Management of the helpless patient after radioiodine ablation therapy - are we being too strict?
BACKGROUND
A helpless patient was administered 1 GBq of I to ablate thyroid remnants post-thyroidectomy. The patient was quadriplegic, doubly incontinent and unable to swallow. Published data suggest that nursing staff may receive a total effective dose of 3400 microSv when dealing with such a patient for one 8 h shift per day for 7 days post-treatment.


OBJECTIVE
To quantify the effective doses received by nursing staff on dealing with a helpless patient undergoing radioiodine ablation therapy.


METHODS
After intravenous administration of 131I, the whole-body doses received by nursing staff were measured using electronic personal dosemeters for 7 days. The nursing staff recorded the times spent in contact with the patient and the activities performed during these times.


RESULTS
The total effective dose received by nursing staff over 7 days was 148 microSv. A nurse working alone for one 8 h shift per day for 7 days could receive an effective dose of 91 microSv. The nursing staff spent an average of 23 min (standard deviation, 15 min) per 8 h shift dealing with the patient. Nursing duties were performed at a contact distance of approximately 0.5 m from the patient.


CONCLUSIONS
The nursing contact times required for the management of a helpless patient post-radioiodine therapy are lower than previously estimated. It is possible to successfully treat such a patient whilst keeping the effective doses to nursing staff within appropriate constraints. The measured nursing contact times provide an up-to-date summary of current nursing practice and will be a useful aid in the planning of future treatments.
Williams
Catherine E
CE
Directorate of Medical Physics and Clinical Engineering, Singleton Hospital, Swansea, UK. catherine.williams@swansea-tr.wales.nhs.uk
Woodward
Alan F
AF
D001822:Body Burden; D006801:Humans; D007457:Iodine Radioisotopes / Q000009:adverse effects* / Q000032:analysis* / Q000627:therapeutic use; D009740:Nursing Staff; D016273:Occupational Exposure / Q000032:analysis*; D010818:Practice Patterns, Physicians'; D011782:Quadriplegia / Q000150:complications; D011829:Radiation Dosage; D011835:Radiation Protection / Q000379:methods*; D019275:Radiopharmaceuticals / Q000009:adverse effects / Q000032:analysis / Q000627:therapeutic use; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013964:Thyroid Neoplasms / Q000150:complications / Q000532:radiotherapy*; D006113:United Kingdom; D014915:Whole-Body Counting / Q000379:methods*
D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals