Estimation of internal exposure to 99Mo in nuclear medicine patients.

(99m)Tc is the most widely used radionuclide in nuclear medicine. It is obtained by elution of (99)Mo-(99m)Tc generators. Depending on the quality of the generator and its integrity, (99)Mo may be extracted from the column during the elution process, becoming a radionuclidic impurity in the (99m)Tc eluate. This fact would impart an unnecessary dose to the patients submitted to diagnostic procedures. The aim of this work is to evaluate (99)Mo incorporation and internal effective doses in nuclear medicine patients through bioassay techniques, providing information on the metabolism of molybdenum in humans. A methodology based on in vivo and in vitro measurements was developed. In vivo measurements were performed with a NaI detector installed in the IRD WBC. Urine samples were analysed with a HPGe at the IRD bioassay laboratory. Patients showed detectable activities of (99)Mo in whole body and urine. Results were interpreted with AIDE software. Estimated incorporation was compared to predicted values based on ICRP model. Effective doses were in the order of micro sieverts. Results suggest the need to implement a routine quality control program of radionuclidic impurity of (99)Mo in (99m)Tc eluates to be conducted by radiopharmacy laboratories of nuclear medicine centers.

A new approach for the determination of 210Pb by liquid scintillation counting.

A new approach to the calibration procedure is presented, as there is no need to discount bismuth from lead spectrum when constructing the efficiency curve. This work presents two calibration methods: one considering mostly lead spectrum contributions and other that considers both lead and bismuth contributions. Both methodologies provide consistent results when evaluated in an intercomparison program. Furthermore, this methodology allows simultaneous analysis of several samples and is suitable for any type of sample after proper digestion in liquid form.

A methodology to evaluate occupational internal exposure to fluorine-18.

The objective of this work is to develop procedures for internal monitoring of (18)F to be applied in cases of possible incorporation of fluoride and (18)FDG, using in vivo and in vitro methods of measurements. The Na I (Tl) 8" x 4" scintillation detector installed at IRD-Whole Body Counter was calibrated for measurements with a whole body anthropomorphic phantom, simulating homogeneous distribution of (18)F in the body. The NaI(Tl) 3"x 3" scintillation detector installed at the IRD-Whole Body Counter was calibrated for in vivo measurements with a brain phantom inserted in an artificial skull, simulating (18)FDG incorporation. The HPGe detection system installed at the IRD-Bioassay Laboratory was calibrated for in vitro measurements of urine samples with 1 liter plastic bottles containing a standard liquid source. A methodology for bioassay data interpretation, based on standard ICRP models edited with the software AIDE-version 6, was established. It is concluded that in vivo measurements have sufficient sensitivity for monitoring (18)F in the forms of fluoride and (18)FDG. The use of both in vitro and in vivo bioassay data can provide useful information for the interpretation of bioassay data in cases of accidental incorporation in order to identify the chemical form of (18)F incorporated.

Optimization of (131)I doses for the treatment of hyperthyroidism.

Several methods can be used to determine the activity of (131)I in the treatment of hyperthyroidism. However, many of them do not consider all the parameters necessary for optimum dose calculation. The relationship between the dose absorbed by the thyroid and the activity administered depends basically on three parameters: organ mass, iodine uptake and effective half-life of iodine in the thyroid. Such parameters should be individually determined for each patient in order to optimize the administered activity. The objective of this work is to develop a methodology for individualized treatment with (131)I in patients with hyperthyroidism of the Grave's Disease. A neck-thyroid phantom developed at the IRD was used to calibrate a scintillation camera and a uptake probe SCT-13004 at the Nuclear Medicine Center of the University Hospital of Rio de Janeiro and a uptake probe SCT-13002, available at the Nuclear Medicine Institute in Goiânia. The biokinetic parameters were determined based on measurements performed in eight voluntary patients. It is concluded that the use of the equipment available at the hospital (scintillation camera and uptake probe) has shown to be a suitable and feasible procedure for dose optimization in terms of effectiveness, simplicity and cost.

A methodology for auto-monitoring of internal contamination by 131I in nuclear medicine workers.

The manipulation of 131I in Nuclear Medicine involves significant risks of internal contamination of the staff. In the event of an accidental contamination, or when the Radiological Protection Program includes routine individual monitoring of internal contamination, it is necessary to implement internal dose estimation through in vivo and in vitro bioassay techniques. Due to the huge extension of the Brazilian country, this type of monitoring becomes unfeasible if all measurements have to be performed at the institutes of the CNEN. Thus, if the Nuclear Medicine Centres (NMC) become able to conduct the monitoring of their employees, this skill would be of great significance. The methodology proposed in this work consists in a simple and inexpensive protocol for auto-monitoring the internal contamination by 131I, using the resources available at the NMC. In order to verify the influence of the phantom in the calibration factor for the measurement of 131I in thyroid, it was performed a comparison among a variety of phantoms commercially available, including the Neck-Thyroid Phantom developed in IRD. A protocol for performing in vivo and in vitro measurements by the NMC was established. The applicability of the individual monitoring techniques was also evaluated by comparing the detection limits with the derived limits associated with the annual dose limits for workers.

In vivo measurements of 210Pb in skull and knee geometries as an indicator of cumulative 222Rn exposure in a underground coal mine in Brazil.

Cumulative exposure to radon can be evaluated by measuring 210Pb in bone. The skull and knee are two convenient parts of the skeleton for in vivo measuring 210Pb because these regions of the body present a high concentration of bone, the detectors are easily positioned and the likelihood of cross contribution from other organs or tissues is low. A radiological survey of non-uranium mines in Brazil indicated that an underground coal mine in Paraná, located in the south of Brazil, exhibited a high radon concentration. In vivo measurements of 32 underground coal miners were performed in the IRD-CNEN Whole Body Counter shielded room using an array of four high-resolution germanium detectors. Estimations of 210Pb in the total skeleton were determined from direct in vivo measurements of 210Pb in the head and knees. In vivo measurements of 210Pb in 6 out of 32 underground coal miners ranged from 80 to 164 Bq, suggesting that these workers were significantly exposed to 222Rn.

Evaluation of internal exposure of nuclear medicine staff through in vivo and in vitro bioassay techniques.

The manipulation of a wide variety of unsealed sources in Nuclear Medicine results in a significant risk of internal exposure of the workers. 131I should be highlighted among the most frequently used radionuclides because of its large application for diagnosis and therapy of thyroid diseases. The increasing use of radionuclides for medical purposes creates a demand for feasible methodologies to perform occupational control of internal contamination. Currently in Brazil, there are approximately 300 nuclear medicine centres in operation but individual monitoring is still restricted to the control of external exposure. This work presents the development of in vivo and in vitro bioassay techniques aimed to quantify incorporation of radionuclides used in Nuclear Medicine. It is also presented the results of a preliminary survey of internal exposure of a group of workers involved in the preparation of therapeutic doses of 131I. Workers were monitored with a gamma camera available in the Nuclear Medicine Service of the University Hospital of Rio de Janeiro and at the Institute of Radiation Protection and Dosimetry Whole-Body Counter (IRD-WBC). The in vivo detection systems were calibrated with a neck-thyroid phantom developed in IRD. Urine samples from radiopharmacy workers were collected after preparation and administration of therapeutic doses (10-250 mCi) of 131I and measured with a HPGe detection system available in the Bioassay Laboratory of IRD. The results show that the bioassay methods developed in this work present enough sensitivity for routine monitoring of nuclear medicine workers. All workers monitored in this survey presented positive results for 131I in urine samples and two workers presented detectable activities in thyroid when measured at the IRD-WBC. The highest committed effective dose per preparation was estimated to be 17 microSv.

Harmonization of internal dosimetry procedures in Latin America--ARCAL/IAEA project.

Under the auspices of the Regional Coordination Agreement for Latin America, representatives of the eight member states have participated in a project to improve radiological protection for workers exposed to unsealed sources of radiation. The design of the project was based on information obtained from a questionnaire circulated among the participants, from which the initial status of internal dosimetry services in each country was characterised. The objective of the project is to harmonize internal dosimetry procedures, with reference to International Atomic Energy Agency recommendations. After the implementation of new procedures and personnel training, four intercomparison exercises were carried out: measurement of iodine in thyroid phantoms, measurement of gamma emitters in urine samples, measurement of beta emitters in urine samples and internal dose assessments. This project has resulted in important improvements in internal dosimetry services in the region.

A protocol for the calibration of gamma cameras to estimate internal contamination in emergency situations.

The concern about accidents involving radioactive materials has led to the search of alternative methods to quickly identify and quantify radionuclides in workers and in the population. One of the options to face up an eventual demand for mass monitoring of internal contamination is the use of a nuclear medicine diagnostic equipment known as gamma camera, a device used to scan patients who have been administered specific amounts of radioactive materials for medical purposes. Although the gamma camera is used for image diagnosis, it can be calibrated with anthropomorphic phantoms or point sources for the quantification of radionuclide activities in the human body. This work presents a protocol for the calibration of gamma cameras for such application. In order to evaluate the suitability of this type of equipment, a gamma camera available in a public hospital located in Rio de Janeiro was calibrated for the in vivo measurement of 131I. The calibration includes the determination of detection efficiencies and minimum detectable activities for each radionuclide. The results show that the gamma camera presents enough sensitivity to detect activity levels corresponding to effective doses below 1 mSv. The protocol is the basis to establish a network of Nuclear Medicine Centres, located in public hospitals in eight countries of Latin America (Argentina, Brazil, Colombia, Cuba, Chile, Mexico, Peru and Uruguay) and in Spain that could be requested to collaborate in remediation actions in the event of an accident involving incorporation of radioactive materials. This protocol is one of the most significant outputs of the IAEA-ARCAL Project (RLA/9/049-LXXVIII) aimed to the Harmonization of Internal Dosimetry Procedures.

IAEA INTERCOMPARISON EXERCISES OF THYROID MEASUREMENT: PERFORMANCE OF LATIN AMERICAN AND CARIBBEAN LABORATORIES.

(131)I is widely used in Latin America and Caribbean Region in the field of nuclear medicine and has been recognised as one of the main sources of potential intake of radionuclides by the staff. The In Vivo Monitoring laboratory of the Institute for Radiation Protection and Dosimetry (IRD-CNEN-Brazil) organised three intercomparison exercises (2005, 2009 and 2013) in the scope of IAEA technical cooperation projects RLA9049 and RLA9066 aimed to disseminate and harmonise the technique for measuring (131)I in the human thyroid. The number of participants in Latin America increased from 9 to 20 institutions from 7 and 13 countries, respectively, over the last 10 y. The participants have improved significantly their ability on the in vivo measurement technique. In the 2013 round all laboratories which reported results presented performances in an acceptable range according to the ISO criteria indicating the benefit of such exercises in the region.

Determination of uncertainties associated to the in vivo measurement of iodine-131 in the thyroid.

Intakes of radionuclides can be estimated through in vivo measurements, and the uncertainties associated to the measured activities should be clearly stated in monitoring program reports. This study aims to evaluate the uncertainties of in vivo monitoring of iodine 131 in the thyroid. The reference values for high-energy photons are based on the IDEAS Guide. Measurements were performed at the In Vivo Monitoring Laboratory of the Institute of Radiation Protection and Dosimetry (IRD) and at the Internal Dosimetry Laboratory of the Regional Center of Nuclear Sciences (CRCN-NE). In both institutions, the experiment was performed using a NaI(Tl) 3''3″ scintillation detector and a neck-thyroid phantom. Scattering factors were calculated and compared in different counting geometries. The results show that the technique produces reproducibility equivalent to the values suggested in the IDEAS Guide and measurement uncertainties is comparable to international quality standards for this type of in vivo monitoring.

Studies of Cs retention in the human body related to body parameters and Prussian blue administration.

Using the in-vivo monitoring data from the individuals that suffered internal contamination in the Goiânia accident, a preliminary study on the elimination of Cs from their body was conducted. It was concluded that elimination follows a first-order linear kinetic pattern, both with and without Prussian Blue treatment. Cesium half-lives for both sexes were shown to be influenced mainly by the weight of each individual. In general, Prussian Blue seems to reduce the half-life by 32%. At the time our study was conducted, patients who were under treatment with the drug were receiving 3 g d-1, 6 g d-1, or 10 g d-1 of the medication. Our results suggest that there is an optimum dosage for a certain weight range to achieve this reduction in half-life, but one would need more data to statistically prove this assumption.

Measurements of 137Cs in blood from individuals exposed during the Goiânia accident.

Blood samples of some highly internally contaminated Goiânian patients were measured for 137Cs activity. The distribution of activity among the blood components was checked. We found that the majority of the activity was confined to the cellular fraction, mainly to the erythrocytes (red cells).

Design and operation of a whole-body monitoring system for the Goiânia radiation accident.

With as many individuals involved in the Goiânia 137Cs accident who had high levels of internal contamination, it was necessary to improvise a whole-body counter installation in loco. The in-vivo counting system was located in a 4.0 X 3.5 X 3.5-m room, where seven layers of 2-mm lead sheets with dimensions of 2.0 m X 1.0 m were overlaid on the floor at loci that were equidistant from the walls. A 20-cm diameter NaI (Tl) detector was installed at a height of 2.05 m above the floor at the center of the room. The detector was shielded and collimated with 5 cm of lead. The enormous amounts of activity in the subjects required the detector to be positioned at a height of 2.05 m. Subjects were required to wear disposable clothing and lie on a reclining, fiberglass chair. Counting time for the subjects was 2 min (live-time). The minimum detectable 137Cs activity for this counting time was 7.3 kBq* (0.05 significance level). Besides the accident victims, all individuals who had direct or indirect contact with contaminated people or areas were also monitored. More than 300 people of both sexes, with ages varying from a few months to 72 y, were measured for whole-body radioactivity. The observed activities ranged from less than the minimum detectable activity (MDA) to 59 MBq.

In vivo measurement technique of 40K as an indicator of the amount of skeletal muscle tissue in the human body.

Potassium is an essential element for human metabolism. It is present in all living cells, predominantly in the skeletal muscle tissue. The energy of the 40K photon and its uniform distribution within the human body allow its in vivo measurement. Subjects of both sexes were monitored at the whole-body counter of the IRD facility for the evaluation of 40K body burden, being divided into two groups: (1) subjects who do not exercise routinely, and (2) subjects who do exercise routinely. The average values found for potassium mass and potassium concentration in group 1 were 99 +/- 17 g of K and 1.3 +/- 0.2 g of K kg(-1) of body mass, respectively, and in group 2 the average values found for potassium mass and potassium concentration were 118 +/- 33 g of K and 1.6 +/- 0.2 g of K kg(-1) of body mass, respectively. The comparison between average values for potassium mass and concentration shows a significant statistical difference.

Performance of IRD-WBC HPGe detection system for low energy photon emitters in lungs.

The Whole Body Counter Facility (WBC) of IRD-CNEN in Brazil has been operating since 1986. The first system installed to perform in vivo measurements of low energy photon emitters radionuclides used Phoswich detectors. In 1998, the WBC unit was upgraded by the installation of an array of four low energy high purity germanium detectors. The performance and suitability of the detection system for lung measurements were evaluated by comparison with the annual dose limits and the detection limits obtained for 238U, 235U, 226Ra and 241Am. This evaluation determined whether the in vivo measurements are adequate. In order to compare the dose limit of 20 mSv y(-1), recommended by the International Commission on Radiological Protection (ICRP), with the in vivo monitoring technique, the minimum detectable intake (MDI) was calculated using the appropriate biokinetic models described in the ICRP Publications. The results were obtained for a single intake through inhalation. The AMAD considered was 5 microm.

Voxel phantoms and Monte Carlo methods applied to in vivo measurements for simultaneous 241Am contamination in four body regions.

A Monte Carlo program, Visual Monte Carlo (VMC) in vivo, was written to simulate photon transport through an anthropomorphic phantom and to detect radiation emitted from the phantom. VMC in vivo uses a voxel phantom provided by Yale University and may be used to calibrate in vivo systems. This paper shows the application of VMC in vivo to the measurement of 241Am deposited simultaneously in the thoracic region, the bones, the liver and in the rest of the body. The percentages of 241Am in the four body regions were calculated using the biokinetic models established by the ICRP, for a single intake via inhalation. The four regions of the voxel phantom were then 'contaminated' in accordance with the calculated percentages. The calibration factor of the in vivo system was then obtained. This procedure was repeated for the radionuclide distributions obtained 5, 30, 120, 240 and 360 days after intake. VMC in vivo was also used to calculate the calibration factor of the in vivo system in which the radionuclide was assumed to be deposited only in the lung, as is normally done. The activities calculated with the radionuclide distributed in the four body regions as a factor of time, and the activities calculated with the radionuclide deposited in the lung only are compared.

A new mammography dosimetric phantom.

Breast phantoms produced with tissue-equivalent materials are used in an attempt to simulate glandular and adipose tissues, in terms of X-ray attenuation and density. In this work, a set of breast tissue-equivalent phantoms (BTE phantoms) with semicircular shapes of different thicknesses and compositions were produced. Such phantoms may be used in the measurement of the incident air kerma (K(i)) and the mean glandular dose (D(G)) delivered to patients undergoing mammography. To characterise the materials used to produce the phantoms, a series of 17-keV X-ray attenuation coefficient measurements were performed. The carbon-nitrogen-hydrogen elemental composition and the densities of the tissue-equivalent materials were also determined and compared with values available in the literature. Linear attenuation coefficients of 0.724 and 0.923 cm(-1) were determined, respectively, for adipose and glandular tissues. Such values agree with data available in the literature. On the basis of the results obtained in this work, it is suggested that BTE phantoms are used instead of polymethyl methacrylate phantoms to select exposure parameters (kV, mAs and target/filter combination) specific for breast glandularities from 0 to 50 % in the optimisation of doses in mammography.

IAEA regional intercomparison of in vivo measurements of 131I in the thyroid: the Latin American and Caribbean experience.

An in vivo intercomparison exercise, organised in the scope of the IAEA Regional Latin American (RLA) Project 9066, was carried out in 2009 aimed to harmonise measurement procedures on the measurement of (131)I in the thyroid among Latin American and Caribbean countries. The exercise consisted in the measurement of an anthropomorphic thyroid phantom spiked with a certified source of (133)Ba. The phantom was supplied by the In Vivo Monitoring Laboratory of Institute for Radiation Protection and Dosimetry (IRD) to 17 Institutions from 12 countries of the regions. Among these, 13 Institutions from 10 countries returned their measurement results as well as a standard report form containing detailed information about their respective counting facilities. All participants reported activities within an acceptable range, considering American National Standard Institute (ANSI) limits. Uncertainties varied from 0.04 to 12.9 %. Although results show that the general performance was acceptable in terms of accuracy, the need for additional action towards the standardisation of uncertainty estimation in this type of measurement in the region should be highlighted.

Accreditation and training on internal dosimetry in a laboratory network in Brazil: an increasing demand.

In recent years, Brazilian Nuclear Programme has been reviewed and updated by government authorities in face of the demand for energy supply and its associated environmental constraints. The immediate impact of new national programmes and projects in nuclear field is the increase in the number of exposed personnel and the consequent need for reliable dosimetry services in the country. Several Technical Documents related to internal dosimetry have been released by the International Atomic Energy Agency and International Commission on Radiological Protection. However, standard bioassay procedures and methodologies for bioassay data interpretation are still under discussion and, in some cases, both in routine and emergency internal monitoring, procedures can vary from one laboratory to another and responses may differ markedly among Dosimetry Laboratories. Thus, it may be difficult to interpret and use bioassay data generated from different laboratories of a network. The main goal of this work is to implement a National Network of Laboratories aimed to provide reliable internal monitoring services in Brazil. The establishment of harmonised in vivo and in vitro radioanalytical techniques, dose assessment methods and the implementation of the ISO/IEC 17025 requirements will result in the recognition of technical competence of the network.