CLINICAL SAFETY

4.0 RADIATION SAFETY

4.1 INTRODUCTION

X-ray machines and radiation emitting sources are used in hospitals for the diagnosis
and treatment of diseases. Some of the hospital employees who work in radiology,
nuclear medicine, radiation oncology, and some laboratories are specifically trained in
the operation of radiation machines and the handling of radioactive materials and
sources. These personnel are called “occupational workers.” Other hospital workers
may work around radiation sources, and may be indirectly exposed to radiation during
performance of their normal duties. These employees are “allied medical workers” and
may belong to nursing, housekeeping, maintenance, security, shipping/receiving, and
clerical departments. In addition, patient transport, operating room, and recovery room
personnel may come in contact with brachytherapy (radioactive implant) and nuclear
medicine patients.

While the potential exposure to allied medical workers from radiation is very low, and
the hazard (risk) is usually minimal, all radiation exposure should be kept to a minimum.
These notes are designed to equip you with knowledge about the nature of radiation, its
use in the hospital, and methods of radiation protection. The major areas covered are:-

 sources of radiation in the medical environment,

 radiation protection methods,
 instructions for allied workers,
 radiation risks and biological effects,
 and radiation exposure and pregnancy.

Let us begin by defining “radiation.”

4.2 RADIATION

Radiation is a general term used to describe a bundle of energy in the form of

electromagnetic waves. All EM radiation travels at the speed of light, 300,000 km/s
(186,000 miles/s). Radio waves, microwaves, ultraviolet (UV), x rays, gamma rays, and
visible light are all forms of electromagnetic or EM waves. Among all the EM radiations,
only light is visible to the human eye. All other EM radiations cannot be seen and special
instruments are required to detect the presence of the invisible types of EM radiation.

Figure 1 shows the electromagnetic spectrum, a comparison of energies and properties

associated with different types of EM radiation. The term radiation also is used to describe
very fast moving particles, such as electrons and neutrons. These particles are found in the
atom, which is the smallest part of any material. When the energy of the radiation is high
enough, it can remove electrons from the atoms or molecules of a substance and is called
ionizing radiation and also penetrating radiation. Not all electromagnetic radiation causes

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ionization. X rays and gamma rays are high-energy ionizing EM radiations and may
simply be called “radiation.” Ionizing radiation can pass through materials.

Penetrating radiations are useful in the diagnosis and treatment of diseases and are part of
the backbone of modern medicine. However, because radiation can ionize and excite
molecules, it can cause damage to living tissues. Therefore we must take precautions
when using and working around it. In this document the term “radiation” refers to
electromagnetic radiation that causes ionization.

FIGURE 1: Electromagnetic Spectrum

4.3 Radiation Terms

To detect the presence and measure the amount of radiation, sensitive and specialized
instruments are used. Radiation is measured in radiation units: roentgen, rad, and rem.
The “roentgen” is a measure of exposure the amount of ionization in air produced by
radiation at a location. The “rad” is the radiation absorbed dose and refers to the amount
of energy absorbed by any material from the radiation. The “rem” determines the
radiobiological equivalent and refers to the biological effect of the absorbed radiation on
living things. From a practical, radiation safety concern, these radiation terms are
frequently used interchangeably despite their different scientific definitions.

The roentgen, rad, and rem represent large quantities of radiation. Because only low levels
of radiation are routinely present in the medical environment to which allied medical
workers are exposed, smaller units are used. These are milliroentgen (mR), millirad
(mrad) and millirem (mrem), and are one one-thousandth (1/1000) of the roentgen, rad
and rem, respectively. Most personnel exposures and measurements are expressed in these

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smaller units. You may also encounter other, newer Système International (SI) radiation
units for exposure, absorbed dose, and dose equivalent, such as the coulomb per kilogram
(C/kg), gray (Gy), and sievert (Sv), respectively.

For radioactive materials, the amount of radioactivity is measured in units of the curie
(Ci). A smaller unit, the millicurie (mCi) is often used, which is one one-thousandth of a
curie. This term describes the rate at which the radioactive material emits radiation. The
SI unit of radioactivity is also being used and is the becquerel (Bq). Table 1 shows the old
and the SI radiation units for various radiation quantities.

The amount of radioactivity present in a material decreases over time as a result of

radioactive “decay.” The period of time that it takes for a material to lose one half of its
radioactivity is called its half-life. The half-life for different radioactive materials varies
from fractions of a second to thousands of years. Radioactive materials are potential
sources of contamination (radioactivity in places where it is not supposed to be).
Contamination can cause radiation exposure.

4.4 Background radiation

The radiations discussed in these notes are x- rays and gamma rays, which are a form of
ionizing radiation. Ionizing radiation can change chemical bonds in molecules of cells and
therefore cause damage and produce biological effects. Some ionizing radiation is present
naturally in the environment everywhere and is called “background” radiation. We are all
exposed to these sources of radiation, which are usually in small quantities. Figure 2
shows the background radiation from the ground and the sky.

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4.5 Natural Radiation Sources

4.5.1 External Sources

External sources of background radiation include: cosmic radiation, which comes from
the sun and other sources in space, and terrestrial radiation, which arises from
radioactive sources found in the earth and in some building materials. We receive
more external radiation exposure from cosmic radiation when we climb mountains and
fly in airplanes than when we are at ground level.

4.5.2 Internal Sources

Internal sources of background radiation include naturally occurring radioactive

materials. We are born with some of them, some are deposited in our bodies from the
food and water we eat and drink, and from the air we breathe. Radon, a naturally
occurring radioactive gas, is present in many locations and exposes our lungs and
bodies. The presence of this and other natural, internal sources in our bodies results in
a small radiation dose. Some of the internal and external radiation sources are shown
in Figure 3.

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4.6 Man-made radiation sources

In addition to the natural sources of radiation, there are also man-made sources of
radiation to which we may be exposed. The largest source of exposure to a person is
from medical procedures. Sources of radiation in medicine include x-ray machines and
radioactive materials used in the diagnosis and treatment of diseases.

4.6.1 Diagnostic Uses

 X-ray machines, including mobile (“portable”) units, fluoroscopes (“C-arms”) and
CT scanners.
 Radioactive materials (capsules, liquids, or gases) used in nuclear medicine for
diagnostic procedures.
 Radioactive materials used in the laboratory to perform “in-vitro” or test-tube
studies on blood, urine, or cells for the diagnosis of diseases.
4.6.2 Therapeutic Uses
 Linear accelerators or teletherapy machines used in radiation therapy for the
treatment of cancer and other diseases.
 Radioactive sources in small, sealed containers used for patient implants for
treatment of cancer.
 Radioactive drugs used to treat patients.

Patients who receive large, therapeutic doses of radioactive drugs or brachytherapy

implanted sources may pose risks to others and, as a consequence, they are typically
confined to their hospital rooms. Workers who encounter any of the radiation sources
described above should ask the following questions:

 What are the radiation sources in the area?

 Are they x-ray machines or radioactive materials?

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 Where are the sources located?

 What safety precautions should I take to minimize my exposure?
 What should I do if I am accidentally exposed to these radiations?
 Whom do I ask for more information regarding radiation in my hospital?
 Is my exposure to radiation at an acceptable level?

The answers to these questions and others are discussed in the following sections.
Smaller amounts of radiation exposure also arise from consumer and electronic
devices such as airport baggage inspection machines, televisions, computer terminals,
and smoke detectors. Table 2 shows some background sources and the associated
radiation levels.

4.7 Medical sources of radiation

4.7.1 Diagnostic Sources

As listed earlier, diagnostic sources include x-ray machines and radioactive materials.
X-ray machines are used in radiography and fluoroscopy, and they may be permanently
installed (“fixed”) or mobile. Radiation protection methods are employed to reduce
radiation exposure to the patient and others. In radiography, the exposure time is very
short, usually less than one second, and x rays are emitted from the machine only when
the control switch to the unit is turned ON by the operator, Personnel are typically not
in the x-ray room during the time the x rays are being emitted.

In fluoroscopy the exposure time may be lengthy, and personnel usually work in the
room while the machine is emitting radiation; therefore, they wear protective aprons to
minimize their risks. The control panel of the machine has lights and audible signals

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that indicate when the machine is emitting radiation. When the control switch is in the
OFF position, x rays are no longer produced from the machine, and no radiation risks
exist.

4.7.2 Fixed X-Ray Machines

These are primarily located in the X-Ray or Radiology Department, but they may be
located in other areas of the hospital, such as operating rooms and emergency rooms.
These x-ray machines are used in the diagnosis of disease. These are located in a
specially shielded room and are typically operated by personnel trained in the proper
use of the equipment. Figures 4 and 5 show typical diagnostic x-ray units for
radiography and fluoroscopy, respectively.

4.7.3 Portable or Mobile X-Ray Machines

Mobile x-ray machines are similar in function to the fixed machines; however, they
are mobile and are transported to the patients who cannot be moved. Mobile machines
are typically used to examine patients in the Operating or Recovery Room during or
after surgery, trauma victims in the Emergency Room, patients located in intensive
care units, neonatal units,and other bedridden patients. Figure 6 shows a mobile x-ray
unit being used in a patient’s room. Personnel and other patients may receive a small
amount of exposure to x rays during the time that the x-ray machine is ON. Personnel
who assist in holding patients should wear protective aprons, as should the operator.

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4.7.4 Computed Tomography Scanners

Computed tomography scanners (CT or CAT scanners) may be located in the

radiology and radiation oncology departments. These scanners use x rays and
computers to produce images of the body in sections called slices. In CT, x rays are
produced only when the unit is turned ON by an operator. A typical time of x-ray
exposure in a CT procedure is 1-30 seconds. Figure 7 shows a CT scanner with a
patient.

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4.7.5 Radioactive Materials

Radioactive materials used in nuclear medicine are radioactive liquids, capsules

containing radioactive materials, or gases. These radioactive materials may be
administered intravenously to patients, or are swallowed or inhaled by them, in order
to obtain an image of a particular organ or body system. Radioactive materials
continually emit radiation and cannot be turned OFF. The patient is temporarily
radioactive until the radioactive material decays to an acceptable level or is eliminated
naturally by the body. Consequently, body fluids from these patients also can be
radioactive, and appropriate precautions should be taken in handling them (e.g.,
normal nursing procedures such as wearing rubber gloves).

Many radioactive materials are potential sources of contamination (radioactivity in

places where it is not supposed to be) and therefore are kept in the area called the “hot
lab.” The hot lab must be locked when unattended. Nuclear Medicine procedures
involve the use of a machine called a “gamma camera” that detects and records
radiations emitted by the radioactive materials administered to the patient. The gamma
camera does not emit radiation; rather, it detects and records the distribution of the
radiations emitted from the radioactive material in the patients. Figure 8 shows a
gamma camera being used in a nuclear medicine department. The radioactive material
administered depends upon the organ or system of interest.

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4.7.6 Laboratory Departments

Some laboratories use small amounts of radioactive material for “in vitro,” or test
tube, diagnostic tracer studies. The amounts of radioactive material used are typically
only a fraction of those used in nuclear medicine studies and generally do not pose any
radiation risk as long as proper procedures are followed.

4.8 Therapeutic Sources

You will recall that the therapeutic sources include radiation therapy machines,
radioactive materials in therapeutic amounts, and scaled radioactive sources that are
implanted in patients.

4.8.1 Radiation Therapy Machines

Radiation therapy machines are located in heavily shielded rooms in the radiation
therapy or radiation oncology departments. These machines deliver high doses of
radiation for the treatment of cancer and other diseases. The radiation dose is
prescribed by a radiation oncologist and administered by a radiation therapist. The
radiation therapy machine may be a high-energy x-ray machine or may be a sealed
radioactive source unit, which houses a high-activity sealed Cesium-137, Iridium-
192, or Cobalt-60 radioactive source.

Alternately, the radiation source may be a high-energy machine, called a linear

accelerator or linac, which produces x rays and electrons. A typical linear accelerator
for the treatment of patients is shown in Figure 9. X rays and high-energy electrons

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are produced from the linear accelerator only when the beam is turned ON, similar
to a diagnostic x-ray machine.

In units that utilize high-activity sealed radioactive sources, radiation is always

emitted, even when the beam is OFF. When the beam is off, the source is well
shielded so that the radiation levels in the room are very low, with no radiation
hazards to personnel. Some radiation therapy departments may have x-ray machines
for therapy that are called orthovoltage or superficial therapy x-ray units. These units
are similar to the diagnostic x-ray machine, except that they operate for longer
exposure times.

4.8.2 Radioactive Sources for Therapeutic Purposes

Radioactive sources used for therapeutic purposes and which are administered
internally may be in sealed or unsealed containers. In both cases, the nursing care
provided to the patient is limited to keep the exposure to nurses at acceptably low
levels. Visitation must be authorized by the Radiation Safety Officer of the hospital.
During the treatment, when the radiation level in the room is high, housekeeping
personnel are not permitted to enter the patient’s room for normal cleaning
purposes.

It is only after the patient has been discharged, and the Radiation Safety Officer has
made sure that the room is free from any source of radiation, that the room may be
released to housekeeping personnel for cleaning purposes. Generally, patients
treated by radioactive sources are hospitalized for a period of one to five
days.Patients treated with sealed sources are not radioactive after the sources are
removed.

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Nuclear Medicine Sources: Radioactive materials in therapeutic amounts are

administered to patients in the form of a liquid or capsule. These materials are
highly radioactive, which means that the patients become sources of emitted
radiation and radioactive contamination for a period of time. They remain
radioactive until the administered radioactive material decays to an acceptable
level, or is eliminated naturally by the body. The patient is typically confined to one
room until the radioactive decay results in acceptably low radiation levels. The
patient may cause significant contamination of items which they touch, and all such
items must be tested before disposal.

Radiation Therapy Sources: Another method of therapeutic use of radiationis to

implant radioactive sources in the form of sealed seeds or rods in patients. These
patients are sources of radiation until the radioactive sources are removed or they
have decayed to acceptably low radiation levels. These patients are sources of
radiation but not contamination. The patient with temporary implants remains in
isolation and is confined to a room until all the radioactive sources have been
removed.

Very rarely, sealed sources come off of a patient and wind up in bed linen or on the
floor. If you should ever see or suspect that such a source is dislodged do not touch
or pick it up. Keep everyone away from it. Call the Radiation Safety Officer to
investigate immediately. Some types of brachytherapy sources used in hospitals are
shown in Figure 10. High dose-rate sources are contained in a specially shielded
container. They are positioned near the patient’s tumor for brief periods of time and
then retracted back into the shielded container. The patient is usually treated as an
outpatient and is not radioactive when she leaves the treatment room.

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Summary: X-ray machines can be switched ON or OFF. They only emit radiation
when they are turned ON. Radioactive material is always “ON” constantly emitting
radiation. Radioactive materials can be shielded so that no radiation escapes from
the container.

4.9 Radiation protection methods

Radiation protection is employed to protect against radiation produced from x-ray and
gamma-ray machines, radiation emitted from radioactive materials, and to protect
against contamination from radioactive material and sources.

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4.9.1 Protection Against Radiation

The most effective methods of radiation protection are to:

1). Minimize Time

2). Maximize Distance
3). Maximize Shielding

Figure 11 shows, schematically, these three methods for radiation protection

4.9.1.1 Time

As the time spent in a radiation field increases, the radiation dose received

also increases. Therefore, it is best to minimize the time spent in any radiation area. If
working in and around radiation areas is a part of a person’s assigned duties, then the
person’s work efforts should be organized and well planned in advance to limit the
work time in the radiation area. This approach applies to nursing personnel taking care
of confined therapy patients who have received radioactive materials or implants,
housekeeping and maintenance personnel, and security personnel responsible for off-
hours radioactive material package receipt and delivery. For radiation therapy
treatments no one except the patient is allowed in the room so the exposure time to
everyone else is zero.

4.9.1.2 Distance

Reduction of exposure due to an increase in distance is governed by the,inverse-square

law. As the distance from a radiation source increases, the radiation exposure
decreases rapidly. Doubling the distance between a person and the radiation source

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reduces the radiation exposure to as little as one-fourth (1/4) of the original exposure.
It is good practice to keep as much distance between yourself and the radiation source
as is reasonably possible, even simply taking one step backward. Operating room or
emergency room nurses are not always able to leave a patient unattended during a
radiographic or fluoroscopic exam, but they can move away from the source as much
as possible and wear lead aprons. An increase in distance from a source always
reduces radiation exposure.

4.9.1.3 Shielding

Material that absorbs the radiation is a shield. The thicker the shielding, the more the
radiation exposure decreases. Some materials are better than others. Lead and concrete
are the most commonly used materials for shielding x rays and gamma rays. They are
very effective in stopping or blocking the radiation beam. The walls of x-ray rooms
are lead-lined to reduce the radiation exposure to those areas on the other side of the
wall. Lead aprons, thyroid shields, and lead gloves are commonly used to shield body
parts from diagnostic radiography and when portable x-ray machines are used. Lead
bricks, lead vials, lead syringe shields and various other tools are used to reduce
radiation exposure in nuclear medicine and radiation oncology departments.

4.9.2 Protection Against Radioactive Material Contamination

Contamination is the undesirable presence of radioactivity, such as a liquid spill on the

floor, or on clothing. It is a potential hazard whenever unsealed radioactive materials
are present. Avoid contaminating an area. Contamination can spread radioactivity to
outside areas, including cars and homes, and can result in the accidental ingestion or
inhalation of radioactive materials.

Prevent contamination by using the same precautions followed when handling

infectious agents, and biological and chemical sub-stances. Wear rubber gloves and
protective clothing. Because the radioactive contamination emits radiation, one must
practice the protection methods described in the previous section. Remember that
radioactivity or contamination cannot be seen. Radiation detecting instruments (survey
meters) are used to survey when contamination is suspected.

Additional safe laboratory practices should be observed when personnel work with
unsealed radioactive materials. Do not eat, drink, smoke, or apply cosmetics in any
radiation areas. These precautions reduce the possibility of the accidental ingestion or
inhalation of radioactive materials.

4.10 RESTRICTED AREAS

The protection methods described above are effective when radiation areas are known,
but how can allied medical workers know if they are in a radiation area? Areas with
radiation sources or radioactive materials are defined to be “Restricted Areas,” which

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are required by federal or state law to be posted with one or more of the following
warning signs:

“Caution Radiation Area”

"Caution High Radiation Area"

“Caution Radioactive Materials.”

Figure 12 shows common radiation warning signs for radioactive materials and x-ray
units. They have a yellow background with magenta or black lettering. Radiation
warning signs should be posted within and around Restricted Areas. Figure 13 shows a
radioactive source storage room where high activity radioactive sources are kept. The
room and nuclear medicine hot lab may look alike. Both of them are used to store
large amounts of radioactive materials. These rooms must be posted with “Caution
Radioactive Materials” signs. If it is unclear as to whether or not an area is a
Restricted Area, contact the Radiation Safety Officer of the hospital, or a staff member
of the radiology, nuclear medicine, or radiation oncology department for clarification.
Your Radiation Safety Officer will tell you whether you are allowed to enter these
areas.

Every hospital employee should recognize restricted radiation areas in the work
environment by looking for the radiation warning signs on:

 department and hallway doors,

 work areas within Restricted Areas,
 waste cans,
 package labels,
 and fume hoods, sinks, and refrigerators.

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4.11 Specific instructions for allied medical Workers

4.11.1 Housekeeping Personnel

All housekeeping employees should be aware of the locations of all Restricted Areas
in order to practice good radiation protection measures. These measures are:

a. Recognize Restricted Areas in your work environment.

b. Get user permission and instructions from the Radiation Safety Officer before
cleaning any spill in a Restricted Area.
c. Do not clean counter tops, hoods, refrigerators, or sinks in Restricted Areas
unless specially requested and instructed by the area supervisor or Radiation
Safety Officer.
d. Do not remove bedclothes, dishes, trash, or other items from rooms posted with
radiation signs, unless specifically instructed by a member of the Radiation
Safety Staff.
4.11.2 Security Personnel

All security personnel should be aware of the locations of all Restricted Areas, and be
able to recognize packages containing radioactive material in order to practice good
radiation protection measures.

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4.11.3 Maintenance Personnel

All maintenance personnel should be aware of the locations of all Restricted Areas so
that they may practice good radiation protection measures.These measures are:

a. Recognize Restricted Areas in your work environment.

b. Obtain permission before working in an area that is in or adjacent to a
Restricted Area.
c. Be aware of hoods, sinks, refrigerators, and storage areas used for radioactive
materials or sources.
4.11.4 Clerical Personnel

All clerical personnel in the departments that use radiation should be aware of the
locations of Restricted Areas so that they may practice good radiation protection
measures. Good practice includes:

a. Recognizing Restricted Areas in your work environment.

b. Refraining from eating, drinking, applying cosmetics, and smoking in areas
where radioactive materials are used.
c. Prohibiting food or soft drink storage in refrigerators used for the storage of
radioactive materials
4.12 Radiation surveys and personnel monitoring

Radiation surveys are measurements of radiation levels with specialized instruments.

A radiation survey of x-ray equipment and adequacy of room shielding is conducted
by the Medical Physics or Radiation Safety staff to document the radiation levels
present during operation. At the time of installation, an in-depth safety evaluation of
the radiation machine is performed before it is used for patient examinations or
treatments. In addition to these surveys, periodic quality assurance checks are
required.

Areas where radioactive materials are used, prepared, or stored are monitored for
radiation levels on a periodic basis, which may be daily, weekly, monthly, or
quarterly, depending on the type of use and the legal requirements. These surveys are
conducted with the use of hand-held radiation survey instruments. The measured
radiation levels are then compared to allowable limits. Surveys are conducted in an
effort to keep radiation exposures As Low As Reasonably Achievable (ALARA) for
everyone.

In addition to the physical surveys described above, some workers must be monitored
for radiation exposure with personnel dosimetry devices, such as film badges, ring
badges, or pocket dosimeters. These devices are intended to record only the radiation
exposure that an individual receives as a result of employment at a particular facility.
The personnel monitoring device should never be exchanged between individuals.
After the device is worn for a specified period of time, it is returned to the place of
evaluation. The radiation dose is evaluated and recorded as a permanent record of
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exposure for that individual, which becomes a legal document. Personnel exposure
records for each individual are maintained for a long period of time, and the
individual’s occupational dose is for that individual’s lifetime.

4.13 Radioactive material package receipt

Radiation surveys should be performed on all packages containing radioactive

materials delivered to or shipped from the hospital. Packages containing radioactive
material are typically delivered to a designated location, such as the nuclear medicine
department, during normal working hours when the staff is available to conduct the
required monitoring.

Sometimes deliveries may be made during off-hours. Each facility is required to have
specific procedures for radioactive material package receipt, which include procedures
for package inspection, receipt records, delivery to appropriate department,
notification of appropriate personnel, and off-hour receipt. Check with your Radiation
Safety Officer for specific procedures of your facility.

Figure 14 shows inspection of a package for radioactivity.

4.14 Radiation emergencies

Each facility has procedures for the control of Radiation Areas during an emergency.
These procedures should be brought to the attention of allied medical workers at the
time of orientation and during their radiation safety continuing education sessions.
Contact the Radiation Safety Officer for explicit instructions for the safety of
Radiation Areas in the event of:

• fire,

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• flood,
• explosion,
• unsecured radiation area,
• theft or vandalism,
• or the presence of suspicious persons.

In case of emergencies in restricted areas, call the Radiation Safety Officer whose
telephone number is posted at each Restricted Area.

4.15 Radiation safety officer

The Radiation Safety Officer (RSO) is designated by the hospital admin istration and
authorized by the State and/or Nuclear Regulatory Commission (NRC) to oversee the
radiation safety program in the hospital for radioactive materials. An RSO must meet
specific training and experience criteria. The name of the RSO and a 24-hour
telephone contact must be posted wherever radioactive materials are used or stored.

In addition to the emergencies described above, an RSO can be contacted for the
following:

• personnel exposure data, if you are monitored for radiation or feel that you
should be;
• regulations, license, and inspection reports;
• if you are pregnant and you work in Restricted Areas;
• if you have questions or suspect problems about radiation;
• or if you want to know about the NRC and other federal or state regulatory
agencies regarding radiation protection.
4.16 Radiation and pregnancy

It has been known since the early 1900s that cells that reproduce more frequently are
more sensitive to radiation damage. Because embryos, fetuses, and children are
growing, and therefore their cells are reproducing more often, they are typically more
sensitive to radiation than adults. When the abdomen of a pregnant female is exposed
to radiation, a fraction of that exposure is also received by the embryo or fetus. The
most radiosensitive period for the embryo is from 8 to 15 weeks gestation age.

Allied medical workers who may be exposed to radiation should contact the RSO if
they become pregnant or are planning to become pregnant. Instructions given to
radiation workers should include information regarding prenatal exposure risks to the
developing embryo and fetus. This information is used by the employee in the event of
pregnancy to assess the risks associated with her particular employment duties and any
possible alternative work environments if deemed necessary. The radiation dose
equivalent to the embryo/fetus is considered separately from the maternal dose, and
the radiation limits during the nine-month gestation period are 500 mrem for the
embryo/fetus.

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It is important to note that the mother assumes all risk until she specifically declares
her pregnancy, in a written and signed statement, to her supervisor or the RSO. At that
time, the hospital is responsible for assuring that the duties of a female worker will not
result in a dose equivalent that is more than 500 mrem to the fetus.

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