Estimated dose rates to members of the public from external exposure to patients with 131I thyroid treatment

PURPOSE

Estimated dose rates that may result from exposure to patients who had been administered iodine-131 ((131)I) as part of medical therapy were calculated. These effective dose rate estimates were compared with simplified assumptions under United States Nuclear Regulatory Commission Regulatory Guide 8.39, which does not consider body tissue attenuation nor time-dependent redistribution and excretion of the administered (131)I.

METHODS

Dose rates were estimated for members of the public potentially exposed to external irradiation from patients recently treated with (131)I. Tissue attenuation and iodine biokinetics were considered in the patient in a larger comprehensive effort to improve external dose rate estimates. The external dose rate estimates are based on Monte Carlo simulations using the Phantom with Movable Arms and Legs (PIMAL), previously developed by Oak Ridge National Laboratory and the United States Nuclear Regulatory Commission. PIMAL was employed to model the relative positions of the (131)I patient and members of the public in three exposure scenarios: (1) traveling on a bus in a total of six seated or standing permutations, (2) two nursing home cases where a caregiver is seated at 30 cm from the patient's bedside and a nursing home resident seated 250 cm away from the patient in an adjacent bed, and (3) two hotel cases where the patient and a guest are in adjacent rooms with beds on opposite sides of the common wall, with the patient and guest both in bed and either seated back-to-back or lying head to head. The biokinetic model predictions of the retention and distribution of (131)I in the patient assumed a single voiding of urinary bladder contents that occurred during the trip at 2, 4, or 8 h after (131)I administration for the public transportation cases, continuous first-order voiding for the nursing home cases, and regular periodic voiding at 4, 8, or 12 h after administration for the hotel room cases. Organ specific activities of (131)I in the thyroid, bladder, and combined remaining tissues were calculated as a function of time after administration. Exposures to members of the public were considered for (131)I patients with normal thyroid uptake (peak thyroid uptake of ∼27% of administered (131)I), differentiated thyroid cancer (DTC, 5% uptake), and hyperthyroidism (80% uptake).

RESULTS

The scenario with the patient seated behind the member of the public yielded the highest dose rate estimate of seated public transportation exposure cases. The dose rate to the adjacent room guest was highest for the exposure scenario in which the hotel guest and patient are seated by a factor of ∼4 for the normal and differentiated thyroid cancer uptake cases and by a factor of ∼3 for the hyperthyroid case.

CONCLUSIONS

It was determined that for all modeled cases, the DTC case yielded the lowest external dose rates, whereas the hyperthyroid case yielded the highest dose rates. In estimating external dose to members of the public from patients with (131)I therapy, consideration must be given to (patient- and case-specific) administered (131)I activities and duration of exposure for a more complete estimate. The method implemented here included a detailed calculation model, which provides a means to determine dose rate estimates for a range of scenarios. The method was demonstrated for variations of three scenarios, showing how dose rates are expected to vary with uptake, voiding pattern, and patient location.

Dose reconstruction for the million worker study: status and guidelines

The primary aim of the epidemiologic study of one million U.S. radiation workers and veterans [the Million Worker Study (MWS)] is to provide scientifically valid information on the level of radiation risk when exposures are received gradually over time and not within seconds, as was the case for Japanese atomic bomb survivors. The primary outcome of the epidemiologic study is cancer mortality, but other causes of death such as cardiovascular disease and cerebrovascular disease will be evaluated. The success of the study is tied to the validity of the dose reconstruction approaches to provide realistic estimates of organ-specific radiation absorbed doses that are as accurate and precise as possible and to properly evaluate their accompanying uncertainties. The dosimetry aspects for the MWS are challenging in that they address diverse exposure scenarios for diverse occupational groups being studied over a period of up to 70 y. The dosimetric issues differ among the varied exposed populations that are considered: atomic veterans, U.S. Department of Energy workers exposed to both penetrating radiation and intakes of radionuclides, nuclear power plant workers, medical radiation workers, and industrial radiographers. While a major source of radiation exposure to the study population comes from external gamma- or x-ray sources, for some of the study groups, there is a meaningful component of radionuclide intakes that requires internal radiation dosimetry assessments. Scientific Committee 6-9 has been established by the National Council on Radiation Protection and Measurements (NCRP) to produce a report on the comprehensive organ dose assessment (including uncertainty analysis) for the MWS. The NCRP dosimetry report will cover the specifics of practical dose reconstruction for the ongoing epidemiologic studies with uncertainty analysis discussions and will be a specific application of the guidance provided in NCRP Report Nos. 158, 163, 164, and 171. The main role of the Committee is to provide guidelines to the various groups of dosimetrists involved in the MWS to ensure that certain dosimetry criteria are considered: calculation of annual absorbed doses in the organs of interest, separation of low and high linear-energy transfer components, evaluation of uncertainties, and quality assurance and quality control. It is recognized that the MWS and its approaches to dosimetry are a work in progress and that there will be flexibility and changes in direction as new information is obtained with regard to both dosimetry and the epidemiologic features of the study components. This paper focuses on the description of the various components of the MWS, the available dosimetry results, and the challenges that have been encountered. It is expected that the Committee will complete its report in 2016.

Validation of the photon dose calculation model in the VARSKIN 4 skin dose computer code

An updated version of the skin dose computer code VARSKIN, namely VARSKIN 4, was examined to determine the accuracy of the photon model in calculating dose rates with different combinations of source geometry and radionuclides. The reference data for this validation were obtained by means of Monte Carlo transport calculations using MCNP5. The geometries tested included the zero volume sources point and disc, as well as the volume sources sphere and cylinder. Three geometries were tested using source directly on the skin, source off the skin with an absorber material between source and skin, and source off the skin with only an air gap between source and skin. The results of these calculations showed that the non-volume sources produced dose rates that were in very good agreement with the Monte Carlo calculations, but the volume sources resulted in overestimates of the dose rates compared with the Monte Carlo results by factors that ranged up to about 2.5. The results for the air gap showed poor agreement with Monte Carlo for all source geometries, with the dose rates overestimated in all cases. The conclusion was that, for situations where the beta dose is dominant, these results are of little significance because the photon dose in such cases is generally a very small fraction of the total dose. For situations in which the photon dose is dominant, use of the point or disc geometries should be adequate in most cases except those in which the dose approaches or exceeds an applicable limit. Such situations will often require a more accurate dose assessment and may require the use of methods such as Monte Carlo transport calculations.

The new VARSKIN 4 photon skin dosimetry model

A new photon skin dosimetry model, described here, was developed as the basis for the enhanced VARSKIN 4 thin tissue dosimetry code. The model employs a point-kernel method that accounts for charged particle build-up, photon attenuation and off-axis scatter. Early comparisons of the new model against Monte Carlo particle transport simulations show that VARSKIN 4 is highly accurate for very small sources on the skin surface, although accuracy at shallow depths is compromised for radiation sources that are on clothing or otherwise elevated from the skin surface. Comparison results are provided for a one-dimensional point source, a two-dimensional disc source and three-dimensional sphere, cylinder and slab sources. For very small source dimensions and sources in contact with the skin, comparisons reveal that the model is highly predictive. With larger source dimensions, air gaps or the addition of clothing between the source and skin; however, VARSKIN 4 yields over-predictions of dose by as much as a factor of 2 to 3. These cursory Monte Carlo comparisons confirm that significant accuracy improvements beyond the previous version were achieved for all geometries. Improvements were obtained while retaining the VARSKIN characteristic user convenience and rapid performance.

Correction factors applied to finger dosimetry: a theoretical assessment of appropriate values for use in handling radiopharmaceuticals

United States Nuclear Regulatory Commission (USNRC) regulations limit the dose to the skin to 500 mSv per year. This is also the dose limit recommended by the International Commission on Radiological Protection (ICRP). The operational quantity recommended by ICRP for quantifying dose to the skin is the personal dose equivalent, Hp(0.07) and is identical to NRC's shallow dose equivalent, Hs, also measured at a skin depth of 7 mg cm-2. However, whereas ICRP recommends averaging the dose to the skin over an area of 1 cm regardless of the size of the exposed area of skin, USNRC requires the shallow dose equivalent to be averaged over 10 cm. To monitor dose to the skin of the hands of workers handling radioactive materials and particularly in radiopharmaceutical manufacturing facilities, which is the focus of this work, workers are frequently required to wear finger ring dosimeters. The dosimeters monitor the dose at the location of the sensitive element, but this is not the dose required to show compliance (i.e., the dose averaged over the highest exposed contiguous 10 cm of skin). Therefore, it may be necessary to apply a correction factor that enables estimation of the required skin dose from the dosimeter reading. This work explored the effects of finger ring placement and of the geometry of the radioactive materials being handled by the worker on the relationship between the dosimeter reading and the desired average dose. A mathematical model of the hand was developed for this purpose that is capable of positioning the fingers in any desired grasping configuration, thereby realistically modeling manipulation of any object. The model was then used with the radiation transport code MCNP to calculate the dose distribution on the skin of the hand when handling a variety of radioactive vials and syringes, as well as the dose to the dosimeter element. Correction factors were calculated using the results of these calculations and examined for any patterns that may be useful in establishing an appropriate correction factor for this type of work. It was determined that a correction factor of one applied to the dosimeter reading, with the dosimeter placed at the base of the middle finger, provides an adequate estimate of the required average dose during a monitoring period for most commonly encountered geometries. Different correction factors may be required for exceptional or unusual source geometries and must be considered on a case-by-case basis.

Verification of the VARSKIN beta skin dose calculation computer code

The computer code VARSKIN is used extensively to calculate dose to the skin resulting from contaminants on the skin or on protective clothing covering the skin. The code uses six pre-programmed source geometries, four of which are volume sources, and a wide range of user-selectable radionuclides. Some verification of this code had been carried out before the current version of the code, version 3.0, was released, but this was limited in extent and did not include all the source geometries that the code is capable of modeling. This work extends this verification to include all the source geometries that are programmed in the code over a wide range of beta radiation energies and skin depths. Verification was carried out by comparing the doses calculated using VARSKIN with the doses for similar geometries calculated using the Monte Carlo radiation transport code MCNP5. Beta end-point energies used in the calculations ranged from 0.3 MeV up to 2.3 MeV. The results showed excellent agreement between the MCNP and VARSKIN calculations, with the agreement being within a few percent for point and disc sources and within 20% for other sources with the exception of a few cases, mainly at the low end of the beta end-point energies. The accuracy of the VARSKIN results, based on the work in this paper, indicates that it is sufficiently accurate for calculation of skin doses resulting from skin contaminations, and that the uncertainties arising from the use of VARSKIN are likely to be small compared with other uncertainties that typically arise in this type of dose assessment, such as those resulting from a lack of exact information on the size, shape, and density of the contaminant, the depth of the sensitive layer of the skin at the location of the contamination, the duration of the exposure, and the possibility of the source moving over various areas of the skin during the exposure period if the contaminant is on protective clothing.

Estimation of the effective dose when protective aprons are used in medical procedures: a theoretical evaluation of several methods

The use of the personal dose equivalent Hp(10), as measured by one or more dosimeters, in estimating the effective dose equivalent H(E) and the effective dose E was examined for situations in which a protective apron is worn by the monitored person during medical procedures. The photon energy range considered was between 0.03-1.0 MeV. Several methods recommended in the technical literature for this purpose were assessed and their ability to provide reasonable estimates for H(E) and E were compared. The assessments were theoretical and used Monte Carlo transport methods and an anthropomorphic phantom to calculate H(E), E, and Hp(10). The results showed that all of the recommended methods, using either one or more dosimeters, were applicable to this situation but that most gave good results only within limited photon energy ranges, outside of which they either considerably over-or under-estimated the doses. Some provided good estimates over the entire energy range considered.

A theoretical evaluation of the assessment of effective dose using multiple personnel dosimeters

The ability of a dose calculation algorithm, using the readings of multiple dosimeters, to accurately assess the effective dose under different photon irradiation conditions was assessed using computer simulation. The algorithm was that described in American National Standards Institute publication N13.41. Monte Carlo calculations with an anthropomorphic humanoid phantom were used to calculate the effective doses and also the expected readings of the multiple dosimeters. The irradiation geometries considered included a point source placed at several locations at a distance of 100 cm in front of the phantom, as well as an anterior-posterior plane parallel beam with a lead shield interposed between the phantom and the source. The point source energies considered were 0.05, 0.6, and 2 MeV, and the beam energy was varied between 0.03 and 10 MeV. Also considered were the estimates of effective dose based on the highest reading of the multiple dosimeters, a practice that is currently used in many work places. The results showed that use of the algorithm resulted in substantial improvements in the ability to accurately estimate effective dose. However, the results also showed that the improvements in accuracy were achievable only by using a calibration factor for the dosimetry that is different from the one obtained in current dosimetry calibration practices, and that without the use of this factor, the algorithm tended to underestimate the effective dose for nearly all the irradiation geometries considered. In addition, it appeared that this calibration factor is not constant but varies with irradiation conditions. There thus appears to be a problem of proper dosimetry calibration for use with the algorithm. This work considered only anterior posterior irradiations, and additional work is needed to assess the performance of the algorithm in other non-uniform irradiation geometries.