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IAEAInternational Atomic Energy Agency
RADIATION PROTECTION INDIAGNOSTIC ANDINTERVENTIONAL RADIOLOGY
L 0. Principles of Radiation Protection andMotivation for the Course
IAEA Standard Syllabus Course on Radiation Protection in Diagnostic and Interventional Radiology
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IAEA
Introduction to Radiation Protection in Diagnostic Radiology 2
Introduction
Subject matter motivation for radioprotectionand quality assurance in diagnostic andinterventional radiology
Give an overview of different contributions ofradiation exposure, the principles ofradiation protection
Specifity of the medical exposure
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Introduction to Radiation Protection in Diagnostic Radiology 3
Is there
RADIATIONin this room?
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Introduction to Radiation Protection in Diagnostic Radiology 4
Radiation - We live with
Natural Radiation: Cosmic rays, radiation within ourbody, in food we eat, water we drink, house we livein, lawn, building material etc.
Human Body: K-40, Ra-226, Ra-228
e.g. a man with 70 kg wt. 140 gm of K140 x 0.012%=0.0168 gm of K-400.1 Ci of K-40
24,000 photons emitted/min
(T1/2 of K-40 = 1.3 billion yrs)
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IAEA
Introduction to Radiation Protection in Diagnostic Radiology 5
K-40 Estimate for Lean Body Mass
Body weight = Fat + lean body mass
K-40 directly related to lean body mass
Whole body counter used
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Introduction to Radiation Protection in Diagnostic Radiology 6
Radiation - We live with
Earth: Top 1m of 0.1 acre garden
=1200 kg of K of which K-40 =1.28 Kg
= +3.6 Kg of Th + 1 Kg Ur
Gy/yrNew Delhi 700
Bangalore 825
Bombay 424
Kerala 4000
(in narrow coastal strip)
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IAEA Introduction to Radiation Protection in Diagnostic Radiology 8
Radiation - We live with
Food Radioactive levels (Bq/kg)
Daily intake(g/d)
Ra-226 Th-228 Pb-210 K-40
Rice 150 0.126 0.267 0.133 62.4
Wheat 270 0.296 0.270 0.133 142.2
Pulses 60 0.233 0.093 0.115 397.0
OtherVegetables
70 0.126 0.167 -- 135.2
LeafyVegetables
15 0.267 0.326 -- 89.1
Milk 90 -- -- -- 38.1CompositeDiet
1370 0.067 0.089 0.063 65.0
Dose equivalent=0.315 mSv/yr
Total dose from Natural sources = 1.0 to 3.0 mSv/yr
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IAEA Introduction to Radiation Protection in Diagnostic Radiology 9
Radiation from Natural Sources
Normally 1-3 mSv/year
In areas of high background, 3-13 mSv/year
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IAEA Introduction to Radiation Protection in Diagnostic Radiology 10
DO WE NEED
RADIATION
PROTECTION ?
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IAEA Introduction to Radiation Protection in Diagnostic Radiology 11
Drinking Hot Coffee
Excess Temperature = 60 - 37 = 23
1 sip = 3ml
3x 23 = 69 calories
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IAEA Introduction to Radiation Protection in Diagnostic Radiology 12
Lethal Dose= 4Gy
LD 50/60 = 4 Gy
For man of 70 kg
Energy absorbed = 4 x 70 = 280 Joules
= 280/418= 67 calories
= 1 sip
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IAEA Introduction to Radiation Protection in Diagnostic Radiology 14
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IAEA Introduction to Radiation Protection in Diagnostic Radiology 15
SO WE NEED
RADIATION
PROTECTION
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IAEA Introduction to Radiation Protection in Diagnostic Radiology 16
We live with1-3 mSv
Can kill4000 mSv
Radiation
Where to stop, where is the safe point?What are the effects of radiation?
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IAEA Introduction to Radiation Protection in Diagnostic Radiology 17
Death
Cancer
Skin Burns
Cataract
InfertilityGenetic effects
What can radiation do?
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IAEA Introduction to Radiation Protection in Diagnostic Radiology 18
CAN X-RAY
CAUSE
DEATH?
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IAEA Introduction to Radiation Protection in Diagnostic Radiology 19
Dose
Deterministic effects
Cataract
infertility
erythema
epilation
500 mSv cataract150 mSv for sterility (temporary-males)
2500 mSv for ovarian
Effect
OBJECTIVES OF RADIATION
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IAEA Introduction to Radiation Protection in Diagnostic Radiology 20
OBJECTIVES OF RADIATIONPROTECTION
PREVENTION of deterministic effect
LIMITING the probability of stochastic effect
HOW? Up to what point?
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IAEA Introduction to Radiation Protection in Diagnostic Radiology 21
OPTIMIZATION
principle
To what extent OPTIMIZATION ?Over-stretching OPTIMIZA TION
F t f id i l i l t di f
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IAEA Introduction to Radiation Protection in Diagnostic Radiology 22
Features of some epidemiological studies ofradiation-induced cancer risks
Life Span Study Massachusetts Children in
(LSS) of Ankylosing tuberculosis patients Israel irradiated
Japanese atomic Spondylitis given chest for ringworm UK National Registry for
bomb survivors Study (ASS) fluoroscopies of the scalp Radiation Workers
Parameter (Shimizu et al) (Weiss et al) (Boice et al) (Ron et al) (Kendall et al)
Population 75991 14109 2573 10834 95217
size (with DS86 doses)
Period of 5-55 years Up to over Up to over 50 years Up to 32 years Up to 40 yearsfollow-up following exposure 50 years
(mean 25.2 (mean 30 years) (mean 26 years)
years)
Ranges of:
(a) ages at All Virtually all Under 15 to over 40 0-15 years 18-64 years
exposure 15 years
(b) sexes Similar numbers of 83.5% male Female Similar number of 92% male
males and females males and females
ethnic Japanese Western (UK) Western (N. American) African and Asian Western (UK)
groups
Setting in War Medical:ther- Medical:diagnostic Medical:therapy Occupational
which apy for non- for non-malignant
exposure malignant diseasewas received disease
F t f id i l i l t di f
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IAEA Introduction to Radiation Protection in Diagnostic Radiology 23
Features of some epidemiological studies ofradiation-induced cancer risks (cont.)
Life Span Study Massachusetts Children in
(LSS) of Ankylosing tuberculosis patients Israel irradiated
Japanese atomic Spondylitis given chest for ringworm UK National Registry
bomb survivors Study (ASS) fluoroscopies of the scalp for Radiation Workers
Parameter (Shimizu et al) (Weiss et al) (Boice et al) (Ron et al) (Kendall et al)
Range of All All (but Mainly breast & lung mainly brain, All
organs mainly those bone marrow,
irradiated in proximity thyroid, skin
to spine and breast
Availability Organ doses: Mean organ Organ doses: Brain, thyroid & Individual whole-body
of dose individual basis doses: indiv. Individual basis skin doses: external doses
estimates only for red individual basis
bone marrow
at present
Range dose Mainly 0-4 Gy Mainly 0-20 Gy Mainly 0-3 Gy Brain: 0-6 Gy Mainly 0-0.5 Sv
(mean 1.5 Gy) (mean 0.034 Sv)
Thyroid:0-0.5 Gy
(mean 0.09 Gy)
Dose rate High High High, but highly High Low
fractionated
Radiation Mainly low-LET Low-LET Low-LET Low-LET Mainly low-LET
Quality
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IAEA Introduction to Radiation Protection in Diagnostic Radiology 24
Dose Limits (ICRP 60)
Occupational PublicEffective dose 20 mSv/yr averaged* 1 mSv in a yr
over 5 yrs.
Annual equivalent
dose to
Lens of eye 150 mSv 15 mSv
Skin 500 mSv 50 mSv
Hands & Feet 500 mSv
* with further provision that dose in any single yr > 30 mSv (AERB)and =50 mSv (ICRP)
N.B.: M.P.D. 1931 = 500 mSv, 1947=150 mSv, 1977=50 mSv &
in 1990=20 mSv
Changes in Dose Limit (ICRP)
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IAEA Introduction to Radiation Protection in Diagnostic Radiology 25
mSv
Year
Changes in Dose Limit (ICRP)(Safe levels)
0
100
200
300
400
500
1931 1947 1977 1990
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IAEA Introduction to Radiation Protection in Diagnostic Radiology 26
WHAT IS
BASIS FOR
DOSE LIMITS?
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WHY
REDUCTION IN
DOSE LIMITS?
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IAEA Introduction to Radiation Protection in Diagnostic Radiology 29
PRINCIPLES
OFRADIATION
PROTECTION
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IAEA Introduction to Radiation Protection in Diagnostic Radiology 30
1. Justification of practices
2. Optimization of protection by
keeping exposure as low asreasonably achievable
3. Dose limits for occupational
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HOW TO APPLY
THESE PRINCIPLES IN
DIAGNOSTIC RADIOLOGY?
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How much time one works with radiation?
RADIOGRAPHY
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Radiation ON Time
Workload=100 exposures/day
CxR = 50x50 m sec = 2500 = 2.5
LS = 50x800 m sec = 40000=40s
Total time = 45 sec/day
Not greater than 1 min/day
S ff D
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IAEA Introduction to Radiation Protection in Diagnostic Radiology 34
Staff Doses
Dose limit ICRP = 20 mSv/yr.
Radiography work 0.1 mS/yr.
i.e. 1/200th ofdose limit
Radiation Doses in Radiological Exam
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IAEA Introduction to Radiation Protection in Diagnostic Radiology 35
Relative Dose Received
number of chest x-rays0 50 100 150 200
Arm, head,ankle & foot (1)Head & Neck (3)
Head CT (10)Thoracic Spine (18)Mammography, Cystography (20)
Pelvis (24)Abdomen, Hip, Upper & lower femur (28)
Ba Swallow (30)
Obsteric abdomen (34)Lumbo-sacral area (43)
Cholangiography (52)Lumber Myelography (60)
Lower abdomen CT male (72)Upper Abdomen CT (73)Ba Meal (76)
Angio-head, Angio-peripheral (80)Urography (87)
Angio-abdominal (120)Chest CT (136)
Lower Abd. CT fem. (142)Ba enema (154)
Lymphan. (180)
mSv.05
0.15
0.49
0.92
1.0
1.22
1.4
1.5
1.7
2.15
2.59
3.0
3.61
3.67
3.8
4.0
4.36
6.0
6.8
7.13
7.69
9.0
Radiation Doses in Radiological Exam.(as multiple of chest x-ray)
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IAEA Introduction to Radiation Protection in Diagnostic Radiology 36
IS IT POSSIBLE TO GET
DETERMINISTIC EFFECTS INRADIOGRAPHIC WORK ?
For staff, for patient..??
Radiography
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IAEA Introduction to Radiation Protection in Diagnostic Radiology 37
Radiography
Risk of Staff Patient Public
DeathSkin burnInfertilityCataractCancerGenetic effect
UU
UU
UU
U: unlikely
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IAEA Introduction to Radiation Protection in Diagnostic Radiology 38
FLUOROSCOPY
ANDCT
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IAEA Introduction to Radiation Protection in Diagnostic Radiology 39
Fluoroscopy
Barium study: 3-6 min/pt x 8 patients/d=40 min/d
ANGIOGRAPHY Diagnostic = 50 min/d Therapeutic = 2-5 hr/d
CT = 10-45 min/d
Fluoroscopy ( l th i )
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IAEA Introduction to Radiation Protection in Diagnostic Radiology 40
Fluoroscopy (excl. ther angio)
Risk of Staff Patient Public
DeathSkin burn
InfertilityCataractCancerGenetic effect
UU
UU
UU
U: unlikely
S
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IAEA Introduction to Radiation Protection in Diagnostic Radiology 41
Summary
1. Radiation we live with
2. Radiation that can be lethal
3. Radiation effects
4. Dose limits
5. Principles of protection
6. Application of protection principles indiagnostic radiology
R di h
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IAEA Part 1: Introductory lecture42
Radiotherapy
One of the main treatment modalities forcancer (often in combination withchemotherapy and surgery)
It is generally assumed that 50 to 60% ofcancer patients will benefit from radiotherapy
Minor role in other diseases
Siemens Oncology
Obj ti f th M d l
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IAEA Part 1: Introductory lecture43
Objectives of the Module
To become familiar with the principles of radiotherapy
the role of radiotherapy in cancer management
the cost effectiveness of radiotherapy
To appreciate the importance of radiationdose in radiotherapy
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IAEA Part 1: Introductory lecture 44
Aim
To kill ALL viablecancer cells
To deliver as muchdose as possible tothe target whileminimising the dose
to surroundinghealthy tissues
target
Patient
Critical
organs
Beam
directions
P ti F t
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IAEA Part 1: Introductory lecture45
Prognostic Factors
Cancer type and stage
Patient performance
Radiation dose
...survival
time
Good prognosis
Bad prognosis
P ti F t
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IAEA Part 1: Introductory lecture46
Prognostic Factors
Cancer type and stage
Patient performance
Radiation dose
...
Accurate dose delivery
matters!
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IAEA Part 1: Introductory lecture47
Doseresponse
100% response
means the tumouris cured with
certainty (TCP) or
unacceptable normal
tissue damage (e.g.
paralysis) is
inevitable
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IAEA Part 1: Introductory lecture48
Doseresponse
Therapeutic window:
Maximum probabilityof Complication FreeTumour Control
Dose sho ld be acc rate
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IAEA Part 1: Introductory lecture49
Dose should be accurate
To target: 5% too low - may result in clinically detectable
reduction in tumour control (e.g. Head and neckcancer: 15%)
To normal tissues: 5% too high - may lead to significant increase in
normal tissue complication probability =
morbidity = unacceptable side effects
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IAEA Part 1: Introductory lecture50
Deviations from Prescribed
Dose
May involve severe or even fatalconsequences.
IAEA Basic Safety Standards (SS 115):require prompt investigation by
licensees in the event of an accidental
medical exposure
Options for dose delivery
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IAEA Part 1: Introductory lecture51
Options for dose delivery
External beam radiotherapy = dose isdelivered from outside the patient usingX Rays or gamma rays or high energy
electrons (refer to part 5 of the course) Brachytherapy = dose delivered from
radioactive sources implanted in the
patient close to the target (brachys =Greek for short distance; refer to part 6of the course)
External beam radiotherapy
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IAEA Part 1: Introductory lecture52
External beam radiotherapy
IAEA Training Material on Radiation Protection in Radiotherapy
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IAEAInternational Atomic Energy Agency
Radiation Protection in
Radiotherapy
IAEA Training Material on Radiation Protection in Radiotherapy
The IAEA
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IAEA Part 0: Lecture CourseOutline54
The IAEA
International Atomic Energy Agency Statutory function: to establish standards
of safety for the protection of health and
to provide for the applications of thesestandards.
Objective to accelerate and enlarge thecontribution of atomic energy to peace,health and prosperity throughout the world.
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IAEA Part 0: Lecture CourseOutline55
Radiotherapy
Constitutes a peaceful
application of ionizing radiation Is an essential part of cancer
management
Issues of safety, quality assurance andorganization must be considered
VARIAN Oncology
Content of the Lecture Course
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IAEA Part 0: Lecture CourseOutline56
Content of the Lecture Course
A Background (Radiotherapy, effectsof radiation, principles of protection)
B Properties of equipment used inradiotherapy
C Radiation exposure (Occupational,medical and accidental)
D Associated issues (Transport,discharge of patients, organization)
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IAEA Part 0: Lecture Course Outline 57
Essential Reading
International Basic SafetyStandards for Protectionagainst Ionizing Radiation
and for the Safety ofRadiation Sources,Vienna 1996 (IAEA, FAO,ILO, OECD/NEA, PAHOand WHO)
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IAEAInternational Atomic Energy Agency
RADIATION PROTECTION IN NUCLEARMEDICINE
Part 0: Introduction to Nuclear Medicine
NUCLEAR MEDICINE
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IAEA Part 0. Introduction toNuclear Medicine59
Clinical problem
Radiopharmaceutical Instrumentation
Diagnosis and therapy withunsealed sources
NUCLEAR MEDICINE
RADIOPHARMACEUTICALS
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IAEA Part 0. Introduction toNuclear Medicine60
Radionuclide Pharmaceutical Organ Parameter
+ colloid Liver RES
Tc-99m + MAA Lungs Regional
perfusion
+ DTPA Kidneys Kidneyfunction
RADIOPHARMACEUTICALS
HISTORY-RADIONUCLIDES
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IAEA Part 0. Introduction toNuclear Medicine61
1896 Natural radioactivity Becquerel1898 Radium Curie
1911 Atomic nucleus Rutherford
1913 Model of the atom Bohr
1930 Cyclotron Lawrence1932 Neutron Chadwick
1934 Artificial radionuclide Joliot-Curie
1938 Production and identification of I-131 Fermi et al
1942 Nuclear reactor Fermi et al
1946 Radionuclides commercially available Harwell
1962 Tc99m in nuclear medicine Harper
HISTORY-RADIONUCLIDES
PIONEERS
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IAEA Part 0. Introduction toNuclear Medicine62
Henri Becquerel Ernest Rutherford Maria Curie
Frederique Joliot-Irene Curie
PIONEERS
CURRENT METHODS-THERAPY
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IAEA Part 0. Introduction toNuclear Medicine63
Radiopharmaceutical For treatment of Route of Maximum
administration activity
I-131 iodide Thyrotoxicosis Oral 1 GBq
I-131 iodide Carcinoma of thyroid Oral 20 GBq
I-131 MIBG Malignancy IV 10 GBq
P-32 phosphate Polycythaemia vera IV or oral 200 MBq
Sr-89 chloride Bone metastases IV 150 MBq
Y-90 colloid Arthritic conditions Intra-articular 250 MBq
malignant effusions Intra-cavitary 5 GBq
Er-169 colloid Arthritic conditions Intra-articular 50 MBq
Re-186 colloid Arthritic conditions Intra-articular 150 MBq
CURRENT METHODS-THERAPY
HISTORY-THERAPY
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IAEA Part 0. Introduction toNuclear Medicine64
1936 Therapeutic use of Na-24 (leukemia) Hamilton et
al
1936 Therapeutic use of P-32 (leukemia and Lawrence
polycythemia vera)
1941 Therapeutic use of iodine in hyperthyroidism Hertz et al1942 Therapeutic use of iodine in treatment of
metastasis from thyroid cancer
1945 Therapeutic use of Au-198 in treatment of Muller
malignant effusion
1958 Treatment of bone metastasis with P-32 Maxfield1963 Medical synovectomy using Au-198 Ansell
HISTORY-THERAPY
I-131 THERAPY
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IAEA Part 0. Introduction toNuclear Medicine65
The absorbed dose to be delivered should be determined
from uptake measurements, effective half-life of the radio-
pharmaceutical and the size of the thyroid.
The radiopharmaceutical is administered p.os.
Hyperthyroidism
Cured after Hypothyroidism3-4 months 1 year after 7 years
85% 98% 14.8% 27.9%
I-131 THERAPY
RADIOSYNOVECTOMY
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RADIOSYNOVECTOMY
PAIN PALLIATION
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PAIN PALLIATION
Intravenous injection of
a radiopharmaceutical which
includes e.g. Sr-89 orSm-153
ANNUAL FREQUENCY-THERAPY
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Thyroid (tumours & hyperthyroidism) 0.39
Polycythemia vera 0.034Other tumours 0.003
Others 0.001
Total 0.428
Number of patients per 1000 population
about 3% of all nuclear medicine
(Sweden 1995)
CURRENT DIAGNOSTIC METHODS
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Imaging
Bone, Brain, Lungs , Thyroid, Kidneys, Liver/spleen,Cardiovascular, Stomach/GI-tract, Tumours, Abscesses .
Non-imaging (probes)
Thyroid uptake, Renography, Cardiac output, Bile acid
resorption.
Laboratory tests
GFR, ERPF, Red cell volume/survival, Absorption
studies (B12, iron, fat), Blood volume, Exchange-
able electrolytes, body water, bone metabolism..
Radioimmunoassays (RIA) Radioguided Surgery
CURRENT DIAGNOSTIC METHODS