[ RadSafe ] Breast cancer - radiological implants.

Wed Aug 22 14:10:10 CDT 2007

Concerning:

"Aviation Week & Space Technology
08/20/2007, page 26
Technology to detect radiation has progressed, says Army Lt. Gen. William
Webster, deputy commander of the U.S. Northern Command. During the most
recent Little League World Series in Williamsport, Pa., detectors picked up
radiation from a fan entering the premises and handheld detectors guided
officials to the fan's location. Upon questioning the fan, officials
discovered she recently underwent radiation therapy for breast cancer and
was still carrying residual amounts of the substance."

Let me preface by saying that treatment is not in my area of study, but as a general

researcher and avid radiation detector/identifier, I do have at hand many resources and connections that can be pressed into service rather quickly. Likewise I have learned that "never say never". 

There are always anomalies, leading edge research tests, and just plain accidents that account for some results, and should be addressed by the RSO. More on this at the end.

As of today, neither the U.S. National Cancer Institute

Ref:

www.cancer.gov

Tel 1-800-422-6237

nor the Center for Devices and Radiological Health ( the FDA rad regulation branch)

Ref: www. FDA.gov/cdrh     (add /MRA to end for European Union references)

Tel 1-800-638-2041

can cite a known Brachytheraphy treatment that involves leaving a "seed" inside a patient's breast.

The Director of the CDRH mentions that it has been known that the Ir-192 "seeds"have broken loose from the Remote Brachytheraphy machine and been deposited inside the patient. This of course is extraordinarily rare, but it seems to have  happened. The Deputy Director, Bill Sutton is presently doing research into any recently approved devices at the Office of Device Evaluation and will get back to me on this today. Repeating, just because a device isn't yet approved does not mean it is not in an experimental test phase.

REMOTE BRACHYTHERAPHY > BREAST involves an interstitial catheter or catheters being implanted into the tumor tissue region, these are simply hollow plastic tubes that stay in until the whole treatment is finished ( 5-7 days instead of 5-7 weeks with external beam) and contain no radiation at all. When it is time for the daily treatment, the catheters are hooked to a machine which contains a sealed "seed" of Ir-192 nuclide. Under computer control, the seed is placed exactly into the right areas and for the correct dwell time, one catheter at a time. A manual operation can be accomplished under direct ultrasound observation. 

This treatment is often carried out under the HDR protocol, High Dose Rate >12 Gy/H, so that a minimum of treatments are required, and over a shorter period of time. Naturally the entire treatment is planned and laid out by an oncologist. None of the Remote Brachytherapy leaves a radiation source inside the person when the leave the hospital. 

Ordinary Brachytherapy  has been with us since the 1920's, when Radium-226 was used. Many isotopes are currency available for different uses, and include the Interoperative seeds that are left inside the body for the duration, as in prostate cancer. These nuclides would include:

Co-60, Cs-137, Au-198, Ir-192, I-125, Pd-103.

Newly developed beam therapy using external beams of X-Rays, Photons, Protons and even Neutrons are getting very popular due to the on site LINAC accelerators available now. Proton and Neutron beams CAN leave atoms in the body radioactive, from "nuclear activation", usually very short half lives though.

As mentioned in previous posts, the RSO - DHS/Homeland Security- First responder-should be aware of the many *DIAGNOSTIC* nuclides that are likely to be seen in rather large doses in the public today, chief among them: I-125, I-131, Tc-99m, F-18, and 50+ more. A good free small booklet to carry in the kit bag is "Nuclear Waste Wallet Card for Radioactive Nuclides" March 2004 rev. free from www.nndc.bnl.gov, or I can send one free for postage. It list most of the isotopes the RSO is likely to encounter, their radiation decay mode and other useful information. Also ask for the free "Nuclear Wallet Cards" booklet. 

Several publications, all called "Radioisotopes in Medicine" are out there, but the ones I have are outdated.

ALL approved radiological medical devices are in the FDA database online. 

First Responders should get a free copy of the CD: BAT TOOL from

Armed Forces Radiobiological Research Institute:

http://www.afrri.usuhs.mil/

Soon the  AFRRI CD 06-1 will be available.

Now my editorial;

Personally, I suspect the lady at the ballpark who was "detected", did indeed have some kind of radiological cancer therapy, but that it was not the source of the alarm. Far more likely would be a routine bone scan, PET-CT or other test that required a radiotracer injection, which was still active some time later. She could have concurrently  received some other kind of therapy like for thyroid, that would leave her radioactive, and never realize the connection. Very unfortunately, the word "seed" is applied both to sealed capsules that are implanted in to the body, and the Ir-`192 "seed" permanently attached to the end of a long insertion wire. Easy to see how a layman (is LAYWOMAN even a word?) could get confused. 

It is up to the RSO, DHS etc. to not only be able to detect the presence of radioactivity but to have at least someone on-call who can *IDENTIFY* it and analyze the risk factor. Very important in the day we live in now. 

Immediately after 9/11, the services grabbed up any and all the radiation detection equipment that they could find on the shelves.

After a few years of struggling with inadequate technologies, the manufacturers began providing much improved and advanced equipment. We are now into what I call the 3rd generation, where the services have enough clout and have had the impetus and time to generate their own specifications for new detection devices. Most of these have automatic isotope identification, advanced detectors with vastly superior sensitivity, and even neutron detection, in extremely small sized and easy to use packages. Pollimaster is ready to release their 4th generation of pager sized isotope identifiers, which communicate directly to a bluetooth equipped cellphone! 

A great consolidation of detection manufacturing companies and probe makers has gone on recently and continues to go on at this time. As equipment gets 'better" it must also get 'smarter" so that an semi-trained person can use it. In some respects. I personally resent that move, but of course totally understand the need. Point-and-Shoot will be the byword in this next generation equipment. 

On a comical note, I always carry a vehicle mounted scintillation based alarm and a pocket pager/scintillator. I do not always carry an identifier, for monetary reasons. A few weeks ago, I got a strong hit on the mobile and traced it to a Federal Building under reconstruction. After roaming the building with the pager, I was about to give up, where upon leaving I got another strong hit. Would up being the granite steps on the front of this 100 year old building (NORM) having enough radioactivity to alert me 3 blocks away.

Bottom line, with today's super sensitive detection equipment, we will continually get HITS from our modern environment, and the field rad community will in this respect be at odds with the medical community who consider the residual radiation just the normal course of action in a days work. By the way, they often seem to me to be very cavalier about their own exposures.

George Dowell, "Geo" 
NLNL/ New London Nucleonics Laboratory

GEOelectronics at netscape.com

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