Workflow to track I-125 seed from receipt to storage

Objectives I-125 seeds have become an alternative to wire-localization in breast cancer surgery. While this technique has clear benefits, more precise localization and ease in scheduling, multiple factors must be considered to ensure a smooth process and compliance with regulatory bodies. The following workflow has been developed through years of experience at Mayo Clinic Arizona.

Methods Seeds are ordered in a bulk vial. The seeds are placed in packets and brought to Central Services by a technologist. After standard sterilization, the seeds are retrieved and stored, shielded, in the hot lab. The seeds are calibrated and brought to Breast Imaging on a per patient basis. Central Services and Breast Imaging are posted when the seeds are present. The seed placement is performed in breast imaging and recorded in a tracking database. This database is again accessed post-operatively to document seed count reconciliation. The dose is also recorded in the pharmacy manager system, EMR, and the RIS system. The patient reports to the hospital for the surgical procedure. The seed is removed with the specimen, and imaged in general radiology to confirm seed count and removal. The specimen is brought to pathology and the seed removed. The seed is brought to Nuclear Medicine, recorded in the database, and stored for decay. This database is a key aspect of the workflow because it is accessible by all, as they are in separate physical locations. It serves as a single reference that documents all staff that was involved in handling, seed count, and the final receipt and disposal of the seeds.

Results To date we have safely administered 163 seeds to 149 patients with no seeds lost and zero patient complications.

Conclusions This technique can be successfully administered in a large multi-site integrated group practice with a broad scope license, such as Mayo Clinic Arizona. Additional considerations would need to be considered for receipt, storage, handling, and transportation of the seed if multiple independent facilities, such as imaging and surgery centers are involved