Introduction

Nuclear medicine – very nature and image-oriented

 1950 – printed images of the thyroid, using I-131, using the rectilinear scanner developed by
Benedict Cassen.
 1958 – Anger Scintillation camera, developed by Hal Anger, could be used to image an entire
organ at one time.
 1963 – Kuhl and Edwards were using the Anger camera to produce tomographic images.

Nuclear medicine images are acquired and stored in computers, making the data easily accessible and
readily available for further processing and quantification.

Nuclear medicine involves handling of radioactive materials that can give rise to external and internal
exposure of staff. The magnitude of exposure depends on radionuclide, its activity and type of work
within a department in which the person is involved. Relatively newer imaging modality that involves
use of positron-emitting radionuclides for PET scanning has lead to the increased exposure of staff.
Within the field of therapeutic application in nuclear medicine, new agents with beta emitters of higher
therapeutic effectiveness have been used. In line with increasing number of medical procedures
involving beta emitting radionuclides, extremity doses and possible skin contamination of nuclear
medicine staff is of special concern.

Radiation protection in nuclear medicine is concerned with the control of both normal and potential
exposure of workers in all situations that involve use of unsealed sources of radiation.

What is Radiation?

Radiation is energy that comes from a source and travels through space and may be able to penetrate
various materials.

There are two types of Radiation

 Ionizing Radiation - radiation that has sufficient energy to dislodge orbital electrons such as
alpha and beta particles, neutrons, gamma rays and x-rays.
 Non Ionizing – radiation that does not have sufficient energy to dislodge orbital electrons
such as microwaves, ultraviolet

What are the effects of radiation?

 Death
 Cancer
 Genetic effects
 Infertility
 Cataracts
  Skin burns

The aim of radiation protection is to prevent reliably the deterministic effects and to reduce the risk pf
stochastic effects to a reasonably achievable effect. The dose limit values are set so that deterministic
effects are rule out.

Measuring Radiation

 Radioactivity amount of ionizing radiation released by a material.

 Exposure amount of radiation travelling through the air.
 Absorbed dose amount of radiation absorbed by an object or person.
 Dose equivalent combines the amount of radiation absorbed and the medical effects of that
type of radiation.
 Effective dose measure of the radiation and the type of the tissue affected.

Who should be protected in Nuclear Medicine?

 Patient – as they undergo the procedure they needs to protected

 Members of patient’s family – if assistance is needed during the procedure they also need to
be protected from the radiation
o In nuclear medicine it is common that family member(s) of the patient
(attendants) need to look after the patient at home who has been administrated
radioactivity. This is not restricted to children or seriously ill family members but
may apply to any member of the family. Moreover proximity to radioactive patient
during travel from hospital to home is also a source of radiation exposure to
attendant. The attendant comes in category of individuals who voluntary support
or comfort patients undergoing procedures that involve ionizing radiation
exposure.  Further details on radiation protection of general public are available at
Radiation Protection of Patients (RPoP) website.
 Workers – medical professionals
 General public

How to protect?

 In order to keep the risk of stochastic damage as low as possible (ALARA), there are three
general principles based on recommendations from the ICRP
 Justification – it means no practice should be undertaken unless sufficient benefit to the
exposed individuals will offset the radiation detriment.
 Optimization – magnitude of individual doses, the number of people exposed, and the
likelihood of incurring exposures should be kept as low as reasonably achievable (ALARA),
economic and social factors being taken into account.
 Dose Limitation the exposure of individuals should be subject to dose limits. These limits are
designed to prevent deterministic effects and to reduce stochastic effects to an “acceptable”
level. In nuclear medicine, total dose includes both internal and external exposure to
ionizing radiation. The sources of exposure of the general public are primarily the same as
 for workers. However, based on the level of acceptable risk, different dose limits apply for
members of the public than for workers.

Protection of patients in Nuclear Medicine

 The use of justification and optimization

 Justification plays a big role in radiation protection, it determines whether the exposure
procedure will take place or not.
 The radiological procedure should be performed in such a way that the radiation protection
and safety is considered and optimized.

Pregnant and breastfeeding patients

 Pregnancy is contraindication of Justification

 The administered activity shall be in proportion to body weight using 70% of the normal
adult activity for the required examination

Nuclear medicine examinations shall be optimized to fulfill the purpose of the procedure while
minimizing the radiation exposure to the patients.

 All staffs are trained and qualified

 Appliances are suitable for the intended examinations and are properly working
 Examination procedures are optimized
 Image quality are sufficient for reliable diagnosis

Radiation protection of the patients

 Before the procedure

o Patients hold proper and exact referral or request of examination
o Patient have been informed about the intended procedure
o Radiation protection and safety have been ascertained
 Before radiopharmaceutical is administered
o Radiation dose to the patient is selected
o Shall be measured to make sure it is the exact amount of dosage
 Prevent radioactive substances from accumulating in organs that are not being examined
 Right patient and right amount of dosage
 Reduce patient exposure

General guidelines for Nuclear Medicine

 Keep inventory of all radioactive materials, radioactive waste and personnel dose
readings.
 Quality control procedures and records for all equipment used to measure radioactivity
and obtain images from radionuclide studies.
  Verify the patient’s name, radionuclide, activity, and administration site prior to the
administration of radiopharmaceutical doses.
 Use syringe shields and vial shields during preparation and administration • Wear
appropriate PPE and use remote handling tools as necessary.
 Wear assigned personal dosimeters while working in areas where radioactive materials
are used and stored.
 Do not eat, drink, apply cosmetics or store personal effects in areas where radioactive
materials are used or stored.
 Use spill trays and absorbent paper to prevent/control contamination from radioactive
materials.
 Perform and document radiation contamination and ambient surveys as required by
regulation.

Classifications of areas in a Nuclear Medicine Department

 Controlled areas: radiation greater than 7.5 micro Sieverts per hour.
o Laboratory
o Injection room
o Storage room
o Imaging rooms
 Supervised areas: greater than 2.5 micro sieverts per hpur t 7.5 micro sieverts per hour.
o All supervised area must be regularly monitored

All radioactive packages that arrive in the Nuclear Medicine Department must be monitored and wipe,
tested for possible contamination.

Radioactive solid waste with half life less than 65 days to be stored till 10 physical half live is over and
then to be disposed as normal waste.

Low level liquid waste can be diluted until their activities drop below acceptable levels, and then
disposed as normal waste.

Three cardinal rules of radiation protection

 Time – lesser time spent near the sources: lesser radiation received
 Distance – the greater the distance from the radiation source the lesser radiation received
 Shielding – behind shielding from source will result for lesser radiation received
Radiation protection in nm (slideshare.net)

Human Health Campus - Radiation protection of workers and the public in nuclear medicine (iaea.org)