[ RadSafe ] I131 patient during intercontinental flight

Dale Boyce daleboyce at charter.net
Fri Feb 20 19:16:27 CST 2009


100 mr at 1 meter sounds high. The old 30 mCi limit was set for 2 mrad/hr, 
and more consistent with what I remember from a lot of patients.

I did have pretty high readings when a patient chose to urinate on the floor 
instead of the toilet once ;), but then you get the beta as well as the 
gamma dose.

----- Original Message ----- 
From: "Brian Rees" <brees at lanl.gov>
To: "Dale Boyce" <daleboyce at charter.net>; <radsafe at radlab.nl>
Sent: Friday, February 20, 2009 10:21 AM
Subject: Re: [ RadSafe ] I131 patient during intercontinental flight


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
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