ASN Report 2017

271 ASN report on the state of nuclear safety and radiation protection in France in 2017 Chapter 09  - Medical uses of ionising radiation purposes. Two areas of therapeutic application of nuclear medicine can be identified: oncology and non-oncological conditions (treatment of hyperthyroidism, synoviorthesis). Several types of cancer treatment can be identified: ཛྷ ཛྷ systemic treatments (thyroid cancer by iodine-131, non- Hodgkin lymphoma by monoclonal antibodies marked with yttrium-90, prostate cancer with bone metastases by radium-223, etc.); ཛྷ ཛྷ treatments administered by selective routes (treatment of liver cancers by administeringmicrospheres markedwith yttrium-90 through a catheter placed in a hepatic artery). Some treatments require patients to be hospitalised for several days in specially fitted-out rooms in the nuclear medicine unit to ensure the radiation protection of the personnel, of people visiting the patients and of the environment. The radiological protection of these rooms is adapted to the nature of the radiation emitted by the radionuclides, and the contaminated urine of the patients is collected in tanks. This is particularly the case with the post-surgical treatment of certain thyroid cancers. The treatments are performed by administering varying activities of iodine-131 (1.1 GBq, 4 GBq or 5.5 GBq). Other treatments can be on an out-patient basis. Examples include administering iodine-131 to treat hyperthyroidism, strontium-89 or samarium-153 for painful bone metastases, and radium-223 for prostate cancer with bone metastases. Joints can also be treated using colloids labelled with yttrium-90, erbium-169 or rhenium-186. Finally, radioimmunotherapy can be used to treat certain lymphomas using yttrium-90 labelled antibodies. 2.1.4 Research in nuclear medicine involving humans Research on humans in nuclear medicine has been particularly dynamic in the last few years: protocols are regularly developed for new radionuclides and vectors. Research is continuing into the use of: ཛྷ ཛྷ PET with fluorine-18, gallium-68 and rubidium-82; ཛྷ ཛྷ ITR with radium-223, microspheres labelled with yttrium-90, vectors labelled with yttrium-90 or lutetium-177 (particularly for the treatment of neuroendocrine tumours). The use of new radiopharmaceuticals means that the radiation protection requirements associated with their use must be integrated as early as possible in the process. Indeed, given the activity levels involved, the characteristics of certain radionuclides and the preparations to produce, appropriate measures must be implemented with regard to operator exposure and environmental impact. 2.2 Layout rules for nuclear medicine facilities Given the radiation protection constraints involved in the use of unsealed radioactive sources, nuclear medicine units are designed and organised so that they can receive, store, prepare and then administer unsealed radioactive sources to patients or handle them in laboratories (radioimmunology for instance). Provision is also made for the collection, storage and disposal of radioactive wastes and effluents produced in the facility, particularly the radionuclides contained in patients’ urine. From the radiological viewpoint, the personnel are subjected to a risk of external exposure – in particular on the fingers – due to the handling of certain radionuclides (case with fluorine-18, iodine-131 or yttrium-90) when preparing and injecting radiopharmaceuticals, and a risk of internal exposure through accidental intake of radioactive substances. Given these conditions, nuclear medicine units must satisfy the rules prescribed by ASN resolution 2014-DC-0463 of 23rd October 2014 relative to the minimum technical rules of design, operation and maintenance governing in vivo nuclear medicine facilities. ASN inspection of the interventional radiology department at the Strasbourg University Hospital, May 2017.