Radiation protection considerations in the case death of radionuclide therapy patients

Radionuclide therapies have been widely used in Irish Nuclear Medicine Centres for decades. Historically, the majority of these were Iodine 131 therapies, which are typically administered across a broad range of patient ages. Palliative therapies such as Strontium 89 and Samarium 153 therapies have also been commonplace in Irish Nuclear Medicine for many years, and are clinically indicated for patient approaching their end of life. The relatively recent advent of Radium 223 therapies has meant that significantly greater numbers of patients, approaching their end of life, are now receiving radionuclide therapies. Life expectancy is a very important consideration for a prescriber in determining patient suitability for a given therapy, however difficulty in accurately estimating life expectancy is a problem among physicians, regardless of their specialty or years of experience. As such unexpected death becomes more likely in end of life care. This paper will detail radiation protection risk assessments for unexpected death of patients following administration of a variety radionuclide therapies. These will include Radium 223, Iodine 131, and also Strontium 89 and Samarium 153. One of the biggest determinants of the control measures required is the clinical pharmacology of the radionuclide in question. There will be discussion regarding radiation protection issues around for emergency surgery and in the case of death: autopsy, embalming, burial and cremation.