Radiation Protection in Radionuclide Imaging and Therapy

HTI37103 Radiation Protection
Lecture 9
Radiation Protection in
Radionuclide Imaging
and Therapy
Dr. Marco TAM

Dose Concerns in Radionuclide Imaging
➢ Use of different types of
radionuclides for medical
imaging and radiation therapy
➢ SPECT/CT and PET/CT are

examinations that include
both Nuclear Medicine and
CT components
➢ Production and preparation of
radiopharmaceuticals from
generators and/ or cyclotrons
➢ Storage of radionuclides
➢ RP in patients and staff

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS
Radiopharmaceuticals
Radiopharmaceuticals used in nuclear medicine can
be classified as follows:
➢ Ready-to-use radiopharmaceuticals
e.g. 131I- MIBG, 131I-iodide, 201Tl-chloride, 111In- DTPA
➢ Instant kits for preparation of products
e.g. 99mTc-MDP, 99mTc-MAA, 99mTc-HIDA,
111In-Octreotide
➢ Kits requiring heating

e.g. 99mTc-MAG3, 99mTc-MIBI
➢ Products requiring significant Tc-99m generator
manipulation
e.g. labelling of blood cells, synthesis and labelling of
radiopharmaceuticals produced in house
12
Sealed Sources in Nuclear Medicine
• Sealed sources used for

calibration and quality control
of equipment (Na-22, Mn-54,
Co-57, Co-60, Cs-137, Cd-109,
I-129, Ba-133, Am-241).
• Point sources and anatomical
markers (Co-57, Au-195).
• The activities are in the range 1
kBq-1GBq.
4
Approximate radiation dose to adults from
diagnostic nuclear medicine procedures
11
PET/CT and SPECT/CT Examination
➢ There is an increasing use of combined PET/CT or
SPECT/CT scanners where the CT component is used
to provide accurate data for attenuation correction
purposes and for dual-modality images (often called
fusion images).
➢ The effective dose to the patient from the CT
component may be larger than that from the
administered radiopharmaceutical.
➢ The CT exposure factors (kVp, mA, time per rotation
and pitch) need to be optimised so that the absorbed
dose from the CT component is minimised whilst still
obtaining the required information.
➢ This is particularly important for examinations on
paediatric patients, who may also be at greater risk
from stochastic effects than the general population. 38

PET/CT and SPECT/CT Examination
➢ Accordingly, protocols should be developed for
all common procedures involving CT using
Automatic Exposure Control wherever possible.
(ICRP 2000b, ICRP 2007a).
➢ If the CT component of the apparatus is
capable of producing diagnostic quality images,
the guidance provided in the Safety Guide for
Radiation Protection in Diagnostic and
Interventional Radiology (ARPANSA 2008c)
should be followed.
39

Typical Effective Dose Values for Common PET/CT investigations
(Contributor: PET procedures)
8
Typical Effective Dose Values for Common SPECT/CT investigations
(Contributor: SPECT procedures)
9
Typical Effective & Organ Dose Values for Common diagnostic CT
investigations
Investigation Effective dose (mSv) Organ absorbed

doses (mGy)
Head CT 2 Lens: 41.2, Thyroid:
2.2
Chest CT 8 Breast: 13.3, Thyroid:
1.4, Lens: 0.1
Abdomen CT 10-15 Uterus and Ovaries:
7.5, Testis: 0.6
Pelvis CT 10-15 Uterus and Ovaries:
24, Testis: 1.6
Whole body CT 20-30
1
DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS0
Classification of Radiotoxicity in Radiotracers
Definition of Radiotoxicity:
The radiotoxicity of a radionuclide is the risk that the radionuclide, following an intake
to the body, will harm the organs and tissues and, is directly related to the committed
equivalent dose to organs/ tissues (related to the ALI [Annual Limit of Intake] in Bq).
10
ICRP57 – Radionuclide Weighting Factors
• Depends on Radiation Type, Half-life, Readiness to be

absorbed by organs, Rate of Radionuclide Clearance
from body
• For Class A, usually beta radiation, several days of Half-
life, high readiness to be absorbed by organs, low rate of
radionuclide clearance from body
1
ICRP57 – Weighting Factors According to Type of Operation
1
ICRP57 – Weighted Activity and Required Facilities
Weighted activity = Activity of the Radionuclide x Radionuclide Weighting Factor x Weight Factor for Operation Type
Weighted Category Floor Surfaces Fume Room Plumbing First aid

activity cupboard ventilation
Less than 50 Low hazard Cleanable Cleanable No Normal Standard Washing
MBq facilities
50 to 50,000 Medium Non- Cleanable Yes Good Standard Washing &
MBq hazard permeable, decontamination
easily facilities
cleanable
Greater High hazard Continuous Cleanable Yes Extractor May Washing &
than 50,000 sheet fan require decontamination
MBq welded to special facilities
walls plumbing
Design of the floor
• Impervious material
• Washable
• Chemical-resistant
• Curved to the walls
• All joints sealed
• Glued to the floor
• No carpet! (Hard
to clean)
41

Design of the Walls and Ceiling
➢ Waiting / resting room

for NM patients should
be finished in a smooth
and washable surface
with joints being
sealed, wherever
practicable.
➢ Walls and ceiling
should be painted with
washable, non-porous
paint (e.g. gloss paint).
42

Worktop surfaces
➢ Worktop surfaces must be

finished in a smooth,
washable and chemical-
resistant surface with all joints
sealed. Some laminates do
not resist certain chemicals,
and the supplier should be
consulted with regard to the
specific chemicals to be used
in the laboratory. Structural reinforcement may be
necessary, since a considerable
weight of lead shielding may be
placed on counter tops.
17
Worktop surfaces
➢ Open shelving should be kept

to a minimum to prevent dust
accumulation.
➢ Services (e.g. gas, electricity,
vacuum) should not be
mounted on top of the bench,
but on walls or upstands.
➢ Surface of the bench should be
covered with waterproof and
Cover the surface with absorbing paper
disposable paper
18
Ventilation
➢ Laboratories in which
unsealed sources,
especially radioactive
aerosols or gases, may be
produced or handled
should have an appropriate
ventilation system that
includes a fume hood,
laminar air flow cabinet or
glove box.
➢ The ventilation system
should be designed such
that the laboratory is at
negative pressure relative
to surrounding areas.
19
Ventilation
➢ The airflow should be from
areas of minimal likelihood
of airborne contamination to
areas where such
contamination is likely.
➢ All air from the laboratory
should be vented through a
fume hood and must not be
recirculated either directly, in
combination with incoming
fresh air in a mixing system,
or indirectly, as a result of
proximity of the exhaust to a
fresh air intake.
46
Sinks
➢ If the Regulatory Authority
allows the release of
aqueous waste to the sewer
a special sink shall be used.
➢ Local rules for the discharge
shall be available.
➢ The sink shall be easy to
decontaminate.
➢ Special flushing units are
available for diluting the
waste and minimizing
contamination of the sink.
21
Washing Facilities
➢ The wash-up sink should be
located in a low-traffic area
adjacent to the work area.
➢ Taps should be operable
without direct hand contact
and disposable towels or hot
air dryer should be available.
➢ An emergency eye-wash
should be installed near the
hand-washing sink and there
should be access to an
emergency shower in or near
the laboratory.
22
Storage of Radioactive Substance
➢ Locked to prevent
unauthorized use and theft
➢ Warning sign
➢ Shielded to <2 µSv/h at 1m
(permanently occupied areas)
➢ Alternatively <20 µSv/h at 1 m
(temporarily occupied areas)
➢ Inventory record
➢ Be resistant to fire
40

Transportation and Receiving of Radiopharmaceuticals
➢ Inspect that the container is no leakage
➢ All radioactive materials being sent to the NM unit have to be
recorded in a log book (e.g. on a shelf nearby the radiotracer
slot) with the following information:
– Date of receiving
– Supplier
– Name of the radioisotope
– Activity (e.g. in mBq/ mCi)
– Volume, if applicable
– Signature of the person receiving the radioactive materials
➢ Check if the right radiotracers are received
➢ All radioactive materials received should be transported in
suitable lead shielding as according to the energy and
activity of the tracers.
➢ All radioactive stock shall be stored on designated room with
appropriate lead shielding, marked with “Storage for
radioactive materials”. 9
Preparation and Dispensation of Radiopharmaceuticals
➢ Shields
➢ Protective clothing
➢ Tools for remote
handling of radioactive
material
➢ Containers for radioactive
waste
➢ Dose rate monitor with
alarm
➢ Contamination monitor
➢ Decontamination kit
➢ Signs, labels and records

Administration of Radiopharmaceuticals – Lead Apron
➢ In certain circumstances staff may need to

wear a protective lead apron.
➢ This may be necessary if staff need to be
in close contact with patients containing
greater than 800 MBq of 99mTc, such as
during myocardial perfusion studies or
gated cardiac blood pool studies.
➢ Protective aprons should preferably have
a thickness of 0.5 mm lead equivalent.
Preferred designs are those comprising
a separate vest and skirt that wrap
around fully, as open back designs are
not recommended.
➢ All protective clothing should be examined
under fluoroscopy at least annually to
confirm the integrity of the protection.
26
Administration of Radiopharmaceuticals – Lead Apron
➢ Lead aprons provide little or no protection (i.e.

too thin) for higher energy photons and should not
be used for radionuclides such as gallium-67 or
iodine-131 or positron emitters (e.g. C-11, N-13,
O-15, F-18).
➢ Staff leaving designated areas should remove
protective clothing, wash their hands and monitor
their hands, clothing and body as appropriate.
➢ Mobile shielding barriers may be required for
therapeutic nuclear medicine procedures using
gamma-emitting radionuclides. 27
Radiation Protection issues in NM – Use of Lead Protection
99mTc with 140 keV photons

✓ HVL (lead) around 0.3mm
✓ Tenth-value layer (TVL) (lead) around
0.99mm
18F-FDG (PET radionuclides) with 511 keV photons
✓HVL (lead) 4mm (narrow beam) & 5mm
(broad beam)
✓TVL (lead) 13.2mm (narrow beam) &
16.5mm (broad beam)
28
Radiation Protection issues in NM – Justification
➢ When considering the justification for a medical
exposure, the benefit is weighed against the
detriment, including radiation effects.
➢ For diagnostic procedures the potential detriment
is the risk of inducing cancer.
➢ This risk is greater in children and decreases with
age.
➢ For effective doses greater than 100 mSv the
overall lifetime risk of fatal cancer is estimated
to be 5% per Sv. (ICRP 2007b)
29
Radiation Protection issues in NM – Justification (Risk Assessment)
General principles
➢ For an effective dose of 20 mSv, the nominal risk is
about 1 in 1200 for adults aged 30 to 60 years at
the time of exposure.
➢ For adults aged 70 or more the risk falls to less
than 1 in 3000.
➢ However, for children up to 10 years old the risk
is about 1 in 450 (NRPB 1993).
➢ Most diagnostic procedures in NM expose the
patient to considerably less than 20 mSv as
illustrated earlier
30
Radiation Protection issues in NM – Optimization
➢ Once clinically justified, each diagnostic

examination should be conducted so that the
dose to the patient is the lowest necessary to
achieve the clinical aim (Optimization).
➢ The quality of the images and the complexity of
the examination should be sufficient for the
intended purpose of the procedure.
31
➢ The optimization process necessarily requires a
balance between administered activity (and thus
patient radiation dose) and image quality.
➢ The activity administered should be sufficient to
produce acceptable image quality for the diagnostic
information being sought.
➢ It is important to plan the examination, including the
requirement for image quality, to fit the clinical problem.
➢ The size and age of the patient, and the time for
which the patient can comfortably remain still for the
study, will influence the activity required to be
administered.

➢ Patient activity surveys indicate wide variations in the

activity administered to patients of standard body size
(Smart and Towson 2000).
➢ This suggests that there may be scope for optimization
of patient protection and lower levels may be
acceptable in some circumstances. However, it is
important that dose reductions are not to such a
degree that an unacceptable loss of diagnostic image
quality or diagnostic information results.
➢ Local or national diagnostic reference levels be
implemented as a practical tool to aid in dose
optimization.

Radiation Protection issues in NM – Dose Limit
➢ Since patients may acquire direct benefits from

medical exposures, it is not appropriate to impose
limits on the doses received from justified
examinations.

Radiation Protection issues in NM – Administration
➢ For all unit patient doses (syringes, capsules or vials)
the patient’s name and the radionuclide and
radiopharmaceutical form should be verified on arrival
and the activity should be confirmed in a dose
calibrator prior to administration to the patient.
➢ The amount of radioactivity required for the
reconstitution of kits is based on the number of patient
doses for the day. The appropriate volume of generator
eluate, or radionuclide solution, should be withdrawn
and diluted if necessary. The withdrawal of the required
activity and subsequent reconstitution of the kit should
be performed behind a lead glass screen, preferably
using a shielded syringe. Calculations should be
checked, and the activity, volume and time recorded.
35
➢ Where possible, visual inspection of the

preparation through a lead glass shield should be
performed to confirm that the appearance
complies with the manufacturer’s specification.
➢ The total activity of the vial should be
measured and the activity, calibration and
expiry time calculated and recorded.
36
After Radiopharmaceutical administration

The patient and/or their carer should receive written
information on:
➢ the type and radioactivity of the
radiopharmaceutical administered;
➢ the date of administration;
➢ any specific radiation safety precautions;
➢ any restrictions on activities including travel home;
and
➢ how long the restrictions or precautions should last.
37
➢ The period of time during which patients (and their
family and friends) should observe the restrictions
will depend on the initial external dose rate from
the patient and the rate of clearance of the
radionuclide from the body.
➢ The recommended values are based on data from
Woodings (2004) and Woodings et al (2005) using
a dose constraint of 1 mSv (0.3 mSv for travel)
for children and members of the public, and 5 mSv
for the carer/partner (ARPANSA 2002a).
38

➢ NM patients keep ‘minimise close contact’ with
other people is to avoid spending more than 15
minutes a day within 1 metre of another person.
➢ NM patients should attempt to maintain distances
greater than 2 metres whenever possible
(including while sleeping).
39
Periods of restriction for patients receiving
radioiodine (131I) therapy for thyrotoxicosis
40
Periods of restriction (days) for
thyrotoxicosis patients to return to work
41
Periods of restriction, after discharge, for patients
receiving radioiodine (131I) therapy for thyroid
cancer after thyroidectomy
DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATI
42
CS
Periods of restriction, after discharge, for patients receiving
radioiodine (131I) therapy for thyroid cancer after
thyroidectomy
➢ Thyroid cancer patients may return to work the day after being
discharged from hospital.
➢ Flush toilet with lid closed.
➢ Travel in a private car does not give a significant dose to other people,
so long as the patient does not sit alongside the driver or passenger(s).
➢ However, public transport (airline, bus, or boat) can involve people
sitting close to each other and restrictions may be required on travel of
long duration.
➢ For long trips patients should be encouraged to find a place where
they can sit alone.
➢ Long distance travel immediately after administration is not
recommended due to the potential for travel sickness and the possibility
for contamination. 30
Number of hours of public transport allowed sitting next to
the same person
31
Radiation Protection Issues in NM – Avoidance of Conception
➢ Advice is to be given to females and males concerning
the avoidance of conception after therapeutic
administrations, if appropriate for the particular
radionuclide therapy.
➢ The period of time for which pregnancy should be
avoided is determined by the rate of clearance of the
radionuclide from the body and by the time necessary
to ensure that the underlying disease is controlled.
➢ The ICRP has recommended that a woman not
become pregnant until the potential fetal dose would
not exceed 1 mGy (ICRP 2000a).
➢ Most female patients are advised (ICRP 2004) not to
become pregnant for at least six months after
therapy with radioiodine.
32

Radiation Protection Issues in NM – Avoidance of Conception
➢ Although there is no evidence that

preconceptual irradiation of males can cause
any abnormality in their offspring, it may be
prudent to advise males receiving
radionuclide therapy to avoid fathering
children for a period of 4 months, which is
greater than the life of a sperm cell (ARSAC
2000).
33

Radiation Protection Issues in NM – Pregnant Patient
➢ If a nuclear medicine study is justified and will be
proceeded with, the administered activity should be as low
as possible, provided it is sufficient to supply the
required diagnostic information.
➢ Prior to the procedure the nuclear medicine specialist
should assess the potential dose and communicate the
risks to the mother in a meaningful manner.
➢ Individual fetal radiation dose estimates may require the
services of a nuclear medicine physicist.
➢ Fetal dose is greatly increased if there is radioiodine in the
maternal circulation once fetal thyroid function begins at
about 10 to 12 weeks gestation. To avoid serious damage
to the fetal thyroid, any procedure resulting in free 131I-
ions at that time, even in small activities, is
contraindicated (ICRP 2001).
34

➢ Before commencing a nuclear medicine procedure, every female
patient of childbearing age should be asked by the administering
person whether she is breast-feeding or caring for a young
child.
➢ Steps can then be taken (if necessary) to minimise the external
radiation dose to the child during periods of close contact with
the patient, and the internal radiation dose from ingested breast
milk.
➢ If the patient is breast-feeding, the child will receive an internal
dose from ingested breast milk in addition to an external dose
from close contact with the patient. Advice about the possible
need to restrict breast-feeding needs to be given to the patient;
this advice will depend on the radiopharmaceutical and its activity,
and should ensure that the infant will receive a total effective
dose of no more than 1 mSv.
35

Radiation Effects on the Fetus
➢ The risk from radiation is related to the fetal dose and to the stage of
pregnancy at which the exposure occurs (ICRP 2000a).
➢ Doses above thresholds of 100 mGy or more can cause failure to
implant (conceptus up to week 2 or 3 of gestation), developmental
abnormalities (embryo weeks 3 to 8) or neurological effects (fetus
weeks 8 to 25).
➢ There is evidence of a slightly increased risk of induction of
childhood cancer or leukemia for doses of more than 10 mGy. This
latter risk is considered to be uniform throughout the pregnancy after
the first 3 to 4 weeks of gestation.
➢ The life-time cancer risk following intra-uterine exposure is assumed to
be similar to that following irradiation in early childhood. In addition to
carcinogenesis, radioiodinated compounds can also cause
subsequent hypothyroidism in the infant (ICRP 2007b).
49
Therapeutic cases
➢ If the procedure is for a therapeutic radionuclide dose, the pregnancy
status of all women of childbearing age must be confirmed by a
definitive biochemical test, e.g. with a serum or urinary β-HCG test,
prior to administration of therapy radiopharmaceuticals
50
Virtual site Visit: HKU PET-CT Centre
51
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Patient toilet
Uncontrolled
area Radiation
controlled area
80
Patient Toilet
➢ A separate toilet room for the exclusive use of injected
patients is recommended.
➢ A sign requesting patients to flush the toilet well and wash
their hands should be displayed to ensure adequate dilution
of excreted radioactive materials and minimise
contamination.
➢ The facilities shall include a wash-up sink as a normal
hygiene measure.
➢ Washrooms designated for use by nuclear medicine patients
should be finished in materials that are easily
decontaminated.
➢ The patient washing facilities should not be used by hospital
staff as it is likely that the floor, toilet seat and sink faucet
handles will be contaminated frequently. 81
82
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86
Homework – Good-to-do (Blackboard)
1. How much effective dose will normally be received from SPECT/CT

or PET/CT?
2. Why lead apron is not used for some NM procedures involving high
energy photons?
3. What recommendations should be given to female and male
patients after radiopharmaceutical administration in terms of
conception?
4. What are the main points in designing PET/CT patient waiting
rooms, preparation labs and patient toilet?
5. What is the effective dose per year received by radiographers in NM
department?
The End!
85

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HTI37103 Radiation Protection

Dr. Marco TAM

➢ SPECT/CT and PET/CT are

➢ RP in patients and staff

➢ Kits requiring heating

• Sealed sources used for

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

Investigation Effective dose (mSv) Organ absorbed

• Depends on Radiation Type, Half-life, Readiness to be

Weighted Category Floor Surfaces Fume Room Plumbing First aid

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

➢ Waiting / resting room

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

➢ Worktop surfaces must be

➢ Open shelving should be kept

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

➢ In certain circumstances staff may need to

➢ Lead aprons provide little or no protection (i.e.

99mTc with 140 keV photons

➢ Once clinically justified, each diagnostic

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

➢ Patient activity surveys indicate wide variations in the

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

➢ Since patients may acquire direct benefits from

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

➢ Where possible, visual inspection of the

After Radiopharmaceutical administration

After Radiopharmaceutical administration

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

➢ Although there is no evidence that

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

DEPARTMENT OF HEALTH TECHNOLOGY AND INFORMATICS

1. How much effective dose will normally be received from SPECT/CT

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