The challenges of radioiodine treatment for incontinent paediatric patients with complex care needs

Abstract

Objective: A thyrotoxic paediatric patient with incontinence, autism and Down’s syndrome was referred for radioiodine therapy. Here, the risk assessment methodology and measures taken to deliver a legally compliant treatment that was acceptable to the family are described. Methods: Prior risk assessment indicated that the most active incontinence waste would require decay storage until it could be transported for disposal. The Health and Safety Executive (HSE) indicated that school staff would be occupationally exposed under the Ionising Radiations Regulations (2017) based on the patient’s retained activity. To avoid the need for HSE registration, it was advised that the patient’s return to school may need to be delayed slightly. Post-treatment, confirmatory waste and patient dose rate measurements were made to refine the advised time scales. Results: Domestic waste disposal resumed at 28 days. The patient recommenced schooling a few days after their school reopened after the summer break. The school underwent HSE notification. Conclusion: Careful planning allowed us to provide a safe, compliant treatment regarding waste management and occupational exposure. Advances in knowledge: Incontinent 131I outpatient treatments require detailed, patient specific waste management. The HSE considered school staff as occupationally exposed by the patient well after normal social restrictions had ended.