Almén Anja
Medical Radiation Physics, Department of Translational Medicine, Lund University, Carl-Bertil, Laurells gata 9, Malmö, SE-20502, Sweden.
Department of Radiation Protection, Swedish Radiation Safety Authority, Stockholm, Sweden.
EJNMMI Phys. 2025 Apr 2;12(1):32. doi: 10.1186/s40658-025-00747-2.
Diagnostic imaging is a dynamic medical field. In nuclear medicine, advancements introduce new procedures utilising innovative radiopharmaceuticals. These developments may influence supply requirements and exposure levels for the patient population. Surveying the frequency of procedures, types of pharmaceuticals, and administered activities provides valuable insights into utilisation trends and radionuclide demand. This knowledge also guides the prioritisation of radiation protection efforts at national and local levels. In Europe, radiation dose assessments for medical exposures are mandatory according to the directive´s requirements.
This study evaluated the utilisation of diagnostic nuclear medicine procedures in Sweden over 15 years (2008-2023), focusing on procedure frequency, effective dose, and collective effective dose. Comprehensive data from all Swedish clinics performing nuclear medicine were analysed, incorporating information on radiopharmaceuticals and administered activities. The method suggested by the UNSCEAR, which includes so-called essential procedures, was used for comparison. The study also investigated some frequent procedures in more detail.
The study identifies noteworthy trends, including a threefold increase in the number of clinics offering Positron Emission Tomography (PET) procedures and a significant rise in PET usage. PET procedures constituted over 50% of the collective effective dose for adults in 2023. Despite this, Gamma Camera (GC) procedures still dominate in frequency but exhibit a steady decline. Procedures using Tc and F accounted for 93% of procedures in 2023. The collective effective dose rose 22% over the study period, with PET procedures driving this increase. PET procedures increasing role became evident by the increased contribution to the total collective dose from 15 to 52%. The UNSCEAR methodology captured 67% of the total frequency and underestimated the collective effective dose by 16%. Administered activity remained stable for the selected procedures and showed low variation between clinics.
PET procedures are increasing in scope and now constitute the largest contribution to radiation dose, and in-house production of PET radiopharmaceuticals is available in around 40% of clinics. The number of radionuclides decreased over the study period, and GC procedures declined. In general, the amount of administered activity remained stable over the period for the procedures studied. Accurately assessing utilisation and exposure trends requires extensive data, and the methodology used affects the result significantly.
诊断成像技术是一个不断发展的医学领域。在核医学中，技术进步带来了使用创新型放射性药物的新检查程序。这些发展可能会影响患者群体的供应需求和辐射剂量水平。调查检查程序的频率、药物类型和给药活度，能够为使用趋势和放射性核素需求提供有价值的见解。这些信息还能指导国家和地方层面辐射防护工作的优先级安排。在欧洲，根据指令要求，必须对医疗照射进行辐射剂量评估。
本研究评估了瑞典15年（2008 - 2023年）间诊断性核医学检查程序的使用情况，重点关注检查程序频率、有效剂量和集体有效剂量。分析了瑞典所有开展核医学的诊所的综合数据，纳入了放射性药物和给药活度的信息。采用联合国原子辐射效应科学委员会（UNSCEAR）建议的方法（包括所谓的基本程序）进行比较。该研究还更详细地调查了一些常见检查程序。
该研究发现了一些值得注意的趋势，包括提供正电子发射断层扫描（PET）检查程序的诊所数量增加了两倍，PET的使用量显著上升。2023年，PET检查程序占成人集体有效剂量的50%以上。尽管如此，γ相机（GC）检查程序在频率上仍占主导，但呈稳步下降趋势。2023年，使用锝（Tc）和氟（F）的检查程序占检查程序总数的93%。在研究期间，集体有效剂量上升了22%，主要是PET检查程序推动的。PET检查程序对总集体剂量的贡献从15%增加到52%，其作用日益明显。UNSCEAR方法涵盖了总频率的67%，但低估了集体有效剂量16%。所选检查程序的给药活度保持稳定，各诊所之间的差异较小。
PET检查程序的范围在扩大，目前对辐射剂量的贡献最大，约40%的诊所能够进行PET放射性药物的内部生产。在研究期间，放射性核素的种类减少，GC检查程序减少。总体而言，在所研究的检查程序中，给药活度在这段时间内保持稳定。准确评估使用情况和辐射剂量趋势需要大量数据，所采用的方法对结果有显著影响。
