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To wear a dosimeter or not to wear a dosimeter?

Ken Repking, BS, CNMT, NMTCB(RS)

That is the question for mammography staff

I have routinely been asked by our clients and have seen the question posed on many forums; should mammography technologists wear dosimeters?  Are all of our surgical personnel required to wear dosimeters?  Although there is not a definitive yes or no answer to this, I hope to provide some insight to help you make an informed decision for your staff and Radiation Protection Program (RPP).

Dose reduction technology across all modalities in radiology, and improved lead or lead-equivalent protection apparel, have given facilities the ability to further minimize the radiation exposure to staff in adherence to ALARA principles. It must be noted that although mammography and surgery are typically considered low dose occupations, it is generally accepted that there is no stated safe level of radiation no matter how low the dose is. However, the probability of a radiation induced effect is extremely low and rare. 

So Why is Dosimetry Important?

This leads to a discussion about who needs to be monitored. First and foremost, you must always refer to your state regulations. The regulations will contain a section regarding individual monitoring and list the criteria or conditions that require monitoring. For most states any individual who is likely to receive 10% of the annual limit listed within the regulations will require dose monitoring. Some states also have special conditions regarding occupational dose monitoring based on the modality, such as Fluoroscopy for example. You must also take into consideration your accrediting bodies standards, if applicable, such as:

  • American College of Radiology
  • The Joint Commission,
  • DNV-GL Healthcare, or
  • American Association for Accreditation of Ambulatory Surgery Facilities

For simplicity we will use mammography as an example. Let’s say you have evaluated your regulations and your accreditation standards and only staff who can potentially receive a dose in excess of 10 percent of the limits require monitoring, according to your state regulations. You have on file at least 6 months of historical dosimetry records which demonstrate that the dose to staff working strictly in this modality is well below the monitoring threshold.

Therefore, you have chosen not to require these staff to wear dosimeters, and in doing so you are in compliance with your state regulations. However, this does not mean your facility is protected from litigation should a case be brought against it from an employee.

Take This Scenario into Consideration

Your mammography technologist does not wear a dosimeter as his/her exposure is below the state requirements for monitoring. This technologist develops a medical condition and believes it is due to prolonged radiation exposure over the years, so decides to seek compensation from the facility. The case goes to litigation and the hospital is asked to provide documentation that the technologist’s exposure was relatively low when compared to the allowed state limits and industry standards. The probability that the technologist was exposed to a dangerous level of radiation is miniscule.

However, without this technologist wearing a dosimeter you cannot prove it or prove there was never a malfunction in the equipment or some other oddity in which the employee was exposed to excess radiation.

Hospitals have had cases like these brought against them.

Therefore, if staff members are occupationally exposed and request to be monitored even though you have shown their exposure to be historically minimal, it is recommended that a dosimeter be provided to that individual, given the obvious concern about occupational exposure.

As stated earlier, there are many ways to look at this and there is no right or wrong way if you are in compliance with your state regulations.

I personally have been asked by The Joint Commission surveyors: “How can you prove there was never a malfunction if the staff do not wear dosimeters?” Therefore, I view the dosimeters as a substitute insurance policy for a minimal cost that may provide protection to your facility from litigation at some point in time. Even periodic monitoring can help demonstrate compliance in areas where constant monitoring might not be required.

Contact LANDAUER today to learn more about how we can help you create a Radiation Protection Program that is sufficient to meet your needs based on your specific requirements.