Hospital discharge policy in thyroid cancer patients treated with 131I: the effect of changing from fixed time to exposure rate threshold.
During 1981-1989, a total of 2,238 thyroid carcinoma patients were treated in limited accommodation in Iran with high-fixed ablation or therapeutic doses of 131I . For the 308 patients admitted in 1989, the external body exposure rate was measured sequentially at 2-4 d post-dose administration. Based on the exposure rate of 6.98 C kg(-1) h(-1) (1.8 mR h(-1) at 1 m, cumulative percentages of patients ablated with 3.7 GBq of 131I (268/308) and discharged from the hospital at 2, 3, and 4 d post-dose administration were 75%, 87%, and 95%, respectively. Likewise, for the group treated with 5.55 GBq (31/308), the cumulative percentages of patients discharged by day 2, 3, and 4 were 30%, 68%, and 79%, respectively. In the former, the remaining 5% (13 patients) had the external exposure rate less than 6.98 C kg(-1) h(-1) at one meter, before day seven PDA. In the latter, only 2 patients were released after day seven, that is at day 10, with the exposure rate less than 1.8 mR/hr at one meter. One patient, from the second group, with extensive metastatic disease was discharged at day 14 PDA with the external exposure rate of 5.81 C kg(-1)h(-1)(1.5 mR/hr) at one meter. By applying the above exposure rate as the requirement for the patient discharge, we changed the policy for release of patients from arbitrary 1-wk hospitalization to the discharge at the point when exposure rate dropped below 6.98 C kg(-1)h(-1)(1.8 mR h(-1)) at 1 m, which led to the significant (300%) increase in throughput of patients treated for thyroid carcinoma with 131I, within the same available space limitations.
Mohammadi
H
H
Faculty of Medicine, Tehran University of Medical Sciences, Iran.
Saghari
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005190:Family; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D007902:Length of Stay; D008297:Male; D008452:Maximum Allowable Concentration; D008875:Middle Aged; D011835:Radiation Protection; D011879:Radiotherapy Dosage; D013964:Thyroid Neoplasms / Q000532:radiotherapy*
D007457:Iodine Radioisotopes