[ RadSafe ] I131 patient during intercontinental flight

Thu Feb 19 22:46:10 CST 2009

There are _no_ regulations on what a released patient may or may not do. At 
least within the U.S.  That said, there are at least three broad categories 
of I-131 therapy. Those with sub 10 mCi levels are typically for Graves 
disease (hyperthyrodism). Around 30 mCi for post surgical thyroidectomy 
ablation for thyroids CA. Finally, 100 to 200+ mCi for metastatic thyroid CA 
(non-thyroid locality).

Urine elimination of non-bound I-131 will account for >~ 50% per day of the 
administered dose. At _very_ roughly 7 days excreta will consist of about 
equal parts bound and previously unbound I-131. Thereafter, excretion will 
be dominated by I-131 that had previously been bound to 
metastatic/nonablated thyroid type tissue. The release of previously bound 
iodine is slow 90-100 day biological half-life, but will be somewhat less 
due to thyroid-like tissue abation (help Mike S.)

So if a 200 mCi CA therapy patient got on an airplane immediately after 
being dosed someone sitting next to them on an airplane will be getting 
about 13 mrad per hr +/- (based on observed dose rates from patients). 
Excreta from said patient would be (ballpark) 6 mCi per hour with 2/3 of 
that in urine (toilet), and 1/3 in sweat. Therefore, about 2 mci per hour in 
sweat which will be, mostly, absorbed into their clothing.

Let's say 10 % of the sweat excretion is transferred to contamination of the 
seat, and that 0.1% of that is ingested or inhaled (a common transfer 
function for contamination), then a patient dosed at the gate for an airline 
flight would subject the next occupant of their seat to a potential thyroid 
up take of 200 nCi.

Significant, but comparable to the ALI for I-131 for occupational exposure. 
Now, apply the same 0.1% transfer function to the transfer of contamination 
to the second passenger, and you get 0.2 pCi. Clearly, in the sub-background 
range of exposure from background.

I am not promoting letting passengers take capsules of I-131 getting on a 
plane immediately. I am asking that people do the physics of health physics. 
Please evaluate the exposure to members of the public before restricting the 
rights of patients. "Opinions", and "feelings", are not science.

Bottomline, HP's, MP's, Dr's, or institutions, do not have the right to 
restrict a patient's freedom under any aspect of the law. Regulations can 
only restrict licensee's to "educating the patient or family" as to 
precautions that _should_ be followed.

Dale

----- Original Message ----- 
From: "McClung, Danny" <danny.k.mcclung at va.gov>
To: "Franz Schönhofer" <franz.schoenhofer at chello.at>; "Moshe Levita" 
<mlevita at tasmc.health.gov.il>; <radsafe at radlab.nl>
Sent: Thursday, February 12, 2009 9:33 AM
Subject: RE: [ RadSafe ] I131 patient during intercontinental flight

Franz,

The regulations in the U.S. are clear. Once you give the patient 
instructions (after evaluating their living arrangements, etc), they can be 
dosed, and then released into the public, providing you meet regulatory 
criteria for dose to others (500 mrem). What happens after that is the 
question here. Do the patients always follow instructions? Probably not...

It happens this way all the time. Hospitalization of I-131 ablation therapy 
patients is infrequent.

Dan

-----Original Message-----
From: radsafe-bounces at radlab.nl [mailto:radsafe-bounces at radlab.nl] On Behalf 
Of Franz Schönhofer
Sent: Thursday, February 12, 2009 9:57 AM
To: 'Moshe Levita'; radsafe at radlab.nl
Subject: AW: [ RadSafe ] I131 patient during intercontinental flight

Dear Moshe and all the RADSAFErs, who engaged in this thread,

In my home country Austria this question is well regulated. Anybody released
from hospital after a I-131 thyroid treatment receives a paper stating that
any close contact with other people, especially family members should be
restricted for at least one week, in some cases for 6 weeks or even three
nonths. This prohibits any overseas flights within this time scale, sitting
close to passengers - even children or pregnant women. The contamination of
not only lavatories, but also the whole aeroplane space is absolutely
unacceptable. I am far from being afraid of any radiation exposure, I have
been exposed already to some Sv (earlier to rems), but I still adhere to the
ALARA principle, which in this given case would require patients to stay a
few more days at the hospital or somewhere else.

Starting from the beginning: Why do have patients to come to Israel for such
a therapy? I hardly believe that there is any country, where such therapy is
not available! And I wonder, why there is at RADSAFE such a number of "hear
say" and "I believe " and "I think" messages; in developed countries the
regulations should be clear!

Best regards

Franz

Franz Schoenhofer, PhD
MinRat i.R.
Habicherg. 31/7
A-1160 Wien/Vienna
AUSTRIA

-----Ursprüngliche Nachricht-----
Von: radsafe-bounces at radlab.nl [mailto:radsafe-bounces at radlab.nl] Im Auftrag
von Moshe Levita
Gesendet: Montag, 09. Februar 2009 09:22
An: radsafe at radlab.nl
Betreff: [ RadSafe ] I131 patient during intercontinental flight

Dear Colleagues,

Many Iodine 131 patients arrives in Israel to be treated and then fly back
home.

The patient stays in the award until the residual dose is below certain
level.

(Residual activity is calculated by the measurement of dose rate at 1 m)

I wonder at what residual activity it will be reasonable to allow the
patient to fly back to his country.

 One have to take into considerations :

1.  Five hours flight of sitting beside another passenger (who might be a
child or pregnant women)

2.  Definite contamination of the airplane toilet, toilet cleaning, toilet
disposal etc.

3.  Possible triggering of airport radiation alarm monitors.

Any suggestion will be welcomed.

Moshe Levita

Chief Radiation Executive

Ministry of Health

Israel
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