Corpse (Photo: Nicolas Tondreau, Getty Images / iStockphoto)
An Arizona man, whose radioactive cadaver has contaminated a local crematorium, raises concerns about how to treat the bodies of cancer patients who have undergone radiotherapy treatment.
A published research letter in the Journal of the American Medical Association this week describes the case of 2017 of a 69-year-old cancer patient who underwent ambulatory infusion radiotherapy at the Mayo Clinic in Arizona.
With the increasing number of Americans choosing cremation and the increasing number of patients being treated with radiation-containing pharmaceuticals, more attention needs to be given to the issue, said one of the authors of the Mayo Clinic Research Letter, Arizona. The Republic of Arizona.
"This is not the second coming of Chernobyl or Fukushima, but unwanted and unnecessary radiation," said Kevin Nelson, a medical physicist, who is responsible for radiation protection at the Mayo Clinic in Arizona.
"I do not think the risk of inadvertently burning a body that can contain low levels of radiation is great, I think the risk is low," he said. "But what we're trying to do is minimize these small levels of exposure, I think we have the burden to do it in the community."
No regulation of Arizona on the cremation of the bodies of patients exposed to radiation
The authors of the research letter indicate that the case shows that further studies are needed to determine the possible health effects of radiation contamination from crematorium operators, as well as the frequency of contamination.
The researchers found that the regulation of cremation of exposed patients varies from state to state. There is no regulation in Arizona or at the federal level.
The regulations on cremation vary from state to state. In Arizona, there are no regulations regarding cremation after the use of radiation-containing pharmaceuticals. (Photo: Getty Images / iStockphoto)
"Radiopharmaceuticals represent a unique and often overlooked challenge in post-mortem safety," says the research letter. "The cremation of an exposed patient volatilizes the radiopharmaceutical, which can then be inhaled by workers (or released into the adjacent community) and result in greater exposure than that of a living patient."
Nelson said he hoped the case would help the medical community, funeral homes and crematoria to become more aware of the risks.
The patient, who had a neuroendocrine tumor on the pancreas, died in another hospital two days later after being treated with lutetum Lu 177 dotatate. He was cremated five days after his radiotherapy.
When Nelson and the patient's Mayo physicians learned of his patient's death about three and a half weeks later, the crematorium had been notified, as had the state's Bureau of Radiation Control.
State study revealed radioactive contamination at crematorium
A study on the state of the installation revealed a radiation contamination in the crematorium oven, the vacuum filter and the bone grinder. According to Nelson, levels of contamination were very low, but nonetheless radioactive and identified as Lutetium Lu 177 dotatate, corresponding to the radiation drug used to treat the patient.
"We have radiation detection equipment that can really tell us which isotope is causing the high levels of radiation we detect," Nelson said.
While there was no lutatum Lu 177 dotatate detected in the urine of the crematorium operator, a different isotope, technetium Tc 99m, was detected in his urine.
This discovery particularly attracted the interest of Nelson, who suspected that technetium-99m was another incinerated patient.
The operator had never received technetium Tc 99m in the course of a medical procedure, and this was not the patient who had received Luetium Lu 177 dotatate, said Nelson.
"The question this raises is how often does it happen?" said Nelson, who has been working in the field of radiation protection for 40 years. "When we look at exposure to members of the general public who do not know what they are exposed to, that's another level of concern."
In Florida, radiotherapy organs are removed before incineration
Exposure to even low radiation levels can accumulate over time if it extends, said Nelson.
Nelson worked at the Mayo Clinic in Florida, which forbids any material other than human remains from being cremated.
Patients who die in Florida after receiving radiotherapy must either harvest their organs before incineration or keep their bodies until the radioactive material has decayed and is no longer radioactive.
Stock image. (Photo: PeopleImages, Getty Images / iStockphoto)
"You can imagine the discussion you need to have with the family – these are difficult discussions," he said. "Because the family wants to go ahead, arrange funerals, it's often easier, in the state of Florida, to collect organs containing radioactivity."
The research letter drew national and international attention.
"This very morning, I was in contact with the funeral home director where this happened and, in his area, this is raising a lot of notoriety," Nelson said. "We want this discussion to take place, which is partly why we published this."
How is the cremation process going? A local funeral home shows us the steps.
Douglas Raflik, reporter for Fond du Lac
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