Paper
ACTIVITY THRESHOLDS FOR PATIENT INSTRUCTION AND RELEASE
FOR POSITRON EMISSION TOMOGRAPHY RADIONUCLIDES
Matthew J. Williamson* and Lawrence T. Dauer†
AbstractVThe use of unconventional or novel radionuclides for
positron emission tomography (PET) is becoming more preva-
lent in both nuclear medicine diagnosis and therapy. Many of
these radionuclides are produced in cyclotrons or are further
eluted from generators. Although half-lives from many of these
unconventional PET radionuclides are considered relatively
short (minutes to hours, but some are days) and the intent of
their use is often as a diagnostic imaging agent, patient release
criteria and patient radiation safety instruction regulatory re-
quirements are based on estimated dose to a member of the
public. This paper reviews a method referenced routinely for
patient release criteria as found in U.S. Nuclear Regulatory
Commission guidance, estimates fundamental quantities used
in the method, compares estimated quantities with the published
literature, and calculates release and patient radiation safety
instruction criteria for several novel PET radionuclides used in
nuclear medicine. It should be recognized that some quantities
of novel PET radionuclides in use today reach the threshold for
patient safety instruction using conservative model procedures
for patient release.
Health Phys. 106(3):341Y352; 2014
Key words: exposure, radiation; medical radiation; nuclear
medicine; positron emission tomography
INTRODUCTION
PATIENT RELEASE criteria after administration of radioactive
materials are based on an estimated dose to a member of
the public. The International Commission on Radiation
Protection (ICRP) recommends that the public dose limit
of 1 mSv per year should be applied to infants, children,
and casual visitors and furthers a dose constraint of 5 mSv
per episode for relatives, visitors, and caregivers (ICRP
2004). The U.S. regulation on patient release originates
*Department of Medical Physics, Memorial Sloan-Kettering Cancer
Center, New York, NY; †Department of Radiology, Memorial Sloan-
Kettering Cancer Center, New York, NY.
The authors declare no conflicts of interest.
For correspondence contact: Matthew Williamson, Department of
Medical Physics, Memorial Sloan-Kettering Cancer Center, 1275 York
Avenue, New York, NY 10021, or email at willim01@mskcc.org.
(Manuscript accepted 30 May 2013)
0017-9078/14/0
Copyright * 2014 Health Physics Society
DOI: 10.1097/HP.0b013e31829efbc4
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with the U.S. Nuclear Regulatory Commission (NRC) in
Title 10 of the Code of Federal Regulations Part 35, sec-
tion 75 (10 CFR 35.75), or similar reference in agreement
states. 10 CFR 35.75(a) authorizes a licensee to release
from its control any individual who has been administered
byproduct material if the total effective dose equivalent to
any other individual from exposure to the released indi-
vidual is not likely to exceed 5 mSv. It requires a licensee
to provide the released individual, or the individual’s parent
or guardian, with instructions, including written instruc-
tions, on actions recommended to maintain doses to other
individuals as low as reasonably achievable if the total
effective dose equivalent to any other individual is likely to
exceed 1 mSv (USNRC 2013). In the U.S., regulatory
guidance is issued to facilitate compliance with radiation
protection regulations. The current U.S. guidance docu-
ment for medical licensees is NUREG 1556 Volume 9,
Revision 2. Appendix U of this guidance document con-
tains a model procedure for release of patients adminis-
tered radioactive materials (USNRC 2007). The model for
patient release is based on an estimated dose to a member
of the public using the gamma constant of the nuclide, an
occupancy factor based on half-life, and a distance from
the patient of 1 m. This model does not account for bio-
logical distribution or removal of the pharmaceutical, self-
attenuation from the patient, or any other parameters that
might be specific to the patient or the scenario. Situational
specific information may be used to better estimate the
dose to a member of the public and is recommended as a
more accurate estimate of the potential dose to a member of
the public (Culver and Dworkin 1992; Al-Haj et al. 2007).
Zanzonico et al. (2000) provide a mechanism for specific
scenarios of public interaction with patients released from
licensee control, which is further reviewed by the NCRP
(Zanzonico et al. 2000; NCRP 2007). Licensees may offer
a mechanism of compliance with patient release and in-
struction regulations by simply committing to the model
procedures contained in the NUREG. Some suggest that
the assumptions in the regulatory guidance are antiquated
and therefore recommend an extra-conservative approach
to patient release (North et al. 2001; Parthasarathy and
341
342 Health Physics
Crawford 2002). While others recognize that the current
guidance is conservative in its assumptions (DeSantis
and Chabot 2001; Rutar et al. 2001; Siegel et al. 2007;
Willegaignon et al. 2007; Stabin et al. 2009; de Carvalho
et al. 2011), licensees often employ its fundamentals when
developing procedures for patient release. The American
Thyroid Association recommends periodic reviews of
programs and protocols regarding patient release and ra-
diation safety instruction while focusing on sound medical
practice and adherence to regulations (Sisson et al. 2011).
The use of unconventional or novel radionuclides for
positron emission tomography (PET) is becoming more
prevalent in both nuclear medicine diagnosis and therapy
(Holland et al. 2010). The basis for patient release and
radiation safety instruction is rooted in an estimated dose
to a member of the public. Assumptions in regulatory
guidance are used often to demonstrate compliance with
patient release requirements. The guidance for patient re-
lease and radiation safety instruction is reviewed and ex-
tended toward novel PET radionuclides.
Historical basis
Siegel traces the history of the 30-mCi patient release
rule to the 1950s (Siegel 2000). Recommendations from
the Atomic Energy Commission (AEC) included hospi-
talization of patients with greater than 30 mCi of any
nuclide. Siegel notes that hardened regulation was limited
to recommendations in licensing guidance and radioactive
material license conditions. A review of historical licenses
at this institution dating to 1963 confirms such license
conditions: ‘‘Patients receiving more than 30 millicuries of
unsealed gamma sources shall remain hospitalized until
the activity is less than 30 millicuries.’’
In 1970, the National Council on Radiation Protection
(NCRP) Report Number 37 recommended measures and
procedures for minimizing unnecessary irradiation with
regard for individuals caring for or associating with pa-
tients who have received therapeutic doses of radioactive
materials (or millicurie range) for diagnostic purposes. The
report states the maximum permissible dose to those not
exposed occupationally as 500 mrem per year (NCRP
1970). In order to estimate exposure for a given radionu-
clide over a period of time, eqn (1) was presented:
34:6GQ0 T ð1
ej0:693t=T Þ
DðtÞ ¼ : ð1Þ
r2
Eqn (1) employs the gamma constant (G) for a particular
radionuclide in units of R cm2 (mCi h)j1, administered
activity (Q0) in millicuries (mCi), exposure time (t) in days,
the physical half-life (T ) in days, distance (r) from the point
of interest in centimeters, and the conversion factor of
24 h dj1 multiplied by the total integration of decay (1.44).
The NCRP states, ‘‘In accordance with the degree of
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March 2014, Volume 106, Number 3
accuracy acceptable in these situations, and to facilitate
the interpolation or extrapolation of the specifications in
this report, the simplifications noted above have been de-
liberately employed’’ (NCRP 1970). It is recognized that this
model is simplistic and contains many uncertainties. For
example, NCRP Report No. 37 does not include occupancy
factors, but it does recognize that exposures may not occur
for the entire 24 h in a day. The NCRP included activity at
discharge and exposure rates at 1 m from the patient for
several radionuclides as an estimate for dose to a member
of the public. It is recommended that exposure rate rather
than activity be used as the mechanism for estimating dose
to the public. This report was progressive as compared to
previous recommendations on patient release, which were
limited to an estimated residual amount of radioactivity in
the patient regardless of the nuclide.
The NRC published for comment the rulemaking for
patient release in the Federal Register in 1985 (USNRC
1985). Patient release was proposed initially as only an ex-
posure rate criterion of 6 mR hj1 at 1 m from a patient
administered a radiopharmaceutical or permanent implant,
as discovered in an earlier notice of proposed rulemaking
issued by the NRC and the Federal Register notice. Using
eqn (1) Ethe gamma constant in NCRP 37, time to infinity,
and solving for D(t)^, the estimated dose at 1 m from a patient
is 1.67 R. The NRC further assumed an occupancy factor
of 8 h dj1 or one-third. Multiplying 1.67 R by one-third
yields an estimated exposure of 0.556 R, which is greater
than 0.5 R. It is probable that the exposure rate release limit
ultimately expressed in the final rule was reduced to 5 mR hj1
at 1 m from the patient due to its resultant estimated ex-
posure of 0.464 mR (i.e., G 0.5R), using the same meth-
odology found in NCRP 37. When the final rule was
published in the Federal Register, the 30 mCi residual ac-
tivity limit was incorporated based on current licensing
practice and the recommendations of the NCRP. However,
using the NCRP 37 guidance, 30 mCi of 131I estimates an
exposure of 0.612 R, in excess of 0.5 R. NCRP 37
suggested a residual activity for 131I of 8 mCi, resulting in
an exposure of 0.5 R for an occupancy factor of 1. An
occupancy factor of one-third increases the residual activity
remaining in the patient to 24 mCi, less than the 30 mCi
proposed by the NRC.
The NRC codified release of patients administered
radiopharmaceuticals in 10 CFR 35.75 with the release
limits of 5 mR hj1 at 1 m from the patient or when the
activity remaining in the patient is less than 30 mCi, re-
gardless of the administered radionuclide in 1987 (USNRC
1987) and was echoed in the patient release recommen-
dations of NRC Regulatory Guide (Reg. Guide) 10.8 Re-
vision 2 (USNRC 1987; Siegel 2000). Although the NCRP
provided recommendations for patient release related to
various radionuclides in their report issued in 1970, the
 Activity thresholds and PET c M. J. WILLIAMSON
NRC continued with a single activity threshold regardless
of the radionuclide.
Carol Marcus initiated a change in thinking while
petitioning the NRC regarding the member-of-the-public
dose limit (1 mSv) offered in the revised 10 CFR 20 and its
application to the release of patients, ultimately leading to
the idea of a dose limit for patient release rather than the
activity and dose rate limit (USNRC 1990). In 1997, the
NRC changed the patient release rule (USNRC 1997a) and
issued NUREG 1492 (USNRC 1997b) and Reg. Guide 8.39
(USNRC 1997c), offering mechanisms to comply with the
dose-based release criterion of 5 mSv to a member of the
public. An additional dose-based criterion of 1 mSv was
provided as a threshold for providing patients with radiation
safety instruction.
Eqns (2) and (3) (from NUREG 1492 and Reg Guide
8.39) are used to estimate a dose to infinity based on the
gamma constant (G) and administered activity (Q0). These
equations contain slight modifications from the equation in
NCRP Report No. 37. Eqn (2) is used for radionuclides
with a physical half-life greater than 1 d and assumes an
occupancy factor of 0.25. Eqn (3) is used for radionuclides
with a physical half-life greater than 1 d and assumes an
occupancy factor of 1:
34:6GQ0 T p ð0:25Þ
DðVÞ ¼ ð2Þ
ð100 cmÞ2
34:6GQ0 T p
DðVÞ ¼ : ð3Þ
ð100 cmÞ2
NUREG 1492 and Reg. Guide 8.39 used eqns (2) and (3)
for radionuclides encountered routinely in nuclear medi-
cine procedures to develop activity and dose rate release
criteria (5 mSv) and thresholds for patient radiation safety
instruction (1 mSv). These are guidance for the licensee in
determining (1) when the licensee may authorize the re-
lease of a patient who has been administered radiophar-
maceutical or permanent implants containing radioactive
material and (2) when instructions to the patient are re-
quired by 10 CFR 35.75(b).
Eqns (2) and (3) may be rewritten, solving for activity
(Q0) and where D(V) is set to equal the dose-based
thresholds of 10 CFR 35.75, for radiation safety instruc-
tion to a patient or patient release; i.e., 1 mSv and 5 mSv, as
demonstrated in eqn (4), respectively. Occupancy is rep-
resented by T and is based on the half-life. Occupancy (T )
is either 1 or 0.25, as noted in eqns (2) and (3):
ð1 mSv or 5 mSvÞð100 cmÞ2
Q0 ¼ : ð4Þ
34:6GT p ðT Þ
International recommendations on patient release stem
from the International Atomic Energy Agency (IAEA)
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AND L. T. DAUER 343
and the ICRP. Other organizations are progressive in
their recommendations. The European Atomic Energy
Community (EURATOM) is an international organiza-
tion under the European Commission that offers publica-
tions and standards on radiation protection. The European
Commission published a set of radiation safety standards in
1996 to include public dose limits. They specifically ex-
cluded individuals knowingly and willingly helping in the
support and comfort of patients undergoing medical diag-
nosis or treatment from the 1 mSv public annual dose limit
(EUR 1996). The European Commission document per-
mits exceeding the 1 mSv public limit for 1 y, provided the
average effective dose over five consecutive years does not
exceed 1 mSv yj1.
The European Commission later published radiation
protection guidance following 131I therapy. The recom-
mendations mimic those published prior for members of
the public and continue to exclude persons knowingly and
willingly caring for patients undergoing medical diagnosis
or treatment from the public dose limit (EUR 1998). They
refer to this population as family and close friends. It is
recommended that persons not caring for the patient be
considered third persons (members of the public), and a
0.3 mSv upper dose limit is recommended. The 1 mSv
limit is interpreted as a cumulative limit, and it is sug-
gested that the third person may encounter other manmade
exposures during the year. This European Commission
document also presents dose constraints for members of
the public for different age groups. For the developing
fetus and all children, a dose constraint of 1 mSv is pre-
sented. The dose constraint for adults up to about 60-y old
is 3 mSv. For those over 60-y old, the dose constraint is
15 mSv (EUR 1997).
IAEA Safety Report Series, Report No. 40, Applying
Radiation Safety Standards in Nuclear Medicine, is in line
with the European Commission public limits; i.e., a public
dose limit of 1 mSv yj1 (IAEA 2005). Report No. 40 also
permits public exposures above the limit; up to 5 mSv yj1
for special circumstances provided the average dose over
five consecutive years does not exceed 1 mSv yj1. This
report does not address caregivers and family members.
IAEA Report No. 63, Release of Patients after Radionuclide
Therapy, restates the public dose limits and permission to
exceed the limits and the average not to exceed 1 mSv over
5 y, but it does not address specifically the 5 mSv maximum
for the year (IAEA 2009). The report also states that there
are no comforter and carer dose limits. The IAEA offers
dose constraints for the comforter and carer population
adjusted for age; 1 mSv per episode for pregnant women
and children up to 10-y-old, 3 mSv per episode for children
older than10 y to adults up to 60 y, and 15 mSv for adults
older than 60 y. Report No. 63 also presents the dose con-
straint of 0.3 mSv per episode to third parties.
344 Health Physics
METHODS
In 2005, NRC guidance for medical licensees and
patient release was consolidated into NUREG 1556 Vol. 9,
revised in 2008. For this study, prior to calculating release
criteria and thresholds for radiation safety instruction for
novel PET radionuclides, the method offered in NUREG
1556 Vol. 9 Rev. 2 Appendix U was verified. The methods
include: the estimation of the linear energy absorption
coefficient in air (men); the comparison of published men
data with estimated data; the estimation of exposure rate
constants (previously referred to as gamma constant) based
on men, radionuclide decay schemes, and additional as-
sumptions; the comparison of these exposure rate constants
with published literature; and the calculation of release
criteria and thresholds for radiation safety instruction for
novel PET radionuclides.
The radionuclides presented in Appendix U were in-
troduced in NCRP Report No. 37 and further evaluated in
NUREG 1492. When not referenced from other sources,
exposure rate constants listed in NUREG 1492 were derived
empirically based on the photon energy, the photon abun-
dance, and the linear energy absorption coefficient in air
(men) for the energy of interest (USNRC 1997b). Many re-
sources derive and list exposure rate constants, and they
vary. In the interest of this model verification, the method
presented in current regulatory guidance and basis docu-
ments was used to determine the exposure rate constant.
The men data from NUREG 1492 were estimated from
the Radiological Health Handbook (USDHEW 1970) as
referenced in NUREG 1492, which is based on data compiled
in the Engineering Compendium on Radiation Shielding
(Jaeger 1968). The men is frequently tabulated with large
intervals between energies. These large gaps in the tabulated
data, combined with a non-linear function with variation in
slope, can lead to differences in reported exposure rate
constants. In order to better interpret the function, the men
graph was scanned from the Radiological Health Handbook
(RHH) (USDHEW 1970) into a portable document format
(PDF) and printed on a 3 feet X 4 feet sheet of paper. The
generated men are compared with available data.
NUREG 1492 presented several radionuclides, their
photon energies, and energy abundances used in calcu-
lating the exposure rate constant. This work recalculates
the exposure rate constants in NUREG 1497 using the de-
rived men and the photon energy and abundances given in the
NUREG. A VLOOKUP formula was used in Microsoft\
Excel 2007 to facilitate the correlation of photon energy
and linear energy absorption coefficients in air. It is noted
that NUREG 1492 used a photon energy threshold of
11.3 keV as employed in NCRP Report No. 41. The basis
for the 11.3 keV photon energy threshold is referenced
as private communication (NCRP 1974).
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The exposure rate constants were recalculated again
for the radionuclides in NUREG 1492, using the photon
energy and abundance from ICRP 107 decay tables (ICRP
2009) that used the derived men. As in NUREG 1492,
photons with energies less than 11.3 keV were not included
in the exposure rate calculation.
Smith and Stabin recently published exposure rate
constants, as this current work was in progress (Smith and
Stabin 2012). They tabulate exposure rate constants for
over 1,000 radionuclides based on ICRP 107 decay schemes.
A photon energy threshold of 15 keV and an abundance
threshold of 0.0001 were used in their calculation of the
exposure rate constant. Using the Smith and Stabin energy
and abundance threshold values, exposure rate constants
were estimated in this work for the radionuclides in NUREG
1492 based on the derived men in air and ICRP 107 decay
tables. The calculated exposure rate constants are compared
in NUREG 1492, NUREG 1556 Vol. 9 Rev. 2, and Smith
and Stabin (2012).
Exposure rate constants are calculated for a listing of
novel radionuclides presented by Holland et al. (2010)
using ICRP 107 decay schemes, the derived men, and en-
ergy and abundance thresholds of 15 keV and 0.0001,
respectively. These are compared to the exposure rate
constants presented by Smith and Stabin (2012). The es-
timated novel radionuclide exposure rate constants from
this work, the half-lives listed in ICRP 107, and the oc-
cupancy factor based on the half-life were used to estimate
patient release criteria and patient radiation safety in-
struction thresholds using eqn (4), the ultimate result of
this work.
RESULTS
Table 1 presents the men in air based on a direct visual
interpretation of the log-log graph of men found on page
135 of the Radiological Health Handbook (USDHEW
1970), converted to PDF and plotted on 3 feet X 4 feet
paper. The error reported for these data is the reading error.
The reading error is estimated as plus or minus half the
lowest division on that section of the graph (Bakke 2009).
Results are reported to the first figure in the error. Fig. 1
was generated using Microsoft Excel (Microsoft\ Office
Excel\ 2007) and the data from Table 1.
Table 2 compares the estimated men in air from Table 1
to published values (ICRU 1970; Shleien et al. 1998; NBS
Handbook 1964). The ratio of the estimated men in air from
Table 1 to the published work is offered. Data columns are
labeled, and the column labels are used to describe the ratio
of this work against the published values.
Fig. 2 shows the exposure rate constants for the nine
radionuclides that were presented with decay schemes and
linear energy-absorption coefficients in NUREG 1492.
 Activity thresholds and PET c M. J. WILLIAMSON AND L. T. DAUER 345

Table 1. Derived men in air from 3 feet x 4 feet copy of page 135 of the Radiological Health Handbook (1970)

MeV men (mj1) Error (mj1) MeV men (mj1) Error (mj1) MeV men (mj1) Error (mj1) MeV men (mj1) Error (mj1)
0.01 0.58 T 0.01 0.066 0.00360 T 0.00005 0.36 0.00380 T 0.00005 0.79 0.00370 T 0.00005
0.011 0.43 T 0.01 0.068 0.00350 T 0.00005 0.37 0.00380 T 0.00005 0.8 0.00370 T 0.00005
0.012 0.330 T 0.005 0.07 0.00345 T 0.00005 0.38 0.00385 T 0.00005 0.81 0.00370 T 0.00005
0.013 0.260 T 0.005 0.072 0.00340 T 0.00005 0.39 0.00385 T 0.00005 0.82 0.00370 T 0.00005
0.014 0.200 T 0.005 0.074 0.00330 T 0.00005 0.4 0.00390 T 0.00005 0.83 0.00365 T 0.00005
0.015 0.160 T 0.005 0.076 0.00325 T 0.00005 0.41 0.00390 T 0.00005 0.84 0.00365 T 0.00005
0.016 0.130 T 0.005 0.078 0.00325 T 0.00005 0.42 0.00390 T 0.00005 0.85 0.00365 T 0.00005
0.017 0.110 T 0.005 0.08 0.00320 T 0.00005 0.43 0.00390 T 0.00005 0.86 0.00365 T 0.00005
0.018 0.090 T 0.001 0.082 0.00315 T 0.00005 0.44 0.00390 T 0.00005 0.87 0.00365 T 0.00005
0.019 0.076 T 0.001 0.084 0.00315 T 0.00005 0.45 0.00390 T 0.00005 0.88 0.00365 T 0.00005
0.02 0.062 T 0.001 0.086 0.00310 T 0.00005 0.46 0.00390 T 0.00005 0.89 0.00365 T 0.00005
0.021 0.058 T 0.001 0.088 0.00305 T 0.00005 0.47 0.00390 T 0.00005 0.9 0.00365 T 0.00005
0.022 0.048 T 0.001 0.09 0.00305 T 0.00005 0.48 0.00390 T 0.00005 0.91 0.00365 T 0.00005
0.023 0.041 T 0.001 0.092 0.00305 T 0.00005 0.49 0.00390 T 0.00005 0.92 0.00365 T 0.00005
0.024 0.0390 T 0.0005 0.094 0.00305 T 0.00005 0.5 0.00390 T 0.00005 0.93 0.00365 T 0.00005
0.025 0.0330 T 0.0005 0.096 0.00305 T 0.00005 0.51 0.00390 T 0.00005 0.94 0.00365 T 0.00005
0.026 0.0300 T 0.0005 0.098 0.00300 T 0.00005 0.52 0.00390 T 0.00005 0.95 0.00365 T 0.00005
0.027 0.0270 T 0.0005 0.1 0.00300 T 0.00005 0.53 0.00390 T 0.00005 0.96 0.00365 T 0.00005
0.028 0.0240 T 0.0005 0.11 0.00305 T 0.00005 0.54 0.00390 T 0.00005 0.97 0.00365 T 0.00005
0.029 0.0215 T 0.0005 0.12 0.00310 T 0.00005 0.55 0.00390 T 0.00005 0.98 0.00360 T 0.00005
0.03 0.0195 T 0.0005 0.13 0.00315 T 0.00005 0.56 0.00390 T 0.00005 0.99 0.00360 T 0.00005
0.031 0.0170 T 0.0005 0.14 0.00320 T 0.00005 0.57 0.00390 T 0.00005 1 0.00355 T 0.00005
0.032 0.0155 T 0.0005 0.15 0.00325 T 0.00005 0.58 0.00390 T 0.00005 1.1 0.00350 T 0.00005
0.033 0.0145 T 0.0005 0.16 0.00330 T 0.00005 0.59 0.00390 T 0.00005 1.2 0.00345 T 0.00005
0.034 0.0135 T 0.0005 0.17 0.00335 T 0.00005 0.6 0.00385 T 0.00005 1.25 0.00345 T 0.00005
0.035 0.0125 T 0.0005 0.18 0.00340 T 0.00005 0.61 0.00380 T 0.00005 1.3 0.00340 T 0.00005
0.036 0.0115 T 0.0005 0.19 0.00345 T 0.00005 0.62 0.00380 T 0.00005 1.4 0.00330 T 0.00005
0.037 0.0105 T 0.0005 0.2 0.00350 T 0.00005 0.63 0.00380 T 0.00005 1.5 0.00325 T 0.00005
0.038 0.0098 T 0.0001 0.21 0.00350 T 0.00005 0.64 0.00380 T 0.00005 1.6 0.00320 T 0.00005
0.039 0.0092 T 0.0001 0.22 0.00350 T 0.00005 0.65 0.00380 T 0.00005 1.7 0.00315 T 0.00005
0.04 0.0086 T 0.0001 0.23 0.00360 T 0.00005 0.66 0.00375 T 0.00005 1.8 0.00315 T 0.00005
0.042 0.0078 T 0.0001 0.24 0.00360 T 0.00005 0.67 0.00375 T 0.00005 1.9 0.00310 T 0.00005
0.044 0.0070 T 0.0001 0.25 0.00360 T 0.00005 0.68 0.00375 T 0.00005 2 0.00305 T 0.00005
0.046 0.0062 T 0.0001 0.26 0.00365 T 0.00005 0.69 0.00375 T 0.00005 2.1 0.00300 T 0.00005
0.048 0.0056 T 0.0001 0.27 0.00365 T 0.00005 0.7 0.00375 T 0.00005 2.2 0.00295 T 0.00005
0.05 0.0051 T 0.0001 0.28 0.00370 T 0.00005 0.71 0.00375 T 0.00005 2.3 0.00290 T 0.00005
0.052 0.0049 T 0.0001 0.29 0.00370 T 0.00005 0.72 0.00370 T 0.00005 2.4 0.00285 T 0.00005
0.054 0.0046 T 0.0001 0.3 0.00370 T 0.00005 0.73 0.00370 T 0.00005 2.5 0.00280 T 0.00005
0.056 0.0043 T 0.0001 0.31 0.00370 T 0.00005 0.74 0.00370 T 0.00005 2.6 0.00275 T 0.00005
0.058 0.0042 T 0.0001 0.32 0.00370 T 0.00005 0.75 0.00370 T 0.00005 2.7 0.00275 T 0.00005
0.06 0.0040 T 0.0001 0.33 0.00375 T 0.00005 0.76 0.00370 T 0.00005 2.8 0.00270 T 0.00005
0.062 0.00385 T 0.00005 0.34 0.00375 T 0.00005 0.77 0.00370 T 0.00005 2.9 0.00270 T 0.00005
0.064 0.00370 T 0.00005 0.35 0.00380 T 0.00005 0.78 0.00370 T 0.00005 3 0.00265 T 0.00005

The figure compares the various exposure rate constants:

(1) NUREG 1492; (2) NUREG 1492, men from Table 1, and
the 11.3 keV photon threshold; (3) ICRP 107 decay schemes,
men from Table 1, and the 11.3 keV photon threshold; (4)
Smith and Stabin exposure rate constants; and (5) ICRP 107
decay schemes, men from Table 1, and energy and abundance
thresholds of 15 keV and 0.0001, respectively.
Table 3 presents published exposure rate constants
from NUREG 1492, NUREG 1556 Vol. 9 Rev. 2., Smith
and Stabin (2012), and this work using the ICRP 107
decay schemes; men from Table 1; and energy and abun-
dance thresholds of 15 keV and 0.0001, respectively. The
calculated exposure rate constants are compared to the
NUREG 1492, NUREG 1556 Vol. 9 Rev. 2, and Smith
and Stabin (2012) values as ratios. Exposure rate constants
are maintained in the units (i.e., R mCi hj1 at 1 cm), since Fig. 1. Linear energy absorption (men) coefficients in air derived
they were initially presented in that format. from Table 1.
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346 Health Physics March 2014, Volume 106, Number 3

Table 2. Comparison of men values from ICRU Report 17 (1970) [A], Shleien et al. (1998 [B]), NBS Handbook No. 85
(1964 [C]), and Table 1 (this work) [D].
ICRU Report Shleien et al. NBS Handbook
17 (1970) (1998) No. 85 (1964) Table 1 (this work)
mj1 Ratio mj1 Ratio mj1 Ratio mj1
MeV [A] [D]:[A] [B] [D]:[B] [C] [D]:[C] [D]
0.01 0.5934 0.98 0.6131 0.95 0.6025 0.96 0.58
0.015 0.1642 0.97 0.1725 0.93 0.1668 0.96 0.160
0.02 0.0652 0.95 0.0697 0.89 0.0667 0.93 0.062
0.03 0.0181 1.08 0.0199 0.98 0.0190 1.03 0.0195
0.04 0.0080 1.07 0.0088 0.97 0.0083 1.04 0.0086
0.05 0.0049 1.04 0.0053 0.96 0.0050 1.03 0.0051
0.06 0.0037 1.08 0.0039 1.02 0.0038 1.06 0.0040
0.08 0.0030 1.07 0.0031 1.03 0.0031 1.05 0.00320
0.1 0.0030 1.01 0.0030 1.00 0.0030 1.00 0.00300
0.15 0.0032 1.02 0.0032 1.01 0.0032 1.00 0.00325
0.2 not listed not listed 0.0035 1.01 0.0035 1.01 0.00350
0.3 not listed not listed 0.0037 1.00 0.0037 0.99 0.00370
0.4 not listed not listed 0.0038 1.02 0.0038 1.02 0.00390
0.5 not listed not listed 0.0038 1.02 0.0038 1.02 0.00390
0.6 not listed not listed 0.0038 1.01 0.0038 1.01 0.00385
0.8 not listed not listed 0.0037 0.99 0.0037 0.98 0.00370
1 not listed not listed 0.0036 0.98 0.0036 0.98 0.00355
1.25 not listed not listed 0.0034 1.00 not listed not listed 0.00345
1.5 not listed not listed 0.0033 0.99 0.0033 0.99 0.00325
2 not listed not listed 0.0030 1.01 0.0030 1.01 0.00305
3 not listed not listed 0.0027 1.00 0.0027 1.00 0.00265

Exposure rate constants are calculated for a listing of
novel radionuclides presented by Holland et al. (2010)
using ICRP 107 decay schemes, the derived men, and en-
ergy and abundance thresholds of 15 keV and 0.0001,
respectively. These data are presented in Table 4. They are
compared to the exposure rate constants by Smith and
Stabin (2012). Data are maintained in U.S. units (R mCi hj1
at 1 cm) as presented by Smith and Stabin and previous
regulatory guidance documents.
The estimated novel radionuclide exposure rate con-
stants from this work, the half-lives listed in ICRP 107,
and the occupancy factor based on the halfYlives were used

Fig. 2. Exposure rate comparison using men interpolation: (1) NUREG 1492; (2) NUREG 1492 assumptions and men (Table 1); (3) ICRP 107
decay schemes, men (Table 1), and 11.3 keV threshold; (4) Smith and Stabin; (5) ICRP 107 decay schemes, men (Table 1), and 15 keV and 0.0001
abundance thresholds.
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 Activity thresholds and PET c M. J. WILLIAMSON AND L. T. DAUER 347

Table 3. Exposure rate constant comparison among NUREG 1492 (1997c)[A], NUREG 1556 Vol 9. Rev. 2 Appendix U
Table U.5 (2007) [B], Smith and Stabin (2012) [C], and this work [D].a
Exposure Rate Constant (R/mCi-h at 1 cm)
NUREG 1492 NUREG 1556
(1997c) Ratio Vol 9 Rev. 2 (2007) Ratio Smith and Stabin (2012) Ratio This work
Radionuclide [A] [D]:[A] [B] [D]:[B] [C] [D]:[C] [D]
Ag-111 0.15 1.00 0.15 1.00 0.15 1.00 0.15
Au-198 2.3 1.00 2.3 1.00 2.3 1.00 2.3
Cr-51 0.16 1.10 0.16 1.10 0.178 0.99 0.176
Cu-64 1.2 0.89 1.2 0.89 1.05 1.02 1.07
Cu-67 0.58 0.99 0.58 0.99 0.574 1.00 0.575
Ga-67 0.753 1.07 0.753 1.07 0.803 1.00 0.803
I-123 1.61 1.03 1.61 1.03 1.78 0.93 1.66
I-125 1.42 1.09 1.42 1.09 1.75 0.89 1.55
I-125 implant 1.11 1.40 1.11 1.40 1.75 0.89 1.55
I-131 2.2 1.00 2.2 1.00 2.2 1.00 2.2
In-111 3.21 1.00 3.21 1.00 3.46 0.93 3.22
Ir-192 implant 4.59 1.01 4.59 1.01 4.60 1.00 4.62
P-32 N/A N/A N/A N/A N/A N/A N/A
Pd-103 implant 1.48 0.95 0.86 1.63 1.41 0.99 1.40
Re-186 0.2 0.52 0.2 0.52 0.103 1.00 0.103
Re-188 0.26 1.22 0.26 1.22 0.316 1.00 0.316
Sc-47 0.56 0.95 0.56 0.95 0.534 0.99 0.530
Se-75 2.6 0.78 2 1.02 2.03 1.00 2.03
Sm-153 0.425 1.15 0.425 1.15 0.481 1.01 0.488
Sn-117m 1.48 1.01 1.48 1.01 1.69 0.88 1.49
Sr-89 N/A N/A N/A N/A N/A N/A N/A
Tc-99m 0.756 1.03 0.756 1.03 0.795 0.97 0.775
Tl-201 0.447 1.01 0.447 1.01 0.450 1.00 0.450
Y-90 N/A N/A N/A N/A N/A N/A N/A
Yb-169 1.83 1.06 1.83 1.06 1.94 1.00 1.94
a
Data are presented in [R/mCi-h at 1 cm] consistent with NUREG 1492 (1997c), NUREG 1556 Vol 9. Rev. 2 (2007), and Smith and
Stabin (2012).

to estimate patient release criteria and patient radiation
safety instruction thresholds using eqn (4). Results are
contained in Tables 5 and 6. Data are offered in both U.S.
and system international (SI) units to maintain consistency
with Tables U.1 and U.2 of Appendix U of NUREG 1556
Vol. 9 Rev 2.
DISCUSSION
Exposure rate constants are available from a variety
of sources and may differ substantially, as presented in
Fig. 2. Use of exposure rate constants in estimating radi-
ation dose to members of the public for patient release
requires a consistent methodology. Derivation of the ex-
posure rate constant is based on the men in air for the en-
ergy of interest, the abundance of that energy, and the
density of air. This work reviews the basis for calculat-
ing these exposure rate constants similar to the method-
ology offered in U.S. regulatory guidance.
Table 1 presents the men in air based on a direct visual
interpretation of the log log graph of men found on page 135
of the Radiological Health Handbook (USDHEW 1970).
Often, the men in air is listed with generous increments in
energy. The plotted curve indicates a substantial slope for
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lower energy interactions that could lead to variations when
calculating exposure rate constants. The absorption curve
was re-created in Microsoft\ Office Excel\ 2007 and is
presented in Fig. 1.
Table 2 compares this estimated men in air to the
ICRU (1970), the RHH (1998), and NBS Handbook
(1964) and provides a ratio as a matter of comparison.
These current estimated data agree within the largest
deviation of 0.89 or a difference of approximately 11%
when compared to published resources. In addition, this
study offers a tabulated interpretation of men in incre-
ments of 1 keV from 10 keV-40 keV, 2 keV increments
from 40 keV-100 keV, 10 keV increments from 100 keV-1
MeV, and 0.1 MeV increments from 1 MeV-3 MeV.
This study reviews the nine radionuclides listed in
NUREG 1492 and presents two exposure rate constants
from different sources of data (NUREG 1492 and Smith
and Stabin). Exposure rate constants were calculated using
three methods: 1) using the decay schemes from NUREG
1492, men from Table 1, and the 11.3 keV photon thresh-
old; 2) using the decay schemes in ICRP 107, men from
Table 1, and the 11.3 keV photon threshold; and 3) using
the decay schemes in ICRP 107, men from Table 1, and
energy and abundance thresholds of 15 keV and 0.0001,

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348 Health Physics March 2014, Volume 106, Number 3

Table 4. Exposure rate constant comparison for novel PET 89 photons are listed in ICRP 107 (including decay of
radionuclides from Smith and Stabin (2012) and this work.a the progeny nuclide, Rhenium-103m), 29 are used to
Exposure rate constant calculate the gamma constant with the 11.3 keV threshold,
(R/mCi-h at 1 cm) and only 16 are used after the energy threshold is raised to
Smith and Stabin This Ratio 15 keV and photons with an abundance less than 0.0001
Radionuclide (2012) [A] work [B] [B]:[A] are omitted. Although the number of photons using ICRP
Generator Mn-52m 12.8 12.8 1.00 107 data is greater than those in NUREG 1492, the
produced Cu-62 5.78 5.9 1.02 abundance of some photons presented in NUREG 1492 is
Ga-68 5.43 5.5 1.02
Rb-82 6.33 6.4 1.01 greater than those contained in ICRP 107 and therefore
In-110m 9.08 9.1 1.00 lead to the higher estimated exposure rate constant. The
Sb-118 4.85 4.9 1.00 103
I-122 5.65 5.7 1.01
Pd exposure rate constant presented in NUREG 1492
Cyclotron C-11 5.86 6 1.02 takes into account the attenuation of photons within the
produced N-13 5.86 6 1.02 implant capsule; however, the exposure rate constant
O-15 5.86 6 1.02
F-18 5.68 5.8 1.02 continues to be greater than the others estimated. Based on
Cl-34m 10 10.2 1.02 estimation of the exposure rate constant using the NUREG
K-38 15.5 15.7 1.01
Ti-45 5 5.1 1.02
1492 decay energies and abundances, the current men and
Mn-51 5.73 5.8 1.02 the 11.3 keV energy threshold, this comparison confirms
Mn-52 18.4 18.2 0.99 the NUREG 1492 value to be higher than ICRP decay
Fe-52 4.12 4.2 1.01
Co-55 11 11 1.00 schemes. This method does not consider attenuation or
Cu-60 19.8 19.9 1.00 buildup in a source capsule.
Cu-61 4.68 4.7 1.01 Ytterbium-169 (169Yb) exposure rate constants from
Cu-64 1.05 1.1 1.02
Ga-66 11.6 11.8 1.02 NUREG 1492 are less than those calculated using ICRP
As-70 22.5 22.5 1.00 decay schemes. NUREG 1492 lists 15 photon energies
As-71 3.13 3.2 1.01
As-74 4.33 4.4 1.02 for 169Yb. ICRP 107 lists 126 photon energies, of which
Br-75 6.77 6.9 1.01 84 meet the photon threshold of 11.3 keV and 35 meet
Br-76 14 14.1 1.01 the 15 keV and 0.0001 abundance thresholds. The sum of
Rb-82m 16 15.9 1.00
Y-86 18.9 18.9 1.00 the contributions of the additional photons listed in ICRP
Zr-89 6.59 6.6 1.00 107 contributes to the higher exposure rate constant.
Nb-90 21.9 22 1.01
Tc-94m 11.1 11.1 1.00
Tellurium-201 (201Tl) exposure rate constant com-
I-120 13.7 13.8 1.01 parisons are similar, except when the exposure rate con-
I-124 6.59 6.6 1.00 stant is derived using ICRP 107 decay schemes combined
a
Data are presented in [R/mCi-h at 1 cm] consistent with NUREG 1492 with the photon energy threshold of 11.3 keV used in
(1997c), NUREG 1556 Vol 9, Rev. 2 (2007), and Smith and Stabin (2012).
NUREG 1492. NUREG 1492 lists seven photon decay
energies. The greatest contributor to energy in air is a
71 keV photon with an abundance of 0.47. ICRP 107 lists
respectively. It is noted that regulatory guidance expo- 70 photons for 201Tl, 55 of which exceed the 11.3 keV
sure rate constants for 103Pd, 125I, and 192Ir presented in threshold, and 16 photons with the 15 keV energy and
NUREG 1492 take into consideration capsule attenua- 0.0001 abundance thresholds. The 39 photons from
tion for sources used routinely in interstitial implants. 11.3Y15 keV contribute significantly to elevate the expo-
The regulatory guidance duly notes these sources as sure rate constant using ICRP 107 decay schemes. These
‘‘implant’ within their tables. The current study does not photons were not listed in NUREG 1492. These energies
include a model for encapsulated sources. are then omitted with the higher energy threshold of
Fig. 2 shows good agreement when comparing the 15 keV, bringing the exposure rate constant in line with
various iterations of exposure rate constants with several the other methods.
radionuclides: 111Ag, 67Ga, 153Sm, and 99mTc. This sug- Smith and Stabin (2012) exposure rate constants for
125
gests concurrence between the decay energies and abun- I and 117Sn are greater than estimated in NUREG 1492
dances listed in NUREG 1492 and ICRP 107 and good and greater than the results of the methods described here.
agreement among the men used by NUREG 1492, Smith Comparing the method using ICRP 107 decay schemes,
and Stabin, and Table 1. men from Table 1, and the same energy and abundance
Palladium-103 (103Pd) and 169Yb data appear to di- thresholds of 15 keV and 0.0001, respectively, the current
verge when the decay schemes of ICRP 107 are used. results are approximately 11.5% lower for 125I and 117Sn.
For 103Pd, seven photon energies are used in the calcula- The only variable that cannot be compared is the men in
tion of the exposure rate constant in NUREG 1492. While air. Smith and Stabin (2012) use a log-log interpolation
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 Activity thresholds and PET c M. J. WILLIAMSON AND L. T. DAUER 349

Table 5. Patient release criteria for novel PET radionuclides.

Activity at or
below which Dose rate at 1 m at or
patients may be below which patients
Exposure rate released may be released
constant Half-life
Radionuclide Tp (d) (R/mCi-h at 1 cm) factor (GBq) (mCi) (mSv hj1) (mrem hj1)
Generator Mn-52m 1.47  10j2 12.8 1 28.53 771 9.86 986
produced Cu-62 6.72  10j3 5.9 1 135.56 3,664 21.51 2,151
Ga-68 4.70  10j2 5.5 1 20.62 557 3.07 307
Rb-82 8.84  10j4 6.4 1 942.69 25,478 163.47 1,6347
In-110m 4.80  10j2 9.1 1 12.28 332 3.01 301
Sb-118 2.50  10j3 4.9 1 439.22 11,871 57.80 5,780
I-122 2.52  10j3 5.7 1 371.28 10,034 57.33 5,733
Cyclotron C-11 1.42  10j2 6 1 63.14 1,706 10.16 1,016
produced N-13 6.92  10j3 6 1 129.65 3,504 20.87 2,087
O-15 1.41  10j3 6 1 633.82 17,130 102.14 10,214
F-18 7.64  10j2 5.8 1 12.12 328 1.89 189
Cl-34m 6.08  10j1 10.2 1 0.87 23 0.24 24
K-38 5.30  10j3 15.7 1 64.30 1,738 27.25 2,725
Ti-45 1.28  10j1 5.1 1 8.20 222 1.13 113
Mn-51 3.22  10j2 5.8 1 28.51 770 4.48 448
Mn-52 5.59 18.2 0.25 0.21 6 0.10 10
Fe-52 3.45  10j1 4.2 1 3.72 101 0.42 42
Co-55 7.30  10j1 11 1 0.66 18 0.20 20
Cu-60 1.65  10j2 19.9 1 16.33 441 8.78 878
Cu-61 1.39  10j1 4.7 1 8.13 220 1.04 104
Cu-64 5.29  10j1 1.1 1 9.43 255 0.27 27
Ga-66 3.95  10j1 11.8 1 1.14 31 0.37 37
As-70 2.72 22.5 0.25 0.35 9 0.21 21
As-71 1.08 3.2 0.25 6.24 169 0.53 53
As-74 1.78  10+1 4.4 0.25 0.27 7 0.03 3
Br-75 6.72  10j2 6.9 1 11.62 314 2.15 215
Br-76 6.75  10j1 14.1 1 0.56 15 0.21 21
Rb-82m 2.70  10j1 15.9 1 1.24 34 0.54 54
Y-86 6.14  10j1 18.9 1 0.46 12 0.24 24
Zr-89 3.27 6.6 0.25 1.00 27 0.18 18
Nb-90 6.08  10j1 22 1 0.40 11 0.24 24
Tc-94m 3.61  10j2 11.1 1 13.33 360 4.00 400
I-120 5.67  10j2 13.8 1 6.83 185 2.55 255
I-124 4.18 6.6 0.25 0.78 21 0.14 14

of the data as compared to the authors’ visual interpretation
of the linear energy absorption curve as listed in Table 1.
Estimated exposure rate constants from NUREG
1492, NUREG 1556 Vol. 9. Rev. 2 Appendix U, Smith
and Stabin (2012), and the current work using ICRP 107
decay schemes, men in air from Table 1 and the energy and
abundance thresholds of 15 keV and 0.0001, respectively,
are presented in Table 3. Notable variations in exposure
rate constants were discussed in the preceding paragraphs.
NUREG 1556 Vol. 9. Rev. 2 Appendix U data are similar
to NUREG 1492 with the exception of 103Pd. NUREG
1556 Vol. 9. Rev. 2 Appendix U uses an ‘‘apparent’’ ac-
tivity for 103Pd, and NUREG 1492 takes into consideration
attenuation by the source capsule. Although one might
assume that these values should be similar, they are not,
and the NUREG 1492 value compares favorably to Smith
and Stabin and this workVboth of which do not consider
attenuation by any source capsule. NUREG 1556 Vol 9.
Rev. 2 Appendix U takes into consideration attenuation
from the source capsule with 125I as well, impacting the
exposure rate constant to a lesser extent.
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The exposure rate constant data appear to agree with
some explainable discrepancies. Based on these comparisons
and the fact that the authors’ novel PET radionuclides are not
contained in source capsules, the current model is verified and
considered appropriate for generation of exposure rate con-
stants for novel PET radionuclides and further estimating
release criteria and thresholds for patient instruction.
This method (ICRP 107 decay schemes, men from
Table 1, and the energy and abundance thresholds of
15 keV and 0.0001, respectively) is used to generate the
exposure rate constants for novel PET radionuclides as
listed by Holland et al. (2010). These exposure rate con-
stants compare favorably to Smith and Stabin (2012) with
a ratio of 1.02 or a variation of 2% or less (see Table 4).
The current exposure rate constants for novel PET
radionuclides are entered into the patient release model
(eqn 4) to develop activities and dose rate thresholds for
patient release and instruction. Results of activity and
dose rate are presented in Table 5 for patient release and
Table 6 for patient instruction in a similar format (U.S.
and SI units) as found in NUREG 1556 Vol. 9 Rev. 2

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350 Health Physics March 2014, Volume 106, Number 3

Table 6. Patient radiation safety instruction criteria for novel PET radionuclides.

Activity above Dose rate at 1 m

which above which
instructions instructions
Exposure rate are required are required
constant Half-life
Radionuclide Tp (d) (R/mCi-h @ 1 cm) factor (GBq) (mCi) (mSv hj1) (mrem hj1)
Generator Mn-52m 1.47  10j2 12.8 1 5.71 154 1.97 197
produced Cu-62 6.72  10j3 5.9 1 27.11 733 4.30 430
Ga-68 4.70  10j2 5.5 1 4.12 111 0.61 61
Rb-82 8.84  10j4 6.4 1 188.54 5,096 32.69 3,269
In-110m 4.80  10j2 9.1 1 2.46 66 0.60 60
Sb-118 2.50  10j3 4.9 1 87.84 2,374 11.56 1,156
I-122 2.52  10j3 5.7 1 74.26 2,007 11.47 1,147
Cyclotron C-11 1.42  10j2 6 1 12.63 341 2.03 203
produced N-13 6.92  10j3 6 1 25.93 701 4.17 417
O-15 1.41  10j3 6 1 126.76 3,426 20.43 2,043
F-18 7.64  10j2 5.8 1 2.42 66 0.38 38
Cl-34m 6.08  10j1 10.2 1 0.17 5 0.05 5
K-38 5.30  10j3 15.7 1 12.86 348 5.45 545
Ti-45 1.28  10j1 5.1 1 1.64 44 0.23 23
Mn-51 3.22  10j2 5.8 1 5.70 154 0.90 90
Mn-52 5.59 18.2 0.25 0.04 1 0.02 2
Fe-52 3.45  10j1 4.2 1 0.74 20 0.08 8
Co-55 7.30  10j1 11 1 0.13 4 0.04 4
Cu-60 1.65  10j2 19.9 1 3.27 88 1.76 176
Cu-61 1.39  10j1 4.7 1 1.63 44 0.21 21
Cu-64 5.29  10j1 1.1 1 1.89 51 0.05 5
Ga-66 3.95  10j1 11.8 1 0.23 6 0.07 7
As-70 2.72 22.5 0.25 0.07 2 0.04 4
As-71 1.08 3.2 0.25 1.25 34 0.11 11
As-74 1.78  10+1 4.4 0.25 0.05 1 0.01 1
Br-75 6.72  10j2 6.9 1 2.32 63 0.43 43
Br-76 6.75  10j1 14.1 1 0.11 3 0.04 4
Rb-82m 2.70  10j1 15.9 1 0.25 7 0.11 11
Y-86 6.14  10j1 18.9 1 0.09 2 0.05 5
Zr-89 3.27 6.6 0.25 0.20 5 0.04 4
Nb-90 6.08  10j1 22 1 0.08 2 0.05 5
Tc-94m 3.61  10j2 11.1 1 2.67 72 0.80 80
I-120 5.67  10j2 13.8 1 1.37 37 0.51 51
I-124 4.18 6.6 0.25 0.16 4 0.03 3

Appendix U. As in the NUREG, it is assumed that 1 R is
equal to 10 mSv (1 rem).
CONCLUSION
The ICRP states that for most diagnostic nuclear
medicine procedures, precautions for the public are rarely
required (ICRP 2004). They also recognized that the lit-
erature has indicated that models used for patient release
are overly conservative. However, patient release is based
on dose to a member of the public, and the ICRP further
states that young children, infants, and visitors who are
not engaged in direct care or comforting should be treated
as members of the public and subject to the 1 mSv per year
dose limit. The international radiation protection com-
munity publishes similar public dose limits as the NRC.
However, the European Commission and IAEA specifi-
cally exempt caregivers from the public dose limits, whereas
the NRC regulation imposes an upper limit of 5 mSv.
Also, the EURATOM and IAEA recognize the potential
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for additional manmade exposures to third party populations
and offers a dose constraint of 0.3 mSv per episode for
third party members of the public. The 0.3-mSv dose
constraint is not used as a criterion for threshold for pa-
tient instruction, but it is achieved easily by modifying
the dose based threshold of eqn (4).
NUREG 1556 Vol. 9. Rev. 2. Appendix U offers a
conservative mechanism for demonstrating compliance
with the concept of estimating dose to a member of the
public. When considering novel PET radionuclides in this
model, several radionuclides demonstrate low activities
and dose rates for which patient instruction could be re-
quired, particularly for licensees who commit to the model
procedures in this guidance.
It is recognized that the model routinely used for
patient release employs conservative parameters. For ex-
ample, the model employs the point source exposure rate
constant negating any absorption in tissue, whereas appli-
cation of correction factors for geometry provide a better
estimation of exposure rate (Willegaignon et al. 2006, 2007).

Copyright © 2014 Health Physics Society. Unauthorized reproduction of this article is prohibited.
 Activity thresholds and PET c M. J. WILLIAMSON
Similarly, the relationship from roentgens to radiation ab-
sorbed dose, to roentgen-equivalent man is assumed to be
equal. The distance from the patient to the member of the
public and the occupancy factor are constant. Whichever
assumptions are chosen, it is recommended that the licensees
be consistent in their methodology.
This work reviews the model for patient radiation
safety instruction and release presented in NRC guidance
and applies the model to several novel PET radionuclides.
Even though these radionuclides are used typically in the
diagnostic setting, some exhibit low thresholds for radia-
tion safety instruction when considering administered
activity or dose rate at 1 m from the patient. Zirconium-89
(89Zr) and 124I are examples of novel PET radionuclides
where the activity and dose rate thresholds are fairly low
when considering patient instruction. A patient dose rate of
0.04 mSv hj1 at 1 m or an activity remaining in the patient
of more than 0.2 GBq with regard to the administration of
89
Zr could require a record of radiation safety instruction.
Similarly for 124I, a dose rate of 0.03 mSv hj1 at 1 m or an
activity remaining in the patient of more than 0.16 GBq
may require a record of radiation safety instruction.
It should be recognized that some quantities of novel
PET radionuclides in use today reach the threshold for
patient safety instruction using conservative model pro-
cedures for patient release.
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