LEVELS OF PATIENTS EXPOSURE AND A POTENTIAL FOR OPTIMIZATION OF THE PET DIAGNOSTICS IN THE RUSSIAN FEDERATION

This study presents an overview of the most common positron emission tomography examinations in Russia, as well as the acquisition protocols and patient doses. The data collection was performed in 2012–2017 in 19 positron emission tomography departments in 12 regions of the Russian Federation by questioning the staff. The majority of the Russian positron emission tomography departments were equipped by modern positron emission tomography scanners combined with computed tomography. In each investigated department, data on all types of positron emission tomography examinations, radiopharmaceuticals, administered activities used for standard patient (body mass 70±5 kg) and parameters of computed tomography protocols was collected. The effective doses of patients from combined positron emission computed tomography examinations were estimated as a sum of the dose from the internal exposure (injected radiopharmaceutical) and the external exposure (computed tomography scan). Whole body positron emission tomography examinations in Russia were commonly performed with 18F-fluorodeoxyglucose (¹⁸F-FDG), ¹⁸F-choline, ¹¹С-choline, ⁶⁸GaPSMA, ⁶⁸Ga-DOTA-TATE, ⁶⁸Ga-DOTA-NOC, brain examinations – ¹⁸F-FDG, ¹¹С-metionine, ¹⁸F-choline, ¹⁸F-tyrosine, myocardial perfusion – ¹³N-ammonie.

The highest patient effective doses (about 17 mSv) were observed for whole-body positron emission computed tomography examinations; for brain examinations – 3,4 – 4,8 mSv; for myocardial perfusion – 2,8 mSv. The computed tomography scan contributes up to 65 – 95% to the total patient effective dose for whole body examinations; 20 – 30% for head examinations. For the multiphase computed tomography scan effective doses may be increased to: 15 mSv for head examinations, 25 – 30 mSv for whole body examinations and 35 – 40 mSv for myocardial examinations. A standardization of acquisition and processing protocols is necessary for optimization of positron emission tomography examinations in Russia and for the intercomparison of results obtained in different positron emission tomography departments. Low dose computed tomography protocols, justification of diagnostic and multiphase computed tomography protocols, application of tube current modulation system and modern reconstruction algorithms, education and training of the staff in the field of radiation protection should be used for optimization of radiation protection of patient. 

1. Official website of the Centre for Development of Nuclear Medicine. Available from: http://www.cdnm.ru/ (Accessed: 30.09.2017) (In Russian).

2. Kostylev V.A., Ryzhikova O.A., Sergienko V.B. Status and prospects for development of positron emission tomography methods in Russia. Meditsinskaya fizika = Medical physics, 2015, № 2, pp. 5-16. (In Russian).

3. Dubinkin D.O. On harmonization of radiation safety for development of nuclear medicine in Russia. Proceedings of the International scientific practical conference Actual issues of radiation hygiene, 2014 October 1-3, St-Petersburg. Available on: http://www.fcpr.ru/netcat_files/userfiles/NIIRG_021014/Doklad-FTsPR_Dubinkin.pdf/ (Accessed: 30.09.2017) (In Russian).

4. A Guide to Clinical PET in Oncology: Improving Clinical Management of Cancer Patients. IAEA-TECDOC-1605. International Atomic Energy Agency. Vienna, Austria, 2008.

5. Boellaard R., Delgado-Bolton R., Oyen W.J.G., Giammarile F. (et al.). FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging, 2015, Vol. 42, pp. 328–354.

6. Anderson T., Elman S., Matesan M., Carnell J. (et al.). Pictorial Review of NCCN Guidelines for Use of FDG PET in Oncology. J Nucl Med, 2017, Vol. 58, № supplement 1 974.

7. Delbeke D., Coleman R.E., Guiberteau M.J., Brown M.L. Procedure Guideline for Tumor Imaging with 18F-FDG PET/ CT 1.0. J Nucl Med, 2006, Vol. 47, №5, pp. 885-895.

8. Shiryaev S.V., Dolgushin B.I., Khmelev A.V. PET status of cancer diagnostics. Vestnik Moskovskogo onkologicheskogo obshchestva = Journal of the Moscow cancer society, 2006, №3, pp. 1-9. (In Russian).

9. International Commission on Radiological Protection. The 2007 Recommendations of the International Commission on Radiological Protection. ICRP Publication 103. Ann.ICRP 37, №2-4: 2007.

10. International Commission on Radiological Protection. Radiological Protection in Medicine. ICRP Publication 105. Ann. ICRP 37, №6: 2007. http://www.icrp.org/docs/P105Russian.pdf; http://niirg.ru/PDF/ICRP-105%20Ru.pdf (Accessed: 30.09.2017). (In Russian).

11. Martin C.J. Effective dose: how should it be applied to medical exposures? The British Journal of Radiology, 2007, Vol. 80, pp. 639–647.

12. Iball G.R., Bebbington N.A., Burniston M. (еt al.). A national survey of computed tomography doses in hybrid PET-CT and SPECT-CT examinations in the UK. Nuclear Medicine Communications, 2017, Vol. 38, pp. 459–470.

13. Willowson K.P., Bailey E.A., Bailey D.L. A retrospective evaluation of addition dose associated with low dose FDG protocols in whole-body PET/CT. Australas Phys Eng Sci, 2012, Vol. 35, №1, pp. 49-53.

14. Radiation Protection 180 pt. 2. Diagnostic Reference Levels in Thirty-six European Countries. European Commission, 2014, 73 p.

15. Avramova-Cholakova S., Ivanova S., Petrova E., Garcheva M., Vassileva J. Patient Doses from PET-CT Procedures. Radiation Protection Dosimetry, 2015, Vol. 165, №1–4, pp. 430–433.

16. Etard C., Celier D., Roch P., Aubert B. National survey of patient doses from whole-body FDG PET-CT examinations in France in 2011. Radiation Protection Dosimetry, 2012, Vol. 152, № 4, pp. 334–338.

17. Kwon H.W., Jong Phil Kim, Hong Jae Lee, Jin Chul Paeng (et al.). Radiation Dose from Whole-Body F-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography: Nationwide Survey in Korea. J Korean Med Sci, 2016, Vol. 31, pp. S69-74.

18. Mattsson S., Söderberg M. Radiation Dose Management in CT, SPECT/CT and PET/Ct Techniques. Radiation Protection Dosimetry, 2011, Vol. 147, №1–2, pp. 13–21.

19. Vodovatov А.V., Kamyshanskaja I.G., Drozdov A.A. New approach for the determination of the standard patient to be used for the optimization of the medical exposure protection. Radiatsionnaya Gygiena = Radiation Hygiene, 2014, Vol. 7, №4, pp. 104-116. (In Russian).

20. International Commission on Radiological Protection. Radiation Dose to Patients from Radiopharmaceuticals: A Compendium of Current Information Related to Frequently Used Substances. ICRP Publication 128. Ann. ICRP 44(2S), 2015.

21. Herrmann K., Bluemel C., Weineisen M., Schottelius M. (et al.). Biodistribution and radiation dosimetry for a probe targeting prostate-specific membrane antigen for imaging and therapy. J Nucl Med, 2015, Vol. 56, №6, pp. 855-61.

22. Sandström M., Velikyan I., Garske-Román U., Sörensen J. (et al.). Comparative biodistribution and radiation dosimetry of 68Ga-DOTATOC and 68Ga-DOTATATE in patients with neuroendocrine tumours. J Nucl Med, 2013, Vol. 54, №10, pp. 1755-1759.

23. Chipiga L., Golikov V., Shleenkova Е., Pozdnyakov А. Estimation of the conversion coefficients from dose length product to effective dose from whole body computed tomography examination using anthropomorphic phantoms. Meditsinskaya fizika = Medical physics, 2016, Vol. 4, pp. 55-62. (In Russian).

24. Stauss J., Franzius C., Pfluger T., Juergens K.U. Guidelines for 18F-FDG PET and PET-CT imaging in paediatric oncology. Eur J Nucl Med Mol Imaging, 2008, Vol. 35, №8, pp. 1581-1588.

25. Surti S. Update on Time-of-Flight PET Imaging. J Nucl Med, 2015, Vol. 56, №1, pp. 98-105.

26. Sureshbabu W., Mawlawi O. PET/CT Imaging Artifacts. J Nucl Med Technol, 2005, Vol. 33, pp. 156-161. Received: October 20, 2017