1. Radiation Protection in Radiotherapy Part 14 Transport Safety IAEA Training Material on Radiation Protection in Radiotherapy

2. Radiation Protection in RadiotherapyPart 14: Transport safety2 Transport of sources l A problem in external beam therapy only for dosimetric check sources and in the context of source replacement for a tele-therapy unit l A day-to-day problem in brachytherapy

3. Radiation Protection in RadiotherapyPart 14: Transport safety3 Objective l To understand the process of n ordering n storage n accounting for n and transport of radiation sources within the hospital and externally l To appreciate the protection and safety issues associated with this process

4. Radiation Protection in RadiotherapyPart 14: Transport safety4 Contents 1 Notes on ordering of sources 2 Transport n IAEA transport regulations n external of the hospital n internal 3 Storage and accounting Disposal discussed in part 15

5. Radiation Protection in RadiotherapyPart 14: Transport safety5 1. Ordering of sources l Need authorization l Require all relevant licenses l Order from approved supplier l More in part 18 of the course

6. Radiation Protection in RadiotherapyPart 14: Transport safety6 The BSS on ordering and transport: l General obligations: “2.7. No practice shall be adopted, introduced, conducted, discontinued or ceased and no source within a practice shall, as applicable, be mined, milled, processed, designed, manufactured, constructed, assembled, acquired, imported, exported, distributed, sold, loaned, hired, received, sited, located, commissioned, possessed, used, operated, maintained, repaired, transferred, decommissioned, disassembled, transported, stored or disposed of, except in accordance with the appropriate requirements of the Standards, unless the exposure from such practice or source is excluded from the Standards or the practice or source is exempted from the requirements of the Standards, including the requirements of notification and authorization.”

7. Radiation Protection in RadiotherapyPart 14: Transport safety7 Receiving of sources l Consignments are often sent ‘by default’ to the hospital store l Care must be taken that: n either sources are directly sent to and received by the person who holds the appropriate license and has the appropriate expertise n or that the hospital receiving officer is trained appropriately, records all details of the shipping and informs the responsible person in radiotherapy immediately l Radioactive sources MUST not be allowed to be stored with other goods without being under immediate control of an appropriately trained person

8. Radiation Protection in RadiotherapyPart 14: Transport safety8 2. Transport of radioactive sources for radiotherapy l Between the radiotherapy center and outside facilities n delivery of sources n disposal of sources n transport between hospitals l Within the radiotherapy center

9. Radiation Protection in RadiotherapyPart 14: Transport safety9 BSS and transport l General obligations: “2.9. The transport of radioactive sources shall be subject to the requirements of the IAEA Regulations for the Safe Transport of Radioactive Material and any applicable international convention.”

10. Radiation Protection in RadiotherapyPart 14: Transport safety10 Transport of Radioactive Material l IAEA Safety Standards No. ST-1: Regulations for the Safe Transport of Radioactive Material, 1996 Edition

11. Radiation Protection in RadiotherapyPart 14: Transport safety11 Objective of the IAEA Transport Regulations l To protect persons, property and the environment from the effects of radiation during the transport of radioactive material. This protection is achieved by requiring: scontainment of the radioactive contents scontrol of external radiation levels sprevention of criticality (not a concern for radiotherapy sources) sprevention of damage caused by heat.

12. Radiation Protection in RadiotherapyPart 14: Transport safety12 Scope of the IAEA Transport Regulations l The Regulations apply to the transport of radioactive material by all modes on land, water or in the air. l The Regulations cover the design and manufacture of packaging, the preparation, consigning, loading, carriage, unloading and receipt of the packages.

13. Radiation Protection in RadiotherapyPart 14: Transport safety13 Types of Packages as defined by the IAEA Transport Regulations l Excepted package l Industrial package Type 1, 2 and 3 l Type A package l Type B(U) package l Type B(M) package l Type C package

14. Radiation Protection in RadiotherapyPart 14: Transport safety14

15. Radiation Protection in RadiotherapyPart 14: Transport safety15 Type B container l Used for transport of 60-Co sources for external beam therapy l Used for 192-Ir sources for high dose rate brachytherapy

16. Radiation Protection in RadiotherapyPart 14: Transport safety16 Please note l Usually the head of a 60- Co unit is NOT a suitable container for transport of the source!

17. Radiation Protection in RadiotherapyPart 14: Transport safety17 In practice l The ‘transport’ container and the treatment unit may be identical (as seen here for the Nucletron HDR brachytherapy afterloading unit) Courtesy of Nucletron

18. Radiation Protection in RadiotherapyPart 14: Transport safety18 Gammamed mobile unit l Must be labelled once source is present l Easy to transport l Must be accompanied by appropriately trained person Courtesy of MDS Nordion

19. Radiation Protection in RadiotherapyPart 14: Transport safety19 The Transport Index l The Transport Index is the maximum radiation level, in mSv/h, at a distance of 1 m from the external surface of the package, multiplied by 100. l The categories of packages, are determined by the Transport Index and the maximum radiation level at any point on the surface of the package. 1.0 m

20. Radiation Protection in RadiotherapyPart 14: Transport safety20 Categories of Packages

21. Radiation Protection in RadiotherapyPart 14: Transport safety21 White-I Label < 5.0  Sv/h @ surface < 0.05  Sv/h @ 1.0 m TI close to 0

22. Radiation Protection in RadiotherapyPart 14: Transport safety22 Yellow-II Label 5  Sv/h @ surface < 10  Sv/h @ 1.0 m 0 < TI < 1.0

23. Radiation Protection in RadiotherapyPart 14: Transport safety23 Yellow-III Label > 500, < 2000  Sv/h @ surface > 10, < 100  Sv/h @ 1.0m 1.0 < TI < 10

24. Radiation Protection in RadiotherapyPart 14: Transport safety24 Vehicle Placards l Required every time activity is transported l Need at least three l Other documentation also required

25. Radiation Protection in RadiotherapyPart 14: Transport safety25 Consignor’s Responsibilities l all labelling and placarding l provision of transport documents l provision of local rules and any other relevant information

26. Radiation Protection in RadiotherapyPart 14: Transport safety26 Package Labels l Package type l Isotope, activity, calibration date l Transport index (surface dose)

27. Radiation Protection in RadiotherapyPart 14: Transport safety27 Potential problems in Brachytherapy l Source order, delivery, calibration and acceptance n Different units were used by the hospital (mCi) and the manufacturer (mg-Ra-equivalent); this led to an overdosage of 74% of one patient n In three cases there was an underdosage due to the use of the sources without checking the source activity.

28. Radiation Protection in RadiotherapyPart 14: Transport safety28 Brachytherapy problems l Source order, delivery, calibration and acceptance. Contributing factors: n Different units were used by the hospital and manufacturer n Insufficient check of documents (order and delivery n No source calibration by the users (source strength determination)

29. Radiation Protection in RadiotherapyPart 14: Transport safety29 Transport of sources between hospitals l Brachytherapy sources prepared on a different site to where they are used n often the case for highly specialized medical areas such as eye surgery l Radioactive applicators stored at a different site to where they are used n ophthalmic applicators

30. Radiation Protection in RadiotherapyPart 14: Transport safety30 Transport of sources between hospitals l May be the case for entire HDR brachytherapy unit and control l Infrastructure (cables, beds, theatre) in place at multiple locations Courtesy of Nucletron

31. Transport within a hospital Aim to minimize all transport needs by initial layout of the facility or choice of brachytherapy areas.

32. Radiation Protection in RadiotherapyPart 14: Transport safety32 Transport within a hospital l Often required for brachytherapy l Need mobile safe to suit the isotope in use l Transport must be accompanied by an appropriately trained person at all times l Labels required

33. Radiation Protection in RadiotherapyPart 14: Transport safety33 Transport containers l Maximum dose rate at the surface should be <100mSv/hr l Should have large wheels to negotiate uneven surfaces l Could double up as emergency storage container Courtesy of Nucletron

34. Radiation Protection in RadiotherapyPart 14: Transport safety34 Transport within a hospital l Some practical suggestions: n Transport routes must be chosen prior to transport and adhered to n Avoid lifts n Avoid public areas (not only to protect patients but also to minimize anxiety of patients and others)

35. Radiation Protection in RadiotherapyPart 14: Transport safety35 Transport of patients with radioactive implants l Should be avoided for brachytherapy patients n shielding is difficult n the implant may move during transport l Label and signs required

36. Radiation Protection in RadiotherapyPart 14: Transport safety36 Transport of patients with implants l l If possible, the activity should be removed prior to transport of the patient

37. Radiation Protection in RadiotherapyPart 14: Transport safety37 Disposal of sources l Only to person licensed to do this l Documentation required l This is a potential for accidents l Compare part 15 of the course BIN

38. Radiation Protection in RadiotherapyPart 14: Transport safety38 3. Source storage l See part 15: “Safety of sources” l Before ordering sources it must be assured that they can be safely stored l Information required for storage is similar to information required for transport

39. Radiation Protection in RadiotherapyPart 14: Transport safety39 Features of source storage l Secure (lock and key) l Labels l Different compartments l Shielding l Easy access

40. Radiation Protection in RadiotherapyPart 14: Transport safety40 BSS on Security of sources 2.34. “Sources shall be kept secure so as to prevent theft or damage and to prevent any unauthorized legal person from carrying out any of the actions specified in the General Obligations for practices of the Standards (see paras 2.7-2.9), by ensuring that:... (b)a source not be transferred unless the receiver possesses a valid authorization; and (c) a periodic inventory of movable sources be conducted at appropriate intervals to confirm that they are in their assigned locations and are secure.”

41. Radiation Protection in RadiotherapyPart 14: Transport safety41 In radiotherapy practice l Source storage area should be close to areas where the sources are to be used (theatres, brachytherapy ward) l Storage and transport containers are usually of different design - a storage container is NOT necessarily suitable for transport

42. Radiation Protection in RadiotherapyPart 14: Transport safety42 Emergency storage l In brachytherapy an emergency storage container should be available in case a source must be removed form the patient.

43. Radiation Protection in RadiotherapyPart 14: Transport safety43 Emergency storage l Next to temporary LDR implants in case sources must be removed for medical emergency l Next to HDR applications in case the source gets stuck and the whole applicator has to be removed

44. Radiation Protection in RadiotherapyPart 14: Transport safety44 Summary l Transport of sources is always a potential for exposure l Source transport is mainly an issue in the context of brachytherapy l Appropriate containers and labeling is required l Transport issues can occur outside and inside of a radiotherapy facility

45. Any questions?

46. Question Please design a source inventory suitable for your institution.

47. Radiation Protection in RadiotherapyPart 14: Transport safety47 Some suggestions l Should include: n Type of source n Activity (and date of specification) n Ordered by: (authorization?) n Received by n Received when n Storage where? n Patient name and identification number (for brachytherapy patients) n Used for? n Can be disposed of when (if applicable) n Disposed by n Disposed when n Disposed to

48. Radiation Protection in RadiotherapyPart 14: Transport safety48 Acknowledgment l Lee Collins, Westmead Hospital, Sydney