SAN DIEGOLead aprons, radiation badges, and patient laundry are
not the normal concerns of nurses. But as new radioimmunotherapy agents are
evaluated and introduced into practice, nurses will need to familiarize
themselves with radiation safety precautions, said Patricia A. Kramer, RN,
MSN, a San Francisco-based oncology nurse educator and consultant. Patient
education and instruction throughout the whole process is key.
Speaking at a Cure for Lymphoma Foundation Symposium at the Oncology
Nursing Society’s 26th Annual Congress, Ms. Kramer reviewed issues
involved in the administration of I-131 tositumomab (Bexxar™), a
radiolabeled monoclonal antibody under review by the FDA for the treatment
of non-Hodgkin’s lymphoma. Tositumomab emits beta and gamma radiation.
Gamma radiation has a half-life of 8 days.
Administering tositumomab requires strict radiation safety procedures and
may require overnight hospitalization because the patient is radioactive.
"The radiation safety procedures we need to familiarize ourselves
with when using this agent have to do with utilizing the principles of time,
distance, and shielding," Ms. Kramer said. Decreasing one’s time
spent with a patient receiving tositumomab will decrease one’s radiation
exposure. Increasing distance from a patient will also decrease radiation
exposure, she said.
Radiation precautions, as outlined below, should be observed for 1 week,
she said. Patients need to maintain a distance of approximately 6 feet from
other people whenever possible.
All staff need to wear monitoring badges to monitor their radiation
exposure and lead aprons when coming into contact with radioimmunotherapy
patients. The aprons will absorb up to 99% of radiation, she said, but
pregnant nurses cannot work with these patients. Special rooms must also be
designated within the institution for administration of radiolabeled
A recent change in the standards set by the Nuclear Regulatory Commission
makes it possible in some cases for patients to receive radioimmunotherapy
as outpatients. The new discharge criteria are dose-based, determined by
patient-specific calculations or the use of a default table.