Death and Cremation of Prostate Seed Implant Patients

[Karin Gordon <KGordon@exchange.hsc.mb.ca>]

Hello Radsafers

In my frozen corner of Canada (Manitoba), we do not yet perform prostate
seed implant brachytherapy - but will probably start within the next year.
So a unknown number of our prostate Ca patients have been referred to cancer
treatment facilities both out of province (Ontario) and out of country (the
US)  where the procedure is available.  We have no central registry of
patients who have left Manitoba for this type of therapy.

An unknown number of these patients have since died (sometimes suddenly of
causes unrelated to their cancer, like heart attack and stroke).  We are
aware of some of them, but not all.  A year ago, one was discovered by a
pathologist, who called me when he found metal seeds in the prostate gland
after he had dissected out the organ at autopsy.  Only one (out of six) of
the local funeral homes requires the next of kin to fill out a
questionnaire, which includes questions about therapeutic procedures with
radioactive material. That funeral home has identified two such cadavers via
the questionnaire process within the last year.  The other funeral homes may
have unknowingly handled and processed such cadavers as well. 

As I have already indicated, we have not started performing this form of
therapy in our jurisdiction, and so had not developed precautions for
hospital or funeral home/crematorium workers handling cadavers with
permanent radioactive seed implants.  

Obviously this is an area of concern for the funeral industry, especially
regarding potential occupational risks related to the cremation of these
cadavers and subsequent handling and processing of the ash materials. The
funeral home that has identified these patients wants a set of precautions
to follow.

I would really appreciate advice from folks who have health physics
experience in this sort of permanent implant brachytherapy on the following
issues:

1) How do you instruct your patients and their next-of-kin about informing
post-mortem workers if the patient dies? Obviously, once dead, the patient
is a poor source of information.  The doctor signing the death certificate
may have no idea that the deceased contains radioactivity.
2) Do you have system for identifying cadavers with permanent radioactive
implants?
3) Do you allow cremation of such cadavers? 
4) If so, do the seeds rupture during cremation and what percentage of the
radioactivity in the seeds is volatized and released up the smoke stack
during the burn? 
4) Do you provide written precautions for  workers handling the remains?
5) Is there any literature on this topic?

 We wish to work with our local pathologists and funeral home industry staff
to develop reasonable protocols to identify such cadavers and then minimize
the related occupational radiation exposure to workers.

I'd greatly appreciate any wisdom you may  be able to contribute on this
topic.
You can send it to me directly at the e-mail address below or post it to
Radsafe, if you think it is of general interest to the list.

Thanks and Happy New Year

Karin

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Karin Gordon RTR, RTNM, RTT
Radiation Safety Office 
Winnipeg Health Sciences Centre
GC-214, 820 Sherbrook Street
Winnipeg, Manitoba
CANADA, R3A 1R9

phone   (204) 787-2903
fax        (204) 787-1313
e-mail    kgordon@hsc.mb.ca
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