Topic 5 Flashcards
Aka Nuclear__, are physicians who use radioactive materials to diagnose and treat disease.
Nuclear medicine radiologist
Nuclear Medicine __ work with nuclear instrumentation and radiation dosimetry
Nuclear medicine physicist
Once known as radiopharmacist, specialize in preparing, dispensing, and distributing radiopharmaceuticals or radioactive drugs
Nuclear pharmacist
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.
Nuclear medicine technologist
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.
Radiation safety officer
__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.
Hospitalization
equal, greater 0.6 GBq
1 meter
equal, greater 25 mSv
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 __.
radioactive iodine (RAI)
radioiodine I-131
urine
saliva, sweat, tears, vaginal secretion and feces
For RAI (I-131) patients with __, one of the most common side effect is hypothyroidism
graves disease
Recommendations for patients undergoing RAI:
Patient should be well hydrated
Patient should urinate frequently
Patient should use antiperspirant medication
Patient should avoid the use of laxatives
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.
Dedicated room
Monitoring px
Furniture and telephone sets are surveyed
Areas suspecting to be contaminated are surveyed
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.
Radiation protection officer (RPO)
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.
1 meter away from the patient and at the door
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.
authorized user, physician
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.
nurse/s
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.
disposable rubber or plastic gloves
urinals, bedpans, emesis basins, etc
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.
5 rem
15 rem
50 rem
0.1 rem
0.5 rem
2 mrem
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.
one meter, 2.5 mR/hr
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.
only disposable items
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.
not
not
short
reasonable distance
Who should be protected in nuclear medicine?
*
*
*
*
How should the people be protected?
*
*
*
Patient
Members of his/her family
Worker
General public
Optimize protection
Justify the exposure
Dose limits
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.
keeping their own radiation exposure as the concept ALARA is applied.
Radioactive Patient
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:
*
*
*
Shielding
Time
Distance
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.
shielding
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.
L-block shield
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.
time distance
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.
long handled tongs
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.
internal radiation exposure
Also, __ . Protective clothing, especially gloves, can minimize absorption through the skin and simplify decontamination if spills occur.
pipetting radioactive solutions by mouth must be strictly prohibited
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.
100 mrem
__ –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.
Unrestricted areas
2mrem
100 mrem
500 mrem
b. __ – must be identified with one of the following signs:
- Caution: __ – this phrases identifies any area which radioactive materials are used to stored in amounts exceeding exempt quantities.
- 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.
Restricted areas
Radioactive Materials
Radiation Area
Isolation rooms
- Caution: __ – this phrase indicates an area in which a major part of the body could receive more than __ (1 mSv) in any one hour
- __- 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.
High Radiation Area, 100 mrem
Very high radiation area
500 rad
- __
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. - __
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.
Restricted area
Unrestricted area
__ 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.
Surveys of areas
Geiger-Muller (GM) counter or ionization chamber
Weekly
__ 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 __
Decontamination
taping sheet of paper
3 years
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
Minor spills
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.
Decontamination
Label
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
Major Spill
Remove contaminated clothing
Evacuate personnel from affected area close and lock all doors to area
__ to inform others
Begin __
Notify the radiation safety officer
Post warning signs
personnel decontamination
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
expensive method
short-lived, low-level
half-life, background levels
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
Long-lived
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.
Xenon-gas and Tc-99m aerosol
Radioxenon
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.
CAUSES OF CONTAMINATION
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
PREVENTION OF CONTAMINATION
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.
Decontamination
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.
Dose calibrator quality control
