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The True Cost of a Cure

Sydney I. Raver

University of Wisconsin, La Crosse

DOS 516 Fundamentals of Radiation Safety

12/6/2022
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“In modern medicine, radiology plays an important role. Even though the benefits of
medical exposures prevail over the radiation risks, there are concerns connected to the unwanted
biological effects of ionizing radiation.”1 Today’s healthcare facilities are filled with different
types of complex machinery responsible for the diagnosis, prevention, and therapy of various
diseases. Access to this equipment has allowed tremendous growth in public health and
medicine’s ultimate goal to decrease morbidity and mortality of the population and elongate a
patient’s life. These machines however come with risks. They are operated with the use of
ionizing radiation and because of that, can have negative views alongside their many benefits.
This leads to a lower level of knowledge about radiation protection in practice and society.

So what is ionizing radiation and why is it a public health concern? “Public health is
defined as “the art and science of preventing disease, prolonging life and promoting health
through the organized efforts of society” implying the involvement in all areas that may have any
impact on human health.”1 Everyday radiation exposure by the use of medical equipment is
growing. In just a short period, medical radiation use is now at nearly half of all radiation
exposure due to constant research and means to better treat patients. Although beneficial for
treatment, ionizing radiation when interacting with cell DNA can cause irretrievable cell damage.
“The mechanisms of ionizing radiation are very complicated and consist of physical, chemical,
and biological processes that cause the final radiobiological effect.”1 There are deterministic
effects that appear immediately following a certain dose exposure and stochastic effects that
increase the probability of a negative outcome later on. The increase of cumulative dose to the
population leads public health on a mission to systematically lower the negative outcomes by
increasing education about radiation and its limitations for the betterment of radiation safety.

Several recommendations and set dose limits have been established by legislation. When
it comes to ionizing radiation, the most important principle in practice is the “as low as
reasonably achievable” (ALARA) principle which ensures only the most necessary usage. Public
health looks closer at the public knowledge about radiobiology considering its constant growth in
medicine. Knowledge is powerful as it has a direct impact on implementing safety measures and
ensuring the protection of the general public. A study known as the Hagi study focused on
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evaluating medical students and their radiation knowledge. Students completed a questionnaire
both before and after a single presentation on the subject. “The results of the study confirmed
that as little as one presentation can help improve the knowledge about general principles
considering ionizing radiation and radiation safety.”1 It is essential that the training and education
of both healthcare workers and the surrounding public keep pace with new trends. The goal of
public health is the safety, support, and development of the population’s well-being. The basic
components of good medical practice accompany this. Set standards and norms have been in
place but public health professionals must have an active attitude toward the issue to minimize
unnecessary fear.

Because the use of radiation for treatment and diagnosis is so necessary, safety is even
more important to prevent any errors. Utilizing the proper focus and resources ensures that
patients receive the maximum benefits possible. Quality control is a measurement of how
radiation can be prepared and delivered and it can uncover specific inaccuracies that may occur.
The importance of organizing such safe efforts has led to Congressional hearings and testimonies
before the Food and Drug Administration. “Approximately 50% of cancer patients receive
radiation throughout the course of their cancer treatment. Although the vast majority of these
treatments are safe and effective, errors (0.4%) when they do occur can have serious
consequences.”2 A substantial safety infrastructure has been developed for appropriate delivery.
The airline industry is the gold standard for demonstrating how to safely operate high-risk,
advanced technology. Many of their methods for doing so can be used in the radiation oncology
world. A national reporting system provides definitions of errors and near misses to better
understand any patterns of wrongdoing. “Given the high dependence on computer-based systems
and the technical and potentially systematic nature of treatment, this approach is appropriate.”2

Prospective and retrospective risk identification strategies inform and guide safety efforts
in the radiation oncology department. FMEA or failure mode and effects analysis is a proactive
risk assessment that seeks to identify hazards in the 270-step treatment process before patients
ever arrive. Possible errors include incorrect information, setup, plan, positioning, and more.2
Briefly mentioned prior was the national error reporting system. “Unlike FMEA, error reporting
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systems collect information on errors that have already occurred.”2 This method has been a
cornerstone in the airline industry. The approach captures incidents in real-time to understand
how change and workflow can truly affect patient safety. The successful and safe use of radiation
is an ongoing cooperation between radiation protection, public health, and occupational health.
Due to the many laws, orders, educational programs, and strategies in place, radiation onclogy
departments have many steps they take to ensure patients are safe and the general safety of the
public is of no worry.
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Bibliography

1. Bárdyová Z, Horváthová M, Pinčáková K, Budošová D. The importance of public health

in Radiology and Radiation Protection. Journal of Public Health Research. 2021;10(3).
doi:10.4081/jphr.2021.2141
2. Terezakis SA, Pronovost P, Harris K, DeWeese T, Ford E. Safety strategies in an
academic radiation oncology department and recommendations for action. The Joint
Commission Journal on Quality and Patient Safety. 2011;37(7):291-299.
doi:10.1016/s1553-7250(11)37037-7