[ RadSafe ] Guidance for I-131 Patients

Tue Feb 19 14:48:13 CST 2008

Hi all,
I have not been following this thread on I-131 use in thyroid ablation very 
closely. Perhaps someone has touched upon the actual total activity being 
routinely used today in thyroid cancer or hyperthyroidism for thyroid 
ablation.

I attended an excellent presentation ["Radiation in the Healing Arts" as I 
recall]  late last year by Larry Dauer of Memorial Sloan Kettering at a 
joint chapter meeting of the NY HPS and ANS.

Larry Dauer mentioned that the amount of I-131 being used by many medical 
centers for thyroid ablation had increased to routinely 100 to 200 mCi --not 
the 30 mCi or so which had been used in the past, and which I've seen 
mentioned in a few recent posts to radsafe on this subject.

Obviously 200 mCi  I-131 administration  presents a very different radiation 
protection challenge regarding quick release of patients than 30 mCi.

FYI, an interesting point of reference on administering treatment doses of 
100 to 200 mCi per patient and I-131 release to the environment. Many years 
ago,  I was responsible for generating  reports of environmental radiation 
measurements  in media sampled around Maine Yankee Nuclear Power Station. I 
recall that the ANNUAL TOTAL RELEASE LIMIT [caps for emphasis] for I-131 in 
gaseous effluents [from what was at the time the largest nuclear plant in 
New England] was 50 mCi. So one patient today, is given 4 times more I-131 
in one slug, than an 800 MW[e] could release in a year.

At one time, during a period of bad fuel rods w/ pinhole leaks,  and 
elevated I-131 in primary coolant, Maine Yankee was exceeding the release 
rate that on a annual basis would equate to somewhat more than 50 mCi per 
year total release in gaseous effluents. I-131 was being detected in milk 
sampled from some very local farms at low concentrations [less than 20 
pCi/liter of milk], but concentrations in excess of what was reportable 
under NRC regs.

Stewart Farber. MS Public Health

Farber Medical Solutions, LLC
Broker for Linac, Medical Imaging, and Radiation Protection Instrumentation
1285 Wood Ave.
Bridgeport, CT 06604
[203] 441-8433 [office]
[203] 522-2817 [cell]
[203] 367-0791 [fax]
website: www.farber-medical.com

----- Original Message ----- 
From: "Maury Siskel" <maurysis at peoplepc.com>
To: "Hansen, Richard" <HansenRG at nv.doe.gov>
Cc: "radsafe" <radsafe at radlab.nl>
Sent: Tuesday, February 19, 2008 2:58 PM
Subject: Re: [ RadSafe ] Guidance for I-131 Patients

>
> Hi again
> see if this is it ... and others on same page ...
>
> https://servicecenter.snm.org/eseries/source/Orders/index.cfm?section=Orders&task=3&CATEGORY=PAMPHLETS&PRODUCT_TYPE=SALES&SKU=113GD&DESCRIPTION=Pamphlets&FindSpec=&CFTOKEN=16519820&continue=1&SEARCH_TYPE=find
>
> -------------------------------
> Hansen, Richard wrote:
>
>>Thanks, Maury.
>>
>>I am trying to find examples of letters/written instructions that nuc
>>med patients may have. We are developing training courses for US DHS and
>>want to help officers clear alarms from innocent medical patients.
>>
>>
>>Rick Hansen
>>Senior Scientist
>>Counter Terrorism Operations Support Program
>>National Security Technologies, LLC, for the U.S. Dept of Energy
>>hansenrg at nv.doe.gov
>>www.nv.doe.gov/nationalsecurity/homelandsecurity/responder.htm
>>
>> -----Original Message-----
>>From: Maury Siskel [mailto:maurysis at peoplepc.com] Sent: Tuesday, February 
>>19, 2008 10:46 AM
>>To: Hansen, Richard
>>Cc: radsafe at radlab.nl
>>Subject: Re: [ RadSafe ] Guidance for I-131 Patients
>>
>>Hi Richard,
>>This may not be the one you want, but this looks pretty relevant .
>>Cheers,
>>Maury&Dog
>>
>>============================
>>http://tech.snmjournals.org/cgi/content/full/29/2/61
>>
>>ABSTRACT
>>TOP
>>INTRODUCTION
>>INITIAL PREPARATIONS
>>PATIENT PREPARATION
>>DOSE ADMINISTRATION
>>AREA SURVEYS
>>PATIENT RELEASE FROM THE...
>>SOURCES OF ASSISTANCE
>>REFERENCES
>>
>>ABSTRACT Objectives: The patient who has been dosed with therapeutic 
>>activities of 131I for thyroid carcinoma poses a unique set of problems 
>>for nuclear
>>
>>medicine technologists in their efforts to reduce personnel exposure and
>>
>>control contamination spread. It is the objective of this article to: (a) 
>>review practical radiation safety concerns associated with hospitalized 
>>131I therapy patients; (b) propose preventative measures that can be taken 
>>to minimize potential exposure and contamination problems; and (c) review 
>>pertinent federal regulations that apply to patients containing 
>>therapeutic levels of radionuclides.
>>
>>=====================
>>Hansen, Richard wrote:
>>
>>
>>>NRC NUREG - 1556, Vol. 9, Rev 2 mentions a pamphlet published by the
>>>Society of Nuclear Medicine regarding information for patients
>>>
>>receiving
>>
>>>treatment with radioiodine. Does anyone have an electronic version of
>>>this pamphlet or know where to get one?
>>>
>>>
>>>Quote from NRC NUREG - 1556, Vol. 9, Rev 2, January 2008
>>>Consolidated Guidance About Materials Licenses Program-Specific
>>>
>>Guidance
>>
>>>About Medical Use Licenses
>>>
>>>Appendix U
>>>Model Procedure for Release of Patients or Human Research Subjects
>>>Administered Radioactive Materials
>>>
>>>Page U-11 (page 400 in PDF file)
>>>
>>>http://www.nrc.gov/reading-rm/doc-collections/nuregs/staff/sr1556/v9/r2
>>>
>>/
>>
>>>sr1556v9r2-final.pdf#app-u
>>>
>>>The Society of Nuclear Medicine published a pamphlet in 1987 that
>>>provides information for patients receiving treatment with radioiodine.
>>>This pamphlet was prepared jointly by the Society of Nuclear Medicine
>>>and the NRC. The pamphlet contains blanks for the physician to fill in
>>>the length of time that each instruction should be followed. Although
>>>this pamphlet was written for the release of patients to whom less than
>>>1,110 megabecquerels (30 millicuries) of iodine-131 had been
>>>administered, the NRC still considers the instructions in this pamphlet
>>>to be an acceptable method for meeting the requirements of 10 CFR
>>>35.75(b), provided the times filled in
>>>the blanks are appropriate for the activity and the medical condition.
>>>
>>>Thanks,
>>>
>>>Rick Hansen
>>>Senior Scientist
>>>Counter Terrorism Operations Support Program
>>>National Security Technologies, LLC, for the U.S. Dept of Energy
>>>hansenrg at nv.doe.gov
>>>www.nv.doe.gov/nationalsecurity/homelandsecurity/responder.htm
>>>
>>>Snippet:
>>>
>>>Date: Sun, 17 Feb 2008 11:02:51 -0800 (PST)
>>>From: John Jacobus <crispy_bird at yahoo.com>
>>>Subject: Re: [ RadSafe ] I-131 Patients and Taxi driver
>>>
>>>Jerry,
>>> The NRC recommends (and everybody generally follows) the restriction
>>>that a patient being treated with I-131 can be released when the
>>>exposure rate at 1 meter is 7 mrem/hr. See column 2 on page 394 at
>>>http://www.nrc.gov/reading-rm/doc-collections/nuregs/staff/sr1556/v9/r2
>>>
>>/
>>
>>>sr1556v9r2-final.pdf#app-u  On page 397, it indicates the instructs are
>>>to be given when the exposure rate exceeds 2 mrem/hour.
>>>
>>>
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>>>
>>>
>>
>>
>>
>>
>>
>
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