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Rapid Responses: Rapid Responses published:
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Advice given to patients regarding persistent radioactivity should be procedure specific
- Iftikhar A Fazal (5 August 2006)
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Guidlines for I-131 Documentation
- Lionel S. Zuckier (29 August 2006)
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Radiation safety after Radioactive iodine
- Prasanna Rao-Balakrishna (3 September 2006)
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Iftikhar A Fazal, Clinical Fellow, Cardiology Queen's Medical Centre, Nottingham NG7 2UH
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Editor I read with interest this article by Gangopadhyay et al higlighting one of the less widely known problems with radioisotopes in medicine. (1) The advice given to patients should be relevant to the investigation or treatment. In general, persistent radioactivity is more of a problem in therapeutic procedures rather than investigations. For example patients receiving radioactive iodine for thyroid disease are much more likely to have persistent radioactivity than patients who have a myocardial perfusion scan with technetium. An additional point is that the so called 'thallium scan' for myocardial perfusion is somewhat of a misnomer. Most nuclear myocardial perfusion scans done in the UK now use technetium 99m rather than thallium 201 (half life 6 hours versus 72). In fact, in the 2003/2004 Health Protection Agency survey of Nuclear Medicine Use in the UK technetium 99m was the most commonly used radioisotope overall for investigation. (2) References 1. Kalyan Kumar Gangopadhyay, Francis Sundram, and Parijat De Triggering radiation alarms after radioiodine treatment BMJ 2006; 333: 293-294 2.http://www.hpa.org.uk/radiation/publications/hpa_rpd_reports/2005/hpa_rpd_003.pdf Competing interests: None declared |
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Lionel S. Zuckier, Director of Nuclear Medicine and PET New Jersey Medical School, Newark, NJ USA 07101
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A recent BMJ "Lesson of the week" reviewed the case of a British patient administered radioactive iodide for treatment of hyperthyroidism who triggered a radiation detector some 6 weeks later upon vacation in the United States (1). I was gratified to note my data quoted concerning the period of potential triggering of radiation detectors used by Homeland Security personnel in the United States (2). The authors cite 4 case reports similar to their own but they have missed a critical fifth case which I believe to be the first reference to suggest that patients be given written documentation regarding their treatment (3). In my opinion, this letter to the editor was responsible for stimulating current awareness within the American medical and regulatory community and, at least in part, prompted letters of guidance which were published by the Society of Nuclear Medicine (4) and by the United States Nuclear Regulatory Commission (5). All three communications suggest necessary elements that patient documentation should contain, and are important references when considering drafting of a letter for patients traveling to the United States in the period following radiopharmaceutical administration. My final point of comment is the confusing nature of the photograph which accompanied the narrative of the "Lesson of the week" (1). The illustration provided depicts a portal metal detector, of the type that is ubiquitously present at airports throughout the world but which has no relevance to detection of gamma-radiation. My own estimates were modeled on the small portable detectors which are frequently worn on the belt of security personnel, in the manner of pagers. 1. Gangopadhyay KK, Sundram F, De P. Triggering radiation alarms after radioiodine treatment. BMJ. 2006 Aug 5;333(7562):293-4. 2. Zuckier L, Stabin M, Garabeno G, Monetti M, Lanka V. Sensitivity of personal homeland security radiation detectors to medical radionuclides and implications for counseling of nuclear medicine patients. Radiological Society of North America (RSNA), 2004 (Abstract) http://rsna2004.rsna.org/rsna2004/V2004/conference/event_display.cfm?em_id=4407767 (accessed 29 Aug 2006). 3. Buettner C, Surks MI. Police detainment of a patient following treatment with radioactive iodine. JAMA. 2002 Dec 4;288:2687. 4. http://interactive.snm.org/index.cfm?PageID=556&RPID=969 (accessed 29 Aug 2006). 5. http://www.nrc.gov/reading-rm/doc-collections/gen-comm/info- notices/2003/in200322.pdf#search=%22NRC%20Information%20Notice%202003- 22%20%22 (accessed 29 Aug 2006). Competing interests: None declared |
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Prasanna Rao-Balakrishna, Specialist Registrar, Endocrinology Hope Hospital, Salford, M6 8HD
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Dear Editor, As usual, this is another of BMJ’s useful publications of practical use. The authors have excellently highlighted the importance of adequately screening and counselling patients before offering them radioactive iodine. In general, clinicians adequately counsel patients to ensure avoidance of post radioiodine treatment exposure to pregnant women and children. It is common practice to give information leaflets explaining the restrictions following the treatment. As clinicians we are rightly concerned regarding the safety of the people around the patient, but tend to forget about pet animals at home. While it may be possible for some to avoid exposure to other people, it may not be possible for all to avoid close contact with their own pet animals. The amount of radiation that these pet animals are exposed to and the risks therein to these animals are unclear. Patients may wish to consider this risk before they consider opting for radioactive iodine treatment as the radiation emitted, however small, may in effect, be perceived as relatively unacceptable for their small pets. Pet animals, their safety and well being, are as important to some, as the people around them. Due consideration should be given to all risks, real as well as perceived, so as to enable the patients to make an informed choice. While discussing and advising treatment options with patients , to ensure radiation safety, it is necessary to obtain a comprehensive overview of the patients home, occupational and social circumstances, including holiday plans and possible future exposure to radiosensitive electronic as well as biotechnology equipments during work or travel. Although patients working with radiation sensitive equipments are usually expected to be well informed and are likely to volunteer this information during consultation and can be expected to take due precautions subsequently, it is the uninformed lay patient, who is likely to walk into an unpleasant and completely avoidable situation like the one described by the authors. Competing interests: None declared |
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