From:	Pomije, Brian D. (LCDR)
Sent:	Thursday, January 19, 2006 4:14 PM
To:	Burke, Gerald; Clark, Dorothy M. (CIV); Ely, Karen D. (CIV); Fairchild Gregory R LT; Feightner, Michael P. LT; Fong, Raynard K   CAPT; Frampton, Scott W  CIV; Giel, Daniel T. (CIV); Goodwill, Michael E; Harden, Gary W; Hecht, Sheila C , LCDR; Houston, Tony L. HM2; Johnson, Gabrielle M.; LaFontaine, Richard L CT; Loscocco, Michele F (CDR); Ozeroglu, Muhammed A  LT; Pomije, Brian D. (LCDR); Ruiz, Steven LCDR; Scott, John H., CIV.; Simays, Andrew E., CDR; Solanki, Haresh P; Swilley, Eugene A. (LT); Tarver, James K. (CDR); Tu, Victor LT; Van Way, Rick L (LCDR); Younes, Georges  E LCDR
Cc:	Rudolph, W. Garry (CAPT); Fallon, Ann P. (CAPT); Clagett, Christopher D, CDR; Clark, Dorothy M. (CIV); Ely, Karen D. (CIV); Pomije, Brian D. (LCDR); Earles, Marvin R LCDR ; Glennon, Brendan K. CDR BUMED; Lino CDR Fragoso (E-mail) (Lino.Fragoso@navy.mil); Hutto, Robert CAPT; Lorenzen, William F GS; Netzer, Patricia H. (CAPT); Styles, Donna L (CAPT)
Subject:	Nuclear Medicine Iodine-131 Patients Undergoing Dialysis

To Radiation Safety Officers and NRMP Permittees,

Please forward the below message to all Radiology and Nuclear Medicine Authorized Users (AUs).

While dialysis on Iodine-131 patients can be done safely without too many radiation safety problems, it has been found that not many of the AUs are taking into account the change in clearance rates of I-131 from the body with dialysis units.  This can significantly affect the radiation dose to the patient, especially to the bone marrow.  To learn more, please refer to the below article from the Journal of Clinical Endocrinology Metabolism.

Very respectfully,

LCDR Pomije

Brian D. Pomije, MS, DABR
Lieutenant Commander, Medical Service Corps, USN
Radiation Health Team Leader
Navy Environmental Health Center
620 John Paul Jones Circle (Suite 1100)
Portsmouth, VA 23708-2103

W: (757) 953-0766; DSN: 377-0766
Cell: (757) 651-2814
Fax: (757) 953-0685

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J Clin Endocrinol Metab. 2000 Sep;85(9):3058-64

Radioiodine dosimetry in patients with end-stage renal disease receiving continuous ambulatory peritoneal dialysis therapy.

Kaptein EM, Levenson H, Siegel ME, Gadallah M, Akmal M.

Department of Medicine, University of Southern California, Los Angeles 90033, USA.

In patients with end-stage renal disease (ESRD), Na131I dosages for thyroid cancer may have to be reduced to avoid excess radiation doses to red marrow, because radioiodine is primarily excreted by kidneys. In ESRD patients receiving continuous ambulatory peritoneal dialysis (CAPD) therapy (three to five 2-L exchanges daily) creatinine clearance rates are very low (mean, 7 mL/min), and radioiodine clearance rates may be proportionately reduced.

Thus, radioiodine kinetic studies were performed in two hypothyroid CAPD patients with thyroid cancer, in eight euthyroid CAPD patients, and in eight thyroid cancer patients with normal renal function. All received Na131I or Na123I orally, with serial blood, urine, and/or dialysate sampling for 24-70 h. Dosimetry calculations were performed using the MIRDOSE3 computer program.

In CAPD patients, serum radioiodine half-times were 5 times longer, and radioiodine clearance rates by urine plus dialysate were 20% of those in patients with normal renal function. Na131I dosages for the two CAPD patients with thyroid cancer were reduced from 150 mCi [5.6 gigabecquerels (GBq)] to 26.6 mCi (0.98 GBq) and 29.9 mCi (1.11 GBq), respectively, resulting in radiation doses to red marrow and total body comparable to those in patients with normal renal function who received a mean of 148 mCi (5.5 GBq) Na131I.

Thus, in patients receiving continuous ambulatory peritoneal dialysis therapy, 5-fold reductions in radioiodine clearance rates require 5-fold decreases in Na131I dosages to avoid excessive radiation doses to total body and red marrow.