title: Treatment room length-of-stay and patient throughput with radioiodine thyroid remnant ablation in differentiated thyroid cancer: comparison of thyroid-stimulating hormone stimulation methods.
abstract: OBJECTIVE
  We sought to empirically compare treatment room length-of-stay and patient throughput for recombinant human thyroid-stimulating hormone (rhTSH)-aided thyroid remnant ablation with thyroid hormone withdrawal (THW)-aided ablation in patients with differentiated thyroid carcinoma (DTC).
  
  
  METHODS
  We retrospectively reviewed charts of all eligible (near) totally thyroidectomized patients with DTC undergoing ablation and 1-year ablation success evaluation at our tertiary referral centre from January 2003 to February 2009 (N=274). M1 disease caused exclusion unless discovered by a postablation scan or present when rhTSH was the only tolerable stimulation method. We extracted data on the length-of-stay, defined as the time between treatment room admission and discharge, and patient throughput, defined as patients ablated per treatment room per week. The treatment room discharge criterion was a whole-body dose rate of less than 60 μSv/h at 50 cm.
  
  
  RESULTS
  The treatment groups (rhTSH, n=187; THW, n=87) had mostly statistically similar characteristics, but differed in primary tumour status distribution. In addition, at ablation, the rhTSH patients had a greater prevalence of prior diagnostic scintigraphy, higher mean serum TSH, and shorter interval since surgery, and received a 5.6% larger mean ablation activity. On average, rhTSH patients had a significantly lower peak whole-body dose rate (57.1 vs. 83.4 μSv/h at 50 cm; P<0.0001) and a significantly shorter treatment room stay than did the THW patients (1.41 vs. 2.02 days; P<0.001). rhTSH use allowed significantly more patients to be ablated per room per week (2.7 vs. 1.2; P<0.001).
  
  
  CONCLUSIONS
  Relative to THW, rhTSH use to aid ablation reduced mean treatment room length-of-stay by almost one-third and more than doubled the average weekly patient throughput, both of which were significant differences.
authors.affiliation: Department of Nuclear Medicine, Reina Sofía University Hospital, Córdoba, Spain. jantonio.vallejo.sspa@juntadeandalucia.es
authors.forename: Juan Antonio
authors.initials: JA
authors.lastname: Vallejo Casas
authors.forename: Luisa M
authors.initials: LM
authors.lastname: Mena Bares
authors.forename: María Angeles
authors.initials: MA
authors.lastname: Gálvez
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Marlowe
authors.forename: José M
authors.initials: JM
authors.lastname: Latre Romero
authors.forename: María
authors.initials: M
authors.lastname: Martínez-Paredes
mesh_terms: D055011:Ablation Techniques; D000328:Adult; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000009:adverse effects; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D010362:Patients' Rooms; D011829:Radiation Dosage; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D013972:Thyrotropin / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D014916:Whole-Body Irradiation
chemical_list: D007457:Iodine Radioisotopes; D013972:Thyrotropin