Re: EVACUATION OF BRACHYTHERAPY PATIENTS

[Ccja@aol.com]

I say yes, teach the nursing staff how to remove the tandem (and ovoids), and
have them do it before the patient leaves the room. This can be done in less
than two minutes. I presume that you keep a mobile, or portable, pig in the
room while the patient is loaded, to which the source carriers should be
transferred. If a survey meter were also left in the room, they could verify
that no sources had been left in the patient,or, more likely dropped in the
bed linens (out of the ovoid carriers). This could be important, because if
they're really in a hurry, they might simply use the sheets as a sling,
forgoing a transfer to a gurney. They should be encouraged to note the time,
although that datum should be relatively easy to estimate, with the requisite
accuracy, after the fact.

Saving lives always takes precedence, so there could be a level of emergency
such that no delay, however brief, could be brooked. The unit commander for
disasters should be trained to make that judgement call. This eventuality is
a good reason to have a stringed tag on the patient's bed, with the type and
location of implant, number of sources, activity of nuclide, and doserate at
a meter. The tag can go with the patient, around her wrist.

If the sources stay in the room, preferably in a strong, shielded container,
control of them, and of the radiation exposure of other people, becomes one
less thing to worry about. You would have your hands full of sick patients.
Since there could be implants for which this would not be an option, e.g., Ir
strands or wires in tongue, breast, or lung, if anyone is still doing those
kinds of radiotherapies, it would seem to be wise to seize the opportunity
this case would offer.

I think that the nurses should know how to insert and remove the carriers,
and what the components of the applicators are (especially the sources) as a
matter of course, firstly as a part of basic orientation, and secondly, so
they know what to do, should a cap come off, or, worse, a carrier slide out
of its tube.

chris alston
ccja@aol.com