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RICHARD L. MORIN, PhDTHE MEDICAL PHYSICS CONSULT

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atient Radiation ID Cardsichard L. Morin, PhD, J. Thomas Payne, PhD

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uestion: Over last New Year’soliday, the U.S. Department ofnergy dispatched casually dresseduclear scientists with sophisticatedadiation detection equipment toook for radiation “dirty” bombs1] in at least 10 major cities andirports [2]. With increased radia-ion surveillance, will patients whoave received permanent brachy-herapy implants (125I or 103Pdrostate seeds) or nuclear medicineadiopharmaceuticals be stoppedor questioning? If so, what should oran be done to help these patients?

Answer: Yes. Patients who haveedical procedures that make

hem radioactive should be givenD cards that describe the nature ofhe radioactive procedures. At ourospital, we use laminated walletards as well as information sheetso document radioactive proce-ures. Figure 1 displays an examplef a wallet card that is given to pros-ate implant patients. These cardsan be printed using a color printernd laminated using clear packingape or a lamination machine.

ig. 1. An example of a wallet ID ca

004 American College of Radiology1-2182/04/$30.00 ● DOI 10.1016/j.jacr.2004.02.007

In addition to the patients de-cribed above, another category ofatients would include those re-eiving 131I treatments (e.g., hyper-hyroid patients, 131I whole-bodycan patients, or thyroid cancer ab-ation patients). A sample card for ahyroid ablation patient is shown inigure 2.In addition to the wallet cards,

n 131I patient can be providedith an information sheet. Cur-

ently, our department is imple-enting Title 10 of the Code ofederal Regulations, Part 35.75,nd releasing patients immediatelyfter the administration of 131I cap-ules and brief observation. The in-ormation sheet for a thyroid cancerblation patient (outpatient proce-ure) is shown below.

Guidelines of Radiation SafetyFollowing Administration of

Iodine-131 for Thyroid Cancer(150 millicuries)

itle 10 of the Code of Federal Reg-lations, Part 35.75, allows the re-ease of an individual who has been

rd that is given to prostate implant

dministered a therapeutic amountf iodine-131 if the total effective dosequivalent to any other individual isot likely to exceed 5 millisieverts500 millirem).xposure estimate calculation:

� 0.25 fractional exposure factor, r

� 100-cm distance, Teff �2.3 days

0 � D(r)2/(34.6)�TeffE

� (0.5 rem)(100 cm)2/(34.6)

(1.7 R cm2/mCi hr)(2.3 days)(0.25)

0 � 150 mCi (an activity of 150 mCi

or less will meet the 500-mrem

limit for the above conditions)

atient Instructions (for 150 milli-uries or less):

Following the administration ofodine-131 for thyroid cancer ther-py, you must agree to abide by theollowing conditions (please checkach condition to signify accep-ance):

� Sleep alone for at least 3days.

patients.

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428 The Medical Physics Consult

� Kissing or contact with othersshould be avoided for at leasta week.

� Keep a safe distance (greaterthan 3 feet) from others for 3days.

� Avoid contact with childrenor pregnant women for atleast a week.

� If you have a baby or youngchildren, avoid contact asmuch as possible. Do nothold an infant or allow it to siton your lap for the first 3days.

� If you are breast-feeding, youmust STOP all breast-feed-ing. To continue to breast-feed may cause permanentdamage to your baby’s thy-roid and be harmful to yourbaby’s health and develop-ment.

� You must NOT be pregnantat this time or anytime soon.If you are planning to becomepregnant, you should waituntil at least 6 months afterthis treatment.

� You should have your owntoilet and wash sink that no

ig. 2. A sample wallet ID card fo

one else uses for at least 3

days. Use the same toilet andsink at all times. Flush the toi-let 2 to 3 times after each use.Rinse the sink thoroughly af-ter each use.

� Drink plenty of fluids to helpspeed the removal of radioac-tive material from yourbloodstream and bladder.

� Use separate eating utensils(preferably plastic disposable)for the first 3 days, and washthem separately from anyother utensils.

� Use separate towels and wash-cloths for 3 days. Launderthese items separately to pre-vent cross-contamination.

� Avoid public transportationfor 3 days. Avoid prolongedtravel with others for 3 days.

� Do not go back to work for atleast 3 days.

atient statement:understand the above conditions

nd agree to abide by them as aondition of my treatment on anutpatient basis. I have had ahance to ask any questions con-erning the radiation safety of oth-rs following my release.

a thyroid ablation patient.

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Patient SignatureDateStaff

This of course raises the issue ofll nuclear medicine outpatients re-eiving ID cards. Given the photonnergies and half-lives of the iso-opes involved, this might result inreat effort for little effect. At ourospital, we have not resolved thisuestion. If cards were given, theyould most likely be for commonrocedures (e.g., bone scans, hearttudies, etc.). The cards would bereprinted for different types of nu-lear medicine studies, with blanksor patients’ names and dates ofreatment.

Regardless, it is also important toonsider procedures for handlingesponses to the contact numbersn ID cards. For example, if a gen-ral department number is givennd a security officer calls, how willhe call be routed to someone whoould verify that the patient actu-lly did receive the implant or iso-ope stated on the card?

Clearly, this discussion demon-trates that changes in the nature ofur daily lives present us withhanges in our radiological prac-

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The Medical Physics Consult 429

EFERENCES

. Nuclear Regulatory Commission fact sheeton dirty bombs. Available at: http://www.nrc.gov/reading-rm/doc-collections/fact-sheets/dirty-bombs.html.

. Mintz J, Schmidt S. “Dirty bomb” was majorNew Year’s worry. The Washington Post.January 7, 2004:A01.

ichard L. Morin, PhD, is from the Mayo Clinic, Jacksonville, Florida.. Thomas Payne, PhD, is from Abbott Northwestern Hospital, Minneapolis, Minnesota.. Thomas Payne, PhD, Abbott Northwestern Hospital, 2545 Chicago Ave., STE 611, Minneapolis, MN 55404-4546; e-mail:homas.payne@allina.com.