Slide 1:Current Update on Mothers Breast Feeding Issue. Author: Leonor F Vazquez


Objectives :Objectives Breast feeding a personal decision Why to stop Breast feeding Procedures to follow is the patient is a breast feeding Patient When Instructions are required? When it is required to record the instructions? Recommendation Duration of interruption of Breast Feeding


Breast Feeding a Personal Decision :Breast Feeding a Personal Decision Breast-feeding is a personal decision A mother needs to make carefully, taking full into account the benefits and burdens it will bring to both mother and baby.  Breast-feeding offers many benefits.   It helps babies get the proper nutrition and can help mothers recover from pregnancy and delivery.  Breast-feeding can promote a “bond” between mother and baby.  Then “””””””.


Why to stop Breast Feeding? :Why to stop Breast Feeding? The cessation of breast feeding enclose to many factors ,but as long as we are a NMT students we are just going to talk about why to stop feeding a Baby when a patient is either under radiotherapy treatment or undergoes to a nuclear medicine investigation ARSAC recommended interruption times for breast feeding to reduce the radiation dose to the infant less than 1 mSV (0.1) rem from ingest radioactivity. Of course the Physician may use discretion in the recommendations, increasing or decreasing the duration of interruption.


Procedures to follow is the patient is a breast feeding Patient :Procedures to follow is the patient is a breast feeding Patient Notify the Authorized User ,Radiation Safety Officer,or Health Physicist before the radiopharmaceutical is administered. The referring Physician may be contacted and questioned whether scanning procedures are still indicated. If is decided by the above that the nuclear medicine precedures is necessary, the patient must be agree to discontinue breast feeding for the period of time prescribed by the Authorized User radiation Safety Officer, or Healthy Physicist Written instructions regarding the length of time to discontinue nursing must be signed by the patient before the dose is administered and documented in the patient chart.


Procedures to follow is the patient is a breast feeding Patient :Procedures to follow is the patient is a breast feeding Patient If is possible ,the patient may save some breast milk prior to the nuclear medicine study, for use during the restricted period after the study. If interruption or cessation of Breast Feeding is necessary ,the patient may need assistance from trained personnel to prevent breast engorgement. When Cessation of Breast Feeding is necessary ,gradual weaning of the infant in advance is preferable if posible.


When Instructions are required? :When Instructions are required? Instruction are required every time that you are going to perform a study in a any breast feeding patient. Examples: Liver/Spleen Scan- (sulfur Colloid) 4 mci ( It is not going to affect your baby


Instructions are requiredabove these dose/ but not stored :Instructions are requiredabove these dose/ but not stored Radiopharmaceutical     Dose Inst/ReQ inst/Rec MBq-mci Ga-67-citrate 1(0.04) Yes No Tc-99m-DTPA 1,OOO(30) Yes No Tc-99m-MAA 50 (1.3) Yes No Tc-99m-RBC (In Vivo 400 (10) Yes No Tc-99m-sestamibi 1000( 30) Yes No Tc-99m-sulfur colloid 300 (7) Yes No


When is required to record the instructions ? :When is required to record the instructions ? It is required to record the instruction when the dose that you are going to give to the patient is going to exceed the normal dose range EXAMPLE: Study Regular Dose Exceed Inst/Rec Dose Bone Scan Tc-MDP( 25- 30 mci) 150 mci Yes


When is required to record the instructions ? :When is required to record the instructions ? Radiopharmaceutical     Dose Inst/ ReQ inst/ Rec MBq-mci   Ga-67-citrate 7 (0.2) Yes Yes Tc-99m-DTPA 6000(150) Yes Yes Tc-99m-MAA 200(6.5) Yes Yes Tc-99m-RBC (In Vivo 2000(50) Yes Yes Tc-99m-sestamibi 6000( 150) Yes Yes Tc-99m-sulfur colloid 1000 (35) Yes Yes


Recommendation Duration of interruption of Breast Feeding :Recommendation Duration of interruption of Breast Feeding Radiopharmaceutical        Dose (MBq/mci)         Recom of interruption               Ga-67-citrate 150/ 4 Complete Cessation I-131- NaI 150 mci Cessation I-123 NaI 0.4 mci Cessation Tc-99m-MAA 150/4 12h Tc-99m-pertechnetate 1100/30 24h 440/12 12h 5 mci 4h Tc-99m-RBC (In Vivo) 740/20 12h Tc-99m WBCs 5 mci 48h Tc-99m-sulfur colloid 440/12 6h TL-201 Chloride 3 mci Cessation


Not necessary to stop Breast Feeding :Not necessary to stop Breast Feeding Radiopharmaceutical         Dose (MBq/mci)        Recom of /I Tc-DTPA Not/Necc Tc-DISIDA Not/Necc  Tc-Glucogeptonate Not/Necc Tc-Mibi Not/Necc Tc-MDP Not/Necc TC-RBC in vitro Not/Necc Tc-DTPA (areosol) Not/Necc TC-MAG3 Not/Necc


Summary :Summary Breast feeding is a personal decision that helps babies get the proper nutrition and can help mothers recover from pregnancy and delivery.  ARSAC recommended interruption times for breast feeding to reduce the radiation dose to the infant less than 1mSV (0.1)rem from ingest radioactivity If is decided that the nuclear medicine procedures is necessary, the patient must be agree to discontinue breast feeding for the period of time prescribed by the Authorized User radiation Safety Officer, or Healthy Physicist Written instructions regarding the length of time to discontinue nursing must be signed by the patient before the dose is administered and documented in the patient chart.


Summary :Summary If interruption or cessation of Breast Feeding is necessary ,the patient may need assistance from trained personnel to prevent breast engorgement. Instruction are required every time that you are going to perform a study in a any breast feeding patient. It is required to record the instruction when the dose that you are going to give to the patient is going to exceed the normal dose range When a recommendation of interruption of Breast Feeding it is not necessary is because the amount of dose that is going to be used for the study is not going to exceed the normal range, what means that is no going to affect your baby.


Question # 1 :Question # 1 Breast feeding a personal decision that can help: A) The mother to loose weight. B) The Babies Intelligent C) It helps babies get the proper nutrition D) Help the mothers to recover from pregnancy and delivery.  E) C and D


ANSWER :ANSWER E) C and D It helps babies get the proper nutrition. Help the mothers to recover from pregnancy and delivery.


Question # 2 :Question # 2 When is required to record the instructions ? when the dose that you are going to give to the patient is going to exceed the normal dose range Every time that a technology is going to perform a study When a patient is under 57 Kg.


ANSWER :ANSWER when the dose that you are going to give to the patient is going to exceed the normal dose range


Question # 3When Instructions are required? :Question # 3When Instructions are required? When the dose is going to exceed the normal range B) Instruction are required every time that you are going to perform a study in a any breast feeding patient. C) When the patient exceed 70 kg


ANSWER :ANSWER B) Instruction are required every time that you are going to perform a study in a any breast feeding patient.


QUESTION # 4 :QUESTION # 4 If you are about to perform a Bone Scan in a breast Feeding Patient and the dose that your are going to use is 30 mci.Do you need to record the Instruction ?   Radiopharmaceutical     Dose (mci) inst/Rec Bone Scan Tc-MDP( 25- 30 mci) ____?


Answer :Answer Radiopharmaceutical     Dose (mci) Inst/Rec Bone Scan Tc-MDP( 25- 30 mci) NO The dose fit in the normal range.


Question # 5 :Question # 5 ARSAC recommended interruption times for breast feeding to reduce the radiation dose to the infant less than: 1 mSv (0.1) rem 0.1 mSv ( 3 rem) 2 mSv (2,5rem)


Answer :Answer 1 mSv (0.1) rem


References :References SNM WEB SITE (http://www.snm.org) British Journal of Radiology (2005) The British Instituted of Radiology http://www.pubmedcentral.nih.gov/pagerender. http://www.bfar.org/possible-diagnostic.shtml http://www.icanl.org/icanl/pdfs/sample_PregnancyBF.pdf http://rpop.iaea.org/RPoP/RPoP/Content/InformationFor/HealthProfessionals/3_NuclearMedicine/DiagnosticNuclearMedicine-Generalissues.htm