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. 5 th November 2013

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 • X- HDR Unit x • X- Emergency stops x x • Access and maze kept clear • Monitored via intercoms/CCTV and slave anaesthetic monitor 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 Immediately start stopwatch -Source fails to return to safe 2. Operate interrupt on treatment console. Assess channel and position source is in from -Source fails to return to safe TCS. 3.Operate emergency stop button. -Source fails to return to safe 4. Open treatment door, breaking interlock. Bleep Brachytherapy -Source fails to return to safe Duty Physicist. Temporally restrict patient/staff movement in 5. Enter treatment room, operate emergency stop 80 4194 corridor adjacent to treatment room. on treatment wall adjacent to machine unit . -Source fails to return to safe 6. Retract source using gold mechanical crank. At maze entrance, switch Geiger Counter to Assist as appropriate. Turn in direction of arrows until crank blocks. speaker mode. -Source fails to return to safe 7. Remove applicators from patient as per Remain at maze entrance and assist Operator 1 Contact clinician if not present . specific technique protocol. as necessary. 8. If feasible use the long handled forceps and wire cutters if necessary, place applicators in Inform RPS if not present emergency lead container and close lid. 9. Move patient to maze and monitor using Report to head of department and RPA. 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 Stop stopwatch. Complete DATIX. patient out of room. 11. Close all doors and attach no-entry signs Record time in HDR treatment log book. Print copy of fault window from TCS. -Reassure patient. 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 on 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 • Gold seed markers • Radiographer, omits • Convenience presence of clinician though-out treatment • CT external beam • Contingency plan 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 Clare.Wilkinson@leedsth.nhs.uk