Prevention of incidents in nuclear medicine
Incidents in nuclear medicine can vary from a mild spillage to something that can have devastating implication such as misadministration of therapy dose of radioiodine to a lactating mother. Most of incidents remain unreported and that creates all problems in analysing and bringing out lessons. Misadministration is the commonest incident. Misadministration means giving the radiopharmaceutical to the wrong patient, giving the wrong radiopharmaceutical or wrong activity to the patient, or unjustified examination of pregnant or lactating female patients. Another type of misadministration is to use the wrong route of administration, which includes complete extravascular injections that can result in very high absorbed exposure at the injection site especially if the volume is small, the activity is high, and the radiopharmaceutical has a long retention time.
A patient undergoing diagnostic and therapeutic procedure will be exposed to many potential risks (probability of harm) besides exposure to ionizing radiation. Each risk deserves due consideration. The radiation risk is low in many instances and the consequences of that risk in most of the cases are not severe, but in some they are.
A review of lessons learned from misadministrations in the past, indicate that many of these have occurred under certain conditions, as: communication problems, busy environment, distraction, not following local rules, lack of training in emergency situations, undefined responsibilities or inefficient or missing quality assurance (including audits to reveal deficiencies and procedures to deal with emergency situations). If such events occur, the primary actions to be taken include the following: immediate use all available means to minimize any adverse effects, informing responsible nuclear medicine physician, patient and referring physician, dose calculation, implementation of corrective measures, and informing all staff of the incident and the corrective measures.
Introduction to References
The Radiation Protection of Patients (RPoP) website contains information on misadministrations, incidents and accident and pregnancy and nuclear medicine, all to help health professionals prevent incidents in nuclear medicine. This website also contains training material on radiation protection in nuclear medicine and radiation protection in PET/CT.
The key standards in this area are the International Basic Safety Standards for Protection against Ionizing Radiation and for the Safety of Radiation Sources, also known as the International BSS. These standards mark the culmination of efforts that have continued over the past several decades towards the harmonization of radiation protection and safety standards internationally. Safety reports to guide users in applying safety standards in different areas of medical application of ionising radiation are available for free download.