This document discusses radiation protection for patients and medical staff during treatment of thyroid conditions with radioactive iodine (I-131). It provides guidelines for ensuring safety, including justifying every administered dose, calculating appropriate individual doses, and choosing radionuclides that deliver lower activities. It also addresses protecting medical staff by minimizing time spent near patients, maximizing distance and barriers, and using personal dosimeters. The conclusion is that radioiodine treatment can be relatively safe when proper safety procedures, training, and nuclear medicine laboratory organization are followed.

1. RADIATION PROTECTION FOR
PATIENTS AND MEDICAL STAFF IN THE
TREATMENT OF THYROID
RADIOIODINE (I-131).
Tomasz Z. Zuzak1, Michał Filip1, Anita Wdowiak1,Monika Hałgas1,
Jan S. Witowski2, Justyna Kocór3
1Students’ Scientific Society at Diagnostic Techniques Laboratory, Medical University of
Lublin, Poland
2Students’ Scientific Society at 2nd Department of General Surgery, Jagiellonian
University, Kraków, Poland
3Student's Scientific Society, Department of Anesthesiology , Intensive Treatment and
Emergency Medicine, Medical University of Silesia in Katowice

2. HISTORY OF TREATMENT
Saul Hertz M.D., 1941 Hal O. Anger, 1958

3. TREATING THE HYPERTHYROIDISM
 There are several known methods for treating
hyperthyroidism e.g. pharmacological treatment surgical
procedures, treatment of radioiodine (I-131).
 Radioiodine is widely used for the treatment of Graves'
hyperthyroidism, toxic adenoma, toxic multinodular goiter.
 United States - therapy of choice being selected by 60
percent of thyroid specialists.
 Europe - only 13 percent thyroid specialists.

4. http://blogs.nejm.org/now/wp-
content/uploads/2011/02/nejmct
1007101_f1.jpeg
Indications:
• Graves’ disease
• toxic adenoma
• toxic multinodular
goiter (MNG)
Aspects while
making the
choice:
• age
• clinical condition
• Anamnesis !

5. METHODS
 Searching PubMed and UpToDate database
using the following search terms: „radiation
protection” & „treatment with radioiodine I-
131”.
 Following the guidelines by International
Commission on Radiological Protection
(ICRP).

6. RADIOIODINE (I-131)
 Iodine-131 is a beta-emitting radionuclide
with a maximum energy of 0.61 MeV, an
average energy of 0.192 MeV, and a range in
tissue of 0.8 mm.
 Random procedure provides the patiens with
ca 2 mSv (CT scan- ca 35 mSv).

7. THE GOLDEN RULE OF RADIOPROTECTION
ALARA
= As Low As Reasonably
Achievable

8. RADIOPROTECTION IN NUCLEAR MEDICINE
LABORATORY
Patient protection
Medical staff protection

9. RADIOPROTECTION IN NUCLEAR MEDICINE
LABORATORY
Patient protection
Medical staff protection

10. PATIENT PROTECTION (1)
 According to ICRP 2016 guidelines:
1. Every administrated dose of any
radionuclide should be strictly justified and
noticed (medical documentation, agreements,
etc.).
2. The dose of radionuclide HAS TO BE
APPROPRIATE (individual calculation of
doses).

11. PATIENT PROTECTION (2)
 According to ICRP 2016 guidelines:
3. If possible- influence the
radiopharmaceutical distribution in organism
should be carried (e.g. Lugol liquid).
4. While choosing the radionuclide- that one
should be selected which activity is lower
(thyroid sctg? - rather Tc-99 than I-131).
5. The time of inception can be shortened
(hydratation).

12. PATIENTS DOUBTS (1)
 ASPECTS:
 Family- Can I kiss my wife? Can I hug my
children? Will my cat die?
 Pregnancy- there are no evidences of sexual
sterility caused by radioiodine treatment!
 Soul ?

13. PATIENTS DOUBTS (2)
 DEATH:
It is proved that one-time radionuclide
treatment shortens life for ca 6 hours (benefits
not included) BUT there are some much more
dangerous situations:
CAR ACCIDENT- 150x more dangerous…
HOME ACCIDENT- 200x more dangerous…
SMOKING- 9 000x more dangerous…

14. For this procedure:
* An adult’s
approximate effective
radiation dose is:
Comparable to natural
background radiation for:
Radiography (X-ray)- GI
Tract
6-8 mSv 2-3 years
Radiography (X-ray)-Spine 1.5 mSv 6 months
Radiography (X-ray)- Chest 5mSv 1-2 years
CT-Head 2 mSv 8 months
CT-Head ± contrast material 4 mSv 16 months
CT-Spine 6 mSv 2 years
CT-Chest 7 mSv 2 years
CT- Abdomen and Pelvis 10-20 mSv 3-7 years
PET/CT 25 mSv 8 years
Mammography 0.4 mSv 7 weeks
THYROID GLAND
EXAMINATION
0.5 mSv 4 months
THYROID GLAND
TREATMENT

15. RADIOPROTECTION IN NUCLEAR MEDICINE
LABORATORY
Patient protection
Medical staff protection

16. MEDICAL STAFF PROTECTION (1)
According to ICRP 2016 modified guidelines
(3 rules):
1. Time: all the procedures must be held as
fast as possible (value of training!).
2. Distance (natural barrier): The farther, the
safer.
3. Covers: gloves, lead aprons, lead blocs
(etc.).

17. MEDICAL STAFF PROTECTION (2)
RADIOPROTECTION SUPERVISON:
 Medical staff is provided with Electronic personal
dosimeters (EPD)
 Supervision is carried out by annual checking of the
absorbed dose in EPD
 Following the recommendations of the ICRP, the
annual effective dose absorbed should not
exceed 50 mSv.

18. COMPREHENSIVE RADIOLOGICAL PROTECTION
PROGRAM

19. CONCLUSIONS
 Hyperthyroidism treated using radioiodine
(I-131) is a relatively safe treatment.
 The safety of patients and of the medical
personnel is ensured by:
1. safety procedures
2. proper training of medical personnel
3. proper organization of work in the nuclear
medicine laboratory

20. REFERENCES
 Beck M.; Radiation safety in the management of patients undergoing radioactive iodine ablation
therapy.; Clin J Oncol Nurs. 2015 Feb;19(1):44-6.
 Cebulska-Wasilewska A, Krzysiek M, Krajewska G, Stępień A, Krajewski P.; Retrospective
Biological Dosimetry at Low and High Doses of Radiation and Radioiodine Impact on Individual
Susceptibility to Ionizing Radiation.; Genome Integr. 2017 Jan 23;8:2.
 Dietlein M, Grünwald F, Schmidt M, Schneider P, Verburg FA, Luster M.; Radioiodine therapy for
benign thyroid diseases (version 5). German Guideline; Nuklearmedizin. 2016 Dec 6;55(6):213-
220.
 Królicki L.; Medycyna Nuklearna; Fundacja im. L. Rydygiera Warszawa 1996.
 Lützen U, Zhao Y, Marx M, Imme T, Assam I, Siebert FA, Culman J, Zuhayra M.; Effective
method of measuring the radioactivity of [ 131I]-capsule prior to radioiodine therapy with
significant reduction of the radiation exposure to the medical staff.; J Appl Clin Med Phys. 2016
Jul;17(4):59-72.
 Ostinelli A, Duchini M, Conti V, Bonfanti P, Rossi S, Cacciatori M.; A new method to evaluate the
residual activity in patients undergoing (131)I thyroid therapy.; Phys Med. 2015 Dec;31(8):1108-
11.
 Sudbrock F, Fischer T, Zimmermanns B, Drzezga A, Schomäcker K.; Exhalation of 131-I
after radioiodine therapy: Dosimetric considerations based on measurements in exhaled air.; J
Environ Radioact. 2017 Jan;166(Pt 1):162-165.

21. THANK YOU FOR YOUR ATTENTION!