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1 Management of Radioactive Waste in a Nuclear Medicine Department A Medical Physics Perspective Dr. Jennie Cooke Medical Physics and Bioengineering Dept St. James’s Hospital

D v P u v } ( Z ] } ] À t ] v E µ o D ] ] v u v · 2019. 11. 20. · í X^ P P ] } v ( ] o µ t o P À } o µ u } ( o } v P o ] À Á X î X> } v P r o ] À } v u ] v v W / r í

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  • 1

    Management of Radioactive Wastein a

    Nuclear Medicine Department

    A Medical Physics Perspective

    Dr. Jennie CookeMedical Physics and Bioengineering Dept

    St. James’s Hospital

  • 2

  • 3

    • Produced from a Mo-99 generator

    • Gamma emitter with energy 140keV

    • Half-life of 6 hours

    • Can be labelled to a wide range of pharmaceuticals

    • Imaging is performed with a SPECT system (Single photon emission computed tomography) typically with CT (x-ray) attenuation correction.

    • Short lived waste (typically < 48 hours storage)

    • Workhorse isotope – relatively large volumes of waste

    Technetium-99m – the (almost) ideal isotope for diagnostics

  • 4Se-75 - tauroselcholic [75 selenium] acid

    • Mimics bile acid for the diagnosis of bile acid malabsorption

    • Half-life – 120 days

    • Activity administered is very low - < 370kBq

    • Outpatient protocol

  • 5Ga-68 PET imaging – the new wave• Produced from a Ge-68 generator

    • Positron emitter - annihilation producing 2 x 511keV photons

    • Half-life of 68 minutes

    • Can be labelled to a range of ligands

    • Imaging is performed with a PET system (Positron emission tomography) typically with CT (x-ray) attenuation correction.

    • Short lived waste (typically < 12 hours storage)

    • Synthesis of gallium peptides produces a large volume of waste. Some contamination with Ge-68 (half life 271 days) is unavoidable.

  • 6

    Radiopharmaceutical Preparation

    Patient administration

    Uptake time & inpatients

  • 7A Simple Radiopharmaceutical Preparation

    Operator dresses in PPE – disposable gown and gloves.

    Operator prepares a drip tray in the laminar flow cabinet lined with a low lint wipe to absorb spills.

    Technetium - 99m (Tc-99m) is eluted from the generator into a glass vial.

    A glass vial of radiopharmaceutical is swabbed with an alcohol wipe. Spills of Tc-99m are also absorbed using these.

    The required volume of Tc-99m is drawn from the eluate vial using a syringe and needle.

    The Tc-99m is diluted with saline from a 10ml plastic vial of NaCl.

  • 8A Simple Radiopharmaceutical Preparation

    Operator dresses in PPE – disposable gown and gloves.

    Operator prepares a drip tray in the laminar flow cabinet lined with a low lint wipe to absorb spills.

    Technetium - 99m (Tc-99m) is eluted from the generator into a glass vial.

    A glass vial of radiopharmaceutical is swabbed with an alcohol wipe. Spills of Tc-99m are also absorbed using these.

    The required volume of Tc-99m is drawn from the eluate vial using a syringe and needle.

    The Tc-99m is diluted with saline from a 10ml plastic vial of NaCl.

  • 9More complex operations…

    In vitro red blood cell labelling with Tc-99m

    In vitro white blood cell labelling with In-111

    Blood handling for glomerular filtration rate measurements

    Complex labelling processes such as synthesis using larger disposables such as cassettes.

  • 10More complex operations…

    In vitro red blood cell labelling with Tc-99m

    In vitro white blood cell labelling with In-111

    Blood handling for glomerular filtration rate measurements

    Complex labelling processes such as synthesis using larger disposables such as cassettes.

  • 11

    Tc-99m Sharps:

    Needles

    Glass vials

    Tc-99m non-

    sharps:

    GlovesGowns

    WipesTray liner

    Long-lived isotopes sharps:

    Synthesis cassettes

    Synthesis waste vials

    Long lived isotopes

    non-sharps

    Non-radioactive

    waste

    Radiopharmacy Waste SegregationRadiopharmacy Waste Segregation

  • 12Radiopharmaceutical Administration

    Intravenous:

    CannulaPPE

    Absorbent sheets

    Capsule:

    CupGloves

    Ventilation Study:

    Vapourisationset

  • 13

    Tc-99m Sharps:

    Needles

    Cannulas

    Tc-99m non-sharps:Gloves

    GownsWipes

    Absorbent sheets

    Radiopharmacy Waste SegregationInjection Room Waste Segregation

    All other waste returned to

    radiopharmacy for disposal

  • 14Waste production during uptake time and from inpatients

  • 15Diagnostic Radiopharmaceutical Challenges

    1. Segregation failures – larger volumes of long lived waste.

    2. Long-lived contaminants: I-123 preparation which should have a half-life of 13.2 hours contains longer lived isotopes in small quantities: I-125 with a half-life of 60 hours and Te-121 (20 days).

    Rather than expected max. storage of 160 hrs – we find we are storing large numbers of vials for >6 months.

  • 16

    The original targeted radiotherapy – iodine is only absorbed by thyroid tissue.

    Patients first have total thyroidectomy.

    Iodine-131 is both a beta and high energy (364keV) gamma emitter (therapy and diagnostic imaging

    possible).

    I-131 has a half-life of 8 days.

    I-131 is administered in capsule form.

    Gamma photons can be detected by gamma camera sometimes producing the characteristic star artifact.

    Beta particles are absorbed by and ablate any residual thyroid cancer cells.

    Radioiodine therapy for thyroid cancer

  • 17Radioiodine therapy for thyroid cancer

    • I-131 ablation patients are inpatients

    • There are no side effects and patients must be self-caring.

    • Specially designed lead lined isolation suite, which is a controlled area when a treated patient is resident.

    • Excretion is predominantly urinary

    • All bodily fluids are contaminated during the first few days.

  • 18Radioiodine therapy – sources of waste

  • 19Radioiodine therapy – sources of waste

    In-sink maceratorIn room washing machine

    Sharps

  • 20Radioiodine therapy – waste storage

    • Large volumes of waste

    • Often contaminated with decaying food (risk of pests)

    • Stored for up to six months

  • 21Radioiodine therapy – special waste challenges

    • Patient with non-emptying colostomy bag

    • Storage required for six months

    • Concerns re odours and patient privacy

    • Solution was to source a metal drum with airtight seal

  • 22Radioactive waste storage

    Waste is tagged, labelled with trefoil, isotope type and date.

    Transferred to short term waste store which is restricted by swipe access and locked out of hours.

    Longer lived isotopes store in long-term waste store where available (fire proof, alarmed).

    Remnants of vial containing prepared radiopharmacuticals (I-123, In-111) and unused capsules (Se-75, I-131) stored in a locked safe inside waste store.

    All waste is stored until decayed to background levels (typically 6-12 half-lives). This is measured using a contamination monitor (scintillation where available, this varies from site to site).

  • 23Final disposal

    • Waste item measured using contamination monitor.

    • If no measurement above background detected item can be disposed.

    • Tags and trefoils are removed.

    • Item is removed from waste register.

    • All waste items tagged with cable tie with identifying number.

    • Moved to general waste collection point.


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