Radioactivity in breast milk following 111In-octreotide

The concentration of 111In in breast milk in a 10 weeks postpartum woman was measured at daily intervals up to 72 h post-injection of 5.3 mCi (196 MBq) of 111In-octreotide (OctreoScan). Radiation surveys were also performed at the breast surface. The disappearance of 111In from the breast milk exhibited a bi-exponential pattern with a maximum concentration of 14.2 nCi (0.54 kBq) per 125 ml feeding at 4 h, with lower values thereafter. External surveys at the breast surface also showed a bi-exponential decrease with time. The maximum reading was 8.3 mrem x h(-1) (0.83 mSv x h(-1)) immediately after administration. This rapidly decreased due to 85% urinary excretion by 24 h. Breast milk tracer content and external surveys at the breast surface were determined at 3 h intervals for up to 10 days. If a newborn is nursed for the first 10 days, the internal and external dose equivalents would be 22.97 mrem (0.23 mSv) and 27.86 mrem (0.28 mSv), respectively, for a total of 50.83 mrem (0.5 mSv). The patient was instructed to resume breast-feeding on day 10, when the newborn received a total dose equivalent of 1.55 mrem (0.016 mSv). This dosimetry is based on a very conservative assumption, whereby 100% of the ingested 111In becomes systemic and follows adult bio-behaviour. Oral indium has been shown to be poorly absorbed from the gastrointestinal tract (approximately 0.15%), which suggests the infant's dose could be considerably less. Based on this case report, mathematical relationships are presented for determining the nursing infant's dose equivalent from internal and external exposures relative to time after the maternal administration of 111In-octreotide (OctreoScan).