HOW TO PROTECT YOUR HANDS

IN NUCLEAR MEDICINE WORK

ICRP Publication 106 Annex E

The membership of the Working Party that prepared Annex E of ICRP Publication 106 was:
J. Liniecki (Chair) J. Jankowski C. Martin S. Mattsson

Author for educational slides on behalf of ICRP

S. Carlsson, M. Andersson
 Sources of exposure
Exposure from external sources (vials, syringes)
Contamination (dispensing, administration)

Slides 2-5 refer to chapter E.1

Radionuclides in diagnosis: planar and
SPECT

Nuclide T1/2 Decay mode Photo emission (keV)

(% abundance) (% abundance)
67
Ga 3.7 d EC (100) 93 (39 %); 185 (21 %); 300 (17 %)
75
Se 119.7 d EC (100) 265 (59 %); 136 (58 %); 280 (25 %)
99m
Tc 6.0 h IT (100) 141 (89 %)
111
In 2.8 d EC (100) 245 (94 %); 171 (91 %)
123
I 13.3 h EC (100) 159 (83 %); 529 (1.4 %)
131
I 8.0 d B- (100) 364 (82 %); 637 (7 %)
201
Tl 72.9 h EC (100) 167 (10 %); 69-80 (several X-rays)

Nuclide data from ICRP Publication 107

Radionuclides in diagnosis: PET
Nuclide T1/2 (min) Decay (% β+ ) β+ Energy (MeV) Range in water (mm)
Max. Mean Max. Mean
18
F 109.77 96.7 0.6335 0.2498 2.4 0.6
64
Cu 762 17.41 0.6531 0.2782 2.9 0.64
11
C 20.39 99.77 0.9602 0.3856 4.1 1.1
13
N 9.97 99.8 1.1985 0.4918 5.1 1.5
15
O 2.037 99.9 1.732 0.7354 7.3 2.5
75
Br 96.7 73.0 2.01 0.719 8.4 2.6
68
Ga 67.7 88.9 1.8991 0.8329 8,2 2.9
124
I 6013 11.7 1.5323 0.6871 6.3 2.3
10.8 2.1376 0.9748 8.7 3.5
62
Cu 9.67 97.81 2.926 1.313 11.9 5.0
82
Rb 1.27 81.8 3.379 1.534 14.1 5.9
13.1 2.5795 1.167 10.5 4.3
86
Y 884 11.9 1.2535 0.535 5.2 1.8
5.6 3.141 0.681 12,7 2.9
66
Ga 569 55.3 4.153 1.739 16.7 7.4

Nuclide data from ICRP Publication 107

RADIONUCLIDES IN THERAPY
Nuclide T1/2 Emax (MeV) and type of decay Accompanying gamma-emission (keV)
β- -emitters
32
P 14.3 d 1.7 (β-) -
89
Sr 50.5 d 1.5 (β-) -
90
Y 2.7 d 2.3 (β-) -
131
I 8.0 d 0.8 (β-) 364 (82 %); 637(7 %)
153
Sm 1.9 d 0.8 (β-) 103 (30 %)
177
Lu 6.6 d 0.5 (β-) 208 (11 %); 113 (6 %)
186
Re 3.7 d 1.1 (β-) 137 (9 %)
188
Re 0.7 d 2.1 (β-) 155 (16 %)
α-emitters
211
At 7.2 h 5.9 (α) -
212
Bi 1.0 h 6.1 (α) 727 (7 %)
223
Ra 11.4 d 5.87 (α) 269 (14 %);154 (6 %)
225
Ac 10.0 d 5.8 (α)
Auger electron emitters
67
Ga 3.3 d Auger electrons 93 (39 %); 185 (21 %); 300 (17 %)
125
I 59.4 d Auger electrons 35 (6.7 %)
195m
Pt 4.0 d Auger electrons 99 (11 %)

Nuclide data from ICRP Publication 107

APPLY ICRP BASIC SYSTEM
OF RADIATION PROTECTION
(JUSTIFICATION)
OPTIMISATION APPLIED TO WORKING
PROCEDURES
DOSE LIMITATION

Slide refer to chapter E.9

DOSE LIMITATION

Annual equivalent dose

Skin 500 mSv averaged over
1cm22
Hands and feet 500 mSv

Slides 7-13 refer to chapter E.4

Image: ICRP Publication 103
Dose limits can easily be exceeded
• The equivalent dose-rate to the unprotected fingers holding a vial
containing 2 GBq 18F is in the order of 200 μSv/s. If we assume that
the content is dispensed to 3 patients and the time required is 10s
per procedure, then the total dose to the fingers of the worker will be
4 mSv. If the procedure is repeated 5 days per week and 45 weeks
per year the annual equivalent dose will be 900 mSv.

• Assume an activity of 40 GBq 99mTc in a volume of 10 ml. One

microdrop (20µl) of the solution will then contain an activity of 80
MBq. If spread over 10 mm2 on the skin the initial dose rate will be
about 2000 mSv/h. If not removed the cumulative dose will be 17 Sv
over the 10 mm2 area, i.e. 1700 mSv averaged over 1 cm2, which
exceeds the dose limit of 500 mGy.
 Dose rate at contact
700
1000

100
-1
mSv.min
20

10
3

1
Tc-99m F-18 Y-90
500 MBq 400 MBq 1 GBq

Contact of an unshielded (5 ml) syringe

(Carnicer, A. et al. Occupational Exposure: With Special Reference to Skin Doses in Hands and
Fingers. In Radiation Protection in Nuclear Medicine (Ed) Mattsson, S. Hoeschen,C. Springer 2013)
 Time
Dose is proportional to
the time exposed

Experienced workers will generally

but not necessarily have lower
exposure of the hands.
TRAINING IS ESSENTIAL!!

Dose = Dose-rate x Time

 Dose rate at contact
Contact of an unshielded (5 ml) syringe

Time (min) to reach 500 mSv

1000.0
167
100.0
25
min

10.0
0.7
1.0

0.1
Tc-99m F-18 Y-90
500 MBq 400 MBq 1 GBq

(Carnicer, A. et al. Occupational Exposure: With Special Reference to Skin Doses in Hands and
Fingers. In Radiation Protection in Nuclear Medicine (Ed) Mattsson, S. Hoeschen,C. Springer 2013)
 Protection measures to reduce
(optimise) external exposure of hands
Shielding
Time (training)
Distance
 Distance
Relative dose-rate
100

80 Inverse square law (ISL):

60  
Dose-rate 1/(distance)2
40 Meaning that if the distance doubles will
the dose rate is reduced to one quarter.
20

0
0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5
Relative distance
 Syringe shield
Not shielded Shielded (2 mm W)

0.4 mSv/h 0.004 mSv/h

0.8 mSv/h 0.01 mSv/h

4.2 mSv/h 0.04 mSv/h

22 mSv/h 0.16 mSv/h

8 mSv/h 6 mSv/h

400 MBq Tc-99m in 1 ml

Slides 14-23 refer to chapter E.5

 Vial shield
Tc
99m

10 GBq
10 ml 560 mGy/h

1 mGy/h

2 mm lead
 RECOMMENDATION
Never touch an unshielded source with your
hands
Use long tweezers for handling of sources
SHIELDING OF SOURCES
Factors affecting the design:
• Radionuclide (type and energy
of emitted radiation)
• activity
• shielding material
Shielding

Bench top shield

Vial shields
Syringe shields
Note:The full garment in the photo is for
aseptic or good manufacturing purposes
and not necessarily for radiation protection
 DEFINITIONS

Dose rate constant

The dose rate , Γ(μSv/h), at 1 m from a point source of 1
MBq

TVL
Tenth value layer, which is the thickness of a material that
reduces the number of incident photons by a factor of 10.
SHIELDING CALCULATIONS
SPECIFIC DOSE-RATE CONSTANT (Γ) FOR SOME RADIONUCLIDES
AND THE TENTH VALUE LAYER OF LEAD.
DATA FROM LM UNGER & DK TRUBEY, SPECIFIC GAMMA-RAY DOSE CONSTANTS FOR NUCLIDES IMPORTANT TO
DOSIMETRY AND RADIOLOGICAL ASSESSMENT, OAK RIDGE NATIONAL LABORATORY, ORNL/RSIC-45/R1 (1982)

Radionuclide Γ (μSvh-1MBq-1) TVL (mm lead)

F-18 0,1851 13.5
Cr-51 0,0063 6.0
Co-57 0.0409 0.57
Ga-67 0,0300 4.8
Se-75 0,2323 2.5
Mo-99 0,0305 19.7
Tc-99m 0,0332 0.83
In-111 0,1356 2.23
I-123 0,0748 1.19
I-125 0,0743 0.06
I-131 0,0764 9.5
Sm-153 0,0244 0.32
Tl-201 0,0236 0.88
 EXAMPLE 1
Estimate the thickness of a lead container for 30 GBq
of 99MTc. Dose rate at 1 m should be 2 μSv/h

Dose rate constant: 0.017 μSv/(h*MBq)

TVL: 0.9 mm lead

Dose rate for unshielded source: 0.017 μSv/(h*MBq) *

30000 MBq = 510 μSv/h

Reduce exposure 255 times which equals:

ln(255)/ln(10) = 2.4 TVL = 2.2 mm lead.
 EXAMPLE 2
What thickness of lead is required to reduce the exposure rate to 20
μSv/h at 1 m for a container designed to store 15 GBq 131I?

According to table Γ=0.0764 μSvh-1MBq-1 for 131I which means that

the unshielded dose rate at 1 m will be 15000x0.0764=1146 μSvh-1 .
The shield should then be designed to reduce the dose-rate a factor
of 1146/20=57.3. which will be achieved by ln(57.3)/ln(10)=1.76 *
TVL From table we learn that TVL for I-131 is 9.5 mm. Hence, a
shield thickness of 1.76*9.5=16.7 mm of lead is required.
 EXAMPLE 3
A vial containing 2 GBq 18F is put in a 2 mm lead shield generally used
for 99mTc sources. How much will this shield reduce the dose-rate at
the surface?

According to table TVL for 18F is 13.5 mm lead. Then the attenuation coefficient
will be ln(10)/TVL=0.1706 mm-1. Assuming monoexponential attenuation, the
dose-rate (D) will be reduced to: D/D0=exp(-0.1706*2)=0.71 of the unshielded
dose-rate (D0).

This example shows the importance of selecting shields aimed

for the source to use.
 SHIELDING IN PET

Protection against high energy

photons requires lead and lead glass
shield of significant thickness (cm)

Biodex Medical

Slide refer to chapter E.8

SHIELDING AGAINST HIGH
ENERGY β-PARTICLES
Y
90

Max energy 2.3 MeV

Polymetylmetakrylat (PMMA) density
1188 mg/cm3 Maximum range ≈1 cm
Bremsstrahlung is generated in the
source and PMMA.
In conclusion:
Use 1 cm of PMMA with an external
layer of a few mm of lead in vial and
syringe shields.

Take home message:

The low z material stops beta and the
high z material stops the created
photons from the beta.

Slides 25-27 refer to chapter E.7

THE EFFECT OF SHIELDING
Procedures Shield Shielding efficiency
99m
Tc preparation Yes 4.3
No
99m
Tc administration Yes 1.8
No
18
F preparation Yes 2.3
No
18
F administration Yes 5.0
No
90
Y-Zevalin® preparation Yes -
No
90
Y-Zevalin® administration Yes 3.1
No

(Carnicer, A. et al. Occupational Exposure: With Special Reference to Skin Doses in Hands and
Fingers. In Radiation Protection in Nuclear Medicine (Ed) Mattsson, S. Hoeschen,C. Springer 2013)
Summary shielding recommendations
For the injection (syringe shielding):
• 2 mm W (or Pb) for 99mTc give a dose reduction of at least 2 order of
magnitudes.
• 5 mm W provides up to a factor 10 in dose reduction for 18F (8 mm W
up to a factor 40).
• For 90Y 10 mm PMMA completely shield beta radiation, nevertheless
5 mm shielding of tungsten provides a better shielding cutting down
bremsstrahlung radiation too.

For the preparation (vial shielding):

• For 18F, 3 cm of Pb provides 2 order of magnitudes on dose reduction.
The same attenuation for 99mTc is obtained with 2 mm Pb.
• For 90Y an acceptable shielding is obtained with 10 mm PMMA with
an external layer of few mm of lead or alternatively 5 mm of W.
• For 131I, 2 cm of Pb provides 2 order of magnitudes on dose reduction

(Carnicer, A. et al. Occupational Exposure: With Special Reference to Skin Doses in Hands and
Fingers. In Radiation Protection in Nuclear Medicine (Ed) Mattsson, S. Hoeschen,C. Springer 2013)
Examples of good working procedures
Preparation of 99m
Tc Preparation of 18F

Administration of 99m
Tc Administration of 18F

(Carnicer, A. et al. Occupational Exposure: With Special Reference to Skin Doses in Hands and
Fingers. In Radiation Protection in Nuclear Medicine (Ed) Mattsson, S. Hoeschen,C. Springer 2013)
Slides 28-29 refer to chapter E.3
Examples of bad working procedures
Preparation of 99m
Tc Preparation of 18F
Unshielded vial and
syringe

Unshielded syringe,
thumb directly Unshielded syringe
exposed

Administration of 99m
Tc Administration of 18F

Left hand holding

Unprotected Unshielded syringe Unshielded syringe the part of the
fingertips
needle
(Carnicer, A. et al. Occupational Exposure: With Special Reference to Skin Doses in Hands and
Fingers. In Radiation Protection in Nuclear Medicine (Ed) Mattsson, S. Hoeschen,C. Springer 2013)
MONITORING EXTERNAL
EXPOSURE
The operational quantity for external individual
monitoring is the personal dose equivalent,
Hp(d), which is the dose equivalent in ICRU
soft tissue at an appropriate depth, d, below a
specified point on the human body.

For skin, hands, and feet personal dose

equivalent, Hp(0.07), a depth d=0.07 mm is
used.

Slides 30-32 refer to chapter E.10

MONITORING EQUIPMENT

+ comfortable
- delayed reading

Wrist TLD Ring TLD

- +direct reading
- uncomfortable

Electronic extremity Electronic extremity

dosimeter dosimeter
 What to measure?
The maximum dose should be evaluated and
tested for conformity with the dose limit

Hand dose distribution for worker T3E, for preparation of 18F.

Each curve corresponds to individual sets of 22 TL readings.

(Carnicer, A. et al. Occupational Exposure: With Special Reference to Skin Doses in Hands and
Fingers. In Radiation Protection in Nuclear Medicine (Ed) Mattsson, S. Hoeschen,C. Springer 2013)
 WHERE TO MEASURE?
The most exposed part of the hands are likely to be the tips
of the index and middle fingers and the thumb of the
dominant hand.
Based on monitoring results it is recommended that a ring
dosimeter should be worn on the middle finger of the
dominant hand with the element on the palm side, and that a
factor of three should be applied to derive an estimate of the
dose to the tip (maximum dose and fraction of dose limit).
When gloves are worn the ring dosimeter should be worn
under the gloves. If the dosimeter element is worn facing the
back side of the hand, a factor of six should be applied.

Slides 33-35 refer to chapter E.10

External exposure of hands

(Carnicer, A. et al. Occupational Exposure: With Special Reference to Skin Doses in Hands and
Fingers. In Radiation Protection in Nuclear Medicine (Ed) Mattsson, S. Hoeschen,C. Springer 2013)
External exposure of hands
Figure shows that the dose is substantially higher to finger tips than the base of the fingers

Gauri S. Pant et. al., JNMT 2006

CONTAMINATION

Clean handprint Contaminated handprint

Contamination of the worker
related to:
• spills
• drawing dose
• administration of radiopharmaceutical
• experimental work with animals
• emergency surgery of a therapy patient
• autopsy of a therapy patient
• other accidents
 CONTAMINATION
FROM PATIENT
Administered activity: 1000 MBq I-131

Excretion Concentration Contamination

Saliva <2 MBq/g utensils 2 kBq

Perspiration <20 Bq/cm2 surfaces 10 Bq/cm2
Breathing 100 Bq/l air 1 Bq/l
Urine <500 kBq/mltoilet 2 kBq/cm2

Generally larger than the derived limits for contamination

given by ICRP (publ. 57)
Skin exposure by contamination
Skin contamination equivalent dose rate factors at a depth of 70 µm

Radionuclide mSv-cm2/MBq-h Radionuclide mSv-cm2/MBq-h

14
C 305 90
Sr-90Y (equilibrium) 4272
18
F 1900 99m
Tc 243
22
Na 1870 111
In 376
24
Na 2357 123
I 365
32
P 2397 125
I 417
35
S 332 131
I 1694
36
Cl 2178 137
Cs-137Ba (equilibrium) 1941
45
Ca 884 147
Pm 612
57
Co 78 153
Sm 1600
59
Fe 1283 192
Ir 1592
60
Co 1146 201
Tl 343
67
Ga 324 204
Tl 1804

DELACROIX, D., GUERRE, J.P., LEBLANC, P., HICKMAN, C., Radionuclide and Radiation Protection
Data Handbook 1998, Radiation Protection Dosimetry, Vol. 76 Nos. 1-2 1998.
 Decontamination of skin
If contamination of the skin occurs, immediately the area should be
thoroughly washed using mild soap and tepid (not hot) water. Particular
care should be paid to cleaning under the fingernails. If this does not
bring the contamination to an acceptably low level the procedure should
be repeated. Scrub with a nail brush but take care not to break the skin.
DECONTAMINATION OF SKIN
Remaining activity (%)
Method
Substance 1 2 3 4
---------------------------------------------------------------------------------
99m
Tc-DTPA 1 0 1 1
99m
Tc-MDP 7 1 3 5
99m
Tc-pertechnetate 5 7 5 7
99m
Tc-colloid <1 <1 <1 <1
131
I-Hippuran <1 <1 <1 <1
131
I-iodide 8 5 <1 2
67
Ga-citrate 3 1 4 1
111
In-DTPA <1 <1 <1 <1
---------------------------------------------------------------------------------
1: 90 s in water, 2: 90 s in soap and water, 3: skin lotion
and 90 s in soap and water, 4: commercial decontamination
substance

IAEA, 2000. Training Material on Radiation Protection in Nuclear

Medicine, Part 5. Occupational Exposure Protection of the Worker
Skin exposure by contamination
In 10 months 560 inspections were carried out. Local
contamination was found on the fingers of nuclear medicine
technologists in 40 cases. The measured activities ranged
from 211 Bq/cm2 to 460 kBq/cm2, resulting in cumulated
skin doses between 0.02 and 809 mSv.

(Covens P, et al Nucl Med Com 33, 2012)

To minimize contamination
- adopt clean operating conditions
- adopt good laboratory practices
- do not eat, smoke etc…
- use nitrile or vinyl gloves (no latex)
and protective clothing
PROTECTIVE CLOTHING

Appropriate clothing should as a minimum include lab coat

and gloves. National regulations may require more.
SAFETY EQUIPMENT (OPTIMISATION)
PREPARING AND DISPENSING RADIOPHARMACEUTICALS

• Shields
• Protective clothing
• Tools for remote handling
of radioactive material
• Shielded containers for
radioactive
waste
• Dose rate monitor with alarm
• Contamination monitor
• Decontamination kit
• Signs, labels and records
SAFETY EQUIPMENT
(OPTIMISATION)
ADMINISTRATION OF
RADIOPHARMACEUTICALS

Syringe shield
Gloves
Lead apron
Absorbing pads
Recommendations (ICRP 106)
 The dispensing protocol and the use of shielding devices in any
radiopharmacy should be assessed carefully to optimise the strategy.
 Shielding of the syringe is the most important factor affecting finger
dose, and syringe shields should be used as much as possible.
 Vials from which radioactive liquid is withdrawn should always be
shielded.
 The choice of manipulation technique only has a minor influence on
finger dose; the most important factor is that staff are able to use the
technique effectively.
 All staff should undergo a period of intense training in which they
practice manipulations using non-radioactive liquid prior to undertaking
any dispensing of radioactive liquid.
 Careful positioning of materials within the dispensing cabinet is
important for streamlining the procedure and minimising doses to the
hands.

Slides 47-49 refer to chapter E.11

Recommendations (ICRP 106)
The most exposed parts of the hands are likely to be the tips of the index and middle

fingers, and the thumb of the dominant hand, with exposure for the index finger being
highest.
Preliminary finger dose monitoring should be undertaken for any person handling >2

GBq/day, and regular monitoring should be carried out if doses to the most exposed part
of the hand exceed 6 mSv/month.
The finger tip or most exposed part of the hand should be monitored wherever possible,

particularly if the dose is likely to approach a dose limit.
If it is not possible to monitor the dose to the most exposed finger tip, an empirical

multiplying factor may be applied to doses recorded by ring dosimeters worn on the
middle finger of the dominant hand to estimate this dose. Factors of three or six should
be used for the dosimeter element on the palm or back of the hand, respectively.
The dispensing technique should be reviewed to confirm that the positions where

dosimeters are worn are the most appropriate.
For injections, prior venous cannulation allows the injection to proceed more rapidly; if

the syringe is shielded, the dose to the hand of the nurse or physician will be kept to a
minimum.
Recommendations (ICRP 106)
 Significant doses can be received from a single administration of a
therapy involving a high-energy beta-particle emitter, and the
following precautions are recommended:
 Administrations of beta-emitting therapy radiopharmaceuticals should
be carefully planned.
 5–10 mm thick PMMA syringe shields should always be used for
administration of 90Y or similar high-energy beta-emitting therapy
radionuclides.
 Close contact with any thin-walled vessel containing therapeutic
levels of 90Y should be avoided through the use of forceps or PMMA
shielding.
 Doses to the most exposed finger tips should be monitored directly
for each session in which 90Y or similar high-energy beta-emitting
therapy radionuclides are administered.
 Thank you
You are invited to use this lesson for training and
to apply them in practice but not for commercial
purposes.
www.icrp.org