Aplicación a tratamientos de tumores hepáticos con microesferas de
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Análisis radioprotector de los procedimientos diagnósticos y terapéuticos con radioisótopos. Directiva Euratom 59/2013. Second Part: Aplicación a tratamientos de tumores hepáticos con microesferas de Y-90 DANIEL PRIETO MORÁN Radiofísica de la dosimetría interna en los procedimientos terapéuticos con radiofármacos Análisis radioprotector de los procedimientos diagnósticos y terapéuticos con radioisótopos. Directiva Euratom 59/2013 Index Medical Physicist: Article 58 Procedure established Results Dose indicators Measurements of dose rate patients. Rules Waste management Contamination measures Typical values in treatments Emergency Conclusions 2 Análisis radioprotector de los procedimientos diagnósticos y terapéuticos con radioisótopos. Directiva Euratom 59/2013 Medical Physicist colaboration Art. 58 (Procedures) d) i) in radiotherapeutic practices other than standardised therapeutic nuclear medicine practices, a medical physics expert shall be closely involved; Non-standard procedure Unusual area (interventional radiology surgery) High risk of contamination Unencapsulated sources: Tc-99m, Y-90 3 Análisis radioprotector de los procedimientos diagnósticos y terapéuticos con radioisótopos. Directiva Euratom 59/2013 TheraSphereTM Glass microspheres Diameter 20-30 µm Activities available: 3, 5, 7, 10, 15 y 20 GBq (81-540mCi) Y-90 4 Análisis radioprotector de los procedimientos diagnósticos y terapéuticos con radioisótopos. Directiva Euratom 59/2013 Yttrium 90 Pure beta emitter Average Energy 0.93 MeV T1/2 = 64h (2.67 d) Tissue range: 11 – 2.5 mm 5 Análisis radioprotector de los procedimientos diagnósticos y terapéuticos con radioisótopos. Directiva Euratom 59/2013 Our Protocol: Operation room preparation: Background radiation measure (cps) All staff with gloves, and waterproof overshoes Placing underpads Close to the injection area Exit of de room Two containers of radioactive waste Inside the operation room Outside (door) 6 Análisis radioprotector de los procedimientos diagnósticos y terapéuticos con radioisótopos. Directiva Euratom 59/2013 7 Análisis radioprotector de los procedimientos diagnósticos y terapéuticos con radioisótopos. Directiva Euratom 59/2013 Yttrium reception in Nuclear Medicine: Reception and measure the dose rate Activity verification with Dose Calibrator (Tolerance 10%) Assembly and preparation dose Move the kit when the patient is prepared 8 Análisis radioprotector de los procedimientos diagnósticos y terapéuticos con radioisótopos. Directiva Euratom 59/2013 Y-90 Kit´s trip to Radiology department NUCLEAR MEDICINE 9 Análisis radioprotector de los procedimientos diagnósticos y terapéuticos con radioisótopos. Directiva Euratom 59/2013 RADIOLOGY DEPARTMENT 10 Análisis radioprotector de los procedimientos diagnósticos y terapéuticos con radioisótopos. Directiva Euratom 59/2013 Injection procedure (Contamination risk): Injection by nuclear medicine specialist If there were contamination On the patient: Clean with gauze and changing the gloves On the floor: Put more underpads Exit of the room One by one and closing the door to prevent patient contribution Surface contamination detector Return to the room with waterproof overshoes 11 Análisis radioprotector de los procedimientos diagnósticos y terapéuticos con radioisótopos. Directiva Euratom 59/2013 Measures: Hands Feet Chest 12 Análisis radioprotector de los procedimientos diagnósticos y terapéuticos con radioisótopos. Directiva Euratom 59/2013 Catheter removal: Deposit it in the waste bin of methacrylate Injection kit moved to the next room Measure of the staff´s contamination Move the patient in the bed to the next room Move the containers to the other room Measure the distance traveled by the bed in the surgery room If there were contamination change the patient's bed Remove the underpads and put into the container 13 Análisis radioprotector de los procedimientos diagnósticos y terapéuticos con radioisótopos. Directiva Euratom 59/2013 Movement of the patient: Measures possible contamination If there were contamination The room will be closed if it continues decontaminate Measures of the containers Background evacuation as biowaste Different of background send it to warehouse of NM Patient´s measures Contact (close to the liver) 1m Transfer the patient to NM Images 14 Análisis radioprotector de los procedimientos diagnósticos y terapéuticos con radioisótopos. Directiva Euratom 59/2013 Index Medical Physicist: Article 58 Procedure established Results Dose indicators Measurements of dose rate patients. Rules Waste management Contamination measures Typical values in treatments Emergency Conclusions 15 Análisis radioprotector de los procedimientos diagnósticos y terapéuticos con radioisótopos. Directiva Euratom 59/2013 Results Dose Indicator Tc-99m Y-90 Average Median Average Median Time of fluoroscope (min) 11.18 10.87 5.16 2.54 DAP (Gy cm2) 177 151 92 69 Kerma (mGy) 1124 716 221 221 16 Análisis radioprotector de los procedimientos diagnósticos y terapéuticos con radioisótopos. Directiva Euratom 59/2013 Results Patient´s measures Average Median Dose Rate in contact (µSv/h) 26.7 27.7 Dose Rate 1m (µSv/h) 3.4 2.5 17 Análisis radioprotector de los procedimientos diagnósticos y terapéuticos con radioisótopos. Directiva Euratom 59/2013 Restricting Instructions: T1/2= 2.67 days Dose Rate Average “contact”= 26.7 µSv/h No pregnant proximity during 3 days No staff pregnant during 3 days Private room or with a patient 60 year old or more 18 Análisis radioprotector de los procedimientos diagnósticos y terapéuticos con radioisótopos. Directiva Euratom 59/2013 Results Radiactive waste Tc-99m Y-90 Average Median Average Median Internal Container (µSv/h) 2.9 Background Background Background Exterior Container (µSv/h) Background Background Background Background Methacrylate Bin Catheter Y90 30 cm (µSv/h) - - 1 0.9 19 Análisis radioprotector de los procedimientos diagnósticos y terapéuticos con radioisótopos. Directiva Euratom 59/2013 Results Backgrounds of the radiology operating rooms Tc-99m Y-90 Average Median Average Median Before intervention (cps) 19.3 19.1 19.6 18.3 After intervention (cps) 21.4 21.1 21.8 20.5 Only once the room was closed (Tc-99m) 20 Análisis radioprotector de los procedimientos diagnósticos y terapéuticos con radioisótopos. Directiva Euratom 59/2013 Results Contaminations 3 cases of 24 intervention: All of them with Tc-99m First: Radiologist´s hands (without gloves) Second: On the floor at the end. • Decontaminant gel two times Third: Radiologist and Nurse • Hair, glasses, thyroid protector and mandil 21 Análisis radioprotector de los procedimientos diagnósticos y terapéuticos con radioisótopos. Directiva Euratom 59/2013 Worse situation of contamination Localization Radiologist (Bq/cm2) Nurse (Bq/cm2) Thyroid protector 17.6 - Glasses - 12.2 Mandil 13.5 - Hair 8.3 7.1 Cause: misplacement of the syringe Solution: Washing under water flood Thyroid protector, mandil, and glasses retired (1day) 22 Análisis radioprotector de los procedimientos diagnósticos y terapéuticos con radioisótopos. Directiva Euratom 59/2013 Results Typical values of the procedure Average Median Irradiated volume (cm3) 919 575 Pulmonar shunt (%) 11.5 11.7 Prescription dose (Gy) 115 120 Lung dose (Gy) 14.5 5.1 Y-90 activity for treatment (GBq) 2.47 1.69 23 Análisis radioprotector de los procedimientos diagnósticos y terapéuticos con radioisótopos. Directiva Euratom 59/2013 Index Medical Physicist: Article 58 Procedure established Results Dose indicators Measurements of dose rate patients. Rules Waste management Contamination measures Typical values in treatments Emergency Conclusions 24 Análisis radioprotector de los procedimientos diagnósticos y terapéuticos con radioisótopos. Directiva Euratom 59/2013 Emergency Patient needed emergency surgery Non –expose workers Variable number of professionals involved Irradiation risk Contamination risk High activities Risk of deterministic effects for the staff 25 Análisis radioprotector de los procedimientos diagnósticos y terapéuticos con radioisótopos. Directiva Euratom 59/2013 RISKS Irradiation risk: Contamination risk: During all the intervention During all the intervention Photons Beta emission Low dose rate In contact 1 meter High activities Blood Liver No risk of deterministic effects Risk of deterministic effects Estimation < 1mSv Rules 26 Análisis radioprotector de los procedimientos diagnósticos y terapéuticos con radioisótopos. Directiva Euratom 59/2013 Contamination risk Mayor serious risk in contact with the liver Estimation with Varskin 3 Average parameters • Volume • Activity Sphere model Use of surgery gloves No gap 27 Análisis radioprotector de los procedimientos diagnósticos y terapéuticos con radioisótopos. Directiva Euratom 59/2013 Erythema risk (2Gy) Time after administration Contact dose rate with Y-90 volume (h) (Gy/h) Time to onset deterministic effect 2Gy Contact dose rate with Y-90 volume per MBq (h) (Gy / MBq h) 0 0.32 6.25 0.13 2 0.31 6.39 0.12 4 0.31 6.53 0.12 6 0.30 6.67 0.12 10 0.29 6.96 0.11 12 0.28 7.12 0.11 24 0.25 8.10 0.10 36 0.22 9.23 0.09 48 0.19 10.50 0.08 72 0.15 13.62 0.06 96 0.11 17.65 0.05 28 Análisis radioprotector de los procedimientos diagnósticos y terapéuticos con radioisótopos. Directiva Euratom 59/2013 Index Medical Physicist: Article 58 Procedure established Results Dose indicators Measurements of dose rate patients. Rules Waste management Contamination measures Typical values in treatments Emergency Conclusions 29 Análisis radioprotector de los procedimientos diagnósticos y terapéuticos con radioisótopos. Directiva Euratom 59/2013 Conclusions Treatments with contamination risk Higher contamination risk with Tc-99m thanks to the kit of Y-90 injection Medical physicist involved in the whole process There is an established protocol Registration of dose indicators Radiological Protection rules for staff, patients and families Emergency protocol 30 Análisis radioprotector de los procedimientos diagnósticos y terapéuticos con radioisótopos. Directiva Euratom 59/2013 Muchas gracias Radiofísica de la dosimetría interna en los procedimientos terapéuticos con radiofármacos Análisis radioprotector de los procedimientos diagnósticos y terapéuticos con radioisótopos. Directiva Euratom 59/2013 Aplicación a tratamientos de tumores hepáticos con microesferas de Y-90 DANIEL PRIETO MORÁN Radiofísica de la dosimetría interna en los procedimientos terapéuticos con radiofármacos
