Tenzin Yiga

DOS516-Fundamentals of Radiation Safety

Week 2-Radiation Safety Paper

Unfortunately, cancer has become a common well known topic today. Most people
probably know at least one person personally or know of someone that has either had or has
cancer. According to the National Cancer Institute, in just the United States alone there were an
estimated 1,735,350 new cases that were diagnosed in 2018.1 With so many new cases coming in
each year it is no wonder why radiation therapy has become an increasingly used treatment
modality. It is also well known among the cancer community that combining different types of
treatment such as chemotherapy, surgery, and radiation therapy have been shown to increase
outcome. Due to this, cancer patients will most likely have radiation therapy suggested as part of
their treatment regimen. That being said, like most medical procedures radiation therapy does
come with risks. There have been documented cases that resulted in death or injury to the patient
due to radiation treatments. Though we are not able to change what has happened in the past we
can learn from it and grow to ensure patient care and create better radiation safety guidelines.
The overall public should not be concerned about radiation overdose. There are many
regulations and guidelines to protect public safety from radiation exposure. When building a
radiation therapy department there are many factors to consider and one of the most important
aspects is shielding for the protection of workers, patients and the public. Shielding is
implemented to reduce the amount of radiation produced by the linear accelerator (treatment
machine) that can be read outside of the treatment room. Shielding factors include use factor (U),
work load (W), and occupancy (T).3 The use factor refers to the fraction of time that the primary
beam is pointed towards a barrier. This includes the side walls in the direct path and also the
ceiling and floor of treatment rooms. Work load takes into account the fraction of time the beam
is in use and occupancy is the fraction of time there are other people on the opposite sides of
those barriers.3 This information is useful when figuring out the general layout of the department
and treatment rooms along with the shielding barrier needed to keep exposure levels down. The
dose limits for an occupational exposure is 5rem/year and .5rem/year for the public.3 Thus
radiation exposure to the public is significantly less.
When it comes to radiation therapy treatments, patient care and patient safety is crucial.
Radiation though it is used as a treatment method to benefit patients, it has also been proven to
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be harmful if delivered improperly. It is also impossible to take back once it’s been delivered and
that is why it is very important to make sure the department as a whole is well educated in
dealing with radiation and radiation safety. This brings to light the concept of radiation
protection culture (RPC) which was first established by the International Radiation Protection
Association (IRPA) in 2008. The idea of RPC is that it is a team effort. It combines the “attitude,
beliefs, practices and rules among the medical professionals, staff and patients regarding
radiation protection”.2 The main concern is not establishing a RPC but instead improving on the
one that is already in the department. The goal is to minimize unsafe practices and control
radiation risks.
Departments can adhere to a RPC by staying educated on new technology, creating great
communication across departments, monitoring patient treatments and maintaining quality
assurance (QA) of the equipment.2 To maintain patient safety most departments go through
training upon hire and fill out a competency list to verify workers are well educated in various
everyday tasks. Generally the physician, physics, medical dosimetry, nursing, and radiation
therapist work together to perform patient care and most facilities will have a set system of
communication between departments. Patient treatments are monitored during chart checks,
chart rounds, tumor boards, offline review, and etc. Quality assurance (QA) is run on all
machines to verify the equipment is working correctly. Not only are the machines performance
tested but individual patient plans go under QA as well.
In June of 2010 American Society of Radiation Oncology (ASTRO) held a meeting
entitled “Safety in Radiation Therapy: A Call to Action”. During this meeting there were a lot of
similarities between ASTRO and the RPC suggestions.4 ASTRO focused on implementation of
regulations and protocols in a department. While deliberating that patient care was the
responsibility of the team as a whole, they emphasized that it was more effective when
management backed up the importance.4 With the improvements in technology and treatment
planning. Patients are able to get treatment with higher doses and more complicated treatment
techniques. It is important for the radiation therapist to stay educated and for the facility to
provide training and education.
Although medical errors do happen and have a negative effect on the public and the
public view not only radiation therapy but the people who are involved in the delivery as well.
Not only can facilities practice radiation protection culture but meetings are held every year on
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the topic of radiation therapy and ways to improve treatment. Radiation therapy is continuously
evolving and with patient care in mind. Treatment planning techniques are improving to help
limit dose to healthy tissues which help lower side effects and improve patient quality of life.
Movements like this is all a part of the concern on patient safety in regards to radiation. There
has been great improvements on policies and systems that strive to keep patient safety as a top
priority.

References

1. Cancer Statistics. National Cancer Institute website. https://www.cancer.gov/about-

cancer/understanding/statistics. Accessed October 24, 2019.
2. Hendee, W. R. and Herman, M. G. (2011), Improving patient safety in radiation
oncology. Med. Phys., 38: 78-82. doi:10.1118/1.3522875. Accessed October 24, 2019.
3. Lenards, N. Area Monitoring Power Point. La Crosse, WI: UWL- Medical Dosimetry Program;
https://softchalkcloud.com/lesson/files/xpNHwKTBActDhR/Area_Monitor_print.html. Accessed
October 24, 2019
4. Ploussi A, Efstathopoulos EP. Importance of establishing radiation protection culture in
Radiology Department. World J Radiol. 2016;8(2):142–147. doi:10.4329/wjr.v8.i2.142.
Accessed October 24, 2019.