Hospital eTool
Radiology Module
Click on the area for more specific information.
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Common safety and health topics:
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Tuberculosis
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Potential Hazard
Exposure of radiology staff to patients with tuberculosis during x-ray procedures. Exposure may also occur after
radiology procedures are completed, from treatment rooms not
properly ventilated after being occupied with a patient who has TB.
Possible Solutions
The hospital‘s safety and health plan should address safe
handling of TB patients in the radiology area, (CPL 2.106 OSHA
Directive,
Enforcement Procedures and Scheduling for Occupational Exposure to Tuberculosis) including:
Facilities in which TB patients are frequently treated
should have an area in the radiology department that is
ventilated separately for TB patients.
- If this is not possible, TB patients should wear
surgical masks and should stay in the radiology
suite the minimum amount of time possible, then be
returned promptly to their isolation rooms.
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Healthcare facilities serving populations that
have a high prevalence of TB may need to supplement
the general ventilation or use additional
engineering approaches in general-use areas where TB
patients are likely to go (e.g., waiting-room areas,
emergency departments, and radiology suites). Engineering approaches include:
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A single-pass, non-recirculating system that
exhausts air directly to the outside.
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A re-circulation system that passes air through
HEPA (High Efficiency Particulate Air) filters
before re-circulating it to the general
ventilation system.
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Upper Air Ultraviolet Germicidal Irradiation (UGVI)
may be used in such areas.
Signs and Tags:
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Employees should receive adequate information
about the hazards of TB through the use of labels
and signs, as indicated in 1910.145
Accident Prevention Signs and Tags. The CDC and OSHA
recommend that signs should be posted at the
entrance to:
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Isolation rooms or areas, such as radiology
examination rooms where procedures or services are
being performed on an individual with suspected or
confirmed infectious TB. The signs could bear a
"STOP" sign and the legend "No
admittance without wearing a type N95 or more
protective respirator."
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Employers should use biological hazard tags on
air transport components (e.g., fans, ducts,
filters), that may reasonably contain air infected
with tuberculosis to warn employees, temporary
employees, or contractors of possible hazards of
contamination.
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Contaminated air ducts leading from this area
should have a warning label posted on them. The
warning labels on these air systems could be
labeled with, "Contaminated
Air-Respiratory Protection Required."
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After the area is vacated by an individual with
suspected or confirmed infectious TB, the sign shall
remain posted at the entrance, until the room or
area has been ventilated according to CDC
recommendations for removal efficiency of 99.9%. (CPL 02.106, Appendix
A, See Appendix A, pg. 35 and Table S3-1, page 72).
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The CDC in CPL 02.106, Appendix
A, document page 72, table S3-1 has published guidelines regarding the length of
time for such sanitation of the room air based upon
the air exchanges per hour. Requiring that the sign
remain posted until the room or area is adequately
ventilated will assure that unprotected employees do
not inadvertently enter while an infection risk is
still present.
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additional information, see HealthCare Wide Hazards - Tuberculosis.
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Ergonomics
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Potential Hazard
Exposure of radiology staff to possible work-related
musculoskeletal disorders (MSDs) (e.g., strain and sprain
injuries to back and shoulder areas) from constant lifting and
reaching for patients during x-ray procedures and/or transfers.
Possible Solutions
Employers should assess the radiology area for ergonomic
stressors and identify and address ways to decrease stressors
such as:
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Train employees in proper lifting techniques:
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Lift items close to the body.
- Avoid awkward postures, such as twisting while lifting.
- Avoid lifting/reaching or working above shoulder height.
- Use mechanical aids to reduce the need to lift.
- Provide sufficient staff to handle lifts.
- Instruct the patient in ways to help facilitate the lift and procedure.
For additional information, see HealthCare Wide Hazards - Ergonomics.
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Potential Hazard
Staff exposure to radiation from portable and fixed X-ray
machines as they are used for diagnostic procedures. Potential
health effects of radiation exposure are somatic (body) and/or
genetic (offspring) in nature:
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Acute: Erythema and dermatitis. Large whole-body
exposures cause nausea, vomiting, diarrhea, weakness, and
death.
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Chronic: Skin cancer and bone marrow suppression.
Genetic effects may lead to congenital defects in the
employee‘s offspring.
Radiation exposure occurs when unprotected employees are near a
machine in operation. The degree of exposure depends on the
amount of radiation, the duration of exposure, the distance form
the source and the type of shielding in place.
Possible Solutions
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Film badges or their equivalent should be used for
long-term monitoring. Examples include:
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Film Badge:
Passive dosimeter for personal exposure
monitoring should be worn whenever working with
x-ray equipment, radioactive patients or
radioactive materials. Depending on the work
situation, body badges may be worn at collar
level, chest level or waist level.
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Double-Badging: Personnel who work in high-dose fluoroscopy settings may be
asked to wear two badges for additional monitoring.
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Ring badges: (used for measuring beta and gamma doses to the hand) should be worn on the hand which is
closest to the radiation source. |
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- X-ray
rooms that are equipped with a barrier wall with a lead platted glass
window so technician can step behind barrier wall to take the x-ray,
and avoid radiation exposure.
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- Lead plated glass is also used as a barrier to
protect against radiation exposure when procedures
must be done close to the patient.
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- Lead strips provide some protection from radiation
exposure for employee running fluoroscopy
procedures.
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- Lead aprons and lead gloves offer some protection
for employees and patients and should be worn in the
direct x-ray field. Opaque goggles are to be worn in
the direct x-ray field.
OSHA Tech Manual Section VI, Chapter 1-Health
Hazards.
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- Some procedures like those that use remote
fluoroscopy can be run from controls in an adjacent
room, free from radiation exposure.
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- A specific person should have the responsibility
for assuring proper maintenance of the portable
x-ray machines. Preventive and corrective
maintenance programs for x-ray machines are detailed
in 21 CFR 1000, Radiological Health.
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- Kits containing radioactive isotopes or specimens
and excreta of humans and animals who have received
radio nucleotides may pose a hazard. Exposure may
also result from handling of radioactive spills (29
CFR 1910.1096),
Ionizing Radiation Standard.
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- There should be a separate storage area for
radioactive sources. This area should be
adequately shielded.
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- Document and retain inventories of radioactive
materials. Only authorized personnel should have
access to storage areas.
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Every employer shall supply
appropriate personnel monitoring equipment, such as
film badges, pocket chambers, pocket dosimeters, or
film rings, and shall require the use of such
equipment 1910.1096(d)(2).
- Employers shall maintain records of the radiation
exposure of all employees for whom personnel
monitoring is required under paragraph (d)
of this section and advise each employee of his
individual exposure at least yearly.
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- At the request of a former employee an employer
shall furnish to the employee a report of the
employee‘s exposure to radiation records 1910.1096(o)(1).
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- Such report shall be furnished within 30 days from the time the request is made.
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- The report shall also include the results of any
calculations and analysis of radioactive material
deposited in the body of the employee.
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- The report shall be in writing and contain the following statement: "You should preserve this report for future reference."
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- Hazard Information Bulletin Radioactive
Contamination of Lead Shielding.(1997,
June 24). Some shielding products used for radiation protection contain
lead contaminated with small amounts of naturally occurring radio
nuclides. The products identified to date include medical devices used
for radiation protection such as lead aprons, gonad shields, and
thyroid shields manufactured after October 1, 1996.
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Additional Information:
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Office of Radiation & Indoor Air Radiation Protection Division
U.S. Environmental Protection Agency, EPA, (1998, May).
Ionizing Radiation Series No.1. Includes a Fact Sheet on the health effects of
ionizing radiation.
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ALARA
(as low as reasonably achievable) exposures by practicing the basic principles of radiation protection.
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OSHA coverage of Ionizing Radiation Sources not Covered by Atomic Energy Act of 1954, (1978, October 30). OSHA Directive.
OSHA covers all radiation sources not regulated by (AEC)
Atomic Energy Commission. Radiation sources such as
X-ray equipment, accelerators, accelerator-produced materials,
electron microscopes, betatrons, and some naturally occurring
radioactive materials are under the jurisdiction of OSHA.
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Duke University Radiation Safety.
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Potential Hazard
There is a potential for slips and falls in the radiology
area, and when using portable X-ray machines if employees slip
on fluids spilled on the floor such as blood, vomit, or
excreta, or trip over x-ray power cords.
Possible Solutions
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[1910.22(a)(2)]
requires floors be kept clean and dry.
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Aisles and passageways shall be kept clear and in good repairs, with no
obstruction across or in aisles that could create a hazard [1910.22(b)(1)].
Provide floor plugs for equipment, so power cords need not run across pathways.
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Good work practice recommends:
- Spills reported and cleaned up immediately.
- The use of no skid waxes and surfaces coated with grit or waterproof footgear to help decrease slip/fall hazards.
For additional information, see HealthCare Wide Hazards -
Slips/Falls.
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Potential Hazard
Exposure of staff to blood and Other Potentially Infectious Materials, (OPIM)
(e.g., excreta, vomit, sputum), during the x-ray process.
Definition for OPIM is found in
1910.1030(b).
Possible Solutions
Implement Universal Precautions according to the Bloodborne Pathogens Standard
[1910.1030(d)(1)].
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Treat all blood and OPIM with appropriate precautions such as:
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Use gloves, masks, and gowns if blood or OPIM exposure is anticipated.
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Use engineering and work practice controls to limit exposure.
Provide appropriate Personal
Protective Equipment (PPE) such as gloves or gowns as required by the
Bloodborne Pathogens Standard 1910.1030(d)(3)(i),
if there is occupational exposure to blood or OPIM.
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Gloves must be worn when hand contact with blood, mucous membranes,
OPIM, or non-intact skin is anticipated, and when performing vascular
access procedures, or when handling contaminated items or surfaces
[1910.1030(d)(3)(ix)].
For additional information, see HealthCare Wide Hazards -
Bloodborne Pathogens and Universal Precautions.
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Workplace Violence
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Potential Hazard
Exposure of employee to potential violence from
uncooperative, disoriented, or combative patients. Many
radiology patients come from the emergency area and may be
confused and violent.
Possible Solutions
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Have a plan in place to deal with difficult patients.
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Provide training to staff to identify, recognize, and
diffuse potentially violent situations and patients.
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Be alert for potential violence and suspicious behavior and
report it.
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Provide adequate staffing levels, with experienced
clinicians on each shift.
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Use appropriate engineering controls to provide security
such as:
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Install concealed panic buttons-in the x-ray area, that
can be pushed for emergency help.
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Improve lighting and video surveillance.
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Use an escort or buddy system, when taking a possibly
violent person to radiology.
For additional information, see HealthCare Wide Hazards -
Workplace Violence Module and the
Emergency Room Module.
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Potential Hazard
Tasks that use a computer (e.g., remote radiology computer
workstation, data entry clerk, secretary) intensively for 4
hours or more per day, can lead to musculoskeletal disorders
of the hand/arm, shoulder, neck and back.
Possible Solutions
For additional information, see HealthCare Wide Hazards -
Administration Module - Computer Workstations.
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