The case of the man who was cremated without anyone knowing that his body had a high radioactive dose

In 2017, a 69-year-old man with pancreatic cancer went to the hospital with abnormally low blood pressure. Unfortunately, he died only two days later and his remains were cremated.

But what no one knew just a day before, he had been injected with a radioactive compound at another hospital to treat his tumor, and when his mortal remains were cremated, this radioactive and potentially dangerous dose of Lutetium Lu 177 dotatat was still inside his body. .

As collected Science Alert, this case was published in an article in 2019, and illustrates the collateral risks potentially posed by an average of 18.6 million nuclear medicine procedures involving radiopharmaceuticals performed in the US each year.

While the rules regulate how these drugs are given to living patients, the picture may become less clear when those patients die. “Radiopharmaceuticals present a unique and often overlooked post-mortem safety challenge,” explained Mayo Clinic researchers.

Cremation of an exposed patient volatilizes the radiopharmaceutical, which can then be inhaled by workers (or released to the adjacent community) and result in greater exposure than a living patient, “say these experts.

In this patient’s case, once doctors and the radiation safety department of the initial hospital learned of the man’s death, they contacted the crematorium.

Almost a month after the cremation took place, they used a Geiger counter to detect radiation levels within the cremation chamber and on equipment, including the oven, vacuum filter, and bone crusher.

What they found were low but high levels of radiation, while a spectroscopic personal radiation detector identified the main culprit for the radionuclide: Lutetium Lu 177, the same radioactive compound used to treat man.

“This was not like Chernobyl or Fukushima, but it was higher than previously thought,” said case co-author and radiation safety officer Kevin Nelson.

When the researchers analyzed the crematorium operator’s urine to see if the employee had also been contaminated by radiation exposure, they couldn’t find any trace of Lutetium Lu 177.

However, they found something: a different radioactive isotope, called technetium Tc 99m. The worker said they had never been exposed to the compound as part of a nuclear medicine procedure.

Because of this, the researchers say it is plausible that the operator had been exposed to volatilized Tc 99m technetium while incinerating other human remains, and if they are right it could be a broader problem, rather than an isolated and unfortunate case.

Still, the amount of radiation we are talking about is very low, so while the problem of accidental volatilization might be pervasive in the cremation industry, it may not actually be as dangerous as it sounds.

“I don’t think this is a problem that could pose any risk of cancer or other radiation-induced diseases,” says cancer researcher Paolo Boffetta of the Icahn School of Medicine at Mount Sinai.

“Having said that, it is clear that it is a possible source of exposure, and if someone is exposed regularly, every week or every few days, then it can become a source of concern,” he added.

Given that more than half of all Americans are cremated, postmortem handling of people receiving radioactive drugs is an area the US healthcare system needs to work on, the researchers say.

This includes better ways to assess radioactivity in deceased patients (before they are cremated) and also standardizing ways to notify crematoria about their clients.

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