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Kelli Braith
University of Wisconsin – La Crosse
DOS 516 – Fundamentals of Radiation Safety
December 6, 2023
Radiation Safety
Radiation is a useful tool when treating cancer. Most commonly the public remembers
negative incidences of overdosing patients or other catastrophic events that have occurred that
have involved radiation. Although errors can occur, the increased precision and accuracy of
radiation has decreased these events. Media has reported on these cases and events, which has
caused worry about radiation exposure. Radiation safety is at the forefront of treatment plans. It
is important to understand the safety measures taken to keep all safe, including quality assurance
needs, individuals advocating for safety, and overall ways to improve patient safety in radiation
oncology.
The increasing complexity of radiation therapy planning and delivery challenges
traditional quality assurance programs that ensure safety and reliability of treatment planning and
delivery systems. Quality management (QM) guidelines have been published by American
Association of Physicists in Medicine (AAPM), European Association of Physicists in Medicine
(ESTRO), and International Atomic Energy Agency (IAEA). The guidelines focus on monitoring
functional performance of radiotherapy equipment by measurable parameters of equipment by
measurable parameters. The equipment has tolerances that are strict but achievable. 1 The
guidelines increase the safety of the radiation treatment plans. The guidelines also reduce human
errors as the radiation plan must pass these tests performed by equipment.
The modern equipment has dramatically increased the number of tests and measurements
that can be taken. There has been a need to prioritize QM activities in a way that balances
achievability and optimally benefits the patients. An understanding of errors over the course of
treatment and the impact it can have on the clinic is needed to direct the resources in a way to
maximize quality of care.1 The tests are designed to ensure safety by having a strike set of
parameters, but also allows for achievement. The resources needed to maximize safety can be
low due to staffing issues. It is vital that plans are generated to pass the measurements, if they do
not pass, staff will address them to ensure safety and quality.
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The radiation safety officer (RSO) is responsible for achieving and maintaining a safe
workplace environment that practices the principle of as low as reasonably achievable
(ALARA). The concept closely scrutinizes past and anticipated future exposures to ensure that
benefit is maximized, and risk is minimized. ALARA focuses on maintaining radiation doses as
low as reasonably achievable, and ensuring regulatory limits are not exceeded. The RSO
develops and enacts a variety of programs for the reason of training, dosimetry, surveys,
inspections, and standard operating procedures. The programs are focused on assessment and
control of radiation exposure to employees and the public.2
The RSO role is focused on safety within the department. The RSO has a unique
mission- maintaining radiation doses ALARA. This allows for a unique perspective other than
the physician who orders additional imaging, the technologist who performs the imaging study,
or the medical physicist that ensures the equipment is functioning properly. The RSO will not
question imaging that is ordered but is required to have a broad knowledge of radiation effects
and an in-depth appreciation of the ALARA principles. The knowledge of ALARA is a resource
to increase patient safety.2 The RSO has many responsibilities to ensure safety for staff and
patients is achieved.
In the early 1990s articles began to appear describing the occurrence of medical mistakes
the put patients at risk. Soon after that, reports surfaced in the media about medical errors that
caused death or severe disability to patients. In response to these reports, an international
conference was held in 1993 to examine the causes and consequences of severe errors in
medicine. Errors are known to happen in radiation oncology. The treatment of cancer patients
with radiation is complicated for many reasons. The reasons include: the complexity of the
disease, the sophistication of the technologies employed, the intricacies of communication
among members of the team, and most likely foremost, the involvement of humans throughout
the treatment regimen. As discussed previously, for the reasons of human involvement, the
practice of radiation oncology includes several quality control steps designed to detect and
correct mistakes and equipment failures before impacting the well- being of patients. 3
Addressing the problem in Radiation Oncology was discussed at the meeting entitled
“Safety in Radiation Therapy: A Call to Action,” was sponsored by AAPM and the American
Society of Radiation Oncology (ASTRO). The intent of the meeting was to convene experts from
within and outside of radiation therapy to identify the causes of mistakes and equipment failures
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to make radiation therapy safer for patients. ASTRO responded to the challenge of improving
quality and reducing errors in radiation oncology by developing a six-point action plan to
improve the safety of patients receiving radiation therapy. The ASTRO six-point action plan
include: creation of an anonymous national database for event reporting; enhance education and
accelerate the ASTRO/ACR Practice Accreditation Program; expand education and training
programs to include intensive focus on quality and safety; develop tools for cancer patients to
use in discussions with radiation oncologists; accelerate development of IHE-RO (Integrated
Health Enterprise- Radiation Oncology) program; advocate for passage of the CARE
(Consistency, Accountability, Responsibility, Excellence in Medical Imaging and Radiation
Therapy) act.3 Implementing this plan ensured the safety of radiation therapy patients. The plan
assists with focusing on training to ensure that staff are educated in quality and safety.
The radiation oncology field has increased the focus on quality and safety. The use of
more strict quality measurements increases the safety of radiation therapy treatment plans. The
increased quality assurance checks ensure that the treatment plan is safe for the patients. The
RSO enforces and ensures that radiation oncology staff are acting in a safe and appropriate
manner. The RSO heightens the importance of using radiation in the safest way. The six-point
plan set by ASTRO sets guidelines for clinics to have a culture that focuses on safety. Currently,
the abundance of safety and quality checks has made radiation a safe option when needed to
combat cancer and other life-threatening diseases.
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References:
1. Huq MS, Fraass BA, Dunscombe PB, et al. A Method for Evaluating Quality Assurance
Needs in Radiation Therapy. International Journal of Radiation
Oncology*Biology*Physics. 2008;71(1, Supplement):S170-S173.
doi:https://doi.org/10.1016/j.ijrobp.2007.06.081
2. Morgan TL. The Radiation Safety Officer as an Advocate for Patient Safety. Health
Physics. Published online July 2019:1. doi:https://doi.org/10.1097/hp.0000000000001128
3. Hendee WR, Herman MG. Improving patient safety in radiation oncology. Medical
Physics. 2010;38(1):78-82. doi:https://doi.org/10.1118/1.3522875