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Accidents and Incidents

1. How to deal with death of patient after radionuclide therapy?

In some cases, especially palliative treatment, the patient may die shortly after the treatment. In such cases, local authorities usually place limits on radioactivity in the body before autopsy, burial or cremation is permitted. The table below has examples of such limits. Local radiation safety authorities must, however, be consulted in each country.

Radionuclide therapy records should be maintained at the hospital and given to the patient along with written precautionary instructions.

In the case of death of a patient within a few months of therapy, it is advisable that the hospital where the patient received treatment, or a radiation protection specialist, be contacted to determine what (if any) precautions are necessary to meet national regulations.

Suggested cadaver activity limits
Radionuclide Autopsy/Embalming MBq) Burial (MBq) Cremation (MBq)
Phosphorus-32 100 2000 30
Strontium-89 50 2000 20
Yttrium-90 200 2000 70
Iodine-131 10 400 400


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2. Will the patient trigger a security alarm at airports or other public places?

Current international security measures such as those in place at airports and border crossing points may include extremely sensitive radiation detectors. It is quite possible that patients treated with gamma-emitting radionuclides could trigger these alarms, particularly in the period immediately following discharge. Triggering of an alarm does not mean that the patient is emitting dangerous levels of radiation - the detectors are designed to detect levels of radioactivity far below those of concern to human health. For example, it is possible to detect 0.01 MBq of iodine-131 at a distance of 2-3 m. This is a tiny fraction of the recommended discharge level in a patient.

The security authorities are well aware of this possibility, and if a patient is likely to travel soon after discharge, the hospital or the patient's doctor should provide a written statement of the therapy and radionuclide used for the patient to carry with him. The security staff are often unlikely to have any training for this occurrence, so patients should be advised to either avoid such travel or be prepared to experience some inconvenience.

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3. One example of an accident

A patient was referred for treatment of Graves' disease with 555 MBq of iodine-131. The radiopharmacist assumed that the administered activity would be 1073 MBq rather than 555 MBq, since 1073 MBq of administered activity is what was routinely used for Graves' disease in that hospital. He therefore requested 1073 MBq of activity from a commercial radiopharmacy. The activity received was 1058 MBq. When the radiopharmacist logged the activity into the computer after being measured by a dose calibrator, he failed to realize that the referring physician’s prescription was only for 550 MBq.  Furthermore, the physician who actually administered the isotope also failed to check the prescription. As a result, the patient's thyroid received a radiation absorbed dose of about 319 Gy instead of the intended 167 Gy, an overdose of 91%.

Reference

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