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Liu G, Li Y, Zhang H, Zhang X, Liu YY, Wu XQ, Niu LM, Zhang R. Thyroid dose assessments due to inhalation of 131I for nuclear medicine workers. Front Public Health 2022; 10:1027782. [PMID: 36544792 PMCID: PMC9760871 DOI: 10.3389/fpubh.2022.1027782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/07/2022] [Indexed: 12/09/2022] Open
Abstract
Background In general, medical staff who work in nuclear medicine should be entirely safe in their professional environment. Nevertheless, we already know that the working environment of the nuclear medicine staff is not completely safe due to the handling of high amounts of radionuclides for diagnostic and therapy applications, which is especially relevant for 131I (as a non-sealed source). Purpose The goal of this study was to assess the inhaled 131I thyroid dose in nuclear medicine workers and to introduce a simple method for internal exposure monitoring. Methods Using 2-IN*2-in NaI (Tl) scintillation spectrometer and its supporting software (InSpector Maintenance Utility and Genie 2000), from 2019 to 2021, internal thyroid irradiation monitoring, an internal thyroid irradiation monitoring investi A NaI (Tl) scintillation spectrometer and its sugation was carried out for 3 consecutive years, between 2019 and 2021, in staff members of nuclear medicine departments engaged with iodine therapy. Results 131I activity was found highest in the thyroid of nuclear medicine workers involved with the manual packaging and delivery of the radioisotope, while it was not detected in staff members involved with the automatic packaging and drug delivery. The activity range was found to be 30.00 ± 6.60-6070.00 ± 1335.40 Bq for the exposed personnel, and the estimated dose was 0.05-6.77 mSv. In 2021, three workers had an annual equivalent dose above 5 mSv. Conclusion By monitoring the thyroid 131I in staff members of the nuclear medicine department, it was found that there are 131I internal occupational exposure risks. The best solution is automatic packaging and drug delivery.
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Brudecki K, Kowalska A, Zagrodzki P, Szczodry A, Mroz T, Janowski P, Mietelski JW. Measurement of 131I activity in thyroid of nuclear medical staff and internal dose assessment in a Polish nuclear medical hospital. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2017; 56:19-26. [PMID: 28040836 PMCID: PMC5315721 DOI: 10.1007/s00411-016-0674-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 12/19/2016] [Indexed: 05/15/2023]
Abstract
This paper presents results of 131I thyroid activity measurements in 30 members of the nuclear medicine personnel of the Department of Endocrinology and Nuclear Medicine Holy Cross Cancer Centre in Kielce, Poland. A whole-body spectrometer equipped with two semiconductor gamma radiation detectors served as the basic research instrument. In ten out of 30 examined staff members, the determined 131I activity was found to be above the detection limit (DL = 5 Bq of 131I in the thyroid). The measured activities ranged from (5 ± 2) Bq to (217 ± 56) Bq. The highest activities in thyroids were detected for technical and cleaning personnel, whereas the lowest values were recorded for medical doctors. Having measured the activities, an attempt has been made to estimate the corresponding annual effective doses, which were found to range from 0.02 to 0.8 mSv. The highest annual equivalent doses have been found for thyroid, ranging from 0.4 to 15.4 mSv, detected for a cleaner and a technician, respectively. The maximum estimated effective dose corresponds to 32% of the annual background dose in Poland, and to circa 4% of the annual limit for the effective dose due to occupational exposure of 20 mSv per year, which is in compliance with the value recommended by the International Commission on Radiological Protection.
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Affiliation(s)
- K Brudecki
- Institute of Nuclear Physics, Polish Academy of Sciences, Radzikowskiego 152, 31-342, Kraków, Poland.
| | - A Kowalska
- Department of Endocrinology and Nuclear Medicine, Holy Cross Cancer Center, Artwińskiego 3, 25-734, Kielce, Poland
| | - P Zagrodzki
- Institute of Nuclear Physics, Polish Academy of Sciences, Radzikowskiego 152, 31-342, Kraków, Poland
- Department of Food Chemistry and Nutrition, Medical College, Jagiellonian University, 30-688, Kraków, Poland
| | - A Szczodry
- Department of Endocrinology and Nuclear Medicine, Holy Cross Cancer Center, Artwińskiego 3, 25-734, Kielce, Poland
| | - T Mroz
- Pedagogical University in Cracow, Podchorążych 2, 30-084, Kraków, Poland
| | - P Janowski
- AGH University of Science and Technology, Mickiewicza 30, 30-059, Kraków, Poland
| | - J W Mietelski
- Institute of Nuclear Physics, Polish Academy of Sciences, Radzikowskiego 152, 31-342, Kraków, Poland
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Laffont S, Rolland Y, Ardisson V, Edeline J, Pracht M, Le Sourd S, Rohou T, Lenoir L, Lepareur N, Garin E. Occupational radiation exposure of medical staff performing ⁹⁰Y-loaded microsphere radioembolization. Eur J Nucl Med Mol Imaging 2015; 43:824-831. [PMID: 26686335 DOI: 10.1007/s00259-015-3277-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 11/27/2015] [Indexed: 01/01/2023]
Abstract
PURPOSE Radioembolization of liver cancer with (90)Y-loaded microspheres is increasingly used but data regarding hospital staff exposure are scarce. We evaluated the radiation exposure of medical staff while preparing and injecting (90)Y-loaded glass and resin microspheres especially in view of the increasing use of these products. METHODS Exposure of the chest and finger of the radiopharmacist, nuclear medicine physician and interventional radiologist during preparation and injection of 78 glass microsphere preparations and 16 resin microsphere preparations was monitored. Electronic dosimeters were used to measure chest exposure and ring dosimeters were used to measure finger exposure. RESULTS Chest exposure was very low for both products used (<10 μSv from preparation and injection). In our experience, finger exposure was significantly lower than the annual limit of 500 mSv for both products. With glass microspheres, the mean finger exposure was 13.7 ± 5.2 μSv/GBq for the radiopharmacist, and initially 17.9 ± 5.4 μSv/GBq for the nuclear medicine physician reducing to 13.97 ± 7.9 μSv/GBq with increasing experience. With resin microspheres, finger exposure was more significant: mean finger exposure for the radiopharmacist was 295.1 ± 271.9 μSv/GBq but with a reduction with increasing experience to 97.5 ± 35.2 μSv/GBq for the six most recent dose preparations. For administration of resin microspheres, the greatest mean finger exposure for the nuclear medicine physician (the most exposed operator) was 235.5 ± 156 μSv/GBq. CONCLUSION Medical staff performing (90)Y-loaded microsphere radioembolization procedures are exposed to safe levels of radiation. Exposure is lower than that from treatments using (131)I-lipiodol. The lowest finger exposure is from glass microspheres. With resin microspheres finger exposure is acceptable but could be optimized in accordance with the ALARA principle, and especially in view of the increasing use of radioembolization.
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Affiliation(s)
- Sophie Laffont
- Department of Nuclear Medicine, Cancer Institute, Centre Eugène Marquis, CS 44229, F-35042, Rennes, France
| | - Yan Rolland
- Department of Interventional Radiology, Cancer Institute, Centre Eugène Marquis, CS 44229, F-35042, Rennes, France
| | - Valérie Ardisson
- Department of Nuclear Medicine, Cancer Institute, Centre Eugène Marquis, CS 44229, F-35042, Rennes, France
| | - Julien Edeline
- University of Rennes 1, F-35043, Rennes, France.,Department of Medical Oncology, Comprehensive Cancer Center, Institute Eugène Marquis, Rennes, France.,Liver Metabolisms and Cancer, INSERM, U-991, F-35033, Rennes, France
| | - Marc Pracht
- Department of Medical Oncology, Comprehensive Cancer Center, Institute Eugène Marquis, Rennes, France
| | - Samuel Le Sourd
- Department of Medical Oncology, Comprehensive Cancer Center, Institute Eugène Marquis, Rennes, France
| | - Tanguy Rohou
- Department of Interventional Radiology, Cancer Institute, Centre Eugène Marquis, CS 44229, F-35042, Rennes, France
| | - Laurence Lenoir
- Department of Nuclear Medicine, Cancer Institute, Centre Eugène Marquis, CS 44229, F-35042, Rennes, France
| | - Nicolas Lepareur
- Department of Nuclear Medicine, Cancer Institute, Centre Eugène Marquis, CS 44229, F-35042, Rennes, France.,Liver Metabolisms and Cancer, INSERM, U-991, F-35033, Rennes, France
| | - Etienne Garin
- Department of Nuclear Medicine, Cancer Institute, Centre Eugène Marquis, CS 44229, F-35042, Rennes, France. .,University of Rennes 1, F-35043, Rennes, France. .,Liver Metabolisms and Cancer, INSERM, U-991, F-35033, Rennes, France.
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(188)Re-SSS/Lipiodol: Development of a Potential Treatment for HCC from Bench to Bedside. INTERNATIONAL JOURNAL OF MOLECULAR IMAGING 2012; 2012:278306. [PMID: 22518301 PMCID: PMC3299367 DOI: 10.1155/2012/278306] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 12/08/2011] [Accepted: 12/13/2011] [Indexed: 12/15/2022]
Abstract
Hepatocellular carcinoma (HCC) is the 5th most common tumour worldwide and has a dark prognosis. For nonoperable cases, metabolic radiotherapy with Lipiodol labelled with β-emitters is a promising therapeutic option. The Comprehensive Cancer Centre Eugène Marquis and the National Graduate School of Chemistry of Rennes (ENSCR) have jointly developed a stable and efficient labelling of Lipiodol with rhenium-188 (Eβmax = 2.1 MeV) for the treatment of HCC. The major “milestones” of this development, from the first syntheses to the recent first injection in man, are described.
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Ahmadzadehfar H, Sabet A, Wilhelm K, Biersack HJ, Risse J. Iodine-131-lipiodol therapy in hepatic tumours. Methods 2011; 55:246-52. [PMID: 21664971 DOI: 10.1016/j.ymeth.2011.05.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Accepted: 05/25/2011] [Indexed: 01/05/2023] Open
Abstract
The incidence of hepatocellular carcinoma (HCC) is worldwide sharply on the rise and patients with advanced disease carry a poor prognosis. HCC is the sixth most common cancer and the third leading cause of cancer associated deaths in the world. Intra-arterially administered (131)I-Lipiodol is selectively retained by hepatocellular carcinomas, and has been used as a vehicle for delivery of therapeutic agents to these tumours. In this review we focus on the therapeutic indications, usefulness and methods of treatment with 131-Iodine Lipiodol. The effectiveness of (131)I-Lipiodol treatment is proven both in the treatment of HCC with portal thrombosis and also as an adjuvant to surgery after the resection of HCCs. It is at least as effective as chemoembolization and is tolerated much better. Severe liver dysfunction represents theoretic contraindication for radioembolization as well as for TACE. In such cases (131)I-Lipiodol is an alternative therapy option especially in tumours smaller than 6cm.
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Raoul JL, Boucher E, Rolland Y, Garin E. Treatment of hepatocellular carcinoma with intra-arterial injection of radionuclides. Nat Rev Gastroenterol Hepatol 2010; 7:41-9. [PMID: 20051971 DOI: 10.1038/nrgastro.2009.202] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Hepatocellular carcinoma (HCC) is becoming an important public health concern. Current therapeutic options are limited and new treatments are therefore being developed. The intra-arterial treatment chemoembolization has limited efficacy and few prospects for further progress. One particularly promising, though little used, alternative to chemoembolization is radioembolization with iodine-131 ((131)I) or rhenium-188 labeled lipiodol or yttrium-90 labeled microspheres (glass or resin beads). Three randomized studies have proven the effectiveness of (131)I-lipiodol in patients with HCC-as adjuvant therapy after surgery, compared with chemoembolization, and also in patients who have portal vein thrombosis. Microspheres enable the delivery of high-dose radiation (>200 Gy) to the tumor while sparing the neighboring hepatic tissue from overexposure. Overall, the efficacy of radioembolization has been good and toxic effects have been low. These results are comparable to those obtained with chemoembolization but further improvement can be expected by combining radioembolization with standard chemotherapy or with targeted therapies, such as anti-angiogenic drugs.
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Garin E, Rolland Y, Boucher E, Ardisson V, Laffont S, Boudjema K, Bourguet P, Raoul JL. First experience of hepatic radioembolization using microspheres labelled with yttrium-90 (TheraSphere): practical aspects concerning its implementation. Eur J Nucl Med Mol Imaging 2009; 37:453-61. [PMID: 19820932 DOI: 10.1007/s00259-009-1279-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 09/07/2009] [Indexed: 12/22/2022]
Abstract
OBJECTIVES We report a first experience involving the use of (90)Y radiolabelled microspheres (TheraSphere) for the treatment of mainly primary hepatic tumours. MATERIALS AND METHODS Treatment using TheraSphere microspheres was planned in 15 patients (13 with hepatocellular carcinoma, 2 with neuroendocrine tumour metastases). The treatment was preceded by a first angiography aimed at embolizing the vascularizing arterial branches of other structures outside the liver and evaluating the percentage of pulmonary shunt by scintiscanning after perfusion with (99m)Tc-MAA. The objective of the treatment carried out during a second angiography was to deliver a dose of 120+/-20 Gy (mean+/-SD) to the target hepatic volume. RESULTS Technical difficulties were encountered in embolizing gastroduodenal or gastric branches in two patients and in one patient these led to cancellation of the treatment. A total of 14 patients were treated with an average activity of 3.18 GBq. In one patient, the injection was defective (stagnation of microspheres at the outlet of the catheter). SPECT/CT acquisitions provided important information in four patients (visualization of the gallbladder in three; visualization of the stomach in one, leading to a new coiling). The average exposure of the nuclear medicine physician carrying out the injections was 64+/-80 microSv at the fingers. A partial response was seen in six patients, stabilization in five and progression in three. One patient presented with a gastric ulcer and two showed an increase in their hepatocellular insufficiency. CONCLUSION Although sometimes technically difficult, the use of TheraSphere microspheres is a worthwhile therapeutic approach because of the low level exposure of operators and the encouraging rate of response or stabilization. The use of SPECT/CT contributes greatly to helping therapeutic planning, especially in the learning curve or when the angiographic procedure is difficult.
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Affiliation(s)
- Etienne Garin
- Department of Nuclear Medicine, Comprehensive Cancer Center Eugène Marquis, Rennes, France.
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Garin E, Bourguet P. Intra-arterial Therapy of Liver Tumours. Clin Nucl Med 2008. [DOI: 10.1007/978-3-540-28026-2_27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lambert B, Van de Wiele C. Treatment of hepatocellular carcinoma by means of radiopharmaceuticals. Eur J Nucl Med Mol Imaging 2005; 32:980-9. [PMID: 16032439 DOI: 10.1007/s00259-005-1859-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Several techniques have been developed for radionuclide therapy of hepatocellular carcinoma (HCC). Medical literature databases (Pubmed, Medline) were screened for available literature and articles were critically analysed as to their scientific relevance. In a palliative setting, intra-arterial administration of 131I-Lipiodol yields responses in 17-92% of patients. According to a randomised study, 131I-Lipiodol was far better tolerated than classic chemo-embolisation. The additive value of a single 131I-Lipiodol administration following partial liver resection for HCC was evaluated and evidence is available that adjuvant radionuclide treatment reduces the recurrence rate. Data concerning the role of 131I-Lipiodol in bridging patient to liver transplantation are scarce but suggest a potential benefit in terms of reducing the drop-out rate while patients are listed for transplantation. 188Re- and 90Y-labelled conjugates are emerging and initial clinical data are promising. Treatment of HCC with 90Y-labelled microspheres is likely as efficacious as treatment with radiolabelled Lipiodol but pretreatment 99mTc-MAA scintigraphy is required in order to exclude patients with significant lung shunting. Several antibodies targeting antigens expressed on HCC have been radiolabelled, almost exclusively with 131I, and evaluated in a preclinical or clinical setting. The use of radiolabelled Lipiodol and microspheres allows for selective targeting of HCC with limited toxicity. Prospective, randomised controlled trials demonstrating that both treatment modalities may provide a survival benefit in a palliative setting are mandatory. In addition, future research should focus on the complementary role of radionuclide treatment in patients at risk for recurrent disease following partial liver resection or while awaiting liver transplantation.
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Affiliation(s)
- Bieke Lambert
- Nuclear Medicine Division, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
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Raoul JL, Boucher E, Olivie D, Guillygomarc'h A, Boudjema K, Garin E. Association of cisplatin and intra-arterial injection of 131I-lipiodol in treatment of hepatocellular carcinoma: results of phase II trial. Int J Radiat Oncol Biol Phys 2005; 64:745-50. [PMID: 16289908 DOI: 10.1016/j.ijrobp.2005.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2005] [Revised: 09/02/2005] [Accepted: 09/04/2005] [Indexed: 01/03/2023]
Abstract
PURPOSE Intra-arterial injections of 131I-lipiodol (131I-Lip) provide an effective treatment for hepatocellular carcinoma. In hepatocellular carcinoma cell cultures, concurrent administration of cisplatin increases the cytotoxicity of 131I. The efficacy and tolerance of intra-arterial injections of 131I-Lip combined with systemic cisplatin was tested in a phase II trial. METHODS AND MATERIALS The inclusion criteria were proven unresectable nonmetastatic hepatocellular carcinoma, compensated liver disease, and adequate laboratory test findings. Treatment comprised the combination of intra-arterial injection of 131I-Lip (2.2 GBq) with intravenous infusion of low-dose cisplatin. The combined treatment could be repeated. RESULTS A total of 41 patients were included; 37 had cirrhosis and 38 had measurable tumors. One to four treatments (median, two) were given. The cisplatin dose was 75 mg for the first course and 72 mg for the second. Grade 3-4 (n/n) adverse effects were observed in 14 patients, polymorphonuclear leukocytes (3/0), platelets (5/1), asthenia (1/0), pain (1/0), and vomiting (1/0). Four patients developed pulmonary toxicity; 2 cases were likely related to 131I-Lip administration and 1 was fatal. The response rate was 47% (18 of 38), and the 1- and 2-year survival rate was 73% +/- 7% and 48% +/- 9%, respectively. CONCLUSION This combination had a tolerable toxicity profile and provided an objective response rate, warranting a phase III trial.
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Affiliation(s)
- Jean-Luc Raoul
- Department of Medical Oncology, Centre E Marquis, Rennes, France.
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Garin E, Noiret N, Malbert CH, Lepareur N, Roucoux A, Dazord L, Caulet-Maugendre S, Turlin B, Moisan A, Lecloirec J, Herry JY, Boucher E, Raoul JL, Bourguet P. Development of 99mTc labelled Lipiodol: biodistribution following injection into the hepatic artery of the healthy pig. Nucl Med Commun 2004; 25:291-7. [PMID: 15094449 DOI: 10.1097/00006231-200403000-00013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND We develop a method for the radiolabelling of Lipiodol with Tc, using a lipophilic complex, [99mTc-(S2CPh)(S3Ph)2], dissolved in Lipiodol (99mTc-SSS Lipiodol). RESULTS The labelling yield is high (96 +/- 0.8%), and the radiochemical purity satisfactory (92 +/- 2.6%). This labelling is reproducible and stable for up to 24 h in vitro. Studies carried out after injection into the hepatic artery of the healthy pig show that the biodistribution of 99mTc-SSS Lipiodol is comparable with that observed for 188Re Lipiodol. MATERIALS AND METHODS The 99mTc-SSS lipiodol was obtained after dissolving a chelating agent, previously labelled with 99mTc, in cold lipiodol. The radiochemical purity (RCP) of the labelling was checked immediately and at 24 h. The 99mTc-SSS lipiodol was injected into the hepatic artery of four healthy pigs for an ex-vivo biodistribution study. An autoradiographic study was performed in two cases. CONCLUSIONS Apart from the specific interest of a Lipiodol-bearing technetiated agent for carrying out dosimetric studies, the labelling of Lipiodol with 99mTc is a preliminary step towards the use of radiolabelling with the 188Re analogue.
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Affiliation(s)
- Etienne Garin
- Service de Médecine Nucléaire, Centre Eugène Marquis, Rennes, France.
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