Caregiver or Family Doses due to Discharged $^{131}I$ Administrated Patient from the Hospital
0
Citation
0
Reference
11
Related Paper
Cite
Thirty‐three hyperthyroid patients treated with radioiodine (mean administered activity 414 MBq, range 163–555) were studied to determine if pretreatment dosimetry could be used to give radiation protection advice that could assure compliance with the effective dose constraints suggested by the European Commission. Effective doses to travelers, co‐workers, and sleeping partners were estimated by integrating the effective dose rate‐versus‐time curve obtained by fitting the dose rates measured several times after radioiodine administration to a biexponential function. The mean estimated effective doses to travelers, co‐workers, and sleeping partners were 0.11 mSv (0.05–0.24), 0.24 mSv (0.07–0.52), and 1.8 mSv (0.6–4.1), respectively. The best correlation was found between effective dose in mSv and maximum activity in MBq taken up in the thyroid: ; ; . Private/public transports are always allowed. For the co‐workers the effective dose constraint of 0.3 mSv is met without restrictions and with 3 days off work if is lower or higher than 185 MBq, respectively. For the sleeping partners the effective dose constraint of 3 mSv is met without restriction and with 4 nights separate sleeping arrangements if is lower or higher than 185 MBq, respectively. The potential for contamination by the patients was determined from perspiration samples taken from the patient's hands, forehead, and neck and in saliva at 4, 24, and 48 h after radioiodine treatment. The mean highest activity levels for hands, forehead, neck, and saliva were , and , respectively. The results indicate that there is minimal risk of contamination from these patients.
Radioiodine therapy
Cumulative dose
Equivalent dose
European commission
Cite
Citations (15)
Patients who receive therapeutic amount of 131I are potentially significant source of radiation to their family members and general public. The aim of this study was to estimate effective dose to family members of patients treated with radioiodine, released after 3 d of hospitalization and to compare with dose constraints proposed by international recommendations. The thermoluminescence dosemeters (TLD 100) and Radiation Dose Assessment Resource (RADAR) software were used for assessment of effective doses to 60 family members of the same number of hyperthyroid and thyroid carcinoma patients. Estimated effective doses were well below recommended dose limits except in a few cases. RADAR-calculated doses were higher than doses measured by TLD. Hyperthyroid patients should continue to be treated on outpatient basis but they should be well informed for their further behavior to provide minimal radiation hazard for the people in their environment.
Cite
Citations (3)
Thyroid cancer patients treated with high-dose radioactive iodine (3.7-7.4 GBq) are different from other people because after the administration, the radionuclide I-131 is excreted via urine, feces, saliva and breathing, and also via exposure to other patients. Caregivers of the patient may receive higher radiation doses than normal. The purposes of this study were to estimate the total effective dose equivalent from internal and external exposure to caregivers of patients treated with high dose I-131 admitted at Siriraj Hospital, and to compare the estimated dose with the dose constraint of 5 mSv per annum for caregivers. Thirteen caregivers of 13 patients who underwent radioiodine therapy for thyroid cancers following a standard protocol were given specific instructions with regard to radiation safety and were attached to an electronic personal dosimeter and a personal air sampler pump continuously to measure received radiation dose on a daily basis over three days in the hospital. On discharge day, caregivers were asked to perform an in vivo bioassay by the thyroid uptake instrument. The results from the thirteen caregivers were divided into 3 groups. The total effective dose equivalent to caregivers of patients administered 3.7 GBq (n = 1), 5.55 GBq (n = 9), and 7.4 GBq (n = 3) were 0.159 mSv, 0.123 to 0.629 mSv, and 0.631 to 0.718 mSv, respectively. There values were well below 5 mSv per episode as proposed in the IAEA Safety Reports Series No. 63 and the ICRP Publication 103.
Equivalent dose
Radioiodine therapy
Cite
Citations (0)
Radioiodine therapy of hyperthyroidism is the most frequently performed radiopharmaceutical therapy. To calculate the activity of 131-I to be administered for giving a certain absorbed dose to the thyroid, the mass of the thyroid and the individual biokinetic data, normally in the form of uptake and biologic half-time, have to be determined. The biologic half-time is estimated from several uptake measurements and the first one is usually made 24 hours after the intake of the test activity. However, many hospitals consider it time-consuming since at least three visits of the patient to the hospital are required (administration of test activity, first uptake measurement, second uptake measurement plus treatment). Instead, many hospitals use a fixed effective half-time or even a fixed administered activity, only requiring two visits. However, none of these methods considers the absorbed dose to the thyroid of the individual patient. In this work a simplified patient-specific method for treating hyperthyroidism is proposed, based on one single uptake measurement, thus requiring only two visits to the hospital. The calculation is as accurate as using the individual biokinetic data. The simplified method is as patient-convenient and time-effective as using a fixed effective half-time or a fixed administered activity. The simplified method is based upon a linear relation between the late uptake measurement 4-7 days after intake of the test activity and the product of the extrapolated initial uptake and the effective half-time. Treatments not considering individual biokinetics in the thyroid result in a distribution of administered absorbed dose to the thyroid, with a range of -50 % to +160 % compared to a protocol calculating the absorbed dose to the thyroid of the individual patient. Treatments with a fixed administered activity of 370 MBq will in general administer 250 % higher activity to the patient, with a range of -30 % to +770 %. The absorbed dose to other organs than the thyroid is also influenced. These doses should also be considered in estimating the risk of late radiation effects in the patients. This is becoming more important as an increasing number of younger patients are treated with radioiodine. If all Swedish hospitals considered the individual biokinetic data the total administrated activity of 131-I would decrease by 10 % (100 GBq) corresponding to a yearly collective effective dose of 17 manSv, thyroid excluded. Seventeen different methods to determine the administered activity of 131-I are in use in 23 Swedish hospitals. Only nine hospitals calculate the administered activity of 131-I using individual biokinetic data. More effort should be done to consider the individual biokinetic data when calculating the administered activity of 131-I and thus decrease unnecessary radiation dose to individual patients, their families and the public.
Radioiodine therapy
Cite
Citations (5)
The drive to reduce hospital stay after radioiodine remnant ablation in patients with thyroid cancer may increase the risk of radiation exposure to family members. The aim of this study was to evaluate the key determinants of dose exposure to familial members, with particular reference to the degree of adherence to current radiation safety guidelines.All participants prospectively received our standard departmental oral and written safety instructions, with a mandatory 3-day restriction period. The postmicturition radiation levels of treated patients were measured (at 1-m distance) at the time of discharge using a portable radiometer. The radiation exposure of cohabitants was assessed with an optically stimulated luminescence-based personal dosimeter during the 3 days after hospital discharge. A questionnaire was used to assess the adherence of relatives/cohabitants to radiation safety guidelines.A total of 38 patients with thyroid cancer and 48 household members were included. At 48 h post therapy, the patient's median emission at 1-m distance was 13.4 μSv/h. The mean cumulative cohabitant exposure was 102 μSv (<50-1000). A positive correlation between cohabitant radiation exposure and the radiation level of the patient was observed (P=0.016). This correlation was absent when the recommended guidelines were followed (P=0.56). Only 17 household members (35.4%) strictly followed the recommended guidelines, but dose exposures exceeded 0.3 mSv in only four cases, in which a mean of between 5.8 and 9.5 h were spent in close proximity to the patient in the first 3 days, including sleeping with treated patients in half of the cases.Despite poor compliance with safety guidelines, a short-stay protocol respects current legislation, and is applicable to most patients treated with 3.7 GBq for radioiodine remnant ablation.
Cumulative dose
Cite
Citations (14)
The purpose of this study was to evaluate the effective dose to family members of thyroid cancer and hyperthyroid patients treated with radioiodine-131, and also to compare the results with dose constraints proposed by the International Commission of Radiological Protection (ICRP) and the Basic Safety Standards (BSS) of the International Atomic Energy Agency (IAEA). For the estimation of the effective doses, sixty family members of sixty patients, treated with radioiodine-131, and thermoluminiscent dosimeters (Model TLD 100) were used. Thyroid cancer patients were hospitalized for three days, while hyperthyroid patients were treated on out-patient basis. The family members wore TLD in front of the torso for seven days. The radiation doses to family members of thyroid cancer patients were well below the recommended dose constraint of 1 mSv. The mean value of effective dose was 0.21 mSv (min 0.02 - max 0.51 mSv). Effective doses, higher than 1 mSv, were detected for 11 family members of hyperthyroid patients. The mean value of effective dose of family members of hyperthyroid patients was 0.87 mSv (min 0.12 - max 6.79). The estimated effective doses to family members of hyperthyroid patients were higher than the effective doses to family members of thyroid carcinoma patients. These findings may be considered when establishing new national guidelines concerning radiation protection and release of patients after a treatment with radioiodine therapy.
Radioiodine therapy
Cite
Citations (5)
Radioiodine therapy
Expression (computer science)
Cite
Citations (0)
Objective There is considerable variation in the national regulations of different countries for the release of patients from hospitals after radioiodine therapy. Individual variations make these practices, when based on the worst case scenarios, too restrictive for the majority of patients. However, there are cases in which strict rules are needed to comply with the dose limits to other individuals, especially children. We have developed a method to individualize radiation safety precautions. Materials and methods Twenty-three patients with differentiated thyroid carcinoma were included in the study. Four weeks after thyroidectomy, 1.1–3.7 GBq of radioiodine was administered and iodine kinetics were followed with external measurements until hospital discharge. The absorbed dose at the wrist holder was measured with thermoluminescence dosimetry (TLD) during hospital stay and after hospital discharge for up to 1 week. The TLD results were compared with the iodine kinetics. The dose to other individuals was estimated with extra TLDs located both on the patient's bed and given to family members. The kinetics data were fitted in both monoexponential and biexponential models and both for the full measurement period (down to the residual activity level<400 MBq) and for the first 24 h after radioiodine administration. Results The biexponential model was capable of predicting the cumulated dose up to 1 week for both the longer and the shorter measured data set. The occupancy factors both for a person sleeping on the same bed and for a person living in the same apartment with the patient were in agreement with the recommended occupancy factor values of the American Thyroid Association. From these findings it is possible to individualize radiation safety precautions by taking into account the iodine pharmacokinetics and living conditions of a patient. Conclusion By measuring the activity content within the body for the first 24 h after radioiodine administration it is possible to individualize radiation safety precautions for thyroid carcinoma patients.
Radioactive iodine
Dose
Cite
Citations (4)
Radionuclide therapy may produce a significant radiation exposure risk to the patient's caregivers. The study aims to assess the radiation exposure rate to caregivers after the patient's discharge from the isolation ward.Patients of the well-Differentiated thyroid cancer (DTC)were given high-dose radioiodine therapy as an inpatient. Their radiation exposure was measured daily, and they were discharged once the exposure rate falls as per standard guidelines. Detail counseling of the patient and caregiver about radiation safety was done before admission and at the time of discharge. Caregivers were given thermoluminescence dosimeter (TLD) to wear as a locket for 7 days. Radiation exposure received by the caregiver was measure after that.A total of 22 patients (8 male and 14 female) of DTC were recruited in the study. The mean age was 39.0 ± 14.5 years. Patients were treated with 3.79 ± 1.07 (102.4 ± 28.9 mCi) (1.85-5.55 (50-150 mCi) GBq of radioiodine. They were discharged from the isolation ward at a radiation level of 0.028 ± 0.015 mSv/h (3.193 ± 1.71 mR). The mean effective dose received by the caregiver was 14.60 ± 3.43 mSv (1460 ± 343 mR) (9.73-24.25 (973-2765 mR) mSv.Our study denotes that the caregivers of DTC patients receive a significant radiation dose. It was well above the caregiver's annual dose-limit constraints regarding the rationales well as international guidelines of 5 mSv/yr. These could be related to the long travel in public transport and housing conditions. There is a need for patient-specific discharge criteria rather than following standard guidelines to minimize radiation exposure to caregivers.
Radioiodine therapy
Cite
Citations (3)
On 27 occasions, radiation doses were measured for a family member designated as the 'caregiver' for a patient receiving high-dose radioiodine outpatient therapy for differentiated thyroid carcinoma. For 25 of the administrations, patients received 3.7 GBq of (131)I. Radiation doses for the designated caregivers were monitored on an hourly basis for 1 week using electronic personal dosemeters. The average penetrating dose was 98 +/- 64 microSv. The maximum penetrating dose was 283 microSv. Measured dose rate profiles showed that, on average, one-third of the caregiver dose was received during the journey home from hospital. The mean dose rate profile showed rapid clearance of (131)I with three distinct phases. The corresponding clearance half-times were <1 h, 21 h and approximately 8 d. These components were associated, respectively, with the drive home, the clearance of radioiodine from an athyreotic patient and small quantities of (131)I contaminating the home.
Radioiodine therapy
Cite
Citations (36)