Dose rates in nuclear medicine and the effectiveness of lead aprons: updating the department's knowledge on old and new procedures

Medical-Radiation-Shielding Film Fabricated by Imitating the Layered Structure Pattern of Abalone Shell and Verification of Its Shielding Effect

Radiation-shielding clothing for medical workers must be light and thin, thus ensuring flexibility. However, controlling the thickness and weight is limited by shielding performance requirements. This study aims to improve shielding performance by considering a shielding structure that mimics the internal structure of an abalone shell. Two shields were produced: a sheet made with a carrier process using a liquid polymer and tungsten mixture, and a fillet made by compounding the same material and laminated using a heat-treatment press after the injection process. The tungsten content and thickness were the same at 85 wt% and 0.3 mm, respectively. In the high-energy region, the shielding film based on the laminated structure of abalone shells showed a shielding rate that was higher by more than 7%. Compared to that of a 0.3 mm lead plate, the shielding ratio of the shielding film was approximately 16% lower at 120 kVp, thereby confirming the radiation-shielding effect of the layered-structure shielding film. Therefore, it is concluded that the laminated structure of the shielding film, which is identical to the internal laminated structure of the abalone shell, expands the impact area of incident radiation and attenuates the energy intensity, thereby improving the medical-radiation-shielding performance.

Radiation exposure assessment of nuclear medicine staff administering [177Lu]Lu-DOTA-TATE with active and passive dosimetry

BACKGROUND

The use of lutetium-177 (177Lu)-based radiopharmaceuticals in peptide receptor nuclear therapy is increasing, but so is the number of nuclear medicine workers exposed to higher levels of radiation. In recent years, [177Lu]Lu-DOTA-TATE has begun to be widely used for the treatment of neuroendocrine tumours. However, there are few studies evaluating the occupational radiation exposure during its administration, and there are still some challenges that can result in higher doses to the staff, such as a lack of trained personnel or fully standardised procedures. In response, this study aims to provide a comprehensive analysis of occupational doses to the staff involved in the administration of [177Lu]Lu-DOTA-TATE.

RESULTS

A total of 32 administrations of [177Lu]Lu-DOTA-TATE (7.4 GBq/session) carried out by a physician and a nurse, were studied. In total, two physicians and four nurses were independently monitored with cumulative (passive) and/or real-time (active) dosemeters. Extremity, eye lens and whole-body doses were evaluated in terms of the dosimetric quantities Hp(0.07), Hp(3) and Hp(10), respectively. It was obtained that lead aprons reduced dose rates and whole-body doses by 71% and 69% for the physicians, respectively, and by 56% and 68% for the nurses. On average, normalised Hp(10) values of 0.65 ± 0.18 µSv/GBq were obtained with active dosimetry, which is generally consistent with passive dosemeters. For physicians, the median of the maximum normalised Hp(0.07) values was 41.5 µSv/GBq on the non-dominant hand and 45.2 µSv/GBq on the dominant hand. For nurses 15.4 µSv/GBq on the non-dominant and 13.9 µSv/GBq on the dominant hand. The ratio or correction factor between the maximum dose measured on the hand and the dose measured on the base of the middle/ring finger of the non-dominant hand resulted in a factor of 5/6 for the physicians and 3/4 for the nurses. Finally, maximum normalised Hp(3) doses resulted in 2.02 µSv/GBq for physicians and 1.76 µSv/GBq for nurses.

CONCLUSIONS

If appropriate safety measures are taken, the administration of [177Lu]Lu-DOTA-TATE is a safe procedure for workers. However, regular monitoring is recommended to ensure that the annual dose limits are not exceeded.

Evaluation of annual staff doses and radiation shielding efficiencies of thyroid shield and lead apron during preparation and administration of 131I, 81Kr, and 99mTc-Labeled radiopharmaceuticals

Nuclear medicine technicians would receive unavoidable exposures during the preparation and administration of radiopharmaceuticals. Based on the staff dose monitoring, the dose reduction efficiencies of the radiation protection shields and the need to implement additional strategies to reduce the staff doses could be evaluated. In this study, medical staff doses during the preparation and administration of Tc-99 m, I-131, and Kr-81 radiopharmaceuticals were evaluated. The dose reduction efficiencies of the lead apron and thyroid shield were also investigated. GR-207 thermoluminescent dosimeter (TLD) chips were used for quantifying the medical staff doses. The occupational dose magnitudes were determined in five organs at risk including eye lens, thyroid, fingers, chest, and gonads. TLDs were located under and over the protective shields for evaluating the dose reduction efficiencies of the lead apron and thyroid shield. The occupational doses were normalized to the activities used in the working shifts. During preparation and injection of Tc-99 m radiopharmaceutical, the average annual doses were higher in the chest (4.49 mGy) and eye lenses (4 mGy). For I-131 radiopharmaceutical, the average annual doses of the point-finger (15.8 mGy) and eye lenses (1.23 mGy) were significantly higher than other organs. During the preparation and administration of Kr-81, the average annual doses of the point-finger (0.65 mGy) and chest (0.44 mGy) were higher. The significant dose reductions were achieved using the lead apron and thyroid shield. The radiation protection shields and minimum contact with the radioactive sources, including patients, are recommended to reduce the staff doses.

Evaluations for Determination of Optimum Shields in Nuclear Medicine

Background:

¹³¹I source is widely used in the treatment of hyperthyroidism and thyroid cancers. ¹³¹I emits both beta and gamma-rays. Radiation protection is considered for gamma rays emitted by ¹³¹I. It seems no special shield against ¹³¹I source to be designed.

Objective:

This research aims to evaluate determination of optimum shields in nuclear medicine against ⁹⁹Tc^m and ¹³¹I sources by dosimetric method. Additionally, Monte Carlo simulation was used to find the optimum thickness of lead for protection against ¹³¹I source.

Material and Methods:

This is an experimental research in the field of radiation protection. A calibrated model of GraetzX5C Plus dosimeter was used to measure exposure rates passing through the shields. The efficiency of the shields was evaluated against ⁹⁹Tc^m and ¹³¹I. Furthermore, Monte Carlo simulation was used to find the optimum thickness of lead for protection against ¹³¹I source.

Results:

The findings of the dosimetric method show that the minimum and maximum efficiencies obtained by the lead apron with lead equivalent thickness of 0.25 mm and the syringe holder shields with thickness of 0.5 mm lead were 50.86% and 99.50%, respectively. The results of the simulations show that the minimum and maximum efficiencies obtained by lead thicknesses of 1 mm and 43 mm were 19.36% and 99.79%, respectively.

Conclusion:

The optimum shields against ⁹⁹Tc^m are the syringe holder shield, the tungsten syringe shield, and the lead partition, respectively. Furthermore, based on simulations, the thicknesses of 11-28 mm of lead with efficiencies between 90.6% to 99% are suggested as the optimum thicknesses to protect against ¹³¹I source.

Perceptions on radioprotective garment usage and underlying reasons for non-adherence among medical radiation workers from public hospitals in a middle-income Asian setting: A qualitative exploration

Background

Radioprotective garments protect medical radiation workers from exposure to radiation at workplace. However, previous studies have found poor adherence to the use of radioprotective garments.

Objectives

We explored the perceptions and practices related to the use of radioprotective garments among medical radiation workers in public hospitals, and sought to understand the reasons for non-adherence.

Design and setting

A qualitative approach was applied by conducting face-to-face in-depth interviews with 18 medical radiation workers from three university hospitals using a semi-structured interview guide.

Results

Five themes emerged with respect to perceptions on the use of radioprotective garments: (i) the dilemmas in practising radiation protection, (ii) indication of workers' credibility, (iii) physical appearance of radioprotective garments, (iv) practicality of radioprotective garment use, and (v) impact on workflow. Actual lack of radioprotective garment use was attributed to inadequate number of thyroid shield and other garments, radioprotective garments' unsightly appearance including being dirty and defective, impracticality of using radioprotective garments for some nuclear medicine procedures, disruption of workflow because of workers’ limited movements, attitudes of workers, and organisational influences.

Conclusion

Medical radiation workers demonstrated a definitive practice of using radioprotective aprons, but often neglected to use thyroid shields and other garments. Availability and hygiene are reported as the core issues, while unclear guidelines on practical use of radioprotective garments appear to lead to confusion among medical radiation workers. To the best of our knowledge, this is the first qualitative study of its kind from a middle-income Asian setting.

An Investigation to Determine an Optimum Protective Garment Material in Nuclear Medicine

AIM

The aim of this study is to find an optimum material to protect garment for protection against ⁹⁹T^cm radionuclide.

MATERIALS AND METHODS

Monte Carlo simulation code was applied to investigate radiation attenuation of 13 shielding materials including: Ba, gray Sn, white Sn, Sb, Bi, Bi₂O₃, BaSO₄, Sn/W, Sb/W, Pb and W with thicknesses of 0.5 and 1 mm to determine an optimum protective garment material in nuclear medicine against ⁹⁹Tc^m. Furthermore, the dose enhancement on the staff body was investigated for shielding materials such as tungsten and lead.

RESULTS

The findings of the simulations show that the maximum and minimum attenuation obtained with thicknesses of 1 mm W and 1 mm BaSO₄ were 96.46% and 14.2%, respectively. The results also demonstrate that tungsten does not cause any dose enhancement on staff body but this is not true for lead. Tungsten provides the highest radiation attenuation without dose enhancement on the body of staff.

CONCLUSION

Among materials evaluated, tungsten is the optimum material and it can be applied for the design of protective garment for nuclear medicine staff against ⁹⁹Tc^m.

Work history and radioprotection practices in relation to cancer incidence and mortality in US radiologic technologists performing nuclear medicine procedures

INTRODUCTION

Technologists working in nuclear medicine (NM) are exposed to higher radiation doses than most other occupationally exposed populations. The aim of this study was to estimate the risk of cancer in NM technologists in relation to work history, procedures performed and radioprotection practices.

METHODS

From the US Radiologic Technologists cohort study, 72 755 radiologic technologists who completed a 2003-2005 questionnaire were followed for cancer mortality through 31 December 2012 and for cancer incidence through completion of a questionnaire in 2012-2013. Multivariable-adjusted models were used to estimate HRs for total cancer incidence and mortality by history of ever performing NM procedures and frequency of performing specific diagnostic or therapeutic NM procedures and associated radiation protection measures by decade.

RESULTS

During follow-up (mean=7.5 years), 960 incident cancers and 425 cancer deaths were reported among the 22 360 technologists who worked with NM procedures. We observed no increased risk of cancer incidence (HR 0.96, 95% CI 0.89 to 1.04) or death (HR 1.05, 95% CI 0.93 to 1.19) among workers who ever performed NM procedures. HRs for cancer incidence but not mortality were higher for technologists who began performing therapeutic procedures in 1960 and later compared with the 1950s. Frequency of performing diagnostic or therapeutic NM procedures and use of radioprotection measures were not consistently associated with cancer risk. No clear associations were observed for specific cancers, but results were based on small numbers.

CONCLUSION

Cancer incidence and mortality were not associated with NM work history practices, including greater frequency of procedures performed.

Answers to if the Lead Aprons are Really Helpful in Nuclear Medicine from the Perspective of Spectroscopy

Wearing lead X-ray-protective aprons is a routine in nuclear medicine department in parts of China. However, the staff are often perplexed by questions such as if it is imperative to wear aprons when injecting radioactive drugs, how much radiation dosage can be shielded and if the apron will produce secondary radiation instead? To answer these questions, a semiconductor detector was employed to record different gamma and X-ray spectra with and without the lead apron or lead sheet. Then, we could estimate the signal shielding ratio to different photons for the lead apron and compare with the hospitals measured data. In general, the two results coincided well. The spectral results showed that the detrimental secondary X-rays irradiation rises when the energy of gamma rays exceeds the K absorption edge of lead (88 keV). Moreover, the aprons are not so effective for gamma rays of 364 keV emitted from 131I and 511 keV emitted from the positron radioactive nuclides. This work is purely a physical measurement in the laboratory. To the best of our knowledge, this is the first quantitative study on the level of gamma rays protection offered by the medical lead aprons and the importance of the spectroscopic measurements is discussed in this paper.

Historical Patterns in the Types of Procedures Performed and Radiation Safety Practices Used in Nuclear Medicine From 1945-2009

The authors evaluated historical patterns in the types of procedures performed in diagnostic and therapeutic nuclear medicine and the associated radiation safety practices used from 1945-2009 in a sample of U.S. radiologic technologists. In 2013-2014, 4,406 participants from the U.S. Radiologic Technologists (USRT) Study who previously reported working with medical radionuclides completed a detailed survey inquiring about the performance of 23 diagnostic and therapeutic radionuclide procedures and the use of radiation safety practices when performing radionuclide procedure-related tasks during five time periods: 1945-1964, 1965-1979, 1980-1989, 1990-1999, and 2000-2009. An overall increase in the proportion of technologists who performed specific diagnostic or therapeutic procedures was observed across the five time periods. Between 1945-1964 and 2000-2009, the median frequency of diagnostic procedures performed substantially increased (from 5 wk to 30 wk), attributable mainly to an increasing frequency of cardiac and non-brain PET scans, while the median frequency of therapeutic procedures performed modestly decreased (from 4 mo to 3 mo). Also a notable increase was observed in the use of most radiation safety practices from 1945-1964 to 2000-2009 (e.g., use of lead-shielded vials during diagnostic radiopharmaceutical preparation increased from 56 to 96%), although lead apron use dramatically decreased (e.g., during diagnostic imaging procedures, from 81 to 7%). These data describe historical practices in nuclear medicine and can be used to support studies of health risks for nuclear medicine technologists.

An evaluation of the shielding effectiveness of lead aprons used in clinics for protection against ionising radiation from novel radioisotopes

The purpose of this study is to evaluate the effectiveness of personal radiation shields currently worn in hospital and other diagnostic environments. This study was performed with four different radioisotopes; (18)F, (99m)Tc, (124)I and (131)I. (18)F results showed a decrease in dose with 0.5-mm Pb shielding but the reduction provided does not warrant its use clinically. (124)I testing demonstrated that dose enhancement can occur in greater shield thicknesses. PET isotope (124)I can be adequately shielded using 0.25-mm Pb equivalent aprons but any higher thickness increase the wearer's dose. As a result more shielding does not always equal more protection. The (131)I test showed that no dose reduction occurred, even when tested with up to 1.25-mm Pb equivalent shielding. Novel radioisotopes being used in the laboratory and clinic should be individually tested as each requires specific shielding testing.