Unintended and accidental medical radiation exposures in radiology: guidelines on investigation and prevention

This paper sets out guidelines for managing radiation exposure incidents involving patients in diagnostic and interventional radiology. The work is based on collation of experiences from representatives of international and national organizations for radiologists, medical physicists, radiographers, regulators, and equipment manufacturers, derived from an International Atomic Energy Agency Technical Meeting. More serious overexposures can result in skin doses high enough to produce tissue reactions, in interventional procedures and computed tomography, most notably from perfusion studies. A major factor involved has been deficiencies in training of staff in operation of equipment and optimization techniques. The use of checklists and time outs before procedures commence, and dose alerts when critical levels are reached during procedures can provide safeguards to reduce risks of these effects occurring. However, unintended and accidental overexposures resulting in relatively small additional doses can take place in any diagnostic or interventional X-ray procedure and it is important to learn from errors that occur, as these may lead to increased risks of stochastic effects. Such events may involve the wrong examinations, procedural errors, or equipment faults. Guidance is given on prevention, investigation and dose calculation for radiology exposure incidents within healthcare facilities. Responsibilities should be clearly set out in formal policies, and procedures should be in place to ensure that root causes are identified and deficiencies addressed. When an overexposure of a patient or an unintended exposure of a foetus occurs, the foetal, organ, skin and/or effective dose may be estimated from exposure data. When doses are very low, generic values for the examination may be sufficient, but a full assessment of doses to all exposed organs and tissues may sometimes be required. The use of general terminology to describe risks from stochastic effects is recommended rather than calculation of numerical values, as these are misleading when applied to individuals

Conducting Nuclear Security Culture Self-Assessments in Nuclear Research Facilities Using the IAEA Methodology

The National Nuclear Energy Agency of Indonesia (BATAN) has promoted the culture and assessment of nuclear security in Indonesia since 2010. After conducting a successful trial assessment in 2012, BATAN performed a second self-assessment in 2015 in three nuclear facilities. The assessment\u27s methodology followed the guidelines set by the International Atomic Energy Agency (IAEA). The objective of this paper is to demonstrate the techniques used in applying the IAEA methodology and to discuss the primary outcomes of the assessment. The data collection consisted of surveys, interviews, document reviews, and observations. A total of about 50% of the three facilities’ employees participated in the survey and/or interview process. Three categories of sub-cultures—security personnel, non‑structural personnel, and structural personnel—were assessed, covering a range of twelve general characteristics and thirty indicators of security culture. An overall average score of 5.25 on a 7-point scale was obtained from the survey. A consolidated assessment of the results from all data collection techniques showed that most of the security culture characteristics assessed reflected some of the anticipated best practices and also demonstrated strengths necessary in security culture. However, certain aspects of leadership behavior need to be enhanced, especially ones relating to motivation. By examining the results from the three different subcultures, it became clear, especially to the researchers and administrative personnel, that further dissemination of nuclear security concepts and policy is needed. The methodology for the IAEA’s nuclear security culture self-assessment has been successfully implemented and has resulted in positive outcomes. The potential improvement of assessment implementation should also be considered, such as in the development of survey questions and the selection of indicators to be elaborated on interviews

IAEA Safety Standards on Management Systems and Safety Culture

The IAEA has developed a new set of Safety Standards for applying an integrated Management System for facilities and activities. The objective of the new Safety Standards is to define requirements and provide guidance for establishing, implementing, assessing and continually improving a Management System that integrates safety, health, environmental, security, quality and economic related elements to ensure that safety is properly taken into account in all the activities of an organization. With an integrated approach to management systems it is also necessary to include the aspect of culture, where the organizational culture and safety culture is seen as crucial elements of the successful implementation of this management system and the attainment of all the goals and particularly the safety goals of the organization. The IAEA has developed a set of services aimed at assisting it’s Member States in establishing, implementing, assessing and continually improving an integrated management system

Promoting Nuclear Security Education and Training Activities at Amity University, India

In the present era of global nuclear governance, it is the responsibility of every individual not only the security personals to be accountable for the security of nuclear materials, facilities and radioactive materials. Amity university and other universities of India are the largest educational networks for young professionals who will enter the nuclear programme in India and will be involved in the management of nuclear and other radioactive materials in a wide variety of applications such as hospitals, industrial applications and nuclear facilities. Amity University Uttar Pradesh is taking leading part to sensitize the importance of nuclear security amongst the students and faculty members of various Indian institutions and research organization. Amity University is also motivating women academicians to take lead in nuclear security. This paper describes details of various events organized in India with the initiative of INSEN, IAEA; Texas A&M University, USA and WINS Academy, Vienna, Austria

China’s Response to Nuclear Safety Post-Fukushima: Genuine or Rhetoric?

The Fukushima crisis has brought the nuclear safety problem to the world’s attention. China is the most ambitious country in the world in nuclear power development. How China perceives and responds to nuclear safety issues carries significant implications on its citizens’ safety and security. This paper examines the Chinese government’s promised and actual response to nuclear safety following the Fukushima crisis, based on (1) statistical analysis of newspaper coverage on nuclear energy, and (2) review of nuclear safety performance and safety governance. Our analysis shows that (i) the Chinese government’s concern over nuclear accidents and safety has surged significantly after Fukushima, (ii) China has displayed strengths in reactor technology design and safety operation, and (iii) China’s safety governance has been continuously challenged by institutional fragmentation, inadequate transparency, inadequate safety professionals, weak safety culture, and ambition to increase nuclear capacity by three-fold by 2050. We suggest that China should improve its nuclear safety standards, as well as safety management and monitoring, reform institutional arrangements to reduce fragmentation, improve information transparency, and public trust and participation, strengthen the safety culture, introduce process-based safety regulations, and promote international collaboration to ensure that China’s response to nuclear safety can be fully implemented in real-life

Approaches to assessing effective improvement of safety culture

In this report we examined the effectiveness assessment of safety culture improvement from a systemic, multilevel perspective. Two complementary approaches were identified. A phenomenon-based approach viewed safety culture improvement from the perspective of cultural dimensions or manifestations, and how they interrelate with each other and with other sociotechnical elements of the organization. A process-based approach viewed safety culture improvement as an organizational function that involves a process dedicated to safety culture improvement, as well as specific activities that aim to improve safety culture.Four practical tools were developed to illustrate the practical application of these two approaches. Two tools illustrated the phenomenon-based approach and aimed at modelling specific safety culture attributes—raising concerns, and procedure compliance. The other two tools illustrated the process-based approach and provided means to evaluate the maturity of the safety culture assessment process and effectiveness of safety culture training. Overall, these two approaches and the four practical tools along with the theoretical and empirical justification behind them serve as a starting point for developing a comprehensive toolbox for assessing the effectiveness of safety culture improvement

The Human Dimension of Nuclear Security: Legacy of the Nuclear Security Summit

A deeply rooted nuclear security culture and adequate human resources at all levels – involving regulators, the law enforcement agencies, academia, industry - are universally recognized as the foundation of a robust and sustainable nuclear security regime, national and global. International cooperation and networks are fundamental elements in ensuring the development and sustainability of what may be called the “human dimension” of Nuclear Security, and the Nuclear Security Summit (NSS) process has been the cornerstone for their consolidation

Radiation Oncology Quality and Safety Considerations in Low Resource Settings: A Medical Physics Perspective

The last few years have seen a significant growth of interest in the global radiation therapy crisis. Various organizations have quantified the need and are providing aid in support of addressing the shortfalls existing in many low-to-middle income countries (LMICs). With the tremendous demand for new facilities, equipment and personnel, it is very important to recognize the quality and safety challenges and to address them directly. An examination of publications on quality and safety in radiation therapy indicates a consistency in a number of the recommendations; however, these authoritative reports were generally based on input from high-resourced contexts. Here we review these recommendations with a special emphasis on issues that are significant in LMICs. While multidimensional, training and staffing are top priorities; any support provided to lower resourced settings must address the numerous facets associated with quality and safety indicators. Strong partnerships between high-income and other countries will enhance the development of safe and resource-appropriate strategies for advancing the radiation treatment process. The real challenge is the engagement of a strong spirit of cooperation, collaboration and communication between the multiple organizations in support of reducing the cancer divide and improving the provision of safe and effective radiation therapy