The extravasation of a therapeutic radionuclide is an issue that is not mentioned in this document. Such incidents can lead to severe deterministic effects for the patients (Van der Pol J. Consequences of radiopharmaceutical extravasation and therapeutic interventions: a systematic review. European Journal of Nuclear Medicine and Molecular Imaging. 2017;44(7):1234-1243 / Baus A Complex upper arm reconstruction using an antero-lateral thigh free flap after an extravasation of Yttrium-90-ibritumomab Tiuxetan: A case report and literature review, Annales de Chirurgie Plastique Esthétique Volume 63, Issue 2, April 2018, Pages 175-181).
L8-L1608-L2174 It should be added that a reliable pregnancy test has to be systematically performed before the administration of therapeutic activity of radionuclides.
L34 A definition of "dose constraint" should be added in the glossary. This term appears in the document more often than the dose limit which is defined in the glossary. Furthermore this concept is used for different cases (workers, public in adjacent areas, comforters) which should be distinguished.
L37 ‘ionising’ instead of ‘ionosing’.
L41-42: can we really say in this case that “Absorbed dose is a measurable quantity for which primary standards exist”? Is this definition coherent with other new glossary? This sentence is not necessary.
L61: ‘radiopharmaceuticals’ instead of ‘rdiopharmaceuticals’.
L118: Formatting problem in the line.
L155: ‘equivalent’ instead of ‘equivqlent’.
L183 (footnote) ‘radiotherapy’ instead of ‘raddiotherapy’
L213 radiation protection experts (EU) / qualified experts (IAEA) could be added to the target audience
L327 The presence of MRI between SPECT and PET and just after sequential retention measurements – even if it refers in fact to volume – can be disturbing.
L542 ‘as appeared as a curative radiopharmaceutical therapy’: what is the definition of a curative therapy. Can we say that 223Ra therapy is curative in this case?
L644 Missing space between 666 and MBq kg-1.
L1011-1013 The article from Lancelot is not correctly reported. 21 µSv is not for 6 treatments but for a session (11,7 injections per session). Extrapolated annual doses of rheumatologists are higher than those of radiopharmacists and nurses, but within limits.
L1030-1032: ‘and leakage rates from sequential imaging are reported to be > 2 % (Klett et al., 1999). In cases of 48 h immobilisation after therapy, the leakage rate of radio-colloids is > 2 % (Klett et al., 1999). These 2 sentences seem redundant. Is it well 2% that the authors wanted to write?
L1052: ‘Whole-body activity’ in bold.
L1107: ‘Glatting et al. 2005’: hard to find this reference concerning the use of dual-head cameras.
L1114: ‘µe [1 cm-1]’: not clear. It would have been preferable to write [1/cm] or [cm-1].
L1219: isn’t it particular to cite only one software solution for the integration of the time activity curves (even if it is at that time potentially the only one that includes statistical criteria).
L1255: semicolon instead of colon.
L1272: Is there any mention of biopsy in chapter 3?
L1350: it is not clear why this equation was rearranged.
L1663 The sentence about accommodation for visitors is placed between sentences about the design of the patient room. Does it mean that visitors will stay in the patient room? If not, this sentence should be placed after the requirements for the patient room.
L1687 The HVL/TVL values for concrete are incorrect. The unit is probably not mm, but cm. Several HVL/TVL values for lead and concrete have been published, sometimes higher than those of table 5.1.
L1696 It should be recommended that treatment rooms be systematically individual and preferably adjacent to each other. Thus in the next sentence “not possible” means “not adjacent” and the neighbouring patient is in an adjacent room. Even between two adjacent treatment rooms, an appropriate (lighter) shielding can be necessary (to reduce the exposure of the workers in a vacant treatment room due to the patient treated in the neighbouring room).
1726: Fetal or foetal?
L1751 According to Stabin (Radiation dose and risks to fetus from nuclear medicine procedures, Physica Medica 43 (2017) 190–198) or ICRP 94 (§179), it can’t be said that the fetal whole-body dose is not usually below 100 mGy in the case of a thyroid carcinoma treatment.
L1839 ‘contamination of the eye’ should be placed before ‘beta radiation’. Protective glasses are especially useful to protect the eyes from contamination. When they are handled, the radionuclides are normally contained in something (syringes and vials with their shields, patient), so exposure from beta radiation is not the major issue.
L1847 Wearing a lead apron to protect from 131I could even lead to increase the exposure when thinking to be protected and staying longer near sources or a patients.
L1866 ‘plastic for beta emitting radionuclides to minimise bremsstrahlung’ is not always true. The ORAMED project (Vanhavere, 2012) showed that for 90Y radioimmunotherapy a 5 mm W syringe shield is (slightly) more protective than a 10 mm PMMA shield.
L1896 Perhaps the ISO 16637 standard (Radiological protection — Monitoring and internal dosimetry for staff members exposed to medical radionuclides as unsealed sources) could be cited. This standard gives advices to design the proper monitoring.
L1923 (§5.4.4) As well as dose rate monitoring, a workplace contamination monitoring have to be performed to prevent individual contamination arising from surface contamination (workbenches, syringe shields, computer keyboards…).
L2051 replace ‘they are subject to dose constraints’ by they are not subject to dose limits, but to dose constraints only. The difference between comforters and other people (workers, public) is that they are not subject to limits. Dose constraints (but not exactly the same) apply to all categories of people (including workers and public).
L2088 paragraph 228 should be moved to the part 5.5.3.
L2093 Visits to patients undergoing radionuclide therapy should be avoided. In some particular cases, visits can be allowed (paediatric treatments).
L2097 Protecting public from contamination is not directly linked with the issue of visitors to patients, but with contamination monitoring, incident prevention, waste management… in the nuclear medicine facilities.
L2117-2120 These 2 sentences are not linked to travel of patients.
L2129-L2141 The end of (232) is redundant with (233).
L2202: ‘2017 Guidelines of the American Thyroid Association’ instead of ‘2016 Guidelines of the American Thyroid Association’.
L2333-2338: The references of Gustafsson et al. are not in the alphabetical order (there are before Garaventa et al.).
L2688: The reference of Sgouros et al. is not in the alphabetical order, between Siegel and Silberstein.