Say the word nuclear and it conjures up mistaken ideas about radiation, an invisible, odorless and intangible force that allows doctors to non-invasively see into the body. Say the words nuclear medicine, and its powerful reality is that it is highly beneficial to life, said Jonathan M. Links, former SNM president, who has written an overview on understanding radiological and nuclear terrorism in the October issue of the Journal of Nuclear Medicine.
“When people hear the words radiation and radioactivity, they initially think negative thoughts,” said Links, professor and director of the Center for Public Health Preparedness at Johns Hopkins Bloomberg School of Public Health in Baltimore, Md. “The public’s perception of the risks of radiation is that radiation is highly risky. It’s best to get the scientific facts. In reality, radiation—a release of energy—allows doctors to effectively diagnose and treat disease,” noted Baltimore’s radiation terror expert and co-author of “Understanding Radiological and Nuclear Terrorism as Public Health Threats: Preparedness and Response Perspectives.”
The use of nuclear medicine—giving tiny amounts of radioactive materials to patients to examine molecular processes in the body to diagnose and treat a variety of diseases—continues to grow and evolve. Every major hospital in this country has a nuclear medicine department. Last year, 19.7 million nuclear medicine procedures were performed on 17.2 million women, men and children in more than 7,200 medical sites in the United States—a 15 percent increase from four years ago. Every day, about 55,000 women, men and children undergo nuclear medicine (also called molecular imaging) procedures to evaluate heart disease, detect cancer and determine response to treatment, diagnose and evaluate brain disorders and locate stress fractures.
When it comes to nuclear medicine, Links says the public should keep in mind these facts.
- Nuclear medicine/molecular imaging procedures are an invaluable way to gather medical information that would otherwise be unavailable, require surgery or necessitate more expensive diagnostic tests.
- The radiation dose to the body a patient may receive from a diagnostic nuclear medicine study is typically equal to or less than the natural “background” radiation dose a person may receive every year from rocks, soil, space (air travel), building materials and radon.
- In use for more than 60 years, nuclear medicine is an established medical specialty that is older than CT, MRI and ultrasound imaging. As nuclear medicine techniques merge with new technologies, hybrid imaging and advances in molecular biology, a new era in molecular imaging will add to the understanding of the molecular basis of disease. Molecular imaging will provide a way to integrate information about location, structure, function and biology, leading to a new package of noninvasive imaging tools that could have vast potential for improving patient care.
- Terrorists use the threat of radiation—of setting off a “dirty bomb” (radioactivity packaged with conventional explosives) or an improvised (crude) nuclear device—to create a climate of fear, says Links. From a public health perspective, this is more a psychological weapon than a physical weapon for a community. “Radiation is an especially powerful terrorism weapon because it instills considerable fear,” notes Links. To counter “the terror of terrorism,” Links suggests integrating excellent crisis communication with every disaster plan created. Public safety and health officials need to communicate with the public about what safeguards are in place to prevent terrorist actions and what plans and infrastructure are in place to rapidly respond to the public’s needs. “Terrorists succeed if we give in to the fear because that’s what they want. Their target isn’t those who may get injured or killed in an explosion—it’s all the rest of us,” said Links.
- Nuclear medicine professionals are knowledgeable about the uses and effects of radiation, and should assist with local police, fire, public safety and health departments in developing community response plans to ensure that local and federal first responders can address issues or circumstances linked to possible terrorist attacks. Links, who works with officials from the Centers for Disease Control and Prevention and the Department of Homeland Security, encourages nuclear medicine professionals to contact local authorities and become identified as subject matter experts. “All preparedness starts locally,” said Links. “Nuclear medicine professionals should actively seek out such collaboration and be part of planning and preparedness activities now,” he said.
- Given heightened concerns about terrorism, sensitive radiation detectors are used in major cities and public transportation facilities. Individuals who receive nuclear medicine procedures may trigger detector alarms and be stopped by security personnel. Common radioisotopes that are used in many nuclear medicine studies that could set off radiation monitors, each with varying half lives or decay time, include technetium-99m, fluorine-18 (FDG) and thallium-201. Most recent problems with radiation monitors have been with the use of iodine-131, which is used to treat hyperthyroidism, thyroid cancer and lymphoma.
- Your physician can help you avoid any security problems by providing a letter containing the following information: the patient’s name, name and date of the nuclear medicine procedure, the related radionuclide, its half life, the administered activity and 24-hour contact information. This letter should provide specific details about who should be contacted. Outside of normal working hours, the contact person should have access to an appropriate source of information so the information in the letter can be independently confirmed.
“Understanding Radiological and Nuclear Terrorism as Public Health Threats: Preparedness and Response Perspectives” appears in the October issue of the Journal of Nuclear Medicine, which is published by SNM, an international scientific and professional organization of more than 16,000 physician, technologist and scientist members. Other co-authors include Daniel J. Barnett and Cindy L. Parker, both Johns Hopkins Center for Public Health Preparedness; Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; David W. Blodgett, Southwest Utah Public Health Department, St. George, Utah, and Johns Hopkins Center for Public Health Preparedness, Baltimore, Md.; and Rachel K. Wierzba, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.
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