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Stephanie Sanford
Safety Essay
October 7, 2017
Medical Dosimetrists role in Safety in Radiation Oncology
In the rapidly evolving field of Radiation Oncology it is extremely important to ensure
safety procedures and safeguards are in place. Every member of the radiation oncology team
must be aware of the responsibilities and duties that their role conducts. There are many
important safety measures conducted by the medical dosimetrist from accurate and clearly
defined communications with other team members to meticulous chart processing and review.
Safety in Radiation Oncology was called into question when in 2010 a highly
controversial article was published in the New York Times outlining the fatal radiation
overdoses of two patients at two separate institutions. In both of these situations the staff failed
to identify errors in treatment delivery parameters prior to their delivery to the patient. Proper
safety checks were either not in place or ignored by the clinical staff and subsequently patients
lost their lives to these errors. Brining these cases to the public light incited the need for a more
in-depth review of safety practices within the field of radiation oncology.
The American Society for Radiation Oncology (ASTRO) and American Association of
Physicists in Medicine (AAPM) initiative to address these quality and safety concerns was
outlined in a white paper defining the importance of an effective quality management system in
radiation oncology departments.2 In this document, they described in detail all of the necessary
components that should be implemented in all radiation oncology practices to ensure the safety
of the patient.
One of the key components of the program as outlined in this paper is the implementation
of a regular prospective peer review process. This practice should not be limited to the
physicians only but also include all clinical staff involved in the patients care. The authors
outline the need for peer review amongst medical dosimetrist to review items such as beam
orientation and weighting as well as evaluation of target coverage and normal tissue sparing. 2
While peer review is important so is quality assurance practices. Some of the QA duties
a medical dosimetrist is involved in include, verifying the accuracy and appropriateness of target
volumes and normal critical tissues, reviewing dose fractionation techniques as well as
dosimetric constraints. These also include verifying beam designs, dose calculation parameters
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and careful evaluation of the plan in that it adequately meets objectives outlined in the planning
directive. At completion of the patients course of treatment the dosimetrist can also be involved
in the retrospective auditing of the patients chart for completeness and accuracy, which may
include review of the physicians summary document.2
In a 2016 study of peer review data collected in a three month window the researchers
found that in the 3.3% of charts with recommended changes over 40% of these variations needed
major planning changes requiring repeat planning or having had a major effect on planning or
clinical outcomes, and in some cases, both.3 Peer review of treatment plans in these cases had a
significant impact by directly affecting the quality of care given to the patient in identifying
important clinical and planning changes needed.3
Another import element of insuring safe practices in radiation oncology is the
implementation of an Incident Reporting System (IRS). ASTRO has teamed up with the AAPM
to create a nationwide reporting system to help improve the quality of care given and reduce
harm to the patient.4 Active participation by all members of the radiation oncology team is
critical for not only identifying when things went wrong what happened but also to identify near
miss incidents and areas for potential safety concern. This may also include participation in the
departmental safety committee for review of these reported incidents and near misses to improve
workflows and put in place safeguards to reduce the likelihood of these errors occurring in the
future.
It is also the responsibility of the medical dosimetrist to maintain current certification as
well as state licensure where applicable. These credentialing bodies require that ongoing
education is obtained and tracked through continuing education credits. Maintaining a current
knowledge of the technological changes and advancements is vital for implementation into
clinical practice.2
Standardization of workflows and processes completed by the medical dosimetrist can
significantly improve both efficiency and accuracy of the critical tasks being performed. Use of
multiple methods to complete duties can lead to confusion and subsequently to errors. A review
committee should be consulted to advise on best practice and this practice should then be
implemented by all team members.2 Use of tools such as quality checklists can also ensure that
steps are consistently taken and in the same order to reduce the likelihood of errors. Utilizing
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lean approaches to reduce unnecessary steps that increase the opportunity for errors to occur also
helps to streamline clinical workflows.5
While this has not been an exhaustive review of the role of the medical dosimetrist in
ensuring safety in radiation oncology it has outlined many of the important items detailed in the
ASTRO document Safety is no Accident. Being vigilant to adhere to safety protocols and
procedures put in place will reduce the probability of errors occurring and protect the patient
from potential harm.
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References
1. Bogdanich W. Radiation Offers New Cures, and Ways to Do Harm. New York Times.
January 23, 2010.
http://www.nytimes.com/2010/01/24/health/24radiation.html?mcubz=0. Accessed
October 7, 2017.
2. ASTRO. Safety is no accident: A framework for quality radiation oncology and care.
https://www.astro.org/uploadedFiles/Main_Site/Clinical_Practice/Patient_Safety/Blue_B
ook/SafetyisnoAccident.pdf. Accessed October 7, 2017.
3. Rouette J, Gutierrez E, ODonnell J, et al. Directly Improving the Quality of Radiation
Treatment Through Peer Review: A Cross-sectional Analysis of Cancer Centers Across
a Provincial Cancer Program. Int J Radiat Oncol Biol Phys. 2016;98(3):521-529.
http://dx.doi.org/ 10.1016/j.ijrobp.2016.10.017.
4. RO-ILS Background. ASTRO website. https://www.astro.org/RO-ILS-Background.aspx.
Accessed October 7, 2017.
5. Marks LB, Jackson M, Xie L, et al. The challenge of maximizing safety in radiation
oncology. Pract Radiat Oncol. 2011;1:2-14. http://dx.doi.org
http://dx.doi.org/10.1016/j.prro.2010.10.001.