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74]

Original Article

A study on room design and radiation safety

around room for Co‑60 after loading HDR
brachytherapy unit converted from room for
Ir‑192 after loading HDR brachytherapy unit
Om Prakash Gurjar, Sandeep Kaushik1,2, Surendra Prasad Mishra3, Rajesh Punia1
Department of Physics, Mewar University, Chittorgarh, Rajasthan, Roentgen SAIMS Radiation Oncology Centre, Sri Aurobindo Institute of
Medical Sciences, Indore, Madhya Pradesh, 1Department of Applied Physics, Guru Jambheshwar University of Science and Technology,
Hisar, Haryana, 2Department of Radiation Oncology, BLK Super Speciality Hospital, New Delhi, 3Department of Radiotherapy,
Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

ABSTRACT are appropriate for annual design dose limits. However,

Context: Use of Co‑60 source in place of Ir‑192 in high
dose rate brachytherapy unit (HDR unit) has come
for discussion in recent publications. Co‑60 based
system has been advocated for centers which have
fewer brachytherapy procedures as it has comparative
economically and administrative advantage. This study
has direct practical application for such institutions, which
are at the cusp of moving from Ir‑192 to Co‑60 based
brachytherapy. Aims: Conversion of Ir‑192 HDR room to
Co‑60 HDR room and to analyze radiation safety around
the room. Materials and Methods: Uniform thickness
of 15 cm concrete was added to all walls (except one
wall adjoining to linear accelerator bunker) to convert
existing room forIr‑192 HDR unit to suitable room
for Co‑60 HDR unit. Radiation survey around room
was done. Actual and calculated wall thicknesses
were compared. Results: Radiation survey data
indicates that modified room is suitable for Co‑60
HDR unit and all values are in full conformity to annual
dose limits mentioned in Safety Code for Radiation
Therapy Sources (SCRTS), Atomic Energy Regulatory
Body (AERB; the regulatory body in India). Also, modified
wall thicknesses are appropriate for annual design
dose limits mentioned in Safety Report Series No. 47 of
International Atomic Energy Agency (IAEA). However,
console wall thickness (0.45 m) is less than the calculated
thickness (0.53 m) for instantaneous dose rate (IDR)
design dose limit (7.5 µSv/h) as perabove safety report
of IAEA. Conclusions: The modified wall thicknesses
console wall thickness is less than the required thickness
for IDR design dose limit. It has been suggested to add
2.64 cm steel on console wall. It has been found that
design dose limits should be considered while making
room layout plan and regulatory body should add these
constraints inSCRTS.
Key words: Co‑60 HDR remote after loading
brachytherapy, concrete, design dose limits
INTRODUCTION
Radiotherapy continues to be the main stay of cancer
management globally. For the treatment of cancer,
more than 50% patients receive radiotherapy and of
these 5–15% patients are treated by brachytherapy
as a single or combined modality. The advent of
precision technology is practices of radiotherapy and
better understanding of radiobiology; dosimetry has
completely revolutionized the radiotherapy practices.
Radiation dose is delivered to a well‑defined treatment
volume by either external beam radiotherapy using
three‑dimensional conformal radiotherapy (3DCRT),
intensity‑modulated radiotherapy (IMRT), and
volumetric‑modulated arc therapy (VMAT), etc., or by
image‑guided brachytherapy.
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Address for correspondence: Mr. Om Prakash Gurjar,

DOI:
Roentgen- SAIMS Radiation Oncology Centre, Sri Aurobindo Institute of
10.4103/2278-344X.153628
Medical Sciences, Indore - 453 111, Madhya Pradesh, India.
E-mail: ominbarc@gmail.com

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Gurjar, et al.: Conversion of room for Ir‑192 HDR unit to room for Co‑60 HDR unit
In brachytherapy, radiation dose is delivered to the
treatment volume either by implant (permanent or
temporary) of radionuclide in tumor volume or by
placement of radionuclide after catheters has been
put in treatment volume. On the basis of dose rate
and its radiobiological consequences brachytherapy
has been categorized in three categories viz. low dose
rate (LDR; 0.4–2 Gy/h), medium dose rate (MDR;
2–12 Gy/h), and high dose rate (HDR; >12 Gy/h)
brachytherapy. [1] Nowadays, HDR afterloading
brachytherapy is commonly used amongst the above
three, where Ir‑192 radionuclide is popularly used
isotope with source strength of 10 Ci or less. [2]
Interstitial brachytherapy (for the treatment of head
and neck tumors, breast, soft tissue sarcoma, and skin
tumors), intracavitary brachytherapy (for the treatment
of cervical cancer), intraluminal brachytherapy (for the
treatment of esophagus, uterus, trachea, bronchus, and
rectum), and topical brachytherapy (for the treatment
of molds of the body part) are the main applications
of brachytherapy.[3]
Very high conformal dose to target volume sparing
the organs at risk (OARs) can be delivered by IMRT
technique. Recent publications suggest that several
brachytherapy procedures have been replaced by these
highly precision external beam techniques. However,
brachytherapy continues to be the most conformal
treatment modality with very high dose delivery to the
core of target volume and excellent dose fall to spare
the OARs with least integral dose. It continues to enjoy
radiobiological superiority and it has the ability to
boost the target volume with judicious choice of target
volume to achieve better outcome. However, some of the
practices have been shifted to external modality because
of ease of the procedure. This has resulted in reduction
of number of brachytherapy procedures; hence, many
radiotherapy centers have very low number of cases.
Since half‑life (T1/2) of Ir‑192 radioisotope is low, that
is, 73.8 days,[2] it requires replacement of source every
3–4 months which work outs economical expenses as
well as a generation and coordination with statutory
authorities for source procurement, loading transporting,
and disposal with multiple documentation procedures
with regulatory body’s rules.
In last few years, Co‑60 with enhanced specific activity
made possible to design miniaturized sources which
are equal to Ir‑192 sources. Applicators are same in
shape and diameter, application techniques are also
same in both, and the irradiation time on average is
only 1.7 times longer for Co‑60 with initial nominal
84 International Journal of Health & Allied Sciences • Vol. 4 • Issue 2 • Apr-Jun 2015
activities of both the sources (370 GBq for Ir‑192 and
74 GBq for Co‑60). [4] So, Co‑60 radioisotope based
HDR remote after loading brachytherapy unit (HDR
unit) is the alternate solution of the above problem
which provides the optimized service considering
clinical benefits, half‑life, cost, and repeated processing
documentation and administrative workouts. The chief
advantage is fairly long half‑life of Co‑60 (5.26 years),[2]
thus source replacement becomes infrequent, although
mean energy of this radioisotope is higher (1.25 MeV)
than that of Ir‑192 (0.38 MeV). This will demand larger
thick concrete walls of brachytherapy housing compared
to Ir‑192 source.[5]
Our institute had prepared room for I‑192 HDR unit,
but later on decided to install Co‑60 HDR remote after
loading brachytherapy unit. The existing room had been
converted to conform to radiological safety requirements
of Co‑60 brachytherapy room by doing some necessary
alterations. This study presents complete details about
design and modifications of Ir‑192 housing to converted to
suit Co‑60 room and evaluation of radiation safety around
the converted room with Co‑60 HDR unit.
MATERIALS AND METHODS
Ir‑192 (max activity 10Ci) HDR unit housing was built
at our institution as per room layout plan approved by
regulatory body “Atomic Energy Regulatory Body (AERB),
Mumbai” as shown in Figure 1 (i). The wall thicknesses
were as follows;
Wall A = 30 cm, wall A' = 40 cm, wall B = 140 cm, maze
wall = 30 cm, wall B' = 35 and 23 cm (back to maze wall),
and roof C = 47 cm.
After the decision to convert the abovementioned
Ir‑192 room to house the HDR unit (Bebig GyneSource
HDR, Eckert and Zeigler Bebig GmbH, Germany) loaded
with Co‑60 radioisotope (model Co0. A86, Eckert and
Ziegler Bebig GmbH, Germany) with initial nominal
activity of 74 GBq and apparent activity of 66.96 GBq,
room layout plan as shown in Figure 1 (ii) was sent to
AERB for approval. After getting official approval, all
the walls (except wall B) and roof was added with 15 cm
uniform thickness of concrete. Since the tenth value
layer (TVL) of concrete for Ir‑192 is 14 cm, whereas, for
Co‑60 it is 21 cm; so for the walls (wall A and maze wall)
with 30 cm thickness prepared for Ir‑192 must be added
15 cm more for housing Co‑60. Although the calculated
thicknesses for other walls (wall A', wall B', and roof C)
came different than 15 cm, but by seeing the surrounding
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Gurjar, et al.: Conversion of room for Ir‑192 HDR unit to room for Co‑60 HDR unit

Figure 1: Approved room Layout plan for (i) Ir-192 (walls sketched with dots) and (ii) Co-60 (walls sketched with dots + fully
black color) high dose rate (HDR) remote afterloading Brachytherapy

of room and uniformity of wall thicknesses, management
decided to add 15 cm additional thickness on all the walls
and roof. Also since the old room was with height of
485 cm which was more than required height, a second
15 cm concrete had to be added which was tough just in
touch with old ceiling. So, the new ceiling with 15 cm
thickness was constructed at 300 cm height. Thus hollow
space of 170 cm got created which is totally empty and
packed from all sides. The thicknesses of all walls and
roof after modification are as follows:
Wall A = 45 cm, wall A' = 55 cm, wall B = 140 cm, maze
wall = 45 cm, wall B' = 50 and 23 cm (back to maze wall),
roof C = 15 cm + 170 cm air space + 47 cm.
Our designing consideration envisages erection of maze
to bolster the radiation safety, thus there is no need of
a heavy lead door to stop the scatter reaching to door.[6]
Simple wooden door with door interlock was put at the
treatment room entrance.
After requisite furnishing and electric fitting, Bebig
GyneSource HDR unit was installed inside the room in
such a way that the patient bed is placed in center of the
room as shown in Figure 1. Gamma area monitor, type
no. ‑ GA720H (Nucleonix Systems Pvt Ltd, Hyderabad,
India) having range 0–100 mR/h was installed on
maze wall towards inner maze entrance and the digital
display (connected with gamma area monitor) was installed
in console so that the instantaneous dose rate (IDR) inside
room can be seen in console.
Co‑60 source was loaded with due observance of statutory
procedures and all necessary quality assurance (QA)
tests were performed as per performa “RP and AD/
Remote QA/01”provided by Radiological Physics and
Advisory Division, Bhabha Atomic Research Centre.[7]
To check the unit leakage, radiation survey around the
HDR unit (in source OFF condition) was done at
5 cm from the unit surface and 1 m from center of the
source storage in all direction as shown in Figure 2,
and then radiation survey was done all around the
room using digital contamination monitor (Micro)
Type: CM710P (Pancake) (Nucleonix Systems Pvt Ltd,
Hyderabad, India) capable of measuring β and γ rays and
having measuring range of 0–200 mR/h. The calibration
accuracy of the contamination monitor is ± 15%. All the
data were taken in doserate mode. The detector type in
this instrument is halogen quenched GM detector. After
commissioning approval from AERB, the unit has been
commissioned for patient treatment.
Since above alterations were done by in‑house expertise of
the institution with the help of architect after documented
approval from regulatory body, unit installation, and
commissioning with the help of service engineer was
accomplished. Since this was the case of modified room,

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Gurjar, et al.: Conversion of room for Ir‑192 HDR unit to room for Co‑60 HDR unit

Figure 2: Radiation survey points around Bebig GyneSource HDR unit

so to analyze the above modified room design calculations consider 100% occupancy in public passage back to wall
were done as follows: at position A’ as shown in Figure 1].

The barrier attenuation to give the acceptable external Calculation for wall thickness
annual dose is given as:[6,8,9]
Walls facing public area
B = (Da × d2)/(Tw × 50 × Γ × A × U × T) (1) B   =   0 . 3 m S v ×   ( 3 . 0 5 m ) 2/ ( 1 h   ×   5 0   ×   3 0 6
µGym2h−1GBq−1 × 66.96 GBq × 1 × 1).
Where
B (The barrier attenuation required to achieve Da). = 2.72 × 10−3

Da (The annual dose constraint) =0.3 mSv annually (design n (number of tenth value layer (TVL)) = −log10B = 2.57
limit for public area).[6,10] TVL (TVL for concrete is 0.21 m).[5]

=6 mSv annually (design limit for occupational Required wall thickness = 0.54 m concrete
exposure).[6,10]

d [The distance from the source (in the patient) to the far Wall facing control console
side of the barrier) ≥3.05  m  (3.05 is nearest distance for B = 6 mSv × (2.8 m) 2/(1h × 50 × 306 µGym2h−1GBq−1 × 66.96
far side of walls facing to public area, see Figure 1] and GBq × 1 × 1).
2.8 m (distance of far side of console wall).
= 4.59 × 10−2
Tw (The average source exposure time per week (hours)
covering all procedures) = 1 hour (our center has maximum n = −log10B = 1.34 TVL (TVL for concrete is 0.21 m)[5]
four patients/week, and the maximum treatment time for
one patient is 15 min with initial activity). Required wall thickness = 0.28 m concrete

Γ (The air kerma rate constant for the radionuclide in Calculation for IDR
the source (µGy/GBq.h@1m)) = 306 µGym2h−1GBq−1 The IDRis calculated as follows:[6,8,9]
(as mentioned in source certificate).
IDR = Γ× A × B/d2(2)
A (The maximum activity (GBq) of the source (at renewal))
= 66.96 GBq
For public area
U (The use factor) = 1 IDR = 306 µGym 2h −1GBq −1 × 66.96 GBq × 2.72 ×
10−3/(3.05 m) 2
T (The occupancy factor in the area adjacent to the barrier)
= 1 [the control area with 100% occupancy and let we = 5.99 µSv/h

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Gurjar, et al.: Conversion of room for Ir‑192 HDR unit to room for Co‑60 HDR unit

For control console of Radiation Protection and Measurements (NCRP),

IDR = 306 µGym 2h −1GBq −1 × 66.96 GBq × 4.59 ×
10−2/(2.8 m) 2
= 119.96 µSv/h
RESULTS AND DISCUSSIONS
The radiation survey data are as shown in Tables 1 and 2.
As per “RP and AD/Remote QA/01”,[7] the dose limits at
5 cm from surface and 1 m from the center of the source
storage are ≤100 and ≤10 µGy/h, respectively. From the
table we can see that the maximum dose rate at 5 cm
distance from surface is 8.49 mR/h (≈84.9 µGy/h) and
at 1 m distance is 0.21 mR/h (≈2.1 µGy/h), hence the
radiation level around unit is well within the tolerance
limit. Also the maximum dose rate around room is
1.12 mR/h  (≈11.2 µGy/h) at room door. However no
one is allowed to stay there while the source is ON.
And the maximum dose measured in control console is
2.37 mR/h  (≈23.7 µGy/h). If we calculate the annual
dose based on work load (maximum 1 h/week, so 52 h in
a year), then it comes 58.24 mR/year (≈0.58 mGy/year)
and 123.24 mR/year (≈1.23 mGy/year); while the annual
dose constraint for general public is 1 mSv/year,[6,8,9,11]
and for radiation workers an effective dose of 20 mSv/y
averaged over 5 consecutive years (calculated on a sliding
scale of 5 years). [11] Hence the radiation survey data
indicates that there is no radiation hazard around the
room with abovementioned maximum work load and
room is suitable for Co‑60 HDR unit as per norms of
regulatory body.
It is imperative to discuss the design dose limits; although
there is no design dose rate constraint mentioned in safety
code of regulatory body in India,[11] but as per Safety
Report Series No. 47 of International Atomic Energy
Agency (IAEA)[6] giving the reference of National Council
USA and Health and Safety Executive (HSE), UK;
the annual design dose limit for public area is 1[12] and
0.3 mSv/year,[10] respectively, and the design dose limits
for occupational exposure is 10[13] and 6 mSv/year,[10]
respectively. Using formula 1 and design dose limits,
0.3 (for public) and 6 mSv/year (for radiation workers),
the calculated wall thickness facing public area is 0.55 m
and wall thickness facing control console is 0.29 m. So,
adding the uniform thickness of 15 cm concrete to roof
and all walls (except wall B) as shown in Figure 1 (ii)
was safe for the radiation safety point of view based on
annual design dose limits.
As per Safety Report Series No. 47 of IAEA[6] giving the
reference of Nuclear Regulatory Commission (NRC),
USA and Institute of Physics and Engineering in
Medicine (IPEM), UK; the IDR design dose limit for
public area is 20[14] and 7.5 µSv/h,[15] respectively, and
the IDR design dose limit for occupational exposure
is 7.5 µSv/h.[15] Using formula 2, the calculated IDR in
public area is 5.99 µSv/h and in control console is 119.96
µSv/h. The calculated IDR for public area is well safe,
but the calculated IDR in console is much higher than the
abovementioned dose limits. Also the measured IDR in
console is 0.55 mR/h (≈5.5 µSv/h). When position of HDR
unit in the room is between the source ON position and
console wall, and 2.37 mR/h (≈23.7 µSv/h) when direct
facing the console wall to source like other walls. Although,
we maintain the position of HDR unit in the room in such a
way that its position remain between the source ON position
and console wall while doing actual patient treatment, so
that dose rate in console remain low. The measure IDR
at room door is 1.12 mR/h (≈11.2 µSv/h), which is less
than the constraint value of NRC, USA, while higher than
that of IPEM, UK. The area having IDR > 7.5 µSv/h is
considered as supervised.[6,15] Therefore, this place has been
declared as supervised area and no one is allowed to stay

Table 1: Radiation survey around Co‑60 HDRafterloading brachytherapy unit (with initial maximum activity 66.96 GBq)
Measuring direction as in figure 2 1 2 3 4 5 6 7 8 9
Measured dose rate (mR/h) at 5 cm 4.21 2.67 4.16 7.74 8.49 0.21 0.19 0.22 0.25
from the surface of the source storage
Measured dose rate (mR/h) at 1 m 0.21 0.14 0.10 0.18 0.16 0.11 0.10 0.10 0.11
from the center of the source storage

Table 2: Radiation survey around Co‑60 HDR afterloading brachytherapy room (with initial maximum activity 66.96 GBq)
Measuring point A A’ B B C C’ D E F
Radiation level (mR/h) 0.55* 2.37# 0.35 0.02 0.06 0.05 0.19 1.12 0.09 0.15
*When position of HDR unit in the room is between the source ON position and console wall, we maintain this position while doing actual patient treatment
also, #on direct facing the console wall to source like other walls. This arrangement was done for taking this data only. Note: The radiation level in
brachytherapy room is negligible when the 15 MV beam live ON in adjoining linear accelerator room. HDR: High dose rate

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Gurjar, et al.: Conversion of room for Ir‑192 HDR unit to room for Co‑60 HDR unit
there while source is ON. Measured IDR values at all other
positions in public area are well within tolerance limit. To
bring the IDR in console less than 7.5 µSv/h, the required
wall thickness of console can be calculated using formula
2 and IDR design dose limit 7.5 µSv/h as follows:
7.5 µSv/h = 306 µGym2h−1GBq−1 × 66.96 GBq × B/(2.8 m) 2
B = 2.87 × 10−3
n = −log10B = 2.54 TVL (TVL for concrete is 0.21 m)[5]
Required wall thickness = 0.53 m concrete.
Hence, 8 cm uniform thickness of concrete (with
density ≥2.35 g/cc) or 2.64 cm steel (equivalent to 8 cm
concrete) is additionally needed to add on console wall to
bring IDR within tolerance limit.
CONCLUSIONS
It is possible to modify the existing room for Ir‑192
HDR brachytherapy unit to room for Co‑60 HDR
brachytherapy unit with minimal alteration if judicious
planning is done. To modify the existing room for
Ir‑192 (370 GBq) HDR unit to suitable room for
Co‑60 (66.96 GBq) HDR unit, additional thickness of
15 cm of concrete was added on all existing walls (except
wall B) and roof. Radiation survey data shows that the
modified room is completely congruent to annual dose
limits mentioned in Radiation Safety Code provided by
regulatory body (AERB).
The modified wall thicknesses are appropriate for annual
design dose limits for public area as well as for occupational
exposure. However, the thickness of console wall (0.45 m)
is less than the required thickness (0.53 m) for IDR design
dose limit. It has been suggested to management to add
2.64 cm steel on console wall.
Design dose limits should also be considered while planning
room layout for radiation facility and regulatory body may
incorporate these constraints in radiation safety code. This
study has direct practical application for such institutions,
which are at the cusp of moving from Ir‑192 to Co‑60 based
brachytherapy in the light of new developments.
88 International Journal of Health & Allied Sciences • Vol. 4 • Issue 2 • Apr-Jun 2015
ACKNOWLEDGEMENT
We thank to Dr. Virendra Bhandari, HOD, Roentgen‑SAIMS
Radiation Oncology Centre, SAIMS, Indore for his positive
support in conducting this study.
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How to cite this article: Gurjar OP, Kaushik S, Mishra SP, Punia R. A
study on room design and radiation safety around room for Co-60 after
loading HDR brachytherapy unit converted from room for Ir-192 after
loading HDR brachytherapy unit. Int J Health Allied Sci 2015;4:83-8.
Source of Support: Equipment support of Roentgen Oncologic
Solutions Pvt. Ltd. and Sri Aurobindo Institute of Medical Sciences,
Indore (India), Conflict of Interest: None declared.