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Re: Contamination from Nuc Med patients

At 08:52 AM 4/2/98 -0600, you wrote:
>How would you handle the following
>incident?  An in-patient given Tc-99m as
>part of a nuclear medicine diagnostic
>procedure becomes incontinent,
>contaminating bedding and part of the
>hospital room.  Should radiation safety
>respond to the incident?  If so, should
>round-the-clock coverage be available
>and a written notification procedure be
>in place?  If not, should the nursing
>staff clean the area following universal
>precautions? Should the nursing staff be
>given radiation safety training
>annually?  What regulatory limits are
>involved?  Is there a practical limit on
>controlling the freedom of a patient?
>Any comments will be appreciated!
>Bill Stephany
>Assistant RSO
>Medical College of Georgia
>Augusta, GA 30912-7520
>(706) 721-9832
>Dear Bill:

This is an easy one.  There is nothing for rad safety to do at all, because
the radiation dose is insignificant.  I guess you don't know how to do these
calculations.  Start with Appendix 1 of NCRP Report no. 37 (1970); the
specific gamma ray constant of Tc-99m in 0.78 R/hr/mCi at 1 cm. You can
usually make a simple model using the information in the package insert or
the USP-DI; a qualified nuclear medicine physician can help you too.  

NRC's recent "Patient Discharge" rule is the operative regulatory limit.
However, don't bother to read NRC's mathematically and medically idiotic Reg
Guide;  the pathetic fools can't even understand a first order rate
equation, and the document is a national embarassment.  

As far as controlling the freedom of a patient, forget it.  Legally, I
cannot even keep a patient in the hospital when there really IS a
possibility of overexposure to a member of the general public.  I did hold a
patient once by getting the local health department to cooperate with me and
quarantine a patient for being "contagious"; a bit far-fetched but it
worked.  I once held a dumb vet in a VA hospital by getting a full colonel
to scare the living shit out of him, but it was all baloney.  If you try to
hold a patient against his will, it's "battery".  

If I can help you with any specific calculations, let me know.

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