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 Commission’s 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.
© 2021 ICRP. Published by SAGE.
Keywords: Occupational radiological protection; Interventional procedures; Exposure monitoring.
Key Points
Brachytherapy treatment utilises sources of exposure that can contribute significantly to occupational, patient, and public exposure, and can result in tissue reactions (deterministic effects) if radiological protection is not implemented properly.
The protection of patients undergoing brachytherapy treatments, including associated imaging guidance during brachytherapy (e.g. computed tomography examinations and fluoroscopy), should be optimised consistent with achieving the desired clinical outcome. Dose reduction techniques should be used whenever applicable to optimise occupational and public exposure.
Staff in charge of occupational protection need knowledge of general radiological protection, but also need to be familiar with the clinical practice of brachytherapy. Likewise, individuals who perform brachytherapy should be familiar with common methods to reduce the dose to patients and staff. Staff must have the appropriate education, training, and certifications.
Staff in charge of occupational protection and individuals who perform brachytherapy have responsibilities to family members, carers, and the public to answer questions and help them to understand their radiological protection.
Proper use of personal monitoring is necessary in brachytherapy facilities in order to assess occupational radiation exposures. It is essential that professionals wear dosimeters correctly. The dose to an individual cannot be reasonably estimated in highly variable radiation fields without using appropriate types of individual monitoring, including extremity dosimetry, at all times of exposure.
High-quality dose management and quality assurance programmes are critical in establishing safe practice for brachytherapy procedures. A qualified medical physicist should be accessible to all staff, and detailed emergency response procedures, roles and responsibilities, and quality assurance programmes should be available for immediate implementation. Sharing information and experience on events, both within the facility and in the broader medical community, is important to continually improve protection.
Executive Summary: Not included in this publication
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 Commission’s 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.
© 2021 ICRP. Published by SAGE.
Keywords: Occupational radiological protection; Interventional procedures; Exposure monitoring.
Key Points
Brachytherapy treatment utilises sources of exposure that can contribute significantly to occupational, patient, and public exposure, and can result in tissue reactions (deterministic effects) if radiological protection is not implemented properly.
The protection of patients undergoing brachytherapy treatments, including associated imaging guidance during brachytherapy (e.g. computed tomography examinations and fluoroscopy), should be optimised consistent with achieving the desired clinical outcome. Dose reduction techniques should be used whenever applicable to optimise occupational and public exposure.
Staff in charge of occupational protection need knowledge of general radiological protection, but also need to be familiar with the clinical practice of brachytherapy. Likewise, individuals who perform brachytherapy should be familiar with common methods to reduce the dose to patients and staff. Staff must have the appropriate education, training, and certifications.
Staff in charge of occupational protection and individuals who perform brachytherapy have responsibilities to family members, carers, and the public to answer questions and help them to understand their radiological protection.
Proper use of personal monitoring is necessary in brachytherapy facilities in order to assess occupational radiation exposures. It is essential that professionals wear dosimeters correctly. The dose to an individual cannot be reasonably estimated in highly variable radiation fields without using appropriate types of individual monitoring, including extremity dosimetry, at all times of exposure.
High-quality dose management and quality assurance programmes are critical in establishing safe practice for brachytherapy procedures. A qualified medical physicist should be accessible to all staff, and detailed emergency response procedures, roles and responsibilities, and quality assurance programmes should be available for immediate implementation. Sharing information and experience on events, both within the facility and in the broader medical community, is important to continually improve protection.
Executive Summary: Not included in this publication
