Paper
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DOSE TO MEDICAL PERSONNEL
M.A. Misdaq,1 H. Harrass,1 H. Saikouk,2 and A. Matrane2
Abstract—Radioiodine 131I is successfully used in nuclear medi-
cine for the treatment of hyperthyroidism and thyroid cancer. This
radionuclide emits b− particles used for the treatment and gamma
photons used for diagnosis. The aim of this study is to determine
gamma radiation doses received by medical personnel situated
at a distance of 1 m from patients having ingested 131I for the
treatment of hyperthyroidism diseases. Indeed, gamma doses were
calculated using a Monte Carlo code based on simulating the inter-
action processes of gamma photons emitted by 131I in the thyroid
gland, air, and an ambient flow meter placed at a distance of 1 m
from the thyroid gland to measure the administered 131I activity.
The thyroid volume of patients was measured by means of a
gamma camera. Gamma dose equivalent rates were measured by
means of an ambient flow meter situated at a distance of 1 m from
the thyroid of the treated patients. Data obtained by the Monte
Carlo and experimental methods were found to be in good agree-
ment with each other.
Health Phys. 118(2):129–135; 2020
Key words: 131I; dose assessment; Monte Carlo; thyroid
INTRODUCTION
RADIOPHARMACEUTICALS, COMPOSED of a molecule vector and
a radionuclide tracer emitting beta particles or/and gamma
rays, are frequently used in nuclear medicine (ICRP 1987).
When injected or ingested, these products transmit beta and
gamma radiation to the human body tissues and organs. In-
formation from the emitted gamma rays is analyzed by a
gamma camera coupled to a computer and is transduced in
images, whereas beta particles, having shorter ranges, cannot
be externally detected. 131I is produced in a nuclear reactor
by neutron bombardment of natural tellurium metal (127Te)
and decays by b− emission with a half-life of 8.04 d to unsta-
ble 131mXe, which decays to stable xenon (131Xe) by emitting
gamma rays of different energies and intensities (ICRP
1
Nuclear Physics and Techniques Laboratory, Faculty of Sciences,
Semlalia, University of Cadi Ayyad, Marrakech, Morocco; 2Nuclear
Medicine Service, Mohammed VI University Hospital Centre, Faculty of
Medicine and Pharmacy, University of Cadi Ayyad, Marrakech, Morocco.
The authors declare no conflicts of interest.
For correspondence contact M.A. Misdaq, Faculty of Sciences Semlalia-
Marrakech, BP 2390, University Cadi Ayyad, Marrakech, Morocco, or email
at misdaq@uca.ac.ma.
(Manuscript accepted 7 May 2019)
0017-9078/20/0
Copyright © 2019 Health Physics Society
DOI: 10.1097/HP.0000000000001140
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Copyright © 2019 Health Physics Society. Unauthorized reproduction of this article is prohibited.
2008). 131I is widely used for diagnostic (Hall et al. 1996)
and therapeutic (Sisson et al. 2011) purposes. For decades,
oral administration of radioiodine has been used in the treat-
ment of benign and malignant thyroid diseases (Wiszomirska
2012). Since a major part of the administered radioiodine
will concentrate in the thyroid gland, the short range of
the beta radiation will result in irradiation of thyroid cells
without any harmful health effects to other organs. How-
ever, 131I emits penetrating and indirectly ionizing gamma
radiation, which may cause radiation damage to other tis-
sues of the patients and other individuals (Cappelen and
Unhjem 2004). Medical staff are exposed to gamma radia-
tion from patients who have ingested 131I for the treatment
of hyperthyroid diseases in nuclear medicine facilities, so
it is necessary to control the calibration of ambient flow me-
ters used and also their position with respect to the thyroid
gland of the patient in order to get precise measurements
of the resulting gamma dose rates. Monte Carlo calculation
methods have been used for evaluating gamma ray dose
from an overhead plume (McNaughton et al. 2017), estimat-
ing gamma dose to the eyes of radiography workers (De
Lima et al. 2017), determining gamma doses from solution
sources in biological tissue (Misdaq and Merzouki 2002),
and evaluating the skin absorbed doses during manipulation
of radioactive sources (Amato and Italiano 2018).
In the present work, we describe a new method based
on exploiting the interaction of gamma photons emitted by
131
I with the thyroid gland of patients, air, and an ambient
flow meter and measuring the administered 131I activities
to evaluate the resulting gamma dose rates to medical per-
sonnel in a nuclear medicine facility.
METHODS
To get reliable gamma dose rate measurements in nuclear
medicine facilities, it is necessary to have well-calibrated
ambient flow meters, and the geometric relationships be-
tween patients and medical staff should be well defined.
We have developed a new Monte Carlo calculation method,
adapted to the experimental conditions, for calculating gamma
equivalent dose rate to medical personnel from patients who
have been treated for hyperthyroid diseases.
129
130 Health Physics
Let us consider the thyroid gland of a patient who has
ingested 131I for the treatment of hyperthyroid disease as a
cylindrical homogeneous source of multienergetic gamma
rays of radius R1, depth D1, and density rTh (g cm−3)
(Fig. 1). The resulting gamma dose equivalent rate in Sv h−1,
at a distance d = 1 m from the source, absorbed in the ambient
flow meter of radius R2, depth D2, and density rAFM (Fig. 1)
is given by:
1
Ḣ ð0Þ ¼ c ð0Þ wR ;
ɛ D ATh ð1Þ
2
where D is the absorbed gamma dose (in Gy) of the consid-
ered source at a distance of 1 m in the ambient flow meter,
c ð0Þ (in Bq) is the initial activity due to
131
ATh I in the thyroid
gland of a patient, ɛ is the detection efficiency of the ambi-
ent flow meter, and wR is the radiation-weighting factor,
which is equal to 1 for gamma rays (ICRP 2007). The term
½ means that only half of the emitted gamma photons inside
the thyroid may lose their energies inside the ambient flow
meter according to Fig. 1.
The absorbed gamma dose is given as follows:
1 The absorption probability of a gamma photon of in-
D¼ ∑k¼5 I k E k 〈Pðl1k Þ〉 〈Pðl2k Þ〉 〈Pðl3k Þ〉; ð2Þ
rAFM p R21 D1 k¼1
where Ik is the intensity of a gamma ray of index k and en-
ergy Ek, 〈P(l1k)〉 is the mean transmission probability of a
gamma ray of index k and energy Ek after crossing a length
l1k in the thyroid gland, 〈P(l2k)〉 is the mean transmission
probability of a gamma ray of index k and energy Ek after
Fig. 1. Thyroid gland-ambient flow meter arrangement. The thyroid has a radius R1 and depth D1. The ambient flow meter has a radius R2 and
depth D2.
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February 2020, Volume 118, Number 2
crossing a length l2k in air, and 〈P(l3k)〉 is the mean absorption
probability of a gamma ray of index k and energy Ek after
crossing a length l3k in the ambient flow meter.
Values of the intensities and energies of gamma rays
emitted by the 131I radionuclide are given in Table 1
(ICRP 2008).
The transmission probability of a gamma photon of
index k and energy Ek generated from point P1 (Fig. 1) af-
ter crossing a path length l1k = P1S1 in the thyroid gland is
given by:
Pðl1k Þ ¼ e−m Th r Th l1k ; ð3Þ
where mTh (in cm2 g−1) is the total attenuation coefficient of
the gamma photon in the thyroid gland tissue.
The transmission probability of a gamma photon of in-
dex k and energy Ek in air after crossing a length l2k = S1Q2
is given by:
Pðl2k Þ ¼ e−m Air rAir l2k ; ð4Þ
where rAir is the density of air and mAir is the total attenua-
tion coefficient of a gamma photon in air.
dex k and energy Ek after crossing a path length l3k in the
gas detector is given by:
Pðl3k Þ ¼ 1− e−mAFM rAFM l3k ; ð5Þ
where mAFM is the total attenuation coefficient of a gamma
photon in the gas detector.
 Dose to medical personnel c M.A. MISDAQ ET AL. 131
8
Table 1. Values of the mass attenuation coefficients of gamma photons >
> 0 if O2 Q2 ≥ R2
emitted by 131I in thyroid gland mTh, air mAir, and ambient flow meter < D
2
mAFM (Berger et al. 2010). Eg and Ig represent the energy and intensity, l3k ¼ if O2 Q2 < R2 and O′2 Q3 ≤ R2 ; ð14Þ
> cos u
>
respectively, of the emitted gamma photons. :
X2 if O2 Q2 < R2 and O′2 Q3 > R2
Eg (MeV) Ig (%) mTh (cm2 g−1) mAir (cm2 g−1) mAFM (cm2 g−1)
where
0.08018 2.6 0.1822 0.1661 0.275 qffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi
0.2843 6.2 0.1202 0.1089 0.1019 O2 Q2 ¼ r 2 ¼ r12 þ ðt1 þ d Þ2 tan2 ðuÞ þ 2r1 ðt1 þ d Þ tanðuÞ cosðcÞ ð15Þ
0.36448 81.6 0.1094 0.09907 0.09139
0.63697 7.1 0.08667 0.07846 0.07138 qffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi
O′2 Q3 ¼ r12 þ ðt1 þ d þ D2 Þ2 tan2 ðuÞ þ 2r1 ðt1 þ d þ D2 Þ tanðuÞ cosðcÞ ð16Þ
0.72289 1.8 0.08188 0.07413 0.06733
qffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi
O′2 Q3 ¼ r22 þ D2 2 tan2 ðuÞ þ 2r2 D2 tanðuÞ cosðφÞ ð17Þ
The mTh, mAir, and mAFM attenuation coefficients have
been evaluated using the XCOM database (Berger et al. 2010) and
8
>
< 0qffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi if tanðuÞ ≥ tanðuMax Þ
(Table 1).
X2 ¼ R22 − r22 sin2 ðφÞ−r1 cosðφÞ ; ð18Þ
The random sampling of the emission point P1 and >
: if tanðuÞ < tanðuMax Þ
sinðuÞ
emission direction is achieved by computing the dis-
tance from the center r1, the depth t1, cosu, and cosc with
with four random numbers (j1, j2, j3 and j4) (Misdaq
R2 −r1
and Merzouki 2002): tanðuMax Þ ¼ : ð19Þ
t1 þ d
pffiffiffiffiffi
r1 ¼ R1 j1 ; 0 ≤ j1 <1 ð6Þ For a large number N0 of gamma photons of index k and en-
ergy Ek, the mean transmission probability in thyroid gland,
t1 ¼ D 1 j 2 ; 0 ≤ j2 <1 ð7Þ mean transmission probability in air, and mean absorption
probability in the gas detector are respectively given by:
d −m Th r Th l1n
cosu ¼ j3 ; 0 ≤ j3 <1 ð8Þ ∑n¼N
n¼1 e
〈Pðl1k Þ〉 ¼ ð20Þ
Nd
c ¼ 2p j4 ; 0 ≤ j4 <1: ð9Þ
d −mAir rAir l2n
∑n¼N
n¼1 e
The path length l1k is given by: 〈Pðl2k Þ〉 ¼ ð21Þ
Nd
8 and
< t1
if R1 ≥ O′1 Q1  
l1k ¼ cosu ; ð10Þ ∑n¼Nd
n¼1 1−e
−mAFM rAFM l3n
: 〈Pðl3k Þ〉 ¼ ; ð22Þ
l ðr1 ; u; cÞ if R1 < O′1 Q1 Nd
where where Nd is the number of detected gamma photons.
The detection efficiency of the ambient flow meter is
qffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi
given by:
O′1 Q1 ¼ r12 þ t1 2 tan 2 ðuÞ þ 2 r1 t1 tanðuÞcosðcÞ ð11Þ
Nd
ɛ¼ : 23
and N0

qffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi The calculation of the efficiency of the ambient flow meter

R21 −r12 sin2 ðcÞ− r1 cosðcÞ as well as gamma dose equivalent rates to medical staff at a
l ðr; u; cÞ ¼ : ð12Þ distance of 1 m from the thyroid gland of patients having
sinðuÞ ingested 131I was performed using a Monte Carlo code,
which is schematically represented in Fig. 2.
The path length l2k is given by:

t1 þ d RESULTS AND DISCUSSION

l2k ¼ − l1k : ð13Þ
cos u 131
I was orally administered to 10 female patients of
The path length l3k is given by: different ages presenting hyperthyroidism pathologies at
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132 Health Physics February 2020, Volume 118, Number 2

Fig. 2. Flow chart of the Monte Carlo code which is used to calculate gamma equivalent dose rates to medical personnel from patients having
ingested 131I and detection efficiency of the ambient flow meter for the emitted gamma rays. (Figure employs the same symbols as in the text.)
N0 = 106 gamma photons.

Mohammed VI University Hospital Center in Marrakech,
Morocco. The thyroid volume was measured for the 10 pa-
tients using a gamma camera type Siemens Symbia T6
(Siemens Healthineers, Erlangen, Germany) (Table 2). An
example of a thyroid scintigraphy image is given in Fig. 3
for patient P8. The initially administered 131I activities
c ð0Þ) to patients were measured by means of an activimeter
(ATh
type Scinti Dose (Lemer Pax 2010) (Table 4). The relative
uncertainty of the 131I activity measurement is 7%. The
mean transmission probability in thyroid, mean transmission
probability in air, mean absorption probability in the ambient
flow meter, efficiency of the ambient flow meter, and gamma
dose equivalent rates to medical personnel have been calcu-
lated for each gamma ray emitted by 131I in the thyroid gland
of the treated patients using the Monte Carlo code developed.
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Data obtained are shown in Table 3. The statistical uncer-
tainty of the mean transmission probability and mean absorp-
tion probability calculation is 1%. Note that gamma dose
equivalent rate due to gamma photons of energy Eg3 =
0.3645 MeV is clearly higher than those due to the other
gamma photons. This is because this gamma ray presents
a higher intensity (81.6 %) than the other gamma photons
(Table 1). To study the influence of Eg and Ig on the
̇
H4cal ̇
(0)/H3cal (0) ratio, we compared this ratio with the
Eg4/Eg3 and Ig4/Ig3 ratios. Indeed, the intensity of the emitted
gamma photons is the predominant factor: the H4cal ̇ (0)
̇ (0)/H3cal
ratio varies in the range of 0.139–0.144 and the Ig4/Ig3 ratio
is equal to 0.087, whereas the Eg4/Eg3 ratio is equal to 1.74
(Table 3). Total gamma dose equivalent rates Ḣ cal ð0Þ to the
medical personnel at a distance of 1 m from the treated

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 Dose to medical personnel c M.A. MISDAQ ET AL. 133

Table 2. Values of the thyroid volume obtained by means of a gamma rates are higher than or equal to the gamma dose rate limit
camera for different patients. ε represents the detection efficiency of given by the International Atomic Energy Agency (IAEA)
the ambient flow meter for gamma photons emitted by 131I.
(20 mSv h−1) (IAEA 2009). Note that medical staff are ex-
Patient Thyroid volume (cm3) R1 (cm) D1 (cm) ε (10−4%) posed to a clearly higher gamma dose equivalent rate from
P1 156.5 1.5 22.13 203 patient P4 than from the other patients. This is due to the
P2 60.7 0.75 34.35 189 fact that this patient has a thyroid depth smaller than those
P3 199.0 1.5 28.15 193 of the other patients and higher detection efficiency
P4 68.6 1.5 9.73 228 (Table 2). One can note that medical staff are exposed to a
P5 196.7 2.0 15.65 220 similar gamma dose equivalent rate from patients P2 and
P6 431.2 2.0 34.31 189 P6; there is correlation between the administered 131I activ-
P7 56.7 1.0 18.05 215 ity to these patients and the square of the thyroid gland ra-
P8 263.0 2.0 20.93 210
dius (R21 ) (eqn 2).The Monte Carlo calculation method has
P9 349.0 2.0 27.77 199
the advantage of being rapid (less than 1 min calculation
P10 236.3 2.0 18.80 214
time on a simple personal computer) and does not require
the use of standards for calibration. It is a good tool for con-
patients due to all emitted gamma photons have been calcu-
trolling the calibration of the ambient flow meter used and
lated (eqn 1). Results obtained are shown in Table 4. The
for checking its position with respect to the thyroid of the
relative uncertainty of the gamma dose equivalent rate de-
treated patients.
termination is around 10%. Total gamma dose equivalent
rates to medical personnel have been measured at a distance
of 1 m from the thyroid of the same treated patients by CONCLUSION
means of an ambient flow meter type Inspector+ (SE
International 2006). The experimental relative uncertainty It has been shown by this study that by using a Monte
on the gamma dose equivalent rate determination is 15% Carlo computer code on a simple personal computer one
(SE International 2006). Data obtained by the experimental can quickly calculate (calculation time less than 1 min) gamma
and Monte Carlo calculation methods are in good agree- equivalent dose rates to medical personnel at a distance of 1 m
ment with each other within the uncertainty interval from patients having ingested 131I for the treatment of hyper-
(Table 4). One can note that patients P1, P4, P5, P7, P8, thyroid disease at a nuclear medicine facility. It is concluded
P9, and P10 cannot be immediately released from the hospi- that the gamma dose rate to medical staff is influenced by the
tal because the corresponding total gamma dose equivalent energy and intensity of the emitted gamma rays, thyroid

Fig. 3. A thyroid scintigraphy image obtained for patient 8 by using a gamma camera type Siemens Symbia T6.
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134 Health Physics February 2020, Volume 118, Number 2

Table 3. Data obtained for the mean transmission probability in thyroid (P1) and air (P2), mean absorption probability in the ambient flow meter (P3), and gamma equivalent dose rate to the Table 4. Values of gamma dose equivalent rates to medical personnel

(mSv h−1)
Ḣ 5cal ð0Þ
from female patients having ingested 131I at Mohammed VI University

0.71
0.40
0.54
0.88
0.70
0.46
0.78
0.58
0.46
0.75
Eg5=0.7229 MeV, Ig5=1.8% Hospital Centre in Marrakech, Morocco, measured by an ambient flow
meter Ḣ mes ð0Þ and calculated by the Monte Carlo method Ḣ cal ð0Þ: Ac(0)
is the 131I initial activity administered to the patients.

0.005
0.005
0.005
0.005
0.005
0.005
0.005
0.005
0.005
0.005
(%)
P3

Ac(0) Ḣ mes ð0Þ Ḣ cal ð0Þ

Patient (mCi) (mSv h−1) (mSv h−1)
99.08
99.07
99.08
99.08
99.08
99.08
99.08
99.08
99.08
99.08
(%)
P2

P1 12.87 ± 1.53 20.00 ± 3.00 22.44 ± 2.47

P2 10.00 ± 0.70 15.87 ± 2.38 12.59 ± 1.38
44.62
37.82
41.43
68.57
56.53
36.09
53.32
48.69
41.25
51.60
(%)
P1

P3 12.00 ± 0.84 17.00 ± 2.55 16.97 ± 1.87

medical personnel Ḣ kcal ð0Þ due to gamma ray of index k and energy Egk emitted by 131I from female patients having been treated for hypothyroid diseases

P4 10.00 ± 0.70 25.43 ± 3.81 30.36 ± 3.34

(mSv h−1)
Ḣ 4cal ð0Þ

P5 10.00 ± 0.70 19.82 ± 2.97 23.15 ± 2.55

2.50
1.44
1.91
3.19
2.50
1.63
2.77
2.06
1.64
2.67
Eg4 = 0.637 MeV, Ig4 = 7.1%

P6 12.00 ± 0.84 15.70 ± 2.35 14.35 ± 1.58

P7 12.00 ± 0.84 20.50 ± 3.07 25.43 ± 2.80
0.005
0.005
0.005
0.005
0.005
0.005
0.005
0.005
0.005
0.005 P8 10.00 ± 0.70 19.08 ± 2.86 18.60 ± 2.05
(%)
P3

P9 10.00 ± 0.70 18.10 ± 2.71 14.58 ± 1.60

P10 12.00 ± 0.84 21.20 ± 3.18 24.29 ± 2.68
99.02
99.01
99.02
99.02
99.02
99.02
99.02
99.02
99.02
99.02
(%)
P2

dimensions, and efficiency of the ambient flow meter. Data

45.97
36.30
39.83
67.20
54.92
34.58
51.69
47.04
39.65
49.95
(%)
P1

obtained by both calculation and experimental methods are

in good agreement with each other. The Monte Carlo calcu-
(mSv h−1)
Ḣ 3cal ð0Þ

17.92
10.08
13.55
24.32
18.40
11.32
20.30
14.84
11.62
19.32
Eg3 = 0.3645 MeV, Ig3 = 81.6%

lation method has the advantage of being simple, moderately

accurate, and rapid, and it does not require the use of standard
sources for calibration. It is a good tool for checking the cal-
0.006
0.006
0.006
0.006
0.006
0.006
0.006
0.006
0.006
0.006
(%)
P3

ibration of the experimental method and controlling the posi-

tion of the ambient flow meter with respect to the thyroid of
98.77
98.75
98.77
98.77
98.77
98.77
98.77
98.77
98.77
98.77

patients. This method is also useful for assessing gamma ra-

(%)
P2

diation doses received by individuals surrounding patients

having undergone nuclear medicine examinations such as
39.24
30.31
33.46
61.15
48.11
28.67
44.87
40.25
33.25
43.11
(%)
P1

scintigraphy or tomography by emission of positrons (TEP).

It has been shown that the gamma dose equivalent rate to
(mSv h−1)
Ḣ 2cal ð0Þ

medical personnel at a distance of 1 m from 10 female pa-

1.11
0.62
0.83
1.54
1.15
0.70
1.26
0.91
0.71
1.20
Eg2 = 0.2843 MeV, Ig2 = 6.2%

tients treated for hyperthyroidism, having ingested 131I ac-

tivities varying from 370 to 476 MBq, ranged from 15.87
0.007
0.007
0.007
0.007
0.007
0.007
0.007
0.007
0.007
0.007

to 21 mSv h−1. Lemoine et al. (2011) have measured gamma

(%)
P3

dose equivalent rates to medical staff at the nuclear medi-

98.65
98.64
98.65
98.65
98.65
98.65
98.65
98.65
98.65
98.65

cine facility of the University Hospital Centre in Grenoble

(%)
P2

(France) using a radiometer; they found an average dose

at 1 m of 13.9 ± 5.9 mSv h−1 from patients treated for hy-
36.69
28.13
31.11
58.65
45.42
26.55
42.22
37.66
30.90
40.47
(%)
P1

perthyroid disease having ingested an average activity of

397.7 ± 170 MBq. One can note that results obtained by
(mSv h−1)
Ḣ 1cal ð0Þ
Eg1 = 0.08018 MeV, Ig1 = 2.6%

0.25
0.14
0.18
0.39
0.27
0.15
0.29
0.21
0.16
0.27

using this method are in good agreement with those obtained

by Lemoine et al. (2011).
0.019
0.020
0.019
0.019
0.019
0.019
0.019
0.019
0.019
0.019
(%)
P3

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