Radiation Protection in Nuclear Medicine PDF
Preview Radiation Protection in Nuclear Medicine
Radiation Protection in Nuclear Medicine . € Soren Mattsson (cid:129) Christoph Hoeschen Editors Radiation Protection in Nuclear Medicine Editors S€orenMattsson ChristophHoeschen MedicalRadiationPhysics HelmholtzZentrumM€unchen DepartmentofClinicalSciencesMalm€o DeutschesForschungszentrumf€ur LundUniversity GesundheitundUmwelt(GmbH) Ska˚neUniversityHospitalMalm€o Ingolst€adterLandstr.1 SE-20502Malm€o DE-85764Neuherberg Sweden Germany ISBN978-3-642-31166-6 ISBN978-3-642-31167-3(eBook) DOI10.1007/978-3-642-31167-3 SpringerHeidelbergNewYorkDordrechtLondon LibraryofCongressControlNumber:2012948005 #Springer-VerlagBerlinHeidelberg2013 Thisworkissubjecttocopyright.AllrightsarereservedbythePublisher,whetherthewholeorpart of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation,broadcasting,reproductiononmicrofilmsorinanyotherphysicalway,andtransmissionor informationstorageandretrieval,electronicadaptation,computersoftware,orbysimilarordissimilar methodologynowknownorhereafterdeveloped.Exemptedfromthislegalreservationarebriefexcerpts inconnectionwithreviewsorscholarlyanalysisormaterialsuppliedspecificallyforthepurposeofbeing enteredandexecutedonacomputersystem,forexclusiveusebythepurchaserofthework.Duplication ofthispublicationorpartsthereofispermittedonlyundertheprovisionsoftheCopyrightLawofthe Publisher’s location, in its current version, and permission for use must always be obtained from Springer.PermissionsforusemaybeobtainedthroughRightsLinkattheCopyrightClearanceCenter. ViolationsareliabletoprosecutionundertherespectiveCopyrightLaw. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publicationdoesnotimply,evenintheabsenceofaspecificstatement,thatsuchnamesareexempt fromtherelevantprotectivelawsandregulationsandthereforefreeforgeneraluse. While the advice and information in this book are believed to be true and accurate at the date of publication,neithertheauthorsnortheeditorsnorthepublishercanacceptanylegalresponsibilityfor anyerrorsoromissionsthatmaybemade.Thepublishermakesnowarranty,expressorimplied,with respecttothematerialcontainedherein. Printedonacid-freepaper SpringerispartofSpringerScience+BusinessMedia(www.springer.com) Preface Radiation protection is an important task for nuclear medicine departments with regard to the use of radiopharmaceuticals for diagnostic and therapeutic purposes. It is important to make sure that the radiation dose to the patients as well as to staff members is kept “as low as reasonable achievable” (ALARA). In the last few years, the use of PET substances with higher photon energy than the previously used radionuclides has been more and more common, and the number of PET radionuclides is increasing. There is a sudden appearance of multimodal PET/CT and SPECT/CT scanners. New radiopharmaceuticals for targeted radio- nuclide therapy are introduced. Radiotracers are more and more used in surgical practices like identification of lymph node involvement in breast cancer and colon cancer, etc. The staff will be exposed to radiation during production, labeling, transport, injection, and when being close to the patients. The increased use of PET-imaging causes a need for new planning of radiation protection and education of all categories of staff members. This was the reason for choosing the topic of radiation protection in nuclear medicine for the second training course organized by the MADEIRA (Minimizing Activities and Doses by Enhancing Image quality in Radiopharmaceutical Administration) project, cofunded by the European Commission through the EURATOM Seventh Frame- work Programme. Thisbookisthesecondbookofaseriesofthreecorrespondingtosuchtraining courses.Itpresentsarticlesrelatedtoquantitiesandunitsaswellasbasicradiobi- ologyforradiationprotection.Thereisaspecialchapterabouttheradiobiologyand dosimetry for the lens of the eye and another one about the protection of embryo andfetuses.Asthequalityoftheequipmentinfluencestheimagequalityaswellas the patient dose, there is a specific chapter about QC of gamma cameras and SPECT/CTandPET/CTunits.Measurementsandcalculationsofdosesarecovered andexamplesofshieldingcalculationsforPET/CTinstallationsaregiven.Releases to the environment through releases from laboratories as well releases through patient excreta are discussed. Finally there is a chapter on “Rules of the thumb” forradiationprotectioninnuclearmedicine. v vi Preface The book is aimed for medical physicists, technicians, physicians in nuclear medicine andradiology,radiochemists,engineers,PhD students,radiationprotec- tion experts, and others involved in nuclear medicine, radionuclide production, andradiationprotection. S€orenMattsson ChristophHoeschen Contents 1 Introduction:TheImportanceofRadiationProtection inNuclearMedicine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 S€orenMattsson PartI Measurements 2 DoseQuantitiesandUnitsforRadiationProtection. . . . . . . . . . . . 7 S€orenMattssonandMarcusS€oderberg PartII RadiationBiology 3 RadiobiologyforRadiationProtection. . . . . . . . . . . . . . . . . . . . . . 21 PeterBernhardt 4 RadiobiologyandRadiationDosimetryfortheLensoftheEye. . . 33 G€untherDietze PartIII RadiationDoseEstimations 5 RadiationExposureoftheEmbryo/FoetusandtheNewbornChild 49 MarieClaireCantone PartIV QualityAssuranceandQualityControl 6 QualityControlofGammaCameras,SPECT/CT andPET/CTUnits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 JennyOddstig,DavidMinarik,andMikaelGunnarsson vii viii Contents PartV OccupationalExposure 7 OccupationalExposure:WithSpecialReferencetoSkinDoses inHandsandFingers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 AdelaCarnicer,Merce` Ginjaume,MartaSans-Merce,LaurentDonadille, IlonaBarth,andFilipVanhavere 8 RadiationDosesfromPatientstoStaffMembers,Comforters andCaregiversandtotheGeneralPopulation. . . . . . . . . . . . . . . . 109 DejanZˇontar 9 ExamplesofShieldingCalculationsforaPET/CTInstallation. . . . 129 MarkusN.Lonsdale PartVI ExposureofthePublic 10 ReleaseofPatientsAfterRadionuclideTherapy:Radionuclide ReleasestotheEnvironmentfromHospitalsandPatients. . . . . . . 139 S€orenMattssonandChristianBernhardsson PartVII RulesofThumbforRadiationProtection inNuclearMedicine 11 RulesoftheThumbandPracticalHintsforRadiationProtection inNuclearMedicine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 S€orenMattssonandMartinAndersson Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 Chapter 1 Introduction: The Importance of Radiation Protection in Nuclear Medicine S€orenMattsson 1.1 The Importance of Radiation Protection in Nuclear Medicine Innuclearmedicine,radiopharmaceuticalsareadministeredtothepatienteitherfor the production of diagnostic images (diagnostic nuclear medicine or molecular imaging) or with the intention to treat using the emitted radiation from the radio- pharmaceutical(nuclearmedicinetherapy).Themostcommonwayforadministra- tion is through an intravenous injection. The radiopharmaceutical is sometimes swallowedbythe patient.Alternatively, thepatient may breathe aradioactivegas oraerosol. Impressive progresses have taken place within diagnostic nuclear medicine duringthelastfewyears.Diagnosticproceduresarenowmoreandmoreperformed usingPET/CTandSPECT/CTunits.EspeciallythePETunitsrequirespecificsite planningandshielding. Inradionuclidetherapy,stilldominatedbyradioiodinetherapyforthyreotoxicosis andthyroidcancer,thereisalsoanincreasinguseofradionuclide-labeledmonoclonal antibodiesand peptides. At therapy, the activities are higher, and the radionuclides used are often different from those used in diagnostic nuclear medicine. They are usually beta emitters (sometimes also low-energy electron or alpha emitters) with longerphysicalandbiologicalhalf-livesandthereforeconstituteagreaterradiation protection problem. Therapy radionuclides may require different facilities than radionuclides used for diagnostic procedures, to ensure the safe preparation and administrationoftheradiopharmaceutical. In both diagnostic and therapeutic nuclear medicine, the patient becomes a source of radiation not only for him/herself but also for staff, caregivers, and the S.Mattsson(*) MedicalRadiationPhysics,DepartmentofClinicalSciencesMalm€o,LundUniversity,Ska˚ne UniversityHospital,20502Malm€o,Sweden e-mail:[email protected] S.MattssonandC.Hoeschen(eds.),RadiationProtectioninNuclearMedicine, 1 DOI10.1007/978-3-642-31167-3_1,#Springer-VerlagBerlinHeidelberg2013 2 S.Mattsson general public and remains so until the radioactive material has decayed or is excreted from the body. Personnel involved in nuclear medicine must have good knowledgeofradiationprotection.Thisisvitalforpatientsafetyaswellasforthe staff’sownsecurity. For patients, radiation protection is ensured (1) by performing only those tests andtreatments that arenecessary (justification)and (2)by optimization, using the bestradiopharmaceuticals,optimallyadjustedandcalibratedequipmenttoprovide the best test results or treatment outcomes, using standard tests, procedures, and administrative controls, and having knowledgeable and trained personnel. The overridingprincipleisthatanytestortreatmentshouldofferthemaximumbenefit tothepatientandlimittheradiationexposure. Whenconsideringthejustificationforamedicalexposure,thebenefitisweighed against the detriment, including radiation effects. For diagnostic procedures, the potentialdetrimentistheriskofinducingcancer.Thisriskisgreaterinchildrenand decreaseswithage.Foradults,theoveralllifetimeriskoffatalcancerisestimated tobe5%perSv[1]. Foraneffectivedoseof20mSv,thenominalriskisabout1in1,200foradults aged30–60yearsatthetimeofexposure.Foradultsaged70ormore,theriskfallsto <1in3,000.However,forchildrenupto10yearsold,theriskisabout1in450[1]. Mostdiagnosticproceduresexposethepatienttoconsiderablylessthan20mSv. Once clinically justified, each diagnostic examination should be conducted so thatthedosetothepatientisthelowestnecessarytoachievetheclinicalaim.The qualityoftheimagesandthecomplexityoftheexaminationshouldbesufficientfor theintendedpurposeoftheprocedure.Sincepatientsmayhavedirectbenefitsfrom the exposures, it is not appropriate to impose limits on the doses received from justifiedexaminations. The optimization process necessarily requires a balance between administered activity(andthuspatientradiationdose)andimagequality.Theactivityadministered shouldbesufficienttoproduceacceptableimagequalityforthediagnosticinforma- tionbeingsought.Itisimportanttoplantheexamination,includingtherequirement forimagequality,tofittheclinicalproblem.Thisensuresthattheinvestigationhasthe bestopportunitytoaddressthediagnosticquestionathand.Thesizeandageofthe patient,andthetimeforwhichthepatientcancomfortablyremainstillforthestudy, willinfluencetheactivityrequiredtobeadministered.Therearewidevariationsinthe activityadministeredtopatientsofstandardbodysize,suggestingthattheremaybe scope for optimization. The implementation of diagnostic reference levels is a practicaltooltoaidindoseoptimization.Repeatingexaminationsduetopoorquality oftheradiopharmaceutical,incorrectadministrationoftheradiopharmaceutical,and technical problems with the imaging equipment should be minimized. Repeated proceduresmaybenecessaryiftheimagedoesnotprovidetheclinicalinformation required.Acomprehensivequalityassuranceprogram,whichincludesradiopharmacy andequipmentqualitycontrol,isimportanttoobtainoptimaldiagnosticinformation from the procedures. When radioiodinated compounds are to be administered for conditionsotherthanthyroiddisease,theuseofathyroidblockingagentshouldbe consideredforthepatientinordertoreducetheradiationdosetothethyroid.
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