154 C. Michel et al.: Radioprotection 2026, 61( 2), 146 – 155
radiation protection staff, if needed. For example, active or passive dosimeters can be worn by staff, and radiation exposure can be minimized by applying the standard rules of time, distance and shielding, and hygiene rules to avoid contamination. A recommended practice is to follow preestablished written internal procedures. Furthermore, depending on the circumstances, the funeral professionals may be informed by the healthcare facility. However, there is no legal obligation to inform them of the radioactive status of the deceased patient, as death certificate does not include a section for this information.
If a patient dies at home after a nuclear medicine treatment, it is more likely that the funeral professionals will not be aware of the recent treatment, as the only way for them to know is to be informed by the deceased patient’ s next of kin.
To mitigate this potential lack of information, patients could be advised to carry a release card at all times for a certain period after the treatment. This card would specify the received treatment and provide the contact details of the nuclear medicine department. Such a card has been developed by HERCA( Heads of the European Radiological Protection Competent Authorities)( HERCA, 2012). Using the HERCA model, a release card has been implemented in Belgium since 2020.( FANC, 2020).
5 Conclusion
This study was based on calculations using conservative assumptions. The study assessed the scenarios in which postmortem procedures( transport and embalming) could be performed on deceased patients after nuclear medicine treatment, while ensuring that the effective dose to the workers remains below 300 mSv per operation.
For each common type of nuclear medicine treatment, practical recommendations were proposed for nuclear medicine departments and funeral professionals in the event of a patient death. This considers the administered radiopharmaceutical and its activity, the time interval between administration and death, as well as the dose rate around the deceased patient, if applicable.
For most nuclear medicine treatments, no special radiation protection measures are required, even if the death occurs immediately after administration of the radiopharmaceutical. However, some radiopharmaceuticals require a more precautionary approach, involving waiting periods before transport and embalming. For the most recent therapeutic radionuclides as lutetium-177, radium-223, holmium-166, and actinium-225 the waiting periods are under one week and fall within the legal time limits in France.
Acknowledgments
The authors thank the professionals at the French cancer center visited following the death of a patient who benefited from a technetium-99m procedure, in particular the members of the radiation protection department and those involved in the management of deceased patients( mortuary chamber officers and their manager).
The authors also thank the professionals at the French university hospital visited following the death of a patient treated with lutetium-177.
Funding
This work was carried out within the framework of a referral from the French Nuclear Safety Authority( ASN) to the French Institute for Radiation Protection and Nuclear Safety( IRSN) in April 2020.
Conflicts of interest
The authors declare that they have no conflict of interest.
Data availability statement
The research data associated with this article are included within the article.
Author contribution statement
All authors contributed to the work related in this article, and all reviewed and approved the final version of the manuscript.
Ethics approval
Ethical approval was not required. Informed consent
This article does not contain any studies involving human subjects.
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