cancer, cleaning personnel, Emergency Rooms, ER, hospital, hospitals, hotels, I 131, insurance, Iodine, medical care, medical radionulides, nuclear medicine, outpatient radioactive iodine treatment, outpatient treatment, radiation exposure, radioactive iodine, radiology, thyroid, thyroid cancer, thyroid treatment, unplanned contamination, US NRC
US Hospitals are ok with sending home patients, who are irradiating family members and sometimes the general public through their breath, urine, etc. But, they don’t want them to come back to the hospital who made them radioactive! Of course, it is not the fault of the health-care workers. But, neither is it the fault of the hapless person who may be unknowingly exposed to high levels of ionizing radiation, nor the hotel worker who may have to clean-up after them, unknowingly exposed to high levels of ionizing radiation.
Today, a Pennsylvania Emergency Room reported an “Unplanned Contamination” “event” to the US NRC. How much were other people in the ER exposed to, before it was discovered that the person had been treated with radioactive I 131? The healthcare workers probably only stayed near the patient for a few minutes. How long were other patients exposed? The person was apparently in the ER, and possibly the hospital, for 12 hours, before it was learned that they were radioactive! Same hospital! Where were hospital records?
The patient was given 61.4 millicuries of I 131, i.e. 2,271,800,000 Bq, i.e. 2.27 billion radioactive disintegrations (Shots) per SECOND. Potassium iodide (KI) is distributed to offer protection against I 131, in the event of a nuclear accident. It cannot be taken on a routine basis. And, yet, one may be exposed by recently released patients. As we noted recently, if this were gunshots, people would be arrested: https://miningawareness.wordpress.com/2016/02/07/nuclear-terrorism-296000-radioactive-shots-per-second-bq-per-liter-of-water-34-oz-near-entergys-indian-pt-nuclear-power-station-compare-to-m134-gun-at-100-rounds-per-second/
US patients are allowed to run around contaminating everyone with 5 times (500 mrem; 5 mSv) the maximum amount of radiation that nuclear reactors are allowed to emit by the US NRC in one year (100 mrem; 1 mSv) and 20 times that allowed by the US EPA (25 mrem; 0.25 mSv). Supposedly the hospital staff only got 3 mrem exposure. While we don’t know the discharge instructions, the “event notice” states that they were not followed, proving that they aren’t always followed. I 131, with a half life of around 8 days, still stays in the environment for months, (because each half life is a half of a half). Hotel workers near US cancer centers may be particularly at risk. Below the “event” report are some excerpts from Peter Crane who has tried for decades to restore public protection, to no avail.
According to Wikipedia, after Radioactive Iodine treatment:
“Some also advise not to hug or hold children when the radiation is still high, and a one or two metre distance to others may be recommended./ Patients should be warned that if they travel by air, they may trigger radiation detectors at airports up to 95 days after their treatment with 131I./ … Patients may also be advised to wear slippers or socks at all times, and keep themselves physically isolated from others. This minimizes accidental exposure by family members, especially children. Use of a decontaminant specially made for radioactive iodine removal may be advised. The use of chlorine bleach solutions, or cleaners that contain chlorine bleach for cleanup, are not advised, since radioactive elemental iodine gas may be released. Airborne I-131 may cause a greater risk of second-hand exposure, spreading contamination over a wide area. Patient is advised if possible needs to stay in a room with a bathroom connected to limit unintended exposure to family members.” https://en.wikipedia.org/wiki/Iodine-131 This last appears a special risk for hotel cleaning personnel and even those staying in hotels. It also will go into the sewer system.
According to Lawrence Berkley (Nuclear) Lab: “Beta emission from 131 I can present an external exposure hazard to skin and eyes. Gamma emissions can present a penetrating external exposure hazard. Individual iodine metabolism can vary considerably (5) . It may be assumed that 30% of an uptake of iodine is translocated to the thyroid and 70% directly excreted in urine (5) . Iodine in the thyroid is retained with a biological half-life of 120 days in the form of organic iodine. Organic iodine is assumed to be uniformly distributed in all organs and tissues of the body except the thyroid, and retained with a biological half-life of 12 days(5). 10% of organic iodine is directly excreted in feces and the rest is returned to the transfer compartment as inorganic iodine (5) .” http://www2.lbl.gov/ehs/html/pdf/iodine131.pdf
“AGREEMENT STATE REPORT – UNPLANNED CONTAMINATION
The following was received from Pennsylvania via fax:
“The licensee discovered the event on February 4, 2016, and notified the Department [PA Dept of Environmental Protection] after normal business hours on Friday, February 5, 2016. It is reportable per 10 CFR 30.50(b)(1)(i).
“A 30 year old female patient was treated with 61.4 milliCuries of Iodine-131(I-131) for thyroid cancer and released, with proper discharge instructions, at noon on 02/03/16. The patient then returned to the emergency room (ER) at the same location at [1300 EST]. The patient did not disclose the previous I-131 treatment to ER staff until later that evening. The ER staff immediately contacted radiation safety personnel at 0100 on 02/04/16. The patient was then segregated and all access to the original room was controlled and posted properly. Surveys were taken and all linens and other potentially contaminated materials were collected for proper storage and decay. A radiation survey performed at 0930 on 02/04/16 estimated the potential maximum radiation exposure to staff to be 3 millirem.
“Patient failed to follow the discharge instructions given.
“A reactive inspection is planned by the Department. More information will be provided upon receipt.” Pennsylvania Event Report ID #: PA160006” http://www.nrc.gov/reading-rm/doc-collections/event-status/event/2016/20160217en.html
How long was the patient there exposing people? It appears to have been from 1 in the afternoon until 1 in the morning! Was she in ER the entire 12 hours? Notice the patient was treated at noon, came back to the ER at 1 pm and was not “segregated” from others until ca 1 am! Was she vomiting, as apparently frequently happens with this treatment? Is that why she was there?
Peter Crane, former USNRC lawyer, has been concerned for decades that “the appropriate precautions to be taken when I-131 is used, so that in treating the cancer patients of today, we do not unintentionally create the patients of tomorrow“. http://www.nrc.gov/reading-rm/doc-collections/commission/tr/2014/crane-05-09-2014-meeting.pdf
He states that: “about five percent of I-131 outpatients recover in hotels, which means that the housekeepers who clean their rooms, unaware of the presence of contamination and unequipped to deal with it in any case, may be the group most endangered by the current Patient Release Rule, as will be discussed later in these comments.”
“At a public meeting in October 2010, an NRC staff official, James Luehman, had expressed concern about one class of hotel worker exposed to radiation from I-131 patients: those who work in hotels near major cancer centers, and who may clean numerous contaminated rooms in the course of a year, accumulating a dose each time. But when the ACMUI subcommittee issued its report in December 2010 on the release of radioactive patients, the issue of the worker who cleans multiple rooms was not even addressed. Looking instead at doses to housekeepers from cleaning a single room, the subcommittee found that radiation doses to hotel workers were well within acceptable limits. This conclusion was premised on the assumption that “dose contribution of possible internal radioactive contamination is considered minor and not included.”… The ACMUI subcommittee’s analysis therefore considered external dose from the urine excreted into bedsheets by radioactive patients, but not internal dose from the urine and saliva that patients leave on bathroom surfaces… When a subcommittee of the Advisory Committee on the Medical Uses of Isotopes reported to the Commission in October 2010 that 10 CFR 35.75 was fine as is and needed no changes, it told the Commissioners, wrongly, that the rule provided a ceiling of 100 millirems for exposures to children, pregnant women, and the public from released patients. Minutes later, the NRC staff corrected the subcommittee: the actual limit is 500 millirems. The ACMUI subcommittee members had supposedly studied the rule for five months, accepting NRC payment for their labors, and in that time, quite clearly, not one of the members had bothered to read it. A similar mistake was made by Dr. James Sisson and 15 co-authors in an article in Thyroid, the journal of the American Thyroid Association, in April 2011, after a three-year study, but in their case, they were unaware that 10 CFR 35.75 existed, and thought that patient release was governed by Part 20. (A correction and apology appeared in the June 2011 issue.) At an international conference on radiation safety in medicine, held in Bonn in December 2012 under the auspices of the International Atomic Energy Agency, a doctor from Memorial Sloan-Kettering Cancer Center, presiding over a panel discussion, informed the attendees that the NRC rule included a 100 millirem ceiling for exposures to the public. I had to tell him from the floor that this was a commonly held misconception.” Read the entire document here: http://pbadupws.nrc.gov/docs/ML1527/ML15275A054.pdf If you look for Peter Crane patient release rule online you can find much more. 500 mrem is 5 mSv. 100 mrem is 1 mSv.