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Patient effective dose from sentinel lymph node lymphoscintigraphy in breast cancer: a study using a female humanoid phantom and thermoluminescent dosemeters

¹ Departments of Clinical Oncology and ³ Surgery, ² Nuclear Medicine Unit, Queen Mary Hospital, 102 Pokfulam Road Hong Kong

The aim of this study was to measure the dose delivered to patients undergoing sentinel lymph node lymphoscintigraphy by taking into account both the transmission scan dose using a ⁵⁷Co flood source and the ⁹⁹Tc^m internal emission dose. An adult female humanoid phantom and a set of thermoluminescent dosemeters were used in the measurements. The choice of measurement organs in the humanoid was guided by the recommendations described in the International Commission on Radiological Protection report number 60. A ⁵⁷Co flood source was used in external transmission to irradiate the humanoid at posterior, left lateral, left posterior oblique, right lateral and right posterior oblique positions. Four ⁹⁹Tc^m deposits as internal emission sources were used to simulate patient peritumoural injection. The individual effective doses for external transmission and internal emission, normalized to the cumulated activity and expressed in µSv(MBq·h)^-1 were then calculated. The effective dose for a transmission scan was on average 0.061 µSv(MBq·h)^-1 for each ⁵⁷Co flood source position and for internal emission 0.312 µSv(MBq·h)^-1 and 0.291 µSv(MBq·h)^-1 for left and right breast injection, respectively. Using these results, the effective dose from both transmission and emission sources can be calculated according to the nuclear medicine scanning protocol and surgical procedure of the individual institution. For our protocols, the patient receives a maximum effective dose of 52 µSv for the 1 day protocol (18 MBq injection) and 204 µSv for the 2 day protocol (74 MBq injection) if only the sentinel lymph node is excised. If other tissues containing radioactivity are removed, the patient effective dose will be reduced by about 50% and 6%, respectively, for the 1 day protocol and 2 day protocol. Although the doses are low compared with other radiological examinations, the results are informative for patients concerned about radiation exposure for this new imaging technique.

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