Download The increasing use of radioactive isotopes in the treatment of

PRECAUTIONS THAT PATHOLOGISTS SHOULD TAKE IN HANDLING BODIES THAT
HAVE RECEIVED RADIOISOTOPES
The increasing use of radioactive isotopes in the treatment of patients has increased the hazard of radiation exposure to the pathologist.2-4 The physician
concerned with the autopsy should be aware of any radiation problems involved,
the types of radiation hazards, conditions that may expose one to these hazards, the
medicolegal responsibilities for identifying a radioactive cadaver and the protective measures to be taken. The recommended maximum permissible occupational exposure rate is 0.3 roentgens per week to the entire body and 1.5 roentgens per week to the hands. It behooves the pathologist to observe precautions
that will prevent him from receiving more than this amount, although brief exposure to greater amounts may be tolerated if the interim doses are much smaller.
The following radioisotopes and therapeutic situations are most often encountered. P 31 may be employed in therapy of patients with hyperthyroidism, carcinoma of the thyroid, or intractable heart disease. Au198 is used in therapy of
ascites or pleural effusion secondary to cancer, and also for infiltration into
prostatic carcinoma. P32 is used in treatment of patients with chronic leukemia
or polycythemia, and may also be used in the form of colloidal chromic phosphate
in malignant effusions.
The greatest hazard to the pathologist arises when he is not aware of the radioactivity in a body. The amount and identity of the isotope used and the data administered should be recorded in the patient's clinical chart. Prior to autopsy,
this information must be communicated to the pathologist. At autopsy, if the
radioactivity is less than 5 millicuries, aside from general precautions observed
in handling radioactivity6 the pathologist need take no extra precaution other
than the wearing of rubber gloves. This recommendation applies to all personnel
participating in autopsies on bodies upon whom recent premortem tracer studies
had been conducted.
When more than 5 millicuries but less than 30 millicuries of activity is present,
a safety officer should be present to prescribe the working time for the examiner
at various distances from the body. If such an officer is not available, the following instructions should suffice. The examiner should wear heavy rubber gloves
of double thickness with gauntlet tops, to minimize beta exposure to his hands.
He should also wear a plastic apron and plastic shoe covers to reduce contamination of wearing apparel. He should wear spectacles to prevent contamination to his eyes. The organs that are most radioactive should be removed first,
by means of a long forceps, and stored in a properly labeled, covered glass jar. 6
The pleural and peritoneal cavities, if they contain fluid, should be flushed copiously with water, taking care not to splash any of the fluid. In the event of any
accident to protective apparel, immediate and thorough cleansing of the affected
parts by soap and water, without brushing, is indicated. All contaminated items
such as protective clothing and instruments are to be saved for survey by the
safety officer.
682
June 1955
683
EDITORIALS
When the patient's body contains more than 30 millicuries of activity, additional safety measures are strongly recommended. The physician administering
the radioactive material should post a chart on the door of the patient's room
stating the date, amount and identity of the isotope given. This chart should
indicate the permissible times of occupational exposure at various distances from
the patient on successive days until permissible levels of exposure are reached.1
The isotope administered and the area of radioactivity should be identified by
marking the skin with a dye. If the patient comes to autopsy, the chart should
be delivered to the pathologist. It is mandatory that a safety officer be present
to prescribe the working limits to the pathologist. Should the body contain more
than 30 millicuries of activity on completion of the autopsy or should a reading be
obtained at the body surface of greater than 30 milliroentgens per hour (these
values are not equivalent), the body should be embalmed in the hospital morgue.
The mortician should be informed in writing of any existing hazards and of precautions to be taken.
Radioisotope Unit
Veterans Administration Hospital
Bines, Illinois
M.D.
FIELDS, M.S.
EEVIN KAPLAN,
THEODORE
REFERENCES
1. F I E L D S , T., AND SEED, L . : Medical Radioisotope L a b o r a t o r y : Technical and Clinica
M a n u a l . New York: Academic Press, Inc., 1955.
2. Handling of radioactive cadavers. (Editorial.) J. A. M. A., 156: 773, 1954.
3. Precautions in autopsy and embalming procedures following the administration of
radioiostopes. (Editorial.) Hosp. Management, 74: 96, 1952.
4. U. S. Armed Forces I n s t i t u t e of Pathology: Letter No. 5. Precautions in handling of
radioactive material. Washington, D . C , April 8, 1952.
5. U. S. National Bureau of S t a n d a r d s : Handbook N o . 42. Safe Handling of Radioactive
Isotopes. Washington, D . C : U. S. D e p a r t m e n t of Commerce, 1949.
6. U. S. National Bureau of S t a n d a r d s : Handbook No. 56. Safe Handling of Cadavers
Containing Radioactive Isotopes. Washington, D . C : U. S. D e p a r t m e n t of Commerce, 1953.