Radiation Safety in Nuclear Medicine: A Practical, Concise Guide

Preface
Contents
1: Basic Physics of Radiation Safety
	1.1	 Atomic and Nuclear Structure
	1.2	 Radioactive Decay
		1.2.1	 Spontaneous Fission
		1.2.2	 Alpha (α) Decay
		1.2.3	 Beta (β−) Decay
		1.2.4	 Positron (β+) Decay
		1.2.5	 Electron Capture
		1.2.6	 Isomeric Transition
	1.3	 Radioactive Decay Equation
		1.3.1	 Successive Decay Equation
			1.3.1.1	 Transient Equilibrium
			1.3.1.2	 Secular Equilibrium
	1.4	 Units of Radioactivity
	1.5	 Interaction of Radiations with Matter
		1.5.1	 Interaction of Particulate Radiations
			1.5.1.1	 Ranges
			1.5.1.2	 Specific Ionization
			1.5.1.3	 Annihilation Radiation
			1.5.1.4	 Bremsstrahlung
		1.5.2	 Interaction of γ Radiations with Matter
		1.5.3	 Attenuation of γ Radiation
		1.5.4	 Linear Energy Transfer
	1.6	 Counting Statistics
		1.6.1	 Poisson Distribution
		1.6.2	 Mean and Standard Deviation
		1.6.3	 Error, Precision, and Accuracy
		1.6.4	 Gaussian Distribution
		1.6.5	 Standard Deviation of Count Rate
		1.6.6	 Propagation of Errors
		1.6.7	 Minimum Detectable Activity
	References and Suggested Reading
2: Essential Equipment in Radiation Safety
	2.1	 Gas-Filled Detector
		2.1.1	 Ionization Chamber Survey Meter
		2.1.2	 Dose Calibrator
		2.1.3	 Pocket Dosimeter
		2.1.4	 Proportional Counter
		2.1.5	 Geiger–Muller Counter
	2.2	 Scintillation Counter
		2.2.1	 Well Counter
		2.2.2	 Thyroid Uptake Probe
		2.2.3	 Liquid Scintillation Counter
	2.3	 Neutron Detector
	2.4	 Personnel Monitoring
		2.4.1	 Film Badge
		2.4.2	 Thermoluminescent Dosimeter
		2.4.3	 Optically Stimulated Luminescence Dosimeter
		2.4.4	 Electronic Personal Dosimeter
	Suggested Reading
3: Radiation Units, Exposure, and Absorbed Dose
	3.1	 Units of Radiation Exposure and Absorbed Dose
	3.2	 Radiation Exposure
		3.2.1	 Sources of Radiation
			3.2.1.1	 Natural Background Radiation
			3.2.1.2	 Medical Radiation Exposure
			3.2.1.3	 Industrial, Security, Education, and Research Exposure
			3.2.1.4	 Occupational Exposure
	3.3	 Absorbed Dose
		3.3.1	 External Dosimetry
			3.3.1.1	 Calculation of External Dose
			3.3.1.2	 Exposure Rate Constant
		3.3.2	 External Exposure from a Point Source
			3.3.2.1	 External Dose from a Line Source
			3.3.2.2	 External Exposure from a Plane Source
			3.3.2.3	 External Exposure from a Volume Source
		3.3.3	 Internal Dosimetry
		3.3.4	 Dose Limits to Radiation Workers and Others
		3.3.5	 Planned Special Exposure
	3.4	 Effective Dose Equivalent and Effective Dose
	3.5	 Reportable Events
	3.6	 Notification of Incidents
	References and Suggested Reading
4: Radiation Protection
	4.1	 Principles of Radiation Protection
		4.1.1	 Time
		4.1.2	 Distance
		4.1.3	 Shielding
		4.1.4	 Do’s and Don’ts in Radiation Protection Practice
	4.2	 NRC Regulations of Radiation Protection
		4.2.1	 Definition of Specific Terms
		4.2.2	 Caution Signs
		4.2.3	 Posting Requirement
		4.2.4	 Labeling Requirement
		4.2.5	 ALARA Program
	4.3	 Security Control of High Radiation Areas
	4.4	 Use of Individual Respiratory Protection Equipment
	4.5	 Receiving and Monitoring of Radioactive Packages
	4.6	 Requirement of Monitoring of Occupational Doses to Radiation Workers
	4.7	 Wearing Badges
	4.8	 Bioassay
	4.9	 Decommissioning of Radiation Laboratory
	4.10	 Verification Card for Radioactive Patient
	4.11	 Radiation Phobia
	References and Suggested Reading
5: Regulatory Framework for Radiation Protection
	5.1	 Introduction
	5.2	 Licensing
		5.2.1	 Agreement State
		5.2.2	 General Domestic License for In Vitro Testing
		5.2.3	 Specific Domestic License of Limited Scope
		5.2.4	 Specific Domestic License of Broad Scope
		5.2.5	 Application for Specific License
	5.3	 Food and Drug Administration Regulations for Radiopharmaceuticals
		5.3.1	 PET Radiopharmaceuticals
		5.3.2	 Radioactive Drug Research Committee
	5.4	 Accreditation of Nuclear Medicine Facility
		5.4.1	 Accreditation by the IAC
		5.4.2	 Accreditation by the ACR
	References and Suggested Reading
6: Medical Uses of Radioactive Materials
	6.1	 Introduction
	6.2	 Application for License or Renewal
	6.3	 Where to File
	6.4	 License Amendment and Notification
	6.5	 Authorities and Responsibilities for Radiation Protection Program
		6.5.1	 Radiation Safety Officer
		6.5.2	 Radiation Safety Committee
	6.6	 Supervision
	6.7	 Training, Retraining, and Instructions to Radiation Workers
	6.8	 Written Directives
	6.9	 Authorization for Calibration, Transmission, and Reference Sources
	6.10	 Requirements for Possession of Sealed Sources
	6.11	 Sterile Preparation of Radioactive Drugs
	6.12	 Measurement of Dosage of Radiopharmaceutical for Patients
	6.13	 Permissible Concentration of 99Mo, 82Sr, and 85Sr in Radionuclide Generators
	6.14	 Use of Unsealed Byproduct Material not Requiring Written Directive
	6.15	 Minimizing Radiation Exposure from Nuclear Medicine Procedures
	6.16	 Labeling of Vials and Syringes
	6.17	 Possession and Calibration of Survey Meter
	6.18	 Survey of Ambient Exposure Rate
	6.19	 Survey for Removable Contamination
	6.20	 Medical Mobile Service
	6.21	 Medical Uses of Byproduct Materials
	6.22	 Special Medical Uses of Byproduct Material
	6.23	 Use of Radioactive Material in Animal Research
	6.24	 Report and Notification of a Medical Event
	6.25	 Report and Notification of Dose to Embryo/Fetus or Nursing Child
	6.26	 Record Keeping
		6.26.1	 Software for Record Keeping
		6.26.2	 Duration of Record Keeping
	References and Suggested Reading
7: Training and Experience of Authorized Personnel
	7.1	 Introduction
	7.2	 Radiation Safety Officer and Associate Radiation Safety Officer
	7.3	 Training for Authorized Medical Physicist
	7.4	 Training for Authorized Nuclear Pharmacist
	7.5	 Authorized Users (Physicians, Dentists, and Podiatrists)
		7.5.1	 7.5.1 Training for Uptake, Dilution, and Excretion Studies
		7.5.2	 Training for Use of Unsealed Byproduct Material for Imaging and Localization Studies
		7.5.3	 Training for Use of Unsealed Byproduct Material for which a Written Directive Is Required
		7.5.4	 Training for Oral Administration of 131I-NaI Requiring a Written Directive in Quantities Less than or Equal to 33 mCi (1.22 GBq) (per 10CFR35.392) and Greater than 33 mCi (1.22 GBq)(per 10CFR35.394)
		7.5.5	 Training for the Parenteral Administration of Unsealed Byproduct Material Requiring a Written Directive
		7.5.6	 Training for Use of Manual Brachytherapy Sources
		7.5.7	 Training for Use of Sealed Sources for Diagnosis
	7.6	 Exemptions for Experienced RSO, AMP, AU, and ANP
	7.7	 Recentness of Training
	References and Suggested Reading
8: Radiation Emergency Procedures
	8.1	 Introduction
	8.2	 Basic Procedures for Containment of a Spill
	8.3	 Radiation Incidents and Accidents
		8.3.1	 Management of Major Accidents
	8.4	 Radiological Dispersal Device
		8.4.1	 Measures to Take Following Explosion of Radiological Dispersal Device
			8.4.1.1	 Get Inside
			8.4.1.2	 Stay Inside
			8.4.1.3	 Stay Tuned
			8.4.1.4	 Other Protection Steps
		8.4.2	 Effects of RDD Dispersion
		8.4.3	 Measures to Prevent RDD
	References and Suggested Reading
9: Management and Release of Patients Administered with Radioactivity
	9.1	 Diagnostic Patients
	9.2	 Therapeutic Patients
		9.2.1	 Therapy with Sealed Sources
		9.2.2	 Therapy with Unsealed Sources
	9.3	 Release of Patients Treated with 131I-NaI and Other Radionuclides
		9.3.1	 Calculation of Administered Activity to Release a Patient
		9.3.2	 Measured Dose Rates from a Patient Administered with Radioactivity to Release
	9.4	 Release of Patients Treated with 131I-NaI Based on Patient-Specific Factors
	9.5	 Written Instructions to the Patient to Follow after Release
	9.6	 Internal Dose
	9.7	 Record Keeping
	References and Suggested Reading
10: Transportation of Radioactive Material
	10.1	 Introduction
	10.2	 Definition
	10.3	 Packaging
		10.3.1	 Stability Tests for Packages
		10.3.2	 Labeling of Packages
	10.4	 Exemption for Limited Quantity of Radioactive Material
	10.5	 Empty Packaging
	10.6	 Vehicles for Transportation of Radioactive Material
	10.7	 Exemption for Licensed Physician
	10.8	 Employee Training
	10.9	 Transportation of Radioactive Materials Within Hospital
	10.10	 Record Keeping
	References and Suggested Reading
11: Disposal of Radioactive Waste
	11.1	 Rationale for Radioactive Waste Disposal
	11.2	 Management and Storage of Radioactive Waste
		11.2.1	 Storage of Dry Solid Waste
		11.2.2	 Storage of Liquid Waste
		11.2.3	 Infectious or Biohazard Radioactive Waste
		11.2.4	 Sharps and Glass Container
		11.2.5	 Radioactive Animal
	11.3	 Radioactive Waste Disposal
		11.3.1	 Decay-in-Storage
		11.3.2	 Disposal by Incineration
		11.3.3	 Disposal of Radioactive Material into Sewerage
		11.3.4	 Transfer to Authorized Recipients
		11.3.5	 Other Disposal Methods
	11.4	 Special Situations for Disposal of Radioactive Waste
		11.4.1	 Disposal of Gaseous Waste
		11.4.2	 Disposal of Sealed Sources
		11.4.3	 Management of Cadavers Containing Radioactive Materials
		11.4.4	 Disposal of Radioactive Animals
	11.5	 Record Keeping
	References and Suggested Reading
12: Biological Effects of Radiation on Humans
	12.1	 Cell Structure and its Function
	12.2	 Apoptosis
	12.3	 Radiation Damage in Human Cells
	12.4	 Factors Affecting Radiation Damage in Genes and Chromosomes
		12.4.1	 Dose and Dose Rate
		12.4.2	 Linear Energy Transfer
		12.4.3	 Radiosensitizer and Radioprotector
		12.4.4	 Stage in the Cell Cycle
	12.5	 Acute Effects of Total-Body Irradiation
		12.5.1	 Hematopoietic Syndromes
		12.5.2	 Gastrointestinal Syndromes
		12.5.3	 Cerebrovascular Syndromes
	12.6	 Long-Term Effects of Radiation
		12.6.1	 Carcinogenesis
		12.6.2	 Dose–Response Relationship
		12.6.3	 Specific Cancers
		12.6.4	 Skin Damage
		12.6.5	 Cataractogenesis
	12.7	 Radiation Damage to Embryo and Fetus
		12.7.1	 Preimplantation Period
		12.7.2	 Major Organogenesis
		12.7.3	 Fetal Stage
	12.8	 Genetic Effects
	12.9	 Risk Versus Benefit in Diagnostic Radiology and Nuclear Medicine Procedures
	References and Suggested Reading
Appendix A: Characteristics of Common Radionuclides
Appendix B: Units and Constants
	Energy
	Charge
	Mass and Energy
	Length
	Activity
	Constants
Appendix C: Answers to Questions
	Chapter 1
	Chapter 2
	Chapter 3
	Chapter 4
	Chapter 5
	Chapter 6
	Chapter 7
	Chapter 8
	Chapter 9
	Chapter 10
	Chapter 11
	Chapter 12
Appendix D: Terms Used in the Text
Appendix E: Abbreviation Used in Text
Appendix F: Typical NRC Notification and Reporting Requirements for Different Situations
Appendix G: Radioactive Decay of 99mTc
Appendix H: Radioactive Decay of 131I
Appendix I: Radioactive Decay of 18F
Appendix J: Frequency of Essential Chores in Nuclear Medicine
Index