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[Radiation protection in the use of tracers in radioguided breast surgery].

PURPOSE: Recent techniques in nuclear medicine have permitted to implement new procedures useful in surgery. Among these, the procedures for locating sentinel lymph nodes and nonpalpable breast lesions are of great interest. The protocols for the location of the sentinel lymph node and for the radioguided location of occult lesions developed at the European Institute of Oncology (IEO, Milan) are based on the administration of radiopharmaceuticals labelled with Technetium-99m (99mTc). We evaluated the dosimetric data relative to patients and hospital personnel to assess whether specific radiation protection procedures are needed. MATERIAL AND METHODS: Fifty patients with nonpalpable breast lesions and 50 patients with suspected lymph node involvement were enrolled in this study. All the patients underwent surgery the day after in-loco administration of the radiopharmaceutical (11 MBq of 99mTc). The absorbed dose to the hospital personnel was estimated from the air kerma rate measured by ionization chamber at different distances from the patients at 0 and 16 hours after the radiopharmaceutical administration. In order to evaluate radiation protection for patients, absorbed doses were measured positioning thermoluminescent dosimeters on the patient's skin for about 16 hours. In the operating room, activity was measured on some excised tissues (lymph nodes and tumors) and on surgical instruments. RESULTS: Absorbed doses were very low for the clinical staff also in case of prolonged patient assistance. After 100 cases, the surgeon mean absorbed dose to the hands and mean effective dose were .45 mGy and .09 mGy, respectively. These values correspond to 1% of the annual dose limit to the hands and to 10% of the annual equivalent effective dose recommended for the population (ICRP 60 and law by decree 230/95). The absorbed dose to healthy tissues of the patients were lower than 1 mGy (mean values: contralateral breast: .9 mGy; abdomen .45 mGy). The mean activity detected in the excised tissues was 9 kBq and 900 kBq in the sentinel lymph nodes and in the tumor lesions (injection site), respectively. The activity detected on the surgical instruments, higher on gauzes (< 100 kBq), was negligible. CONCLUSIONS: From the radiation protection point of view, the data support the validity of our protocols. Absorbed doses to the hospital personnel are low and require neither a radiation protection control nor a classification of exposed workers as classes A or B. Special containers for radioactive wastes are necessary in the administration room but not in the operating room, where the levels of possible contamination are negligible.

Breast Neoplasms↗

A review of the history of U.S. radiation protection regulations, recommendations, and standards.

Shortly after the discovery of x rays by Wilhelm Konrad Roentgen in 1895, and the isolation of the element radium by Pierre and Marie Curie three years later, the fascination with and potential for an array of uses of ionizing radiation in medicine, science, and technology was born. As with any new technology, there was a need to balance both the beneficial and potential detrimental effects of uses of these new technologies for the advancement of humankind. In the early days, radiation hazards were not well understood. Over the decades increasing concerns in the scientific community and lay population demanded that standardized guidance and recommendations be developed for the use of ionizing radiation. Today, U.S. radiation protection standards and recommendations to protect the occupational worker, members of the general public, and the environment are numerous and complex. This review summarizes the history of the development and application of radiation protection standards and regulations to assure the safe use of radiation and radioactive materials. The evolution and roles of international and national scientific recommending and regulatory organizations that shape U.S. radiation protection policy are described and discussed.

Government Agencies↗

A review of the history of U.S. radiation protection regulations, recommendations, and standards.

Shortly after the discovery of x rays by Wilhelm Konrad Roentgen in 1895, and the isolation of the element radium by Pierre and Marie Curie three years later, the fascination with and potential for an array of uses of ionizing radiation in medicine, science, and technology was born. As with any new technology, there was a need to balance both the beneficial and potential detrimental effects of uses of these new technologies for the advancement of humankind. In the early days, radiation hazards were not well understood. Over the decades increasing concerns in the scientific community and lay population demanded that standardized guidance and recommendations be developed for the use of ionizing radiation. Today, U.S. radiation protection standards and recommendations to protect the occupational worker, members of the general public, and the environment are numerous and complex. This review summarizes the history of the development and application of radiation protection standards and regulations to assure the safe use of radiation and radioactive materials. The evolution and roles of international and national scientific recommending and regulatory organizations that shape U.S. radiation protection policy are described and discussed.

Government Agencies↗

Survey of radiography and radiation protection in general dental practice in Uganda.

OBJECTIVES: To carry out the first survey in Uganda of all dentists and all public health dental officers (PHDO) to assess the status of dental radiography and radiation protection. METHODS: All 74 dentists and 76 PHDOs in Uganda were sent a postal questionnaire including 33 questions relating to various demographic details, radiographic equipment and radiographic techniques, including processing and radiation protection. A second questionnaire was sent to non-respondents after 3 months. RESULTS: Eighty-two per cent of dentists responded and 83% of PHDOs. Seventy per cent of the dentists and 100% of the PHDOs were trained in Uganda. Seventy-five per cent of the dentists and 30% of the PHDOs had access to one of the approximately 30 X-ray machines in the country. The majority of the equipment did not comply with current recommendations in Europe. Fifty-one per cent of dentists used machines with mechanical timers, 28% used machines with no visual warning signal and 17% used equipment with no audible warning signal. Most of the equipment was over 30 years old and only 15% of dentists knew when the equipment was last serviced. The most relevant finding of the surveys was the level of 'don't know' responses to many questions from both groups. CONCLUSIONS: The lack of knowledge regarding dental radiography and radiation protection plus the condition of most equipment in Uganda is a matter of concern. Standards of care are considerably lower than in developed countries requiring improved undergraduate training, provision of postgraduate courses and Ugandan governmental or international financial assistance.

Adult↗

Chemical screening of radiation protecting agents.

An aqueous solution of 2-propanol was chosen as chemical system for fundamental study of the chemical screening of organic compounds on the responsibility for ionizing radiation. The effect of additives on the yield of acetone was investigated by subjecting this system on gamma-radiolysis. The results show that this system is suitable for the estimation of radiation protecting character of the known radiation protecting agents and compounds which act as a OH scavenger. On the basis of these results, various nitrogen-containing additives having free amino group, guanidine group and hetero-cyclic amine were examined first of all in expectation of improvement for the toxicity of sulfur-containing compounds.

1-Propanol↗

How to use and cite Internet resources, with special attention to radiation protection and health physics WWW sites.

This paper describes an Internet search for the phrases radiation protection and health physics using major search engines and discusses the search procedure and the related problems. Depending on the search engine used, the number of hits ranged from 10,000 to only 17. The author presents some of the most relevant Web sites for radiation protection and health physics, and gives their URLs. As expected, these are mainly the sites of major national and international organizations. The author discusses a model for citation of WWW resources and refers to Internet links where this issue has been elaborated in more detail. Numerous links to various institutions and Web resources are given as well.

Computer Communication Networks↗

Can benchmarking be applied to radiation protection? And is it useful?

PURPOSE: Any program of protection from the ionizing radiations used for health care must ultimately lead to the total prevention of graduated effects and to the limitation of probabilistic effects to acceptable levels. The latter are the more dangerous because they may occur even at very low doses and involve the whole population including unexposed subjects; these effects may appear in the generations to come. The specific protection of the health of operators, patients, and the general population, depends on a series of physical-technical and bureaucratic-administrative factors. These must be known and applied based on precise reference standards, recommended or stated by law, as well as on appropriately regulated and controlled procedures. We chose to apply the benchmarking method to radiation protection in order to standardize and increase the efficacy of prevention and to plan, according to Deming's cycle, the continuous improvement of radiation protection performance. METHOD: Benchmarking is a qualitative intercomparison method widely used in business economics to improve performance referring to best practice and the best in class. When applied in a department where all the partners belong (internal benchmarking), the method features a subdivision into different (sub)processes integrated according to the logic of problem-solving. These stages are: planning: 1) identifying benchmarking issues; 2) identifying the participants; 3) deciding the data collection method; 4) data collection; analysis: 5) measuring the gap; 6) planning future performance; integration: 7) reporting the results; 8) setting the functional goals; action: 9) developing and implementing plans; 10) checking results and resetting the target. The gross subdivision of resources into human and structural permits to check the gap between an actual and an ideal setting separately. Thus, the procedures will give information on the human factor which will be periodically checked in loco relative to all active and passive conducts, while standards will be used to assess the available spaces, facilities and equipment, as well as the relative regular activity. Specific physical-technical and bureaucratic-administrative indices will be needed in both cases. RESULTS AND DISCUSSION: Solving the operators' doubts and consequently decreasing the statistical errors and/or the cases of incorrect performance has resulted in improved rendered quality, which will be further increased after the planned replacement of substandard or unsafe equipment. Meanwhile, the early application of equipment quality controls has helped rationalize and markedly decrease maintenance costs, which results in possible technologic investment to improve emergency imaging. Greater attention to their protection has made patients feel an improvement in received quality and has increased empathy in general. Total quality, as compared with the best practice, has increased thanks to the positive stimulus from standardization, emulation and sharing, and not only to the controls performed. It is difficult to evaluate the management indices, especially the performance efficacy, that is the relationship between radiation protection and results, because the work is in progress and we still lack the actual data on the decrease in accidents at work or occupational diseases of the operators. Moreover, the epidemiological data on radiation-induced conditions will be difficult to collect and interpret, which will make the dynamics of lawsuits for unwarranted or excessive exposure a useful and more readily available piece of information. Finally, relative to economic results, we would like to stress that no additional costs have been necessary to implement safety and quality in a setting involving, directly or indirectly, thousands of people. (ABSTRACT TRUNCATED)

Algorithms↗

Radiation protection issues in galactic cosmic ray risk assessment.

Radiation protection involves the limitation of exposure to below threshold doses for direct (or deterministic) effects and a knowledge of the risk of stochastic effects after low doses. The principal stochastic risk associated with low dose rate galactic cosmic rays is the increased risk of cancer. Estimates of this risk depend on two factors (a) estimates of cancer risk for low-LET radiation and (b) values of the appropriate radiation weighting factors, WR, for the high-LET radiations of galactic cosmic rays. Both factors are subject to considerable uncertainty. The low-LET cancer risk derived from the late effects of the atomic bombs is vulnerable to a number of uncertainties including especially that from projection in time, and from extrapolation from high to low dose rate. Nevertheless, recent low dose studies of workers and others tend to confirm these estimates. WR, relies on biological effects studied mainly in non-human systems. Additional laboratory studies could reduce the uncertainties in WR and thus produce a more confident estimate of the overall risk of galactic cosmic rays.

Adolescent↗

[Experimental and theoretical studies on radiation protective effect of a lighter non-lead protective apron].

Non-lead aprons using composite materials are often used for radiation protective aprons instead of heavy lead aprons. However, the protective effect of the lighter, non-lead aprons has not been well evaluated, and it is not yet clear how they compare with lead aprons. Therefore, we investigated the protective performance of non-lead aprons theoretically and experimentally by comparing them with lead aprons under clinical conditions. We measured the energy spectra for direct and scattered X-rays passing through protective aprons or not, and measured doses with glass dosimeters for validation of theoretical calculations based on the energy spectra. We found that the protective effect of non-lead aprons was higher than that of lead aprons at X-ray of tube voltages of 70-100 kV, which are often used for radiography and fluorography. This demonstrated that the non-lead aprons are more useful in many situations than heavy lead aprons.

Lead↗

[Proposals for the revision of radiation protection measures for doses up to 222 MBq iodine-131 for whole body scintiscan for the detection of metastatic lesions].

The goal of this study was to estimate the necessary period of time, required for radiation protection instructions to be followed by patients with differentiated thyroid carcinoma (DTC) after total thyroidectomy who are given iodine-131 ((131)I) for a whole body scintiscan (WBS) in relation to the instructions of the European Commission and the ICRP. In order to estimate and evaluate the dose received by the family members and the general public, we have studied 30 patients and were given a dose of 92-222 MBq of (131)I for a diagnostic WBS. The patients studied were four men with mean age+/-standard deviation (M+/-SD)=55+/-6 y and 26 women with: M+/-SD=47+/-14 y. Dose rate measurements were carried out at the Nuclear Medicine Department of the AHEPA University Hospital; 1 h after the patients had received the (131)I dose and 48 h later when they returned to the hospital for the WBS. The calculated doses received by the in-living relatives of the patients and by the general public, assuming that radiation protection measures were applied for 2d, ranged between 76-640 microSv and 22-171 microSv respectively. In conclusion, the results of this study, compared to the dose constraints suggested by the European Commission, indicate that the duration of radiation protection guidelines for patients receiving (131)I for diagnostic purposes could be reduced to only two days without any potential risk to family members or to members of the public. The case of children of the immediate family environment, aged less than 3 y, was not investigated in this study.

Body Burden↗

[Techniques for radiation protection in the radiography of small animals].

Effective radiation protection demands that radiographic personnel should employ manual restraint of small animal patients only in exceptional circumstances. This publication describes methods and aids for restraint of small animals for some of the most frequently used projections. Suggestions for suitable sedation are also given.

Animals↗

ICRP special radiation protection issues in interventional radiology, digital and cardiac imaging.

The International Commission on Radiological Protection (ICRP) has published two reports giving recommendations dealing with the avoidance of deterministic injuries in interventional radiology and the management of patient dose in digital radiology in 2001 and 2004, respectively. Another document, on radiation protection for cardiologists performing fluoroscopically guided procedures, will be produced during 2005. This paper highlights some of the topics of the published reports, their relevance to European legislation on medical exposures and the importance of radiation protection research in underpinning the ICRP task groups' work in to producing these documents. It is also anticipated that the results, obtained in the cardiology work package of the European research project, will be used in the new document on radiation protection for cardiologists.

Heart↗

Radiographic quality and radiation protection in general medical practice and small hospitals.

Radiation protection and image quality were assessed in a survey of 22 general medical practices and the 24 smallest hospitals with x-ray facilities. Limited radiography, usually of extremities for trauma, was being performed in these facilities since access to regular radiology services was restricted, mainly for geographic reasons. An anthropomorphic ankle phantom with simulated fractures was presented at each facility for radiography, and the resulting films assessed for radiographic technique and basic diagnostic usefulness. While the standard of radiographic techniques was lower than in regular x-ray departments, most films of the phantom ankle were still diagnostically useful and only 4 were rejected entirely. The principal deficiency in general practice x-ray was in darkrooms and x-ray film processing. Generally, the x-ray equipment was adequate for the range of procedures performed and complied with the National Radiation Laboratory Code of Safe Practice for the Use of X-rays in Diagnosis (Medical). Radiation doses to the ankle phantom ranged widely for effectively the same procedure although none was excessive. Improved x-ray film processing, and tighter x-ray beam collimation, would result in a narrower range of doses to patients. Personnel exposures to radiation were satisfactorily low and special shieldings are not required in general practice.

Adult↗