Development and Validation of a New Tool to Measure Performance Knowledge and Communication Skill of Multidisciplinary Health Science Learners on Radiation Emergency Preparedness and Response Management.

OBJECTIVE: The purpose of the study was to design, develop, and validate a newer tool on radiation emergency preparedness responses (RadEM-PREM IPE tool) to measure communication, knowledge, performance skills in multidisciplinary health science learners. METHODS: The study design is a prospective, single centric, pilot study. Five subject experts designed, analyzed, and selected items of the instrument for relevant content and domain. Psychometrics that the tool assessed were content validity, internal consistency, test-retest reliability, and intraclass correlation coefficient. Twenty-eight participants completed test-retest reliability for validation of 21 sorted out items calculated percentage of agreement >70% I-CVI/UA (item content validity index with universal acceptability) and S-CVI/UA (scale content validity index with universal agreement method). RESULTS: Items with percentage agreement >70% and I-CVI over 0.80 were kept, ranged from 0.70 to 0.78 were revised, and below 0.70 were rejected. Items with kappa values ranging from 0.04 to 0.59 were revised and ≥0.74 were retained. Internal consistency assessed using Cronbach's alpha was 0.449. Positive correlation between attitude and communication (r = 0.448), between performance and communication (r = 0.443) were statistically significant at 0.01 level. Overall, intraclass correlation coefficient for all the measures is 0.646, which is statistically significant at 0.05 level (P < 0.05). CONCLUSIONS: Study concludes that the RadEM-PREM IPE tool would be a new measuring tool to assess knowledge, performance, and communication skills of interprofessional radiation emergency response team learner's evaluation.

Feasibility of 18F-FDG Labelling of Leucocytes in a Centre Without an On-Site Cyclotron and Monitoring of Radiation Dose to Occupational Worker in the Labelling Procedure.

Objectives: Differentiation of infection from sterile inflammation is still a major concern for clinicians. The 18F-WBC positron emission tomography/computed tomography scan has been considered a promising tool for accurate diagnosis of infection owing to its high specificity, but it renders the availability of a medical cyclotron a necessity. The aim of the present study was to determine the feasibility of labeling leukocytes and establish the protocol in a center without the availability of an on-site medical cyclotron. The secondary aim was to monitor radiation doses to occupational workers involved in labeling of leukocytes with 18F-FDG. Materials and Methods: Leukocyte separation was performed and leukocytes were radiolabeled with 18F-FDG in a sterile environment according to the procedure described by Bhattacharya et al. In vitro leukocyte viability was assessed using the trypan dye exclusion technique. Labeling efficiency and yield were also estimated for all radiolabeling procedures. Whole-body and extremity doses received by the personnel involved in the radiolabeling procedure were also estimated using pocket dosimeters. Results: Leukocyte labeling was carried out in 35 runs, during which there were two failed labeling attempts due to clotting of the blood sample. The total time involved in the whole procedure was around 2.5 h. The average labeling efficiency was 78.01% ± 6.99% (range 63.46%-86.54%), cell viability was 98%, and the cell suspension was stable up to 4 h. The mean dose was measured as 17 µSv at the chest level and 32 µSv at the extremity level, per procedure. Conclusions: Labeling of leukocytes with 18F-FDG is possible at a tertiary nuclear medicine setup without the availability of an on-site medical cyclotron, with reasonable labeling efficiency of 78.01% ± 6.99%. In addition, in-house labeling of leukocytes with 18F-FDG is safe and the radiation doses incurred by the personnel during the labeling procedure are well within the occupational dose limits established by the national regulatory authority.

Assessment of Radiation Exposure and Radioactivity from the Liquid Discharge in a Nuclear Medicine Facility.

AIM: Radionuclide imaging and therapies produce radioactive liquid waste that may lead to significant radiation exposure to the general public. The study aims to assess the radiation exposure rate to public sewerage from a modified delay tank facility. We shall also evaluate the exposure rates and overall radioactivity at several points. MATERIALS AND METHODS: After having appropriate permission from the AERB, we measured the radiation exposure from the radionuclide therapy ward. Ward has three isolation beds and a single delay and decay tank of a capacity of 7500 liters. Effluents from the delay tank are processed at the filtration plant of the institute and subsequently released in the public sewerage. We obtained samples from several sites to determine discharged radioactivity. RESULTS: A total of 38 patients received 129.4 ± 42 mCi (Range 40- 200) radioiodine therapy during the study. Discharge of the tanks was done two times during the study. The radioactivity discharges into aeration plant were 89.2 and 71.2 mCi that correspond to 440.05 and 351 MBq/m3, respectively. This was diluted by the aeration tank (6 million liters). Finally, at the discharge time, the radioactivity in the discharge was 1.6 and 1.5 MBq/m3, respectively. The highest exposure rates were 14 µSv/h near the delay tank, which rapidly decreased on moving to the surrounding. CONCLUSION: Our study indicates that the addition of the dilution method and close monitoring may significantly reduce the radiation exposure and overall radioactivity release from the facility. Old facilities that do not have space to add up the tank capacity may get a benefit from it. A small change in the practice, such as admitting patients alternate months or providing extra decay time for radioactive waste, may lead to a cost-effective alternative.

Radiation Exposure to the Nuclear Medicine Personnel During Preparation and Handling of 213Bi-Radiopharmaceuticals.

Because of the excellent ability of α-particles to transfer a high amount of energy over a short tissue range, targeted α-therapy has been attracting rising numbers of nuclear medicine centers. In this study, we estimated the radiation exposure to the occupational workers with pocket dosimeters during handling of the α-emitter 213Bi, used for targeted α-therapy of neuroendocrine tumor and castration-resistant prostate cancer patients. The dose rates from patients at different distances and time points after injection of the therapy were also evaluated. Methods: This prospective study was done in the Department of Nuclear Medicine at Fortis Memorial Research Institute, Gurgaon, India. Twelve patients with neuroendocrine tumors or castration-resistant prostate cancer were enrolled to receive 213Bi-DOTATOC or 213Bi-prostate-specific membrane antigen therapy, respectively. Each patient received 2-3 intravenous injections of 213Bi-peptide, 266-362 MBq (7.2-9.8 mCi) in a single cycle over 2-3 d. The radiation exposure to nuclear medicine personnel at the chest and extremity levels was assessed for tasks such as elution, dispensing, injecting, and collecting blood samples. Radiation levels were measured at distances of 1 cm and 1 m from patients immediately after, and at 1, 2, and 4 h after, the administration of 213Bi-peptide. Results: The external dose incurred at the chest level by radiopharmacists during synthesis, by physicians during injection, by technologists during imaging, and by nurses during sample collection was 2-7 µSv/procedure. The extremity dose was 1-14 µSv/procedure. The dose rate at 1 m from patients immediately after 213Bi-radiopharmaceutical injection was 0.02-0.03 µSv/MBq⋅h. Conclusion: The external radiation doses received by occupational workers involved in various procedures were far below the limit prescribed by the regulatory authority (20 mSv/y).

Radiation Dose to the Occupational Worker during the Synthesis of 188Re-labeled Radiopharmaceuticals in the Nuclear Medicine Department.

AIM: The aim of this study is to estimate whole-body radiation dose to the radiopharmacist involved in labeling of three different 188Re-labeled compounds, namely, 188Re-Lipiodol, 188Re-tin colloid, and 188Re-hydroxyl-ethylidene-diphosphonate (HEDP) and to compare the occupational burden with the dose limits recommended by Atomic Energy Regulatory Board, India. MATERIALS AND METHODS: The Department of Nuclear Medicine at Fortis Memorial Research Institute currently synthesizes three different Rhenium-188 labeled compounds, namely, 188Re-Lipiodol, 188Re-HEDP, and 188Re-tin colloid. To estimate the radiation exposure to the radiopharmacist involved in the synthesis, a survey meter was used to measure radiation level before the start of labeling procedure in the radiopharmacy by keeping it at the location where the radiopharmacist normally stands during preparation. Data were collected for 6 syntheses of each 188Re-Lipiodol, 4 for 188Re-HEDP, and 3 for 188Re-tin colloid followed by the quality control. The pocket dosimeter was used by the radiopharmacistat chest level, performing the labeling of 188Re-labeled compounds. All radiopharmaceuticals were synthesized by a single radiopharmacist. RESULTS: 1850 MBq (50 mCi) 188W-188Re generator was eluted before the preparation of each radiopharmaceutical. The amount of 188ReO4- used for labeling with lipiodol/4-hexadecyl-1,2,9,9-tetramethyl-4,7-diaza-1,10-decanethiol, HEDP, and Tin colloid was in the range of 3182-4440 MBq (86-120 mCi), 2812-3774 MBq (76-102 mCi), and 962-1295 MBq (26-35 mCi), respectively. Meantime required to complete the synthesis was 95, 40, and 131.5 min, respectively. Mean whole-body effective dose received was 0.052, 0.009, and 0.004 mSv, respectively, as measured by using the pocket dosimeter. CONCLUSION: From this small study, we observed that the whole-body radiation dose to the radiopharmacist in radiolabeling and quality control of 188Re-labeled radiopharmaceuticals is within prescribed limits at the current synthesis frequency.

(170)Tm-EDTMP: a potential cost-effective alternative to (89)SrCl(2) for bone pain palliation.

INTRODUCTION: Metastron ((89)SrCl(2)) is a radiopharmaceutical currently used for bone pain palliation in several countries since the long half-life of (89)Sr (50.5 days) favors wider distribution than other radioisotopes approved for this application, which have shorter half-lives. Strontium-89 is not ideal for bone pain palliation due to its high energy beta(-) particle emission [E(beta(max))=1.49 MeV] and is also difficult to produce in large quantities. A (170)Tm [T(1/2)=128.4 days, E(beta(max))=968 keV, E(gamma)=84 keV (3.26%)]-based radiopharmaceutical for bone pain palliation could offer significant advantages over that of (89)Sr. The present study constitutes the first report of the preparation of a (170)Tm-based agent, (170)Tm-ethylenediaminetetramethylene phosphonic acid (EDTMP), and its preliminary biological evaluation in animal models. METHODS: (170)Tm was produced by thermal neutron bombardment on natural Tm(2)O(3) target for a period of 60 days at a flux of 6x10(13) neutrons/cm(2).s. (170)Tm-EDTMP complex was prepared at room temperature. Biodistribution and scintigraphic imaging studies with (170)Tm-EDTMP complex were performed in normal Wistar rats. Preliminary dosimetric estimation was made using the data to adjudge the suitability of (170)Tm-EDTMP for bone pain palliation. RESULTS: (170)Tm was produced with a specific activity of 6.36 GBq/mg and radionuclidic purity of 100%. The (170)Tm-EDTMP was prepared with high radiochemical purity (>99%) and the complex exhibited satisfactory in vitro stability. Biodistribution and imaging studies showed good skeletal accumulation (50-55% of the injected activity) with insignificant uptake in any other vital organ/tissue. Activity was observed to be retained in skeleton until 60 days post-injection demonstrating that (170)Tm-EDTMP exhibits good bone-seeking properties with long retention. It is predicted that a dose of approximately 0.5 microGy/MBq is accrued to red bone marrow and 4.3 Gy/MBq is delivered to the skeleton. CONCLUSION: (170)Tm-EDTMP shows promising biodistribution features, encouraging dosimetric values and warrants further investigation in order to develop it as a bone pain palliative radiopharmaceutical. Despite the relatively long half-life (128.4 days) of (170)Tm, (170)Tm-EDTMP could be explored as a cost-effective alternative to (89)SrCl(2).

A novel approach to prepare (90)Y-EGMP patches for superficial brachytherapy.

A novel method to prepare (90)Y-EGMP patches has been developed for brachytherapy applications.EGMP films of 1cmx1cm size, incorporating approximately 185MBq of (90)Y were prepared and sealed between thin plastic sheets with uniform distribution of (90)Y. The leachability of (90)Y from radioactive patches was less than 0.01%. There was no leakage of radioactivity from radioactive patches, when tested in water or saline. The studies related to establish therapeutic efficacy of these patches are warranted.

Faunal diversity during rainy season in reclaimed sodic land of Uttar Pradesh, India.

Faunal diversity is an indicator of soil amelioration. Estimating the population size or density of an animal species in an area is fundamental to understand its status and demography and to plan for its management and conservation. Considering this, faunal diversity in reclamed sodic land was monitored during rainy season 2000-01 at different locations of district viz., Aligarh, Etah, Fatehpur, Mainpuri and Raebareli in Uttar Pradesh. The Shannon-Weiner species diversity index (H) of different fauna complex of each location was compared with zero years (1995-1996) indexes (before reclamation). Insects diversity index, in reclaimed sodic soil, varied from 3.8178 (Fatehpur: Bariyampur) to 4.623 (Fatehpur: Katoghan), which was 3.028 in zero year at Katoghan in Fatehpur 'H' index of other-arthropods ranged widely from 0.9743 (Etah: Bawali) to 2.0674 (Mainpuri: Pundari). The species diversity index of molluscs registered as high as 1.8637 at Ladhauwa site in Aligarh, which exhibited identical with Saripur site of Raebareli. 'H' index of mammal resulted with the highest (2.19) at Pundari in district Mainpuri. The avifauna and amphibian's indices were recovered maximal at Saripur site of Raebareli and Bariyampur site of Fatehpur respectively. Our result revealed that various fauna enriched with soil reclamation, which is good indicator of restoration of land, primarily due to soil-arthropods and earthworms and its eventual improvement along with succeeding rice-wheat cropping system widespread over there. It clearly shows that soil fauna strongly affects the composition of natural vegetation and we suggest that this knowledge might improve the restoration and conservation of biodiversity.

Bioevaluation studies of 32P incorporated mould brachytherapy sources for potential application in treatment of superficial tumors.

AIM: To prepare 32P-based user-friendly mould brachytherpy sources for the treatment of superficial tumors. METHODS: 32P as orthophosphoric acid was adsorbed on 15-25 mm (diameter) circular sheets of cellulose-based adsorbent paper to prepare sources containing approximately 37-74 MBq of 32P per cm of strip. The sources were immobilized between plastic sheets of 40 microm thickness. Autoradiography studies were carried out to determine the uniformity of 32P deposition in the source. Dosimetric evaluation of the sources was also carried out. Bioevaluation studies were carried out in C57BL6 mice bearing melanoma using 37-74 MBq sources. RESULTS: Cellulose-based sources containing 37-74 MBq of 32P per cm2 could be prepared from which no radioactivity leakage could be detected in water or saline. Autoradiography studies revealed 32P to be uniformly distributed in these sources. Dosimetric evaluation showed that the contact dose imparted was 10 Gy/h, sufficient for treatment of superficial tumors. In mice bearing melanoma, complete tumor regression could be achieved with two applications of 37-74 MBq sources, at an interval of 3 days. Histopathological examination of the skin tissue from the treated area proved the absence of tumor as compared with the controls. CONCLUSION: Preparation of P sources of various shapes and sizes (based on the tumor size) having uniform 32P activity distribution could be achieved. Efficacy of these sources in treating melanoma tumors could be established in the animal model.

Extremity dosimetry for radiation workers handling unsealed radionuclides in nuclear medicine departments in India.

In India, for the past five decades, whole body radiation dose of radiation workers has been monitored by means of film and thermoluminescent dosimeter (TLD) badges worn on the body. However, there are no provision/regulatory requirements to monitor doses received at the extremities, i.e., to fingers. Finger dose monitoring is essential for controlling the extremity dose limits for occupational personnel handling unsealed radioactive sources. In order to estimate the doses received in various types of procedures using unsealed sources, finger dose monitoring was carried out in 54 major institutions in the country using a specially designed plastic finger ring embedded with a TLD. The maximum finger dose of occupational workers involved in handling Tc in such activities as extraction and radiopharmacy work is 0.35 mSv GBq; during injection of radiopharmaceuticals and scintigraphy, the doses were observed to be 1 and 0.95 mSv GBq, respectively. Similarly, while handling F-FDG, the maximum doses received during dispensing, injection, and scintigraphy were 0.098, 0.324, and 0.56 mSv GBq, respectively. The maximum radiation dose received during Re/Re balloon angioplasty and while handling Sm was 3.92 and 6.5 mSv GBq, respectively. All the doses recorded were well within the prescribed limit. However, monitoring of these doses periodically would help in compiling the feedback regarding the work practices followed in institutions handling radioisotopes in the country and would also help in maintaining a record of safe work procedures while handling radioisotopes.

Estimation of radiation dose at various depths for commonly used radionuclides in radiosynoviorthesis in a tissue equivalent material.

The purpose of the paper is to report on the dose estimation studies at various depths for the commonly used beta-emitting 90Y, 166Ho, 153Sm, 32p, and 177Lu radionuclides in a phantom fabricated using the poly methyl methacrylate tissue equivalent material having a density of 1.19 gm/cc, by using thermoluminescent dosemeters. GAFChromic MD-55 films were used to calculate the calibration factor for the thermoluminescent micro-rods used in our study. It is observed that 90Y delivers the highest dose at 1 mm amongst the radionuclides tested followed by 32p, 166Ho, 153Sm, and 177Lu, whereas the cumulative dose received by the joint was found to be more for 32P followed by 90Y, 166Ho, 153Sm, and 177Lu. The highest therapeutic range obtained is 3.1 mm for 153Sm amongst the tested radionuclides. The dose values obtained for all the above-mentioned radionuclides can serve as reference material for those researchers and clinicians who are interested in selection of the radionuclide for the type of joint treated and the amount of dose necessary to be delivered to the synovial membrane.