Sbonias Evangelos
Department of Medical Physics, Navy Hospital, Dinokratous 70, 115 21 Athens, Greece.
Hell J Nucl Med. 2005 May-Aug;8(2):68-73.
Due to the fact that the existing commercial analgesic drugs are not able to reduce effectively the pain caused by the metastatic bone disease, the use of radiopharmaceuticals with avidity to selectively localize in the metastatic skeletal sites, such as strondium-89 chloride (89Sr-Cl2), rhenium-186-hydroxy ethylene diphosphonate (186Re-HEDP), and samarium-153-ethylene diamine tetramethylene (153Sm-EDTMP), is widely accepted. However this medical application may be dangerous for the occupied personnel and more for general public, if radioactive waste is not properly disposed. In the following article we try to estimate the degree and the significance of that risk. For that reason we discuss the physical properties of these radionuclides and their distribution in the body of the patient. We conclude that 89Sr is not harmful for the physician, the attending personnel or those who live with the patient, because it radiates beta-radiation, while its gamma-radiation is negligeable. The radionuclides 186Re and 153Sm besides beta-radiation, also emit a perceptible amount of gamma-radiation. It has been shown that the exposure to gamma-radiation from these radionuclides of the physician, the attending personnel or those who live with the patient is very low as compared to the internationally accepted radioprotection limits. However the environmental contamination per treatment by either of these three radionuclides is not negligeable in comparison to the national and international accepted limits. Patients that are not in good clinical condition may pose an additional contamination danger to those attending them. For limiting radiocontamination, the annual number of treatments by the above three previous radionuclides, should be considered according to the ALARA principle in relation with the correct handling of these patients, and also considering the fundamentals of radioprotection.
由于现有的商用镇痛药物无法有效减轻转移性骨病引起的疼痛,因此使用对转移性骨骼部位具有亲和力的放射性药物,如氯化锶-89(89Sr-Cl2)、铼-186-羟基乙叉二膦酸盐(186Re-HEDP)和钐-153-乙二胺四亚甲基膦酸盐(153Sm-EDTMP),已被广泛接受。然而,如果放射性废物处理不当,这种医疗应用可能对相关人员尤其是公众造成危险。在接下来的文章中,我们试图评估这种风险的程度和重要性。为此,我们讨论了这些放射性核素的物理性质及其在患者体内的分布。我们得出结论,89Sr对医生、护理人员或与患者同住的人无害,因为它发射β射线,而其γ射线可忽略不计。放射性核素186Re和153Sm除了发射β射线外,还发射可观数量的γ射线。研究表明,与国际认可的辐射防护限值相比,医生、护理人员或与患者同住的人因这些放射性核素受到的γ射线照射非常低。然而,与国家和国际认可的限值相比,这三种放射性核素每次治疗造成的环境污染不可忽略。临床状况不佳的患者可能会给护理他们的人带来额外的污染危险。为了限制放射性污染,应根据ALARA原则,并结合对这些患者的正确处理以及辐射防护的基本原则,考虑上述三种放射性核素的年度治疗次数。