Radiation exposure of hemophiliacs after radiosynoviorthesis with 186Re colloid.
Very limited data are available in the literature on the doses of unwanted radiation that patients receive following treatment with radiosynoviorthesis (RSO).


OBJECTIVE
The aim of this study was to assess the radiation exposure after RSO with (186)Re colloid in hemophiliacs.


METHODS
This study involved 12 hemophiliacs who were treated for hemophilic joint disease with 14 RSOs by using (186)Re colloid. Whole-body scintigrams were performed 1, 6, and 24 hours and 3 and 7 days after RSO. Measurements, using a whole-body counter, were done immediately after scintigraphy, with the treated joint protected with a lead shield. The cumulative activity of (186)Re in the body and in the lymph nodes was calculated. The distribution of (186)Re in the body was determined by using the values for small colloids as proposed by the International Commission on Radiological Protection (ICRP) Publication 53. The computer code, OLINDA/EXM (Vanderbilt University, Nashville, TN), was used for the calculation of the internal dose. A constant distance of 1 m between the ankle joint and body organs, and of 0.33 m between the elbow or shoulder joint and body organs, was used to calculate the contribution of gamma radiation to the effective radiation dose.


RESULTS
The mean effective dose received by hemophiliacs after RSO with (186)Re colloid was 28 +/- 9 microSv/MBq of the activity injected into the joint. The patients received 0.8-3.7 mSv (1.9 +/- 0.8 mSv) owing to the leakage of (186)Re from the treated joint and its retention in the body. The highest doses were established in the spleen (26.0 +/- 10.7 mGy), the liver (17.6 +/- 7.2 mGy), and red marrow (3.0 +/- 0.8 mGy). The contribution of gamma radiation to the effective dose was less than 0.1 mSv in RSO of the ankle, 0.4 mSv in the elbow, and 0.6 mSv in the shoulder-joint treatment. The activity of (186)Re in the regional lymph nodes was noted in 4 of the 14 treatments. In these cases, the estimated average dose received by individual lymph nodes was 14.7 +/- 1.9 Gy.


CONCLUSIONS
RSO with (186)Re colloid is a safe treatment method. The effective dose received by patients after RSO by using (186)Re colloid is low, as are the radiation doses to the most exposed organs. If (186)Re is retained in the regional lymph nodes, the lymph node radiation dose would be high.
Grmek
Marko
M
Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia. marko.grmek@guest.arnes.si
Milcinski
Metka
M
Fettich
Jurij
J
Brecelj
Janez
J
D003102:Colloids; D006467:Hemophilia A / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D007592:Joint Diseases / Q000532:radiotherapy*; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D008297:Male; D011859:Radiography; D011868:Radioisotopes / Q000627:therapeutic use*; D019275:Radiopharmaceuticals / Q000009:adverse effects / Q000627:therapeutic use; D011878:Radiotherapy / Q000379:methods; D012211:Rhenium / Q000627:therapeutic use*; D000074402:Synovectomy; D013583:Synovial Membrane / Q000528:radiation effects; D013585:Synovitis / Q000209:etiology / Q000532:radiotherapy*
D003102:Colloids; D011868:Radioisotopes; D019275:Radiopharmaceuticals; D012211:Rhenium