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Radiation Safety Office Supports New Radiotherapy Procedure at UNC Medical Center

The Radiation Safety Office (RSO) supported the Nuclear Medicine Division of Radiology in the design, planning, licensing, training, and implementation of a new radiotherapy procedure used to treat pediatric patients with neuroblastoma. This new treatment, referred to as pediatric MIBG (Meta-Iodo-Benzyl-Guanidine), uses large activities of radioactive materials in patients during in-patient treatment, requiring careful contamination control processes. The first procedure occurred in October 2018. These procedures are especially challenging since:

  • Atypically large amounts of radioactivity are used,
  • The patients are children, so their parents will be involved,
  • The patient has to be catheterized so the urine can be pumped away, and
  • The facility was not designed to accommodate the amount of radioactivity used in these procedures.

Because such large amounts of radioactive materials are used, there is significant occupational radiation dose potential, as well as general public dose potential to the caregiver (parents) and surrounding patients. The RSO had to amend the radioactive materials license to allow for these procedures, adjust dose limits to care givers who are members of the general public, ensure the regulatory agency that these procedures can be performed safely, and develop all the pertinent procedures and training materials to limit occupational doses to nurses, physicians, nuclear pharmacists and caregivers as well as patients in nearby rooms. This included shielding evaluation of the patient room to determine the extent of local shielding necessary to conduct the procedure.

The RSO was involved in determining the necessary radiation protection measures for transport of the radiopharmaceutical, for handling the patient’s bodily excretions and excrement and for servicing the patient to protect all persons involved in the care of the patient. The RSO’s involvement involved pre-treatment preparations, monitoring during the multi-day treatment and post-treatment decontamination and clean up. Also, radiation monitoring had to be performed using frisking stations in and out of the contamination zone (which is the patient room), active dosimeters to determine doses to caregivers (parents) and passive dosimeters to determine occupational dose of record for involved staff.

This medical procedure required a large multidisciplinary effort in planning, training, and implementation to ensure that radiation risk to staff, caregivers, and general public is ALARA (as low as reasonably achievable).

Radiation Safety Office Helps Pave the way for Peptide Receptor Radiation Therapy (PRRT)

The Radiation Safety Office helped to establish a program to allow the UNC Medical Center to begin a new therapy procedure to treat neuroendocrine tumors using Lutetium-177 in a drug called Lutathera. This effort involved licensing the new procedure with the state regulatory agency, approving the procedure through the UNC Medical Center Radiation Safety Subcommittee, collaborating with Nuclear Medicine and Oncology to develop all the radiation safety SOPs and establishing the release criteria including after treatment response. A particular complexity of this procedure will be that the patient will typically feel nauseous during the day-long treatment due to the amino acids that are administered.

Performance measurement is a critical part of the EHS management system. Education, customer service and internal processes are the three most essential components of our work. The chart below indicates the performance in these areas over a five-year period with Level Four representing optimum performance. The adjacent tab shows the specific performance activities and the level of that performance for 2018.

Components, Years and Level Completed
Education Customer Service Internal Processes
2014 2015 2016 2017 2018 2014 2015 2016 2017 2018 2014 2015 2016 2017 2018
2 4 4 3 4 3 4 4 4 4 3 3 3 3 2

Education

  • Radiation safety training courses were administered to 2106 persons; non-ionizing radiation safety training was administered to 606 persons.
  • Taught Radiologic Health Physics course (RADI 585) for UNC Allied Health Sciences in Fall 2018.
  • Provided lectures for the Chemistry Department’s (CHEM 073) Nuclear Chemistry Class.
  • Provided a lecture for the Epidemiology Class (EPID 785) on Radiation Dose Assessment.
  • Provided a lecture for the Health Effects of Environmental Agents (ENVR 430) course.
  • Provided a lecture for the Health Hazards of Industrial Operations (ENVR 433) course.
  • Provided lectures for the Radiology Residents program.
  • Hosted six Nuclear Medicine Technology students for two week rotations through radiation safety as part of the NMT didactic program.
  • Hosted one Radiologic Science student from Alamance County for two weeks to show medical health physics duties.
  • Annual radiation safety class was given in August to incoming BBSP (Biological and Biomedical Sciences Program) Ph.D. students.
  • Annual radiation safety class was given in May to incoming SURE (Summer Undergraduate Research Experience) Program
  • Trained UNC Police and UNCH Hospitals on use of Radeye G PRDs (Personal Radiation Detectors).

Customer Service

  • Services were provided to the hospital and patients for 219 radiation-related procedures.
  • Processed over 30 X-ray Registration changes for the Medical Center complex.
  • Radiation instrument calibration services were provided for 253 instruments.
  • 278 X-ray tubes were inspected and tested.
  • 1191 persons were monitored for external radiation exposure.
  • 79 bioassays were conducted for potential internal radiation exposure.
  • 611 collaborative laboratory inspections were conducted.
  • 439 radiation safety laboratory inspections were conducted.
  • Coordinated with DLAM, SOM administration, researchers, and vendors to repair a XRAD xray irradiator that was out-of-service interrupting time -sensitive research.
  • Provided radiation safety services (including instrument calibration and/or annual program reviews) to sister campuses in the UNC system (Appalachian State, UNC-Greensboro, Gateway University Research Park, Western Carolina, NC A&T, and North Carolina Central).
  • Provided free materials to PIs including lead sheets and bricks, geiger counters or parts, and multiple pieces of plexiglass shielding.
  • Licensed a new Cyberknife and a new HDR Brachytherapy unit for UNC Medical Center.

Internal Processes

  • Received, processed, and delivered 436 containers of radioactive materials for PIs’ research.
  • Reviewed 31 Institutional Review Board research protocols utilizing radioactive materials for human use.
  • Administered eight quarterly hospital and campus radiation safety committee meetings to review and approve research and clinical use of radioactive materials and to review employee radiation dose information and 4 held Radioactive Drug Research Committee meetings.
  • The UNC and UNCH radioactive material licenses were amended 4 times in 2018 to accommodate research and clinical use of radiation and radioactive materials. This includes the renewal of the NRI license.
  • Participated in planning and design activities for UNCH Proton Therapy Facility
  • Conducted required annual radiation protection program review for eight licenses and 21 x-ray registrations, including all off-site locations.