Radiation emergency in Nuclear Medicine

1. RADIATION EMERGENCY
IN NUCLEAR MEDICINE
ARVIND KUMAR GUPTA
MEDICAL PHYSICIST (RSO)
AIIMS JODHPUR

2.  Nuclear medicine, large amounts of unsealed radionuclides are used for
diagnosis of diseases and in the treatment of cancer and abnormalities.
 Any error, carelessness, absence/failure of safety facility/equipment, may lead
to an accident or mishap.
 An accident is an unintended event or mishap, the consequences of which are
not negligible from the radiation protection or safety point of view.
 It is an unplanned abnormal event leading to loss of control over the source of
radiation with actual or potential consequences for person's safety and/or impact on
the environment.

3. SOME EMERGENCY SITUA TIONS
IN NUCLEA R MEDICINE
DEPARTMENT .
 spillage of radio-pharmaceuticals.
 mis-administration of radio-pharmaceuticals to patient,
 loss of sources in the department or in transit.

4. * two other types of mishaps, that can be envisaged in nuclear
medicine and are beyond the control of the radiation worker
1.vomiting of radio-pharmaceutical by the-patient,
2.death of a patient with administered radio-pharmaceuticals in the
body.

5. SPILLAGE OF RADIO-
PHARMACEUTICAL
 Factors leading to spillage
-While working with radio-pharmaceuticals.
-spillage can take place due to tilt of vial
containing radio-pharmaceutical
-leakage from the syringe or splash of liquid.
-vomiting of administered radio-pharmaceutical by the patient results in
spread of radioactivity.

6. PREVENTION OF SPILLAGE
The spillage can be prevented to some extent, by observing following methods:
1. Performing wet and dummy trials prior to handling the radio-pharmaceutical.
2.Keeping vial containing the radio-pharmaceutical in an appropriate outer
container with heavy base in order to avoid tilting of the vial,
3. Performing all wet operations in a tray lined with polythene and absorbent paper
so that the spilled radioactivity is contained and spread of contamination is
restricted,

7. 4. Transporting the radio-pharmaceuticals within the lab in
appropriate shielded transport containers,
5. Preparation of doses in a careful manner by skilled person,
6. Adopting standard code of practice in the preparation of
doses/radio- pharmaceuticals,
7. Ensuring stable condition of patient to avoid vomiting.

8. HANDLING PROCEDURES
OF SPILLAGE
1.Confine the spill immediately, by dropping paper towels or other absorbent
material onto it.
2. Evacuate the immediate area so that persons will not walk over the spill and
spread the contamination.
3. If the spilled material has splashed onto a person or clothing, immediate steps
should be taken to remove the clothes and collect the same in a polythene bag and
to be kept in the radioactive waste storage room, It should be ensured that the
person with contaminated clothes does not leave the area before removing the
protective clothing.

9. 4.Hands and other contaminated areas of the body should be washed
thoroughly with soap and water. Care should be taken not to abrate or
inflame the skin surface,
5. Possible care must be taken to prevent intake of radioactive material.
-If intake of radioactive material has taken place, immediate action should
be taken to prevent or minimise the deposition in organs or tissues.
-If necessary, steps should be taken to bring out the ingested radioactive
material under the expert medical guidance,

10. 6. The internal deposition of radioactive material should be estimated
by carrying out bioassay, whole body counting or both,
7. Contaminated area should be decontaminated by expert team using
appropriate methods,
8. The waste, collected during decontamination of the area, should
be treated as radioactive waste and be disposed as per state safety
guidelines.

11. MIS-ADMINISTRATION OF
RADIO-PHARMACEUTICALS
Types of mis-administration
1. administration of radio-pharmaceutical to a wrong patient,
2. administration of wrong activity,
3. administration of wrong radio pharmaceuticals,
4. administration through wrong route e.g. oral, intravenous injection
or muscular injection,
5. administration of radio-pharmaceutical in pregnant female patient
without confirming the pregnancy.

12. CONSEQUENCES OF MIS-
ADMINISTRATION
 The consequences of mis-administration of radio-pharmaceutical.
(a) non- justified exposure,
(b) increased radiation risks,
(c) delayed diagnosis
(d) increase in cost,
(e) increase in time,
(f) reduction in confidence.

13.  Causes of mis-administration
The main causes of mis-administration of radio-pharmaceuticals in patient are
1. communication problems or gaps,
2. busy environment or distraction,
3. bypassing local rules or code of practice,
4. no training in emergency situations,
5. absence of clearly defined responsibilities,
6. absence of efficient quality assurance programme.

14. PREVENTION OF MIS-
ADMINISTRATION
*Hances of mis-administration of radio-pharmaceuticals in patient can be reduced.
1. using transparent vial and syringe shields,
2. tagging and segregating the vials and syringes with proper labelling,
3.writing the amount of activity, name of the source and the patient on the vial or syringe
containing dose,
4. checking the labels of vial or syringes before administration,
5. checking the labels of vial or syringes before administration,
7. identifying the name, number and case of the patient with his/her case file,
8. ensuring that the female patient is not pregnant,

15. GE NE RAL ME THODS OF PRE VE NTION
OF ACCIDE NTS
 accident of spillage and mis-administration can be avoided by
preparing safe code of practice in the department, putting it in
practice and educating the staff by the RSO in radiation safety of
personnel, patient, members of public and the environment.

16. 1. There should be adequate number of trained staff available in the
department to carry out the emergency plan,
2. The personnel/staff should be instructed to exercise care in
respective areas to avoid situations that may lead to an accident,
3. All radiation monitoring, measuring instruments and safety devices
should be routinely checked and kept in working condition. Handling
equipment e.g. tongs, forceps, etc., should be kept in ready access,

17. 4. A proper inventory of radioisotopes received, used, in stock and disposed should
be maintained.
-Handling of emergency involves variety of actions and involvement of persons in
different fields.
-In many medical institutions, a team of experts,
sometimes referred as the Emergency Response Committee, is formed.
- Each member of the team or committee is assigned specific responsibilities
- Thus it is a teamwork.

18.  The Emergency Response Committee should consist of the following officials:
1. Authorised nuclear medicine physician
2. Physicist
3. Radiation Safety Officer (RSO)
4. Administrative personnel
5. Electronic instrumentation expert
6. Emergency Director
7. Laboratory assistant.

19. DEATH OF PATIENT
ADMINISTERED WITH
RADIOPHARMACEUTICALS
 In case of death of a patient with therapeutic quantity of radio-pharmaceuticals in the body, the body should
be released to relatives only when the levels of activity.
 body is within the permissible limit for cremation, burial, post-mortem or balming, prescribed by AERB.
 If the level of activity is higher than the prescribed limits, the body should be kept in morgue for decay of the
activity and should be released when the levels come down to the prescribed limits.
 the-situation demands immediate release of body, the organs with
accumulated activity be removed before the release. Further, it should be ensured that the amount of activity, even
after removal of vital organs containing radioactivity, at the time of release of body does not exceed the limit.
 The removed organs with radioactivity should be disposed as per the disposal rules.

20.  Thank you