[Drizzt]

Police Detainment of a Patient Following Treatment With Radioactive Iodine


To the Editor: We recently treated a 34-year-old man for Graves disease with 20 mCi of iodine 131. Twenty-four hours after treatment, his radioactive iodine uptake was 63%. Three weeks after treatment, he returned to our clinic complaining that he had been strip-searched twice at Manhattan subway stations. Police had identified him as emitting radiation and had detained him for further questioning. He returned to the clinic and requested a letter stating that he had recently been treated with radioactive iodine.

This patient's experience indicates that radiation detection devices are being installed in public places in New York City and perhaps elsewhere. Patients who have been treated with radioactive iodine or other isotopes may be identified and interrogated by the police because of the radiation they emit.

We called the Terrorism Task Force of the New York City Police Department to determine how to prevent detainment of this group of patients. They recommended that treating physicians provide such patients with letters describing the isotope used and its dose, its biological half-life, and the date and time of treatment. The letters should also provide the physician's 24-hour telephone numbers to allow the police to verify the content of the letters. If a person who has been detected as emitting radiation provides such a letter, the police would then verify the letter's authenticity. Even in the best-case scenario, however, the patient would have to wait during this verification process. Patients should be informed about this potential problem after treatment with radioactive isotopes; they may choose not to use public transportation to avoid this inconvenience.



Christoph Buettner, MD, PhD
Martin I. Surks, MD
Department of Medicine
Albert Einstein College of Medicine
New York, NY


http://jama.ama-assn.org/issues/v288n21/ffull/jlt1204-3.html

[KMKeller]

They recommended that treating physicians provide such patients with letters describing the isotope used and its dose, its biological half-life, and the date and time of treatment. The letters should also provide the physician's 24-hour telephone numbers to allow the police to verify the content of the letters. If a person who has been detected as emitting radiation provides such a letter, the police would then verify the letter's authenticity. Can you say, "violation of Dr.-patient confidentiality"?

[ojibweindian]

A bizarre twist on "Your papers, please".

[Khornet]

but I think it's reasonable. It permits pts. to get treated and lets security do its job. No harm.

AND it's good to see that folks are out there with rad detectors!

[Tamara]

No different than the letters some folks who have steel in them carry around.

[foghornl]

Sheeeeeeeeeeessshhhhh

Big Brother just keeps getting bigger, stupider and more intrusive every day :banghead:

[Rangerover]

I find it reassuring that our authorities have instituted measures to detect trace amounts of radiation like this. It's a step in the right direction. Might make it a little harder for the Mullahs to sneak a portable, low-yield "Thinking Of You" card into our midst. Maybe.

Now before all the radioactive folks get in a tizzy, I am NOT "anti-radioactive folks"! Feller has a right to glow in the dark if he (OR SHE!!) wants to. We just want you to be able to, uh, explain how ya got that way. :p

[KMKeller]

No different than the letters some folks who have steel in them carry around.

It's not the requirement to carry the letter around that I find disconcerting, but,

The letters should also provide the physician's 24-hour telephone numbers to allow the police to verify the content of the letters. bothers me.

At current, many physicians are currently charging, or are moving towards charging a modest fee for after hours contact.

[dj53]

I treat patients with radioactive iodine as part of my medical practice. It is hard for me to believe that New York has installed detectors sensitive enough to detect the amount of radiation that this patient would be emitting three weeks after treatment, from the distance that the detectors would have been installed.

The patient was treated with 20 mCi and had an uptake of 63%, so about 12 mCi in the thyroid. We don't know what the biological half-life is, but in hyperthyroid patients, it is usually shorter than the physical uptake of I131 (8 days). Using the worst case scenario of an 8 day half-life, after three weeks, the patient would still be carrying, at most, 1.5 mCi (about three half-lives 12-6-3-1.5).

Detectable radiation falls off with an inverse square (double the distance, 1/4 the detection). So any detector placed to monitor a wide area and capable of detecting 1.5 mCi would have to be so sensitive that it would probably give quite a few false alarms. Having not heard reports of people falsely detained as a result of a radiation monitor, I wonder about this story........

Hyperthyroid patients can get a bit delusional, NYC doctors are probably not all that interested in checking out their patients stories......

I am taking this one with a grain of salt (iodized of course!):neener:

[Khornet]

131-I is an alpha particle emitter, if I recall, and should result in minimal detectable radiation beyond a foot or so, I would think.

As far as billing for telephone services, I can't and never have been able to. But I see nothing wrong with it. It's work, aint it? If I call my lawyer I get billed for the time. Insurances and Medicare have loads of cute tricks to keep from paying us for the work we do.

[KMKeller]

dj53

Always nice to have a local subject matter expert! :D

[dj53]

I guess we have strayed a little far afield but I131 is a beta emitter, and if that were the only thing, it would be hard to detect, but it also has a gamma emission, and it is the gamma energy that we use for medical imaging and probably what the detectors would be looking for at a distance.......

[Gordon]

How about a subway turnstyle for a close range scan?

[Khornet]

it's been since the 1970s that I was a Nuc Med tech. But I'm pretty sure it's the Beta that does the job in Graves' disease. The gamma emiters, I125 or 123 I think, are the imaging and uptake measuring radiopharmaceuticals.

Hell, when I was a tech we were using rectilinear scanners!

[M1911Owner]

According to the EPA's web site, I131 is a beta emitter with a half life of 8 days, as dj53 has said. As beta emissions have almost no penetration ability, it doesn't seem likely that much or any of it could have actually penetrated through tissue and skin and out of that guy's body.

[madkiwi]

Remind me not to ride the NYC subway with my old radium enhanced wristwatch!

madkiwi

[rock jock]

This is not an abuse of civil rights. LE is not scrutinizing the general public. They are specifically targeting those who indicate highly suspicious behavior. For those of you who complain about the most reasonable of efforts by LE to prevent an attack of WMD, I hope you are near ground zero when it comes so you can fully experience the "acceptable risk" of not preparing for this contingency.

[Blackhawk]

Velly, velly innterresting...!

If true, I'm glad the federalies are looking for protons and stuff. If not true, I hope they are....

[Mal H]

One other possibility for detection of the I-131 is that it has a relatively high thermal neutron cross section. That is, it will absorb neutrons at a higher rate than most materials. The CS of I-131 is higher than Uranium and Radium, but about 1/4 that of Plutonium. Technology exists to actively detect such materials at fairly long distances (greater than 5 meters), which is far greater than the passive detection of the beta or gamma radiation from such a small amount of material. If such detection is indeed taking place, then a transportation hub (airport, subway, train station) is the logical place for it.

[M1911Owner]

Mal H,

You've got me totally perplexed about how that would work. I know a wee little bit about this stuff, almost enough to be dangerous, but not quite. If I understand nature correctly, there normally is no thermal neutron flux in the environment, or at most a very, very small flux. I would expect that one would normally find a thermal neutron flex in the core of a moderated nuclear reactor. So, am I wrong--is there a substantial natural thermal neutron flux? That doesn't really make sense, because, as you've said, stuff absorbs thermal neutrons, which in many cases makes them radioactive. For example, the transmutation of U238 into plutonium 239 occurs when the U238 absorbs a thermal neutron. Since that conversion isn't happening in nature, I would again think that there aren't a lot of thermal neutrons bouncing around in nature. I can't imagine that they would be irradiating a subway station with thermal neutrons--I would think that that would be rather deadly.

Could you please give a little more detail about how this process you're referring to works?

Thanks

[Leadbutt]

Its not as nuts as it sounds, my department is the first in the US to install them in the Port areas, and they will pick up any amount,but with that said we have been trained that once the scan is done with the hand held to ask if medical treatment has been recieved and if so when and what kind such as a type of stress trest or being treated for prostrate cancer. We are not allowed to go futher than that on our own,if the answers just don't seem right they we call in customs to handle it. So far no problems.And we have never detained anyone for more than 20 minutes

[PATH]

I wish someone would verify the veracity of this story. It sounds a little far fetched. I may well be wrong but it does sound far fetched. Interesting thread though!

[Mal H]

M1911Owner - You are correct that a continuous bombardment of a station with neutrons would be very deadly. But, equipment exists today that will produce a continuous but very short (microsecond) pulsed beam of thermal neutrons (usually a small self-contained deuterium-tritium reactor). Couple that with a few strategically placed neutron detectors (or gamma ray detectors since gamma rays are the by-product of N capture) and you have your "radioactive material detection system". With the short pulses, the Rem values are smaller than what you might get standing in sunlight.

[Shadowman]

PATH

the JAMA link appears legit... now whether the Dr or patient fabricated?




NBC link (http://www.nbc17.com/news/1819415/detail.html)

What's the level of sensitivity on these detectors?

mCi= milliCurie
20mCi given x 60% retention = 12 mCi
12 mCi x 1/2 x 1/2 x 1/2 = 1.5 mCi

1.5 mCi sure seems significant - 3 million dpm