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Release criteria and exposure of caregivers and public after discharge of patients undergoing 131I-MIBG, 131I-NaI and 177Lu-DOTATATE therapies

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Abstract

The aim of this work is to investigate a protocol for discharging patients undergoing treatment with 131I-NaI, 131I-MIBG and 177Lu-DOTATATE based on the patient-specific biokinetics. Release criteria and radiation protection recommendations have been determined according to the criteria established by European Commission Directive 2013/59/Euratom. The study analyzed dose rate at different distances of pediatric patients. Data have been used to establish radiation protection restrictions after discharge through a calculation model tailored on patients age and needs. Since younger patients need assistance even during hospitalization, caregivers exposure have been estimated through electronic dosimeters and these exposures were taken into account for the evaluation of prescriptions after patients discharge. Effective doses for caregivers of younger patients resulted up to 10 mSv during hospitalization for 131I-MIBG administrations. The mean dose rate at 1 m at patient discharge was 10.3 µSv/h (ranging from 0.1 µSv/h to 82.5 µSv/h) for 131I-NaI administrations, 45.4 µSv/h (ranging from 9.8 µSv/h to 103.5 µSv/h) for 131I-MIBG administrations and 2.7 µSv/h (ranging from 0.6 µSv/h to 5.4 µSv/h) for 177Lu-DOTATATE administrations. Radiation protection prescriptions have been evaluated considering the dose constraints for public and caregivers according to the Euratom Directive transposition in the Italian law. For public, obtained results showed that some days of abstention from every day activities are necessary especially for patients undergoing 131I-MIBG therapies. Caregivers precautions have been evaluated stratifying patients in different age classes in order to consider that the younger is the patient, the more he need to receive contact assistance.

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References

  1. M.S. Mongane, W.I.D. Rae, Patient release criteria following radioactive iodine-131 treatment in the light of internal practice: where does South Africa fit in? Nucl. Med. Commun. (2017). https://doi.org/10.1097/MNM.0000000000000717

    Article  Google Scholar 

  2. S.L. Lee, Radioactive iodine therapy. Curr. Opin. Endocrinol. Diabetes Obes. 19(5), 420–428 (2012)

    Article  Google Scholar 

  3. R.J. Robbins, M.J. Schlumberger, The evolving role of 131I for the treatment of differentiated thyroid carcinoma. J. Nucl. Med. 46, 28S-37S (2005)

    Google Scholar 

  4. S.G. DuBois, K.K. Matthay, Radiolabeled Metaiodobenzylguanidine for the Treatment of Neuroblastoma. Nucl. Med. Biol. 35(Suppl 1), S35–S48 (2008)

    Article  Google Scholar 

  5. D. Kayano, S. Kinuya, Iodine-131 Metaiodobenzylguanidine therapy for neuroblastoma: Reports so far and future perspective. Hindawi Publishing Corporation. Sci. World J. (2015). https://doi.org/10.1155/2015/189135

    Article  Google Scholar 

  6. D. Levart, E. Kalogianni, B. Corcoran, N. Mulholland, G. Vivian, Radiation precautions for inpatients and outpatients 177Lu-DOTATATE peptide receptor radionuclide therapy of neuroendocrine tumours. EJNMMI Phys. 6(1), 1–12 (2019)

    Article  Google Scholar 

  7. J.E. Gains, J.B. Bomanji, N.L. Fersht et al., 177Lu-DOTATATE Molecular Radiotherapy for Childhood Neuroblastoma. J. Nucl. Med. 52, 1041–1047 (2011)

    Article  Google Scholar 

  8. COUNCIL DIRECTIVE 2013/59/EURATOM. Laying down basic safety standards for protection against the dangers arising from exposure to ionising radiation, and repealing Directives 89/618/Euratom, 90/641/Euratom, 96/29/Euratom, 97/43/Euratom and 2003/122/Euratom. (2013).

  9. F.J. Rutar, C. Augustine, D. Colcher et al., Outpatient treatment with 131I-Anti-B1 antibody: Radiation exposure to family members basic science investigations. J. Nucl. Med. 42, 907–915 (2001)

    Google Scholar 

  10. C. Mair, B. Warwitz, K. Fink et al., Radiation exposure after 177Lu-DOTATATE and 177Lu-PSMA-617 therapy. Ann. Nucl. Med. 32, 499–502 (2018)

    Article  Google Scholar 

  11. DECRETO LEGISLATIVO 31 luglio 2020, n. 101. Attuazione della direttiva 2013/59/Euratom, che stabilisce norme fondamentali di sicurezza relative alla protezione contro i pericoli derivanti dall'esposizione alle radiazioni ionizzanti, e che abroga le direttive 89/618/Euratom, 90/641/Euratom, 96/29/Euratom, 97/43/Euratom e 2003/122/Euratom e riordino della normativa di settore in attuazione dell'articolo 20, comma 1, lettera a), della legge 4 ottobre 2019, n. 117.

  12. International Commission on Radiological Protection, Release of patients after therapy with unsealed radionuclides. Ann. ICRP. 34(2), 1–79 (2004)

    Google Scholar 

  13. European Commission. Radiation Protection 97. Radiation protection following Iodine-131 therapy (exposures due to out-patients or discharged in-patients), (1998).

  14. ARPANSA. Discharge of patients undergoing treatment with radioactive substances. Radiation Protection Series No. 4 (2002).

  15. M. D’Arienzo, G.M. Contessa, S. Sandri, L. Indovina, Management of patients receiving radionuclide therapy with unsealed radionuclides: a proposed approach to the definition of release criteria in Italy. Eur. Phys. J. Plus. 136, 1055 (2021)

    Article  Google Scholar 

  16. J.A. Siegel, C.S. Marcus, R.B. Sparks, Calculating the Absorbed Dose from Radioactive patients: the line-source versus point-source model. J. Nucl. Med. 43(9), 1241–1244 (2002)

    Google Scholar 

  17. IAEA. Release of patients after radionuclide therapy. Safety report series No. 63 (2009).

  18. S.F. Barrington, A.G. Kettle, M.J. O’Doherty et al., Radiation dose rates from patients receiving iodine-131 therapy for carcinoma of the thyroid. Eur. J. Nucl. Med. 23, 123–130 (1996)

    Article  Google Scholar 

  19. J. Gear, C. Chiesa, M. Lassmann et al., EANM Dosimetry Committee series on standard operational procedures for internal dosimetry for 131I mIBG treatment of neuroendocrine tumours. EJNMMI Phys. 7, 15 (2020)

    Article  Google Scholar 

  20. R. Ravichandran, J.P. Binukumar, A. Al Saadi, Estimation of effective half life of clearance of radioactive Iodine (131I) in patients treated for hyperthyroidism and carcinoma thyroid. Indian J. Nucl. Med. 25(2), 49–52 (2010)

    Article  Google Scholar 

  21. J. Willegaignon, K.P. Crema, N.C. Oliveira et al., Pediatric 131I-MIBG therapy for neuroblastoma whole-body 131I-MIBG clearance, radiation doses to patients, family caregivers, medical staff, and radiation safety measures. Clin. Nucl. Med. 43(8), 572–578 (2018)

    Article  Google Scholar 

  22. The British Institute of Radiology, Patients leaving hospital after administration of radioactive substances. Brit. J. Radiol. 72(854), 121–125 (1999)

    Article  Google Scholar 

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Acknowledgements

The authors would like to thank Valerio Nicoloso, Elisa Villanucci and Giorgio Marchetti as well as all the current and former Bambino Gesù Children’s Hospital employees who contributed to the acquisition of data included in this study.

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Authors and Affiliations

  1. Medical Physics Unit, IRCCS Bambino Gesù Children’s Hospital, Piazza S. Onofrio, 4, 00165, Rome, Italy

    Claudia Polito, Davide Ciucci, Federica Martire, Salvatore Donatiello, Antonio Napolitano & Vittorio Cannatà

  2. Postgraduate School of Medical Physics, Tor Vergata University, Rome, Italy

    Davide Ciucci & Federica Martire

  3. Nuclear Medicine Unit, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy

    Milena Pizzoferro, Maria Felicia Villani, Claudio Altini & Maria Carmen Garganese

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  1. Claudia Polito
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  2. Davide Ciucci
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  3. Federica Martire
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  4. Salvatore Donatiello
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Correspondence to Claudia Polito.

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Polito, C., Ciucci, D., Martire, F. et al. Release criteria and exposure of caregivers and public after discharge of patients undergoing 131I-MIBG, 131I-NaI and 177Lu-DOTATATE therapies. Eur. Phys. J. Plus 137, 1088 (2022). https://doi.org/10.1140/epjp/s13360-022-03288-0

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