Radiation Dose to Patients from Radiopharmaceuticals

ObjectiveTo give a comprehensive overview of fetal doses reported in the literature when imaging the pregnant woman with suspected pulmonary embolism (PE).MethodsA comprehensive literature search in the PubMed, MEDLINE and EMBASE databases yielded a total of 1,687 papers that were included in the analysis and have been analysed with regard to fetal dose in suspected PE radiological imaging strategies.ResultsFetal dose in chest computed tomography (CT) ranges between 0.013 and 0.026 mGy in early and 0.06–0.1 mGy in late pregnancy compared with 99mTc-MAA perfusion scintigraphy with a fetal dose of 0.1–0.6 mGy in early and 0.6–0.8 mGy in late pregnancy. 99mTc-aerosol ventilation scintigraphy results in 0.1–0.3 mGy. However, there is concern about female breast irradiation in CT, which is higher than in scintigraphy. CT radiation risks for breast tissue remain unclear.ConclusionKnowledge of dosimetry and radiation risks is crucial in the radiological work-up of suspected PE in pregnancy. It is reasonable to reserve scintigraphy for pregnant patients with normal chest radiography findings and no history of asthma or chronic lung disease. Performing CT applying dose reduction instead of scintigraphy will minimise fetal radiation dose and maximise the diagnostic value.

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“…Huda [26] reported fetal doses of 0.9 mGy for 370 MBq 99m Tc-MAA perfusion imaging, based on old numbers from the ICRP [37]. …”

Section: Introductionmentioning

confidence: 99%

“…Using 133 Xe results in a very low embryo dose (<0.01 mGy). The inhalation of approximately 110 MBq 99m Tc DTPA will result in an embryo dose of about 0.9 mGy [37]. It is absorbed through the lung and excreted via the kidneys, and while in the bladder it will contribute to fetal dose.…”

Section: Introductionmentioning

confidence: 99%

Imaging for suspected pulmonary embolism in pregnancy—what about the fetal dose? A comprehensive review of the literature

et al. 2010

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“…The International Commission on Radiological Protection (ICRP) publication 53 presents estimates of the biokinetic model based on these early data [26]. In the subsequent addenda to this ICRP publication (ICRP publication 80, based on some assumptions from ICRP publication 60), absorbed dose estimates for MIBG changed due to new assumptions in specific absorbed fractions to calculate the S values [27, 28].…”

Section: Discussionmentioning

confidence: 99%

Clinical performance and radiation dosimetry of no-carrier-added vs carrier-added 123I-metaiodobenzylguanidine (MIBG) for the assessment of cardiac sympathetic nerve activity

Verberne

Sokole

Moerkerken

et al. 2008

Eur J Nucl Med Mol Imaging

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PurposeWe hypothesized that assessment of myocardial sympathetic activity with no-carrier-added (nca) 123I-meta-iodobenzylguanidine (MIBG) compared to carrier-added (ca) 123I-MIBG would lead to an improvement of clinical performance without major differences in radiation dosimetry.MethodsIn nine healthy volunteers, 15 min and 4 h planar thoracic scintigrams and conjugate whole-body scans were performed up to 48 h following intravenous injection of 185 MBq 123I-MIBG. The subjects were given both nca and ca 123I-MIBG. Early heart/mediastinal ratios (H/M), late H/M ratios and myocardial washout were calculated. The fraction of administered activity in ten source organs was quantified from the attenuation-corrected geometric mean counts in conjugate views. Radiation-absorbed doses were estimated with OLINDA/EXM software.ResultsBoth early and late H/M were higher for nca 123I-MIBG (ca 123I-MIBG early H/M 2.46 ± 0.15 vs nca 123I-MIBG 2.84 ± 0.15, p = 0.001 and ca 123I-MIBG late H/M 2.69 ± 0.14 vs nca 123I-MIBG 3.34 ± 0.18, p = 0.002). Myocardial washout showed a longer retention time for nca 123I-MIBG (p < 0.001). The effective dose equivalent (adult male model) for nca 123I-MIBG was similar to that for ca 123I-MIBG (0.025 ± 0.002 mSv/MBq vs 0.026 ± 0.002 mSv/MBq, p = 0.055, respectively).ConclusionNo-carrier-added 123I-MIBG yields a higher relative myocardial uptake and is associated with a higher myocardial retention. This difference between nca 123I-MIBG and ca 123I-MIBG in myocardial uptake did not result in major differences in estimated absorbed doses. Therefore, nca 123I-MIBG is to be preferred over ca 123I-MIBG for the assessment of cardiac sympathetic activity.

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“…The most significant residence times for 81m Kr, 133 Xe, 99m Tc (technegas), the 99m Tc (MAA) in the biokinetic organs used in dose calculations are shown in Table 1 [6,16]. This table includes times of residence for 99m Tc (DTPA)-aerosol and 99m Tc (MSA) [17].…”

Section: Materials Y Methodsmentioning

confidence: 99%

“…Table 1. Residence time in hours used as organs of biokinetic [6,16,17] In the Tables 2 and 3 are shown the characteristics of photons, and particles emitted in the decay of 99m Tc, 133 Xe and 81m Kr [16] that were used in the dose calculation.…”

Section: Materials Y Methodsmentioning

confidence: 99%

Dosimetry of radiopharmaceuticals used in adult patients with suspected pulmonary embolism

Vasquez-Arteaga

Vega‐Carrillo

Rodriguez-Benites

et al. 2021

Momento

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The absorbed dose of radiopharmaceuticals is estimated in adults with suspected pulmonary embolism explored by ventilation/perfusion studies. For pulmonary ventilation studies 81mKr, 133Xe, 99mTc (Technegas)-aerosol and 99mTc (DTPA)-aerosol are used. For perfusion agents, 99mTc(MAA), 99mTc (MSA) (macroaggregates and albumin microspheres) are used. For the dose calculation, the MIRD methodology and the anthropomorphic representation of the biokinetic organs of Cristy-Eckerman are used. In ventilation/perfusion studies, the lowest dose absorbed by the lungs with suspected embolism is due to 81mKr/ 99mTc (MSA), and the highest dose is due to 99mTc (Technegas)/99mTc (MAA) calculated for activities of 150 MBq for perfusion agents and 40 MBq for ventilation agents.

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Radiation Dose to Patients from Radiopharmaceuticals

Cited by 162 publications

References 147 publications

Imaging for suspected pulmonary embolism in pregnancy—what about the fetal dose? A comprehensive review of the literature

Imaging for suspected pulmonary embolism in pregnancy—what about the fetal dose? A comprehensive review of the literature

Clinical performance and radiation dosimetry of no-carrier-added vs carrier-added 123I-metaiodobenzylguanidine (MIBG) for the assessment of cardiac sympathetic nerve activity

Dosimetry of radiopharmaceuticals used in adult patients with suspected pulmonary embolism

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