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What is the first thing that comes to mind when hearing the word radiation?

Immediately,
most people think about nuclear weapons, the atomic bomb, or even cartoon depictions of
growing extra limbs or eyes. Because of its potential power, radiation is often associated with
negative images or thoughts. Understandably so; mass media has served to fuel radiation fears
with embellished stories about cases of misadministration or overdose. Health care workers in
fields related to or directly using radiation must tackle this hurdle with almost every patient they
encounter, determined to help patients understand how controlled amounts of radiation can
positively impact their lives. It is crucial for patient-facing staff to have a strong radiation safety
knowledge base so they can assuage these fears in order to gain patient trust and confidence,
leading to cooperation and ultimately the best care provision possible.
The quality assurance surrounding radiation oncology is incredibly complex. It is
impossible for all staff to know or understand the nuances involved in quality assurance, but
appreciating that such oversight exists and being able to describe such processes in simple terms
is a skill not to be overlooked. Many agencies exist to advise or impart standards for radiation
use, including but not limited to the International Commission on Radiological Protection
(ICRP), the National Council on Radiation Protection and Measurements (NCRP), and the
Nuclear Regulatory Commission (NRC).1 Additionally, professional organizations such as the
American Association of Physicists in Medicine (AAPM) function to improve the safety of
radiation for medical uses, forming committees whose goal is to identify and educate on areas
needing improvement.
One such committee worth mentioning is Task Group 100 of the AAPM. This particular
group came out with a report in 2016 that acknowledged the rapid growth of radiation oncology
technology and suggested quality assurance techniques to continue the safe delivery of radiation
to patients.2 It was recognized that most errors occurring within radiation oncology departments
were a result of workflow issues rather than equipment failure.2 Task Group 100 was charged
with 3 main goals: to review and critique the existing AAPM guidance, to identify a quality
assurance approach that balances patient safety and resources, and to develop a framework of a
quality assurance program.2
A strong take-away from the report developed by Task Group 100 recommends that
radiation oncology departments develop a quality assurance program with input from pertinent

staff. At the minimum, this group should include a radiation oncologist, a medical physicist, a
dosimetrist, a radiation therapist, an engineer, and IT personnel.2 This diverse assembly will be
able to look at issues regarding radiation safety from multiple views, working together to
develop the most efficient and safest way to carry out quality assurance recommendations while
taking into consideration how that particular department functions best. Task Group 100
recognized the complexity of systems and workflows, hence the recommendation to form a
quality assurance committee to address potential issues from all sides.
In addition to following quality assurance guidelines in regards to radiation safety,
radiation oncology departments should have in place a near-miss or treatment deviation reporting
process. A punitive-free error-reporting system allows for review and identification of incidents,
leading to error prevention by improving practices and patient safety.3 As those who work in the
field of radiation oncology understand, radiation treatment development and delivery is
incredibly complex, involving a multitude of staff and equipment. Consequently, errors are
inevitable, and having a system with which to enter and review data surrounding these incidents
is crucial for improvement of radiation safety.
Systems that allow for radiation-specific error reporting can exist in many different
fashions, from simple pen-and-paper recording to online reporting tools. In todays technological
age, online reporting has significant benefits over other systems. For example, being part of a
national online reporting program allows analytical data to be extracted, highlighting workflow
inefficiencies and technology-specific equipment failures.3 Focused education and relevant
protocols can then be developed within departments, leading to error prevention and
subsequently an increase in patient safety.3 Awareness of potential workflow errors is also raised
within the radiation oncology field so departments can be proactive about radiation safety
protocols.
Innumerable decisions made within a radiation oncology department relate in some way,
shape or form to radiation safety. Guidelines are constantly being developed and improved upon
as technology and processes change, always with the end goal of delivering radiation to patients
in the safest possible way. Along with these recommendations for quality assurance, near-miss
and error-reporting systems also exist to identify potential safety issues and improve processes in
order to prevent errors from occurring. Therefore, it is paramount that staff not only follow

quality assurance guidelines but also have a general knowledge of how and why they are doing
so. This will build confidence in staff, translating to safer and higher quality care for patients.

1. Khan FM, Gibbons JP. Radiation Protection. Khans The Physics of Radiation Therapy. 5th ed.
Philadelphia, PA: Lippincott Williams & Wilkins; 2014:348.
2. Huq MS, Fraass BA, Dunscombe PB, et al. The report of Task Group 100 of the AAPM:
Application of risk analysis methods to radiation therapy quality management. Med Phys.
2016;43(7):1-54. http://dx.doi.org/10.1118/1.4947547
3. Arnold A, Delaney GP, Cassapi L, Barton M. The use of categorized time-trend reporting of
radiation oncology incidents: a proactive analytical approach to improving quality and safety
over time. Int J Radiation Oncology Biol Phys. 2010;78(5):1548-1544.
http://dx.doi.org/10.1016/j.ijrobp.2010.02.029