School of radiologic technology



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B. EQUIPMENT:

  1. Radiographic equipment is extremely expensive. Handle ALL equipment with care.

  2. Students will NOT call the service engineer for equipment repair. This is the obligation of the radiographer or supervisor of the department.


C. CLINICAL ASSIGNMENTS:

  1. Students are to remain in their assigned area unless otherwise instructed by the Program Director, Clinical Coordinator, or clinical department supervisor/instructor.

  2. Students are under the direct supervision of the RT until that student achieves competency. This means that the RT must be physically present during procedures. When the student achieves competency he/she is under indirect supervision, and the RT must be immediately available to the student.

  3. Students are not to be in other areas of the hospital “observing or wandering around looking”. This includes the Emergency Department or any other areas when not assigned.

  4. Students will not be loitering around the front desk, processing area, or hallways.

  5. Students are to be active team members and assist in keeping assigned clinical areas stocked with supplies and clean linen and to assist in keeping the assigned room or area clean and neat, including room equipment or portables and restrooms. It is important to discuss responsibilities for assigned areas with assigned RT on the first day of a new assignment.

  6. Students MUST NOT leave the hospital without the permission of the Program Director/Clinical Coordinator (or Clinical Instructor in their absence). An RT, supervisor, or others DO NOT have the authority to permit any student to leave the hospital. This includes ALL clinical assignments.

  7. Students are to follow the directions of the assigned RT as related to the assigned clinical tasks and patient care activities.

  8. Chewing gum is NOT permitted during patient care activities. It is very unprofessional, rude, and distracting.

  9. The use of profanity will NOT be tolerated by anyone.

  10. When an RT answers a question for you, instructs you, or checks/evaluates radiographic images, you are not to ask another RT their opinion. Such conduct is unprofessional.

  11. The student is not to take offense when instructed, corrected, or given constructive criticism.




  1. Students will be introduced to various modalities in addition to routine radiography while in the program. These special rotations will be designated in certain semesters in the areas of MRI, Nuclear Medicine, Radiation Therapy, Special Procedures, Ultrasound, and Cardiac Cath Lab. Mammography will not be a part of the special rotations as male students cannot observe in that particular modality. Since the program must assure that all students have equitable opportunities to observe, it is recommended that any female student interested observing in Mammography should make arrangements with a Breast Imaging Center to do an observation during a semester break while not in school. The college also has a Mammography course that is one semester, post-graduation, which is held on even year rotations with CT on odd years. Students interested in Mammography should register for this post-graduate course where they will be able to learn more about this modality and will be able to assigned to clinicals in the Breast Imaging Department.



POLICIES REGARDING THE USE OF HOSPITAL TELEPHONES
Students are NOT to use Radiology Department telephones except in cases of EMERGENCY. Students shall NOT receive telephone calls except in cases of EMERGENCY. Family members may telephone the school office and provide a message which will be relayed to the student. School faculty and staff members are not responsible for the lack of information with the message. All outgoing telephone calls shall be made from the student’s own cell phone and should be made during breaks or at lunch time, or, at the end of the shift, if not an emergency. No long distance telephone calls will be placed by students and billed to the hospital. Cell phones are not permitted in the clinical area. They should be left in the student’s assigned locker or in their vehicle.

POLICIES REGARDING VISITORS
A visitor is defined as ANYONE (including family members and friends) coming in and desiring to see you for any period of time for any reason. Students are NOT allowed to have visitors during clinical or academic class hours. No children are allowed at the college or clinical sites.
POLICIES REGARDING ACCIDENTS
If a student is involved in an accident or witnesses an accident or injury involving a student, employee, patient, or visitor while within the hospital or on hospital property, he/she should report it immediately to the supervisor in that area and notify the Program Director. If the person is injured, no attempt should be made to move him/her until approved by a physician or supervisor.
A written occurrence report of the incident must be completed and given to the department supervisor/department manager. This report is documentation of the incident and is kept on file in the hospital for legal purposes. The hospitals are not responsible for the medical care of injured persons not handled in accordance with the above procedures.
For accidents involving students, each Clinical Facility will provide the initial first aid or medical treatment on site of the accident or injury. All ongoing treatment or follow-up is the total responsibility of the student. Students injured while on clinical duty time and referred to outside physicians, specialist, etc. are responsible for payment of fees as billed by such parties.

All students enrolled at Columbus Technical College have school-time-only accident insurance. Please see Columbus Technical College student handbook or Student Services under policies and procedures. Forms should be picked up in the Human Resources Department in the Hartline Building as soon as possible for completion. Students are covered under the liability insurance of the college during all clinical time assigned, per the Human Resources Department.


Injuries and/or illnesses incurred outside of clinical time and those injuries not related to clinical time are the responsibility of the student. Hospital physicians should not be asked to treat students for such problems. Students should see their private physicians on their own time.
Time off due to accident or injuries occurring during clinical assignment time is not an excused absence. Any absences must be made up during vacation time between semesters.


POLICIES REGARDING SAFETY
Safety rules shall be followed for the sake of patients and employees. The student’s cooperation is expected in demonstration and observation of all safety precautions which will result in a better environment at each of the clinical sites.
The following are some safety rules:

  • Report or correct any unsafe condition that you observe.

  • If there is any foreign material on the floor, pick it up or see that it is removed.

  • Always walk and keep to the right of the hallway. Be particularly cautious at hallway intersections.

  • The hospital is not a place for horseplay or practical jokes. Serious injury could result.

  • Defective or broken equipment should be reported at once.

  • Report all safety violations or injuries to the Department Manager or Supervisor/Clinical Instructor as soon as possible.

  • Keep informed on fire safety and weather disaster plans. Know the position of alarm boxes, extinguishers, civil defense shelters, and methods of evacuating patients.

  • Avoid wet hands when handling electrical equipment.

  • Remember safety rules and body mechanics when using wheelchairs, stretchers, beds, and other equipment used by patients.

  • Allow others to exit the elevator before you attempt to enter. This is common courtesy, especially if you are pushing radiographic equipment.


11/23/15

RADIATION SAFETY


  1. STATEMENT:

Radiation exposure should always be kept to the lowest possible level (ALARA). Various methods of radiation protection can be applied to insure safety for persons employed in fields involving radiation. Students, as well as the Radiologic Technologists, are responsible for using accepted methods in order to protect themselves and others. One concept all personnel should be aware of and utilize is the “ALARA CONCEPT”, which says that radiation exposure should be kept “as low as reasonably achievable”.


II. EXPOSURE RECOMMENDATIONS:

The National Council on Radiation Protection (NCRP #116) recommends an annual effective dose

equivalent limit of 5 REM. The following table may be referred to when questions about exposure

levels arise:



Occupational exposures

1. Effective dose limits

a) Annual 50 mSv (5 rem)

b) Cumulative 10mSv x age (1 rem x age in years)

2. Equivalent dose annual limits

for tissues and organs

a) Lens of eye 150 mSv (15 rem)

b) Skin, hands and feet 500 mSv (50 rem)


Public exposures (annual)

1. Effective dose limit, continuous

or frequent exposure 1 mSv (0.1 rem)

2. Effective dose limit, infrequent

Exposure 5 mSv (0.5 rem)

3. Equivalent dose limits for tissues

And organs

a) Lens of eye 15 mSv

b) Skin, hand and feet 50 mSv

4. Remedial action for natural sources:

a) Effective dose (excluding radon) >5 mSv

Education and training exposures (annual)

1. Effective dose limit 1 mSv (0.1 rem)

2. Equivalent dose limit for tissues

And organs

a) Lens of eye 15 mSv

b) Skin, hands and feet 50 mSv


Embryo-fetus exposures (monthly)

1. Equivalent dose limit 0.5 mSv (0.5 rem)


Negligible individual dose (annual) 0.01 mSv (.001 rem)
_____________________________________________________________

Source: NCRP #116

In order to insure proper monitoring from radiation, all students are provided Radiation Monitoring badges. These are issued through Columbus Technical College. The badge insert should be changed out once a month as directed by the Clinical Coordinator/Program Director. The Clinical Coordinator obtains the new insert and exchanges them with the students for old ones. The old badge inserts are sent in for reading. Badge reports are received, read, and kept on file.
The following shall be followed:


  1. No student is to be permitted into the radiology department for clinical assignment without a radiation badge.




  1. Radiation monitoring badges shall be worn by each student on the designated area of their person each day of clinical assignment. Badges are to be worn on the uniform collar. When wearing a lead apron, badges should be worn outside the apron on the uniform collar. Pregnant females are double badged with the second badge worn at the waist and under the apron.




  1. Students employed in Radiology outside of school time MUST wear a badge from that facility. The student badge must only be worn on student clinical assignment times.




  1. It is the student’s responsibility to turn in the badge monthly for interpretation.




  1. It is the student’s responsibility to take care of the badge during the period of time worn. If any of the following should occur, you MUST report it immediately to the Clinical Coordinator:

A. If you lose or misplace your badge

B. If any incident or accident affects a badge, it is the student’s responsibility to report the

incident immediately. When a student badge is lost, the Program Director or Clinical

Coordinator will make documentation of the incident and assign a spare badge to the student,

contacting Landauer, Inc. to be sure the spare badge number is associated with that student for

that particular month.




  1. Student badge reading reports will be reviewed by the program monthly and students will initial the

report denoting that they have seen the report within 30 days following receipt of data. Badge reports are placed in the files maintained by the Columbus Technical College Radiography Program. If a reading of 60 mrems or higher is received within a month, the student will be counseled by the Program Director/Clinical Coordinator to determine where the student was scheduled and what may have attributed to the higher reading. The Radiation Safety Officer of Midtown Medical Center will be a backup for information concerning elevated badge readings and may be contacted to consult in this situation, if necessary. The program will also contact Landauer, if necessary to have the badge re-read for accuracy of data. An excess of the Federal Standards may result in a leave of absence from the Program until a designated time is determined by the appropriate officials.

Reviewed and Revised 11/23/2015


III. POLICIES AND PROCEDURES TO CONTROL STUDENT RADIATION EXPOSURE


  1. Students must not hold image receptors or patients during exposures at any time. Use of proper imaging equipment or tape to hold image receptors is recommended. Use of acceptable immobilization techniques to prevent or minimize the need to hold patients should be employed. Other healthcare workers or patient family members should assist in holding the patient or image receptor during the exam.




  1. Anyone holding a patient during a radiographic exam MUST NOT stand in direct alignment with the primary beam.




  1. Protective aprons must be worn by each person in the fluoroscopic room, excluding the patient, who should be shielded as appropriate, according to the procedure being performed. DO NOT stand near the x-ray tube or adjacent to the patient when performing fluoroscopic exams OR portable radiography. During fluoroscopy, DO NOT turn your back to the table (this leaves one unprotected). Keep your arms behind you whenever possible.




  1. A lead shielding device which covers the Bucky slot should be used during fluoroscopy. Any malfunctions of this device should be reported immediately.




  1. Protective lead drapes must be left on the image intensifier during fluoroscopy.




  1. When operating portable units, a lead apron MUST be worn. DO NOT stand in direct alignment with the primary beam. Stand at least six feet or more and at right angle from the patient and the tube, if you cannot leave the room during the exposure.




  1. Under no circumstances will the student permit themselves or fellow students (or any other human being) to serve as patients for test procedures or experimentation.

11/23/2015



IV. POLICIES AND PROCEDURES TO FOLLOW TO LIMIT EXPOSURE TO

PERSONNEL, PATIENTS AND PUBLIC:


  1. Doors to the radiographic rooms must be closed at all times during an examination. There is usually a relay device which prohibits the production of radiation if the door is ajar.




  1. During fluoroscopic examinations, set the timer to begin the exam as instructed. DO NOT continually reset the timer unless instructed by the radiologist and/or staff technologist assigned to the room. When the timer is reset, record the time that was used and announce to the radiologist or physician how much fluoro time has accumulated.




  1. 1.5mm aluminum filtration has been added to the 1mm inherent filtration of the tube housing and collimator to provide the total filtration required of 2.5mm Al. Added filtration should be checked frequently.




  1. The field of radiation should be collimated to the smallest size possible but yet include the area being examined. At no time should the field of radiation exceed the size of film being used.




  1. Any female patient of childbearing age MUST be questioned for the date of her last menstrual period before any exposure is made. If the possibility of pregnancy does exist, a radiologist must be consulted.




  1. If a patient is pregnant and must have a radiographic exam, additional lead shielding is placed over the fetus, if at all possible. The exam should only be done if absolutely necessary.




  1. Gonads should be shielded on any radiographic exam of the abdominal area unless shielding would interfere with the objectives of the exam.




  1. The ovaries should be shielded on any radiographic exam of the abdominal area unless shielding would interfere with the objective of the exam.




  1. Periodic cassette/IR checks should be made to check the alignment of the primary beam with the localization light of the collimator.

The above policies and procedures will be instructed in the classroom during the first semester of the program. The faculty will demonstrate the application of any equipment use during the first semester. The academic and clinical instruction will be performed prior to students being assigned in the clinical sites.


A separate policy regarding radiation exposure and protection of a pregnant student is also found in this handbook. (See Section 5, page 72-74)
NOTE: In order to be considered as a candidate to the Program, individuals must be 18 years of age by the beginning date of the Program. The purpose of this requirement is due to meeting the Federal Regulation of Radiation exposure to the individual considered as a minor.

Rev. 11/23/15



RADIATION EXPOSURE DURING PREGNANCY:
The National Council on Radiation Protection and Measurements (NCRP) recommends that the monthly effective dose equivalent (EDE) to the embryo-fetus from occupational exposure to the expectant mother should be limited to 0.05 REM. Through proper instruction of all safety precautions, it can be possible to limit all occupational exposure to under 0.5 REM for the entire gestation period and prevent fetal total equivalent dose limits from being surpassed.
Students enrolled in the Program are instructed in proper safety precautions and personnel monitoring prior to being admitted to any ionizing radiation areas. Students are required to abide by all safety precautions and to remember the importance of keeping exposure as low as reasonably achievable (ALARA) through a combination of Time, Distance, and Shielding. Students are strongly encouraged to consider how the status of pregnancy will place additional stress and requirements with the successful completions in the academic assignments and exams to be met within a number and variety of courses in the academic curriculum, and further, the importance of successfully maintaining a rotational clinical schedule throughout the various assignments without interruption.
PREGNANCY POLICY:

Should a student become pregnant:



  1. it is the student’s decision to voluntarily disclose her pregnancy to the Program Director. The Program follows the declared pregnant worker definition as “A female student who has voluntarily informed her designated program official, in writing, of her pregnancy and the estimated date of conception”;

  2. the pregnant student will receive additional radiation safety counseling;

  3. the student is responsible for wearing provided radiation protective clothing and for good work habits;

  4. all pregnant students are issued two radiation monitoring badges. One badge will be worn on the collar outside of the lead apron. The other badge is to be worn at the abdominal level under the apron;

  5. the monthly badge reports will be reviewed by the Program Director of the Radiologic Technology Program and, should any level be reached above the normal limits under the apron of 500mR or above during the 9 month period, the student will be counseled and necessary action will be taken, including removal from all areas of fluoroscopy as needed.

  6. student will sign Declaration/Un-declaration of Pregnancy form of understanding, releasing college and affiliates of any liability associated with fetal damage should she decide to remain in the program.

Once informed of the student’s pregnancy, the program offers students several options to be considered due to the possible hazards of radiation exposure. The student should make her decision known by indicating the option of choice on the 2nd page of the Declaration/Un-declaration Form provided. In addition, the student should submit recommendations made by her physician regarding the pregnancy. The options available to the student are:



  1. Withdrawl from program both academically and clinically.

  2. Request a leave of absence from the program, returning after pregnancy terminates at appropriate semester.

  3. Continue with academic courses and withdraw from clinical courses. Clinical courses must be completed after termination of pregnancy.

  4. Continue with academic and clinical components with no modifications, until termination of pregnancy.


**Any student can undeclared her pregnancy at any time by filling out the Declaration/Un-declaration of Pregnancy Form, which follows this policy on Pages 56 and 57.

The Pregnancy Policy is presented to each Radiology Student candidate during orientation of the program. A copy of the Student Handbook is also available to prospective students. Each candidate is issued a copy of the Student Handbook (Policy and Procedure Manual) to take home and permitted to review all policies. The Policy and Procedure Manual is reviewed the first official day/week with all students and policies are explained by the Program Director as Radiation Protection Exposure and Safety measure are presented.

THE ABOVE POLICY IS SUBJECT TO CHANGE DEPENDENT UPON FEDERAL OR STATE REGULATION CHANGES. Revised 11/23/15

More information may be obtained at the following U.S.NRC website:

http://www.nrc.gov/reading-rm/doc-collections/cfr/part020/part020-1208.html

The Code of Federal Regulations in 10 CFR Part 19, "Notices, Instructions and Reports to Workers: Inspection and Investigations," in Section 19.12, "Instructions to Workers," requires instruction in "the health protection problems associated with exposure to radiation and/or radioactive material, in precautions or procedures to minimize exposure, and in the purposes and functions of protective devices employed." The instructions must be "commensurate with potential radiological health protection problems present in the work place."

The Nuclear Regulatory Commission's (NRC's) regulations on radiation protection are specified in 10 CFR Part 20, "Standards for Protection Against Radiation"; and Section 20.1208, "Dose to an Embryo/Fetus," requires licensees to "ensure that the dose to an embryo/fetus during the entire pregnancy, due to occupational exposure of a declared pregnant woman, does not exceed 0.5 rem (5 mSv)." Section 20.1208 also requires licensees to "make efforts to avoid substantial variation above a uniform monthly exposure rate to a declared pregnant woman." A declared pregnant woman is defined in 10 CFR 20.1003 as a woman who has voluntarily informed her employer, in writing, of her pregnancy and the estimated date of conception.

This regulatory guide is intended to provide information to pregnant women, and other personnel, to help them make decisions regarding radiation exposure during pregnancy. This Regulatory Guide 8.13 supplements Regulatory Guide 8.29 pdf icon, "Instruction Concerning Risks from Occupational Radiation Exposure" (Ref. 1), which contains a broad discussion of the risks from exposure to ionizing radiation.

Other sections of the NRC's regulations also specify requirements for monitoring external and internal occupational dose to a declared pregnant woman. In 10 CFR 20.1502, "Conditions Requiring Individual Monitoring of External and Internal Occupational Dose," licensees are required to monitor the occupational dose to a declared pregnant woman, using an individual monitoring device, if it is likely that the declared pregnant woman will receive, from external sources, a deep dose equivalent in excess of 0.1 rem (1 mSv). According to Paragraph (e) of 10 CFR 20.2106, "Records of Individual Monitoring Results," the licensee must maintain records of dose to an embryo/fetus if monitoring was required, and the records of dose to the embryo/fetus must be kept with the records of dose to the declared pregnant woman. The declaration of pregnancy must be kept on file, but may be maintained separately from the dose records. The licensee must retain the required form or record until the Commission terminates each pertinent license requiring the record.

The information collections in this regulatory guide are covered by the requirements of 10 CFR Parts 19 or 20, which were approved by the Office of Management and Budget, approval numbers 3150-0044 and 3150-0014, respectively. The NRC may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number





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