Need for harmonisation of extremity dose monitoring in nuclear medicine: Results of a survey amongst national dose registries in Europe

Staff handling radiopharmaceuticals in nuclear medicine (NM) may receive significant extremity doses. Over the last decade in particular there has been an increase in NM procedures and new radiopharmaceuticals have been introduced. However, literature provides limited recent data on the exposure of the extremities. In addition, proper assessment of the equivalent dose to the skin can be difficult when applied to the fingertips. In order to gain insight in the actual exposure and to find out how European countries are dealing with monitoring of the extremities, a survey was performed amongst European regulatory authorities. The questions covered general aspects of the national dose registries (NDRs), the measured extremity doses and the practice of the monitoring of workers. The survey shows that extremity dosimetry is performed for about 25%–50% of the monitored workers in NM. Also, the recorded extremity doses in the NDRs are low (mean values 5–29 mSv yr-1) compared to the dose limit. Despite the recommendations that have been published in the last 10 years, few countries provide guidance on the wearing position of extremity dosemeters and the correction factor to estimate the maximum equivalent skin dose from the measured dose. This may lead to an underestimation of the maximum skin dose. Thermoluminescence ring dosemeters are widely used, but wrist dosemeters are also very common, even though the correlation of the measurement with the maximum skin dose is worse than for ring dosemeters. Furthermore, not all countries had a central registration of the extremity dose at the time the survey was performed.Peer ReviewedObjectius de Desenvolupament Sostenible::3 - Salut i BenestarPostprint (published version

How to establish an adequate system for eye lens dose monitoring: a proposal for typical workplaces

For years, the dose limit of 150 mSv for occupational exposure of the lens of the eye to ionising radiation was rarely exceeded, and the dose to the eye was only monitored occasionally. With the national implementation of the European Basic Safety Standards in 2018, this dose limit was reduced to 20 mSv and the Member States are expected to implement an adequate system for the monitoring of category A workers. Where the system for monitoring the whole body dose is settled in most countries, this is not the situation for the lens of the eye. This article presents a system for eye lens dose monitoring, based on the particle type, energy, angle of incidence and geometry of the radiation field and the use of protective measures. The system provides recommendations for the adequate operational quantity and dosemeter position for some of the most relevant workplaces

A European survey on the regulatory status for the estimation of the effective dose and the equivalent dose to the lens of the eye when radiation protection garments are used

Following the proposal of the ICRP for the reduction of the dose limit for the lens of the eye, which has been adopted by the International Atomic Energy Agency and the European Council, concerns have been raised about the implementation of proper dose monitoring methods as defined in national regulations, and about the harmonisation between European countries. The European Radiation Dosimetry Group organised a survey at the end of 2017, through a web questionnaire, regarding national dose monitoring regulations. The questions were related to: double dosimetry, algorithms for the estimation of the effective dose, methodology for the determination of the equivalent dose to the lens of the eye and structure of the national dose registry. The results showed that more than 50% of the countries that responded to the survey have legal requirements about the number and the position of dosemeters used for estimation of the effective dose when radiation protection garments are used. However, in only five out of 26 countries are there nationally approved algorithms for the estimation of the effective dose. In 14 out of 26 countries there is a legal requirement to estimate the dose to the lens of the eye. All of the responding countries use some kind of national database for storing individual monitoring data but in only 12 out of 26 countries are the estimated effective dose values stored. The personal dose equivalent at depth 3 mm is stored in the registry of only seven out of 26 countries. From the survey, performed just before the implementation of the European Basic Safety Standards Directive, it is concluded that national occupational exposure frameworks require intensive and immediate work under the coordination of the competent authorities to bring them into line with the latest basic safety standards and achieve harmonisation between European countries

Review of extremity dosimetry in nuclear medicine

The exposure of the fingers is one of the major radiation protection concerns in nuclear medicine (NM). The purpose of this paper is to provide an overview of the exposure, dosimetry and protection of the extremities in NM. A wide range of reported finger doses were found in the literature. Historically, the highest finger doses are found at the fingertip in the preparation and dispensing of18F for diagnostic procedures and90Y for therapeutic procedures. Doses can be significantly reduced by following recommendations on source shielding, increasing distance and training. Additionally, important trends contributing to a lower dose to the fingers are the use of automated procedures (especially for positron emission tomography (PET)) and the use of prefilled syringes. On the other hand, the workload of PET procedures has substantially increased during the last ten years. In many cases, the accuracy of dose assessment is limited by the location of the dosimeter at the base of the finger and the maximum dose at the fingertip is underestimated (typical dose ratios between 1.4 and 7). It should also be noted that not all dosimeters are sensitive to low-energy beta particles and there is a risk for underestimation of the finger dose when the detector or its filter is too thick. While substantial information has been published on the most common procedures (using99mTc,18F and90Y), less information is available for more recent applications, such as the use of68Ga for PET imaging. Also, there is a need for continuous awareness with respect to contamination of the fingers, as this factor can contribute substantially to the finger dose.Peer ReviewedObjectius de Desenvolupament Sostenible::3 - Salut i BenestarPostprint (published version

High dose rate and flattening filter free irradiation can be safely implemented in clinical practice

PURPOSE: We hypothesize that flattening filter free (FFF) high dose rate irradiation will decrease cell survival in normal and cancer cells with more pronounced effects in DNA repair deficient cells. Additionally, we hypothesize that removal of the flattening filter will result in an enhanced relative biological effectiveness independent of the dose rate. MATERIALS AND METHODS: Clonogenic survival was assessed after exposure to dose rates of 4 or 24 Gy/min (FFF 10 megavolt [MV] photon beam) using a Varian TrueBeam accelerator. Additionally, cells were exposed to 4 Gy/min with or without flattening filter. Relative biological effectiveness estimations were performed comparing the different beam photon spectra. RESULTS: Cell survival in tumor and normal cell lines was not influenced by high dose rate irradiation. The intrinsic radiation sensitivity of DNA repair deficient cells was not affected by high dose rate compared to normal dose rate. Furthermore, the relative biological effectiveness was not significantly different from unity in any of the cell lines for both FFF and conventional flattened beam exposures. CONCLUSIONS: High dose rate irradiation did not affect long-term survival and DNA repair for cell lines of different tissues. This suggests that high dose rate does not influence treatment outcome or treatment toxicity and could be safely implemented in clinical routine