Designing of High-Volume PET/CT Facility with Optimal Reduction of Radiation Exposure to the Staff: Implementation and Optimization in a Tertiary Health Care Facility in India

The potential advantages and workflow challenges of long axial field of view PET/CT

Recently developed Long (≥100 cm) axial field of view (AFOV) PET/CT scanners are capable of producing images with higher signal-to-noise ratio, or performing faster whole-body acquisitions, or scanning with lower radiation dose to the patient, compared with conventional PET/CT scanners. These benefits, which arise due to their substantially higher, by more than an order of magnitude, geometric efficiency, have been well described in the recent literature. The introduction of Long AFOV PET/CT technology into the clinic also has important implications for the design and workflow of PET/CT facilities and their effects on radiation exposure to staff and patients. Maximising the considerable benefits of this technology requires a thorough understanding of the relationships between these factors to optimise workflows while appropriately managing radiation exposure. This article reviews current knowledge on PET/CT facility design, workflows and their effects on radiation exposure, identifies gaps in the literature and discusses the challenges that need to be considered with the introduction of Long AFOV PET/CT into the clinic.

"I Pumped That Milk Off My Breast and Dumped It in Trash": Breastfeeding Experiences of Mothers Working in hospital radiation settings-A Qualitative Study

Purpose: The qualitative study was conducted to determine the breastfeeding experiences of mothers working in radiation areas in hospitals. Materials and Methods: The study was conducted in Turkey between December 2022 and February 2023 through in-depth interviews held with 13 mothers who met the inclusion criteria. The content analysis method was used in the analysis of the data. Results: As a result of the analyses of the data obtained in the interviews, four themes regarding the breastfeeding experiences of health professionals working in radiation environments in hospitals were identified. These themes were institutional/administrative obstacles, support systems, unhealthy childcare, and feeling of incompetence as a mother. The main theme of unhealthy childcare consisted of four categories, which were low-quality breast milk, toxic breast milk, frequent diseases, and future risk of cancer. The main theme of feeling of incompetence as a mother was composed of three categories, which were fear, feeling of guilt, and "Am I a mother?" The theme of institutional/administrative obstacles consisted of three categories, namely working environment, working duration, and awareness of managers. Finally, the theme of support systems included two categories, positive perceptions and negative perceptions. Conclusion: In this study, it was determined that the mothers who worked in radiation areas in hospitals experienced problems due to individual, social, and institutional factors. The main concern of the mothers was found to be hurting their infants with their breast milk. Suitable working environments and the adequacy of practices related to daycare centers, social support, and motherhood rights are the main needs of working mothers aiming to keep breastfeeding their infants.

G, Chakrabarti D, Singh PK, Mangalore S, Venkatapura R. Radiation Safety for Anesthesiologists and Other Personnel on Simultaneous PET/MRI: Possible Radiation Exposure from Patients While Performing Prolonged Duration Scans

This observational study was conducted owing to the challenges of the positron emission tomography/magnetic resonance imaging (PET/MRI) that requires longer duration scanning of radiopharmaceutical injected patient and added MRI environment. The aim of this study was to assess radiation dose at different distances from the patient and the radiation burden to anesthesiologist and other personnel in performing PET/MRI under general anesthesia or sedation. First, the pre- and postscan whole body radiation exposure (WBE) from the patient were obtained for 45 minutes (n = 109) after injection of the radiopharmaceutical. The WBE was obtained at specific distances from brain (10, 30, and 100 cm) and abdomen (10 and 30cm) of patients undergoing F18 fluorodeoxyglucose PET/MRI brain or whole body studies. Second, WBE of the anesthesiologist and other staff working was separately measured using pocket dosimeters during the whole procedure. In brain scans, the mean absorbed dose rates (ADR) of prescan (45 minutes) and postscan (45 minutes) were 44.4 and 31.1 μSv at 10 cm, 14.9 and 9.7μSv at 30 cm, and 3.5 and 2.8 μSv at 100 cm, respectively, from surface of head. Similarly, it was 54.8 and 30.3 μSv at 10 cm, 23 and 13.6μSv at 30 cm, respectively, from surface of abdomen. In WB scans, the mean ADR was higher than the brain scans. Anesthesiologist exposure overall was found to be 4.84 µSv/patient/scan (112 patients). The anesthesiologist receives a safe mean effective dose in PET/MRI scanning. With good training and adequate planning, it is possible to decrease the radiation exposure to all the concerned personnel including anesthesiologists.

Nuclear Medicine Facility Design in Indonesia Based on National Regulation and International Guidelines

Nuclear medicine is a medical science that utilizes radionuclide with gamma ray radiation energy to ionizing the patient’s object either aimed for diagnostic imaging or cancer therapy. Total number of nuclear medicine facilities in Indonesia is 17 hospitals. Unfortunately, there are only 10 hospitals that actively carrying out nuclear medicine services. In order to support the Indonesia cancer management commitment program, the Ministry of Health urges the nuclear medicine facility in Indonesia need to be improved both the quality and facility’s requirement. The standard of nuclear medicine facility services in Indonesia is regulated by the Ministry of Health decree number 008/ MENKES/SK/I/2009, yet unfortunately it has not regulated any specified facility’s technical requirements including layout design, mechanical and electrical aspects. Hence, in this research, we conducted a literature review on the nuclear medicine service facilities’ requirements, referring to the Ministry of Health, the Indonesia Nuclear Energy Agency, and the International Health Facility Guidelines. We conducted thoroughly field observations in ten nuclear medicine facilities in Indonesia to propose the technical requirements and room’s layout design recommendations for nuclear medicine facility in Indonesia. In conclusion of this investigation, the availability of room, utility and instrumentation of nuclear medicine in Indonesia mostly meet the International guidelines, except the room construction aspect. Therefore, our study will promote this shortcoming to fulfill the facility’s requirement recommendation in new regulation of nuclear medicine facilities in Indonesia in the near future for the sake of better patients’ and healthworkers’ safety.

Estimation of Radiation Exposure to Workers During [18F] FDG PET/CT Procedures at Molecular Imaging Center, Oman

Positron-emission tomography (PET) is the imaging modality of choice in oncology. In addition, there are several indications for using PET in cardiology and neurology. The main radiotracer used is the radiolabeled glucose analog [¹⁸F] fluorodeoxyglucose ([¹⁸F] FDG). The high-energy annihilation radiation from positron emission may lead to significant radiation exposure to medical imaging professionals such as technologists and staff nurses, patients, and direct acquaintances of the patient. In this cross-sectional observational study, the effective dose to workers in the Molecular Imaging Center from patients injected with [¹⁸F] FDG is assessed. Dose rates were estimated by a calibrated, portable gamma-ray survey meter at 0.3, 0.5, 1.0, and 2.0 m from 70 patients who underwent whole body [¹⁸F] FDG PET/CT procedure immediately and 2 hours post-injection. Electronic personal dosimeters were used to determine the radiation doses per PET/CT imaging for the five staff who directly involved in handling of the injected patients. The staff includes two technologists, two staff nurses, and one medical physicist. The mean dose rates from patients after injection and standard deviation (μSv/h) for the four distances were 98.1 ± 20.0, 55.3 ± 20.0, 28.2 ± 10.0, and 10.8 ± 5.0, respectively. After 2 hours, the measurements significantly dropped to 45.7 ± 10.0, 23.6 ± 10.0, 9.9 ± 4.0, and 3.7 ± 1.0 μSv/h. The average effective dose values for a technologist from injected patients throughout the procedure of PET/CT study was 4.17 μSv per study or 5 mSv/y. This is less than the annual limit recommended by the International Commission on Radiological Protection of 20 mSv/y received in the medical imaging profession.

Reduction of Radiation Exposure to Patients and Professionals by Reducing the Administered Activity of 18F-Fluorodeoxyglucose in a Positron-emission Tomography/Computed Tomography Study

AIM

With increased clinical indications for positron-emission tomography/computed tomography (PET/CT) and repeated PET/CT scans, there is a need to reduce the radiation burden to the patient, professionals as well as public. This requires a redefining of the workflow and the 18-F-fluorodeoxyglucose (18F-FDG) administered activity. The objective of our study is to observe the impact of strike out reduction of administered activity on the radiation exposure to personnel and public, as well as the absorbed dose to the patient with no compromise on image quality by increasing the image acquisition time.

MATERIALS AND METHODS

Nineteen patients evaluated in this study (11 males, 8 females) were put into two groups, namely, A and B. Patients in Group A (n = 10) were administered with 18F-FDG equivalent to the recommended dose (7-8 MBq/kg body weight) whereas patients in Group B (n = 9) were administered with 18F-FDG equivalent to half the recommended dose (3-4MBq/kg body weight). The exposure rates from the patients at the body surface and 100 cm distance were measured immediately and 1 h postinjection.

RESULTS

The average surface dose rate and 100 cm dose rate of the adult patients immediately postinjection for patients of Group A were 0.94 ± 0.19 mSv/h and 0.057 ± 0.007 mSv/h, and for Group B were 0.34 ± 0.24 mSv/h and 0.031 ± 0.01 mSv/h.

CONCLUSION

This study suggests that reduction in injected 18F-FDG activity reduces the radiation exposure rate from the patient, absorbed dose to the patient with reportable image quality.