Radiation protection issues for the introduction of intraoperative radiotherapy (IORT), using Intrabeam®, into surgical theatres

Abstract

A large Irish non-radiotherapy academic teaching hospital has introduced intraoperative radiotherapy (IORT) into its operating theatres for the treatment of breast cancer patients. Immediately following a surgical lumpectomy procedure, the tumour bed in a selection of patients is treated with 50 kVp X-rays. This reduces the outpatient attendance times by eliminating the need for further post-surgical radiotherapy or “boost” doses. The surgery is carried out by the non-radiotherapy hospital staff in their theatres and the radiotherapy treatment is then delivered by staff from the co-located radiotherapy hospital, using an Intrabeam® 50 kVp X-ray device. The surgeon selects an appropriate sized spherical applicator to attach to the X-ray source probe, which is inserted into the surgical area to provide a radially symmetric radiation dose to the tumour bed. Staff from the radiotherapy hospital operate the Intrabeam® to validate, deliver and verify the dose to the patient in accordance with their therapy protocols. The roll out of this service involved the collaboration of a large multi-disciplinary group comprising of over 35 staff from two separate national service providers. The environmental radiation doses in the theatre during treatment will be presented. Provided certain measures are taken, staff doses can be kept below those typically encountered during operation of a mobile C-arm for interventional procedures. The presentation will also highlight the unique staff radiation protection physics, governance and licensing issues around the joint delivery of the first intraoperative radiotherapy for breast cancer treatment in Ireland.