Re: MONITORING UNIVERSITY HEALTH CENTER PERSONNEL

[lambert@HAL.HAHNEMANN.EDU]

On Tue, 30 Apr 1996 sandy_perle@email.fpl.com wrote:

>      1. While a dose history is adequate to meet regulatory requirements,   
>         i.e., does the individual "require" to be monitored, the has more   
>         to do with what risk are you willing to assume in the event an      
>         individual enters into future litigation regarding your facility.
>      
>      As I started this post, the answer each facility must ask itself has 
>      to do with how much information do you want to maintain and how much 
>      risk do you want to assume if you had used dosimetry and decide to 
>      stop providing it. How much risk are you avoiding with providing cheap 
>      dosimetry. Cheap insurance in my opinion.

These seem to me to be decisions that a Risk Manager, rather than a 
Health Physicist should be making (albeit with HP input).  With this 
logic, should I also monitor every person that walks into my hospital, 
after all, they might be exposed, too.  They could spend time in the 
radiology waiting room, or accidentally walk into a research laboratory.  
Why would they be any less likely to sue?  

I do not see this as cheap insurance.  Radiation monitoring is the second 
largest line item in my budget, only salaries are higher.

It seems to me that we need to take some of our own medicine - we ask
radiation workers to accept certain minimal risks, but are we willing to
accept the minimal risk of litigation?  Are we using the threat of
litigation as a scare tactic to, in part, justify our employement?  Maybe
the risk is not so minimal, but I have never seen any numbers to support
this.  Does anyone have any FACTS on the percent of hospitals that have
been sued due occupational or public exposure to radiation (not
malpractice)?  How about dollars awarded per hospital per year?  With this
information, then the HP and the Risk Manager should be able to establish
a policy with a supportable basis rather than based on speculative scare
tactics

>      4. If an individual is worn, at least you have some control of who     
>         entered an area and what the dosimetry reported back. If no         
>         dosimetry is provided, what methodology of control are you going to 
>         refer to?

How does assigning a film badge control access to areas in a hospital?  

>	 6. You're also assuming that the x-ray machine is always working
>           way it is supposed to be. How often do you do maintenance on 
            the  unit, and how often is the timer checked, the collimation,
            the kvP checked, etc.

Read JCAHO requirements for these standards.  Can you explain how an 
x-ray machine might fail such that it is exposing individuals 
standing in the shielded control booth, yet at the same time produce 
acceptable radiographic images using the established technique factors?  
Should I also monitor the patient as well?  If the technologist 
might be overexposed in a shielded area several feet from the source when 
exposed to only scattered radiation, imagine the dose to the patient.


Kent Lambert
LAMBERT@hal.hahnemann.edu

All opinions are well reasoned and insightful.
Needless to say they are not the opinion of my
employer. - Paraphrased from Michael Feldman.