Povinností každého pracoviště, jež v rámci lékařského ozáření nakládá se zdroji ionizujícího záření, je mimo jiné dodržovat principy radiační ochrany včetně respektování pravidla ALARA (As Low As Reasonably Achievable). Cílem této práce bylo posoudit úroveň optimalizace radiační ochrany zdravotnických pracovníků na PET/CT pracovištích s ohledem na obdrženou osobní dávku, používání pomůcek, stavební uspořádání pracoviště a také zkušenosti a zručnost pracovníků. Všechna PET/CT a PET/MR pracoviště v ČR včetně dvou pracovišť, která nepracují s pozitronovými radiofarmaky, byla oslovena, aby se pomocí vyplnění dvou elektronických dotazníků a poskytnutím dalších důležitých informací a dat zapojila do studie. Následně byla získaná data osobní dozimetrie (za respektování GDPR), informace o množství aplikované aktivity, odpovědi na subjektivní hodnocení situace vedoucími pracovníky a také obdržené plány stavebního uspořádání pracoviště zpracovány a porovnány. Pro orientační statistické zpracování byla použita regresní analýza. Sady hodnot byly porovnány neparametrickými testy Mann-Whitney a Kruskal-Wallis. Pro každého pracovníka byla vypočtena jeho průměrná efektivní a ekvivalentní dávka ve vztahu k aplikované aktivitě a také kolektivní dávka pro každé pracoviště. V dalším kroku byla vypočtena obdržená hodnota Hp(10) a HT z 1 GBq na jednoho pracovníka (v μSv). Z celkového počtu 22 oslovených pracovišť ČR a Slovenska odpovědělo na 1. dotazník 18 pracovišť. Návratnost u dotazníku č. 2 byla 55,6 %. Následně mohlo být do studie zahrnuto 10 pracovišť. Výsledky ukázaly rozdíly úrovně radiační ochrany mezi jednotlivými pracovišti. Hlavní roli zde hrají vybavenost a dostatek personálu. Rozdíly byly nalezeny také v obdržené dávce na kůži rukou. Nepotvrdila se domněnka, že práce s pozitronovými radiofarmaky přináší větší radiační zátěž a také se nepotvrdilo, že s pořízením automatických aplikačních systémů automaticky klesne kolektivní dávka. Důležitá je praktická zručnost a zkušenost pracovníků. Pro jednotlivá pracoviště byla navržena konkrétní doporučení pro zlepšení úrovně optimalizace.

It is responsibility of every workplace that utilize ionizing radiation sources under medical exposure to abide the principles of radiation protection, including compliance with the ALARA rule (As Low As Reasonably Achievable). The aim of this thesis was to assess the level of optimization of radiation protection of medical professionals on PET/CT departments with respect to the received personal dose, personal protective aids utilization, construction of the premises and also the experience and skills of the workers. All PET/CT and PET/MR departments in the Czech Republic, including two non-PET sites, were asked to participate in the study by completing two electronic questionnaires and providing other important information. Out of the total number of 22 surveyed departments in the Czech Republic and Slovakia 18 workplaces responded the first questionnaire. The return rate of the questionnaire 2 was 55,6 %. Subsequently, 10 sites were included in the study. Subsequently, the obtained personal dosimetry data (respecting GDPR), information about administered activities, responses to the subjective evaluation of the situation of executives and also received plans of the construction of the premises were processed and compared. A regression analysis was used for statistical assessment. The sets of values were compared by Mann-Whitney and Kruskal-Wallis non-parametric tests. For each worker the average effective and equivalent doses in relation to the applied activity was calculated as well as the collective dose for each workplace. In the next step, the received value of Hp(10) and HT was calculated from 1 GBq per worker (in It is responsibility of every workplace that utilize ionizing radiation sources under medical exposure to abide the principles of radiation protection, including compliance with the ALARA rule (As Low As Reasonably Achievable). The aim of this thesis was to assess the level of optimization of radiation protection of medical professionals on PET/CT departments with respect to the received personal dose, personal protective aids utilization, construction of the premises and also the experience and skills of the workers. All PET/CT and PET/MR departments in the Czech Republic, including two non-PET sites, were asked to participate in the study by completing two electronic questionnaires and providing other important information. Out of the total number of 22 surveyed departments in the Czech Republic and Slovakia 18 workplaces responded the first questionnaire. The return rate of the questionnaire 2 was 55,6 %. Subsequently, 10 sites were included in the study. Subsequently, the obtained personal dosimetry data (respecting GDPR), information about administered activities, responses to the subjective evaluation of the situation of executives and also received plans of the construction of the premises were processed and compared. A regression analysis was used for statistical assessment. The sets of values were compared by Mann-Whitney and Kruskal-Wallis non-parametric tests. For each worker the average effective and equivalent doses in relation to the applied activity was calculated as well as the collective dose for each workplace. In the next step, the received value of Hp(10) and HT was calculated from 1 GBq per worker (in μSv). The results revealed differences in the level of radiation protection between individual workplaces. Equipment and sufficient staff play a major role. Differences were also found in the dose received on the skin of the hands. The assumption that utilization of positron radiopharmaceuticals is connected to a greater radiation burden has not been confirmed, as well as that the acquisition of automatic delivery systems does not decrease the collective dose automatically. Practical skills and experience of employees are important. Specific recommendations to improve the level of optimization were proposed for individual departments.

Klinika nukleární medicíny Fakultní nemocnice Ostrava

Lékařská fakulta Ostravská univerzita

Ústav epidemiologie a ochrany veřejného zdraví Ostravská univerzita

Optimization of radiation protection of medical staff at PET/CT departments