Standard Operating Procedure Nuclear Medicine Imaging Safety Procedures at PERFORM

Transcription

1 Standard Operating Procedure Nuclear Medicine Imaging Safety Procedures at PERFORM PC- SOP-IM-004-v03 Revision History Version Reason for Revision Date 02 Update and general review Reflect organisational changes o CAO to SD o Associate Director, Bio-Imaging Emergency procedures limit to be in line with RSM s limit of 1mSv for reporting 03 Major changes Annual dose limit for eye lens Added safety screening form to appendix January/30/2015 July/13/2017 Summary The content of this standard operating procedure (SOP) is to maintain compliance with safe practice during research procedures in the Nuclear Medicine Imaging area of the PERFORM Centre, as radioisotopes and ionizing radiation emitting equipment present known safety hazards. Printed copies are not controlled. Page 1 of 14

2 Table of Contents 1. Definition of Terms Introduction Background Purpose Scope Responsibilities Relevant Documents Procedure General Rules Restricted Access Area Nuclear Medicine Technologist Infection Control Emergency Procedures Incidental Findings Dose Limits for Occupational Ionizing Radiation Exposures Action Levels APPENDIX I: Nuclear Medicine Safety Screening Form APPENDIX II: Nuclear Medicine Emergency Procedures APPENDIX III: Radiation Contamination Monitoring Record APPENDIX IV: SOP Training Record Form Printed copies are not controlled. Page 2 of 14

3 1. Definition of Terms ALARA Alconox Benchkote Background radiation Bq As Low As Reasonably Achievable Alconox is a concentrated, anionic detergent, designed for laboratory applications An absorbent, impermeable material designed to protect laboratory surfaces against hazardous spills Ionizing radiation that the general population is exposed to, including natural and artificial sources Becquerel. One Bq is defined as the activity of a quantity of radioactive material in which one nucleus decays per second CAMRT CNSC CPM Dosimeter EHS Hot Lab Hot Spot Incidental Findings Ionizing Radiation MBq msv Nuclear Energy Worker (NEW) Nuclear Medicine Canadian Association of Medical Radiation Technologists Canadian Nuclear Safety Commission Counts per minute; a measure of the quantity of radioactive material present in a given localization A device for measuring the quantity of ionizing radiation to which a person has been exposed Concordia University Environmental Health & Safety A room for working with high-activity radioactive compounds A contaminated area with increased radioactivity Incidental findings are unexpected discoveries or observations of potential clinical significance detected during the course of a study/activity, that are outside the scope, or unrelated to the purpose or variables of the study/activity Radiation with sufficient energy to cause the removal of electrons from neutral atoms to create ions 1 MBq = Bq Millisievert. 1/1000 th of the SI unit of ionizing radiation effective dose. (sievert) A person who is required, in the course of one s business or occupation in connection with a nuclear substance or nuclear facility, to perform duties in such circumstances that there is a reasonable probability of receiving a dose of radiation that is greater than the prescribed limit for the general public A medical specialty involving the application of radioactive substances in the diagnosis and treatment of disease Printed copies are not controlled. Page 3 of 14

4 OTIMROEPMQ Principal Investigator (PI) PET-CT Radiation dose Radiopharmaceutical Radioisotope RSO SI Units Sparkleen SPECT-CT Tomography User Wipe Tests Ordres des technologies en imagerie médicale, en radio-oncologie et en électrophysiologie médicale du Québec Head researcher that is responsible for all aspects of a given research project or program at PERFORM Positron Emission Tomography - Computed Tomography Energy released in the form of particle or electromagnetic waves in a unit mass of material A radioactive drug used for diagnostic or therapeutic purposes A version of a chemical element that has an unstable nucleus and emits radiation during its decay Radiation Safety Officer, responsible for the safe use of radiation and radioactive materials as well as regulatory compliance Units from the International System of Units A detergent that removes proteins, fats, oils, media, wax pencil marks, dried blood and other organic-inorganic deposits. Single-photon emission computed tomography - Computed Tomography A method of producing three-dimensional images of the internal structure of a solid object Person using space or equipment at the PERFORM Centre who has received adequate technical and safety training. A test for radioactive contamination in which the suspected surface or area is wiped with a filter paper (or other material) Printed copies are not controlled. Page 4 of 14

5 2. Introduction 2.1 Background All users of radioactive isotopes are required to follow specific rules and regulations in order to promote safety and security for themselves, for research participants and for the general public. 2.2 Purpose The objective of the current SOP is to outline the minimum requirements and general rules to be adhered to in the Nuclear Medicine section of Bio Imaging. 2.3 Scope This SOP applies to all PERFORM users working with, or in close proximity to, radionuclides. This includes PERFORM researchers, staff, University auxiliary staff, students and authorized visitors. 2.4 Responsibilities 2.4.1Users All users are responsible for: Following all applicable regulations, safety rules and practices as outlined in this SOP, applicable Concordia policies, and the obligations of any professional bodies/orders they belong to Reporting all potential hazards, unsafe conditions or safety issues to the Nuclear Medicine Supervisor, designate or RSO Using and wearing all relevant personal protective equipment (lead aprons, lab coats, gloves etc.) as required by any study protocols and postings in relevant areas of the imaging suite Attending all training courses as directed by EHS and PERFORM administration Wearing a radiation dosimeter if they are required to do so as deemed necessary by the RSO PERFORM Scientific Director The PERFORM Scientific Director is responsible for ensuring that a safety program is in place and that reviews are conducted regularly to ensure compliance with Concordia University regulatory requirements PERFORM Associate Director, Bio Imaging Printed copies are not controlled. Page 5 of 14

6 The PERFORM Associate Director, Biomedical Imaging has overall responsibility for the Bio Imaging department. That person ensures proper review of, and guidance for, research protocol development so they meet regulatory requirements for public safety while maintaining integrity of data provided to investigators. That person valuates the need for medical supervision during research protocols and authorizes technologists and other potential responsible users to work in the imaging suite PERFORM Nuclear Medicine Supervisor & Radiation Safety Officer (RSO) The Nuclear Medicine Supervisor has the responsibility to ensure that all users of the Bio Imaging Suite have completed the proper training to be able to conduct activities in a safe manner. That person must ensure that all users follow the regulations stipulated by the CNSC and Concordia s Radiation Protection program for all Nuclear Medicine studies. As per university regulations, the RSO will maintain a list of all the users who are authorized to access the Bio Imaging suite. Together, they will establish and maintain records including radiation exposure for all research participants, staff and designated project members. The RSO implements and enforces the Radiation Safety Program. The RSO has the authority to suspend any procedure involving radiation which is considered unsafe or has the potential to cause harm to a person or the environment. Any incident involving radioactivity or otherwise in the Bio Imaging suite will need to be reported to the RSO and to the principal investigator/ project lead Principal investigator/project Lead The Principal Investor/Project Lead is responsible for ensuring all their team members (staff and students) and any other users in their protocols/projects have completed the proper training as directed by the Nuclear Medicine Supervisor, RSO, PERFORM Administration and EHS. 2.5 Relevant Documents VPS-40 Environmental Health and Safety Policy VPS-48 Hazardous material spill response policy VPS-46 Radiation Safety Policy Radiation Safety Manuel PC-SOP-GA-007 General Access to PERFORM Centre PC-SOP-GA-009 Emergency Response Procedures at the PERFORM Centre PC-SOP-GA-011 Guidelines for Management of Incidental Findings at PERFORM PC-SOP-IM-001 General Procedures for Bio Imaging suite Access at PERFORM Printed copies are not controlled. Page 6 of 14

7 Note: This SOP defers to Concordia policies at all times 3. Procedure The following must be adhered to when working in the Nuclear Medicine suites. 3.1 General Rules All users are responsible for: Respecting their legal responsibility to protect themselves and their colleagues from radiation hazards arising from their work Keeping radiation exposures to members of staff, researchers, students, and visitors at a level which is as low as reasonably achievable (ALARA principle) Ensuring that radionuclides are handled only by authorized members of staff, researchers and students who have received training in radiation safety Ensuring that visitors and research participants entering laboratories where radionuclides are used are accompanied by an authorized member of staff Ensuring that no eating, drinking, smoking or application of cosmetics takes place in the Bio Imaging Suite Wearing protective clothing when manipulating radionuclides. Laboratory coat (fastened at the front) or a surgical gown. Disposable gloves Making sure that protective clothing is removed at the end of the procedure. Before commencing work, cuts and breaks in the skin of hands should be covered with an adhesive bandage Performing personal contamination monitoring of the hands on leaving the Hot Lab Performing contamination monitoring for background, work surface, floor area, disposal sink, and equipment before and after work (Appendix III). Printed copies are not controlled. Page 7 of 14

8 Performing personal contamination monitoring of the body following a contamination incident. Results of monitoring must be recorded on the sheet provided for this purpose. If contamination is detected, decontamination procedures are to be followed Dosimeters are worn to record cumulative radiation doses received from occupational exposure to ionizing radiation, including x-rays, received from working around and near radiation emitting devices and participants. They are worn between the waist and the neck to record whole body exposure. The dosimeters have Al2O3 chips which record the exposure to ionizing radiation. Exposure monitoring with personal dosimeters is done to determine the radiation levels an individual has been exposed to and to prevent an over-exposure by ongoing monitoring. Information obtained from exposure reports is useful to evaluate the effectiveness of the radiation safety program. All monitoring results are maintained and evaluated by the Radiation Safety Officer. Dosimeters are assigned to individuals who have the potential to be exposed to more radiation than permissible for the general public, i.e. 1mSv. They are not to be shared or transferred to another individual. Care should be taken that the dose recorded by the dosimeter is representative of the true dose for the individual. The dosimeter must not be left in an area where it could receive a radiation exposure when not worn by the individual (e.g. on a lab coat or near a radiation source) Verifying, when manipulating unsealed radionuclides, that a suitable contamination monitor is at hand and regularly used to check for personal and laboratory contamination. Particular attention is to be given to the hands, clothing, bench surfaces and floor around the work area. The thyroid must be monitored 24 hours after any procedures involving manipulation of an unsealed radioiodine source having an activity greater than 1MBq or when intake of radioactive iodine is suspected. The result must be recorded in writing. Any sealed source should be treated as an unsealed source unless satisfactorily wipe tested Performing contamination monitoring of surfaces and apparatus before and after any procedure involving unsealed radioactive material. The result of monitoring must be recorded. The only exception to this rule is that it can be disregarded when the delay linked to performing a thorough contamination monitoring check could adversely affect a research participant s investigation or safety, or the user s safety. In those circumstances only, the user may leave without monitoring for contamination provided that arrangements are made with staff to monitor for them immediately after the manipulation. If staff are not Printed copies are not controlled. Page 8 of 14

9 available the user must perform the contamination monitoring as soon as they are available to do so and prior to ending their day Ensuring that radioactive material is at all times clearly identified with radioactive material hazard warning tape, and marked with information on the nature of the radionuclide, date, approximate activity, and name of member of staff or group responsible for it Using the radioactive materials tracking database on the Hot Lab computer Working with radioactive material over a containment tray lined with absorbent wipes laid over plastic-backed absorbent paper (e.g. Benchkote) Reporting all accidents (including spills) involving radioactivity to the Nuclear Medicine Supervisor or designate Ensuring that unused radioactive material is always stored in a secure location, taking special care to minimize the possibility of accidental contamination during storage. In particular, radioactive material stored in a refrigerator is to be double-contained and separated from non-active materials Making sure the laboratories in which radioactive material is used or stored are locked when unoccupied. 3.2 Restricted Access Area Certain areas such as the SPECT-CT, PET-CT and the tracer preparation laboratory (Hot Lab) in the Bio Imaging Suite will be inaccessible in the absence of a Technologist or Nuclear Energy Worker as per university, provincial and/or federal regulations. Any access to such area will need to be approved by PERFORM s Nuclear Medicine Supervisor/RSO on a daily basis. The Bio Imaging Suite is identified as a restricted area to which access is permitted to authorized persons only. Those authorized to work within the restricted area must have completed appropriate safety training and must comply with all approved SOPs. Printed copies are not controlled. Page 9 of 14

10 Bio Imaging Suite highlighted in yellow 3.3 Nuclear Medicine Technologist All Nuclear Medicine Technologists will be trained as evidenced by signed documentation and will be accredited by the national or provincial association for Nuclear Medicine Technologists: CAMRT and/or OTIMROEPMQ The Nuclear Medicine Technologist must be certain that any female participant is not pregnant before radiopharmaceutical injection. In a case where this is not clearly established, the Nuclear Medicine Technologist can demand a pregnancy test before proceeding, and can decide to cancel a study if she/he remains uncertain about the participant s status The Nuclear Medicine Technologist must be present at all times and will verbally monitor the participant throughout the procedure The Nuclear Medicine Technologist has the authority to stop procedures when he/she considers them to be unsafe. Printed copies are not controlled. Page 10 of 14

11 3.5 Infection Control The scanning room table and any other surface that has come in contact with a research participant must be cleaned and the linen/table paper changed before placing another research participant on the scanning table Gloves must be removed and disposed of properly before touching common areas such as scanner key board, log books, light switches, counter surface and other objects Surfaces touched with gloves must be cleaned properly before leaving the area All biohazard material must be disposed according to PERFORM SOP-GA- 002 Handling of Biological Materials at PERFORM. 3.6 Nuclear Medicine Emergency Procedures See Appendix (II) 3.7 Incidental Findings Incidental findings (IFs) are unexpected discoveries or observations of potential clinical significance detected during the course of a study/activity that are outside the scope, or unrelated to the purpose or variables of the study/activity. They must be dealt with in accordance with PC-SOP-GA Dose Limits for Occupational Ionizing Radiation Exposures Iindividuals may be classified in one of two categories: (1) nuclear energy workers, individuals who are occupationally exposed to radiation and (2) members of the public. The dose limits are given for both categories in the table. Those dose limits are based on the latest recommendations from the International Commission on Radiological Protection (ICRP) as specified in ICRP Publication 60 (ICRP, 1991). Dose limits for radiation technologists apply only to irradiation resulting directly from their occupation and do not include radiation exposure from other sources, such as medical diagnosis and background radiation. Printed copies are not controlled. Page 11 of 14

12 Applicable Body Organ or Tissue Annual Dose Limits NEW (msv) Members of the Public (msv) Printed copies are not controlled. Page 12 of 14 Whole Body 20 1 Lens of the eye 50* 15 Skin Hands All other organs *New limit to be enforced by the CNSC It is emphasized that from a regulatory perspective any irradiation involves some degree of risk and that the levels suggested are maximum values. All doses must be kept as low as reasonably achievable and any unnecessary radiation exposure must be avoided The ICRP does not recommend discrimination in the dose limits between men and women of reproductive capacity, if the dose is received at an approximately regular rate For occupationally exposed women, once pregnancy has been declared, the fetus must be protected from ionizing radiation exposure for the remainder of the pregnancy. For women who are also occupationally exposed, an effective dose limit of 4 msv must be applied, for the remainder of the pregnancy, from all sources of radiation. This is considered to ensure that the fetus is not exposed to more than 1 msv (i.e., the dose limit for the general population). Under the scope of this document, occupational exposure to pregnant technologists arises mainly from scattered X-radiation. In this case, the most effective method of monitoring exposures to the fetus, is to measure the equivalent dose to the surface of the abdomen using a thermoluminescent dosimeter For technologists-in-training and students, the recommended dose limits for members of the public should apply ICRP does not recommend different limits for individual organs. For occupationally exposed technologists, ICRP believes that deterministic effects will be prevented by applying an equivalent dose limit of 500 msv in a year to all tissues except the lens of the eye, for which it recommends a limit of 50 msv in a year For the skin, the equivalent dose is averaged over its whole area. In situations where deterministic effects are possible, the recommended equivalent dose limit for

13 the skin is 500 msv and is averaged over areas of no more than 1 cm 2. This limit applies to the skin of the face and hands Some provincial or territorial jurisdictions may have different dose limits for some technologists. The appropriate agency should be consulted to determine the dose limits in effect in a particular jurisdiction. 3.9 Action Levels The use of action levels plays an important part in a radiation management program. Action levels are designed to alert radiation safety personnel before regulatory limits are reached. Action levels are defined as "a specific dose of radiation or other parameter that, if reached, may indicate a loss of control of part of a Permit Holder's radiation protection program, and triggers a requirement for a specific action to be taken". The primary goal of the action to be taken is to prevent a re-occurrence of the event. The table below lists the action level for the corresponding activity. Table of Action Levels is shown below. Action levels have been identified as required for the following activities: Activity Initial Responsibility Action Level Personnel Dosimetry for (Whole-body/Extremity) NEW 1 RSO >10mSv 3 for2 consecutive periods Pregnant NEW RSO >0.1 msv/month Radiation user RSO >0.5 msv/2 consecutive periods Public RSO Not applicable Thyroid Bioassay RSO >1000 Bq 4 (investigation Level) > 10,000 Bq (Reporting Level) Action Taken Investigate cause of exposure in all cases Investigate and report to CNSC 5 Leak Testing for Sealed Radioisotopes RSO >200 Bq Investigate and dispose of sealed radioisotope Printed copies are not controlled. Page 13 of 14

14 Radioactive Surface Contamination (i.e. wipe tests) RSO & Permit Holder Decommissioning RSO >0.5 Bq/cm 2 for all emitters except for alphas >0.5 Bq/cm 2 Investigate cause and decontaminate >0.05 Bq/cm 2 for alphas emitters Investigate cause of contamination and decontaminate in both cases Package Receipt Receiving Staff or users 1 Nuclear Energy Worker 2 Radiation Safety Officer 3 Millisievert 4 Becquerel 5 Canadian Nuclear Safety Commission Damaged package or radiation level > than package designation Reinforce CNSC guidelines: CNSC INFO 0426 Receiving Radioactive Packages Packaging and Transport of Nuclear Substances Regulations Printed copies are not controlled. Page 14 of 14

15 APPENDIX I Nuclear Medicine Safety Screening Form Printed copies are not controlled. Appendix I

16 NUCLEAR MEDICINE SAFETY SCREENING FORM Project number: (use as last name) Sex: DOB: Allergies: Participant ID: (use as first name) Height: Weight: To ensure your safety, this form MUST BE completed in the presence of a qualified Nuclear Medicine Technologist Are you pregnant? Yes No Are you breast feeding? Yes No Are you less than18 years old? Yes No How many X-ray and/or Nuclear Medicine exams you have undergone in the past 12 months that were for research purposes? Number/type of exams (description): Medications: I have informed the participant about the Nuclear Medicine exam and how it will be performed. I have completed the above questionnaire with the participant and reviewed possible contraindications to the Nuclear Medicine exam. Physician/Technologist: Date: Participant Initials: Version 1.0 dated 11-April-2017 Page 1 of 1

17 APPENDIX II Nuclear Medicine Emergency Procedures Printed copies are not controlled. APPENDIX II Printed copies are not controlled. Page 16 of 27

18 Nuclear Medicine Emergency Procedures An individual or research participant who becomes ill or is injured must be treated for that acute condition above all else. Stop the imaging sequence or remove the subject from the nuclear medicine hot lab as required. If emergency response is required, call Security (extension 3717) and follow procedures as outlined in PC-SOP-GA-009. If an emergency does not involve radiation contamination the security department shall: 1. Answer emergency telephones and other calls for assistance. 2. Arrive on the site of the emergency with appropriate first aid equipment to assess the situation and, if necessary, administer first aid. 3. Contact the appropriate health and safety facility or municipal emergency response personnel. 4. Arrange for appropriate transportation to a medical facility as required. 5. Keep records of all such calls and the steps taken by entering that information in a log book. 6. Complete an Incident Report Form ( 7. Notify EHS within 24 hours or, in case of a serious medical situation, as soon as possible. If an emergency involves one of the following: 1. A spill of radioactive material outside of the radioactive work area. 2. Personal contamination (including clothing). 3. Known or suspected internal contamination (inhalation, ingestion, injection). 4. Known or suspected external exposure where a person may have received a dose in excess of 1 msv. 5. Widespread contamination in the laboratory. 6. Loss or theft of any quantity of nuclear substance (radioactive material). 7. A release of a quantity of a radioactive substance in the environment not authorized by licensed activity. 8. An attempted or actual breach of security or sabotage at the site of the licensed activity. 9. A serious illness or injury incurred or possibly incurred as a result of the Version 1.0 dated 11-April-2017 Page 1 of 5 Printed copies are not controlled. Page 23 of 27

19 licensed activity. 10. The death of any person at a nuclear facility as a result of licensed activity. The following steps must be taken: 1. Notify all occupants in the area about the spill; if contaminant is volatile evacuate the area immediately. 2. Secure the area and keep all individuals from entering. 3. Ensure prompt first aid treatment is administered to injured persons. 4. Remove all contaminated clothing and place in a plastic bag. 5. Attempts must be made to remove all external contamination as soon as possible. Flush the area for a minimum of 15 minutes, if contamination is splashed in the eyes, mouth, or on skin. 6. Report the spill to the Nuclear Medicine Supervisor/RSO and Security immediately. 7. Contain large volumes of non-volatile liquid spills to prevent further spreading. 8. Ensure proper personal protective equipment is being worn. 9. Remain in the area to provide information and assistance in the clean-up operation. 10. Ensure that all spilled and contaminated material is properly packaged for disposal and is treated as radioactive and/or hazardous waste as required. 11. Ensure that all other items used in the clean-up process are decontaminated. Managing Personal Contamination Immediate actions should be taken if you know or suspect that you may have sustained radioactive contamination of your clothing or skin. Prompt action will minimize your exposure and will prevent further contamination. The primary concern regarding contamination of clothing or skin is the increased probability of intake and resultant internal radiation exposure. Remember, radioactivity can enter the body by way of inhalation, ingestion, absorption or through breaks in the skin. Version 1.0 dated 11-April-2017 Page 2 of 5 Printed copies are not controlled. Page 23 of 27

20 Contaminated Wounds Minor wounds (puncture, scrape, and cut) while working with radioactive materials require rapid action to limit any possible internal radiation exposure. Since minor wounds typically involve the hands, the following guideline is written for this situation. 1. Remove your gloves; turn them inside out, and DO NOT dispose. 2. Save the gloves and the object that caused the wound for monitoring and isotope identification. Information obtained from these items may help determine whether an internal exposure is likely. 3. Allow the wound to bleed and flush it gently with clean water for approximately FIVE minutes. This will remove any radioactivity present in the wound and may prevent its absorption into the body. 4. Bandage or cover the wound, and seek medical attention if required. NOTE: For serious injuries or illnesses, always seek prompt medical attention first. Treatment and safety of the seriously injured person(s) ALWAYS takes precedence over radioactive contamination control. Contaminated Clothing 1. Put on a clean pair of gloves to carefully remove all contaminated clothing in such a way as to prevent further contamination, especially to the skin. 2. Remove clothing inside out to contain the contamination. 3. Seal the contaminated clothing in a plastic bag. Write the following information on the bag: Name, telephone number of the owner of the clothing, and the radioisotope(s) involved. 4. After removal of contaminated clothing, carefully monitor all exposed skin areas. Monitor your hands. Follow the guidelines below if skin contamination is detected. 5. Contact the RSO, for cleaning of contaminated clothing. The clothing will most likely be stored until the radioactivity has decayed. Personal Contamination Radioactive contamination should be removed from the skin as soon as possible to reduce radiation exposure. Contamination deposited directly on the skin can cause intense irradiation of the skin as well as substantially increase the risk for intake into the body. Version 1.0 dated 11-April-2017 Page 3 of 5 Printed copies are not controlled. Page 23 of 27

21 1. Use mild hand soap or other appropriate solution for use on the skin. Some decontamination solutions and cleansers contain harsh chemicals and are not intended for use on the skin. 2. Water used for skin decontamination should be lukewarm in temperature. Water that is too hot or too cold will increase the blood flow to the area and increase the absorption of the contaminant. 3. Gently wash the affected skin areas for about 2 to 3 minutes. Pay special attention to the fingernails if the hands are contaminated. 4. Rinse with clean water and gently pat dry. Re-monitor the area with a contamination monitor. 5. Repeat this procedure as necessary. RUB, DO NOT SCRUB. NOTE: Gloves should be worn to prevent the spread of radioactive contamination to the hands during decontamination operations. 6. Work from the center of your body out (if your forearm is contaminated wash from the elbow towards the hand, hold your arm such that the water runs off your arm into the sink, not onto the floor or your body. 7. Monitor affected skin areas after every decontamination; attempt to determine effectiveness. 8. Stop cleaning immediately if contamination cannot be removed, or if the skin becomes irritated. 9. Rinse your eyes in an eyewash station for at least 15 minutes to flush foreign material out. 10. Rinse your mouth with water, but DO NOT swallow. 11. Blow your nose and keep the tissue, it will be analyzed for radioactive contamination. The nose filters approximately 50% of particulate matter. 12. Have someone absorb surface liquids. If liquids have entered the outer ear, lean to the side of the contamination. Do not introduce foreign material in your ear. Decontamination of Equipment and Areas Tools, equipment and work areas must be free of radioactive contamination. All users are responsible for conducting surveys, promptly closing off contaminated areas and notifying the RSO. The RSO will take charge of the decontaminating process, if required. Version 1.0 dated 11-April-2017 Page 4 of 5 Printed copies are not controlled. Page 23 of 27

22 Any incident causing injury to an individual or research participant must be reported to the Associate director, Biomedical Imaging, Nuclear Medicine Supervisor/RSO, as well as to the Environmental Health and Safety service. In case of an accident or injury when the Principal Investigator (PI) is not present, the technologist or responsible user must report to PI. If an accident or injury occurs that is not related to the nuclear medicine study, then the technologist or responsible user on site is responsible and should report to the Nuclear Medicine Supervisor/RSO and to EHS as per normal procedure by filling out an incident report ( Version 1.0 dated 11-April-2017 Page 5 of 5 Printed copies are not controlled. Page 23 of 27

23 APPENDIX III Radiation Contamination Monitoring Record Printed copies are not controlled. APPENDIX III Printed copies are not controlled. Page 23 of 27

24 Radiation Contamination Monitoring Record Contamination monitoring with an appropriate monitor must be performed before and after each work activity involving radioactive open-source materials. This will hopefully confirm that the previous user of the area has not left any contamination, and check that your work activity has not contaminated the area. Monitoring should include: 1- Work surfaces 2- Floor area near the work area 3- Disposal sink 4- All equipment used Record Counts Per Minute (CPM) for the following areas, before and after work. Note: readings 3 x background represent contaminated areas. Date Name Monitor Type & Serial No. Area Background Work Surface Before starting work After work completed Comments / Action Taken Floor Area Disposal Sink Equipment Background Work Surface Floor Area Disposal Sink Equipment Background Work Surface Floor Area Disposal Sink Equipment Background Work Surface Floor Area Disposal Sink Equipment Background Work Surface Floor Area Disposal Sink Equipment Note: Any hot spot must be identified on the form and CPM recorded before and after decontamination. Contamination left by a previous worker should be reported to the Radiation Safety Officer. Version 1.0 dated 11-April-2017 Page 1 of 1 Printed copies are not controlled. Page 24 of 27

25 APPENDIX IV SOP Training Record Form Printed copies are not controlled. APPENDIX IV Printed copies are not controlled. Page 27 of 27

26 SOP Title Nuclear Medicine Imaging Safety Procedures at PERFORM SOP Code Ownership Document type Area SOP Number Version PC SOP IM Training Record Full Name Institution Contact ( or phone number) Signature Sign here and return to SOP custodian Date SOP Training Record Printed copies are not controlled. Page 27 of 27