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Internal Dose Assessment after 131I-Iodide Misadministration in a Patient With Incompletely Blocked Thyroid Uptake

Personalized Internal Dose Assessment by Estimating Individual-Specific Biokinetics

Kwon, Tae-Eun1; Park, MinSeok1; Kang, Jin-Kyu1; Cho, Minsu1; Jang, Seongjae1; Kim, Kyeong Min2; Ha, Wi-Ho1; Jin, Young Woo1

doi: 10.1097/HP.0000000000001019
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In July 2017, a medical accident occurred in South Korea, in which 131I-iodide solution was misadministered to the wrong patient. Although the International Commission on Radiological Protection provided internal dose coefficients for iodine for blocked thyroid, they were not reliable enough for determining the dose to the patient (whose thyroid uptake was incompletely blocked) due to a discrepancy in biokinetics. Therefore, a personalized dose assessment was performed to derive the individual-specific dose coefficients for the patient. Initially, the thyroid biokinetics of the patient were statistically clarified by fitting bioassay monitoring results and the corresponding predicted bioassay values, which were calculated repeatedly for varying iodine transfer rates in an iodine biokinetic model. After determining the transfer rate for the patient, the individual-specific dose coefficients were then calculated in accordance with latest recommendations of the International Commission on Radiological Protection. According to the individual-specific biokinetics, the 24 h thyroid uptake fraction of iodine was estimated as 0.52%. The thyroid absorbed dose of the patient was evaluated as 21.2 Gy, which differed greatly (by about 9 Gy) from the dose evaluated simply using the reference data for blocked thyroid uptake. The personalized dose assessment carried out for the patient not only reduced considerable uncertainties in the internal dose calculation, but also improved the reliability of the calculated internal dose by adopting the latest dosimetric data, including specific absorbed fraction values based on voxel phantoms. Through the dose assessment of the patient, the methodology of personalized dose assessment considering individual-specific biokinetics was developed.

1National Radiation Emergency Center, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea;

2Research Institute of Radiological and Medical Science, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea.

The authors declare no conflicts of interest.

For correspondence contact Wi-Ho Ha, Health Physics Team, National Radiation Emergency Center, Korea Institute of Radiological and Medical Sciences, 75, Nowon-gil, Nowon-gu, Seoul, Republic of Korea 01812, or email at lovin@kirams.re.kr.

(Manuscript accepted 9 October 2018)

© 2019 by the Health Physics Society