Prostate Cancer Brachytherapy: Radiation Protection Issues

Abstract

The main concern in radiation protection in prostate cancer brachytherapy should be first to avoid accidents.Analysis of past accidents and incidents has shown that the risks appear to be higher when working with HDR sources. It has been stressed that in case of a problem with an HDR source (the most common being sticking of the source somewhere in the drive mechanism or disconnection of the source from the cable), corrective actions have to take place in the first few minutes following the event. This will only be possible with well trained and practiced staff, able to react rapidly, with a precise definition of responsibilities and a specific quality assurance program. LDR sources appear to pose less frequent problems, however a number of radioprotection issues has to be considered, in particular the dose received by people approaching the implanted patients, the problems linked to expelled sources, and the cremation of the dead body in the period following the implantation. Three successive recommendations of the International Commission for Radiological Protection -ICRP- focused on those issues: the ICRP 86 document, published in 2000, was dealing with the prevention of accidents in radiotherapy. The more specific ICRP 97 document, released in 2005, concentrated on the risk linked to the High Dose Rate (HDR) procedures, while the ICRP 98, also released in 2005, addressed the radioprotection issues for Low Dose Rate (LDR) prostate brachytherapy. The main conclusion of those documents, as well as of recent complementary studies, is that adherence to clear regulations, as well as adequate quality assurance programs, should significantly reduce the probability of most accidents, and make prostate brachytherapy a particularly safe procedure.