Worries about the dangers of handling deceased cancer patients have been raised following a US case in which a crematorium was found to be contaminated by radiation.
In a study reported in the journal JAMA, doctors led by Nathan Yu of the Mayo Clinic in Phoenix, Arizona, describe the case of a 69-year-old man who was treated by radiation therapy for pancreatic cancer in an Arizona hospital in 2017.
On the following day, the man fell ill from an unrelated cause and was admitted to a different hospital, where he died a few days later.
Staff at the first hospital were unaware of the man’s second admission, or his subsequent death, and therefore did not inform their colleagues that he had been irradiated.
Staff and the second hospital, thus, did not inform mortuary staff who, in turn, did not alert the crematorium operator when the deceased patient was cremated five days after the cancer treatment.
Indeed, it took a month before the medicos at the first hospital found out about the situation. They immediately informed the crematorium, and dispatched radiation safety officers to test the rooms, the equipment and the operator himself for radiation contamination.
The substance used to treat the patient, lutetium (Lu 177), has a penetrative range of just 1.5 millimetres and a half-life of only six days. Nevertheless, four weeks after exposure, the crematorium’s equipment, including the vacuum filter, bone-crusher and oven, yielded Geiger-counter readings of between 5000 and 25,000 counts per minute.
The crematorium operator was asked to provide a urine sample. It came back negative for lutetium but, surprisingly, returned trace results for another radioactive isotope sometimes used in nuclear medicine, technetium (Tc 99m).
Yu and his colleagues suggest the contamination resulted from an earlier cremation of another cancer patient, again without the treatment status being revealed.
Cremating irradiated people, they note, creates a hazard not found in living nuclear medicine recipients. The high heat of the crematorium oven can volatilise radio-nucleotides, meaning they can be inhaled.
Given the half-lives of the two substances involved, the researchers write, the annual radiation level “for members of the public, set by the Nuclear Regulatory Commission, was unlikely to have been exceeded”.
However, they note that regulations governing the treatment of deceased irradiated people varies significantly from state to state in the US, and around the world, and call for the creation of better safety protocols.