18F-FDG和18F-FET PET-CT检查致受检者辐射剂量研究

目的 估算接受¹⁸F-FDG(¹⁸F-2-deoxy-D-glucose)和¹⁸F-FET(O-2-¹⁸F-fluoroethyl-L-tyrosine)PET-CT全身检查受检者的有效剂量和器官剂量。方法 使用两种PET-CT扫描协议进行全身显像。PET部分的有效剂量和器官剂量利用基于医学内照射剂量(Medical Internal Radiation Dose, MIRD)计算模式的计算程序IDAC 2.1进行计算,CT部分的有效剂量和器官剂量利用VirtualDose软件计算,PET和CT剂量之和为受检者总的有效剂量。结果 在常规PET-CT扫描中,男性受检者受¹⁸F-FDG辐射所致的有效剂量为(4.81 ±1.04) mSv,女性受检者为(6.09 ±0.73) mSv;男性受检者受¹⁸F-FET辐射所致的有效剂量为(2.67 ±0.38) mSv,女性受检者为(3.21 ±0.38) mSv;CT部分男性受检者的有效剂量为(5.63 ±0.32) mSv,女性受检者为(5.51 ±0.29) mSv。¹⁸F-FDG PET-CT检查男性和女性受检者所受总有效剂量分别为(10.44 ±1.09) mSv和(11.60 ±0.79) mSv。¹⁸F-FET PET-CT检查总有效剂量分别为(8.30 ±0.50) mSv和(8.72 ±0.49) mSv。在诊断性CT扫描中,CT扫描致男性受检者的有效剂量为(16.28 ±1.01) mSv,女性受检者为(13.49 ±0.72) mSv;¹⁸F-FDG PET-CT检查男性和女性受检者总有效剂量分别为(21.09 ±1.45) mSv和(19.58 ±1.03) mSv。¹⁸F-FET PET-CT检查总有效剂量分别为(18.95 ±1.08) mSv和(16.70 ±0.81) mSv。结论 不同的PET-CT扫描参数致受检者受到不同大小的辐射剂量,在日常工作中应根据受检者的实际情况,优化PET和CT的采集参数,降低受检者剂量,实践辐射防护最优化。     

福建省部分PET/CT放射工作人员职业受照剂量分析

目的 分析评估福建省PET/CT放射工作人员的职业受照剂量。方法 根据福建省2014-2016年5家PET/CT工作场所周围剂量当量率和放射工作人员个人剂量的监测结果,分析PET/CT放射工作人员职业受照剂量,并与国家标准剂量限值进行比较。结果 放射工作人员人均年有效剂量为0.50 mSv,所有放射工作人员年有效剂量均低于5 mSv。从事放射性药物分装、注射和PET/CT同室摆位作业的放射工作人员,在未采取个人防护措施的情况下,手部、头颈部和胸部位置最大年受照剂量估算值分别为549.0、137.4、134.0 mSv。结论 在正常工作条件下,放射工作人员职业受照剂量处于较低水平,符合相关标准要求。未采用有效的个人防护措施时,放射工作人员的职业受照剂量可超过国家标准职业照射限值。     

PET/CT放射性核素的分装和注射人员受照剂量

目的 测量PET/CT中心分装和注射人员职业受照剂量,为PET/CT中心防护设计和国家防护标准制定提供基本资料。方法 应用普通TLD测量PET/CT中心分装和注射人员胸部、颈部受照剂量,用指环剂量计测量他们手部剂量,每月测量一次,共测量6个月;同时在铅衣内、外相对位置粘贴剂量计,比较两者剂量大小。结果 PET/CT中心分装和注射人员全身剂量较高,他们分担了各自中心集体剂量的64%~94%;甲状腺受照剂量为1.20~1.70mSv/a,个别人员手部剂量超过了500mSv/a;穿铅衣可以将受照剂量减少8%。结论 分装和注射人员是PET/CT中心主要的受照人群,需要采取更多的措施降低他们的受照剂量,尤其是手部剂量。     

Population radiation absorbed dose from nuclear medicine procedures in The Netherlands

The mean radiation absorbed dose per patient and for the whole population per caput per year in the Netherlands from diagnostic nuclear medicine procedures has been estimated using patient data from 10 large hospitals during either 1984 or 1985. The mean effective dose equivalent and the mean gonad dose equivalent per patient were 2.7 mSv and 1.7 mSv, respectively. Extrapolating these figures to all diagnostic nuclear medicine procedures in the Netherlands, the mean effective dose equivalent and the mean gonad dose equivalent per caput per year were 0.037 mSv and 0.024 mSv, respectively.     

A comprehensive dose reconstruction methodology for former rocketdyne/atomics international radiation workers

Incomplete radiation exposure histories, inadequate treatment of internally deposited radionuclides, and failure to account for neutron exposures can be important uncertainties in epidemiologic studies of radiation workers. Organ-specific doses from lifetime occupational exposures and radionuclide intakes were estimated for an epidemiologic study of 5,801 Rocketdyne/Atomics International (AI) radiation workers engaged in nuclear technologies between 1948 and 1999. The entire workforce of 46,970 Rocketdyne/AI employees was identified from 35,042 Kardex work histories cards, 26,136 electronic personnel listings, and 14,189 radiation folders containing individual exposure histories. To obtain prior and subsequent occupational exposure information, the roster of all workers was matched against nationwide dosimetry files from the Department of Energy, the Nuclear Regulatory Commission, the Landauer dosimetry company, the U.S. Army, and the U.S. Air Force. Dosimetry files of other worker studies were also accessed. Computation of organ doses from radionuclide intakes was complicated by the diversity of bioassay data collected over a 40-y period (urine and fecal samples, lung counts, whole-body counts, nasal smears, and wound and incident reports) and the variety of radionuclides with documented intake including isotopes of uranium, plutonium, americium, calcium, cesium, cerium, zirconium, thorium, polonium, promethium, iodine, zinc, strontium, and hydrogen (tritium). Over 30,000 individual bioassay measurements, recorded on 11 different bioassay forms, were abstracted. The bioassay data were evaluated using ICRP biokinetic models recommended in current or upcoming ICRP documents (modified for one inhaled material to reflect site-specific information) to estimate annual doses for 16 organs or tissues taking into account time of exposure, type of radionuclide, and excretion patterns. Detailed internal exposure scenarios were developed and annual internal doses were derived on a case-by-case basis for workers with committed equivalent doses indicated by screening criteria to be greater than 10 mSv to the organ with the highest internal dose. Overall, 5,801 workers were monitored for radiation at Rocketdyne/AI: 5,743 for external exposure and 2,232 for internal intakes of radionuclides; 41,169 workers were not monitored for radiation. The mean cumulative external dose based on Rocketdyne/AI records alone was 10.0 mSv, and the dose distribution was highly skewed with most workers experiencing low cumulative doses and only a few with high doses (maximum 500 mSv). Only 45 workers received greater than 200 mSv while employed at Rocketdyne/AI. However, nearly 32% (or 1,833) of the Rocketdyne/AI workers had been monitored for radiation at other nuclear facilities and incorporation of these doses increased the mean dose to 13.5 mSv (maximum 1,005 mSv) and the number of workers with >200 mSv to 69. For a small number of workers (n=292), lung doses from internal radionuclide intakes were relatively high (mean 106 mSv; maximum 3,560 mSv) and increased the overall population mean dose to 19.0 mSv and the number of workers with lung dose>200 mSv to 109. Nearly 10% of the radiation workers (584) were monitored for neutron exposures (mean 1.2 mSv) at Rocketdyne/AI, and another 2% were monitored for neutron exposures elsewhere. Interestingly, 1,477 workers not monitored for radiation at Rocketdyne/AI (3.6%) were found to have worn dosimeters at other nuclear facilities (mean external dose of 2.6 mSv, maximum 188 mSv). Without considering all sources of occupational exposure, an incorrect characterization of worker exposure would have occurred with the potential to bias epidemiologic results. For these pioneering workers in the nuclear industry, 26.5% of their total occupational dose (collective dose) was received at other facilities both prior to and after employment at Rocketdyne/AI. In addition, a small number of workers monitored for internal radionuclides contributed disproportionately to the number of workers with high lung doses. Although nearly 12% of radiation workers had been monitored for neutron exposures during their career, the cumulative dose levels were small in comparison with other external and internal exposure. Risk estimates based on nuclear worker data must be interpreted cautiously if internally deposited radionuclides and occupational doses received elsewhere are not considered.     

双源CT低剂量适应性序列扫描技术在心律不齐患者冠状动脉CT血管造影(CTA)中的应用价值探讨

目的研究双源CT低剂量适应性序列扫描技术在心律不齐患者冠状动脉CT血管造影(CTA)中的应用价值。方法选择2011年3月—2013年4月在我院行双源CT冠状动脉CTA检查的心律不齐患者128例,分成A组(常规回顾性心电门控螺旋扫描,n=84)和B组(低剂量适应性序列扫描,n=64)。对比两组双源CT冠状动脉CTA的图像,比较两组患者的辐射剂量差异。结果根据冠状动脉血管显像的情况,A组诊断冠状动脉整体≥50%狭窄的特异性、敏感性、阳性预测值、阴性预测值和B组进行比较分析,差异无统计学意义(P>0.05)。A组的有效剂量为(8.0±0.1)mSv,明显高于B组(3.0±0.7)mSv,差异有统计学意义(Z=–9.824,P=0.00)。结论应用双源CT适应性序列扫描技术对心律不齐患者进行CTA检查时,可以明显降低辐射剂量,值得临床推广。     

仿真人体模型测量腹部CT受检者受照剂量研究

目的 通过仿真人体模型实验,针对现在所使用的腹部扫描条件,对患者的受照情况进行全面了解。方法 选择常规扫描参数和低剂量扫描参数,利用仿真人体模型,在相应体表位置和预定孔中插入剂量计,测量体表剂量和器官或组织的吸收剂量,并计算有效剂量。结果 常规剂量组和低剂量组的器官或组织的受照剂量范围分别为0.014~96.7 mGy,0.00148~5.56 mGy,有效剂量结果分别为14.5 mSv和1.52 mSv。结论 合理减少CT检查所致受检者剂量,需要建立科学实用的放射诊断的医疗照射参考(指导)水平。     

A proposal for a generally applicable de minimis dose

This paper presents a proposal for a generally applicable de minimis radiation dose for members of the general public. A de minimis dose defines a level below which control of radiation exposures would be deliberately and specifically curtailed. Thus, such a dose must be set well below established limits on acceptable dose from all sources of exposure and, furthermore, must be below any established dose limit for specific practices. The proposed de minimis level consists of two dose limits: a principal limit on annual committed effective dose equivalent averaged over a lifetime of 0.01 mSv (1 mrem) and a subsidiary limit on committed effective dose equivalent in any year of 0.05 mSv (5 mrem). The proposed values are 1% of the limits on acceptable dose from all sources currently recommended by the International Commission on Radiological Protection (ICRP85), and correspond to a lifetime risk from continuous exposure of about 10(-5).     

Nuclear Medicine Staff Exposure To Ionising Radiation in 18F-FDG PET/CT Practice: a Preliminary Retrospective Study

This retrospective study provides an insight into the levels of radiation exposure of six nuclear medicine (NM) staff (four technologists and two nurses) performing routine diagnostic ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography-computed tomography (PET/CT) at the University Clinical Centre of the Republic of Srpska, Department of Nuclear Medicine and Thyroid Disorders, Banja Luka, Bosnia and Herzegovina. Data analysis included monthly staff exposure measured with personal thermoluminescent dosimeters (TLD) between June and December 2018, quantified in terms of normalised dose for the whole body [Hp(10)] and dominant hand [Hp(0.07)] and their comparison between each staff member and between the two groups (technologists and nurses). The study goal was to establish how our Department compared with reports from other PET/CT centres worldwide in terms of annual number of procedures and exposure limits and whether there could be room for further improvements in radiation protection. The number of procedures rose considerably from 208 in 2016 to 876 in 2019 and was 423 in the observed seven-month period. Mean individual whole-body exposure dose per GBq of injected ¹⁸F-FDG activity, [Hp(10)/A] was 18.55 μSv/GBq for the four technologists and 15.61 μSv/GBq for the two nurses. Mean dominant-hand exposure dose per GBq of injected ¹⁸F-FDG activity [Hp(0.07)/A] was 16.99 μSv/GBq and 25.44 μSv/GBq for the two groups, respectively. The average annual cumulative dose for all staff was (1.06±0.29) mSv for Hp(10) and (1.15±0.32) mSv for Hp(0.07). These results are comparable with those of similar studies. Staff doses were well below the annual limits. Nurses received slightly higher extremity doses than technologists. In view of the increasing trends in the number of PET/CT procedures, dose monitoring should be continued to identify exposure hotspots and maintain doses as low as possible.Key words: ¹⁸F-fluorodeoxyglucose, ALARA principle, automated dispensing systems, occupational dose, positron emission tomography-computed tomography, thermoluminescent dosimeters, TLD     

PET/CT受检者的受照剂量知多少

PET/CT是临床中不可替代的工具。PET/CT受检者的受照剂量是由PET和CT两部分导致的受照剂量之和。本文通过研究数据论述PET/CT受检者受照水平。PET/CT和其他的放射诊断方法一样，均为所获得的益处高于辐射风险。对受检者受照剂量的夸大及忽视均不可取。在满足临床需求的条件下，应尽量控制受检者的受照剂量。     

新疆某医院PET/CT工作场所中辐射性水平及辐射安全管理

目的通过实际测量调查,了解新疆某医院PET/CT工作场所中辐射性水平;提出相应的辐射安全管理对策。方法使用Identifinder-N型X-γ剂量计和能谱仪、FH40G+FHT752型中子剂量当量仪、BH3206型表面沾污仪进行工作场所监测。结果部分工作场所γ外照射明显高于环境本底水平,其中加速器防护门γ辐射剂量率最高达到7.92μGy/h,机房外环境的中子剂量率为辐射环境本底水平,β放射性表面污染属于正常水平;估算出职业工作人员年均有效剂量为3.99mSv,符合5 mSv/a的管理限值。结论应加强对PET/CT工作场所辐射安全管理,降低工作场所环境放射性水平,并提出相应的辐射安全管理对策。     

Relationship between kidney burden and radiation dose from chronic ingestion of U: implications for radiation standards for the public

Metabolic models for U in adults recommended by Wrenn et al. (1985) and the International Commission on Radiological Protection (ICRP 1979a) were used to study the relationship between kidney burden and radiation dose from chronic ingestion of soluble 238U or natural U and whether current radiation standards for the public provide adequate protection against chemical toxicity from U in the kidney. We assumed that the threshold concentration for chemical toxicity is 1 microgram of U g-1 of kidney and that a safety factor of 10 should be applied in limiting kidney burdens for maximally exposed individuals in the general public. We found that a limit on annual effective dose equivalent of 1 mSv (0.1 rem) for chronic exposures of the public from all sources, as recommended by the ICRP (1985) and the National Council on Radiation Protection and Measurements (NCRP 1987), corresponds to concentrations of U in the kidney from chronic ingestion that exceed the assumed threshold for chemical toxicity of 1 microgram g-1 only for 238U using the metabolic model of the ICRP (1979a). However, using either metabolic model (ICRP 1979a; Wrenn et al. 1985), the predicted concentrations of U in the kidney exceeded the limit of 0.1 microgram g-1, based on the assumed safety factor for protection of the public, for both 238U and natural U. From these results, we concluded that chemical toxicity should be considered in developing health protection standards for the public for ingestion of soluble 238U or natural U. Environmental radiation standards for certain practices established by the U.S. Environmental Protection Agency and Nuclear Regulatory Commission (EPA 1987a, 1987b, 1987c, 1987d; NRC 1988a) are consistent with a limit on annual effective dose equivalent of 0.25 mSv (25 mrem) per practice. If the metabolic model of Wrenn et al. (1985) is assumed to be appropriate for chronic ingestion of soluble U in the environment, then the dose limit of 0.25 mSv corresponds to a concentration of 238U or natural U in the kidney that is below the assumed limit of 0.1 microgram g-1 for members of the public. Inhalation of soluble and insoluble U and ingestion of insoluble U were considered. Except for inhalation of soluble U, these modes of intake reduced predicted concentrations in the kidney per unit effective dose equivalent compared with values for ingestion of soluble U. Unresolved issues of importance for determining the significance of chemical toxicity relative to radiation dose in establishing limits on public exposures for U also are discussed.     

低剂量CT在肺癌筛查中的应用研究

目的 探讨肺部结节随访时低剂量CT较常规CT在肺癌筛查中的价值。方法 21名测试者分别行低剂量CT和常规CT检查,所有测试者的检测图像分别由5名专业医师进行独立评估。结果 低剂量CT和常规CT对肺癌的筛查无显著差异。结节病变检出率一致性接近82%（P<0.001）,病变确诊率一致性超过96%（P<0.001）。低剂量CT的肺部辐射剂量范围为1.5~3.6 mSv,仅为常规CT肺部辐射剂量的1/6左右。结论 在肺部结节随访中,低剂量CT能够作为常规CT的有效替代方式,并可减少诊疗过程中的辐射剂量。     

PET/CT中CT自动管电流调制模式下受检者有效剂量的研究

目的 研究PET/CT中CT自动管电流模式下受检者有效剂量与管电流阈值及噪声指数的关系,为确定最优化采集条件提供理论基础。方法 选用GE Discovery ST-16型和Discovery Elite型PET/CT,使用RS-550型仿真人体模型获得PET/CT中CT所致受检者有效剂量。两机型采用相同采集条件,即管电压120 kV,螺距为1.375,转速0.8 s/转,噪声指数（NI）8-30,间隔为2,自动管电流低限均为30 mA,高限为200~350mA,间隔为50 mA。模拟临床PET/CT的头颈部和体部分段扫描方式对仿真人体模型进行扫描。记录各种采集条件下剂量长度乘积（DLP）,计算有效剂量（ED_CT）。结果 采用相同采集条件,CT扫描所致有效剂量随噪声指数增大而降低,且曲线随自动管电流高限的增加而陡峭;Discovery Elite型扫描CT所致受检者全身有效剂量低于Discovery ST-16型。结论 对确定的受检者,PET/CT中CT所致有效剂量随扫描条件不同有较大差异。可以根据不同临床需求,选择最优化采集方案,从而尽可能降低受检者的有效剂量。     

A study of worker dose distributions with respect to ICRP dose limitation recommendations

This paper describes an investigation into the distribution of radiation doses to workers, undertaken at the request of ICRP Committee 4. Three main questions are considered. Firstly, the distribution of annual doses to workers is described. Doses are generally well below the ICRP dose limits and most are below 15 mSv y-1. However, doses are not distributed randomly from year to year. The second part of the paper examines recording levels in use and the implications of using the recording level recommended by the ICRP. The data presented here show that little dosimetric information would be lost and many fewer doses would need to be stored if the ICRP-recommended recording level were used. The last part of the paper considers the distribution of doses in individual monitoring periods. It is shown that the distribution of doses to all individuals in a particular monitoring period is not necessarily the same as the distribution of doses to a particular individual in all monitoring periods. This places limitations on the extent to which missing doses may be estimated from doses to the workforce as a whole.     

CT dose: how to measure, how to reduce

The fundamental radiation dose parameter in computed tomography (CT) is the CT dose index (CTDI), which is an integral under the radiation dose profile of a single axial scan normalized to the nominal x-ray beam width. It estimates the average dose from a multiple-scan examination and is a directly measurable and standardized quantity. From this information, the dose length product (DLP) is calculated, which estimates the total dose delivered over a specific scan length. Finally, effective dose can be estimated and used to reflect the risk of a non-uniform exposure in terms of a whole-body exposure. To manage dose from CT while maintaining diagnostic image quality, scanner manufacturers have implemented tube current modulation, which may occur angularly around the patient, along the long axis of the patient, or both. Dose reductions of 20 to 50% have been reported using tube current modulation schemes. In the past two decades, the capabilities of CT imaging have expanded tremendously, including narrower image widths, improved temporal and spatial resolution, shorter scan times, and cardiac imaging techniques. Yet, the dose per typical exam (e.g., routine abdominal CT) has decreased by a factor of two or more over the same time period. Therefore, patients should be reassured that the benefits of medically-justified and appropriately-performed CT examinations are associated with radiation doses that continue to decrease as technology continues to evolve.     

Measurements of occupational exposure for a technologist performing 18F FDG PET scans

Radiation doses to one PET technologist performing 100 18F FDG (18F fluorodeoxyglucose) imaging procedures were measured in a clinical setting using two types of thermoluminescent dosimeter (TLD) badges, one finger-ring TLD and one electronic pocket dosimeter (EPD). 18F FDG was handled either with unshielded or with viewing window tungsten shielded syringes. The resulting doses using unshielded syringes were 13.8 +/- 0.8 microSv/370 MBq and 14.3 +/- 0.4 microSv/370 MBq, measured with TLD 100 and with TLD 700H/600H, respectively. For the same series of measurements, the doses obtained using shielded syringes were 10.7 +/- 0.4 microSv/370 MBq and 7.2 +/- 2.1 microSv/370 MBq with TLD700H/600H and with EPD, respectively. The dose to the right hand from shielded syringes was 69.3 +/- 5.5 microSv/370 MBq. All these values are within the ICRP recommended dose limits. Extrapolated to 725 examinations per year, the resulting effective dose measured with TLD would be 10 mSv with unshielded and 7.5 mSv with shielded syringes, respectively (25% dose reduction). The doses measured by TLD were consistently higher than those measured by EPD, suggesting that EPD measurements might underestimate occupational doses.     

2017—2021年某市医疗机构放射工作人员职业性外照射个人剂量监测结果分析

目的 分析某市医疗机构放射工作人员职业性外照射个人剂量水平,为放射防护管理提供参考依据。方法 依据《职业性外照射个人监测规范》,采用热释光剂量测读系统对放射工作人员进行职业性外照射个人剂量监测,将每年监测4次及以上的人员作为研究对象,对监测结果进行汇总与分析。结果 2017—2021年共收集3 010人个人剂量监测结果,放射工作人员年有效剂量中位数为0.11 mSv·a^-1。98.84%放射工作人员的年有效剂量≤1.0 mSv;5人年有效剂量>5.0 m Sv。2019年放射工作人员年有效剂量中位数为0.10 mSv·a^-1,低于2017年的0.11 mSv·a^-1、2018年的0.12 m Sv·a^-1和2020年的0.12 mSv·a^-1(P均<0.05);核医学放射工作人员年有效剂量中位数为0.08 mSv·a^-1,低于诊断放射学的0.11 m Sv·a^-1、牙科放射学的0.14 mSv·a^-1...     

介入放射工作人员个人剂量检测结果分析

目的:了解医疗机构从事介入放射工作人员职业性外照射的个人剂量情况。方法:选取浙江省3家综合性医院的介入放射工作人员50名,普通放射工作人员49名,采用个人剂量监测方法进行检测分析。结果:介入放射工作人员人均年有效剂量2.22 mSv,普通放射工作人员为0.36 mSv,介入放射工作人员的年剂量明显高于普通放射工作人员(P<0.01)。介入放射工作人员中高于5 mSv而低于10 mSv,占总数的12.0%,高于10 mSv而低于20 mSv,占总数的8.0%。结论:应加强对介入放射工作人员的放射防护监督与管理,以降低个人剂量水平。     

External effective radiation dose to workers in the restricted area of the Fukushima Daiichi Nuclear Power Plant during the third year after the Great East Japan Earthquake

Since the Great East Japan Earthquake on 11 March 2011, Iitate Village has continued to be classified as a deliberate evacuation area, in which residents are estimated to receive an annual additional effective radiation dose of >20 mSv. Some companies still operate in Iitate Village, with a special permit from the Cabinet Office Team in Charge of Assisting the Lives of Disaster Victims. In this study, we measured the annual effective radiation dose to workers in Iitate Village from 15 January to 13 December 2013. The workers stayed in Iitate for 10 h and left the village for the remaining 14 h each working day. They worked for 5 days each week in Iitate Village, but stayed outside of the village for the remaining 2 days each week. We found that the effective radiation dose of 70% of the workers was <2 mSv, including natural radiation; the maximum dose was 3.6 mSv. We estimated the potential annual additional effective radiation dose if people returned full-time to Iitate. Our analysis supports the plan for people to return to their home village at the end of 2017.