TY - JOUR
AU - Birkenfeld,, Bozena
AB - Abstract Staff at nuclear medicine departments receive doses of ionising radiation higher than the staff of radiotherapy and radiology departments, with the exception of interventional radiologists. Due to the updated lower occupational exposure limit for the lens of the eye, we measured eye exposure in workers of the Nuclear Medicine Department, Pomeranian Medical University in Szczecin, Poland. EYE-D™ dosimeters were used for 3 months by 10 employees working with sources of ionising radiation. Personal dosimeters also measured the exposure of the whole body and hands. The 3-month dose equivalents for the lens of the eye in the employees was 0.20–0.72 mSv. Staff at NMD PMU do not require regular routine eye lens dose monitoring. Eye lens doses were well within the new annual limit of 20 mSv. Doses to the whole body may be used as an indicator of the eye lens doses in the monitored department. INTRODUCTION Personnel of nuclear medicine departments work with open and sealed sources of ionising radiation. In hot labs they prepare radiopharmaceuticals for patients. Nurses and doctors administer radiopharmaceuticals for diagnostic and therapeutic purposes. Technicians performing imaging studies position (temporarily) radioactive patients, and calibrate scintigraphic equipment using reference sources of radiation. Imaging with hybrid gamma cameras, integral parts of computer tomographs, is standard practice in nuclear medicine departments. Many authors reported(1–3) that the personnel of nuclear medicine departments receive doses of ionising radiation higher than the personnel of radiotherapy and radiology departments, with the exception of interventional radiologists. Nuclear medicine department staff are routinely equipped with personal dosimeters monitoring the exposure of the whole body, and dosimetric rings monitoring the exposure of hands to ionising radiation. Recent studies have demonstrated that the lens of the eye is much more sensitive to ionising radiation than previously thought(4, 5). Meanwhile, the European Council Directive 2013/59/EUROATOM reduced the occupational dose limit for the lens of the eye from 150 to 20 mSv per year(6). This year all European Union Member States are obliged to transpose this new dose limit in the national legislation on radiation protection. Literature data on the doses absorbed by the personnel of nuclear medicine departments vary significantly. The absorbed dose of radiation depends on many different factors, such as the scope of duties, total working time with sources of radiation, radioactivity level handled by the employee, the use of radiation shields and devices reducing exposure, personal manual skills, experience and professional predispositions. Therefore, workers in similar positions with the same scope of duties may receive very different doses of radiation. The aim of the study was to measure the dose equivalents for the lens of the eye in employees of the Nuclear Medicine Department of the Pomeranian Medical University (NMD PMU) in Szczecin. Measured values were used when making decisions on equipping personnel most exposed to ionising radiation with personal eye dosimeters. The study also analysed the potential correlation between eye doses Hp(3), whole body doses Hp(10) and hand doses Hp(0.07). METHODS The study was conducted in a typical nuclear medicine department. During three analysed months a total of 934 radioisotope planar imaging, 542 SPECT and SPECT/CT studies, and 57 outpatient 131I thyroid therapies were performed. A total of 10 employees (three nurses, two physicians and five technicians) were equipped with personal dosimeters for the measurement of the dose equivalent for the lens of the eye Hp(3). EYE-D™ dosimeters with high-sensitivity MCP-N thermoluminescent detectors were supplied and then analysed for their indications by the Institute of Nuclear Physics, Polish Academy of Sciences (IFJ PAN) in Cracow. The minimum detection level (MDL) for this TLD system was 0.1 mSv. Dosimeters were used for 3 months by the employees during their work with sources of ionising radiation. At the same time, employees carried TLD dosimeters attached to protective clothing on the chest area, monitoring the exposure of the whole body Hp(10), and TLD dosimetric rings monitoring the exposure of hands Hp(0.07). Two physicians and one technician performed medical procedures using radiopharmaceuticals labelled with 131I. One physician administered on average eight capsules of 131I iodine and performed 10 subcutaneous or intradermal injections of 99mTc in the period under consideration. Physicians administered 131I capsules to patients for therapeutic purposes using protective lead containers with an applicator. Other employees carried out medical procedures using 99mTc. Radiopharmaceuticals were prepared in a hot laboratory in the rotating roster system. Nurses prepared radiopharmaceuticals in a hot laboratory and administered them to patients. On average one nurse had 8 days on duty in a hot laboratory and gave 300 intravenous injections of radiopharmaceutical to patients during the analysed period. Technicians were involved in preparing radiopharmaceuticals and patient imaging. On average one technician had 7 days on duty in a hot laboratory and carried out 180 imagining studies during the analysed period. Standard gamma radiation shielding (lead glazing, source containers, etc.) were used while preparing radiopharmaceuticals. Radioisotopes were injected with tungsten-shielded syringes. The radioactivity of isotopes handled by individual employees participating in the study was documented throughout the 3-month monitoring of eye dose radiation exposure. RESULTS Technicians and nurses were exposed to radiation from technetium radioisotope 99mTc, which is used in over 90% of all scintigraphic studies at the Nuclear Medicine Department, SPSK1 PMU. Physicians were exposed mainly to radiation from 131I during the administration of therapeutic capsules to patients. Readings from personal dosimeters measuring 3-month dose equivalents for the lens of the eye, whole body and hands are presented in Table 1. Doses for the lens of the eye in the staff were in the range of 0.20–0.72 mSv. The highest doses for the lens of the eye per unit of radioactivity, 17.51 and 13.70 μSv/GBq, were recorded for two physicians who administered therapeutic capsules with iodine 131I. Table 1. Three-month personal dose equivalents for the lens of the eye, whole body and hands in monitored medical staff, and their measurement uncertainties. Occupational group Dose equivalents for the eye lens (mSv) Dose equivalents for the eye lens per unit of radioactivity (μSv/GBq) Dose equivalents for the whole body (mSv) Dose equivalents for the hands (mSv) Physician 1 0.20 ± 0.03 17.51 ± 2.80 0.10 ± 0.03 0.10 ± 0.01 Physician 2 0.20 ± 0.03 13.70 ± 2.19 0.10 ± 0.03 0.73 ± 0.05 Technician 1 0.20 ± 0.03 3.40 ± 0.54 0.10 ± 0.03 1.23 ± 0.07 Technician 2 0.20 ± 0.03 1.47 ± 0.25 0.12 ± 0.03 8.08 ± 0.44 Technician 3 0.72 ± 0.04 4.75 ± 0.31 0.10 ± 0.03 26.05 ± 1.43 Technician 4 0.12 ± 0.03 0.48 ± 0.13 0.25 ± 0.06 2.76 ± 0.15 Technician 5 0.36 ± 0.03 0.76 ± 0.07 0.97 ± 0.12 0.10 ± 0.01 Nurse 1 0.29 ± 0.03 0.65 ± 0.07 0.27 ± 0.06 7.22 ± 0.04 Nurse 2 0.26 ± 0.03 0.61 ± 0.08 0.26 ± 0.05 4.67 ± 0.26 Nurse 3 0.41 ± 0.03 0.64 ± 0.05 0.56 ± 0.01 19.26 ± 1.06 Occupational group Dose equivalents for the eye lens (mSv) Dose equivalents for the eye lens per unit of radioactivity (μSv/GBq) Dose equivalents for the whole body (mSv) Dose equivalents for the hands (mSv) Physician 1 0.20 ± 0.03 17.51 ± 2.80 0.10 ± 0.03 0.10 ± 0.01 Physician 2 0.20 ± 0.03 13.70 ± 2.19 0.10 ± 0.03 0.73 ± 0.05 Technician 1 0.20 ± 0.03 3.40 ± 0.54 0.10 ± 0.03 1.23 ± 0.07 Technician 2 0.20 ± 0.03 1.47 ± 0.25 0.12 ± 0.03 8.08 ± 0.44 Technician 3 0.72 ± 0.04 4.75 ± 0.31 0.10 ± 0.03 26.05 ± 1.43 Technician 4 0.12 ± 0.03 0.48 ± 0.13 0.25 ± 0.06 2.76 ± 0.15 Technician 5 0.36 ± 0.03 0.76 ± 0.07 0.97 ± 0.12 0.10 ± 0.01 Nurse 1 0.29 ± 0.03 0.65 ± 0.07 0.27 ± 0.06 7.22 ± 0.04 Nurse 2 0.26 ± 0.03 0.61 ± 0.08 0.26 ± 0.05 4.67 ± 0.26 Nurse 3 0.41 ± 0.03 0.64 ± 0.05 0.56 ± 0.01 19.26 ± 1.06 Table 1. Three-month personal dose equivalents for the lens of the eye, whole body and hands in monitored medical staff, and their measurement uncertainties. Occupational group Dose equivalents for the eye lens (mSv) Dose equivalents for the eye lens per unit of radioactivity (μSv/GBq) Dose equivalents for the whole body (mSv) Dose equivalents for the hands (mSv) Physician 1 0.20 ± 0.03 17.51 ± 2.80 0.10 ± 0.03 0.10 ± 0.01 Physician 2 0.20 ± 0.03 13.70 ± 2.19 0.10 ± 0.03 0.73 ± 0.05 Technician 1 0.20 ± 0.03 3.40 ± 0.54 0.10 ± 0.03 1.23 ± 0.07 Technician 2 0.20 ± 0.03 1.47 ± 0.25 0.12 ± 0.03 8.08 ± 0.44 Technician 3 0.72 ± 0.04 4.75 ± 0.31 0.10 ± 0.03 26.05 ± 1.43 Technician 4 0.12 ± 0.03 0.48 ± 0.13 0.25 ± 0.06 2.76 ± 0.15 Technician 5 0.36 ± 0.03 0.76 ± 0.07 0.97 ± 0.12 0.10 ± 0.01 Nurse 1 0.29 ± 0.03 0.65 ± 0.07 0.27 ± 0.06 7.22 ± 0.04 Nurse 2 0.26 ± 0.03 0.61 ± 0.08 0.26 ± 0.05 4.67 ± 0.26 Nurse 3 0.41 ± 0.03 0.64 ± 0.05 0.56 ± 0.01 19.26 ± 1.06 Occupational group Dose equivalents for the eye lens (mSv) Dose equivalents for the eye lens per unit of radioactivity (μSv/GBq) Dose equivalents for the whole body (mSv) Dose equivalents for the hands (mSv) Physician 1 0.20 ± 0.03 17.51 ± 2.80 0.10 ± 0.03 0.10 ± 0.01 Physician 2 0.20 ± 0.03 13.70 ± 2.19 0.10 ± 0.03 0.73 ± 0.05 Technician 1 0.20 ± 0.03 3.40 ± 0.54 0.10 ± 0.03 1.23 ± 0.07 Technician 2 0.20 ± 0.03 1.47 ± 0.25 0.12 ± 0.03 8.08 ± 0.44 Technician 3 0.72 ± 0.04 4.75 ± 0.31 0.10 ± 0.03 26.05 ± 1.43 Technician 4 0.12 ± 0.03 0.48 ± 0.13 0.25 ± 0.06 2.76 ± 0.15 Technician 5 0.36 ± 0.03 0.76 ± 0.07 0.97 ± 0.12 0.10 ± 0.01 Nurse 1 0.29 ± 0.03 0.65 ± 0.07 0.27 ± 0.06 7.22 ± 0.04 Nurse 2 0.26 ± 0.03 0.61 ± 0.08 0.26 ± 0.05 4.67 ± 0.26 Nurse 3 0.41 ± 0.03 0.64 ± 0.05 0.56 ± 0.01 19.26 ± 1.06 Mean dose equivalents for the lens of the eye (Hp(3)), for the whole body (Hp(10)), and for hands (Hp(0.07)), measured over 3 months for individual occupational groups (physicians, nurses and technicians), are shown in Table 2. The mean dose equivalent for the lens of the eye for technicians and nurses was 0.32 mSv. Mean dose equivalents for the whole body of technicians and nurses were comparable and reached 0.31 and 0.36 mSv, respectively. The mean dose for hands in nurses was 10.38 mSv, and it was higher than the doses for hands in physicians and technicians. Table 2. Mean dose equivalents for the lens of the eye, whole body and hands, and their measurement uncertainties in occupational groups. Occupational group Mean dose equivalent for the lens of the eye Hp(3) (mSv) Mean dose equivalent for the whole body Hp(10) (mSv) Mean dose equivalent for the hands Hp(0.07) (mSv) Physicians 0.20 ± 0.03 0.10 ± 0.03 0.42 ± 0.03 Technicians 0.32 ± 0.03 0.31 ± 0.05 7.64 ± 0.42 Nurses 0.32 ± 0.03 0.36 ± 0.04 10.38 ± 0.46 Occupational group Mean dose equivalent for the lens of the eye Hp(3) (mSv) Mean dose equivalent for the whole body Hp(10) (mSv) Mean dose equivalent for the hands Hp(0.07) (mSv) Physicians 0.20 ± 0.03 0.10 ± 0.03 0.42 ± 0.03 Technicians 0.32 ± 0.03 0.31 ± 0.05 7.64 ± 0.42 Nurses 0.32 ± 0.03 0.36 ± 0.04 10.38 ± 0.46 Table 2. Mean dose equivalents for the lens of the eye, whole body and hands, and their measurement uncertainties in occupational groups. Occupational group Mean dose equivalent for the lens of the eye Hp(3) (mSv) Mean dose equivalent for the whole body Hp(10) (mSv) Mean dose equivalent for the hands Hp(0.07) (mSv) Physicians 0.20 ± 0.03 0.10 ± 0.03 0.42 ± 0.03 Technicians 0.32 ± 0.03 0.31 ± 0.05 7.64 ± 0.42 Nurses 0.32 ± 0.03 0.36 ± 0.04 10.38 ± 0.46 Occupational group Mean dose equivalent for the lens of the eye Hp(3) (mSv) Mean dose equivalent for the whole body Hp(10) (mSv) Mean dose equivalent for the hands Hp(0.07) (mSv) Physicians 0.20 ± 0.03 0.10 ± 0.03 0.42 ± 0.03 Technicians 0.32 ± 0.03 0.31 ± 0.05 7.64 ± 0.42 Nurses 0.32 ± 0.03 0.36 ± 0.04 10.38 ± 0.46 Table 3 presents mean dose equivalents for the lens of the eye per unit of isotope radioactivity in occupational groups. We found significant differences in normalised dose equivalents in occupational groups. The mean normalised dose for hands in nurses was the lowest and amounted to 0.63 μSv/GBq. The table also shows the ratios of mean dose equivalents: whole body/the lens of the eye and hands/the lens of the eye. For technicians and nurses Hp(10)/Hp(3) was 1.0 and 1.1, and Hp(0.07)/Hp(3) was 23.9 and 32.4. Table 3. Mean dose equivalents for the lens of the eye Hp(3) per unit of radioactivity, Hp(10)/Hp(3) ratio and Hp(00.7)/Hp(3) ratio, and their measurement uncertainties. Occupational group Hp(3) per unit of radioactivity (μSv/GBq) Hp(10)/Hp(3) Hp(0.07)/Hp(3) Physicians 15.61 ± 2.50 0.5 ± 0.2 2.1 ± 0.5 Technicians 2.17 ± 0.26 1.0 ± 0.3 23.9 ± 3.4 Nurses 0.63 ± 0.07 1.1 ± 0.2 32.4 ± 4.5 Occupational group Hp(3) per unit of radioactivity (μSv/GBq) Hp(10)/Hp(3) Hp(0.07)/Hp(3) Physicians 15.61 ± 2.50 0.5 ± 0.2 2.1 ± 0.5 Technicians 2.17 ± 0.26 1.0 ± 0.3 23.9 ± 3.4 Nurses 0.63 ± 0.07 1.1 ± 0.2 32.4 ± 4.5 Table 3. Mean dose equivalents for the lens of the eye Hp(3) per unit of radioactivity, Hp(10)/Hp(3) ratio and Hp(00.7)/Hp(3) ratio, and their measurement uncertainties. Occupational group Hp(3) per unit of radioactivity (μSv/GBq) Hp(10)/Hp(3) Hp(0.07)/Hp(3) Physicians 15.61 ± 2.50 0.5 ± 0.2 2.1 ± 0.5 Technicians 2.17 ± 0.26 1.0 ± 0.3 23.9 ± 3.4 Nurses 0.63 ± 0.07 1.1 ± 0.2 32.4 ± 4.5 Occupational group Hp(3) per unit of radioactivity (μSv/GBq) Hp(10)/Hp(3) Hp(0.07)/Hp(3) Physicians 15.61 ± 2.50 0.5 ± 0.2 2.1 ± 0.5 Technicians 2.17 ± 0.26 1.0 ± 0.3 23.9 ± 3.4 Nurses 0.63 ± 0.07 1.1 ± 0.2 32.4 ± 4.5 Spearman’s coefficient of correlation was 0.52 for dose equivalents for the eyes and hands, and 0.61 for dose equivalents for the eyes and the whole body. DISCUSSION The 3-month dose equivalents for the lens of the eye measured for the employees of NMD PMU was 0.20–0.72 mSv. Assuming that monitored staff perform a similar number of medical procedures in each quarter as in our study, the dose equivalent for the lens of the eye per year should be in the range of 0.80–3.00 mSv. When data reported by Leide-Svegborn(7) in 2012 were considered and values converted to match working conditions at NMD PMU in Szczecin, the absorbed dose was ~3 mGy per year. In a study by Dabin et al.(8) published in 2016 the estimated dose equivalents for the personnel of a nuclear medicine department were in the range of 0.6–9.3 mSv. In this study we calculated dose equivalents per unit of radioactivity handled by an employee to obtain an objective comparison of eye exposure. The occupational exposure per unit of radioactivity reported by Kopeć et al.(9) in 2011 was 3.3 for technicians, 3.4 for nurses and 1.2 μSv/GBq for physicians. At our department the exposure was 2.17 for technicians, 0.63 for nurses and 15.61 μSv/GBq for physicians. The lower values of the dose equivalents per unit of radioactivity for nurses and technicians may indicate the proper use of shields, as well as the good manual skills and experience of the personnel handling radioisotopes. The higher value of the dose equivalent normalised per unit of radioactivity for physicians compared to that reported by Kopeć et al.(9) results from the fact that in our study physicians handled iodine 131I, which has higher energy of radiation than 99mTc. In other studies(9, 10) the dose equivalent for employees has been calculated per number of procedures performed using isotopes. These procedures are not strictly defined and standardised, and individual nuclear medicine departments use different techniques for the preparation and administration of radiopharmaceuticals. Therefore, comparisons of medical centres in terms of the dose equivalent/procedure would not be correct for methodological reasons. More objective information may be derived from the comparison of the ratio of dose equivalents for the whole body and eye lens in employees Hp(10)/Hp(3), which was 1.0 for technicians and 1.1 for nurses. For these occupational groups, Rehani(11) reported Hp(10)/Hp(3) in the range of 0.7–1.1, while Kopeć et al.(9) found 0.9 for technicians and 1.4 for nurses. The ratio of dose equivalents for the hands and the lens of the eye Hp(0.07)/Hp(3) in our study was 23.9 for technicians and 32.4 for nurses, compared to 11.3 and 11.9 reported by Kopeć et al.(9). Similar ratios for the dose equivalents for the whole body and the lens of the eye found for employees (Hp(10/Hp3)), as well as the demonstrated correlation between the 3-month dose equivalents Hp(10) and Hp(3) suggest that the dose equivalent for the whole body can be a kind of indicator (though not an absolute determinant) of exposure for the lens of the eye of the monitored employees of NMD PUM. Many studies have demonstrated a significant positive correlation between Hp(10) and Hp(3) dose equivalents, both for the monitored employees of nuclear medicine departments(8, 9) and interventional radiologists(12, 13). Moreover, other studies(14, 15) have suggested that for interventional radiologists the eye lens doses strongly correlate with deep-dose equivalents for the whole body measured at the level of the neck collar of the lead apron. Due to the relatively low level of eye dose radiation exposure in the monitored employees of NMD PMU, which should not exceed 3 mSv per year, there is no need to routinely monitor the exposure of the lens of the eye with personal dosimeters. The EURATOM Directive recommends regular personal monitoring for those exposed workers who are liable to receive an equivalent dose of 15 mSv or greater per year for the lens of the eye(6). However, because of the significant variability of the measured doses between different monitored workers, as well as the limited duration of monitoring, it is advisable to periodically monitor eye lens doses in workers most exposed to ionising radiation who prepare and administer radiopharmaceuticals. For the dose range measured in our study, the EUROATOM Directive accepts estimating individual doses based on dosimetry of the workplace. The exposure of the lens of the eye in the analysed department is much lower than in departments producing radioisotopes and in interventional radiology departments, where protective lead glasses should be the standard element of radiation protection measures(16, 17). The weaker correlation between the measured doses for hands and the lens of the eye compared to that between whole body doses and lens of the eye may result from many factors, including the lack of a standardised way of wearing a dosimetric ring, or a significant difference in the geometrical position of a radioactive source in relation to the hands and eyes of employees. CONCLUSIONS Personnel of NMD SPSK1 PMU in Szczecin, performing classical scintigraphic imaging using the planar technique, SPECT, SPECT/CT and radioisotope therapies using iodine 131I, do not require regular personal eye dosimetry. Eye doses were found to be well within the new proposed annual limit of 20 mSv. Nevertheless, because of the limited duration and range of the study, periodic monitoring of individual eye-lens doses in the most exposed workers is recommended. The rotating roster system in which radiopharmaceuticals are prepared and administered plays an important role in the radiological protection of staff. Doses for the whole body of staff can be used as an indicator of their eye doses in the monitored Nuclear Medicine Department. REFERENCES 1 Kamenopoulou , V. , Driko , G. and Dimitriou , P. Dose constraints to the individual annual doses of exposed workers in the medical sector . Eur. J. Radiol. 37 , 204 – 208 ( 2001 ). 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Comparing cardiology, neuroradiology and interventional radiology . Radiat. Prot. Dosim. 165 ( 1–4 ), 279 – 283 ( 2015 ). Google Scholar Crossref Search ADS © The Author(s) 2018. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
TI - SHOULD PERSONNEL OF NUCLEAR MEDICINE DEPARTMENTS USE PERSONAL DOSIMETERS FOR EYE LENS DOSE MONITORING?
JF - Radiation Protection Dosimetry
DO - 10.1093/rpd/ncy118
DA - 2019-05-01
UR - https://www.deepdyve.com/lp/oxford-university-press/should-personnel-of-nuclear-medicine-departments-use-personal-EKdgmmEwFu
SP - 393
VL - 183
IS - 3
DP - DeepDyve
ER -