Radiation Safety in Nuclear Medicine - 2nd Edition
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Radiation
Title Page
Safety
in
Nuclear
Medicine
Second Edition
Max H. Lombardi
Boca Raton London New York
CRC is an imprint of the Taylor & Francis Group,
an informa business
8168_C000.fm Page iv Thursday, August 31, 2006 3:38 PM
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Library of Congress Cataloging-in-Publication Data
Lombardi, Max H., 1932-
Radiation safety in nuclear medicine / Max H. Lombardi. -- 2nd ed.
p. cm.
Includes bibliographical references (p. ).
ISBN 0-8493-8168-1 (alk. paper)
1. Radioisotope scanning--Safety measures. I. Title.
RC78.7.R4L65 2006
616.07’575--dc22 2006047551
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To my students
in Oak Ridge, Tampa, and in
Central and South America —
my best wishes
wherever they may be
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8168_C000.fm Page vii Thursday, August 31, 2006 3:38 PM
Preface to the Second Edition
The main objectives of this book remain unchanged in this second edition. They are
to teach the students of nuclear medicine (NM) technology: (1) the principles of
radiation physics, (2) the units of radioactivity, radiation exposure, and radiation
dosimetry, (3) the principles of instrumentation needed for radiation detection and
measurement, (4) the basis of NM imaging, (5) the scientific basis of radiation safety,
(6) the rules and regulations of radiation safety, (7) the practice of radiation safety
in hospitals and clinics in the United States, and (8) the fundamentals of radiobiology.
The field of NM has made many advances in the few years since this book was
first published in 1999. Thanks to the efforts of the global biomedical community,
those advances are making the diagnosis, the management, and the treatment of
illnesses more sensitive, more specific, more accurate, and safer for patients of all
ages. In this second edition, those advances are introduced keeping in mind that the
final scope is the teaching of the radiological safety of the patients, the NM personnel,
and all visitors to the NM department of hospitals and clinics. Some examples of
those advancements follow.
1. The progress made in positron emission tomography (PET), its related
radiopharmaceuticals, instrumentation, and procedures has been remark-
able. This has been possible for two reasons: (1) the expansion of Medicare
coverage and other insurance plans for PET imaging procedures and (2)
the subsequent multiplication of medical cyclotron facilities (PET centers)
in metropolitan areas. These facilities produce the necessary positron-
emitting radionuclides and the labeled compounds using robotic radio-
chemical synthesizers.
2. The merging of two imaging modalities: (1) the metabolic images of PET
using 18F-labeled deoxyglucose (FDG) and (2) the exquisite anatomical
images of computerized tomography (CT), in one scanning procedure
lasting less than eight minutes. This combination is, without a doubt, of
utmost importance to the patient.
3. Many new imaging and therapeutic radiopharmaceuticals that use “molec-
ular targeting” as a method of localization are being tested now and soon
shall become routine in NM. This should not surprise us since for years
radiolabeled antibodies have been used to target specific antigens within
tissues both for imaging and for treatment. The “magic bullets” and the
age of molecular medicine are here to stay.
Recent revisions in the U.S. Code of Federal Regulations, Title 10, (10CFR),
parts 19, 20, 30, and 35, which apply to the use of radiopharmaceuticals in medicine,
are also introduced in this second edition of the book. The CFR is the document
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enforced by the Nuclear Regulatory Commission (NRC) in 18 states and the desig-
nated agencies in the remaining 32 “agreement states” within the U.S.
The role played by nuclear medicine technologists (NMTs) in the everyday
practice of NM must be recognized. As their responsibilities become more and more
complex with the arrival of new methodologies, they must participate in “on-site”
training programs and in continuing education plans to earn and maintain accredi-
tation. The efforts of the Society of Nuclear Medicine, Technology Section (SNMTS),
in this regard must be recognized and appreciated, also. Its “Performance and Respon-
sibility Guidelines for NMTs,” approved at the SNM annual meeting of June 2003,
is contributing to the update and upgrade of educational programs for NMTs.
The author wishes to express his gratitude to the many persons who directly or
indirectly participated in making this second edition a reality. Special recognition
and appreciation is given to Martin Sabarsky, vice president of corporate develop-
ment, Diversa Corporation, San Diego, for his invaluable assistance in the editing
of the original manuscript and in the remaking of six illustrations. My gratitude is
extended also to Pete Shackett, B.A., C.N.M.T., A.R.R.T.(N), of Palmetto, Florida,
and to Beverly Ammidown, C.N.M.T., of Gainesville, Florida, for their assistance
in the literature research. My love goes to all the members of my family for their
constant encouragement in the pursuit of this worthwhile project.
Max H. Lombardi
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Author
Max H. Lombardi was born in Peru, South America. He attended primary and
secondary schools in Mollendo and Lima. He earned his B.V.M. and D.V.M. degrees
at the University of San Marcos in 1957 and 1958, respectively. In 1960, he earned
a fellowship from the Rockefeller Foundation to study radiation biology at Cornell.
The following year, he earned his M.S. degree with a major in radiation biology and
minors in biochemistry and animal nutrition. He then returned to the University of
San Marcos where he took the position of assistant professor.
In 1964, the Oak Ridge Institute of Nuclear Studies (ORINS) asked Dr. Lombardi
to organize and coordinate the training programs of “Atoms in Action” for Latin
America, an exhibit sponsored by the U.S. Atomic Energy Commission (USAEC).
Between 1964 and 1969, the exhibit was successfully presented in nine countries
of Central and South America. In 1965, he was asked to join the staff of ORINS as
a scientist.
In 1968, Dr. Lombardi was promoted to senior scientist, assuming responsibility
for the coordination of radiation biology training programs for college teachers
sponsored by the National Science Foundation. At the time, he developed a number
of training experiments using animals and computers and published a number of
articles in the Journal of Veterinary Research.
In 1969, he took responsibility for the Medical Radioisotopes Qualification
Course, which, under the USAEC, trained physicians in the science and practice of
nuclear medicine (NM). He remained in that position until 1977. More than 1,000
physicians were trained in that period. In December of 1970, he became a U.S. citizen.
In 1977, Dr. Lombardi competed for and won the position of full-time professor
of nuclear medicine at the Hillsborough Community College (HCC) in Tampa,
Florida. In 1979, he earned certification by the American Board of Science in Nuclear
Medicine (ABSNM). In 1982, he became director of the NMT Program and radiation
safety officer of HCC, positions which he held until his retirement in 1997. During
his tenure, he has trained over 300 nuclear medicine technologists.
During his career, Dr. Lombardi has participated in many conferences and con-
tinuing education programs by the Society of NM, the Florida NMT Association, the
Health Physics Society, the Clinical Ligand Assays Society, the World Federation of
Nuclear Medicine and Biology, and the Association of Latin American NM. He has
lectured in the U.S. and twelve foreign countries. Dr. Lombardi is fluent in Spanish,
English, Portuguese, and Italian. At present, he resides in San Diego, California.
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Contents
Chapter 1 Principles of Radiation Physics ...........................................................1
I. Rationale ........................................................................................................1
II. Brief History of Radiation Science ...............................................................1
A. The Nature of Matter ............................................................................1
B. Atoms and Molecules ...........................................................................2
C. X-Rays and Natural Radioactivity ........................................................2
D. Relativity ...............................................................................................3
E. Quantum Physics...................................................................................3
F. Radiation Physics ..................................................................................4
III. Matter and Energy .........................................................................................4
A. Nature of Matter....................................................................................4
B. Laws of Thermodynamics.....................................................................4
C. Some Basic Units ..................................................................................5
1. Mass.................................................................................................5
2. Distance ...........................................................................................5
3. Time.................................................................................................6
4. Energy..............................................................................................6
5. Speed of Light (c) ...........................................................................6
6. Mass–Energy Equivalence (E = mc2) .............................................6
7. Electrical Charge .............................................................................6
IV. Atomic Structure and Radioactivity..............................................................6
A. Basic Structure ......................................................................................6
B. Nuclear Stability....................................................................................7
C. Radioactive Decay.................................................................................8
D. Modes of Radioactive Decay ..............................................................10
1. Alpha Decay..................................................................................10
2. Negatron Decay.............................................................................11
3. Positron Decay ..............................................................................13
4. Electron Capture............................................................................14
5. Gamma Decay ...............................................................................15
6. Isomeric Transition (IT) ................................................................15
E. Electromagnetic (EM) Radiations.......................................................16
1. The EM Spectrum .........................................................................18
V. Particle Interactions .....................................................................................19
A. General Considerations .......................................................................19
1. Electrical Charge ...........................................................................19
2. Momentum ....................................................................................19
3. Impulse ..........................................................................................19
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B.Alpha Interactions ...............................................................................19
1. Trajectory.......................................................................................19
2. Range.............................................................................................20
3. Specific Ionization (S)...................................................................20
C. Beta Interactions (Positrons and Negatrons) ......................................20
1. Trajectory.......................................................................................20
2. Range.............................................................................................20
3. Bremsstrahlung (Braking Radiation) ............................................21
4. Backscatter ....................................................................................21
5. Annihilation Radiation ..................................................................21
VI. Gamma Ray Interactions .............................................................................21
A. General Considerations .......................................................................21
B. Photoelectric Effect (τ) .......................................................................21
C. Compton Effect (σ) .............................................................................22
D. Pair Production (κ)..............................................................................23
E. Internal Conversion (IC) .....................................................................24
VII. Gamma Ray Interactions with Lead and Water ..........................................24
A. Some Properties of Lead.....................................................................24
B. Some Properties of Water ...................................................................24
C. Gamma Ray Attenuation.....................................................................25
D. In Lead.................................................................................................25
E. In Water or Soft Tissue .......................................................................26
Problems ..................................................................................................................26
References................................................................................................................26
Chapter 2 Units of Radiation Exposure and Dose .............................................29
I. Rationale ......................................................................................................29
II. Basic Concepts ............................................................................................29
A. Activity (A) .........................................................................................30
1. Relative Standardization................................................................30
2. Absolute Standardization ..............................................................31
B. Exposure (X) .......................................................................................31
C. Absorbed Dose (D) .............................................................................32
D. Equivalent Dose (HT,R) ........................................................................32
E. Effective Dose (E)...............................................................................33
F. Relative Biological Effectiveness (RBE)............................................34
III. Other Concepts ............................................................................................34
A. Specific Ionization...............................................................................34
B. The W Value........................................................................................35
C. Linear Energy Transfer (LET) ............................................................35
D. Range of Beta Particles.......................................................................35
E. The f Value (rad/R) .............................................................................35
IV. Specific Gamma Constant (Γ) .....................................................................37
V. About S.I. Units...........................................................................................38
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Problems ..................................................................................................................39
References................................................................................................................39
Chapter 3 Guidelines for Radiation Protection ..................................................41
I. Rationale ......................................................................................................41
II. National and International Agencies ...........................................................41
A. The Big Picture ...................................................................................41
B. National Council on Radiation Protection and Measurement............42
C. International Commission on Radiation Protection (ICRP)...............42
D. International Commission on Radiation Units and
Measurements......................................................................................43
E. Nuclear Regulatory Commission (NRC)............................................43
F. Environmental Protection Agency (EPA) ...........................................43
G. Food and Drug Administration (FDA) ...............................................43
H. Department of Transportation (DOT) .................................................44
I. Joint Commission on Accreditation of Health Organizations ............45
J. Other Consulting Organizations..........................................................45
III. Radiation Safety and the Law .....................................................................46
A. Objective..............................................................................................46
B. Philosophy ...........................................................................................46
C. The Concept of Risk ...........................................................................47
D. The ALARA Policy.............................................................................47
E. Method.................................................................................................47
F. Licensing (10CFR19.3).......................................................................48
1. General Licenses ...........................................................................48
2. Specific Licenses ...........................................................................48
IV. Types of Radiation Effects ..........................................................................48
A. Acute and Chronic Exposures ............................................................48
B. Deterministic Effects...........................................................................48
C. Stochastic Effects ................................................................................49
V. Other Concepts in Dosimetry......................................................................49
A. Committed Equivalent Dose, HT(τ) ....................................................49
B. Committed Effective Dose, E(τ).........................................................49
C. Annual Limit on Intake (ALI) ............................................................50
D. Derived Air Concentrations (DACs) ...................................................50
E. Deep Dose (Hd) ...................................................................................50
F. Shallow Dose (Hs)...............................................................................50
G. Lens Dose (LD)...................................................................................51
VI. Recommended Dose Limits ........................................................................51
A. Occupational Dose Limits (10CFR20.1201) ......................................51
B. General Public Dose Limits (10CFR20.1301) ...................................51
C. Comments............................................................................................51
VII. Radiation Safety Practice ............................................................................52
A. Radiation Safety Officer (RSO) ..........................................................52
B. Radiation Safety Committee (RSC)....................................................52
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C. Radiation Safety Program (RSP) ........................................................52
D. Quality Management Program (QMP) ...............................................52
E. The ALARA Program .........................................................................52
F. Radiation Warning Signs.....................................................................53
Problems ..................................................................................................................54
References................................................................................................................54
Chapter 4 Radiation Detection and Measurement..............................................57
I. Rationale ......................................................................................................57
II. Fundamentals ...............................................................................................57
A. Principles .............................................................................................57
B. Detection..............................................................................................58
C. Radioactive Contamination .................................................................58
D. Measurement .......................................................................................58
E. Radiation Survey Instruments .............................................................58
1. Gas Detectors ................................................................................58
2. Personal Exposure Monitors .........................................................59
3. Scintillation Detectors ...................................................................59
F. Interpretation .......................................................................................59
III. Gas Detectors...............................................................................................59
A. Basic Design........................................................................................59
1. Components...................................................................................59
2. Ions Collected and Voltage ...........................................................59
B. GM Survey Meters..............................................................................61
1. Design............................................................................................61
2. Scales.............................................................................................61
3. Wall Thickness ..............................................................................61
4. Gases..............................................................................................61
5. Error of Detection .........................................................................61
6. Time Constant ...............................................................................62
7. Disadvantage .................................................................................62
C. Calibration of GM Survey Meters ......................................................62
1. Sealed Source ................................................................................62
2. Regulation......................................................................................62
3. Correction Factor...........................................................................62
D. Wipe-Test Counters .............................................................................63
1. Design............................................................................................63
2. Positive Wipes ...............................................................................63
E. Portable Ionization Chambers.............................................................63
1. Properties.......................................................................................63
2. Accuracy........................................................................................63
3. Scales.............................................................................................63
F. Dose Calibrators..................................................................................63
1. Accurate Assays ............................................................................63
2. Safety.............................................................................................64
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G. Pocket Dosimeters...............................................................................64
1. Design............................................................................................64
2. Operation .......................................................................................64
3. Applications...................................................................................64
4. Advantage......................................................................................64
H. Summary of Gas Detectors .................................................................65
IV. Scintillation Detectors .................................................................................65
A. Basic Design........................................................................................65
1. The Na(Tl) Detector......................................................................65
2. Principle.........................................................................................66
B. Associated Electronics ........................................................................66
1. Single-Channel Analyzer (SCA)...................................................66
2. The Window ..................................................................................67
3. Applications...................................................................................67
4. Other Scintillation Detectors.........................................................67
V. Imaging Instrumentation..............................................................................67
A. Conventional Imaging .........................................................................68
1. Planar Imaging ..............................................................................68
2. SPECT ...........................................................................................68
B. Pet Imaging .........................................................................................68
1. Metabolic Tracers..........................................................................68
2. The PET Scanner ..........................................................................69
C. The Merging of PET and CT..............................................................69
1. Computerized Tomography (CT) ..................................................69
2. Coverage........................................................................................69
3. The PET/CT Scanner ....................................................................70
4. Applications...................................................................................70
VI. Statistics of Counting ..................................................................................70
A. Types of Errors....................................................................................70
1. Systematic Errors ..........................................................................70
2. Random Errors ..............................................................................70
3. Blunders.........................................................................................70
B. Statistical Distributions .......................................................................70
1. Poisson Distribution ......................................................................70
2. Gaussian Distribution ....................................................................71
C. The Normal Distribution .....................................................................71
1. Sample ...........................................................................................71
2. Ranges of Confidence ...................................................................71
3. The Meaning of σs ........................................................................72
4. Practical Rules...............................................................................72
5. Background Radiation...................................................................72
6. Coefficient of Variation (CV)........................................................73
7. Standard Deviation of the Mean, σ x .............................................73
8. Total Counts Collected (N) ...........................................................73
9. Reliability ......................................................................................73
10. Rejection of Data ..........................................................................74
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VII. Making Decisions ........................................................................................74
A. Relative Error (τ).................................................................................74
1. Detector Performance....................................................................74
2. Is There Contamination? ...............................................................75
VIII. Minimum Detectable Activity (MDA) ........................................................75
IX. Quality Assurance of Radiation Counters...................................................76
A. Reliability ............................................................................................76
B. QA Tests ..............................................................................................76
1. The Relative Error (τ) ...................................................................76
2. The Reliability Factor (RF)...........................................................76
3. The Chi-Squared Test (χ2) ............................................................77
Problems ..................................................................................................................78
References................................................................................................................78
Chapter 5 Radiation Safety in the Nuclear Medicine Department ....................81
I. Rationale ......................................................................................................81
II. Design of the NM Department....................................................................82
A. Cold Areas ...........................................................................................82
B. Lukewarm Areas..................................................................................82
C. Warm Areas .........................................................................................83
D. Hot Areas.............................................................................................83
III. Description of Some Areas..........................................................................83
A. Waiting Room and Reception .............................................................83
B. Nonimaging Procedures Room ...........................................................83
1. Radioimmunoassays (RIAs)..........................................................84
2. Thyroid Uptake of Radioiodide ....................................................84
3. Schilling Test.................................................................................84
4. Blood Volume Test ........................................................................84
C. Control Room......................................................................................84
D. Imaging Rooms ...................................................................................84
E. Radiopharmacy (Hot Lab) ..................................................................85
IV. Molecular Medicine.....................................................................................86
V. The Radiation Safety Program (RSP) .........................................................89
A. General Considerations .......................................................................89
B. Contents...............................................................................................90
VI. Radiation Safety Committee (RSC) ............................................................90
VII. Radiation Safety Officer (RSO) ..................................................................90
VIII. Radioactive Materials License.....................................................................91
IX. Quality Management Program (QMP)........................................................91
A. Definition.............................................................................................91
B. Misadministrations ..............................................................................92
C. Recordable Events...............................................................................92
D. Reportable Events ...............................................................................92
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X. The ALARA Program .................................................................................92
A. Objective..............................................................................................92
1. Inclusion ........................................................................................93
XI. The Practice of Radiation Safety ................................................................93
A. Authorized Users.................................................................................93
B. Training of Personnel..........................................................................93
C. Personnel Exposures ...........................................................................93
D. Record Keeping...................................................................................93
E. Inspections (10CFR19.14, 10CFR30.52)............................................94
F. Reception of Radioactive Packages ....................................................94
G. Radiopharmaceuticals..........................................................................95
H. Dose Calibrators..................................................................................95
I. Laboratory Rules .................................................................................96
J. Use of Radioactive Materials..............................................................96
K. Radioactive Waste Disposal ................................................................96
L. Laboratory Surveys .............................................................................98
M. Sealed Sources.....................................................................................98
N. Radionuclide Therapy .........................................................................98
O. Radiation Emergencies........................................................................98
Problems ..................................................................................................................99
References..............................................................................................................100
Chapter 6 Safe Handling of Radioactivity .......................................................103
I. Rationale ....................................................................................................103
II. Minimizing External Exposures ................................................................103
A. Principles ...........................................................................................103
1. Quantity of Radioactivity Used ..................................................103
2. Time of Exposure........................................................................104
3. Effect of Distance........................................................................105
4. Effect of Shielding ......................................................................106
III. Preventing Internal Contamination............................................................110
A. Ingestion ............................................................................................110
B. Inhalation...........................................................................................110
C. Percutaneous Absorption...................................................................111
D. Accidental Injection ..........................................................................112
IV. Laboratory Rules .......................................................................................112
V. Radiation Hazards......................................................................................113
A. Alpha Emitters...................................................................................113
B. Negatron Emitters .............................................................................114
C. Positron Emitters ...............................................................................115
D. Gamma Emitters................................................................................116
E. Neutrons ............................................................................................116
VI. Radionuclide Therapy................................................................................117
A. Radioiodine Therapy .........................................................................117
1. Imaging of Metastases ................................................................117
