Re: Strontium Therapy on In

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

        Reply to:   RE>Strontium Therapy on In patients

Hi Frank and the rest of you Radsafers:

This is one of those gray areas with little or no "official" guidance.  We
treat these Sr-89 in-patients with a modification of our I-131 Rx protocol. 
We cover the room because with a 50 day half-life it potentially could mean
closing a contaminated room down for quite some time.  The only difference is
we tell the nursing staff that these patients do not pose a significant source
of external exposure and we usually release them from isolation after 24 - 48
hours.  We follow up by inservicing the nursing personnel who get the patient
after release from isolation, if they are not released directly to home.    

Although, these patients meet the "current" NRC criteria for immediate
release, in-patients do pose a problem.  If they contaminate the room they're
in, it's part of your licensed facility, and subject to your license
conditions for removable activity upon release of the patient.  I haven't
posed this question directly to the NRC, but it's my interpretation of our
license conditions that we need to do it.  We wipe test the room using LSC and
calibrate the system with a Cl-36 LSC standard.

As for the second part of your question, all hospital staff should be
following good "Universal Precautions", which should handle the personnel
contamination hazard.  However, the O.R. is at risk for contamination unless
you are there to limit the contamination as best you can.  I think you would
be hard pressed to find a regulator who would say you could ignore these
issues with these patients.

Are there any regulators out there you might venture an "opinion" on this
issue???  Good question!!!


<><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><
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: 27/02/97 7:09 AM
To: Mike Bohan
From: radsafe@romulus.ehs.uiuc.edu
What is considered reasonable and desirable in terms of:
 
Waste handling/collection, room surveys, staff education, and room
preparation/posting for In-patient strontium-89 treatments?
 
Also, what should be done for these patients, or actually for house staff,
in the event of a need for emergency surgery on a treated patient or
events involving patient bleeding?
 
Frank P. Dawry
Miami, VAMC
dawry.frank@miami.va.gov