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 Table of Contents  
Year : 2018  |  Volume : 13  |  Issue : 1  |  Page : 73-74

Targeting radiation safety improvements through objective training in radiation synovectomy

1 Department of Radiology, Combined Military Hospital, Quetta, Pakistan
2 Department of Medical Physics, Institute of Radiotherapy and Nuclear Medicine, Peshawar, Pakistan

Date of Web Publication26-Feb-2018

Correspondence Address:
Dr. Iftikhar Ahmad
Institute of Radiotherapy and Nuclear Medicine, University Campus, Peshawar
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/injr.injr_3_18

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How to cite this article:
Aamir MO, Ahmad I. Targeting radiation safety improvements through objective training in radiation synovectomy. Indian J Rheumatol 2018;13:73-4

How to cite this URL:
Aamir MO, Ahmad I. Targeting radiation safety improvements through objective training in radiation synovectomy. Indian J Rheumatol [serial online] 2018 [cited 2021 Jul 31];13:73-4. Available from:

Dear Editor,

Radiation synovectomy (RSO) is an essential part of therapeutic nuclear medicine where selected β-emitting radionuclides are directly injected into the inflamed synovial joint, as opposed to the conventional strategies of therapeutic nuclear medicine linking the radionuclide with target-specific molecules (for example, antibodies, peptides, and specific proteins) to deliver the therapeutic doses of radiation to the target sites.[1] Importantly, direct injection of the radionuclide into the intra-articular space demands high precision and longer times as compared to the typical approaches (i.e., intravenous or oral administration) for other therapeutic nuclear medicine applications. Indeed, significant (~one-third) extra-articular manifestation of such injections has been reported.[2] In addition, RSO differs from other therapeutic (and diagnostic) nuclear medicine procedures in that significantly higher specific activities (~500 MBq/ml) are manipulated, enabling high local skin doses.[3]

Contamination risk in handling higher unsealed specific activities further complicates the radiation safety as a tiny invisible drop spilling is capable of high exposures. Moreover, firm griping of the radiopharmaceutical cannula/syringe with the forceps at the time of injection (for increasing the distance between the hands and the vessels) is sometimes difficult, and a slip or failure may possibly cause contamination or injury of the related structures.[4] More importantly, the frequently used radionuclides in RSO clinics are often high-energy β-emitters (Y-90; Eβmax= 2.28 MeV and Re-188; Eβmax= 2.12 MeV). Collectively, all these factors result in considerably higher exposure to the medical staff (i.e., radiochemist, therapist physician, and attending nurse) working in RSO clinics compared to other therapeutic or diagnostic nuclear medicine procedures (~mSv/MBq vs. nSv/MBq), as quantitatively described in many studies.[5],[6] These key differences attest the need to promote objective radiation protection practices in RSO clinics to minimize the radiation exposures to the staff.

Formal education of the medical staff through trainings and hands-on workshops has always been an integral component of radiation safety in nuclear medicine. Indeed, a significant number of educational programs are being offered to stimulate the awareness and improve the skills of medical staff, ultimately manifesting in the safer use of radiation in nuclear medicine clinics.[7],[8] However, the majority of these educational activities are primarily aimed at the safer use of radiation in diagnostic nuclear medicine while it appears that the therapeutic aspect is relatively less elucidated despite its potential importance. Nevertheless, radiation exposure reduction in the RSO clinics requires special considerations that are different from those observed in diagnostic nuclear medicine. In particular, the unavailability or limited access to specific and detailed trainings for medical staff involved in RSO procedures is one of the major barriers to the clinical implementation of a more effective radiation protection program, particularly for clinicians with limited experience such as in developing countries.

It is speculated that training in radiation protection and safety in the RSO clinics have been inadequate in developing countries and the need for formal training is quite evident. We posit educational activities specifically for RSO clinics, primarily aimed at developing countries where the RSO-associated medical staff is not yet sufficiently experienced. In the first place, a simple teaching module with illustrative examples would be ideal for such countries, which might be floated online and available free of charges. Thereafter, arranging hands-on workshops would provide practical guidance on how to ensure radiation protection and workers' safety in RSO clinics.

Specialized trainings targeting the radiation protection in RSO clinics would likely elevate the efficacy of protective measures and improve the safety standards, ultimately manifesting in exposure reduction of the medical staff, particularly in the developing countries.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Dash A, Knapp FF, Pillai MR. Targeted radionuclide therapy – An overview. Curr Radiopharm 2013;6:152-80.  Back to cited text no. 1
Lockman LE. Practice tips. Knee joint injections and aspirations: The triangle technique. Can Fam Physician 2006;52:1403-4.  Back to cited text no. 2
Rimpler A, Barth I. Beta radiation exposure of medical staff and implications for extremity dose monitoring. Radiat Prot Dosimetry 2007;125:335-9.  Back to cited text no. 3
Karavida N, Notopoulos A. Radiation synovectomy: An effective alternative treatment for inflamed small joints. Hippokratia 2010;14:22-7.  Back to cited text no. 4
Roberts FO, Gunawardana DH, Pathmaraj K, Wallace A, Paul LU, Mi T, et al. Radiation dose to PET technologists and strategies to lower occupational exposure. J Nucl Med Technol 2005;33:44-7.  Back to cited text no. 5
Barth I, Mielcarek J. Occupational Radiation exposure during radiosynoviorthesis and vascular brachytherapy. In: Proceedings of the International Conference on Occupational Radiation Protection: Protecting Workers Against Exposure to Ionizing Radiation, 26-30 August, 2002. Geneva, Switzerland: Published on CD-ROM; 2002.  Back to cited text no. 6
Patterson HE, Nunez M, Philotheou GM, Hutton BF. Meeting the challenges of global nuclear medicine technologist training in the 21st century: The IAEA distance assisted training (DAT) program. Semin Nucl Med 2013;43:195-201.  Back to cited text no. 7
Pascual TN, Dondi M, Paez D, Kashyap R, Nunez-Miller R. IAEA programs in empowering the nuclear medicine profession through online educational resources. Semin Nucl Med 2013;43:161-6.  Back to cited text no. 8


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