The introduction of automated dispensing and injection during PET procedures: a step in the optimisation of extremity doses and whole-body doses of nuclear medicine staff

Covens, Peter; Berus, Danielle; Vanhavere, F.; Caveliers, Vicky

doi:10.1093/rpd/ncq110

Cited by 39 publications

(30 citation statements)

References 12 publications

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“…The authors estimated that between 15% and 20% of those working with both 99m Tc and 18 F may exceed the annual skin dose limit of 500 mSv. Similar finger doses have been reported by Covens et al [7] in a review and by Rimpler and Barth [8]. …”

Section: Data On Extremity Dosesupporting

confidence: 87%

Extremity doses of nuclear medicine personnel: a concern

Kemerink

Vanhavere

Barth

et al. 2011

Eur J Nucl Med Mol Imaging

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Section: Data On Extremity Dosesupporting

confidence: 87%

Extremity doses of nuclear medicine personnel: a concern

Kemerink

Vanhavere

Barth

et al. 2011

Eur J Nucl Med Mol Imaging

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“…Shielded automated infusion devices have recently been introduced, allowing for subsequent reductions in radiation exposure to staff during patient dosing procedures (8)(9)(10)). These dose reductions are possible for several reasons.…”

mentioning

confidence: 99%

Occupational Radiation Dosimetry Assessment Using an Automated Infusion Device for Positron-Emitting Radiotracers

Schleipman

Gerbaudo

2012

Journal of Nuclear Medicine Technology

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Handling and administration of radiopharmaceuticals are a key contributor to staff radiation dose. Shielded automated infusion devices potentially standardize and reduce radiation exposure during procedures. However, loading the devices adds incremental radiation exposure, which may mitigate dose savings. We measured radiation doses from the loading and use of an automated infusion device and compared these with those from manual injection of 18 F radiotracers. Methods: Adult patients were administered 18 F-FDG or 18 F-FLT before 3-dimensional PET whole-body or brain imaging, respectively. Radioactivity amounts from manual injections performed with protective syringe shields and vial holders were measured by a standard dose calibrator before and after injection. Automated infusions were performed using the shielded infusion device. Staff wore electronic dosimeters at the wrist and trunk. Electronic dosimeters were also worn while multidose 18 F-FDG vials were loaded and unloaded. For each task, background radiation was determined and subtracted from the electronic dosimeter values. Results: Twenty-seven manually injected unit doses yielded a mean administered dose to patients of 480.7 6 66.2 MBq (12.99 6 1.79 mCi), compared with 431.9 6 22.7 MBq (11.67 6 0.61 mCi) in 34 automated injections. The mean difference was statistically significant. To control for this difference, results were expressed as a standardized dose per unit of activity. With the automated infusion device, the mean extremity dose per injection was 0.003 6 0.002 mSv/MBq, compared with 0.026 6 0.017 mSv/MBq with manual injections. Mean body dose per procedure with automated infusion was 0.001 mSv/MBq, versus 0.011 mSv/MBq with manual injection (P , 0.001). The changing of bulk 18 F-FDG vials in 37 procedures added a mean dose per vial change of 0.89 6 1.3 mSv to the extremities and 0.47 6 2.0 mSv to the body. Conclusion: The use of a shielded automatic infusion device in a clinical PET setting resulted in an approximately 10-fold decrease in staff extremity and body doses during the administration of 18 F-labeled radiopharmaceuticals. Loading and unloading bulk vials of radiotracer did not significantly offset these dose savings. Reduci ng radiation exposure to patients, nuclear medicine staff, and others is a common goal of professionals in radiation protection and nuclear medicine. Potential increases in both medical and occupational radiation exposure have become a more urgent and persistent issue with the increasing dissemination of PET imaging, which uses higher-photon-yield radiopharmaceuticals such as 18 F-FDG (1-3). Task-based analyses often point to the handling and administration of radioactive materials as a key contributor to increased dose to staff (4-7).Shielded automated infusion devices have recently been introduced, allowing for subsequent reductions in radiation exposure to staff during patient dosing procedures (8-10). These dose reductions are possible for several reasons. The first is the increased distance of operators from...

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“…Although use of a syringe shield is a practical solution to reduce radiation dose to fingers during manual injection, other efficient systems such as automatic (or semiautomatic) dispensing/injection systems have been recommended to limit the finger dose. Covens et al (2010) studied one of these automated dispensing/injection systems, and found that extremity dose can be reduced by more than 95% with the use of an automated dispensing/injection system. Lecchi et al (2012) studied the use of a combined dispensring/injector system, and reported that the extremity dose to the physician (when administration of 18 F-FDG was performed by a physician) was reduced by 93%.…”

Section: Extremity Dosementioning

confidence: 99%

Trends in radiation protection of positron emission tomography/computed tomography imaging

Alenezi

Soliman

2014

Ann ICRP

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Over the past decade, the number of positron emission tomography/computed tomography (PET/CT) imaging procedures has increased substantially. This imaging technique provides accurate functional and anatomical information, particularly for oncological applications. Separately, both PET and CT are considered as high-dose imaging modalities. With the increased use of PET/CT, one could expect an increase in radiation doses to staff and patients. As such, major efforts have been made to reduce radiation dose in PET/CT facilities. Variations in working techniques have made it difficult to compare published results. This study aimed to review the literature on proposed methods to reduce patient and staff dose in clinical PET/CT imaging. A brief overview of some published information on staff and patient doses will be analysed and presented. Recent trends regarding radiation protection in PET/CT imaging will be discussed, and practical recommendations for reducing radiation doses to staff and patients will be discussed and summarised. Generally, the CT dose component is often higher in magnitude than the dose from PET alone; as such, focusing on CT dose reduction will decrease the overall patient dose in PET/CT imaging studies. The following factors should be considered in order to reduce the patient's dose from CT alone: proper justification for ordering contrast-enhanced CT; use of automatic exposure control features; use of adaptive statistical iterative reconstruction algorithms; and optimisation of scan parameters, especially scan length. The PET dose component can be reduced by administration of lower activity to the patient, optimisation of the workflow, and appropriate use of protective devices and engineered systems. At the international level, there is wide variation in work practices among institutions. The current observed trends are such that the annual dose limits for radiation workers in PET/CT imaging are unlikely to be exceeded.

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The introduction of automated dispensing and injection during PET procedures: a step in the optimisation of extremity doses and whole-body doses of nuclear medicine staff

Cited by 39 publications

References 12 publications

Extremity doses of nuclear medicine personnel: a concern

Extremity doses of nuclear medicine personnel: a concern

Occupational Radiation Dosimetry Assessment Using an Automated Infusion Device for Positron-Emitting Radiotracers

Trends in radiation protection of positron emission tomography/computed tomography imaging

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