Radioactive Seed grossing

[Patologika]

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I was wondering if any of the path residnents gross the radioactive seed breast excisons that come through your program. If so, do you use any special protective/monitoring equipment? I would really appreciate your answers as our program will be starting this for first and second years.

 

[TMZ2007]

Not for breast, but we've gotten a few prostates with radioactive seeds in them. We are told that there should be no serious adverse impact or special protective equipment needed for grossing the specimen in the usual fashion. Somebody from the department that handles other radioactive materials (occupational health?) comes down to the gross room with a some kind of lead-lined box and collects the seeds as we pull them out, though...

 

[pathstudent]

Not for breast, but we've gotten a few prostates with radioactive seeds in them. We are told that there should be no serious adverse impact or special protective equipment needed for grossing the specimen in the usual fashion. Somebody from the department that handles other radioactive materials (occupational health?) comes down to the gross room with a some kind of lead-lined box and collects the seeds as we pull them out, though...

Yes they are so safe then need to be stored in a lead box and buried 10 miles below ground.

 

[Patologika]

Were you provided with any long-term studies supporting the safety of these seeds or any information at all? Do you use a shield at least while grossing?

 

[Patologika]

I would like to know how many programs are having there residents gross these seeds.

 

[Path2009]

One of my co-residents just wrote a really nice paper on this here http://www.ncbi.nlm.nih.gov/pubmed?term=graham%20rp%20breast

 

[TMZ2007]

That was a nice paper, thanks. We haven't started using the radioactive seeds for breast localization, but we've gotten a few prostatectomies where (I think) the patient was getting radiotherapy and as we grossed the thing, we pulled out the metal bits and put them into the radiation guy's little shielded box. We were notified in advance that it was coming and the radiation guy arrived with the specimen. One time we were missing a bead and had to xray the partly-grossed specimen to find it (which was kind of annoying).

 

[Path2009]

The residents here regularly gross them.

It is legend that one time a radioactive seed was actually cut on the frozen section blade and it shut the lab down. There was much weeping, wailing, and gnashing of teeth.

 

[KeratinPearls]

Some PhD dude came down and measured the radiation and it was pretty high. He handled it and put the seeds in a container and surrounded the container with several lead??? bars. I wouldnt feel comfortable grossing the specimen with that amount of radiation that was being emitted....the PhD dude said it was higher than he expected.

 

[lazers]

It depends on what radioactive seeds are in the tissues and when they were placed. For prostate brachytherapy the seed placed is palladium-103 which has a half life of 17 days. Anyways if you feel uncomfortable you should take a dosimeter and scan the specimens to determine it's radioactivity. I'd definitely be nervous about touching the radioactive seeds with my hands (if they haven't yet depleted) due to the possibility of sarcomas later in life.

 

[yaah]

Hospitals should have a radiation safety department or something like that that works with the lab to provide guidelines for what to do when you contact such specimens. Don't just fly blind.

 

[member0007]

what was wrong with those tiny clips etc? why radiation seeds?

 

[Substance]

I would carefully document the fact that you were handling these things. If in 20 years you develop some weird cancer because of it, you may be able to sue.

 

[hesperion]

what was wrong with those tiny clips etc? why radiation seeds?

My understanding is it's not a choice between clips or seeds but rather between wire locs and seeds. Wires are placed the morning of surgery and a seed could be placed up to a week (or something) before surgery. It's more of a convenience for the patient and for Radiology.