Need for harmonisation of extremity dose monitoring in nuclear medicine: results of a survey amongst national dose registries in Europe

Abstract

Staff handling radiopharmaceuticals in nuclear medicine (NM) may receive significant extremity doses. Especially over the last decade there is an increase in NM procedures and new radiopharmaceuticals have been introduced. However, literature provides limited recent data on the exposure of the extremities. In addition, proper assessment of the equivalent dose to the skin can be difficult when applied to the fingertips. In order to gain insight in the actual exposure and to find out how the European countries are dealing with monitoring of the extremities, a survey was performed amongst European regulatory authorities. The questions covered general aspects of the National Dose Registries (NDRs), the measured extremity doses and the practice of the monitoring of workers. The survey shows that extremity dosimetry is performed for about 25-50% of the monitored workers in NM. Also, the recorded extremity doses in the NDRs are low (mean values 5-29 mSv per year) compared to the dose limit . Despite the recommendations that have been published in the last 10 years, few countries provide guidance on the wearing position of extremity dosemeters and the correction factor to estimate the maximum equivalent skin dose from the measured dose. This may lead to an underestimation of the maximum skin dose. Thermoluminescence ring dosemeters are widely used but wrist dosemeters are also very common, even though the correlation of the measurement with the maximum skin dose is worse than for ring dosemeters. Furthermore, not all countries had a central registration of the extremity dose at the time the survey was performed.

Review of extremity dosimetry in nuclear medicine

“…With the available recommendations from ORAMED, ICRP and the Personal Dosimetry Working Party of the UK Institute of Physics and Engineering in Medicine [105], the radiation protection experts are guided to standardise the monitoring location and estimation of the maximum finger dose during different procedures. However, recent surveys from our EURADOS task group show that there is still a wide variety in monitoring locations (both in the finger and hand on which the dosimeter is worn) and wrist dosimeters are commonly used in some European countries [8]. Important steps still need to be taken in the harmonisation of dosimetry in NM in order to better compare the results of extremity dosimetry and reduce the uncertainties in the estimation of the maximum finger dose.…”

“…The recently performed questionnaire amongst national dose registries suggests that in most workplaces the maximum extremity dose is limited and that there is only a small group for which the maximum extremity dose is close to the dose limits [8]. However, the questionnaire also shows there is still a wide variety in the methods for dosimetry and determination of the maximum dose to the extremities in NM.…”

“…The aim of this paper is to review the information in the literature on the monitoring and protection of the extremities for all procedures that play a role in current NM practice and to identify gaps in the current knowledge on this topic. Together with the results from questionnaires distributed amongst national dose registries [8] and members of the European Association for Nuclear Medicine (EANM), the results of this literature review will be used to guide future EURADOS research activities with respect to the exposure of the extremities in NM.…”

Contact restriction time after common nuclear medicine therapies: spreadsheet implementation based on conservative retention function and individual measurements

“…This situation invites us to reconsider radiation protection issues in nuclear medicine, which covers radionuclide production, exposure of staff, patients and members of the public, waste management and even handling of corpses and cremation (ICRP 2019, Martin et al 2019, European Commission 2020, Kyriakidou et al 2021.…”

Occupational radiation exposure assessment during the management of [68Ga]Ga-DOTA-TOC

“…This is especially relevant when it comes to extremity dosimetry, since as a positron emitter, handling a 68 Ga-based radiopharmaceutical at short distances can considerably increase the absorbed dose to the skin of the hands [ 14 ]. According to a recent survey among national dose registries, performed by Kyriakidou et al [ 15 ], there are still large variations in the methods of dosimetry and determination of the maximum dose to extremities in NM departments. This leads to the need to arbitrate methods to reduce the uncertainty in the estimation of NM doses, and to facilitate comparisons between different dosimetry results.…”