Nuclear Medicine

Radioactive material is used in various designated areas within the Veterinary Teaching Hospital (VTH) and Equine Medical Center (EMC) to support diagnostic and therapeutic procedures. Research activity is also developing at the Animal Cancer Care and Research Center (ACCRC) and the Fralin Biomedical Research Institute (FBRI) in Roanoke.   

Radioisotopes used at Virginia Tech in nuclear medicine

Technetium 99m is used for internal imaging of dogs, cats, and horses and emits readily detectable gamma rays. This radioisotope has a very short half-life of six hours (i.e. half of the radioactivity will be gone in six hours). This means that within three days, the radioactivity will decay to background radiation levels as Tc99m changes to Tc99 yielding soft beta rays.

Iodine 131 (I 131) has been used for thyroid treatment for dogs and cats in both patient and research status. The half-life of this isotope is 8 days emitting beta and gamma radiation. Therefore, it requires different safety precautions than either Tc99 previously mentioned. The radiation levels, when using I 131, are expected to be at background amounts within 80 days of the administration of doses.

Fluorine 18 is used for research projects in Roanoke and has been used in equine PET scans at EMC. The isotope has a half-life of just under 110 minutes and decays mainly by positron emission.   

Iodine 123 has been used for thyroid imaging of dogs and cats. This radioisotope has a short half-life of 13.3 hours and emits gamma rays while decaying. Within six days the radioactivity decays to background radiation levels.   

Strontium 90 (Sr90) was used as a treatment tool for ocular lesions in the past, only at VTH.

The half-life of Sr90 is a little over 29 years (approximately 10,622 days). The beta-emitting decay changes Sr90 to Yttrium 90, which actually works as the mechanism for treatment. The decay rate will affect the ability to regulate treatment dose and therefore must be taken into consideration periodically.

Scope

All university personnel using radioisotopes or involved with their use must be authorized, trained, and included in the dosimetry program. These requirements follow the standard university protocol for radiation material use.

Basic safety precautions are to be followed regardless of which location is referenced. These are critical for following ALARA (as low as reasonably achievable) principles in keeping radiation exposures to a minimum.

The survey meter is critical for helping to ensure that material is contained and that work practices are effective. Check calibration due date, batteries, and response to a known source before each use of a portable survey instrument. Check the calibration due date located on the side of the meter and verify that the due date is not passed. Turn the instrument to battery test and verify it indicates good battery condition. Verify the instrument responds to a known source of radiation, radioactive check source, or natural background (i.e.: audible clicks and needle reads above zero).

Reducing personal contamination

• Lab coats and disposable gloves are required during and after radiopharmaceutical injections and whenever close contact with patients is possible;
• Shoe covers must be worn whenever floor contamination is possible (entering runs or stalls);
• Exit contaminated areas properly; and
• Monitor hands, feet, and clothing after any involvement.

Security

• Radiation levels accessible by individuals that are not authorized radiation workers will be kept very low.
• Rooms will be locked to control access to the areas involved except equine stalls.
• Radiation levels on the outside of the rooms will be checked on a routine basis.
• Floors and other surfaces accessible by individuals are monitored to keep below limits in order to prevent contamination. These levels are checked on a routine basis.

Each area or room in which radioactive material is used will be posted with the radiation warning symbol and the words "CAUTION - RADIOACTIVE MATERIAL" and possibly "CAUTION - RADIATION AREA" which is used if the radiation level in the room is greater than 5 mR/hr.

Other required postings follow guidelines as detailed in the Radiation Safety Program and include authorized personnel listing, emergency contacts, laboratory hygiene notices, etc.

Please refer to the Required Postings section of the Radioactive Materials Safety Program.

If a contamination problem does occur, emergency procedures have been developed for principal users to control and clean up the contamination quickly. A list of main steps follows.

Emergency steps

• Notify people in the immediate area.
• Restrict access to the affected area.
• Clean up the contamination under the supervision of a principal user.
• Confirm cleaning success with monitoring.
• Restore access to the affected area.
   

The Radiation Safety Office can be contacted at 540- 231-5364 to discuss any radiation-related concerns. If the accident is located at the Equine Medical Center, then Patrick Wolak must be notified as well. During an emergency, if there is no answer at 540-231-5364, or it is after normal working hours (8 a.m to 5 p.m.), call the Virginia Tech Police at 911 and ask them to contact the Radiation Safety Office staff. To contact Virginia Tech Police from the Equine Medical Center, call 540-382-4343.

• Principal users - VTH:
• Michael Ciepluch
  
• Stephanie DeMonaco
  
• Michael Edwards
  
• Martha Larson
  
• Ashley Ferguson
  
• Karson Sluss
  
• Valerie Vaught
  
• Rachel Young
  

Primary locations for nuclear medicine activities at VTH are:

• Nuclear Pharmacy (in Radiology)
• Scintillation Camera Room (Radiology
• Equine Nuclear Medicine Stalls
  
• Radiology hallway (from Equine stalls to camera room)
  
• Small Animal Medicine Ward
  
• Iodine cat ward
  
• Necropsy cooler

DOs

• Do check the status of the survey meter before every use as noted earlier.
• Do wear personal dosimeter badges when cleaning the nuclear medicine stall, working around sources of radioactive material, X-ray machines, nuclear medicine patients, or their urine or feces.
• Do read and follow the rights and responsibilities on the State Notice to Employees.
• Do report areas that should be kept locked for the security of radioactive materials, if they are not locked.
• Do put all radioactive waste in a well-marked, appropriate container. Waste can be liquid, sharps, or solid radioactive waste including used protective clothing.
• Do notify your supervisor or the Radiation Safety Office at (540) 231-5364 or through the Virginia Tech Police at 911 immediately if there is a spill of radioactive material or some other event or you are asked to get help.
• Do notify the Radiation Safety Office anytime you have a question or want to declare your pregnancy.
• Do ask to see your radiation dose report if you have a dosimeter badge and you are concerned about your dose history.
• Do wear lab coats and gloves any time you may come in contact with radioactive materials or a radioactive patient. Carefully remove gloves and wash hands with soap and water when done.
• Do wear booties or protective shoe covers if there is a chance that you will enter a nuclear medicine stall.
• Do get training in the control of patients, visitors, contamination, waste, and become informed on how to notify the Radiation Safety Office and the principal user before working with radioactive materials or animals.
• Do ensure that all nuclear medicine patients remain until 24 hours post-injection.
• Do notify the Radiation Safety Office if a radioactive nuclear medicine patient requires surgery. Establish contamination control by wearing protective clothing, consider all equipment and supplies contacting the patient contaminated and clean equipment and work areas, and survey for contamination prior to reuse.
• Do notify the Radiation Safety Office if a radioactive nuclear medicine patient dies. If a nuclear medicine patient dies or is euthanized before it reaches background radiation levels, the carcass must be stored in a probably marked area in the necropsy cooler until background radiation levels are reached.
• Do use time, distance, and shielding consistent with good patient care. Limit time to only that needed to do the job (anything routine that can be done away from the patient and radiation fields should be). A syringe shield should be used whenever possible.
• Do ensure that stalls are not cleaned until 60 hours post-injection, they are surveyed and are indistinguishable from the background, and radioactive material signs and cable ties have been removed from the stall.
• Do clean stalls, runs, and cages with copious amounts of water. Avoid splattering.
• Do always use two persons to transport any patient and have a spill kit available. Use a cart or carrier with absorbent and muzzle when appropriate.
• Do, if an equine nuclear medicine patient urinates in a hallway, avoid the splatter, warn others, cordon off the area and contact the Radiation Safety Office at (540) 231-5364 for assistance.

DON'Ts

• Don't allow owners or visitors to touch or enter stalls or runs. Visits should be discouraged and all visitors should be escorted by a student or clinician.
• Don't clean stalls until released by principal users. Seek them out during any emergency. They include Drs. Daniel, DeMonaco, and Larson, Valerie Vaught, Brittany Robertson, among others.
• Don't prepare or administer radiopharmaceuticals unless you are a principal user.
• Don't enter stalls or runs with "Caution Radioactive Material" signs.
• Don't enter or clean the nuclear medicine stall from the "A Barn" side. Always clean it from the radiology hallway door.
• Don't eat, drink, or store foods in areas where radioactive material is used or stored. Look out for "Caution Radioactive Material" signs.
• Don't have unnecessary objects in radioactive material areas where they may become contaminated.
• Don't work around or use radioactive material unless you have completed required training and have a radiation dosimeter badge.
• Don't flush small animal urine or feces until after 24 hours.
• Don't flush small animal runs unless you are a principal user.

Principal users for the Equine Medical Center:

• Jennifer Barrett
  
• Sarah Repta
  
• Laura Dawson
• Meaghan Dunn
• Alex Ambelang
  
• Sara Lundy
• Ann Masters-Stern
• Taylor Martin
  
• Payton Lawrence

Primary locations for nuclear medicine activities are:

• Nuclear Pharmacy (in Radiology)
• Scintillation Camera Room (Radiology)
• Equine Nuclear Medicine Stalls
• Quarantine dumpsters for bedding
• Necropsy cooler

DOs

• Do check the status of the survey meter(s) before use as detailed earlier in the general requirements.
• Do wear personal dosimeter badges when cleaning the nuclear medicine stall, working around sources of radioactive material, x-ray machines, nuclear medicine patients, or their urine or feces.
• Do read and follow the rights and responsibilities on the posted state form, "Notice to Employees."
• Do report areas that should be kept locked for the security of radioactive materials, if they are not locked.
• Do put all radioactive waste in a well-marked, appropriate container. Waste can be liquid, sharps, or solid radioactive waste including used protective clothing.
• Do notify immediately, in the event of a radioactive material spill or if you are asked to request help: your supervisor; the Equine Medical Center imaging manager; and the campus Radiation Safety Office at 540-231-5364. If you cannot reach the Radiation Safety Office, contact the Virginia Tech Police at 540-382-4343.
• Do notify the Radiation Safety Office anytime you have a question or want to declare your pregnancy.
• Do ask to see your radiation dose report if you have a dosimeter badge and you are concerned about your dose history.
• Do wear lab coats and gloves any time you may come in contact with radioactive materials or a radioactive patient. Carefully remove gloves and wash hands with soap and water when done.
• Do wear booties or protective shoe covers if there is a chance that you will enter a nuclear medicine stall.
• Do get training in the control of patients, visitors, contamination, waste, and become informed on how to notify the Radiation Safety Office and the principal user before working with radioactive materials or animals.
• Do ensure that all nuclear medicine patients remain until 24 hours post-injection.
• Do notify the Radiation Safety Office if a radioactive nuclear medicine patient requires surgery. Establish contamination control by wearing protective clothing, consider all equipment and supplies contacting the patient contaminated and clean equipment and work areas, and survey for contamination prior to reuse.
• Do notify the Radiation Safety Office if a radioactive nuclear medicine patient dies. If a nuclear medicine patient dies or is euthanized before it reaches background radiation levels, the carcass must be stored in a properly marked area in the necropsy cooler until background radiation levels are reached.
• Do use time, distance, and shielding consistent with good patient care. Limit time to only that needed to do the job (anything routine that can be done away from the patient and radiation fields should be). A syringe shield should be used whenever possible.
• Do ensure that stalls are not cleaned until 72 hours post-injection, they are surveyed and are indistinguishable from the background, and radioactive material signs and cable ties have been removed from the stall.
• Do clean stalls, runs, and cages with copious amounts of water. Avoid splattering.
• Do always use two persons to transport any patient and have a spill kit available.
• Do if an equine nuclear medicine patient urinates in a hallway, avoid the splatter, warn others, cordon off the area and contact the Equine Medical Center imaging manager for assistance.

DON'Ts

• Don't allow owners or visitors to touch or enter stalls or runs. Visits should be discouraged and all visitors should be escorted by a student or clinician.
• Don't clean stalls until released by principal users. Seek them out during any emergency.
• Don't prepare or administer radiopharmaceuticals unless you are a principal user.
• Don't enter stalls or runs with "Caution Radioactive Material" signs.
• Don't eat, drink, or store foods in areas where radioactive material is used or stored. Look out for "Caution Radioactive Material" signs.
• Don't have unnecessary objects in radioactive material areas where they may become contaminated.
• Don't work around or use radioactive material unless you have been trained by a lecture on this material, pass the nuclear medicine test, and have a radiation dosimeter badge.

Visit the training class schedule to preregister for a particular training module. Scroll down to the Radiation Safety section. Everyone must preregister.

Principal users should use the links below to access the training information for required refresher training. Please select the location (EMC or VTH) as appropriate. After reviewing the slides, complete the quiz either by contacting your designated coordinator or from email attachment from Environmental Health and Safety.

Equine Medical Center (EMC) training slides - after review, please contact Dr. Kelleher to complete the quiz.

Veterniary Teaching Hospital (VTH) training slides - after review, please complete the quiz and forward to Environmental Health & Safety personnel.

This is a listing of the principal users in Nuclear Medicine at the Equine Medical Center. Please refer to these individuals for questions regarding procedures, concerns, problems/emergencies, etc. The university radiation safety officer at 540-231-5364 is also available for support as may be needed.

• Maureen Kelleher
• Jennifer Barrett
• Sarah Repta
• Taylor Martin
  
• Laura Dawson
• Meaghan Dunn
• Alex Ambelang
  
• Sarah Lundy
• Ann Masters-Stern
• Payton Lawrence

This is a listing of the principal users in nuclear medicine at the VTH. Please refer to these individuals as directed in the Ancillary Training for questions regarding procedures, concerns, problems/emergencies, etc. The radiation safety officer, reached at 540-231-5364, is also available for support as needed.

Clinicians

• Dr. Greg Daniel
• Dr. Kemba Clapp
• Dr. Michelle Greer
• Dr. Martha Larson
• Dr. David Panciera
• Dr. Tim Bolton
• Dr. Stephanie DeMonaco
• Dr. Nam Joo (Polly) Baik

• Radiology staff
• Valerie Vaught
  
• Rachel Young
• Ashley Ferguson
  
• Karson Sluss
  

Refer to this example of completed contamination survey records.

A graphic explanation of some of the important points of a Geiger-Muller Survey Instrument. If you have any questions, please contact 540-231-5364.

Survey meter response should be verified for instruments in use. The Radiation Safety Office prepared check sources using small quantities of uranyl acetate to simplify this step. The material is encapsulated in heavy tape and affixed to the side of the meters with labeling.  If the meter does not show response to the source and/or if you suspect the protective tape has been compromised, please contact the radiation safety officer at 540-231-5364 or Environmental Health & Safety at 540-231-3600. 

Contamination Survey Record Example

Emergency Procedures (DOC)

Emergency Procedures (PDF)

Food Permitted Sign

Food Prohibited Sign

Initial Nuclear Medicine Training Ancillary, EMC

Notice to Employees

NRC IN 90-58 Strontium-90 Applicators

Nuclear Medicine PU Refresher - VTH

Nuclear Medicine PU Refresher 2017 - EMC

Radioactive Material Decontamination 

Radioactive Material Safety Program (doc)

Radioactive Material Safety Program (pdf)

Tc-99m Decay Table