Radioactive Decedents What is the risk? Glenn M. Sturchio, PhD, CHP Radiation Safety Officer Alan Crutchfield Clinical Research Intern ICCFA Annual Convention & Expo Nashville, TN 08 April 2017 2017 MFMER slide-1
Overview Scope Radiation 101 Medical uses Risks from handling decedent How to minimize risk 2017 MFMER slide-2
What risks DO you worry about? Musculoskeletal injury from lifting Exposure during embalming operations HIV; Hepatitis B & C; Tuberculosis; MRSA Chemicals Exposure during cremation operations Heat Noise Dust Radiation REALLY? OR-OSHA 440-4989 (7/14) 2017 MFMER slide-3
What we are NOT discussing www.remm.nlm.gov 2017 MFMER slide-4
What we are NOT discussing Crude weapon = 0.1 kt Fatalities ~1,590 Injuries ~3,300 NUKEMAP 2017 MFMER slide-5
What we are NOT discussing siemens.com 2017 MFMER slide-6
What we are NOT discussing siemens.com 2017 MFMER slide-7
What we are NOT discussing elekta.com 2017 MFMER slide-8
What we will be discussing Nuclear Medicine General diagnostic imaging ( 99m Tc) Positron Emission Tomography ( 18 F) Radiation Oncology Radiopharmaceutical ( 131 I) Implants ( 125 I, 90 Y) 2017 MFMER slide-9
Radiation 101 X-ray edtech2.boisestate.edu 2017 MFMER slide-10
Radiation 101 www.engineertech.org 2017 MFMER slide-11
Radiation 101 pnausa.org 2017 MFMER slide-12
Radiation 101 youtube.com ashley esfandiari 2017 MFMER slide-13
Radiation 101 Exposure Contamination cdc.gov 2017 MFMER slide-14
Radiation 101 Conventional radiography/fluoroscopy (medical) Interventional fluoroscopy 5% (medical) 7% Consumer 2% Occupational (< 0.1%) Industrial (< 0.1%) Percent contribution of various sources of radiation exposure to the total effective dose per individual in the U.S. population (6.2 msv) for 2006. Nuclear Medicine (medical) 12% Radon & Thoron (background) 38% Computed tomography (CT) (medical) 25% Internal (background) 5% Space (background) 5% NCRP Report 106 Terrestrial (background) 1% 2017 MFMER slide-15
Nuclear Medicine Diagnostic exams that result in images of body anatomy and function. Images based on the detection of energy emitted from a radioactive substance given to the patient, either intravenously or by mouth. pinterest 2017 MFMER slide-16
Nuclear Medicine Uses include: Analyze kidney function Image blood flow and function of the heart Scan lungs for respiratory and blood-flow problems Evaluate bones for fracture, infection, arthritis or tumor Determine the presence or spread of cancer Locate the presence of infection Measure thyroid function radiology.ucsf.edu 2017 MFMER slide-17
Radiation Oncology - brachytherapy Permanent brachytherapy involves placing radioactive seeds or pellets (about the size of a grain of rice) in or near the tumor and leaving them there permanently. After several weeks or months, the radioactivity level of the implants eventually diminishes to nothing. The seeds then remain in the body, with no lasting effect on the patient. 2017 MFMER slide-18
Brachytherapy Prostate Cancer I-125 seeds va.gov 2017 MFMER slide-19
Brachytherapy Hepatocellular Cancer Y-90 microspheres and human hair Journal of Cancer Therapy, 7, 505-518 Crit Rev Oncol Hematol 2013; 88:530-49 2017 MFMER slide-20
What s The Risk it depends Radionuclide characteristics Type of radiation (alpha, beta, gamma) Energy of radiation Half-life Form (liquid, solid) Time Post administration Engaged with body Distance 2017 MFMER slide-21
Half-life Radionuclide Physical Half-life Days to <1% of initial activity I-131 8 d 56 Tc-99m 6 h <2 F-18 2 h <1 Y-90 64 h 19 I-125 Implant 60 d 420 Diagnostic Nuclear Medicine Patients Do Not Present A Risk To Funeral Home Staff 2017 MFMER slide-22
Effective Half-life: Retained 131 I Med Phys 42(4), April 2015 2017 MFMER slide-23
Radiation Type and Energy Radionuclide Primary Radiation Radiation Energy I-131 gamma 364 kev Y-90 beta 2,280 kev I-125 Implant X-ray ~30 kev 2017 MFMER slide-24
Regulatory Limitations The Health Physics Society maintains that release of patients poses no discernible risk to the public and provides significant benefits to patients, their families, and society. 2017 MFMER slide-25
Activities and Dose Rates For Patient Release Radionuclide Dose Rate @ 1m At or Below Which Patient may Be Released (mrem/h) I-131 7 Y-90 0.5 I-125 Implant 1 Note: Y-90 value based on our practice experience Radiation Dose (mrem/h) From 1 Hour Exposure Radionuclide @ 0.5 m @ 2 m @ 3 m I-131 28 1.75 0.8 Y-90 2 0.12 0.06 I-125 Implant 4 0.25 0.1 NUREG-1556, Vol 9 2017 MFMER slide-26
What are the expected exposures? Embalming 1 h at 0.5 m I-131 = 28 mrem Y-90 = 2 mrem I-125 = 4 mrem civilwarundertaker.net 2017 MFMER slide-27
What are the expected exposures? whitehouse.archives.gov Viewing: 15 min at 0.5 m + 2 h at 3 m I-131 = 8.6 mrem Y-90 = 0.6 mrem I-125 = 1.2 mrem 2017 MFMER slide-28
How do the exposures compare to Activity Radiation Dose (mrem) Living in MD for 1 y 15 Living in CO for 1 y 65 Chest X-ray 20 Annual Public Dose Limit 100 Annual Natural Background Radiation 300 Annual Occupational Dose Limit 5,000 Threshold for Acute Radiation Syndrome 50,000 50% Fatality 500,000 emergency.cdc.gov 2017 MFMER slide-29
Radiation Risk Stochastic effects Developed to derive occupational risk factors Acute effects 2017 MFMER slide-30
The dose makes the poison 81 mg/d X 365 d/y = 30 g FDA says death may be expected at 30 g. 2017 MFMER slide-31
Steps to reduce exposure Awareness. Wear appropriate PPE when potential for contact with body fluids or ash. Drain blood during embalming directly into the sanitary sewer system [I-131]. Do not aspirate unless necessary. Drain body fluids directly to sanitary sewer system [I-131]. Maximize distance to the body. Minimize time in close vicinity to body. 2017 MFMER slide-32
What about cremation? There have been instances reported where organs have been removed prior to cremation of decedents containing I-125 seeds and Y-90 microspheres. Is this necessary? 2017 MFMER slide-33
Family impact Did the additional burden contribute to further pain or psychological impact? Future research: Survey of impacted families 2017 MFMER slide-34
CREMATION OF A BODY WITH A RADIOACTIVE IMPLANT [I-125] informed the NRC Region I office that a patient that was implanted iodine-125 seeds on July 17, 2000, expired on July 23, 2000. The estimated activity was 9.8 millicuries. The licensee stated that the family had refused an autopsy and there was no regulatory basis that required the iodine-125 seeds to be removed from the body. However, the licensee informed the funeral home in writing that the body contained radioactive seeds and to use precautions in handling and cremating the body. Additionally, the licensee planned to perform area surveys following the cremation. 2017 MFMER slide-35
CREMATION OF A BODY WITH A RADIOACTIVE IMPLANT [I-125] On July 25, 2000, the licensee informed the NRC Region I that the body was cremated as planned. The licensee performed radiological surveys of the affected areas and the surveys did not indicate any radiation levels above the natural background level. Radiation level of 2 mr/hour was measured in contact with the plastic bag that contained the body remains (ashes). These levels were reduced to background level when the plastic bag was placed in a metal urn. USNRC Morning Report for July 27, 2000 2017 MFMER slide-36
Y-90 Therasphere Cremation Crematory chambers operate between 1400 to 2400 degrees Glass melts between 2500 and 2900 degrees Effluent to public not an issue 2017 MFMER slide-37
Y-90 Therasphere Cremation Risk = Likelihood x Severity Exposure (severity) is minimal Frequency (likelihood) is very low 2/70 cases in last 3 years (<2%) Minimal x infrequent = VERY LOW RISK 2017 MFMER slide-38
Conclusions In extreme cases, exposure not likely to exceed public dose limit and never harmful Regulations need to be clarified to appropriately match requirements to actual risk. 2017 MFMER slide-39
sturchio.glenn@mayo.edu 2017 MFMER slide-40