Emergency Plans in Nuclear Medicine

Overview

The licensee must prepare emergency procedures based on events identified by a safety assessment. These procedures should be clear, concise, and unambiguous. Emergency plans should be posted visibly where needed. The plan should at a minimum list and describe the following:

• Predictable incidents and accidents, and measures to deal with them.
• The persons responsible for taking actions, with full contact details.
• The responsibilities of individual personnel in emergency procedures (e.g., nuclear medicine physicians, medical physicists, technologists).
• Equipment and tools necessary for emergency procedures.
• Training and periodic drills.
• The recording and reporting system.
• Immediate measures to avoid unnecessary radiation doses to patients, staff, and the public.
• Measures to prevent access of persons to the affected area.
• Measures to prevent the spread of contamination.

Types of Accidents

The most likely accident in a nuclear medicine facility is contamination of workers, patients, equipment, and facilities. Contamination incidents can range from small to large spillages of radioactivity, such as damage to the technetium generator or spillage of several gigabecquerels of iodine-131 (131I).

The following outlines what should be done in cases of contamination:

• Small contamination should be handled by technologists, and cleaning procedures should be practiced regularly.
• Severe contamination should be supervised by the Radiation Protection Officer (RPO).
• Local rules should define what constitutes serious contamination based on radionuclide, activity, and whether contamination involves persons, equipment, or facilities.

Emergency Kit for Contamination

Facilities should have an emergency kit readily available in case of contamination. The kit should contain:

• Protective clothing (e.g., overshoes, gloves).
• Decontamination materials (absorbent materials for wiping up spills).
• Decontamination materials for persons.
• Warning notices.
• Portable monitoring equipment (in working order and regularly checked).
• Bags for waste, tape, labels, pencils.

Severe Accidents and Misadministration

Several severe accidents and incidents in medical exposures in nuclear medicine are associated with radionuclide therapy, especially using iodine-131 (131I) for thyroid disease treatments. There have also been incidents with misadministration of radiopharmaceuticals, which may involve:

• Examination of the wrong patient.
• Administration of the wrong radiopharmaceutical or wrong activity.

Common issues include administering the wrong radiopharmaceutical, which may not cause severe injury but can lead to non-justified exposure, delayed diagnosis, increased costs, and reduced confidence in the practice of nuclear medicine.

Handling Radionuclide Patients

In diagnostic nuclear medicine, the death of a patient containing radionuclides is generally handled without specific measures. However, in radionuclide therapy, emergency plans should cover handling the cadaver. Depending on ethical and religious rules, guidance from national authorities should be consulted for such sensitive issues.