Sigrid Leide-Svegborn

Effective dose from radiopharmaceuticals

An unfortunate error in the calculation program resulted in too high effective dose values for a minor fraction of the substances listed. For the iron isotopes, 51Cr and 99mTc labelled erythrocytes, 99mTc and 123I labelled fibrinogen and for 99mTc HSA, the error can be considered as significant in relation to the overall uncertainty of the effective dose estimates. The correct value for these substances is therefore given below. Table 1. Effective dose per unit administered activity

ICRP Publication 128: Radiation Dose to Patients from Radiopharmaceuticals: a Compendium of Current Information Related to Frequently Used Substances

This report provides a compendium of current information relating to radiation dose to patients, including biokinetic models, biokinetic data, dose coefficients for organ and tissue absorbed doses, and effective dose for major radiopharmaceuticals based on the radiation protection guidance given in Publication 60(ICRP, 1991). These data were mainly compiled from Publications 53, 80, and 106(ICRP, 1987, 1998, 2008), and related amendments and corrections. This report also includes new information for 82Rb-chloride, iodide (123I, 124I, 125I, and 131I) and 123I labeled 2ß-carbomethoxy 3ß-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (FPCIT).The coefficients tabulated in this publication will be superseded in due course by values calculated using new International Commission on Radiation Units and Measurements/International Commission on Radiological Protection adult and paediatric reference phantoms and Publication 103 methodology (ICRP,2007). The data presented in this report are intended for diagnostic nuclear medicine and not for therapeutic applications.

Radiation exposure of patients and personnel from a PET/CT procedure with 18F-FDG.

The positron emission tomography (PET)/computed tomography (CT) camera is a combination of a PET camera and a CT. The image from the PET camera is based on the detection of radiation that is emitted from a radioactive tracer, which has been given to the patient as an intravenous injection. The radiation that is emitted from the radioactive tracer is more energetic than any other radiation used in medical diagnostic procedures and this requires special radiation protection routines. The CT image is based on the detection of radiation produced from an X-ray tube and transmitted through the patient. The radiation exposure of the personnel during the CT procedure is generally very low. Regarding radiation exposure of the patient, it is important to notice whether a CT scan has been performed prior to the PET/CT in order to avoid any unnecessary irradiation. The total effective dose to the patient from a PET/CT procedure is approximately 10 mSv. The major part comes from internal irradiation due to radiopharmaceuticals within the patients (e.g. (18)F-FDG: approximately 6-7 mSv), and a minor part is due to the CT scan (low-dose CT scan: approximately 2-4 mSv). If a full diagnostic CT investigation is performed, the effective dose may be considerably higher. If the patient is pregnant, a PET/CT procedure should be avoided or postponed, unless it is vital for the patient. An interruption in breastfeeding is not necessary after a PET/CT procedure of the nursing mother. Close contact between the patient and a small child should however be avoided for a couple of hours after the administration of the radiopharmaceutical. The radiation dose to the personnel arises mainly due to handling of the radiopharmaceuticals (syringe withdrawal, injection, waste handling, etc.) and from close contact to the patient. This radiation dose can be limited by using the inverse-square law, i.e. by using the fact that the absorbed dose decreases substantially with increasing distance between the radiation source and the personnel.

Biokinetics of iodide in man: refinement of current ICRP dosimetry models.

A compartmental model describing the distribution and retention of radioactive iodide in thyroid and other organs is presented. The model is developed from published ICRP models. It is designed primarily for radiation dosimetry of iodine radionuclides used in nuclear medicine, but may also be useful for occupational radiation protection. In the proposed model, the distribution of iodide to the thyroid is assumed to be more rapid than in earlier models. Uptakes in stomach wall and salivary glands are considered, and the absorbed doses to these organs calculated. The partitioning of iodide between stomach wall and content is also discussed. Recirculation of organic iodine is also taken into account. Age-dependent half-times for iodide in the thyroid, as well as for organically-bound iodine are presented. The proposed model is applicable for dose estimations with different uptakes in the thyroid as well as for the situation when the thyroid is blocked, completely or incompletely.

Effective dose to adult patients from 338 radiopharmaceuticals estimated using ICRP biokinetic data, ICRP/ICRU computational reference phantoms and ICRP 2007 tissue weighting factors

BackgroundEffective dose represents the potential risk to a population of stochastic effects of ionizing radiation (mainly lethal cancer). In recent years, there have been a number of revisions and updates influencing the way to estimate the effective dose. The aim of this work was to recalculate the effective dose values for the 338 different radiopharmaceuticals previously published by the International Commission on Radiological Protection (ICRP).MethodThe new estimations are based on information on the cumulated activities per unit administered activity in various organs and tissues and for the various radiopharmaceuticals obtained from the ICRP publications 53, 80 and 106. The effective dose for adults was calculated using the new ICRP/International Commission on Radiation Units (ICRU) reference voxel phantoms and decay data from the ICRP publication 107. The ICRP human alimentary tract model has also been applied at the recalculations. The effective dose was calculated using the new tissue weighting factors from ICRP publications 103 and the prior factors from ICRP publication 60. The results of the new calculations were compared with the effective dose values published by the ICRP, which were generated with the Medical Internal Radiation Dose (MIRD) adult phantom and the tissue weighting factors from ICRP publication 60.ResultsFor 79% of the radiopharmaceuticals, the new calculations gave a lower effective dose per unit administered activity than earlier estimated. As a mean for all radiopharmaceuticals, the effective dose was 25% lower. The use of the new adult computational voxel phantoms has a larger impact on the change of effective doses than the change to new tissue weighting factors.ConclusionThe use of the new computational voxel phantoms and the new weighting factors has generated new effective dose estimations. These are supposed to result in more realistic estimations of the radiation risk to a population undergoing nuclear medicine investigations than hitherto available values.

Application of accelerator mass spectrometry (AMS) for high-sensitivity measurements of 14CO2 in long-term studies of fat metabolism

Long-term measurements of 14C in CO2 expired after ingestion of 14C-labelled triolein were performed using accelerator mass spectrometry (AMS). About 30% of a given amount of 14C-labelled triolein was catabolized rapidly, while the remaining 70% had a very slow turnover. The study shows the potential of the AMS technique for the study of the long-term biokinetics of 14C-labelled pharmaceuticals. The AMS technique allows the administered activity to be reduced by several orders of magnitude without compromising the study. It may also allow studies of rare drug metabolites.

A Compartmental Model for Biokinetics and Dosimetry of 18F-Choline in Prostate Cancer Patients

PET with 18F-choline (18F-FCH) is used in the diagnosis of prostate cancer and its recurrences. In this work, biodistribution data from a recent study conducted at Skåne University Hospital Malmö were used for the development of a biokinetic and dosimetric model. Methods: The biodistribution of 18F-FCH was followed for 10 patients using PET up to 4 h after administration. Activity concentrations in blood and urine samples were also determined. A compartmental model structure was developed, and values of the model parameters were obtained for each single patient and for a reference patient using a population kinetic approach. Radiation doses to the organs were determined using computational (voxel) phantoms for the determination of the S factors. Results: The model structure consists of a central exchange compartment (blood), 2 compartments each for the liver and kidneys, 1 for spleen, 1 for urinary bladder, and 1 generic compartment accounting for the remaining material. The model can successfully describe the individual patients’ data. The parameters showing the greatest interindividual variations are the blood volume (the clearance process is rapid, and early blood data are not available for several patients) and the transfer out from liver (the physical half-life of 18F is too short to follow this long-term process with the necessary accuracy). The organs receiving the highest doses are the kidneys (reference patient, 0.079 mGy/MBq; individual values, 0.033–0.105 mGy/MBq) and the liver (reference patient, 0.062 mGy/MBq; individual values, 0.036–0.082 mGy/MBq). The dose to the urinary bladder wall of the reference patient varies between 0.017 and 0.030 mGy/MBq, depending on the assumptions on bladder voiding. Conclusion: The model gives a satisfactory description of the biodistribution of 18F-FCH and realistic estimates of the radiation dose received by the patients.

Biokinetics and radiation dosimetry for patients undergoing a glycerol tri[1-14C]oleate fat malabsorption breath test.

The glycerol tri[1-14C]olein test for fat malabsorption was carried out in two male volunteers and measurements of the loss of 14C in expired air, urine and faeces and the retention of 14C in biopsy samples of abdominal fat were made using accelerator mass spectrometry. Exhalation accounted for 73% and 55% of the administered activity and could be described by three-component exponential functions with halftimes of about 1h, 2 days and 150 days, respectively. Urinary excretion accounted for 24% of the administered activity, almost all during the first 24h after administration; about 2% was excreted in the faeces in 48h. The halftime of retention of 14C in fat ranged from 137 to 620 days. Absorbed dose calculations indicate that for a normal adult the largest dose, 1.5-7.0mGy/MBq is received by the adipose tissue, and that the effective dose is 0.3-0.5mSv/MBq. It is concluded that no restrictions need to be placed on radiation safety grounds on the administration of 0.05-0.1MBq 14C-triolein for the triolein breath test.

External radiation exposure of personnel in nuclear medicine from 18F, 99mTc and 131I with special reference to fingers, eyes and thyroid

The radiation exposure of fingers, thyroid and eyes of workers handling radiopharmaceuticals during various nuclear medicine procedures was measured using thermoluminescent dosemeters. Dosemeters were placed on the finger tips of 19 workers on several different occasions for various procedures. Additionally, the routinely determined whole-body doses to various groups of workers were analysed. The finger dose measurements demonstrated clear differences between the various tasks, from 0.0012 µGy MBq(-1) (unpacking and installing (99)Mo/(99m)Tc-generator) to 3.0 µGy MBq(-1) (syringe withdrawal, injection and waste handling of (18)F-FDG). As long as the worker was handling (99m)Tc, the dose to the fingers was well below the ICRP dose limits, even when the activity was high. Special concern should, however, be devoted to the handling of (18)F, since the dose to the fingers could easily reach the dose limits. The estimated dose to eyes and thyroid was well below the dose limits. Since the introduction of the positron emission tomography/computed tomography facility, the annual whole-body dose has increased for those directly involved in the handling of (18)F. The annual whole-body dose of 0.2-2.5 mGy was, however, well below the dose limits.

An internal radiation dosimetry computer program, IDAC 2.0, for estimation of patient doses from radiopharmaceuticals.

The internal dosimetry computer program internal dose assessment by computer (IDAC) for calculations of absorbed doses to organs and tissues as well as effective doses to patients from examinations with radiopharmaceuticals has been developed. The new version, IDAC2.0, incorporates the International Commission on Radiation Protection (ICRP)/ICRU computational adult male and female voxel phantoms and decay data from the ICRP publication 107. Instead of only 25 source and target regions, calculation can now be made with 63 source regions to 73 target regions. The major advantage of having the new phantom is that the calculations of the effective doses can be made with the latest tissue weighting factors of ICRP publication 103. IDAC2.0 uses the ICRP human alimentary tract (HAT) model for orally administrated activity and for excretion through the gastrointestinal tract and effective doses have been recalculated for radiopharmaceuticals that are orally administered. The results of the program are consistent with published data using the same specific absorption fractions and also compared with published data from the same computational phantoms but with segmentation of organs leading to another set of specific absorption fractions. The effective dose is recalculated for all the 34 radiopharmaceuticals that are administered orally and has been published by the ICRP. Using the new HAT model, new tissue weighting factors and the new adult computational voxel phantoms lead to an average effective dose of half of its earlier estimated value. The reduction mainly depends on electron transport simulations to walled organs and the transition from the stylised phantom with unrealistic interorgan distances to more realistic voxel phantoms.