The effect of work system on the hand exposure of workers in 18F-FDG production centres

The effect of work system on the hand exposure of workers in 18F-FDG production centres 18 18 The production of the F isotope—the marker of deoxyglucose ( F-FDG)—the radiopharmaceutical most commonly used in the oncological diagnostic technique of positron emission tomography, requires a cyclotron device. At present, there are nine facilities working in Poland that are equipped with cyclotrons used for producing the short-lived isotopes. The aim of the paper is to determine the hand exposure of workers employed in the two F-FDG production centres taking in to account the production procedures and work system in those facilities. Measurements, which included all professional workers exposed to ionizing radiation that were employed in two facilities, were performed by using high-sensitivity thermoluminescent detectors during the routine activities of the personnel. The work system used at the production centre has an impact on the level of the recorded doses. Among the production procedures performed by the staff, the highest ionizing radiation doses have been received by the staff during the F-FDG quality control. The maximum estimated annual Hp(0.07) for chemists from the quality control department can exceed the annual skin limit dose (500 mSv). The source of lowest doses on the hands are the cyclotron operating procedure and the F-FDG production, provided that these procedures can’t be combined with other production procedures. Keywords Radiopharmaceuticals · Work system · Nuclear medicine · Personnel exposure · Radiation protection Introduction production. Non-commercial production means that the radi- opharmaceuticals labeled with short-lived isotopes are solely 18 18 F-labeled deoxyglucose ( F-FDG), is in wide use in onco- for the purposes of a PET-CT diagnostic centre (located, logical diagnostics via positron emission tomography (PET) in most cases, in the immediate vicinity of the production technique [1]. The production of F-FDG is a multistep centre). Commercial production purpose also accounts for process that begins by obtaining the F, and subsequently: the needs of a diagnostic facility located in the immediate labelling the radiopharmaceutical; preparing the individual vicinity. F-FDG vial activity; quality control of the resulting com- In both centre types, the personnel includes physicists, pound; packaging the vials with radiopharmaceutical into chemists and technical staff. However, in the case of F- shielded containers; and transportation of the produced com- FDG production centres that operate solely for the needs of pound to PET departments [2]. the nearest PET-CT departments only, nursing staff should Currently in Poland, there are nine centres equipped with also be taken into consideration. The publication presents an a cyclotron for the production of positron-emitting radio- analysis of the personnel, as well as the working system in isotopes. Polish centres producing radiopharmaceuticals the F-FDG production centres, in terms of hand exposure for the purpose of positron emission tomography can be to ionizing radiation of the medical staff employed. This divided taking into account commercial and non-commercial work complements the paper by Wrzesień [3] which exam- ined the exposure of the eye lens of workers in radiophar- maceutical production centers. * Małgorzata Wrzesień mwrzesien@uni.lodz.pl Faculty of Physics and Applied Informatics, Department of Nuclear Physics and Radiation Safety, University of Lodz, Pomorska 149/153, 90-236 Lodz, Poland Vol.:(0123456789) 1 3 542 Australasian Physical & Engineering Sciences in Medicine (2018) 41:541–548 in contrast to the first facility, in the group of chemists, Materials and methods procedures are not strictly assigned to individual people. Thus, all the procedures: production, quality control, and Measurements were carried out in two F-FDG produc- dispensing the dose of radiopharmaceutical for an indi- tion centres by using high-sensitivity thermoluminescent vidual patient at the facility can be done by one person. detectors (TLDs): LiF: Mg, Cu, P (MCP-N) [4, 5] pro- The production of F-FDG is carried out in the facility duced by RADCARD. A gamma radiation source— Cs 60 137 three times a week. The measurements were performed ( Co/ Cs irradiator) was used to calibrate the detectors during the 11 days of work. in the Secondary Standards Laboratory in Nofer Institute From the point of view of the occupational structure of of Occupational Medicine in Lodz. Dosimeters were cali- the workers employed in RPC II, Chemist 1 performs only brated in accordance with ISO 4037-3 [6] in the range the combined procedures of the production and dispensing from 0.05 to 30 mGy as the air kerma. The H (0.07) for of doses of F-FDG for patients; alternatively, in addition fingers was calculated taking into account the conversion to the above procedures, quality control of the radiopharma- coefficient h (0.07), given in the ISO International Stand- pK ceutical is carried out as well. Chemist 2 performs only the ard. We used the rod phantoms [7]. The readings of the F-FDG quality control procedures or combines all three dosimeters were read out using an RA ‘04 reader from procedures— F-FDG production, quality control and dis- Mikrolab Co. pensing doses of F-FDG for patients. Chemist 3 performs Measurements were carried out during routine work of three production procedures or carries out only the proce- the staff in both departments. In the case of the production dure for dispensing doses of F-FDG for individual patients. centre marked RPC I, which produces F-FDG essentially And the last in the group of chemists from the center RPC for commercial purposes, the structure of employment is II—Chemist 4 performs only the procedure of dispensing dominated by a clear division, which in turn is dictated by doses of F-FDG for patients during the second shift. The production procedures performed in the facility. The meas- work specificity of RPC II means that the personnel also urements were carried out for three groups of employ- includes nurses working in shifts. ees: operators of a cyclotron (two physicists), production Before the measurements, the detectors were annealed in workers (three chemists), and quality control staff (two accordance with the manufacturer’s guidelines and each of chemists). them was individually vacuum packed in foil. Thus prepared Measurements were performed in the span of 3 weeks. detectors were placed at the fingertips of the left and right The production process at the facility takes place from hand and also in a standard ring dosimeter location (both Monday to Thursday, which represented a total of 11 hands) as shown in Fig. 1. measurement days. The production, depending on the The statistical analysis was performed using the number of orders, included one or two production runs Mann–Whitney test and applying STATISTICA v. 10.0 MR1 (shifts) which meant that, during the 11 days of measuring, software. Any differences found was considered statistically the F-FDG was produced 19 times. One shift (production significant if p value was below 0.05. run) represents one vial of the finished product that goes to the quality control laboratory [3]. The activities performed by production workers included the placement of a vial in Results a synthesizer; the vials were automatically filled with the final radiopharmaceutical product [3 ]. Personnel in radiopharmaceutical production In the case of the facility producing F-FDG solely for centres (RPC) the needs of a neighboring PET-CT department (marked RPC II), the structure of employment is no longer so heav- Figure 2 presents the values of Hp(0.07) recorded during ily dominated by the production procedures carried out one working day on the hands of staff employed in radiop- in the facility. Here, it is generally easier to distribute the harmaceutical production centres, taking into account the employees based on their specialty training (education). professional position of workers. Measurements have covered four chemists, two physicists The greatest differences of Hp(0.07) values recorded dur - and four nurses. The task of the physicists was the daily ing one working day relate to the chemists, in particular supervision of the proper functioning of the cyclotron. The those employed in RPC II. This is due to the diversity and nurses inject the F-FDG to the patients in the activity spread of production procedures carried out by the same prescribed by the medical doctor. For the chemists, the people representing that professional group. This means, division of work tasks is not as clearly defined, because therefore, a detailed analysis of individual production pro- the staff were trained so that, in the event of an absence of cedures carried out in both production facilities taking into a worker, another may cover their tasks. This means that, account the structure of employment is required. 1 3 Australasian Physical & Engineering Sciences in Medicine (2018) 41:541–548 543 Fig. 1 Location of TLDs on worker’s hand. Points ‘11’ and ‘12’ denote points placed at the base of the middle finger of the left and right work - er’s hands and corresponding the standard ring dosimeter location Chemist1(production+dose dispension)RPCII mean Chemist1(production+QC+dose dispension)RPCII 75th percentile Chemist2(production+QC+dose dispension)RPCII median Chemist3(production+QC+dose dispension)RPCII 25th percentile 1 Chemist1(production)RPCI max Chemist2(production)RPCI min 3 Chemist3(production)RPCI 0.1 0.01 physicists RPC Iphysicist RPC II chemists RPC Ichemists RPC II nurses RPC II 12345678 9101112 Professional position Location of measuring points Fig. 2 The Hp(0.07) recorded during one working day on hands of Fig. 3 The mean working-day values of Hp(0.07) for staff who per - the staff employed in radiopharmaceutical production centres, tak - formed F-FDG production procedures in RPC I and RPC II, taking ing into account the professional position of workers. RPCI, RPCII into account the professional position of workers denote, respectively, Radiopharmaceutical Production Centre I and II 18 18 Hand exposure during  F‑FDG production cumulative procedures, including F-FDG production and dispensing doses of the radiopharmaceutical, or they jointly procedures performed all three production procedures ( F-FDG pro- duction, quality control and dispensing doses for patients). Figure 3 presents mean working-day values of Hp(0.07) for staff who performed F-FDG production procedures in RPC The maximum value of Hp(0.07) recorded during one work- ing day for Chemist 1 employed in RPC II, who performed I and RPC II, taking into account the professional position of workers. cumulative procedures including the production, quality control and dispensing of doses of the radiopharmaceuti- The highest values of Hp(0.07) recorded during one working day involve basically the chemists employed in RPC cal was: 4.32 ± 0.07 mSv (for tip of the ring finger of the non-dominant, left hand). In the case of the same worker II. Chemists (1, 2 and 3) employed in RPC I, are perform- ing only the F-FDG production procedures. In RPC II, (Chemist 1), who performed two production procedures ( F-FDG production, and dispensing dose of radiopharma- employed chemists were performing mostly “cumulative” production procedures, which means that one chemist can ceutical for patients) and additionally in the same measur- ing point, the highest value of Hp(0.07) recorded during perform two or even three radiopharmaceuticals production procedures. During the measurements the Chemist 1, Chem- one working day was 4.26 ± 0.03 mSv. There are no statis- tically significant differences between the distributions of ist 2 and Chemist 3 employed in RPC II were performing 1 3 Hp(0.07) [mSv] Hp(0.07) [mSv] 544 Australasian Physical & Engineering Sciences in Medicine (2018) 41:541–548 Hp(0.07)/A (normalized value of Hp(0.07) to the activity this case seems to be the activity of the radiopharmaceuti- of F-FDG) recorded for Chemist 1 during two production cal forwarded to the quality control department. During the 18 18 procedures including F-FDG production and dispensing first shift, the average F-FDG activity was 6.4 GBq, for doses of radiopharmaceutical, and all three production pro- employees of the second shift it was 6.7 GBq [2]. cedures being performed together. At the same time, com- In the production facility RPC II, there is no clear assign- paring the distributions of Hp(0.07)/A registered during one ment of the employee to a specific production procedure; working day for three chemists carrying out a total of three however, it was possible to isolate the quality control proce- production procedures ( F-FDG production, quality control dure in the case of one employee. The comparison of aver- and dispensing dose of radiopharmaceutical for patients), age values Hp(0.07) normalized by the activity in the case there was no statistically significant difference. In the case of employees of the quality control lab in two production of the RPC I sta— ff chemists, who perform only the F-FDG centres is shown in Fig. 5. production procedure, a statistically significant difference It is worth noting that the highest Hp(0.07)/A was exists between the distribution of Hp(0.07) recorded within recorded for the worker from RPC II—centre, which pro- one working day for Chemist 2 and 3 (p = 0.000037) and duces the F-FDG solely for the use of a neighboring PET- Chemist 3 compared with Chemist 1 (p = 0.000097). Such a CT department. difference is not found between the distributions of values Even though the quality control procedures of radiophar- Hp(0.07) obtained for Chemist 1 and 2 (p = 0.14). In this maceuticals produced in both production centres are similar, case the individualized activities performed by individual the mean values of Hp(0.07) normalized by activity, par- chemists especially Chemist 3 may influence on the level ticularly in the case of the left hand of RPC II worker, are of the Hp(0.07). at least one order of magnitude higher compared to the two workers from RPC I. Hand exposure of quality control workers from the shift (production run) point of view Hand exposure of workers performing the cyclotron operators procedures against the professional The shift-based working system in the first production facil- position ity (RPC I) makes it possible to check the influence of the order of the shifts of quality control employees on the level Operating of the cyclotron is a procedure during which the of the recorded dose. values of Hp(0.07) for employees from the RPC I are, on Figure  4 shows that the trend of the higher fingertips average, higher than those recorded by the detectors placed exposure during the second shift is preserved only for the on the hands of the staff from RPC II who performed the Chemist 5. In the case of the Chemist 4, the fingertips of same procedure (Fig. 6). In terms of the task associated with the left hand (except the little finger) receive higher doses the operation of the cyclotron, the activities carried out by during the first working shift. The most important factor in 0.30 QC1-Chemist4 Chemist4-RPC I QC2-Chemist4 0.25 Chemist5-RPC I QC1-Chemist5 Chemist2-RPC II QC2-Chemist5 0.20 0.15 0.1 0.10 0.01 0.05 0.00 12345678 9101112 1E-3 123456789 10 11 12 Measuring points Location of measuring points Fig. 4 The average values of H (0.07)/A for quality control staff tak - Fig. 5 Distribution of mean values of Hp(0.07)/A on the left and ing into account the production run. QC1 and QC2 denoted the order right hand two employees of the quality control department at RPC I of the shift (production run) in radiopharmaceuticals quality control and one employee in RPC II department 1 3 Hp(0.07)/A [mSv/GBq] Hp(0.07)/A [mSv/GBq] Australasian Physical & Engineering Sciences in Medicine (2018) 41:541–548 545 0.05 performing the injection of F-FDG to the patients. All Physicist1-RPCII Physicist2-RPCII workers are employees in the RPC II. Physicist1-RPCI Physicist2-RPCI The statistically significant difference between the distri- 0.04 butions of normalized Hp(0.07) obtained during one work- ing day for Chemist 3 and 4 for measuring point 1, 2 and 3 0.03 and also 11 and 12 was found (p = 0.018904). Comparing the distributions of mean values of Hp(0.07)/A for chemists 0.02 and nurses, a statistically significant difference was found for Chemist 3 and Nurse 1 (p = 0.014138) and Chemist 4 and Nurse 1 (p = 0.035090). Nurse 1 employed at RPC II 0.01 works ad hoc solely in case of the absence of Nurse 2 or 3. It is true that differences in the distributions of Hp(0.07)/A 0.00 recorded for three nurses can be seen primarily in the case 12345678 9101112 of the tip of the thumb, as well as index and middle fingers Location of measuring points of the left hand. The data for Chemist 3 and 4 during the dispensing Fig. 6 Mean values of Hp(0.07) recorded by the individual measuring of doses of F-FDG for patients was compared with the points of cyclotron operating personnel in both radiopharmaceuticals data from another diagnostic department, where this pro- production centres cedure is realized by a physicist. The total daily F-FDG activity prepared for patients by a physicist is in the range physicists working in RPC II and physicists from the RPC 0.68–2.52 GBq and in the case of chemists: 0.83–3.12 GBq. I are different. Figure 8 shows the distribution of Hp(0.07)/A recorded by TLD at the fingertips of the left hands and right hands dur - Hand exposure of workers during dispensing ing the dispensing of doses of F-FDG for patients carried doses of  F‑FDG for patients and injection out by chemists working in the center RPC II and physicist radiopharmaceuticals to the patients employed in the Medical Diagnostic Centre (MDC) in Lodz provided with PET/CT unit [8]. Individual dispensing of doses of F-FDG for patients was The average number of patients diagnosed during 1 day performed by two chemists. Figure 7 presents the mean val- in two centres is similar (ten patients), the value of the F- ues Hp(0.07)/A for the two chemists performing only the FDG activity dispensed for a single patient is also approxi- dispensing doses of F-FDG for patients and three nurses mately the same. 0.9 Chemist3 Chemist3 Chemist4 0.8 Chemist4 Physicist 1E-01 Nurse1 0.7 Nurse2 Nurse3 1E-02 0.6 0.5 1E-03 0.4 1E-04 0.3 1E-05 0.2 0.1 1E-06 0.0 1 2345678 910 12345678 9101112 Location measuring points Location of measuring points Fig. 8 Distribution of Hp(0.07)/A recorded by TLD placed at the fin- Fig. 7 Mean values Hp(0.07)/A recorded by the individual measuring gertips of the left hand and right hand during the dispensing doses 18 18 points of chemists who dispense doses of F-FDG for patients and of F-FDG for patients carried out by the chemists employed in the nurses performing injection of the radiopharmaceutical. All workers RPC II center and physicist employed in Medical Diagnostic Centre are employees in RPC II (MDC) 1 3 Hp(0.07)/A [mSv/GBq] Hp(0.07) [mSv] Hp(0.07)/A [mSv/GBq] 546 Australasian Physical & Engineering Sciences in Medicine (2018) 41:541–548 18 18 procedures involving cyclotron operation, F-FDG produc- Estimated annual dose for the workers in  F‑FDG production centres tion and quality control of the finished radiopharmaceuti- cal, varies depending on the order of duty resulting from a In the case of employees of RPC I, the maximum annual schedule roster. In the RPC II, producing F-FDG solely for the purpose of a PET-CT diagnostic department, located Hp(0.07) was estimated assuming the implementation of 300 production procedures, taking into account only the mostly in the immediate vicinity of the production centre, each employee has been trained for the implementation of most exposure fingertips. Annual fingers exposure to ion- izing radiation in case of RPC II employees, was estimated all procedures, so that, if necessary, they can perform any of the required production procedures. Here, however, the taking into account the nature of professional’s work. It was assumed that F-FDG production took place three times a shift working system included only Chemist 3 and Chemist 4. Hence Chemist 4 as the only worker from the chemists week (120 working days a year in total). Estimated values are presented in Table 1. group performs the dispensing of doses of F-FDG for the patients, and doing this only during the second shift. Fig- ure 3 seems to confirm the assumption that specializing in carrying out specific activities optimizes radiation protec- Discussion tion of personnel and helps reduce the doses of ionizing radiation. The production of radiopharmaceuticals based on short-lived isotopes arouses much interest from the point of view of It seems that the working system based on the combined radiopharmaceutical production procedures implemented in exposure of personnel performing various production pro- cedures despite the automation of some production proce- RPC II, compared to the RPC I should be a source of higher Hp(0.07) for the personnel performing only the procedure dures. Exposure of personnel in nuclear medicine facilities during the labeling of radiopharmaceuticals by using even of F-FDG production or quality control of the radiophar- 99m maceutical. The explanation of this fact seems simple: per- Tc shows that the main source of exposure of person- nel is the same process of radiopharmaceuticals labeling forming the same manipulations during a single procedure, every single day, results in higher efficiency and thus short- [9]. The ORAMED project [10, 11] discusses in detail the exposure of medical personnel performing procedures using ens the time performing the procedure. The only case when the recorded value of Hp(0.07) at all measurement points for the isotope F as well. In this case, however, it analyzed the exposure of workers performing manual procedures of the staff of the RPC I are higher in comparison with the RPC II concerns the cyclotron operating procedure. The tasks of labeling the radiopharmaceuticals. The exposure of workers from two F-FDG production centers discussed in the paper, chemists from the RPC I, in addition to the daily supervision of the proper functioning of the cyclotron and the replenish- taking into account both the professional position, as well as the specificity of the work in the facility, suggests that in ment of water enriched in O, includes the preparation of the tungsten containers containing the product ready to leave this area there are also issues that require careful analysis, taking into account the work system of production centres. the centre. This is another example of an increased dose dur- ing the implementation of a greater number of procedures The RPC I implements the philosophy of F-FDG pro- duction based on the assignment of specific procedures using the radiopharmaceutical (even if the radiopharmaceu- ticals are covered by tungsten). for employees while taking into account the shift working system. This means that the person performing the various Dispensing doses of F-FDG for patients according to the value specified by the medical doctor in a second pro- duction centre (RPC II) is also performed by chemists (two persons). Hand exposure of both employees looks differ - Table 1 Maximum estimated annual Hp(0.07) for the staff employed ent, as a consequence of differences relating to the way they in RPC I and RPC II work. Chemist 4 uses both hands when dispensing doses of Professional groups/RPC Maximum estimated F-FDG for the patient, as shown in particular in points 1–5 annual Hp(0.07) (mSv) (Fig. 7). In the case of Chemist 3, if it is possible to perform Physicists/RPC I 11 the same procedure by using only one hand, the procedure Chemists/RPC I 445 is carried out just like that. This way of working reliably Physicists/RPC II 3 minimizes the exposure of the non-dominant hand. How- Chemists/RPC II 512 ever, it affects the rate of actions and increases the exposure Nurses/RPC II 135 of the dominant hand. The data for Chemist 3 and 4 during the dispensing of doses of F-FDG for patients was also A bold font was used to emphasize that the maximum estimated compared with the data from another diagnostic department, annual Hp(0.07) for chemists from the quality control department exceed the annual skin limit dose—500 mSv 1 3 Australasian Physical & Engineering Sciences in Medicine (2018) 41:541–548 547 where this procedure is realized by a physicist. The results physicists, it will not exceed 0.6% of the annual dose limit, are shown in Fig. 8. which is 500 mSv [12]. The procedure of filling up the syringe F-FDG with Acknowledgements The author would like to warmly thank all the activity occurs automatically. Similarities also arise in which people from the Radiopharmaceuticals Production Centres for their fingertips are the most exposed: the thumb and index finger help in collecting these data. This research was financially supported of the right hand while performing this procedure. Despite by the Ministry of Science and Higher Education of Poland, project these similarities, the difference between the Hp(0.07)/A for number B 1411500000542.02 and B 1611500001135.02. the thumb and index finger of the right hand for employees RPC II and MDC is, on average, three orders of magnitude. Compliance with ethical standards These differences can be explained by an individualization Conflict of interest The author declares that there is no conflict of in- of manipulations and, above all, the time it takes to perform terest. these. Measurements performed in both centres also allow us to Ethical approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the insti- determine which of the activities/procedures carried out by tutional and/or national research committee and with the 1964 Helsinki the staff of both units contributes the most to the recorded declaration and its later amendments or comparable ethical standards. dose. In the case of the RPC I, the greatest contribution to This article does not contain any studies with animals performed by the dose recorded by TLD placed on the fingertips (80% for any of the authors. the left hand, and 89% for the right hand) is by the quality Informed consent Informed consent was obtained from all individual control of the radiopharmaceutical. The case of RPC II is participants included in the study. similar. Here, the percentage of radiopharmaceutical qual- ity control procedures for the left hand is over 96%; for the Open Access This article is distributed under the terms of the Crea- right hand, it is 83%. tive Commons Attribution 4.0 International License (http://creat iveco mmons.or g/licenses/b y/4.0/), which permits unrestricted use, distribu- tion, and reproduction in any medium, provided you give appropriate Conclusions credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The measurements performed allow us to reach the follow- ing conclusions. The work system undoubtedly affects the References level of recorded doses; specialization in performing specic fi activities/procedures shortens the time of performed proce- 1. Królicki L, Kunikowska J, Kobylecka M, Mączewska J, Froncze- dures, which in turn results in lower doses. Automatic pro- wska K (2011) Positron emission tomography (PET) in diagnosis duction of F-FDG promotes the optimization of radiation of oncological diseases. Prog Med Sci 2:104–108 protection of personnel. Combining automatically performed 2. Wrzesień M, Albiniak Ł (2016) Hand exposure of workers in F- FDG production centre. J Radiol Prot 36:N67–N76 production procedures with fragments of manual activities 3. Wrzesień M (2018). F-FDG production procedures as a source performed as part of the quality control of the radiopharma- of eye lens exposure to radiation. J Radiol Prot 38:382–393. https ceutical results in increased of hand exposure. ://doi.org/10.1088/1361-6498/aaa28 7 The highest ionizing radiation doses have been received 4. Niewiadomski T, Bilski P, Budzanowski M, Olko P, Ryba E (1996) Progress in thermoluminescent dosimetry for radiation by the staff during the F-FDG quality control. Hand expo- protection and medicine. Nukleonika 41(2):93–104 sure of nurses performing the administration of radiophar- 5. Bilski P (2002) Lithium fluoride: from LiF:Mg,Ti to LiF:Mg,Cu,P. maceuticals to the patient is different from the exposure of Radiat. Prot Dosim 100:199–206. https ://doi.org/10.1093/oxfor the hands of the chemists who dispensed the doses of F-djour nals.rpd.a0058 47 6. International Organization for Standardization (ISO) (1999) X and FDG for patients. The source of lowest doses on the hands gamma reference radiation for calibrating dosemeters and doser- are the cyclotron operating procedure and the F-FDG pro- ate meters and determining their response as a function of photon duction, provided that these procedures can’t be combined energy. Part 3: Calibration of area and personal dosemeters and with other production procedures. the measurement of their response as a function of energy and angle of incidence. International Standard ISO- 4037-3, Geneva The maximum estimated annual Hp(0.07) for chemists 7. International Organization for Standardization, (2000) Nuclear from the quality control department employed in RPC I does energy—radiation protection—individual thermoluminescence not exceed 445 mSv. For the physicists from RPC I, it will dosemeters for extremities and eyes ISO Report 12794. ISO, not exceed 11 mSv. In the case of workers employed in RPC Geneva 8. Wrzesień M, Napolska K (2015) Investigation of radiation protec- II, the maximum annual equivalent dose was estimated in the tion of medical staff performing medical diagnostic examinations group of chemists—512 mSv. In the group of nurses it will by using PET/CT technique. J Radiol Prot 35:197–207. https://doi. reach up to 27% of the annual limit, while in the group of org/10.1088/0952-4746/35/1/197 1 3 548 Australasian Physical & Engineering Sciences in Medicine (2018) 41:541–548 9. Wrzesień M (2018) Simplicity or complexity of the radiophar- 11. Vanhavere F, Carinou E, Gualdrini G, Clairand I, Sans Merce M, maceutical production process in the light of optimization of Ginjaume M, Nikodemova D, Jankowski J, Bordy J-M, Rimpler 99m 18 radiation protection of staff— Tc versus F. Medycyna Pracy A, Wach S, Martin P, Struelens L, Krim S, Koukorava C, Ferrari 69(3):(Polish). https ://doi.org/10.13075 /mp.5893.00687 P, Mariotti F, Fantuzzi E, Donadille L, Itié C, Ruiz N, Carnicer 10. Carnicer A, Sans-Merce M, Baechler S, Barth I, Donadille L, Fer- A, Fulop M, Domienik J, Brodecki M, Daures J, Barth I, Bilski rari P, Fulop M, Ginjaume M, Gualdrini G, Krim S, Mariotti M, P. (2012) Optimization of radiation protection of medical staff Ortega X, Rimpler A, Ruiz N, Vanhavere F (2011) Hand exposure EURADOS Report 2012-02 Braunschweig 18 99m in diagnostic nuclear medicine with F- and Tc-labelled radi- 12. EURATOM Basic Safety Standard (BSS) Directive 2013/59 opharmaceuticals—Results of the ORAMED project. Radiat Meas 46:1277–1282. https ://doi.org/10.1016/j.radme as.2011.07.019 1 3 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Australasian Physical & Engineering Sciences in Medicine Springer Journals

The effect of work system on the hand exposure of workers in 18F-FDG production centres

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Biomedicine; Biomedicine, general; Biological and Medical Physics, Biophysics; Medical and Radiation Physics; Biomedical Engineering
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Abstract

18 18 The production of the F isotope—the marker of deoxyglucose ( F-FDG)—the radiopharmaceutical most commonly used in the oncological diagnostic technique of positron emission tomography, requires a cyclotron device. At present, there are nine facilities working in Poland that are equipped with cyclotrons used for producing the short-lived isotopes. The aim of the paper is to determine the hand exposure of workers employed in the two F-FDG production centres taking in to account the production procedures and work system in those facilities. Measurements, which included all professional workers exposed to ionizing radiation that were employed in two facilities, were performed by using high-sensitivity thermoluminescent detectors during the routine activities of the personnel. The work system used at the production centre has an impact on the level of the recorded doses. Among the production procedures performed by the staff, the highest ionizing radiation doses have been received by the staff during the F-FDG quality control. The maximum estimated annual Hp(0.07) for chemists from the quality control department can exceed the annual skin limit dose (500 mSv). The source of lowest doses on the hands are the cyclotron operating procedure and the F-FDG production, provided that these procedures can’t be combined with other production procedures. Keywords Radiopharmaceuticals · Work system · Nuclear medicine · Personnel exposure · Radiation protection Introduction production. Non-commercial production means that the radi- opharmaceuticals labeled with short-lived isotopes are solely 18 18 F-labeled deoxyglucose ( F-FDG), is in wide use in onco- for the purposes of a PET-CT diagnostic centre (located, logical diagnostics via positron emission tomography (PET) in most cases, in the immediate vicinity of the production technique [1]. The production of F-FDG is a multistep centre). Commercial production purpose also accounts for process that begins by obtaining the F, and subsequently: the needs of a diagnostic facility located in the immediate labelling the radiopharmaceutical; preparing the individual vicinity. F-FDG vial activity; quality control of the resulting com- In both centre types, the personnel includes physicists, pound; packaging the vials with radiopharmaceutical into chemists and technical staff. However, in the case of F- shielded containers; and transportation of the produced com- FDG production centres that operate solely for the needs of pound to PET departments [2]. the nearest PET-CT departments only, nursing staff should Currently in Poland, there are nine centres equipped with also be taken into consideration. The publication presents an a cyclotron for the production of positron-emitting radio- analysis of the personnel, as well as the working system in isotopes. Polish centres producing radiopharmaceuticals the F-FDG production centres, in terms of hand exposure for the purpose of positron emission tomography can be to ionizing radiation of the medical staff employed. This divided taking into account commercial and non-commercial work complements the paper by Wrzesień [3] which exam- ined the exposure of the eye lens of workers in radiophar- maceutical production centers. * Małgorzata Wrzesień mwrzesien@uni.lodz.pl Faculty of Physics and Applied Informatics, Department of Nuclear Physics and Radiation Safety, University of Lodz, Pomorska 149/153, 90-236 Lodz, Poland Vol.:(0123456789) 1 3 542 Australasian Physical & Engineering Sciences in Medicine (2018) 41:541–548 in contrast to the first facility, in the group of chemists, Materials and methods procedures are not strictly assigned to individual people. Thus, all the procedures: production, quality control, and Measurements were carried out in two F-FDG produc- dispensing the dose of radiopharmaceutical for an indi- tion centres by using high-sensitivity thermoluminescent vidual patient at the facility can be done by one person. detectors (TLDs): LiF: Mg, Cu, P (MCP-N) [4, 5] pro- The production of F-FDG is carried out in the facility duced by RADCARD. A gamma radiation source— Cs 60 137 three times a week. The measurements were performed ( Co/ Cs irradiator) was used to calibrate the detectors during the 11 days of work. in the Secondary Standards Laboratory in Nofer Institute From the point of view of the occupational structure of of Occupational Medicine in Lodz. Dosimeters were cali- the workers employed in RPC II, Chemist 1 performs only brated in accordance with ISO 4037-3 [6] in the range the combined procedures of the production and dispensing from 0.05 to 30 mGy as the air kerma. The H (0.07) for of doses of F-FDG for patients; alternatively, in addition fingers was calculated taking into account the conversion to the above procedures, quality control of the radiopharma- coefficient h (0.07), given in the ISO International Stand- pK ceutical is carried out as well. Chemist 2 performs only the ard. We used the rod phantoms [7]. The readings of the F-FDG quality control procedures or combines all three dosimeters were read out using an RA ‘04 reader from procedures— F-FDG production, quality control and dis- Mikrolab Co. pensing doses of F-FDG for patients. Chemist 3 performs Measurements were carried out during routine work of three production procedures or carries out only the proce- the staff in both departments. In the case of the production dure for dispensing doses of F-FDG for individual patients. centre marked RPC I, which produces F-FDG essentially And the last in the group of chemists from the center RPC for commercial purposes, the structure of employment is II—Chemist 4 performs only the procedure of dispensing dominated by a clear division, which in turn is dictated by doses of F-FDG for patients during the second shift. The production procedures performed in the facility. The meas- work specificity of RPC II means that the personnel also urements were carried out for three groups of employ- includes nurses working in shifts. ees: operators of a cyclotron (two physicists), production Before the measurements, the detectors were annealed in workers (three chemists), and quality control staff (two accordance with the manufacturer’s guidelines and each of chemists). them was individually vacuum packed in foil. Thus prepared Measurements were performed in the span of 3 weeks. detectors were placed at the fingertips of the left and right The production process at the facility takes place from hand and also in a standard ring dosimeter location (both Monday to Thursday, which represented a total of 11 hands) as shown in Fig. 1. measurement days. The production, depending on the The statistical analysis was performed using the number of orders, included one or two production runs Mann–Whitney test and applying STATISTICA v. 10.0 MR1 (shifts) which meant that, during the 11 days of measuring, software. Any differences found was considered statistically the F-FDG was produced 19 times. One shift (production significant if p value was below 0.05. run) represents one vial of the finished product that goes to the quality control laboratory [3]. The activities performed by production workers included the placement of a vial in Results a synthesizer; the vials were automatically filled with the final radiopharmaceutical product [3 ]. Personnel in radiopharmaceutical production In the case of the facility producing F-FDG solely for centres (RPC) the needs of a neighboring PET-CT department (marked RPC II), the structure of employment is no longer so heav- Figure 2 presents the values of Hp(0.07) recorded during ily dominated by the production procedures carried out one working day on the hands of staff employed in radiop- in the facility. Here, it is generally easier to distribute the harmaceutical production centres, taking into account the employees based on their specialty training (education). professional position of workers. Measurements have covered four chemists, two physicists The greatest differences of Hp(0.07) values recorded dur - and four nurses. The task of the physicists was the daily ing one working day relate to the chemists, in particular supervision of the proper functioning of the cyclotron. The those employed in RPC II. This is due to the diversity and nurses inject the F-FDG to the patients in the activity spread of production procedures carried out by the same prescribed by the medical doctor. For the chemists, the people representing that professional group. This means, division of work tasks is not as clearly defined, because therefore, a detailed analysis of individual production pro- the staff were trained so that, in the event of an absence of cedures carried out in both production facilities taking into a worker, another may cover their tasks. This means that, account the structure of employment is required. 1 3 Australasian Physical & Engineering Sciences in Medicine (2018) 41:541–548 543 Fig. 1 Location of TLDs on worker’s hand. Points ‘11’ and ‘12’ denote points placed at the base of the middle finger of the left and right work - er’s hands and corresponding the standard ring dosimeter location Chemist1(production+dose dispension)RPCII mean Chemist1(production+QC+dose dispension)RPCII 75th percentile Chemist2(production+QC+dose dispension)RPCII median Chemist3(production+QC+dose dispension)RPCII 25th percentile 1 Chemist1(production)RPCI max Chemist2(production)RPCI min 3 Chemist3(production)RPCI 0.1 0.01 physicists RPC Iphysicist RPC II chemists RPC Ichemists RPC II nurses RPC II 12345678 9101112 Professional position Location of measuring points Fig. 2 The Hp(0.07) recorded during one working day on hands of Fig. 3 The mean working-day values of Hp(0.07) for staff who per - the staff employed in radiopharmaceutical production centres, tak - formed F-FDG production procedures in RPC I and RPC II, taking ing into account the professional position of workers. RPCI, RPCII into account the professional position of workers denote, respectively, Radiopharmaceutical Production Centre I and II 18 18 Hand exposure during  F‑FDG production cumulative procedures, including F-FDG production and dispensing doses of the radiopharmaceutical, or they jointly procedures performed all three production procedures ( F-FDG pro- duction, quality control and dispensing doses for patients). Figure 3 presents mean working-day values of Hp(0.07) for staff who performed F-FDG production procedures in RPC The maximum value of Hp(0.07) recorded during one work- ing day for Chemist 1 employed in RPC II, who performed I and RPC II, taking into account the professional position of workers. cumulative procedures including the production, quality control and dispensing of doses of the radiopharmaceuti- The highest values of Hp(0.07) recorded during one working day involve basically the chemists employed in RPC cal was: 4.32 ± 0.07 mSv (for tip of the ring finger of the non-dominant, left hand). In the case of the same worker II. Chemists (1, 2 and 3) employed in RPC I, are perform- ing only the F-FDG production procedures. In RPC II, (Chemist 1), who performed two production procedures ( F-FDG production, and dispensing dose of radiopharma- employed chemists were performing mostly “cumulative” production procedures, which means that one chemist can ceutical for patients) and additionally in the same measur- ing point, the highest value of Hp(0.07) recorded during perform two or even three radiopharmaceuticals production procedures. During the measurements the Chemist 1, Chem- one working day was 4.26 ± 0.03 mSv. There are no statis- tically significant differences between the distributions of ist 2 and Chemist 3 employed in RPC II were performing 1 3 Hp(0.07) [mSv] Hp(0.07) [mSv] 544 Australasian Physical & Engineering Sciences in Medicine (2018) 41:541–548 Hp(0.07)/A (normalized value of Hp(0.07) to the activity this case seems to be the activity of the radiopharmaceuti- of F-FDG) recorded for Chemist 1 during two production cal forwarded to the quality control department. During the 18 18 procedures including F-FDG production and dispensing first shift, the average F-FDG activity was 6.4 GBq, for doses of radiopharmaceutical, and all three production pro- employees of the second shift it was 6.7 GBq [2]. cedures being performed together. At the same time, com- In the production facility RPC II, there is no clear assign- paring the distributions of Hp(0.07)/A registered during one ment of the employee to a specific production procedure; working day for three chemists carrying out a total of three however, it was possible to isolate the quality control proce- production procedures ( F-FDG production, quality control dure in the case of one employee. The comparison of aver- and dispensing dose of radiopharmaceutical for patients), age values Hp(0.07) normalized by the activity in the case there was no statistically significant difference. In the case of employees of the quality control lab in two production of the RPC I sta— ff chemists, who perform only the F-FDG centres is shown in Fig. 5. production procedure, a statistically significant difference It is worth noting that the highest Hp(0.07)/A was exists between the distribution of Hp(0.07) recorded within recorded for the worker from RPC II—centre, which pro- one working day for Chemist 2 and 3 (p = 0.000037) and duces the F-FDG solely for the use of a neighboring PET- Chemist 3 compared with Chemist 1 (p = 0.000097). Such a CT department. difference is not found between the distributions of values Even though the quality control procedures of radiophar- Hp(0.07) obtained for Chemist 1 and 2 (p = 0.14). In this maceuticals produced in both production centres are similar, case the individualized activities performed by individual the mean values of Hp(0.07) normalized by activity, par- chemists especially Chemist 3 may influence on the level ticularly in the case of the left hand of RPC II worker, are of the Hp(0.07). at least one order of magnitude higher compared to the two workers from RPC I. Hand exposure of quality control workers from the shift (production run) point of view Hand exposure of workers performing the cyclotron operators procedures against the professional The shift-based working system in the first production facil- position ity (RPC I) makes it possible to check the influence of the order of the shifts of quality control employees on the level Operating of the cyclotron is a procedure during which the of the recorded dose. values of Hp(0.07) for employees from the RPC I are, on Figure  4 shows that the trend of the higher fingertips average, higher than those recorded by the detectors placed exposure during the second shift is preserved only for the on the hands of the staff from RPC II who performed the Chemist 5. In the case of the Chemist 4, the fingertips of same procedure (Fig. 6). In terms of the task associated with the left hand (except the little finger) receive higher doses the operation of the cyclotron, the activities carried out by during the first working shift. The most important factor in 0.30 QC1-Chemist4 Chemist4-RPC I QC2-Chemist4 0.25 Chemist5-RPC I QC1-Chemist5 Chemist2-RPC II QC2-Chemist5 0.20 0.15 0.1 0.10 0.01 0.05 0.00 12345678 9101112 1E-3 123456789 10 11 12 Measuring points Location of measuring points Fig. 4 The average values of H (0.07)/A for quality control staff tak - Fig. 5 Distribution of mean values of Hp(0.07)/A on the left and ing into account the production run. QC1 and QC2 denoted the order right hand two employees of the quality control department at RPC I of the shift (production run) in radiopharmaceuticals quality control and one employee in RPC II department 1 3 Hp(0.07)/A [mSv/GBq] Hp(0.07)/A [mSv/GBq] Australasian Physical & Engineering Sciences in Medicine (2018) 41:541–548 545 0.05 performing the injection of F-FDG to the patients. All Physicist1-RPCII Physicist2-RPCII workers are employees in the RPC II. Physicist1-RPCI Physicist2-RPCI The statistically significant difference between the distri- 0.04 butions of normalized Hp(0.07) obtained during one work- ing day for Chemist 3 and 4 for measuring point 1, 2 and 3 0.03 and also 11 and 12 was found (p = 0.018904). Comparing the distributions of mean values of Hp(0.07)/A for chemists 0.02 and nurses, a statistically significant difference was found for Chemist 3 and Nurse 1 (p = 0.014138) and Chemist 4 and Nurse 1 (p = 0.035090). Nurse 1 employed at RPC II 0.01 works ad hoc solely in case of the absence of Nurse 2 or 3. It is true that differences in the distributions of Hp(0.07)/A 0.00 recorded for three nurses can be seen primarily in the case 12345678 9101112 of the tip of the thumb, as well as index and middle fingers Location of measuring points of the left hand. The data for Chemist 3 and 4 during the dispensing Fig. 6 Mean values of Hp(0.07) recorded by the individual measuring of doses of F-FDG for patients was compared with the points of cyclotron operating personnel in both radiopharmaceuticals data from another diagnostic department, where this pro- production centres cedure is realized by a physicist. The total daily F-FDG activity prepared for patients by a physicist is in the range physicists working in RPC II and physicists from the RPC 0.68–2.52 GBq and in the case of chemists: 0.83–3.12 GBq. I are different. Figure 8 shows the distribution of Hp(0.07)/A recorded by TLD at the fingertips of the left hands and right hands dur - Hand exposure of workers during dispensing ing the dispensing of doses of F-FDG for patients carried doses of  F‑FDG for patients and injection out by chemists working in the center RPC II and physicist radiopharmaceuticals to the patients employed in the Medical Diagnostic Centre (MDC) in Lodz provided with PET/CT unit [8]. Individual dispensing of doses of F-FDG for patients was The average number of patients diagnosed during 1 day performed by two chemists. Figure 7 presents the mean val- in two centres is similar (ten patients), the value of the F- ues Hp(0.07)/A for the two chemists performing only the FDG activity dispensed for a single patient is also approxi- dispensing doses of F-FDG for patients and three nurses mately the same. 0.9 Chemist3 Chemist3 Chemist4 0.8 Chemist4 Physicist 1E-01 Nurse1 0.7 Nurse2 Nurse3 1E-02 0.6 0.5 1E-03 0.4 1E-04 0.3 1E-05 0.2 0.1 1E-06 0.0 1 2345678 910 12345678 9101112 Location measuring points Location of measuring points Fig. 8 Distribution of Hp(0.07)/A recorded by TLD placed at the fin- Fig. 7 Mean values Hp(0.07)/A recorded by the individual measuring gertips of the left hand and right hand during the dispensing doses 18 18 points of chemists who dispense doses of F-FDG for patients and of F-FDG for patients carried out by the chemists employed in the nurses performing injection of the radiopharmaceutical. All workers RPC II center and physicist employed in Medical Diagnostic Centre are employees in RPC II (MDC) 1 3 Hp(0.07)/A [mSv/GBq] Hp(0.07) [mSv] Hp(0.07)/A [mSv/GBq] 546 Australasian Physical & Engineering Sciences in Medicine (2018) 41:541–548 18 18 procedures involving cyclotron operation, F-FDG produc- Estimated annual dose for the workers in  F‑FDG production centres tion and quality control of the finished radiopharmaceuti- cal, varies depending on the order of duty resulting from a In the case of employees of RPC I, the maximum annual schedule roster. In the RPC II, producing F-FDG solely for the purpose of a PET-CT diagnostic department, located Hp(0.07) was estimated assuming the implementation of 300 production procedures, taking into account only the mostly in the immediate vicinity of the production centre, each employee has been trained for the implementation of most exposure fingertips. Annual fingers exposure to ion- izing radiation in case of RPC II employees, was estimated all procedures, so that, if necessary, they can perform any of the required production procedures. Here, however, the taking into account the nature of professional’s work. It was assumed that F-FDG production took place three times a shift working system included only Chemist 3 and Chemist 4. Hence Chemist 4 as the only worker from the chemists week (120 working days a year in total). Estimated values are presented in Table 1. group performs the dispensing of doses of F-FDG for the patients, and doing this only during the second shift. Fig- ure 3 seems to confirm the assumption that specializing in carrying out specific activities optimizes radiation protec- Discussion tion of personnel and helps reduce the doses of ionizing radiation. The production of radiopharmaceuticals based on short-lived isotopes arouses much interest from the point of view of It seems that the working system based on the combined radiopharmaceutical production procedures implemented in exposure of personnel performing various production pro- cedures despite the automation of some production proce- RPC II, compared to the RPC I should be a source of higher Hp(0.07) for the personnel performing only the procedure dures. Exposure of personnel in nuclear medicine facilities during the labeling of radiopharmaceuticals by using even of F-FDG production or quality control of the radiophar- 99m maceutical. The explanation of this fact seems simple: per- Tc shows that the main source of exposure of person- nel is the same process of radiopharmaceuticals labeling forming the same manipulations during a single procedure, every single day, results in higher efficiency and thus short- [9]. The ORAMED project [10, 11] discusses in detail the exposure of medical personnel performing procedures using ens the time performing the procedure. The only case when the recorded value of Hp(0.07) at all measurement points for the isotope F as well. In this case, however, it analyzed the exposure of workers performing manual procedures of the staff of the RPC I are higher in comparison with the RPC II concerns the cyclotron operating procedure. The tasks of labeling the radiopharmaceuticals. The exposure of workers from two F-FDG production centers discussed in the paper, chemists from the RPC I, in addition to the daily supervision of the proper functioning of the cyclotron and the replenish- taking into account both the professional position, as well as the specificity of the work in the facility, suggests that in ment of water enriched in O, includes the preparation of the tungsten containers containing the product ready to leave this area there are also issues that require careful analysis, taking into account the work system of production centres. the centre. This is another example of an increased dose dur- ing the implementation of a greater number of procedures The RPC I implements the philosophy of F-FDG pro- duction based on the assignment of specific procedures using the radiopharmaceutical (even if the radiopharmaceu- ticals are covered by tungsten). for employees while taking into account the shift working system. This means that the person performing the various Dispensing doses of F-FDG for patients according to the value specified by the medical doctor in a second pro- duction centre (RPC II) is also performed by chemists (two persons). Hand exposure of both employees looks differ - Table 1 Maximum estimated annual Hp(0.07) for the staff employed ent, as a consequence of differences relating to the way they in RPC I and RPC II work. Chemist 4 uses both hands when dispensing doses of Professional groups/RPC Maximum estimated F-FDG for the patient, as shown in particular in points 1–5 annual Hp(0.07) (mSv) (Fig. 7). In the case of Chemist 3, if it is possible to perform Physicists/RPC I 11 the same procedure by using only one hand, the procedure Chemists/RPC I 445 is carried out just like that. This way of working reliably Physicists/RPC II 3 minimizes the exposure of the non-dominant hand. How- Chemists/RPC II 512 ever, it affects the rate of actions and increases the exposure Nurses/RPC II 135 of the dominant hand. The data for Chemist 3 and 4 during the dispensing of doses of F-FDG for patients was also A bold font was used to emphasize that the maximum estimated compared with the data from another diagnostic department, annual Hp(0.07) for chemists from the quality control department exceed the annual skin limit dose—500 mSv 1 3 Australasian Physical & Engineering Sciences in Medicine (2018) 41:541–548 547 where this procedure is realized by a physicist. The results physicists, it will not exceed 0.6% of the annual dose limit, are shown in Fig. 8. which is 500 mSv [12]. The procedure of filling up the syringe F-FDG with Acknowledgements The author would like to warmly thank all the activity occurs automatically. Similarities also arise in which people from the Radiopharmaceuticals Production Centres for their fingertips are the most exposed: the thumb and index finger help in collecting these data. This research was financially supported of the right hand while performing this procedure. Despite by the Ministry of Science and Higher Education of Poland, project these similarities, the difference between the Hp(0.07)/A for number B 1411500000542.02 and B 1611500001135.02. the thumb and index finger of the right hand for employees RPC II and MDC is, on average, three orders of magnitude. Compliance with ethical standards These differences can be explained by an individualization Conflict of interest The author declares that there is no conflict of in- of manipulations and, above all, the time it takes to perform terest. these. Measurements performed in both centres also allow us to Ethical approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the insti- determine which of the activities/procedures carried out by tutional and/or national research committee and with the 1964 Helsinki the staff of both units contributes the most to the recorded declaration and its later amendments or comparable ethical standards. dose. In the case of the RPC I, the greatest contribution to This article does not contain any studies with animals performed by the dose recorded by TLD placed on the fingertips (80% for any of the authors. the left hand, and 89% for the right hand) is by the quality Informed consent Informed consent was obtained from all individual control of the radiopharmaceutical. The case of RPC II is participants included in the study. similar. Here, the percentage of radiopharmaceutical qual- ity control procedures for the left hand is over 96%; for the Open Access This article is distributed under the terms of the Crea- right hand, it is 83%. tive Commons Attribution 4.0 International License (http://creat iveco mmons.or g/licenses/b y/4.0/), which permits unrestricted use, distribu- tion, and reproduction in any medium, provided you give appropriate Conclusions credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The measurements performed allow us to reach the follow- ing conclusions. The work system undoubtedly affects the References level of recorded doses; specialization in performing specic fi activities/procedures shortens the time of performed proce- 1. Królicki L, Kunikowska J, Kobylecka M, Mączewska J, Froncze- dures, which in turn results in lower doses. Automatic pro- wska K (2011) Positron emission tomography (PET) in diagnosis duction of F-FDG promotes the optimization of radiation of oncological diseases. Prog Med Sci 2:104–108 protection of personnel. Combining automatically performed 2. Wrzesień M, Albiniak Ł (2016) Hand exposure of workers in F- FDG production centre. J Radiol Prot 36:N67–N76 production procedures with fragments of manual activities 3. Wrzesień M (2018). F-FDG production procedures as a source performed as part of the quality control of the radiopharma- of eye lens exposure to radiation. J Radiol Prot 38:382–393. https ceutical results in increased of hand exposure. ://doi.org/10.1088/1361-6498/aaa28 7 The highest ionizing radiation doses have been received 4. Niewiadomski T, Bilski P, Budzanowski M, Olko P, Ryba E (1996) Progress in thermoluminescent dosimetry for radiation by the staff during the F-FDG quality control. Hand expo- protection and medicine. Nukleonika 41(2):93–104 sure of nurses performing the administration of radiophar- 5. Bilski P (2002) Lithium fluoride: from LiF:Mg,Ti to LiF:Mg,Cu,P. maceuticals to the patient is different from the exposure of Radiat. Prot Dosim 100:199–206. https ://doi.org/10.1093/oxfor the hands of the chemists who dispensed the doses of F-djour nals.rpd.a0058 47 6. International Organization for Standardization (ISO) (1999) X and FDG for patients. The source of lowest doses on the hands gamma reference radiation for calibrating dosemeters and doser- are the cyclotron operating procedure and the F-FDG pro- ate meters and determining their response as a function of photon duction, provided that these procedures can’t be combined energy. Part 3: Calibration of area and personal dosemeters and with other production procedures. the measurement of their response as a function of energy and angle of incidence. International Standard ISO- 4037-3, Geneva The maximum estimated annual Hp(0.07) for chemists 7. International Organization for Standardization, (2000) Nuclear from the quality control department employed in RPC I does energy—radiation protection—individual thermoluminescence not exceed 445 mSv. For the physicists from RPC I, it will dosemeters for extremities and eyes ISO Report 12794. ISO, not exceed 11 mSv. In the case of workers employed in RPC Geneva 8. Wrzesień M, Napolska K (2015) Investigation of radiation protec- II, the maximum annual equivalent dose was estimated in the tion of medical staff performing medical diagnostic examinations group of chemists—512 mSv. In the group of nurses it will by using PET/CT technique. J Radiol Prot 35:197–207. https://doi. reach up to 27% of the annual limit, while in the group of org/10.1088/0952-4746/35/1/197 1 3 548 Australasian Physical & Engineering Sciences in Medicine (2018) 41:541–548 9. Wrzesień M (2018) Simplicity or complexity of the radiophar- 11. Vanhavere F, Carinou E, Gualdrini G, Clairand I, Sans Merce M, maceutical production process in the light of optimization of Ginjaume M, Nikodemova D, Jankowski J, Bordy J-M, Rimpler 99m 18 radiation protection of staff— Tc versus F. Medycyna Pracy A, Wach S, Martin P, Struelens L, Krim S, Koukorava C, Ferrari 69(3):(Polish). https ://doi.org/10.13075 /mp.5893.00687 P, Mariotti F, Fantuzzi E, Donadille L, Itié C, Ruiz N, Carnicer 10. Carnicer A, Sans-Merce M, Baechler S, Barth I, Donadille L, Fer- A, Fulop M, Domienik J, Brodecki M, Daures J, Barth I, Bilski rari P, Fulop M, Ginjaume M, Gualdrini G, Krim S, Mariotti M, P. (2012) Optimization of radiation protection of medical staff Ortega X, Rimpler A, Ruiz N, Vanhavere F (2011) Hand exposure EURADOS Report 2012-02 Braunschweig 18 99m in diagnostic nuclear medicine with F- and Tc-labelled radi- 12. EURATOM Basic Safety Standard (BSS) Directive 2013/59 opharmaceuticals—Results of the ORAMED project. Radiat Meas 46:1277–1282. https ://doi.org/10.1016/j.radme as.2011.07.019 1 3

Journal

Australasian Physical & Engineering Sciences in MedicineSpringer Journals

Published: May 7, 2018

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