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Radiation Exposure and Safety Precautions Following 131Cs Brachytherapy in Patients with Brain Tumors

Yondorf, Menachem Z.; Schwartz, Theodore H.; Boockvar, John A.; Pannullo, Susan; Stieg, Philip; Sabbas, Albert; Pavese, Albert; Trichter, Samuel; Nedialkova, Lucy; Parashar, Bhupesh; Nori, Dattatreyudu; Chao, K.S. Clifford; Wernicke, A. Gabriella

doi: 10.1097/HP.0000000000000551
Operational Topics

Abstract: Cesium‐131 (131Cs) brachytherapy is a safe and convenient treatment option for patients with resected brain tumors. This study prospectively analyzes radiation exposure in the patient population who were treated with a maximally safe neurosurgical resection and 131Cs brachytherapy. Following implantation, radiation dose rate measurements were taken at the surface, 35 cm, and 100 cm distances. Using the half-life of 131Cs (9.69 d), the dose rates were extrapolated at these distances over a period of time (t = 30 d). Data from dosimetry badges and rings worn by surgeons and radiation oncologists were collected and analyzed. Postoperatively, median dose rate was 0.2475 mSv h−1, 0.01 mSv h−1, and 0.001 mSv h−1 and at 30 d post-implant, 0.0298 mSv h−1, 0.0012 mSv h−1, and 0.0001 mSv h−1 at the surface, 35 cm, and 100 cm, respectively. All but one badge and ring measured a dose equivalent corresponding to ~0 mSv h−1, while 1 badge measured 0.02/0.02/0.02 mSv h−1. There was a significant correlation between the number of seeds implanted and dose rate at the surface (p = 0.0169). When stratified by the number of seeds: 4–15 seeds (n = 14) and 20–50 seeds (n = 4) had median dose rates of 0.1475 mSv h−1 and 0.5565 mSv h−1, respectively (p = 0.0015). Using National Council on Radiation Protection guidelines, this study shows that dose equivalent from permanent 131Cs brachytherapy for the treatment of brain tumors is limited, and it maintains safe levels of exposure to family and medical personnel. Such information is critical knowledge for the neurosurgeons, radiation oncologists, nurses, hospital staff, and family as this method is gaining nationwide popularity.

*Stich Radiation Oncology, Weill Medical College of Cornell University, New York, NY; †Department of Neurosurgery, Weill Medical College of Cornell University, New York, NY.

Dr. A. Gabriella Wernicke was supported by the NIH KL2 grant 3KL2RR024997.

Disclosure: All the authors declare that they have no personal financial or institutional conflict of interest in any of the materials discussed in this article.

Financial support: Dr. A.Gabriella Wernicke was supported by the NIH KL2 grant 3KL2RR024997.

Conflict of interest: none.

For correspondence contact: A. Gabriella Wernicke, MD, MSc, Weill Medical College of Cornell University, Stich Radiation Oncology, 525 East 68th Street, New York, New York 10065 Telephone: (212) 746–3641, Fax: (212) 746–8749 or email at

(Manuscript accepted 28 April 2016)

© 2017 by the Health Physics Society