NRC PROPOSES $6,000 FINE AGAINST ST. JOSEPH MERCY HOSPITAL IN MICHIGAN FOR OVEREXPOSURE TO A MEMBER OF THE PUBLIC

[Carol Marcus <csmarcus@ucla.edu>]

Dear Radsafers:


I have been interested in this interchange, and am quite surprised that

no one has strongly questioned the radiation dose range alleged by the

NRC.  Having performed many hundreds of these calculations over the

years (I had the "500 mrem rule"  years before anyone else

in the country), I immediately thought that the dose numbers were highly

inflated.  Due to the fact that we are not given the actual data of

how long the most exposed member of the family was actually at the

bedside, and have no real information about the patient's clearance rate

of I-131, I made a number of calculations assuming several different

situations.  I also made a measurement of the distance between the

center of gravity of a patient lying in bed and the center of gravity of

a visitor sitting at the bedside (that is, umbilicus to

umbilicus).


I asked my husband to lie down in bed and I brought up a chair and sat

beside him, facing him.  One cannot sit too close, because it is

necessary to have room for your legs.  The measurement was several

inches longer than my yardstick, or about a meter.  So, I will use

one meter as the distance in these calculations.  Arguing that the

family member was closer than that is difficult to substantiate with

actual measurement.  Try it yourself.


I don't know why the patient died, but it may have been from

complications of thyroid cancer or something unrelated.  Plenty of

people die of thyroid cancer, but these are the people whose tumors no

longer take up significant quantities of radioiodine.  The large

dose given (285 mCi) suggests that this was a patient with a large tumor

burden and a low, very low, or perhaps even indiscernible uptake of

radioiodine but a high thyroglobulin.  The uptake in the tumor would

probably have been negligible, and most probably no higher than a small

fraction of 1 per cent.  Using the fact that NRC criticized the

hospital for not shielding the urine bag, I assume that the urine bag

held very radioactive urine, and that the patient therefore had renal

function.  


NRC is notorious for ignoring shielding and assuming that the patient is

an unshielded point source.  (This was seen in 94 calculations

performed in the infamous Indiana, PA Ir-192 HDR accident, and is also in

the current NUREG 1556 vol. 9 assumptions).  However, the patient is

a shielded line source (Siegel JA, Marcus CS, and Sparks RB, J Nucl Med

2002; 43:1241-1244), and the shielding correction for I-131 is a factor

of 2.1 (Sparks RB, Siegel JA, and Wahl RL, Health Physics 1998;

75(4):385-388).   The NRC says it is being

"conservative".  I call it a physics and mathematics

"misadministration" of at least 100%, and in specific cases, up

to at least 1000%.  What sort of "violation" and fine

shall we give the NRC for such abuse of science?


While the NRC made a fuss about not keeping the member of the family

behind a shield, what kind of shield was it?  While radiology

departments use shields for the low energy of x-rays used, this shielding

is not significantly useful for 364 kev photons of I-131.  Just how

much protection would it have given?

 

My first calculation, using the method of NCRP no. 37, Appendix I, 

assumes that virtually nothing goes to thyroid cancer tissue, wherever it

is, and that the I-131 has a slowed renal excretion halftime

characteristic of that seen in some hypothyroid patients (as the patient

may well have been).  I assumed a renal clearance halflife of 12

hours.  I assumed that the most highly exposed family member was at

the bedside 25% of each day for 6 days.  The effective halflife is

0.47 days.  Without taking into account radiation from the urine

bag, which probably was emptied at least each shift, and would be about a

meter away from the member of the family, the member of the family

received approximately 120 mrem.  If the member was at the bedside

12 hours/day, that would be 240 mrem.  If, on the other hand, the

patient was in complete renal failure and none of the I-131 was excreted

in the urine, and none in the feces (this is not really true; a

significant amount would come out in the feces in renal failure

patients), and the patient was not on dialysis, a member of the family at

the bedside would receive about 850 mrem if there for 25% of the time, or

1.7 rad if there 50% of the time.  Such a scenario is quite

doubtful, because (1) we know that there was significant radioactivity in

the urine bag, and (2) the radiation dose to the patient's marrow would

probably have eventually been lethal, so no competent physician would

have done this.


So, where does 3 to 15 rem come from? Nowhere credible.  As I see

it, the member of the family elected to get a radiation dose that is

judged safe for radiation workers, in order to be with a dying

relative.  Seems reasonable to me.


It may be reasonable to point out that 10 CFR Part 20 includes the last

sentence of 20.1001:  "However, nothing in this part shall be

construed as limiting actions that may be necessary to protect health and

safety."  I would sincerely argue that the mental health of the

member of the family comes under this clause, and that the standards need

not apply.  The care and peace of mind of the dying patient should

be considered as well.  While I would go to great lengths to prevent

a member of the family from receiving a dose that I know to be harmful, I

don't see any reason to become hysterical about a dose that is about what

a radiation worker may receive in a year, or significantly less.  In

NCRP no. 37, it is recommended that family members over 45 not receive

more than 5 rads from the patient.  I don't know how old the family

member in question was, but clearly there are standards that would

support much higher radiation doses than the NRC seems prepared to permit

in extreme circumstances.


In Emergency Departments throughout the country, parents hold down

screaming children with broken bones so that they can get an x-ray. 

Is this minimizing dose to members of the public?  No, of course

not, and so what?


This case is a perfect example of why the National Academy of

Sciences-Institute of Medicine recommended in 1996 that NRC's medical

program be eliminated, and the Atomic Energy Act changed to prevent NRC

from ever interfering with medical and medical research uses of byproduct

material again.


What has really happened?  A licensee gave adequate instructions to

a member of the family who, in a circumstance that became impending

death, decided not to take the licensee's advice.  Why fine anyone,

or screech about "violations"?  None of this is

important.  The family could have taken the patient out of the

hospital the minute after the patient received the I-131, and the

licensee could not have done anything about it, nor could the NRC. 

Why is NRC making such a moral abortion out of this?  And why the

inflated dose estimation?  And why are  the Commissioners doing

nothing to stop this mindless, irrational, and dysfunctional use of

power?  You all know what I think of the NRC.  Judge for

yourself.


Ciao, Carol


Carol S. Marcus, Ph.D., M.D.

<csmarcus@ucla.edu>