/policies/,/policies/administrative/,/policies/administrative/uwmf/,/policies/administrative/uwmf/uwmf-wide/,/policies/administrative/uwmf/uwmf-wide/medical-imaging/,

/policies/administrative/uwmf/uwmf-wide/medical-imaging/112002.policy

201411314

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100

UWMF,

Policies,Administrative,UWMF,UWMF-wide,Medical Imaging

Inspection of Radiation Protection Items (Lead Aprons) (112.002)

Inspection of Radiation Protection Items (Lead Aprons) (112.002) - Policies, Administrative, UWMF, UWMF-wide, Medical Imaging

112.002

UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
IMAGING POLICY AND PROCEDURE
Inspection of Radiation Protection Items (Lead Aprons)

Effective Date: September 1 2013 Approval: See Authorization
Supersedes Protocol: None Contact:

Reviewed


PURPOSE: To establish guidelines for new personal radiation protection items and the
continuing inspection to ensure that radiation workers receive adequate protection from
radiation exposure, and that radiation levels are kept below regulatory limits and As Low
As Reasonably Achievable (ALARA)..

POLICY:
A. The department assigned medical physicist or appointee shall be notified when
the lead worker or manager of that section or department acquires a new personal
radiation protection item.
B. Leaded personal radiation protection items in use will be inspected by medical
physicists or appointee visually and using fluoroscopy or radiograph to evaluate
the integrity of the lead lining at least every year.
C. An ongoing visual inspection of personal radiation protection items is the
responsibility of each lead worker or manager.
D. Leaded personnel radiation protection items include aprons, gloves, vests, skirts,
thyroid shields, and gonadal shields.
PROCEDURE:
A. The department assigned medical physicist or appointee shall be notified when
the lead worker or manager of that section or department acquires a new personal
radiation protection item. Medical Physics can be reached at 262-2170.
B. Medical physicists or appointee will then inspect the items radiographically or
fluoroscopically and will keep a record of each item along with its test dates. Each
item will be marked with a unique identification code and test dates.
C. If any personal radiation protection item in use shows a most recent test date more
than two years old, the lead worker or manager of the section or department to
which the item belongs shall notify Medical Physics.
D. Any item that appears damaged, no longer needed, or fails medical physics testing
shall either be delivered to the Radiology Equipment Coordinator to be

permanently removed from service or brought to the attention of Medical Physics
for further evaluation.
E. The lead worker or manager of the section will notify Medical Physics of any
items permanently removed from service so that the database of radiation
protection items in active use can be updated appropriately.



WRITTEN BY:
Kari Pulfer, R.T. (R)(CT) BS, Medical Imaging Manager

REVIEWED BY:
Lynn Broderick, MD Modality Chief Radiologist – Radiology, University of Wisconsin
Peter Chase, MD Modality Chief Radiologist – Radiology, University of Wisconsin
Samuel Charles, MD Medical Director Radiologist – Radiology, University of Wisconsin
Department of Radiology Community Section
John Vetter PhD ASSOC PROFESSOR (CHS) (UWSMPH) Medical Physicist, University of
Wisconsin

AUTHORIZATION: Richard Welnick, MD, Medical Director, UWMF

REFERENCES:
Wisconsin Department of Health Services Administrative Code 157.



Medical Director Date