The real cost of theoretic risk avoidance: the need to challenge unsubstantiated concerns about (131)I therapy.

Formanyyears,t he Nuclear Regulatory Commission in the United States required hospitalization for purposes of radiation isolation of patients receiving 1.11 GBq (30 mCi) or more of 131 I. Furthermore, admission for purposes of radiation isolation was required even if the patient was an adult who lived alone or had a separate bedroom and bathroom and was capable of self-care. Once admitted, these patients remained hospitalized until radiation safety personnel confirmed that the radiation emitted from the patient was less than 5 mR/h at 1 m. This criterion often resulted in an overnight stay, but patients who received doses See page 683 of 3.7 GBq (100 mCi) or more and older patients whose renal excretion of the 131 I was impaired often required 2 or more overnight stays. Although this practice offered a respite from job and household chores for some patients, others complained about the inconvenience associated with this hospitalization and the consequent loss of many personal conveniences. In addition , the admission required occupancy of a single room with toilet facilities, preferably in a building of older, more substantial construction, possibly a corner room to avoid potential exposure of patients in an adjoining room or preferably a room adjacent to an unoccupied resource such as an electrical or supply closet or a stairwell. In Europe and other jurisdictions, the requirement for isolation was established for even lower doses, even as low as 185 MBq (5 mCi) of 131 I. In certain cases, the facilities had isolated plumbing and storage tanks for bodily wastes. All these details involve incre-mental costs and compete with other necessary hospital and societal services. In 1997, after considerable examination of commentary presented by knowledgeable sources, the Nuclear Regulatory Commission revised title 10 of Code of Federal Regulations part 35.75 to permit release of patients treated with 131 I in doses greater than 1.11 GBq provided that no other individual was likely to be exposed to more than 5 mSv. This seemed at the time a reasonable response to the concerns about the incremental costs associated with hospitalization and the evidence that, in practice, the exposure of any individual was not likely to exceed the specified level, a level considered to be far below an absorbed dose that is apt to have consequences for the exposed individual. Despite the logic of this reasoning, there was, and continues to be, opposition by a variety of individuals to …