Institute of Pathophysiology and Nuclear Medicine "Acad Isac S. Tadzer", Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia
Introduction: Radiation monitoring of professionally exposed workers is obligatory in nuclear medicine departments. The purpose of our study was to evaluate the radiation exposure dose received by medical workers during radioguided sentinel lymph node biopsy in breast cancer and endometrial cancer patients. Methods: Radiation exposure dose of medical staff was prospectively recorded during 35 radioguided sentinel lymph node biopsy procedures in a 6-month period. All patients received 4 mCi [99mTc]Tc-SENTI-SCINT on the day of surgery. Thermoluminescent dosimeters in the shape of a bracelet, ring and badge were used for recordings and data was compared to dose limits imposed by the regulations. Results: Mean time interval between activity administration and surgery was 223.63 min and mean duration of surgery was 142.5 min. The recorded 6-month cumulative dose was 0.33 mSv for the senior surgeon, 0.25 mSv for the surgeon's first assistant, 0.24 mSv for the anesthesiologist and 0.54 for both nuclear medicine physician and resident. The approximately equivalent dose for the surgical staff in each procedure was 9.7 µSv, 7.3 µSv and 7.05 µSv respectively, which means that the senior surgeon could perform 106 and 2127 sentinel lymph node biopsy procedures per year in order to reach the annual dose limit for a public member and a radiation worker. Conclusion: Occupational radiation exposure dose of medical staff during radioguided sentinel lymph node biopsy is low and under annual dose limits, requiring no routinely personal dosimetry for surgical staff performing the procedure.
International Atomic Energy Agency. Occupational radiation protection: IAEA safety standards series No. GSG-7, Vienna: 2018.
Zahoor S, Haji A, Battoo A, Qurieshi M, Mir W, Shah M. Sentinel lymph node biopsy in breast cancer: A clinical review and update. J Breast Cancer. 2017;20(3):217–227.
Lyman GH, Somerfield MR, Bosserman LD, Perkins CL, Weaver DL, Giuliano AE. Sentinel lymph node biopsy for patients with early-stage breast cancer: American society of clinical oncology clinical practice guideline update. J Clin Oncol. 2017; 35:561-564.
Abdelazim IA, Abu-Faza M, Zhurabekova G, Shikanova S, Karimova B, Sarsembayev M, Starchenko T, Mukhambetalyeva G. Sentinel Lymph Nodes in Endometrial Cancer Update 2018. Gynecol Minim Invasive Ther. 2019 Aug 29;8(3):94-100.
Holloway RW, Abu-Rustum NR, Backes FJ, Boggess JF, Gotlieb WH, Jeffrey Lowery W, Rossi EC, Tanner EJ, Wolsky RJ. Sentinel lymph node mapping and staging in endometrial cancer: A Society of Gynecologic Oncology literature review with consensus recommendations. Gynecol Oncol. 2017 Aug;146(2):405-415.
Giammarile F, Alazraki N, Aarsvold JN, Audisio RA, Glass E, Grant SF, Kunikowska J, Leidenius M, Moncayo VM, Uren RF, Oyen WJG, Valdes Olmos RA, Vidal Sicart S. The EANM and SNMMI practice guideline for lymphoscintigraphy and sentinel node localization in breast cancer. Eur J Nucl Med Mol Imaging. 2013 Dec;40(12):1932-47.
Vaiserman A, Koliada A, Zabuga O, Socol Y. Health impacts of low-dose ionizing radiation: Current scientific debates and regulatory issues. Dose Response. 2018 Sep;16(3):1559325818796331.
Bailey DL, Humm JL, Todd-Pokropek A, van Aswegen A. Nuclear medicine physics: A handbook for teachers and students. Vienna: IAEA;2014.
Menzel HG, Harrison J. Effective dose: A radiation protection quantity. Ann ICRP. 2012 Oct-Dec;41(3-4):117-23.
International Commission on Radiological Protection, The 2007 recommendations of the international commission on radiological protection. ICRP publication 103, Ann ICRP. 2007;37(2-4):1-332.
Shapiro J. Radiation protection: A guide for scientists, regulators and physicians 4th ed. Harvard University Press; 2002.
Najafi M, Nedaie HA, Lahooti A, Omranipour R, Nafissi N, Akbari ME, Olfatbakhsh A, Kaviani A, Alavi N. Radiation exposure of the surgeons in sentinel lymph node biopsy. Iran J Radiat Res 2012;10(1):53-57
Waddington WA, Keshtgar MR, Taylor I, Lakhani SR, Short MD, Ell PJ. Radiation safety of the sentinel lymph node technique in breast cancer. Eur J Nucl Med. 2000 Apr;27(4):377-91.
Peştean C, Larg MI, Bărbuş E, Bădulescu C, Piciu D. Quantification of radiation exposure of non-dominant index for the surgeon performing sentinel lymph-node removal procedure. Curr Radiopharm. 2018;11(1):64-68.
Burrah R, James K, Poonawala S. Evaluation of radiation exposure during sentinel lymph node biopsy in breast cancer: A retrospective study. World J Surg. 2019; 43:2250–2253.
Coventry BJ, Collins PJ, Kollias J, Bochner M, Rodgers N, Gill PG, Chatterton BE, Farshid G. Ensuring radiation safety to staff in lymphatic tracing and sentinel lymph node biopsy surgery – some recommendations. J Nucl Med Radiat Ther. 2012; S2:008.
Klausen TL, Chakera AH, Friis E, Rank F, Hesse B, Holm S. Radiation doses to staff involved in sentinel node operations for breast cancer. Clin Physiol Funct Imaging. 2005 Jul;25(4):196-202.
Bekis R, Celik P, Uysal B, Kocdor MA, Sevinc A, Saydam S, Harmancioglu O, Durak H. Exposure of surgical staff to radiation during surgical probe applications in breast cancer. J Breast Cancer. 2009 March;12(1):27-31.
Kimura F, Yoshimura M, Koizumi K, Kaise H, Yamada K, Ueda A, Kohno N.Radiation exposure during sentinel lymph node biopsy for breast cancer: effect on pregnant female physicians. Breast Cancer. 2015;22:469–474.
RSSC radiation protection 07/11. Chapter 3. University of Florida; 2012. p. 3-16
Strzelczyk I, Finlayson C. Sentinel node biopsy: ALARA and other considerations. Health Phys. 2004;86(Suppl 2):S31-S34.
Jankulovska, A., Sazdova Danova, I., Manevska, N., Stojanoski, S., & Miladinova, D. (2022). Radiation exposure dose of medical workers during radioguided sentinel lymph node biopsy. Iranian Journal of Nuclear Medicine, 30(2), 96-102.
Anamarija Jankulovska; Irena Sazdova Danova; Nevena Manevska; Sinisa Stojanoski; Daniela Miladinova. "Radiation exposure dose of medical workers during radioguided sentinel lymph node biopsy". Iranian Journal of Nuclear Medicine, 30, 2, 2022, 96-102.
Jankulovska, A., Sazdova Danova, I., Manevska, N., Stojanoski, S., Miladinova, D. (2022). 'Radiation exposure dose of medical workers during radioguided sentinel lymph node biopsy', Iranian Journal of Nuclear Medicine, 30(2), pp. 96-102.
Jankulovska, A., Sazdova Danova, I., Manevska, N., Stojanoski, S., Miladinova, D. Radiation exposure dose of medical workers during radioguided sentinel lymph node biopsy. Iranian Journal of Nuclear Medicine, 2022; 30(2): 96-102.