Autopsy

Liquid Radioisotopes If radioisotopes had been administered intraperitoneally (32P, 90Y, 198Au), much activity will be removed with pleural and ascitic fluids but some activity will remain on serous surfaces (7). Drying the open cavity with sponges can reduce the radioactivity level. Double gloving or thick rubber gloves should be used. Table 13-2 shows dose to the hands from work performed in the peritoneal cavity. Whenever possible, the use of long-handled instruments is recommended. With beta emitters, distances of as little as 15 cm of air or 2.5 cm of tissue can appreciably reduce extremity exposure.

For handling an autopsy case with a high 131I radioactivity burden, emphasis must be placed on reducing external exposure levels and contamination potential of the dead body while it is still at the hospital and before it is released to a local funeral home where regulatory exposure limits for the general public apply (4,9). Risks to persons outside the hospital appear to be reduced by removal of organs with high activity burdens. During these procedures, external exposure should be monitored by issuing each individual one dosimeter to be worn on the torso and one to be worn on the dominant hand under gloves. When this was tested, the highest doses were received by the lead pathologist (who worked on the cadaver with high activity organs still in place); doses were 22 mrem to the whole body and 550 mrem to the hand, well below annual permissible dose levels. Precautions designed to reduce radiation exposure of employees included the use of personal protective equipment, limiting personnel time (20-min rotations), instructing staff to maintain increased distance from the cadaver when feasible, and general methods to reduce room contamination. When this was tested, employees other than the lead pathologist received a maximum of 13 mrem to the whole body and 59 mrem to the hand (9).

Other recommended precautions in such a setting included preselection of surgical instruments that were either easy to clean or disposable, controlled access to the autopsy room, and complete stocking of the room so that personnel did not need to exit for supplies (10). Action-specific procedures were similar to those used at a decontamination facility—that is, correct donning and removal of personal protective equipment, use of a "clean" (not radioactively contaminated) area, and frequent personal surveys with a portable radiation detection monitor. When this was tested, the pathologist received 20 mrem to the whole body and 70 mrem to the hand (10). In that study, radioactive organs were not removed nor was the body embalmed; instead, the funeral director placed the body directly into a commercial casket liner made of steel and sealed it shut. Although radiation levels could still be detected through the casket, they diminished rapidly due to the short (8 d) half-life.

Synopsis of Precautions Based on the aforementioned experiences and consensus standard recommendations (7), the following procedures should be followed for bodies containing high levels of radioactivity:

1. Supervision by an individual knowledgeable in radiation (local institution radiation safety officer);

2. External exposure monitoring of personnel (whole body and hand);

3. Use of disposable tools or tools that are easy to clean;

4. Storage of sufficient supplies in the autopsy room;

5. Secured area access;

6. Personnel time limits (rotation of personnel);

7. Bioassay of personnel at conclusion of procedure (to assure contamination was not inhaled, absorbed, or ingested);

8. Surveys of personnel with portable instrumentation upon exit from secured area;

9. Survey and decontamination of area and all equipment;

10. Observance of the procedures for proper disposal of radioactive waste items; and

11. Use of personal protective equipment, which includes a. double gloves, b. face mask, c. eye splash protection, d. surgical hats, e. plastic gowns, f. plastic shoe covers, and g. lead aprons (if they are expected to reduce exposure levels).

Removal of highly radioactive organs depends on anticipated disposition of the body. If a full autopsy will be performed, removal of the organs is encouraged to limit pathologist

Table 13-3

Radiation Exposure Rates From Radioactive Implants

Exposure rates (rem/h) for 50 mCi

Table 13-3

Radiation Exposure Rates From Radioactive Implants

Exposure rates (rem/h) for 50 mCi

Distance

No

Tissuea

No

Tissuea

No

Tissuea

No

Tissuea

(cm)

shielding

shielding

shielding

shielding

shielding

shielding

shielding

shielding

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