The Six Habits of a Highly Successful RSO

Habit 1: Develop a Team Approach to Radiation Safety

To use a sports analogy, the RSO is the quarterback of a radiation safety team. But just like a quarterback, they need teammates to execute the plays, or in the case of an RSO, the radiation protection program. Senior management, administrators, physicians, nurses, technologists, and other support personnel are all involved in maintaining a high-quality radiation protection program, and the RSO must all work with them all to build a trusting relationship, as any team leader must.

While Apex and Krueger-Gilbert encourage RSOs to make radiation safety their primary focus, in many cases, an RSO has another full-time job (physician, physicist, nuclear medicine technologist), so they require the help of other team members to keep the program in compliance and keep patients and staff safe. Highly effective RSOs who regularly hold meetings, engage team members, and hold them accountable for their roles in the radiation protection program will have better results and fewer incidents.

Habit 2: Focus on Physical Presence

The US Nuclear Regulatory Commission (NRC) regulations governing RSOs do not specify a minimum time requirement to fulfill the role, but the NUREG 1556 guidance documents dictate that the RSO “be on site periodically to conduct meaningful, person-to-person interactions” with medical facility personnel.

In short, the more visible and widely known the RSO is as the expert on radiation safety in a medical facility, the more opportunities the RSO has to see, hear, and be asked about radiation safety. Factors involved with safety include proper signage, the wearing of dosimetry badges, the proper storage of radioactive materials, and the adherence to and testing of procedures. An RSO must have a regular presence on site, which can vary based on the medical facility’s complexity, to be highly effective.

Habit 3: Invest in Radiation Safety Expertise

While the basics of radiation safety don’t tend to change, radiation safety is a complex field with ever-changing regulations and new procedures developed and recommended by organizations like the American College of Radiology and the NRC. As mentioned in part 1, the competency required to be the RSO for a small physician group is very different from the competency required for a large research hospital.

Even within a medical facility, an RSO may not have the requisite expertise for all ionizing radiation uses under the license. For example, new types of isotopes for imaging and treatment require updated policies and new training for anyone using these isotopes. A highly effective RSO knows what they don’t know and will invest in engaging relevant experts to supplement their knowledge and maintain high standards in their radiation protection program.

Habit 4: Foster Senior Management Buy-In

While the RSO has the authority and responsibility for the day-to-day management of the radiation protection program, senior management retains the ultimate responsibility. More importantly, their engagement and support of the RSO and the radiation protection program can help bolster participation in and compliance with various policies and procedures. Senior management abdicating responsibility for radiation safety can lead to trouble: fines, revoked accreditation, or, most importantly, incidents that cause negative health effects.

Highly effective RSOs seek appropriate and ongoing engagement with senior management on policies, procedures, and initiatives designed to increase safety and compliance in the radiation protection program. An effective RSO should coordinate with senior management on quarterly (or more frequent) reviews to identify areas for improvement and reveal how fewer issues in the radiation protection program contribute to higher overall quality and reduced incidents.

Habit 5: Commit to Ongoing Training

Aside from physical presence, training is the most critical aspect of ensuring the quality and compliance of an RSO’s radiation protection program. Given constant changes in regulations and procedures, medical facility personnel cannot always be trusted to remember all of the various policies and procedures related to radiation safety. They may forget what to do or who to notify in case of a spill or misadministration of ionizing radiation.

Regular and continuous training in various formats combats these lapses and reinforces a culture of compliance within a medical facility that extends to all personnel. Highly effective RSOs train, train, and then train some more! They find training opportunities at all times, and their programs benefit from that commitment to training.

Habit 6: Establish a Succession Plan for RSO

Highly effective RSOs begin with the end in mind. Recognizing the significant educational and competency requirements, including a preceptor RSO (i.e., cosigner) for a new RSO’s competency and training, highly effective RSOs work with senior management to identify future staff members or third-party consultants who can serve as RSO in case of a job transition, incapacity, or other extenuating circumstances. Recognizing a need for clear succession plans, the NRC has recently allowed sites to designate an assistant RSO to fill in for the primary RSO when necessary. 

The panic that we have witnessed firsthand when an RSO is suddenly unable to serve is palpable and is completely unavoidable. Radiation protection programs suffer when the entire program is dependent only on the RSO and has no plans for succession.

In closing, the RSO role is vital to our medical facilities today and needs to be understood by those working closely with them. By understanding the RSO 101 basics and using the six habits, your facility can be well on its way to radiation safety success!