Body of a Cancer Patient Left Radioactive Material at Arizona Crematorium

A crematorium
A crematorium
Photo: Georg Lippitsch (Wikimedia Commons)

An Arizona crematorium was contaminated with radiation after the cremation of a patient who’d received radiopharmaceutical treatment, according to a new case study.

Advertisement

Radioactive materials have a variety of uses in medicine, for both diagnosis and treatment. An occasionally overlooked matter is what to do with the body after the patient has died, a problem for which there are no federal regulations. Exposure to radiation contamination after the cremation of a patient who received radiopharmaceutical treatment is especially important here in the United States, where the cremation rate is higher than 50 percent.

“Without regulation, communication is really important” in cases like this, Kevin Nelson, study author in the Department of Diagnostic Radiology at the Mayo Clinic in Phoenix, Arizona told Gizmodo. That communication did not happen here.

Advertisement

The case study documents a 69-year-old man with an uncommon tumor in his pancreas who received a radioactive treatment intravenously, called lutetium-177 dotatate. He unexpectedly died two days later at a different hospital from where he was receiving his radiation treatment. That hospital did not tell the funeral home/crematorium about his radiation treatment, and he was cremated five days later.

Once the researchers found out about the case, they asked the Arizona Bureau of Radiation Control whether there were regulations in place for these situations. There were not, and the Bureau sent representatives to survey the crematorium. The researchers also tested a crematorium employee’s urine to determine whether the operator had inadvertently been exposed to the radioactive lutetium from the treatment.

Indeed, the equipment set off the Geiger counter used to measure the radiation, with a maximum exposure rate of 7.5 mR per hour when the counter was touching the equipment. That’s nearly 200 times the average radiation experienced by humans living at sea level, with the caveat that radiation exposure decreases quickly with distance, so the operator would not receive that level exposure just from standing in the room. Also, lutetium decays into non-radioactive elements, so after about two months there would be no detectable levels of radiation, said Nelson.

The crematory operator had no lutetium in his urine, but the researchers did find a tiny amount of the radiopharmaceutical treatment technetium 99m, perhaps from cremating someone else.

Advertisement

“The crematorium operator had never had technetium 99m administered as part of a procedure,” Nathan Yu, study author in the Department of Radiation Oncology at the Mayo Clinic in Phoenix, Arizona, told Gizmodo. “This brings to light one of the mechanisms by which there’s potential unnecessary exposure for crematory workers.”

The researchers noted that the operator probably didn’t receive more than the exposure limit set by the Nuclear Regulatory Commission. Still, according to the study published in the Journal of the American Medical Association, “further studies are needed to evaluate the frequency and scope of radiation contamination and health effects of repeated or long-term exposure of employees in crematoriums in the United States.”

Advertisement

I reached out to National Funeral Directors Association about what this meant for crematory operators, and a spokesperson provided the following statement:

Given the widespread use of radiation in nuclear medicine (diagnosis and treatment) and radiation oncology (cancer treatment) procedures in the United States and around the world, it is likely that crematory operators have cared for the bodies of individuals who have undergone such treatments. One of the tenets of National Funeral Directors Association’s Certified Crematory Operator Program™ is to ensure that the crematory operator has the necessary information about the decedent to conduct the cremation safely. Crematory operators are expected to be informed whether there are any devices, including pacemakers, radioactive implants, or other implanted devices that may possibly require special precautions when placed in a cremation chamber and subjected to heat. This article reports on a single case involving the cremation of an individual who had been treated with a particular radionuclide for a pancreatic tumor and who died a short time after treatment and was cremated five days after treatment. Prior to the cremation, no notification of cancer treatment was provided to the crematory operator, including whether safety precautions were advisable under the circumstances. NFDA supports further study of this issue and welcomes recommendations on how the health and safety of crematory staff and the community can be protected to the greatest degree possible, including, as the research letter suggests, by evaluating radioactivity in deceased patients prior to cremation and by ensuring that crematory operators receive notification sufficient to employ the proper safety precautions, if needed.

Advertisement

This isn’t the first time someone’s realized that radiopharmaceutical patients can leave behind residual radiation, but it’s one of the first studies to report the contamination of the facility itself. Still, it’s just a case study, meaning it’s not necessarily representative of a pattern. The authors of the study recommend that facilities should test deceased patients for radioactivity prior to cremation.

Yu told Gizmodo that the next step is to “identify the frequency and scope of this issue, and see if there are any potential effects for repeated and long-term exposure for these employees.”

Advertisement

Science Writer, Founder of Birdmodo

Share This Story

Get our newsletter

DISCUSSION

coverclock
Chip Overclock®

Ann (not her real name), a former colleague and close friend of mine for a couple of decades now, was to undergo treatment for thyroid cancer. A typical approach to this is that surgeons remove as much of the thyroid as possible, then the patient is treated with radioactive iodine. Thyroid cells absorb iodine. So the idea was that any cancerous thyroid cells left behind would absorb the radioactive iodine isotope and be killed by the radiation. Eventually both the dead cells and the leftover iodine would be expelled as waste though the normal channels.

Both of us being nerdy types, and being in a situation that we thought could use a bit of levity, I proposed the following experiment. I have access to a laboratory quality Geiger counter. I would come over to her house before her first treatment and take some readings. Then just after her treatment I’d come back over and take more readings, and we’d compare results.

This Geiger counter is a pretty neat gadget. My spousal unit once asked me if it would pick anything up from the tritium dial of one of my wristwatches. Great idea! I tried it; nothing really. But as I swept the device over my watch collection, it suddenly went crazy. I had a Vietnam-era vintage French military surplus mechanical wristwatch. It had a radium dial. I had no idea. I ended up putting that watch in a lead-lined bag like you used to use with photographic film, and stored it with the Geiger counter.

So a day or two before Ann’s treatment, I came over and we took various readings with the instrument, set at various levels of sensitivity, and made some notes. There will always be some incidental radiation in this part of the country, west of Denver Colorado, particularly where Ann lived because it was a former mining town. Piles of mine tailings, radioactive because of the traces of uranium, are not uncommon. I have an exhaust fan in the crawlspace of my home that runs 24x7 to exhaust radioactive radon cause by the decay of naturally occurring uranium underground. A former nuclear weapons plant and one-time EPA Super Fund sight is just a few minutes from here. We’ve learned to live with it.

Her physicians had warned her about the radioactive iodine. She couldn’t sleep with anyone. She had to flush the toilet right after using it. She shouldn’t feed or even pet her two cats. The medical personnel who injected the iodine wore lead garments. The dose was in a heavy lead container they wheeled into the treatment area. They handled the injection with tongs. It all looked pretty serious.

Later that day I went back over to Ann’s house. I got out the Geiger counter, turned it on and... it went off the fracking scale. Seriously. It didn’t click, it was just a continuous buzz. The count was so high that the little micro controller inside maxed out the digital display at its highest reading.

Ann was *HOT*... and not in a good way. I backed away from her slowly. We joked about her having a glow - but in fact, it was a sobering experience for both of us. What was intended to bring some humor to the situation instead shocked both of us. I’ll admit, I was relieved to get in my car and drive away.

Never the less, I went back twice more, once a few days later, and once again after she had been cleared by her physicians. The readings on the Geiger counter showed a reduction both times.

That’s how I learned that radiopharmaceuticals are no laughing matter.