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Nuke Med Risk Research
Guidance on prevention of unintended and accidental radiation exposures in nuclear medicine https://iopscience.iop.org/article/10.10...ab19d8/pdf


Nuclear medicine (NM) procedures for diagnosis and treatment of disease are performed routinely in hospitals throughout the world. These involve preparation and administration to patients of pharmaceuticals labelled with radioactive material. There is potential for incidents to occur, involving unintended exposures of patients or staff members, throughout all stages of a procedure. The International Atomic Energy Agency (IAEA) and the World Health Organisation highlighted the need for improvement in prevention of medical radiation incidents and accidents in the Bonn Call-for-Action in 2012. An IAEA Technical Meeting was held on prevention of unintended exposures and accidents in NM in 2018 to address the issue. Exposures can take place at any time when radioactive material is being produced and used, and the risk continues after procedures have been completed. Thus there is potential for staff or members of the general public to be exposed, as well as patients. This paper sets out guidelines for incident prevention based on presentations and discussions at the meeting, and review of reports from the literature. It deals with potential incidents in in-house radionuclide production, radiopharmaceutical preparation, administration to patients, and following a procedure, as well as aspects in management of radioactive materials. Special attention has been paid to therapeutic procedures, as these have the potential to cause more harm to patients from erroneous administrations, including tissue reactions from extravasation of radiopharmaceutical, and could lead to significant contamination events. Administration of NM therapy is generally contraindicated in pregnancy. Identification of any patient who may be pregnant is crucial and it might be necessary to verify this with a pregnancy test for patients within the age band considered to be fertile. Inclusion of NM therapy incidents in the IAEA automated reporting system SAFRON is recommended. In summary, the paper aims to highlight errors that could occur during different phases of NM procedures in order to aid prevention of incidents. The value of periodic audit in evaluating systems in place on a regular basis is emphasized. Approaches to incident investigation and follow-up are described, and the need to ensure corrective action is taken to address any deficiencies stressed."

Nod to NRC nuclear event notices involving nuc med mistakes.
just pm me if needed.
One could well ask; out of every 1000 adverse reactions to medical radiation, how many are recognized, and of those, how many are reported?   Having had some hospital experience and medical radiation,  (almost everybody has some),  my guess, my 1/2 cents worth, is that not even one adverse reaction in a thousand is reported.  For any reaction less than acute, we are simply in the hospital for too short a time to see the range of adverse reactions.  They arent doing tests to see changes in radiation induced metabolic dysfunction.  Most people, including medical staff will not be able to differentiate problems due to radiation within the complex milieu of their disease state and uncertainties of age related dysfunction. 

Here is a study that tried to quantify medical related radiation accidents;

Reported Radiation Overexposure Accidents Worldwide, 1980-2013: A Systematic Review
"297 out of 5189 publications and reports and 194 records from the REAC/TS registry met our eligibility criteria. From these, 634 reported radiation accidents were retrieved, involving 2390 overexposed people, of whom 190 died from their overexposure. The number of reported cases has decreased for all types of radiation use, but the medical one. 64% of retrieved overexposure cases occurred with the use of radiation therapy and fluoroscopy."


The authors say " The main limitation of this study is the likely underreporting of radiation overexposures"
Everyone agrees it is human nature to not report our mistakes, if at all possible. 
But what constitutes an overexposure? This is the crux for me. If only severe or acute responses are the criterion of overexposure, then of course the estimate of radiation harm from accidents will not include any but the most extreme morbid responses.  A small percentage of the total radioactive impact. 

"A case of radiation overexposure was defined as presenting at least one of the following criteria: (i) unintended global overexposure of 1 Gy or more, (ii) unintended local skin overexposure of 3 Gy or more, (iii) unintended local organ overexposure (e.g. brain, thyroid, prostate) of 5 Gy or more, or (iv) description of clinical presentation providing reasonable index of suspicion for unintended ionizing radiation overexposure (i.e., acute radiation syndrome, radiodermatitis, permanent alopecia, dry or moist desquamation, blister formation, skin ulceration, dermal atrophy, invasive fibrosis, organ failure, radio-necrosis). "

 How serious is 1 to 5 Gy?
"Radiation above 1 Gy causes a complex of symptoms such as nausea and blood changes, known as radiation sickness. High radioactive doses are above 3 Gy (300 rad), which are very dangerous. Doses above 6 Gy (600 rad) are almost always fatal, leading to death within months. 

Its like quantifying bicycle accidents but only using data from impact by semi-trailer trucks.

Another study puts this into perspective;
Since the end of the Second World War, industrial and medical uses of radiation have been considerably increasing. Accidental overexposures of persons, in either the occupational or public field, have caused deaths and severe injuries and complications. The rate of severe accidents seems to increase with time, especially those involving the public; in addition, accidents are often not immediately recognised, which means that the real number of events remains unknown.
we are healthy with background radiation but unhealthy with the same dose from fallout
Causes me to think about the Farley nuclear worker death (NRC Event Notice posted by Staup yesterday http://caferadlab.com/thread-3440.html).

The immediate report from management is that they don't think it was work (radiation) related. They back that up by saying the worker was in a radiation controlled area at the time. Unless they do a forensic exam, whole body counter, tissue sampling, they can't rule out radiation as the cause of the worker's death. How long had the deceased been working at the facility? Did they ever come into contact with radioactive substances? Were they medically tested previously for any radiation exposure related health concerns?
just pm me if needed.

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