Nationwide survey on radiation doses received by patients in nuclear medicine imaging procedures.

National diagnostic reference levels (DRLs) are essential tools for optimizing protocols and protecting patients from an unjustified radiation exposure. The aim of this study was to conduct a nationwide survey of adult patient doses received from nuclear medicine (NM) procedures and to update national DRL (NDRL) values for most common procedures. Data on the radioactivity administered to standard adult patients were collected from all Lithuanian hospitals using NM applications in practice, between 2017 and 2022. Twelve of the most commonly performed NM diagnostic procedures: myocardial perfusion scintigraphy (two parts), thyroid scintigraphy, lung perfusion scintigraphy, bone scintigraphy, dynamic renal scintigraphy (divided into two procedures), parathyroid scintigraphy, hepatobiliary scintigraphy, lymphoscintigraphy, neuroendocrine tumour scan, and oncology positron emission tomography/computed tomography (PET/CT) imaging were included. The 75th percentile of the dose distribution was estimated for establishing NDRLs. During the data collection period, the NM imaging equipment was upgraded. The procedures were completed with 12 single photon emission computed tomography (SPECT) and SPECT/CT gamma cameras (2 with cadmium zinc telluride (CZT) detectors), 2 cardiac-centred gamma cameras with CZT detectors, and 2 PET/CT scanners. Data were collected on 7979 activities administered to the patients. For each procedure, depending on its frequency, 50-580 administered radiopharmaceutical activities were selected. Based on the collected data, NDRLs were updated in 2021 for three procedures. A large part of the procedures were performed with scanners manufactured between 2008 and 2011. In the past few years, the main Lithuanian hospitals that provide NM services have updated their SPECT/CT systems. In the future, the data collection process should be continued in order to reassess DRLs with respect to new scanning systems (e.g. with CZT detectors and newer PET/CT technology). Variations in the prescribed radiopharmaceutical activities showed that optimization and harmonization procedures may be performed in some hospitals.

Occupational radiation exposure of health professionals and cancer risk assessment for Lithuanian nuclear medicine workers.

BACKGROUND: Reconstruction and analysis of low doses received by the occupationally exposed medical radiation workers, especially nuclear medicine staff dealing with radioisotopes may significantly contribute to the understanding of radiation impact on individuals, assess and predict radiation related risks for the development of cancer or other specific diseases. METHODS: A pool of 2059 annual effective doses corresponding to 272 job's positions occupied by nuclear medicine and radiology workers for a certain time period over 26 years in five Lithuanian hospitals was investigated in order to analyze the occupational exposure tendencies to medical staff. Requested data, measured in terms of whole body dose, personal dose equivalent Hp(10), was obtained from the National Register of Sources of Ionizing Radiation and Occupational Exposure. Considering that nuclear medicine staff is dealing with open sources/radioisotopes, doses to extremities, Hp(0.07), were measured using thermoluminescent dosimeters (TLD) of LiF:Mg, Ti type. Lifetime risk estimations for the development of specific cancer (thyroid cancer and leukemia) for exposed radiation workers were performed using risk models included in BEIR VII report (BEIR VII, 2006). The conservative assessment of the thyroid exposure was performed using RadRAT 4.1.1 tool. RESULTS: Doses to radiology technologists and radiology nurses were found to be highest over the years. However, their annual doses never exceeded dose limit of 20 mSv and were following the same decreasing tendency as the doses of other personnel. There was no increase of doses to nuclear medicine staff observed after installation of two new PET/CT machines, indicating increased radiation protection culture and application of relevant technical and protective measures by the staff. Measured fingertip doses were 2-3 times higher than the hand doses measured with TLD ring and were dependent on the type and frequency of the nuclear medicine examination procedure and on the type and activity of isotopes used for examination. CONCLUSIONS: For the first time, retrospective dose evaluation for the cohort of medical radiation workers was performed in the country. It enabled estimation of lifetime attributable risk for the development of two cancer types: thyroid and leukemia cancer among occupationally exposed medical radiation staff. Projected risk was low, ~10-5, however it was found that the risk of thyroid cancer for female staff was 5.7 times higher than for the males. Obtained results will be used for the predictive assessment of possible radiation induced health effects to occupationally exposed medical radiation workers.

Cytogenetic monitoring of nuclear workers occupationally exposed to ionising radiation.

Chromosome aberration (CA) analysis using Giemsa techniques was performed in blood lymphocytes of 84 nuclear workers with cumulative doses of 1-632 mSv during employment periods of 1-25 y. The control group comprised 82 healthy male donors. An estimated CA frequency in the total radiation-exposed group was significantly higher when compared with the controls (2.27 vs. 1.76 CA/100 cells, p < 0.05). CA analyses revealed no significant differences between workers with external gamma radiation exposure and the controls (1.60 vs. 1.76 CA/100 cells, p > 0.05). However, significant increase in the total CA frequency was determined in workers with additional internal exposure (2.54 CA/100 cells, p < 0.05) and those with registered neutron doses (2.95 CA/100 cells, p < 0.01). No correlation was found between CA frequency and occupational exposure dose. Borderline significant correlation was found between duration of employment and total CA (r = 0.218, p = 0.046, Fig. 2) and chromosome-type aberration (r = 0.265, p = 0.015) frequency.

The overview of internal exposure monitoring in Lithuania.

This study deals with analysis of situation and results of internal exposure monitoring of radiation workers and population in Lithuania. Radiation workers are assessed for internal exposures by direct methods--whole body counting or organ counting by gamma spectrometry at the Radiation Protection Centre and Ignalina Nuclear Power Plant (INPP). Results of monitoring of INPP and nuclear medicine workers show that no significant activities were detected. The annual committed effective doses of workers are <1 mSv. The measured average activity of 40K in males and females was 3.7 +/- 1.0 and 2.5 +/- 0.7 kBq, respectively. Mixed diet sampled at hospitals in 2001-5 was analysed for (90)Sr and (137)Cs activity concentrations. Average effective dose due to 90Sr and 137Cs in mixed diet was 0.6 +/- 0.2 and 0.47 +/- 0.13 microSv, respectively. Indoor radon measurements were done in multi-storey houses. Average concentration was 15.1 +/- 1.0 Bq m(-3). The annual effective dose aused by radon was 0.38 mSv.

The 15-Country Collaborative Study of Cancer Risk among Radiation Workers in the Nuclear Industry: study of errors in dosimetry.

To provide direct estimates of cancer risk after low-dose protracted exposure to ionizing radiation, a large-scale epidemiological study of nuclear industry workers was conducted in 15 countries. As part of this study, identification and quantification of errors in historical recorded doses was conducted based on a review of dosimetric practices and technologies in participating facilities. The main sources of errors on doses from "high-energy" photons (100-3000 keV) were identified as the response of dosimeters in workplace exposure conditions and historical calibration practices. Errors related to dosimetry technology and radiation fields were quantified to derive period- and facility-specific estimates of bias and uncertainties in recorded doses. This was based on (1) an evaluation of predominant workplace radiation from measurement studies and dosimetry expert assessment and (2) an estimation of the energy and geometry response of dosimeters used historically in study facilities. Coefficients were derived to convert recorded doses to H(p) (10) and organ dose, taking into account different aspects of the calibration procedures. A parametric, lognormal error structure model was developed to describe errors in doses as a function of facility and time period. Doses from other radiation types, particularly neutrons and radionuclide intake, could not be adequately reconstructed in the framework of the 15-Country Study. Workers with substantial doses from these radiation types were therefore identified and excluded from analyses. Doses from "lower-energy" photons (<100 keV) and from "higher-energy" photons (>3 MeV) were estimated to be small.

Current status of internal dosimetry in Lithuania.

After Lithuania regained independence, the legal basis for existing radiation protection was modified radically according to the IAEA, ICRP recommendations and the requirements of legislation of the European Community. The legal basis for internal dosimetry and a functioning system of assessment of exposure to intake of radionuclides have been created in the Radiation Protection Centre (regulatory authority in radiation protection). Direct and indirect measurements of concentrations of radionuclides are used for the assessment of internal doses of workers and the public.

Current status of personal dosimetry in industry, research and medicine in Lithuania.

The personal dosimetry service of the Radiation Protection Centre performs individual monitoring for all the industrial, medical and research radiation workers. The RADOS and DTU TLD systems are used for monitoring of doses. The DTU TLD system is used for measurements of doses to extremities and for measurements of public external exposure. Finger ring TLDs are used in therapy which uses radiopharmaceuticals. The RADOS system is also used for evaluation of patients' doses in selected hospitals. The dosimetry service recently provided individual monitoring of approximately 3000 workers. The average occupational dose was about 1.06 mSv for medical workers and 3.2 mSv for industrial radiography workers in 1999. Detailed analysis of doses received by different categories of workers is performed. A system for the urgent review of work conditions in the case of increased dose has been set up.