Guidelines for Clinicians Around Patients Receiving Radiation Therapy
Clinicians do not need to take special precautions when caring for most patients receiving external beam radiation therapy, but should follow specific safety protocols for patients receiving brachytherapy or radiopharmaceutical treatments.
Types of Radiation Therapy and Associated Precautions
External Beam Radiation Therapy
- No special precautions needed: Patients receiving external beam radiation therapy do not emit radiation after treatment sessions
- External beam radiation is delivered via linear accelerators that produce radiation only when the machine is on
- Clinicians can safely interact with these patients without radiation exposure concerns
- This includes patients receiving:
- Conventional fractionated radiation therapy
- Intensity-modulated radiotherapy (IMRT)
- Stereotactic body radiotherapy (SBRT)
- Volumetric modulated arc therapy (VMAT) 1
Brachytherapy
Brachytherapy involves radioactive sources placed directly into or adjacent to tumor tissue. Precautions vary by type:
Low-Dose Rate (LDR) Permanent Implants (e.g., prostate seed implants)
- Radiation exposure to family members and healthcare providers is very low and well below regulatory limits 2
- Basic precautions for healthcare providers:
High-Dose Rate (HDR) Temporary Implants
- No radiation precautions needed after the radioactive source is removed
- During treatment:
- Only necessary personnel should enter the treatment room
- Follow institutional radiation safety protocols
- Respect restricted areas during active treatment 3
Nuclear Medicine Treatments/Radiopharmaceuticals
- Most restrictive precautions apply to patients receiving radioiodine (I-131) and other unsealed sources 4
- Guidelines for clinicians:
- Limit time spent in close proximity (<3 feet) to patient
- Use disposable gloves when handling bodily fluids
- Pregnant staff should not care for these patients
- Follow specific institutional protocols for waste handling
- Radiation safety officer should be consulted for specific precautions 5
Radiation Safety Principles for All Healthcare Providers
Time, Distance, and Shielding
- Time: Minimize time spent in close proximity to radioactive sources
- Distance: Maintain maximum practical distance from radiation source
- Shielding: Use appropriate barriers when indicated by radiation safety officer 6
Documentation and Monitoring
- Radiation monitoring badges may be required for staff working regularly with brachytherapy or nuclear medicine patients
- Follow institutional protocols for radiation exposure documentation
- Report any concerns about radiation exposure to radiation safety officer 6
Special Considerations
Pregnant Healthcare Workers
- Pregnant healthcare workers should inform radiation safety officer of pregnancy
- Should avoid caring for patients with:
- Unsealed radioactive sources (I-131 treatments)
- Recently implanted permanent brachytherapy seeds
- Active temporary brachytherapy implants 5
Emergency Situations
- In emergency situations (cardiac arrest, etc.):
- For external beam patients: No special precautions needed
- For brachytherapy patients: Provide necessary care while minimizing time in close proximity
- For nuclear medicine patients: Use universal precautions and notify radiation safety officer immediately
Conclusion
Most radiation therapy patients pose minimal risk to healthcare providers. External beam radiation therapy patients emit no radiation after treatment. Specific precautions are needed primarily for patients with brachytherapy implants or those who have received radiopharmaceutical treatments. Always consult with the radiation safety officer when uncertain about appropriate precautions.