RT Journal Article
SR Electronic
T1 Paraplegic Patient with Metastatic Papillary Thyroid Cancer: A Multidisciplinary Approach to Radioactive Iodine Therapy Safety and Efficacy Strategy
JF Journal of Nuclear Medicine
JO J Nucl Med
FD Society of Nuclear Medicine
SP 1336
OP 1339
DO 10.2967/jnumed.123.266955
VO 65
IS 9
A1 Al-Naqeeb, Ghadah
A1 Munger, Eric
A1 Ramanathan, Amrita L.
A1 Makarewicz, Andrew
A1 Behairy, Noha
A1 Veraraghavan, Padmasree
A1 Cochran, Craig
A1 Bernaldez, Philip
A1 Clinton, Iman
A1 Devaraj, Newbegin
A1 Lee, Korressa
A1 Fisher, Teresa
A1 Owoade, Olumide
A1 Maass-Moreno, Roberto
A1 Saboury, Babak
A1 Gubbi, Sriram
A1 Klubo-Gwiezdzinska, Joanna
YR 2024
UL http://jnm.snmjournals.org/content/65/9/1336.abstract
AB High-activity radioactive iodine (RAI) therapy for metastatic thyroid cancer (TC) requires isolation to minimize radiation exposure to third parties, thus posing challenges for patients needing hands-on care. There are limited data on the approach to high-activity RAI treatment in paraplegic patients. We report a state-of-the-art multidisciplinary approach to the management of bedbound patients, covering necessary radiation safety measures that lead to radiation exposure levels as low as reasonably achievable. Given the limited literature resources on standardized approaches, we provide a practical example of the safe and successful treatment of a woman with BRAFV600E-mutant tall-cell–variant papillary TC and pulmonary metastases, who underwent dabrafenib redifferentiation before RAI therapy. The patient was 69 y old and had become paraplegic because of a motor-vehicle accident. Since caring for a paraplegic patient with neurogenic bowel and bladder dysfunction poses radiation safety challenges, a multidisciplinary team comprising endocrinologists, nuclear medicine physicians, radiation safety specialists, and the nursing department developed a radiation mitigation strategy to ensure patient and staff safety during RAI therapy. The proposed standardized approach includes thorough monitoring of radiation levels in the workplace, providing additional protective equipment for workers who handle radioactive materials or are in direct patient contact, and implementing strict guidelines for safely disposing of radioactive waste such as urine collected in lead-lined containers. This approach requires enhanced training, role preparation, and practice; use of physical therapy equipment to increase the exposure distance; and estimation of the safe exposure time for caregivers based on dosimetry. The effective and safe treatment of metastatic TC in paraplegic patients can be successfully implemented with a comprehensive radiation mitigation strategy and thorough surveying of personnel for contamination.