Work

Hemodialysis‐associated radioactive waste management in [ 131 I]I and [ 177 Lu]Lu radionuclide therapy

Year: 2025

Type: article

Abstract: Background Radionuclide therapy, such as with iodine‐131 or lutetium‐177–labeled substances, is used to treat thyroid cancer and neuroendocrine tumors. Due to the incorporated radioactivity, patients must remain hospitalized until radiation levels are deemed safe, according to national regulations. This is particularly problematic for patients who require hemodialysis (HD). While contamination of dialysis waste after radionuclide therapy is generally well recognized, a critical gap remains regarding its duration and extent. This poses risks for patient management and outpatient staff. Purpose This study aims to demonstrate the problems with classifying residual waste and provides arguments for appropriate regulation. It evaluates if the radioactivity of the dialysate and residuals at discharge, based on whole‐body measurements, complies with relevant limits. If not, the waste is classified as radioactive and treated accordingly. Methods We studied four patients treated by radionuclide therapy who required dialysis: three received [ 131 I]I for thyroid disease and one [ 177 Lu]Lu‐DOTATATE for neuroendocrine neoplasia. Dialysis was performed in the nuclear medicine ward, and patients were discharged once the local dose rate limits were met. Subsequent dialysis sessions were conducted in a radiation protection area until the activity concentration in the dialysate dropped below the specific limit. Results Patient 1 ([ 131 I]I, thyroid cancer) showed the highest extraction rate and was discharged after 9 days, requiring nine additional dialysis sessions over 21 days. Patients 2 and 3 ([ 131 I]I, benign thyroid disease) were discharged after 8 and 4 days, with dialysis continued for 31 and 18 days under supervision, respectively. Patient 4 ([ 177 Lu]Lu‐DOTATATE) lost 4.9% of the total body radioactivity per dialysis session and was discharged after 9 days; supervised dialysis continued for 17 days. Conclusions This study highlights the need for refined monitoring and the limitations of standard discharge strategies for patients requiring dialysis during radionuclide therapy. Even if dose limits are met, dialysate and residuals may still require regulated handling and storage.

Source: Journal of Applied Clinical Medical Physics

DOI: 10.1002/acm2.70314

Authors: Dennis Kupitz, Heiko Wissel, Martin Volk, Michael C. Kreissl, Oliver S. Grosser

Institutions: University Hospital Magdeburg, Otto-von-Guericke-Universität Magdeburg

Language: English

Topic: Radiopharmaceutical Chemistry and Applications

Subfield: Radiology, Nuclear Medicine and Imaging

Field: Medicine

Domain: Health Sciences

SDGs: Good health and well-being, Responsible consumption and production

Open Access status: gold

Estimated APC paid: $900