How Does Feofaniia Work? Visit of Belgian Experts to All-Ukrainian Radiosurgery Center

Would you prefer to be afraid of the unknown or to try to learn more about it? The Feofaniia Clinical Hospital of the State Management of Affairs of Ukraine in the minds of Ukrainians historically overgrown with legends and myths. In fact, it is overgrown with flowers, trees and modern buildings, which altogether are combined in a composition that delights the eye. Myths are born in the absence of knowledge and reliable information. It is always easier to imagine the first cycle of hell in the place where you have never been. The same thing is with radiation. It is difficult to realize the effect of something that you cannot feel, but that actually is real and can harm you.

For some reasons, we rarely remember that radiation has undeniable benefits in everyday life. If you think about it for a while, the production of radiopharmaceuticals in the most mythologized clinic in Ukraine is very symbolic and sounds scary. However, there are certain rules. If you strictly follow them, you can work with such a dangerous matter as radioisotopes. Is everything in the Feofaniia Clinical Hospital going in compliance with the approved requirements? We dared to check this with Tetiana Lytvynska, Iaroslav Bielov, Dmytro Bielykh of the State Scientific and Technical Center for Nuclear and Radiation Safety (SSTC NRS), and Belgian experts Vera Pirlet, Head of the Department for Physical Control of Radiation in the University of Liege, and Gregory Delecaut, Head of Business Unit Services in the Institute for Radioelements. The visit was arranged within the agreement between the SSTC NRS and the Institute for Radioelements of Belgium.

“It is so beautiful and calm here”, experts note when we enter the territory of Feofaniia. In fact, this is the first thing that strikes you when you are in the hospital vicinity. It is located in the forest. There are no signs or indicators that Feofaniia is located here. Only Google maps or detailed instructions from someone who has already been here will help to find it. The new three-storey building is the All-Ukrainian Radiosurgery Center, which has both the production of radiopharmaceuticals and diagnostic equipment for PET-CT, as well as therapeutic accelerators. At the entrance, a friendly man with excellent English welcomed us. Boris Bondar is a leading engineer-radiophysicist and a person responsible for radiation safety. He will be our guide to the magical world of radioisotopes. We decide that first the experts from Belgium will tell how such centers are arranged in their country and how the radiation protection is ensured there.

Center staff involved into the production of radiopharmaceuticals gathered in a cozy and modernly equipped conference room. The lecture takes about twenty minutes. Vera Pirlet tells that all incidents and accidents that occur during the production and use of radiopharmaceuticals are assessed according to the International Nuclear Event Scale (INES), as it is in the nuclear energy. A surprising fact is that it is usual and even beneficial practice for the image of the hospital to share their errors and emergencies with similar organizations. “Therefore, it is much easier to prevent the same cases, both in our establishment and in other similar centers” Vera Pirlet explained. The situation is different in Ukraine. Everything that goes beyond the standard procedure is considered a great secret that can only be shared with the State Nuclear Regulatory Inspectorate of Ukraine.

Speaking about the protection in the cyclotron bunker, Vera Pirlet explained that the shielding of 45-cm concrete wall is enough for a type of cyclotron like the one installed in Feofaniia. Borys Bondar said that current Ukrainian standards for the protection calculation require the use of a “2” coefficient for calculation parameters, which significantly increases the output parameters of the stationary protection of the room from radiation. As a result, the wall thickness of the room with cyclotron in Feofaniia is 70 cm. An interesting fact is that an expert on radiation protection is the one to choose which particular annual dose limit to take into account in calculation: as for personnel (20 mSv) or as for ordinary citizens (1 mSv).

When the presentation was over, we went to the first floor directly to the cyclotron chamber. Fortunately, there was a technological break in the All-Ukrainian Radiosurgery Center production process, so we had an opportunity for safe observation of the protection systems and the cyclotron building. The experts positively perceived everything told by Feofaniia specialists about obligatory dosimetric measures, door interlocking, means of protection and waste management. Then, we proceeded to the ventilation room equipped next to the cyclotron. Air comes there from cyclotron bunker and room of radiopharmaceutical production. It is checked for the specific activity of radionuclides and whether this level exceeds the standard established by law.

Belgian experts saw such a system for the first time. They asked to specify many details on filter types and the material of the detectors. Experts are surprised by the availability of automated special drain system for people undergoing PET-CT examinations. The special drain system is located in the basement and consists of three main and one standby tanks, in which everything that came from diagnostic department toilets is stored for a day and then drained into the common sewer system.

“Do you have unsealed radionuclide therapy?” The expert asks. “No, only diagnostics”. “It’s strange, because such systems are constructed in Belgium only in radiotherapy departments with unsealed sources. However, you have only fluorine-18. It’s not necessary, but it’s wonderful” (fluorine-18 is a short-lived isotope, its activity decreases twice in an hour and a half, and the activity used in the diagnostics is very low). Radiation protection at a level above the European standard, there is something to be proud of.

All data from different radiation control subsystems: from the production department, cyclotron bunker, ventilation room, special sewage room and the diagnostic department using radiopharmaceuticals are sent to the radiation protection and dosimetry control department on the third floor of the All-Ukrainian Radiosurgery Center. The engineers of the department are constantly monitoring the indicators, and in case of exceeding the activity limits or radiation dose rate, they will be able to respond in a timely manner. A complete set of tools and individual dosimeters allows controlling the safety of any process for both patients and personnel.

For personnel working with radiopharmaceuticals, in addition to usual dosimeters, from which readings are taken once a quarter (TLD), there are also direct-reading dosimeters that allow timely response to high equivalent dose at the workplace, as well as ring dosimeters that allow control of the equivalent dose of personnel for the hands. A specialist in Feofaniia shows his investigation results: a comparison of the dose accumulated by personnel during one year that was measured using direct-reading dosimeters and TLDs. They were similar, if you do not take into account the usual error for such measurements.

“How many PET-CT departments are in Ukraine?” “I think, four, but I’m not sure. All of them are in Kyiv. How much of them are in Belgium? ” “Oh, a lot, almost in every hospital, this is a very common procedure”.

We go to the SSTC NRS to continue the work according to the plan after examining the institution and sharing the general problems that exist in radiation protection in any country (e.g., a lot of paper work).

Medical radiation safety in Ukraine has long been the first from the end when the matter concerned the things, on which money will be spent and attention will be paid. The situation has been changing for the better very quickly and fundamentally last years. “Are there many state hospitals in Ukraine similar to Feofaniia?” guests from Belgium ask. This level is surely not accessible to every healthcare institution. However, much can be done actually without raising capital: at least adherence to the rules, standards and regulations on radiation safety. Editorial Board