A radioactive corpse that contaminated an Arizona crematorium is leading to concerns about how to handle the bodies of cancer patients who have had radiation treatment.

A research letter published in the Journal of the American Medical Association this week describes the 2017 case of a 69-year-old cancer patient who had undergone an outpatient infusion radiation treatment at the Mayo Clinic in Arizona.

With more Americans choosing cremation, and an increasing number of patients getting treated with pharmaceuticals that contain radiation, more attention to the issue is needed, one of the research letter's authors from the Mayo Clinic in Arizona told The Arizona Republic.

"It's not the second coming of Chernobyl or Fukushima, but it's unwanted, unnecessary radiation," said Kevin Nelson, a medical health physicist who is the radiation safety officer at Mayo Clinic in Arizona.

"I don't think the risk from inadvertently cremating a body that might contain small levels of radiation is large. I think the risk is small," he continued. "But what we're trying to do is reduce even those small levels of exposure as much as we possibly can. I think we have an onus in the community to try to do that."

No Arizona regulations on cremating bodies of radiation-exposed patients

The research letter's authors say the case shows that further studies are needed to figure out possible health impacts of radiation contamination on crematorium operators, as well as how often contamination is happening.

Regulations for cremation of exposed patients vary by state — there are no regulations in Arizona, nor are there any at the federal level, the researchers found.

"Radiopharmaceuticals present a unique and often overlooked postmortem safety challenge," the research letter says. "Cremating an exposed patient volatilizes 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."

Nelson said he hopes the case helps make the medical community, funeral homes and crematoriums become more aware of the risks.

The patient, who had a neuroendocrine tumor on his pancreas, died at a different hospital two days later after his treatment with drug the lutetium Lu 177 dotatate. He was cremated five days after his radiation treatment.

When Nelson and the patient's Mayo physicians became aware of his death approximately three-and-a-half weeks later, the crematorium was notified, as was the state's Bureau of Radiation Control.

A state survey found radiation contamination in the crematorium

A state survey of the facility turned up radiation contamination in the crematorium oven, vacuum filter and bone crusher. The contamination levels were very low, Nelson said, but nonetheless radioactive and identified as lutetium Lu 177 dotatate, matching the radiation drug that was used to treat the patient.

"We have radiation detection equipment that can actually tell us what the isotope is that's causing the elevated levels of radiation that we're detecting," Nelson said.

While there was no lutetium Lu 177 dotatate detected in the crematorium operator's urine, a different radiation isotope — technetium Tc 99m — was detected in his urine.

That discovery in particular got Nelson's interest, as he suspects the technetium Tc 99m was from another cremated patient.

The operator had never received technetium Tc 99m as part of any medical procedure, and it wasn't from the patient who received the lutetium Lu 177 dotatate, Nelson said.

"The question that this raises is how frequently is this occurring?" said Nelson, who has worked in radiation safety for 40 years. "When we look at exposure to members of the general public who don't know they are being exposed, that's another level of concern."

In Florida, radiation patients have organs removed before cremation

Exposure to even low levels of radiation can add up over time if it's prolonged, Nelson said.

Nelson worked at the Mayo Clinic in Florida, which prohibits any material other than human remains from being cremated.

Patients who die in Florida after receiving radiation therapy must either have their organs removed before they are cremated, or their bodies have to be stored until the radioactive material has decayed and is no longer radioactive.

"You can imagine the discussion you have to have with the family. Those are tough conversations," he said. "Because the family wants to move on, because they want to make funeral arrangements, oftentimes in the state of Florida it's easier to remove the organs that contain the radioactivity."

The research letter has received national and international attention.

"Just this morning I was in contact with the funeral home director where this occurred and in his industry this is getting a lot of notoriety," Nelson said. "We want that discussion to happen. That was partially the reason we published this."

Reach the reporter at stephanie.innes@gannett.com or follow her on Twitter: @stephanieinnes.