ENS 57098
ENS Event | |
|---|---|
05:00 Apr 30, 2024 | |
| Title | Overexposure to an Embryo / Fetus |
| Event Description | The following information was obtained from the Illinois Emergency Management Agency (the Agency) via email:
The Agency was contacted on April 30, 2024, by Advocate Illinois Masonic Medical Center in Chicago, IL, to advise a patient was administered a therapeutic dose of iodine-131 on March 7, 2024, and was confirmed pregnant on April 29, 2024. The licensee estimates the pregnancy began 3-7 days after the iodine administration. Negative pregnancy test results were confirmed prior to the administration. Both the patient and the referring physician were notified on April 29, 2024. Using dose modeling [published by the International Commission on Radiological Protection] (ICRP-88) methodology, and assuming conception was 3 days post-administration, the Agency estimates dose to the embryo/fetus over the term of the pregnancy to be 19.8 rem. This is based on an effective half-life of 5.5 days over the 3 days from administration. The patient has had a thyroidectomy which complicates the use of available biokinetic models, but likely also alters the effective half-life. The licensee is researching to determine an appropriate value for the effective half-life (which may range down to 14.4 hours4.62963e-5 days <br />0.00111 hours <br />6.613757e-6 weeks <br />1.522e-6 months <br /> and result in a 900 mrem effective dose). Agency inspectors will conduct a reactionary inspection, and this report will be updated as additional information becomes available. IL Report Number: IL240010
The following was received from the Illinois Emergency Management Agency (the Agency) via email: Agency inspectors performed a reactive inspection on 5/3/24. The licensee and involved physicians performed a detailed literature and patient review (remnant thyroid) and concluded 9.4 to 56.4 hours4.62963e-5 days <br />0.00111 hours <br />6.613757e-6 weeks <br />1.522e-6 months <br /> was the range of applicable effective half-lives. The licensee asserts, given the patients sex, age, recombinant human thyroid stimulating hormone (rhTSH) treatment status, weight, renal function and disease burden; that 14.4 hours4.62963e-5 days <br />0.00111 hours <br />6.613757e-6 weeks <br />1.522e-6 months <br /> is the appropriate effective half-life to utilize. Empirical calculation using whole body counts was no longer viable due to decay/clearance. Based on a review of available literature and previous incidents, the Agency would concur that 14.4 hours4.62963e-5 days <br />0.00111 hours <br />6.613757e-6 weeks <br />1.522e-6 months <br /> is an appropriate value for a patient having undergone a thyroidectomy. Estimates on the date of conception relative to the date of administration were confirmed by the licensee and a range of 3/10/24 to 3/18/24 provided. The 3/10/24 date was utilized (as a means of conservation) which results in a 0.9 rem (9 mSv) dose to the embryo using the afore mentioned ICRP 88 methodology. The licensee submitted their written report and assessment on 5/10/24. The licensee consulted the I-131 package insert for tissue-specific dose conversion factors. Consistent with ICRP 88, the dose to the patients uterus was used as representative of that to the embryo. While relying on dose conversion factors differing from those in ICRP 88, the licensee calculated a 5.19 mSv embryonic exposure. Notwithstanding the variation between the licensees 5.2 mSv vs. the Agencys 9 mSv dose estimate; the dose falls beneath the reportable criteria. Notified R3DO (Ruiz), NMSS Regional Coordinator (Riveria-Capella), and NMSS Events Notification via email. |
| Where | |
|---|---|
| Advocate Illinois Chicago, Illinois (NRC Region 3) | |
| License number: | IL01224-02 |
| Organization: | Illinois Emergency Mgmt. Agency |
| Reporting | |
| Agreement State | |
| Time - Person (Reporting Time:+33.23 h1.385 days <br />0.198 weeks <br />0.0455 months <br />) | |
| Opened: | Gary Forsee 14:14 May 1, 2024 |
| NRC Officer: | Eric Simpson |
| Last Updated: | May 10, 2024 |
| 57098 - NRC Website
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Advocate Illinois with Agreement State | |
WEEKMONTHYEARENS 570982024-04-30T05:00:00030 April 2024 05:00:00
[Table view]Agreement State Overexposure to an Embryo / Fetus 2024-04-30T05:00:00 | |