title: Radiation exposure to surgical staff during hyperthermic isolated limb perfusion with 99m Technetium labeled red blood cells.
abstract: OBJECTIVE
  Hyperthermic isolated limb perfusion (HILP) is an effective method in the treatment of recurrent melanomas and soft tissue sarcomas. To avoid systemic toxicity, leakage from the limb perfusate into the systemic circulation is real-time monitored by administration of a radioactive agent to the limb circuit. This has made HILP safe for the patient. However, the radiation exposure to the surgical staff has never been measured and could be a limiting factor for the use of HILP. The purpose of the present study was to measure and evaluate the radiation exposure to the surgical staff performing HILP with (99m)Technetium labeled red blood cells.
  
  
  METHODS
  Thirteen patients had HILP performed in 11 lower limbs and two upper limbs at our inpatient clinic between October 2006 and February 2007. The surgeon and nurse had thermoluminescence dosimetry (TLD) chips attached to the finger pulp and to the ring area of the left fourth finger, as well as an electronic dosimeter attached to the anterior lining of the trousers. The anesthesiologist and perfusion technologist also carried electronic dosimeters.
  
  
  RESULTS
  The surgeon had the highest radioactive exposure with an average dose per procedure to the finger pulp of 16.2 microSv, to the ring area of 8.5 microSv, and to the abdominal wall of 4.2 +/- 0.6 microSv.
  
  
  CONCLUSIONS
  HILP with (99m)technetium-labeled red blood cells does not constitute a safety risk to the operating team with respect to radioactive exposure. Routine dose monitoring of the staff or special precautions for fertile women are not necessary.
authors.affiliation: Department of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital, Rigshospitalet, Denmark. ulriksk@mfi.ku.dk
authors.forename: Ulrik Sloth
authors.initials: US
authors.lastname: Kristoffersen
authors.forename: Kristina
authors.initials: K
authors.lastname: Straalman
authors.forename: Grethe
authors.initials: G
authors.lastname: Schmidt
authors.forename: Helle
authors.initials: H
authors.lastname: Klyver
authors.forename: Jann
authors.initials: J
authors.lastname: Mortensen
authors.forename: Peter Andreas
authors.initials: PA
authors.lastname: Andersen
authors.forename: Annette Hougaard
authors.initials: AH
authors.lastname: Chakera
authors.forename: Andreas
authors.initials: A
authors.lastname: Kjaer
mesh_terms: D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D004912:Erythrocytes / Q000378:metabolism*; D005260:Female; D006282:Health Personnel; D006801:Humans; D009369:Neoplasms / Q000628:therapy*; D016273:Occupational Exposure; D011874:Radiometry; D019275:Radiopharmaceuticals / Q000009:adverse effects*; D013667:Technetium / Q000009:adverse effects*
chemical_list: D019275:Radiopharmaceuticals; D013667:Technetium