3 Radiation Protection in Brachytherapy

Radiation Protection in Brachytherapy

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THE GEC ESTRO HANDBOOK OF BRACHYTHERAPY | Part I: The basics of Brachytherapy Version 1 - 01/12/2014

The radiation protection program should clearly document and specify the medical staff members or the groups of medical staff members who are permitted to be involved in brachytherapy procedures and their respective responsibilities in the proce- dures. Adequate training should be provided and documented. A typical medical team for a brachytherapy program consists of radiation oncologists, medical physicists, dosimetrists, radiation therapists, nurses and radiation safety officers. It is critical to es- tablish the rule that only qualified radiation oncologists, medical physicists, and radiation safety officers are allowed to conduct brachytherapy procedures. All of the team members should receive adequate training in the brachytherapy procedures to be implemented before being au- thorized to perform the procedures. The training should cover not only the operation of brachytherapy systems, but also radia- tion safety and protection, including the principles, regulations, safety features of brachytherapy delivery machines and treat- ment room, radiation surveys, radiation monitoring, records, reports, and emergency procedures and measures. The training should be provided to new staff members and periodically to current staff members. The radiation protection program should establish policies for radiation surveys to protect medical staff members, patients and general public and to be compliant with government regulations. Radiation surveys should be conducted after receiving and be- fore shipping out radioactive sources, before and after patient treatments, and periodically on brachytherapy units and radio- active sources in stock. The survey results should be documented for future reference. The radiation protection program should also establish poli- cies for radiation monitoring. Individual radiation monitoring devices should be provided to the medical staff members who are involved in brachytherapy procedures and to the individuals who may potentially receive radiation doses higher than the set limits. Solid security systems should be put in place for brachytherapy units and hot labs where radioactive materials are stored. Ap- propriate radiation warning signs should be placed to prevent accidental entries. Emergency procedures should be established for each individu- al brachytherapy procedure. The emergency procedures should be distributed and taught to each of the brachytherapy team members before the start of the program. The procedures should also be posted in areas where the brachytherapy treatments are conducted. Periodical training should be provided to the team members. The radiation protection program should establish policies for radiation related accidents or errors. The policies should be compliant with respective government regulations and provide guidelines for procedures after accidents, including patient care and instructions, reporting channels and steps, and corrective actions. A comprehensive quality assurance (QA) program should be set up and strictly enforced for brachytherapy programs. As clear- ly stated in the Code of practice for brachytherapy physics (30) “the goal of the brachytherapy quality assurance program is to maximize the likelihood that each individual treatment is ad-

ministered consistently, that it accurately realizes the radiation oncologist’s clinical intent, and that it is executed with regard to safety of the patient and others who may be exposed to radiation during the course of treatment.” A well designed and execut- ed QA program not only safeguards the quality of patient care but also protects patients, medical staff and the general public from unnecessary radiation exposures and minimizes radiation accidents. A typical brachytherapy QA program should address processes of radioactive source handling and assays, applica- tor preparation and insertion, treatment design and planning, treatment delivery, and post-treatment evaluation and patient instructions. On the other hand, since different brachytherapy procedures usually require different types of devices and consist of different components, a QA program should be specifically designed for each brachytherapy procedure, based on its features and work flow, characteristics of the equipment and radioactive sources, and specific concerns about radiation safety and pro- tection. Records of the radiation protection program should be system- atically maintained and be compliant with relevant national reg- ulations. The records should include the provisions and policies of the radiation protection program, written directives, radiation surveys, radioactive source logging information, and records of individual radiation monitoring results, occupational radiation doses, brachytherapy procedures, brachytherapy equipment, staff credentials and training certificates, and dose to individual members of the general public. Radiation related accidents and incidents, including medical events and loss and theft of radioactive sources, should be re- ported directly to the institutional authority and government agencies that are authorized to regulate the radioactive sources and brachytherapy programs. The reporting process should be in compliance with the government regulations and should be clearly documented in the provisions of the radiation protection program. Instructions and training should be provided to staff members about the reporting process. Reports of other radiation related records and results should also be conducted following the institutional rules and government regulations. A relatively new issue in radioprotection is the obligation to pre- vent malicious use of radioactive material. This is discussed in the IAEA nuclear security series No. 11 report “Security of ra- dioactive sources: implementing guide” (14). This report offers guidance for implementing security measures for different class- es of radioactive sources. It includes guidance and recommend- ed measures for the prevention of, detection of, and response to malicious acts involving radioactive sources. This guide rec- ommends that security measures be applied on a graded basis, taking into account the current evaluation of the threat, the rela- tive attractiveness of the source, and the potential consequences resulting from malicious use. The requisite level of security is achieved through a combination of deterrence, detection, delay, response and security management. The report applies to radi- oactive sources that may pose a significant risk to individuals, society, and the environment, i.e. sources that are categorized as classes 1–3 (on a scale of 1-5). The source categorization used in the report is based on the concept of ‘dangerous sources’, which is dealt with in more detail in another IAEA publication: “Catego- rization of Radioactive Sources” (10). According to this report, the sources widely used in brachytherapy afterloaders providing medium and high dose rate treatment fall into category 2. As with other IAEA recommendations, states will translate these