Recommended citation
ICRP, 2021. Occupational radiological protection in brachytherapy. ICRP Publication 149. Ann. ICRP 50(3).

Authors on behalf of ICRP
L.T. Dauer, C. Baureus Koch, J.M. Cosset, M. Doruff, A. Damato, F. Guedea, P. Scalliet, B. Thomadsen, L. Pinillos-Ashton, W. Small

Abstract - Brachytherapy procedures account for an important share of occupational radiation exposure in medicine for some facilities. Additionally, workers (staff) in brachytherapy treatment facilities can receive high radiation doses if radiological protection tools are not used properly. The Commission has provided recommendations for aspects of radiological protection during brachytherapy in Publications 97 and 98 (ICRP, 2005a,b), and for training in radiological protection associated with diagnostic and interventional procedures in Publication 113 (ICRP, 2009). This publication is focused specifically on occupational exposure during brachytherapy, and brings together information relevant to brachytherapy and occupational safety from the Commissions published documents. The material and recommendations in the current publication have been updated to reflect the most recent recommendations of the Commission. While external beam radiation therapy results in minimal (or no) occupational doses with an appropriately shielded facility, brachytherapy uniquely presents the possibility for doses received by staff that require active management. In modern brachytherapy centres, radiation doses are incurred by staff (e.g. loading of seeds, plaques, caesium implants, associated fluoroscopy). There is also wide variation in the practice of brachytherapy on a global scale, and several facilities still practice older techniques with significantly higher staff dose potential (e.g. use of 226Ra, 192Ir wires). In addition, technological developments and newer techniques present new protection concerns for staff that need to be addressed with specific recommendations for the practising medical community. This publication includes discussions of the biological effects of radiation, principles of radiological protection, protection of staff during brachytherapy procedures, radiological protection training, and establishment of a quality assurance programme. Specific recommendations include training, monitoring, and robust quality assurance programmes.