Radiation Safety

As a general rule, it is prudent to keep radiation exposures at the lowest possible levels. This is the principle underlying the phrase "As low as reasonably achievable," or ALARA. As national radiation safety regulations may vary, the following recommendations should be considered as suggestions only.

Patients who receive more than 1100 MBq (30 mCi) of I-131 should be admitted to an individual hospital room with a private bathroom. Appropriate radioactive trash disposal containers should be placed in the room. A radiation sign should be placed on the patient's door, and public access should be restricted.

Although patients may wear their personal clothes, disposable articles (e.g., cutlery, food trays) should be used. Abundant liquid ingestion should be encouraged to reduce radiation exposure to the urinary bladder and salivary glands and to improve renal clearance of radioiodine during the first two days.

All staff should be familiar with methods of minimizing radiation exposure. All persons involved in radioiodine therapy should wear monitor badges. Badges must be processed on a periodic basis; the frequency is to be determined by the local Radiation Safety Division. Members of the staff directly involved in the administration of radioiodine therapy, mainly in the liquid form, should obtain a thyroid burden measurement within one week following administration of the therapy dose.

Usually, patients submitted to treatment with I-131 do not need special nursing assistance. For the very special patient whose clinical status requires close nursing procedures, personnel rotation is advised. Protective gloves and shoe covers should be worn on entering the patient's room and hands should be washed after leaving the room. As a general rule, the time spent close to the patients should be limited to a minimum.

Therapy with iodine-131—radiation safety: general guidelines for the staff

Time spent close to patients should be limited to a minimum Use of monitoring badges

Thyroid burden measurement for members of the staff directly involved in the administration of radioiodine therapy (especially when administered in liquid form) Use of protective gloves and shoe covers whenever entering the patient's room

Threrapy with iodine-131—radiation safety: general guidelines for the patient

Abundant liquid ingestion

Lemon juice ingestion; chewing lemon drops

Patients may be released when activity levels within the patient drop below 1110 MBq (30 mCi) or when the dose rate at 1 m is less than 0.07 mSv/hr (7.0 mrem/hr) (94). However, national regulations may vary and have to be considered by the practitioner.

After discharge, the entire room should be monitored for the presence of radioactive contamination. Disposable gloves and shoe covers should be used when changing bed linens, washing the floor, and the like. After discharge from the hospital and up to one week after treatment, a simple set of measures usually is enough to reduce radiation exposure of the family members or to the general public. The general principle is to avoid prolonged, close contact with other people during this period. Patients with infants at home should arrange for care to be provided by another person for the first days after treatment.

Therapy with iodine-131—radiation safety: general guidelines after discharge (up to one week after treatment)

Limit the time spent in public places

Limit traveling by public transportation and prolonged automobile trips with others Delay returning to work if there is close contact with others Use private bathroom and flush toilet twice after each use Use disposable eating utensils, linen, towels, and clothes, and wash separately Sleep alone and avoid prolonged intimate contact (mainly with children and pregnant women)

Do not prepare food for others or use gloves to do so

Approximately three to seven days after the administration of the ablative dose of radioiodine, a post-therapy whole-body scan should be performed to confirm irradiation of functional thyroid tissue. Because of its greater sensitivity than the diagnostic scan it can be used as a sensitive survey for the presence of radioiodine avid metastases.

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