RADIATION EMERGENCIES

INCLUDING
DECONTAMINATION PROCEDURES

Dr. Priyanka Gupta

Nuclear Medicine Department
All India Institute of Medical Sciences, New Delhi
 RADIATION EMERGENCY
• An unintended event or mishap, the consequences
or potential consequences of which are not
negligible from the radiation protection or safety
point of view.

• An unplanned abnormal event leading to loss of

control over the source of radiation with actual or
potential consequences for person's safety and/or
impact on the environment.
• Radiation emergency
• Classification of emergency
• Consequences
• Source of error leading to emergency
• Regulations regarding emergency
• Handling of emergency
• Practice of safety
• Conclusion and steps to avoid in future
RADIATION EMERGENCIES
• Radiology

• Radiotherapy

• Nuclear medicine

• Nuclear emergency
 RADIATION EMERGENCIES IN
NUCLEAR MEDICINE

• Large amounts of unsealed radionuclides - diagnosis

of diseases and in the treatment of cancer and
abnormalities.

• Any error, carelessness, absence/failure of safety

facility/equipment, may lead to an accident or
mishap. 
 Emergency situations arising in nuclear medicine
department are:

• Spillage of radio-pharmaceuticals

• Mis-administration of radio-pharmaceuticals to
patient

• Loss of sources in the department or in transit.

 Two other types of mishaps that can be envisaged in
nuclear medicine and are beyond the control of the
radiation worker :

• Vomiting of radio-pharmaceutical by the patient

• Death of a patient with administered radio-

pharmaceuticals in the body.
 Sites
• Radiopharmacy
• History taking
• Injection room
• Patient waiting room
• Camera room
• During transport
• Radioactive waste area
• Therapy ward
 Factors leading to spillage

While working with radio-pharmaceuticals

• due to tilt of vial containing radio-pharmaceutical

• leakage from the syringe or splash of liquid

• During injection - through cannula

 Vomiting

• Vomiting of administered radio-pharmaceutical

by the patient - spillage
 Prevention of spillage

• Performing wet and dummy trials prior to handling

• Keeping vial containing the rp in appropriate outer

container with heavy base - to avoid tilting of vial

• Performing all wet operations in a tray lined with

polythene and absorbent paper
– spilled radioactivity is contained and spread of contamination
is restricted
• Transporting rp within the lab in appropriate shielded
transport containers

• Preparation of doses in a careful manner by skilled

person

• Adopting standard code of practice in the preparation

of dosages/radio- pharmaceuticals

• Ensuring stable condition of patient to avoid vomiting

• Spillage may lead to
– personnel exposure
– external contamination
– Internal contamination
– or both external/internal contamination

• Essential to ensure sufficient level of

emergency preparedness
 Handling procedures of spillage
• Confine the spill
– dropping paper towels/other absorbent material

• Evacuate the immediate area

– people do not walk over the spill and spread the
contamination.

• Contamination due to spillage can be either

– transferable (loose)
– non transferable (fixed)
• Fixed contamination
– source of external hazard
– cannot be removed even after repeated smearing

• Loose or transferable contamination

– can be removed by easy smearing of surface
– source of both external and internal hazard

• There are derived permissible limits of contamination at

specific surfaces for specific type of radiation.
 Loose contamination

• If the spilled material has splashed onto a person or clothing-

remove the clothes and collect the same in a polythene bag -
to be kept in radioactive waste storage room.

• Person with contaminated clothes should not leave the area

before removing the protective clothing.

• Any skin swabs, nasal blows or other biological samples

should be retained in case they are needed to provide
information in support of an assessment of the incident.
• For injured persons, first aid or partial decontamination is
advised – if delay in reaching the medical facility

• For generalized contamination - shower bath followed by a

complete radiological survey

• If contamination is localised over a limited body area (e.g.

hands, feet, neck, etc.) - thorough washing with soap and
water (but not hot water)

• Special attention - to body folds, the hair, finger nails

• Care should be taken not to abrate or inflame the skin surface

• Materials used for personnel decontamination - to be
treated as radioactive waste

• Special medical attention should be sought :

– if washing appears to be ineffective
– skin contamination is not reduced to acceptable levels
after several mild washings

• Possible care must be taken to prevent intake of radioactive

material
• If intake of radioactive material has taken place, immediate
action should be taken to prevent or minimise the deposition in
organs or tissues.

• Contamination that is caused internally (i.e., by inhalation,

ingestion or translocation from a wound or from skin) requires
medical attention.

• If necessary, steps should be taken to bring out and to enhance

the excretion of the ingested radioactive material under the
expert medical guidance

• The internal deposition of radioactive material should be

estimated by carrying out bioassay, whole body counting or both
• For the spilled activity on a surface - decontamination
by experienced persons

• wear protective clothing like surgical gloves, shoe

covers and surgical face mask etc.

• Tongs or forceps - to remove contamination, confined

by absorbent materials.

• Absorbent materials so collected - kept in a polythene

bag to be treated as radioactive waste.
• After as much contamination as possible have been
removed in this way, the surface should be-mopped with
damp (not wet) cotton or tissue paper held by forceps

• Always working towards the centre of the contaminated

area, rather than away from it

• It start on the outer perimeter of a contaminated area

and proceed towards the central point.
• A contamination monitor should be used to monitor the area as well
as the personnel during the procedure of decontamination.

• Contamination monitor - operated by a person other than the

person who does the cleaning up, to avoid the possible
contamination of the instrument.

• Contaminated gloves, shoes covers, etc., should be kept in a

polythene bag for decay for ultimate disposal as radioactive waste
as per AERB safety guidelines

• The forceps/tongs should be kept separately covered in polythene

bag for decay of radioactivity present on it.
• If the spilled radioactive material is of a very short half life, say
few hours, the closure of the laboratory (if possible) for a day
or overnight is recommended.

• Since the natural decay process reduces the activity, the

method is preferred to the immediate decontamination steps
as mentioned above.

• In this case, cleaning up operations should be carried out

once the activity is decayed to the safe levels.

• After around 8 to 10 half lives - surface can be cleaned with

moist swab
• Water is most commonly used decontaminating agent

• If unsuccessful, detergents like soap solution, teepol,

EDTA, etc. to be tried to remove the contaminant.

• Soap solution, teepol, EDTA - very suitable for

removing loose contamination from smooth, hard,
and nonporous surfaces

• Equally effective for those radioactive compounds

which are water soluble.
• To remove contamination from glass wares –
soap solution or chromic acid

• For metal surfaces - mild acids like 0.1 N HCI or HNO3

• In all these procedures, it is necessary to give time to

moist the surface before removing the contaminant

• Decontamination to be continued till the level of

contamination reduced to the specified levels .
 Fixed contamination

• Can be removed by gentle abrasion

• If fixed contaminant emits high energy gamma

radiation and has long half-life - contaminated object
may be treated as radioactive waste and be disposed
off permanently.

• Deep burial – if contamination cannot be removed

• If large release of radioactive powder or aerosol -
room must be immediately isolated from the surrounding by
shutting off mechanical ventilation and by closing windows
and doors.

• Room with heavy air contamination - decontaminated from

within by drawing the air of the room through an
appropriate filter.

• Complete records of the accident giving details of the

radioisotope, activity involved and follow up procedures,
etc. should be maintained.
Mis-administration of radio-pharmaceuticals

• Wrong administration of rp

• Administration other than the intended/required

– Rp
– Activity
– Route
– Person
 Types of mis-administration
• administration of radio-pharmaceutical to a wrong patient

• administration of wrong activity

• administration of wrong radio-pharmaceuticals

• administration through wrong route

• administration of radio-pharmaceutical in pregnant female

patient without confirming the pregnancy.
• Administration of wrong activity :

– radioactivity >10% from the prescribed dose of

therapy activity

– radioactivity > 50% from the prescribed dose of

diagnostic activity
• General prevalance :

– 80% of mis-administration are due to

administration of wrong radio-pharmaceuticals

– 10% by administration to wrong patient

– 2% by administration of wrong activity

 Causes of mis-administration

• communication problems or gaps,

• busy environment or distraction,
• bypassing local rules or code of practice,
• no training in emergency situations,
• absence of clearly defined responsibilities,
• absence of efficient quality assurance programme
• Imroper handling of radiopharmaceuticals
• Lack of planning and identification of patients
Consequences of mis-administration
• non- justified exposure

• increased radiation risks

• delayed diagnosis

• increase in cost

• increase in workload

• reduction in confidence
Prevention of mis-administration
• using transparent vial and syringe shields
• tagging, segregating the vials and syringes
• write activity, source, patient on vial or syringe containing
dosages
• check labels of vial or syringes before administration

• measuring the activity in radio-pharmaceutical

• identifying name, no., case of the patient

• ensuring that the female patient is not pregnant

 Loss of sources
• From department
– Radiopharmacy
– Radioactive waste/storage area
– Therapy ward

• During transit/transportation
• Inform
– Consignor
– RSO
– National authority - AERB
Emergency situations during transport of
radioactive material

• Damage to the package due to improper

handling or accident

• Package engulfed in fire

• Misplacement or theft of package

Emergency situations during transport of
radioactive material

Handling

• TREMCARD – spells out the action plan

• Rescue injured – provide medical aid

• Fight fire, if any

• Cordon off atleast 5 m distance from package

• Study the condition of package from safe

distance
• Inform consignor and national authority
 Death of patient administered with RP

With therapeutic quantity of rp in the body

• Body should be released to relatives only when the levels of

activity in the body is within the permissible limit prescribed by
AERB for
– cremation, burial, post-mortem or balming

• If the level of activity is higher than the prescribed limits

– body should be kept in morgue for decay of the activity
– should be released when the levels come down to the prescribed
limits
• If situation demands immediate release of body

– organs with accumulated activity be removed before the

release
– even after removal of vital organs containing radioactivity,
it should be ensured that the amount of activity, at the
time of release of body does not exceed the limit

• Removed organs with radioactivity should be disposed

as per the disposal rules
• Accident may cause personnel exposure, internal/external
contamination or both

• Ensure sufficient level of emergency preparedness

• Licensee and RSO together should devise and implement

an emergency response plans

• Use of possible means, methods and facilities available in

the department to prevent the accident

• Observing simple and minor practices can prevent a

number of accidents.
General methods for prevention of accidents

• Preparing and practicing safe code of practice in the

department

• Educating the staff by the RSO in radiation safety of

– Personnel
– Patient
– Members of public
– Environment

• Effort should be taken to inculcate safety culture in the

department.
 Emergency Preparedness
• Adequate number of trained staff available in the department to
carry out the emergency plan

• Personnel/staff should exercise care in respective areas to avoid

situations that may lead to an accident

• Ventilation system of radioisotope laboratory should be checked

periodically and maintained properly.

• Proper inventory of radioisotopes received, used, in stock and

disposed off should be maintained
• All radiation monitoring, measuring instruments and safety
devices - routinely checked and kept in working condition.

• Handling equipment e.g. tongs, forceps, etc., should be kept

in ready access

• Charts detailing the steps to be taken in case of a radiation

emergency, should be conspicuously displayed

• Decontamination kit - accessories like tongs, forceps, waste

receptacles etc., required for decontamination
RSO should

– identify emergency situations

– assess the causes and probabilities of occurring accidents

– in critical and normal situations in the department

– Planning of appropriate counter measures for each type

of situation to avoid accidents
 Emergency Response Team
• Handling of emergency involves
– Variety of actions
– Involvement of persons in different fields
– Teamwork

• Emergency Response Committee - Team of experts

– Each member -assigned specific responsibilities
– Have to be familiar with workings in the institution to assure
co-ordination among them
Emergency Response Committee
• Authorised nuclear medicine physician

• Nuclear Medicine Physicist

• Laboratory assistant

• Radiation Safety Officer (RSO)

• Administrative personnel

• Electronic instrumentation expert

• Emergency Director

The Committee should discuss the problems periodically

to avoid recurrence of accidents.
What to do in an emergency
• Do not panic

• Inform
– RSO
– Head of department
– Emergency response team
– other staff members

• Attend to the emergency immediately as per procedures

detailed by regulatory authority

• Report to National authority – AERB

(through ELORA)
• Learning lesson

• Avoid in future

Prevention is better than cure

Thanks