According to a new case study, an Arizona crematorium was contaminated with radiation after the cremation of a patient who had received radiopharmaceutical treatment.
Radioactive materials have various uses in medicine, both for diagnosis and treatment. Sometimes we forget what to do with the body after the death of the patient, a problem for which there is no federal regulation. Exposure to radioactive contamination after cremation of a patient who has received radiopharmaceutical treatment is especially important here in the United States, where the cremation rate is greater than 50%.
"Without regulation, communication is really important" in such cases, said Gizmodo Kevin Nelson, author of the study at the Diagnostic Radiology Department of the Mayo Clinic in Phoenix, Arizona. This communication did not take place here.
The case study describes a 69-year-old man with an unusual tumor in the pancreas who received intravenous radioactive therapy called lutetium-177 dotatate. He died suddenly two days later in a hospital different from the one where he received his radiation treatment. This hospital did not inform the funeral home / crematorium of his radiotherapy treatment and he was cremated five days later.
Once the researchers discovered the case, they asked the Arizona Radiation Bureau if regulations were in place for these situations. There was none and the Bureau sent representatives to inspect the crematorium. The researchers also analyzed the urine of a crematorium employee to determine if the operator had been inadvertently exposed to the radioactive lutetium resulting from the treatment.
In fact, the equipment triggered the Geiger counter used to measure radiation, with a maximum exposure rate of 7.5 mR per hour when the meter touched the equipment. This is nearly 200 times the average radiation experienced by humans living at sea level. However, exposure to radiation decreases rapidly with distance, so the operator does not get this level of exposure simply staying in the room. In addition, Lutetium disintegrates into non-radioactive elements, so that after about two months there would be no detectable levels of radiation, Nelson said.
The crematorium operator had no lutetium in his urine, but the researchers found a tiny amount of technetium, 99m radiopharmaceutical treatment, possibly from the cremation of someone else.
"The crematorium operator had never administered technetium-99m in a procedure," Nathan Yu, author of the study at the Radiation Oncology Department at the Mayo Clinic in Phoenix, Arizona, told Gizmodo. . "This highlights one of the mechanisms by which there is potentially unnecessary exposure for crematorium workers."
The researchers noted that the operator probably did not receive more than the exposure limit set by the Nuclear Regulatory Commission. Still, according to the study published in the journal of the American Medical Association, "further studies are needed to assess the frequency and magnitude of radioactive contamination and health effects." from repeated or long-term exposure of employees in crematoria in the United States. "
I contacted the National Funeral Directors Association about what it meant for crematorium operators, and a spokesperson provided the following statement:
Given the widespread use of radiation in nuclear medicine (diagnosis and treatment) and radiation oncology (cancer treatment) procedures in the United States and around the world, it is likely that crematorium operators of the body of people who have undergone such treatments. One of the principles of the National Funeral Directors Association's Certified Cremator Operator Program ™ is to ensure that the crematorium operator has the necessary information about the deceased to safely conduct the cremation. Crematorial operators are expected to be informed of the possibility of devices, such as pacemakers, radioactive implants or other implanted devices, that may require special precautions when placed in a cremation chamber and subjected to heat. . This article describes a single case involving the cremation of a person who had been treated with a radionuclide for a pancreatic tumor and who died shortly after treatment and who was incinerated five days after treatment. Prior to the cremation, no crematorium operator had been informed of the treatment of a cancer, indicating in particular whether safety precautions were desirable in the circumstances. NFDA supports further study of this issue and welcomes recommendations on how to best protect the health and safety of crematorium and community personnel, including, as suggested in the research letter, assessing the radioactivity of patients who died before cremation and ensuring that crematorium operators are given sufficient notice to apply appropriate safety precautions, as appropriate.
This is not the first time that radiopharmaceutical patients have been able to leave residual radiation, but this is one of the first studies to report contamination of the facility itself. Nevertheless, it is simply a case study, which means that it is not necessarily representative of a model. The authors of the study recommend that institutions test the radioactivity of patients who died before cremation.
Yu explained to Gizmodo that the next step was to "identify the frequency and scope of this problem and to see if there were any potential effects on repeated and long-term exposure for these employees."