THE EVALUATION OF DOSE RATE MEASUREMENTS AND PATIENTS DISCHARGE IN RADIONUCLIDE THERAPY

Abstract

Objective: The aim of this study is to measure radiation dose rate from hospitalized patients and to determine release dose for discharge time after radionuclide therapy.

Materials and Methods: Our study included 840 patients undergoing radionuclide therapy in which 576 patients were treated by different doses of iodine: 3700, 5550 ve 7400 MBq, 144 patients weere treated with variable amounts of 177Lu-DOTATATE : 3700 and 7400 MBq, 245 patients were subjected to 177Lu-PSMA therapy with activity range 1500-4500 MBq and 19 patients were arbitraryly selected for 90Y microsphere therapy. Dose rates were measured at a distance of 1 meter from patients via Geiger- Müller (GM) probe. Dose rate readings >30 μS/h were repeated at 48 hours.

Results: The average dose rate measured at 24 hours after administration of 3700, 5550 and 7400 MBq 131I was 24.6±7 μSv/h, 52.3±17 μSv/h and 66.7±15 μSv/h respectively, the average dose rate was 3.7±1, 5.1±2 and 7.1±3 µSv/h after administration of 3700, 5550 and 7400 MBq 177Lu-DOTATATE respectively; whereas the dose rate was 4±0.3 μSv/h in 90Y microsphere treatment and 7.2±3 µSv/h after administration of 7400 MBq 177Lu-PSMA. The mean dose rate after 48 hours following radioiodine therapy using activity of 3700, 5550 ve 7400 MBq 131I was 13±6, 13.2±5 ve 17.2±4 µSv/h repectively.

Conclusion: We concluded that patients treated with 3700 MBq 131I must stay in lead-shielded rooms at least 24 hours and patients treated with 5550 and 7400 MBq 131I should stay up to 48 hours to assure dose rate less than 30 µSv/h as recommended by TAEK, while in 177Lu and 90Y treatment maximum 24 hours is found adequate for discharge of patients.

Keywords: Radionuclide treatment; dose rate; thyroid cancer; neuroendocrine tumour; radiomicrosphere treatment.

Keywords

• Radionuclide treatment,dose rate,thyroid cancer,neuroendocrine tumour,radiomicrosphere treatment

RADYONÜKLİD TEDAVİLERDE DOZ HIZI ÖLÇÜMLERİ VE HASTA TABURCU EDİLME KOŞULLARININ DEĞERLENDİRİLMESİ

Abstract

Amaç: Yatarak radyonüklid tedavi gören kanser hastalarından yayılan radyasyonun doz hızlarını ölçmek, ölçüm sonuçlarına göre hastaların taburcu edilebilme koşullarını belirlemektir.

Gereç ve Yöntem: Çalışmamıza 3700, 5550 ve 7400 Megabecquerel (MBq) aktivite miktarlarında İyot 131 (131I) tedavisi uygulanan 576 tiroit kanseri hastası, 3700, 5550 ve 7400 MBq aktivite miktarlarında Lutesyum-177 (177Lu)- DOTA-(Tyr3)-octreotate (DOTATATE) uygulanan nöroendokrin tümörlü hasta, 7400 MBq aktivite miktarında 177Lu-Prostat Spesifik Membran Antijen (PSMA) uygulanan prostat kanseri olmak üzere toplam 245 hasta, 1500-4500 MBq aktivite miktarı aralığında Yitrium-90 (90Y) tedavisi uygulanan 19 hasta olmak üzere toplamda radyonüklid tedavi uygulanan toplam 840 hasta alındı. Doz hızları Geiger-Müller (GM) problu detektörle 1 m mesafeden ölçüldü. Doz hızı ölçümleri >30 µSv/sa olan hastaların tedavi ünitesinde yatırılmasına devam edildi ve 48. saatte doz hızı ölçümleri tekrar yapıldı.

Bulgular: 24. saatte ölçülen doz hızı ortalamaları 131I tedavilerinde 3700, 5550 ve 7400 MBq için sırasıyla; 24.7±7 µSv/sa, 52.1±17 µSv/sa ve 66.7±15 µSv/sa; 177Lu- DOTATATE tedavilerinde 3700, 5550 ve 7400 MBq için sırasıyla; 3.7±1, 5.1±2 ve 7.1±3 µSv/sa, 177Lu-PSMA tedavisinde 7400 MBq için 7.2±3 µSv/sa ve 90Y mikroküre tedavisinde 4±0.3 µSv/sa olarak bulundu. 3700, 5550 ve 7400 MBq 131I tedavilerinde 48. saatteki doz hızı ise 13±6, 13.2±5 ve 17.2±4 µSv/sa olarak bulundu.

Sonuç: Bu sonuçlara göre 3700 MBq 131I, tedavilerinde hastaların en az 24 saat, 177Lu ve 90Y tedavilerinde hastaların en fazla 24 saat nükleer tıp servisinde kurşun izolasyonlu odalarda yatırılmaları, 5500 ve 7400 MBq 131I tedavisi uygulanan ve Türkiye Atom Enerjisi Kurumu (TAEK) tarafından belirlenen kritere göre doz hızı >30 µSv/sa olarak ölçülen hastaların 48 saat yatırılmalarının yeterli olduğu belirlendi.

Anahtar kelimeler: Radyonüklid tedavi; doz hızı; tiroit kanseri; nöroendokrin tümör; radyomikroküre tedavisi.

Keywords

• Radyonüklid tedavi,doz hızı,tiroit kanseri,nöroendokrin tümör,radyomikroküre tedavisi

References

1. 1. Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Amer J Med 1994; 97: 418-28.
2. 2. Demir M. Nükleer Tıp Fiziği ve Klinik Uygulamaları, İstanbul, 2014,sayfa 368-72.
3. 3. Europan Comission. Radiation Protection Following İodine-131therapy (Exposure Due To Out-Patients Or Discharged İn-Patient). Directorate-General Environment, Nuclear Safety And Civil Protection. Radiation Protection 97, Elseviere Science Inc. 1998.3.
4. 4. TAEK (Türkiye Atom Enerjisi Kurumu), Radyasyon Güvenliği Yönetmeliği Ek-5, 2004.
5. 5. Ahmed Asm S, Demir M, Yaşar D, Uslu İ. Quantification of absorbed doses to urine bladder depending on drinking water during radioiodine therapy to thyroid cancer patients: a clinical study using MIRDOSE3. Nuclear Medicine Communication 2003; 24:749-59.
6. 6. National Council on Radiation Protection and Measurements. Mis administration of radioactive material in medicine: scientific background. Bethesda, MD: NCRP, 1991; 27.
7. 7. Paganelli G, Bodei L, Handkiewicz Junak D, P. Rocca, S. Papi, M. Lopera Sierra at al. 90Y-DOTA -D-Phe(1)-Try(3)-octreotide in therapy of neuroendocrine malignancies. Biopolymers 2002; 66:393–8.
8. 8. Murthy R, Nunez R, Szklaruk J, Erwin W, Madoff DC, Gupta S. et al. Yttrium-90 Microsphere Therapy for Hepatic Malignancy: Devices, Indications, Technical Considerations, and Potential Complications. Radio Graphics 2005; 25: 41-55.

9. 9. Valkema R, Pauwels SA, Kvols LK, Kwekkeboom DJ, Jamar F, de Jong M at al. Long-term follow-up of renal function after peptide receptor radiation therapy with (90)Y-DOTA(0),Tyr(3)-octreotide and (177)Lu-DOTA(0), Tyr(3)-octreotate. J Nucl Med. 2005; 46:83–91.
10. 10. Gulec SA, Mesoloras G and Stabin M, Dosimetric Techniques in 90Y-Microsphere Therapy of Liver Cancer: The MIRD Equations for Dose Calculations, J Nucl Med. 2006;47(7):1209-11.
11. 11. Vetter RJ. Regulations for radioiodine therapy in the United States: current status and the process of change. Thyroid 1997; 7:209–11.
12. 12. European Commission Radiation Protection 97: Radiation Protection Following Iodine-131 Therapy (Exposure Due to Out-Patients or Discharged Inpatients). Luxembourg, Belgium: Office for Official Publications of the European Communities; 1998.
13. 13. Yeyin N, Demir M. Hasta ve atıklarından çevreye salınan radyasyon miktarının belirlenmesi ve doz hızı ölçümleri. 1.Ulusal Sağlık Kuruluşları Çevre Yönetim Sempozyumu Yayınları, İstanbul, 29-30 Kasım 2012.
14. 14. Ravichandran R, Binukumar JP, and Saadi AA. Estimation of effective half life of clearance of radioactive Iodine (131I) in patients treated for hyperthyroid is mand carcinoma thyroid. Indian J Nucl Med 2010; 25:49-52.
15. 15. Culver CM, Dworkin HJ. Radiation Safety Considerations for Post-Iodine 131 Thyroid Cancer Therapy. J Nucl Med 1992; 33:1402-05.
16. 16. Calais PJ, Turner JH. Radiation safety of outpatient 177Lu-octreotate radiopeptide therapy of neuroendocrine tumors. Ann Nucl Med. 2014 Jul;28(6):531-9.
17. 17. Demir M, Parlak Y, Çavdar İ, Yeyin N, Tanyıldızı H, Gümüser G at al. The evaluation of urine activity and external dose rate from patients receiving radioiodine therapy for thyroid cancer. Radiation Protection Dosimetry 2013;3:1–5.
18. 18. Demir M, Abuqbeitah M, Uslu-Besli L, Yıldırım Ö, Yeyin N, Çavdar İ at al. Evaluation of radiation safety in (177)Lu-PSMA therapy and development of outpatient treatment protocol. Journal of Radiological Protection 2016;36(2):269-78.