Usulan kriteria pemulangan pasien (patient release) kedokteran nuklir di Indonesia

Nuclear medicine procedures are carried out by applying a radioactive substance to the patient’s body. Thus, the patient can be assumed to be a ‘radiation source’ and needs to follow special provisions so that his presence does not expose nearby individuals unnecessarily. Therefore, when the patient is released from the hospital, it must ensure that the patient’s radiation exposure does not expose the individuals in the vicinity. However, several related regulations have not regulated this in detail. In this paper, a study is carried out regarding the criteria considered in the release of nuclear medicine patients. The method used is a literature study. The study results recommend release criteria through two approaches based on the estimated maximum effective dose that the public may accept, namely conditional release with a calculated dose of less than or equal to 5 mSv and unconditional release with an estimated dose of less than or equal to 1 mSv. Conditional release is the release of a patient provided with post-release guidance, while unconditional release is the release of the patient without being supplied with post-release advice. Keywords: nuclear medicine, patient release, conditional release, unconditional release

Cumulative radiation doses due to nuclear medicine examinations: a systematic review

Objectives: To systematically review the published data regarding the cumulative exposure to radiation in selected cohorts of adults or paediatric patients due to diagnostic nuclear medicine examinations. Methods: We conducted PubMed/Medline searches of peer-reviewed papers on cumulated effective dose (CED) from diagnostic nuclear medicine procedures published between 01 January 2010 until 31 January 2021. Studies were considered eligible if the contribution of nuclear medicine examinations to total CED was >10%. Studies reporting cumulative doses in a single episode of care or in a limited time (≤1 year) were excluded. The main outcomes for which data were sought were the CED accrued by patients, the period in which the CED was accrued, the percentage of patients with CED > 100 mSv and the percentage contribution due to nuclear medicine procedures to the overall CED. Results: The studies included in the synthesis were 18 which enrolled a total of 1,76,371 patients. Eleven (1,757 patients), three (1,74,079 patients) and four (535 patients) were related to oncological, cardiologic and transplanted patients, respectively. All the studies were retrospective; some of the source materials referred to small number of patients and some of the patients were followed for a short time. Not many studies accurately quantified the contribution of nuclear medicine procedures to the overall radiation exposure due to medical imaging. Finally, most of the studies covered an observation period which extended mainly in the 2000–2010 decade. Conclusions: There is a need of prospective, multicentric studies enrolling a greater number of patients, followed for longer period in selected groups of patients to fully capture the cumulative exposure to radiation in these settings Advances in knowledge: This systematic review allows to identify selected group of patients with a specific health status in which the cumulated exposure to radiation may be of concern and where the contribution of nuclear medicine procedures to the total CED is significant.

Changes in the global impact of COVID-19 on nuclear medicine departments during 2020: an international follow-up survey

Aim As a follow-up to the international survey conducted by the International Atomic Energy Agency (IAEA) in April 2020, this survey aims to provide a situational snapshot of the COVID-19 impact on nuclear medicine services worldwide, 1 year later. The survey was designed to determine the impact of the pandemic at two specific time points: June and October 2020, and compare them to the previously collected data. Materials and methods A web-based questionnaire, in the same format as the April 2020 survey was disseminated to nuclear medicine facilities worldwide. Survey data was collected using a secure software platform hosted by the IAEA; it was made available for 6 weeks, from November 23 to December 31, 2020. Results From 505 replies received from 96 countries, data was extracted from 355 questionnaires (of which 338 were fully completed). The responses came from centres across varying regions of the world and with heterogeneous income distributions. Regional differences and challenges across the world were identified and analysed. Globally, the volume of nuclear medicine procedures decreased by 73.3% in June 2020 and 56.9% in October 2020. Among the nuclear medicine procedures, oncological PET studies showed less of a decline in utilization compared to conventional nuclear medicine, particularly nuclear cardiology. The negative impact was also significantly less pronounced in high-income countries. A trend towards a gradual return to the pre-COVID-19 situation of the supply chains of radioisotopes, generators, and other essential materials was evident. Conclusion The year 2020 has a significant decrease in nuclear medicine diagnostic and therapeutic procedures as a result of the pandemic-related challenges. In June, the global decline recorded in the survey was greater than in October when the situation began to show improvement. However, the total number of procedures remained below those recorded in April 2020 and fell to less than half of the volumes normally carried out pre-pandemic.

One Year Later: Global Impact of COVID-19 on Nuclear Medicine Departments; an International Follow-up Survey

Aim: As a follow-up to the international survey conducted in April 2020, this survey aims to provide a situational snapshot of the COVID-19 impact on nuclear medicine services worldwide, one year later. The survey was designed to determine the impact of the pandemic at two specific time-points: June and October 2020 and compare them to the previously collected data.Materials and Methods: A web-based questionnaire, in the same format as the April 2020 survey was disseminated to nuclear medicine facilities worldwide. Survey data was collected using a secure software platform hosted by the International Atomic Energy Agency (IAEA); it was made available for 6 weeks, from November 23 to December 31, 2020.Results: From 505 replies from 96 countries, data was extracted from 355 questionnaires (of which 338 were fully completed). The responses came from centres evenly distributed in different regions of the world and with different income status. Regional differences and challenges across the world were identified and analysed. Globally, the volume of nuclear medicine procedures decreased by 73.3% in June 2020 and 56.9% in October 2020. Among the nuclear medicine procedures, oncological PET studies showed less of a decline in utilization compared to conventional nuclear medicine and particularly nuclear cardiology. The impact was also significantly less in high-income countries. A trend towards a return to the pre-COVID-19 situation of the supply chains of radioisotopes, generators, and other essential materials was evident.Conclusion: The impact of the COVID-19 pandemic was associated with a significant reduction in nuclear medicine diagnostic and therapeutic procedures throughout 2020. In June, the global decline recorded in the survey was greater than in October when there was a slight improvement. However, the total number of procedures continued below that recorded in April 2020, and less than half of the volumes normally carried out before the pandemic

Research reactor model for isotope production based on the design of VVER-440 reactors

The following work is an attempt to develop a model research reactor based on VVER-440 technologies, primarily for the production of radioisotopes used in nuclear medicine procedures. The article describes the basic design features of the model 10 MW multipurpose VVR reactor, including the features of reactor fuel, core, and related structures. A comparative analysis of targets for maximizing 99Mo production is also presented.

SOLLID – a single centre study to develop methods to investigate the effects of low radiation doses within nuclear medicine, to enable multicentre epidemiological investigations

There is continuing debate concerning the risks of secondary malignancies from low levels of radiation exposure. The current model used for radiation protection is predicated on the assumption that even very low levels of exposure may entail risk. This has profound implications for medical procedures involving ionising radiation as radiation doses must be carefully monitored, and for diagnostic procedures are minimised as far as possible. This incurs considerable expense. The SOLLID study (ClinicalTrials.gov Identifier: NCT03580161) aims to develop the methodology to enable a large-scale epidemiological investigation of the effect of radiopharmaceutical administrations to patients undergoing diagnostic nuclear medicine procedures. Patients will undergo a series of scans in addition to that acquired as standard of care to enable the radiation doses delivered to healthy organs to be accurately calculated. Detailed analysis will be performed to determine the uncertainty in the radiation dose calculations as a function of the number and type of scans acquired. It is intended that this will inform a subsequent long-term multicentre epidemiological study that would address the question definitively. Secondary aims of the study are to evaluate the range of absorbed doses that are delivered from diagnostic nuclear medicine procedures and to use current risk models to ascertain the relative risks from these administrations.