[ RadSafe ] I131 patient during intercontinental flight

Fri Feb 20 12:21:37 CST 2009

I had a project to measure the response of 
various instruments to nuclear medicine patient 
volunteers.  I did have one (I-131 thyroid) 
ablation patient.  The pt. had received 150 mCi, 
and I was able to measure the pt. prior to their 
1st urination, as well as discuss various aspects 
of the experience.  The pt. was reading approx 
100 mr/hr at 1 meter, although this was not with 
an ion chamber.  I was able to (easily) detect 
the pt. at 100m with a pager-type radiation 
detector.   There was a marked decrease (I recall 
~ 20%) in radiation dose rate post (1st) 
urination.   They had been instructed to push fluids to reduce kidney dose.

The pt. reported that the meds and recent 
treatment(s) had left them feeling not well, and 
their energy level was such that I doubted their 
ability or willingness to do much travel in the 
near future.  They had been well briefed and 
understood their (discharge) instructions 
well.  FWIW,  the pt. was a PhD and quite 
interested in the disease and treatment.  They 
were glad to be able to return home and not have 
to remain in hospital.  I was able to obtain 
their underwear, and I-131 was quite measurable and identifiable.

Brian Rees

At 09:57 AM 2/20/2009, you wrote:
>Glenn and Ed,
>
>I was not promoting that a recent I-131 patient 
>get on a plane. I was trying to show that the 
>consequences are minimal. Also, that after about 
>a week it isn't going to continue to be less of 
>a risk as fast. Glenn, I may have been a little 
>facitious about taking the I-131 right before 
>boarding a flight. Take the more realistic case 
>where a patient is packed for vacation, goes to 
>the hospital, gets the dose, goes through the 
>bureaucracy of getting released, drives to the 
>airport, checks in with the hour or so preflight 
>required, etc. They would be at about the 
>maximum excretion rate during the flight.
>
>As Ed points out governments may have the 
>ability through public safety laws to intervene 
>in a specific case, but they will seldom have 
>the information necessary to do so. Also, with 
>the speed at which courts move by the time a 
>government could act the risk would be over.
>
>Again, I am not advocating patients doing this. 
>It is just not very practical to prevent it. I 
>know of at least one country that requires 
>hospitalization for nuclear medical procedures, 
>and even prostate brachytherapy. Can you imagine 
>how much that would cost in the U.S.?
>
>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
>_______________________________________________
>You are currently subscribed to the RadSafe mailing list
>
>Before posting a message to RadSafe be sure to have read and understood the
>RadSafe rules. These can be found at:
>http://radlab.nl/radsafe/radsaferules.html
>
>For information on how to subscribe or unsubscribe and other settings visit:
>http://radlab.nl/radsafe/
>
>_______________________________________________
>You are currently subscribed to the RadSafe mailing list
>
>Before posting a message to RadSafe be sure to 
>have read and understood the RadSafe rules. 
>These can be found at: http://radlab.nl/radsafe/radsaferules.html
>
>For information on how to subscribe or 
>unsubscribe and other settings visit: http://radlab.nl/radsafe/
>_______________________________________________
>You are currently subscribed to the RadSafe mailing list
>
>Before posting a message to RadSafe be sure to 
>have read and understood the RadSafe rules. 
>These can be found at: http://radlab.nl/radsafe/radsaferules.html
>
>For information on how to subscribe or 
>unsubscribe and other settings visit: http://radlab.nl/radsafe/
>
>
>--
>Internal Virus Database is out-of-date.
>Checked by AVG.
>Version: 7.5.552 / Virus Database: 270.10.18 - Release Date: 2/4/2009 12:00 AM
>
>
>_______________________________________________
>You are currently subscribed to the RadSafe mailing list
>
>Before posting a message to RadSafe be sure to 
>have read and understood the RadSafe rules. 
>These can be found at: http://radlab.nl/radsafe/radsaferules.html
>
>For information on how to subscribe or 
>unsubscribe and other settings visit: http://radlab.nl/radsafe/