Re: safety guide to patients

["Mike Bohan" <mike.bohan@yale.edu>]

        Reply to:   RE>safety guide to patients who is a day care teacher and...

To whomever Rywu@aol.com is, (Hint! Hint!)

This is a tough question.

1. It is too specific for the SNM or others to prepare a generic guide for it.

2. I would educate the patient, so he/she would have a good understanding as to
the exposure/contamination issues involved.

3. How would the parents know about the day care teacher's condition?  Was her
medical privacy compromised by her employer or did she voluntarily reveal the
information to the parents?  This could, under the wrong circumstances cause
significant problems for all parties concerned.  Sometimes ignorance is bliss
and ethical also!  (See later analysis)

4. My general recommendation (I have no authority to order!), would be to wait 1
week.  At that time, any unbound I-131 would be low on the skin, and
contamination concerns from normal contact would be minimal.  Although, I would
recommend frequent hand washing & daily showering for CYA purposes.  

Also, the type of I-131 treatment might be important to know for external dose
rate estimates.  Hyperthyroidism  is generally treated with 5-29.9 mCi
(regulatory release limit).  These patients generally have an uptake of >50%, so
even after a week, external dose rates @ 1 meter could be 2 - 3 mR/hr, assuming
an uptake of 50%, an effective T1/2 of 7 days and an exposure conversion factor
of 5 mR/mCi-hr.  A Thyroid cancer patient with minimal mets and near total
thyroidectomy has an uptake usually < 2-3% and a initial treatment dose of 100 -
200 mCi.  Using the appropriate assumptions, estimated external dose rates of
0.5 - 1 mR/hr @ 1 meter after 1 week.

4. There is NO WAY to confirm to parents that there is NO RISK (What an
OXYMORON!!!???).  However, in virtual reality (see prior threads on this), the
likelihood of significant health hazards, to the children, with a conscientious
day care worker are nil!

5. As an RSO, your legal responsibility is to educate the patient as best you
can about the issues and then get out of the way!  Then it becomes the patient's
responsibility.  If you do any more, you risk violating the patient's privacy
rights, which can also get you into trouble.  

Boy, Professor Peabody, Where the ethical reality on this one???

Mike Bohan,

Hard working, tired, RSO at the end of the day.  UT OH!, my wife's calling me to
tell me to COME HOME!  LATER!!!  {8*)]

<><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><
Michael J. Bohan, RSO   |  e-mail: mike.bohan@yale.edu
Yale-New Haven Hospital |    Tele: (203) 785-2950
Radiological Physics    |     FAX: (203) 737-4252
20 York St. - WWW 204   |    As usual, everything I say may be plausibly
New Haven, CT    06504  |    denied at my employer's convenience ...
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--------------------------------------
Date: 27/06/96 10:50 AM
To: Mike Bohan
From: radsafe@romulus.ehs.uiuc.edu
Society of Nuclear Medicine published a safety guide for nursing mother who
under the I-131 treatment. Anybody know if there is a guide for day care
teacher who under the treatment of I-131. When can they resume their duty
after the treatment? How to confirm to the parents that their child has
NO-RISK under the care the this teacher? As an RSO, what is the legal
responsibity. Thanks for advise.