Suggestion for ICRP draft
195 Positron emission tomography (PET) is a nuclear medicine diagnostic technique
Suggestion: Start with a brief intro before this line. E.g., "In the realm of diagnostic medicine, Positron emission tomography (PET) stands out as a vital tool."
providing functional, metabolic, and molecular information using positron emitters.
197 :The positron emitted undergoes annihilation producing two 511 keV photons that can be
Suggestion: "When the emitted positron undergoes annihilation, it produces two photons, each with a 511 keV energy, which are..."
198:detected by the PET scanner. This can be used together with computed tomography (CT) in a
Suggestion: "The PET scanner detects these photons. Additionally, PET can be integrated with computed tomography (CT) to form..."
199 :PET/CT scanner, or with magnetic resonance imaging (MRI) in a combined PET/MR; providing better anatomical detail (hybrid fused images).
Suggestion: " combined PET/CT scanner or with Magnetic Resonance Imaging (MRI) in a PET/MR setup, both yielding enhanced anatomical details through hybrid fused images."
200-201: The A rates of PET are growing as clinical indications expand with the addition of new PET radiopharmaceuticals. In some countries, PET/CT scans currently make up about 10 % of all nuclear medicine examinations and about 20 % of the effective dose delivered in nuclear medicine.
Suggestions : "With expanding clinical indications and the introduction of new PET radiopharmaceuticals, the use of PET has been on the rise. In certain countries, for instance, PET/CT scans now constitute approximately 10% of all nuclear medicine tests, accounting for about 20% of the total effective dose."
202-203 :The short half-lives of PET radionuclides and the high energies of annihilation photons emitted present challenges for radiological protection of staff.
Suggestion: "Given the short half-lives of PET radionuclides and the emitted annihilation photons' high energies, ensuring the radiological safety of medical staff becomes challenging."
204-205 :This publication provides guidance on occupational, patient, and public radiological protection in PET and PET/CT.
Suggestion: "This document offers comprehensive guidelines on radiological protection—addressing the safety of professionals, patients, and the public—in the context of PET and PET/CT."
Introduction
304 (1) :Nuclear medicine is a medical speciality that involves the use of radiopharmaceuticals
Suggestion: "Nuclear medicine employs radiopharmaceuticals."
308-310 :The images obtained give functional, metabolic, and molecular information. Gamma or annihilation photons produced as a consequence of radioactive disintegration are detected with a suitable system and this information is presented in images that show the biodistribution of the radiopharmaceutical.
Suggestion: "Images in nuclear medicine offer functional and molecular insights, capturing gamma photons from radioactive disintegration to depict radiopharmaceutical distribution."
312-314: Positron emission tomography (PET) is a nuclear medicine technique that produces images of the distribution within the body of radioactive tracers that emit positrons, such as 11C, 13N, 15O, and 18 F.
Suggestion: "PET, a nuclear medicine technique, images the body's distribution of positron-emitting tracers like 11C and 18F."
317-320: PET radiopharmaceuticals can be incorporated readily into biological processes and have an increasingly important role in oncology, namely in diagnosis, staging, treatment response and assessment for recurrence. They are also used in neurology and cardiology.
Suggestion: "PET radiopharmaceuticals are pivotal in oncology for diagnosis and treatment monitoring, and are also applied in neurology and cardiology."
321-324: CT images are used to correct for the attenuation of the annihilation photons in the patient's body. Introduced in early 2000 (Beyer et al., 2002), PET/CT scanners have become the standard technology configuration for PET imaging.
Suggestion: "CT images adjust for photon attenuation. Since the early 2000s, PET/CT scanners have become the norm for PET imaging."
327-331 A few positron emitting radionuclides are produced by generators, such as 68Ge/68 Ga, 62Zn/62Cu, and 82Sr/82Rb. Most PET radiopharmaceuticals, however, are labelled with 11 C, 13N, 15O, or 18 F, which are produced in a cyclotron.
Suggestion: "While some radionuclides like 68Ge/68 Ga come from generators, most PET tracers are cyclotron-produced, labeled with elements like 11C and 18F."
332-335 The directory of cyclotrons used for radionuclide production in 39 Member States of the IAEA, updated in 2006, had 262 entries for cyclotrons. However, it was believed to be a total of about 350 cyclotrons operating in the world, involved in some aspects of radionuclide production.
Suggestion: "The 2006 IAEA directory listed 262 cyclotrons across 39 Member States, though globally around 350 cyclotrons are believed to be in operation for radionuclide production."
336-340 The increase in number during these years was driven by several factors: advances in medical imaging, the introduction of a compact, user friendly medical cyclotron; and a decision that costs for [15O]-oxygen PET studies in Japan and 2-[ 18 F]FDG PET studies in Germany and the United States of America were eligible for reimbursement.
Suggestion: "Growth in cyclotron numbers was spurred by medical imaging advancements, user-centric cyclotron innovations, and reimbursement policies for certain PET studies in countries like Japan, Germany, and the USA."
344-345 The number of cyclotrons is still increasing, with more than 1300 cyclotron facilities worldwide (IAEA, 2021a), and 1484 are quoted in by another report (Goethals, 2020).
Suggestion: "Cyclotron counts are on the rise, with over 1300 facilities globally as per IAEA (2021a), and Goethals (2020) cites 1484."
346-350 The use of unsealed radionuclides, which implies their production, and the use of CT in diagnostic PET examinations, involves exposure of staff, patients and public to two different radiation sources.
Suggestion: "Using unsealed radionuclides and CT in PET diagnostics exposes staff and patients to dual radiation sources."
351-354 This report will cover the principles and technology behind PET and PET/CT, and include a summary of the clinical applications in Section 2, provide general guidelines on facility design in Section 3, and review the imaging equipment life cycle in Section 4.
Suggestion: "This report delves into PET principles and tech, summarizing clinical applications in Section 2, facility design in Section 3, and equipment life cycle in Section 4."
Grammar & Consistency:
304 (1) The phrasing "that involves the use of" could be simplified.
Suggestion: "Nuclear medicine uses radiopharmaceuticals..."
313 Space is missing between "18" and "314 F".
Suggestion: "...such as 11C, 13N, 15O, and 18F."
321-323 Instead of two separate sentences, consider combining for a smoother flow.
Suggestion: "Introduced in early 2000 (Beyer et al., 2002), PET/CT scanners, which correct for the attenuation of the annihilation photons in the patient's body using CT images, have become the standard technology for PET imaging."
327 There's a space between "68" and "Ga".
Suggestion: "...generators, such as 68Ge/68Ga,..."
343-344 Avoid redundancy. You mentioned the increasing number of cyclotrons twice.
Suggestion: "The number of cyclotrons is still increasing. Over 1300 cyclotron facilities are reported worldwide, with some sources like Goethals (2020) citing as many as 1484."
Clarity & Precision:
310 The phrase "and this information" is vague.
Suggestion: "Gamma or annihilation photons from radioactive disintegration are captured, presenting images that show the biodistribution of the radiopharmaceutical."
328-329 "which are produced in a cyclotron" might be better placed earlier in the sentence for clarity.
Suggestion: "Most PET radiopharmaceuticals are labelled with radionuclides like 11C, 13N, 15O, or 18F, produced in cyclotrons."
Terminology & Technicality:
313-314 Ensure that the elements "11C, 13N, 15O, and 18F" are consistent in format throughout the document.
342 The phrase "2-[ 18 F]FDG" has inconsistent spacing. It appears differently in lines 338 and 341. Maintain a uniform format.
Suggestion: "2-[18F]FDG"
General:
359 The term "clinical applications specialists" might be unfamiliar to some readers. Consider providing a brief explanation or context if this term is crucial to the report's audience.
Layout & Aesthetics:
The provided text uses numbered lines (e.g., "304 (1)"). If this is a draft for publication, consider using a more conventional approach, like bullet points or numbered sections, for a cleaner layout.
364-369: Well-structured and no evident mistakes.
370: Instead of starting with "Two principles," consider "Of the three principles," for clarity.
371-376: Clear and well-written.
378-382: Good elaboration on the third principle.
383: The sentence is clear, but consider adding a subject for more clarity, like, "These three principles apply specifically to the radiological protection of both the worker and the public."
384-389: Well-written, but avoid repeating the same reference (ICRP, 2007a) twice in close proximity.
390-395: Clear and comprehensive.
396-402: Good explanation and flow. However, consider using a consistent citation format. For example, "(ICRP 2007a)" lacks a comma.
403-409: Please replace "year2" with the appropriate year.
410-417: The content is clear, but to avoid redundancy, consider combining the two sentences that mention the two levels of optimization.
418-426: Consider replacing "year1" and "year2" with the appropriate years.
427-436: Well-structured and clear.
437-446: Clearly written.
447: There's an incorrect break in the line, specifically "99m 447 Tc". Consider adjusting it for continuity.
448-465: Clear and concise.
466-471: Well-structured.
472-475: No evident mistakes.
476-484: Clear explanation.
485-496: The information flows logically.
497-502: Good historical context.
503-511: Comprehensive statistics, but ensure that your citation style is consistent. For instance, the year is inside the parenthesis in some citations (e.g., "(EC, 2014a)") but outside in others (e.g., "(NCRP...").
1.5. Public exposure
Mistakes:
527-533: "Because" starts the sentence awkwardly.
Suggestions:
Use "Since" in place of "Because."
Change the sentence "Recommendations concerning minimization of public exposure will be provided in Section 7" to "Section 7 will provide recommendations on minimizing public exposure."
1.6. Staff exposure
Mistakes:
535-546: Overly verbose and complicated sentence structure.
549-558: Unclear distinction between the ORAMED project's findings and the protective measures.
559-565: Ambiguity between ORAMED project's dosimetry methods and Publication 106's recommendations.
Suggestions:
Simplify the description of challenges posed by PET radionuclides and effective doses data.
Clearly separate and simplify information related to the ORAMED project's findings and the protective measures taken.
Clearly differentiate between the dosimetry methods of the ORAMED project and the recommendations from Publication 106.
1.7. Education and ongoing training
Mistakes:
567-572: Repetition and verbosity.
Suggestions:
Condense the information on the training aspects.
1.8. Scope
Mistakes:
574-583: Repetitive sentence structure.
Suggestions:
Streamline the presentation of the scope for better flow.
1.9. Target audience
Mistakes:
585-590: The list of target audience members is one long sentence.
Suggestions:
Break the list of target audience members into simpler sentences or bullet points.
PET AND PET/CT PRINCIPLES
594 • PET uses a detection principle based on the annihilation photon radiation that follows a
595 positron decay.
Mistake: Potentially convoluted sentence structure.
Improvement: "PET's detection principle is based on the annihilation photon radiation resulting from positron decay."
596 • The PET detection principle has the advantage that high resolution can be obtained
597 without compromising sensitivity.
Mistake: Passive sentence structure.
Improvement: "The PET detection principle offers high resolution without compromising sensitivity."
598 • Biologically important elements like carbon, nitrogen, and oxygen have positron
599 emitting isotopes with short half-lives.
Mistake: "like" can be ambiguous in a scientific context.
Improvement: Replace "like" with "such as" for clarity.
603 • The combination of PET with CT into one system has been a driving force for the
604 clinical applications.
Mistake: Passive voice.
Improvement: "Combining PET with CT into a single system drove the expansion of clinical applications."
607 • The short half-life of PET-nuclides requires either an on-site cyclotron, a fast
608 distribution system, and/or the use of generator systems.
Mistake: The use of "either" followed by "and/or" is contradictory.
Improvement: "The short half-life of PET-nuclides requires an on-site cyclotron, a fast distribution system, or the use of generator systems."
38)
Mistake: In line 611, the sentence starts with "Positron emission tomography," but it lacks context or an introductory statement.
Improvement: Begin the sentence with an introductory statement explaining what positron emission tomography (PET) is before delving into the technical details.
Correction: Positron emission tomography (PET), as the name indicates, utilizes positron decay taking place in certain radioactive nuclides with an excess number of protons. Having lost its initial kinetic energy by interacting with matter over a short distance, the positron will annihilate with its antiparticle, an electron (from another atom), and create a pair of annihilation photons, each having an energy of 511 keV corresponding to the particle masses (E = mc²).
Mistake: The sentence in line 618 mentions "Neglecting the traveling distance of the positron during slow-down, this line is assumed to contain the point of decay," which might be confusing.
Improvement: Clarify the concept of the "line of decay" and why it's relevant in PET imaging.
Correction: Neglecting the traveling distance of the positron during slow-down, this line is assumed to contain the point of decay. In the following, some important technical aspects of relevance for radiation doses and protection are described together with a brief view of today's clinical applications.
(39)
Mistake: In line 639, it mentions "Dependent on the timing properties of the detection system," without earlier context about detection systems.
Improvement: Provide an introduction to detection systems and their role in PET imaging before discussing timing properties.
Correction: Dependent on the timing properties of the detection system, such a coincidence event can either just be assigned to the line [Line of Response (LOR)] or, by more precisely observing the time difference between the two detectors, to a point or interval on that line.
(40)
Mistake: The sentence mentions "sampling takes place in all directions (angles) simultaneously," but it doesn't explain why this is important or how it relates to PET imaging.
Improvement: Provide a brief explanation of why simultaneous sampling in all directions is advantageous in PET imaging.
Correction: One major advantage of the coincidence principle is that sampling takes place in all directions (angles) simultaneously without the need for rotating parts or collimators. This allows for a high detection efficiency (sensitivity) well suited for dynamic studies, and it also means that spatial resolution can be improved (e.g., by smaller detection elements) without compromising the sensitivity.
Mistake: In line 651, it mentions "any attempt to improve resolution necessarily further reduces the number of events that can reach the detector," which might need further clarification.
Improvement: Explain the trade-off between spatial resolution and the number of events that can reach the detector in more detail.
Correction: In nuclear medicine imaging outside PET, where only 'single photons' are available, imaging requires a collimator with narrow holes to define the direction of origin, and only a very limited fraction of the emitted photons can contribute to the image. Under these circumstances, any attempt to improve resolution necessarily further reduces the number of events that can reach the detector, and this trade-off represents a serious limitation for dose reductions.
(41)
Mistake: The sentence mentions isotopes with positron decay (11C, 13N, 15O) but does not provide context regarding their significance in PET imaging.
Improvement: Explain why isotopes with positron decay are important in PET imaging and how they relate to biological elements like carbon, nitrogen, and oxygen.
Correction: Another fundamental advantage of PET is that biologically important elements like carbon, nitrogen, and oxygen all have isotopes with positron decay (11C, 13N, 15O), but no gamma-emitting isotopes suited for single photon detection.
(44)
Mistake: The sentence mentions "add noise to the data," but it's unclear what "add noise" refers to.
Improvement: Clarify that the subtraction of false counts increases data noise.
Correction: Since the necessary subtraction of false counts from scatter and, in particular, random events increases noise in the data, this effectively limits the useful count rate that can be obtained from a system.
Mistake: In line 693, it mentions "NECr curve rises slowly," but it should be "NECr curve increases slowly."
Improvement: Correct the phrasing by changing "rises" to "increases."
Correction: After an initial almost linear increase, the NECr curve increases slowly towards a maximum peak at a certain activity (concentration) and then decreases due to dead time effects (Fig. 2.4).
(45)
Mistake: In line 699, it mentions "efficiency the activity is utilised," but it should be "efficiency of the activity is utilized."
Improvement: Correct the wording by changing "efficiency the" to "efficiency of."
Correction: Knowledge of the NECr curve, in principle, allows for an evaluation of how efficiently the activity is utilized (Watson et al., 2005).
(46)
Mistake: In line 725, there's a typo, "photomultiplier tubes" should be "photomultiplier tubes (PMTs)."
Improvement: Correct the abbreviation for "photomultiplier tubes" by adding the abbreviation "PMTs."
Correction: The amplification part can be made either with traditional photomultiplier tubes (PMTs) or recently with solid-state based materials. Due to the size and cost of PMTs, detectors have traditionally been built as an assembly of detector crystals covered with a (smaller) number of PMTs, in a so-called block structure which requires a decoding scheme similar to gamma camera Anger logic to assign events to a single crystal element (Casey and Hoffman, 1986).
Mistake: In line 728, there's a typo, "gamma camera Anger logic" should be "gamma camera Anger logic."
Improvement: Correct the phrase by capitalizing "gamma camera Anger logic."
Correction: detectors have traditionally been built as an assembly of detector crystals covered with a (smaller) number of PMTs, in a so-called block structure which requires a decoding scheme similar to Gamma camera Anger logic to assign events to a single crystal element (Casey and Hoffman, 1986).
(47)
Mistake: In line 732, there's a missing article before "high stopping power," it should be "a high stopping power."
Improvement: Add the article "a" before "high stopping power" for proper grammar.
Correction: To stop the energetic photons, a scintillation material with a high stopping power is needed, which requires a high element number (Z) and a high density. The material should also convert the energy into low energy photons (visible or UV, 2–3 eV) with high efficiency, and this process of scintillation decay from excitation must be fast as well. A fast and high signal from the crystal eases the timing detection, which basically must rely on the first few light photons that arrive at the 'amplifier'. It is also important in reducing the dead time of the system and thereby determines the count rate applicable. While sodium iodide (NaI) is still the dominant crystal material for most nuclear medicine applications, it is insufficient to stop 511 keV. For many years (1985–2000) bismuth germanate (BGO, Bi4Ge3O12) became the material of choice, having very good stopping power (Z for Bi is 83) but less perfect photons/keV (9) and timing properties (T½ = 300 ns). Most current PET systems use Lutetium (Z=77) based crystals, either lutetium oxyorthosilicate [LSO, (Lu2SiO5:Ce)], lutetium yttrium orthosilicate [LYSO, (Lu,Y)2SiO5:Ce], or others all having high stopping power, high density, photons/keV (35) , and short decay times (40 ns).
(48)
Mistake: In line 745, there's a typographical error, "improved" should be "improvement."
Improvement: Correct the typo by changing "improved" to "improvement."
Correction: Such systems may offer TOF (Surti et al., 2007) and the time resolution has been improved down to 0.2 ns, corresponding to a spatial uncertainty of only 3 cm (van Sluis et al., 2019).
(49)
Mistake: In line 748, "rest on" should be "rests on."
Improvement: Correct the verb agreement by changing "rest on" to "rests on."
Correction: The advantage of using solid-state amplification [avalanche photo diodes (APDs), or silicon photo multipliers (SiPM) rests on their smaller size, and the insensitivity to magnetic fields that make them compatible with MR systems. In particular, SiPM also has less timing uncertainty on the signal peak ('time jitter') and a potential gain in sensitivity with better utilization of the light output from the crystals. One vendor provides a matched crystal-SiPM system (one-to-one coupling) (Zhang et al., 2018) while others have maintained a block decoding. One disadvantage of SiPM is a high temperature dependency that requires strict control of local temperatures with distributed cooling tubes to all elements and potentially online sensitivity corrections.
(50)
Mistake: In line 757, there's a missing article before "energy (511 keV)," it should be "the energy (511 keV)."
Improvement: Add the article "the" before "energy (511 keV)" for proper grammar.
Correction: Signal handling includes validation of the pulse in terms of the energy (511 keV), assignment to a certain detector crystal using a decoding scheme, and decision of a potential coincidence with any other (relevant) detector element. This requires a scheme for energy windowing at the crystal level and a very precise timing calibration between detectors.
(51)
Mistake: In line 765, there's a missing comma after "time frames and."
Improvement: Add a comma after "time frames and" for better punctuation.
Correction: Raw data in a PET acquisition are either stored in sinogram matrices where each element corresponds to one LOR (detector pair) and each sinogram contains the information of one detection plane, or are acquired in 'list mode' where the events are registered sequentially by writing the addresses of the detector pair together with a time stamp to a data stream. In this mode, also signals from cardiac and respiratory gating can be included. After the end of acquisition, the list mode data may be 'replayed' and sorted into time frames and/or gating bins without the need to define these before scanning. Random events are either subtracted online (in list mode during the sorting) or are stored separately for later processing during reconstruction.
(52)
Mistake: In line 774, "photons/keV (35)" is not clear and needs clarification.
Improvement: Clarify the meaning of "photons/keV (35)" or rephrase it for clarity.
Correction: Reconstruction of raw data into transaxial image sets can be performed either by direct Fourier methods [Filtered back projection (FBP)] or by iterative reconstructions which are now the methods of choice in PET. When applying all necessary corrections, the PET images form a three-dimensional quantitative representation of the activity distribution within the depicted object. The corrections are (among others) for geometry of the LOR’s, dead time of detector and coincidence electronics, random and scattered coincidences, and attenuation. The stack of transaxial slices can be resampled to provide sagittal or coronal slices or, for heart studies, the traditional long and short axis representations. For that purpose, an isotropic spatial resolution is an advantage to avoid any resampling artifacts.
(53)
Mistake: In line 786, there's a typographical error, "proximal" should be "proximate."
Improvement: Correct the typo by changing "proximal" to "proximate."
Correction: It was therefore a major breakthrough when PET was combined with Computed Tomography, CT, to form PET/CT (Beyer et al., 2000). CT can, in a very short time, provide attenuation information that is essentially noiseless. In today’s iterative reconstructions,
(55)
Mistake: There's a typographical error in line 796. "realistic" should be "realistically."
Improvement: Correct the typo by changing "realistic" to "realistically."
Correction: The development of PET instrumentation has improved the spatial resolution by providing smaller detector elements, and values of <4 mm are now achievable in a clinical setting. The dependency on position in the gantry (centre or edge) and direction (radial or tangential) can be corrected by including knowledge about the point spread function (PSF), the image of an ideal point source (Tong et al., 2010). This can also improve the results from nuclides with high positron energy (like 15O, 68Ga, or 82Rb) where the influence of the width of the PSF is otherwise considerable.
(56)
Mistake: In line 808, "the acceptance of inter-ring coincidences" could be rephrased for clarity.
Improvement: Rephrase "the acceptance of inter-ring coincidences" to "accepting inter-ring coincidences."
Correction: The sensitivity has also been vastly improved. First, by extending the axial field of view (scanned length of the patient without the patient moving) from 10 cm in early systems (~1985) to 15 cm (~1993) allowing dynamic scans of the whole brain or myocardium, and next, most importantly, by accepting inter-ring coincidences (known as 3D). Current systems are often modular in construction, providing axial field of views of 15–25 cm or more. Since the sensitivity is almost quadratic in this parameter, an extension from 15 to 25 cm nearly triples the sensitivity. Recently, a system has been proposed and built that covers a full body length of 2 m (Badawi et al., 2019). Since a major part of the price of a system scales with length, systems like that will most likely remain instruments for research and special applications, e.g., the study of whole-body tracer kinetics, while systems spanning 0.5–1 m are more likely to gain clinical importance.
(57)
Mistake: In line 820, "count rate" could be better phrased as "counting rate" for clarity.
Improvement: Replace "count rate" with "counting rate."
Correction: The axial sensitivity profile when scanning in 3D mode forms a triangle with the top in the center slice(s) and approaching zero at the edges. When used for whole-body scanning or, actually, as soon as more than one axial field of view is required, an overlap of up to 50% between adjacent bed positions is used. Recently, systems have been delivered that move the patient bed continuously through the system with a speed that can be adjusted to the counting rate and required image quality in different regions (Osborne et al., 2014). This requires a more complex correction scheme since some corrections are linked to the detector (e.g., sensitivity normalization) while others depend on the patient (attenuation and scatter).
(58)
Mistake: In line 830, "unfortunately term" should be "unfortunate term."
Improvement: Correct the typo by changing "unfortunately term" to "unfortunate term."
Correction: From a radiological protection perspective, the most important technical improvements are those increasing sensitivity. While higher resolution actually will require more photons to maintain a certain noise level, and better counting rate performance might allow the patient throughput to be raised by increasing patient activity, the advent of '3D' and increased axial field of view also makes it possible to decrease the injected activity (patient dose) while still maintaining image quality. TOF-PET may also reduce noise by using the added position information in reconstruction, a feature sometimes (with a slightly unfortunate term) marketed by vendors as increased 'effective sensitivity.'
(59)
Mistake: In line 832, "mammography" could be better phrased as "breast imaging" for clarity.
Improvement: Replace "mammography" with "breast imaging."
Correction: A number of PET systems have been designed or are under development for specific purposes, e.g., breast imaging (Raylman, 2018), prostate imaging (Cañizares, 2020), brain imaging (Akamatsu, 2019), and also a whole range of special animal scanners (e.g., for mice and rats) are available, but until now, the mainstream PET system remains a ring system with a body-sized opening (and CT attached).
2.2 CT
(61)
Mistake: In line 838, "oppositely mounted detector arch" could be rephrased for clarity.
Improvement: Rephrase "oppositely mounted detector arch" to "detector arch mounted opposite the x-ray tube."
Correction: Almost all CT systems today are so-called third-generation systems, where data collection is made by fast continuous rotation of a balanced arrangement with an x-ray tube exposing (with a fan beam) a detector arch mounted opposite the x-ray tube. CT images provide the tomographic reconstruction of recorded attenuation of the object.
(62)
Mistake: The phrase "a comprehensive description of x rays and CT" in line 845 could be more specific.
Improvement: Specify the type of information provided in "a comprehensive description of x rays and CT," e.g., "a comprehensive description of the principles of x-ray generation and CT imaging."
Correction: The attenuation of a material is determined by the atomic composition and the density of the material as well as the photon energy applied in the measurement. The possibility of an anatomical interpretation is caused by the fact that different tissues have (slightly) different atomic composition and density. For a comprehensive description of the principles of x-ray generation and CT imaging, see (Mahesh, 2009; Bushberg et al., 2020).
(64)
Mistake: In line 856, "rotating anode" should be "rotating anode tube" for clarity.
Improvement: Replace "rotating anode" with "rotating anode tube."
Correction: In early CT systems, the x-ray tube heat capacity and cooling rate were a limitation for scanning extended body regions. This has been solved in some modern tube designs that allow the rotating anode tube to be cooled by direct heat transfer, rather than through a radiative process out of the tube containment. An important correlate to this is that there is no longer a simple inherent technical limitation to the dose that might be given to a patient during a scanning session, and other safeguards must be in place to secure against unintended high exposure.
(65)
Mistake: In line 867, "total scan area" could be more specific, e.g., "total scan length."
Improvement: Replace "total scan area" with "total scan length."
Correction: A typical CT session will consist of: 1) a prescan, 2) a CT acquisition, and 3) the reconstruction of images. The CT acquisition parameters of importance for image quality and patient dose (to be set before scanning) are: high voltage (kV), tube current (mA), rotation time, slice collimation, and bed movement per rotation; the latter is normally specified by the 'pitch,' the ratio of bed movement to collimation width. Of course, the selection (from the prescan) of the total scan length is also important.
(68)
Mistake: In line 899, the phrase "software solution that can handle sequentially acquired data sets" could be more concise.
Improvement: Simplify "software solution that can handle sequentially acquired data sets" to "software for handling sequentially acquired data sets."
Correction: Also, the tube voltage may be selected by the system based on calculations on the pre-scan data. Unlike the tube current modulation, however, the tube voltage is normally kept fixed during a scan. Recently, systems with 'dual energy' capability have been built; these can either be systems with two complete source-detector arrangements running at different keV, a single source system with fast kV switching or dual filters, or software for handling sequentially acquired data sets.
(69)
Mistake: In line 904, "no systems have been installed as PET only" could be made clearer.
Improvement: Clarify "no systems have been installed as PET only" to "almost no standalone PET systems have been installed."
Correction: The combination of PET and CT, developed in the late 1990s (Beyer et al., 2000) and introduced commercially in 2001, marked an important turning point for the use of PET in general. The number of installations grew rapidly, and since 2004 almost no standalone PET systems have been installed (Jones, 2017). The combined PET and CT systems continue for many practical reasons (including transport into hospital buildings) to be manufactured as two separate gantries that are mounted together on site, but computer systems and programs have become more integrated over time (Fig. 2.5).
(70)
Mistake: In line 911, the figure description is separated from the figure itself.
Improvement: Move the figure description next to the figure for clarity.
Correction: Fig. 2.5. One of the first commercial PET/CT systems (Discovery LS, General Electric, 2001) with the two gantries separated for service. The CT is in front, with the x-ray tube at the bottom and the detector arch at the top. In the back, the PET gantry is seen with its modular detector assemblies arranged in a ring around the patient bore. This two-gantry configuration is maintained in contemporary systems. Image: Søren Holm, Denmark.
(71)
Mistake: In line 924, there's a minor grammatical issue with "the presence of materials other than air, soft tissue and bone."
Improvement: Slightly rephrase to "the presence of materials other than air, soft tissue, and bone."
Correction: The CT image represents a distribution of attenuation values obtained with the actual CT energy spectrum. To use it for 511 keV requires some modeling and calculations (scaling) (Kinahan et al., 1998; Holm, 2017). In general, this works well, but artifacts may arise in the presence of materials other than air, soft tissue, and bone, e.g., contrast agents, metal implants, and dental work not included in the simplified model (IAEA, 2014a).
(72)
Mistake: In line 928, "a pre-scan providing a simple x-ray projection image" could be more concise.
Improvement: Simplify "a pre-scan providing a simple x-ray projection image" to "a pre-scan providing an x-ray projection."
Correction: A typical PET/CT session will consist of 1) a pre-scan providing an x-ray projection, 2) a CT scan, and 3) a PET scan.
(73)
Mistake: In line 943, "the scatter from CT would disturb the PET detectors" could be more specific about what "scatter" means in this context.
Improvement: Specify that "scatter" refers to radiation scattering.
Correction: It should be noted here that the photon flux during a (diagnostic) CT scan can be 4–5 orders of magnitude higher than the emission rate from a patient injected with a typical activity for the PET scan, delivering the same absorbed dose to the exposed tissue in a second as the injected tracer will provide over the lifetime of the activity. The high flux ratio explains why it is not feasible to perform simultaneous measurement of PET and CT because the radiation scattering from CT would disturb the PET detectors.
PET/MR
(74)
Mistake: In line 948, "or minimise interference" could be improved for clarity.
Improvement: Clarify by changing "or minimise interference" to "to minimize interference."
Correction: The PET electronics are placed behind the magnet and (electrically) well shielded in a copper Faraday cage to exclude or minimize interference between the MR radiofrequency signals and the PET pulse handling electronics (Fig. 2.6).
(75)
Mistake: In line 955, "works quantitatively satisfying" should be revised for better grammar.
Improvement: Revise "works quantitatively satisfying" to "works quantitatively satisfactorily."
Correction: In such a system, PET and MR can be performed truly simultaneously, in contrast to PET/CT where the acquisitions must be performed sequentially. One major issue in PET/MR is that, unlike CT, the MR signal and image does not provide an immediate source for AC. Air-filled structures as well as bone have no or low signal from MR, and yet these two have the most different attenuation for the PET photons. For the brain, solutions have now been found that work quantitatively satisfactorily (Ladefoged et al., 2017), and also for whole-body scans, results are normally reasonably accurate (Keereman et al., 2013). For a review of recent methods, see Catana (2020).
(76)
Mistake: In line 963, "will not be dealt with in detail in this work" could be clarified.
Improvement: Specify what "this work" refers to, such as "will not be dealt with in detail in this document."
Correction: The clinical use of PET/MR is currently limited, and specific clinical indications remain to be proven. One obvious advantage, from a radiological protection point of view if replacing a PET/CT examination, is that the (often high) radiation dose from CT is avoided. This is of particular interest in the examination of children. Since the radiological protection for the PET in PET/MR is not much different from other uses of PET, PET/MR will not be dealt with in detail in this document. For MRI safety, see references in Sections 8, 9, and 10.
2.5 Cyclotron
(77)
Mistake: In line 974, "by bombardment with high energy protons" could be made clearer.
Improvement: Make it clearer by changing "by bombardment with high energy protons" to "by bombarding them with high-energy protons."
Correction: The cyclotron principle was introduced by Lawrence in 1930 for accelerating protons (Lawrence and Livingston, 1932). Originally only meant to provide a proton beam for physics experiments, the possibility of creating artificial radioactivity by bombarding them with high-energy protons was soon detected (Curie and Joliot, 1934). Today, the cyclotron is an essential device for producing the nuclides used in PET and is an important integrated part of many PET centers (Braccini, 2016).
(78)
Mistake: In line 989, "for a pressurised gas-target" could be clarified.
Improvement: Clarify by changing "for a pressurised gas-target" to "for a pressurized gas target."
Correction: Targets can be gas- or liquid-based or can be solid targets. A critical part of the cyclotron is the foil separating the cyclotron tank vacuum from the target material. It has to be thin, not to take out too much energy of the beam particles, yet it should be able to withstand the pressure difference that for a pressurized gas target may be 20–50 bar.
(80)
Mistake: In line 1014, "beam particles" could be made clearer.
Improvement: Make it clearer by changing "beam particles" to "accelerated particles."
Correction: Transporting the product from gas or liquid targets into radiochemistry hot cells can be controlled remotely by blowing inert helium or argon gas through thin plastic tubes; the use of a solid target normally will require access to the cyclotron vault, although some automated systems have been built.
(83)
Mistake: In line 1041, "inferred dose constraints" could be made clearer.
Improvement: Clarify by changing "inferred dose constraints" to "considered dose constraints."
Correction: A typical reaction in the target is (p,n) or similar (Table 2.1), where excess energy from the compound nucleus is removed by (one or more) neutrons. This means that during bombardment, a high neutron flux will be present around the target (in the cyclotron vault). Often, the neutrons will be the determining factor for shielding requirements. Further, neutron activation of cyclotron components and building materials is an issue that must be considered carefully in the planning phase.
3.2. Cyclotron facilities
(97)
Mistake: In line 1185, "nevertherless" should be corrected to "nevertheless."
Improvement: Correct the spelling by changing "nevertherless" to "nevertheless."
Correction: Self-shielded or locally shielded cyclotrons require a lower level of additional shielding, but nevertheless, they need to be placed inside a vault to provide additional shielding (NCRP 2003; Schmor, 2011).
(100)
Mistake: In line 1209, there is a typo "1 H (p)" which should be corrected to "1H (p)."
Improvement: Correct the typo by changing "1 H (p)" to "1H (p)."
Correction: PET Cyclotrons produce radionuclides through bombarding a suitable target with 1H (p) or 2H (d), involving nuclear reactions such as (p,n), (p,2n), (p,α), (d,n), etc.
(105)
Mistake: In line 1278, "prospective evaluation" should be corrected to "prospective evaluations."
Improvement: Correct the grammar by changing "prospective evaluation" to "prospective evaluations."
Correction: Access to the bunker should require that the operator wear specific work clothes and use gloves and face masks. For the maintenance operations carried out inside the acceleration chamber of the cyclotron, these requirements can be more stringent, in particular to avoid the inhalation of contaminated or activated dust (Calandrino et al., 2010; Terranova et al., 2011; Biegała et al., 2022), as well as for the protection from beta radiation that could arise from some components.
(109)
Mistake: In line 1320, "and either" could be clearer if it mentions what is being referred to as "either."
Improvement: Make it clearer by specifying what "either" refers to in the sentence.
Correction: All surfaces within the vault should be hard, washable, and smooth, and either painted or covered with an epoxy coating, to minimize the creation of dust and allow any contamination to be removed easily.
3.2.2. Radionuclide production and transfer:
Some sentences are quite long and complex, which might make them challenging to understand. Breaking these into shorter, more precise sentences could improve readability. For example:
Original: "The pattern of airflow within a facility should be designed to control airborne contamination."
Suggested: "Facilities should design their airflow patterns to effectively control airborne contamination."
Ensure consistent use of terms throughout the document. For instance, if "hot laboratories" and "radiopharmacy laboratories" refer to the same spaces, choose one term and stick with it for clarity.
Some sections could benefit from more specific technical details. For instance, when discussing the types of filters used (HEPA, ULPA), include the specific contaminants they are effective against, or their efficiency ratings.
Emphasize safety protocols more explicitly, especially in sections discussing maintenance operations in radiation-prone areas. Detail the types of protective clothing, gloves, and masks that should be used.
Consider including diagrams or flowcharts to illustrate complex systems or processes, like the airflow in different laboratory sections or the placement of filters and fans.
Ensure that the document is free from grammatical errors. For example, in section 1411, "dose rates in close contact with internal components will be limited to a range of several tens of µSv h−1," consider rephrasing for clarity.
PET radiopharmacy/radiochemistry laboratory
1450 3.3.1. Laboratory facilities:
Consider breaking down longer sentences into shorter, more concise ones. This improves readability and comprehension. For instance, in the sentence spanning lines 1451-1454, consider breaking it into two sentences for better clarity.
Where possible, provide specific examples or elaborations. For example, when discussing the requirement for controlled environmental conditions in line 1471, you could briefly mention what those conditions might entail.
1578 3.4. Radiation components of PET/CT imaging
While the document mentions the exposure of staff to radiation, incorporating specific safety measures or protocols to minimize exposure during radiopharmaceutical preparation, injection, and scanning processes would be beneficial.
3.5. The Journey of the PET Patient Through the Facility
The steps for patient preparation are well outlined, but adding more detail on each step, such as the specific instructions given to patients during fasting or the conditions in the administration-uptake room, could be helpful.
While patient safety is addressed, emphasizing the importance of patient comfort and anxiety reduction throughout the process, particularly during the waiting and resting periods, would be beneficial.
The post-imaging care instructions are clear. Additional guidance on managing patients who may require extended observation post-imaging, or how to handle patients who may experience delayed reactions to the radiopharmaceutical, would be useful.
Section 3.6 "Design of a PET Facility:
3.6.1. Planning the Facility: This sub-section likely discusses the initial steps and considerations in the planning phase of a PET facility. It might include topics such as site selection, facility layout, budget considerations, and compliance with regulatory requirements.
3.6.4. Assessment of Dose Levels and Protection Requirements: This sub-section probably elaborates on methods for assessing radiation dose levels within the facility and the necessary protective measures. This might involve discussing dosimetry techniques, establishing safety protocols, and implementing protective equipment and barriers.
3.6.3. 511 keV Photon Dose Rates around PET Patients
Advanced Shielding Materials: Research and implement cutting-edge shielding materials that offer better protection against 511 keV photons.
Real-Time Monitoring Systems: Install systems for real-time monitoring of photon dose rates to ensure immediate response to any radiation safety concerns.
Patient and Staff Education: Provide comprehensive education programs about radiation safety for both patients and staff.
3.6.4. Assessment of Dose Levels and Protection Requirements
Innovative Dosimetry Techniques: Utilize advanced dosimetry techniques for more accurate assessment of dose levels.
Customized Protection Plans: Develop customized radiation protection plans based on the specific layout and equipment of the facility.
Regular Safety Audits: Conduct regular safety audits to ensure ongoing compliance with radiation safety standards and to identify areas for improvement.
Implementing these suggestions can enhance the safety, efficiency, and patient experience of a PET facility, ensuring it meets the highest standards of medical care and operational excellence.
1968 3.7. Determination of shielding requirements for a PET/CT imaging facility
3.7.2. PET/CT Scanning Room Design and Protection
Provide more detailed guidelines on the design of PET/CT scanning rooms, including specifics on room dimensions, materials, and layout to optimize safety and functionality.
Suggest versatile design concepts that can be adapted to various facility sizes and constraints, offering a range of solutions for different scenarios.
Emphasize not just the physical aspects of radiation shielding but also operational procedures and safety protocols to ensure comprehensive protection for both patients and staff.
4: Quality Assurance (QA) Programme
Understanding of Equipment Life Cycle
Provide more detailed descriptions of each stage of the life cycle, including end-of-life considerations and disposal or recycling of imaging equipment, to ensure comprehensive understanding.
Incorporate a section on lifecycle cost analysis, emphasizing the importance of considering not just the acquisition cost but also maintenance, upgrades, and eventual decommissioning costs.
Team Approach and Skills Respect
Clarify and define the roles and responsibilities of each professional involved in the lifecycle management more explicitly, ensuring clear understanding and collaboration.
Suggest implementing interdisciplinary training programs to enhance understanding and cooperation among different professionals involved in equipment management.
Stages in Planning and Creation of a PET/CT Facility
Elaborate on the justification criteria for new equipment, including a more comprehensive assessment of clinical, technical, and economic factors.
Emphasize the importance of user-centric considerations in the design and specification phase, ensuring equipment meets the practical needs of end users.
Quality Assurance (QA) Programme
Propose the integration of more advanced quality control (QC) techniques and technologies to ensure equipment performance and reliability.
Define clear performance metrics and benchmarks for equipment evaluation, ensuring consistent standards are applied.
Recommend proactive and predictive maintenance strategies rather than just scheduled maintenance, to improve equipment longevity and reduce downtime.
5.1 Characteristics of PET, PET/CT, and PET/MRI in association with justification
Provide more detailed and updated descriptions of PET, PET/CT, and PET/MRI technologies, focusing on their specific roles, advantages, and limitations in different clinical scenarios.
Include more comprehensive criteria for justifying the use of these technologies, considering not only diagnostic accuracy but also cost-effectiveness, patient throughput, and long-term clinical outcomes.
5.2. Justification of Radiological Practices
Offer clearer guidelines on the three levels of justification for radiological practices, ensuring that the rationale for using PET, PET/CT, and PET/MRI is well understood and properly documented.
Address ethical considerations in radiological practices, especially regarding patient consent and understanding of the procedures.
5.3. Justification of PET, PET/CT, and PET/MRI Procedures
Provide more detailed, procedure-specific guidelines for justification, particularly in complex cases where multiple imaging modalities may be options.
Include case studies or examples where PET, PET/CT, and PET/MRI have been effectively justified in clinical practice, highlighting the decision-making process.
5.4. Optimisation of Radiological Practices
Detail specific techniques and strategies for optimizing radiological practices in PET, PET/CT, and PET/MRI, including dose reduction, image quality enhancement, and patient throughput optimization.
Emphasize a patient-centric approach in optimization, balancing the need for diagnostic accuracy to minimize radiation exposure.
6.1. Dose Estimation of Patients
Provide more detailed methodologies for estimating doses, including factors influencing dose variability and how to account for them.
Include examples illustrating dose estimation in various clinical scenarios, aiding in understanding and application.
6.2. Optimisation and Dose Reduction Strategies
Update the section with the latest techniques and technologies for dose reduction, such as advanced imaging protocols and software enhancements.
Emphasize the importance of personalized dose management based on patient-specific factors like age, body size, and clinical condition.
6.3. Radiological Protection Optimisation Using Both Hardware and Software
Discuss the potential of integrating artificial intelligence (AI) and machine learning (ML) in optimizing radiological protection.
Ensure recommendations for software are up-to-date and include information about the frequency of updates and the impact of software changes on dose optimization.
6.4. The Value of DRLs for Optimisation of PET and PET/CT
Suggest the implementation of dynamic diagnostic reference levels (DRLs) that can adapt to technological advancements and changing clinical practices.
Include a section on how DRLs vary internationally and the importance of contextualizing DRLs within specific healthcare systems.
6.5. Radiological Protection and Dose Issues in Paediatric Patients
Emphasize the need for age and size-specific imaging protocols to minimize radiation exposure in paediatric patients.
Propose the creation of educational materials for parents/guardians to inform them about radiological protection for their children.
6.6. Breast Feeding
Provide clearer, more detailed guidelines for breastfeeding post-PET imaging, including specific timeframes and precautions.
Radiopharmaceutical-Specific Information: Offer detailed information on different radiopharmaceuticals and their impact on breastfeeding.
6.7. Fetal Dose
Include specific protocols and guidelines for imaging pregnant patients, focusing on minimizing fetal dose.
Emphasize the importance of effective communication regarding risks to the fetus and involve obstetric care providers in the decision-making process.
6.8. Carers/Comforters
Detail specific protection measures for carers and comforters, including the use of protective equipment and minimizing time in radiation areas.
Propose training or informational sessions for carers/comforters on radiological safety.
6.9. Research Volunteers
Strengthen the section on ethical considerations, informed consent, and the right to withdraw without penalty.
Suggest protocols for long-term monitoring and follow-up of research volunteers who have been exposed to radiation.
7 "Radiological Protection for the Public
7.1. Background
Include comparisons of radiological protection standards and practices between PET/CT and other medical imaging modalities to contextualize the unique challenges and approaches in PET/CT.
7.2. General Recommendation on Radiation Dose to the General Public
Provide clearer, more detailed guidelines on the acceptable levels of radiation dose to the general public, including specific numbers and thresholds where applicable.
Emphasize effective risk communication strategies to the public, ensuring that the information about radiation risks is accessible and understandable.
7.3. Radiation Dose to Non-Radiation Workers
Outline specific protection measures for non-radiation workers who might be indirectly exposed, such as administrative staff or visitors in medical facilities.
Suggest protocols for monitoring and reporting radiation exposure levels in non-radiation workers, ensuring adherence to safety standards.
7.4. Patient to Patient Dose
Discuss strategies to prevent cross-contamination and unintended radiation exposure between patients, especially in high-throughput facilities.
Include case studies or examples where patient-to-patient radiation exposure was effectively managed or mitigated, providing practical insights.
8.1.1.1. External Contamination
Detailed Decontamination Procedures: Provide more detailed procedures and protocols for dealing with external contamination, including steps for immediate response and subsequent decontamination processes.
8.1.1.2. Internal Contamination
Emphasize preventive measures to avoid internal contamination, including proper use of personal protective equipment (PPE) and safe handling practices.
8.1.2. Staff Irradiation During Patient Management
8.1.2.1. Whole-body Dose
Dose Reduction Techniques: Outline specific techniques and practices for reducing whole-body doses to staff, such as time, distance, and shielding principles.
8.1.2.2. Hand Exposure
Suggest the use of advanced protective gloves and other equipment to reduce hand exposure, especially during procedures involving direct contact with radiopharmaceuticals.
8.1.2.3. Eye Lens Exposure
Provide clear guidelines on eye protection, including when and what type of protective eyewear should be used.
8.1.3. Staff Irradiation During Radiopharmaceutical Production
Recommend enhanced shielding in areas where radiopharmaceuticals are produced and the use of automation to minimize staff exposure.
8.2. Measures to Optimise Staff Radiological Protection
8.2.2. Use of Automatic Units
Strongly advocate for the adoption of automatic units for handling radiopharmaceuticals to reduce manual handling and associated exposure.
8.2.3. During Patient Management
Provide detailed best practices for patient handling to minimize staff exposure, including positioning and movement techniques.
8.2.6. Summary of Measures for Optimisation
Offer a comprehensive summary that clearly articulates the key measures for optimisation, serving as a quick reference for staff.
8.3. Staff Dose Monitoring
8.3.1. Introductory Information
Emphasize the context and importance of dose monitoring as a critical component of staff safety.
8.3.2. Routine Monitoring of Staff
Advocate for regular and systematic monitoring protocols to track staff exposure over time.
8.3.3. Dosimeter Positioning to Monitor the Extremity Dose
Provide clear guidelines on the correct positioning of dosimeters for accurate extremity dose monitoring.
8.3.4. Type of Extremity Dosimeters
Discuss the latest dosimeter technologies and their appropriate use cases.
8.3.5. Guidance on the Use of Extremity Dosimeters
Offer detailed instructions on the use of extremity dosimeters, including maintenance and calibration.
8.3.6. Skin Dose Monitoring Under Contamination
Suggest protocols for assessing skin doses, particularly in contamination scenarios.
8.3.7. Internal Dose Monitoring
Provide guidelines for monitoring and managing internal exposure risks.
9.1. Regulatory Authority and Legal Framework
9.1.1. Management Systems
Expand on the details of management systems, including how they integrate with regulatory requirements and best practices in dose management.
9.1.2. Medical Imaging Team
Clarify the roles and responsibilities of each team member in the context of dose management and quality assurance.
9.1.3. Quality Assurance and Quality Control in Radiological Protection
Provide a more comprehensive overview of quality assurance (QA) and quality control (QC) strategies, including how they specifically apply to radiological protection.
9.2. Optimisation of Dose to Patient
9.2.1. Patient Dose Management
Emphasize the importance of patient-specific dose optimisation strategies, taking into account individual patient characteristics.
9.2.2. Standard Operating Policy for Accidents Radioactive Spillage or Misadministration of Radiopharmaceuticals
Enhance this subsection with detailed protocols for responding to incidents, including immediate steps, reporting mechanisms, and post-incident analysis.
9.3. Optimisation of Equipment Parameters
9.3.1. PET Subsystem
Update this section to reflect the latest technological advancements in PET imaging and their implications for dose optimization.
9.3.2. CT Subsystem
Incorporate recent developments in CT imaging that contribute to dose reduction, such as iterative reconstruction techniques.
9.4. QA/QC Program Overview in a PET Imaging Facility
9.4.1. QC Imaging Personnel
Focus on the training and certification requirements for QC imaging personnel, ensuring they are up-to-date with current standards.
9.4.2. QC Process Overview
Provide guidelines for ensuring the efficiency and effectiveness of the QC process in a PET imaging facility.
9.5. Components of QC Program
9.5.1. QC Acceptance Testing on Equipment
Standardise acceptance testing procedures across different types of equipment for consistency.
9.5.2. QC Periodic and Performance Testing on Equipment
Establish clear performance benchmarks for periodic and performance testing.
9.6. QC Testing PET PET/CT or PET/MRI
9.6.1. QC Acceptance Testing
Define detailed acceptance criteria for each type of imaging system.
9.6.2. Daily and Weekly QC
9.6.2.1. Daily QC on PET Subsystem
Develop a comprehensive checklist for daily QC activities specific to the PET subsystem.
9.6.2.2. Daily QC on CT Subsystem
Elaborate on CT-specific QC protocols, focusing on areas like dose calibration and image quality.
9.6.2.3. Daily QC on MRI sub-component of PET/MRI
Outline the unique QC requirements for the MRI component in PET/MRI systems.
9.6.3. Periodic QC
9.6.3.1. QC Testing PET Subsystem
Provide guidelines for periodic testing of the PET subsystem, including frequency and specific tests.
9.6.3.2. QC Testing CT Subsystem
Introduce advanced protocols for periodic CT testing.
9.6.3.3. QC Testing MRI Subsystem
Comprehensive MRI Testing: Ensure comprehensive testing protocols are in place for the MRI subsystem, addressing both hardware and software aspects.
9.7. QC Testing Radionuclide Calibrator
Emphasize the importance of regular and accurate calibration of radionuclide calibrators, outlining standard procedures.
9.8. QC Radiation Monitoring Instruments and Other Equipment
Provide detailed guidelines for the maintenance and calibration of radiation monitoring instruments.
9.9. Summary Overall QC Program
Focus on the continuous evaluation and improvement of the QC program, including feedback mechanisms and regular reviews.
10.1. Curriculum Development
Ensure the curriculum covers all fundamental aspects of radiological protection, including physics of radiation, radiation biology, dose assessment, and safety protocols.
Regularly update the curriculum to include current research and developments in the field of radiological protection.
10.2. Target Audience and Learning Objectives
Tailor training programs to cater to a diverse audience, including medical staff, technicians, and administrative personnel.
Set clear, measurable learning objectives for each training module, ensuring that they align with professional standards and regulatory requirements.
10.3. Training Delivery Methods
Utilize a combination of traditional and modern educational methods, such as in-person lectures, hands-on training, and online learning platforms.
Incorporate interactive elements like simulations, case studies, and group discussions to enhance engagement and understanding.
10.4. Assessment and Certification
Implement regular assessments to evaluate the understanding and application of radiological protection principles by the trainees.
Establish a certification process to recognize the completion of training and ensure a standardized level of knowledge and competence.
10.5. Continuing Education
Provide opportunities for ongoing education and professional development in radiological protection, including workshops, seminars, and online courses.
Consider making continuing education in radiological protection mandatory to ensure that staff remain updated on the latest practices and regulations.
10.6. Training for Specialized Procedures
Offer specialized training for procedures that involve higher levels of radiation exposure or complex techniques.
Emphasize hands-on training in a controlled environment to allow staff to gain practical experience under expert supervision.
10.7. Feedback and Improvement
Implement feedback mechanisms to gather insights from trainees about the effectiveness of the training programs.
Use feedback to continuously improve the education and training programs, ensuring they remain relevant and effective.
Comment