Effectiveness of a Standardized Intracavitary HDR Brachytherapy Emergency Training Protocol

Abstract

The US NRC requires annual training for high dose rate (HDR) brachytherapy emergencies for authorized users. Previous training at our institution involved verbal instruction by the afterloader vendor, followed by a brief hands-on skills session. Based on perceived knowledge gaps and uncertainty in how to respond to HDR “stuck source” emergencies by staff, we developed and evaluated a new HDR emergency training protocol (HDR-ETP). Standardized HDR “stuck source” emergency procedures were developed based on recommendations from the afterloader vendor, modified to reflect clinical practicalities. Detailed action lists for three different HDR staff were developed. An HDR-ETP was then created, consisting of an instructional video, demonstrating use of emergency procedures for various scenarios, and a hands-on HDR emergency simulation. Protocol training commenced with HDR staff watching the short instructional video. Then, a hands-on HDR emergency drill was completed in a team setting, consisting of a physician, a physicist and a radiation therapist. Trained observers evaluated staff on their performance during the simulation and gave direct feedback to each participant. Both before and after completing the HDR-ETP, staff completed a survey to evaluate their knowledge of HDR emergency procedures (using multiple choice questions) and assess their comfort level performing these tasks (using a 5 point Likert scale). A total of 18 staff members participated in the new HDR-ETP. Prior to initiation of training, 22% of participants strongly agreed with the statements “I am familiar with the procedures to follow during an HDR emergency” and “I feel confident in performing my role during an HDR emergency”. After training, 93% and 87% of participants strongly agreed with the above statements, respectively. The average score for knowledge-based questions was 83% (range 60-100%) prior to training. After training, the average score improved to 90% (range 80-100%). Despite high pre-test scores, 44% (8/18) participants made one or more errors during the hands-on simulation. Simulation errors included failure to engage source-retract interlocks, failure to perform a survey for radioactivity at the end of the simulation and general process errors. After training completion, all participants either somewhat or strongly agreed to the statements “I found the video training useful” and “I found the hands-on practice useful”. A standardized HDR-ETP was developed that included an instructional video and a hands-on drill for brachytherapy staff. Our HDR-ETP resulted in improved familiarity and confidence with emergency procedures. Despite good pre-test knowledge and the instructional video, multiple participants made errors during the hands-on simulation, highlighting the necessity of simulated emergency events.