Are Radioactive Thyroid Patients a Public Health Hazard?

A patient talks with a doctor.
A patient talks with a doctor. Morsa Images/Getty Images

In 2010, Massachusetts Congressman Edward Markey called it "drive-thru radiation." And tabloid headlines refer to patients as "human dirty bombs." They are referring to the common practice in the United States of giving radioactive treatments—in particular, radioactive iodine for thyroid cancer—and then releasing patients, who can remain measurably "radioactive" for as long as a week or more.

Guidance on Radioactive Treatment

In Europe, most patients receiving radioactive treatments stay at the hospital in protected areas to avoid contaminating others. But in the U.S., since 1997, the Nuclear Regulatory Commission has not required that patients be quarantined after radioactive treatments. (It's thought that this move may have been primarily for cost reasons, supported by insurers and HMOs who want to avoid the additional costs involved with hospital quarantine for patients having radioactive iodine treatment.)

Voluntary guidelines suggest that after radioactive treatment, patients avoid close proximity to others, sleep alone for a week, and avoid close proximity (i.e., hugs) with infants and children, and avoid pregnant women. And yet, these guidelines are not being followed, and many of these patients, while still "radioactive" so to speak, end up in public, riding public transportation, or, to avoid exposing their own families, frequently stay in hotel rooms which then become contaminated by radiation.

According to some scientists, even the second-hand exposure to someone who has had a radioactive medical treatment can provide a single dose of radiation that exceeds the typical annual dose from all sources received by a typical American, and maybe as much as four times higher than the level considered safe for a pregnant woman.

Markey's Congressional Investigation Concerning Radiation Treatments

During then Rep. Markey's Congressional investigation (Markey is now a senator) examining patients released from the hospital after radioactive treatments in 2010, a number of problems were identified, including patients who set off radiation detectors at airports and in tunnels, rode public buses, shared a bathroom or bedroom with a pregnant woman or child, and their house trash has triggered radiation detectors at landfills.

Hotels are a particular concern, because, according to the report, 7 percent of the patients surveyed had radioactive iodine treatment, and then checked in to a hotel "where they contaminate sheets, bedspreads, and other common room surfaces and could also potentially expose pregnant hotel workers or children of guests—who are the most susceptible to developing cancer as a result of radiation exposure. In 2007, a patient was discovered to have contaminated two individuals as well as the sheets and towels used in almost an entire hotel in Illinois."

According to Rep. Markey's statement, the Nuclear Regulatory Commission (NRC) is ignoring the problem. "My investigation has led me to conclude that the levels of unintentional radiation received by members of the public who have been exposed to patients that have received 'drive through' radiation treatments may well exceed international safe levels established for pregnant women and children...This has occurred because of weak NRC regulations, ineffective oversight of those who administer these medical treatments, and the absence of clear guidance to patients and to physicians.

The NRC's Response to the Radiation Issue

On January 21, 2011, the NRC responded to Markey's congressional investigation in part by stating the following about people being discharged from radiation treatment:

It is important to note that human patients, unlike an animal, have the ability to understand and follow precautions for maintaining distances from other individuals and distinguishing between time and distance differences for closeness to adults or children. A physician also can screen a patient’s ability to follow instructions and understand the need for precautions to reduce radiation exposure to others. Additionally, the regulations for animal release take into account other factors, such as the management of radioactive waste not controlled by a sanitary sewer system, as is generally the case with human waste.

These distinctions, together with factors such as the potential benefits of allowing patients to return to their families, the Commission’s policy of not interfering in the practice of medicine, not placing an unacceptable burden on the medical community and other supporting information discussed above and in the enclosure, lead us to conclude that the current release limit for human patients is appropriate and protective of public health and safety. As stated above, we do plan to consider the utility of collecting data on the doses from release of patients treated with medical isotopes.

Ultimately, the NRC politely told Markey that based on current research and knowledge, they didn't want to further isolate patients who received radiation treatment. Doing so would place an unnecessary burden on the medical community.

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