Texas Radiation Texas Radiation Protection Program Protection Program Outcomes Outcomes

Robert Emery, DrPH, CHP, CIH, CSP, RBP, CHMM, CPP, ARMVice President for Safety, Health, Environment & Risk ManagementThe University of Texas Heath Science Center at Houston

Associate Professor of Occupational HealthThe University of Texas School of Public Health 1851 Crosspoint Drive OCB 1.330Houston, Texas(713) 500-8100

Radiation Protection Program Radiation Protection Program OutcomesOutcomes

Ideally, a public health regulatory control program would rely on health outcome data as its “systemic” outcome measure of performance

But since acute radiation injuries are rare, and latent illnesses possibly not recognized as radiation-related, other “organic” outcome indicators must be relied upon, such as:

Inspection results (violations) Reported incidents Reported complaints Specific events

Misadministration/dose irregularities Overexposures Stolen sources

Scope of Texas Operations

Approximately 15,000 registrants of radiation producing devices

Approximately 1,500 licensees of radioactive materials

All permit holders are inspected on a pre-determined schedule

Outcome Data

DSHS maintains extensive records on Violations Incidents, complaints

UTHSCH students accessed this data from as far back as 1956 Format varied from paper, floppy disk, CD Entered into standardized electronic format

Represents the most comprehensive radiation protection outcome dataset in the nationWhat can we learn from the data….

Licensees: Top Ten Violations Licensees: Top Ten Violations 1988-19971988-1997

Procedures 11%Procedures 11%

Absent surveys 10%Absent surveys 10%

Leak testing 8%Leak testing 8%

Personnel monitoring 7%Personnel monitoring 7%

Instrument calibration 7%Instrument calibration 7%

Inventories 6%Inventories 6%

Transfer records 6%Transfer records 6%

Disposal records 4%Disposal records 4%

Main program 4%Main program 4%

Training 2%Training 2%

TotalTotal†† 65% 65%

††Annual Top Ten Varied from 55% to 75% of all NOVsAnnual Top Ten Varied from 55% to 75% of all NOVs

Licensee Top Ten Violations By YearLicensee Top Ten Violations By Year1988-19971988-1997

1988

1991

1994

1997Pro

cedu

res

Sur

veys

Not

Don

e

Leak

Tes

ts N

ot D

one

Mon

itorin

g R

ecor

ds

Cal

ibra

tion

Exc

eede

d

Inve

ntor

y/U

se L

og

Tra

nsfe

r R

ecor

ds

Sur

veys

/Dis

posa

l Rec

ords

Insp

./Mai

n. N

ot D

one

Tra

inin

g

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

Percent of All Violations Issued

Year

Licensee Violations Severity Level Licensee Violations Severity Level Distribution 1988-1997Distribution 1988-1997

Severity Level IV72%

Severity Level III21%

Severity Level I1%

Severity Level V4%

Severity Level II2%

Registrants: Top Ten Registrants: Top Ten Violations 1988-1997Violations 1988-1997

OS&P NC/NA 20%OS&P NC/NA 20%

Time/temp chart 11%Time/temp chart 11%

No QC 10%No QC 10%

Alignment 7%Alignment 7%

Annual PE tests 6%Annual PE tests 6%

Technique chart 5%Technique chart 5%

Reg not current 4%Reg not current 4%

Dosimetry 4%Dosimetry 4%

Timer 3%Timer 3%

““Other x-ray” Other x-ray” 3%3%

TotalTotal†† 73% 73%

††Annual Top Ten Varied from 61% to 78% of all NOVsAnnual Top Ten Varied from 61% to 78% of all NOVs

1988

1991

1994

1997

OS

&P

/Ce

rt./R

PP

N/A

Tim

e/te

mp

., L

igh

ts N

/A

Co

mp

l. T

est

/Film

Lo

g N

/A

Co

llim

ato

r, P

BL

, Fie

ld N

/A

Ap

ron

Te

st N

/A

Te

chn

iqu

e c

ha

rt N

A

Re

g. o

r ce

rtifi

catio

n N

/A

Do

se r

eco

rds

Tim

er

ina

ccu

rate

Oth

er

x-ra

y/m

am

mo

Sh

ield

ing

su

rve

ys N

/A

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

Percent ofAll Violations Issued

Year

Registrants: Top Ten Violations By Registrants: Top Ten Violations By YearYear1988-19971988-1997

Registrant Violations Severity Registrant Violations Severity Level Distribution 1988-1997Level Distribution 1988-1997

Severity Level IV58%

Severity Level III19%

Severity Level II12%

Severity Level I0%

Severity Level V11%

Texas Compared to Maine and Texas Compared to Maine and Washington StateWashington State

Comparison of the most common notices of violation (NOVs) issued to specific licensees

of radioactive materials in Maine, Texas and Washington State in calendar year 1999.

0%

5%

10%

15%

20%

25%

30%

Inadequate/unapproved operating procedures

Radiation surveys or sampling not done

Leak testing or other radiation source not done at re

quired interval

Physical inventories/utilization logs not done or documented

Inspection/maintainance program of sources/equipment

Detection/measurement instruments not calibrated at approved intervals

Personnel monitoring records

Radiation surveys and disposal records incomplete/inaccurate

Incomplete/missing transfer re

cords

Training of radiation workers insufficient/in

appropriateOther

Pe

rce

nta

ge

of

To

tal

No

tic

es o

f V

iola

tio

n

Maine 1999 NOVs

Texas 1999 NOVs

Washington State 1999 NOVs

Complaints by Permit TypeComplaints by Permit Type1988-1997 in Texas (n=857)1988-1997 in Texas (n=857)

Uncredentialed Technician

20%

Unauthorized Possession

3%

Unauthorized Disposal6%

Regulation Violations16%

Radiation Injury2%

RAM Found2%

Quality Assurance Not Performed

2%

Protective Equipment Not Supplied

2%

Personnel Monitoring Not Supplied

5%

Patient Overexposure2%

Other6%

Overexposure8%

Malfunction2%

Improper Storage2%

Improper Posting2%

Elevated Radiation Levels

3%Contamination4%

Unsafe working conditions

2%

Unregistered X-ray6%

Unregistered Laser1%

Unqualified Individual4%

Complaint SummaryComplaint Summary1988-1997 in Texas (n=857)1988-1997 in Texas (n=857)

Incidents by Permit Type Incidents by Permit Type 1988-1997 in Texas (n=2,126)1988-1997 in Texas (n=2,126)

Other8%

Registrants23%

Licensees69%

Incidents by Work Setting Incidents by Work Setting 1988-1997 in Texas (n=2,126)1988-1997 in Texas (n=2,126)

Industrial46%

Medical48%

Education6%

Other0%

Summary of Reported Incidents in Texas from 1988-1997Summary of Reported Incidents in Texas from 1988-1997

Overexposure28% Misadministration

8%

Malfunction3%

Leaking Source3%

Irregularity8%

Improper Storage0%

Improper Transport0%

Equipment Damaged2%

Elevated Bioassay1%

Contamination4%

Badge Overexposure14%Source Stolen

3%

Unauthorized Possession

0%

Unauthorized Release0%

Unauthorized Source Use0%

Unauthorized Storage0%

Uranium Spill1%

Unauthorized Disposal

3%Transportation Accident

2%

Source Lost7%

Source Fire1%

Source Found4%

Source Downhole2%

Radiation Injury1%

Safety Violations0%

Source Disconnect3%

(n=2,026)(n=2,026)

Total overexposures in Texas, 1970 to 2002

0

50

100

150

200

250

300

1970 1975 1980 1985 1990 1995 2000 2005

Year

To

tal o

vere

xpo

sure

s

Total overexposures

Active Radioactive Materials Licenses In Texas, 1970 to 2000

0

200

400

600

800

1000

1200

1400

1600

1800

2000

1970 1975 1980 1985 1990 1995 2000

Year

Nu

mb

er o

f L

icen

ses

0

50

100

150

200

250

300

1970 1975 1980 1985 1990 1995 2000

Year

Ove

rexp

osur

e

0

200

400

600

800

1000

1200

1400

1600

1800

2000

Rad

ioac

tive

licen

ses

Overexposure

Radioactive licenses

Reported overexposure events compared to the number of radioactive licenses issued in Texas, 1970 to 2000

Total overexposures in Texas, 1970 to 2002

0

50

100

150

200

250

300

1970 1975 1980 1985 1990 1995 2000 2005

Year

To

tal o

vere

xpo

sure

s

Total overexposures

Radiographer training requirement

Regulatory dose limit change

Ir-19234%

U2%

Cs-13712%

P-322%

Co-6010%

Tl-2012%

Tc-998%

I-1314%

Ra-2266%

I-1254%

Am-2418%

Other8%

Overexposure Incidents in Texas 1956-2000 By Source (n=2,066)

>5rem/yr17%

>1.25rem/3month79%

>100mrem/yr4%

Overexposure Incidents in Texas 1956-2000 by Dose Rate (n = 2,066)

<5 rem82%

10-25 rem5%

25-100 rem3%

5-10 rem8%

>100 rem2%

Overexposure Incidents in Texas by Total Dose, 1956-2000 (n = 2,066)

Rig count in Texas, 1970 to 2004

0

200

400

600

800

1000

1200

1400

1970 1975 1980 1985 1990 1995 2000 2005

Year

Rig

co

un

t

Rig count

Rig count 1970 to 2004 and Total overexposures 1970 to 2002, in Texas

0

200

400

600

800

1000

1200

1400

1970 1975 1980 1985 1990 1995 2000 2005

Year

Rig

co

un

t

0

50

100

150

200

250

300

To

tal o

vere

xpo

sure

s

Rig count

Total overexposures

Rig count 1970 to 2004 and Total overexposures 1970 to 2002, in Texas

0

200

400

600

800

1000

1200

1400

1970 1975 1980 1985 1990 1995 2000 2005

Year

Rig

co

un

t

0

50

100

150

200

250

300

To

tal o

vere

xpo

sure

s

Rig count

Total overexposures

Radiographer training requirement

Regulatory does limit change

Rig count 1970 to 2007 and Total overexposures 1970 to 2002, in Texas

0

200

400

600

800

1000

1200

1400

1970 1975 1980 1985 1990 1995 2000 2005 2010

Year

Rig

co

un

t

0

50

100

150

200

250

300

To

tal o

vere

xpo

sure

s

Rig count

Total overexposures

79% exceeded quarterly 1.25 rem dose limit

17% exceeded annual 5 rem limit

Occupational Overexposure Incidents in Texas 1956-2000 by Dose Rate (n = 1,983)

Classic Heinrich’s ratio – for every 1 major accident, there were likely 30 minor events and perhaps 300 unsafe acts. An especially useful concept for rare events, by monitoring for the precursors to the major accident. The problem is…..

17% exceeded annual 5 rem limit

Occupational Overexposure Incidents in Texas 1956-2000 by Dose Rate (n = 1,983)

The baseline surveillance indicator of “unsafe acts” for radiation doses is now missing!

Misadministrations & Dose Misadministrations & Dose IrregularitiesIrregularities

Misadministrations & Dose Misadministrations & Dose IrregularitiesIrregularities

Misadministrations & Dose Misadministrations & Dose IrregularitiesIrregularities

Stolen Source Events

From Home1%

Left Unsecured1%

From Vehicle49%

With Vehicle22%

In Transit71%

From Work Site27%

Fig. 5 Characteristics associated with reported stolen source events in Texas, 1956-2000 (n=113)

Reported Stolen Source Events in Texas, 1956 to 2000 by transporter (n=64)

Licensee97%

Common Carrier0%

Unspecified3%

Summary Observations

The collective performance of the radiation safety profession (inclusive of regulators and permitted community) has been very good, and should be considered a model for other public health efforts.

The ultimate outcome, overexposures, has dramatically decreased as a rate over time.

Longitudinal data analysis affords the identification of some interesting trends and commonalties that can be used to further improve the process

Putting Radiation Risks Into Perspective: The Public Health Significance of Workplace Safety

In 2007 there were: 5,657 workplace fatalities

That’s 15 people per day that left for work and didn’t come home

4,002,700 recordable workplace injuries or illnesses That’s a workplace injury or illness being recorded

every 10 seconds

Fires, which are only one of many property “perils", resulting in $14,639,000,000 in direct property loss

Sources bls.gov, nfpa.org

Special UT SPH Student Acknowledgment

Special thanks goes to the students who collectively worked on the assembly of this data for the benefit of their academic pursuits and the State of Texas

ReferencesEmery, R.J., Pollock, J., Charlton, M., "Notices of Violation Issued to Texas Radioactive Material Licensees Inspected in 1995", Health Physics, 73(4): 706-709, 1997.

Emery, R.J., Charlton, M.A., Goodman, G.R., “Texas Radiation Safety Program Outcomes as Indicated by Regulatory Compliance Activities from 1988 to 1997” Health Physics, 78(3): 335-342, 2000.

Emery, R.J., Charlton, M.A., Mathis, J.L, "Estimating the Administrative Cost of Regulatory Noncompliance: A Pilot Method for Quantifying the Value of Prevention", Health Physics 78(Supplement 2): S40-S47, 2000.

Emery, R.J., Charlton, M.A., Orders, A. B., Hernandez, M. "Using Fault Tree Analysis to Identify Causes of Non-Compliance: Enhancing Violation Outcome Data for the Purposes of Education and Prevention" Health Physics, 80(Supplement 1): S16-S21, 2001.

Charlton, M.A., Emery, R.J., "Radioisotope Misadministration and Dose Irregularity Trends in Texas" Health Physics, 81(5): 585-591; 2001.

Emery, R.J., Orders, A.O., Charlton, M.A. "Piloting a New Radiation Protection Program Strategy: Rewarding Compliance Rather Than Sanctioning Non-compliance "Health Physics, 82(Supplement 1):S18-S22; 2002.

ReferencesEmery, R.J., Orders, A.B., McCrary, J.R., Charlton, M.A. "An Evaluation and Comparison of Compliance Inspection Outcome Data for Radiation Protection Programs in Maine and Texas" Health Physics, 82(3): 395-399, 2002.

Emery, R.J., Orders, A.O., Charlton, M.A., "Texas Dental X-ray Compliance: An Analysis of Trends for the Purposes of Education and Prevention" Texas Dental Journal, 119(9) 916-921, 2002.

Maness, K., Emery, R.J., Casserly, D., “An Analysis of 45 Years of Reported Overexposure Incidents in Texas, 1956 to 2001” Health Physics Journal, 86(2): 197-202, 2004.

Brown, B.J., Emery, R.J., Stock, T., Lee, E.S., “Radiation Protection Program Outcomes as Assessed by the Results of Compliance Inspections in Washington, as Compared to the States of Texas and Maine”. Health Physics Journal, 86(3):308-315; 2004.

Emery, R.J., Valizadeh, F., Kennedy, V., Shelton, A. “An Analysis of Variables Influencing the Number of Radiation Overexposure Events in Texas from 1970 to 2000” Health Physics Journal, in press.

Korshukin, M., Emery, R.J., “An Analysis of Reported Events of Stolen Sources of Radioactivity in Texas from 1956 to 2000 “ Health Physics Journal, in publication.