ML17279B143
| ML17279B143 | |
| Person / Time | |
|---|---|
| Issue date: | 01/29/2018 |
| From: | Dapas M Office of Nuclear Material Safety and Safeguards |
| To: | |
| Tapp K | |
| Shared Package | |
| ML17279B139 | List: |
| References | |
| Download: ML17279B143 (7) | |
Text
Enclosure 2 Summary of Assessment of Where Patients Reside Immediately Following Their Release Report Introduction As described in the "Summary of Patient Release after Radioiodine Therapy Research Review,"
the literature review conducted by the U.S. Nuclear Regulatory Commission (NRC) staff did not result in the identification of studies that analyzed the doses to members of the public that are unknown to the patient, such as nursing home staff/residents and hotel workers. Therefore, the NRC staff decided to conduct a pilot study to evaluate the extent to which patients treated with Iodine-131 (I-131) for hyperthyroidism or thyroid cancer go to locations other than their homes immediately following treatment. This enclosure provides the methodology and results of the draft pilot study.
Methodology
This study involved a questionnaire that requested information from a limited number of licensees about patient behavior following I-131 treatment. The questionnaire requested information regarding the annual number of patients treated with I-131 by each licensee over the past 2 years, what number of these patients were hospitalized, and how many patients went to locations other than their homes. The questionnaire also asked the licensees to provide information regarding their treatment protocol and treatment facility.
The questionnaire was sent to nine non-Federal licensees. Table 1 provides characteristics of the licensees that were sent questionnaires. The licensees to whom the survey was sent were selected to provide results from a range of sizes of facilities and from different regions in the country. The assigned regions for those facilities were based on United States Census Bureau divisions. Table 1. Pilot Study Non-Federal Treatment Facilities Region Number of Beds East North Central> 1,400 main campus 4,450 system-wide Mid-Atlantic 1 1,100 West South Central 636 New England 1,150 Mountain 268 Mid-Atlantic 2 400 West North Central794 Pacific 411 East South Central836 The questionnaire was also sent to Federal licensees that deliver I-131 treatment, including the Veterans Administration (VA), military services (i.e., Navy and Air Force), and the National Institutes of Health. In addition, the NRC staff requested information from the Federal Bureau of Prisons (BOP), even though the staff presumed that most inmates return to their correctional institutions following treatment, in order to determine where the inmates are treated and what protocols are applied to minimize radiation exposure to others (e.g., institutional personnel and
other inmates).
2 Results Non-Federal Facilities Nine non-Federal licensees responded to the questionnaire. Tables 1 and 2 summarize the results. Table 1 provides a comparison of the patients that were released after treatment to the patients that were not released and hospitalized. As reflected in Table 1, most of the licensees had a small percentage of treated patients who were hospitalized- approximately 8 percent of patients were hospitalized following thyroid cancer treatments and 0.4 percent following hyperthyroid treatments. One licensee stated that it hospitalized approximately 60 percent of thyroid cancer patients. Table 2 provides a summary of patients that were treated and released to locations other than their homes (nursing homes, assisted living facilities, prisons, or hotels). As Table 2 indicates, one of the licensees sent a substantial number of treated patients to locations other than their homes. It should be noted that several of the questionnaire responders indicated that not all patients inform licensees where they intend to go after treatment or the distance they travel to and from treatment facilities.
Table 1. Pilot Study Non-Federal Facilities Survey Summary Region Patients Treated with I-131 per Year:
Patients Hospitalized for Treatment per Year: Thyroid Cancer Hyper-thyroidismThyroid CancerHyper-thyroidism East North Central 137 59 17 0 Mid-Atlantic 1 60 60 2 1 West South Central 53 22 20 0 New England 338 112 4 0 Mountain 46 16 1 0 Mid-Atlantic 2 25 25 15 0 West North Central 80 160 8 0 Pacific 23 13 3 1 East South Central 133 69 2 0 Table 2. Pilot Study Non-Federal Facilities Survey Summary Region Number of Patients Returning to locations per year: Nursing Home Assisted Living Prison Hotel East North Central 0 0 0 0 Mid-Atlantic 1 1 0 0 0 West South Central 0 0 0 0 New England 0 2 0 0 Mountain 0 0 0 2 Mid-Atlantic 2 0 0 0 0 West North Central Not known Not known Not known Yes Pacific 0 0 0 0 East South Central 3 3 6 33 3 Federal Facilities Approximately 110 VA medical facilities provide radionuclide therapy and administer I-131 for thyroid disease. Nineteen VA medical facilities responded to the questionnaire. The summary of the VA responses to the questionnaire are provided in Tables 3 and 4. As shown in Table 3, the VA medical facilities responded that an average of approximately 23 percent of patients were hospitalized following thyroid cancer treatments and 0.3 percent following hyperthyroid treatments. As shown in Table 4, the VA medical facilities responded that they sent a very small number of treated patients to locations other than their homes.
Table 3. Pilot Study Veterans Administration Survey Summary Region Patients Treated With I-131 per Year:
Patients Hospitalized for Treatment per Year:Thyroid Cancer Hyper-thyroidismThyroid Cancer Hyper-thyroidism East South Central 3 5 2 0 West South Central 1 0 3 0 0 West South Central 2 10 20 1 0 Pacific 1 4 17 1 1 Pacific 2 3 1 3 0 South Atlantic 1 24 3 0 0 South Atlantic 2 5 3 5 3 West South Central 5 10 0 0 New England 5 5 2 0 West North Central 1 10 8 1 1 West North Central 2 15 9 1 0 South Atlantic 3 4 0 0 Mid-Atlantic 3 8 0 0 East North Central 1 7 7 1 0 East North Central 2 6 15 1 1 Mid-Atlantic 8 10 0 0 West South Central < 6 < 20 1 0 Pacific 1 5 4 2 0 Pacific 2 13 30 10 0
4 Table 4. Pilot Study Veterans Administration Survey Summary Region Number of Patients Returning to: Nursing Home Assisted Living Prison Hotel East South Central 0 0 0 0 West South Central 1 0 0 0 0 West South Central 2 0 0 0 0 Pacific 1 0 0 0 0 Pacific 2 0 0 0 0 South Atlantic 1 0 0 0 0 South Atlantic 2 0 0 0 0 West South Central 0 0 0 0 New England 0 0 0 0 West North Central 1 0 0 0 0 West North Central 2 1 0 0 0 South Atlantic 0 0 0 0 Mid-Atlantic 0 0 0 0 East North Central 1 0 0 0 0 East North Central 2 0 0 0 0 Mid-Atlantic 0 1 0 0 West South Central 0 0 0 0 Pacific 1 0 0 0 0 Pacific 2 0 0 0 2 The military services maintain 51 medical facilities, which include both hospitals and clinics, of which 22 provide I-131 treatments. Seven facilities responded to the questionnaire; however, the Navy combined its responses for 3 of its medical facilities. The collected data is summarized in Tables 5 and 6.
5 Table 5. Pilot Study Military Survey Summary Location Patients Treated with I-131 per Year: Patients Hospitalized for Treatment per Year: Thyroid Cancer Hyper-thyroidismThyroid Cancer Hyper-thyroidism Air Force Base 1 7 6 1 0 Base 2 3 4 0 0 Base 3 0 0 0 0 Base 4 10 5 1 0 Navy Combined 85 80 31 10 Table 6. Pilot Study Military Survey Summary Location Number of Patients Returning Nursing Home Assisted Living Prison Hotel Other Camp Air Force Base 1 0 0 0 0 Base 2 0 0 0 3 Base 3 0 0 0 0 Base 4 0 0 0 0 Navy Combined 0 0 0 2 2 The BOP responded to the NRC, stating it had no specific procedures and standards for handling inmates requiring I-131 treatment. The BOP reported that three individuals were treated in 2014 with I-131 as outpatients at outside civilian medical facilities for thyroid cancer and four were treated for hyperthyroidism.
Conclusions Although this study has limitations due to the small number of licensees who received questionnaires, it did provide the NRC staff with valuable information. First, this study demonstrates that some licensees knowingly send patients to locations other than their homes.
However, none of the licensees surveyed reported that they sent a significant number of patients to a specific location other than the patient's home. Second, this study also showed that the majority of patients are not being hospitalized following I-131 treatment.
Attachment:
Questionnaire Attachment
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