With the field of theranostics booming in nuclear medicine, it’s crucial that radiology staff are aware of how to safely handle imaging agents, according to a February 26 presentation at ECR in Vienna.
Karen Borg Grima, PhD, of the University of Malta.
Karen Borg Grima, PhD, of the University of Malta in Msida noted that staff (trained radiographers, or radiologic technologists) can be exposed to dangerous radiation doses while unpacking and storing the radiotracers, performing activity measurements, preparing and administering injections, and even handling waste. Yet there is one common factor among all these activities, Grima said.
“The common factor [is] the hands," she said. "The hands here are the part of the body that will tend to get the most radiation.”
Grima encouraged the use of tongs and tweezers when handling radiotracers to increase the distance from the agent and noted that syringes and lead pots are also important everyday working tools. She stressed the importance of limiting the time the hands stay in the radioisotope hood or cabinet.
“I think one of the biggest mistakes may be of trainees in nuclear medicine are that they tend to leave their hands in the radioisotope cabinet while they are waiting for a dose to be calibrated or while waiting for an elution,” she said.
Grima also emphasized the importance of shielding. She said it might be tempting for staff members to think they can withdraw a dose from the radioisotope cabinet without a shield, since it can be done quickly. But even in these instances, not using shielding can incur “nearly 100 times more doses to the hands,” according to Grima.
Another tip is to rotate staff daily, Grima said, so that staff may work in the radiopharmacy one day and in the scanning room the next to even out doses and promote a safe culture. Using dummy sources, such as water instead of technetium-99 to train staff how to handle syringe shields and lead pots outside of the radiopharmacy can also help, she added.
Moreover, ensuring staff safety can align with sustainable use, Grima said. For instance, while iodine-131 and iodine-123 metaiodobenzylguanidine (MIBG) tracers can both be used to image tumors, iodine-131 emits less radiation and thus gives lesser dose to the staff, to patients, and has less environmental impact, she said.
“So it is in a way more sustainable. It's true, it's more costly, but at the end, you have a lot of points that are in its favor and also better diagnostic images,” she noted.
Finally, Grima said she can’t emphasize enough the importance of continuous staff training, especially given the rapid pace at which new radioisotopes entering the field. There may be simulation-based learning programs that can help trainees handle and administer the radiotracers, she added. Ultimately, having a radiographer who is trained in nuclear medicine and expecting that radiographer to then know it all for the years to come is not acceptable, she said.
“Safe practices essentially involve our usual three mantra words: time, distance, and shielding,” Grima concluded.
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