1. Part 12 IAEA Training Material on Radiation Protection in Nuclear Medicine Protection of the General Public

2. Nuclear Medicine Part 12. Protection of the general public2 Objective To become aware of the BSS requirements for the protection of the public and how these are applied to restrictions in the care of the nuclear medicine patients as well as the design and operation of a nuclear medicine facility

3. Nuclear Medicine Part 12. Protection of the general public3 Content l Dose limits Dose limits Dose limits l Design considerations Design considerations Design considerations l The patient The patient The patient l Special problems Special problems Special problems l Transportation Transportation

4. Nuclear Medicine Part 12. Protection of the general public4 Exposure of the general public l Spread of contamination outside the department l Lost sources l The nuclear medicine patient l Disposal of radioactive waste l Transportation of sources

5. Nuclear Medicine Part 12. Protection of the general public5 RESPONSIBILITIES l BSS III.1. Registrants and licensees shall apply the requirements of the Standards as specified by the Regulatory Authority to any public exposure delivered by a practice or source for which they are responsible, unless the exposure is excluded from the Standards or the practice or source delivering the exposure is exempted from the requirements of the Standards.

6. IAEA Training Material on Radiation Protection in Nuclear Medicine Part 12 Protection of the General Public Module 12.1. Dose limits

7. Nuclear Medicine Part 12. Protection of the general public7

8. Nuclear Medicine Part 12. Protection of the general public8 If nationally not available, the local Radiation Protection Committee, should establish appropriate dose constraints, such as: Co-workers to the patient, and other members of the general public: 0.3 mSv/procedure DOSE CONSTRAINTS

9. IAEA Training Material on Radiation Protection in Nuclear Medicine Part 12 Protection of the General Public Module 12.2. Design considerations Working procedures

10. Nuclear Medicine Part 12. Protection of the general public10 RADIOACTIVE CONTAMINATION BSS III.7. Registrants and licensees shall ensure that: (a) for sources for which they are responsible, measures that are optimized in accordance with the requirements of the Standards be taken as appropriate for restricting public exposure to contamination in areas accessible to the public; and (b) specific containment provisions be established for the construction and operation of a source that could cause spread of contamination in areas accessible to the public.

11. Nuclear Medicine Part 12. Protection of the general public11 Reduce the risk of uncontrolled contamination l Classification of areas l Well trained staff l Documented safe procedures in the handling of radiopharmaceuticals (receipt, preparation, administration, waste disposal) l Workplace monitoring

12. Nuclear Medicine Part 12. Protection of the general public12 Layout of a nuclear medicine department From high to low activity

13. Nuclear Medicine Part 12. Protection of the general public13 CLASSIFICATION OF AREAS Controlled area Supervised area

14. Nuclear Medicine Part 12. Protection of the general public14 CONTROL OF VISITORS BSS III.5. Registrants and licensees, in co-operation with employers when appropriate, shall: BSS III.5. Registrants and licensees, in co-operation with employers when appropriate, shall: (a) ensure that visitors be accompanied in any controlled area by a person knowledgeable about the protection and safety measures for that area; (b) provide adequate information and instruction to visitors before they enter a controlled area so as to ensure appropriate protection of the visitors and of other individuals who could be affected by their actions; and (c) ensure that adequate control over entry of visitors to a supervised area be maintained and that appropriate signs be posted in such areas.

15. Nuclear Medicine Part 12. Protection of the general public15 Patient areas Separation of radioactive patients and other patients waiting is an example of good practice, especially in a busy department. Separate toilet room for the exclusive use of injected patients should always be considered. This patient washroom should not be used by general public or hospital staff as it is likely that the floor, toilet seat and sink faucet handles will be contaminated frequently.

16. Nuclear Medicine Part 12. Protection of the general public16 STRUCTURAL SHIELDING Patient with I-131 D mSv/h0.3 mSv/procedure Distance d General public The absorbed dose is determined by factors such as: source strength; length of exposure; distance from the source; transmission through the protective barrier.

17. Nuclear Medicine Part 12. Protection of the general public17 locked to prevent unauthorized use and theft warning sign shielded to <2 uSv/h at 1m (permanently occupied areas) alternatively <20 uSv/h at 1 m (temporarily occupied areas) inventory record locked to prevent unauthorized use and theft warning sign shielded to <2 uSv/h at 1m (permanently occupied areas) alternatively <20 uSv/h at 1 m (temporarily occupied areas) inventory record STORAGE OF SOURCES

18. Nuclear Medicine Part 12. Protection of the general public18 RADIOACTIVE WASTE BSS III.8. Registrants and licensees shall: (a) ensure that the activity and volume of any radioactive waste that results from the sources for which they are responsible be kept to the minimum practicable, and that the waste be managed, i.e. collected, handled, treated, conditioned, transported, stored and disposed of, in accordance with the requirements of the Standards and any other applicable standard [26]; and (b) segregate, and treat separately if appropriate, different types of radioactive waste where warranted by differences in factors such as radionuclide content, half-life, concentration, volume and physical and chemical properties, taking into account the available options for waste disposal.

19. Nuclear Medicine Part 12. Protection of the general public19 Discharge of radioactive substances BSS III.9. Registrants and licensees shall ensure that radioactive substances from authorized practices and sources not be discharged to the environment unless: BSS III.9. Registrants and licensees shall ensure that radioactive substances from authorized practices and sources not be discharged to the environment unless: (a) the discharge is within the discharge limits authorized by the Regulatory Authority; (b) the discharges are controlled; (c) the public exposures committed by the discharges are limited as specified in Schedule II; and (d) the control of the discharges is optimized in accordance with the Principal Requirements of the Standards.

20. IAEA Training Material on Radiation Protection in Nuclear Medicine Part 12 Protection of the General Public Module 12.3. The patient

21. Nuclear Medicine Part 12. Protection of the general public21 The radioactive patient Uncontrolled radioactive source that causes external exposure and contamination of the general public? YES! (after leaving the hospital)

22. Nuclear Medicine Part 12. Protection of the general public22 The Radioactive Patient 1000 MBq I-131 0 0.5 1 2 m 0.5 0.1 0.06 0.03 mSv/h Contamination External saliva perspiration breath urine

23. Nuclear Medicine Part 12. Protection of the general public23 The radioactive patient Keep the patient in the hospital Release the patient without any restrictions Release the patient with restrictions Exposure of general public

24. Nuclear Medicine Part 12. Protection of the general public24 The dose rate at 1 m from the patient should be down to an acceptable level established by the RPC. Hospitalize: >1100 MBq I-131 Release with restrictions: Treatment of thyrotoxicosis Pain palliation (Sr-89, Sm-153) Lactating women (specified procedures) Release without restrictions: Diagnostic procedures Patient survey

25. Nuclear Medicine Part 12. Protection of the general public25 Use only a WC and flush 2-3 times. Keep the toilet and the floor clean. Wash Your hands frequently and take a shower every day. Avoid close contact to members of the family, children and pregnant women etc according to the time table attached Avoid solid waste INSTRUCTIONS TO OUT-PATIENTS (Example to minimize exposure of the general public) Off work: 6d Avoid close contact with children and pregnant women:20 d Public travel:1h/day (1st week)

26. IAEA Training Material on Radiation Protection in Nuclear Medicine Part 12 Protection of the General Public Module 12.4. Special problems

27. Nuclear Medicine Part 12. Protection of the general public27 In the event of death of a patient who has recently received a therapeutic dose of a radionuclide care has to be taken to ensure that personnel receive as low dose as possible at all stages prior to the burial or cremation. DEATH OF PATIENT Activity (MBq) (UK)

28. Nuclear Medicine Part 12. Protection of the general public28 Precautions that should be given are depending on the residual activity and the expert advice provided by the RPO and may involve the following: preparation for burial or cremation should be controlled by a competent person, relatives should be prevented from coming into close contact with the body, people should not be allowed to linger in the presence of the coffin, all personnel involved in handling the corpse should be instructed by the RPO and monitored if appropriate, all objects, clothes, documents etc that might have been in contact with the deceased must be tested for contamination, it may be expedient to wrap the cadaver in waterproof material immediately after death to prevent spread of contaminated body fluids, embalming of cadavers should, if possible, be avoided, autopsy of a highly radioactive cadavers should be restricted to the absolute minimum DEATH OF PATIENT

29. IAEA Training Material on Radiation Protection in Nuclear Medicine Part 12 Protection of the General Public Module 12.5. Transportation

30. Nuclear Medicine Part 12. Protection of the general public30 TRANSPORT CONTAINER Cartoon Liner Sealed can Liner Lead container Source

31. Nuclear Medicine Part 12. Protection of the general public31 Transport Container

32. Nuclear Medicine Part 12. Protection of the general public32 Transport Index (TI) 1.0 m TI = max dose-rate @ 1.0m (  Sv/h) 10

33. Nuclear Medicine Part 12. Protection of the general public33 White-I Label < 5.0  Sv/h @ surface < 0.05  Sv/h @ 1.0 m TI = 0

34. Nuclear Medicine Part 12. Protection of the general public34 Yellow-II Label 5  Sv/h @ surface < 10  Sv/h @ 1.0 m 0 < TI < 1.0

35. Nuclear Medicine Part 12. Protection of the general public35 Yellow-III Label > 500  Sv/h,< 2000  Sv/h @ surface > 10  Sv/h, < 100  Sv/h @ 1.0m 1.0 < TI < 10

36. Nuclear Medicine Part 12. Protection of the general public36 Vehicle Placards 3 placards on vehicle

37. Nuclear Medicine Part 12. Protection of the general public37 Consignor’s Responsibilities l all labelling and placarding l provision of transport documents l provision of local rules and any other relevant information

38. Nuclear Medicine Part 12. Protection of the general public38 Internal transport If the administration of radiopharmaceutical to the patient takes place far from the dispensing room, use a transport container with absorbent pads. Make sure that a warning sign is on the container together with patient name, activity and date. Travel by the most direct route avoiding more heavily occupied areas

39. Nuclear Medicine Part 12. Protection of the general public39 Questions?

40. Nuclear Medicine Part 12. Protection of the general public40 DISCUSSION You get a phone-call from a colleague in another hospital about 0.5 h away. He is in an urgent need of Tc99m-MAA for a lung scan. Can you help him?

41. Nuclear Medicine Part 12. Protection of the general public41 DISCUSSION You get a phone call from a relative to a patient who yesterday got 4 GBq Sm-153. The patient died at home today. What to do?

42. Nuclear Medicine Part 12. Protection of the general public42 DISCUSSION A patient has received 300 MBq I-131 in a treatment of thyrotoxicosis. She is working in a school preparing food for the children. She was told to stay off work for 2 weeks. You get a message that she actually went back to work the day after the treatment, which was 10 days ago. What to do?

43. Nuclear Medicine Part 12. Protection of the general public43 Where to Get More Information l l Other sessions n n Part 4. Security of sources, Design of facilities n n Part 5. Occupational protection n n Part 6. Medical exposure n n Part 8. Optimization of medical exposure. Therapeutic procedures n n Part 10. Radioactive waste l Further readings n n IAEA Basic Safety Standards n n IAEA Model regulations on radiation safety in nuclear medicine (in preparation) n n WHO. Manual on Radiation Protection in Hospitals and General Practices. Volume 4: Nuclear Medicine (in preparation)