Martin C J, Marengo M, Vassileva J, Giammarile F, Poli G L, Marks P
Department of Clinical Physics and Bioengineering, University of Glasgow, Gartnavel Royal Hospital, G12 0XH, Glasgow, United Kingdom.
J Radiol Prot. 2019 Sep;39(3):665-695. doi: 10.1088/1361-6498/ab19d8. Epub 2019 Apr 16.
Nuclear medicine (NM) procedures for diagnosis and treatment of disease are performed routinely in hospitals throughout the world. These involve preparation and administration to patients of pharmaceuticals labelled with radioactive material. The International Atomic Energy Agency (IAEA) and the World Health Organisation highlighted the need for improvement in prevention of medical radiation incidents and accidents in the Bonn Call-for-Action in 2012. An IAEA Technical Meeting was held on prevention of unintended exposures and accidents in NM in 2018 to address the issue. Exposures can take place at any time when radioactive material is being produced and used, and the risk continues after procedures have been completed. Thus there is potential for staff or members of the general public to be exposed, as well as patients. This paper sets out guidelines for incident prevention based on presentations and discussions at the meeting, and review of reports from the literature. It deals with potential incidents in in-house radionuclide production, radiopharmaceutical preparation, administration to patients, and following a procedure, as well as aspects in management of radioactive materials. Special attention has been paid to therapeutic procedures, as these have the potential to cause more harm to patients from erroneous administrations, including tissue reactions from extravasation of radiopharmaceutical, and could lead to significant contamination events. Administration of NM therapy is generally contraindicated in pregnancy. Identification of any patient who may be pregnant is crucial and it might be necessary to verify this with a pregnancy test for patients within the age band considered to be fertile. Inclusion of NM therapy incidents in the IAEA automated reporting system SAFRON is recommended. In summary, the paper aims to highlight errors that could occur during different phases of NM procedures in order to aid prevention of incidents. The value of periodic audit in evaluating systems in place on a regular basis is emphasised. Approaches to incident investigation and follow-up are described, and the need to ensure corrective action is taken to address any deficiencies stressed.
核医学（NM）诊断和治疗疾病的程序在世界各地的医院中常规开展。这些程序涉及为患者制备和施用标记有放射性物质的药物。国际原子能机构（IAEA）和世界卫生组织在2012年的《波恩行动呼吁》中强调了改进医疗辐射事件和事故预防工作的必要性。2018年举行了一次IAEA技术会议，讨论核医学中意外照射和事故的预防问题以解决该问题。在放射性物质的生产和使用过程中的任何时候都可能发生照射，并且在程序完成后风险仍然存在。因此，工作人员、公众以及患者都有可能受到照射。本文根据会议上的报告和讨论以及文献报告的综述，制定了事故预防指南。它涉及内部放射性核素生产、放射性药物制备、给患者施用以及程序之后的潜在事故，以及放射性物质管理方面。对治疗程序给予了特别关注，因为这些程序有可能因错误施用对患者造成更大伤害，包括放射性药物外渗引起的组织反应，并可能导致重大污染事件。核医学治疗通常在怀孕期间禁忌使用。识别任何可能怀孕的患者至关重要，对于处于育龄期的患者，可能有必要通过妊娠试验进行核实。建议将核医学治疗事故纳入IAEA自动报告系统SAFRON。总之，本文旨在突出核医学程序不同阶段可能发生的错误，以帮助预防事故。强调了定期审核在定期评估现有系统方面的价值。描述了事故调查和后续跟进的方法，并强调了确保采取纠正措施以解决任何缺陷的必要性。
