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Covid-19 HSE Clinical Guidance and Evidence

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Cancer Care - Radiation Oncology

NCCP guidance on the use of PPE by medical professionals when managing patients requiring radiotherapy in response to the current novel coronavirus (COVID-19) pandemic (CD19-063-005/23.02.21)

  • Current events surrounding the COVID-19 pandemic are challenging and all public health bodies are placing the safety of patients, staff and communities first in all decisions.
  • This is an evolving situation. This advice is based on current information, it is additional to the advice of the NPHET, the HSE and the DoH, and will be updated as necessary.
  • The NCCP acknowledges that each hospital is working under individual constraints, including staff and infrastructure, and as a result will implement this advice based on their own unique circumstances.
  • The purpose of this advice is to maximise the safety of patients and make the best use of HSE resources, while protecting staff from infection. It will also enable services to match the capacity for cancer care to patient needs if services become limited due to the COVID-19 pandemic.
  • Any clinician seeking to apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to determine any patient's care or treatment.
  • COVID-19 vaccination is now available and is being rolled out to priority groups as agreed nationally. More information on the vaccine and its roll-out is available online from the HSE here:  
  • Information for cancer healthcare professionals on vaccinations for adult patients with cancer is available on the NCCP website at:
  • Receipt of the vaccine (in either healthcare workers or their patients) does not eliminate the need to use appropriate PPE and to adhere to public health advice in relation to COVID-19.


NPHET, HSE and DoH advice

​​​​​Hospitals will operate under the overarching advice of the National Public Health Emergency Team (NPHET), the HSE and the DoH. Information is available at:


  • The purpose of this guidance document is to outline the use of PPE by radiotherapists to avoid cross contamination to patients, healthcare workers and the environment during the COVID-19 pandemic.
  • The use of tracheostomy, mouth bites, immobilisation masks and certain radiotherapy procedures can lead to coughing, spluttering and gagging of the patient. Although these are not necessarily an aerosol generating procedure, in view of the increased droplets and close proximity of the Radiation Therapist to the patient it is deemed that increased precautions should be observed by the therapist at this time.
  • Where a healthcare professional cannot maintain a distance of 2 meters from the patient for example delivering radiotherapy, PPE should be available.

Policy on PPE requirements
  • There are five broad groups of patients receiving radiotherapy during the COVID 19 pandemic requiring different levels of PPE. This is guidance only; there may be individual patients who require PPE over and above the group they would normally fall into.
  • Group 1                Suspected or COVID-19 positive patients or close contacts
  • Group 2                Patients with tracheostomy (considered aerosol generating)
  • Group 3                Patients requiring mouth-bites or DIBH with ABC
  • Group 4                Patients requiring immobilisation masks
  • Group 5                All other patients.

Current recommendations for use of PPE in clinical setting
  • There are two levels of radiation therapist
    • Radiation Therapist (RT) Level 1 - therapist within 2 metres of the patient’s head,
    • Radiation Therapist (RT) Level 2 - therapists greater than 2 meters away from the patient’s head

064 table

* Where there is reduced availability of long sleeved gowns they can be replaced by another option such as a plastic apron in patients not suspected of COVID-19.

** In the context of very high transmission/outbreak, FFP2 masks, goggles and visor should be considered for all patient facing contact. Risk assessment should be considered for all lung patients, RT1 may require FFP mask.

Roles and Responsibilities
  • All therapists should be familiar with the HPSC ‘Current recommendations for the use of Personal Protective Equipment (PPE) for Possible or Confirmed COVID-19 in a pandemic setting’.
  • All staff working under a derogation should consult with occupational health and infection prevention and control.
  • All HSE staff should complete the online HSELanD course on how to don (put on) and how to doff (remove) PPE as soon as possible.
  • Considerations should be given to planning so some therapists do not have direct physical contact with patients.
  • All staff must maintain physical distance of at least 1 metre but ideally 2 metres from individuals with respiratory symptoms where possible.
  • All staff must clean their hands regularly as per WHO 5 moments, avoid touching their face and promote respiratory hygiene and cough etiquette.

There should be hand hygiene between each patient along with changing gloves and apron




Guidance Development Group
  • Dr Aileen Flavin - Consultant Radiation Oncologist,
  • Dr Cormac Small - Consultant Radiation Oncologist,
  • Dr Carol McGibney - Consultant Radiation Oncologist,
  • Dr Clare Faul - Consultant Radiation Oncologist,
  • Dr Caitriona McCarthy – Consultant in Public Health, NCCP,
  • Dr Eve O’Toole - Guideline Lead, NCCP,
  • Ms Ruth Ryan - Programme Manager, NCCP,
  • Ms Louise Murphy - Research Officer, NCCP.

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