Dealing with Radiological Implants and How to use the Geiger Counter

A patient who comes in s/p I 131 (radioactive iodine) treatment within a month of their treatment

Isolate the patient in an Isolation room in the ED if condition allows.  Stay 6 feet away from the patient as much as possible at all times.
Keep pregnant staff and children away from the patient.
Take geiger readings as documented below.
Call Endocrinology Consult 24/7 to make them aware the patient is in the Emergency Department also page the Radiation Safety Officer (RSO).
If the patient needs admission, admit them to the “Radiation Room” on A3 OR a private room if this is not available.
If it was a patient recently discharged from EHC and needs admission – re-admit the patient back to the room from where they were discharged.
Individual Staff should have no greater than 30 minutes close contact (within 6 feet)
All trash except sharps, should be placed in a red biohazard bag near the patient’s bedside and not disposed of by housekeeping. The RSO will arrange for this trash to be picked up.

Prostatic Implants

Get readings with the Geiger Counter and call radiation safety officer.

How to use the Geiger Counter

Get the geiger counter from hospital police

Remove the red shield (do not discard)

Turn the on switch to x0.1

  1. Turn off audio
  2. Test the battery, when you press the button, the indicator should move to the battery test area of the display
  3. Press reset
  4. Make sure the f/s switch is turned to “f”
  5. Take a background reading at least 15 feet from the patient
  6. Now wand as close as possible to the affected area
  7. Look at the mR/hr area of the display (the one in the middle of the 3 arcs), look at the number and divide by 10 (you have set the machine to the “x0.1″ setting so all readings need to be divided by 10)
  8. Where the arrow settles is the reading
  9. If the indicator moves all the way to the right, change the setting from x0.1 to x1, then to x10, x100
  10. Retake the reading
  11. Take readings at 1 inch, 1 foot, and 3 feet, 6 feet, and background readings (>12 feet from patient). The best way I have found is take a piece of paper and write down the reading and the dial setting next to it and do the multiplication later  (i.e. write down that at 3 feet the dial reads 0.4 mR/hour when set at 10x, then sit down out of the room and calculate the actual 3 foot reading is 4 mR/hr).

What to do with the readings

Call or Page the radiation safety officer

Until they advise–

  • < 2mr/ hr all children and pregnant staff need to stay 6 feet from patient.
  • >2mr/ hr all staff need to stay 6 feet from the patient.
  • If the patient is in extremis, treat the patient first as radiation emission is a secondary concern and brief exposure to implants will not cause a significant exposure to staff.  Pregnant staff should not treat the patient.