What is ALARA (As Low As Reasonably Achievable) and why do surveyors ask for evidence about policies and practices? The guiding principle of radiation safety is “ALARA”. ALARA means avoiding exposure to radiation that does not have a direct benefit to you, even if the dose is small.
In July of 2015, the Center for Medicare and Medicaid Services (CMS) implemented standards that require radiology services to maintain proper safety precautions against radiation hazards. Surveyors will verify that the organization has written policies, procedures, and protocols that address the ALARA principles and any other safety and risk-reduction measures that are in place. ALARA radiation safety practice minimizes radiation doses and releases of radioactive materials using all reasonable methods available. Surveyors will also ask for evidence that the safety protocols are reviewed periodically and updated if applicable. Nuclear medicine services are included as well.
So, what are the ALARA Principles? The ALARA principles for radiation safety are comprised of three main elements. For reducing unsafe exposure, the three principles are: time, distance and shielding.
Time
Radiation exposure can be accumulated over the time of exposure. The longer the exposure time is, the more radiation the patient or personnel will be exposed to. Think about it in terms of being exposed to the sun. The longer you are outside and exposed to the sun, the greater the chances are that you will incur a sunburn.
Radiation exposure can be accumulated over the time of exposure. The longer the exposure time is, the more radiation the patient or personnel will be exposed to. Think about it in terms of being exposed to the sun. The longer you are outside and exposed to the sun, the greater the chances are that you will incur a sunburn.
Distance
A greater distance from the radiation source can reduce radiation exposure. Think about if you are sitting very close to a fireplace. You feel the intensity of the heat that it generates. Now when you move across the room the heat isn’t as intense and may even be more comfortable. Increase your distance and you decrease your dose.
A greater distance from the radiation source can reduce radiation exposure. Think about if you are sitting very close to a fireplace. You feel the intensity of the heat that it generates. Now when you move across the room the heat isn’t as intense and may even be more comfortable. Increase your distance and you decrease your dose.
Shielding
Shielding is using radiation protective devices for radiation protection. This applies to patients as well as personnel and providers. These devices must be kept in good working order and be evaluated routinely for their ability to protect those from ionizing radiation.
Shielding is using radiation protective devices for radiation protection. This applies to patients as well as personnel and providers. These devices must be kept in good working order and be evaluated routinely for their ability to protect those from ionizing radiation.
The CMS regulations for ALARA principles can be found under §482.26. Hospitals are expected to apply the fundamental principles of ALARA to minimize the risks of radiation exposure and maximize patient safety. A policy demonstrating the level of commitment to radiation safety, including ALARA principles, should be available for review by the survey team. The American College of Radiology has sample policies available for your review, if needed.
Image Gently and Image Wisely are programs focusing on educating personnel on radiation safety practices and are supported by the American College of Radiology. These web-based programs are free. Surveyors may ask for evidence that your radiology technicians have completed these programs demonstrating knowledge in exposure reduction principles. There are case studies available in Nuclear Medicine and Fluoroscopy as well.
Healthcare facilities must adopt and implement radiologic services policies and procedures that provide safety for affected patients and hospital personnel which are consistent with accepted professional standards for radiologic services. The department Radiation Safety Officer is responsible for establishing and overseeing operating and safety procedures that maintain radiation exposures as low as reasonably achievable (ALARA) and should review them regularly to ensure that the procedures are current and conform with regulations. Accrediting organizations, assure you are following ALARA principles in protocols, policies, and practices, to keep radiation exposure at a minimum for patients, personnel, and providers.
References
American College of Radiology (2021 Revision) ACR-AAPM Radiation Safety Officer Resources
Center for Disease Control and Prevention, Radiation Safety: ALARA – As Low As Reasonably Achievable, last review 5/17/22
Center for Medicare and Medicaid Services, Standard Operating Manual (2/21/20 Edition) §482.26(b) Radiology Services Interpretive Guidelines
Image Gently; imagegently.org
Image Wisely; imagewisely.org
National Institute of Health, ALARA and an integrated approach to radiation protection, PMID: 3961515
American College of Radiology (2021 Revision) ACR-AAPM Radiation Safety Officer Resources
Center for Disease Control and Prevention, Radiation Safety: ALARA – As Low As Reasonably Achievable, last review 5/17/22
Center for Medicare and Medicaid Services, Standard Operating Manual (2/21/20 Edition) §482.26(b) Radiology Services Interpretive Guidelines
Image Gently; imagegently.org
Image Wisely; imagewisely.org
National Institute of Health, ALARA and an integrated approach to radiation protection, PMID: 3961515