As a medical center without a pre-existing radiopharmaceutical therapy program, it was a daunting endeavor to implement a 131I metaiodobenzylguanidine (mIBG) high-dose treatment regimen. It took several years of planning with hospital administration, vendors, and Texas Department of Health Radiological Control regulators to establish a viable program. Effective communication between physicians, nursing, nuclear medicine, environmental services, maintenance, and other support staff is essential and paramount for the successful execution and continued sustainability of the mIBG therapy program. Besides providing an effective treatment for patients, an additional goal for the program is to keep radiation exposure As Low As Reasonably Achievable (ALARA) for staff and patient caregivers. As such, start-up presented many training, logistical, and radiation safety challenges. The location of the isolation room and shielding specifications were designed to keep radiation exposure to public access areas to less than 2 microsieverts per hour. Before the first patient was treated the policies and procedures for training, radiation safety, product quality control, and infusion process needed to be developed, tested, and approved by various committees. Furthermore, a similar process was required for developing room set-up, post therapy cleanup, and waste storage procedures. Throughout the maturation process of the program, the departments involved have found that our safety culture has continually improved by the re-enforcement of knowledge and lessons learned, as both the ancillary and treatment staff grew more confident in each other’s ability during more patient treatments are performed. This article describes the process and lessons learned during the time leading up to the startup and early years of the mIBG therapy program.
1Cook Children's Medical Center, Fort Worth, TX.
The authors declare no conflicts of interest.
Jaime Ann Barnes has been working in the nuclear industry since 2002. She is currently a radiation safety specialist working at a pediatric hospital in Fort Worth, Texas. The majority of her time is spent working with a multi-disciplinary team that is using high dose MIBG 131I experimental pharmaceutical in the treatment of neuroblastoma in pediatric patients. Jamie Ann executes all of the NRC/DOT and IATA shipping for radioactive materials. Before working at the hospital she worked in commercial nuclear plants during outage and operation, Department of Energy National Labs, and environmental cleanups throughout the United States.