152 C. Michel et al.: Radioprotection 2026, 61( 2), 146 – 155
Table 7. Therapeutic procedures for which no special radiation protection measures are required for transport and embalming of deceased patients, meeting the 300 mSv dose criterion per post-mortem procedure.
Therapeutic procedure Administered activity How to proceed: body transport and embalming
phosphorus-32: polycythemia treatment strontium-89: bone metastases treatment yttrium-90: Radiation synovectomy Non-Hodgkin lymphoma treatment Radioembolization of liver cancers with microspheres
iodine-131: benign thyroid diseases( below 700 MBq) erbium-169: radiation synovectomy rhenium-186: radiation synovectomy radium-223: bone metastases treatment actinium-225: metastatic prostate cancer
260 MBq 150 MBq
225 MBq 1.2 GBq 2 GBq( SIR-sphere ®) 5 GBq( Therasphere ®) 700 MBq 750 MBq 370 MBq 6 MBq 15 MBq
No special radiation protection measures *( These post-mortem procedures can be carried out immediately)
* In this study, external and internal contamination were not considered as funeral professionals routinely wear personal protective equipment( e. g., gloves) when handling the body, regardless of its radioactive status.
3.4 Synthesis of recommendations
The recommendations for all radiopharmaceuticals considered in this study are summarized in Table 7 for therapeutic procedures requiring no special radiation protection measures and Table 8 for others.
4 Discussion
The results of this study indicate that the radiation protection following a patient’ s death can be effectively addressed through recommendations based on estimated exposures of workers handling the deceased patient.
For lutetium-177, radium-223, actinium-225 and holmium-166 considered as the most recently introduced therapeutic radionuclides in France, the calculated waiting periods between patient death and transport or embalming, meeting the dose criterion, were under 6 days. This result matches the embalming time limit in France at the time of the calculations( 2022).
More recently, since 2024, the regulations have changed( JORF, 2024) and the time limit for embalming has been extended to 14 days. Consequently, regardless of whether the limit is 6 or 14 days, no exemption from State representatives is required for the 4 new radionuclides listed above.
In some other countries, radiation protection recommendations differ from those in France, for example in Belgium( FANC, 2025) and Switzerland( DFI-IFSN, 2017). They are not based on exposure estimates, but on exemption levels of radioactivity.
In Belgium, an Excel-based calculator is available( FANC, 2025) to calculate a precaution period according to the radiopharmaceutical and the administered activity. This period is related to the radiological risks. In other terms, if a patient dies within this period which start from radiopharmaceutical administration, special radiation protection precautions are needed to manage the deceased patient. These precautions are based on radiation protection principles( time, distance, shielding), and hygiene rules to avoid contamination.
Regardless of the level or type of radioactivity present, thanatopraxy is prohibited in Belgium.
Because the underlying concepts differ between France and Belgium, the Belgian precaution period is not directly comparable to the two types of time frame calculated for France, namely the waiting period after death and the time interval between administration and death.
However, it is possible to show, in these two countries, the practical consequences for the example of administration of 7.4 GBq of lutetium-177-PSMA: – In the first case, in France according to this study, if the death occurs immediately after administration, the deceased patient can be transported immediately without specific radiation protection precautions, while a waiting period of 4 days is necessary to embalm( body cleansing, dressing, and thanatopraxy). In Belgium, the precaution period is 28 days, and then precaution measures must be taken for body transport, body cleansing and dressing, based on basic principles of radiation protection( time, distance, shielding) and hygiene to avoid contamination.
– In the second case, if the death occurs 1 week after administration, no specific radiation protection precautions are necessary for body transport and embalming in France according to this study. In Belgium, the time of death is still within the precaution period of 28 days, therefore the same precautions as in the first case have to be followed.
– In the third case, if the death occurs 1 month after administration, no specific radiation protection precautions are necessary for body transport and embalming( body cleansing, dressing and thanatopraxy) in France according to this study. In Belgium, since the death occurs after the precaution period of 28 days, no specific radiation precautions are necessary for body transport, body cleansing and dressing.
In France, if a patient who has recently undergone nuclear medicine treatment dies in the same healthcare facility, the healthcare professionals are generally aware of the recent treatment. In such cases, radiation protection measures can be implemented, with the assistance of