[Radiation hygiene in medical X-ray imaging, part 1: physical and technical basics]. / Strahlenhygiene in der medizinischen Röntgenbildgebung, Teil 1 : Physikalisch-technische Grundlagen.

In this first part of a series of three articles on radiation hygiene in medical X-ray imaging the characteristics of X-rays, their interactions with matter and the components of X-ray equipment are described from a radiation protection point of view. The fundamental radiation protection measures like filtration and beam limitation are introduced as well as the various conventional and digital image receptor systems. Moreover the absorbed dose and other practical dose terms as well as metrological and theoretical methods for dose assessment are introduced. The aim of this paper is to explain the essential physical and technical basics of X-ray imaging and the assessment of the resulting radiation dose.

Beta radiation exposure of staff during and after therapies with 90Y-labelled substances.

Radioimmunotherapies (RITs) and peptide receptor radiotherapies (PRRTs) with (90)Y-labelled compounds offer promising prospects for tumor treatment in nuclear medicine. However, when preparing and performing these therapies, which require manipulations of high activities of (90)Y (>1 GBq), technicians and physicians may receive high exposures, mainly to the skin of the hands. Even non-occupationally exposed persons, such as caregivers and family members, receive external exposures in the initial period after therapy, arising from the (90)Y in the patient. The local skin doses of the individual staff members, measured during RITs and PRRTs with thermoluminescence detectors fixed with tapes to the fingers, vary considerably. The exposure of staff can exceed the annual permissible dose limit of 500 mSv if radiation protection standards are low. Thus, adequate safety measures are needed. Measurements of the dose rate around patients, made using survey meters with sufficient response to beta particles, indicate that the exposure of caregivers and family members is considerably higher than previously assumed, and was dominated by primary beta radiation instead of bremsstrahlung. Nevertheless, under normal circumstances, the annual dose limits for the public (effective dose: 1 mSv, skin dose: 50 mSv) will be complied with.

An overview on extremity dosimetry in medical applications.

Some activities of EURADOS Working Group 9 (WG9) are presently funded by the European Commission (CONRAD project). The objective of WG9 is to promote and co-ordinate research activities for the assessment of occupational exposures to staff at workplaces in interventional radiology (IR) and nuclear medicine. For some of these applications, the skin of the fingers is the limiting organ for individual monitoring of external radiation. Therefore, sub-group 1 of WG9 deals with the use of extremity dosemeters in medical radiation fields. The wide variety of radiation field characteristics present in a medical environment together with the difficulties in measuring a local dose that is representative for the maximum skin dose, usually with one single detector, makes it difficult to perform accurate extremity dosimetry. Sub-group 1 worked out a thorough literature review on extremity dosimetry issues in diagnostic and therapeutic nuclear medicine and positron emission tomography, interventional radiology and interventional cardiology and brachytherapy. Some studies showed that the annual dose limits could be exceeded if the required protection measures are not taken, especially in nuclear medicine. The continuous progress in new applications and techniques requires an important effort in radiation protection and training.

An overview of the use of extremity dosemeters in some European countries for medical applications.

Some medical applications are associated with high doses to the extremities of the staff exposed to ionising radiation. At workplaces in nuclear medicine, interventional radiology, interventional cardiology and brachytherapy, extremities can be the limiting organs as far as regulatory dose limits for workers are concerned. However, although the need for routine extremity monitoring is clear for these applications, no data about the status of routine extremity monitoring reported by different countries was collected and analysed so far, at least at a European level. In this article, data collected from seven European countries are presented. They are compared with extremity doses extracted from dedicated studies published in the literature which were reviewed in a previous publication. The analysis shows that dedicated studies lead to extremity doses significantly higher than the reported doses, suggesting that either the most exposed workers are not monitored, or the dosemeters are not routinely worn or not worn at appropriate positions.

Extremity ring dosimetry intercomparison in reference and workplace fields.

An intercomparison of ring dosemeters has been organised with the aim of assessing the technical capabilities of available extremity dosemeters and focusing on their performance at clinical workplaces with potentially high extremity doses. Twenty-four services from 16 countries participated in the intercomparison. The dosemeters were exposed to reference photon ((137)Cs) and beta ((147)Pm, (85)Kr and (90)Sr/(90)Y) fields together with fields representing realistic exposure situations in interventional radiology (direct and scattered radiation) and nuclear medicine ((99 m)Tc and (18)F). It has been found that most dosemeters provided satisfactory measurements of H(p)(0.07) for photon radiation, both in reference and realistic fields. However, only four dosemeters fulfilled the established requirements for all radiation qualities. The main difficulties were found for the measurement of low-energy beta radiation. Finally, the results also showed a general under-response of detectors to (18)F, which was attributed to the difficulties of the dosimetric systems to measure the positron contribution to the dose.

Beta radiation exposure of medical staff and implications for extremity dose monitoring.

Sealed and unsealed beta radiation sources come into use to a greater extent in radiation therapy, e.g. for treating inflammatory joint diseases by radiosynoviorthesis (RSO), by injecting 90Y, 186Re or 169Er-solutions. Sealed 90Sr/90Y and 32P-sources or 188Re-liquid-filled balloon catheter are applied in vascular brachytherapy. Recently, 90Y-labelled antibodies are being successfully used in radioimmunotherapy (RIT) of malign lymphoma. Such practices require handling of high activities at small distances to the skin. Thus, the medical staff may be exposed to high beta doses. Investigations of the extremity exposure were performed at several workplaces, in particular during RSO treatments. The local skin dose (LSD), Hp(0,07), was measured with thin-layer TLD (LiF:Mg,P,Cu) fixed to the fingers (TLD-tapes). The findings indicate that the exposure of the staff can exceed the annual dose limit of 500 mSv when working at low protection standard. Routine monitoring of the extremity exposures with ring dosemeters appropriate to beta radiation and provided by the approved German dosimetry services was found to be needed. But even monitoring with these official 'beta-dosemeters' does mostly not give suitable results to demonstrate compliance with the dose limit. A study was conducted at RSO-workplaces in order reveal a correlation between doses measured with ring dosemeters and the maximum LSD obtained from the TLD-tapes. The results are discussed and conclusions for routine monitoring are drawn.

[Radiation exposure in (90)Y-Zevalin therapy: results of a prospective multicentre trial]. / Strahlenexposition bei der (90)Y-Zevalin-Therapie: Ergebnisse einer prospektiven multizentrischen Studie.

UNLABELLED: AIM of this study was the assessment of the radiation exposure from preparation and application of (90)Y-Zevalin, the measurement of the dose rate at the patient, the exposure of family members as well as the determination of the activity concentration in urine of patients. METHODS: Overall data from 31 therapeutic administrations carried out in four institutions were evaluated. During preparation and application of (90)Y-Zevalin the finger exposures of radiochemists, technicians, and physicians were measured. The dose rate of the patient was measured immediately after radioimmunotherapy. In patients treated in a nuclear medicine therapy unit, urine was collected over a two day period and the corresponding activity was determined. Family members of outpatients were asked to wear a dosimeter over a seven day period. RESULTS: During the preparation we found a maximum skin dose of 6 mSv at the average, and during application of 3 mSv, respectively. After administration of (90)Y the dose rate was 0.4 +/- 0.1 microSv/h at 2 m distance. Urine measurements yielded a cumulated 24 h excretion of 3.9 +/- 1.4% and 4.4 +/- 1.4% within 48 h, respectively, that is equivalent to 43 +/- 18 and 50 +/- 20 MBq of (90)Y, respectively. Family members received a radiation exposure of 40 +/- 14 microSv over seven days. CONCLUSION: During preparation and application of (90)Y-Zevalin appropriate radiation shielding is necessary. For family members as well as nursing staff no additional special radiation protection measures beyond those being common for other nuclear medicine procedures are necessary.

Comparison of measured and calculated dose rates for the Castor HAW 20/28 CG.

In January 2003 neutron and gamma dose rate measurements at a CASTOR HAW 20/28 CG were performed by the Bundesamt für Strahlenschutz at Gorleben. First, commercial dose rate measurement devices were used, then spectral measurements with a Bonner sphere system were made to verify the results. Axial and circumferential dose rate profiles were measured near the cask surface and spectral measurements were performed for some locations. A shielding analysis of the cask was performed with the MCNP Monte Carlo Code with ENDF/B-VI cross section libraries. The cask was modelled 'as built', i.e. with its real inventory, dimensions and material densities and with the same configuration and position as in the storage facility. The average C/E-ratios are 1.3 for neutron dose rates and 1.4 for gamma dose rates. Both the measured and calculated dose rates show the same qualitative trends in the axial and circumferential direction. The spectral measurements show a variation in the spectra across the cask surface. This correlates with the variation found in the C/E-ratios. At cask midheight good agreement between the Bonner sphere system and the commercial device (LB 6411) is found with a 7% lower derived H*(10) dose rate from the Bonner sphere system.

Albedo neutron dosimetry in Germany: regulations and performance.

Personal neutron dosimetry has been performed in Germany using albedo dosemeters for >20 y. This paper describes the main principles, the national standards, regulations and recommendations, the quality management and the overall performance, giving some examples.

Extremity exposure in nuclear medicine: preliminary results of a European study.

The Work Package 4 of the ORAMED project, a collaborative project (2008-11) supported by the European Commission within its seventh Framework Programme, is concerned with the optimisation of the extremity dosimetry of medical staff in nuclear medicine. To evaluate the extremity doses and dose distributions across the hands of medical staff working in nuclear medicine departments, an extensive measurement programme has been started in 32 nuclear medicine departments in Europe. This was done using a standard protocol recording all relevant information for radiation exposure, i.e. radiation protection devices and tools. This study shows the preliminary results obtained for this measurement campaign. For diagnostic purposes, the two most-used radionuclides were considered: (99m)Tc and (18)F. For therapeutic treatments, Zevalin(®) and DOTATOC (both labelled with (90)Y) were chosen. Large variations of doses were observed across the hands depending on different parameters. Furthermore, this study highlights the importance of the positioning of the extremity dosemeter for a correct estimate of the maximum skin doses.