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Patient education regarding iodine therapy (NM Specific)

 

Patients undergoing 131I-NaI therapy are counselled on its effects and the restrictions and precautions that accompany the therapy

 

+ Special considerations for 131I-NaI

  • Patients are radioactive after therapy with 131I-NaI.
    • Those who come into contact with the patient are at risk of being exposed to the radioactivity
    • With simple precautions, the radiation exposure to others is low (less than 1 mSv)1

 

  • Patients continue to excrete 131I-NaI for at least two days following therapy.2
    • The majority of the 131I-NaI leaves through the urine
    • Small amounts will also be excreted in saliva, sweat, tears, vaginal secretions, and feces

+ Restrictions and precautions

  • Patients are counselled on restrictions and precautions they must follow in the days following treatment.
    • The restrictions associated with 131I-NaI therapy are addressed with patients as part of the education during the consent process
    • MRTs review important restrictions and precautions with patients prior to administration
    • Patient support materials are helpful to illustrate the concepts being explained and can serve as a reference and reminder when the patient leaves the department2
    • MRTs remind patients about the importance of staying well hydrated and voiding frequently

 

  • Following therapy, precautions are exercised to avoid exposing others to radioactivity.

     

  • The recommended duration of precautions, as well as the specifics of the precaution (e.g., distances), vary according to the dose.
    • General precautionary measures are similar for all doses
    • Differences for high-dose therapy are highlighted in the right-hand column of the table below

Where the institution has more stringent guidelines, those should be followed.1-10


Low-dose 131I-NaI

High-dose 131I-NaI

Less than 1110 MBq Greater than or equal to 1110 MBq
Duration of precautions Duration of precautions
Up to 7 days 7-10 days*
Personal contact Personal contact (same as low-dose with identified adjustments)
Avoiding intimate or prolonged physical contact with others3 Avoiding intimate or prolonged physical contact with others3
Maintaining a distance of at least 1 meter from others1 Maintaining a distance of at least 2 meters from others1
Sleeping in a separate room4 Sleeping in a separate room4
Avoiding situations that put the patient in close contact with others, such as public transport and public events Having no close contact with others, such as public transport and public events
Travelling alone after treatment. If not possible, the greatest distance possible between the patient and others should be maintained, while limiting time spent with others in confined spaces (e.g., car)5 Travelling alone after treatment. If not possible, the greatest distance possible between the patient and others should be maintained, while limiting time spent with others in confined spaces (e.g., car)5
Avoiding prolonged contact with pregnant women and children under 18 Having no contact with pregnant women and children under 18
Washing hands frequently with soap and warm water6 Washing hands frequently with soap and warm water6

Taking further precautions to ensure others don't come into contact with their radioactive bodily fluids:
- Wearing slippers or socks at all times7
- Avoiding foods that create residual saliva, such as bones, peels or chewing gum, that require disposal

Taking further precautions to ensure others don't come into contact with their radioactive bodily fluids:
- Wearing slippers or socks at all times7
- Avoiding foods that create residual saliva, such as bones, peels or chewing gum, that require disposal
Bathroom Bathroom
Using a bathroom reserved for their exclusive use for at least 2 days following treatment (because the majority of radioactivity will be excreted via the urine)8 Using a bathroom reserved for their exclusive use for at least 2 days following treatment (because the majority of radioactivity will be excreted via the urine)8
Flushing the toilet twice after each use with the toilet lid closed5 Flushing the toilet twice after each use with the toilet lid closed5
Sitting when using the toilet (both genders)1 Sitting when using the toilet (both genders)1
Taking extra care to wash hands with soap and warm water after using the bathroom6 Taking extra care to wash hands with soap and warm water after using the bathroom6
Showering at least once a day - baths should be avoided6 Showering at least once a day - baths should be avoided6
Cleaning the bathroom thoroughly after the precautionary period has passed, before anyone else uses the room, and items that have come into contact with bodily fluids should be disposed of (e.g., toothbrush)6 Cleaning the bathroom thoroughly after the precautionary period has passed, before anyone else uses the room, and items that have come into contact with bodily fluids should be disposed of (e.g., toothbrush)6
Pregnancy, breastfeeding and conception Pregnancy, breastfeeding and conception
131I-NaI may be passed to an infant via the placenta and the breast milk and cause permanent damage to the thyroid9 131I-NaI may be passed to an infant via the placenta and the breast milk and cause permanent damage to the thyroid9
Waiting to conceive: both men and women wait 6-12 months before attempting to conceive a child1 Waiting to conceive: both men and women wait 6-12 months before attempting to conceive a child1
Ceasing breastfeeding 6 weeks prior to treatment: due to excessive dose to the breast tissue1 Ceasing breastfeeding 6 weeks prior to treatment: due to excessive dose to the breast tissue1
Not resuming breastfeeding after treatment for the current child9 Not resuming breastfeeding after treatment for the current child9
Patients may safely breastfeed subsequent babies Patients may safely breastfeed subsequent babies

  • Patients and/or caregivers are informed that they should contact the department in the event of contamination (urine spill, vomiting).
    • If the patient expires, the caregiver(s) should contact the department for guidance
 

+ Patient compliance with precautions (High-dose 131I-NaI)

  • The physician may choose to have the patient admitted to hospital.
  • Doses over 1110 MBq (30 mCi) are administered to out-patients only when there is confidence that the patient understands and will comply with the strict radiation safety precaution1,10
    • Specific dose levels for determining out-patient procedures may vary, depending on the values submitted and approved by the CNSC during the licence application process
    • MRTs comply with the procedures laid out in their CNSC therapy license conditions10
    • If the MRT believes the patient is unwilling or unable to comply, a physician is consulted before the dose is administered

+ References

  1. Silberstein EB, Alavi A, Balon HR, et al. Society of Nuclear Medicine Procedure Guidelines for Therapy of Thyroid Disease with Iodine-131 (Sodium Iodide). Version 2.0. Available at: http://interactive.snm.org/docs/Therapy%20of%20Thyroid%20Disease%20with%20Iodine-131%20v2.0.pdf. Accessed February 21, 2013.
  2. Radiologyinfo.org. Radioiodine (I -131) Therapy for Hyperthyroidism. Available at: http://www.radiologyinfo.org/en/info.cfm?pg=radioiodine. Accessed February 21, 2013.
  3. Mettler FA. Essentials of Nuclear Medicine, 6th Ed. Philadelphia, PA: Elsevier Saunders; 2012.
  4. Health Physics Society. Therapy—Nuclear Medicine. Available at: http://hps.org/publicinformation/ate/faqs/nuclearmedicinetherapy.html. Accessed February 21, 2013.
  5. Henkin R. Nuclear Medicine, 2nd ed. Philadelphia, PA: Mosby; 2006.
  6. St. Joseph's Healthcare Hamilton. Precautions after Out-patient Radioactive Iodine (I-131) Therapy. Available at: http://www.stjosham.on.ca/media/PatientED/F-J/PD%206177%20I131RadioactiveIodineTherapySJH-trh.pdf. Accessed February 21, 2013.
  7. Department of Nuclear Medicine McMaster University Medical Centre. Hamilton Health Sciences Patient Information. Precautions after Out-patient Radioactive Iodine (I-131) Therapy. Available at: http://www.hamiltonhealthsciences.ca/documents/Patient%20Education/I131RadioactiveIodineTherapyHHS-trh.pdf Accessed February 21, 2013.
  8. Sisson JC, Freitas J, McDougall IR, et al. Radiation safety in the treatment of patients with thyroid diseases by radioiodine 131I : practice recommendations of the American Thyroid Association. Thyroid 2011;21(4):335-346.
  9. Society of Nuclear Medicine and Molecular Imaging. Quick reference for press & media. Guidelines for Patients Receiving Radioiodine I-131 Treatment. Available at: http://interactive.snm.org/index.cfm?PageID=11031. Accessed February 21, 2013.
  10. RD/GD 371 Licence Application Guide, Nuclear Substances and radiation Devices, Section E2.4

 

Validation

May 8, 2013

 

 
Canadian Association of Medical Radiation Technologists
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