Answer to Question #9577 Submitted to "Ask the Experts"

Category: Nuclear Medicine Patient Issues — Therapeutic Nuclear Medicine

The following question was answered by an expert in the appropriate field:

I'm looking for guidance on the inpatient treatment (and release) of a doubly incontinent radioiodine ablation candidate. The patient requires full caudal care (due to multiple sclerosis) and will return to a nursing home (further complicating patient release).

I'm familiar with patient release based on NUREG 1556 Vol. 9, Rev. 2, but I think this case falls outside of those bounds.

Any guidance or help would be appreciated.
A patient such as this can be a challenge, especially from the standpoint of dealing with the anxiety of the caregivers. Actual exposures to caregivers or health care workers will be very low. The type of intensive care you describe is not common for patients who typically receive ablation therapy so there is little published but there is anecdotal information for complicated cases, such as yours.

We have personally dealt with two such cases in recent years and neither led to excessive exposures to the health care workers. Practically speaking, I would suggest that you schedule the patient to receive inpatient therapy as early in the week as possible. We kept the patients in the hospital for four days. During the hospital stay, no health care worker received greater than 50 mrem and most were significantly less. The highest readings were received by those providing care for the first 24 hours. Even the two staff members who alternated emptying the Foley bag for the first 48 hours received less than the reporting threshold on their whole-body badge and finger ring (usually less than 0.1 mSv).

If the patient is not able to drink well, the physicians may consider administering intravenous fluids for the first one or two days to keep the patient hydrated and assure timely elimination of the unbound iodine-131. Adequate hydration will lead to the patient having very little material left in their system by the time he/she is discharged to the nursing home. Exposure rates will almost certainly be less than 2 mR h-1 at one foot. Standard precautions at the nursing home (i.e., the use of gloves and gown) should minimize the chance of staff getting contaminated.
Answer posted on 3 March 2011. The information posted on this web page is intended as general reference information only. Specific facts and circumstances may affect the applicability of concepts, materials, and information described herein. The information provided is not a substitute for professional advice and should not be relied upon in the absence of such professional advice. To the best of our knowledge, answers are correct at the time they are posted. Be advised that over time, requirements could change, new data could be made available, and Internet links could change, affecting the correctness of the answers. Answers are the professional opinions of the expert responding to each question; they do not necessarily represent the position of the Health Physics Society.