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Section G

Comforters and carers

 

“Comforter and carer” means an individual who (other than as part of his occupation) knowingly and willingly incurs an exposure to ionising radiation resulting from the support and comfort of another person who is undergoing or who has undergone any medical exposure (paragraph 127 of L121, HSE 2000)

Comforters and carers are normally adults and are often relatives or friends of patients. They must be informed of the risks of incurring exposures whilst acting in this role during an exposure. Regulation 8(3) requires the use of dose constraints to restrict exposure controlled by the concept of as low as reasonably practicable (ALARP) and a dose constraint of 5mSv has been advised (Schedule 4(7). See pages 37 – 38 of L121, (HSE, 2000) for further details.

The HSE 2003 guidance entitled “Dose constraints for comforters and carers” available at www.hse.gov.uk/research/rrhtm/rr155.htm has been prepared by the Royal Hallamshire Hospital to enable guidance to be developed for Employers, to assist them in meeting relevant legislative requirements for the exposure of persons who offer support and care to patients undergoing procedures involving ionising radiation where this would not be considered part of their occupation.

SCoR Guidance

Diagnostic Radiography
The designation of the special category of “comforter and carer” is not normally required in the diagnostic imaging department as those helping will be exposed to well below the member of the public dose limit (>1mSv) as long as they do not undertake this role on a regular basis.
Reference should be made to the risk assessment for patient assistance during radiography procedures and also, for staff, the Local Rules for Ancillary Staff working in the Clinical Imaging Departments. For those involved in assisting patients during radiographic procedures it is important that they only remain present in the x-ray room during the exposure if this is absolutely essential – they should stand behind the control panel and lead screen whenever possible.  If the patient cannot be left alone during exposure, the person who stays with them must wear the protective lead garments provided and be advised where to stand by the radiographer.  In the case of a female comforter or carer, the radiographer must check that the possibility of pregnancy has been ruled out before allowing the person to stay with the patient during exposure.
If it is necessary to use manual restraint due to a lack of patient co-operation and, in such cases, when the examination must proceed, the comforter/carer must wear the protective lead (Pb) as appropriate.  The comforter/carer must be positioned as far away as possible from the primary x-ray beam.

Records of doses received by comforters and carers
Records (name, exposure factors, DAP readings) must be kept for all staff or relatives who assist during exposures and these should be audited by the RPS to ensure that the same person is not routinely asked to assist.

Therapeutic Radiography
External Beam Radiotherapy
No person other than the patient must be in the treatment room during mega-voltage or kilo-voltage treatment. Advice within the Medical and Dental Guidance Notes (IPEM, 2002) states that in exceptional circumstances a person other that the patient may be present in the treatment room during kilo-voltage treatment. In such cases adherence to the guidance for comforters and carers in diagnostic radiography is advised.

SCoR Guidance
Before any intervention takes place which requires a person remaining in the room with a patient, the RPA, the Medical Physics Expert and the RPS should undertake a detailed PRA. There should be a written system of work formulated.  The results of the PRA must be fully explained to the individual as part of a formal process of knowingly and willingly obtaining consent to act as the comforter/carer. It is advised that the comforter/carer sign a disclaimer given the extreme doses that could be received as a result of his/her failure to comply with the issued precautions.

CT and Simulation
Adherence to the guidance for comforters and carers in diagnostic radiography is advised.

Nuclear Medicine
Due to the increased risk of exposure the role of comforters and carers should not involve a female who is or is suspected of being pregnant. Information for comforters and carers should be included in the patient information leaflets. This should include avoiding direct continuous contact with a patient particularly in bed at night or, in the case of a child, for example, on the lap watching television. The exact length of time to avoid continuous contact with a patient who has undergone a nuclear medicine procedure will depend on the isotope being administered.
This information should be written in conjunction with the RPS and RPA and made available by the radiographer or technologist.

Interventional Radiology
The guidance for comforters and carers for diagnostic radiography also applies to interventional radiography – the high doses associated with interventional examinations indicate that such individuals should only be present if absolutely necessary and in such instances they should stand as far away from the patient and equipment as possible throughout the procedure which, in most cases, means that their role of comforter or carer is not feasible.

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