1

Caitlin Qualley
University of Wisconsin-La Crosse
DOS 516 – Fundamentals of Radiation Safety

Patient Safety in Radiation Oncology

Patient safety has been recognized as an issue of worldwide importance for over a decade. The
World Health Organization cites as many as 4 in 10 patients are harmed in primary and clinical
settings, and up to 80% of this harm is preventable.1 Radiation oncology is not exempt from
medical events and error. In eleven years of work as a radiation therapist, I have experienced the
growing emphasis on a culture of safety in healthcare. Increased annual safety training,
modifications to quality assurance checks, and development of quality improvement committees
are a few shifts in protocols I have participated in as radiation oncology departments strive to
become safer.

The New York Times published several articles in 2010 which alerted the public to multiple
instances of radiation overdoses. With titles such as As Technology Surges, Radiation
Safeguards Lag and Radiation Offers New Cures, and Ways to Do Harm, readers were informed
that radiation was to be feared.2,3 Whether citing technologist error, staffing shortages, lack of
plan verification, or machine malfunction, the end result was the same: patients had been lethally
overdosed.2,3 The articles ignited public fear, but brought to light the need for change in radiation
oncology practices.

Perhaps in response to the release of these records, Target Safely was launched the same year by
the American Society of Radiation Oncology (ASTRO) as a campaign to reduce the risk of
medical error and improve patient safety.4 This plan included an initiative to hold equipment
vendors to a measured standard, a strategy to strengthen accreditation measures, and provisions
for patient resources to be provided to medical organizations, cancer survivors, and support
groups.4 Two more goals were to incorporate quality and safety content into annual meetings and
support the development of Radiation Oncology Incident Learning System (RO-ILS). The RO-
ILS is a national medical error reporting system and patient safety database.4 Departments across
the nation were charged to employ or modify existing protocols in the name of patient safety.
 2

Radiation oncology departments adopt various ways to encourage a culture of safety. Every team
member is a responsible party when it comes to patient safety. Patient-facing employees such as
front-desk staff, nursing, and radiation therapists are accountable for positively identifying a
patient, verifying their treatment plan, and utilizing the correct equipment for treatment delivery.
Quality assurance on equipment is the job of therapists and the physics team. The dosimetrists
and radiation oncologists work together to create a safe and effective treatment plan which is
reviewed by the physics team as well. Some departments require onboarding and annual safety
training for its employees, and quality improvement committees exist to analyze events and
improve processes. As these are mostly behind-the-scenes actions, it is the responsibility of the
team to ensure patients are aware of the safeguards and processes in place to ease anxiety and
build trust.

A large radiation oncology department which serves over 400 patients each day implemented a
quality and safety culture education program (Q-SCEP) in response to ASTRO’s 2010 campaign.
The aim was to bring awareness to human error and heighten the safety culture.5 The Q-SCEP
curriculum included didactic lectures, meetings, and workshops. The focus of these activities
ranged from human errors to failure modes and root cause analysis. In the span of 5 years, 19
sessions were put on with 100% participation from employees.5 The results of these sessions
show improved staff awareness and knowledge. Post-course survey results also showed
improvement each year and a higher level of retention as time passed. The implementation and
improvement of a department-wide learning initiative proved valuable in clinical practice.5 This
department recognizes the need to evaluate effectiveness and make ongoing improvements.

Encouraging patients to have an active role in safety has been found to contribute to treatment
safety.6 Through observation and interviews of staff at a general hospital and cancer clinic,
different avenues for patient engagement were analyzed. Patient education included sharing the
number of treatments, number of beams, the importance of being still during treatment, and the
encouragement of error reporting. Screening for mental acuity and physical ability were
evaluated on an individual basis prior to participation.6 The idea is that patients having an active
role in their treatment would provide an extra safeguard in accuracy. While this kind of
involvement cannot be mandatory or used in place of departmental practices, it could promote
trust.6
 3

Directed and ongoing practices which encourage an environment of safety for patients are
critical for the advancement of medicine and trust of the public. As technology and healthcare
evolve, so must our practices and policies. Active participation in learning and educating patients
will serve to disseminate worries and fears. Safety should remain a top priority for the betterment
of patients and progression of the radiation oncology field.
 4

References
1. Patient Safety. World Health Organiziation. https://www.who.int/news-room/fact-
sheets/detail/patient-safety. September 13, 2019. Accessed October 27.2021.
2. Bogdanich W. As Technology Surges, Radiation Safeguards Lag. The New York Times.
Published January 26, 2010. Accessed October 27, 2021.
3. Bogdanich W. Radiation Offers New Cures, and Ways to Do Harm. The New York Times.
Published January 23, 2010. Accessed October 27, 2021.
4. Target Safely. ASTRO. https://www.astro.org/Patient-Care-and-Research/Patient-
Safety/Target-Safely. Published September 2015. Accessed October 27, 2021.
5. Woodhouse K, Volz E, Bellerive M, et al. The implementation and assessment of a quality and
safety culture education program in a large radiation oncology department. Practical Radiation
Oncology. 2016; 6(4): e127-e134.
6. Pernet A, Mollo V, Bibault J.-E, Giraud P. Evaluation of patients’ engagement in radiation
therapy safety. Cancer radiothérapie. 2016-12; 20(8): p.765-767