Operating rooms for brachytherapy

[Photoner]

Hi, sorry if the question is a little weird, but I'm a medical physicist, not a radiation oncologist, and I'm quite a layman when it comes to surgery-related stuff.

Until now, my clinic offers superficial and intracavitary brachytherapy, and the implant is done in the treatment room, where the afterloader is. Of course the applicators and material used for intracavitary implants are sterilized and the physician performing the implant wears single-use sterile gloves and clothing, but the rest of the room is not sterile. The head of service is planning to do interstitial too (gynaecological and prostate) in the same room (although other radoncs are not very willing, aparently because of concerns about the risk of bleeding when removing the applicators among other reasons), and I have the impression that the place does not meet the conditions of a typical operating room. There is an anesthesia trolley and some basic material, but I think it will be difficult to maintain sterility, there is not even a nearby changing room where you can put the scrubs on. For nurses, physicist, and other staff appart from the radonc, I think the idea is simply to cover shoes and possibly head with single-use caps when entering the room and little else. Is that relly enough?

Thanks!

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[Barcelona PSG]

Brachytherapy is a clean procedure,, not necessarily a sterile procedure. I have done Syed and prostate implant in the procedure rooms and have not faced any infection-related concerns. Bleeding is always a concern with Gyn interstitial but Gyn rad oncs are usually well-equipped to manage the complications. Once in a while, you do have bad bleeding cases that need inpatient admission and management.
If the physician is comfortable doing procedures in the treatment room, I dont see why it should be a concern to physics.

 

[OTN]

Hi, sorry if the question is a little weird, but I'm a medical physicist, not a radiation oncologist, and I'm quite a layman when it comes to surgery-related stuff.

Until now, my clinic offers superficial and intracavitary brachytherapy, and the implant is done in the treatment room, where the afterloader is. Of course the applicators and material used for intracavitary implants are sterilized and the physician performing the implant wears single-use sterile gloves and clothing, but the rest of the room is not sterile. The head of service is planning to do interstitial too (gynaecological and prostate) in the same room (although other radoncs are not very willing, aparently because of concerns about the risk of bleeding when removing the applicators among other reasons), and I have the impression that the place does not meet the conditions of a typical operating room. There is an anesthesia trolley and some basic material, but I think it will be difficult to maintain sterility, there is not even a nearby changing room where you can put the scrubs on. For nurses, physicist, and other staff appart from the radonc, I think the idea is simply to cover shoes and possibly head with single-use caps when entering the room and little else. Is that relly enough?

Thanks!

Yes

 

[ramsesthenice]

Hi, sorry if the question is a little weird, but I'm a medical physicist, not a radiation oncologist, and I'm quite a layman when it comes to surgery-related stuff.

Until now, my clinic offers superficial and intracavitary brachytherapy, and the implant is done in the treatment room, where the afterloader is. Of course the applicators and material used for intracavitary implants are sterilized and the physician performing the implant wears single-use sterile gloves and clothing, but the rest of the room is not sterile. The head of service is planning to do interstitial too (gynaecological and prostate) in the same room (although other radoncs are not very willing, aparently because of concerns about the risk of bleeding when removing the applicators among other reasons), and I have the impression that the place does not meet the conditions of a typical operating room. There is an anesthesia trolley and some basic material, but I think it will be difficult to maintain sterility, there is not even a nearby changing room where you can put the scrubs on. For nurses, physicist, and other staff appart from the radonc, I think the idea is simply to cover shoes and possibly head with single-use caps when entering the room and little else. Is that relly enough?

Thanks!

Like I tell my residents, it’s hard to think of anything less sterile than what nature intended to go in a vagina.

Most rad oncs are way too squeamish about interstitial. I’ve done at least 8-10 a month (usually more than that) for the last 5 years and had one admission for hematuria for a prostate patient. If he would have been open to going home with a 30cc balloon pulled tight for the night, it would be zero. The only Gyn admission I’ve had was a cuff dehiscence after a cylinder (which was very late…she got six cycles of chemo before VCBT). Few Gyn cases need any intervention. Vaginal packing and Monsel’s can handle the rest.

I’ve also had 0 post procedural infections. I do give a dose of antibiotics if inserting needles. Our procedure suite sounds similar to the set up you described, though it may look more like an OR since it’s set up for general anesthesia.

 

[evilbooyaa]

One does not need a sterile OR to do interstitial brachytherapy.

The concern about bleeding is not an unreasonable one. I have had two significant bleeds with gyn hybrid that have required Gyn/Onc back-up and at least admission. Sure, if I didn't have that, I could have aggressively packed the patient and transport them to the ER, but fortunately not necessary. Granted, we're probably looking at less than 2%of patients requiring this.

However, the devices are frequently not removed in the 'operating room' so whether that matters is unclear.

While, post-op infection risk is not zero (and I don't prophylaxis my interstitial patients anymore), it is low enough that the discussion of whether an entire room needs to be cleaned like an OR makes me say "nah not really". What's more important is the anesthesia services that are providable. If you have a room that can provide sufficient anesthesia for the procedure you are doing, go for it.

Yes, Rad Onc should use sterile gloves, sterile equipment, sterile technique, prepping the area, prophylactic Abx as appropriate, etc., but a full sterile OR room is not necessary. Many places do their cases in the OR because that's where the anesthesiologists live...

I do mandate a mask for the folks working near the preppared area to avoid people from breathing on the sterile field. I do not care about the anesthesia team wearing masks. I don't care about surgical caps or shoe covers.