Release of I-131 Patients

["Richard, Mack L" <mrichar@iupui.edu>]

Dear Radsafers:

In response to a few non-medical HPs that have expressed interest in the
release of I-131 patients - Don't you know that radiation from these
patients is "good" radiation, but radiation from power plants is "bad"
radiation??!!! - JUST KIDDING!!!

I do agree that 500 mrem is 500 mrem, regardless of the source.  Fortunately
(from the medical community's standpoint), nuclear medicine physicians did a
good job of selling the idea that the release of these patients probably
constitutes very little radiation hazard.  Basically, it boils down to
perspective - it's OK to expose the general public to a little radiation if
we are treating cancer, but it's not OK to expose them to the same amount to
generate electrical power.  I'm not saying what's right - I'm just saying
what is (at least in my opinion).

Another issue regarding I-131 patients is the cost of hospitalization.  Both
now and in the past, most patients treated with I-131 do/did not require
hospitalization for medical care reasons.  It's purely a matter of isolating
them to protect the general public at a cost of greater than $1000 per day
for a hospital room.  I've never understood why the medical insurance groups
never questioned this.  I would bet that as more and more hospitals elect to
release these patients, the medical insurance groups will really pressure
all hospitals to follow suit.  I'm not an expert on medical insurance
carriers, but I believe that the trend is for medical insurance to pay a
specific amount for a certain disease.  If the patient is hospitalized, the
cost may exceed what the insurance carrier pays.  Thus, the hospital either
has to eat the additional cost or the patient must pay the difference out of
his/her pocket.  Again, this is my perspective which may or may not be
correct.

I would like to point out that we medical folks don't just administer 100 to
200 mCis of I-131 and tell the patient, "Don't let the door hit you in the
behind on the way out."  Realistically, the individuals most likely to
receive the highest effective doses from these patients are other members of
their family.  At our facility, we go through a fairly extensive
questionnaire which gives us a reasonable idea of the patient's home
situation.  We also ask a question about their occupation (e.g., do they sit
next to a co-worker 8 hours/day).  Based upon the answers to these questions
we make a determination of how much I-131 can be administered to the patient
without requiring hospitalization and/or if the patient should be
hospitalized.  We also provide the patient with written instructions (as
required by NRC), some of which may be specific to the patient's situation.
The doctor goes over these instructions with the patient and both the
patient and the doctor sign them.  

You can certainly argue that the patient may not understand the instructions
or simply elect not to follow them; however, our doctors are pretty good at
identifying such patients and will hospitalize them if necessary.
Realistically, most patients are willing to follow these instructions to
protect their family members.  We have even had a couple of patients who
requested to be hospitalized to protect their family (they had small
children at home).  In addition to the written instructions, we are
currently developing an automated "Powerpoint" presentation to help the
patient understand the importance of following the instructions.

It seems that I have heard of a couple of facilities that have attempted to
measure external dose equivalents to the family members of I-131 patients by
issuing film or TLD badges to those family members.  Anyone know about this
and if so, where we can view the results?  That would be interesting.

Mack L. Richard, M.S., C.H.P.
Radiation Safety Officer - IUPUI/Indiana Univ. Med. Cntr.
Phone #: (317) 274-0330   Fax #: (317) 274-2332
E-Mail Address:  mrichar@iupui.edu

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