Safety Orientation

1. Proton Therapy Center, Houston Safety Orientation Environmental Health & Safety

2. Training Objectives • Gain a general understanding of the Proton Therapy Center–Houston (PTCH) • Become aware of radiation hazards and signage at PTCH • Understand chemical and blood borne pathogen hazards and know how to protect yourself • Know how to respond to a fire or other emergency situation at PTCH

3. Proton Therapy – An Advanced Treatment • Objectives of radiation therapy are to: • Deliver a dose of radiation to the tumor • Spare normal tissues • Limit dose deposited to neighboring critical structures

4. Proton Therapy – An Advanced Treatment • Types of radiation therapy commonly used: • Photons – linear accelerators or cobalt are used to generate photons • Electrons – linear accelerators are used to generate electrons • Protons – cyclotrons or synchrotrons are used to generate protons (a synchrotron is used at the PTCH)

5. What are Protons? • Positively charged particles located in the nucleus of all atoms • Protons deposit their energy over smaller distances in the cell

6. Protons vs. Photons • Photons deposit most of their energy as entrance dose in front of the target site • vs. • Protons deposit the majority of their energy inside the tumor, sparing the surrounding tissues • Proton beams are “heavier” than photon beams resulting in less lateral scatter • Proton therapy is ideal for tumors in or near critical structures that cannot tolerate much radiation and/or are inoperable

7. What is a Gantry? • At PTCH, the term ‘gantry’ refers to the large cylinder space behind the proton treatment room where the patient will be when receiving treatment. • There are three gantries in all.

8. Radiation Areas Radiation exposure should always be kept to a level that is as low as reasonably achievable. The radiation hazards and operations at the PTCH are the same as the treatment areas at the main hospital.

9. Radiation Warning Signage • At the PTCH, we have areas that are clearly marked as radiation areas. • The type of signage that is used depends on the possible dose one might receive if they were in the area while the proton beam was active. EXAMPLES

10. Radiation Warning Signage • This sign is posted in areas where radioactive material is used or stored. • DONOT enter these areas while the beam is on. Wait until authorized personnel inform you that it is okay to enter after the beam has been turned off.

11. Radiation Warning Labels • This label is required on each container with radioactive material.

12. Radiation Monitoring Area Monitors Neutron and gamma monitors are placed on the treatment level of the facility to ensure that radiation is not escaping the confines of the shielding. Portable Monitors These will be used to conduct specific monitoring of equipment and building structures.

13. Radiation Monitoring • Personal Dosimeters • If you regularly work in the treatment areas or in the beam line (in the synchrotron or behind the gantries), you may be issued a personal radiation exposure dosimeter. • These should be worn at all times while working at the PTCH. • Contact your supervisor regarding the need for these monitoring devices. • PTCH-specific radiation training may be required to work in these areas.

14. Treatment Room Status Displays • Proton beam status displays are located on the outside and inside of the radiation areas. • They utilize colored lights to communicate the status of the proton beam and other equipment in the area.

15. Treatment Room Status Displays • In proton treatment areas, the color of the lights communicates the following: • Green Light – proton beam is off, and the area is not ready for the beam • Orange Light – proton beam is ready, and the area is ready for the beam • Red Light – proton beam is on; the beam is on in area

16. Treatment Room Status Displays • In X-ray imaging areas, the color of the lights communicates the following: • Green Light – X-rays are off; X-ray console key is turned off • Yellow Light – X-rays are ready: the high voltage generator on, the image receptor is inserted and the console key is turned on • Red Light – X-rays requested or on

17. Chemical Hazards • Chemicals can have different effects on you depending on the type of exposure you receive. • The Hazard Communication Act, or Right-to-Know Act, is in place to protect employees from hazardous chemicals. • The act mandates that employers have a written hazard communication plan, that labels and other forms of warning are used, that material safety data sheets are available, and that employee training is provided.

18. Chemical Hazards Acute effectsoccur when you sustain a short exposure to a chemical once (or a few times) and it has an adverse effect on you. • Example: Exposure to concentrated acid would burn your skin.

19. Chemical Hazards Chronic effects occur when you are exposed to a chemical multiple times over a long period of time and it has an adverse effect on you. • Example: Exposure to benzene over a long period of time is known to increase the risk of developing leukemia.

20. Exposure If you are exposed to a chemical, the exposure severity depends on three factors: Dose – how much of the chemical gets on or in you Toxicity – how hazardous the chemical is Length of exposure – how long the chemical is on or in you

21. Routes of Entry • If you reduce any of these, you reduce the chemical’s affect on you: • Inhalation • Absorption • Ingestion • Injection

22. Protecting Yourself from Chemical Hazards • Use the least hazardous chemical possible • Use existing engineering controls (chemical fume hood, local exhaust) • Wear the appropriate personal protective equipment

23. Protecting Yourself from Chemical Hazards • If you find a chemical spill by seeing it and/or smelling it: • Secure the location • Leave the area • Call Environmental Health & Safety at 713-792-2888

24. Health Hazards • Irritants cause discomfort to the skin or respiratory system • Sensitizers may produce an increasingly severe, allergy-like reaction with each successive contact • Carcinogens cause cancer in humans or animals • Corrosives can cause severe chemical burns to the skin, eyes and mucous membranes

25. Physical Hazards • Flammable liquids readily ignite at temperatures less than 100F (e.g. ethanol) • Combustible liquids readily ignite at temperatures greater than 100F (e.g. diesel) • Oxidizers create exothermic reactions that make fires burn more fiercely (e.g. chlorine) • Compressed gases are contained in tanks/bottles and are pressurized (e.g. oxygen)

26. Physical Hazards • Reactive materials are chemicals that react with air or water (e.g. sodium metal) • Incompatible materials react with each other (e.g. sulfuric acid and water)

27. Material Safety Data Sheets • MSDS provide standardized information on chemical hazards, such as: • Hazards identification • First aid information • Exposure controls, personal protection • Stability and reactivity • Information on specific chemicals stored and/or used at PTCH can be found by reviewing the emergency preparation plan or by using the internet and accessing the following website: http://hq.msdsonline.com/mdanderson

28. Labeling • Labels should include the following information: • Identity of the hazardous chemical(s) • Appropriate physical and health hazard warnings • Secondary containers must be compatible and properly labeled.

29. Personal Protective Equipment (PPE) • Safety gloves or face shield • Gloves – pick the right glove for the task • Lab coat or coveralls • Long pants • Closed-toe shoes • Respirator – fit testing, training and medical evaluation required before wearing a respirator

30. Responding to a Chemical Spill • Leave the area and secure the location by closing the door • Contact Environmental Health and Safety by calling 713-792-2888 • EH&S will send a representative to clean up the spill. We are available 24 hours a day, 7 days a week.

31. Responding to a Chemical Spill • When you call, provide: • Your name • A phone number where you can be reached • Room number of the spill • Chemical name • Approximate amount spilled • EH&S will send a representative to clean up the spill. We are available 24 hours a day, 7 days a week.

32. If a Chemical is Spilled on You • Wash the affected area or eyes for 15 minutes with water at the safety shower/eye wash locations at PTCH • Notify your supervisor after getting first aid • Contact Employee Health & Well Being at 713-792-6900 • Contact Environmental Health & Safety for cleanup at 713-792-2888 • Call 911 if there is a medical emergency related to the spill

33. Chemical Disposal • Do not keep old or unwanted chemical substances • Complete a “hazardous waste” label and place it on the container • Go to the EH&S site and fill out E-form for a hazardous waste pickup • EH&S will pick the waste up and dispose of it properly for you • DO NOTpour chemicals down a sink or storm drain

34. Chemical Storage Locations • Chemicals are stored in the following locations at the PTCH: • Physics Work Room • Patient Exam Rooms • Blood Draw Rooms • Machine Shop • Mechanical Rooms • Copier Room (toner) • Receiving Dock • Warehouse • Anesthesia Prep • Janitor Closets • Penthouse

35. Blood-borne Pathogen Hazards Human blood and body fluids will be the only substances that will contain blood-borne pathogens at PTCH. Blood-borne pathogens are spread via blood-to-blood contact. You must have broken skin (i.e. cut) that the contaminated substance contacts to contract a blood-borne pathogen.

36. Blood-borne Pathogen Hazards • Three key blood-borne pathogens are: • Human Immunodeficiency Virus (HIV) • Hepatitis B Virus (HBV) • Hepatitis C Virus (HCV) • There is a vaccine for hepatitis B available through Employee Health & Well Being. For more information, contact 713-792-6900.

37. Blood-borne Pathogen Hazards • Universal / Standard Precautions: • Follow safe work practices • Wear appropriate personal protective equipment • Use safety equipment such as hand washing sinks and sharp disposal containers • Treat all blood and body fluids as if they are infectious

38. Blood-borne Pathogen Hazards • Sharps disposal container characteristics: • Puncture resistant • Completely enclose all contents • Prevent leakage of fluids during handling and storage • Sealed lid to prevent sharps from falling out of the container and to prevent people from putting their hands in • Labeled with biohazard symbol • Red in color

39. Blood-borne Pathogen Hazards Needlestick hotline: Needlesticks should be reported to Employee Health & Well-being via the needlestick hotline pager. The number is 713-604-OUCH.

40. Fire Safety • R.A.C.E. for safety: • Rescue – Remove patients, visitors and employees from immediate danger • Alarm – Activate the fire alarm via a manual pull station • Confine – Close all doors • Extinguish – If capable using appropriate fire extinguisher or evacuate

41. Fire Safety • In the event of a fire or seeing or smelling smoke: • Immediately call 911 • Follow R.A.C.E. • Evacuate the building and meet on the southwest side of the building

42. Emergency Evacuation When evacuating the PTCH due to an evacuation announcement, use the curved stairs as a means of evacuating the Treatment level. PTCH has UTPD guards on-duty 24 hours a day/ 7 days a week to help with any emergency situation and general safety or security issues. PTCH uses a sign-in roster at the front main entry door for personnel accountability in the event of an emergency.

43. Emergency Management • PTCH Emergency Preparedness Officers: • Denise Lippy – Vice President of Operations • John Shaffer – Facilities Director • Ryan Barrett – Director of Operations • Steve Helton – Chief Financial Officer

44. Emergency Response EPOs will receive notification regarding any emergency situation affecting MD Anderson. The University of Texas Police Department will be the contact for emergency situations and, once on-site, will assist the PTCH administrator in directing activities. Emergency communications / instructions will be given via the facility’s public address system. Everyone must follow these instructions. The meeting location, in the event of an evacuation, will be the southwest parking lot, behind the building near the SCRB cooling towers.

45. Emergency Response • Severe weather – Employees should call the RING line (713-792-7464) to determine the status of the institution. Employees on-site during severe weather events may be instructed to perform tasks from their department’s emergency preparation plan. • Shelter-in-place – In the event of an outside emergency (i.e. chemical, biological, radiological materials or tornado), the building will shelter in place. Employees will proceed to the interior of the building, away from windows.

46. Emergency Response The emergency preparation plan is available to all employees; simply ask your supervisor. The emergency preparation plan is part of the PTCH safety manual.

47. Test Your Knowledge Please complete the following 20-question exam. A passing score of at least 80% is required.

48. Proton Therapy Center - Houston

49. Thank you for completing the PTCH Safety Orientation You may print your certificate from your transcript in the Education Center.Click the exit tab in the upper right corner to exit the course. Questions? Contact Environmental Health and Safety (713) 792-2888