Re: incontinent patient dosed with ~100 mCi of I-131

[carol marcus <csmarcus@ucla.edu>]

At 02:45 PM 6/19/00 -0500, you wrote:
>Ignorant question number 2 - just wondering.....
>Any dose to skin considerations for a patient in a diaper that may
>be wet with I-131 urine for several hours between changes?
>
>Aggie
>Standard disclaimer
>Agnes.Barlow@Yale.edu
>
>
>Douglas Simpkin wrote:
>> 
>> Folks:
>> 
>> Ignorant question time!
>> 
>> Our nuclear medicine physicians are talking about treating an incontinent
>> patient with ~100 mCi of I-131. Even if we hold her (and her diapers) in
>> the hospital for a few days, she'll still be generating I-131 waste once
>> she gets home.
>> 
>> How would others handling this?
>> 1. Ignore waste she generates at home, and hope the landfill doesn't monitor.
>> 2. Have her collect her own waste for decay in her basement?
>> 3. Have her collect her own waste, and we then pick up the trash for
>> decay-in-storage here. What are the DOT repercussions of me having a
>> trunk-full of hot Depends?
>> 
>> Any comments?
>> Thanks,
>> Doug
>> Douglas J. Simpkin, Ph.D., D.A.B.R.
>> St. Luke's Medical Center
>> 2900 West Oklahoma Avenue
>> Milwaukee, WI 53215
>> phone: (414)649-6457
>> fax: (414)649-5118
>> email: dsimpkin@execpc.com
>> 
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Dear Radsafers:

In any competent nuclear medicine practice, a follow-up body scan is
performed about a week after a therapy dose.  Have the patient or her
caregiver save her diapers in double plastic bags and bring them with her
when she comes for the scan.  If you're afraid of the garbage dump
detectors, decay it out yourself until it will not trigger the dump detectors.  

Remember that the diapers with I-131 are unregulated material.  DOT does not
apply, and neither does Part 20 radioactive decay in storage requirements.
The only reason to decay the diapers is because your garbage dumps have dumb
rules that are not compatible with 10 CFR Part 20 dose limits to members of
the public from patients given radiopharmaceuticals. They SHOULD be
compatible, and as NRC absolutely refuses to do anything about it, and has
refused to for at least 15 years, CRCPD should show some intellectual muscle
and do it itself.

As far as skin doses to the patient, well, I haven't done the calculations,
but as we have not had a problem with buttocks skin in the 64 years we have
been treating thyroid cancer with radioiodine (first with I-130, and then
I-131 starting 1946), and there must have been many incontinent patients, I
believe this is a non-problem.  Unless your hospital is doing skin grafts
for I-131 radiation burns(!), better find something else to justify your
time. If the patient is hospitalized, incontinence is usually handled with a
Foley catheter.  With a biological halflife of 8-12 hours, there isn't that
much I-131 coming into diapers if the patient is hospitalized for 2-3 days
before going home and using diapers.

Ciao, Carol

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