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Staff Exposure During a HDR Endobronchial Brachytherapy Stuck Source Event Requiring Surgical Extraction: A Full Scale Simulation

N Octave*, M Goulet, P Duguay-drouin, M Lagace, A Dagnault, CISSS - Chaudiere-Appalaches, Levis, QCCA,


(Sunday, 7/12/2020)   [Eastern Time (GMT-4)]

Room: AAPM ePoster Library

Purpose: A stuck source inside the patient represents a major emergency in HDR brachytherapy. Canadian nuclear safety regulations ask that a Radiation Protection Training Program (RPTP) provides all stakeholders with safety training in regards of their tasks. Our aim was to simulate an emergency source extraction procedure and assess all staff resulting exposure.

Methods: Teams were recorded in an emergency setting during a simulated endobronchial HDR treatment. The event was gradually escalated in severity with the corresponding personnel until a surgical source extraction was simulated by an emergency surgery team. Operators’ locations and exposure durations were extracted from video recording to: 1) measure exposure rates at those locations and 2) estimate total exposure duration for each staff member. Level of preparedness was surveyed at the end of exercise.

Results: 9 staff members including professionals from outside radiation oncology were involved. The total estimated time from source emergency inception to extraction is evaluated at 2.5h to 3h, mainly due to patient’s preparation for lung surgery, including anesthesia and positioning in lateral decubitus (up to 60 min), and surgery (60 min). Doses estimates range from 0.2mSv for the least exposed (radiation technologist) to 102.4mSv for the most exposed staff members (surgeon and assistant). All staff members agreed on the need for simulated exercises in treating conditions to increase level of confidence in emergency response, and have better understanding of each others’ tasks.

Conclusion: Dose estimates for staff were obtained for an emergency lung HDR simulation. This exercise is now included annually in the RPTP, with the prerogative that each simulation should be specifically adapted to the site treated. Effective dose estimates recorded were all below the recommended CSNC limit of 500mSv. While designing training and in light of those results, further questions implying ethics and the ALARA principle remain under investigation.


Brachytherapy, Health Physics, Radiation Protection


TH- Brachytherapy: HDR Brachytherapy

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