1.Part 4Part 4 Safety of SourcesSafety of Sources Design of facilitiesDesign of facilities IAEA Training Material on Radiation Protection in Nuclear Medicine

2. Part 4. Design 2Nuclear Medicine OBJECTIVEOBJECTIVE To become familiar with the types of sources used in nuclear medicine. To become aware of how the basic principles of defence in depth, safety of sources and optimization are applied to the design of a nuclear medicine facility. To get basic information about shielding calculations. 3. Part 4. Design 3Nuclear Medicine ContentContent SourcesSources Work with sourcesWork with sources Security of sourcesSecurity of sources Defense in depthDefense in depth Categorization of hazardCategorization of hazard Building requirementsBuilding requirements Safety equipmentSafety equipment 4. Part 4. Design of facilitiesPart 4. Design of facilities Safety of SourcesSafety of Sources Module 4.1. SourcesModule 4.1. Sources IAEA Training Material on Radiation Protection in Nuclear Medicine 5. Part 4. Design 5Nuclear Medicine Sealed sources in nuclear medicineSealed sources in nuclear medicine Sealed sources used for calibration and quality control of equipment (Na-22, Mn-54, Co57, Co-60, Cs137, Cd-109, I-129, Ba-133, Am-241). Point sources and anatomical markers (Co- 57, Au-195). The activities are in the range 1 kBq-1GBq. 6. Part 4. Design 6Nuclear Medicine Unsealed sources in nuclear medicineUnsealed sources in nuclear medicine Nuclide Half-life Decay Particle energy(max) (MeV) Photon energy (MeV) Max activity (MBq) H-3 12.4y - 0.016(100%) - 10 C-14 5730y - 0.155(100%) - 0.5 Na-24 15h - 1.39(100%) 1.37(100%) 2.75(100%) 1 S-35 87.2d - 0.17(100%) - 8 K-42 12.45h - 2.0(18%) 3.6(82%) 1.52(18%) 1 K-43 22h - 0.47(8%) 0.83(87%) 1.24(3.5%) more 0.370(85%) 0.390(18%) 0.610(81%) more 1 Ca-45 163d - 0.25(100%) - 0.8 Ca-47 4.5d - 0.66(83%) 0.480(6%) 0.8 Cr-51 27.8d EC (100%) 0.323(8%) 5 Fe-59 45d - 0.27(46%) 0.46(53%) more 1.10(56%) 1.29(44%) more 0.05 Co-57 270d EC (100%) 0.122(88%) 0.136(10%) 0.3 Co-58 71d EC + (85%) 0.47(15%) 0.81(101%) 0.51(30%) 0.3 Cu-64 12.8h - + EC 0.57(38%) 0.66(19%) (43%) 0.51(38%) more 20 Zn-65 64d EC, + (98.5%) 0.33(1.5%) 1.115(51%) 0.5 Se-75 121d EC (100%) 0.140(54%) 0.270(56%) more 0.4 I-125 60d EC (100%) 0.035(8%) X(138%) 5 7. Part 4. Design 7Nuclear Medicine Unsealed sources in nuclear medicineUnsealed sources in nuclear medicine Nuclide Half-life Decay Particle energy (max) (MeV) Photon energy (MeV) Max activity (MBq) P-32 14.3 d - 1.71 (100%) - 200 Sr-89 50.5 d - 1.46 (100%) 0.909 (1%) 150 Y-90 64.2 h - 2.27 (100%) - 5000 I-131 8.04 d - 0.33 (9%) 0.61 (87%) more 0.365 (80%) 0.640 (9%) more 20000 Er-169 9.3 d - 0.03 (100%) - 50 Re-186 90 h - 0.93 (23%) 1.07 (73%) 0.137 (10%) 0.122 (1%) 150 Au-198 2.7 d - 0.96 (99%) more 0.412 (96%) more 2000 8. Part 4. Design 8Nuclear Medicine Unsealed sources in nuclear medicineUnsealed sources in nuclear medicine Nuclide Half-life Decay Particle energy (max) (MeV) Photon energy (MeV) Max activity (MBq) C-11 20.4m + 0.39 (mean) 0.511 (A) 1000 O-15 2.2m + 0.72 (mean) 0.511 (A) 3500 F-18 110m + 0.25 (mean) 0.511 (A) 500 Ga-67 78.3h EC (100%) X(38%) 0.185 (24%) 0.300 (17%) more 250 Se-75 121 d EC (100%) 0.140 (54%) 0.270 (56%) 0.280 (23%) more 10 Kr-81m 13s IT - 0.191 (66%) 6000 Tc-99m 6 h IT - 0.140 (90%) 1000 In-111 2.8d EC (100%) 0.171 (91%) 0.245 (94%) 200 In-113m 1.66h EC (100%) 0.393 (64%) 20 I-123 13.2h EC (100%) X(86%) 0.159 (83%) 400 I-125 60 d EC (100%) X(138%) 0.035 (7%) 10 I-131 8.04d - 0.33 (9%) 0.61 (87%) more 0.365 (80%) 0.640 (9%) more 100 Xe-133 5.27d - 0.34(100%) 0.081 (35%) 500 Tl-201 73 h EC (100%) X(95%) 0.167 (10%) more 150 9. Part 4. Design 9Nuclear Medicine RADIOTOXICITYRADIOTOXICITY Class A. Very high e.g. Am-241, Cf-252 Class B. High e.g. Na-22, Ca-45, Mn-54, Co-60, Sr-89, I-125, I-131 Class C. Medium e.g. C-14, F-18, P-32, Cr-51, Co-57, Ga-67, Se-75, Mo-99, In-111, I-123, Au-198, Tl-201 Class D. Low e.g. H-3, C-11, N-13, O-15, Tc-99m, Xe-133 10. Part 4. Design 10Nuclear Medicine Radionuclide Pure emitter () e.g. ; Tc99m, In111, Ga67, I123 Positron emitters (+ ) e.g. : F-18 , - emitters e.g. : I131, Sm153 Pure - emitters e.g. : Sr89, Y90, Er169 emitters e.g. : At211, Bi213 Diagnostics Therapy Nuclear medicine applicationNuclear medicine application according to type of radionuclideaccording to type of radionuclide 11. Part 4. Design 11Nuclear Medicine 9999 Mo-Mo-99m99m Tc GENERATORTc GENERATOR 99 Mo 87.6% 99m Tc 140 keV T = 6.02 h 99 Tc - 292 keV T = 2*105 y 99 Ru stable 12.4% - 442 keV 739 keV T = 2.75 d 12. Part 4. Design 12Nuclear Medicine Mo-99 Tc-99m Tc-99 66 h 6h NaCl AlO2 Mo-99 +Tc-99m Tc-99m Technetium generatorTechnetium generator 13. Part 4. Design 13Nuclear Medicine Technetium generatorTechnetium generator 14. Part 4. Design 14Nuclear Medicine Technetium generatorTechnetium generator 15. Part 4. Design 15Nuclear Medicine Technetium generatorTechnetium generator 16. Part 4. Design 16Nuclear Medicine Technetium generatorTechnetium generator 17. Part 4. Design 17Nuclear Medicine Technetium generatorTechnetium generator 18. Part 4. Design 18Nuclear Medicine Radionuclide Pharmaceutical Organ Parameter + colloid Liver RES Tc-99m + MAA Lungs Regional perfusion + DTPA Kidneys Kidney function RadiopharmaceuticalsRadiopharmaceuticals 19. Part 4. Design 19Nuclear Medicine RADIOPHARMACEUTICALSRADIOPHARMACEUTICALS Radiopharmaceuticals used in nuclear medicine can be classified as follows: ready-to-use radiopharmaceuticals e.g. 131 I- MIBG, 131 I-iodide, 201 Tl-chloride, 111 In- DTPA instant kits for preparation of products e.g. 99m Tc-MDP, 99m Tc-MAA, 99m Tc-HIDA, 111 In-Octreotide kits requiring heating e.g. 99m Tc-MAG3, 99m Tc-MIBI products requiring significant manipulation e.g. labelling of blood cells, synthesis and labelling of radiopharmaceuticals produced in house 20. Part 4. Design 20Nuclear Medicine RADIOPHARMACEUTICALSRADIOPHARMACEUTICALS Radiopharmaceutical labeling must be performed in accordance with : Radiation safety regulations GMP requirements Requirements of these respective regulations are sometimes conflicting : Manipulation of radioactive material must be performed in closed area under negative air pressure Manufacturing of sterile injectable preparation must be performed under filtered positive air pressure (laminar flow) 21. Part 4. Design of facilitiesPart 4. Design of facilities Safety of SourcesSafety of Sources Module 4.2. Work with sourcesModule 4.2. Work with sources IAEA Training Material on Radiation Protection in Nuclear Medicine 22. Part 4. Design 22Nuclear Medicine Production of radionuclidesProduction of radionuclides Medical cyclotron Industrial cyclotron 23. Part 4. Design 23Nuclear Medicine Preparation and dispensationPreparation and dispensation ofof radiopharmaceuticalsradiopharmaceuticals 24. Part 4. Design 24Nuclear Medicine Laboratory work withLaboratory work with radionuclidesradionuclides 25. Part 4. Design 25Nuclear Medicine Administration ofAdministration of radiopharmaceuticalsradiopharmaceuticals 26. Part 4. Design 26Nuclear Medicine Patient examinationsPatient examinations 27. Part 4. Design 27Nuclear Medicine Animal experimentsAnimal experiments 28. Part 4. Design 28Nuclear Medicine CARE OF RADIOACTIVECARE OF RADIOACTIVE PATIENTSPATIENTS 29. Part 4. Design 29Nuclear Medicine Storage of radionuclidesStorage of radionuclides 30. Part 4. Design of facilitiesPart 4. Design of facilities Safety of SourcesSafety of Sources Module 4.3. Security of sourcesModule 4.3. Security of sources IAEA Training Material on Radiation Protection in Nuclear Medicine 31. Part 4. Design 31Nuclear Medicine LOCATION AND SITING OFLOCATION AND SITING OF SOURCES (BSS)SOURCES (BSS) IV.13. Account shall be taken in choosing the location for any small source within installations and facilities such as hospitals and manufacturing plants of: a) Factors that could affect the safety and security of the source; b) Factors that could affect occupational exposure and public exposure caused by the source, including features such as ventilation, shielding and distance from occupied areas; and c) The feasibility in engineering design of taking into account the foregoing factors. 32. Part 4. Design 32Nuclear Medicine Requirements forRequirements for the Safety of Sourcesthe Safety of Sources General ResponsibilitiesGeneral Responsibilities Licensees shall ensure safety of theLicensees shall ensure safety of the sourcessources A multilevel system of provisions forA multilevel system of provisions for preventing accidentspreventing accidents mitigating consequencesmitigating consequences restoring sources to safe conditionsrestoring sources to safe conditions Use of sound engineering practice on allUse of sound engineering practice on all operations with sourcesoperations with sources 33. Part 4. Design 33Nuclear Medicine Security of sourcesSecurity of sources BSS 2.34: SourcesBSS 2.34: Sources shall be kept secure so asshall be kept secure so as to prevent theft or damage and to prevent anyto prevent theft or damage and to prevent any unauthorized legal person from carrying outunauthorized legal person from carrying out any of the actions specified in the Generalany of the actions specified in the General Obligations for practices of the StandardsObligations for practices of the Standards (see paras 2.7-2.9),(see paras 2.7-2.9), 34. Part 4. Design 34Nuclear Medicine RequirementsRequirements Accountability and security of sourcesAccountability and security of sources Records of source inventory (sourceRecords of source inventory (source characteristics, locations)characteristics, locations) Periodic inventory of sourcesPeriodic inventory of sources Records of receipt, transfer and disposalRecords of receipt, transfer and disposal Transfers only to receiver holding a licenseTransfers only to receiver holding a license Prompt communication of information to thePrompt communication of information to the Regulatory Authority regarding decontrolled,Regulatory Authority regarding decontrolled, lost, stolen or missing sourceslost, stolen or missing sources 35. Part 4. Design 35Nuclear Medicine SECURITY OF SOURCESSECURITY OF SOURCES UseStorage of waste Transport (in house) Storage before use Receipt The security of sources shall be taken into account in the different steps of the lifetime of a source in a hospital 36. Part 4. Design 36Nuclear Medicine Local rules should specify Persons authorized to order radionuclides Routines for delivering radioactive material to the department Routines for check and unpacking of shipment Routines in case of damaged package Routines for check of radionuclide and activity Records to be kept RECEIPT PROCEDURERECEIPT PROCEDURE 37. Part 4. Design 37Nuclear Medicine Source StorageSource Storage Source stores must:Source stores must: provide protection againstprovide protection against environmental conditionsenvironmental conditions be only for radioactivebe only for radioactive materialsmaterials provide sufficient shieldingprovide sufficient shielding be resistant to firebe resistant to fire be securebe secure 38. Part 4. Design 38Nuclear Medicine locked to prevent unauthorized use and theft warning sign shielded to 50000 MBq High hazard Categorization of hazard 58. Part 4. Design 58Nuclear Medicine Category of hazardCategory of hazard (premises not frequented by patients)(premises not frequented by patients) Typical results of hazard calculationsTypical results of hazard calculations High hazard Room for preparation and dispensing radiopharmaceuticals Temporary storage of waste Medium hazard Room for storage of radionuclides Low hazard Room for measuring samples Radiochemical work (RIA) Offices 59. Part 4. Design 59Nuclear Medicine High hazard Room for administration of radiopharmaceuticals Examination room Isolation ward Medium hazard Waiting room Patient toilet Low hazard Reception Category of hazardCategory of hazard ((premises frequented by patients)premises frequented by patients) Typical results of hazard calculationsTypical results of hazard calculations 60. Part 4. Design 60Nuclear Medicine Building requirementsBuilding requirements Category Structural shielding Floors Worktop surfaces of hazard walls, ceiling Low no cleanable cleanable Medium no continuous cleanable sheet High possibly continuous cleanable one sheet folded to walls What the room is used for should be taken into account e.g. waiting room 61. Part 4. Design 61Nuclear Medicine Building requirementsBuilding requirements Category Fume hood Ventilation Plumbing First aid of hazard Low no normal standard washing Medium yes good standard washing & decontamination facilities High yes may need may need washing & special forced special decontamination ventilation plumbing facilities facilities facilities 62. Part 4. Design 62Nuclear Medicine Design ObjectivesDesign Objectives Safety of sources Optimize exposure of staff, patients and general public Maintain low background where most needed Fulfil requirements regarding pharmaceutical work Prevent uncontrolled spread of contamination 63. Part 4. Design of facilitiesPart 4. Design of facilities Safety of SourcesSafety of Sources Module 4.6. Building requirementsModule 4.6. Building requirements IAEA Training Material on Radiation Protection in Nuclear Medicine 64. Part 4. Design 64Nuclear Medicine FloorsFloors Impervious material Washable Chemical-resistant Curved to the walls All joints sealed Glued to the floor No carpet! 65. Part 4. Design 65Nuclear Medicine Walls and ceilingWalls and ceiling Should be finished in a smooth and washable surface with joints being sealed, wherever practicable. Walls should be painted with washable, non-porous paint (e.g. gloss paint). What the room is used for should be taken into account e.g. waiting room 66. Part 4. Design 66Nuclear Medicine Worktop surfacesWorktop surfaces Worktop surfaces must be finished in a smooth, washable and chemical-resistant surface with all joints sealed. Some laminates do not resist certain chemicals, and the supplier should be consulted with regard to the specific chemicals to be used in the laboratory. Open shelving should be kept to a minimum to prevent dust accumulation. Services (e.g. gas, electricity, vacuum) should not be mounted on top of the bench, but on walls or upstands. Light fixtures should be easy to clean and of an enclosed type in order to minimize dust accumulation. 67. Part 4. Design 67Nuclear Medicine Worktop surfacesWorktop surfaces Structural reinforcement may be necessary, since a considerable weight of lead shielding may be placed on counter tops. 68. Part 4. Design 68Nuclear Medicine Worktop surfacesWorktop surfaces Cover the surface with absorbing paper 69. Part 4. Design 69Nuclear Medicine VENTILATIONVENTILATION Laboratories in which unsealed sources, especially radioactive aerosols or gases, may be produced or handled should have an appropriate ventilation system that includes a fume hood, laminar air flow cabinet or glove box. The ventilation system should be designed such that the laboratory is at negative pressure relative to surrounding areas. The airflow should be from areas of minimal likelihood of airborne contamination to areas where such contamination is likely. All air from the laboratory should be vented through a fume hood and must not be recirculated either directly, in combination with incoming fresh air in a mixing system, or indirectly, as a result of proximity of the exhaust to a fresh air intake. 70. Part 4. Design 70Nuclear Medicine VENTILATIONVENTILATION Sterile room negative pressure filtered air Dispensation negative pressure Corridor Injection room Fume hood Laminar air flow cabinets Passage Work bench 71. Part 4. Design 71Nuclear Medicine Alarm system Continuous monitoring of air pressure gradients 72. Part 4. Design 72Nuclear Medicine Fume hoodFume hood The fume hood must be constructed of smooth, impervious, washable and chemical-resistant material. The working surface should have a slightly raised lip to contain any spills and must be strong enough to bear the weight of any lead shielding that may be required. The air-handling capacity of the fume hood should be such that the linear face velocity is between 0.5 and 1.0 metres/second with the sash in the normal working position. This should be checked regularly. 73. Part 4. Design 73Nuclear Medicine PLUMBINGPLUMBING sinks washing facilities patient toilets 74. Part 4. Design 74Nuclear Medicine SinksSinks If the Regulatory Authority allows the release of aqueous waste to the sewer a special sink shall be used. Local rules for the discharge shall be available. The sink shall be easy to decontaminate. Special flushing units are available for diluting the waste and minimizing contamination of the sink. 75. Part 4. Design 75Nuclear Medicine Washing facilitiesWashing facilities The wash-up sink should be located in a low-traffic area adjacent to the work area. Taps should be operable without direct hand contact and disposable towels or hot air dryer should be available. An emergency eye-wash should be installed near the hand-washing sink and there should be access to an emergency shower in or near the laboratory. 76. Part 4. Design 76Nuclear Medicine Patient toiletPatient toilet A separate toilet room for the exclusive use of injected patients is recommended. A sign requesting patients to flush the toilet well and wash their hands should be displayed to ensure adequate dilution of excreted radioactive materials and minimise contamination. The facilities shall include a wash-up sink as a normal hygiene measure. Washrooms designated for use by nuclear medicine patients should be finished in materials that are easily decontaminated. The patient washing facilities should not be used by hospital staff as it is likely that the floor, toilet seat and sink faucet handles will be contaminated frequently. 77. Part 4. Design 77Nuclear Medicine PipesPipes Drain-pipes from the radioisotope laboratory sink should go as directly as possible to the main building sewer, and should not connect with other drains within the building, unless those other drains also carry radioactive material. This is to minimize the possibility of a "back up" contaminating other, non-controlled areas. and the final plans of the drainage system which are supplied to maintenance personnel must show which drains are from radioisotope laboratories. Note: Some countries require that drain-pipes from the nuclear medicine department and especially from isolation wards for patients undergoing radionuclide therapy shall end up in a delay tank. 78. Part 4. Design 78Nuclear Medicine ShieldingShielding Much cheaper and more convenient to shield the source, where possible, rather than the room or the person. Structural shielding is generally not necessary in a nuclear medicine department. However, the need for wall shielding should be assessed e.g. in the design of a therapy ward (to protect other patients and staff) and in the design of a laboratory housing sensitive instruments (to keep a low background in a well counter, gamma camera, etc) 79. Part 4. Design 79Nuclear Medicine Layout of aLayout of a nuclear medicine departmentnuclear medicine department From high to low activity 80. Part 4. Design of facilitiesPart 4. Design of facilities Safety of SourcesSafety of Sources Module 4.7. Safety equipmentModule 4.7. Safety equipment IAEA Training Material on Radiation Protection in Nuclear Medicine 81. Part 4. Design 81Nuclear Medicine Safety equipmentSafety equipment Shields Protective clothing Tools for remote handling of radioactive material Containers for radioactive waste Dose rate monitor with alarm Contamination monitor Decontamination kit Signs, labels and records 82. Part 4. Design 82Nuclear Medicine SHIELDINGSHIELDING Bench top shield Vial shields Syringe shields Structural shielding 83. Part 4. Design 83Nuclear Medicine FORCEPS AND TONGSFORCEPS AND TONGS 84. Part 4. Design 84Nuclear Medicine Containers for radioactive wasteContainers for radioactive waste Several containers should be available in order to segregate the waste at the point of origin (radionuclides, half-lives, glass, paper, syringes etc.) 85. Part 4. Design 85Nuclear Medicine Personal (effective dose, extremity dose & contamination) Workplace (external dose rate & contamination) MONITORING EQUIPMENT 86. Part 4. Design 86Nuclear Medicine EMERGENCY KITEMERGENCY KIT Should be kept readily available for use in an emergency. It may include the following: protective clothing e.g. overshoes, gloves decontamination materials for the affected areas including absorbent materials for wiping up spills, decontamination materials for persons warning notices, portable monitoring equipment bags for waste, tape, labels, pencils. 87. Part 4. Design 87Nuclear Medicine Signs, labels and recordsSigns, labels and records Activity:4312 MBq Volume:12 ml Activity concentration; 359 MBq/ml Date: 2001-10-18 Time: 07.45 Signature:SC Tc99m-MDP DateDate TimeTime ActivityActivity VolumeVolume SignatureSignature Oct 15Oct 15 07.3007.30 22572 MBq22572 MBq 15 ml15 ml SCSC Tc.generator no: A2376 Reference activity: 30 GBq Reference date: Oct 12 12.00 GMT 88. Part 4. Design 88Nuclear Medicine Questions? 89. Part 4. Design 89Nuclear Medicine DISCUSSIONDISCUSSION A hospital is setting up a new nuclear medicine practice with 2 gamma cameras. Discuss the layout, furnishing, safety equipment etc. required in the imaging room. 90. Part 4. Design 90Nuclear Medicine DISCUSSIONDISCUSSION Discuss a programme for daily cleaning of the department. When, where and how? Local rules? 91. Part 4. Design 91Nuclear Medicine DISCUSSIONDISCUSSION A laboratory is performing only preparation and measurements of plasma samples containing Cr-51. What safety equipment is needed? 92. Part 4. Design 92Nuclear Medicine Where to Get More InformationWhere to Get More Information Practical sessionPractical session Visit to a Nuclear Medicine Department, Simulated inspection of facilities Other sessionsOther sessions Part 5.. Occupational exposure Part 8. Medical exposure. Therapy Part 10. Radioactive waste Part 11. Protection of general public Part 12. Potential exposure Further readingsFurther readings IAEA, International Basic Safety Standards for Protection Against Ionizing Radiation and for the Safety of Radiation Sources Safety Series No.115, (1996) IAEA/WHO Manual on Radiation Protection in Hospital and General Practice, Volume 4, Nuclear Medicine. (draft) Saha GB, Fundamentals of Nuclear Pharmacy. 4th edition. Springer Verlag, 1998. ISBN 0-387-98341-4.