Radiation Safety Following

Prostate Brachytherapy
Alyssa Mellott
12/08/14

Permanent prostate seed implants using radioactive sources is

currently a common procedure for localized prostate cancer. This
method is now considered to be just as effective as external beam
radiation therapy and prostatectomy in many cases. I will be reviewing
radiation safety concerns following prostate brachytherapy, and ways
to prevent these risks. These concerns mainly pertain to people that
will be in close proximity to the patient following their treatment. In
the first article I chose, researchers assessed the lifetime dose to
family and household members of the average prostate brachytherapy
patient. This information could be very valuable to early stage
prostate cancer patients who are trying to compare the risks of
different treatment routes. The next article looked at the radiation
safety instructions given to patients, as well as the possibility of
exposure to the public following the procedure. We know that we need
to give the patient rules to protect the people close to them, but is the
general public a concern as well? In my last source, the authors chose
to further analyze the radiation from these patients by particularly
focusing on different body postures and lifestyle habits of the subjects.
Overall, the goal is to see how much of a radiation risk these patients
pose to others, and if the safety instructions given to them are
adequate. Prostate brachytherapy is less invasive than surgery and

much less time consuming than external beam radiation therapy, but
is the possible risk to others a reason to avoid this alternative?
The first article I will be reviewing is called Radiation Exposure to
Family and Household Members After Prostate Brachytherapy. In this
study, researchers wanted to determine if people close to these
brachytherapy patients would receive a significant dose of radiation.
They utilized 44 patients with Pd-103 or I-125 implants. Each patient
was given two optically stimulated luminescence dosimeters (OSLDs),
and each family member (including pets) was given a single OSLD.
The rooms that the patient occupied most were also monitored for
radiation. The dosimeters were returned and read three weeks later.
Lifetime exposures were determined using a function of the isotopes
half-lives and the initial dose rate at the time of the implant. Average
background radiation was also taken into consideration. Michalski
stated, the mean (range) effective dose equivalent for the spouses
was 0.10 (range: 0.04 0.55) mSv for an iodine implant and 0.02
(range: 0.0150.074) mSv for a palladium implant. Other family
members and pets had a mean effective dose equivalent of 0.07
(range: 0.04 0.32) mSv for iodine implants and 0.02 (range: 0.015
0.044) mSv for palladium implants. The majority (94%) of the room
monitors had no detectable exposure above background (p. 766).
Keeping in mind that annual effective dose limit for members of the
public is 1 mSv, these doses are not even slightly concerning.

Michalski also use a comparative chart to show how minimal this

exposure is; it shows that a round trip flight from LA to Tokyo will result
in an exposure of .2 mSv/trip (p. 767). Overall, radiation exposure to
family members should not be a major concern in the patients
decision process. As long as they take simple precautions, there will
not be any danger of significant exposure to others. This leads me to
my next article, which asks similar questions and puts focus on the
safety instructions given to patients.
My second source is titled Assessment of Radiation Safety
Instructions to Patients Based on Measured Dose Rates Following
Prostate Brachytherapy. In this study, the goal was to measure
potential doses to the public, and validate safety instructions given to
I-125 and Pd-103 prostate implant patients. To test the possible
radiation dose, measurements were obtained in the immediate
postoperative period, on the anterior skin surface, at the point of the
symphysis pubis. They were recorded 30 cm perpendicular to the
surface, and 100 cm perpendicular to this surface. Dauer stated, The
mean radiation dose rate at the anterior skin surface following a
prostate implant was .037 mSv/hr for I-125 and .008 mSv/hr for Pd103. At 30 cm from the anterior skin surface, these dose rates were
reduced to .006 mSv/hr for I-125 and .003 mSv/hr for Pd-103. At 1 m
from the anterior skin surface the dose rates from both types of
implants were reduced to less than .001 mSv/hr (p. 1). They also

concluded that ALARA instructions to patients should include avoiding

contact (closer than 30 cm) with others for extended periods of time,
and avoiding sleeping in the spoon position. Once again, the doses
are minimal when considering the annual effective dose limit of 1 mSv
for members of the public. The safety instructions are simple, and if
followed, these patients should not pose a threat to close family
members or the general public.
Finally, I chose to utilize a study titled Assessing Protection Against
Radiation Exposure After Prostate I-125 Brachytherapy. These
researchers go a little more in depth to determine the dose given off
by prostate brachytherapy patients. They considered the patients
body posture, distance from the skin surface, and the possible use of
led-lined underwear as another level of protection. The final
conclusions of this study were very similar to the previous two, but
there were significant findings when it came to the body posture
aspect of it. Hanada and his colleagues found that, Radiation
exposure varies according to the patients body posture, with results
differing as much as approximately 40.0% in measured radiation dose
rates at 30 cm from the anterior skin surface (p. 311). Though the
dose varied when the patients were in different positions, the possible
doses to others were all still negligible. As previously concluded, this
study once again solidifies the idea that patients should not worry
about being a radiation risk to the public after I-125 brachytherapy.

They do, however bring up the fact that there are different levels of
fear associated with radiation exposure nationally. For individuals who
have more concerns related to this treatment, the led-lined underwear
or a led-lined apron would be sufficient in decreasing the exposure risk
even further.
In conclusion, it is safe to say that prostate brachytherapy using I125 or Pd-103 does not pose a safety threat to family members or the
general public as long as safety guidelines are followed. For prostate
cancer patients who have multiple treatment options, the safety of
their loved ones should not deter them from choosing the
brachytherapy route. None of the recorded doses come close to the
limits for the general public, and someone would have to be in very
close proximity to the patients skin surface to receive any dose from
the radiation sources. This information is very reassuring, especially
since brachytherapy is a top treatment option for many patients with
early-stage prostate cancer. I truly believe that these three studies
cover all of the bases when it comes to the radiation safety of others
after prostate brachytherapy.

Bibliography:
Dauer L, Zelefsky M, Horan C, Yamada Y, St. Germain J. Assessment
of radiation safety instructions to patients based on measured dose

rates following prostate brachytherapy. Brachytherapy [serial online].

March 2004;3(1):1. Available from: Academic Search Complete,
Ipswich, MA. Accessed November 23, 2014.

Hanada T, Yorozu A, Kikumura R, Ohashi T, Shigematsu N.

Assessing protection against radiation exposure after prostate 125I
brachytherapy. Brachytherapy [serial online]. May 2014;13(3):311318. Available from: Academic Search Complete, Ipswich, MA.
Accessed November 23, 2014.

Michalski J, Mutic S, Eichling J, Ahmed S. Radiation exposure to

family and household members after prostate brachytherapy.
International Journal Of Radiation Oncology, Biology, Physics [serial
online]. July 2003;56(3):764. Available from: Academic Search
Complete, Ipswich, MA. Accessed November 23, 2014.