Abstract
The amount of radioactivity excreted in breast milk following administration of 11 different radiopharmaceuticals, including technetium-99m labelled microspheres, pyrophosphate, diisopropyl-iminodiacetic acid (DISIDA) and sestamibi, has been measured. This report summarises the data collected from 60 patients. An effective decay constant for the series of samples from each patient was calculated from exponential curves fitted by least squares to the data. It is difficult to compare values from individual patients, since times of expression, volumes of milk and the activity administered are not uniform. In order to formulate reliable guidelines, we therefore calculated the total activity theoretically excreted in milk until complete decay of the radionuclide, which is usually higher than that actually measured over the actual period of collection. Of the various 99mTc compounds, pertechnetate clearly reaches the highest concentrations in breast milk. The wide variability of data from different patients who received the same radiopharmaceutical despite identical methods of sample collection and data processing confirms the impression gained from literature that transfer of radionuclides into milk varies greatly between individuals. Although we have calculated average values for each compound, very large standard deviations were obtained, and we believe that for radiation protection purposes, a “worst case” approach is the most appropriate. With new data available and the revision of ICRP recommendations, the guidelines applicable when radiopharmaceuticals are administered to breast-feeding mothers are reviewed. The effective dose resulting from close contact between patient and infant was included in these calculations. Breast feeding need not be interrupted after administration of 99mTc-DISIDA, -sulphur colloid, -gluconate and-methoxyisobutylisonitrile (MIBI). However, after administration of 99mTc-MIBI, close contact should be restricted. 99mTc-pyrophosphate and -microspheres require interruption periods of several hours. High activities of 99mTc-pertechnetate may require interruption longer than 2 days. For pertechnetate and 99mTc-labelled red blood cells, interruption of breast feeding with measurement of activity in expressed milk samples is recommended. Breast feeding is contra-indicated after administration of 67Ga and 131I. General guidelines regarding breast feeding after administration of radiopharmaceuticals are summarised.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Larson SM, Schall GL. Gallium 67 concentration in human breast milk. JAMA 1971; 218: 257
O'Connell MEA, Sutton H. Excretion of radioactivity in breast milk following 99mTc-Sn polyphosphate. Br J Radiol 1976; 49: 377–379
Heaton B. The build-up of technetium in breast milk following the administration of 99mTcO4 labelled macroaggregated albumin. Br J Radiol 1979; 52: 149–150
Greener AW, Conte PJ, Steidley KD. Update on gallium-67 concentration in human breast milk. J Nucl Med Technol 1983; 11: 171–172
Vagenakis AG, Abreau CM, Braverman LE. Duration of radioactivity in the milk of a nursing mother following Tc-99m administration. J Nucl Med 1971; 12: 188
Ahlgren L, Ivarsson S, Johansson L, et al. Excretion of radionuclides in human breast milk after the administration of radiopharmaceuticals. J Nucl Med 1985; 26: 1085–1090
Brown DM, Jenness R, Ulstrom RA. A study of the composition of milk from a patient with hypothyroidism and galactorrhea. J Clin Endocrinol Metab 1965; 25: 1225–1230
Romney BM, Nickoloff EL, Esser PD, et al. Radionuclide administration to nursing mothers: mathematically derived guidelines. Radiology 1986; 160: 549–554
Mountford PJ, Coakley AJ. A review of the secretion of radioactivity in human breast milk: data, quantitative analysis and recommendations. Nucl Med Commun 1989; 10: 15–27
Fulton B, Moore L. The galactopharmacopedia. Radiopharmaceuticals and lactation. J Human Lact 1990; 6: 181–184
Rose MR, Prescott MC, Herman KJ. Excretion of iodine-123-hippuran, technetium-99m-red blood cells, and technetium99m-macroaggregated albumin into breast milk. J Nucl Med 1990; 31: 978–984
International Commission on Radiological Protection. 1990 Recommendations of the ICRP. Annals of the ICRP 21 no 1–3, ICRP publication 60. Oxford: Pergamon Press, 1991
International Commission on Radiological Protection. Annual limits on intake of radionuclides by workers based on the 1990 recommendations. Annals of the ICRP 21 no 4, ICRP publication 61. Oxford: Pergamon Press, 1991
Dydek GJ, Blue PW. Human breast milk excretion of iodine-131 following diagnostic and therapeutic administration to a lactating patient with Graves' disease. J Nucl Med 1988; 29: 407–410
Mountford PJ, O'Doherty MJ, Forge NI, et al. Radiation dose rates from adult patients undergoing nuclear medicine investigations. Nucl Med Commun 1991; 12: 767–777
Mountford PJ. Estimation of close contact doses to young infants from surface dose rates on radioactive adults. Nucl Med Commun 1987; 8: 857–863
Rubow SM, Ellmann A, Le Roux J, Klopper J. Excretion of technetium 99m hexakismethoxyisobutylisonitrile in milk. Eur J Nucl Med 1991; 18: 363–365
Ogunleye OT. Assessment of radiation dose to infants from breast milk following the administration of Tc-99m pertechnetate to nursing mothers. Health Phys 1983; 45: 149–151
CIS Bio international. Kit for the preparation of an injectable suspension of human albumin microspheres (Package insert). Gif-sur-Yvette: CIS, 1990
Davis MA. Particulate radiopharmaceuticals for pulmonary studies. In Subramanian G et al. eds. Radiopharmaceuticals. New York: Society of Nuclear Medicine; 1975: 267–281
Subramanian G, McAfee JG, Blair RJ, Thomas FD. An evaluation of 99mTc-labeled phosphate compounds as bone-imaging agents. In: Subramanian G et al, eds. Radiopharmaceuticals. New York: Society of Nuclear Medicine; 1975: 319–328
Saha GB. Fundamentals of Nuclear Pharmacy, 3rd edn. New York: Springer, 1992
Mountford PJ, Coakley AJ. Breast milk radioactivity following injection of 99Tcm-pertechnetate and 99Tcm-glucohep-tonate. Nucl Med Commun 1987; 8: 839–845
Tobin RE, Schneider PB. Uptake of Ga-67 in the lactating breast and its persistence in milk: case report. J Nucl Med 1976; 17: 1055–1056
Lengemann FW. Metabolism of radioiodide by lactating goats given I-131 for extended periods. J Dairy Sci 1970; 53: 165–170
Hedrick WR, et al. Radiation dosimetry from breast milk excretion of radioiodine and pertechnetate. J Nucl Med 1986; 27: 1569–1571
Rubow S, Klopper J. Excretion of radioiodine in human milk following a therapeutic dose of I-131. Eur J Nucl Med 1988; 18: 632–633
Mattson S, Johansson L, Nosslin B, et al. Excretion of radionuclides in human breast milk following administration of 125I-fibrinogen, 99mTc-MAA and 51Cr-EDTA. Third International Radiopharmaceutical Dosimetry Symposium. Rockville: US Department of Health and Human Services; 1981: 102–110
Blue PW, Dydek GJ. Excretion of radioiodine in breast milk (letter). J Nucl Med 1989; 30: 127–128
Author information
Authors and Affiliations
Additional information
Correspondence to: S. Rubow
Rights and permissions
About this article
Cite this article
Rubow, S., Klopper, J., Wasserman, H. et al. The excretion of radiopharmaceuticals in human breast milk: additional data and dosimetry. Eur J Nucl Med 21, 144–153 (1994). https://doi.org/10.1007/BF00175762
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF00175762