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Laura O’Connor
University of Wisconsin – La Crosse
DOS 516 – Fundamentals of Radiation Safety
December 10, 2023
Radiation Safety

The invention of the x-ray occurred over 100 years ago in 1895 by Wilhem Conrad
Roentgen and was marked by an iconic x-ray of his wife’s hand. Around this same time other
scientists such as Henri Becquerel and Marie Curie came about the discovery of naturally
occurring radiation from mineral sources. The years following these initial discoveries were
marked with excitement as research continued and they were eventually able to diagnose and
treat a variety of ailments in patients unlike ever before. With widespread use of radiation beams
and sources without any safety measures, eventually injuries began to arise. Radiation causes
damage at the cellular level therefore it can take time for conditions to present themselves, so it
was hard to pinpoint the exact cause of injury at first. It soon became evident that radiation had
promising benefits in the medical field, but there was risk involved, which stands true today. 1

The use of radiation in the medical field has come a long way since 1895 to say the least.
Radiation therapy today plays a crucial role in curative cancer treatments as well as palliation
and symptom control in advanced cases.2 Numerous advances in technology have allowed
radiation to better target tumors while sparing surrounding healthy tissues, thus making it safer
for patients with less side effects. Advances such as three-dimensional computed tomography-
based planning, multi-leaf collimation, and intensity modulation techniques, have allowed
treatment plans to be highly conformal. To ensure that these conformal treatment plans are
delivered with precision and increased safety, image-guided radiation therapy (IGRT) has been
developed and helps ensure the patient is optimally positioned prior to delivering any radiation. 3
Cancer is a complex disease and the technology used to treat it is highly sophisticated, requiring
a large team of experts to plan and safely deliver radiation treatments. Modern-day radiation
techniques have benefited patient outcomes and propelled the development of centers across the
nation and world. It is estimated that the number of linear accelerators in the United States went
from less than 500 to over 4000 from 1975-2009.2 When technology and patient volume is
evolving this rapidly, the risk of error inevitably increases.
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In 2010 a series of New York Times articles came out describing “accidents” in radiation
therapy leading to patient’s losing their lives or being severely handicapped from radiation
treatments. This article heightened the already existing fears that patients and the public often
have surrounding radiation. To lessen the fears and ensure safety in radiation oncology going
forward, a meeting was held titled “Safety in Radiation Therapy: A Call to Action,” and was
sponsored by the American Association of Physicists in Medicine (AAPM) and the American
Society of Radiation Oncology (ASTRO). Nearly 400 individuals from all areas of expertise
were in attendance. It was recognized that radiation oncology is complex and there is potential
for error in many forms, including technology malfunction, misunderstandings between team
members, or simply human error. Knowing where errors originate helps to focus efforts so that
mistakes can be caught before reaching the patient. The meeting determined several
recommendations aiming to improve quality control and reduce errors in radiation oncology.
Some notable recommendations included implementation of error reporting systems, keeping to
recommended staffing levels, timely assistance from vendors when issues arise, and
simplification of the operator’s interface.2

When determining the best customized treatment plan for a patient that involves radiation
therapy, the risk associated with radiation exposure needs to be justified and properly explained.
When a patient is part of the decision-making process for their treatment and is educated on the
risks and benefits at stake, it can help to calm their fears. A code of federal regulations also
ensures that all personnel will be following the principle of ALARA, As Low as Reasonably
Achievable, which ensures all measures to reduce unnecessary exposure will be taken.4 Radiation
therapy departments administer high doses of radiation and therefore need to prioritize safety and
ALARA principles. Quality assurance programs have been developed by national and
international organizations for radiation oncology departments. Strategies included in quality
assurance include weekly peer review conferences, quality assurance measures on the machines
to catch any miscalibration or misalignment of the beam, radiation dose checks via radiation
detectors and the use of x-rays or cone-beam CT to verify patient position daily.5

The precision and benefits that radiation therapy offers patients today is exceptional. By
realizing how far the field has come and being aware of the collaborative efforts of the entire
radiation oncology team to mitigate errors, patients can rest easy knowing their safety is a top
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priority. A patient can trust the medical team best when they are well informed and part of the
decision-making process for their treatment. Safety in radiation oncology is important to the
entire team, as highlighted at the “Safety in Radiation Therapy: A Call to Action” meeting 4. By
adhering to the ALARA principles, following strict quality control procedures, having an error
tracking system in place, and keeping up with the rapidly changing technology, allows optimal
safety in radiation oncology. The future of radiation therapy is exciting and by keeping radiation
safety at the forefront of everyone’s minds will allow for optimal treatment outcomes for
patients.
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References:

1. Donya M, Radford M, ElGuindy A, Firmin D, Yacoub MH. Radiation in medicine: Origins,

risks and aspirations. Glob Cardiol Sci Pract. 2014;2014(4):437-448. Published 2014 Dec
31. doi:10.5339/gcsp.2014.57
2. Magrini SM, Pasinetti N, Belgioia L, et al. Applying radiation protection and safety in
radiotherapy. La radiologia medica. 2019;124(8):777-782. https://doi.org/10.1007/s11547-
019-01043-7
3 Hendee WR, Herman MG. Improving patient safety in radiation oncology. Medical Physics.
2010;38(1):78-82. https://doi.org/10.1118/1.3522875
4 Frane N, Bitterman A. Radiation Safety and Protection. [Updated 2023 May 22]. In:
StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK557499/
5 Terezakis SA, Pronovost P, Harris K, Deweese T, Ford E. Safety strategies in an academic
radiation oncology department and recommendations for action. Jt Comm J Qual Patient Saf.
2011;37(7):291-299. doi:10.1016/s1553-7250(11)37037-7‌