Guidance on prevention of unintended and accidental radiation exposures in nuclear medicine

Abstract

Nuclear medicine (NM) procedures for diagnosis and treatment of disease are performed routinely in hospitals throughout the world. These involve preparation and administration to patients of pharmaceuticals labelled with radioactive material. The International Atomic Energy Agency (IAEA) and the World Health Organisation highlighted the need for improvement in prevention of medical radiation incidents and accidents in the Bonn Call-for-Action in 2012. An IAEA Technical Meeting was held on prevention of unintended exposures and accidents in NM in 2018 to address the issue. Exposures can take place at any time when radioactive material is being produced and used, and the risk continues after procedures have been completed. Thus there is potential for staff or members of the general public to be exposed, as well as patients. This paper sets out guidelines for incident prevention based on presentations and discussions at the meeting, and review of reports from the literature. It deals with potential incidents in in-house radionuclide production, radiopharmaceutical preparation, administration to patients, and following a procedure, as well as aspects in management of radioactive materials. Special attention has been paid to therapeutic procedures, as these have the potential to cause more harm to patients from erroneous administrations, including tissue reactions from extravasation of radiopharmaceutical, and could lead to significant contamination events. Administration of NM therapy is generally contraindicated in pregnancy. Identification of any patient who may be pregnant is crucial and it might be necessary to verify this with a pregnancy test for patients within the age band considered to be fertile. Inclusion of NM therapy incidents in the IAEA automated reporting system SAFRON is recommended. In summary, the paper aims to highlight errors that could occur during different phases of NM procedures in order to aid prevention of incidents. The value of periodic audit in evaluating systems in place on a regular basis is emphasised. Approaches to incident investigation and follow-up are described, and the need to ensure corrective action is taken to address any deficiencies stressed.

Comparison of Standard Training to Virtual Reality Training in Nuclear Radiation Emergency Medical Rescue Education

“…When a nuclear and radiation emergency occurs, on-site rescue mainly includes: searching for casualties; preliminary classification (including injury detection and identification); timely rescue of life-threatening casualties; ensuring that patients with overirradiation and/or radionuclide body surface contamination, wound contamination, and internal radionuclide intake receive timely and effective disposal; collecting relevant information to analyze the medical consequences of a nuclear accident; assessing the medical consequences of a nuclear accident and medical disposal capabilities of the site; providing timely recommendations to the site emergency command; reporting to the medical emergency command to reduce the medical consequences of the nuclear accident to a minimum; establishing a temporary rescue and disposal station on site, classifying and transferring the injured; collecting the necessary samples, providing relevant information for subsequent diagnosis and treatment. 4,[11][12][13][14] The traditional training mode of nuclear and radiation emergency first aid is mainly knowledge training and emergency drill.…”

How often does it happen? A review of unintended, unnecessary and unavoidable high-dose radiation exposures

“…Although there are anecdotal examples in the literature of overexposures from therapeutic nuclear medicine events with potentially severe consequences (e.g. [31,32]), there seem to be fewer systematic studies on the frequency of events in this modality than in radiotherapy.…”

Contact restriction time after common nuclear medicine therapies: spreadsheet implementation based on conservative retention function and individual measurements

“…This situation invites us to reconsider radiation protection issues in nuclear medicine, which covers radionuclide production, exposure of staff, patients and members of the public, waste management and even handling of corpses and cremation (ICRP 2019, Martin et al 2019, European Commission 2020, Kyriakidou et al 2021.…”