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Decoteau MA, Steuterman S, Kurian SM, Case J, Lewis PR, Fisher JS, Schaffer RL, Marsh CL. Mitigation of radiation exposure during surgical hepatectomy after yttrium-90 radioembolization. J Radiol Prot 2021; 41:N1-N11. [PMID: 34107455 DOI: 10.1088/1361-6498/ac09c0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/09/2021] [Indexed: 06/12/2023]
Abstract
Yttrium-90 (Y-90) radioembolization for the treatment of hepatocellular carcinoma can present safety challenges when transplanting recently treated Y-90 patients. To reduce surgeons' contact with radioactive tissue and remain within occupational dose limits, current guidelines recommend delaying transplants at least 14 days, if possible. We wanted to determine the level of radiation exposure to the transplant surgeon when explanting an irradiated liver before the recommended decay period. Anex-vivoradiation exposure analysis was conducted on the explanted liver of a patient who received Y-90 therapy 46 h prior to orthotopic liver transplant. To estimate exposure to the surgeon's hands, radiation dosimeter rings were placed inside three different surgical glove configurations and exposed to the explanted liver. Estimated radiation doses corrected for Y-90 decay were calculated. Radiation safety gloves performed best, with an average radiation exposure rate of 5.36 mSV h-1in the static hand position, an 83% reduction in exposure over controls with no glove (31.31 mSv h-1). Interestingly, non-radiation safety gloves also demonstrated reduced exposure rates, well below occupational regulation limits. Handling of Y-90 radiated organs within the immediate post-treatment period can be done safely and does not exceed federal occupational dose limits if appropriate gloves and necessary precautions are exercised.
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Affiliation(s)
- Mary A Decoteau
- Scripps Center for Organ and Cell Transplantation, Scripps Clinic and Scripps Green Hospital, 10666 N Torrey Pines Road, 200N, La Jolla, CA 92037, United States of America
- Department of General Surgery, Naval Medical Center San Diego, San Diego, CA, United States of America
| | - Steven Steuterman
- Scripps Center for Organ and Cell Transplantation, Scripps Clinic and Scripps Green Hospital, 10666 N Torrey Pines Road, 200N, La Jolla, CA 92037, United States of America
- Department of Medical Physics and Radiation Safety, Scripps Clinic and Scripps Green Hospital, La Jolla, CA, United States of America
| | - Sunil M Kurian
- Scripps Center for Organ and Cell Transplantation, Scripps Clinic and Scripps Green Hospital, 10666 N Torrey Pines Road, 200N, La Jolla, CA 92037, United States of America
- Scripps Clinic Bio-Repository and Bio-Informatics Core, Scripps Green Hospital, La Jolla, CA, United States of America
| | - Jamie Case
- Scripps Center for Organ and Cell Transplantation, Scripps Clinic and Scripps Green Hospital, 10666 N Torrey Pines Road, 200N, La Jolla, CA 92037, United States of America
- Scripps Clinic Bio-Repository and Bio-Informatics Core, Scripps Green Hospital, La Jolla, CA, United States of America
| | - Paul R Lewis
- Scripps Center for Organ and Cell Transplantation, Scripps Clinic and Scripps Green Hospital, 10666 N Torrey Pines Road, 200N, La Jolla, CA 92037, United States of America
- Department of General Surgery, Naval Medical Center San Diego, San Diego, CA, United States of America
| | - Jonathan S Fisher
- Scripps Center for Organ and Cell Transplantation, Scripps Clinic and Scripps Green Hospital, 10666 N Torrey Pines Road, 200N, La Jolla, CA 92037, United States of America
| | - Randolph L Schaffer
- Scripps Center for Organ and Cell Transplantation, Scripps Clinic and Scripps Green Hospital, 10666 N Torrey Pines Road, 200N, La Jolla, CA 92037, United States of America
| | - Christopher L Marsh
- Scripps Center for Organ and Cell Transplantation, Scripps Clinic and Scripps Green Hospital, 10666 N Torrey Pines Road, 200N, La Jolla, CA 92037, United States of America
- Scripps Clinic Bio-Repository and Bio-Informatics Core, Scripps Green Hospital, La Jolla, CA, United States of America
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