[Emergency rescue in accidents with HDR afterloading units]. 1999

T W Kaulich, and G Becker, and U Lamprecht, and F Nüsslin, and M Bamberg
Abteilung für Medizinische Physik, Radiologischen Universitätsklinik Tübingen. theodor.kaulich@med.uni-tuebingen.de

OBJECTIVE HDR brachyradiotherapy has minimized the exposure to radiation of the personnel working in this field. Nonetheless there are periodically reported troubles with afterloading units concerning the retraction of sources that require immediate action for the limitation of possible damage. LEGAL PRINCIPLES ACCORDING TO THE GERMAN REGULATION CONCERNING PROTECTION AGAINST RADIATION (STRAHLENSCHUTZVERORDNUNG = STRLSCHV): If in afterloading brachyradiotherapy the radiation source remains extended through malfunction we deal with an emergency according to the StrlSchV. The rescue personnel should be chosen in accordance with section 50 StrlSchV (Table 1). The quickest possible rescue of a patient in an emergency demands an unequivocal definition of responsibilities. Our recommendations in this instance: the physicist is responsible for the organization of the emergency rescue. The radiation oncologist in charge informs himself about the necessary emergency measures before starting the treatment and carries out the emergency rescue. If the physicist diagnoses a failure in the retraction of the source he tries to remove the failure. If he doesn't succeed in retracting the source the radiation oncologist carries out the rescue of the patient. The organizational structure of the clinic allowing, the emergency physician should invariably be the physician who placed the applicator. In the emergency rescue the radiation oncologist should be protected by a lead barrier (Figure 1, Table 2) and use manipulators (Figure 1). The radiation exposure of the rescue personnel is calculated from the photon-equivalence dose HX with the help of the dose-rate constant of 192Ir (Table 3). According to the same procedure there can be evaluated the local radiation exposure of the patient concerned (Table 3). CONCLUSIONS Generally speaking, all considerations regarding the topic of emergency rescue should always start out from a worst-case scenario. Of all the people involved the patient is the one who is most exposed if the radiation source is located inside his or her body. If an emergency rescue is necessary the radiation exposure of patient and personnel can only be minimized by a quick rescue. This end requires a properly equipped emergency workplace, good training of all the people concerned, and regular exercises of the rescue procedures. A well-practiced emergency management can be of life-saving importance for the patient.

UI MeSH Term Description Entries
D010348 Patient Care Team Care of patients by a multidisciplinary team usually organized under the leadership of a physician; each member of the team has specific responsibilities and the whole team contributes to the care of the patient. Health Care Team,Interdisciplinary Health Team,Medical Care Team,Multidisciplinary Care Team,Multidisciplinary Health Team,Healthcare Team,Care Team, Health,Care Team, Medical,Care Team, Multidisciplinary,Care Team, Patient,Care Teams, Health,Care Teams, Patient,Health Care Teams,Health Team, Interdisciplinary,Health Team, Multidisciplinary,Healthcare Teams,Interdisciplinary Health Teams,Medical Care Teams,Multidisciplinary Care Teams,Multidisciplinary Health Teams,Patient Care Teams,Team, Health Care,Team, Healthcare,Team, Interdisciplinary Health,Team, Medical Care,Team, Multidisciplinary Care,Team, Multidisciplinary Health,Team, Patient Care,Teams, Interdisciplinary Health
D011835 Radiation Protection Methods and practices adopted to protect against RADIATION. Protection, Radiation
D011836 Radiation Tolerance The ability of some cells or tissues to survive lethal doses of IONIZING RADIATION. Tolerance depends on the species, cell type, and physical and chemical variables, including RADIATION-PROTECTIVE AGENTS and RADIATION-SENSITIZING AGENTS. Radiation Sensitivity,Radiosensitivity,Sensitivity, Radiation,Tolerance, Radiation,Radiation Sensitivities,Radiation Tolerances,Radiosensitivities,Sensitivities, Radiation,Tolerances, Radiation
D012066 Relief Work Assistance, such as money, food, or shelter, given to the needy, aged, or victims of disaster. It is usually granted on a temporary basis. (From The American Heritage Dictionary, 2d college ed) Humanitarian Assistance,Assistance, Humanitarian,Assistances, Humanitarian,Humanitarian Assistances,Relief Works,Work, Relief,Works, Relief
D001918 Brachytherapy A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. Curietherapy,Implant Radiotherapy,Plaque Therapy, Radioisotope,Radioisotope Brachytherapy,Radiotherapy, Interstitial,Radiotherapy, Intracavity,Radiotherapy, Surface,Brachytherapy, Radioisotope,Interstitial Radiotherapy,Intracavity Radiotherapy,Radioisotope Plaque Therapy,Radiotherapy, Implant,Surface Radiotherapy,Therapy, Radioisotope Plaque
D004307 Dose-Response Relationship, Radiation The relationship between the dose of administered radiation and the response of the organism or tissue to the radiation. Dose Response Relationship, Radiation,Dose-Response Relationships, Radiation,Radiation Dose-Response Relationship,Radiation Dose-Response Relationships,Relationship, Radiation Dose-Response,Relationships, Radiation Dose-Response
D004630 Emergencies Situations or conditions requiring immediate intervention to avoid serious adverse results. Emergency
D004868 Equipment Failure Failure of equipment to perform to standard. The failure may be due to defects or improper use. Defects, Equipment,Device Failure,Failure, Equipment,Malfunction, Equipment,Medical Device Failure,Misuse, Equipment,Device Failure, Medical,Device Failures, Medical,Failure, Medical Device,Failures, Medical Device,Defect, Equipment,Device Failures,Equipment Defect,Equipment Defects,Equipment Failures,Equipment Malfunction,Equipment Malfunctions,Equipment Misuse,Equipment Misuses,Failure, Device,Failures, Device,Failures, Equipment,Malfunctions, Equipment,Misuses, Equipment
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D018788 Radioactive Hazard Release Uncontrolled release of radioactive material from its containment. This either threatens to, or does, cause exposure to a radioactive hazard. Such an incident may occur accidentally or deliberately. Accidents, Nuclear,Accidents, Nuclear Reactor,Accidents, Radiation,Nuclear Accidents,Nuclear Reactor Accidents,Radiation Accidents,Accident, Radiation,Radiation Accident,Accident, Nuclear,Accident, Nuclear Reactor,Hazard Release, Radioactive,Hazard Releases, Radioactive,Nuclear Accident,Nuclear Reactor Accident,Radioactive Hazard Releases,Reactor Accident, Nuclear,Reactor Accidents, Nuclear,Release, Radioactive Hazard,Releases, Radioactive Hazard

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