[Date Prev][Date Next][Thread Prev][Thread Next][Date Index][Thread Index]
RE: overexposure - mother breast feeds child after I-131
Based on the clearance and uptake data available for I-131, the effective
dose (if this means anything at these levels) could be as high as 10.3 Sv
or 1003 rem to the child.Depends very much on the age of the child, volume
and frequency of the feeds, time after administration of the dose at which
feeding resumed etc etc.
For anyone interested in doses to infants from breast feeding, a summary
document is available in html format (breast_Milk.htm) on the
ftp.largnet.uwo.ca anonymous ftp server. Login as anonymous and cd to
/pub/nucmed/Programs. Alternatively, point your web browser at
ftp://ftp.largnet.uwo.ca/pub/nucmed/Programs/breast_Milk.htm
Cheers
John Cormack
>At 02:40 PM 8/10/98 -0500, you wrote:
>>Just for grins .....
>>
>>I measured the child's uptake on 8/3 and calculated a 2.7uCi. In order to
>>provide a conservative estimate of the radiation dose I assumed that the
>>material was delivered on 7/28, the day the mother was administered. Back
>>decaying the activity to 7/28, the activity is on the order of 5uCi. Using
>>the MIRDose 3 program and an residence time of 276 hours, provides a dose of
>>184 rads.
>>
>>-----Original Message-----
>>From: radsafe@romulus.ehs.uiuc.edu
>>[mailto:radsafe@romulus.ehs.uiuc.edu]On Behalf Of carol marcus
>>Sent: Monday, August 10, 1998 11:08 AM
>>To: Multiple recipients of list
>>Subject: Re: overexposure - mother breast feeds child after I-131
>>
>>
>>At 09:06 AM 8/10/98 -0500, you wrote:
>>>HOSPITAL | |EVENT NUMBER: 34618 |
>>>
>>>+----------------------------------+ +-----------------------+
>>>
>>>
>>>
>>>+------------------------------------------------+-------------------------
>>----
>>>+
>>>|LICENSEE: WESTERN PENNSYLVANIA HOSPITAL |NOTIFICATION DATE:
>>>08/07/98
>>>|
>>>| CITY: PITTSBURGH REGION: 1 |NOTIFICATION TIME: 17:03
>>>[ET]|
>>>| COUNTY: ALLEGHENY STATE: PA |EVENT DATE:
>>>07/28/98
>>>|
>>>|LICENSE#: AGREEMENT: N |EVENT TIME:
>>>12:00[EDT]|
>>>| DOCKET: |LAST UPDATE DATE:
>>>08/07/98
>>>|
>>>|
>>>+-----------------------------+
>>>| |PERSON
>>>ORGANIZATION|
>>>| |TOM MOSLAK RDO
>>>
>>>|
>>>| |FRED COMBS, NMSS EO
>>>
>>>|
>>>+------------------------------------------------+
>>>
>>>|
>>>|NRC NOTIFIED BY: MILE PACILIO, RAD SAF OFF |
>>>
>>>|
>>>|HQ OPS OFFICER: DICK JOLLIFFE |
>>>
>>>|
>>>+------------------------------------------------+
>>>
>>>|
>>>|EMERGENCY CLASS: NOT APPLICABLE |
>>>
>>>|
>>>|10 CFR SECTION: |
>>>
>>>|
>>>|BAE1 20.2202(b)(1) PERS OVEREXPOSURE |
>>>
>>>|
>>>| |
>>>
>>>|
>>>| |
>>>
>>>|
>>>| |
>>>
>>>|
>>>| |
>>>
>>>|
>>>+------------------------------------------------+-------------------------
>>----
>>>+
>>>
>>> EVENT TEXT
>>>
>>>+--------------------------------------------------------------------------
>>----
>>>+
>>>| - OVEREXPOSURE OF A 4 YEAR OLD CHILD DUE TO BREAST FEEDING BY HIS
>>MOTHER -
>>>
>>>|
>>>|
>>>
>>>|
>>>| ON 07/28/98, A 43 YEAR OLD FEMALE PATIENT REPORTED TO WESTERN
>>PENNSYLVANIA
>>>
>>>|
>>>| HOSPITAL TO BE EVALUATED FOR THYROID ABLATION THERAPY. DURING
>>>CONSULTATION
>>>|
>>>| WITH HOSPITAL PERSONNEL, THE PATIENT DENIED BREAST FEEDING HER 4 YEAR OLD
>>>
>>>|
>>>| SON. THE PATIENT CLEARLY HAD THE ABILITY TO SPEAK AND UNDERSTAND THE
>>>
>>>|
>>>| ENGLISH LANGUAGE. A HOSPITAL RADIATION TECHNOLOGIST ADMINISTERED A 3.02
>>>
>>>|
>>>| MILLICURIE CAPSULE OF I-131 TO THE PATIENT IN PREPARATION FOR A WHOLE
>>BODY
>>>
>>>|
>>>| SCAN SCHEDULED ON 07/31/98.
>>>
>>>|
>>>|
>>>
>>>|
>>>| ON 07/31/98, THE PATIENT RETURNED TO THE HOSPITAL FOR A WHOLE BODY SCAN.
>>>
>>>|
>>>| THE PATIENT WAS COUNSELLED BY THE ATTENDING HOSPITAL PHYSICIAN AND A
>>>
>>>|
>>>| MEMBER OF THE HOSPITAL RADIATION SAFETY OFFICE CONCERNING THE PRECAUTIONS
>>>
>>>|
>>>| SURROUNDING THE IMPENDING ABLATION THERAPY SCHEDULED FOR 08/04/98. AFTER
>>>
>>>|
>>>| THIS COUNSELLING, THE PATIENT ADMITTED TO BREAST FEEDING HER SON DURING
>>>
>>>|
>>>| THE PREVIOUS THREE DAYS, STATING THAT SHE HAD BEEN TOO EMBARRASSED TO
>>>
>>>|
>>>| DISCLOSE THIS DURING HER PREVIOUS HOSPITAL VISIT. THREE HOSPITAL
>>>EMPLOYEES
>>>|
>>>| TOLD THE PATIENT TO IMMEDIATELY DISCONTINUE BREAST FEEDING HER SON.
>>>
>>>|
>>>|
>>>
>>>|
>>>| ON 08/03/98, THE PATIENT AND HER SON RETURNED TO THE HOSPITAL IN ORDER TO
>>>
>>>|
>>>| HAVE ANY UPTAKE BY HER SON ASSESSED. A BIOASSAY OF THE CHILD'S THYROID
>>>
>>>|
>>>| GLAND DETERMINED THAT IT HAD A BURDEN OF 2.7 MICROCURIES OF I-131, WHICH
>>>
>>>|
>>>| EQUATES TO AN ORGAN DOSE OF 184 RADS (TEDE = 5.5 RADS). DURING
>>SUBSEQUENT
>>>
>>>|
>>>| CONVERSATIONS WITH THE PATIENT, SHE REVEALED THAT SHE HAD CONTINUED
>>>
>>>|
>>>| TO BREAST FEED HER SON OVER THE WEEKEND, INCLUDING IMMEDIATELY BEFORE
>>>
>>>|
>>>| REPORTING TO THE HOSPITAL FOR THE BIOASSAY.
>>>
>>>|
>>>|
>>>
>>>|
>>>| HOSPITAL PERSONNEL SUSPENDED ADMINISTERING ANY ADDITIONAL I-131 TO THE
>>>
>>>|
>>>| PATIENT AND ARE CONTINUING TO FOLLOW THE CONDITION OF THE PATIENT AND
>>>
>>>|
>>>| THE CHILD. THE HOSPITAL NUCLEAR PHYSICIAN NOTIFIED THE CHILD'S PHYSICIAN
>>>
>>>|
>>>| WHO IS COORDINATING FOLLOWUP CARE, INCLUDING ASSESSMENT BY A PEDIATRIC
>>>
>>>|
>>>| ENDOCRINOLOGIST AND PROTECTION BY THE LOCAL CHILD YOUTH SERVICES.
>>>
>>>|
>>>| THE HOSPITAL NUCLEAR PHYSICIAN ALSO NOTIFIED THE PATIENT'S ATTENDING
>>>
>>>|
>>>| PHYSICIAN AND SURGEON CONCERNING THIS INCIDENT IN ORDER TO COORDINATE
>>>
>>>|
>>>| THE PROTECTION OR TREATMENT ALTERNATIVES FOR THIS PATIENT.
>>>
>>>|
>>>|
>>>
>>>|
>>>| HOSPITAL PERSONNEL DO NOT PLAN TO ISSUE A PRESS RELEASE REGARDING THIS
>>>
>>>|
>>>| INCIDENT.
>>>
>>>|
>>>+--------------------------------------------------------------------------
>>----
>>>+
>>>
>>>
>>>************************************************************************
>>>The RADSAFE Frequently Asked Questions list, archives and subscription
>>>information can be accessed at http://www.ehs.uiuc.edu/~rad/radsafe.html
>>>
>>>Dear Radsafers:
>>
>>Does anyone have the actual dosimetry calculations for this case? Using
>>ICRP no. 53 for a 5-year old, and assuming the peak uptake is the measured
>>uptake, I calculate only 76 rad, about 2 1/2 times lower than stated.
>>
>>In any case, this dose is not expected to have any significance for the
>>child.
>>
>>Watch NRC spin-doctor this into a radiation emergency, and report this as an
>>Abnormal Occurrence to Congress! NRC will probably figure out some way to
>>blame the licensee, as well. After all, the breast-feeding incident in 1990
>>at Tripler in Hawaii was also entirely the mother's fault, yet the NRC's
>>Anapolis graduates blamed the Army docs at Tripler even though NRC's medical
>>consultant and the ACMUI blamed the patient's mother.
>>
>>************************************************************************
>>The RADSAFE Frequently Asked Questions list, archives and subscription
>>information can be accessed at http://www.ehs.uiuc.edu/~rad/radsafe.html
>>
>>************************************************************************
>>The RADSAFE Frequently Asked Questions list, archives and subscription
>>information can be accessed at http://www.ehs.uiuc.edu/~rad/radsafe.html
>>
>>Dear Radsafers:
>
>Michael Pacilio's calculations are certainly conservative, but perhaps
>somewhat more than necessary. A euthyroid adult will have maximum uptake at
>48 hours, with most of it taken up by 24 hours. Assuming 24 hours for a
>4-year old is probably conservative enough. The residence time listed for
>I-131 in a 5-year old with a 25% uptake (very reasonable) in ICRP is 2.32
>days, or only 56 hours.
>I have not run this on MIRDOSE 3, but plugging into the ICRP 53 table gives
>126 rad.
>
>Assessment by an endocrinologist gives the illusion that damage has occurred
>and may be evaluated. This is not so. 126 rad of CHRONIC radiation means
>between 12.6 and 63 rad of ACUTE radiation equivalent. There will be no
>observable effects, and nothing to treat. While the mother went over a
>regulatory limit, it is important to realize that this radiation dose will
>not harm her child. The psychological effects of breast feeding at this age
>might be a lot more significant.
>
>If the licensee, and the NRC, act AS THOUGH harm were done, you will then
>fill this poor woman with a great deal of fear and guilt, causing
>irreparable damage to her, while nothing has actually happened to the child.
>
>As far as treatment alternatives for the mother are concerned, there are
>none. She should be told that she must stop breast feeding now for her own
>good (the ability to treat her) and her child's good (breastfeeding after a
>therapy dose would cause more radiation dose to her child), and that's that.
>No fuss, no guilt, no regulatory bullshit or propaganda. This is why NRC
>needs to be removed from medical practice issues. Shall we start a pool to
>estimate how much User Fee money NRC will waste on this nonevent?
>
>Ciao, Carol
>
>Carol S. Marcus, Ph.D., M.D.
><csmarcus@ucla.edu>
>
>************************************************************************
>The RADSAFE Frequently Asked Questions list, archives and subscription
>information can be accessed at http://www.ehs.uiuc.edu/~rad/radsafe.html
_____________________________________________________
John Cormack
Chief Medical Scientist
Division of Medical Imaging
Flinders Medical Centre
Bedford Park
South Australia 5042
Ph:08-8204-4642 National, 618-8204-4642 International
Fax:08-8204-5450 National, 618-8204-5450 International
************************************************************************
The RADSAFE Frequently Asked Questions list, archives and subscription
information can be accessed at http://www.ehs.uiuc.edu/~rad/radsafe.html