What do we know about hot labs and their applications, the risks associated with them, as well as the rules and safety protocols that have to be followed while working in these labs?
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What are Hot Labs?
Hot labs are the rooms in nuclear medicine hospitals that have been specially designed to deliver, store, and prepare radioactive materials required for diagnostic imaging and radiotherapy. Radionuclides and/or radiopharmaceuticals are prepared in hot labs by nuclear medicine technologists. The molybdenum-technetium 99Mo/99mTc-generator is used as a primary source in hot labs to generate radionuclide required for nuclear medicine applications. An extremely small amount of radionuclide is utilized during nuclear imaging to primarily study the functions of organs and tissues.
Different forms of xenon, iodine, gallium, thallium, and technetium are used as radionuclides based on the part of the body under investigation and the type of study being performed. For instance, radioactive materials such as Tc-99m oxidronate hydroxydiphosphonate (HDP) and I-131 sodium iodide capsules are prepared in hot labs and used in nuclear imaging to assess the osteogenic activity and thyroid functions, respectively.
Significance of Radionuclides in Nuclear Imaging
After the absorption of the radionuclide in the body tissue or organ, the radiation emitted by the radionuclide is detected using a radiation detector, such as a gamma camera. Digital signals are generated and stored by a computer when the radiation detector detects the radiation.
By measuring the radionuclide behavior in the body during nuclear imaging, different complications, such as cysts, organ enlargement, hematomas, infections, or tumors, can be assessed and diagnosed. In a nuclear scan, the regions that absorbed the radionuclide in higher amounts are referred to as hot spots since they appear bright in the image, while the regions that do not absorb radionuclide are referred to as cold spots since they appear less bright in the image. Single-photon emission computerized tomography (SPECT) produces axial slices of the investigated body part as the gamma camera rotates around the patient during imaging.
Equipment Used in Hot Labs
A nuclear medicine hot lab package typically contains a dose calibrator, 5 microcuries cobalt-57 vial source, and 200 microcuries cesium-137 vial source for dose calibrator quality control (QC), wipe test counter, survey meter with pancake probe, 0.5 microcuries nominal cesium-137 rod source for wipe test counter QC, bar phantom and flood source for gamma camera QC, lead-lined cabinets and bricks, 5 and 3 cubic capacity syringe shields, 10-inch curved forceps, lead-lined sharps shields and containers, waste containers, and syringe carriers.
Other major pieces of equipment in a hot lab package include decontamination soaps, sprays, and kit, injection stand/injection chair, step stool, leg rest/knee bolsters, arm support for SPECT cardiac imaging, intravenous therapy stand, and a number of signs cautioning about radiation and the presence of radioactive materials in the lab and prohibiting eating/drinking and entry of pregnant women in the lab.
Risks Associated with Hot Labs
Leakage of radioactive materials and exposure to radiation are the most common and significant risks associated with hot labs. Specifically, the contamination of radioactive materials in the body through inhalation, absorption, and ingestion can lead to acute health complications. Apart from these risks, smoke and fire, physical damages to the structure that is housing the lab, and natural disasters such as earthquakes also represent other risks to hot labs.
General Rules for Safe Handling of Radioactive Materials in Hot Labs
Only sealed radioactive materials should be taken out of a hot lab to prevent transmission of radioactivity outside of it. The laboratory work area must be surveyed to check the contamination levels either at the end of the day or after each procedure. The area should be decontaminated if the radioactive contamination is very high.
Additionally, radioactive waste should be disposed of in properly shielded receptacles such as sharps containers. Radioactive materials must be stored in clearly labeled containers where the labels indicate the name of the radionuclide. Moreover, radioactive materials must be stored in locked cabinets.
Safety Protocols to be Followed in Hot Labs
Patient Safety Protocols
Radiopharmaceuticals used in hot labs, such as 99mTc-medronate, must be sterile to ensure patient safety as they are typically injected through the intravenous mode. Thus, the radiopharmacist preparing radiopharmaceuticals must utilize only sterile licensed starting materials and sterile equipment, strictly adhere to aseptic working techniques such as preparing the radiopharmaceutical in a laminar airflow (LAF) cabinet, and wear a hat, mouth mask, and a dust-free lab coat while working at the LAF cabinet.
The safety of personnel working with radiopharmaceuticals in a hot lab is crucial as these substances contain radioactive materials. The personnel must wear a personal dosimeter to monitor the radiation dose received by his/her whole body while handling radioactive materials.
Additionally, a ring dosimeter must be worn on their hands while manipulating a high level of radioactivity during the preparation of radiopharmaceuticals in order to monitor the radiation dose received by their fingers. The lab staff must wear disposable gloves while working with radioactive materials to protect themselves from radioactive contamination. Moreover, overshoes should be worn over normal shoes while entering the hot lab to prevent potential radioactive contamination of footwear.
To summarize, hot labs play a significant role in nuclear medicine applications, specifically in nuclear imaging. However, extreme precautions must be maintained to ensure the safety of the technicians working in hot labs and the patients undergoing nuclear imaging.
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References and Further Reading
JRT Associates. Typical Nuclear Medicine Hot Lab Package. https://jrtassociates.com/typicalnuclearmedicinehotlabpackage.aspx
Nuclear Medicine - Radionuclides And Radiopharmaceuticals. (n.d.). Decay, Organ, Life, and Radiation - JRank Articles. https://science.jrank.org/pages/4738/Nuclear-Medicine-Radionuclides-radiopharmaceuticals.html
Nuclear Medicine. (n.d.). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/nuclear-medicine
Entering the Hot Lab. (n.d.). Human Health Campus - https://humanhealth.iaea.org/HHW/Radiopharmacy/VirRad/Entering_the_Hot_Lab/index.html
Nuclear Medicine Hot Lab Emergency Procedures:: Public Safety @. (n.d.). Bellevue College. https://www.bellevuecollege.edu/publicsafety/nuclear-medicine-hot-lab-emergency-procedures/#section-3-radioactive-materials-information
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