Radiation Doses vs Patient’s Life Styles

radiation sickness Doses vs Patients Life Styles radiation doses from 131I treated hyperthyroid glandism patient roles vs deportment style- AsurveyA.S. Shah*, Hameedullah, F. Saeed, K.A.Shah, A. Khan, M. Rauf Khattak hornswoggleThe Radioactive Iodine is widely used for the give-and-take of various thyroid disorders. The patientsundergoing such treatments ar advised to re rigid their social and work related activities to ensn atomic number 18 light beam exposures to others. The present work describes the results of a structured surveyconducted on patients visiting Institute of Radiotherapy and nuclear Medicine (IRNUM), Peshawar,for the thyrotoxicosis treatment. The patients were asked about their lodging conditions, family setup, number of kids, locomotion sensory system and time back home from the hospital. The radiation doses to theother people with whom they might come in contact in their living environment were estimated. Theradiation doses to others at sensation meter from the patients were calculated as 0.76, 1.53, 2.29, 3.06, 3.82and 4.58mSv. The results of the survey indicate that the radiation protection advice and other regulative requirements hold to be reviewed keeping in view individual patients circumstances.INTRODUCTIONThe radioactive iodine (RAI) is widely used for the treatment of various thyroid disorderssince long. The differentiated thyroid cancer (DTC) is treated by admitting the patients inhospital where as hyperthyroidism patients ar treated on out patient root in most of thecountries (1-4). The safety issues for the patients, their families, comforters, hospital staff andthe general public arise with either treatment approach. The radiation contingencys are more in type of hyperthyroidism treatment than the DTC treatment due to shorter effective half lifeof the 131I in the later application. Therefore at the time of release of the patient from medical checkup confinement, the retained radioactivity in DTC patients is much lower causing lowrisk of radiation exposure to other people. In case of thyrotoxicosis treatment theadministered radioactivity is much lower as compared to DTC treatment but radiationdoses to others are more due to high uptake of RAI by these patients (5-8). The patientsundergoing such treatments are advised to restrict their social and work related activitiesto reduce radiation exposure to others when they return to their families in community (9-16). This radiation protection advice is usu entirelyy base on residual activity or radiation exposure level and is not specific to an individual patient circumstances or socioeconomiccondition. These advices are usually formulated by the developed countries and areadopted as such in most of the developing countries. In actual practice the obligingness to theprotection advice depends on socioeconomic conditions and the life style of the patients.Therefore keeping in view this aspect of RAI treatments, an interview based structuredsurvey was c onducted on patients visiting our hospital for the treatment of thyrotoxicosis.The patients were asked about their housing conditions, family/home set up, number ofkids, mode of travelling and travelling time to back home from the hospital. The radiationdoses to the other people with whom they might come in contact in their livingenvironmentMATERIAL AND METHODSThe patients were asked about their housing conditions, family set up, number of kids andtravelling periods back home. The total number of patients inducted in the present surveywas 419. The data collected was tabulated and reviewed for completeness. A calibrateddose of 131I (185-1106MBq) was administered to the patients. The exposure rate from thepatient was mensural at a distance of angiotensin converting enzyme(a) meter from standing position with a hand-heldpressurized battery operated survey meter, Victoreen Model 450P, calibrated fromsecondary bar dosemetry laboratory, Islamabad. The dose rate was recorded in units of Svhr-1. The patients were instructed to sleep alone, drink fluids liberally and avoid prolonged close personal contact with others for the first 2 days. The patients and familymembers were told that they could retrieve normal activities thereafter (9-12). The estimatedradiation doses to the maximally uncovered person were calculated using the formula given inequation 2 (14).RESULTSThere were 385 (93%) patients residing in joint and 29 (07%) in separate family system confuse 1. It was found that 15.27 % of the patients were male and 84.73% females with agewise distribution as shown in add-in 2.The heedful hospital leaving dose rate at one meter from the patients were 5.7, 11.0, 15.7,18.7, 23.0 and 28.0Svh-1 for administered RAI activity of 5, 10, 15, 20, 25 and 29.9mCi singly. The corresponding radiation doses to others from exposure to the patient atone meter using occupancy component part of 0.25 were calculated as 0.76, 1.53, 2029, 3.06, 3.82 and4.58mSv board 3.They surve y showed that 4.77, 17.66, 22.91, 24.10, 12.66 and 17.90% patients hadaccommodation consisting of one, two, three, four, five and more than five roomsrespectively Table 4.It was observed that 78.04% patients used public transport and 21.96% used privatetransport for back home after RAI administration. The radiation doses to others duringtravelling were estimated using occupancy factor of 0.1m and 1m distance plotted versustravelling time of the patient from hospital to back home Figure 1 and Figure 2 respectively.It was also observed that 1.67% of the patients had no sanitary arrangements at home andthey used open space in the fields as toilet. The patients residing in localities where there iscomparatively better sanitation arrangements had one (31.74%), two (36.04%), three(17.42%) and more than three (13.13%) toilets available Table 5.In addition 11.93% of the patients had no kids where 10.74% lived in joint family systemand 1.19% as separate. The survey showed that 88.7% of the p atients had kids and 82.33%of these lived in joint family system where as 5.73% lived separate. The number of kids andthe family status showed that 17.18%, 31.50% and 33.65% patients had 1-3, 4-6 and morethan 6 kids respectively lived in joint family system while 2.86%, 1.91% and 0.95% patientshad 1-3, 4-6 and more than 6 kids respectively and they used to live in separate familysystem Table 6.DISCUSSIONThe patients treated for thyrotoxicosis with RAI (131I) are advised certain restrictions onbehavior in order to ensure the radiation safety of all other individuals with whom they maycome into contact. Generally it is assumed that the patients are unlikely to create a hazardto other persons. A dose limit of 5mSv and 1mSv had been recommended for these peoplesdepending upon the nature and type of their interaction with the patient (17). Thecompliance to the safety instructions depend upon patients literacy level, termination makingcapacity, health education, grasping and understandin g disclosure of treatment in generaland patients socioeconomic conditions and life styles in particular(18,19).The over all literacy level of the survey region is 37.26 % (20). Literacy level reflects theability of the patients to comprehend that they emit detectable levels of radiation forspecified period of time after their treatment which are hazardous for other peoples. It wasobserved that 93% of the patients inducted in the survey used to reside in joint familysystem and 07% lived in separate system Table 1. This aspect coupled with the low literacylevel puts emphasis on the patients receiving treatments to comply with the instructionsstrictly to limit radiation exposure to others.The restriction on mode of travelling back to home is important factor in RAI treatmentespecially when 78.96% of the patients used public transport to back home from hospital. Itis practically tight to measure radiation doses to other passengers traveling in the samevehicle. The measured hospital lea ving dose rate at one meter from the patients designatethat the time restrictions to travel by private transport (at 1m distance) are not required,although they should not sit immediately adjacent to another passenger, accompanyingperson or driver Table 3.Similarly restrictions would not be required for public transport (0.1m distance) for onehour journey. It was observed that radiation doses to others at 1m and 0.1m withadministered 131I radioactivity of 185, 555 and 1106MBq increases linearly with the travelling time Figure 1 2. The patients needing greater travelling time back home shoulduse private transport after RAI administration. Therefore regulatory authorities need toreassess the situation with respect to private or public mode of travelling whilerecommending discharge limits for RAI treatments. The radiation doses from the exposureto the patient to total decay (t=) at one meter using occupancy factor of 0.25 for RAIadministered were well within recommended dose limit of 5mSv for adult comforters Table3. even so for patients residing in single room accommodation, with kids and joint familysystem, the dose limit of 1mSv is unlikely to be adhered. This aspect becomes moreimportant where a very large office of the patients (88.07%) had kids and 82.33% ofthose used to live in joint family system as observed in the present survey Table 6. Thesanitary conditions of the patients at home are important to protect family members fromradioactive contamination and associated external radiation exposure. It was observed thatpatients having better sanitation arrangements would not pose radiation related problems.However patients having no proper sanitation (1.67%) are source of concern for thecommunities where they reside Table 5.The trends observed indicate that the patients with single room accommodation, havingkids and joint family system need strict compliance to radiation protection advice to restrictradiation doses to the immediate family members. Theref ore RAI treatments need to becarried out keeping in view patients living conditions and life styles.CONCLUSIONThe radiation protection advice and regulatory requirements need to be formulatedkeeping in view patients socioeconomic, life style and living conditions. It needs to bereviewed depending upon individual patients circumstances.Table 1 Family Status (N=419)Status No of patients (%)Joint Family 390 (93)Separate Family 29(07)Table 2 Age and Sex Distribution of PatientsAge No. of Patients (%)17 to 28 36(8.59)29 to 40 161 (38.42)41 to 50 119 (28.4)51 TO 60 67 (15.9)60 33 (7.8)*15.27 % of patients are males** 84.73 % of patients are femalesTable 3 131I administered Vs Average Radiation DosesS.No131I activity (mCi) No. of patients (%)Average leavingdose rate at 1meter(Sv/hr)Average Dose*to others at 1meter(mSv)1 05 12 (2.88) 5.7 0.762 10 18 (4.3) 11 1.533 15 99 (23.62) 15.7 2.294 20 233 (55.6) 18.7 3.065 25 47 (11.21) 23 3.826 29.9 10 (2.3) 28 4.58* Average doses to total decay (t= ) to other individual exposed to the patient at one meter usingoccupancy factor of 0.25.Table 4 Status of Patients in Relation to No. of Rooms in Joint/ Separate SystemNo. of roomsin homeNo. of Patients(%)Patientsliving inJoint FamilySystemPatientsliving in one after another1 20(4.77) 18 22 74(17.66) 69 73 96(22.91) 90 74 101(24.10) 96 45 53(12.66) 46 4More than 5 75(17.90) 71 5Table 5 Sanitary Status of PatientsNo. of Toilets in home of Patients No. of Patients (%)Open without flush 07(1.67)With one flush 133(31.74)With two flush 151(36.04)With three flush 73(17.42)More than three flush 55(13.13)Table 6 Kids Status Vs Family SystemFigure 1 RadiationDoses (mSv) at 0.1mVs Travelling Time(Hrs)Kids Status Joint Families (%) Separate Families (%)Without Kids50(11.93)45(10.74) 05(1.19)With Kids 369(88.07) 345(82.33) 24(5.73)Up to 3 Kids4 to 6 Kids7 and above72(17.18)132(31.50)141(33.65)12(2.86)08(1.91)04(0.95)Figure 2 Radiation Doses (mSv) at 1m Vs Travelling Time (Hrs)