Safety Reports Series No.58 Radiation Protection i n N e w e r M e d i c a l I m a g i n g Te c h n i q u e s : PET/CT IAEA SAFETY RELATED PUBLICATIONS IAEA SAFETY STANDARDS Under the terms of Article III of its Statute, the IAEA is authorized to establish or adopt standards of safety for protection of health and minimization of danger to life and property, and to provide for the application of these standards. The publications by means of which the IAEA establishes standards are issued in the IAEA Safety Standards Series. This series covers nuclear safety, radiation safety, transport safety and waste safety, and also general safety (i.e. all these areas of safety). The publication categories in the series are Safety Fundamentals, Safety Requirements and Safety Guides. Safety standards are coded according to their coverage: nuclear safety (NS), radiation safety (RS), transport safety (TS), waste safety (WS) and general safety (GS). 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RADIATION PROTECTION IN NEWER MEDICAL IMAGING TECHNIQUES: PET/CT The following States are Members of the International Atomic Energy Agency: AFGHANISTAN GUATEMALA PAKISTAN ALBANIA HAITI PALAU ALGERIA HOLY SEE PANAMA ANGOLA HONDURAS PARAGUAY ARGENTINA HUNGARY PERU ARMENIA ICELAND PHILIPPINES AUSTRALIA INDIA POLAND AUSTRIA INDONESIA PORTUGAL AZERBAIJAN IRAN, ISLAMIC REPUBLIC OF QATAR BANGLADESH IRAQ REPUBLIC OF MOLDOVA BELARUS IRELAND ROMANIA BELGIUM ISRAEL RUSSIAN FEDERATION BELIZE ITALY SAUDI ARABIA BENIN JAMAICA SENEGAL BOLIVIA JAPAN SERBIA BOSNIA AND HERZEGOVINA JORDAN SEYCHELLES BOTSWANA KAZAKHSTAN BRAZIL KENYA SIERRA LEONE BULGARIA KOREA, REPUBLIC OF SINGAPORE BURKINA FASO KUWAIT SLOVAKIA CAMEROON KYRGYZSTAN SLOVENIA CANADA LATVIA SOUTH AFRICA CENTRAL AFRICAN LEBANON SPAIN REPUBLIC LIBERIA SRI LANKA CHAD LIBYAN ARAB JAMAHIRIYA SUDAN CHILE LIECHTENSTEIN SWEDEN CHINA LITHUANIA SWITZERLAND COLOMBIA LUXEMBOURG SYRIAN ARAB REPUBLIC COSTA RICA MADAGASCAR TAJIKISTAN CÔTE D’IVOIRE MALAWI THAILAND CROATIA MALAYSIA THE FORMER YUGOSLAV CUBA MALI REPUBLIC OF MACEDONIA CYPRUS MALTA TUNISIA CZECH REPUBLIC MARSHALL ISLANDS TURKEY DEMOCRATIC REPUBLIC MAURITANIA UGANDA OF THE CONGO MAURITIUS UKRAINE DENMARK MEXICO UNITED ARAB EMIRATES DOMINICAN REPUBLIC MONACO UNITED KINGDOM OF ECUADOR MONGOLIA GREAT BRITAIN AND EGYPT MONTENEGRO NORTHERN IRELAND EL SALVADOR MOROCCO ERITREA MOZAMBIQUE UNITED REPUBLIC ESTONIA MYANMAR OF TANZANIA ETHIOPIA NAMIBIA UNITED STATES OF AMERICA FINLAND NEPAL URUGUAY FRANCE NETHERLANDS UZBEKISTAN GABON NEW ZEALAND VENEZUELA GEORGIA NICARAGUA VIETNAM GERMANY NIGER YEMEN GHANA NIGERIA ZAMBIA GREECE NORWAY ZIMBABWE The Agency’s Statute was approved on 23 October 1956 by the Conference on the Statute of the IAEA held at United Nations Headquarters, New York; it entered into force on 29 July 1957. The Headquarters of the Agency are situated in Vienna. Its principal objective is “to accelerate and enlarge the contribution of atomic energy to peace, health and prosperity throughout the world’’. SAFETY REPORTS SERIES No. 58 RADIATION PROTECTION IN NEWER MEDICAL IMAGING TECHNIQUES: PET/CT INTERNATIONAL ATOMIC ENERGY AGENCY VIENNA, 2008 COPYRIGHT NOTICE All IAEA scientific and technical publications are protected by the terms of the Universal Copyright Convention as adopted in 1952 (Berne) and as revised in 1972 (Paris). The copyright has since been extended by the World Intellectual Property Organization (Geneva) to include electronic and virtual intellectual property. Permission to use whole or parts of texts contained in IAEA publications in printed or electronic form must be obtained and is usually subject to royalty agreements. Proposals for non-commercial reproductions and translations are welcomed and considered on a case-by-case basis. Enquiries should be addressed to the IAEA Publishing Section at: Sales and Promotion, Publishing Section International Atomic Energy Agency Wagramer Strasse 5 P. O. B o x 1 0 0 1400 Vienna, Austria fax: +43 1 2600 29302 tel.: +43 1 2600 22417 email: [email protected] http://www.iaea.org/books © IAEA, 2008 Printed by the IAEA in Austria December 2008 STI/PUB/1343 IAEA Library Cataloguing in Publication Data Radiation protection in newer medical imaging techniques : PET/CT. — Vienna : International Atomic Energy Agency, 2008. p. ; 24 cm. — (Safety reports series, ISSN 1020–6450 ; no. 58) STI/PUB/1343 ISBN 978–92–0–106808–8 Includes bibliographical references. 1. Radiation — Safety measures. 2. Tomography. 3. Ionizing radiation — Safety measures. 4. Tomography — Emission. 5. Positrons — Emission. 6. Radioisotope scanning. I. International Atomic Energy Agency. II. Series. IAEAL 05–00549 FOREWORD A major part of patient exposure now arises from practices that barely existed two decades ago, and the technological basis for their successful dissemination only began to flourish in the last decade or so. Hybrid imaging systems, such as the combination of computed tomography (CT) and positron emission tomography (PET), are an example of a technique that has only been introduced in the last decade. PET/CT has established a valuable place for itself in medical research and diagnosis. However, it is an application that can result in high patient and staff doses. For practitioners and regulators, it is evident that innovation has been driven both by the imaging industry and by an increasing array of new applications generated and validated in the clinical environment. Regulation, industrial standardization, safety procedures and advice on best practices lag (inevitably) behind the industrial and clinical innovations. This series of Safety Reports (Nos 58, 60 and 61) is designed to help fill the growing vacuum, by bringing up to date and timely advice from experienced practitioners to bear on the problems involved. The advice in this report has been developed within the IAEA’s statutory responsibility to establish standards for the protection of people against exposure to ionizing radiation and to provide for the worldwide application of these standards. The Fundamental Safety Principles and the International Basic Safety Standards for Protection against Ionizing Radiation and for the Safety of Radiation Sources (BSS) were issued by the IAEA and co-sponsored by organizations including the Food and Agriculture Organization of the United Nations (FAO), the International Labour Organisation (ILO), the OECD Nuclear Energy Agency (OECD/NEA), the Pan American Health Organization (PAHO) and the World Health Organization (WHO), and require the radiation protection of patients undergoing medical exposures through justification of the procedures involved and through optimization. In keeping with its responsibility on the application of standards, the IAEA programme on radiation protection of patients encourages the reduction of patient doses without losing diagnostic benefits. To facilitate this, the IAEA has issued specific advice on the application of the BSS in the field of radiology in Safety Reports Series Nos 39 and 40. This Safety Report is a further contribution to the resources provided by the IAEA in support of the implementation of the BSS. In addition, it has embarked on a series of coordinated research projects in radiology, mammography, fluoroscopy and interventional radiology, and CT, the results from which will appear in other IAEA publications. The International Action Plan for the Radiological Protection of Patients, approved by the General Conference of the IAEA in September 2002, requires that: “The practice-specific documents under preparation should be finalized as guidance rather than regulations, and they should include input from professional bodies, from international organizations and from authorities with responsibility for radiation protection and medical care.” This Safety Report, and the other two related reports