Precautions for certain categories of individuals in contact with a patient after radionuclide therapy
https://doi.org/10.21514/1998-426X-2025-18-1-59-69
Abstract
Patients undergoing radionuclide therapy with radiopharmaceuticals may become a radiation source of external exposure. Release of the patients requires strict abidance of radiation safety regulations to minimize exposure to individuals in contact with patient, especially children and pregnant women.
The purpose of the current study was to determine precautions for patients after radionuclide therapy to limit the contact time with others and to develop guidelines to reduce doses to individuals in contact with patient.
Two cases were considered for analysis: contact with young children and co-sleeping with partners. Determination of the necessary time limitations was performed using open-assessed publications and Monte Carlo calculations at different distances from the patient. The results showed that radionuclide therapy with 225Ac, 223Ra, 89Sr, and 90Y would not exceed the limit of 0.3 mSv to individuals in contact with patient after radionuclide therapy, even in the case of no precautions. However, for patients with 131I, 177Lu and 153Sm, precautions to limit the time of close contact with children and co-sleeping with partners are required. The suggested precautions ensure the radiation safety of individuals in contact with the patient after radionuclide therapy by limiting the exposure limits and allow patients to maintain social contacts, which is important for their rehabilitation.
Keywords
About the Authors
L. A. ChipigaRussian Federation
Larisa A. Chipiga, Candidate of Engineering Sciences, Research Fellow, Docent
197101; Mira Str., 8; Saint Petersburg
A. V. Likhacheva
Russian Federation
Anastasia V. Likhacheva, Acting Junior Researcher, Radiation Safety Engineer
Saint Petersburg
I. A. Zvonova
Russian Federation
Irina A. Zvonova, Doctor of Engineering Sciences, Chief Researcher
Protection Laboratory
Saint Petersburg
A. V. Vodovatov
Russian Federation
Aleksandr V. Vodovatov, Candidate of Biological Sciences, Head of Laboratory, Docent
Saint Petersburg
O. Yu. Toskin
Russian Federation
Oleg Yu. Toskin, Head of Department
Radiation Safety Department
Moscow
A. A. Sapelnikov
Russian Federation
Aleksandr A. Sapelnikov, Radiation Safety Engineer
Moscow
K. S. Velichkina
Russian Federation
Kristina S. Velichkina, Engineer
Saint Petersburg
A. S. Terenteva
Russian Federation
Anastasia S. Terenteva, Engineer
Saint Petersburg
A. A. Stanzhevsky
Russian Federation
Andrey A. Stanzhevsky, Doctor of Medical Sciences, Deputy Director for Research
Saint Petersburg
References
1. Evaluation of Medical Exposure to Ionizing Radiation. United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) 2020/2021 Report Volume I. Annex A.
2. Scott AM, Zeglis BM, Lapi SE, Scott PJH, Windhorst AD, Abdel-Wahab M, et al. Trends in nuclear medicine and the radiopharmaceutical sciences in oncology: workforce challenges and training in the age of theranostics. Lancet Oncology. 2024;25(6):e250-e259. DOI: 10.1016/S1470-2045(24)00037-8. Erratum in: Lancet Oncology. 2024;25(8):e336. DOI: 10.1016/S1470-2045(24)00378-4.
3. International Commission on Radiological Protection. Release of patients after therapy with unsealed radionuclides. ICRP Publication 94. Annals of the ICRP. 2004;34(2).
4. International Atomic Energy Agency. Release of Patients After Radionuclide Therapy. Safety Reports Series No. 63. IAEA. Vienna; 2009.
5. Balonov MI, Golikov VYu, Zvonova IA. Radiological Criteria for Patient Release from Clinic after Radionuclide Therapy of Brachytherapy with Sealed Source Implantation. Radiatsionnaya Gygiena = Radiation Hygiene. 2009;2(4): 5-9. (In Russian).
6. Release criteria for patients having undergone radionuclide therapy and criteria or their crossing the state border of the Russian Federation. Radiation Protection Dosimetry. 2011;147(1-2): 254-257. DOI: 10.1093/rpd/ncr308.
7. Narkevich BYa, Lysak YuV. Radiation Safety in the Outpatient Regimen for the Use of Therapeutic Radiopharmaceuticals. Meditsinskaya radiologiya i radiatsionnaya bezopasnost = Medical Radiology and Radiation Safety. 2015;60(4): 27-35. (In Russian).
8. Chipiga LA, Zvonova IA, Vodovatov AV, Petryakova AV, Stanzhevsky AA, Vazhenina DA, et al. Improvement of the approach to definition of patient release criteria after radionuclide therapy. Radiatsionnaya Gygiena = Radiation Hygiene. 2023;16(2): 19-31. (In Russian). DOI: 10.21514/1998-426X-2023-16-2-19-31.
9. Mattsson S, Hoeschen C. Radiation Protection in Nuclear. Medicine. Springer-Verlag Berlin Heidelberg; 2013. 159 p.
10. Chipiga LA, Vodovatov AV, Zvonova IA, Stanzhevsky AA, Petryakova AV, Anokina EE, et al. Management of biological waste of patients after radionuclide therapy. Radiatsionnaya Gygiena = Radiation Hygiene. 2022;15(2): 19-30. (In Russian). DOI: 10.21514/1998-426X-2022-15-2-19-30.
11. Chipiga LA, Vodovatov AV, Petryakova AV, Zvonova IA, Stanzhevsky AA, Maistrenko DN, et al. Justification of differential approach to management of patient biological waste in nuclear medicine departments. Radiatsionnaya Gygiena = Radiation Hygiene. 2022;15(4): 34-44. (In Russian). DOI: 10.21514/1998-426X-2022-15-4-34-44.
12. Demir M, Abuqbeitah M, Uslu-Beşli L, Yıldırım Ö, Yeyin N, Çavdar İ, et al. Evaluation of radiation safety in 177Lu-PSMA therapy and development of outpatient treatment protocol. Journal of Radiological Protection. 2016;36(2): 269-278. DOI: 10.1088/0952-4746/36/2/269.
13. Wanke C, Pinkert J, Szermerski B, Geworski L. Assessment of the radiation exposure of relatives and caregivers of patients treated with Ra-223 - Results of a German multicenter study. Zeitschrift fur Medizinische Physik. 2021;31(1): 58-64. DOI: 10.1016/j.zemedi.2020.09.002.
14. Dauer LT, Williamson MJ, Humm J, O'Donoghue J, Ghani R, Awadallah R, et al. Radiation safety considerations for the use of ²²³RaCl₂ DE in men with castration-resistant prostate cancer. Health Physics. 2014;106(4): 494-504. DOI: 10.1097/HP.0b013e3182a82b37.
15. Serencsits B, Chu BP, Pandit-Taskar N, McDevitt MR, Dauer LT. Radiation Safety Considerations and Clinical Advantages of α-Emitting Therapy Radionuclides. Journal of Nuclear Medicine Technology. 2022;50(1): 10-16. DOI: 10.2967/jnmt.121.262294.
16. NCRP report № 155. Management of Radionuclide Therapy Patients. National Council on Radiation Protection and Measurements, New York; 2007.
17. International Commission on Radiological Protection. Conversion Coefficients for Radiological Protection Quantities for External Radiation Exposures. ICRP Publication 116. Annals of the ICRP. 2010;40(2-5).
Review
For citations:
Chipiga L.A., Likhacheva A.V., Zvonova I.A., Vodovatov A.V., Toskin O.Yu., Sapelnikov A.A., Velichkina K.S., Terenteva A.S., Stanzhevsky A.A. Precautions for certain categories of individuals in contact with a patient after radionuclide therapy. Radiatsionnaya Gygiena = Radiation Hygiene. 2025;18(1):59-69. (In Russ.) https://doi.org/10.21514/1998-426X-2025-18-1-59-69