Situation: A 48-year-old woman with stage IIB squamous cell carcinoma of the cervix is receiving external beam pelvic radiation with weekly cisplatin. Low-dose-rate intracavitary brachytherapy is planned after the external beam course. The room is prepared according to the radiation safety protocol. During morning care, the nurse sees the radioactive source lying on the bed linen. What should the nurse do FIRST?

All four actions are needed, but an unshielded source keeps irradiating the client and anyone in the room, so it is contained first. The nurse, never touching it by hand, picks it up with the long-handled forceps kept in the room and places it in the lead container. Radiation oncology is then notified, the applicator is checked with them, and the event is documented.

Radiation Safety Priority During intracavitary brachytherapy, the radioactive source delivers a continuous, high-dose radiation field to the tumor while also posing an exposure risk to anyone nearby. When a source becomes dislodged and lies unshielded on bed linen, it continues to emit radiation with no applicator or tissue attenuation. The immediate priority is to reduce exposure time and distance by placing the source into the lead container, because radiation dose to the client, nurse, and room is directly proportional to the time the source remains unshielded.

Why Containment Comes First The four options are all components of a complete response, but the sequence is determined by the principle of ALARA (as low as reasonably achievable). Time, distance, and shielding are the three cardinal protective factors. An unshielded source on the bed means the nurse is within close proximity, and every second of delay increases the cumulative dose received by both the client and staff. Using long-handled forceps maximizes distance from the source, and the lead container provides shielding, so this single action simultaneously addresses two of the three ALARA factors. Documentation, notification, and applicator assessment do not stop the ongoing radiation exposure.

Safe Handling Technique The nurse must never touch the radioactive source with gloved or bare hands. Long-handled forceps are kept in the brachytherapy room specifically for this emergency. The forceps increase the distance between the nurse’s hand and the source, which reduces the dose according to the inverse square law—doubling the distance reduces exposure to one-fourth. The source is then placed into a lead container, which absorbs the emitted radiation and protects everyone in the room. Key point! The forceps and lead container are always prepared before the source is loaded, so they are immediately available when dislodgement occurs.

Sequence After Containment Once the source is secured, the nurse notifies radiation oncology and the radiation safety officer. Together with the radiation oncology team, the nurse checks whether the applicator remains in the correct intracavitary position. Finally, the event is documented, including the time the source was found, the time it was contained, and the estimated duration of unshielded exposure. Watch out! Do not leave the client’s room to call for help before containing the source—the client and anyone entering the room remain exposed until the source is shielded.

Clinical Context for Cervical Brachytherapy In locally advanced cervical cancer, brachytherapy is an essential component of curative treatment because it delivers a very high radiation dose to the cervix and parametria while relatively sparing the bladder and rectum. The overall treatment time—from the start of external beam radiation to the completion of brachytherapy—is a critical determinant of local control. Delays in treatment, including those caused by source dislodgement or applicator problems, can negatively affect outcomes. However, during an active dislodgement event, the immediate radiation hazard to the client and staff supersedes concerns about treatment interruption. The source is contained first to stop the unintended exposure; treatment continuity is addressed afterward with the radiation oncology team.

Action	Rationale	Timing
Place source in lead container with forceps	Stops ongoing radiation exposure; applies distance and shielding	Immediately, before any other action
Notify radiation oncology	Activates expert response and source accountability	After containment
Check applicator position	Determines whether treatment can resume or must be replanned	With radiation oncology team
Document the event	Records exposure time and incident details for safety review	After the source is secured and team notified

Why the Other Options Are Not First Documenting the event (option 1) is important for legal and safety records, but writing notes while the source remains unshielded prolongs exposure. Notifying radiation oncology (option 3) is necessary, but calling or paging takes time during which the source continues to irradiate the room. Checking the applicator (option 4) is a clinical assessment that must occur, but it does not remove the radiation hazard. Key point! In any radiation emergency, the order is always: shield the source first, then notify, then assess, then document.