NCRP report no 124 sources and magnitude of occupational and public exposures from nuclear medicine procedures

NCRP REPORT No 124 SOURCES AND MAGNITUDE OF OCCUPATIONAL AND PUBLIC EXPOSURES FROM NUCLEAR MEDICINE PROCEDURES Recommendations of the NATIONAL COUNCIL O N RADIATION PROTECTION AND MEASUREMENTS Issued March 11, 1996 National Council on Radiation Protection and Measurements I Bethesda, MD 20814-3095 7910 Woodmont Avenue LEGAL NOTICE This report was prepared by the National Council on Radiation Protection a n d Measurements (NCRP) The Council strives to provide accurate, complete and useful information in its reports However, neither the NCRP, the members of NCRP, other persons contributing to or assisting in the preparation of this Report, nor any person acting on the behalf of any of these parties: (a) makes any warranty or representation, express or implied, with respect to the accuracy, completeness or usefulness of the information contained i n this Report, or that the use of any information, method or process disclosed i n this Report may not infringe on privately owned rights; or (b) assumes any liability with respect to the use of, or for damages resulting from the use of any information, method or process disclosed in this Report, under the Civil Rights Act of 1964, Section 701 et seq, as amended 42 U.S.C Section 2000e et seq (Title VII) or any other statutory or common law theory governing liability Library of Congress Cataloging-in-Publication Data National Council on Radiation Protection and Measurements Sources and magnitude of occupational and public exposures from nuclear medicine procedures / recommendations of the National Council on Radiation Protection and Measurements cm - (NCRP report ; no 124) p "Prepared by Scientific Committee 77 on Guidance on Occupational and Public Exposure Resulting from Diagnostic Nuclear Medicine Proceduresn-Pref "Issued March 1996." Includes bibliographical references and index ISBN 0-929600-51-7 Nuclear medicine-Safety measures Radiation-Dosage I National Council on Radiation Protection and Measurements Scientific Committee 77 on Guidance on Occupational and Public Exposure Resulting from Diagnostic Nuclear Medicine Procedures 11 Title 111 Series [DNLM: Nuclear Medicine Occupational Exposure Radiation Effects Risk Radiation Protection WN 440 N2765s 19961 RA569.N355 1996 616.9'897-dc20 DNLMfDLC for Library of Congress 96-690 CIP Copyright O National Council on Radiation Protection and Measurements 1996 All rights reserved This publication is protected by copyright No part of this publication may be reproduced in any form or by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotation in critical articles or reviews Preface This Report addresses the sources of exposures incurred in the practice of nuclear medicine and provides the necessary data to evaluate the magnitude of exposures to those directly associated with that practice and to those who provide nursing care to the patients containing radiopharmaceuticals Exposure to members of the public are also addressed The primary emphasis of this Report is on these individuals and not on the patient, since the patient receives the direct benefit from the nuclear medicine procedure I t is recognized that the patient also receives the bulk of any potential radiation decrement This Report was prepared by Scientific Committee 77 on Guidance on Occupational and Public Exposure Resulting from Diagnostic Nuclear Medicine Procedures Serving on the Scientific Committee were: Kenneth L Miller, Chairman Pennsylvania State University Hershey, Pennsylvania Members Frank P Castronovo, Jr Brigham & Women's Hospital Boston, Massachusetts Martin L Nusynowitz University of Texas Medical Branch at Galveston Galveston , Texas Arnold P Jacobson University of Michigan School of Public Health Ann Arbor, Michigan Dennis D Patton University of Arizona College of Medicine Tucson, Arizona Sheila I Kronenberger Stanford University Stanford, California Consultant Edward W Webster Massachusetts General Hospital Boston, Massachusetts iv PREFACE NCRP Secretariat James A Spahn, Jr., Senior Staff Scientist Cindy L O'Brien, Editorial Assistant The Council wishes to express its appreciation to the Committee members for the time and effort devoted to the preparation of this Report Charles B Meinhold President Contents Introduction 1.1 Scope 1.2 Quantities and Units Public SigniGcance of Nuclear Medicine 2.1 Nature and Advantages 2.2 Size and Growth Radiation Risk in Perspective 3.1 Introduction 3.2 Risk 3.3 Radiation Risks 3.3.1 Low-Level Radiation Doses 3.3.2 Dose Limits 3.3.3 Radiation Effects a t Low Doses 3.3.3.1 Hereditary Defects 3.3.3.2 Developmental Defects 3.3.3.3 Cancer Induction 3.3.4 Comparative Risks Receipt and Delivery of Radioactive Materials 4.1 Introduction 4.2 Shipment of Radioactive Sources 4.3 Receipt of Radionuclides 4.4 "In-House" Transportation of Radioactive Materials 4.5 Transport of Patients 4.6 Transport of Specimens from Nuclear Medicine Patients Radiation Exposure from Nuclear Medicine Practice 5.1 Nuclear Medicine Personnel Exposure 5.2 Radiation Doses to Patients and Persons Nearby and Members of the Public 5.3 Exposure of Nurses and Other Medical Personnel 5.4 Exposure of the General Public Radiopharmaceutical Handling Procedures in Nuclear Medicine 6.1 Introduction 6.2 Radiopharmaceutical Dosage Preparation vi / CONTENTS 6.2.1 Commercial Radiopharmacy Unit Dosages 6.2.2 "In-House" Radiopharmacy 6.2.3 Generators 6.2.4 Chemical Formulation 6.2.5 Xenon 6.2.6 Nebulizers 6.2.7 Iodine (Diagnosis and Therapy) 6.3 Dosage Calibrations 6.4 Radiopharmaceutical Administration 6.5 Imaging 6.6 Contamination Control 6.7 Misadministration 6.8 Safety Considerations with Nursing Mothers 6.9 Radioactive Waste Disposal Radiation Safety Considerations for the Nursing Staff 7.1 Radiopharmaceutical Administrations 7.2 Notification of Radiopharmaceutical Administration 7.3 When Radioactive Precautions Are Necessary 7.3.1 The Patient 7.3.1.1 For Diagnostic Purposes 7.3.1.2 For Therapeutic Purposes 7.3.2 Collection and Handling of Excreta 7.3.2.1 From Diagnostic Dosages 7.3.2.2 From Therapeutic Dosages 7.3.3 Collected Specimens Glossary References The NCRP NCRP Publications Index Introduction 1.1 Scope The medical use of unsealed radioactive materials, generally referred to as nuclear medicine, subjects four classes of persons to radiation exposure These are patients, health care radiation workers, health care nonradiation workers, and members of the general public who are in the vicinity of these materials before, during or after their medical use Considerations of patient exposure have been included in two previous reports of the National Council on Radiation Protection and Measurements (NCRP), namely NCRP Report No 70, Nuclear Medicine-Factors Influencing the Choice and Use of Radionuclides in Diagnosis and Therapy (NCRP, 1982) and NCRP Report No 73, Protection in Nuclear Medicine and Ultrasound Diagnostic Procedures in Children (NCRP, 1983) Estimates of the quantities of radionuclides administered to patients in nuclear medicine procedures together with evaluations of the equivalent dose to the gonads and effective dose, and their contribution to the population exposure and dose are included in NCRP Report No 100, Exposure of the U.S Population from Diagnostic Medical Radiation (NCRP, 1989a) A primary concern is the evaluation and control of occupational exposures to nuclear medicine and allied health personnel and to members of the public other than the patient Since the general public would potentially receive exposure from patients containing radioactive material, t h e radiation levels close t o these patients are also important Many groups of medical personnel may receive radiation exposure from radioactive materials used in medical practice The principal groups are physicians, technologists, radiopharmacists and others who handle the radioactive material and radioactive waste or provide care for the nuclear medicine patient In addition, other physicians, nurses, x-ray technologists, receiving room personnel, security staff, those who transport patients within the hospital, operating room staff, maintenance workers and others, may occasionally be exposed Specific radiation protection guidelines for these and other allied health personnel have been given in NCRP Report No 105, Radiation Protection for Medical and Allied Health Personnel (NCRP, 1 INTRODUCTION 1989b) Members of the general public who might receive small exposures include other patients in waiting rooms, wards or multibed rooms, visitors and persons close to radioactive patients while in transit or in the home Section of this Report addresses the impact of nuclear medicine on the practice of medicine and on the diagnosis and treatment of disease Its ability to image parts or organs of the body or, when necessary, the whole body and to treat cancers without performing surgery was a major public health accomplishment The use of radioimmunoassay techniques was another major accomplishment that aided in a more complete understanding of diseases and disease processes The advent of single photon emission computed tomography (SPECT) and positron emission tomography (PET) have added to the number and kind of nuclear medicine procedures being performed Section focuses on radiation risk and presents a few comparisons which will help to improve understanding of risk and provide some perspective on the importance of comparing risks of radiation exposure to other risks faced by our society There is a brief discussion of limits of radiation exposure followed by an equally brief discussion of radiation effects Section traces the path of radioactive materials from receipt at a facility through delivery of the material to the nuclear medicine department, preparation of a dosage for administration to the patient, and dosage of the patient Since, when the patient receives the radioactive material, he or she becomes a source of exposure to others, the patient is then followed through the facility Another aspect examined is the movement of specimens from the patient to the laboratory for examination or testing This may or may not represent another source of exposure The subject of radiation exposure to individuals is further developed in Section There are three principal sources to radiation workers-dosage preparation and assay, administration, and patient imaging or treatment The details of each of these areas is analyzed and techniques useful to reduce exposures are examined Finally, the exposure of those not involved in administration of radiopharmaceuticals to patients is examined This group includes patients other than nuclear medicine patients who may walk through the halls or share a patient room, waiting room or elevator with a nuclear medicine patient, nurses or other providers of care to the patient, and members of the public The more detailed examination of the handling procedures used in nuclear medicine are covered in Section The two areas for preparation of dosages for administration to the patient are a 1.2 QUANTITIESANDUNITS / commercial radiopharmacy or the nuclear medicine department The exposures from these two sources and the advantages and disadvantages are discussed The calibration and use of dosage calibrators are reviewed The techniques of the administration of the radiopharmaceuticals to the patient by injection, inhalation or oral administration a r e reviewed The subjects of contamination control, misadministration and safety consideration for nursing mothers are discussed There is also a brief review of radioactive waste disposal Section treats the very important topic of radiation safety in the care of the hospitalized patient These are generally patients who have received therapeutic amounts of radionuclides and, at least in the early times after administration, represent a significant source of exposure 1.2 Quantities and Units In NCRP Report No 116 (NCRP, 1993a),the NCRP recommended the use of a new quantity to be known as effective dose By combining doses to radiosensitive organs in the body in a manner that accounts for their relative contributions to the total radiation detriment, the effective dose provides a single measure of dose that is directly related to detriment The unit for this effective dose is sievert (Sv) Wherever in this Report the term dose is used, unless otherwise qualified, its meaning is effective dose The energy absorbed per unit mass at a point in the human body exposed to radiation is known as the absorbed dose in tissue The unit of absorbed dose is gray (Gy) For this Report, the quantity air kerma, and its special unit Gy, will be used in place of the quantity exposure The two quantities are not interchangeable as the unit for air kerma is joules per kilogram and the unit for exposure is coulombs per kilogram Since they are not interchangeable, the conventional unit name, roentgen, will not be used but, until such time as radiation detection and survey meters are calibrated in air kerma, the numerical value of exposure in roentgens may be assumed to be approximately equal to the numerical value of air kerma in rads, which is equal to air kerma in centigray For a more complete discussion ofthese concepts see ICRU Reports 33 and 51 (ICRU, 1980; 1993) and for a more complete discussion of Systeme Internationale (SI) units see NCRP Report No 82 (NCRP, 1985a) Public Significance of Nuclear Medicine 2.1 Nature and Advantages Radiopharmaceuticals (drugs containing radionuclides) a r e administered to patients in order to make a physiologic measurement, to obtain images of organs or organ systems, or to provide treatment Drugs or compounds tagged with specific radionuclides will deposit within the human body in a predictable manner (both as to location and amount) The advantages of using these techniques are that spatial distributions and physiologic behavior may be studied simply, noninvasively, a t low cost and withlow risk to the patient As a n example, nuclear medicine imaging of the heart and studies of function are frequently used to provide information otherwise obtainable only by cardiac catheterization, an invasive procedure The latter usually requires hospitalization and is accompanied by higher radiation dose, mortality, morbidity and cost Another example is the determination of whether newly discovered breast cancer has metastasized (spread) to the bone The nuclear bone imaging procedure is the most cost effective method available for making such a determination If metastases in bone are found, they provide information important for developing a n appropriate treatment protocol for breast cancer Numerous similar applications exist which illustrate the impact of this technology on clinical decision making in the management of patient problems Although treatment (as distinct from diagnosis) with radiopharmaceuticals is a small part of the practice of nuclear medicine, it is very effective for certain medical conditions The dosage administered for therapeutic purposes is 10 to 50 times the dosage administered for diagnostic purposes The treatment of hyperthyroidism, (overactivity of the thyroid gland), is a routinely used procedure in nuclear medicine In contrast, surgery requires hospitalization and has higher associated mortality, morbidity and expense A third segment of nuclear medicine is radioimmunoassay laboratory testing Such procedures not require the administration of radioactive materials to the patient In these tests, a biological NCRP Publications NCRP publications are distributed by the NCRP Publications Office Information on prices and how to order may be obtained by directing an inquiry to: NCRP Publications 79 10 Woodmont Avenue Suite 800 Bethesda, MD 20814-3095 The currently available publications are listed below NCRP Reports No Title Control and Removal ofRadioactive Contamination i n Laboratories (1951) Maximum Permissible Body Burdens and Maximum Permissible Concentrations of Radionuclides i n Air and i n Water for Occupational Exposure (1959) [Includes Addendum 1issued in August 19631 Measurement of Neutron Flux and Spectra for Physical and Biological Applications (1960) Measurement ofAbsorbed Dose of Neutrons, and of Mixtures of Neutrons and Gamma Rays (1961) Stopping Powers for Use with Cavity Chambers (1961) Safe Handling of Radioactive Materials (1964) Radiation Protection in Educational Institutions (1966) Dental X-Ray Protection (1970) Radiation Protection in Veterinary Medicine ( 1970) Precautions i n the Management of Patients Who Have Received Therapeutic Amounts of Radionuclides (1970) Protection Against Neutron Radiation (1971) Protection Against Radiation from Brachytherapy Sources (1972) Specification of Gamma-Ray Brachytherapy Sources (1974) Radiological Factors Affecting Decision-Making i n a Nuclear Attack (1974) 64 / NCRP PUBLICATIONS Krypton-85 i n the Atmosphere-Accumulation, Biological Significance, and Control Technology (1975) Alpha-Emitting Particles in Lungs (1975) Tritium Measurement Techniques (1976) Structural Shielding Design and Evaluation for Medical Use of X Rays and Gamma Rays of Energies Up to 10 MeV (1976) Environmental Radiation Measurements (1976) Radiation Protection Design Guidelines for 0.1-100 MeV Particle Accelerator Facilities (1977) Cesium-137from the Environment to Man: Metabolism and Dose (1977) Medical Radiation Exposure of Pregnant and Potentially Pregnant Women (1977) Protection of the Thyroid Gland i n the Event of Releases of Radioiodine (1977) Instrumentation and Monitoring Methods for Radiation Protection (1978) A Handbook of Radioactivity Measurements Procedures, 2nd ed (1985) Operational Radiation Safety Program (1978) Physical, Chemical, and Biological Properties of Radwcerium Relevant to Radiation Protection Guidelines (1978) Radiation Safety Training Criteria for Industrial Radiography (1978) Tritium i n the Environment (1979) Tritium and Other Radionuclide Labeled Organic Compounds Incorporated in Genetic Material (1979) Influence o f Dose and Its Distribution i n Time on DoseResponse Relationships for Low-LET Radiations (1980) Management of Persons Accidentally Contaminated with Radionuclides (1980) Radiofrequency Electromagnetic Fields-Properties, Quantities and Units, Biophysical Interaction, and Measurements (1981) Radiation Protection i n Pediatric Radiology (1981) Dosimetry of X-Ray and Gamma-Ray Beams for Radiation Therapy in the Energy Range 10 keV to 50 MeV (1981) Nuclear Medicine-Factors Influencing the Choice and Use of Radionuclides i n Diagnosis and Therapy (1982) Operational Radiation Safety-Training (1983) Radiation Protection and Measurement for Low-Voltage Neutron Generators (1983) NCRP PUBLICATIONS / 65 Protection in Nuclear Medicine and Ultrasound Diagnostic Procedures in Children (1983) Biological Effects of Ultrasound: Mechanisms and Clinical Implications (1983) Iodine-129: Evaluation of Releases from Nuclear Power Generation (1983) Radiological Assessment: Predicting the Transport, Bioaccumulation, and Uptake by Man of Radionuclides Released to the Environment (1984) Exposures from the Uranium Series with Emphasis on Radon and Its Daughters (1984) Evaluation of Occupational and Environmental Exposures to Radon and Radon Daughters in the United States (1984) Neutron Contamination from Medical Electron Accelerators (1984) Induction of Thyroid Cancer by Ionizing Radiation (1985) Carbon-14 in the Environment (1985) SI Units in Radiation Protection and Measurements (1985) The Experimental Basis for Absorbed-Dose Calculations in Medical Uses of Radionuclides (1985) General Concepts for the Dosimetry of Internally Deposited Radionuclides (1985) Mammography-A User's Guide (1986) Biological Effects and Exposure Criteria for Radiofrequency Electromagnetic Fields (1986) Use ofBioassay Proceduresfor Assessment oflnternal Radionuclide Deposition (1987) Radiation Alarms and Access Control Systems (1986) Genetic Effects from Internally Deposited Radionuclides (1987) Neptunium: Radiation Protection Guidelines (1988) Public Radiation Exposure from Nuclear Power Generation in the United States (1987) Ionizing Radiation Exposure of the Population of the United States (1987) Exposure of the Population in the United States and Canada from Natural Background Radiation (1987) Radiation Exposure of the U.S Population from Consumer Products and Miscellaneous Sources (1987) Comparative Carcinogenicity of Ionizing Radiation and Chemicals (1989) Measurement of Radon and Radon Daughters in Air (1988) Guidance on Radiation Received in Space Activities (1989) Quality Assurance for Diagnostic Imaging (1988) Exposure of the U.S Population from Diagnostic Medical Radiation (1989) 66 / NCRP PUBLICATIONS Exposure of the U.S Population from Occupational Radiation (1989) Medical X-Ray, Electron Beam and Gamma-Ray Protection for Energies Up to 50 MeV (Equipment Design, Performance and Use) (1989) Control of Radon in Houses (1989) The Relative Biological Effectiveness ofRadiations of Different Quality (1990) Radiation Protection for Medical and Allied Health Personnel (1989) Limit for Exposure to "Hot Particles" on the Skin (1989) Implementation of the Principle of As Low As Reasonably Achievable (ALARA) for Medical and Dental Personnel (1990) Conceptual Basis for Calculations of Absorbed-Dose Distributions (1991) Effects of Ionizing Radiation on Aquatic Organisms (1991) Some Aspects of Strontium Radiobiology (1991) Developing Radiation Emergency Plans for Academic, Medical or Industrial Facilities (1991) Calibration of Survey Instruments Used i n Radiation Protection for the Assessment of Ionizing Radiation Fields and Radioactive Surface Contamination (1991) Exposure Criteria for Medical Diagnostic Ultrasound:I Criteria Based on Thermal Mechanisms (1992) Maintaining Radiation Protection Records (1992) Risk Estimates for Radiation Protection (1993) Limitation of Exposure to Ionizing Radiation (1993) Research Needs for Radiation Protection (1993) Radiation Protection i n the Mineral Extraction Industry (1993) A Practical Guide to the Determination of Human Exposure to Radiofrequency Fields (1993) Dose Control at Nuclear Power Plants (1994) Principles and Application of Collective Dose in Radiation Protection (1995) Use of Personal Monitors to Estimate Effective Dose Equivalent and Effective Dose to Workers for External Exposure to Low-LET Radiation (1995) Screening Models for Releases of Radionuclides to Atmosphere, Surface Water, and Ground (1996) Sources and Magnitude of Occupational and Public Exposures from Nuclear Medicine Procedures (1996) NCRP PUBLICATIONS 67 Binders for NCRP reports are available Two sizes make it possible to collect into small binders the "old series" of reports (NCRP Reports Nos 8-30)and into large binders the more recent publications (NCRP Reports Nos 32-124) Each binder will accommodate from five to seven reports The binders carry the identification "NCRP Reports" and come with label holders which permit the user to attach labels showing the reports contained in each binder The following bound sets of NCRP reports are also available: Volume I NCRP Reports Nos , 2 Volume 11 NCRP Reports Nos 23, 25, 27, 30 Volume 111 NCRP Reports Nos 32, 35, 36, 37 Volume IV NCRP Reports Nos 38, 40, 41 Volume V NCRP Reports Nos 42,44,46 Volume VI NCRP Reports Nos 47, 49,50,51 Volume VII NCRP Reports Nos 52, 53, 54, 55, 57 Volume VIII NCRP Report No 58 Volume IX.NCRP Reports Nos 59,60,61, 62,63 Volume X NCRP Reports Nos 64,65, 66,67 Volume XI NCRP Reports Nos 68,69, 70, 71, 72 Volume XII NCRP Reports Nos 73, 74, 75, 76 Volume XIII NCRP Reports Nos 77, 78, 79, 80 Volume XIV NCRP Reports Nos 81,82,83, 84,85 Volume XV.NCRP Reports Nos 86, 87,88,89 Volume XVI NCRP Reports Nos 90,91,92,93 Volume XVII NCRP Reports Nos 94,95, 96,97 Volume XVIII NCRP Reports Nos 98,99, 100 Volume XIX NCRP Reports Nos 101,102,103, 104 Volume XX.NCRP Reports Nos 105,106, 107, 108 Volume XXI NCRP Reports Nos 109, 110, 111 Volume XXII NCRP Reports Nos 112, 113, 114 Volume XXIII NCRP Reports Nos 115, 116, 117, 118 (Titles of the individual reports contained in each volume are given above.) NCRP Commentaries No Title Krypton-85 in the Atmosphere-With Specific Reference to the Public Health Significance of the Proposed Controlled Release at Three Mile Island (1980) Screening Techniques for Determining Compliance with 68 / NCRP PUBLICATIONS Environmental Standards-Releases of Radionuclides to the Atmosphere (1986), Revised (1989) Guidelines for the Release o f Waste Water from Nuclear Facilities with Special Reference to the Public Health Significance of the Proposed Release of Treated Waste Waters at Three Mile Island (1987) Review of the Publication, Living Without Landfills (1989) Radon Exposure of the U.S Population-Status of the Problem (1991) Misadministration of Radioactive Material in MedicineScientific Background (1991) Uncertainty i n NCRP Screening Mo&ls Relating to Atmospheric Transport, Deposition and Uptake by Humans (1993) Considerations Regarding the Unintended Radiation Exposure of the Embryo, Fetus or Nursing Child (1994) Advising the Public about Radiation Emergencies: A Document for Public Comment (1994) Dose Limits for Individuals Who Receive Exposure from Radionuclide Therapy Patients (1995) Radiation Exposure and High-Altitude Flight (1995) A n Introduction to Eficacy in Diagnostic Radiology and Nuclear Medicine (Justification of Medical Radiation Exposure) (1995) Proceedings of the Annual Meeting No Title Perceptions of Risk, Proceedings of the Fifteenth Annual Meeting held on March 14-15,1979(includingTaylor Lecture No 3) (1980) Critical Issues in Setting Radiation Dose Limits, Proceedings of the Seventeenth Annual Meeting held on April 8-9, 1981 (including Taylor Lecture No 5) (1982) R a d i a t i o n Protection a n d New Medical Diagnostic Approaches, Proceedings of the Eighteenth Annual Meeting held on April 6-7, 1982 (including Taylor Lecture No 6) (1983) Environmental Radioactivity, Proceedings of the Nineteenth Annual Meeting held on April 6-7,1983 (including Taylor Lecture No 7) (1983) Some Issues Important in Developing Basic Radiation Protection Recommendations, Proceedings of the Twentieth NCRP PUBLICATIONS / 69 Annual Meeting held on April 4-5,1984 (including Taylor Lecture No 8) (1985) Radioactive Waste, Proceedings of the Twenty-first Annual Meeting held on April 3-4,1985 (includingTaylor Lecture No 9) (1986) Nonionizing Electromagnetic Radiations and Ultrasound, Proceedings of the Twenty-second Annual Meeting held on April 2-3,1986 (includingTaylor Lecture No 10)(1988) New Dosimetry at Hiroshima and Nagasaki and Its Implications for Risk Estimates, Proceedings of the Twenty-third Annual Meeting held on April 8-9, 1987 (includingTaylor Lecture No 11) (1988) Radon, Proceedings of the Twenty-fourth Annual Meeting held on March 30-31, 1988 (including Taylor Lecture No 12) (1989) Radiation Protection Today-The NCRP at Sixty Years, Proceedings of the Twenty-fifth Annual Meeting held on April 5-6, 1989 (including Taylor Lecture No 13) (1990) Health and Ecological Implications of Radioactively Contaminated Environments, Proceedings of the Twenty-sixth Annual Meeting held on April 4-5, 1990 (including Taylor Lecture No 14) (1991) Genes, Cancer and Radiation Protection, Proceedings of the Twenty-seventh Annual Meeting held on April 3-4, 1991 (including Taylor Lecture No 15) (1992) Radiation Protection in Medicine, Proceedings of the Twentyeighth Annual Meeting held on April 1-2, 1992 (including Taylor Lecture No 16) (1993) Radiation Science and Societal Decision Making, Proceedings of the Twenty-ninth Annual Meeting held on April 7-8, 1993 (including Taylor Lecture No 17) (1994) Lauriston S Taylor Lectures No Title The Squares of the Natural Numbers in Radiation Protection by Herbert M Parker (1977) Why be Quantitative about Radiation Risk Estimates? by Sir Edward Pochin (1978) Radiation Protection-Concepts and Trade Offs by Hymer L Friedell (1979) [Available also in Perceptions of Risk, see above] From "Quantity of Radiation"and "Dose" to "Exposure" and / NCRP PUBLICATIONS "Absorbed Dose9'-An Historical Review by Harold Wyckoff (1980) How Well Can We Assess Genetic Risk? Not Very by James F Crow (1981) [Available also in Critical Issues in Setting Radiation Dose Limits, see abovel Ethics, Trade-offs and Medical Radiation by Eugene L Saenger (1982) [Available also in Radiation Protection and New Medical Diagnostic Approaches, see abovel The Human Environment-Past, Present and Future by Merril Eisenbud (1983) [Available also in Environmental Radioactivity, see abovel Limitation and Assessmnt in Radiation Protection by Harald H Rossi (1984) [Availablealso in Some Issues Important i n Developing Basic Radiation Protection Recommendations, see abovel Truth (and Beauty) i n Radiation Measurement b y John H Harley (1985) [Available also in Radioactive Waste, see abovel Biological Effects ofNon-ionizingRadiations: Cellular Properties and Interactions by Herman P Schwan (1987) [Available also in Nonionizing Electromagnetic Radiations and Ultrasound, see abovel How to be Quantitative about Radiation Risk Estimates by Seymour Jablon (1988) [Available also in New Dosimetry at Hiroshima and Nagasaki and its Implications for Risk Estimates, see above] How Safe is Safe Enough? by Bo Lindell(1988) [Available also in Radon, see above] Radiobiology and Radiation Protection: The Past Century and Prospects for the Future by Arthur C Upton (1989) [Available also in Radiation Protection Today, see abovel Radiation Protection and the Internal Emitter Saga by J Newel1 Stannard (1990) [Available also in Health and Ecological Implications of Radioactively Contaminated Environments, see abovel When is a Dose Not a Dose? by Victor P Bond (1992) [Available also in Genes, Cancer and Radiation Protection, see abovel Dose and Risk i n Diagnostic Radiology: How Big? How Little?by Edward W Webster (1992)[Availablealso inRadiation Protection i n Medicine, see abovel Science, Radiation Protection and the NCRP by Warren K Sinclair (1993)[Available also in Radiation Science and Societal Decision Making, see abovel NCRP PUBLICATIONS 18 71 Mice, Myths and Men by R.J Michael Fry (1995) Symposium Proceedings No Title The Control of Exposure of the Public to Ionizing Radiation in the Event ofAccident orAttack, Proceedings of a Symposium held April 27-29, 1981 (1982) Radioactive and Mixed Waste-Risk as a Basis for Waste Classification, Proceedings of a Symposium held November 9, 1994 (1995) NCRP Statements No Title "Blood Counts, Statement of the National Committee on Radiation Protection," Radiology 63, 428 (1954) "Statements on Maximum Permissible Dose from Television Receivers and Maximum Permissible Dose to the Skin of the Whole Body," Am J Roentgenol., Radium Ther and Nucl Med 84, 152 (1960) and Radiology 75, 122 (1960) X-Ray Protection Standards for Home Television Receivers, Interim Statement of the National Council on Radiation Protection and Measurements (1968) Specificationof Units ofNatural Uranium and Natural Thorium, Statement of the National Council on Radiation Protection and Measurements (1973) NCRP Statement on Dose Limit for Neutrons (1980) Control of Air Emissions of Radionuclides (1984) The Probability That a Particular Malignancy May Have Been Caused by a Specified Irradiation (1992) Other Documents The following documents of the NCRP were published outside of the NCRP report, commentary and statement series: Somatic Radiation Dose for the General Population, Report of the Ad Hoc Committee of the National Council on Radiation Protection and Measurements, May 1959, Science, February 19, 1960, Vol 131, No 3399, pages 482-486 72 / NCRP PUBLICATIONS Dose Effect Modifying Factors in Radiation Protection, Report of Subcommittee M-4 (Relative Biological Effectiveness) of the National Council on Radiation Protection and Measurements, Report BNL 50073 (T-471) (1967) Brookhaven National Laboratory (National Technical Information Service Springfield, Virginia) The following documents are now superseded andlor out of print: NCRP Reports No Title X-Ray Protection (1931) [Superseded by NCRP Report No 31 Radium Protection (1934) [Superseded by NCRP Report No 41 X-Ray Protection (1936) [Superseded by NCRP Report No 61 Radium Protection (1938) [Superseded by NCRP Report No 131 Safe Handling of Radioactive Luminous Compound (1941) [Out of Printl Medical X-Ray Protection Up to Two Million Volts (1949) [Superseded by NCRP Report No 181 Safe Handling of Radioactive Isotopes (1949) [Superseded by NCRP Report No 301 Recommendations for Waste Disposal of Phosphorus-32 and Iodine-131 for Medical Users (1951) [Out of Printl Radiological Monitoring Methods and Instruments (1952) [Superseded by NCRP Report No 571 Maximum Permissible Amounts of Radioisotopes i n the Human Body and Maximum Permissible Concentrations in Air and Water (1953) [Superseded by NCRP Report No 221 Recommendations for the Disposal o f Carbon-14 Wastes , (1953) [Superseded by NCRP Report No 811 Protection Against Radiations from Radium, Cobalt-60 and Cesium-137 (1954) [Superseded by NCRP Report No 241 Protection Against Betatron-Synchrotron Radiations Up to 100 Million Electron Volts (1954) [Superseded by NCRP Report No 511 Safe Handling of Cadavers Containing Radioactive Isotopes (1953) [Superseded by NCRP Report No 211 Radioactive-Waste Disposal i n the Ocean (1954) [Out of Printl NCRP PUBLICATIONS 17 18 19 20 21 24 26 28 29 31 33 34 39 43 45 48 53 56 58 66 91 73 Permissible Dose from External Sources of Ionizing Radiation (1954) including Maximum Permissible Exposures to Man, Addendum to National Bureau of Standards Handbook 59 (1958) [Superseded by NCFP Report No 391 X-Ray Protection (1955) [Superseded by NCRP Report No 261 Regulation of Radiation Exposure by Legislative Means (1955) [Out of Print] Protection Against Neutron Radiation Up to 30 Million Electron Volts (1957) [Superseded by NCRP Report No 381 Safe Handling of Bodies Containing Radioactive Isotopes (1958) [Superseded by NCRP Report No 371 Protection Against Radiations from Sealed Gamma Sources (1960) [Superseded by NCRP Reports No 33,34 and 401 Medical X-Ray Protection Up to Three Million Volts (1961) [Superseded by NCRP Reports No 33,34, 35 and 361 A Manual of Radioactivity Procedures (1961) [Superseded by NCRP Report No 581 Exposure to Radiation i n an Emergency (1962) [Superseded by NCRP Report No 421 * Shielding for High-Energy Electron Accelerator Installations (1964) [Superseded by NCRP Report No 511 Medical X-Ray and Gamma-Ray Protection for Energies Up to 10 MeV-Equipment Design and Use (1968) [Superseded by NCRP Report No 1021 Medical X-Ray and Gamma-Ray Protection for Energies Up to 10 MeV-Structural Shielding Design and Evaluation Handbook (1970) [Superseded by NCRP Report No 491 Basic Radiation Protection Criteria (1971) [Superseded by NCRP Report No 911 Review of the Current State of Radiation Protection Philosophy (1975) [Superseded by NCRP Report No 911 Natural Background Radiation in the United States (1975) [Superseded by NCFP Report No 941 Radiation Protection for Medical and Allied Health Personnel (1976) [Superseded by NCRP Report No 1051 Review ofNCRP Radiation Dose Limit for Embryo and Fetus i n Occupationally-Exposed Women (1977) [Out of Printl Radiation Exposure from Consumer Products and Miscellaneous Sources (1977) [Supersededby NCRP Report No 951 A Handbook of Radioactivity Measurements Procedures, 1st ed (1978) [Superseded by NCRP Report No 58,2nd ed.1 Mammography (1980) [Out of Print] Recommendations on Limits for Exposure to Ionizing Radiation (1987) [Superseded by NCRP Report No 1161 74 NCRP PUBLICATIONS NCRP Commentaries No Title Preliminary Evaluation of Criteria for the Disposal of Transuranic Contaminated Waste (1982) [Out of Print1 NCRP Proceedings No Title Quantitative Risk in Standards Setting, Proceedings of the Sixteenth Annual Meeting held on April 2-3, 1980 [Out of Print] Index Absorbed dose 3,8, 42 Exposure 3,44 Air kerma Cancer induction 12-13 estimation by statistical methods 12 from high-dose exposures 12 latency 12-13 Chemical formulation 26-27 Comparative risks 9, 13 Computers and software Contamination control 30-32 air 31 personnel 31-32 surfaces 31 Developmental defects 12 embryolfetus 12 growth retardation 12 malformation 12 mental retardation 12 Dosage 25-30, 43 Dosage calibrations 29-30, 43 activity measurement 29 dosage calibrator 29, 43 periodic calibration 29 reference source check 29 Dose limits 10,45 general public 10 lifetime 10 occupational 10 Dose to patients 20-21 source of exposure to persons nearby 20 source of exposure to public 20 Effective dose 3,43 Effects at low doses 10-11 damage to DNA 11 hereditary 11 somatic 10 Generator eluate 25,26,44 Glossary 42-47 Hereditary defects 11-12 animal species 11 lower forms of life 11 Instrumentation Late effects 11-13, 45 cancer 11-13 mutagenic effects 11-12 teratogenic effects 11-12 Latent period 13,45 dependent variables 13 Low-level radiation doses 9-13 natural background 10 nuclear power 10 occupational 10 public 10 Misadministration 32 Multidose radiopharmaceuticals 25,26 New procedures Nursing mothers 32-33 counseling 32-33 exposure potential to infants 33 radionuclide therapy patients, exposure to 33 restrictions on 32-33 safety considerations 32-33 Organ doses 76 / INDEX Personnel exposure 19-24 nuclear medicine personnel 19-20 administration to patients 19-20 dosage preparation 19 imaging 19-20 positioning of patient 20 radiopharmacy 19 nurses 21-23 patients 20-21 persons near patients 20-21 public 20-21,23-24 PET 2,8,45 Public significance of nuclear medicine 4-8 diagnosis imaging growth rate metastasis location nature and advantages 4-6 physiological measurement radioimmunoassay size and growth 6-8 therapy Radiation exposure from nuclear medicine practice 19-24 nuclear medicine personnel 19-20 nurses and other medical personnel 1-23 general public 23-24 Radiation risk 9-13 comparative risk 9, 13 dose limits 10 effects at low doses 10 low-level doses 9-10 Radiation safety considerations 35-41 collection and handling of excreta 37-39 radiopharmaceutical administration 35 for diagnostic purposes 36-37 for therapeutic purposes 37 notification of 35 staff nurses 35-41 Radioactive materials 14-18 in-house transportation of 15-16 receipt of 15 receipt and delivery of 14-18 shipment of sources 14-15 transport of patients 16-17 transport of specimens 17-18 Radioactive waste disposal 33-34, 46 Radioimmunoassay 4, 46 Radionuclides activity half-life physical characteristics Radiopharmaceuticals 4, 8, 46 Radiopharmaceutical handling procedures 25-34 administration to patient 25, 30 calibration of dosages 25 calibration of stock vials 25 chemical formulation 26-27 compounding and dispensing 25 contamination control 30 imaging 30 iodine diagnosis and therapy 28-29 misadministration 32 radioactive waste disposal 33-34 radiopharmacy 25, 26 safety considerations with nursing mothers 32-33 xenon 27-28 Radiopharmacy 25-26,42 central 42 generator eluate 25 in-house 26 multidose radiopharmaceuticals 25 unit dosage 25,47 Regulation of nucIear medicine 5-6 agreement states FDA NRC Repair 11 INDEX Repopulation 11 Risk comparisons 9,13 Somatic effects 13 SPECT , , Significance of nuclear medicine 4-8 Size and growth of nuclear medicine 6-8 Unit dosages 25,47 Xenon 27-28 / 77 ... Library of Congress Cataloging-in-Publication Data National Council on Radiation Protection and Measurements Sources and magnitude of occupational and public exposures from nuclear medicine procedures. .. in Diagnosis and Therapy (NCRP, 1982) and NCRP Report No 73, Protection in Nuclear Medicine and Ultrasound Diagnostic Procedures in Children (NCRP, 1983) Estimates of the quantities of radionuclides... NCRP Report No 100, Exposure of the U.S Population from Diagnostic Medical Radiation (NCRP, 1989a) A primary concern is the evaluation and control of occupational exposures to nuclear medicine and