Re: Release of Patients Receiving Therapeutic Doses of Radionuclides

[Ccja@aol.com]

The first thing I'd suggest is talking with your director of risk management
(I hope that she/he's a member of your Rad Safety Committee). From the
medical center's POV, this would seem to be, effectively, a special case of
leaving against medical advice, which happens more often than one might
readily believe. Beyond that, the patient and his/her family should be given
instructions to keep exposures to other persons within regulatory limits and
ALARA, just as they would if it were a routine discharge. I also would think
that the regulatory authorities should be notified, since this is clearly out
of bounds. The question would be: on what schedule would the notification be
required? I assume that such an incident would be a part of your routine
reporting to your Committee (quarterly meetings, annual audit, etc.), and the
licensing entity would of course review those records on routine inspection.
There are rules (10CFR20.2203, etc.) on the reporting of overexposures, but
it's not entirely clear to me that they'd be applicable, or how one would
show that they were, or not (badging of the patients family, or the usual
assumptive time study calculations?). If it were I, I'd call my licensing
people and bat it around. It's a very good question though and one that I've
not had to face in the real world.

I am curious to know what sort of permanent implants are done, such that
there is a real possibility of significantly increased exposure to the
general public, if a patient leaves before they're officially released. We
haven't done these for several years (it's all HDR, now), and anyway the only
permanent implants of which I have experience are I125 and Pd103 for prostate
Ca. There we're talking about ~1 mrem/h at a meter (I125), is my
recollection, and the dose rate doesn't change importantly (again I125) over
the first few days after implantation. The only difference is that a patient
is much more likely to pass a seed transurethrally in the first 48h
post-implant, but it's hard to see how anyone could get a significant dose as
a result, since more often than not it's emitted during urination.