Radiation decontamination unit for the community hospital

"Freestanding" radiation decontamination units including surgical capability can be developed and made operational in small/medium sized community hospitals at relatively small cost and with minimal plant reconstruction. Because of the development of nuclear power plants in relatively remote areas and widespread transportation of radioactive materials it is important for hospitals and physicians to be prepared to handle radiation accident victims. The Radiological Assistance Program of the United States Department of Energy and the Radiation Emergency Assistance Center Training Site of Oak Ridge Associated Universities are ready to support individual hospitals and physicians in this endeavor. Adequate planning rather than luck, should be used in dealing with potential radiation accident victims. The radiation emergency team is headed by a physician on duty in the hospital. It is important that the team leader be knowledgeable in radiation accident management and have personnel trained in radiation accident management as members of this team. The senior administrative person on duty is responsible for intramural and extramural communications. Rapid mobilization of the radiation decontamination unit is important. Periodic drills are necessary for this mobilization and the smooth operation of the unit.     

Operation Castle Cascade: managing multiple casualties from a simulated chemical weapons attack

In the wake of the recent terrorist attack on the United States, there is an ever-increasing need for the defense against weapons of mass destruction. The use of explosive devices in combination with chemical agents could result in a community disaster with multiple traumatic and medical injuries. Military medical personnel may be the first called upon due to their unique training and equipment. Operation Castle Cascade was a large-scale exercise on a military instillation involving the apprehension of hostages and detonation of an explosive device containing dimethyl sulfate. We will provide details on the medical management of 50 patients with simulated chemical and traumatic injuries. Issues relating to on-site chemical identification, triage, decontamination, treatment, casualty collection, and transportation of casualties are addressed in this article.     

The trauma continuum-of-care quality forum integration committee system-wide video teleconference

The lessons learned in the care of combat casualties throughout time have been vitally important to the improvement of military medicine. However, often the lessons learned were essentially personal, because the ability to transmit those lessons to other medical personnel was not systematized and organized. In past wars, the transmission of those lessons to other care providers was difficult and often long after the fact. Consultant visits were made and War Medicine conferences were held, but policy changes and actual changes in the mechanisms to provide care often lagged. Lessons learned often were not widely spread until years later. New capabilities in medical communications have permitted the development of real-time casualty care information exchange and rapid policy decision-making. This article describes one such effort.     

Indications and instructions to patients for a positron emission tomography-PET scan. The importance of the hybridic PET/CT-computerised tomography scan and which specialty should be responsible for its function

Indications and instructions to patients for performing a positron emission tomography - PET scan are mentioned. Although PET camera was developed in 1970 its clinical indications were established in about 1998. The hybridic PET/CT- computerized tomography scanner appeared in 2001 and its clinical indications are still under discussion. These discussions refer to both the use of PET/CT as an acquisition correction and anatomic localization device for PET images (AC/A) and to its use as a diagnostic CT scan (dCT). Most of the patients submitted for a PET scan have already done a dCT scan. This was the case in 286 out of the first 300 patients referred to "Evangelismos" hospital in Athens for a PET scan. These two scans can be matched electronically. Extra cost, space, personnel and radiation absorption dose especially in children, are additional factors to be considered in using the PET/CT scanner. The specialty of Nuclear Medicine is now based on the PET camera, its best part and main equipment for molecular imaging. It is very much easier and faster for a Nuclear Medicine physician who routinely reports tomographic PET and SPET images, to be familiar with the CT images than for a Radiologist to get to "know how" about the PET camera and the whole Nuclear Medicine Department. Nuclear Medicine is about open radiation sources, molecular imaging, specific radio-pharmacology, radiobiology, radiation protection etc, while on the other hand in some countries, Nuclear Physicians have already spent, as part of their official training, six months in a Radiology Department whose function is considered to be at least 25% about the CT scanner. We come to the conclusion that the PET/CT scanner should be under the responsibility of the Nuclear Medicine Department and the Radiologist should act as an advisor.     

Techniques for radioactive decontamination in nuclear medicine

Working with unsealed radioactive sources in nuclear medicine carries the potential risk of contamination. Careful design of a department and its operational procedures will minimize but never completely eliminate the possibility of such incidents occurring. Contingency planning forms as important a part of handling such incidents as the procedures to reduce the hazard once an incident has occurred. It should include anticipating where such incidents are likely to occur, training and exercising staff in the appropriate procedures to deal with these incidents, providing a comprehensive decontamination kit, and implementing a routine contamination monitoring survey. Assessing the magnitude of the radiation hazard and the effect of decontamination efforts, containing the spread of contamination, minimizing the radiation dose to individuals, and continuing to decontaminate to the lowest level possible are principles to follow in managing any incident. Nuclear medicine staff should be familiar with techniques for decontaminating different anatomical sites on the body; for eliminating or reducing the uptake of radioactivity absorbed into the body; and for decontaminating dry and wet surfaces, equipment, clothing, and bedding. Radiopharmaceutical dispensing procedures, ventilation scanning, and decontaminating 131I treatment areas are identified as the most likely causes of body surface and internal contamination of nuclear medicine staff.     

Is hybridic positron emission tomography/computerized tomography the only option? The future of nuclear medicine and molecular imaging

As we all know, Nuclear Medicine is the medical science using nuclear radiation for diagnosis, treatment and research. Nuclear Medicine, in contrast to Radiology, makes use of unsealed sources of radiation. Nuclear Medicine a few years ago has partly offered Nuclear Cardiology, the most lucrative of all Nuclear Medicine "children" at that time, to Cardiology. Radiology, has succeeded in being recognized by the European Union Authorities as Clinical Radiology. The word "clinical" offers greater independence to Clinical Radiology and makes it difficult for such a specialty to relinquish any of its equipment i.e. the diagnostic CT scan or the newly developed fast angiography CT, to other specialties. Contrary to Clinical Radiology, Nuclear Medicine being a laboratory specialty in most countries seems to have no right to deny offering, after some period of "proper certified education", its PET camera to Clinical Radiologists. Nuclear Medicine by virtue of its unique diagnostic techniques and treatments, is and should be recognized as a "Clinical Specialty" The interference of other specialties in the fields of Nuclear Medicine is also indicated by the fact that in vitro techniques of Nuclear Medicine are often used by Endocrinologists and Oncologists in their own laboratories. Also in some hospitals the Director of the Radiology Department acts as the Director of Nuclear Medicine Laboratory. Finally at present, Radiologists wish after "proper certified education", to be on equal terms in charge of the new hybridic equipment, the PET/CT scanner. If that is followed to happen, Nuclear Medicine will be in a difficult position losing at least part of PET and consequently should ask for help from its "Overlords and Protectors" i.e. the National and the European Societies of Nuclear Medicine and the Society of Nuclear Medicine of the United States of America. Radiology as a specialty participating om equal terms with the PET camera will then include the study of: a) "open sources of radiation" b) nuclear radiation and c) molecular nuclear medicine. The "European Journal of Nuclear Medicine and Molecular Imaging" shall have to erase the three last words of its title and be renamed. As Professor Abass Alavi et al (2007), have mentioned: "Is PET/CT the only option?" In favor of PET/CT are the following: Attenuation correction (AC) and better anatomical localization of lesions visualized with PET. Also PET/CT can be used as a diagnostic CT scanner (dCT). Against using the PET/CT scanners are the following arguments: a) This equipment is not necessary because we can always ask the Radiologists for a dCT scan. Many patients have already done a dCT scan at the time they are referred for a PET scan to the Nuclear Medicine Department. b) The absolute clinical indications for PET/CT with the use of a contrast agent, are under investigation. c) Although there is at present a list of indications suggested for the PET/CT scanner, there are studies disputing some of these indications, as for example in metastatic colon cancer where a high diagnostic accuracy for PET study alone, has been reported. d) The option of AC performed by the PET/CT scanner has also been questioned. Artifacts may be up to 84%. e) The PET/CT is expensive, time consuming, space occupying, and needs additional medical and technical personnel. f) Not to mention the extra radiation dose to the patients. g) Shall we inform those young medical students who wish to become nuclear medicine physicians, to hold their decision till the content of future Nuclear Medicine is clarified? We may suggest that: Our specialty could be renamed as: "Clinical Nuclear Medicine" and include additional "proper certified education" on the PET/CT equipment. The PET/CT scanner should remain in the Nuclear Medicine Department where Radiologists could act as advisors.     

Management of individuals accidentally exposed to radiation or radioactive materials

Sources of ionizing radiation are being used with increasing frequency in a wide spectrum of applications in society. These uses are accompanied by the possible occurrence of accidents resulting in persons exposed to radiation and contaminated with radioactivity. These persons pose a risk to facilities and attending personnel upon their arrival at the hospital. This risk can be minimized without compromising the quality of patient care only if careful planning for such patients has been conducted by the hospital. Planning should include identification of a radiation emergency area within the hospital, delineation of a radiation emergency response team of individuals knowledgeable about radiation and radioactivity, and development of protocols for the medical care and decontamination of patients involved in radiation accidents. Various agencies, including the Joint Commission on Accreditation of Hospitals, have stressed the need for preparation and periodic testing of radiation emergency response plans for hospitals.     

Containment aircraft transit isolator

The Containment Aircraft Transit Isolator is a self-contained unit capable of transporting a patient with a highly virulent disease and at the same time providing maximum microbiological security while full nursing care and treatment are carried out. The isolator was employed in a trans-Atlantic simulated aeromedical evacuation in a Canadian Forces Boeing 707. During the exercise, flight testing was undertaken and nursing care, treatment, and decontamination procedures were developed and evaluated. Flight medical personnel were trained in the use of the unit. It was concluded that flight-trained medical teams, well versed in general aviation medicine and with a detailed familiarity with the isolator, are necessary for safely transporting patients with exotic diseases.     

Expanding the scope of practice for radiology managers: radiation safety duties

In addition to financial responsibilities and patient care duties, many medical facilities also expect radiology department managers to wear "safety" hats and complete fundamental quality control/quality assurance, conduct routine safety surveillance in the department, and to meet regulatory demands in the workplace. All managers influence continuous quality improvement initiatives, from effective utilization of resource and staffing allocations, to efficacy of patient scheduling tactics. It is critically important to understand continuous quality improvement (CQI) and its relationship with the radiology manager, specifically quality assurance/quality control in routine work, as these are the fundamentals of institutional safety, including radiation safety. When an institution applies for a registration for radiation-producing devices or a license for the use of radioactive materials, the permit granting body has specific requirements, policies and procedures that must be satisfied in order to be granted a permit and to maintain it continuously. In the 32 U.S. Agreement states, which are states that have radiation safety programs equivalent to the Nuclear Regulatory Commission programs, individual facilities apply for permits through the local governing body of radiation protection. Other states are directly licensed by the Nuclear Regulatory Commission and associated regulatory entities. These regulatory agencies grant permits, set conditions for use in accordance with state and federal laws, monitor and enforce radiation safety activities, and audit facilities for compliance with their regulations. Every radiology department and associated areas of radiation use are subject to inspection and enforcement policies in order to ensure safety of equipment and personnel. In today's business practice, department managers or chief technologists may actively participate in the duties associated with institutional radiation safety, especially in smaller institutions, while other facilities may assign the duties and title of "radiation safety officer" to a radiologist or other management, per the requirements of regulatory agencies in that state. Radiation safety in a medical setting can be delineated into two main categories--equipment and personnel requirements--each having very specific guidelines. The literature fails to adequately address the blatant link between radiology department managers and radiation safety duties. The breadth and depth of this relationship is of utmost concern and warrants deeper insight as the demands of the regulatory agencies increase with the new advances in technology, procedures and treatments associated with radiation-producing devices and radioactive materials.     

The Ramstein airshow disaster

In August 1988 an aircraft of the Italian aerobatic display team fell into the spectator enclosure at the Ramstein Airshow, causing over 500 casualties. The survivors were triaged, treated and evacuated from Ramstein within 96 minutes. The speed and efficiency of this evacuation was a result of prior planning, thorough training, medical reinforcement, co-operation with other agencies and the availability of an abundance of vehicles for both air and road evacuation. Not suprisingly, though, problems did occur, especially with communications, casualty identification and documentation.     

Manual on the proper use of lutetium-177-labeled somatostatin analogue (Lu-177-DOTA-TATE) injectable in radionuclide therapy (2nd ed.)

Here we present the guideline for the treatment of neuroendocrine tumors using Lu-177-DOTA-TATE on the basis of radiation safety aspects in Japan. This guideline was prepared by a study supported by Ministry of Health, Labour, and Welfare, and approved by Japanese Society of Nuclear Medicine. Lu-177-DOTA-TATE treatment in Japan should be carried out according to this guideline. Although this guideline is applied in Japan, the issues for radiation protection shown in this guideline are considered internationally useful as well. Only the original Japanese version is the formal document.     

A unified emergency care system from first aid to definitive care

The Unified Emergency Care System (UECS) provides an integrated system of medical support from point of injury to the time a casualty is handed over to specialist care within hospital. It enables personnel at all skill levels to deliver life-saving support to casualties with a broad range of acute injuries and illness. The UECS facilitates standardised training with each level building upon the previous, yet it retains an inherent flexibility to adapt to specific operational and service requirements.     

Status and problems of postgraduate training of medical staff of Disaster Medicine Service

An analysis of the postgraduate training of doctors of Disaster Medicine Service in the central and local training bases in the federal districts of Russian Federation in 2010 is performed. It was concluded that the existing Department of Emergency Medicine and mobilization training and health education can not reach those who need further training. It was proposed to create on the basis of a FSI VTSMK "Protection" Institute of Emergency Medicine to improve the training of doctors, training and methodological support of teaching and training of the teaching staff.     

ACR–ABS–ACNM–ASTRO–SIR–SNMMI practice parameter for selective internal radiation therapy or radioembolization for treatment of liver malignancies

PurposeThe American College of Radiology (ACR), American Brachytherapy Society (ABS), American College of Nuclear Medicine (ACNM), American Society for Radiation Oncology (ASTRO), Society of Interventional Radiology (SIR), and Society of Nuclear Medicine and Molecular Imaging (SNMMI) have jointly developed a practice parameter on selective internal radiation therapy (SIRT) or radioembolization for treatment of liver malignancies. Radioembolization is the embolization of the hepatic arterial supply of hepatic primary tumors or metastases with a microsphere yttrium-90 brachytherapy device.Materials and MethodsThe ACR -ABS -ACNM -ASTRO -SIR -SNMMI practice parameter for SIRT or radioembolization for treatment of liver malignancies was revised in accordance with the process described on the ACR website (https://www.acr.org/ClinicalResources/Practice-Parameters-and-Technical-Standards) by the Committee on Practice Parameters—Interventional and Cardiovascular Radiology of the ACR Commission on Interventional and Cardiovascular, Committee on Practice Parameters and Technical Standards—Nuclear Medicine and Molecular Imaging of the ACR Commission on Nuclear Medicine and Molecular Imaging and the Committee on Practice Parameters—Radiation Oncology of the ACR Commission on Radiation Oncology in collaboration with ABS, ACNM, ASTRO, SIR, and SNMMI.ResultsThis practice parameter is developed to serve as a tool in the appropriate application of radioembolization in the care of patients with conditions where indicated. It addresses clinical implementation of radioembolization including personnel qualifications, quality assurance standards, indications, and suggested documentation.ConclusionsThis practice parameter is a tool to guide clinical use of radioembolization. It focuses on the best practices and principles to consider when using radioemboliozation effectively. The clinical benefit and medical necessity of the treatment should be tailored to each individual patient.     

Respiratory protection for Health Care Workers

Chemical, Biological, Radiological and Nuclear incidents are rare, but the likelihood of any medical facility having to deal with contaminated or contagious casualties is not, Health Care Workers (HCW) often being exposed to infectious or toxic substances. Although medical staff routinely take measures to protect themselves against exposure to infection by wearing protective clothing, they rarely consider the inhalational route as a threat. This paper presents a series of cases where HCW's have been exposed to toxic or infectious material through the respiratory route, discusses standards of respiratory protection and describes how this risk can be mitigated to protect medical personnel.     

Are you ready?��lessons learned from the Fort Hood shooting in Texas

On November 5, 2009, a US Army psychiatrist allegedly opened fire with one or more handguns, killing 12 military personnel and one civilian at Fort Hood in Killeen, Texas. The most severely wounded casualties were transported to Scott and White Memorial Hospital, a Level I trauma center and tertiary care teaching hospital in Temple, Texas associated with the Texas A&M University College of Medicine. Ten victims arrived in a 1-h period with another two arriving in the second hour, necessitating an emergency response to a mass casualty event. Our radiology department's response was largely unplanned and was therefore the result of many spontaneous actions and ideas. We share our experiences and from them formulate guidelines for a general radiology surge model for mass casualty events. It is our hope to raise awareness and help other radiology departments to prepare for such an unexpected event.     

Joint service training for medical readiness

Medical Readiness Training is of major importance in preparing to meet the challenge of medical care during wartime and national emergencies or disasters. As an alternative to simulated casualty training, the U.S. Public Health Service and the U.S. Army joined forces to provide "real world" medical care for troops during training. Although simulated training provides insight into casualty and trauma medicine, it is felt that many aspects of real medical care are often ignored or taken for granted. Providing medical care under austere field conditions provides a realistic environment and presents situations that can not be evaluated by simulated training.     

Nuclear medicine in responding to global pandemic COVID-19—American College of Nuclear Medicine member experience

European Journal of Nuclear Medicine and Molecular Imaging - In the global pandemic COVID-19, it is important for everyone including nuclear medicine personnel to know how to stop transmission and...     

Radiation exposure and dosimetry in transplant patients due to nuclear medicine studies.

Organ transplantation is now an accepted method of therapy for treating patients with end stage failure of kidneys, liver, heart or lung. Nuclear Medicine may provide functional data and semi-quantitative parameters. However, one serious factor that hampers the use of nuclear medicine procedures in transplant patients is the general clinical concern about radiation exposure to the patient. This leads us to discuss the effective doses and radiation dosimetry associated with radionuclide procedures used in the management and follow-up of transplant patients. A simple way to place the risk associated with Nuclear Medicine studies in an appropriate context is to compare the dose with that received from a more familiar source of exposure such as from a diagnostic X-ray procedure. The radiation dose for the different radiopharmaceuticals used to study transplant organ function ranges between 0.1 and 5.3 mSv which is comparable to X-ray procedures with the exception of 201Tl and 111In-antimyosin. Thus Nuclear Medicine studies do not bear a higher radiation risk than the often used X-ray studies in transplant patients.     

Dosimetry of iodine 131 metaiodobenzylguanidine for treatment of resistant neuroblastoma: results of a UK study

In 1987, the United Kingdom Children's Cancer Study Group (UKCCSG) set up a multi-centre study to investigate the toxicity of iodine 131 metaiodobenzyl-guanidine (mIBG) in the treatment of resistant neuroblastoma. Since December 1987, 25 children suffering from neuroblastoma have been treated with¹³¹I-mIBG at six UK centres. All centres followed standardised physics and clinical protocols to provide consistent toxicity and dosimetry data. These protocols describe the methods employed for both the tracer study using¹³¹I-mIBG and the subsequent therapy. Whole-body dosimetry calculations were performed on data from the tracer study. The activity administered for therapy was the amount predicted to deliver a predefined whole-body dose. Estimates of doses delivered to various organs during treatment are given in Table 1.On behalf of the mIBG Targetting Group of the United Kingdom Children's Cancer Study Group (UKCCSG), University of Leicester, Leicester, UK:Members of the mIBG Targetting Group: Christie Hospital, Manchester- P. Nuttall, S. Owens (Physics), H.R. Gattamaneni (Radiotherapy); Cookridge Hospital, Leeds - M. Sheppard, S. Packar (Physics), S. Cartright, R. Taylor (Radiotherapy); Newcastle General Hospital - A. Simpson, P. Bartholomew (Physics), H. Lucraft (Radiotherapy); Medical School, University of Newcastle upon Tyne - A. Pearson (Paediatric Oncology); Royal Hospital for Sick Children, Edinburgh - T. Eden (Paediatric Oncology); Royal Manchester Childrens' Hospital - P. Morris-Jones (Paediatric Oncology); Royal Marsden Hospital, Sutton - R. Ott, M. Rosenbloom (Physics), S. Meller, R. Corbett, R. Pinkerton (Paediatric Oncology); Royal South Hants Hospital, Southampton - V. Hall (Radiotherapy); Royal Victoria Infirmary, Newcastle upon Tyne - A. Craft (Paediatrics); Southampton General Hospital - G. Blake, M. Tristam (Physics), J. Kohler (Paediatric Oncology), V. Lewington (Nuclear Medicine); St Bartholomews Hospital, London - K. Britton, L. Hawkins (Nuclear Medicine), J. Kingston, J. Moyes (Paediatric Oncology), J. Malpas (Oncology), N. Plowman (Radiotherapy); Western General Hospital, Edinburgh - J. Hannan (Physics), M. Merrick (Nuclear Medicine), A. Rodger (Radiotherapy); Western Infirmary, Glasgow - T. Hilditch (Physics), A. Barrett (Radiotherapy), T. Wheldon, J. O'Donoghue (Radiobiology); Amersham International, Bucks-R. Bayly; UKCCSG Offices, Leicester-J. Barnes.