Radioactive Patients: New Guidelines Issued to Protect Babies and Children from Thyroid Patients Receiving Radioactive Iodine
Thursday May 29, 2008
The Nuclear Regulatory Commission (NRC) has released new guidelines for practitioners who are overseeing thyroid patients receiving radioactive iodine treatment (Iodine 131). The guidelines recommend that existing recommendations to protect infants and young children from radiation exposure be strengthened.
The guidance was developed in response to concerns raised by the International Commission on Radiation Protection, who recommended in 2007 that patients receiving radioactive iodine treatment to the thyroid "must be informed orally to avoid close body contact with children and of other necessary precautions by specialists for conduct of their therapy."
The new guidance from the NRC recommends that the practitioners providing the radioactive iodine treatment counsel their patients as follows:
patients receiving radioactive iodine should avoid all direct or indirect contact (i.e., shared living space) with infants and young children following the treatment. (The specific amount of time would be determined by the doctor, depending on the dosage of iodine-131 given, but would typically be from two to seven days. More guidance on the timeframe will be detailed in the NRC's "Regulatory Issue Summary".) Ideally, infants and children should stay outside the home.
If a patient can't avoid direct or indirect contact with infants and young children, physicians should consider hospitalizing the patient.
If separation or hospitalization is not possible, patients should be isolated to an area of the home that can be used exclusively by the patient for a specific period of time. In particular, a bathroom should not be shared.
NRC regulations from 1997 allow patients to be released if the total radiation dose to those around them is not likely to exceed 500 millirem. (In comparison, the typical American receives about 300 millirem over the course of an entire year, from various natural radiation sources.) But these new guidelines reflect the understanding that family members -- and in particular, children and infants whose thyroid glands are most susceptible to radiation exposure -- may be at additional risk.
The guidelines are not, however, legally binding, and there are questions as to whether insurers or HMOs will honor the recommendation to hospitalize some patients to protect children from radiation exposure. Peter Crane, thyroid cancer survivor and lawyer who served with the NRC from 1975 to 1999, does not believe that these voluntary guidelines go far enough. He has been fighting to get regulations in place regarding public exposure to radioactiove iodine.
