Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
Institute for Informatics, Washington University School of Medicine, St. Louis, MO, USA.
Clin Chem. 2021 Oct 1;67(10):1415-1425. doi: 10.1093/clinchem/hvab135.
Biological specimens from patients who have received radiopharmaceuticals are often collected for diagnostic testing and sent to clinical laboratories. Residual radiation has long been assumed to be minimal. However, literature is sparse and may not represent the specimen volumes or spectrum of radionuclides currently seen at National Cancer Institute (NCI)-designated cancer centers. This study examined the radiopharmaceuticals associated with patient specimens received in the hospital core laboratory and assessed the potential risk of external radiation exposure to laboratory personnel.
The types and amounts of radiopharmaceuticals administered in a large metropolitan hospital system were retrospectively examined over a 20-month study period. The associated biological specimens sent to the largest core laboratory in the system for testing were evaluated. In addition, manual survey meter assessment of random clinical specimens and weekly wipe tests were performed for 44 weeks, and wearable and environmental dosimeters were placed for 6 months.
Over 11 000 specimens, collected within 5 physical half-lives of radiopharmaceutical administration, were processed by our laboratory. Manual survey meter assessment of random clinical specimens routinely identified radioactive specimens. If held in a closed palm for >2 min, many samples could potentially deliver a 0.02 mSv effective dose of radiation.
The laboratory regularly receives radioactive patient specimens without radioactive labels. Although the vast majority of these are blood specimens associated with low-dose diagnostic radiopharmaceuticals, some samples may be capable of delivering a significant amount of radiation. Recommendations for laboratories associated with NCI cancer centers are given.
接受放射性药物治疗的患者的生物标本通常用于诊断检测，并送到临床实验室。长期以来，人们一直认为残留辐射极小。然而，相关文献很少，可能无法代表目前在国立癌症研究所（NCI）指定癌症中心看到的标本量或放射性核素谱。本研究检查了医院核心实验室收到的与患者标本相关的放射性药物，并评估了实验室人员受到外照射的潜在风险。
在 20 个月的研究期间，回顾性检查了一个大型都市医院系统中使用的放射性药物的类型和用量。评估了送往该系统最大核心实验室进行检测的相关生物标本。此外，对随机临床标本进行了 44 周的手动表面污染监测仪评估和每周擦拭测试，并放置了可穿戴和环境剂量计 6 个月。
在放射性药物给药后 5 个物理半衰期内，我们实验室处理了超过 11000 个标本。对随机临床标本进行手动表面污染监测仪评估常规识别放射性标本。如果在封闭的手掌中握持超过 2 分钟，许多样本可能会潜在地产生 0.02 毫希沃特的有效剂量辐射。
实验室经常收到没有放射性标签的放射性患者标本。尽管这些标本绝大多数是与低剂量诊断放射性药物相关的血液标本，但一些样本可能能够产生大量辐射。为 NCI 癌症中心相关实验室提供了建议。
