Radiation exposure for 'caregivers' during high-dose outpatient radioiodine therapy

On 27 occasions, radiation doses were measured for a family member designated as the 'caregiver' for a patient receiving high-dose radioiodine outpatient therapy for differentiated thyroid carcinoma. For 25 of the administrations, patients received 3.7 GBq of (131)I. Radiation doses for the designated caregivers were monitored on an hourly basis for 1 week using electronic personal dosemeters. The average penetrating dose was 98 +/- 64 microSv. The maximum penetrating dose was 283 microSv. Measured dose rate profiles showed that, on average, one-third of the caregiver dose was received during the journey home from hospital. The mean dose rate profile showed rapid clearance of (131)I with three distinct phases. The corresponding clearance half-times were <1 h, 21 h and approximately 8 d. These components were associated, respectively, with the drive home, the clearance of radioiodine from an athyreotic patient and small quantities of (131)I contaminating the home.     

Influence of radionuclides distributed in the whole body on the thyroid dose estimates obtained from direct thyroid measurements made in Belarus after the Chernobyl accident

Thyroid dose reconstruction is most accurate when using the results of direct thyroid measurements, in which gamma radiation emitted by radionuclides present in the thyroid and in the remainder of the body is recorded by means of a radiation detector positioned against the neck. A large number of such measurements were performed in Belarus in May-June 1986. Owing to the short half-life of 131I and to the intake and accumulation of caesium radioisotopes (mainly 134Cs and 137Cs) in the body, the thyroid doses derived from thyroid measurements made after the beginning of June 1986 have so far been often considered to be unreliable. To evaluate the influence of the caesium radioisotopes to the signal recorded by an instrument performing measurement of 131I activity in the thyroid, a Monte Carlo method was used to calculate the calibration factors of that instrument. These calculations were made for males of six reference ages: newborn, 1, 5, 10 and 15 years old, and adult. The calibration factors were combined with estimated time-dependent intake functions for 131I and caesium radioisotopes. The fractions of the instrument indications that were due to 131I in thyroid were thus estimated as a function of the age of the subject that was measured and of the time elapsed since the accident. Using this information when processing the thyroid measurements made in May 1986 would improve the accuracy of the thyroid dose estimates, and may make it possible to use a larger proportion of the thyroid measurements made in June 1986.     

Biological half-life of iodine in adults with intact thyroid function and in athyreotic persons

A joint project between the Human Monitoring Laboratory (HML) and the Ottawa Hospital has measured the retention of 131I in patients who have received the radioiodine diagnostically. Thirty-nine subjects with intact thyroid glands and nine athyreotic subjects were measured in the HML's whole-body/thyroid counter to determine the retention of 131I following its medical administration. The average biological half-life of 131I in 26 euthyroid subjects was found to be 66.1+/-6.3 days which may he statistically significantly lower than the ICRP recommended value of 80 days. Nine hyperthyroid patients had a mean biological half-life of 38.2+/-8.6 days and in three hypothyroid patients the corresponding value was 29.3+/-8.8 days. Thyroid 131I uptake was measured in a conventional clinical fashion at the Ottawa Hospital Civic campus 24 h after oral administration of the radioiodine using a collimated thick sodium iodide detector placed over the neck anteriorly. Measured values were 10.144+/-0.009, 0.314+/-0.035 and 0.045+/-0.010 of the administered dose in euthyroid, hyperthyroid and hypothyroid patients respectively. The euthyroid range at the hospital is 0.06 - 0.22. Uptake was significantly lower for the euthyroid group than the ICRP value of 0.3. The radioiodine retention in athyreotic subjects followed a two compartment model with biological half-lives of 1.0+/-1.2 days and 18.4+/-1.1 days.     

Study of the correlation between administered activity and radiation committed dose to the thyroid in 131I therapy of Graves' disease

Substantial reduction in the thyroid volume (up to 70-80%) after 131I therapy of Graves' disease has been demonstrated and reported in the literature. Recently a mathematical model of thyroid mass reduction during the first month after therapy has been developed and a new algorithm for the radiation committed dose calculation has been proposed. Reduction of the thyroid mass and the radiation committed dose to the gland depend on a parameter k, defined for each subject. The calculation of k allows the prediction of the activity to administer, depending on the radiation committed dose chosen by the physician. In this paper a method for calculating k is proposed. The calculated values of k are compared to values derived from measurements of the changes in thyroid mass in twenty-six patients treated by 131I for Graves' disease. The radiation committed dose to the thyroid can be predicted within 21%, and the radioiodine activity to administer to the patient can be predicted within 22% using the calculated values of k. The thyroid volume reduction during the first month after therapy administration can be also predicted with good accuracy using the calculated values of k. The radiation committed dose and the radioiodine activity to administer were calculated using a new, very simple algorithm. A comparison between the values calculated by this new algorithm and the old, classical Marinelli-Quimby algorithm shows that the new method is more accurate.     

Estimating individual thyroid doses for a case-control study of childhood thyroid cancer in Bryansk Oblast, Russia

Following the Chernobyl accident, radioactive fission products, including (131)I and (137)Cs, were deposited in Bryansk Oblast in Russia. Intakes of radioiodines, mainly (131)I in milk, were the principal sources of radiation doses to thyroids of residents of the contaminated areas, but those radionuclides decayed before detailed contamination surveys could be performed. As a result, (137)Cs deposition density is the primary measure of the contamination due to the accident and there are relatively few measurements of the ratio of (131)I to (137)Cs in vegetation or soil samples from this area. Although many measurements of radiation emitted from the necks of residents were performed and used to estimate thyroidal (131)I activities and thyroid doses, such data are not available for all subjects. The semi-empirical model was selected to provide a dose calculation method to be applied uniformly to cases and controls in the study. The model was developed using dose estimates from direct measurements of (131)I in adult thyroids, and relates settlement average thyroid doses to (137)Cs contamination levels and ratios of (131)I to (137)Cs. This model is useful for areas where thyroid monitoring was not performed and can be used to estimate doses to exposed individuals. For application to children in this study, adjustment factors are used to address differences in age-dependent intake rates and thyroid dosimetry. Other individual dietary factors and sources (private/public) of milk consumed are reflected in the dose estimates. Countermeasures that reduced thyroid dose, such as cessation of milk consumption and intake of stable iodine, are also considered for each subject. The necessary personal information of subjects was obtained by interview, most frequently of their mothers, using a questionnaire developed for the study. Uncertainties in thyroid dose, estimated using Monte Carlo techniques, are presented for reference conditions. Thyroid dose estimates for individual children made using the semi-empirical model and questionnaire data compare reasonably well with dose estimates made for 19 children whose thyroid burdens of (131)I were measured from May to June 1986.     

131I exhalation by patients undergoing therapy of thyroid diseases

In the departments of nuclear medicine, patients are treated with relatively large activities of (131)I for therapeutic purposes. The applied activities are in the range of 200-10 000 MBq. Consequently, individuals situated in the dwellings of the patients dismissed from the hospital are subjected to an external as well as an internal radioiodine exposition. Internal exposition is due to the inhalation of (131)I exhaled by the patients. In this article, the measurements of radioactivity exhaled by patients with various thyroid diseases, treated with (131)I in the department of Nuclear Medicine of the Radiological Centre in Goettingen and in the Hospital of Nuclear Medicine in Wuerzburg are presented. The measurements of activities exhaled by patients were repeated daily, up to 25 d after the treatment. In addition, the residual activities were monitored by measuring the external dose rates, and by measuring the (131)I activity in the urine of these patients. In some cases, the exhaled radioiodine was separated into three fractions: the elemental, the organically bound and the aerosol-bound iodine fraction. On the basis of the proposed measurements, the doses received by the family members of a discharged patient treated with (131)I were estimated by a model calculation.     

Using total beta-activity measurements in milk to derive thyroid doses from Chernobyl fallout

Following the Chernobyl accident, more than 200 childhood thyroid cancer cases have been observed in Brest Oblast of Belarus in territories slightly contaminated with 137Cs, but with suspected relatively high 131I fallout. The most helpful measurements available that can be used to estimate thyroid doses for the population of Brest Oblast are the total beta-activity measurements in cow's milk performed using DP-100 device within a few weeks after the accident. The 131I concentrations in milk were derived from the total beta-activity measurements on the basis of (1) a radioecological model used to estimate the variation with time of the radionuclide composition in milk and (2) the determination of the calibration factors of the DP-100 device for the most important radionuclides present in milk. As a result, 131I concentrations in milk were reconstructed for territories with different levels of 137Cs deposition. A non-linear dependence of the 131I concentration in milk on the 137Cs deposition density was obtained; it was used to estimate the thyroid doses from the consumption of 131I-contaminated cow's milk by the population of Brest Oblast. The average individual thyroid doses have been estimated to be 0.15, 0.18, 0.12, 0.06, 0.04 and 0.03 Gy for newborn, children aged 1, 5, 10 and 15 y and adults, respectively. The collective thyroid dose for the entire population of Brest Oblast is estimated to be 64,500 man Gy, the contribution from the adult population being about one half of the total. The methodology that is described could be applied in the framework of epidemiological studies of the relationship between radiation exposure to the thyroid gland and thyroid cancer in areas where numerous total beta-activity measurements in cow's milk were performed within a few weeks after the accident.     

Thyroid dosimetry in the western trace of the Chernobyl accident plume

According to World Health Organization guidelines (WHO/SDE/PHE/99.6), the reference level for consideration in stable iodine prophylaxis is based on the inhalation exposure pathway. In the western trace of the Chernobyl accident, the measurement of airborne (131)I fractions (aerosol-associated, gaseous reactive and gaseous organic) indicates that airborne gaseous reactive and, especially, organic (131)I fractions were the major contributors to thyroid exposure due to inhalation. The contribution of inhaled short-lived radioiodines was negligible. To attain more precise thyroid exposure evaluation, (131)I dose factors were determined as a function of age and prevalence of stable iodine deficiency. The results demonstrate that children with a stable iodine deficiency experienced at least two times higher thyroid doses than did children with a dietary iodine sufficiency. The results of these investigations demonstrate that in thyroid dosimetry it is important to know the stable iodine status as well as to have a standardised method for airborne radioiodine measurements, especially for consideration of stable iodine prophylaxis based on the inhalation exposure pathway.     

Contributions of short-lived radioiodines to thyroid doses received by evacuees from the Chernobyl area estimated using early in vivo activity measurements

A series of in vivo gamma spectrometric measurements of 65 people evacuated from Pripyat 1.5 days after the Chernobyl Nuclear Power Plant Unit 4 explosion was performed in St Petersburg, Russia, as early as 30 April 1986. The historical spectra and interviews were recently processed and the results used for thyroid dose estimation. Activities of 131I in thyroid and 132Te in lungs were determined easily; for estimation of 132I and 133I activities in thyroid, sophisticated methods of spectral processing were developed. According to thyroid measurement data, the mean ratio of 133I/131I activities (at the time of the accident) inhaled by residents of Pripyat was 2.0. The mean ratio of thyroid dose from 133I inhalation to that caused by 131I amounts to 0.3, which confirms the accuracy of dose estimates based on the evolution of the Chernobyl accident. The mean ratio of 132I activity in thyroid to that of 132Te in lungs was assessed from the human measurement data to be 0.2, which is in reasonable agreement with the metabolic properties of these radionuclides. The mean ratio of thyroid dose from 132I originating from 132Te deposited in lungs to the dose caused by 131I was 0.13 +/- 0.02 for Pripyat residents who did not take KI pills and 0.9 +/- 0.1 for persons who took KI pills. Thus, the contribution of short-lived radioiodines to total thyroid dose of Pripyat residents, which was on average 30% for persons who did not use stable iodine prophylaxis, and about 50% for persons who took KI pills on 26-27 April, should be accounted for in the assessment of thyroid health effects.     

Age-dependent potassium iodide effect on the thyroid irradiation by 131I and 133I in the nuclear emergency

The initial near-field exposure is primarily through inhalation in a nuclear emergency and the dominant contribution to the effective inhalation dose comes from radioiodine. Thyroid blockade by oral potassium iodide (KI) is efficient and practical for public in the nuclear emergency. Age-dependent radioprotective effect of KI on the thyroid irradiation by (131)I and (133)I has been derived using the simplified compartment model of iodine metabolism and WinSAAM program. Administration of KI within 2 h after (131)I and (133)I intake can block thyroid uptake significantly, yielding protective effect of 78.9% and 74.3%, respectively, for (131)I and (133)I for adults. The mean absorbed doses decrease with age, while protective effects of KI are similar for all age groups.     

Uncertainties on the committed equivalent dose to the thyroid as a function of age for different iodine isotopes

This study compares uncertainties of equivalent doses after internal contamination by 125I, 129I or 131I. Uncertainties were calculated using reported distributions of physiological parameters and Monte Carlo simulation. In adults, uncertainties increase from 131I to 125I and 129I with 1% of the population receiving 3.9, 4.0 and 7.2 times the median dose for the respective isotopes. In newborns, these values were 7.5, 12.3 and 19.0 for 131I, 125I and 129I respectively. The ratio of the beta dose delivered to the epithelium versus a homogeneous distributed dose was estimated for different iodine concentrations in colloid, epithelium and interstitium. In adults, for 131I, about 40% of the beta dose was delivered to the epithelial cells, whereas this fraction varied depending on the concentration for 125I and 129I, i.e. 20-30% at a relative epithelial concentration of 20% and 7-14% at a concentration of 3%. Small variations were observed depending on age.     

Radiation dose to family members of hyperthyroidism and thyroid cancer patients treated with 131I

The thermoluminescence dosemeter (TLD) was used for measuring radiation dose to family members of thyrotoxicosis and thyroid cancer patients treated with (131)I using CaSO(4):Dy discs. There were 45 family members of thyrotoxicosis patients, who were divided into two groups with 22 in the first and 23 in the second group. Radiation safety instructions were the same for both the groups except in the second group where the patients were advised to use a separate bed at home for the first 3 d of dose administration. An activity ranging from 185 to 500 MBq was administered to these patients. The whole-body dose to family members ranged from 0.4 to 2.4 mSv (mean 1.1 mSv) in the first group and 0-1.9 mSv (mean 0.6 mSv) in the second group. A total of 297 family members of thyroid cancer patients were studied for whole-body dose estimation. An activity ranging from 0.925 to 7.4 GBq was administered to the thyroid cancer patients. The family members were divided into three groups depending upon the mode of transport and facilities available at home to avoid close proximity with the patient. Group A with 25 family members received a dose ranging from 0 to 0.9 mSv (mean 0.4 mSv), group B with 96 family members received a dose ranging from 0 to 8.5 mSv (mean 0.8 mSv) and group C with 176 family members received a dose ranging from 0 to 5.0 mSv (mean 0.8 mSv). The thyroid monitoring was also done in 103 family members who attended the patients in isolation wards for >2 d. Thyroid dose in them ranged from 0 to 2.5 mGy (mean 0.1 mGy).     

Measurements and prediction of the ambient dose rate from patient receiving radioiodine administration after thyroid ablation

Empirical equations were proposed for the prediction of the ambient dose equivalent rates from patients administered with radioiodine for the treatment of thyroid cancers. Ambient dose equivalent rates were measured for 59 patients who received high-dose (131)I treatment after thyroid ablation at different times after the administration. An ion chamber was used to measure the dose equivalent rates at 1 m away from the body and on contact to the thyroid of the patients. The resulting equations for estimating dose equivalent rates at 1 m from the body and on contact to the thyroid are, respectively, dot H(1)(body)=0.236e(-0.0501t) (mSv h(-1) GBq(-1)) and dot H(c)(thy)=2.676e(-0.0443t) (mSv h(-1) GBq(-1)). The effective half-times in total body appeared to be 13.86 h.     

A minimally invasive method to evaluate 131I kinetics in blood

The dose limiting factor for 131I therapy in patients with thyroid cancer is myelotoxicity, thus an accurate determination of radioiodine activity in the red marrow is of paramount importance. The reference method for red marrow dosimetry in radiometabolic therapy is based on the measurement of radioiodine kinetics, particularly the activity/time curve in blood. Such a measurement requires withdrawal of blood samples at various times after 131I administration. This procedure involves some potential risk from the radiation protection point of view, such as possible contamination of personnel with blood and disposal of the radioactive blood samples (and syringes). We present here a minimally invasive method to evaluate radioiodine kinetics in the blood, which only requires one blood sample and a set of measurements on the patient's thigh made with a collimated NaI(Tl) probe. The method has been validated in four patients treated with 131I for thyroid cancer.     

Excess radiation absorbed doses from non-optimised radioiodine treatment of hyperthyroidism

Radioiodine therapy is often the method of choice for treatment of hyperthyroidism because it is considered safe, is relatively inexpensive, and is convenient for the patient and except for occasional hypothyroidism, almost without side effects. Even though radioiodine treatment has been performed for over 50 years, the method of treatment differs from country to country and even from hospital to hospital within the same country. To illuminate such differences 187 radioiodine treatments for Graves' disease at Malm? University Hospital in Sweden have been analysed. Comparative dose calculations were carried out assuming that the individual patients had also been treated according to a number of other protocols in current use. The results show that the protocol used for calculating the administered activity in radioiodine therapy is far from optimised in many hospitals. Following the protocols where the absorbed dose to the thyroid is calculated without any uptake measurements after administration of a test activity, most of the patients were treated with an unnecessarily high activity, as a mean factor of 2.5 times too high and in individual patients up to eight times too high, leading to an unnecessary radiation exposure both for the patient, the family and the public. This is not in accordance with generally accepted radiation protection principles. Using higher activity than necessary will also prolong the patient's stay at the hospital and thus increase the costs for the care. Unnecessarily high activity will also necessitate more long-lasting radiation protection restriction relative to family members when the patient is back home.     

Radiation dose from 3D rotational X-ray imaging: organ and effective dose with conversion factors

The purpose of this study was to measure organ doses and the effective dose (ED) using a three-dimensional rotational X-ray (3D-RX) system and to determine the ED conversion factor from the dose area product (DAP) for skull, spine and biliary protocols. A commercial 3D-RX imaging system was used to simulate the protocols with the adult female anthropomorphic phantom. Twenty MOSFET detectors were used to measure the absorbed doses at various organ locations. The ED was calculated for each protocol and the corresponding DAP was obtained. The skin dose was the highest for all the protocols. The second highest organ doses were those of the brain for the skull, the intestine for the spine and the kidney for the biliary protocol. The ED was 0.4-0.9, 4.2-8.4 and 3.2-4.6 mSv, and the ED conversion factor was 0.06-0.09, 0.18-0.31 and 0.13-0.23 mSv Gy(-1) cm(-2) for each protocol, respectively. This data may be used to estimate the patient ED for those protocols in the 3D-RX.     

Hand exposure of nuclear medicine workers during administration of radioiodine

(131)I has been widely used in nuclear medicine for many years, particularly in the form of iodide for the diagnosis and therapy of thyroid cancer and other thyroid diseases. Manual dispensing of radioiodine-based radiopharmaceuticals results in potentially significant radiation doses to the hands of nuclear medicine personnel performing this task. This article reports the results of thermoluminescent dosemeter-based measurement of radiation doses at various points on the hands of personnel dispensing radioiodine radiopharmaceuticals.     

Excretion of volatile ¹³¹I from rats following administration of Na¹³¹I or MIBG-¹³¹I

Current practice for radiation protection associated with (131)I therapy mainly focuses on external and internal exposure caused by physical contamination of the hospital staff, other patients and family members. However, if volatile (131)I is excreted by the treated patients, these individuals could also be exposed through inhalation of (131)I. This study quantifies the amount of volatile (131)I excreted by rats after intravenous administration of metaiodobenzylguanidine (MIBG)-(131)I or Na(131)I, the two most common forms of (131)I therapy. The results indicate that in 4 d following administration, the total excretion of volatile (131)I was 0.036 and 0.17 % of the administered activities of MIBG-(131)I and Na(131)I, respectively. As administered activities for (131)I therapy are typically of the order of 1-10 GBq, the overall excretion of volatile (131)I from a patient can be as high as 20 MBq. As a result, a family member can receive up to 0.07 mSv committed effective dose from inhaling the volatile (131)I excreted by the patient.     

Radiation exposure to patients during paediatric cardiac catheterisation

Radiation doses were investigated for 18 infants and children undergoing cardiac catheterisation procedures with thermoluminescence dosemeters. The range of integrated current values used during cardiac catheterisation procedure was wide, from 12.2 to 1195.8 mA.min (mean 604.9). The average was 22.9 mA.min for fluoroscopy, and 616.1 mA.min for cineangiography, and the ratio of cineangiography to fluoroscopy ranged from 10.5 to 89.5 with an average of 34.0. The cineangiographic contribution was estimated to be 90% of the total doses. The entrance surface doses and thyroid doses varied widely. The ratio of maximum to minimum for entrance surface doses was 98.5, for left and right thyroid it was 59.8 and 104.4, respectively. The analysis of the entrance surface doses in three age groups showed that there was no significant difference among them. There was a weak inverse relation between the thyroid dose and the weight of the patient, while no correlation was found between the thyroid dose and the entrance surface dose. The average of entrance surface doses to the patients was 847.3 mGy, which was 1-2 orders of magnitude higher than common X ray examinations.     

Infant doses from the transfer of radionuclides in mothers' milk

Assessments of potential internal exposures of the child following radionuclide intakes by the mother require consideration of transfers during lactation as well as during pregnancy. Current ICRP work on internal dosimetry includes the estimation of radiation doses to newborn infants from radionuclides ingested in mothers' milk. Infant doses will be calculated for maternal intakes by ingestion or inhalation of the radionuclides, radioisotopes of 31 elements, for which fetal dose coefficients have been published. In this paper, modelling approaches are examined, concentrating on models developed for iodine, caesium, polonium, alkaline earth elements and the actinides. Comparisons of model predictions show maximum overall transfer to milk following maternal ingestion during lactation of about 30% of ingested activity for 131I, 20% for 45Ca and 137Cs, 10% for 90Sr, 1% for 210Po and low values of less than 0.01% for 239Pu and 241Am. The corresponding infant doses from milk consumption are estimated in preliminary calculations to be about two to three times the adult dose for 45Ca and 131I, 70-80% of the adult dose for 90Sr, about 40% for 137Cs, 20% for 210Po, and <0.1% for 239Pu and 241Am. Infant doses from radionuclides in breast milk are compared with doses to the offspring resulting from in utero exposures during pregnancy.