radioactive substances or irradiating

apparatus until the RPO is satisfied that he or she has received adequate training.

iii. At least once each year the radiation protection officer shall ascertain that all staff is familiar

with the abnormal situation.

iv. When any new procedure involving radioactive materials is instigated or an existing

procedure is modified the radiation protection officer must give approval and all relevant staff

must be trained in the new procedure.

v. Document and periodically review all competency and training program for their

effectiveness. Suitable proficiency shall be achieved and maintained according to current

needs of the organization.

vi. HSAJB shall ensure that all radiation workers are competent and have received appropriate

trainings to allow them to carry out their duties and responsibilities in normal and abnormal

situations safely.

vii. Those involved in radiation protection management shall be identified and established.

Arrangements shall be made to ensure all employees are competent to carry out activities

safely.

viii. HSAJB shall;

a. Ensure skill and training programmes be given to all employees that are directly and

indirectly involve with radiation hazards.

b. Ensure skill and training programmes be conducted by competent and accredited

person by local authority.

c. Ensure that the RPO has attended continual education and training approved by the

relevant authorities.


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27

8.0 DISPOSAL OF RADIOACTIVE WASTE

All waste must be disposed within the limits as stated in Atomic Energy Licensing (Radioactive

Waste Management) Regulations 2011 certificate of authorization accumulation and disposal of

radioactive waste. Copies are held and displayed on each site. Departmental records must be kept.

Types of Radioactive Waste:

i. Solid - Solid materials which have become contaminated during research protocols. These

may include gloves, absorbent paper, pipette tips, etc.

ii. Liquid - Liquid materials which have become contaminated during research protocols. These

include solutions, buffers, rinses, etc.

iii. Biological/Animal Carcass - Biologically active or remains of animals which have been

subjected to radioactive material protocols. These include animal carcasses, pathological

waste, microbiological waste, etc.

iv. Sharp/Broken Glass - Sharp objects or broken glass which have become contaminated

during research protocols. These may include needles, razor blades, pasteur pipettes, broken

glass, etc.

8.1 General Requirements and Responsibilities

i. Each Authorized User should accurately identify, quantify and label the types, quantities,

and forms of radioisotopes that are placed in the radioactive waste generated in under their

authorization.

ii. Radioactive waste containers in the lab should be stored as close to the work area as

possible to minimize the probability of spillage during the transfer to the containers.

iii. Unattended radioactive waste containers are prohibited from being stored in unrestricted

areas.

iv. Radioactive waste containers should be covered when not in use.

v. Radioactive waste containers should be posted with a “Caution Radioactive Material” label.

vi. When handling or transferring radioactive waste the individual should wear proper personal

protective equipment.

vii. Radioactive wastes containing carcinogens, biological hazards, sharps, or acutely

hazardous chemicals must be inactivated, if possible, and packaged to present minimal

hazards to RPO.


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28

8.2 General Disposal Way of Radioactive waste

i. Aqueous liquid waste must be disposed in designated sink. All disposed radio activities must

be recorded. A good water flow must be used.

ii. Organic solvents should be disposed as described in the authorization.

iii. Where gaseous substances are used (e.g 131

I) fume hood must be used for disposal.

iv. Sharp containers must be used for the disposal of radioactive syringes and needles.

v. Other known or suspected radioactive materials e.g. gloves should be disposed of in the waste

bag in the lead lined bins (injection room and hot lab)

vi. Bags of waste removed from the waste room must be monitored to check that they are not

radioactive and all radioactive warning labels removed.

vii. The radioactive waste shall be segregated between long and short half-life storage area in the

department.

8.3 Procedure for Decommissioning of Radiation Produce Machine

A radiation producing machine is said to be “decommissioned” only after;

i. Source of the radiation is removed from the equipment using sealed radioactive materials.

ii. Source of the radiation is completely impaired from the equipment using X ray tubes. The

tubes should be impaired in a manner that it will be impossible to use the tube again in the

future. Contact RPO for further questions.

iii. The equipment is sent back to the manufacturer or supplying vendor for reuse or recycling.

iv. The equipment is sold to an individual outside HSAJB premise. (The equipment owner

should verify that the new owner possess any required license prior to selling the equipment).

v. The RPO should be notified prior to the decommissioning of the equipment. RPO will co-

ordinate all license cancellations.

8.4 Leak Test for Sealed Radioactive Material

All sealed sources should be checked for leakage by the owner of the sealed source at least once every

12 months. A register of the wipe tests conducted should be maintained. The source is considered

leaking if the count rates from the wipe test are above three times background count rate.

Where any radioactive substance is leaking, or is likely to leak:

i. Radiation Workers shall notify RPO immediately


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ii. Immediate vacation of all appropriate areas to safeguard every individual present in the

vicinity of the sealed source

iii. A leak-proof container shall be used to contain the leak until completely repaired.

iv. Decontamination carried out by properly equipped individuals supervised by the licensee or

qualified individual.

8.5 Equipment Releases

Equipment containing a radioactive source (e.g. liquid scintillation counters, gas chromatographs,

spectrometers) or equipment contaminated by radioactive material (e.g. refrigerators, centrifuges,

water baths) must be properly decontaminated or arrangements have been made for the source

removed prior to transferring to surplus, off-site, or to an unrestricted area. Guidelines for the transfer

of equipment follow:

i. For equipment that has come into contact with radioactive materials, investigators shall

decontaminate equipment and conduct the appropriate surveys to ensure that any

contamination is below the release for unrestricted use limits.

ii. For equipment that contains a radioactive source, the RPO will make arrangements to

extricate the source and arrange for the proper disposal.

iii. Prior to transfer of the equipment, the RPO should be contacted. A confirmatory survey

will then be conducted and approval for the transfer will be granted.


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30

9.0 RADIOLOGICAL EMERGENCY MANAGEMENT

An emergency exists whenever health, life, or property is jeopardized. The response to such a

situation must be prompt. In the event of emergencies, all personnel must be accounted for and

examined to determine the extent of injury. HSAJB has established emergency protocols (refer

HSAJB Medical Response Team policy) to be followed for various situations and procedures must be

followed as directed in the protocols.

Radiation injuries and contamination injuries may be treated at HSAJB. In the event of a radiation

injury, notify the RPO. Examples of emergency situations are:

i. Fire in a Radiation Hazard Area;

ii. A catastrophic water leak near electrical equipment in a Radiation Hazard Area;

iii. Rupture of a highly radioactive target;

iv. Trapping of an individual in a Radiation Hazard Area;

v. Catastrophic failure of shielding around a Radiation Hazard Area;

vi. Release of large quantities of airborne radioactive materials (especially alpha emitters) into

the building or outside environment;

vii. Serious injury to an individual in the presence of radioactive materials.

In a contamination accident, affected personnel will be moved to a safe area for decontamination.

Traffic must be controlled to prevent spreading the contamination, and the contaminated area must be

roped off as soon as is practical. In the event of any spillage of radioactive material the departmental

procedures must be followed. A copy of this procedure is kept with each decontamination kit.

9.1 Notifications, Reports and Records of Reportable Events Procedure

For any administration of radioactive material or radiation that results in a reportable event, the

licensee shall:

i. notify the local authority by telephone no later than the next day after the licensee ascertains

and confirms that a reportable event has occurred;

ii. submit a written report to the local authority within 30 days after the licensee ascertains and

confirms that a reportable event has occurred. The written report must include:

a. the HSAJB Director name;

b. the prescribing physician's name;

c. a brief description of the reportable event;

d. why the reportable event occurred;

e. the effect on the patient;

f. what improvements are needed to prevent recurrence;


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31

g. actions taken to prevent recurrence;

h. whether the licensee informed the patient (or the patient's responsible relative or

guardian);

i. if not, why not; and if the patient was informed, what information was provided to the

patient; and

j. The report must not include the patient's name or other information that could lead to

identification of the patient;

iii. Notify the patient of the reportable event within 30 days after the licensee ascertains and

confirms that a reportable event has occurred, unless the referring physician agrees to inform

the patient or believes, based on medical judgement, that telling the patient would be harmful.

If the referring physician or patient cannot be reached within 30 days, the licensee shall notify

them as soon as practicable. The licensee is not required to notify the patient without first

consulting the referring physician; however, the licensee shall not delay any appropriate

medical care for the patient because of any delay in notification; and

iv. If the patient was notified, provide a written report to the patient within 30 days after the

licensee ascertains and confirms that a reportable event has occurred. The report to the

patient shall be either a copy of the report that was submitted to the appropriate authority or a

brief description of both the event and the consequences, as they may affect the patient,

provided that a statement is included that the report submitted to the appropriate authority can

be obtained from the licensee.

9.2 Defining Incidents and Emergencies

The following may constitute an incident or emergency:

i. Loss or theft of any radioactive material or radiation producing device.

ii. High or potentially high radiation exposure to an employee or member of the general public.

For example:

a. Greater than 10 mSv whole-body in one month to an occupationally exposed

individual;

b. Greater than 100 mSv in one month to the extremities of an occupationally exposed

individual; or

c. Greater than 1 mSv to any member of the general public.

iii. Intake of radioactive material by inhalation, ingestion, skin absorption or injection through

the skin or wound.

iv. Deceptive or potentially deceptive exposure of a dosimeter.

v. Personnel contamination which cannot be removed after two washes with soap and water.

vi. Spills involving significant activities of 125

I or 131

I with the potential for inhalation.


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vii. Removable contamination in unrestricted areas (e.g. hallways, offices, vehicles, etc.) which

exceed the regulatory limits.

viii. Radiation fields in unrestricted areas which exceed the limits specified for members of the

general public.

ix. Accidental or unmeasured releases of radioactive material to the environment.

x. Fire or floods which threaten to release radioactive material to the environment or which

threaten to expose emergency response personnel.

xi. An on-site transportation accident involving radioactive material.

xii. Personnel injuries which may involve radioactive material contamination of the wound.

xiii. Additional situations deemed pertinent by the Radiation Safety Committee or RPO.

9.3 Fire Emergencies

Anyone who spots fire or smoke should immediately follow HSAJB Fire Emergency Procedure.

If the fire is small enough that it can be contained by a wall mounted extinguisher, every attempt

should be made to do so by whoever is in the area. Under no circumstances should an individual

attempt to fight a fire without someone else being present that can remove them from an area should

they be overcome by smoke. Anyone not involved with fighting the fire should evacuate the building

immediately. When the general alarm is activated, call the Code Blue for further notification.

9.4 Minor Spills

i. Notify the RPO of the spill. The following information is necessary:

a. Laboratory location of the spill;

b. Identity of the caller;

c. Extent of personnel injuries;

d. Radionuclide’s involved;

e. Amount of radioactive material involved (in MBq); and

f. The chemical or physical form.

ii. If the spill occurs:

a. During working hours - call RPO at phone number 07-2257000 extension 2003

b. After working hours - call 017-2151234

iii. Attend to the spill as soon as possible.

iv. Use appropriate personal protective equipment (e.g. gloves, laboratory jacket, etc.).


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9.5 Major Spillage

Radiation emergencies are incidents which involve actual or suspected exposure to uncontrolled

sources of radioactivity that cause or threaten to cause an external dose in excess of 250 mSv to the

whole body, or gross radioactive personnel contamination resulting in ingestion, inhalation, injection,

or skin absorption of radioactive material leading to comparable risk.

i. Provide the following information to RPO;

a. Laboratory location of the spill or emergency;

b. Identity of the caller;

c. Extent of personnel injuries;

d. Radionuclide’s involved;

e. Amount of radioactive material involved (in MBq); and

f. The chemical or physical form.

ii. Life-saving or first aid measures take precedence over radiation hazards and decontamination

efforts.

iii. Stand clear of a contaminated area.


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10.0 RECORD KEEPING

10.1 General Requirements

i. RPO shall maintain all required records such as personnel dose monitoring, personnel medical

examination, area dose monitoring, and patient dose, management of radioactive material,

incidence and accidental exposure.

ii. Required records shall include the date and identification of the individual making the record,

and, as applicable, a unique identification of the survey instrument(s) used, and an exact

description of the survey location.

iii. The record must also generate as well in the RADIA System Ministry of Health.

10.2 Transfer of Radioactive Material

An Authorized User may transfer radioactive materials to another Authorized User provided the

recipient is authorized for the radioactive material and quantities involved. The RPO should be

notified before the transfer and will generate a new inventory form for the recipient. The transferring

user records the transfer on their inventory form and this form is submitted to the RPO.

10.3 Shipment of Radioactive Material

Shipment of radioactive material must be approved by the RPO. Shipment of any radioactive

materials to an outside institution requires verification by the RPO that the receiving institution is

licensed to receive the materials. Generally, this means that a copy of the license authorizing the

recipient to possess the source must be on file in the RPO room before shipping the source.

All regulated radioactive materials and devices will be shipped from this institution in accordance

with the Act 304 and IATA packaging and shipping policy.


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ANNEX

Table 1: Annual occupational dose limits and ALARA action level for adult radiation workers.

Applicable Dose Limit Annual Limit ALARA Action Level

(mSv) (mSv)

Total Effective Dose Equivalent 20 5

Total Organ Dose Equivalent 500 125

Skin Dose Equivalent 500 125

Extremity Dose Equivalent 500 125

Eye (Lens) Dose Equivalent 150 37.5

Table 2: Apprentices or student of 16 to 18 years who are training for employment involving

exposure to radiation or required to use radiation source in the course of their studies.

Applicable Dose Limit Annual Limit ALARA Action Level

(mSv) (mSv)

Total Effective Dose Equivalent 6 1.5

Total Organ Dose Equivalent 50 12.5

Skin Dose Equivalent 250 62.5

Extremity Dose Equivalent 150 37.5

Eye (Lens) Dose Equivalent 15 3.75


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Table 3: Radionuclide Contamination Limits

Class of Radionuclide Controlled Area

(Bq/cm2)

Public Area

(Bq/cm2)

Class A - Typically long lived and emit

alpha radiation 3 0.3

Class B - Typically long lived and emit

beta or gamma radiation (I-131) 30 3

Class C - Typically short lived and emit

beta or gamma radiation (F-18,

Tc-99m)

300 30

Consult RPO for specific class of isotopes used in your laboratory


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APPENDIX

HSAJB/RS/SOP-01................................................................................ Receiving Radioactive Material

HSAJB/RS/SOP-02................................................................................ Storage of Radioactive Material

HSAJB/RS/SOP-03..................................................... Transfer of Radioactive Material Within Premise

HSAJB/RS/SOP-04................................................................ External Transfer of Radioactive Material

HSAJB/RS/SOP-05............................................................................... Radioactive Waste Management

HSAJB/RS/SOP-06............................................................ Managing Patient Administered Radioactive

HSAJB/RS/SOP-07.......................................................... Handling Pregnancy Patient with Radioactive

HSAJB/RS/SOP-08 .......................................................... Transfer Radioactive Patient Within Premise

HSAJB/RS/SOP-09........................................................... Transfer Radioactive Patient outside Premise

HSAJB/RS/SOP-10 ........................................................... Patient Exposure Monitoring - Survey Meter

HSAJB/RS/SOP-11 ................................................................... Patient Exposure Monitoring - PADOS

HSAJB/RS/SOP-12............................................................................................ Monitoring of Personnel

HSAJB/RS/SOP-13...................................................................................... Pregnancy Staff Monitoring

HSAJB/RS/SOP-14.................................................................... Personel Dosimeter Manual Guidelines

HSAJB/RS/SOP-15.................................................................................................... Area Classification

HSAJB/RS/SOP-16........................................................................................................ Area Monitoring

HSAJB/RS/SOP-17......................................................................................... Handling Radiation Meter

HSAJB/RS/SOP-18....................................................... Contamination and Decontamination Procedure

HSAJB/RS/SOP-19........................................................................ Death Body containing Radionuclide

HSAJB/RS/SOP-20........................................................................................... Emergency Preparedness

Documents

RADIATION PROTECTION PROGRAMME