What happens when a patient treated with radioactive drugs is cremated?



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At crematoriums, such as the famous Père-Lachaise Cemetery in Paris, employees warn employees that they may be exposed to low levels.

In crematoriums, such as the famous Père-Lachaise Cemetery in Paris, employees warn employees that they may be exposed to low levels of radiation from remnants of cancer patients.

At the end of 2017, a 69-year-old American who had just received Lutetium 177 radiotherapy for his pancreatic cancer died. Five days later, his remains were cremated.

Three weeks later, Kevin Nelson, Radiation Safety Officer at Mayo Clinic, Arizona, began to worry.

Nelson learned of the man's death with a little delay because he had died in another hospital.

In Florida, where Nelson had previously worked, cremating human remains contaminated with radioactive substances was illegal. But was it illegal in Arizona?

No, it turns out. The state radiation control office in southwestern Canada told Nelson that legislation in this area was not regularized.

The experts at this office nevertheless decided to measure the levels of radiation at the crematorium, with Nelson in tow.

"It was just happy," said Nelson to Nelson. Another doctor might not even have thought of it.

A Geiger-Mueller counter was put in contact with the cremation unit, a vacuum filter and a bone grinder: traces of lutetium were detected.

The investigators took urine samples from the operator of the establishment.

No similar trace of lutetium was found … but small traces of another radioactive substance, technetium 99 – widely used by hospitals for diagnostic tests – appeared.

The crematorium worker was probably contaminated by the inhalation of technetium when the remains of another patient were incinerated. At high temperature, the molecules would have vaporized in the air.

& # 39; Very, very small level & # 39;

The case is described in a research letter published Tuesday in the press. Journal of the American Medical Association (JAMA) by Nelson and his colleague Nathan Yu, Resident Physician, Radiation Oncology, Mayo Clinic, Arizona.

"It's the first time that contamination of facilities is documented," Yu told AFP.

Nelson described the level of radiation found as "very very very small".

"We are very confident to say that it is unlikely that the crematorium operator who has captured this radiation has anything close to the limit for the general public" set by the Nuclear Regulatory Commission (NRC ), he added.

Before cremating human remains, crematoria remove pacemakers, defibrillators and any other implanted device that may explode.

But most US states do not seem to have tackled the thorny issue of radioactive substances in corpses.

At the federal level, an NRC spokesman told AFP that the current regulations for patients treated with radioactive substances extended to cremation and autopsy.

But NRC does not technically regulate the cremation services sector. So for regulation to work, hospitals must inform the crematoriums of any potential risk of exposure.

"This is not something that is widely known or thought of," Yu admitted.

In the case examined, the employee was exposed to a dose of non-hazardous radiation.

But there are many other radiopharmaceuticals, which become volatile at varying temperatures, have variable half-lives and are administered in varying doses, and the results could be very different, Yu said.

Forty million treatments and examinations using radioactive drugs were performed worldwide in 2006, according to doctors, citing the most recent data available. They are calling for better ways to assess the risk.

The National Funeral Directors Association told AFP that she was not aware of the most recent case until recently but that she was in favor of "a more study." in depth of this question ".

The association also said it accepted the recommendations to better protect crematorium staff and the general public, including "assessing the radioactivity of patients who died before cremation".

In Virginia, the head of the radiological health office told AFP that there were no health regulations in the registers because cremation facilities are not authorized users of materials radioactive.

In Maryland, Lynn Newman, chief of the council of physician-practitioners of the state, has confessed his surprise at the thought that members of his profession may be contaminated.

"That never came to my mind," Newman told AFP.


Arguments in favor of maintaining the existing regulation on treatment by I-131


More information:
Journal of the American Medical Association (2019). DOI: 10.1001 / jama.2018.21673

© 2019 AFP

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What happens when a patient treated with radioactive drugs is cremated? (February 26, 2019)
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