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Kristen Dezell
University of Wisconsin - La Crosse
DOS 516 - Fundamentals of Radiation Safety
October 28, 2021
Radiation Safety

Radiation plays an important and effective role in the treatment of cancer, both curatively
and palliatively. However, the administration of radiation requires a high degree of precision
and accuracy for proper delivery, and there is always potential for error and misadministration.
In the past, there have been incidences of overdosing patients with radiation, occasionally
leading to death. This has caused the general public to become worried about radiation
exposure, but there have been many improvements to radiation safety throughout the past few
decades. When reviewing radiotherapy incidents and overall public safety, it is important to
keep in mind regulatory radiation dose limits, how radiation exposure is monitored, and
additional steps taken by radiation therapy departments to consistently review and improve
patient safety.

Radiation dose limits were recognized soon after the discovery of x-rays in 1895.
Initially, limits were created based on the dose and time required to produce erythema, or skin
reddening. By 1902, dose limits were set to 10 rad per day (3000 rad per year) based on the
lowest amount of observable exposure that fogged a photographic plate.1 Studies around this
time also showed that x-rays could produce cancer and that certain organs were more vulnerable
to radiation damage than others, especially the skin, blood forming organs, and reproductive
organs.

The first official standard for radiation protection was developed in 1934 by the U.S.
Advisory Committee on X-ray and Radium Protection (now called the National Council on
Radiation Protection and Measurements, NCRP), and dose limits were reduced further
throughout the next few decades. In the 1940’s, radium was ingested by workers painting dials
on watches, and this led to many unfortunate deaths and public fear of radiation. Furthermore,
following World War II and the atomic bomb in Japan, one study thought there were radiation-
induced genetic effects based on the ratio of males to females born to atomic bomb survivors.
Patient Safety 2

This led to even more public fear, but it also led to the first standards for annual dose limits to
the public at 500 mrem (5 mSv) per year by the NCRP in 1957.1 Though this particular study
was later proven to be incorrect, the risk of developing cancers such as leukemia and solid
tumors from radiation exposure became evident. These findings brought about even lower dose
limits that were adopted by the International Commission on Radiological Protection (ICRP) and
NCRP.

Despite the atomic bomb survivor study being wrong, a lot of public fear remains from
that initial publication and from the risk of developing cancer. The ICRP decided to focus on
justification for radiation use, optimization to keep dose “as low as reasonably achievable”
(ALARA), and limitation to not exceed dose limits occupationally or to the general public.1 In
1993, the NCRP Report No. 116 recommended official dose limits still in use today to reduce
stochastic and deterministic effects of radiation. Currently, the public annual tolerance is set to 1
mSv effective dose for continuous or frequent exposure; 5 mSv effective dose for infrequent
exposure; 15 mSv to the lens of the eye to reduce the risk of cataracts; and 50 mSv to the skin,
hands, and feet. Also, a maximum of 0.5 mSv monthly to an embryo or fetus is recommended.2

The NCRP Report No. 116 has set limitations for radiation exposure, and this is further
monitored through federal quality assurance (QA) protocols. The risk of error is high in
radiation oncology, as treatment requires very detailed measurements and calculations,
knowledge of the body and each organ’s response to radiation, setup accuracy, and
communication to many modalities that requires data transfer between machines and computer
systems.4 QA protocols effectively help to reduce human errors and radiation accidents.

The World Health Organization (WHO) similarly stresses the importance of employee
training, good communication, and strict adherence to regulations and protocols to ensure patient
safety in radiation oncology. While new treatment technology has been intended to reduce
treatment errors, it can also lead to new sources of human error through lack of training or proper
use of the new technology. A study completed from 1976 - 2007 found that the highest number
of deaths and over- or under-dosing of patients resulted within the planning stage of radiation
oncology, from using wrong decay charts, software programming errors, incorrect data entry,
etc.4 From this study, the Radiotherapy Risk Profile (a WHO Alliance for Patient Safety) started
safety projects to review reported incidents and make suggestions for improvement, such as peer
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review processes and feedback, competency certifications, record and verify systems, and
independent audits.4

Along with the Radiotherapy Risk Profile, each healthcare organization using radiation
has a medical Radiation Safety Officer (RSO) that is responsible for evaluating past and potential
future exposures, maintaining ALARA, and ensuring federal regulation limits are not exceeded.3
The RSO plays a very important role in influencing patient safety. They advocate for effective
policies, education, and collaboration between medical physicists and physicians to minimize
radiation risk to the public and occupational workers.3

While the RSO is constantly reviewing procedures and looking for ways to further
maintain the concept of ALARA, radiation therapy departments must take additional steps to
ensure public safety and help reduce the general fear of radiation. Radiation therapists complete
continued education through the American Registry of Radiologic Technologists (ARRT) along
with annual workplace training to maintain treatment competencies. Overall, communication
and speaking up when in doubt are key to improving safety and helping the general public feel
safe and less worried about radiation. The radiation therapist can give a patient a sense of
confidence through their own knowledge of radiation safety, and it is important to continue
educating the public that radiation is used only when it is justified, optimized, and limited.
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References:

1. Inkret WC, Taschner JC, and Meinhold CB. Radiation and risk: a hard look at the data, a
brief history of radiation. Los Alamos Science. 1995;23:116-123. https://lib-
www.lanl.gov/cgi-bin/getfile?00326631.pdf. Accessed October 24, 2021.
2. Limitation of Exposure to Ionizing Radiation: Recommendations of the National Council
on Radiation Protection and Measurements NCRP Report No. 116. Bethesda, MD:
National Council on Radiation Protection and Measurements; 1993. NIH Publication 13.
54-56. https://archive.org/details/limitationofexpo00nati/page/n5/mode/2up. Accessed
October 25, 2021.
3. Morgan TL. The Radiation Safety Officer as an Advocate for Patient Safety. Health
Physics. 2020;118(1):75-78. doi: 10.1097/HP.0000000000001128. Accessed October 24,
2021.
4. Shafiq J, Barton M, Noble D, Lemer C, Donaldson LJ. An international review of patient
safety measures in radiotherapy practice [published correction appears in Radiother
Oncol. 2009 Dec;93(3):657]. Radiother Oncol. 2009;92(1):15-21.
doi:10.1016/j.radonc.2009.03.007. Accessed October 24, 2021.