The way
we have our procedures set up is authorized users or authorized technicians by
virtue of their training and experience are authorized to handle rad
material. This being the case, the surgeons are not either trained or
authorized to handle rad material. This being said, if it is determined
medically that the surgeon needs to perform the injection, this is allowed if
the rad material is under constant surveillance of an authorized user/technician
at all times. In practice this means in your case, the technician or
authorized user would have to bring the dose to the OR and watch while it was
being physically being injected. The tech/user would then be responsible
for meter surveys, contamination control, etc. upon completion of the
procedure.
This touches on the
other question that I originally posed. What is the consensus of the
community on these procedures. It is, I think, accepted that the exposure
to personnel from the nodes, and the contamination, as long as universal
precautions are used, is minimal. However, once the surgeons start
performing injections, then consideration would have to be given to appropriate
education, and potentially dosimetry especially on the
hands.
The hope of many
physicians is the lab evaluation of the nodes can be done while the patient is on the table. They hope the link
between the node results and metastases are strong enough to make the medical
call for further, more radical, procedures or not. If this can be
concluded, the docs can avoid reopening the patient at a later date once the
node eval is done.
The issues
with this process are many.
1. Dosimetery for the staff during the
procedure?
2. Contamination
control in the OR for instruments, table,
etc.
3. Waste issues - the
gause etc will have Tc-99m on it, will placing this into the regular waste
stream be a problem?
4. If
the node is evaluated in the lab at a later time, how much later does it have to
be to not worry about contamiation in the lab (remember 200
dpm/100cm^2).
5. If the node
is evaluated immediately, then do we have to train the lab personnel? Do
we have to set up a rad use area? Do we have to do
surveys?
Clearly our goal is
to assist the physicain do procedures and do them safely. From a regultory
stand point what are the requirements we need to follow?
LOUIE TONRY, CHP
MAJOR,
MS
Chief, Radiation Protection
Division
Eisenhower Army Medical Center
ATTN: MCHF-LOG-HP (Radiation
Protection), Box 264
Ft. Gordon, Georgia 30905-5650
Voice:
Facsimile:
DSN: 773-4692/6392
DSN:
773-3427
Commercial:
(706) 787-4692/6392 Commercial: (706)
787-3427
Internet:
Louie.Tonry@SE.AMEDD.ARMY.MIL
-----Original
Message-----
From: Chris Alston [mailto:alstonc@odrge.odr.georgetown.edu]
Sent:
Wednesday, August 23, 2000 5:55 PM
To: Multiple recipients of
list
Subject: sentinel node
>From: Charles Narayanan
<Iyer77@AOL.COM>
>
>Hi!
>One of our surgeons is doing
breast sentinel node biopsies.
>
>Now he wants to start a new
protocols for Colon cancer where they open up the
>abdomen and inject
Technetium. In this case they will be actually injecting
>the
radiopharmaceutical and not Nuc. med techs.
>How are the surgeons covered
in ref. to NRC Regulations.
>Can they do it under the so called
supervision of the Radiologists(NUC>MED)
>Do they need any formal
classroom training.
>Do they need to be trained to handle
spills.
>
>Would appreciate some input.
>Thank
you.
>
>Charles
Narayanan
************************************************************************
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