[Date Prev][Date Next][Thread Prev][Thread Next][Date Index][Thread Index]
Re[2]: incontinent patient dosed with ~100 mCi of I-131
I will be out of the office from June 20 through July 4, returning July 5th.
Please contact Jennifer Smulling on x2978 if you need imediate assistance.
___________________________________________________________________________
Subject: RE: incontinent patient dosed with ~100 mCi of I-131
From: radsafe@romulus.ehs.uiuc.edu
Date: 06/19/00 17:42:31
--=====================_24041968==_.ALT
Content-Type: text/plain; charset="us-ascii"; format=flowed
RADSAFERS:
Stupid question #3 or #4 so far on this thread. If this incontinent
patient's attending physicians already agree/know that the patient is
incontinent, what is so difficult about catheterizing the patient and
collecting the radioactive urine in a bag/bottle which could then be
periodically poured down the hospital commode by a hospital radiological
control technician supporting this operation?
Best regards David W. Lee, Radiological Engineering Team Leader, Los
Alamos National Laboratory (lee_david_w@lanl.gov), PH: (505) 667-8085;
FAX: (505) 667-9726
At 03:23 PM 06/19/2000 -0500, you wrote:
> I assume your patient has thyroid cancer, has undergone a sub-total
>thyroidectomy and you are treating her with 100 mCi (2.7 GBq or 2700 MBq) of
>I-131 to ablate post-surgical thyroid tissue remnants, or you are treating
>post-thyroidectomy metastatic disease. In this case, you would expect the
>patient to excrete >95% of the administered activity, primarily through the
>urine. I would have a great deal of concern about potential deterministic
>radiation effects to the skin of the buttocks and genitals of this patient.
>NCRP Report #111 "Developing Radiation Emergency Plans for Academic, Medical
>or Industrial Facilities" table 4.3 gives a skin contamination dose
>equivalent for I-131 of 1694 mSv per square centimetre per MBq per hour.
>
>During the first night after oral administration of the radioactivity, it
>would not be unusual for the patient to void 10% of the activity, which
>would be trapped over a surface area in her diaper of about 100 cm^2.
>Assuming the patient sleeps 8 hours with 10 mCi (370 MBq) or more of
>excreted I-131 in her diaper (direct contact with her skin), she could
>theoretically receive a skin dose of 50 Sv per cm^2 - which could lead to a
>spectrum of nasty skin effects, including erythema, moist desquamation,
>total breakdown. The threshold dose for moist desquamation is 15 Sv. And
>that's just the skin dose for the first night. The skin in that area is
>already fragile and vulnerable to breakdown because of constant exposure to
>ammonia in the urine - have you ever seen a baby with diaper rash?? Very
>nasty and long-term effects for the patient, plus high potential for a
>successful medical malpractice suit against the physican and medical
>institution.
>
>If this were our patient, I would strongly recommend hospitalizing the
>patient for at least 48 hours so that she could be catheterised with the
>shielded "hot" urine collection bag emptied to the toilet every few hours by
>trained nursing staff. I would make sure the patient is very well-hydrated
>(I.V. drip) and/or lots of liquid orally to flush out of her system the
>radioactivity not taken up by the target tissue As a matter of fact, I have
>done this for an incontinent patient in diapers being treated for Graves
>disease with much less activity - when we expected only about 5 mCi excreted
>via the urine.
>
>Regards,
>
>Karin
>Gordon**********************************************************************
>**
>*****************
>Karin Gordon RTR, RTNM, RTT
>Radiation Safety Coordinator
>Winnipeg Regional Health Authority
>Health Sciences Centre
>GC-214, 820 Sherbrook Street
>Winnipeg, Manitoba
>CANADA, R3A 1R9
>
>phone (204) 787-2903
>fax (204) 787-1313
>e-mail kgordon@hsc.mb.ca
>************************************************************************
>*****************
>
>Message-----
>From: Douglas Simpkin [mailto:dsimpkin@execpc.com]
>Sent: Monday, June 19, 2000 12:37 PM
>To: Multiple recipients of list
>Subject: incontinent patient dosed with ~100 mCi of I-131
>
>
>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
>
>************************************************************************
>The RADSAFE Frequently Asked Questions list, archives and subscription
>information can be accessed at http://www.ehs.uiuc.edu/~rad/radsafe.html
>
>************************************************************************
>The RADSAFE Frequently Asked Questions list, archives and subscription
>information can be accessed at http://www.ehs.uiuc.edu/~rad/radsafe.html
DAVID W. LEE, CHP
Los Alamos National Laboratory
Radiation Protection Services
Radiological Engineering Team Leader
ESH-12, MS K483
Los Alamos, NM 87545
PH: (505) 667-8085
FAX: (505) 667-9726
lee_david_w@lanl.gov
--=====================_24041968==_.ALT
Content-Type: text/html; charset="us-ascii"
<html>
<font size=3>RADSAFERS:<br>
<br>
Stupid question #3 or #4 so far on this thread. If this incontinent
patient's attending physicians already agree/know that the patient is
incontinent, what is so difficult about catheterizing the patient and
collecting the radioactive urine in a bag/bottle which could then be
periodically poured down the hospital commode by a hospital radiological
control technician supporting this operation?<br>
<br>
Best regards David W. Lee, Radiological Engineering Team Leader,
Los Alamos National Laboratory (lee_david_w@lanl.gov), PH: (505)
667-8085; FAX: (505) 667-9726<br>
<br>
<br>
<br>
<br>
At 03:23 PM 06/19/2000 -0500, you wrote:<br>
<blockquote type=cite cite> I assume your patient has thyroid
cancer, has undergone a sub-total<br>
thyroidectomy and you are treating her with 100 mCi (2.7 GBq or 2700 MBq)
of<br>
I-131 to ablate post-surgical thyroid tissue remnants, or you are
treating<br>
post-thyroidectomy metastatic disease. In this case, you would
expect the<br>
patient to excrete >95% of the administered activity, primarily
through the<br>
urine. I would have a great deal of concern about potential
deterministic<br>
radiation effects to the skin of the buttocks and genitals of this
patient.<br>
NCRP Report #111 "Developing Radiation Emergency Plans for Academic,
Medical<br>
or Industrial Facilities" table 4.3 gives a skin contamination
dose<br>
equivalent for I-131 of 1694 mSv per square centimetre per MBq per
hour.<br>
<br>
During the first night after oral administration of the radioactivity,
it<br>
would not be unusual for the patient to void 10% of the activity,
which<br>
would be trapped over a surface area in her diaper of about 100
cm^2.<br>
Assuming the patient sleeps 8 hours with 10 mCi (370 MBq) or more
of<br>
excreted I-131 in her diaper (direct contact with her skin), she
could<br>
theoretically receive a skin dose of 50 Sv per cm^2 - which could
lead to a<br>
spectrum of nasty skin effects, including erythema, moist
desquamation,<br>
total breakdown. The threshold dose for moist desquamation is 15
Sv. And<br>
that's just the skin dose for the first night. The skin in that
area is<br>
already fragile and vulnerable to breakdown because of constant exposure
to<br>
ammonia in the urine - have you ever seen a baby with diaper rash??
Very<br>
nasty and long-term effects for the patient, plus high potential for
a<br>
successful medical malpractice suit against the physican and
medical<br>
institution.<br>
<br>
If this were our patient, I would strongly recommend hospitalizing
the<br>
patient for at least 48 hours so that she could be catheterised with
the<br>
shielded "hot" urine collection bag emptied to the toilet every
few hours by<br>
trained nursing staff. I would make sure the patient is very
well-hydrated<br>
(I.V. drip) and/or lots of liquid orally to flush out of her system
the<br>
radioactivity not taken up by the target tissue As a matter of fact, I
have<br>
done this for an incontinent patient in diapers being treated for
Graves<br>
disease with much less activity - when we expected only about 5 mCi
excreted<br>
via the urine. <br>
<br>
Regards,<br>
<br>
Karin<br>
Gordon**********************************************************************<br>
**<br>
*****************<br>
Karin Gordon RTR, RTNM, RTT<br>
Radiation Safety Coordinator<br>
Winnipeg Regional Health Authority<br>
Health Sciences Centre<br>
GC-214, 820 Sherbrook Street<br>
Winnipeg, Manitoba<br>
CANADA, R3A 1R9<br>
<br>
phone (204) 787-2903<br>
fax (204) 787-1313<br>
e-mail kgordon@hsc.mb.ca<br>
************************************************************************<br>
*****************<br>
<br>
Message-----<br>
From: Douglas Simpkin
[<a href="mailto:dsimpkin@execpc.com"; eudora="autourl">mailto:dsimpkin@execpc.com</a>]<br>
Sent: Monday, June 19, 2000 12:37 PM<br>
To: Multiple recipients of list<br>
Subject: incontinent patient dosed with ~100 mCi of I-131<br>
<br>
<br>
Folks:<br>
<br>
Ignorant question time!<br>
<br>
Our nuclear medicine physicians are talking about treating an incontinent
<br>
patient with ~100 mCi of I-131. Even if we hold her (and her diapers) in
<br>
the hospital for a few days, she'll still be generating I-131 waste once
<br>
she gets home.<br>
<br>
How would others handling this?<br>
1. Ignore waste she generates at home, and hope the landfill
doesn't<br>
monitor.<br>
2. Have her collect her own waste for decay in her basement?<br>
3. Have her collect her own waste, and we then pick up the trash for
<br>
decay-in-storage here. What are the DOT repercussions of me having a
<br>
trunk-full of hot Depends?<br>
<br>
Any comments?<br>
Thanks,<br>
Doug<br>
Douglas J. Simpkin, Ph.D., D.A.B.R.<br>
St. Luke's Medical Center<br>
2900 West Oklahoma Avenue<br>
Milwaukee, WI 53215<br>
phone: (414)649-6457<br>
fax: (414)649-5118<br>
email: dsimpkin@execpc.com<br>
<br>
************************************************************************<br>
The RADSAFE Frequently Asked Questions list, archives and
subscription<br>
information can be accessed at
<a href="http://www.ehs.uiuc.edu/~rad/radsafe.html"; eudora="autourl">http://www.ehs.uiuc.edu/~rad/radsafe.html</a><br>
<br>
************************************************************************<br>
The RADSAFE Frequently Asked Questions list, archives and
subscription<br>
information can be accessed at
<a href="http://www.ehs.uiuc.edu/~rad/radsafe.html"; eudora="autourl">http://www.ehs.uiuc.edu/~rad/radsafe.html</a></font></blockquote><br>
<br>
<font size=3>DAVID W. LEE, CHP<br>
Los Alamos National Laboratory<br>
Radiation Protection Services<br>
Radiological Engineering Team Leader<br>
ESH-12, MS K483<br>
Los Alamos, NM 87545<br>
PH: (505) 667-8085<br>
FAX: (505) 667-9726<br>
lee_david_w@lanl.gov<br>
</font></html>
--=====================_24041968==_.ALT--
************************************************************************
The RADSAFE Frequently Asked Questions list, archives and subscription
information can be accessed at http://www.ehs.uiuc.edu/~rad/radsafe.html
************************************************************************
The RADSAFE Frequently Asked Questions list, archives and subscription
information can be accessed at http://www.ehs.uiuc.edu/~rad/radsafe.html