Monday, 12 December 2011

Atomic Energy Regulatory Board norms on safe handling of bodies with radionuclides observed more in breach: The hazards of nuclear medicine

Syed Akbar
Hyerabad: Nuclear medicine hazard looms large in hospitals in the state with many of them not following the safety code of the Atomic Energy Regulatory Board (AERB). The “safety code for nuclear medicine facilities” deals with handling of nuclear radio isotopes for diagnostic facilities and treatment of certain diseases like cancers, as well as safe disposal of the bodies of patients, who die while on radiation therapy.

Though most hospitals have followed the building code for housing the nuclear medicine department, many of them flout the rules with regard to the management of cadavers containing radionuclides. Many hospitals do not have local safety committees to ensure that the code is followed.

Even senior doctors admit that they are not aware of the AERB code on safe nuclear medicine and the procedure of handling bodies of patients under radiation therapy. In some cases, patients die during radiation therapy. Doctors just hand over the bodies to the relatives without ensuring that the quantum of radionuclides in the body is within the permissible limits.

According to AERB guidelines, the maximum permissible level of iodine131 radioisotope for a body meant for postmortem is 10 megabecquerel and 400 for burial and cremation. In case of yttrium90 isotope, it is 200, 2000 and 70 MBq for postmortem, burial and cremation respectively. The corresponding figures for Au198 (isotope of gold) is 400, 400 and 100; for phosphorous32 is 100, 2000 and 30; and for strontium89 is 50, 2000 and 20 MBq. Doctors should ensure to keep radiation doses and contamination risks “as low as reasonably achievable” (ALRA).

Senior oncologist Dr P. Raghu Ram said radiological monitoring should be followed before doctors and others leave the scene in case of mishap in nuclear medicine unit. “Assume that all materials, equipment and personnel have been contaminated if they were in the immediate area of the incident. There should be strict isolation precautions,” he added.

In case the body is meant for cremation, prior authorisation, and specific precautions to be observed during cremation, should be obtained from the radiation safety officer concerned. In case of burial, relatives should be prevented from coming into contact with the body and people must not stay near the coffin.

The body should be handled with disposable gloves and kept on plastic sheets to control spread of contamination. Autopsy on contaminated cadavers should be performed only in a special autopsy room, which many hospitals in the State do not have.

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