Radiation Safety Concerns for Nurses Caring for Cancer Patients

Nursing staff encountering radiation (Forwarded from the Director's mailbox)

Dear Director,
I apologize for disturbing you.
Our hospital has admitted a patient who underwent medical treatment in mainland China on January 9th of this year.
He is a colon cancer patient with metastasis to the liver.
On January 9th, 2013, he had 30 iodine-125 seeds implanted in his body at a hospital in Guangzhou, China.
We have searched online multiple times but found no detailed information regarding radiation protection.

As we care for this patient daily, we are deeply concerned about potential radiation exposure.
The radiology department has advised maintaining a distance of more than one meter, but without any protective measures, we are in close contact with the patient every day.
We have raised our concerns to our superiors, but they believe we are overreacting.
We simply want to work in a safe medical environment.

Please provide us with information on this matter; we feel helpless and are in urgent need of assistance.
Thank you on behalf of all the nursing staff in the ward.
I apologize for the confusion regarding the options below; if we select the wrong one, please ensure it reaches the correct department.
Thank you for your hard work.

Ms. Tsai, 20~29 year old female. Ask Date: 2013/02/08

Dr. Xu Zhongyuan reply Radiology

Dear Ms.
Tsai,
Iodine-125 has a half-life of 60 days and emits gamma rays with a maximum energy of 35 keV (kiloelectronvolts).
Since it only emits gamma rays, it is not suitable for brachytherapy (which typically uses alpha or beta-emitting isotopes).
Currently, it is more commonly used in in vitro radioimmunoassays (RIA).
If the information provided is accurate and iodine-125 is indeed being used for brachytherapy, then radiation protection should consider the administered dose.
Additionally, since it is sealed within the patient's body, there is no concern for external radiation contamination.
Given that the energy of the emitted gamma rays is relatively low (35 keV), most of the radiation will be attenuated by the patient's tissues, and the radiation dose received by caregivers should not be excessively high.

However, since the dose of iodine-125 used in brachytherapy is unknown, it is advisable, based on the principle of minimizing radiation exposure, that family members and healthcare personnel adhere to the following three principles of radiation protection to reasonably reduce their exposure to the lowest possible levels:
1.
Distance: Maintain a distance of at least 1 meter whenever possible.
2.
Time: Minimize the duration of contact with the patient.
3.
Shielding: If possible, use lead shielding (or lead aprons).
Wishing you safety and health.
Sincerely,
Dr.
Hsu Chung-Yuan
Attending Physician, Nuclear Medicine
Taoyuan General Hospital, Department of Health

Reply Date: 2013/02/08

More Info

Radiation safety is a significant concern for healthcare professionals, especially for nurses who care for patients undergoing treatments involving radioactive materials, such as iodine-125 (I-125) brachytherapy. Understanding the nature of the radiation, the potential risks, and the protective measures is crucial for ensuring both patient and caregiver safety.

Iodine-125 is a radioactive isotope commonly used in the treatment of certain cancers, including prostate and thyroid cancers, and in some cases, colorectal cancer that has metastasized to the liver. The isotope emits low-energy gamma radiation, which has a half-life of approximately 60 days. This means that the radioactivity decreases over time, but it is essential to understand how to manage exposure during the period when the isotope is active.

The primary concern for nurses caring for patients with I-125 implants is the potential for radiation exposure. The recommendation to maintain a distance of at least one meter from the patient is a standard precaution. This distance helps to minimize exposure to radiation, as the intensity of radiation decreases significantly with distance. Additionally, the radiation emitted by I-125 is primarily gamma radiation, which can penetrate tissues but is attenuated by the body's own tissues. Therefore, while there is some risk, the actual exposure to caregivers is generally low if proper precautions are taken.

To further enhance safety, nurses should adhere to the three fundamental principles of radiation protection: distance, time, and shielding.
1. Distance: As mentioned, maintaining a distance of at least one meter from the patient is crucial. The farther away you are from the source of radiation, the lower your exposure will be.

2. Time: Reducing the amount of time spent in close proximity to the patient can significantly decrease radiation exposure. Nurses should aim to perform necessary tasks efficiently and minimize unnecessary interactions.

3. Shielding: While it may not always be feasible to use lead aprons or other shielding materials in a hospital setting, it is advisable to use any available protective barriers when caring for patients with radioactive implants.

It is also important to communicate with your hospital's radiation safety officer or the radiology department for specific guidelines and protocols related to patient care involving radioactive materials. They can provide additional training and resources to ensure that all staff members are aware of the risks and the best practices for minimizing exposure.

Regarding the emotional and psychological aspects of working with radioactive patients, it is understandable to feel anxious about potential radiation exposure. However, it is essential to rely on scientific evidence and established safety protocols. The risk of significant radiation exposure in a clinical setting, when proper precautions are followed, is typically low.
If you have concerns about specific cases or protocols, do not hesitate to bring them up with your supervisors or the radiation safety committee at your hospital. It is vital for healthcare workers to feel safe and supported in their work environment, and addressing these concerns is an important part of maintaining a healthy workplace.

In summary, while caring for patients with I-125 implants does involve some level of radiation exposure, adhering to safety protocols and understanding the nature of the radiation can significantly mitigate risks. By following the principles of distance, time, and shielding, nurses can provide effective care while ensuring their safety and that of their patients.

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