Clinical staff exposures

The current situation is exemplified by a study of clinical staff exposures in cardiac angiography at the Montreal Heart Institute (Renaud, 1992). Extensive measurements of staff exposures were made using thermoluminescent dosimeters (TLDs) for 15,000 procedures in three cardiac catheterization laboratories over a 5 y period (1984 to 1988). The TLDs were located under the protective apron at the waist and at the collar outside and above the apron. Readings were made at three-month intervals, with a minimum reportable value of 0.2 mSv. Average values (in mSv per y) for various groups of staff, based on measurements with TLDs worn at the collar, are given in Table 3.3. 

Table 3.3—Clinical staff exposures in cardiac angiography. Group averages (in mSv per y) based on measurements with TLDs worn on the collar outside and above protective aprons (Renaud, 1992). ...

Become aware of potentially hazardous environmental conditions in order to prevent unnecessary exposure to accidents or adverse health risks. The employee should have the chance to express concerns about environmental problems, and a line of communication should exist between the laboratory and the clinical staff... 

Contamination should be excluded. Once this has been done, these casualties do not present a risk to clinical staff and can be treated in a completely normal manner. Further investigation and management will depend on the magnitude of their radiation exposure. 

The therapeutic efficacy of diverse mono and bis-quaternary pyridine aldoximes as antidotes against OP poisoning has been established in hundreds of publications, and three of them, 2-PAM (38), toxogonin (40) and HI-6 (41), are available in autoinjectors for post-exposure self-treatment or treatment by medical staff. For further information on the clinical use and potential side effects of these oximes the reader is referred to the reviews of Kassa, Eyer and of Marrs and colleagues . ... 

Should an early decision be made to develop the eutomer, then the drug development program would be the same as for conventional NCEs, with the possible exception that assessment of in vitro and/or in vivo chiral inversion may be desirable. However, if development continues with the racemate, time, cost, and staff resource commitments become magnified. For example, a very important variable to consider is spedes differences in enantiomer exposure. Appropriate toxicokinetic studies are advisable in order to assure that, at toxicological doses, the animal species tested have attained suffident plasma concentrations of each enantiomer to support clinical evaluation at therapeutic doses in humans. The enantiomeric ratio (based on maximum drug concentrations fCmax] and/or area under the plasma drug concentration-time curve [ALJC]) should be evaluated, and... 

For the interventional staff, radiation exposure is a product of the procedure, and the occupational dose received during all such procedures should be minimized to the extent possible without compromising appropriate patient care, a precaution referred to as ALARA (as low as reasonably achievable). Relevant aspect to minimize radiation exposure is reducing the amount of fluoroscopy and cine time to the clinically required minimum. It is important to avoid the Tead-foot syndrome the operator must learn to press the fluoroscopy pedal briefly, when it is necessary to confirm the sheath position, and to reflexively take his or her foot off the pedal whenever looking away from the television monitor [8]. 

The emergency department (ED) physician s interest is aroused by the injuries that are not explained by the patient s story. He consults the local burn center and discovers that the clinical picture suggests radiation exposure. The ED physician is concerned the patient might present a contamination hazard to the staff and has nuclear medicine personnel check him with a pancake probe. The wounds are positive for gamma radiation. The... 

Eor clinical applications there are safety guidelines from official national organizations limiting the exposure of staff and patients to static and varying magnetic fields, RF fields, and acoustic noise (from gradient coils). In nonclinical applications these guidelines may often be relaxed unless human volunteers are involved. 

In the Tokyo subway attacks in 1995, 10-23 % of rescuers at the scene and hospital emergency staff displayed the clinical features of exposure to sarin. Some of these displayed chronic physiological abnormalities such as disturbed lymphocyte function 3 years later and cognitive impairment at least 7 years afterwards. In one instance, 11 doctors were significantly affected while treating two patients (one required treatment for seizures, the other received cardiopulmonary resuscitation for 40 min). 

The environment in which exposure to hazards is created, mitigated.or eliminated, and where adverse events occur or are prevented. Not just the bedside and other clinical settings but also the laboratory, magnetic resonance imaging unit, hallway,patient shuttles, etc.- any place staff, patients,and. or technology interact... 

Engaging both clinical and administrative staff in the identification of exposures at the bedside... 

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