Endocrine Abstracts

The amount of radioactivity given to patients undergoing ablation for remnant tissue in thyroid cancer at our centre has been greatly reduced to 1100 MBq I-131 in recent years, prompting a review of practice. An extensive risk assessment, focusing particularly on radiation exposure to the public during the patient’s commute home was conducted and found patients could now be discharged safely on the day of treatment. Owing to these findings and audit showing 86% of patients waited for at least 3 h and 29% were waiting beyond 1700 for bed availability for inpatient treatment, with a knock-on late discharge the following day, we moved to day case treatment in a carefully selected group; eliminating the need for hospital admission and improving waiting times. Currently, all patients meet with the ARSAC license holder and a nuclear medicine physicist prior to being scheduled for their ablation. After a rigorous risk assessment by the nuclear medicine physicist confirming the patient’s ability to comply with the necessary restrictions, the patient is consented and given dates to attend for thyrogen administration, blood tests (+/− a pregnancy test), treatment and post-therapy imaging. Only patients who are unable to comply with the precautions are admitted for therapy. Between May 2018 and June 2019, we administered ablation dose to fifty-three patients; twenty (37%) were discharged home the same day, without any reported adverse events. This equates to ˜£14 000 in admission saving (estimated admission cost £340) and the equivalent number of bed nights on a busy oncology ward. Other benefits include approximately 4 physicist hours saved, increased bed availability and an anticipated improved patient experience. Retrospective analysis of our data suggests we could double the number of day case treatments through education of the wider team. We plan to collect more patient feedback and continue to expand our practice.