Answer to Question #53 Submitted to "Ask the Experts"

Q

I need technical information on risks at autopsy for pathologists.

A

Since this question was posted on the HPS Web site, I assume you are referring to the risks from exposure to radiation from radioactive materials. Attention is directed to two reports of the National Council of Radiation Protection and Measurements (NCRP), Report No. 105, Radiation Protection for Medical and Allied Health Personnel, (1989), Section 8.10 "Pathologists/Morticians," pp. 72-73; and Report No. 37, Precautions in the Management of Patients Who have Received Therapeutic Amounts of Radionuclides, Chapter 5, "Emergency Surgery or Death of the Radioactive Patient," pp. 24-35. NCRP Report 105 states: "With regard to postmortem examinations, there are generally three ways in which personnel can come in contact with radioactive materials: (1) death of a patient being treated with therapeutic amounts of radionuclides, (2) death of a patient given radionuclides for diagnostic purposes, or (3) handling specimens taken from these patients.

Although radiation therapy is not usually administered to dying patients, there is an occasional death of such patients during treatment." The radionuclides and the quantities administered in diagnostic and therapeutic nuclear medicine and in brachytherapy (implantation of discrete radioactive sources), the tissues in which the radioactive material is likely to be concentrated, and the radiation levels expected as a function of distance around the patient may be found in various nuclear medicine and brachytherapy references, including NCRP Reports No. 37 and No. 105. The risks associated with the body of the deceased patient are primarily those due to the emitted gamma radiation and would be similar to those to nursing personnel. Brachytherapy sources that are intended for reuse should have been removed by the therapist prior to the postmortem examination. In the case of sources intended as permanent implants, it should be possible to excise the area containing these sources and remove them to another area so that the examination can proceed with less radiation exposure.

In the case of nuclear medicine patients, body fluids and tissues may contain radioactive materials and these are sources of radioactive contamination in the autopsy and the laboratory examination of specimens. Risks of contamination and radiation exposure are similar to other laboratory work with similar kinds and quantities of radioactive materials.

If you are interested in radiation protection measures, refer to radiation protection procedures for dealing with patients who have received radionuclides (such as NCRP Reports No. 37 and No. 105). For protection during the removal of fluids and specimens and for the handling of radioactive specimens, refer to the above-mentioned reports and to other literature on the safe handling of radioactive material. If radionuclides are being administered to patients at a particular institution, there will most likely be a radiation safety officer (RSO); the RSO should be consulted when dealing with deceased patients containing radioactive materials. There is abundant literature dealing with the administration of radioactive materials to patients, the nursing care of these patients and the laboratory handling of contaminated materials; most of these recommendations can be adapted to the autopsy case. Literature written specifically for instructing pathology personnel at the autopsy appears to be limited.

It might be a worthwhile endeavor for the pathology profession to commission the preparation of such guidelines. NCRP Reports can be ordered by accessing the NCRP Web site.

Charles E. Roessler, CHP, PhD