Country Management approach Notes Direct discharge Wastewater treatment France   ✔ Effluents eliminated by patients in protected rooms (iodine dose > 740 MBq) are normally collected via bi–sectional toilets. Effluents from ordinary sanitary installations in the nuclear medicine unit are usually linked to a septic tank. Due to the length of time the material stays in the septic tank. The volume activity of the radionuclides in the collector is thus greatly reduced before release into sewage network. Germany   ✔ All facilities are required to have holding tanks installed and discharges from facilities must remain below a limit of 5 Bq/l at the point of discharge into the public wastewater network. Northern Ireland   ✔ Decay storage is used, although it is not a regulatory requirement. Activity concentration limit is set at 80 kBq/l prior to discharge to sewer. Lithuania   ✔ Wastewater is retained in holding tanks for between 30 and 60 days prior to discharge to sewer. Two tanks are used, one being filled as the other is left to decay prior to discharge. Luxemburg   ✔ All new treatment facilities are required to install holding tanks, with patient excreta being held for a minimum of 210 days prior to discharge. Activity concentrations of 131I in discharges from the holding tanks to sewer should remain below 5 Bq/l. The Netherlands   ✔ Radioactive waste with radionuclides with half- lives below 100 days should be stored for up to 2 years to allow for decay. No specific mention is made or requirements for patient excreta.

Table 1: List of countries that stipulate the installation of a wastewater treatment plant for patient excreta [Punt 2010].