Evaluation of activity kinetics in breast milk and calculation of the resulting effective radiation dose after ^99mTc-MIBI scintigraphy of a breastfeeding women

Abstract

Introduction In breastfeeding women, the indication for scintigraphic imaging is strongly restricted due to potential transition of the radiopharmaceutical to the child via breast milk. The potential activity uptake of the breastfed child depends on the chemical compound of the radio pharmaceutical as well as biokinetics and metabolism in the maternal body.

Methods In the presented case ^99mTc-MIBI scintigraphy was performed in a breastfeeding woman with sonographically suspicious thyroid nodules. Breastfeeding was interrupted for 30 hours and the breast milk during this period was collected and analysed to determine the excreted activity and the potentially resulting dose to the breastfed child.

Results Activity concentration in the first breast milk sample (1.83 hours after administration of 500 MBq ^99mTc-MIBI) was 380 Bq/mL, resulting in an absolute activity of 50 kBq for a sample size of 132 mL. Subsequently activity concentration decreased to 6 Bq/mL (29.8 hours p.i.). The calculated effective half-life of the secretion of ^99mTc-MIBI via breast milk was 4.7 hours. The potentially resulting effective dose for the breastfed child was 13.4 µSv (ICRP80: dose coefficient: 0.13 mSv/MBq for ^99mTc).

Conclusion Time activity curve showed a rapid decrease of the ^99mTc-MIBI activity secreted to the breast milk. More than 90 % of the total secreted activity is attributable to the first 12 hours after administration. Therefore, an interruption of breastfeeding of 24 hours seems to be adequate.

Keywords

Breast milk - ^99mTc-MIBI scintigraphy - radiation dose

• References

• 1 Happel C, Borowski M, Kamp A. et al. Prenatal Radiation Exposure in Nuclear Medicine. Nuklearmedizin 2021; 60 (03) 233-239
• 2 Fachinformation CardioTOP [Tetrakis (1-isocyan-2-methoxy-2-methylpropan)kupfer(1+)-tetrafluorborat]. Polatom, National Centre for Nuclear Research. 08/2016.
• 3 Borowski M, Pirl L, Happel C. et al. Frequency and radiation exposure of nuclear medicine examinations in Germany. Der Nuklearmediziner 2021; 44 (04) 384-394
• 4 International Commission on Radiological Protection. ICRP Publication 80: Radiation Dose to Patients from Radiopharaceuticals, Addendum 2 to ICRP 53. Oxford: Pergamon Press; 1998