Low Radioactivity Levels in Blood Samples After Targeted Radionuclide Therapy: Minimal Radiation Exposure of Healthcare Staff.

Background/

Objectives

The increasing use of radiopharmaceuticals in clinical practice has raised concerns regarding potential radiation exposure for healthcare personnel handling biological samples from treated patients. The objective of this study was to assess the radioactivity levels in clinically necessary blood samples taken from patients treated with radioactive iodine-131 (I-131) or lutetium-177 (Lu-177) in a real-world setting.

Methods

Prospective, tertiary care single-center study. Blood samples, at the clinically necessary time points, from 220 consecutive targeted radionuclide therapies (TRTs) used to treat 151 distinct patients between October 2021 and January 2025 were included. The influences of the eGFR and the time interval between tracer administration and blood sampling on radioactivity concentration were investigated by linear regression models. The applied amount of radioactivity was excluded as a confounder by adjusting all cases to 1 GBq. Statistical programming language R was utilized and p < 0.05 was considered significant.

Results

The mean age of the patients was 62 years and 52% were male. Mean radioactivity concentrations of 6 vs. 60 kBq/mL were measured at 52 vs. 13 h after application of 1.9 vs. 6.7 GBq I-131 vs. Lu-177, respectively. Better renal function and later blood sampling were both associated with lower radioactivity concentration in blood samples (each p < 0.001). Total radioactivity levels in all samples were well below the upper limits for the disposal of biological samples (1 MBq for I-131 and 10 MBq for Lu-177).

Conclusions

There was only a low exposure risk for nuclear medicine personnel and laboratory staff. These findings emphasize that handling blood samples from patients treated with I-131 and Lu-177 in clinical routine is minimal.