Curative yet potentially injurious, radiation plays a major role in diagnosing ailments and in treating cancer. Knowing what precautions to take when working around radiation helps keep nurses safe.
"The whole concept of radiation safety is time, distance and shielding," says Vanessa Magel, RN, BSN, clinical nursing supervisor at the Cancer Therapy and Research Center at the University of Texas Health Science Center at San Antonio.
Less time spent near a source of radiation, a greater distance from the source and shielding behind a lead barrier results in less exposure. The radiation source determines protective actions.
More than half of all cancer patients receive radiation therapy, according to the National Cancer Institute. It may be used curatively, palliatively or as an adjuvant therapy. Radiation is also employed in diagnostic imaging studies and must be handled carefully.
"Radiation can cause a number of health concerns," says Susan Y. Parnell, RN, MSN, MPH, COHN-S, CIC, instructor in nursing at the University of Texas Health Science Center at Houston School of Nursing, offering as examples skin cancer, leukemia, bone cancers and genetic mutations in an unborn baby brought about by excessive exposure to radiation. Pregnant nurses should inform their employer as early as possible about the pregnancy.
People are exposed to a certain amount of radiation as part of everyday life. In fact, the U.S. Nuclear Regulatory Commission (NRC) estimates Americans receive about 360 millirem annually, about 80% of it from natural sources, such as from the sun, stars, food and water. The balance results from man-made sources, including medical diagnostics, televisions, smoke detectors and other products.
Occupational exposure also occurs. Anyone working with radiation and likely to receive a dose of more than 100 millirem a year must receive training about how to protect themselves, according to NRC regulations. Duke University estimates staff working on units at Duke University Medical Center where radiation is used can expect to receive less than 200 millirem per year. In comparison, the current U.S. annual occupational dose limit is 5,000 millirem.
"It's very important that nurses protect themselves and limit amount of radiation they are exposed to in the workplace," Parnell says. "[Nurses] need to know what radiation they are working with and what the precautions are for that type of radiation."
The hospital's radiation safety officer can explain about the different types and what steps are necessary to decrease occupational risk. Nurses working in areas in which radiation is frequently used will wear a dosimeter or film badge, which tracks the cumulative dose of radiation. If too high, Parnell says, the person would be given a "radiation holiday." However, it is unusual to have an elevation because safety measures are practiced consistently. Jumps would likely result from an accident or other breach in practice.
Diagnostic and Surgical Imaging
Whenever caring for a patient about to receive a portable X-ray at the bedside or in the radiology department, the nurse should step outside when the image is taken. If nurses must stay in the room for some reason or are within six feet of the machine, they must wear a lead apron, Parnell says.
Nurses who must assist in holding a patient during a portable X-ray should avoid placing their hands in the direct beam, according to the Duke University and Duke Medicine Radiation Safety Division.
In the OR, nurses working around fluoroscopy machines should wear a lead apron if they are within 1 meter of the patient. The apron should be in good repair, with no tears or missing straps or buckles. The waist-level strap should be placed above the hips to shift the apron's weight off the shoulders, per Duke.
When entering a nuclear medicine room, the nurse should put on personal protective gloves and shoe covers before entering. A lead apron is necessary if the nurse is close to the source of radiation. Patients returning from a nuclear medicine scan present almost no hazard, according to Duke.
Radiation Therapy
Internal radiation may include patients treated with radioactive iodine or other isotopes and patients treated with brachytherapy, implanted seeds or devices. Patients receiving radioactive iodine are placed in a lead-lined room. The phone, call bell and remote controls are covered in protective plastic. Patients should be given scrubs to wear and disposable grooming aids. Personal items, such as books, should be disposed of at discharge or allowed to decay for 90 days after the isolation ends, recommends Michael A. Thompson at the University of Alabama at Birmingham in a 2001 Journal of Nuclear Medicine Technology article.
The nurse should don personal protective equipment, including gloves and shoe covers, before entering the room. Pregnant nurses and those trying to conceive should not be assigned to the patient, per Thompson. Protective barriers may include a lead apron or shield if working within 1 meter of the patient. However, Duke indicates a lead apron is minimally effective, reducing exposure during a prolonged procedure at close proximity by about 15%.
Trash, linen and leftover food stay in the room and are disposed of by radiation safety officers. Nurses should remove gloves and shoe covers and place them in a trash box inside the room, per Duke, and wash hands after exiting. Blood and body fluids of patients treated with radioactive iodine are considered radioactive, since the body excretes the material.
Nurses caring for patients with a radioactive implant in a body cavity, such as the vaginal vault, follow similar precautions. Nurses could share responsibility with a patient care technician, letting the tech empty the Foley bag and pick up the dinner tray so the nurse can spend her time assessing the patient. That way, both individuals receive less exposure than if the nurse did everything.
The University of Texas system and other NRC-regulated facilities follow the ALARA principal -- as low as reasonably achievable -- when it comes to safely using radiation. Doses and exposures should be kept to a minimum and closely monitored.
