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How the IAEA Helps Maintain Health and Safety in Nuclear Medicine: Technical Meeting on Preventing Unintended and Accidental Exposure


IAEA experts addressing the Technical Meeting on Preventing Unintended and Accidental Exposures in Nuclear Medicine. (Photo: F. Nassif/IAEA)

The exponential rise in nuclear medicine procedures performed around the world benefits an increasing number of patients, but it also intensifies the need to avoid any related accidental radiation exposure. Participants in an IAEA meeting last week discussed how to ensure the safety of patients, health workers and the public in nuclear medicine.

There are over 30 million nuclear medicine procedures performed annually. In these a patient receives a radioactive tracer orally or by intravenous injection, for diagnosis, staging of disease, therapy or monitoring. That means a new procedure starting every second somewhere in the world.

“Our role is to ensure that on balance, the benefits outweigh the risks associated with the use of radioactive substances,” said Peter Johnston, Director of Radiation Transport and Waste Safety at the IAEA, speaking at the opening of the first IAEA Technical Meeting on Preventing Unintended and Accidental Exposures in Nuclear Medicine last week.

The meeting attracted 45 nuclear medicine physicians, medical physicists, radiopharmacists, radiation technologists and regulators from over 30 countries and nine international organizations, including the World Health Organization (WHO), the International Commission on Radiological Protection (ICRP) and several professional societies.

The goal of the three-day meeting, held from 16 to 18 May, was to share experience, learn from past incidents and prepare guidelines on how to avoid accidents in the future, said Jenia Vassileva, a radiation protection specialist at the IAEA. “Incidents, including near-misses, happen more frequently than accidents, and by looking at them and learning from them, we can improve safety.”

Incidents can happen during the preparation of radiopharmaceuticals, during the management of radioactive materials and during the procedure on the patient.

Patients are not the only individuals affected by these incidents, but so could be the people they are in contact with: if a patient leaves the hospital too soon after a therapeutic nuclear medicine procedure, he or she may expose others in transport or at home. Medical staff working with radiopharmaceuticals also need to be protected: while the exposure from a syringe filled with radiopharmaceuticals is relatively small, for a professional handling thousands of these a year, the exposure can add up.

Describing and categorizing the incidents is the first step towards identifying procedures for their prevention. “It is very important to evaluate and discuss what systems need to be in place for each different type of potential incident, because the causes vary, so it is important to include preventions for each type,” said Colin Martin, a medical physicist from the United Kingdom and the Chair of the meeting.

Report and learn

After categorization comes the need for reporting, so that trends can be understood and conclusions drawn. “If the incidents are not reported, there will be no improvement,” Vassileva said. Accurate and timely reporting is therefore a primary goal and an important part of the process, she said. Experts provided guidance on how to encourage and prioritize the reporting of incidents, as well as what information should be included in the reports.

In addition, participants proposed to include radionuclide therapy in SAFRON, Safety in Radiation Oncology, an integrated voluntary and anonymous reporting and learning system of radiotherapy incidents and near misses, run by the IAEA and designed to support the sharing of safety-related information.

Over the course of the meeting the importance of strengthening safety culture in nuclear medicine for the prevention of incidents and accidents was also highlighted. “Developing a safety culture is important to prevent incidents and accidents from happening,” said Martin. “We need to address unsafe conditions by increasing awareness and alertness, develop comprehensive operating procedures, training and understanding and clearly defining responsibilities.”

A report on guidance for safety measures from the results and discussion of the meeting will be published in coming weeks in order to support national authorities and hospitals in ensuring safety of patients, staff and the public.

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