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Daijajuan Alexander
DOS 516 – Fundamentals of Radiation Safety
October 29, 2020
Radiation Safety
Cancer is a disease that affects all ages and continues to be a problem around the world.
Cancer can be treated with surgery, chemotherapy, radiation, or a combination of all three. As
with any procedure, there are associated risk that come with the benefit. Depending on the
treatment modality chosen, there will be a team of staff looking over the patient. For radiation
therapy, the patient would have a multidisciplinary team, consisting of a radiation oncologist,
dosimetrist, physicist, and at least two radiation therapists. With all these people working
together, to get the patient through treatment, there is opportunity for error.
Over the last three decades, advances in radiation have caused a rapid growth of the clinical
practice. With the integration of computer hardware and software applications the complexity of
radiation therapy delivery has increased. There has been a transition from analog (manually
setting treatment parameters) to digital (preprogrammed parameters) which has changed the
education of radiation therapists and the execution and assessment of their work.1 Treatment
facilities are equipped with state of the art linear accelerator systems, Proton therapy
accelerators, and super computers; that allow the delivery of treatment techniques such as SBRT,
IMRT, VMAT, and Proton IMRT.2 With the treatment process requiring the interaction between
many groups, and working with complex technology, there is always the possibility of error.
Although, some errors can be a matter of life and death, these events serve as learning
opportunities to improve patient safety and prevent future mishaps.
In 2010, Bogdanich published an article in the New York Times about the harm that can
result when safety rules are violated and ever more powerful and technologically complex
machines go awry.3 He describes cases from across the country of patients who were treated
incorrectly, or overdosed, leading to further complications or death. With improvements in
technology, radiation therapists are granted better precision in targeting tumors while sparing
normal tissue. This benefit, combined with fewer fractions per patient, and an increased
radiation dose per fraction, give opportunity for incident severity to increase. Errors can occur
because of improperly installed or calibrated equipment, the wrong site being treated, or the
wrong patient being selected. Bogdanich would publish a string of these articles highlighting
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accidents in radiation therapy, and capture the attention of the public, professionals in radiation
oncology, federal agencies, and the U.S. Congress.
In June 2010, the American Association of Physicists in Medicine (AAPM) and the
American Society of Radiation Oncology (ASTRO) would sponsor a meeting entitled “Safety in
Radiation Therapy: A Call to Action.” The meeting would attract over 400 attendees, to address
issues regarding patient safety in radiation oncology. The meeting would help identify the
causes behind mistakes and how to address equipment concerns. As a result of the meeting, it
was determined that members of the treatment team, vendors, administrators, and regulators
must all work together to simplify the delivery of radiation and reduce the number of mistakes.
The organizations involved would propose 20 recommendations that provide a pathway to
reducing errors and improving patient safety in radiation therapy facilities everywhere.
In their 2011 paper, Hendee and Herman described the 20 recommendations to reduce errors
and improve patient safety. Many recommendations deal with making workstations clutter free,
having access to information on demand, limiting distractions when treating, implementing fail
safe systems, and creating standard operating procedures (SOPs) for employees. To ensure the
safety of patients, radiation oncology staff must work together to properly relay relevant
information about the patient. Having protocols in place such as identifying the patient prior to
treatment, having two therapist present in order to beam on, and notifying a physicist whenever
concerns to treatment arise, will help to ensure patient safety. The major conclusions from the
meeting are that leaders in the workplace must emphasize safety, patient safety is everyone’s
responsibility, and that the entire team must work collaboratively.4
No matter how hard one tries, it is impossible to be eliminate errors in radiation oncology.
Errors can occur because of the complex treatment planning systems, and therapist inability to
verify treatments are delivered as intended. There is always the possibility for human error, with
the chance for miscommunication or miscalculation. Our growing dependence on computers
also contributes to these errors with the possibility for malfunction. Today the chance for error
has been reduced. Systems are now designed to catch, and even correct errors before they can
harm the patient. Interlock systems exist that make sure correct treatment devices are in place,
the correct patient is identified, and the correct dose is delivered.
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References
1. Adams R. Using Human Factors Engineering and Lean to Increase Patient Safety in
Radiation Oncology. Radiation Therapist. 2019;28(2):143-157. Accessed October 30,
2020. https://search-ebscohost-com.libweb.uwlax.edu/login.aspx?
direct=true&AuthType=ip,uid&db=rzh&AN=139544954&site=ehost-live&scope=site
2. Joshi CP. Patient safety in an environment of rapidly advancing technology in radiation
therapy. J Med Phys. 2014;39(2):61-63. doi:10.4103/0971-6203.131276
3. Bogdanich W. Case Studies: When Medical Radiation Goes Awry. The New York
Times. 2010.
4. Hendee WR, Herman MG. Improving patient safety in radiation oncology. Med Phys.
2011;38(1):78-82. doi:10.1118/1.3522875