title: 2011 investigation of internal contamination with radioactive strontium following rubidium Rb 82 cardiac PET scan.
abstract: During routine screening in 2011, US Customs and Border Protection (CBP) identified 2 persons with elevated radioactivity. CBP, in collaboration with Los Alamos National Laboratory, informed the Food and Drug Administration (FDA) that these people could have increased radiation exposure as a result of undergoing cardiac Positron Emission Tomography (PET) scans several months earlier with rubidium Rb 82 chloride injection from CardioGen-82. We conducted a multistate investigation to assess the potential extent and magnitude of radioactive strontium overexposure among patients who had undergone Rb 82 PET scans. We selected a convenience sample of clinical sites in 4 states and reviewed records to identify eligible study participants, defined as people who had had an Rb 82 PET scan between February and July 2011. All participants received direct radiation screening using a radioisotope identifier able to detect the gamma energy specific for strontium-85 (514 keV) and urine bioassay for excreted radioactive strontium. We referred a subset of participants with direct radiation screening counts above background readings for whole body counting (WBC) using a rank ordering of direct radiation screening. The rank order list, from highest to lowest, was used to contact and offer voluntary enrollment for WBC. Of 308 participants, 292 (95%) had direct radiation screening results indistinguishable from background radiation measurements; 261 of 265 (98%) participants with sufficient urine for analysis had radioactive strontium results below minimum detectable activity. None of the 23 participants who underwent WBC demonstrated elevated strontium activity above levels associated with routine use of the rubidium Rb 82 generator. Among investigation participants, we did not identify evidence of strontium internal contamination above permissible levels. This investigation might serve as a model for future investigations of radioactive internal contamination incidents.
authors.forename: Satish K
authors.initials: SK
authors.lastname: Pillai
authors.forename: Arthur
authors.initials: A
authors.lastname: Chang
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Murphy
authors.forename: Jennifer
authors.initials: J
authors.lastname: Buzzell
authors.forename: Armin
authors.initials: A
authors.lastname: Ansari
authors.forename: Robert C
authors.initials: RC
authors.lastname: Whitcomb
authors.forename: Charles
authors.initials: C
authors.lastname: Miller
authors.forename: Robert
authors.initials: R
authors.lastname: Jones
authors.forename: David P
authors.initials: DP
authors.lastname: Saunders
authors.forename: Philip
authors.initials: P
authors.lastname: Cavicchia
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Watkins
authors.forename: Carina
authors.initials: C
authors.lastname: Blackmore
authors.forename: John A
authors.initials: JA
authors.lastname: Williamson
authors.forename: Michael
authors.initials: M
authors.lastname: Stephens
authors.forename: Melissa
authors.initials: M
authors.lastname: Morrison
authors.forename: James
authors.initials: J
authors.lastname: McNees
authors.forename: Rendi
authors.initials: R
authors.lastname: Murphree
authors.forename: Martha
authors.initials: M
authors.lastname: Buchanan
authors.forename: Anthony
authors.initials: A
authors.lastname: Hogan
authors.forename: James
authors.initials: J
authors.lastname: Lando
authors.forename: Atmaram
authors.initials: A
authors.lastname: Nambiar
authors.forename: Lauren
authors.initials: L
authors.lastname: Torso
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Melnic
authors.forename: Lucie
authors.initials: L
authors.lastname: Yang
authors.forename: Lauren
authors.initials: L
authors.lastname: Lewis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D012414:Rubidium Radioisotopes / Q000032:analysis; D013324:Strontium / Q000302:isolation & purification*; D014057:Tomography, X-Ray Computed; D014481:United States
chemical_list: D012414:Rubidium Radioisotopes; D013324:Strontium