Applied radionuclides in Switzerland 2016, in GBq.
After World War II, the use of artificially produced radionuclides in medicine began and led to great success in the fight against cancer and other diseases. However, the highly radioactive compounds had to be handled with great care to protect patients and hospital personnel from radiation. The survey of these radionuclides in the environment followed some years later. In Switzerland, double-tracked monitoring programs were started. On the emission side, hospitals and industries handling radiopharmaceuticals had to report their consummation of radionuclides yearly. A monitoring program of their waste waters and solid wastes was also started. On the immission side, the remaining radioactive wastes, which were released to the environment, had to be surveyed. Overall, only a few violations of the limits for radiopharmaceuticals were observed over the last 30 years in Switzerland. Nevertheless, the monitoring of radioactivity in the environment remains an important task as long as radionuclides are used in medicine.
- sewage sludge
- sewer sludge
- suspended matter
Radiopharmaceuticals were first synthesised back in 1933. In Paris, Irène and Frédéric Joliot-Curie produced the first synthetic radionuclide by irradiating aluminium foil with alpha particles. They obtained a radioactive phosphor nuclide (30P). The irradiation of boron resulted in a radioactive nitrogen nuclide . Soon after their discovery of synthetic radionuclides, first applications were published (e.g., studies of metabolism with radioactive tracers and the use of radionuclides in diagnosis and therapy started). After World War II, the nuclear pharmacy industry started in USA. In the 1960s, a group of scientists founded the “radiological chemistry” at the University of Basel. Their focus was on the synthesis and applications of protein-bound radionuclides. They were the first to develop DOTATOC1-bound 111In and 90Y and apply them with success against tumours.
1.1. Application of radiopharmaceuticals
Today, a broad range of radiopharmaceuticals are used for diagnostics and the fight against cancer and other diseases. Radionuclides are either used in their pure form (e.g., 223RaCl2) or bound on a carrier. For diagnosis, they are used in scintigraphy, positron emission tomography (PET), single photon emission computed tomography (SPECT) and others. Specific radionuclides that are in use include the following:99mTc (technetium-99m), which is used for the scintigraphy of the skeleton, heart, lung, brain, liver, kidney, marrow etc. It is also used in techniques, such as myocardia- and parotid scintigraphy.
For the detection of neuroendocrine tumours, 111In (indium-111) and 68Ga (gallium-68) can be used.
For the diagnosis of prostate tumours, brain tumours and metastases in bones, 18F (fluorine-18) is commonly used as the radionuclide in scintigraphy.
Specific radionuclides used in therapeutical applications include the following:
131I (iodine-131), a thyreostatica which is administered in the form of swallowable 131I–capsules, is used to treat diseases of the thyrea (hyperthyroidism and Basedow’s disease). In Switzerland, 200 MBq may be applied for ambulatory treated patients. For higher activities, patients have to stay at specially isolated rooms, until the required dose becomes less than 5 μSv/h at a distance of 1 m. 131I is also applied bound with MIBG (metaiodobenzyl-guanidine).
90Y (yttrium-90) and 177Lu (lutetium-177) are applied successfully against neuroendocrine tumours. These radionuclides are bound to DOTATOC, an octapeptide, which has a similar structure as the hormone somatostatin. 90Y is applied in selective, internal radiotherapy (SIRT) bound on spherical polymer particles.
90Y–Zevalin is used against lymphoma.
Other radionuclides, such as 90Y, 188Re (rhenium-188), 169Er (erbium-169), are applied for radiation synovectomy2.
A recently available radionuclide is 223Ra (radium-223). In the form of radium dichloride, Xofigo, it can be used against prostate tumours that have spread to the skeleton. In Basel, it has been administered since 2013.
1.2. Use of radiopharmaceuticals in Basel and Switzerland
The Federal Office for Public Health, Radioprotection Section, publishes annually the consumption of radionuclides and radiopharmaceuticals by industry and hospitals together with data from the radioactivity monitoring of the effluents of waste water treatment plants (WWTP) and other emission sources in Switzerland .
Today, 33 Swiss hospitals use radionuclides. Twenty-three of these hospitals discharge their contaminated waste waters to WWTPs, which are connected to the Rhine/Aar River system. Table 1 lists the most used radionuclides in Switzerland and the percentage of their use in Basel compared to the whole Switzerland .
|Switzerland||Hospitals in Basel City||Percentage of Basel City|
|131I ambulant appl.||25.2||0||0|
|131I hospitalised appl.||2.593||221||9|
As can be observed, the Basel University Hospital is highly specialised in applications of 90Y and 177Lu. Only a few GBq of 177Lu are applied in hospital centres at Bern, St. Gallen, Lausanne and Zurich. 90Y is used in many hospitals, but in remarkably lower activities than in Basel. Figure 1 shows consumption of radionuclides of radionuclides over the last 18 years. The consumption of 131I is almost stable between 300 and 500 GBq/year. 90Y shows a maximum in 2009 (2500 GBq/year); its use has been reduced since 2009 to almost 1000 GBq/year. Applications of 177Lu started in 2002 and started to rise over the years to 3000 GBq/year in 2016. In that year, the hospitals of Basel used overall 4.5 TBq activity. In Basel, more than 8000 persons per year were treated with radiopharmaceuticals for diagnosis and therapies against cancer and for other applications .
Waste water and other wastes of patients are collected in special stainless steel tanks, while the patients are hospitalised. Due to their short half-lives, the activity of the radionuclides declines very fast. Cooling time in the storage tanks is several weeks. Once a week, tanks are discharged into the waste net when the activity of the radionuclides falls below a specified activity level. This level is fixed in such a way that the limit values for rivers cannot be reached.
2. Legislation in Switzerland
Since 1991, in Switzerland, radionuclides are regulated by the Radioprotection Act (from 22 March 1991)  and the Radioprotection Ordinance (RPO) (from 22 June 1994) . In Annex 2 of the RPO, solid and liquid wastes may not reach activities higher than a permitted limit (EL3). For higher activities, the material has to be treated as “radioactive” according to the Ordinance. For waste water, the activity limit is set to 1% of the EL of each radionuclide. Mixtures of radionuclides are considered as follows (summation rule):
with axe: activity of radionuclide x, ELx: exemption limit of radionuclide x.
The sum in Eq. (1) has to be below 0.01; then, the activity of the waste water is under the limit value. Further, a specific discharge limit per month for treated and untreated waste water has to be fulfilled. A violation is present when both limits are overridden. The aim of these restrictions is to guarantee a limit value of 1/50 of EL for each radionuclide in rivers and lakes (according to Art.102. Par. 2 of the RPO). The Federal Office of Public Health uses the same limits for treated waste waters that are discharged to rivers and lakes (Table 2).
|Activity limit (Bq/kg)1||Activity load per month2|
|Limit value for surface water3|
|44Sc||3.93 h||β+, γ||30.000||300||3.000||600|
|68Ga||68 m||β+, γ||100.000||1.000||10.000||2.000|
|110mAg||249.9 d||β−, γ||4.000||40||400||80|
|131I||8.04 d||β−, γ||500||5||50||10|
|133I||20.8 h||β−, γ||2.000||20||200||40|
|153Sm||46.7 h||β−, γ||10.000||100||1.000||200|
|169Er||9.3 d||β−, γ||30.000||300||3.000||600|
|177Lu||6.71 d||β−, γ||20.000||200||2.000||400|
|177mLu||160.9 d||β−, γ||6.000||60||600||120|
|186Re||90.6 h||β−, γ||7.000||70||700||140|
|188Re||17.0 h||β−, γ||7.000||70||700||140|
3. The waste treatment in Basel City
3.1. The waste water treatment: The municipal WWTP of Basel
The whole waste water of the city of Basel is treated at the
A total of 270,000 inhabitants of Basel City and surrounding villages (several villages of France and Germany included) release their waste waters to the waste net of the city, which has a length of about 360 km. It ends at the WWTP in the north of the city. The WWTP treats 82,000 m3 of waste water a day; 30 million m3 waste water a year, respectively. About 40% of the waste water originates from households (170 L of water are used per person per day). Special waste waters are discharged by the hospitals and industries. Waste waters from chemical industries in Basel are treated in a separate, independent WWTP, especially built for the treatment of chemical waste waters. For more details about the WWTP, visit the website of
3.2. The solid waste treatment at Basel: The municipal waste incineration plant of Basel
The waste incineration plant
4. Materials and methods
4.1. Swiss monitoring programme
Since 1956, environmental radioactivity has been continuously monitored in Switzerland. The motivation for the programme was the occurrence of the global fallout from bomb tests. Since 1986, the Federal Office of Public Health (BAG) is authorized to survey the ionising radiation and radioactivity in the environment. It has to organise a yearly monitoring programme. Part of this programme is the survey of the consumption of radiopharmaceuticals from hospitals and their discharge to the environment. The basic data are delivered by the hospitals (yearly consumption of radiopharmaceuticals and the discharge of total activity in 131I–equivalents to the rivers). Several Swiss WWTPs and waste incineration plants, which are in the catchment area of hospitals, chemical radionuclide producing industries and watch industries are monitored continuously. Yearly, the BAG publishes the data .
4.2.1. Water samples
For balancing radionuclides in waste water, a permanent sampling is necessary. This is only possible by using automatic water samplers. At the WWTP
4.2.2. Solid samples
For the balancing experiments at WWTP
In 1980–2012, suspended matter of the Rhine River was collected in 50 L barrels in three months periods upstream of the city of Basel. The suspended matter was then co-precipitated with potassium zinc hexacyanoferrate-(II), clarified using Carrez solutions, dried and analysed with gamma ray spectrometry. After 2002, the suspended matter from Rhine River was sampled once a month at the
4.3. Gamma ray spectrometry
The water samples are filled without filtration into 1 L Marinelli beakers and counted for 24 hours with high resolution gamma ray spectrometers (Ge detectors). Different Ge detectors from Ortec and Canberra are used at the State Laboratory of Basel City (25–50% relative efficiencies, all detectors are of coaxial type). For recording and analysis of the pulse high spectra, Maestro Dspec jr. from Ortec combined with Interwinner-software from ITEC is used. Regularly, all detectors are recalibrated with calibration sources from Czech Metrology Institute at Prague (mixtures of 241Am and 152Eu). All spectra are background subtracted. For water samples, no density correction is necessary because of the same density of the calibration sources (
4.4. Beta ray spectrometry
Radionuclides, such as 90Y, are pure beta-emitters. Therefore, pre-treatment is necessary before a sample can be analysed with beta-spectrometry. Hospitals usually convert these activities into 131I–equivalent values. For a specific analysis of 90Y, samples of 50–100 mL are prepared as follows. First, the 90Y is co-precipitated with oxalic acid in the presence of a non-active Y-carrier (Y3Cl). The precipitates are isolated and ashed at 850°C. They are then dissolved in HCl and precipitated again at a pH of 5. 40K and most of the alkaline earth metals are isolated in this step. The 90Y is then precipitated in a strong alkaline medium as Y2Ox3. The decay of 90Y in these pure beta-sources is measured in 10 consecutive runs of 400 minutes each by means of a gas proportional counter (LB 4000 from Canberra). Beta-background and relative efficiencies of the beta-detectors (30–40%) have to be considered. The beta-efficiencies of the detectors are regularly tested using own 90Sr/90Y oxalate sources .
5.1. The waste water monitoring at WWTP
In 1997, a monitoring programme for cleaned waste water was started in Basel. This treated waste water is analysed on a weekly basis for 3H and gamma-active radiopharmaceuticals. In 1998, higher activities for 131I near the limit value were noted. The activity limit of 5 Bq/L was not crossed, but the discharge activity of 12 GBq exceeded by far the limit of 50 kBq for 131I. In that year, four violations were noted. Three of the four violations were due to discharges of waste water from the University Hospital. The reasons for the violations were diverse: overfilling of waste water storage tanks, emptying of a wrong tank and technical problems with tank filling indication devices at the University Hospital. The State Laboratory Basel City started disciplinary proceedings against the responsible personnel . The fourth violation was caused by the waste incineration plant of
Since 1999, no more violations of the limit values (e.g., 5 Bq/L for 131I, see Table 2) have been noted. In 2005, first activities of 111In were detected in the treated waste water of the city. In 2003, the University Hospital of Basel started applications of 177Lu, which were growing over the years. This can clearly be seen in Figure 3. Besides 177Lu, 131I and 111In, other radionuclides are detected sporadically, such as 188Re, 67Ga, 153Sm and 99mTc (Table 3). Radionuclides with very short half-lives, such as 99mTc or 18F, normally are not detected in the waste water .
|Radionuclide||Activity range||Number of positive samples||Mean ± s.d.|
|131I||<0.1–4.8||1015||0.3 ± 0.3|
|177Lu||<0.5–5.2||605||0.6 ± 0.9|
|111In||<0.1–0.6||97||0.2 ± 0.1|
|67Ga||<0.3–8.4||48||0.5 ± 1.5|
|186Re||<0.5–23||7||4.4 ± 7.8|
|153Sm||<0.3–0.72||3||0.5 ± 0.2|
At the hospitals, only a part of the applied radioactivity is released to the waste net. A non negligible amount of radioactive wastes is released at homes. Here, all treated patients remain emission sources for the following weeks. In Section 5.3, we present measurements in the waste net that clearly show this fact. Most of the patients treated at the local hospitals live in the vicinity of Basel. Their wastes are also treated at
5.2. Waste water monitoring at the incineration plant
Originally, the monitoring programme of cleaned waste water from wet scrubbing of flue gases was focused on the survey of the beta-nuclide 3H (tritium). From time to time, violations of the limits occurred, but no polluter could be identified. In 2001, the monitoring was extended for the survey of radiopharmaceuticals. To date, 131I is the only radionuclide that caused several violations of the limit values. In April 2008, a violation of both limits for 131I was noted. The activity of the effluent was 30 Bq/L and the discharge was calculated to be 15 MBq/month; both values were clearly over the limit . In May 2014, a further violation of 131I was noted. The mean activity then was 24 Bq/L (limit value: 5 Bq/L) and the discharge was 6.4 MBq per month (limit: 50 kBq/month) . In both cases, no specific polluter could be found. We suppose that the 131I–containing wastes were delivered by the local hospitals. Other radiopharmaceuticals were only detected sporadically (Figure 4, Table 4). Without specific indications, it is almost impossible to find a polluter.
|Radionuclide||Activity range||Number of positive samples||Mean ± s.d.|
|131I||<0.1–36||708||1.0 ± 2.8|
|111In||<0.1–1.6||7||0.7 ± 0.6|
|177Lu||<0.5–2.7||6||1.0 ± 0.8|
|153Sm||<0.3–34||4||11 ± 13|
|110mAg||<0.1–0.14||3||0.1 ± 0.03|
|186Re||<0.5–9.6||2||5.4 ± 4.2|
5.3. Detection of radioactive contamination in the waste net
The investigation of waste water by taking random samples in a waste net does not lead to representative results. This can only be achieved by using automatic water samplers. The installation and use of such samplers in the waste net is a difficult task. Therefore, it is only realised for the monitoring of specific emissions sources, which are under suspicion to violate the law. Another approach is the monitoring of sewer sludge or sewer slime. Sewer sludge is called a biofilm that grows on the interface of the waste water and the concrete of the waste net. Algae, bacteria and fungi build this biofilm, which acts as an excellent sorbent surface for many contaminants, such as heavy metals, polycyclic aromatic hydrocarbons, organochlorine compounds etc. [18, 19]. Radionuclides too, are adsorbed on this biofilms. The substances stay adsorbed until they are washed away from the concrete walls together with the sewer sludge or, in the case of the radionuclides, they have disintegrated. Therefore, sewer sludge can serve as a memory of the load of the run through waste water (Figure 5) .
Table 5 shows impressively the discrepancy between random sampling of waste water and the sampling of sewer sludge, which memorizes contamination of the waste system for a certain time. Only at two positions, site B and E, were traces of 131I and 177Lu detectable in the waste water on the sampling day, whereas 131I and 177Lu were detectable in the sewer sludge of several sites above and below the emission source. These activities are the result from past discharges of radioactive waste water. The fact that even above the emission source, radionuclides were detected shows that patients at home are also emission sources for a certain time . The sampling of sewer sludge illustrates the contamination of the waste net over a certain time period (some days, depending on the half-life of the analysed radionuclide); but it is not representative enough for the calculation of loads or the release of radionuclides in the waste net. Sewer slime analyses can be very useful to look for specific emission sources in a waste net .
|Sample date: 21.10.2014||Waste water (Bq/L)||Sewer sludge (Bq/kg d.w.)|
|Above University Hospital|
|Below University Hospital|
5.4. Balance of radiopharmaceuticals at WWTPs
In 2014, Rumpel analysed influents and effluents of the WWTP
|Untreated waste water||Treated waste water||Sewage sludge||Ash from sewage sludge||Elimination rate %|
For 131I, similar observations were reported by Rose. The investigations of six WWTP’s in USA showed that most of the 131I passed the WWTP’s with the treated waste water . In Finland, most of the 131I (up to 94 Bq/L) was found in the water phase, whereas, in the sewage sludge, 51Cr, 111In, 201/202Tl and other radionuclides were found. Also, sporadically other radionuclides from nuclear power stations were detectable, such as 58Co, 60Co, 110mAg, or 124Sb . In Kurume City, Japan, four hospitals discharge their waste waters to the local WWTP. The main activities of radiopharmaceuticals were found in the waste water. About 1–4% of the applied activities of 99mTc, 123I, 67Ga and 201Tl were detected in the WWTP. 131I was only found in the sewage sludge . This is confirmed by others. Investigations in Canada, Italy, France and Sweden showed that the main activities were in the sewage sludge [25, 26, 27, 28]. About 1–250 Bq/kg of 201Tl, 99mTc, 131I were measured in the sewage sludge of French WWTPs . In the WWTP of Valladolid, Spain, 75–1238 Bq/kg d.w. of 131I was found in sewage sludge . Hormann and Fischer investigated the WWTP of Bremen-Seehausen in Germany. They found an overall elimination rate of 50–75% for 131I. Most of the 131I was bound to the sewage sludge. They concluded that 131I was bound to the return sludge and therefore a longer residence time of the waste water resulted. About 30% of the input was organically bound. After the cleaning processes, over 90% was organically bound and therefore could be eliminated from the waste water cycle .
Such discrepancies of the fate of radiopharmaceuticals in WWTPs can be explained as follows. The waste water treatment processes, which can vary from WWTP to WWTP, also have influence on the behaviour of the radiopharmaceuticals during the waste water cleaning process. How radiopharmaceuticals are administered (inorganic unbound, or organically bound) is crucial for the elimination behaviour of radiopharmaceuticals in a WWTP.
5.5. Monitoring of suspended matter of Rhine River at Basel
Since 1982, the suspended matter of Rhine River is collected periodically and analysed for radio contamination. This is part of the monitoring programmes of the BAG for the survey of Swiss Nuclear Power Plants (NPP) and WWTPs. From 1982 to 2002, suspended matter was collected in three month periods upstream of the city of Basel. Since 2002, suspended matter was collected monthly by means of a centrifuge at the river monitoring station Weil am Rhein downstream of the city.
In 1982 and 1986, high activities of 131I were found in suspended matter of Rhine River. In 1982, the NPP of Mühleberg discharged radioactive water to Aar River, which is connected to Rhine River . As a consequence, in 1982, the suspended matter contained 14.8 Bq/kg of 131I and 88 Bq/kg of 137Cs. Additionally, some activation products typically found in emissions from NPPs, such as 60Co (85 Bq/kg) and 54Mn (14.8 Bq/kg), could be detected .
In 1986, 2,580 ± 1,680 Bq/kg of 131I were found in the suspended matter of Rhine River, together with 1,720 ± 930 Bq/kg of 134Cs and 3,500 ± 1,740 Bq/kg of 137Cs. These high contaminations originated from the fallout of the reactor fire at Chernobyl in that year . Only after 2006, a regular monitoring for short-lived radionuclides from pharmaceutical use was realised. When short-lived radionuclides have to be monitored, it is important to analyse the collected suspended matter as soon as possible. Before 2006, samples were collected over a year and analysed at the end of the year. Therefore, the short-lived radionuclides were already disintegrated. In suspended matter, the radionuclides 131I and 177Lu are prominent. Since 2009, they are detectable in almost every sample and reflect mainly the local emissions from the WWTP
|Radionuclide||Activity range||Number of positive samples||Mean ± s.d.|
|67Ga||0–59||7||30 ± 21|
|85Sr||0–83||21||25 ± 22|
|131I||0–258||94||5.8 ± 5.6|
|153Sm||0–183||6||105 ± 65|
|177Lu||0–390||92||82 ± 117|
|177mLu||0–3||4||3.0 ± 0.1|
|223Ra||0–33||8||16 ± 8.2|
Our monitoring programmes for radiopharmaceuticals show that radioactivity is permanently released to the environment despite rigorous treatment and cleaning of the radioactive wastes from hospitals. The limits for radionuclides in rivers and lakes are observed. Nevertheless, little is known about the low dose effects of radiation on aquatic organisms, which may occur well below these limits. Overall, the permanent monitoring of radionuclides in the environment of cities remains an important task.
I would like to thank the operators of the WWTP
- DOTATOC: 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetate coupled with an octapeptide.
- An application of radiopharmaceuticals to fight arthritis and arthrosis.
- EL: exemption limit. The ingestion of 1 kg of a radionuclide with a specific activity of 1 EL yields a committed effective dose of 10 μSv .