Hey mate! So I had a nuclear medicine scan the other day (the doc said it looked good) and on the way home I had a close call in traffic that left me a little shaken. And it got me to wondering whether or not, had the incident gone poorly, my remains would have put people at risk from the radioactivity they’d injected into me, and how the radioactivity would affect the final disposition. A little morbid, for which I apologize – but my curiosity’s piqued and I just have to know. Can you help satisfy my need to know? Thanks!
You know, I had to look into this about 20 years ago when I was RSO for a university and its associated hospital, and again more recently as part of a report I was working on. Turns out the Centers for Disease Control and Prevention (CDC) has weighed in on the matter, as has the National Council on Radiation Protection and Measurements (NCRP). So let’s see what they have to say.
I should start by noting that it’s more than just nuclear medicine patients who sometimes leave the hospital with radioactivity inside their bodies – there are some cancer treatments in which as many as 200 tiny, low-activity radioactive sources (called “seeds”) are implanted into a tumor in order to deliver enough dose to kill the cancer cells, and there have been medical accidents in which higher-activity sources have been accidentally left inside a patient who was then discharged from the hospital. But something like this might also be seen following a terrorist attack; it’s plausible that radioactive source fragments or contaminated shrapnel and debris might become embedded in a bystander. In any of these cases it’s important to ensure the safety of those handling the body (e.g. medical examiner, mortician) as well as the family and friends attending to it.
So let’s start with the big question – does a deceased nuclear medicine or radiation oncology patient pose a health risk to those around them? The only scenarios I can think of where that might be remotely possible would be if the deceased had a relatively high-activity radioactive source or source fragment (something with several curies of activity) or if they’d just had treatment for thyroid cancer. Aside from those two cases (and the latter is a bit of a stretch), the radioactivity in a person’s body isn’t likely to pose a risk to anyone. Having said that, in the spirit of ALARA (keeping radiation exposures as low as reasonably achievable) it still makes sense to be careful.
Medical examiner and mortician and their assistants normally wear protective clothing (e.g. gloves) and, in addition to protecting them from microbes and chemicals, this will also protect them against radioactive contamination from, say, radioiodine on a person’s skin. The only worrisome risk here is radiation dose to the fingers if they remove embedded radioactive materials – a Co-60 pellet, for example, is about the size of a BB and can contain a few to several curies of activity. Similarly, a cancer therapy source that’s accidentally left inside the body can also produce high radiation levels that can damage the fingers if a medical examiner or mortician were to handle it directly. For this reason, it’s recommended that the body be surveyed to locate any areas with elevated radiation levels before beginning work.
So that’s how to handle embedded sources! And, as I noted earlier, contamination shouldn’t pose a risk as long as everyone is wearing gloves and other protective gear – what’s referred to a Universal Precautions or Standard Precautions – precautions with which the practitioners should be familiar. But something that might be less familiar is that the tables and the floors of the rooms in which the remains are examined and prepared for burial should be covered with plastic sheeting to minimize contamination, and any samples or organs removed for study should be marked and treated as contaminated.
One of the things I needed to be aware of as a hospital RSO was when a patient who had been administered radiopharmaceuticals or had implanted sources passed away. Radiopharmaceuticals were not necessarily a big concern, but if we knew that a patient had implanted sources then we needed to ask a surgeon to remove the sources or the tissues in which they were implanted. Short-lived nuclides could be stored (in a freezer) for radioactive decay; for long-lived nuclides, removing the sources was preferred. The same is true, incidentally, for sources present in tissues removed for biopsy. The way we addressed this at my hospital was to develop a policy and procedure that was communicated to Nuclear Medicine, Radiation Oncology, and Pathology, the departments most likely to be affected.
That brings us to mourners and final disposition of the deceased. Some cultures and religions call for the deceased to be washed, dressed, and/or attended by family members from the time of death until the time of burial, potentially exposing the attendants to radiation and/or contamination. Luckily, unless a high-activity source is embedded in the body, the risk to these attendants is minimal, provided they minimize contact with the body or wear protective gloves.
And that brings us to the final disposition of the body. There are stories of bodies being buried in lead-lined coffins to protect people from radioactive remains. Some of the pioneers in radiation science certainly did ingest and inhale large quantities of radioactivity, as did many of the “Radium Girls” working in glow-in-the-dark watch, clock, and instrument factories at the start of the last century. More recently, I read an account of the soldiers killed at the SL-1 reactor accident in 1961; specifically, that the bodies were so highly contaminated that they needed to be buried in lead coffins. But we’ve learned to avoid the mistakes of the past, and accidents that might cause such high levels of contamination are few and far between – not saying that they’re impossible so much as that their occurrence is vanishingly rare. All of this means that there is usually no reason to interfere with the religious and cultural customs of the deceased on account of radiological concerns.
Final disposition, though, might have some limitations.
Burial isn’t likely to be a problem, especially in a sturdy coffin that contains contamination. Cremation, however, is another story since volatile isotopes such as I-131 (used in diagnosing and treating thyroid cancer) will be emitted from the crematory, potentially contaminating the areas (and people) downwind. For this reason, CDC and NCRP recommend avoiding cremation if possible and, if the family insists, to delay (if possible) until short-lived nuclides have decayed away. Other methods – donating the body to science, burial at sea, composting, sky burial, and so forth should be evaluated for potential dose to the public and the environment.
That’s the gist of it. The bottom line is that it’s very unlikely that anybody will be at risk from radiation or contamination, a few common-sense precautions will reduce that risk even further, and it’s usually possible to follow the rituals and customs of the decedent’s culture and religion without placing people at risk.
And I almost forgot – I’m glad your doc said things are looking OK!