EMERGENCY IN HDR BRACHYTHERAPY

1. EMERGENCY IN HDR
BRACHYTHERAPY
- DR. MONIK PATEL
Resident, MD RADIATION ONCOLOGY
GCRI , Ahmedabad .

2.  The following emergency procedures are presented in HDR
Brachytherapy:
 1.Improper Source Retraction
 2. Electrical Power Loss
 3. Applicator Dislodging
 4. Timer Failure

3.  Appropriate emergency equipment must be available at all
times.for example,…
 Two pairs of long-handled forceps,
 shielded container,
 heavy-duty cable cutters
 pair of long-handled scissors,
 portable survey meter
 stop watch or timer

4. 1.Improper Source Retraction
If the room monitor or afterloader console indicates that the active
source wire has failed to retract, proceed as follows:
 Enter the room with a portable survey meter and observe the
emergency hand wheel.
 If the hand wheel is not turning, and radiation is present, turn
the wheel clockwise through eight revolutions, or until the
independent radiation monitor no longer detects radiation.
 If radiation is still detected, proceed to procedure (B).
 If the hand wheel is turning, and radiation is present, proceed
to procedure (B).

5.  Remove all applicators/catheters from the patient without
disconnection at any point and place them in the shielded
container.
 The removal of applicators/catheters is accomplished by
cutting any external sutures, physically removing the entire
applicator/catheter apparatus, and placing it in the shielded
container provided.
 Surgical tools for removal of the sutures are located in the
HDR treatment room.

6.  In all cases, remove the patient from the immediate area, survey
the patient, and if it is safe to do so, evacuate the patient from
the room and lock the room.
 Post a warning sign: “This room must remain locked. HDR source
exposed. Do not enter.”
 Notify all emergency contacts listed here (e.g., radiation safety
officer, vendor).
 Estimate and record the additional dose to the patient.
 Also estimate and record any exposure to hospital staff.

7. 2. Electrical Power Loss
 In case of power loss during treatment, the afterloader unit
has an uninterrupted power supply (UPS) that enables all
systems to continue operation for up to 30 minutes.
 This will enable completion of any HDR treatment in progress
at the time of alternating current (AC) power failure.

8.  If both AC power and the UPS system fail to operate, the HDR
afterloader unit is equipped with an emergency backup
source retract battery that will automatically retract the source
into the storage position and, if a patient is being treated, will
record the date and time at which the patient treatment is
interrupted.
 If the AC power, UPS, and emergency backup source retract
battery all fail at the same time, the operator must follow the
emergency manual source retraction procedure.

9. 3. Applicator Dislodging
 In the event that the applicator dislodges from the patient
during an HDR treatment, or a source guide tube becomes
dislodged, the following emergency steps must be taken:
 Activate the HDR emergency off button at the control console.
 If the source fails to retract, follow emergency manual source
retraction procedure.
 Immediately notify individuals on the emergency call list
posted at the HDR console.

10. 4. Timer Failure
 In the event that the HDR treatment timer fails to operate or
terminate the treatment, the following steps must be taken:
 Activate the HDR emergency off button at the control console.
 Stop the manual timer at the time the emergency off button
retracts source (this manual timer is started at the beginning of
every HDR treatment).
 If this emergency off button fails to retract the source, follow the
emergency manual source retraction procedure.
 Immediately call persons on the emergency call list posted at the
HDR console.

11. Thank you