Need for harmonisation of extremity dose monitoring in nuclear medicine: results of a survey amongst national dose registries in Europe

Staff handling radiopharmaceuticals in nuclear medicine (NM) may receive significant extremity doses. Over the last decade in particular there has been an increase in NM procedures and new radiopharmaceuticals have been introduced. However, literature provides limited recent data on the exposure of the extremities. In addition, proper assessment of the equivalent dose to the skin can be difficult when applied to the fingertips. In order to gain insight in the actual exposure and to find out how European countries are dealing with monitoring of the extremities, a survey was performed amongst European regulatory authorities. The questions covered general aspects of the national dose registries (NDRs), the measured extremity doses and the practice of the monitoring of workers. The survey shows that extremity dosimetry is performed for about 25%-50% of the monitored workers in NM. Also, the recorded extremity doses in the NDRs are low (mean values 5-29 mSv yr(-1)) compared to the dose limit. Despite the recommendations that have been published in the last 10 years, few countries provide guidance on the wearing position of extremity dosemeters and the correction factor to estimate the maximum equivalent skin dose from the measured dose. This may lead to an underestimation of the maximum skin dose. Thermoluminescence ring dosemeters are widely used, but wrist dosemeters are also very common, even though the correlation of the measurement with the maximum skin dose is worse than for ring dosemeters. Furthermore, not all countries had a central registration of the extremity dose at the time the survey was performed.