IAEA Training Material on Radiation Protection in Nuclear Medicine

Part 12

Protection of the
General Public
 Objective
To become aware of the BSS requirements
for the protection of the public and how these
are applied to restrictions in the care of the
nuclear medicine patients as well as the
design and operation of a nuclear medicine
facility

Nuclear Medicine Part 12. Protection of the general public 2

Contents
 Dose limits
 Design considerations
 The patient
 Special problems
 Transportation

Nuclear Medicine Part 12. Protection of the general public 3

Exposure of the General Public
 Spread of contamination outside the
department
 Lost sources
 The nuclear medicine patient
 Disposal of radioactive waste
 Transportation of sources

Nuclear Medicine Part 12. Protection of the general public 4

Responsibilities of the Government
(BSS: Interim Edition)
 Requirement 29: The government or the
regulatory body shall establish the
responsibilities of relevant parties that are
specific to public exposure, shall establish
and enforce requirements for optimization,
and shall establish, and the regulatory body
shall enforce compliance with, dose limits for
public exposure.

Nuclear Medicine Part 12. Protection of the general public 5

Responsibilities of the Government
(BSS: Interim Edition)
“3.118. The government or the regulatory body shall establish the
responsibilities of registrants, licensees, suppliers, and
providers of consumer products in relation to the application of
requirements for public exposure in planned exposure
situations.
3.119. The government or the regulatory body shall establish and
enforce requirements for the optimization of protection and
safety for situations in which individuals are or could be subject
to public exposure.
3.120. The government or the regulatory body shall establish or
approve constraints on dose and on risk to be used in the
optimization of protection and safety for members of the public.
When establishing or approving constraints in respect of a
source within a practice, the government or the regulatory body
shall take into account, as appropriate”
Nuclear Medicine Part 12. Protection of the general public 6
 IAEA Training Material on Radiation Protection in Nuclear Medicine

Part 12
Protection of the General Public

Module 12.1. Dose Limits

 Public Exposure: Dose limits
 As per Schedule III-3 of BSS (Interim Edition, 2011)
for public exposure, the dose limits are:
 (a) An effective dose of 1 mSv in a year;
 (b) In special circumstances, a higher value of
effective dose in a single year could apply,
provided that the average effective dose over five
consecutive years does not exceed 1 mSv per
year;
 (c) An equivalent dose to the lens of the eye of 15
mSv in a year;
 (d) An equivalent dose to the skin of 50 mSv in a
year.

Nuclear Medicine Part 12. Protection of the general public 8

 Dose Constraints

If nationally not available, the local Radiation Protection

Committee, should establish appropriate dose constraints.

Nuclear Medicine Part 12. Protection of the general public 9

 IAEA Training Material on Radiation Protection in Nuclear Medicine

Part 12
Protection of the General Public

Module 12.2. Design Considerations

Working Procedures
 Public Exposure Considerations
BSS: Interim Edition
“3.126. Registrants and licensees in cooperation with suppliers, in
applying the principle of optimization of protection and safety in the
design, planning, operation and decommissioning of a source (or for
closure and the post-closure period for waste disposal facilities), shall
take into account:
 (a) Possible changes in any conditions that could affect exposure of members of
the public, such as changes in the characteristics and use of the source, changes in
environmental dispersion conditions, changes in exposure pathways or changes in
values of parameters used for the determination of the representative person;
 (b) Good practice in the operation of similar sources or the conduct of similar
practices;
 (c) Possible buildup and accumulation in the environment of radioactive substances
from discharges during the lifetime of the source;
 (d) Uncertainties in the assessment of doses, especially uncertainties in
contributions to doses if the source and the representative person are separated in
space or in time.”

Nuclear Medicine Part 12. Protection of the general public 11

Reduce the Risk of Uncontrolled
Contamination
 Classification of areas
 Well trained staff
 Documented safe procedures in the
handling of radiopharmaceuticals (receipt,
preparation, administration, waste
disposal)
 Workplace monitoring

Nuclear Medicine Part 12. Protection of the general public 12

 Layout of a
Nuclear Medicine Department

From high to low activity

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 CLASSIFICATION OF AREAS

• Controlled area

• Supervised area

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Control of Visitors (BSS: Interim Edition)
“3.128. Registrants and licensees, in cooperation with employers
where appropriate:
 (a) Shall apply the relevant requirements of these Standards
in respect of public exposure for visitors to a controlled area
or a supervised area;
 (b) Shall ensure that visitors are accompanied in any
controlled area by a person who knows the measures for
protection and safety for the controlled area;
 (c) Shall provide adequate information and instructions to
visitors before they enter a controlled area or a supervised
area so as to provide for protection and safety for visitors and
other individuals who could be affected by their actions;
 (d) Shall ensure that adequate control is maintained over the
entry of visitors to a controlled area or a supervised area,
including the use of signs for such areas.

Nuclear Medicine Part 12. Protection of the general public 15

 Patient Areas
• Separation of radioactive patients and other patients waiting is an
example of good practice, especially in a busy department.

• Separate toilet room for the exclusive use of injected patients should
always be considered. This patient washroom should not be used by
general public or hospital staff as it is likely that the floor, toilet seat
and sink faucet handles will be contaminated
frequently.

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 Structural Shielding
The absorbed dose is determined by factors such as:
• source strength;
• length of exposure;
• distance from the source;
• transmission through the protective barrier.

Patient with I-131 General public

D mSv/h 0.3 mSv/procedure

Distance d

Nuclear Medicine Part 12. Protection of the general public 17

 Storage of Sources

• locked to prevent unauthorized use

and theft
• warning sign
• shielded to <2 uSv/h at 1m
(permanently occupied areas)
alternatively <20 uSv/h at 1 m
(temporarily occupied areas)
• inventory record

Nuclear Medicine Part 12. Protection of the general public 18

Radioactive Waste: BSS Interim Edition
“3.131. Registrants and licensees, in cooperation with suppliers, as
appropriate:
 (a) Shall ensure that any radioactive waste generated is kept to the
minimum practicable in terms of both activity and volume;
 (b) Shall ensure that radioactive waste is managed in accordance
with the requirements of these Standards and the requirements of other
applicable IAEA standards, and in accordance with the relevant
authorization;
 ………
 (d) Shall ensure that activities for the predisposal management of and
for the disposal of radioactive waste are conducted in accordance with the
requirements of applicable IAEA standards, and in accordance with the
authorization;
 (e) Shall maintain an inventory of all radioactive waste that is
generated, stored, transferred or disposed of;
 (f) Shall develop and implement a strategy for radioactive waste
management and shall include appropriate evidence that protection and
safety is optimized.”
Nuclear Medicine Part 12. Protection of the general public 19
Discharge of Radioactive Substances
BSS: Interim Edition
“3.132. Registrants and licensees, in cooperation with suppliers, in
applying for an authorization for discharges, as appropriate:
 (a) Shall determine the characteristics and activity of the material to
be discharged, and the possible points and methods of discharge;
 (b) Shall determine by an appropriate pre-operational study all
significant exposure pathways by which discharged radionuclides
could give rise to exposure of members of the public;
 (c) Shall assess the doses to the representative person due to the
planned discharges;
 (d) Shall consider the radiological environmental impacts in an
integrated manner with features of the system of protection and
safety, as required by the regulatory body;
 (e) Shall submit to the regulatory body the findings of (a) to (d)
above as an input to the establishment by the regulatory body…”

Nuclear Medicine Part 12. Protection of the general public 20

 IAEA Training Material on Radiation Protection in Nuclear Medicine

Part 12
Protection of the General Public

Module 12.3.
The Patient
 The Radioactive Patient
Uncontrolled radioactive source
that causes external exposure and
contamination of the general
public?

YES!
(after leaving the hospital)

Nuclear Medicine Part 12. Protection of the general public 22

 The Radioactive Patient
Contamination External

saliva
perspiration
breath
urine
0.5 0.1 0.06 0.03 mSv/h

1000 MBq
I-131

0 0.5 1 2m

Nuclear Medicine Part 12. Protection of the general public 23

 The Radioactive Patient

Exposure of general public

Release the patient without any restrictions

Release the patient with restrictions

Keep the patient in the hospital

Nuclear Medicine Part 12. Protection of the general public 24

 Patient Survey

The dose rate at 1 m from the patient

should be down to an acceptable
level established by the RPC.

Hospitalize:
• >1100 MBq I-131
Release with restrictions:
• Treatment of thyrotoxicosis
• Pain palliation (Sr-89, Sm-153)
• Lactating women (specified
procedures)
Release without restrictions:
• Diagnostic procedures

Nuclear Medicine Part 12. Protection of the general public 25

INSTRUCTIONS TO OUT-PATIENTS
(Example to minimize exposure of the
general public)

• Use only a WC and flush 2-3 times. Keep the toilet and the floor
clean.
• Wash Your hands frequently and take a shower every day.
• Avoid close contact to members of the family, children and pregnant
women etc according to the time table attached
• Avoid solid waste

Off work: 6d
Avoid close contact with
children and pregnant women: 20 d

Public travel: 1h/day (1st week)

Nuclear Medicine Part 12. Protection of the general public 26

 IAEA Training Material on Radiation Protection in Nuclear Medicine

Part 12
Protection of the General Public

Module 12.4. Special Problems

 Death of Patient
In the event of death of a patient who has recently received
a therapeutic dose of a radionuclide care has to be taken to
ensure that personnel receive as low dose as possible at all
stages prior to the burial or cremation.

Activity (MBq)
Radionuclide Burial Cremation
I-131 400 400
Y-90 colloid 2000 70
Au-198 colloid 400 100
P-32 2000 30
Sr-89 2000 200

(UK)

Nuclear Medicine Part 12. Protection of the general public 28

 Death of Patient
Precautions that should be given are depending on the residual activity
and the expert advice provided by the RPO and may involve the
following:

• preparation for burial or cremation should be controlled by a

competent person,
• relatives should be prevented from coming into close contact with the
body,
• people should not be allowed to linger in the presence of the coffin,
• all personnel involved in handling the corpse should be instructed by
the RPO and monitored if appropriate,
• all objects, clothes, documents etc that might have been in contact
with the deceased must be tested for contamination,
• it may be expedient to wrap the cadaver in waterproof material
immediately after death to prevent spread of contaminated body fluids,
• embalming of cadavers should, if possible, be avoided,
• autopsy of a highly radioactive cadavers should be restricted to the
absolute minimum

Nuclear Medicine Part 12. Protection of the general public 29

 IAEA Training Material on Radiation Protection in Nuclear Medicine

Part 12
Protection of the General Public

Module 12.5. Transportation

 Transport Container
Cartoon

Liner

Sealed can

Liner

Lead container

Source

Nuclear Medicine Part 12. Protection of the general public 31

 Transport Container

Nuclear Medicine Part 12. Protection of the general public 32

 Transport Index (TI)

1.0 m

TI = max dose-rate @ 1.0m

(Sv/h) 10
Nuclear Medicine Part 12. Protection of the general public 33
 White-I Label

< 5.0 Sv/h @ surface

< 0.05 Sv/h @ 1.0 m
 TI = 0

Nuclear Medicine Part 12. Protection of the general public 34

 Yellow-II Label

< 500 Sv/h, > 5 Sv/h

@ surface
< 10 Sv/h @ 1.0 m
 0 < TI < 1.0

Nuclear Medicine Part 12. Protection of the general public 35

 Yellow-III Label

 > 500 Sv/h,< 2000Sv/h

@ surface
 > 10Sv/h, < 100Sv/h
@ 1.0m
 1.0 < TI < 10

Nuclear Medicine Part 12. Protection of the general public 36

 Vehicle Placards

3 placards on vehicle

Nuclear Medicine Part 12. Protection of the general public 37

 Consignor’s Responsibilities

 all labelling and placarding

 provision of transport documents
 provision of local rules and any other relevant
information

Nuclear Medicine Part 12. Protection of the general public 38

 Internal Transport
If the administration of radiopharmaceutical to the patient takes
place far from the dispensing room, use a transport container with
absorbent pads.

Make sure that a warning sign is on the container together

with patient name, activity and date.

Travel by the most direct route avoiding more heavily

occupied areas

Nuclear Medicine Part 12. Protection of the general public 39

 Questions?

Nuclear Medicine Part 12. Protection of the general public 40

 Discussion

You get a phone-call from a colleague in another

hospital about 0.5 h away. He is in an urgent need
of Tc99m-MAA for a lung scan. Can you help him?

Nuclear Medicine Part 12. Protection of the general public 41

 Discussion

You get a phone call from a relative to a patient who

yesterday got 4 GBq Sm-153. The patient died at home
today. What to do?

Nuclear Medicine Part 12. Protection of the general public 42

 Discussion
A patient has received 300 MBq I-131 in a treatment
of thyrotoxicosis. She is working in a school preparing
food for the children. She was told to stay off work for
2 weeks. You get a message that she actually went
back to work the day after the treatment, which was
10 days ago. What to do?

Nuclear Medicine Part 12. Protection of the general public 43

 Where to Get More
Information
 Other sessions
 Part 4. Security of Sources, Design of Facilities
 Part 5. Occupational Protection
 Part 6. Medical Exposure
 Part 8. Optimization of medical exposure. Therapeutic
Procedures
 Part 10. Radioactive Waste
 Further readings
 IAEA Basic Safety Standards: Interim Edition (2011)
 IAEA Model regulations on radiation safety in nuclear
medicine
 WHO. Manual on Radiation Protection in Hospitals and
General Practices. Volume 4: Nuclear Medicine

Nuclear Medicine Part 12. Protection of the general public 44