Basic Physics

&
Radiation Safety
in Nuclear Medicine
G.S Pant

1
 human-made source of radiation exposure

95% ↓
Medical exposure

continual development of new technologies and new

techniques adds to the range of procedures available in the practic
medicine, and the role of imaging is becoming increasingly
important in day to day clinical practice.

The introduction of hybrid imaging technologies, such as positron

emission tomography/computed tomography (PET/CT) and single
photon emission computed tomography (SPECT)/CT, means that the
boundaries between traditional nuclear medicine procedures and
X ray technologies are becoming blurred.

3.5
mpy
nuclear medicine examinations

2
 1 Protection of Staff

Topics 2 Classification of Work Areas

3 Sources of External Exposure

 Protection of Staff
In nuclear medicine, where open or unsealed sources of radioisotopes or radiopharmaceuticals are handled, the
possibility of internal exposures to the staff also exists in addition to the external exposure. Therefore
additional precautions have to be taken to prevent radioactive contamination while handling unsealed sources.

If proper safety rules and practices are followed, the risk of internal
contamination from these procedures is very minimal, but that from
external irradiation may be more, especially during preparation and
administration of radiopharmaceuticals.

Several factors contribute to the safety

of the NM staff and they are explained in the following
slides.
 Proper design and lay-out of the facility
A full-fledged NM department generally requires the following areas:

Radioactive waste storage facility

Radiopharmacy

Radionuclide treatment room and

isolation ward for large dose radioiodine
Decontamination rooms therapy with fume hood and adequate
exhaust facility

Dosage administration room Storage delay tank facility

Patient waiting rooms In-vitro counting laboratories

In-vivo counting and imaging rooms
The design of NM facility should be such that it aids the
workflow of the department.

The planning and locating the relevant clinical areas close to each other in a
logical progression
radiopharmacy and the radionuclide storage

dosage administration area

patient waiting areas

counting
and imaging area.
 The degree of radiation safety requirements to be incorporated into the design of the department generally depends on several
factors

The proposed amount of activity to be used

1 The concept of weighted activity

1. Assess the largest amount of activity that would be present or handled at any time in the area

2. This figure is multiplied by a modifying factor according to the radionuclide being used

The obtained figure is then multiplied by a second modifying factor that considers the type of operation or area
 This takes into consideration the hazards
associated with a particular operation or an area
and the complexity of the operation.

The final figure derived from the above two steps gives the weighted activity and from this the category of hazard can be determined

Categorization of Hazard
The category of hazard once
established, the broad
requirements of planning could
then be determined using table
 Example
An activity of up to 10 GBq of 99mTc is to be used in a radiopharmacy laboratory for simple wet dispensing and
labeling.

Activity = 10 GBq (10000 MBq)

Radionuclide weighting factor = 1.0
Operational weighting factor = 1.0
Therefore, Weighted activity = 10000 x 1 x 1 = 10000 MBq.
Category of Hazard = Medium
Radiation Safety Requirements
At the design stage itself,

The issues of normal and potential external

exposure and contamination

Maintaining low background levels in general

areas and also in imaging rooms
considerations

Meeting pharmaceutical preparation standards

To ensure safety and security of the radioactive source

• It may be felt necessary to have a wall with structural shielding in a gamma camera room
or a counting room to maintain a low background or in a PET room or a radionuclide
therapy facility.

• The calculation of shielding material thickness can be done on a case-to-case basis

depending on the distance of the occupied areas, the rate of occupancy and the estimated
workload (GBq-h/week) for the various radionuclides to be used.

The half-value thickness (HVT) of different materials typically used for structural shielding for
different radionuclides
 The shielding thickness can be calculated using the following formula:

occupancy factor
intended exposure rate

tenth value thickness, which is equal

to 3.3 times HVT
distance in centimetres from the
source to obtain HR

shielding thickness required

distance at which exposure rate is known

exposure rate at ro cm from source

● Depending on the area and the occupancy factor, the value of the intended exposure rate H R,
would vary.

● The occupancy factors for workplaces, general corridors and waiting areas are considered to be
1, ¼ and 1/16 respectively.

● The value of HR for work (controlled) areas considering 40 working hours is 400 μSv/week or
10 μSv/h and other unrestricted areas is 20 μSv/week or 0.5 μSv/h.

● A typical shielding specification should attenuate the radiation intensity by a factor of at least
1000 i.e. 10 times HVT.
 In addition to the features in design and layout shown in Table 9, the other general considerations are
as follows:

The laboratory should be large enough to permit ease of use, should be well lit and shadow free.

1
Separate workbenches should be provided for carrying out radioactive and nonradioactive

2 work.

Walls and ceilings of the radioisotope laboratory should be covered with a smooth, washable, non-porous and

3 strippable paint.

The floors should be of an impermeable material and non-slippery and that is easily washable and resistant to

4 chemical change and should be curved to walls, with all joints sealed and glued to the floor.
 In addition to the features in design and layout shown in Table 9, the other general considerations are
as follows:

All workbenches should be non-porous, non-reactive and have impervious surfaces that can be

5 decontaminated easily and should have sufficient weight bearing capacity to support the weight of any
shielding material or radionuclide generator.

Sinks or washbasins should be preferably of stainless steel with a smooth finish and the taps should be either

6 elbow or foot operated work.

Plumbing lines carrying radioactive effluents should be of a non-corrosive material like HDPE and marked so

7 as to ensure monitoring prior to any maintenance.

The effluent lines from the diagnostic NM laboratories should go as directly as possible to the main sewers and

8 should not be connected with other drains carrying non-active effluents within the building
 In addition to the features in design and layout shown in Table 9, the other general considerations are
as follows:

Fume-hood should be constructed of a material that is smooth, impervious, washable and resistant to

9 chemicals. The ducts carrying the exhausted contaminated air from the fume-hood should be of a non-corrosive
material and should be able to withstand harsh weather conditions.

1 The exhaust fan of the fumehood should be located at the rear end of the filtration duct assembly i.e. after the
filtration unit and just before the point of final exhaust into the atmosphere.

01 Toilet facilities designated for use by NM patients should be of a material that can be easily decontaminated.

1 All counting and imaging rooms should have provisions to suitably control the temperatures and humidity as per
the technical specifications of the equipment supplier.

12 Furniture and fixtures should be kept to the basic minimum and should have smooth, non-absorbent surface and
should be easily washable.
As per the recent IAEA publication , the level of NM services is categorized according to three levels of needs;

Level 1:
2: Private
3: Academic
Generalset Hospital
institution
up
● This
Therelevel
area multiple
is is
need
appropriate
for imaging
comprehensive
where
rooms
onlyin
NMone
which
service,
gamma
in-vitro
human
camera
andresource
other
is needed
non-imaging
development
for imaging
purposes.
modalities
and research
would
programs.
generally
Radionuclide
be performed
therapy
in addition
for inpatients
to radionuclide
and outpatients
therapy.
is
also provided.
● The radiopharmaceuticals supply, physics and radiation protection and other
services are contracted from outside.

● A single imaging room connected to a shared reporting room should be sufficient,

with a staff of one NM physician and one NM technologist, with back up.

In India, before starting the practice of NM, the design, plan and layout of the department needs to
have the approval of the regulatory body –the Atomic Energy Regulatory Board
 Classification of
Work Areas

Controlled Areas Supervised Areas Unclassified

● Areas in which no protection measures

● Areas in which there is a potential to are required and the occupational
receive more than three-tenths of the ● Areas in which there is a potential for exposures need not be kept under
annual effective dose (>6mSv) the annual dose of an individual staff review or in other words,annual
member is likely to exceed 1/20th but effective dose limits are less than
● Rooms for storage, preparation and not more than 3/10th of annual dose 1mSv.
administration of radiopharmaceuticals, as limit (1-6mSv)
well as areas like radionuclide therapy ● The minimum requirement for
rooms and isolation wards. ● Examination rooms, counting and supervised areas is that management
imaging departments and post- establishes a program of surveillance to
radiopharmaceutical administration detect any deterioration in the radiation
patient waiting rooms protection arrangement.
The operational procedures for radiation safety are often referred to as “local safety rules”. They typically for NM could
be as follows:

1. Not to eat, drink, smoke or apply cosmetics in controlled or supervised areas.

2. Wear laboratory coats or other protective clothing at all times when working with
radioactive material.

3. Wear disposable gloves at all times while handling radioactive material. Wear personnel
monitoring devices (TLD or film badge) at all times while working with gamma- and high-energy
beta-emitting radioactive material.

4. Personnel monitoring devices, when not in use, should be stored in a designated low
background area.

5. Always transport radioactive material in shielded containers. Always store syringes that contain
radioactive material in a radiation shield.

6. Always use syringe shields as and when practical for routine preparation of patient
doses and administration to patients.

7. Always use vial shields when preparing or handling a vial that contains a
radiopharmaceutical.
The operational procedures for radiation safety are often referred to as “local safety rules”. They typically for NM could
be as follows:

8. Always use syringe shields as and when practical for routine preparation of patient
doses and administration to patients.

9. Dispose of radioactive waste only in specially designated and properly shielded

receptacle.

10. Monitor hands and clothing for contamination after each procedure or before leaving
the area.
At Nuclear Medicine Department, RCC
 Sources of External Exposure
In majority of the departments, the staff may be associated with several aspects of NM procedures. These typically would
involve activities like:

1 Elution of 99mTc from 99M 4 Dose administration to patients

2 Measurement of eluted stock

99m
TcO4- activity
5 Counting and imaging
procedures

3 Dispensing of individual
patient dose
6 Quality control procedures
 Control of External Exposure
For controlling external radiation hazards, the three cardinal parameters are:
 Control of External Exposure
The relationship between the exposure rate from a point source and distance from it follows inverse-square law, which can be
expressed as:

● R = exposure rate

● A = activity of the source

● k = specific gamma constant or exposure rate constant (slide 30 )

● d = distance from source

 α Rarely used in NM
can be easily absorbed and hence do not pose an external hazard

β 0.019 MeV
do not require shielding

β 1.71 MeV
● more penetrating and interact with shielding materials to produce
bremsstrahlung radiation
● plastic or Lucite will reduce the intensity of beta particles and minimize the
production of bremsstrahlung radiation surrounded by lead lining

X/४ high atomic number material like lead, concrete or iron is necessary to attenuate the
dose rate and reduce it to acceptable levels.

A guide to shielding requirements may be obtained from HVL values (slide 30). In NM, 10 times the HVT/HVL are considered to
provide effective shielding
 Control of Exposure in Radiopharmacy and Dosage Administration

Precautions

The attenuation of lead apron at this energy is modest. In some

NM departments where lead-vinyl aprons having a lead
equivalent of about 0.35-0.5 mm are used
As compared to the whole body, the doses to the fingers and extremities may be far larger in magnitude during preparation,
dispensing and administration of radiopharmaceuticals.

In circumstances where administration using

shield is difficult, the syringe without a
shield may be used to expedite the
administration of the radiopharmaceutical.
The syringe should be maintained in a shield
until ready to inject.

In such cases and also otherwise, it is important to have a proper practice of holding syringes at the rear end, as
there is a pronounced effect of distance on dose rate, which is particularly noticeable at short distances. For example,
the dose to the fingers placed directly over a solution of 99mTc in a syringe will be reduced by a factor of about 40 by
holding the syringe at the end.
 Control of Exposure in Cyclotron Facility
The Cyclotron facility has three components :

1. Cyclotrons that produce positron emitting radionuclides like 18F

2. PET Radiochemistry(hot) laboratory where the radiopharmaceuticals are synthesized

3. Radiopharmacy(QC lab), where QC of end product is done

For 1. and 2. are heavily shielded and there is a remote chance of excessive exposure however, radiation monitoring system
should still be in place.

If,
● Cyclotron are not self-shielded then it should not be opened immediately as there is a high level of stray radiation even
if irradiation is over.
● RMS is not available then portable radiation should be placed at appropriate locations
 Control of Exposure in Cyclotron Facility
● There is a risk of staff exposure in the QC lab as the radiopharmacist has to use activity for various QC tests. Although,
the activity is small, precautions are taken to reduce exposure through “time, distance and shielding”.

● An exhaust system should be available in QC.

● Radiation monitoring in the stack is necessary to check the efficacy of active carbon filters in limiting the radiation
that is released to the atmosphere.

● If required, additional carbon filter may be added to meet the national regulatory requirement.

● Alternately, the emissions from the radiochemistry laboratory may be collected in a bag inside lead shielding and may
be released to the stack the next day.
 Control of Exposure in handling PET radiopharmaceuticals
● Specific gamma constant for F18 = 5.7 Rcm2/h/mCi but for Tc99m labeled compounds it is = 0.8 Rcm2/h/mCi which is
7 times less than for F18.

● Thus, F18 will give 7 times more exposure at a given distance.

● Keeping this in mind, the shielding requirements are much higher while handling PET radiopharmaceuticals.

● Since F18 has a short half life (110 minutes) so the contaminated items and generated waste should be left for
24 hours to decay, after which it may be transferred to radioactive waste storage room for further decay, if
required.
 Control of Exposure During Imaging
● The use of shielding is not always practical, thus, the time spent and distance from the radiation source are practical
methods of reducing exposures

● These practises are particularly useful, when dealing with patients, who have been administered radiopharmaceuticals.

● The typical dose rates at different distances from an adult patient after administration of a radiopharmaceutical has been
reported by IAEA and given in the table below
 Control of Exposure During Imaging
● The situation is different in PET imaging due to two reasons :

● The high gamma ray constant of F18 ● Use of penetrating gamma radiation (511 keV)

Wall thickness takes care of shielding against x-rays in CT unit.

Safety precautions need to be take care of during dose preparations and

administrations.
* Auto injectors are used in some centres

* If syringe shields are not used then loaded syringes are placed in a
shielded container and picked up for sode administration after putting
cannula in place
 Control of Exposure During Imaging
● Exposure from patients administered F18-FDG

Distance from chest Dose rate (μSv/h) immediately after Dose rate (μSv/h) after completion
surface of the patient administration of ≅370 MBq of F18-FDG * of PET/CT imaging *
(m)

0.0 832.7 ± 36.2 325.2 ± 14.9

0.5 123.4 ± 12.6 54.1 ± 6.8

1.0 39.8 ± 4.1 18.5 ± 3.9

2.0 17.3 ± 2.9 6.3 ± 2.2

* (mean± SD)
QC Of Gamma Camera

● Gamma camera is the most ● sensitive electronic

important instrument in components/ circuits
nuclear medicine, which is
used both for planar and ● associated computer system
tomographic imaging.
● mechanical movements
particularly during rotation of
the detector head in SPECT
studies
QC Of Gamma Camera
QM

● QM which
Quality assurance refers to all aspects of a procedure,
contribute to the quality of the results obtained
QA
● Quality assurance of nuclear medicine instrumentation will
Q of
include all aspects of evaluation for the performance
A hard
various equipment, computer hardware and software,
copy device, image quality assessment and finally their
organisation and implementation to provide best quality
image QC
Q
C
QC Of Gamma Camera
QM

● The term quality control basically refers to the evaluation of

all those parameters, which are related to the performance of
the instrument. QA

● Calibration basically refers to the adjustments of parameters

or values for optimum performance of the equipment.

● The quality control of instrumentation starts right from its QC

selection. Selection of the equipment, site selection for their
installation and provision for providing and maintaining
adequate power and environmental conditions may be
treated as a part of full quality control programme.
Procedures that need to be carried out with The proper operation and service
the proposed equipment manuals must accompany each
instrument.

The essential kits/phantoms and standard Environmental conditions also

radiation sources Equipment Selection need proper consideration

Sound base of service support Eatables

● After meeting all these requirements the system may be installed and subjected to acceptance tests.

● The acceptance tests are done to check whether the system conforms to the quoted specifications of
the manufacturer.

● These tests are usually done as prescribed by the manufacturer.

● If the same protocol is to be followed by the user in future then acceptance and reference tests are to
be the same.

● The acceptance and reference test parameters should be properly recorded. There are limits to which
the deviation for each performance parameters can be accepted both at acceptance and at routine or
periodic tests. A

● Gradual deterioration in some parameters may indicate a necessary correction/repair. After the
repair or replacement of some components, acceptance tests may be repeated
Quality control tests
● The most common test protocols in use have been developed by the :

○ National Electrical Manufacturers’ Association (NEMA)

○ American Association of Physicist in Medicine (AAPM)

○ International Electrotechnical Commission (IEC)

○ IAEA.

The system is then subjected to quality control tests to check the various performance parameters,
which are mentioned in the next slide.
Quality control tests

1.

2.

3.

4.

5.

6.
Thank You