You are on page 1of 4

1

Alecia Eliason
DOS 518 Professional Issues
Safety Essay
A Medical Dosimetrists Role in Radiation Oncology Safety
Read literally, dosimetrist translates to measurer of dose. A medical dosimetrist,
however, is so much more. According to the American Association of Medical Dosimetrists
(AAMD),1 a medical dosimetrist has knowledge and expertise regarding radiation oncology
treatment machines and equipment and applies that knowledge in collaboration with radiation
oncologists and medical physicists to produce radiation treatment plans, including dose
distributions and calculations. General knowledge and familiarity with brachytherapy procedures
and calculations are also required of medical dosimetrists, although many facilities do not task
medical dosimetrists with these responsibilities. The core duty of a medical dosimetrist is to
create treatment plans adhering to the physicians wishes, sparing critical structures while
delivering the prescribed dose to the target volume(s). The role of educator may also be assigned
to radiation therapy and/or medical dosimetry students, as well as to medical residents.
In addition, medical dosimetrists are required to be active members of a quality assurance
(QA) program, ensuring proper documentation and abiding by safety policies and procedures.
Some facilities require medical dosimetrists to take part in the measurement of radiation via
thermoluminescence or ion chambers, and/or assisting with machine calibration under the
direction of a medical physicist.1 Routine quality assurance of radiation therapy treatment
machines and simulators are also responsibilities sometimes allocated to medical dosimetrists.
Quality assurance process checks by a medical dosimetrist include planning directive
verification, approval of volumes, treatment prescription accuracy, treatment plan quality, and
final accuracy and completeness checks.2 Via these and other QA procedures, medical
dosimetrists are a vital part of the radiation oncology team, contributing to high quality patient
treatments and error prevention.
A specific area of QA found to be extremely effective in error prevention within a
radiation oncology department is voluntary near-miss and error reporting. Near-miss
documentation in particular is hugely valuable; by identifying problems and/or potential issues
before they become errors or reach the patient, processes can be adjusted or improved upon, thus
prevented rather than causing harm.2 Kalapurakal et al3 reported that a system used for error-
2

reporting allows for structured analyzation of errors, implementation of QA processes, and


feedback in regards to the measures taken. Non-punitive reporting of errors is an imperative part
of this process so that team members will not fear repercussions but will instead contribute
valuable information regarding near-misses or errors. Certain error-reporting systems, such as
Radiation Oncology Incident Learning System (RO-ILS) sponsored by both the American
Society for Radiation Oncology (ASTRO) and the American Association of Physicists in
Medicine (AAPM), contribute reported data to a national database, so comparisons can be made
against other organizations and quarterly reports for improvement suggestions are available to
participating institutions.4
Regardless of the way errors and near-misses are reported, a committee specifically
tasked with safety monitoring should exist within every radiation oncology department. This
committee should be made up of members from all groups within the department, including
physicians, medical physicists, medical dosimetrists, nurses, and radiation therapists.2 Ensuring
compliance with licensure and credentialing safety issues is an important task for which this
group is responsible. Additionally, besides confirming a near-miss and error-reporting system is
in place, this committee must keep leadership updated with proceedings, as well as implementing
process-improvements when needed. Again, non-punitive reporting is essential to a successful
error-reporting system; data and notes reviewed by a safety committee leading to process
changes must not be identifying in order to ensure reporting of all relevant incidents.
Safe delivery of radiation can also be enhanced by an effective peer-review process. Most
institutions have guidelines in place for physician to physician peer-review, but medical
dosimetrists can also use this method to better themselves and their planning capabilities.2 For
example, asking for advice from another medical dosimetrist may result in utilizing planning
techniques that would otherwise not have been considered, resulting in a higher quality treatment
plan. Multidisciplinary peer-review is also valuable to bring together members of the treatment
planning team (i.e. physicians, physicists, and medical dosimetrists) in order to fulfill the
physicians orders safely and effectively. If a physician has inadvertently overlapped a target
volume contour with that of an organ at risk (OAR), and the treatment planning objectives
specify that OAR volume to receive a maximum dose less than the prescribed dose to the target
volume, identifying this issue early on in the planning process will prevent headaches later.
3

Another specific way in which medical dosimetrists can contribute to a culture of safety
is to utilize quality checklists for certain tasks.3 Timeouts, a patient-identification and/or
procedure-verification process, have been quite successful when those involved employ
checklists. These checklists break down information and tasks into simple, easy-to-follow steps,
ensuring all items are complete before moving on to the next. Medical dosimetrists can use a
similar process during treatment planning. Confirming completion of safety procedures such as
on-screen checks by medical physicists and intensity-modulated radiation therapy (IMRT) QA
via checklists will establish confidence of a safe and high-quality treatment plan. Checklists also
serve as a paper trail, albeit it usually electronic, in the instance of an error occurrence so that a
systematic review of what lead to the error is readily available.
An issue all radiation oncology departments deal with at one point or another is efficient
and safe treatment planning of emergent cases. Exceptional prioritization is an essential skill for
medical dosimetrists, but even the most organized day can be muddled by an unplanned-for or
added-on patient plan. Time pressures such as those imposed by situations like this often make
available opportunities for errors that would otherwise be avoided. Again, following quality
checklist processes to ensure all steps are completed during the planning process is vital in these
situations. Medical dosimetrists must be adamant about following all QA processes, even if it
takes more time than is allotted by unrealistic scheduling. This is often easier said than done, as
the patient may be waiting within the department until the plan is ready for treatment, or the
radiation therapists or physicians may demand a rapid turnaround. Keeping patient safety always
in mind during these situations will help medical dosimetrists to remain calm and work as
efficiently as possible.
All of the demonstrations of safe practices within a radiation oncology department
discussed here only skim the surface. It is vital for each member of the team to keep safety at the
forefront of every task. Medical dosimetrists, in particular, must be conscientious of each click of
the mouse or keyboard, as one move in the wrong direction could have a domino effect on the
remainder of the treatment planning process. Following departmental and legal safety processes
and procedures is key, as these have been adapted or put in place to catch and/or eliminate errors.
Quality assurance and safety within radiation oncology has come a very long way, but
improvements can always be made, because even one error is one too many.
4

References

1. What is a medical dosimetrist? American Association of Medical Dosimetrists.


https://www.medicaldosimetry.org/about/medical-dosimetrist/. Published 2017. Accessed
October 4, 2017.
2. Zietman AI, Palta JR, Steinberg ML, et al. Safety is no accident: a framework for quality
radiation oncology and care. Arlington, VA: ASTRO; 2012.
3. Kalapurkal JA, Zafirovski A, Smith J, et al. A comprehensive quality assurance program for
personnel and procedures in radiation oncology: value of voluntary error reporting and
checklists. Int J Radiat Oncol Biol Phys. 2013;86(2):241-248.
dx.doi.org/10.1016/j.ijrobp.2013.02.003
4. RO-ILS: Radiation Oncology Incident Learning System. ASTRO: targeting cancer care.
https://www.astro.org/RO-ILS.aspx. Published 2017. Accessed October 4, 2017.