[Histonet] RE: Radioactive Policies

[Terri Braud]

Hi -  I Think I can help.  We have a policy and I've provided it here.
Also, we have a separate policy in our autopsy manual concerning the
handling of radioactive cadavers, which is rather extensive.  We also
participate in an annual Radiation Accident Drill which is county wide
and covers emergency response teams, hospital emergency, laboratory, and
morgue services.  Its quite a big deal to witness and lots of fun to
participate in.
Here is our tissue procedure.  Please let me know if you need a copy of
the other.

PURPOSE: To provide guidelines for the handling of sentinel lymph nodes
and other tissue with possible radioactivity.

PRINCIPLE:
The technique of sentinel lymph node biopsy (SLN) attempts to detect
regional node metastases by identification of the "sentinel" lymph
node(s) using a combination of radiolabeled colloid (99m Technetium
labeled sulfur or Human Serum Albumin) and isosulfuran blue dye.  The
premise is that lymph node metastases will initially travel by lymphatic
drainage to the "sentinel" node.  Other tissues that might contain
radioactive substances are identified and handled according to the
Radiation Safety Officer's recommendations.

PROCEDURE:

1.	During the validation phase of the SLN biopsy technique, the
sentinel lymph node(s) and the completion lymph node dissection will be
submitted to Pathology in separately labeled containers.  For mapping
with a radiolabeled colloid, an injected dose of technetium (99mTc) in
the range of 0.1 to 1.0 mCi (3.7 to 37 MBq) is approximately 4% of that
administered for a conventional bone scan. No isolation, precautions, or
special radiation monitoring are required. 

2.	Specimens should be submitted in 10% neutral buffered formalin
unless an intraoperative consultation is requested.

3.	Gross examination will identify the number and the size of the
sentinel lymph node(s).  Nodes should be sectioned into 2-3 mm slices.
Grossly evident metastatic disease should be noted. 

4.	Following tissue processing, at the pathologist's instruction,
the SLN block will be sectioned at 3 levels at 4 microns.  All levels
will be stained with hematoxylin and eosin.  Immunostaining will also be
performed when appropriate.  Lymph nodes demonstrating metastatic
disease on Frozen Section are routinely cut at one level only.

5.	If the pathologist does not ask for the protocol procedure, then
the lymph node is to be sectioned as regular tissue.

6.	For any other tissue sent to the Histology, suspected or labeled
as containing radioactive substances, the Histology Tech is to
immediately call the Hospital Radiation Safety Officer for radiation
measurement and instructions for the handling of the tissue. 

7.	The tech will immediately notify the pathologist on call that
tissue with suspect radiation has been received and the Radiation Safety
Officer has been called 

8.	The Radiation Safety Officer's handling instructions will
supersede any further processing of the tissue. Documentation of the
Radiation Safety Officer's tissue handling recommendations will be
included on the requisition.


Reference: JCO October 20, 2005 vol. 23 no. 30 7703-7720


Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Holy Redeemer Hospital Laboratory
1648 Huntingdon Pike
Meadowbrook, PA 19046
Ph: 215-938-3676
Fax: 215-938-3874


-----Original Message-----

Today's Topics:
   1. Re: Radioactive specimens policy (Bob Richmond)
   6. RE: Re: Radioactive specimens policy (Joelle Weaver)
   

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