Therapeutic applications of radioactive (131)iodine: Procedures and incidents with capsules

BACKGROUND: Treatments for thyrotoxicosis and carcinoma thyroid are carried out by oral administration of radioactive iodine ((131)I) in the form of liquid or capsules. The liquid form of (131)I has higher risk factors such as vapourization, spillage and need for management of higher activity wastes. Use of (131)I in capsule form simplify procedures of handling compared to liquid form of (131)I. The guidelines of safe handling and quality assurance aspects for therapeutic use (131)I are well outlined by International Atomic Energy Agency (IAEA) reports. AIM: A few unusual incidents with I-131 capsules encountered in the past need to be highlighted from health physics point of view. MATERIALS AND METHODS: In Royal Hospital, Oman, I-131 is imported in capsules, and the total activity handled/year steadily increased over 10 years. Discrete activities range from 185 MBq (5 mCi) up to 7.4 GBq (200 mCi). In four incidents deviations in standard operational procedures were recorded. RESULTS: Nature of incidents is described as follows: (1) After assay of activity, the capsule was directly put in the lead container with missing of inner cap. (2) Patient poured water in the Perspex tube, when the capsule was handed over to her, making an emergency situation. (3) In 3 high activity capsules (2 nos 2.96 GBq, 1 no. 4.26 GBq), observed sticky behavior in capsule holder on the 2(nd) day post receipt, which were in order on the 1(st) day. (4) A capsule could not be swallowed by a patient, which was taken back from the mouth. Monitoring of patient later did not show residual ingested activity. CONCLUSIONS: The report documents some of the unusual incidents for information to other centers engaged in such radioactive administrations.