Potential for Contamination during Removal of Radioactive Seeds from Surgically Excised Tissue

Abstract

The purpose of this study was to determine whether the use of a scalpel or electrocautery to remove radioactive sealed sources ("seeds") from surgically excised tissue could damage the seed and cause it to leak its radioactive contents. Attempts were made to cut or burn Oncura Model 6711 non-radioactive seeds while in pig muscle or on a stainless steel plate. Additionally, one active 125I seed was purposely charred using pressure with an electrocautery knife to see whether the casing could be damaged. Electron microscopy scanning was performed on the dummy seeds to determine if the integrity of the metal casing had been compromised. Two types of leak tests were performed on the active seed to verify the presence or absence of loose contamination. The seed casing was not damaged from either use of a scalpel or electrocautery when the seed was in tissue. The active seed was not found to be leaking after applying pressure with an electrocautery knife while the seed was on a stainless steel plate. We conclude that removal of active Model 6711 seeds from surgically excised tissue can be done safely with a scalpel or electrocautery because constant, firm pressure cannot be applied to the seed. This is likely true for seeds made of similar materials.

Radioactive Seed Localization With 125I For Nonpalpable Lesions Prior to Breast Lumpectomy and/or Excisional Biopsy

“…Any loss requiring follow up would be documented in the patient medical record, including an absorbed dose estimate. Breached or leaking seeds were not expected using typical surgical procedures (Classic et al 2009); however, in the rare event of unexpected seed leakage, Radiation Safety would be contacted to conduct a radioactive contamination assessment. If leakage were confirmed, all contaminated materials would be handled as radioactive waste.…”

“…A final radiation survey of the remaining specimen material was performed using the RSL gamma probe to verify the absence of any remaining implants. This important step was emphasized during training of the pathology staff to preclude the possibility of cutting of the seeds during microtome sectioning of specimens (Classic et al 2009). …”

Handling of radioactive seed localisation breast specimens in the histopathology laboratory: the Western Australian experience

“…The likelihood is minimal as the titanium seed shell is resistant to damage from the blades and forceps used in routine pathology practice. 13 This scenario is best to avoid and therefore our recommendation, and the recommendation of others, 14 is that snips or scissors should not be used in seed handling and that forceps should be only be used with finesse. 13,14 In studies specifically examining seed damage, complete seed severance has only been achieved by deliberately cutting a seed on a hard metal surface and by tightly grasping a seed with forceps.…”

“…13,14 In studies specifically examining seed damage, complete seed severance has only been achieved by deliberately cutting a seed on a hard metal surface and by tightly grasping a seed with forceps. The likelihood is minimal as the titanium seed shell is resistant to damage from the blades and forceps used in routine pathology practice.…”

Initial Community Hospital Performance of Radioactive Seed Localization for Breast Cancer Patients

“…A study in pig tissue demonstrated that the I-125 seed had to be immobilized with tweezers before it could be damaged with either a scalpel or an electrocautery blade (Classic, Brunette, & Carlson, 2009). …”