Referral to radioisotope examination as a source of additional radiation exposure for staff

Background: Every exposure of human to ionizing radiation increases the likelihood of deterministic sequelae. At the same time, it is associated with the risk of stochastic effects. Consequently, this can lead to cancer, mainly of the hematopoietic system. Organs or tissues show a different affinity for gamma radiation. There are many technical and organizational measures which minimize the impact of this radiation on people and especially on the staff of the nuclear medicine laboratory. Materials and methods: The study was based on 208 referrals to the scintigraphic laboratory, which were executed between 26.09.2018 and 13.11.2018 in the Department of Nuclear Medicine of Military Medical Academy Memorial Teaching Hospital of the Medical University of Lodz – Central Veterans` Hospital. Referrals concerned scintigraphic tests of bones, salivary glands, parathyroid glands, myocardial perfusion, somatostatin receptor analogues, renoscintigraphic and lymphoscintigraphic tests. In case of each referral, radiation power was measured at a distance of approx. 10 cm with the use of a calibrated Geiger-Muller detector. Measurements were performed immediately after the end of the last examination each day. Daily measurement of the background radiation dose was also a standard procedure. For calculations, this value was averaged to 0.18µSv/h. Based on the above measurements, a statistical analysis of all data was performed. Obtained data was also analysed after it was ascribed to the person complexing radiopharmaceuticals on a given day. The annual dose for a radiopharmacist is 0.12 mSv, for a technician 0.35 mSv and for a doctor 0.45 mSv. Results: The average radiation dose received every working day by the staff was 11.49 µSv/h. After considering the average distance from the potential source of exposure (50 cm), this power decreased to 0.46µSv/h. In order to calculate the quarterly and annual radiation dose, it was assumed that the employee worked 250 days a year. Conclusions: Medical records may pose an additional personnel exposure to ionizing radiation. Physicians are the most vulnerable group of employees. The way of radiopharmacists work contributes to the contamination of medical records

Multidirectional assessment of medical treatment influence on lower limb perfusion in patients suffering from obliterative atheromatosis

Wstęp. Przewlekłe niedokrwienie kończyn dolnych jest przedmiotem wielu badań, jednak w większości z nich nie dokonuje się porównania spoczynkowego i wysiłkowego przepływu naczyniowego. Medycyna nuklearna dysponuje metodami i programami pozwalającymi rozwiązać to zagadnienie. Celem pracy jest określenie za pomocą metod radioizotopowych zaburzeń perfuzji mięśni kończyn dolnych w spoczynku i po wysiłku u chorych z miażdżycą zarostową tętnic i porównanie wyników ze standardowymi metodami oceniającymi ukrwienie kończyn dolnych oraz ocena wpływu leczenia zachowawczego na analizowane parametry ukrwienia. Materiał i metody. Materiał stanowiło 35 pacjentów, leczonych zachowawczo z powodu niedokrwienia kończyn dolnych. Badaniem objęto chorych, którzy w momencie przyjęcia zgłaszali ziębniecie, drętwienie, chromanie przestankowe od 30-500 m. W celu kwalifikacji do grup u wszystkich chorych wykonano doplerowskie badanie USG kodowane kolorem. Do dalszych badań włączono chorych z drugim stopniem według klasyfikacji Foutaine’a (IIa i IIb), których dystans chromania wahał się w granicach 30÷500 m. Leczenie zachowawcze obejmowało modyfikację czynników i skojarzoną farmakoterapię oraz określenie wskaźników kostka-ramię, udo-goleń i udo-kostka. Radioizotopowe badania perfuzji mięśni kończyn dolnych w spoczynku i po wysiłku wykonywano za pomocą gamma-kamery według własnej metody i programu ALLP, określających wskaźniki perfuzji w badanych mięśniach. Wnioski. 1. Sześciomiesięczne leczenie zachowawcze, w tym skojarzone leczenie farmakologiczne, powoduje niewielką poprawę ukrwienia w zakresie krążenia w kończynach dolnych polegającą głównie na wzroście wartości wskaźnika kostka-ramię, obniżeniu wartości wskaźników udo-kostka i udo-goleń oraz poprawie prędkości przepływu we wszystkich badanych tętnicach. 2. Bardzo czułym i wartościowym badaniem określającym zmiany ukrwienia kończyn dolnych (goleni i ud) w spoczynku i po wysiłku, po zastosowaniu terapii zachowawczej, jest radioizotopowe badanie perfuzji mięśni. Uzyskane wskaźniki perfuzji precyzyjnie informują o wielkości zmian w mikrokrążeniu oraz pozwalają monitorować efekty leczenia zachowawczego. 3. Metoda radioizotopowa komplementarnie uzupełnia dotychczasową diagnostykę zaburzeń ukrwienia mięśni kończyn dolnych u chorych z miażdżycą zarostową tętnic.Background. Chronic lower-limb ischaemia has been the subject of several studies; however, most of them do not give a comparison between vascular flow at rest and vascular flow after exercise. Nuclear medicine is vested with methods and programmes allowing the solution of this matter. The aim of this study was to define, with the use of radioisotopic methods, the perfusion disturbances of lower limb muscles at rest and after exercise in patients with arterial obliterative atheromatosis, and to compare the results with the standard methods assessing lower limb perfusion, as well as to assess the influence of the medical treatment on the analyzed parameters of the perfusion. Material and methods. The material included 35 patients, medically treated because of lower limbs ischaemia. The study covered patients who, at the time of admission, reported feeling cold, numbness and intermittent claudication at 30 to 500 m For group classification, all the patients underwent USG-Doppler examination with a colour option. The patients with the second degree according to Foutaine (IIa, IIb), whose claudication distance ranged between 30 and 500 m, were included in the study. Medical treatment included modification of the factors and combined pharmacotherapy, and defining factors: ankle-brachial, femoral-tibial and femoral-ankle. Radioisotopic examinations of lower limb perfusion at rest and after exercise were performed with the use of a gamma camera according to our own method and an ALLP programme defining the perfusion indicators in the examined muscles. Conclusions. 1. A six-month period of medical treatment, including combined pharmacological treatment, causes a slight increase of lower limb perfusion, expressed mainly by an increase of the ankle-brachial index, decrease of the femoral-ankle and femoral-tibial indexes, and improvement of the speed of flow in all examined arteries. 2. Radioisotopic examination of muscle perfusion is a very precise and beneficial examination defining the changes in perfusion in the lower limbs (tibias and femora) at rest and after exercise. The obtained perfusion indexes give precise information about the scale of changes in microcirculation and allow the effects of the medical treatment to be monitored. 3. The radioisotopic method has completed previous diagnostics of lower limb perfusion disturbances in patients suffering from arterial obliterative atheromatosis

Izotopowe określenie prawidłowych wartości perfuzji mięśni kończyn dolnych w spoczynku i wysiłku z uwzględnieniem możliwości ich zastosowania w diagnostyce klinicznej

Background: The lack of a range of normal values of perfusion in the lower limbs during stress and at rest narrows the use of this type of diagnostic tool to the estimation of the current state of relative perfusion without indications of the presence or level of perfusion disturbances. Numerous reports on early changes in endothelium reactivity (depending on disease and degree of vessel pathology) encouraged us to assess lower limb perfusion in healthy people. Our goal was to 1) work out a program and method which would enable lower limb perfusion assessment under stress and at rest in patients without signs of lower limb circulation deprivation and 2) establish the normal range of indexes of lower limb perfusion under stress and at rest which would enable their use in the diagnostics of lower limb muscle circulation. Material and Methods: 33 male patients aged between 25 to 45 years (mean: 35.30 ± 6.04) without signs of circulatory problems were entered into the study. To exclude circulatory disturbances, Doppler USG, blood pressure, and laboratory tests were performed on every patient at rest 5 min. after the injection of 11.1 MBq/kg 99 mTc MIBI. Whole body as well as thigh and calf scintigrams were made with an ELSCINT SP6HR gamma-camera. The symmetry of the thigh and calf perfusion (WSU, WSP) and the indexes of the thigh (WPLU, WPPU) and calf (WPLP, WSPP) perfusion of both lower limbs were estimated. Results: At rest: WSP: 96.47% ± 1.02, WSP: 96.47% ± 1.02, WPLP: 9.77 ± 0.32, WPPP: 9.78 ± 0.31, WPLU: 8.45 ± 0.22, WPPU: 8.48 ± 0.22. Under stress: WSP: 96.69% ± 1.32, WSU: 96.41% ± 1.20, WPLP: 8.78 ± 0.26, WPPP: 8.81 ± 0.25, WPLU: 7.77 ± 0.25, WPPU: 7.82 ± 0.26. Anamnesis, additional studies, and laboratory tests in the group examined did not show any circulatory disturbances. Conclusions: The estimated values in patients without circulatory disturbances are similar and within a narrow range, which allows us to calculate the norms of lower limb perfusion at rest and under stress. The determined normal values may be essential in diagnostics in permitting differentiation of healthy patients from those with vascular pathology of the lower limb circulation at an early stage

Radioisotopic assessment of bone metabolism of the operated vertebra after inter-process stabilizer implantation in the lumbar segment of the spine

Introduction: Lack of efficacy of pharmacotherapy and physiotherapy in spinal pain syndrome is an indication for intervertebral stabilizer implantation between the processes in the lumbar segment of the spine. Material and methods: The group consisted of 32 patients qualified after radioisotopic single-photon emission computed tomography/computed tomography (SPECT/CT) examinations with assessment of bone metabolism and mineral density. For comparative purposes, the L2 vertebra was defined as normal. Parameters defined in the area of operated vertebrae were comparable to L2. Imaging examinations and a pain intensity test were performed before and 12 months after the procedure. Results: In SPECT, osteotropic isotope (OI) activity in spinous bodies and processes was close to L2 values. Density assessed in CT of analysed vertebrae was close to L2. In the control examination, activity of OI in spinous bodies and processes was higher in the procedure area. Under the stabilizer, there was a strong positive correlation with the L2 parameters. The differences were statistically significant (p = 0.0002). The increase of OI activity in the elements above the stabilizer was variable. In the control examination, there was higher density of spinous processes and bodies above and under the stabilizer. The difference, compared to the L2 density, was statistically significant. Conclusions : The radioisotopic method with SPECT/CT allows for the precise assessment of bone metabolism in the spine. After the procedure, a negative correlation was observed between bone metabolism changes and pain intensity test results