RE: Release of I-131 Patients

[carol marcus <csmarcus@ucla.edu>]

At 09:08 AM 10/29/99 -0500, you wrote:
>Having a few years of Operational Health Physics Supervision behind me, I
>would be interested in some dialogue discussing the impact that has been
>witnessed from "Patients that have been released."
>
>I remember an episode when we had an individual set off our "Exit" monitors
>on his way into the plant.  To make a long story, and a long investigation
>short, this individual had visited a local restaurant, used the
>"facilities", and left.  Further investigation revealed that one of the
>restaurant employees had received Iodine treatment and been released.  This
>individual was using the same restroom that the patrons were utilizing.
>
>The impact was felt on the individual that could not start work when needed,
>the amount of time and effort spent on the investigation by power plant
>personnel and on the unknowing multitudes that used the same restroom.
>
>Hold your stones, grammar and spelling not checked intentionally, just want
>open, honest dialogue.
>
>Mark Settles
>Innovative Industrial Solutions, Inc.
>msettles@cswnet.com
>
>
>> -----Original Message-----
>> From: radsafe@romulus.ehs.uiuc.edu
>> [mailto:radsafe@romulus.ehs.uiuc.edu]On Behalf Of Richard, Mack L
>> Sent: Friday, October 29, 1999 8:36 AM
>> To: Multiple recipients of list
>> Subject: Release of I-131 Patients
>>
>>
>> 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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Dear Mark and Radsafers:

The problem was not the patient who was released.  The problem is NRC's
nonsensical requirements at power plants.  Fix those.

We had a related incident in Los Angeles at a sanitary landfill that had
installed highly sensitive NaI(Tl) detectors.  We were picking up diapers
and other remnants of nuclear medicine procedures.  One day Rad Health spent
hours trying to locate the radioactive trash in a truck, and it turned out
that the driver had had an NaI-123 thyroid scan and when he drove the truck
past the detectors, he set them off. We fixed the problem.  We measured all
trash with nuclear medicine contamination, and set the baseline of the
detector at 10x background and stopped "discovering" this problem.  All was
fine for years until a different agency took over, set the meter at 3x
background, and this "problem" occurred again.

The problem is not the patients.  It is foolish regulators who set limits
that are irrational, and cause all sorts of silly "problems" as a result.
Today, we have portable spectrometers and can even relay spectrometry
information to anyone with an identification program.  We could solve this
"problem" with state-of-the-art technology and good scientific sense.
Hello?  NRC?  Is anyone home?  Is this going to be the basis for the new
solid waste regs, or is it going to be another negotiated settlement with
antinuke hysterical liars?

Ciao, Carol

Carol S. Marcus, Ph.D., M.D.
<csmarcus@ucla.edu>

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