Radiation safety precautions and guidelines for healthcare professionals interacting with patients who have been recently treated with radiopharmaceutical therapies.

Radiation safety instructions have already been discussed and provided to the patient, with a written copy they’ve signed. The precautions vary by type of therapy as detailed below:

177Lu/Lutetium based therapies
Radioactive iodine therapy (131I- NaI)
Xofigo (223Ra/Radium)

Importantly, these radiation safety precautions do not supersede the medical care that needs to be provided, as overall, the radiation exposure to healthcare workers will be well within the safety guidelines while caring for the patient. Also, as a general concept, these precautions are most important over the first 24 hours, and can become more lenient over the days to follow, as the amount of radiation decreases exponentially over time.

Pregnant healthcare workers (and children if present) should use extra-caution, doubling the recommended distance detailed below, and extending the period of precautions to 7 days after treatment.

Precautions following 177Lu/Lutetium based therapies

Most commonly Pluvicto (¹⁷⁷Lu-PSMA) and Lutathera (¹⁷⁷Lu-DOTATATE)

For the first 2 days:

• Patient admission:
  • At OHSU: contact our team to ensure their room and bathroom are prepped appropriately and for additional guidance in case of a surgery or a procedure.
  • Non-OHSU facilities: contact the RSO or the Nuclear Medicine department at your institution.

• Distance from others: the patient should maintain a 3-foot distance from others, if possible
  • Avoid seating the patient in a busy waiting area. Help them maintain a 3-foot distance from others or have them wait in a private room.
  • Follow the time and distance concept while interacting with the patient: keep a 3-foot distance when possible, and when close contact is necessary, minimize the time. For example, maintain a 3-foot distance during the conversation part of the visit, and limit direct contact to the physical exam, blood draws, procedures, etc.

• Shared restrooms: the patient may use the shared restrooms and are given the following bathroom hygiene instructions
  • Sit down when using the toilet
  • Put the lid down afterwards and flush twice
  • Wash hands thoroughly
  • Clean any potential spills with flushable wipes
  • Do not leave any contaminated unflushable waste in public bathrooms

• Urine or blood drops: potential urine or blood drops can be safely cleaned with flushable wipes. However, if a significant contamination with bodily fluid occurs, don’t attempt to clean, and follow below instructions.
  • If the patient is seen at OHSU, maintain 3-foot distance from the spill and contact the RSO. The RSO will assess the situation and provide further instructions accordingly.
  • If the patient is seen outside OHSU, please maintain 3-foot distance from the spill and contact the RSO at your institution.

• Foley catheter or nephrostomy tubes: if a Foley catheter or nephrostomy tubes are present or placed during the visit, use caution when handling the bags as the accumulating urine contains radioactive material. The content can be safely flushed in the toilet, and potential spills can be managed as above.

• Large waste containing bodily fluids that cannot be flushed: in case of large waste containing bodily fluids that cannot be flushed in the toilet (for example contaminated urinary pads, contaminated tubing, catheters, or bags):
  • Place them in a separate bag and contact our team to ensure proper disposal.

• After the patient leaves: unless there is contamination (or a suspicion of contamination) with bodily fluids, there is no need to survey the area after the patient leaves.

Precautions following radioactive iodine therapy (131I- NaI)

For the first 4 days:

• Patient admission:
  • At OHSU: contact our team to ensure their room and bathroom are prepped appropriately and for additional guidance in case of a surgery or a procedure.
  • Non-OHSU facilities: contact the RSO or the Nuclear Medicine department at your institution.

• Distance from others: the patient should maintain at least a 6-foot distance from others. This includes:
  • Avoid seating the patient in a busy waiting area. Help them maintain a 6-foot distance from others or have them wait in a private room.
  • Follow the time and distance concept while interacting with the patient. Keep a 6-foot distance when possible, and when close contact is necessary, minimize the time. For example: maintain a 6-foot distance during the conversation part of the visit, and limit direct contact to the physical exam, blood draws, procedures, etc.

• Shared restrooms: the patient may use the shared restrooms and are given the following bathroom hygiene instructions
  • Sit down when using the toilet
  • Put the lid down afterwards and flush twice
  • Wash hands thoroughly
  • Clean any potential spills with flushable wipes
  • Do not leave any contaminated unflushable waste in public bathrooms

• Urine or blood drops: potential urine or blood drops can be safely cleaned with flushable wipes. However, if a significant contamination with bodily fluid occurs, don’t attempt to clean, and follow below instructions.
  • If the patient is seen at OHSU, maintain 6-foot distance from the spill and contact the RSO. The RSO will assess the situation and provide further instructions accordingly.
  • If the patient is seen outside OHSU, please maintain 6-foot distance from the spill and contact the RSO at your institution.

• Foley catheter or nephrostomy tubes: if a Foley catheter or nephrostomy tubes are present or placed during the visit, use caution when handling the bags as the accumulating urine contains radioactive material. The content can be safely flushed in the toilet, and potential spills can be managed as above.

• Large waste containing bodily fluids that cannot be flushed: in case of large waste containing bodily fluids that cannot be flushed in the toilet (for example contaminated urinary pads, contaminated tubing, catheters, or bags):
  • Place them in a separate bag and contact our team to ensure proper disposal.

• After the patient leaves: unless there is contamination (or a suspicion of contamination) with bodily fluids, there is no need to survey the area after the patient leaves.

Precautions following Xofigo (223Ra/Radium)

• Distance from others: no distancing is necessary (the particles are not emitted through the skin)

• Urine and feces: use caution by wearing double gloves when handling urine and feces

• Urine or blood drops: potential urine or blood drops can be safely cleaned with flushable wipes. However, if a significant contamination with bodily fluid occurs, don’t attempt to clean, and follow below instructions.
  • If the patient is seen at OHSU, maintain 3-foot distance from the spill and contact the RSO. The RSO will assess the situation and provide further instructions accordingly.
  • If the patient is seen outside OHSU, please maintain 3-foot distance from the spill and contact the RSO at your institution.

• Large waste containing bodily fluids that cannot be flushed: in case of large waste containing bodily fluids that cannot be flushed in the toilet (for example contaminated urinary pads, contaminated tubing, catheters, or bags):
  •  Can be placed in secure bag, and can subsequently be safely disposed in the regular garbage.

• After the patient leaves: unless there is contamination (or a suspicion of contamination) with bodily fluids, there is no need to survey the area after the patient leaves.