1. Radiation Safety Refresher Training for PET Imaging For Record of Attendance E-mail or Interoffice Mail Test to: Stephen.David@uth.tmc.edu Stephen David, EH&S, CYF G.102 Radiation Safety Program Environmental Health & Safety 713-500-5840

2. PET & PET/CT Imaging In PET imaging, the system detects the annihilation photons (511 keV) from the positron-emitting radionuclide introduced into the body.

3. PET Imaging & Radiation Sources The primary radiation source does not come from the camera but from the patient itself.

4. PET & PET/CT Imaging & Radiation Sources Close patient-staff interaction during and following administration of patient dose may contribute to higher occupational dose.

5. Radiation Area Monitoring Stationary area monitoring has been in place at the PET Center to assess potential radiation exposures from both PET and PET/CT imaging just outside the imaging suite. PET SUITE

6. Area Monitor Example Area Monitor = ENV Series, PET Suite 04801 Dose Should be Less Than 100 mrem per Year

7. Contamination Monitoring Wipe Tests P erformed routinely to assess removable contamination. GM Detector Survey Used for fixed and removable contamination assessments.

8. Routine Contamination Monitoring Routine contamination surveys are performed by both PET staff users and Radiation Safety Program Staff of EH&S in accordance with Texas Radioactive Material License L02774.

9. ALARA Review Minimize time near radiation Maximize distance Use appropriate shielding Keep Occupational Exposures As Low As Reasonably Achievable while maintaining patient care!

10. UTHSC-H levels to initiate ALARA investigation to ensure doses as low as reasonably achievable (ALARA), doses in mrem. ALARA Investigation Level

11. Occupational Considerations in PET Imaging External Exposures from ex. F-18 FDG Majority from patient, typically Unsealed sources (should be periodically monitored for potential spills) PET cameras often combined with CT Internal Exposures/Contamination Unsealed radiopharmaceuticals (i.e. spills, digestion, needle prick)

12. *Note: Using N-13 due to lack of CardioGen-82 Generator Personnel Monitoring Examples

13. *Note: Using N-13 due to lack of CardioGen-82 Generator Personnel Monitoring Examples

14. PET Shielding Syringe Shielding very effective at reducing exposure to hand 511 keV Gamma energy needs thicker shielding than other common nuclear medicine procedures

15. PET Shielding Syringe Shielding A syringe shield made of tungsten with a thickness of 0.34” (9mm) attenuates FDG-18 by 88%.

16. Radioactive Spill Procedures PET uses unsealed radioactive sources. Spills may occur and contaminate: imaging cameras, beds, tables, bathrooms, technologists, etc. Specific procedures & protocols are in the UTHSC-H Radiation Safety Manual and PET Suite Operating Procedures.

17. Radioactive Spill Supplies Obtain necessary supplies for cleanup Paper towels or diapers RADCON or Scrubbing Bubbles (DOW) Opaque plastic bags for waste Labels Gloves Descriptive forms for documentation if needed If very short-lived, may restrict area for decay to background levels (ex. overnight for F-18 spill)

18. Records of Patients’ Log Information on each patient’s administration of a dose should all be logged according to procedures. Example: Radionuclide Activity at Date & Time Compound Unique Number

19. Declared Pregnancy Program for Employees The Program will assist the pregnant, occupationally exposed employee in assessing the potential radiation risk to the unborn child during the course of employment. We can also help with methods of minimizing the radiation dose and the risk to the unborn child and maintaining the radiation doses as low as reasonably achievable.

20. Declared Pregnancy Program for Employees Declared Pregnancy Program Discuss current radiation levels with Radiation Safety. Discuss techniques and options to minimize dose to mother and baby. Declare in writing with Radiation Safety for reduced limit. Reduced limits Exposure should not exceed 0.05 rem/month. Exposure shall not exceed 0.5 rem/gestation period. Up to individual to declare If she decides to declare, consult with Radiation Safety and implement procedures. In rare cases, declaration may change job duties. To discuss with Radiation Safety, Call 713-500-5840

21. Pregnancy Check for Patients in PET imaging Female patients ages 12-55 will be screened for pregnancy prior to diagnostic procedure. If patient unable to confirm non- pregnancy, urine test will be performed prior to procedure. Screening is done to avoid unintended dose to the fetus.

22. Pregnancy Check for Patients in PET imaging If diagnostic information received outweighs risks, test will be performed with written consent of patient. The UTHSC-H Radiation Safety Manual Addendum contains requirements for human use of radioactive material with regards to pregnancy checks for patients.

23. Unintended Dose to the Fetus Report immediately upon discovery to the Radiation Safety Officer for notification to State of a dose to an embryo/fetus if : Any dose to an embryo/fetus that is greater than 5 rem (50 mSv) dose equivalent that is a result of an administration to a pregnant individual, unless the dose to the embryo/fetus was specifically approved, in advance, by the authorized user. From 25 TAC §289.256(vvv)

24. Unintended Dose to the Nursing Child Report immediately upon discovery to the Radiation Safety Officer for notification to State of a dose to a nursing child if : The dose is greater than 5 rem (50 mSv) dose equivalent that is a result of an administration to a breast feeding individual. Or has resulted in unintended permanent functional damage to an organ or a physiological system, as determined by a physician. From 25 TAC §289.256(vvv)

25. Medical Event (Misadministration is a Medical Event) For all medical uses of licensed radioactive materials, a “Medical Event” occurs if BOTH of the following criteria are met : (1) The difference between the dose administered and the prescribed dose exceeds one of the reporting limits the annual occupational dose limits at 25 TAC §289.202 or 10 CFR §20.1201, (ex. 5 rem effective dose equivalent)

26. Unintended Dose to the Fetus When to contact RSO to call state Medical Event AND  One or more of the following representative incidents occur: the dose administered to a patient differs from the prescribed dose by at least 20% the wrong radioactive drug is administered the radioactive drug is administrated by the wrong route the dose is administered to the wrong individual

27. Unintended Dose to the Fetus When to contact RSO to call state Survey Instruments in PET Geiger-Meuller (GM) Counter Ideal for assessing removable contamination of typical PET radionuclides

28. Unintended Dose to the Fetus When to contact RSO to call state Survey Instruments in PET Ionization Chambers Ideal for assessing exposure levels from radiation sources

29. Survey Instruments in PET Well counter It is a small scintillation counter To determine very small activity in dpm (disintegration per minute) For wipe test and leak tests Counts one sample at the time

30. Unintended Dose to the Fetus When to contact RSO to call state Survey Instruments in PET Dose Calibrator (ionization chamber measuring dose to the patients) It is used to assay the amount of radioactivity in the test tube, vial, or syringe. It has to be calibrated for all specific radionuclide used by the department. E.g. Rb-82, F-18, N-13, O-15, C-11, I-124, Cu-62…

31. Unintended Dose to the Fetus When to contact RSO to call state Receipt of Radioactive Material Requirements DOT/FAA receipt training needed every 3 years, specific to what individual receives. Cannot exceed limits of the license. Receipt procedures for PET Personnel for shipments delivered directly to center Wipe test upon arrival & record results in dpm. Record surface readings in mrem/hr if Yellow II Record activity received and date

32. Complete 5 Question Test For Record of Attendance E-mail or Interoffice Mail Test to: Stephen.David@uth.tmc.edu Stephen David, EH&S, CYF G.102 Questions: 713-500-5840 Radiation Safety Program of EH&S