Topic 5

Question 1

Aka Nuclear__, are physicians who use radioactive materials to diagnose and treat disease.

Answer 1

Nuclear medicine radiologist

Question 2

Nuclear Medicine __ work with nuclear instrumentation and radiation dosimetry

Answer 2

Nuclear medicine physicist

Question 3

Once known as radiopharmacist, specialize in preparing, dispensing, and distributing radiopharmaceuticals or radioactive drugs

Answer 3

Nuclear pharmacist

Question 4

Works closely with the nuclear medicine radiologist. The technologist may prepare and administer radiopharmaceuticals, perform imaging procedures, enhancing images utilizing a computer and analyzes biomedical specimens.

*He/she also performs statistical analysis of the data and must digitally process the images.

*Key responsibilities: Patient Safety and accurate documentation.

Answer 4

Nuclear medicine technologist

Question 5

He/she reviews the imaging protocols used in the nuclear medicine department and reviewing all dosimetry records for the facilty.
He/She served on the radiation safety committee.

Answer 5

Radiation safety officer

Question 6

__is required if the activity administered to the patient is __ or __ than (15mCi), or if the dose rate at __ distance from the radioactive patient is __ or __ than (2.5 mrem) per hour.

Answer 6

Hospitalization
equal, greater 0.6 GBq
1 meter
equal, greater 25 mSv

Question 7

The __ is often chosen for treatment of hyperthyroidism because of its simplicity: it is given in a single dose. Another advantages of __ is its lack of side effects.

Treatment for hyperthyroidism is almost always done in an outpatient basis because the dose required is relatively small.

The __ is swallowed in a single dose, in capsule or liquid form and is quickly absorbed into the blood stream in the GI tract and concentrated from the blood by the thyroid gland;

The patient will be able to return home following radioactive iodine treatment, but should avoid prolonged close contact with other people for several days, particularly to pregnant women and small children.

Nearly all the radioactive iodine leaves the body during the first 2 days following the treatment, primarily through the __. Small amounts will also be excreted through __,__,__,__, and __.

Answer 7

radioactive iodine (RAI)
radioiodine I-131
urine
saliva, sweat, tears, vaginal secretion and feces

Question 8

For RAI (I-131) patients with __, one of the most common side effect is hypothyroidism

Answer 8

graves disease

Question 9

Recommendations for patients undergoing RAI:

Answer 9

Patient should be well hydrated
Patient should urinate frequently
Patient should use antiperspirant medication
Patient should avoid the use of laxatives

Question 10

When possible, each patient receiving radiopharmaceutical for therapy and is hospitalized shall be provided with a __ furnished with private toilet and bathroom, and entrance door posted with appropriate radiation warning sign.

Answer 10

Dedicated room

Question 11

Monitoring px

Answer 11

Furniture and telephone sets are surveyed
Areas suspecting to be contaminated are surveyed

Question 12

The __ must make daily visits on the patient to conduct an overall radiologic assessment. Records of such visit must be attached or incorporated in the patient’s chart. Any event, problem or unforeseen circumstances involving the radioactive patient must be reported to the __ and must be incorporated in a log book/patient’s chart.
Radiation survey of the room and the surrounding areas must be conducted immediately after administration of the therapeutic dosage of the radioactive material.

Answer 12

Radiation protection officer (RPO)

Question 13

Exposure rates shall be measured at the bedside, ____ . The RPO must determine how long the visitors may remain outside a delineated area which shall be posted on the patient’s chart and on the door.
He must conduct daily monitoring of the room and the surrounding areas and recalculate permitted times for visitors.

Answer 13

1 meter away from the patient and at the door

Question 14

The __ or the __ must conduct regular assessment of the patient to determine potential radiation effects on the patient other than that intended by the therapy procedures. Any potential effects must be recorded and evaluated.

Answer 14

authorized user, physician

Question 15

the __ who will be attending to hospitalized radioactive patients must have a basic knowledge on radiation protection and must be properly trained to handle such patients. The nursing staff must be instructed on the details of the nature and activity of the radioactive substances, the time and date of administration and any relevant instructions for nurses and visitors.

The __ must be provided with a personnel monitor, if possible. __ must limit their time spent near the radioactive patient. Special restrictions must be noted on the patient’s chart. Nurses must become familiar with the RPO’s instructions or restrictions before attending the patient.

Answer 15

nurse/s

Question 16

Attending nuclear medicine technologist must wear __ or __ when handling __, __, __, . After use, they must dispose the gloves in the designated radioactive waste container then wash their hands.

Answer 16

disposable rubber or plastic gloves
urinals, bedpans, emesis basins, etc

Question 17

Occupational dose

The annual limit of the occupational dose to an individual adult__ (0.05 Sv)
The annual limit on the occupational dose to the lens of the eye is __(0.15 Sv).
The annual limit on the occupational dose to the skin and other extremities is the shallow-dose equivalent of __ (0.5 Sv).
The total effective dose equivalent to individual members of the public is __ (0.001 Sv) per year.
However, this limit can be increased to __ (0.005 Sv) provided the need for such a higher limit is demonstrated.
The dose in an unrestricted area from an external source is __ (0.02mSv) in an hour.

Answer 17

5 rem
15 rem
50 rem
0.1 rem
0.5 rem
2 mrem

Question 18

the patient can be discharged if the radiation level at __ from the patient is less than __. Even if the patient will be discharged, he must not come in contact with children or pregnant women.

Answer 18

one meter, 2.5 mR/hr

Question 19

Whenever possible, __ shall be used in attending to radioactive patient. All used disposable plates, cups, eating utensils, tissue paper and other similar waste items must be collected into tagged plastic bags and placed in designated waste containers.
The waste materials shall be removed from the room daily, checked for contamination and stored to decay in radioactive waste storage room..

Non-disposable items such as linens, hospital gowns, laundry used by the radioactive patient shall be contained and sealed in plastic bags. After checking for contamination, the items may be washed for normal use, store to decay or decontaminated , as may be appropriate.

Answer 19

only disposable items

Question 20

Visitors are __ allowed to visit in the first 24 hour period after the patient receives the treatment.
Pregnant women and children under the age of 18 are __ permitted to visit (unless with the permission from the RPO.)
Keep the visit __ (less than 30 min)
Keep a __ (e.g. 2m) away from the patient.
Do not kiss the patient
Do not eat, drink or smoke in the patient’s room
Do not touch the toilet or sink in the patient’s room.

Answer 20

not
not
short
reasonable distance

Question 21

Who should be protected in nuclear medicine?
*
*
*
*

How should the people be protected?
*
*
*

Answer 21

Patient
Members of his/her family
Worker
General public

Optimize protection
Justify the exposure
Dose limits

Question 22

Nuclear medicine technologist are responsible for __

The form: Nursing Instructions to __ must be filled-up and completed immediately upon the confinement of the patient. A copy of filled-up form shall be kept with the patients chart. Clearance for the consequent use of the room must be issued by the RPO.

Answer 22

keeping their own radiation exposure as the concept ALARA is applied.

Radioactive Patient

Question 23

monitoring personnel radiation exposure is one way to assess that radiation safety practices and the ALARA concept being observed. Therefore, it is important that personnel monitors be used consistently and handled properly to ensure that the readings are an accurate reflection of a technologist’s radiation exposure.

Protection control by:
*
*
*

Answer 23

Shielding
Time
Distance

Question 24

One of the most effective means in decreasing radiation exposure is to absorb most of the radiation through the use of the __ around the radioactive source.

Specially designed lead shields that fit around radionuclide generators are necessary.

The PNRI requires that syringes be __ during radiopharmaceutical kit preparation and administration to the patient, unless the use of shield is contraindicated for a particular patient.

Answer 24

shielding

Question 25

An __ should be used during the preparation of radiopharmaceutical kits and unit doses. The leaded glass window permits the technologist to see the manipulation of the equipment while affording some protection to the eyes and torso.

Answer 25

L-block shield

Question 26

In some instances, the use of shielding is not practical. Minimizing the __ spent working with the radiation source and maximizing the __ from the radiation source are other practical methods of reducing radiation exposure.
Using devices/restraint device are also more effective in maintaining a given position than holding the patient (and can decrease the number of repeat acquisition due to patient motion.) This action will be less likely to perceived as punitive and uncaring if the technologist explains the reasons for restraining the patient.

Answer 26

time distance

Question 27

Using the __ to move unshielded radioactive material is another way to use distance for radiation protection.
Likewise, working efficiently with radioactive materials, practicing new procedures with non-radioactive materials, and remaining in the “hot lab” only for the time necessary all decrease radiation exposure by minimizing the time the technologist is exposed to radiation.

Answer 27

long handled tongs

Question 28

Technologist can receive __ by inhaling or ingesting radioactivity or by absorbing it through the skin or wounds. Since internal exposure is not detected by a personal radiation monitor or routinely monitored through bioassay, it is controlled primarily by eliminating potential causes of internal contamination.

This type of contamination may be avoided by abstaining from eating, drinking, smoking or applying cosmetics in areas where radioactive materials are used. Food should not be kept in the same refrigerators where radioactive materials are sored.

Answer 28

internal radiation exposure

Question 29

Also, __ . Protective clothing, especially gloves, can minimize absorption through the skin and simplify decontamination if spills occur.

Answer 29

pipetting radioactive solutions by mouth must be strictly prohibited

Question 30

Since nuclear medicine technologist are routinely exposed to radiation during the performance of their work responsibilities, they are considered to be occupationally exposed workers, according to the PNRI.

However, a fetus is limited to receiving not more than
__ (1 mSv) during the gestation period. Consequently, determining and limiting radiation dose to the fetus become important considerations for the pregnant an potentially pregnant technologist.

Answer 30

100 mrem

Question 31

__ –access by general public, anyone who occupies an area must receive:
not more than __ (0.02 mSv) in any single hour
not more than __ (1 mSv) in 7 consecutive days;
and not more than __ (5mSv) in a year.

Answer 31

Unrestricted areas
2mrem
100 mrem
500 mrem

Question 32

b. __ – must be identified with one of the following signs:

1. Caution: __ – this phrases identifies any area which radioactive materials are used to stored in amounts exceeding exempt quantities.
2. Caution: __ – this words indicate an area in which a major part of the body could receive greater than 5mrem (0.05mSv) in any one hour or more than 100 mrem (1 mSv) in 5 consecutive days

a. __ for radioiodine therapy and radiopharmacy hot labs are areas that often require this sign.

Answer 32

Restricted areas
Radioactive Materials
Radiation Area
Isolation rooms

Question 33

3. Caution: __ – this phrase indicates an area in which a major part of the body could receive more than __ (1 mSv) in any one hour
4. __- area in which an individual could receive from radiation sources an absorbed dose in excess of __ (5 Gy) in 1 hr at 1 m from the source.

Answer 33

High Radiation Area, 100 mrem
Very high radiation area
500 rad

Question 34

5. __
   is an area of limited access that the licensee establishes for the purpose of protecting individuals against undue risks from exposure to radiation and radioactive materials.
6. __
   is an area in which an individual could receive from an
   external source a maximum dose of 2 mrem (20 mSv)/hr, and access to the area is neither limited nor controlled by the licensee.

Answer 34

Restricted area
Unrestricted area

Question 35

__ in which radioactivity is used or stored are required by the NRC to monitor external radiation exposure.

Daily monitoring with __ is required in areas where radiopharmaceuticals are prepared and administered.

__ monitor are required in areas where radioactive chamber are stored. Places where higher than background levels of radiation should be wipe tested to determine whether the contamination can be removed.

Answer 35

Surveys of areas
Geiger-Muller (GM) counter or ionization chamber
Weekly

Question 36

__ of sites should be carried out if the wipe test indicate that radioactivity is removable

if contamination cannot be removed, __ over the area will remind others about the contamination.

NRC required that records of area surveys and wipe test be maintained for __

Answer 36

Decontamination
taping sheet of paper
3 years

Question 37

involving only a small area of low level of radioactivity, can be handled as outlined
Inform other people working in the area that spill occur
Pour on protective clothing
Confine the spill to a small area as possible

Answer 37

Minor spills

Question 38

If personnel are contaminated, they should decontaminated as soon as possible
__ may involved simply the removal of contaminated clothing or washing affected areas of the skin with mild soap or water.
place all materials use to clean up the spill in plastic bags for monitor and disposal
Monitor the area of the spill with the Geiger-muller
When decontamination is finished, removed all the protective wear and discard with other contaminated materials
__ all discarded materials as radioactive
Notify the RPO about the spill.

Answer 38

Decontamination
Label

Question 39

involving high level of radiation exposure or widespread contamination require special handling. Guidelines for major spills include;
Shut off ventilation, air conditioning and heating systems and fume hoods to contain the spread of airborne contamination

Answer 39

Major Spill

Question 40

Remove contaminated clothing
Evacuate personnel from affected area close and lock all doors to area
__ to inform others
Begin __
Notify the radiation safety officer

Answer 40

Post warning signs
personnel decontamination

Question 41

decay in storage is an __ of disposal for__ radioactive waste such as generated in nuclear medicine department.
The waste is separated according to __ and allowed to decay to __
Radiation waste that contains potentially biohazardous materials, is incinerated after it has decayed to background radiation levels

Answer 41

expensive method
short-lived, low-level
half-life, background levels

Question 42

Disposal of certain soluble materials through the sewer system is allowed, providing the amounts do not exceed calculated limits.
__ (half-life greater than 65 days) radioactive waste is disposed of by transfer to licensed commercial waste handlers

Answer 42

Long-lived

Question 43

radioactive __ and __ are both use for lung ventilation imaging. Both require special handling to prevent the spread of radioactive contamination
__ is administered to the patient from closed system through a mouthpiece making a patient part of the system.

Answer 43

Xenon-gas and Tc-99m aerosol
Radioxenon

Question 44

Chemical/physical operations in the area, e.g./ evaporation, solvent extraction, chemical reactions, stirring in breakers
Minute particulates of the radioactive material getting into the atmosphere
Spillages
In-leakages of contaminated air from fume hoods where radioactive work is progressing.
Spread of contamination due to poor housekeeping habits in the laboratory, e.g. further use of contaminated absorbent material
Transfer of radioactive material from one area to another.

Answer 44

CAUSES OF CONTAMINATION

Question 45

Proper design of working areas
Proper choice of surface materials
Use of correct and appropriate protective clothing
Training of operating personnel
Correct operating procedures
Good housekeeping procedures
Use of appropriate contamination monitoring instruments

Answer 45

PREVENTION OF CONTAMINATION

Question 46

Wet decontamination methods should always be used in preference to dry
Mild decontamination methods should be tried before resorting to treatment which can damage the surfaces involved.
Precautions must always be taken to prevent the spread of the contaminating radioactive material during decontamination operations.
Where possible, contamination involving short-lived activities should be segregated and isolated to allow natural decay to take its course.

Answer 46

Decontamination

Question 47

According to the NRC regulations, the following quality control tests must
be performed at the frequencies indicated:
1. constancy (daily)
2. accuracy (at installation, annually, and after repairs)
3. linearity (at installation, quarterly, and after repairs)
4. geometry (at installation and after repairs).

The measured activity during the QC tests must agree with the stated activity within 10%. Other-wise, the dose calibrator needs repair as replacement.

Answer 47

Dose calibrator quality control