Radium-223 dichloride is a radiopharmaceutical used to treat prostate cancer with bone metastases. Radium-223 (Ra-223) predominantly emits alpha-radiation. Alpha-particles have a short range in tissue and cannot penetrate protective clothing such as examination or surgical gloves. The particles are only a radiation hazard if Ra-223 is ingested or inhaled, or in direct contact with skin or mucosa.

Ra-223 will be present in the patient’s blood, urine, faeces and bones in variable quantities after receiving the treatment. Healthcare professionals caring for patients who have received Ra-223 will need to take precautions to avoid ingestion or inhalation of the radium for three months after the last dose has been administered.

General Precautions

• Close contact with the patient is safe for all staff, including those who are pregnant.
• Good hygiene practices, including wearing gloves and aprons, will be sufficient to prevent ingestion in most situations.
• Wash hands with soap and water after patient contact rather than using hand-sanitiser.
• If dealing with body fluids or faeces and there is the risk of splashing, additional measures (such as masks, goggles or face shields) may be appropriate.
• Dispose of urine or faeces to the drains via a toilet or sluice.  Flush twice after use to ensure any Ra-223 has been washed away.
• Bag up any linen or waste contaminated with the patient’s blood, urine or faeces, label as “Radioactive – not for disposal” and store securely. Contact your local Nuclear Medicine department or Radiation Protection Advisor (RPA) for advice.

Additional precautions for surgical procedures

• When there is a risk of airborne radioactive contamination from the patient (e.g. during bone sawing or drilling) FFP3 face masks must be worn by all staff in the theatre.
• Generated clinical waste (including excised tissue) may be radioactive and cannot be disposed of via the normal route. Bag these materials separately, label as “Radioactive – not for disposal” and store securely until further advice is given by your local Nuclear Medicine department or RPA.
• Specimens for pathology or other analysis may also be radioactive. Advise the laboratory that this is the case and ask the staff to retain the samples until advice can be sought from their local Nuclear Medicine department or RPA.

Death of Patient

In the event of the death of the patient within three months of the last administration of Ra-223, special precautions will be needed to ensure the safety of personnel if post-mortem examination, embalming or cremation is being considered. Handling and storing the body will not pose a hazard provided standard hygiene precautions are followed and no invasive actions are performed. Contact your local Nuclear Medicine Department or RPA for further advice.

For patients treated at Hull University Teaching Hospitals NHS Trust, the Nuclear Medicine department can be contacted on 01482 622125 (Mon-Fri, 8:30am-5pm).