Radioprotection 2025, 60( 3), 250 – 255 © H. Khajmi et al., Published by EDP Sciences 2025 https:// doi. org / 10.1051 / radiopro / 2024061
Available online at: www. radioprotection. org
ARTICLE
Establishing diagnostic reference levels for scintigraphy exams at the Mohammed VI University Hospital Centre in Marrakech-Morocco
H. Khajmi 1,*, A. Tounsi 2 and L. Oufni 3
1 Higher Institute of Nursing Professions and Health Technics, Marrakech, Morocco. 2 Environmental, Ecological and Agro-Industrial Engineering Laboratory, University Sultan Moulay Sliman, Béni Mellal, Morocco. 3 Sultan Moulay Sliman University, Faculty of Sciences and Techniques, Department of Physics( LPM), B. P. 523, 23000 Béni Mellal,
Morocco. Received: 26 August 2024 / Accepted: 8 December 2024
Abstract – This work aims to determine the local diagnostic reference levels( LDRL) for scintigraphy exams( SE) in the nuclear medicine( NM) department of the Oncology and Haematology Hospital, Mohammed VI University Hospital Centre of Marrakech region of Morocco( OHH, Med VI UHC-MM). The LDRLs calculations were based on the most recent recommendations from the ICRP in 2023. We compared the local DRL with the published literature. The methodology applied consisted of using data recorded in the files of patients who had undergone scintigraphy exams in our nuclear medicine department during the period 2021 – 2023. Typical LDRLs values, based on the median of the distribution of administered activity( MBq) for exams like bone( HMDP- 99m Tc), thyroid( 99m Tc), parathyroid( Sestamibi- 99m Tc / 99m Tc), renal( DMSA- 99m Tc), octreoscan( Tectrotyd- 99m Tc), pulmonary( Pulmocis- 99m Tc), cardiac( Sestamibi- 99m Tc)( stress / rest), and cerebral( HMPAO- 99m Tc) were 666 MBq, 144 MBq, 86 MBq / 666 MBq, 136 MBq, 555 MBq, 144 MBq, 333 MBq / 1073 MBq, and 703 MBq, respectively. In general, the results showed that the LDRLs were higher than the national diagnostic reference levels( NDRL) observed in France in 2021 and lower than those observed in South Korea in 2019, Croatia in 2020, and Switzerland in 2023.
Keywords: DRL / nuclear medicine / injected activities / radiation protection
1 Introduction
Nuclear medicine( NM) is one of the medical specialties that involve exposure to ionizing radiation, as stated by the United Nations Scientific Committee on the Effects of Atomic Radiation( UNSCEAR, 2017). Nuclear medicine has evolved significantly due to the growing diversity of radiopharmaceuticals used in healthcare. These radioactive compounds are crucial for obtaining functional images of the body, enabling early disease detection and accurate treatment assessment. However, its contribution to the radiation exposure of patients varies between countries, ranging from 0.4 % to 14.5 % of the total medical exposure( European Commission, 2014).
Given the growing importance of NM in the diagnosis and treatment of various pathologies, it is becoming crucial to optimize the activities administered to patients during scintigraphy examinations( SE). The optimization is achieved
* e-mail: khajmi. hassan @ gmail. com considering the balance between the patient’ s irradiation and the image quality, ensuring the lowest amount required for diagnostic purposes. This is resumed by the ALARA principle( ICRP, 2007): « Optimizing radiation protection involves keeping doses as low as reasonably achievable, taking into account economic and social factors, and is best described as managing the radiation dose to the patient in a manner that is consistent with the medical goal ». Indeed, a study carried out in 2012( Roch and Aubert, 2012) showed significant variations in the activities delivered due to factors such as age, weight, and sex. In order to overcome these heterogeneities, DRLs are a type of reference for injected activities in nuclear medicine that were first introduced by the International Commission on Radiological Protection( ICRP) in 1996( ICRP, 1996).
In 2022, research conducted in a university hospital in France showed that the application of an activity optimization system based on national DRLs decreased the average radiation exposure of patients by 15 % on average( Aubert et al., 2022). National DRLs must be updated regularly due to modifications in medical practice, the introduction of new
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