Breast milk excretion of radiopharmaceuticals: mechanisms, findings, and radiation dosimetry.

The excretion of radiopharmaceuticals in breast milk is studied to understand excretion mechanisms and to determine recommended breast feeding interruption times for many compounds based on the radiation absorbed dose estimated. A literature review is summarized, providing information on breast milk excretion of many radiopharmaceuticals, including the observed fractions of administered activity excreted and the disappearance half-times. Radiation doses to the infant and to the mother's breasts have been calculated using mathematical models of the activity clearance into milk, with interruption schedules for the nursing infant derived using a dose criteria of 1 mSv effective dose to the infant. In only 9 of the 25 radiopharmaceuticals considered here is interruption in breast feeding thought necessary. However, in the literature, breast milk concentrations of radiopharmaceuticals and half-times varied considerably between subjects, and individual measurements are encouraged to raise confidence in specific cases. The absorbed dose to the mother's breast approaches 10-20 mGy (1-2 rad) for a few nuclides, but most doses are quite low. Therapeutic administration of 131I-NaI is a special case, for which the breast dose for a 5550 MBq (150 mCi) administration could approach 2 Gy (200 rad). In this article, these data are discussed, with the aim of assisting others in evaluating the significance of administration of radiopharmaceuticals to lactating women. An example of a sampling scheme and calculation to determine dose for a specific patient is also developed.