Department of Radiation Oncology
KENNETH NORRIS JR. CANCER CENTER
1441 Eastlake Ave., Los Angeles, CA, 90033 (323) 865‑3050
INSTRUCTIONS FOR PATIENT AND FAMILY WHEN PATIENT IS RELEASED FROM HOSPITAL
WITH AN OPHTHALMIC PLAQUE CONTAINING RADIOACTIVE I‑125 SEEDS
_________________________________________________ was treated on ______________
name of patient date
with ______ millicuries of I‑125 in the form of _____ seeds in a gold ophthalmic plaque. Maximum exposure rate at 1 meter was measured to be ____ mR/hr (must be < 2 mR/hr) with the lead eye patch in place. The plaque is scheduled to be removed at _________ on _________________ .
Please show this form to every physician consulted concerning the patient until the plaque is removed. Until the plaque is removed, persons under 45 years of age should not remain closer than 2 meters (≈6 feet) from the patient for ____ hours per day. No further radiation safety precautions will be necessary after you return to the hospital and have the plaque removed.
The State of California has issued strict guidelines governing the release from the hospital of patients that have radioactive sources in their body. For I‑125 eye plaque patients, such as yourself, the guidelines are easily met if you rigorously comply with the few rules given in the following:
SPECIAL PRECAUTIONS while the plaque is in place:
1. To keep hospital costs to a minimum, I‑1 25 eye plaque patients for whom there is no medical reason for hospitalization, are allowed to convalesce at home during the nominal one week treatment time. In accepting the hospital discharge, you, the patient agree to abide by all the following safety guidelines. If you are unable to comply with the following rules, please advise the ophthalmology and radiation oncology physicians in charge of your care so that arrangements can be made.
2. The radiation dose to other people from the isotopes contained in your eye depends on three factors: time, shielding and distance. By sitting across the room from people and wearing your lead lined eye patch, you can reduce the radiation levels to other persons to levels that are well within regulations. Please wear the eye patch at all times when others are around, and maintain a distance of six feet or greater from them.
3. To minimize the concerns of non‑family members and the possible exposure of children and pregnant women to radiation, we have the following rules:
a) No children under 18 or pregnant women may visit while you have the plaque in place.
b) You must restrict your activities to your home and backyard. You may not go out in public, go to work, go to church or to a friend's house.
4. Use of the lead lined eye shield and the six foot rule reduces the radiation levels so that it is safe for your own childrenand family. Remembering that distances of separation greater than six feet offer increased levels of protection, you may wish to modify your life style to achieve this during the week.
5. It is preferred that you sleep in a bed by yourself while you have the plaque.
6. Spouse or other person caring for patient:________________________________________________
7. Other: ___________________________________________________________________________
IF THE PATIENT MUST BE HOSPITALIZED, OR IF DEATH SHOULD OCCUR,