The Real Time Image Guided HDR Brachytherapy for Prostate Cancer. - - PowerPoint PPT Presentation

The Real Time Image Guided HDR Brachytherapy for Prostate Cancer. Treatment Delivery.

Clare Wilkinson. 5th November 2013

Clare.Wilkinson@leedsth.nhs.uk

Radiographers Responsibilities.

Ensure safety of:

• 1. Patient - Positive identification by Operator 1
• Aware of whole procedure and consented.
• 2. Radiographers - Local rules
• Daily QA
• Competent (operating unit/specific procedure)
• Contingency plan for procedure
• Attended source exchange/annual walk-through
• Team brief and time out.

Clare.Wilkinson@leedsth.nhs.uk

Radiographers Responsibilities.

• 3. Visitors - Local Rules for area
• Operating Department Practitioners (ODP), Agency Staff,

Anaesthetist aware of roles.

• 4. HDR Unit - Daily QA
• Faults/discrepancies reported

Clare.Wilkinson@leedsth.nhs.uk

HDR Treatment Room Set Up

• Shaded area where both HDR

unit, transfer tubes/applicators and patient must be positioned within this area.

• X- HDR Unit
• X- Emergency stops
• Access and maze kept clear
• Monitored via intercoms/CCTV

and slave anaesthetic monitor

x x x x

Clare.Wilkinson@leedsth.nhs.uk

Operator roles and Contingency Plans

The emergency procedure is a hierarchic sequence of actions in case the source fails to return to the safe position. Each Radiographer must be clear of their roles and responsibilities. Operator 1 role - identified the patient

• initiate the exposure
• responsible in emergency to activate interrupt/emergency

stops and enter the treatment room. Operator 2 role - assist as required by protocol

Clare.Wilkinson@leedsth.nhs.uk

Clare.Wilkinson@leedsth.nhs.uk

Operator 1 Operator 2

1.Warning system alert

• Source fails to return to safe
• 2. Operate interrupt on treatment console.
• Source fails to return to safe

3.Operate emergency stop button.

• Source fails to return to safe
• 4. Open treatment door, breaking interlock.
• Source fails to return to safe
• 5. Enter treatment room, operate emergency stop
• n treatment wall adjacent to machine unit.
• Source fails to return to safe
• 6. Retract source using gold mechanical crank.

Turn in direction of arrows until crank blocks.

• Source fails to return to safe
• 7. Remove applicators from patient as per

specific technique protocol.

• 8. If feasible use the long handled forceps and

wire cutters if necessary, place applicators in emergency lead container and close lid.

• 9. Move patient to maze and monitor using

Geiger Counter.

• (If radiation is detected the patient must be isolated

in treatment room, gain advice from physics/medics , locate sources and remove source/applicator into lead pot)

• 10. If no radiation detected on patient then move

patient out of room.

• 11. Close all doors and attach no-entry signs
• Reassure patient.

Immediately start stopwatch Assess channel and position source is in from TCS. Bleep Brachytherapy Duty Physicist. 80 4194 At maze entrance, switch Geiger Counter to speaker mode. Remain at maze entrance and assist Operator 1 as necessary. Stop stopwatch. Record time in HDR treatment log book. Temporally restrict patient/staff movement in corridor adjacent to treatment room. Assist as appropriate. Contact clinician if not present. Inform RPS if not present Report to head of department and RPA. Complete DATIX. Print copy of fault window from TCS. Inform Elekta.

Clare.Wilkinson@leedsth.nhs.uk

Emergency Removal of Interstitial Needles - Prostate

• Patient trolley to contain portable Oxygen and monitor.
• Uncouple transit tubes from indexer ring.
• Move trolley (patient) away from treatment unit.
• This should release drive cable and source.
• Anaesthetist to transfer patient to portable oxygen and monitor.
• Move patient to maze, monitor for radiation if none proceed to

recovery room.

Clare.Wilkinson@leedsth.nhs.uk

Treatment Delivery

• Pre treatment

Needle QA -checked independently

• Free length measured and recorded
• Tolerance
• Discrepancies

Transfer tube connection -Tube number and grid reference read by

• n radiographer, second connects
• Inferior left of patient
• Checked by first radiographer.

Clare.Wilkinson@leedsth.nhs.uk

Treatment Delivery

• Plan Imported
• Data checked by both radiographers independently.
• Crossed checked with prescription.
• Ensure both approved and prescribed and signed by clinician
• Planned checked and signed by physics
• Patient Id
• Plan name and plan Id
• Date, time and AKR of plan
• Prescribed D90
• Total dwell time
• Number of channels, dwell positions start/end and channel time

Clare.Wilkinson@leedsth.nhs.uk

Treatment

• Ensure Anaesthetist knows length of treatment
• Ensure all access is clear of obstructions
• All personnel removed from room
• Slave monitor and CCTV monitors are positioned correctly
• Patient monitored through out treatment
• Ensure Anaesthetist aware can interrupt treatment

Clare.Wilkinson@leedsth.nhs.uk

Radiotherapy Treatment Data Set (RTDS)

• April 2013 mandatory that brachy data is provided to

commissioners.

• Scheduling via Mosaiq as in main department no

interface with HDR Unit.

• Manually enter data in Mosaiq and recorded manually for

all brachytherapy treatments.

Clare.Wilkinson@leedsth.nhs.uk

Post Treatment

• Needle removal
• Radiographer, omits

presence of clinician though-out treatment

• Contingency plan
• Gold seed markers
• Convenience
• CT external beam

following day.

Clare.Wilkinson@leedsth.nhs.uk

Future Developments

• Integrated with an Record and verify system.
• Automatically submits and captures RTDS.
• Paper light .

Clare.Wilkinson@leedsth.nhs.uk

Thank You