Haley Kroeplin 1

DOS 516 – Fundamentals of Radiation Safety

Radiation Safety Paper

In 2010, the New York Times article entitled “Radiation Offers New Cures, and Ways to
Do Harm,” was the first of several publications in the United States, highlighting the medical
errors in radiation oncology in which patients suffered fatal injuries and debilitating side effects.
These publications led the general public to question the safety of patients during radiation
therapy treatments and provoked fears that they may too be overexposed, if they were to be
among the 50% of cancer patients who are prescribed radiotherapy for the management of their
disease each year.1 Similarly, these reports about the unfortunate events grabbed the attention of
federal agencies and radiation oncology professionals alike. With a primary focus to improve
quality and patient safety in radiation oncology, these groups set out to learn from these
accidents by identifying the root causes of the errors and recommending the implementation of
new safety measures in radiation oncology departments.
The American Society of Radiation Oncology (ASTRO) and the American Association
of Physicists in Medicine (AAPM) hosted a meeting in June 2010 to address safety concerns
raised by these articles and facilitate dialogue among administrators, regulators and radiation
oncology personnel, including radiation oncologists, medical physicists, medical dosimetrists
and radiation therapists. During this meeting, participants found that medical errors in radiation
oncology are contributed to the complex nature of the patient’s disease and treatment process,
radiation therapists’ work environments, convoluted communication among treatment team
members, technological advancements, and likely the greatest factor, the human involvement
throughout the entire treatment process.3
With the main factors of radiation oncology errors identified and valuable input provided
by the participants at this meeting, ASTRO developed a six point action plan which included
numerous recommendations that would reduce medical errors; thus improving the quality of
radiation therapy treatments and most importantly, the safety of patients.3
Due to the complexity of the treatment delivery process, ASTRO recommended
adjustments to the radiation therapists’ work environment. They proposed a reduction in the
number of computer monitors and keyboards.3 Rather than multiple computer monitors
displaying similar treatment functions, radiation therapists should use a single computer to
access the information needed for treatment. They also recommended minimizing the traffic and
noise surrounding a treatment console.3 By limiting the amount of interruptions, radiation
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therapists are able to focus on the patient’s treatment and take appropriate action if they notice a
deviation in the treatment plan or standard operating procedure.
ASTRO also proposed the implementation of methods, such as failure mode effects
analysis and root-cause analysis in radiation oncology departments. These methods, respectively,
are designed to recognize areas of potential error and identify the cause of error, in order to
prevent incidences from occurring.3 According to Hendee and Herman,3 these methods should be
incorporated into every department’s endeavor to improve patient safety. In addition, ASTRO
also supported the establishment of a nationwide anonymous incident reporting system where
radiation oncology personnel are able to submit reports on equipment malfunctions or mistakes
that happen in their departments. Ganesh stated,2 incident reporting systems are not meant to be a
“blame culture” but rather a “learn culture,” so reporters should not fear any repercussions.
Reporting is a vital step in the learning process as it allows radiation therapy departments to learn
from other departments’ mistakes, good catches and near misses.2 This in turn gives radiation
oncology departments an opportunity to implement safety features that would hopefully prevent
the incident from occurring in their facility.
In addition, the use of checklists and time out procedures during the radiation therapy
treatment process to reduce the chance of errors were also recommended by ASTRO. According
to Hendee and Herman,3 checklists are an essential part of quality control and treatment delivery.
Time out procedures grant team members a chance to ask questions or bring up any concerns that
they may have about a patient’s treatment. Only when every question or concern has been
addressed, and everyone feels comfortable with proceeding is when the treatment should
continue.
Radiation oncology departments were also provided recommendations for new staffing
levels, facility accreditation, developing and updating policies and procedures as needed,
performing audits and employee compentencies.3
Even though radiation therapy is regarded as one of the safest fields of modern medicine,
errors unfortunately do occur and can directly or indirectly lead to adverse side effects for
patients.2 Due to the complexity and human involvement of the radiotherapy treatment process,
mistakes are unable to be completely eradicated. However, learning from past mistakes and
implementing the recommended safety measures can greatly reduce the likelihood of medical
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errors happening. Thus, creating a safe environment where patients can be confident they will
receive an effective and quality cancer treatment.
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References:
1. Jaffray DA, Gospodarowicz, MK. Radiation Therapy for Cancer. Cancer: Disease Control
Priorities. 3rd ed. Washington, DC. The International Bank for Reconstruction and Development/
The World Bank. 2015: 239-247. https://www.ncbi.nlm.nih.gov/books/NBK343621/. Accessed
October 18, 2019.
2. Ganesh T. Incident reporting and learning in radiation oncology: Need of the hour. Journal of
Medical Physics. 2014;39(4):203-205.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4258726/. Published October 1, 2014. Accessed
October 18, 2019.
3. Hendee WR, Herman MG. Improving patient safety in radiation oncology. Medical Physics.
2010;38(1):78-82. https://aapm.onlinelibrary.wiley.com/doi/full/10.1118/1.3522875. Published
December 14, 2010. Accessed October 18, 2019.