# A nurse cares for a client receiving brachytherapy with an internal radiation implant (cesium-137) for cervical cancer. Which actions correctly apply the time, distance, and shielding principles of radiation safety? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=366657&lang=en  
> language: en  
> subject: Handling Hazardous/Infectious Materials  
> category: SIPC

## Question

A nurse cares for a client receiving brachytherapy with an internal radiation implant (cesium-137) for cervical cancer. Which actions correctly apply the time, distance, and shielding principles of radiation safety? Select all that apply.

1

Allow visitors unlimited time at the bedside as long as they are wearing regular clothes

2

Maintain a distance of at least 6 feet (1.8 m) from the implant when not directly providing care

3

Pregnant nurses may safely care for this client without restrictions per facility policy

4

Wear a personal dosimeter at all times and a lead apron when providing direct care

5

Limit time at the bedside to no more than 30 minutes per shift per nurse

## Explanation

Radiation safety follows the ALARA principle (As Low As Reasonably Achievable) using time, distance, and shielding. Limit caregiver time, maintain at least 6 feet of distance, wear dosimeter and lead apron. Visitors should be limited to short visits (typically 30 minutes per day, 6 feet away) and pregnant women and children under 18 must NOT enter the room or care for the client during active brachytherapy.

## In-depth explanation

Clinical Judgment
ALARA principles: Time (limit), Distance (maximize), Shielding (lead apron). Brachytherapy implants emit gamma radiation; pregnant staff and visitors and children <18 are excluded. Dosimeter logs cumulative dose. Bed rest for the client to prevent dislodgement.

Memory Tip
ALARA: Time + Distance + Shielding. Pregnant + Children = NO entry.

KR vs U
NRC and Joint Commission (US), Korean Nuclear Safety and Security Commission align on ALARA principles. Korean tertiary cancer hospitals follow the same time-distance-shielding rules and dosimeter monitoring.

## Clinical scenario

Clinical Practice Guide
Brachytherapy nursing safety bundle:
- Private room with appropriate signage
- Dosimeter worn at all times by direct caregivers
- Time limit: 30 minutes per shift maximum bedside time
- Distance: 6 feet (1.8 m) when not actively providing care
- Lead apron for direct care
- Visitor restrictions: 30 min/day max, 6 feet away, no pregnant women or children under 18
- Bed rest: keep the client supine to prevent dislodgement
- Long forceps and lead container at bedside in case the implant dislodges — never touch with bare hands

Caution
If the implant dislodges: use long-handled forceps to place it in the lead container, do NOT touch with bare hands, evacuate visitors, notify radiation safety officer immediately. Document and assess the client and any exposed staff.

## Key concepts

- **ALARA** — Radiation safety principle: As Low As Reasonably Achievable. Achieved through time (limit exposure duration), distance (maximize from source), and shielding (lead barrier). Apply to ionizing radiation in brachytherapy, fluoroscopy, CT, and nuclear medicine.
- **Brachytherapy** — Internal radiation therapy where a sealed radioactive source is placed in or near the tumor (cervical, prostate, breast). Permanent implants (low dose) or temporary implants (high dose). Active period: nurse caregivers follow ALARA; visitors limited; pregnant staff and children excluded.
- **Dosimeter** — Personal radiation monitor worn by healthcare workers exposed to ionizing radiation. Records cumulative dose for occupational safety tracking. Annual occupational dose limit per ICRP and NRC: 50 mSv whole body, 150 mSv lens of eye.

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