U.S. NUCLEAR REGULATORY COMMISSION April 2011

 Revision 2

REGULATORY GUIDE

OFFICE OF NUCLEAR REGULATORY RESEARCH 

The NRC issues regulatory guides to describe and make available to the public methods that the NRC staff considers acceptable 

for use in implementing specific parts of the agency’s regulations, techniques that the staff uses in evaluating specific problems 

or postulated accidents, and data that the staff needs in reviewing applications for permits and licenses. Regulatory guides are not 

substitutes for regulations, and compliance with them is not required. Methods and solutions that differ from those set forth in 

regulatory guides will be deemed acceptable if they provide a basis for the findings required for the issuance or continuance of a 

permit or license by the Commission. 

This guide was issued after consideration of comments received from the public. 

Regulatory guides are issued in 10 broad divisions: 1, Power Reactors; 2, Research and Test Reactors; 3, Fuels and Materials 

Facilities; 4, Environmental and Siting; 5, Materials and Plant Protection; 6, Products; 7, Transportation; 8, Occupational Health; 

9, Antitrust and Financial Review; and 10, General. 

Electronic copies of this guide and other recently issued guides are available through the NRC’s public Web site under the 

Regulatory Guides document collection of the NRC’s Electronic Reading Room at http://www.nrc.gov/reading-rm/ 

doc-collections/ and through the NRC’s Agencywide Documents Access and Management System (ADAMS) at 

http://www.nrc.gov/reading-rm/adams.html, under Accession No. ML102350460. The regulatory analysis may be found in 

ADAMS under Accession No. ML10102350474.

REGULATORY GUIDE 8.18 

(Draft was issued as DG-8037, dated May 2009)

INFORMATION RELEVANT TO ENSURING THAT RADIATION 

EXPOSURES AT MEDICAL INSTITUTIONS WILL BE 

AS LOW AS IS REASONABLY ACHIEVABLE 

A. INTRODUCTION 

This guide is directed specifically toward medical licensees and recommends methods that the 

staff of the U.S. Nuclear Regulatory Commission (NRC) considers acceptable to maintain exposures as 

low as is reasonably achievable (ALARA) in medical institutions. In a medical institution, certain 

persons other than employees are exposed to radiation from licensed radioactive material. These persons 

include visitors and patients other than those being treated with radioactive material. This guide 

addresses the protection of these individuals. The content of this guide is also applicable to veterinary 

medical institutions, insofar as specific diagnostic or therapeutic procedures are performed. Similar 

protection practices apply for keeping employee and visitor exposures ALARA, whether the patients are 

animal or human. 

The regulatory framework that the NRC has established for medical licensees includes Title 10, 

Section 20.1101(b), of the Code of Federal Regulations (10 CFR 20.1101(b)) (Ref. 1). In this regulation, 

the NRC states that the licensee shall use, to the extent practical, procedures and engineering controls 

based on sound radiation protection principles to achieve occupational doses and doses to members of the 

public that are ALARA. Regulatory Guide 8.10, “Operating Philosophy for Maintaining Occupational 

Radiation Exposures as Low as Is Reasonably Achievable,” issued May 1977 (Ref. 2), provides guidance 

for the philosophy and general management policies and programs that licensees should follow to 

maintain radiation exposures to employees ALARA. NUREG-1556, Volume 9, Revision 2, 

“Consolidated Guidance about Materials Licenses: Program-Specific Guidance about 

Medical Use Licenses,” issued January 2008 (Ref. 3), includes information on an acceptable management 

program for keeping exposures ALARA, as well as specific examples of radiation protection programs 
Rev. 2 of RG 8.18, Page 2 

and practices acceptable to the NRC’s licensing staff. For recommendations on ALARA levels for 

effluents from medical facilities, please refer to Regulatory Guide 8.37, “ALARA for Effluents from 

Materials Facilities” (Ref. 4). 

Specific guidance on radioactive materials in effluents to unrestricted areas is beyond the scope of 

this guide. This topic is mentioned only in connection with actions that influence both occupational 

exposure and effluent control. NUREG-1556, Volume 9, provides further details on this subject. In 

addition, this guide addresses only radioactive materials subject to licensing by the NRC. The regulations 

and recommendations of other agencies should be consulted in regard to controlling radiation exposures 

from x-ray machines, other radiation-emitting equipment, and materials not licensed by the NRC. 

The NRC issues regulatory guides to describe to the public methods that the staff considers 

acceptable for use in implementing specific parts of the agency’s regulations, to explain techniques that 

the staff uses in evaluating specific problems or postulated accidents, and to provide guidance to 

applicants. Regulatory guides are not substitutes for regulations and compliance with them is not 

required. 

This regulatory guide contains information collection requirements covered by 10 CFR Part 20, 

“Standards for Protection against Radiation,” that the Office of Management and Budget (OMB) 

approved under OMB control number 3150-0014. The NRC may neither conduct nor sponsor, and a 

person is not required to respond to, any information collection request or requirement unless the 

requesting document displays a currently valid OMB control number. The NRC has determined that this 

regulatory guide is not a major rule as designated by the Congressional Review Act and verified this 

determination with OMB. 

B. DISCUSSION 

Some organizations have recommended that exposures be kept ALARA. In its regulations and 

guides, the NRC licensing staff has considered the basic radiation protection philosophy reflected in the 

following: 

• National Council on Radiation Protection and Measurements (NCRP), Report No. 107, 

“Implementation of the Principle of As Low As Reasonably Achievable (ALARA) for Medical 

and Dental Personnel,” 1990 (Ref. 5); 

• NCRP Report No. 116, “Limitation of Exposure to Ionizing Radiation,” 1993 (Ref. 6); 

• National Academy of Sciences, “The Effects on Populations of Exposure to Low Levels of 

Ionizing Radiation: 1980” (Ref. 7); 

• Federal Radiation Council Report No. 5, “Background Material for the Development of Radiation 

Protection Standards,” 1964 (Ref. 8); 

• International Commission on Radiation Protection (ICRP) Publication 60, “1990 

Recommendations of the International Commission on Radiological Protection,” 1990 (Ref. 9); 

• ICRP Publication 103, “The 2007 Recommendations of the International Commission on 

Radiological Protection,” 2007 (Ref. 10); and 

• American Conference of Governmental Industrial Hygienists, Committee on Industrial 

Ventilation, “Industrial Ventilation: A Manual of Recommended Practice for Design,”

February 1, 2007 (Ref. 11). 

The values proposed for maximum doses present a small risk when compared to the other hazards 

of life. Nevertheless, in view of the incomplete evidence upon which the values are based, coupled with 

the assumption that certain radiation effects are irreversible and cumulative, the NRC licensing staff 
Rev. 2 of RG 8.18, Page 3 

strongly recommends that every effort be made to reduce exposure to all types of ionizing radiation to the 

lowest reasonable level.

C. REGULATORY POSITION 

The NRC will consider a licensee’s radiation protection program to be in compliance with the ALARA 

requirements in 10 CFR Part 20 if the licensee has adopted and implemented the major principles and 

practices identified below as part of its policies and programs. 

1. Management Philosophy and Organization 

a. The radiation protection responsibility of licensee management1

 at a medical institution is to 

maintain exposures ALARA for employees, visitors, students, and patients who do not receive 

radiation or radioactive materials as part of their hospital care. The licensee should carry out this 

responsibility with respect to employees and staff by the following means: 

(1) information and policy statements2

 to the medical and hospital staff; 

(2) periodic management audit of operational efforts to maintain exposures ALARA; 

(3) continuing management evaluation of radiation safety staffing, program, and budget 

requirements; 

(4) management programs to ensure that all staff and employees who may be exposed to 

radiation receive appropriate briefings and training in radiation safety, including ALARA 

concepts; 

(5) delegation of sufficient authority to the Radiation Safety Officer (RSO) to enforce regulations 

and administrative policies regarding radiation safety; and 

(6) administrative direction to ensure that any new hospital facilities or equipment that may 

affect radiation protection are planned or designed in consultation with the RSO. 

b. Appendix M, “Model Procedures for an Occupational Dose Program,” to NUREG-1556, 

Volume 9, presents a model program for implementing this management philosophy. 

2. Radiation Safety Officer Functions 

This guide uses the term “Radiation Safety Officer” (or RSO) to indicate the individual who 

should be appointed, as provided in 10 CFR 35.24(b) (Ref. 12), to be responsible for implementing the 

radiation protection program. 

3. Staffing and Organizational Requirements 

Appendix A to this guide presents a sample outline of the various tasks of a typical radiation 

safety office. The time and effort required for each of the listed tasks vary widely depending on the size 

of the medical institution and the nature and extent of radioactive material usage. Management should 

(1) review the staffing requirements for each of these tasks and provide the necessary personnel to 

establish and carry out radiation protection program requirements and (2) evaluate them annually. 

4. Radiation Safety Personnel Qualifications 

 

1

 “Management” means the chief executive officer or other individual having the authority to manage, direct, or 

administer the licensee’s activities, or those persons’ delegate or delegates.

2

 Policy statements should include a detailed set of radiation exposure investigational levels, as presented in Appendix M 

to NUREG-1556, Volume 9. 
Rev. 2 of RG 8.18, Page 4 

Management should select an RSO who meets the requirements of 10 CFR 35.50, “Training for 

Radiation Safety Officer,” and of 10 CFR 35.59, “Recentness of Training.” Management should carefully 

review radiation protection personnel qualifications, based on the nature of the radiation safety program 

and the extent of effort and expertise required to carry out the tasks noted in Appendix A to this guide. 

Management should select radiation safety personnel appropriate to the radiation safety program 

after careful review of the nature of the program and the extent of effort and expertise required to carry 

out the tasks noted in the appendix. 

5. Space and Equipment 

a. The radiation safety office should have adequate equipment and space in appropriate locations to 

allow the RSO to carry out the following functions: 

(1) maintain, repair, and perform electronic calibrations on radiation safety equipment; 

(2) calibrate radiation safety equipment with radioactive sources and check the calibrations of 

other hospital sources (e.g., cobalt-60 if radiation safety and medical physics functions are 

combined);` 

(3) stock radiation safety supplies for labeling, surveys, decontamination, and personnel 

protection and monitoring; 

(4) conduct radiometric measurement of smear tests from contamination surveys and source leak 

tests; 

(5) store radioactive waste and sources not in use; 

(6) decontaminate personnel, clothing, and equipment; 

(7) process orders for licensed radioactive materials and receive and distribute such materials; 

(8) receive, process, and file regulations and licensing correspondence; 

(9) prepare reports and records of surveys and personnel monitoring as required by 

10 CFR Part 20; and 

(10) instruct and brief personnel as required by 10 CFR Part 19, “Notices, Instructions and 

Reports to Workers: Inspection and Investigations” (Ref. 13). 

b. In addition, licensees should examine the tasks listed in the appendix to this guide for other 

activities that may require specific space allocations for radiation safety offices in larger 

hospitals. 

6. Tasks and Procedures 

The RSO and the radiation safety staff are responsible for conducting surveillance programs and 

investigations to ensure that occupational exposures are ALARA. In addition, they should be vigilant in 

seeking new and better ways to reduce doses for jobs involving radiation exposure. The appendix to this 

guide, as well as NUREG-1556, Volume 9, provides a list of the types of tasks carried out by a radiation 

safety office to ensure good radiation safety surveillance and to meet regulatory and license conditions. 

For medical institutions that have a full or part-time professional health physics staff, this staff 

should coordinate the planning of radiation safety procedures with management to ensure optimum 

efficiency and exposures that are ALARA. This coordination should extend to the implementation of the 

ongoing radiation protection program by the professional health physicists under the general supervision 

of the RSO. 
Rev. 2 of RG 8.18, Page 5 

7. Administrative Authority 

The radiation safety office, supervised by the RSO, should carry out the radiation protection 

program, including the tasks listed in the appendix to this guide. In accordance with 10 CFR 35.24(e), the 

licensee shall establish the authority, duties, and responsibilities of the RSO in writing. The licensee’s 

designation should include authority for the RSO to communicate directly with the level of management 

that is able to take corrective action when needed to enforce rules and procedures pertaining to the 

institution’s radiation protection program. The RSO should also be granted administrative authority to 

suspend certain activities temporarily when necessary in emergencies to avoid immediate danger to life or 

health. However, the RSO should exercise his or her authority to suspend activities only when their 

suspension will not interfere with life-saving medical procedures that warrant an overriding priority and 

that cannot await alleviation of the radiation safety problems. 

8. Radiation Safety Committee 

Licensees that are authorized for two or more different types of uses of byproduct material under 

Subparts E, F, and H of 10 CFR Part 35, “Medical Use of Byproduct Material,” or two or more types of 

units under Subpart H, shall, under 10 CFR 35.24(f), establish a radiation safety committee to oversee all 

uses of byproduct material permitted by the license. As required by 10 CFR 35.24(f), the Committee 

must include an authorized user of each type of use permitted by the license, the RSO, a representative of 

the nursing service, and a representative of management who is neither an authorized user nor an RSO. 

The Committee may include other members whom the licensee considers appropriate. 

9. Facility and Equipment Design: General Considerations 

The design of facilities and equipment required for the medical uses of radioactive materials 

depends not only on hospital and medical care considerations but also on the nature and quantity of 

radioactive materials involved and the relative potential for external and internal radiation exposure. 

Regulatory Positions 10–21 below discuss the major aspects of planning and design that the licensee 

should consider. 

10. Space Layout 

The licensee should plan the facility layout to maintain employee exposures ALARA, while at the 

same time ensuring that actions taken to achieve this objective do not increase exposure to other persons 

in restricted or unrestricted areas. Considerations should include the following: 

a. the need for access to radiation or radioactive material areas by medical staff, employees, 

patients, visitors, and others, while providing optimum separation between work areas with 

frequent occupancy and radiation sources or contamination; 

b. ventilation requirements, including whether to maintain lower pressures in rooms in which 

radioactive gases may possibly be spilled or volatilized; 

c. floor loading for heavily shielded sources; 

d. receipt and shipment of radioactive material, including radiation surveys of the shipping 

containers; 

e. ingress and egress of some radiation therapy and nuclear medicine outpatients, including parking; 

and 

f. the need to protect supplies of stored diagnostic films from radiation exposure. 

11. Shielding 
Rev. 2 of RG 8.18, Page 6 

Permanent shielding may be needed in some cases for walls, floors, and ceilings to protect against 

radiation associated with radioactive materials currently housed in the institution, as well as radioactive 

materials that might be introduced into the area by future medical care requirements. Regulatory 

Position 19 of this guide discusses permanent shielding for radiation therapy facilities. In shielding 

calculations for a radiation therapy facility, the licensee should consider occupancy and use factors, as 

recommended in NCRP handbooks, but such factors should be chosen with the principle of ALARA in 

mind. The licensee should consult the NRC licensing staff during the planning and design stage to obtain 

guidance on acceptable use and occupancy factors in shielding design. 

12. Caution Signs and Interlocks 

The licensee should use caution signs, alarm, electronic surveillance, and locks, as required by 

10 CFR Part 20 and 10 CFR Part 35, to control or restrict access to certain areas. 

13. Ventilation 

To the extent possible, the licensee should take the following actions: 

a. Provide any necessary local exhaust ventilation (such as chemical hoods) or general ventilation, 

as recommended by professional health physicists, for areas where breathable concentrations of 

radioactive material may be present. 

b. Locate exhaust vents so as to provide meteorological diffusion and dilution adequate to meet 

10 CFR Part 20 requirements for effluents to unrestricted areas and ALARA exposure 

considerations for the public, as well as to avoid recirculating contaminated exhaust air into the 

building. 

c. Where appropriate, include specific types of filters or air cleaners for the exhaust air. 

d. Maintain rooms in which radioactive gases may be released at negative pressure with respect to 

adjacent rooms by appropriate exhaust ventilation. 

14. Fire Control 

Licensees should consider the need for personnel to exit and close the facility to prevent the 

spread of radioactive material for areas in which laboratory procedures could result in dispersal of 

radioactive material in the event of a fire. Licensees should provide local showers and fire extinguishers, 

where necessary. For the vast majority of medical institutions, emergency procedures and training should 

include immediate fire control as a priority item. 

15. Special Laboratory Design Features 

a. Licensees should consider providing laboratory surfaces that may be easily cleaned and 

decontaminated daily to maintain minimal contamination levels and radiation exposures, as well 

as minimal interference with medical and clinical procedures. Laboratory needs may also include 

the following: 

(1) provision for appropriate placement of radiation- and contamination-monitoring instruments, 

(2) designated sinks for rinsing and disposing of minor quantities of radioactive wastes (within 

10 CFR Part 20 limits), 

(3) special plumbing and waste storage provisions, and 
Rev. 2 of RG 8.18, Page 7 

(4) adequate separation between areas occupied by personnel and radiation sources or 

contamination. 

b. In general, no hospital procedure should use quantities of radioactive material that, because of 

their radiotoxicity, could result in potential air concentrations approaching the concentration 

values given in 10 CFR Part 20. Licensees should design ventilation and contamination control 

to maintain air concentrations and contamination levels ALARA. 

16. Storage, Source Control, and Inventory 

In institutions ordering a number and variety of radioactive material sources, it is often easier, 

less costly, and more secure to provide a centralized storage room for radioactive materials not in use or 

used only occasionally. Such a facility is also helpful in keeping exposures ALARA, since it may result 

in a decrease in the amount of radioactive material stored in laboratories occupied by personnel. 

17. Shipping and Receiving 

Medical institutions should take the following actions: 

a. Plan specific radioactive material storage areas for day, night, and weekend deliveries, so that 

deliveries of radioactive materials may be received at any time and placed in a secure locked 

location where they may not cause unnecessary exposure to personnel while awaiting survey by 

the radiation safety staff or the user. The licensee should ensure that a written procedure for 

receipt, survey, and storage of deliveries is provided to anyone responsible for the receipt or 

delivery of radioactive material. 

b. Handle packages in such a way as to maintain exposures ALARA. For example, when packages 

may expose couriers to measurable radiation, provide a cart or carrier that maintains an adequate 

distance between the person transporting the material and the package to keep exposures 

ALARA. 

c. Locate shipping and receiving areas and access to them near areas where radioactive materials are 

used to (1) minimize the time required for transporting radioactive material to areas where it is to 

be used and (2) avoid the need to transport radioactive materials through crowded areas or areas 

occupied by personnel, patients, or visitors. 

18. Equipment Considerations 

Licensees should employ the following general features when using equipment to handle or 

contain radioactive materials: 

a. Surfaces should be easy to clean and decontaminate, in case unsealed radioactive material is 

released. 

b. Equipment should be designed to optimize the ease of carrying out procedures where personnel 

are exposed to radiation, thereby minimizing working times, and to maximize distances of 

personnel from the radioactive materials with which they are working, to an extent consistent 

with the purposes of the procedure. 

c. Equipment should operate in such a fashion that it would not damage radiation sources and 

release radioactive materials if it were to fail. 
Rev. 2 of RG 8.18, Page 8 

d. Adequate shielding should be provided as part of the equipment, where feasible, to keep 

exposures ALARA. 

e. Appropriate caution signs, symbols, signals, and alarms should be provided as part of the 

equipment to meet the requirements of 10 CFR Part 20 and recommended standards of the 

medical physics profession. 

19. Radiation Therapy Equipment and Facilities 

The NRC licensing staff provides specific licensing guides for licensed radiation therapy 

programs and reviews the safety aspects of facilities and equipment before issuing a license. In designing 

shielding for radiotherapy treatment rooms (e.g., teletherapy and gamma stereotactic radiosurgery units, 

high-dose-rate brachytherapy, and gamma knife), the medical institution should consult NCRP 

Report No. 151, “Structural Shielding Design and Evaluation for Megavoltage X- and Gamma-Ray 

Radiotherapy Facilities,” issued in 2005 (Ref. 14), for recommended design details; specifications; 

methods of shielding against direct, scattered, and leakage radiation; and general principles of radiation 

safety design. 

a. In addition, the institution should protect each radiotherapy treatment room from inadvertent 

entry by the following means: 

(1) Provide a door interlock that allows a “Beam On” condition only when the door is closed and 

turns the beam off if the door is opened. 

(2) Provide independent backup caution lights on the console, above the door, and inside the 

treatment room to indicate the “Beam On” condition to radiotherapy technologists and other 

staff members. Independent audible signals provide added safety if the caution lights fail. 

(3) Establish a procedure for determining whether everyone except the patient is out of the 

treatment room before the door is closed and the beam is turned on. 

(4) Install independent gamma-ray-sensing caution lights or signals near the entry inside the 

treatment rooms to warn the radiotherapy technologist or others entering the room in case the 

door interlock system fails when the beam is in the “on” condition. 

(5) Provide a scram button for emergency shutdown of the source from inside the room and 

provide audio communication into the room from the outside control panel. 

b. The institution should consider leakage through the radiotherapy unit with the source in the “on” 

position when designing shielding. Data provided by the manufacturer of the radiotherapy unit 

and NCRP recommendations can be used for this purpose. 

c. The institution should design areas adjacent to the treatment room that will be occupied by 

personnel, patients, or visitors who are not associated with the radiation therapy department so 

that exposures to these areas are maintained ALARA. Reduction of occupational exposures to 

radiation therapy personnel should be achieved by design provisions, procedures, or beam 

orientations that are directed toward unoccupied or low-occupancy areas. The design should 

ensure that dose rates will not exceed 0.002 rem (0.02 millisievert) in 1 hour and 0.05 rem 
Rev. 2 of RG 8.18, Page 9 

(0.5 millisievert) in a year (see 10 CFR 20.1301, “Dose Limits for Individual Members of the 

Public”) in restricted or unrestricted areas adjacent to the radiotherapy treatment rooms. 

20. Nuclear Medicine Facilities 

a. To ensure that exposures are ALARA, the layout and design for new nuclear medicine facilities 

and equipment should accomplish the following: 

Allow sufficient space for personnel operating nuclear medicine equipment to be at least 1 meter, 

and preferably 2 meters, from any patient undergoing imaging, whenever the condition of the 

patient and other conditions permit, or provide adequate portable shields. 

b. Allow adequate space for stretcher patients awaiting scans, as well as for outpatients. Dosed 

patients awaiting scans may generate radiation levels on the order of 0.010 rem (0.10 millisievert) 

or more near the edge of the stretcher. These patients may need to be segregated from the general 

waiting area to reduce radiation exposure to receptionists and persons passing through the area, 

such as technologists and aides. 

c. Locate physicians’ offices and other occupied areas within easy access to needed 

radiopharmaceuticals, but allow enough distance (several meters is usually sufficient) to 

minimize exposures from stored radiopharmaceuticals and radioactive wastes. 

d. Provide adequate shielding for stored radiopharmaceuticals and adequate body shielding for 

employees preparing dosages for patients. 

e. Supply an adequate number of syringe shields and vial shields (as well as appropriate tongs or 

forceps) near the place of dosage preparation. 

f. Provide adequate exhaust ventilation (see Ref. 11) in the laboratory near or in the 

radiopharmaceutical storage and dose preparation areas to protect against airborne radioactive or 

toxic materials that might result from accidental release or spill of radiopharmaceuticals. 

g. Include a special shielded waste receptacle for used syringes and other radioactive wastes in the 

nuclear medicine laboratory near the dosage preparation area. 

h. Locate a permanently fixed radiation counter or rate meter near the entrance to the nuclear 

medicine preparation laboratory for employees to check regularly for hand or clothing 

contamination when leaving the department. A portable survey meter available at a convenient 

location should also help keep exposures ALARA. 

i. Provide individual labeled lockers and change areas for segregating laboratory coats that may be 

contaminated from other clothing when operations are such that contamination levels on persons 

or clothing may exceed the action levels of Regulatory Guide 8.23, “Radiation Safety Surveys at 

Medical Institutions” (Ref. 15). 

j. Provide finger badges or dosimeters, as well as body dosimeters, to monitor the occupational 

exposure of personnel involved in dose preparation and the injection and handling of patients. 

21. In Vitro Clinical and Research Laboratories 
Rev. 2 of RG 8.18, Page 10 

Many of the design considerations for in vitro clinical and research laboratories are similar to 

those already stated for other facilities. Special considerations include the following: 

a. easily discarded bench paper, absorbent on the top surface only, for catching and easily disposing 

of small amounts of contamination that may drip or be removed from laboratory apparatus and 

glassware; 

b. suitable, easily cleaned drip trays for manipulating radioactive materials where spillage may 

occur; and 

c. protective clothing, including disposable gloves (which should be changed frequently), for 

persons working with radioactive materials. 

In addition, the licensee should provide equipment for monitoring clothing before laundering. 

Radioactive laundry and radioactive wastes should be turned over to the radiation safety office for further 

disposition when surveys indicate contamination levels that may exceed 5000 dpm per 100 square 

centimeters. 

NCRP Report No. 105, “Radiation Protection for Medical and Allied Health Personnel,” issued in 

1989 (Ref. 16), provides additional information on carrying out in vivo experiments with animals. 

22. Safe Work Practices and Procedures: General Principles 

The NRC staff recommends, as a minimum, the safe work practices and procedures contained in 

this section for handling radioactive materials in medical institutions. Regulatory Guide 8.23 and 

NUREG-1556, Volume 9, contain additional information. 

23. Periodic Inventory and Control of All Radiation Sources 

Many of the more serious occupational exposures, as well as patient exposures, have resulted 

from misplaced or lost radioactive material, which may inadvertently expose unsuspecting persons or may 

be subject to improper use by unauthorized persons. Licensees should use the following procedures to 

guard against these problems: 

a. According to 10 CFR 35.67(g), a licensee in possession of sealed sources or brachytherapy 

sources, except for gamma stereotactic radiosurgery sources, shall conduct a semiannual physical 

inventory of all such sources in its possession. The licensee shall retain each inventory record in 

accordance with 10 CFR 35.2067(b). The inventory should be combined with an inspection to 

ensure proper labeling (see 10 CFR 35.69, “Labeling of Vials and Syringes,” and 

10 CFR 20.1902, “Posting Requirements”). 

b. Sources should be secured within locked rooms or storage areas when authorized users or their 

responsible employees are not present (see Regulatory Position 16 of this guide). Licensees 

should provide special shielded vaults or containers in the storage area for sealed sources. 

c. Authorized persons should be required to sign for the removal and return of each source. The 

radiation safety office staff should regularly check the source log. 

24. Shielding 
Rev. 2 of RG 8.18, Page 11 

All radioactive material not in use should be shielded so that exposure rates in any area that may 

be occupied by personnel should be well below (i.e., ALARA) the levels for unrestricted areas given in 

10 CFR Part 20. Whenever radioactive materials are in use, the material should be unshielded only in the 

direction necessary for its use and to the extent that accessibility to the source is necessary. 

25. Control of Contamination 

Licensees should ensure that radioactive materials in unsealed form or undergoing chemical or 

physical processing should be handled only in properly designed facilities (as described in Regulatory 

Position 20 of this guide) and with proper procedures to avoid transferring radioactive material to the air 

or to surfaces if inhalation or ingestion of the material by personnel is possible. Heat sterilization should 

be avoided if it might rupture the source. If necessary to ensure that exposures are ALARA, licensees 

should conduct preliminary tests of procedures with nonradioactive simulated materials or colored liquids 

to check provisions for containment, handling, and ventilation. The radiation safety office staff may 

make preliminary estimates of job exposure commitments using tracer levels of radioactive material. 

Trays and absorbent materials should be used as a backup to catch and limit the spread of 

radioactive contamination whenever a possibility exists that planned procedures may fail to contain the 

radioactive material. 

Personnel should wear protective clothing appropriate to the type and quantity of the radioactive 

material being processed whenever escape of radioactive contamination is considered possible. 

26. Proper Work Habits 

a. In general, licensees should train all personnel handling radioactive materials to use appropriate 

shielding materials, maintain as much distance as possible from radiation sources, and limit the 

time of exposure to radiation sources to the time necessary to carry out the required task or 

clinical procedure. 

b. The following good work habits are particularly important in ensuring that exposures are 

maintained ALARA: 

(1) Except for very low level sources, such as flood sources or other sources designed for manual 

use in checking instrumentation, sealed or unsealed sources should not be touched or held with 

the fingers, but only with tongs or tweezers appropriate to the operation. 

(2) Personnel who are handling or manipulating unsealed or unshielded sources with tongs or 

forceps or who are holding partially shielded containers of radioactive material with their 

hands should wear finger dosimeters,3

 as well as body dosimeters. However, these 

dosimeters are not needed for personnel handling only the types of sources used for tracerlevel in vitro studies or if dose rates are less than 5 millirem (0.05 millisievert) per hour at 

1 centimeter. 

(3) Special attention should be given to instructing all nursing staff and others coming in contact 

with a patient who may be excreting radioactive material that they may need to follow 

precautions to avoid contaminating themselves and others. 

 

3

 With some finger dosimeters, labels may wash off or the badge may rip protective gloves. In these cases, wrist badges 

may be preferable. In any case, the user should be aware that neither of these dosimeters will measure very high 

finger-contact doses, and handling unshielded syringes or bottles with the fingers should absolutely be avoided. 
Rev. 2 of RG 8.18, Page 12 

(4) When working with unencapsulated radioactive materials, personnel should wear disposable 

gloves and other special clothing. 

(5) Care should be taken to avoid needless contamination of objects such as light switches, taps, 

or door knobs. 

(6) Radioactive solutions should never be pipetted by mouth. 

(7) Eating, smoking, drinking, and application of cosmetics should be prohibited in laboratories 

where radioactive materials are handled. 

(8) Special precautions should be taken to avoid the possibility of small amounts of radioactive 

material entering cuts. 

(9) The use of containers or glassware with sharp edges should be avoided. Care should be taken 

to avoid bites or scratches when working with animals to which radioactive materials have 

been administered. 

(10) Food and drink should not be stored in the same place (e.g., the refrigerator) with radioactive 

materials. 

(11) Radioactive materials should be secured (e.g., placed in a locked room) when personnel are 

not present. 

(12) Surveillance of individual operations, such as “milking” generators, should be provided to 

ensure that workloads are distributed so that individual employee doses are kept ALARA. 

(13) Hand lotion may be used after removing disposable gloves and washing hands. 

(14) Training and education on good practice (e.g., procedure planning, repeating procedures 

using nonradioactive sources) should be provided to the workers. 

(15) All tools increasing the distance (e.g., forceps) between the hand/finger and the source are 

very effective for dose reduction. 

(16) Use of shields or increasing the distance is more effective than accelerating the work speed. 

27. Radiation or Radioactivity Monitoring 

Section C.2 of this guide discusses the independent radiation surveys, inspections, inventories, 

and smear tests to be carried out by the radiation safety office staff. In addition, each user of radioactive 

materials should survey radiation and radioactivity levels at the end of each day of use (10 CFR 35.70(a)) 

within his or her own operations to help maintain exposures ALARA. A simple logbook of readings or 

general levels of radiation or contamination maintained by the user may help to indicate any changes in 

radiation or radioactivity levels that show a need to modify procedures or equipment to meet ALARA 

radiation exposure objectives. Regulatory Guide 8.23 and NUREG-1556, Volume 9, offer further 

guidance on radiation surveys in medical institutions and nuclear pharmacies. 

In hospital situations in which higher exposure rates may occur (e.g., in teletherapy rooms where, 

in an accident, the limits of 10 CFR Part 20 could be approached before an indication is provided by 
Rev. 2 of RG 8.18, Page 13 

routine personnel monitoring devices), self-reading devices that the wearer may read at least daily, as well 

as warning devices worn on the body, may help to maintain exposures ALARA. 

28. Training 

Licensees should make employees aware of the ALARA provisions of 10 CFR Part 20 and the 

guidance of Regulatory Guide 8.10. Employees should be instructed in the philosophy and 

recommendations of Regulatory Guide 8.13, “Instruction Concerning Prenatal Radiation Exposure” 

(Ref. 17), whenever there is a possibility that pregnant women may be exposed to radiation. 

Employees should be acquainted with their individual institution’s own procedures for handling 

radioactive sources and radioactive materials and with NRC licenses and their radiation safety provisions 

(including license conditions incorporated from license applications and correspondence). Licensees 

should make available copies of these procedures, licenses, and related correspondence for review by 

employees as part of their orientation to radiation safety requirements. Licensees should also support 

professional education and development to ensure that staff members are up to date on radiation safety 

methods. 

Licensees should consult this regulatory guide and NUREG-1556, Volume 9, for topics important 

in training radiation workers. 

29. Radiation Therapy 

This guide provides recommendations for maintaining exposures ALARA in three subdivisions 

of radiation therapy: 

a. Radiotherapy—the treatment of patients with high-energy beams from shielded equipment 

containing sources of high gamma-ray emission rates 

b. Brachytherapy—the treatment of patients by insertion of sealed sources such as needles or tubes 

for interstitial or intracavitary irradiation or by surface application 

c. Radiopharmaceutical therapy—the injection or oral administration of solutions or radioactive 

pharmaceuticals that tend to concentrate in and irradiate the organs in which they are dispersed or 

absorbed 

30. Radiotherapy 

Radiation protection measures in radiotherapy should rely primarily on the adequacy of facilities 

and equipment, since very intense radiation levels are generated. Nevertheless, the licensee 

should use the following basic and routine operating principles for maintaining occupational 

exposures ALARA: 

a. With the aid of the maintenance and operating manuals provided by the manufacturer of the 

radiotherapy unit, procedures for routine maintenance and checking of safety-related features of 

the teletherapy unit should be established. 

b. A daily morning checkout procedure should be established and posted for the therapy 

technologist to carry out simple operational checks of indicator lights, caution lights and signs, 

key and door interlocks, gamma radiation-level indicators, timer operation, and interlock 

function. 
Rev. 2 of RG 8.18, Page 14 

c. A general safety check, including a spot or point radiation output check and a check on beam 

alignment and confining devices, should be made and recorded at least monthly. All records of 

the monthly output and safety check, as well as the morning checkouts, should be signed and 

dated by the persons carrying out the tests. 

d. During patient treatment or operation of the radiotherapy unit for calibration or maintenance 

procedures, care should be taken to follow written instructions and to use installed safety devices 

to ensure that no personnel except the patient to be exposed are in the treatment room during the 

“Beam On” condition. These procedures are also important when personnel carry out test 

procedures with phantoms on the treatment table. 

e. During “Beam On” operation, the operator at the console should remain in a position of lowest 

radiation intensity, while maintaining vigilance of the console and the patient during treatment, as 

advised by the radiation safety office staff using the post installation radiation survey. In a welldesigned facility, the shielding provides a very high degree of protection at the location of the 

console. However, all persons not required to remain near the console should remain or work in 

areas of lower radiation intensity while the radiotherapy unit is in operation. During “Beam Off” 

conditions, treatment setup should be accomplished with minimum occupancy of the room and 

minimum time spent near the source to keep exposures from leakage radiation ALARA. 

f. Emergency procedures established as required by NRC regulations or license conditions should 

be tested by regular familiarization sessions or by staging mock emergencies for the training of 

personnel. 

31. Brachytherapy 

NCRP Report No. 40, “Protection Against Radiation from Brachytherapy Sources,” issued in 

1972 (Ref. 18), provides detailed recommendations for reducing radiation exposures in brachytherapy, 

and NCRP Report No. 155, “Management of Radionuclide Therapy Patients,” issued in 2006 (Ref. 19), 

contains additional recommendations pertinent to brachytherapy, as well as to radiopharmaceutical 

therapy. The licensee should also consider the following important practices for maintaining exposures 

ALARA: 

a. Afterloading devices should be used wherever medically acceptable. Remote afterloaders are 

particularly effective in keeping exposures ALARA. 

b. Jigs or remote afterloaders should be prepared and tested for ease in loading sources into 

afterloading devices in the patient’s room. 

c. When manual afterloading is used, jigs for loading the afterloaders should be set up behind 

shields with lead-glass viewing windows, and auxiliary lead-brick shielding should be provided 

to shield the arms of the personnel loading the afterloaders for as much of the duration of the 

procedure as possible. 

d. When the radiation sources of afterloading sleeves or ovoids are loaded, they should be placed in 

adequately shielded carts or transport devices for liquid sterilization or transport to the patient’s 

room when the physician is ready to insert the afterloaders. These carts should be properly 

tagged and should, at all times, be under the supervision of the radiation physicist, the radiation 

safety staff, or a member of the radiotherapy staff. 
Rev. 2 of RG 8.18, Page 15 

e. Similar protection should be provided for use in threading radioactive needles for implant 

therapy. 

f. While manipulating sources, loading the afterloaders, and threading needles, personnel should be 

provided with tongs and surgical clamps to maintain the distance of the fingers at least 

30 centimeters from these sources. 

g. Personnel should wear finger dosimeters, as well as body dosimeters, when they are loading or 

preparing sources for insertion. Also, the radiation safety office staff should periodically survey 

the loading procedures and provide job-time and exposure information to help employees 

maintain exposures ALARA. Use of a gamma alarm monitor in the storage or loading area will 

indicate when radiation sources are outside their shields and help to avoid inadvertent exposures 

resulting from lost or misplaced sources (see 10 CFR 20.1101(b) and 10 CFR 20.1601, “Control 

of Access to High Radiation Areas”). 

h. A continuing list and count of removals and returns of individual sources from the storage 

containers should be maintained to help ensure against inadvertent loss of sources and exposure 

of personnel. 

i. Sources maintained in fixed position for a constancy check on the operation of any intracavitary 

ion chambers should be kept within shielded wells in constant geometry so they can be used for a 

rapid and safe check of ion chamber operation before the treatment of each patient. 

j. The radiation safety staff should carry out job-time/exposure studies on typical surgical implants 

and typical insertions of radioactive sources—either in the operating room or by afterloading in 

the patient’s room. These time/exposure studies should be recorded and reported to the personnel 

involved to maintain an awareness of radiation exposures resulting from these procedures. 

k. The radiation safety office staff or the radiation therapy staff should directly supervise the 

transport of a patient containing radioactive material to areas outside the operating room and to 

his or her room. Also, radiation safety office staff or radiation therapy staff should check and 

supervise the transport of afterloading sources and supplies for the insertion of applicators, lead 

bedside shields for the nurses, and any other supplies and equipment required for expediting an 

efficient afterloading procedure. Radiation surveys should also be carried out on a sample basis 

and recorded to maintain an awareness of the exposures resulting from these procedures. 

l. Nursing personnel should be provided with personnel dosimeters (when required by 

10 CFR Part 20) and should be trained in their use. 

m. Radiation safety staff or radiation therapy staff should survey patients after removal of 

brachytherapy sources and before discharge as a final step to check against incomplete removal of 

these sources from the patient, leakage of contamination from sources, or inadvertent loss of 

sources. All linens and waste should remain in the room until checked by a survey meter or until 

all sources are accounted for. 

32. Radiopharmaceutical Therapy (Nuclear Medicine Therapy with Unsealed Radioactive Materials) 

Where feasible and in the best interests of the patient, licensees should ensure that administration 

of the types of radioactive drugs used for therapy of specific diseases is carried out in a specific area or 

room separate from other nuclear medicine or radiotherapy operations. However, this special area or 

room should be in the general vicinity of the laboratory where the radiopharmaceuticals are stored to 
Rev. 2 of RG 8.18, Page 16 

eliminate the need to transport these materials over long distances or through other areas of the institution. 

When these materials must be transported to a patient’s room for administration, good radiation safety 

practice and efficient medical procedures often dictate that the radiation safety staff or nuclear medicine 

therapy staff monitor and assist in the preparation of the materials and supplies, the transport of the 

materials to the patient’s room, and the administration of the radioactive drugs, as directed by the 

physician in charge. When therapy is carried out with potentially volatile radioiodine compounds, 

licensees should consult Regulatory Guide 8.20, “Applications of Bioassay for I-125 and I-131” 

(Ref. 20), to determine whether employees who have participated in the radioiodine administration should 

be sampled for bioassay. 

Licensees must follow the requirements in 10 CFR 35.75, “Release of individuals containing 

unsealed byproduct material or implants containing byproduct material,” in authorizing the release from 

control of any individual who has been administered unsealed byproduct material or implants containing 

byproduct material. The patient release criteria used for the patient and the instructions given on ways to 

minimize contamination of the environment and exposure to members of the public should be also in 

accordance with Regulatory Guide 8.39, “Release of Patients Administered Radioactive Materials” 

(Ref. 21). 

After treatment, all articles such as bedding, clothing, food, towels, and food trays should be 

surveyed for possible contamination before they are released from the room. Contaminated articles must 

be held for decay or disposal according to 10 CFR 35.92, “Decay-in-Storage.” The patient should be 

surveyed before release and should be instructed on ways to minimize contamination of the environment 

and exposure of other members of the public. 

In supervising the administration of radiopharmaceuticals to patients, the physician in charge and 

the radiation safety staff may use many of the principles given for brachytherapy in Regulatory 

Position 31 of this guide, as well as principles and practices presented in NCRP Report No. 155. The use 

of these procedures should help to ensure that exposures to hospital staff and private-duty nurses are 

ALARA, not only during the administration of the dosage to the patient but also during any hospital care 

of the patient, during and after discharge of the patient, and in the event of any later surgery, autopsy, or 

burial of the patient. NUREG-1556, Volume 9, provides additional guidance. 

33. Diagnostic Nuclear Medicine 

Many of the principles of radiation protection practice in diagnostic nuclear medicine and general 

principles of safe work practices in handling radioactive materials were discussed in previous sections on 

recommendations for nuclear medicine facilities and equipment and general principles of safe work 

practices in handling radioactive materials. Additional recommendations include the following: 

a. Use syringe shields for administering all injections of radioactive material; only compromise this 

procedure on rare occasions when absolutely necessary. Use disposable gloves to protect against 

possible hand contamination. 

b. Place radionuclide generators in a remote, well-shielded enclosure to reduce external exposure to 

personnel. 

c. Use samples in shielded bottles for checking the assay of eluates in the nuclear medicine dose 

calibrator or other suitable assay system. Calibration procedures with a smaller quantity of 

radioactive material may sometimes reduce exposures to the staff. 
Rev. 2 of RG 8.18, Page 17 

d. Shield chamber calibrators, where possible, to maintain employee exposures ALARA and reduce 

background radiation while nuclear medicine doses are being calibrated. Recalibrate refitted 

chambers as necessary. 

e. Use fume hoods (see Ref. 11) and good contamination control principles in situations that involve 

potential airborne radioactive materials. 

f. Consistent with ease of disposal, keep shielded radioactive waste cans for used syringes and other 

radioactive wastes at the greatest distance from those areas in the laboratory most frequently 

occupied by personnel. 

g. Use protective lead screens to shield employees and other patients during procedures using 

technetium-99m (Tc-99m) or other gamma emitters if the screens do not interfere with the 

diagnostic tests. Portable screens of lead only 2 millimeters thick will reduce Tc-99m gamma-ray 

exposure rates to less than 1 percent of those without the screens. 

h. In lung perfusion or ventilation studies with xenon-133 (Xe-133), use additional lead shielding 

1.6 millimeters thick (or appropriate thicknesses for other radioactive gases or aerosols) around 

the absorber canister, oxygen bag, and waste receptacle to reduce occupational exposures when 

undertaking frequent procedures. Use proper equipment to prevent leakage or contamination 

from the radioactive material being used. Installation of a Xe-133 monitor in the room where 

ventilation studies are performed should warn of any leakage of Xe-133. 

i. In addition to regular nursing staff members who receive personnel monitoring, private-duty 

nurses and others who may come in close contact with patients who have been administered 

radiopharmaceuticals for diagnostic or therapeutic purposes should receive appropriate 

instructions and briefings on radiation protection procedures. 

34. Low-Level Clinical or Medical Research Laboratory Activities 

Laboratories in medical institutions that use tracer amounts of the less radiotoxic nuclides may 

keep exposures ALARA by using the recommendations contained in regulatory positions previously 

described in this guide. Many of the radionuclides used for in vitro clinical tests, such as 

radioimmunoassay, and other low-level in vitro or animal studies involve pure beta emitters or weak 

gamma emitters, with individual personnel handling and processing only microcurie or submicrocurie 

quantities at any one time. External and internal radiation exposures to personnel in such laboratories 

should ordinarily be maintained well below 10 percent of the permissible occupational exposure limits of 

10 CFR Part 20 through careful initial planning of laboratory facilities, equipment, and procedures by the 

laboratory supervisor, in conjunction with qualified health physics personnel. 

35. Management Audit and Inspection of the Radiation Protection Program 

The governing body of the hospital bears the ultimate responsibility for the establishment and 

continuation of an adequate radiation protection program in a medical institution. The administrator 

reporting to this governing body should be sufficiently informed at all times to ensure that all regulations 

are faithfully adhered to and that radioisotopes are properly used and safely handled to maintain 

exposures ALARA. 

 The hospital administration should perform an annual audit of the radiation protection program in 

cooperation with members of the radiation safety committee and the radiation safety office. The results 

of this audit may then be discussed at a radiation safety committee meeting to ensure that all users and 
Rev. 2 of RG 8.18, Page 18 

responsible staff are aware of current policies and procedures and methods for their improvement. 

NUREG-1556, Volume 9, contains a sample checklist of items that may be inspected by the 

administration during this annual audit. The radiation safety office should maintain a report of the results 

of the audit for possible use in expediting any inspections by regulatory or accrediting agencies, as well as 

for reference in further audits and for improving the ALARA program. 

D. IMPLEMENTATION 

The purpose of this section is to provide information to applicants and licensees regarding the 

NRC’s plans for using this regulatory guide. The NRC does not intend or approve any imposition or 

backfit in connection with its issuance. 

In some cases, applicants or licensees may propose an alternative method for complying with 

specified portions of the NRC’s regulations. Otherwise, the methods described in this guide will be used 

in evaluating compliance with the applicable regulations for license applications, license amendment 

applications, and amendment requests. 

. 
REFERENCES4

1. 10 CFR Part 20, “Standards for Protection against Radiation,” U.S. Nuclear Regulatory 

Commission, Washington, DC.

2. Regulatory Guide 8.10, “Operating Philosophy for Maintaining Occupational Radiation 

Exposures as Low as Is Reasonably Achievable,” U.S. Nuclear Regulatory Commission, 

Washington, DC. 

3. NUREG-1556, Volume 9, Revision 2, “Consolidated Guidance about Materials Licenses: 

Program-Specific Guidance about Medical Use Licenses,” U.S. Nuclear Regulatory Commission, 

Washington, DC, January 2008. 

4. Regulatory Guide 8.37, “ALARA for Effluents from Materials Facilities,” U.S. Nuclear 

Regulatory Commission, Washington, DC.

5. NCRP Report No. 107, “Implementation of the Principle of As Low As Reasonably Achievable 

(ALARA) for Medical and Dental Personnel,” National Council on Radiation Protection and 

Measurements, Bethesda, MD, 1990.5 

6. NCRP Report No. 116, “Limitation of Exposure to Ionizing Radiation,” National Council on 

Radiation Protection and Measurements, Bethesda, MD, 1993.

7. “The Effects on Populations of Exposure to Low Levels of Ionizing Radiation: 1980,” National 

Academy of Sciences—National Research Council, Washington, DC, 1980.6

8. Report No. 5, “Background Material for the Development of Radiation Protection Standards,” 

Federal Radiation Council, Washington, DC, 1964.7

9. ICRP Publication 60, “1990 Recommendations of the International Commission on Radiological 

Protection,” Pergamon Press, Oxford, 1990.

10. ICRP Publication 103, “The 2007 Recommendations of the International Commission on 

Radiological Protection,” Pergamon Press, Oxford, 2007.

 

4

 Publicly available NRC published documents listed herein are available electronically through the Electronic Reading 

room on the NRC’s public Web site at: http://www.nrc.gov/reading-rm/doc-collections/. The documents can also be 

viewed on-line or printed for a fee in the NRC’s Public Document Room (PDR) at 11555 Rockville Pike, Rockville, 

MD; the mailing address is USNRC PDR, Washington, DC 20555; telephone (301) 415-4737 or (800) 397-4209; fax 

(301) 415-3548; and e-mail PDR.Resource@nrc.gov. 

5

 Copies may be purchased from the National Council on Radiation Protection and Measurements (NCRP), 7910 

Woodmont Avenue, Suite 400, Bethesda, MD 20814-3095 (telephone: (301) 657-2652). Purchase information is 

available through the NCRP Web site at http://www.ncrppublications.org/Reports/. 

6

 Copies of National Academy of Science reports may be found at The National Academies Web site at 

http://www.nasonline.org/site/PageServer. 

7

 Copies of Federal Radiation Council reports may be found at the U.S. Environmental Protection Agency Web site at 

http://www.epa.gov/radiation/federal/techdocs.html#report5. 

 
11. “Industrial Ventilation: A Manual of Recommended Practice for Design,” American Conference 

of Governmental Industrial Hygienists, Committee on Industrial Ventilation, Cincinnati, OH,

February 1, 2007.8

12. 10 CFR Part 35, “Medical Use of Byproduct Material,” U.S. Nuclear Regulatory Commission, 

Washington, DC.

13. 10 CFR Part 19, “Notices, Instructions and Reports to Workers: Inspection and Investigations,” 

U.S. Nuclear Regulatory Commission, Washington, DC.

14. NCRP Report No. 151, “Structural Shielding Design and Evaluation for Megavoltage X- and 

Gamma-Ray Radiotherapy Facilities,” National Council on Radiation Protection and 

Measurements, Bethesda, MD, 2005.

15. Regulatory Guide 8.23, “Radiation Safety Surveys at Medical Institutions,” U.S. Nuclear 

Regulatory Commission, Washington, DC.

16. NCRP Report No. 105, “Radiation Protection for Medical and Allied Health Personnel,” National 

Council on Radiation Protection and Measurements, Bethesda, MD, 1989.

17. Regulatory Guide 8.13, “Instruction Concerning Prenatal Radiation Exposure,” U.S. Nuclear 

Regulatory Commission, Washington, DC.

18. NCRP Report No. 40, “Protection Against Radiation from Brachytherapy Sources,” National 

Council on Radiation Protection and Measurements, Bethesda, MD, 1972.

19. NCRP Report No. 155, “Management of Radionuclide Therapy Patients,” National Council on 

Radiation Protection and Measurements, Bethesda, MD, 2006.

20. Regulatory Guide 8.20, “Applications of Bioassay for I-125 and I-131,” U.S. Nuclear Regulatory 

Commission, Washington, DC. 

21. Regulatory Guide 8.39, “Release of Patients Administered Radioactive Materials,” U.S. Nuclear 

Regulatory Commission, Washington, DC. 

 

8

 Copies may be purchase from the American Conference of Governmental Industrial Hygienist website at 

http://www.acgih.org/store/ProductDetail.cfm?id=1874.
APPENDIX A 

RADIATION SAFETY TASKS INVOLVED IN KEEPING 

OCCUPATIONAL EXPOSURES AS LOW AS IS REASONABLY 

ACHIEVABLE (ALARA) 

A-1. Surveys of Radioactivity Areas

a. nuclear medicine 

b. radiation therapy 

c. oncology 

d. nuclear cardiology 

e. radioactive waste disposal and storage 

f. other research and clinical laboratories using radioactive materials 

g. pathology 

h. operating rooms 

A-2. Survey of Diagnostic and Therapeutic Machines and Generators

a. teletherapy sources and machines 

b. positron emission tomography cameras 

c. gamma knife 

d. gamma irradators 

A-3. Personnel Monitoring

a. review of personnel exposure data and reports 

b. review of reports required by regulations 

c. filing, collecting, and mailing personnel monitoring devices (including late and lost) 

d. special investigations of exposure and notifications to regulatory agencies where appropriate 

e. calibration of personnel monitoring dosimeters, including commercially supplied film badge 

service 

A-4. Radiation Safety Instrument Calibration and Maintenance 

Licensees should ensure that radiation safety instruments are properly calibrated and maintained 

using the following methods: 

a. calibration 

b. battery replacement and adjustment 

c. pocket chamber and thermoluminescence dosimeter calibration 

d. minor repair (electronic) 

e. instrument selection and distribution 

f. check-source calibration 
A-5. Decontamination and Waste Disposal Practices 

a. collection and packaging 

b. surveying 

c. recording 

d. shipping arrangements 

e. placarding 

f. decontamination of surgical instruments, rooms, and laboratories 

A-6. Techniques for Leak-Testing of Radioactive Sources 

a. wiping 

b. counting 

c. calculations 

d. recording 

e. counter calibration 

A-7. Means of Evaluating Internal Exposure 

a. collection of samples, including air samples, where applicable 

b. radiochemical or scintillation bioassay analysis 

c. counter calibration 

d. in vivo counting 

e. computer analysis of results 

A-8. Special Surveys of Patients and Rooms for Implant, Intracavitary, or Unsealed 

Radiopharmaceutical Therapy

a. room preparation and protective covering 

b. labeling (bed, chart, door) 

c. nursing staff and housekeeping staff briefings 

d. background surveys 

e. source insertion and afterloading surveys 

f. surveys of patients in operating and recovery rooms 

g. placing of lead barriers 

h. recovery of sources and wastes surveys of room cleanup and decontamination instructions to 

patient and to family of patient, as appropriate 

i. measurement of radiation from cadavers and briefings to pathology staff and funeral directors, 

where appropriate 

A-9. Administration and Consultation

a. approval of facilities, equipment, and procedures used in areas where radioactive materials are 

handled 

b. preparation of license applications and amendments 

c. preparation of hazard evaluation reports for licensing 

d. programming of routine required surveys 

e. supervision of routine radiation safety operations 

f. revisions to radiation safety manual 

g. periodic radiation safety instruction for hospital staff and administration 

h. training of residents and medical staff 
i. conferences with physicians and other safety staff 

j. coordination of radiation safety committee meetings and minutes 

k. inspections and discussions with Government regulatory agency representatives 

l. professional meetings 

m. selection and ordering of equipment and supplies 

n. planning and budgeting 

(1) facility and shield design and meetings with architects 

(2) records maintenance and related computer programming 

(3) planning for prompt, effective response to incidents and emergencies involving radiation 

(4) provision of instruction or direction for outside persons (e.g., firefighters) who would 

respond to an emergency situation involving or potentially involving radiation 

(5) preparation of radiation safety office reports to hospital administration