In 2017, a 69-year-old man with pancreatic cancer went to hospital with abnormally low blood pressure. Sadly, he died only two days later, and his remains were cremated.

What nobody at the hospital or the crematorium knew, was that this hadn’t been the man’s only recent trip to hospital. ust one day earlier, in fact, he had been injected with a radioactive compound at another hospital to treat his tumour – and when his mortal remains were incinerated, this radioactive and potentially dangerous dose of lutetium Lu 177 dotatate was still inside his body.

This alarming case, reported in a research letter published in February this year, illustrates the collateral risks potentially posed by on average 18.6 million nuclear medicine procedures involving radiopharmaceuticals performed in the US every year.

While rules regulate how these drugs are administered to living patients, the picture can become less clear when those patients die, thanks to a patchwork of different laws and standards in each state – not to mention situations like the 69-year-old man, whose radioactive status simply slipped through the cracks.

“Radiopharmaceuticals present a unique and often overlooked postmortem safety challenge,” researchers from the Mayo Clinic explained in a case note.

“Cremating an exposed patient volatilises the radiopharmaceutical, which can then be inhaled by workers (or released into the adjacent community) and result in greater exposure than from a living patient.”……..

Given more than half of all Americans eventually get cremated, postmortem management of individuals who receive radioactive drugs is an area the US health system needs to work on, the researchers say.

This includes better ways of evaluating radioactivity in deceased patients (prior to them being cremated), and also standardising ways of notifying crematoriums about their clients.

After all, nobody really has any idea how often this is happening.

As nuclear scientist Marco Kaltofen from the Worcester Polytechnic Institute in Massachusetts, who wasn’t involved with the research, told BuzzFeed News: “They only happened to catch this one case because normally they don’t look.”

The findings were reported in JAMA. https://www.sciencealert.com/a-dead-man-was-cremated-in-arizona-without-anyone-knowing-he-was-radioactive