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Jenna Payne
DOS 516 Fundamentals of Radiation Safety
December 4, 2023
Maintaining Safety in Radiation Oncology

Advancements in technology and scientific research have continuously led to the

increased utilization of Radiation Therapy (RT) in healthcare. In fact, more than half of all cancer
patients are likely to receive some form of radiation treatment during their illness. 1,2 Unlike other
healthcare modalities involving ionizing radiation, the goal of RT is to deliver exceptionally high
doses of radiation to specific areas of the body. This is a heavily regulated field with historically
low incident rates when compared to the large number of treatments delivered annually.
However, there have been cases of RT errors, or medical events, that were investigated and
highly publicized.2 Understandably, these past errors with devasting results and the expanding
use of radiation in healthcare, have both contributed to public concern regarding patient safety. It
is imperative that the public is informed and updated about the changes to the systems in place,
the increased dedication to patient safety culture throughout the years, and the role that patients
may take to ensure the safety of everyone involved within this high-risk discipline. These
actions, as well as adherence to regulations and quality assurance measures, can ease the worries
that have developed surrounding the topic of medical radiation.
Healthcare safety has advanced by moving away from traditional approaches that center
only on the healthcare personnel (HCP) involved in incidences. This led to blame being placed,
retraining of only one or a few staff members, and instilled a disagreeable reporting environment.
Instead, healthcare has begun transitioning to a human factors and systems engineering model
that has been effectively utilized in other industries, such as transportation and aviation. In this
approach, healthcare systems are proactively designed to accomplish a common goal of
providing safe and high-quality care to patients. For a RT department, the system includes staff
members, their knowledge, equipment used, patients, management, policies, procedures, and
more. Focusing on human factors, such as behaviors, abilities, and limitations as well as the
other system characteristics, provides an environment that is comfortable, productive, and
effective for human use. This design creates a better fit to the people within, which is key,
because the path to patient safety runs through HCP. Improvements in patient safety are
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established because the system can proactively identify issues, adapt as needed, highlight why
problems may exist, and promote better teamwork and communication. Also, by ridding of the
blame method, participation in event reporting and developing solutions is increased.
Implementing a successful human factors and systems engineering strategy can decrease the
probability of errors and stress while leading to increased productivity, job satisfaction, and most
importantly, patient safety.3
The topic of radiation’s biologic effects and risks to those exposed has been extensively
researched since its discovery and is a primary reason that patient safety culture has become a
vital component of RT operations.2 Many advisory organizations, such as the International
Commission on Radiation Protection and the National Council on Radiation Protection and
Measurements, publish regularly updated recommendations on the safe use of radiation and
radioactive materials. The Nuclear Regulatory Commission (NRC) is a federal authority that,
along with agreement states, regulates radioactive materials, byproducts, and incident reporting.
The NRC requires a Radiation Safety Officer be named to implement a facility’s radiation safety
program. The program must include a Radiation Safety Committee to oversee it, multiple quality
assurance (QA) assessments on equipment and treatment plans, and the reporting of medical
events.4 These regulations verify that staff is adequately trained, and accurate radiation doses are
being delivered appropriately through constant checks and balances performed by HCP.
An organization that is filled with individual and group beliefs, values, and attitudes
centered around a commitment to safety management creates a patient safety culture within. The
Agency for Healthcare Research and Quality developed the Hospital Survey on Patient Safety
Culture and distributed it to RT departments worldwide. This survey aimed to examine factors
that influence safety culture, identify areas working well and needing improvement, and to
investigate knowledge of and commitment to safety among frontline RT staff. The results of the
study showed, in general, a positive response to the 12 dimensions of safety culture presented.
Teamwork within units, organizational learning-continuous improvement, and feedback and
communication about errors, were all identified as areas of strength. The study named 8 of the 12
dimensions as areas for improvement, and handoff /transitions as the only weakness to be
corrected. Encouraging patient safety culture to RT staff has been an important factor in reducing
adverse events.2
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An additional approach to subside patient fears is to offer education and allow patient
engagement when possible. In RT specifically, there are many instances of patients not speaking
up when they notice differences in their treatments. This does not necessarily represent an error
but could have the possibility of preventing one. A study that evaluated how RT patients’
engagement can contribute to safety, through interviews and observation of adverse events,
found that positioning and identification errors represented most of the 192 events reported (55%
and 22% respectively). Patients that are empowered to engage in their own care are more likely
to ask questions and inform staff of error detection. This also encourages a more trusting
relationship to form in a field likely to cause high levels of patient anxiety. Radiation staff is
practiced in informing patients about their treatments and safety, such as number of fractions and
treatment beams, the importance of holding still, typical side effects, breathing instruction,
reasoning behind specific positioning, and more. This type of education is a crucial step because
patients that can comprehend the reasoning behind actions taken are less likely to become a
source of error themselves.1
There have been and continue to be many changes to the field of RT that, coupled with
news of unfortunate events, have caused a public unease surrounding radiation use. However, the
safety of patients has remained a top priority through it all. The recommendations and
regulations set forth by radiation governing and advising agencies establish a high standard for
quality and safety within RT departments.4 Also, the knowledge that RT staff and facilities evolve
with these changes through trainings, continuing education, additional QA measures, and system
adaptations, can offer comfort to patients needing radiation treatments. Finally, taking the time to
answer questions, educating patients and their families, and listening to concerns throughout the
RT process will help patients feel empowered, build trust, and reduce fears.
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References:
1. Pernet A, Mollo V, Bibault J-E, Giraud P. Evaluation of patients’ engagement in radiation
therapy safety. Can/Rad. 2016;20(8): 765-767. doi:10.1016/j.canrad.2016.02.010
2. Leonard S, O’Donovan A. Measuring safety culture: application of the hospital survey on
patient safety culture to radiation therapy departments worldwide. PRRO. 2018;8(1):17-26.
doi:10.1016/j.prro.2017.08.005
3. Joy Rivera A, Karsh B-T. Human factors and systems engineering approach to patient safety
for radiotherapy. IJROBP. 2008;71(1):174-177. doi:10.1016/j.ijrobp.2007.06.088
4. Murshed H. Radiation Protection and Safety. Fundamentals of Radiation Oncology: Physical,
Biological, and Clinical Aspects. 3rd ed. Academic Press; 2019:chap 2. Accessed December
6, 2023. https://www.sciencedirect.com/science/article/pii/B9780128141281000027