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Radiation Safety

Madeline Doberstein

DOS 516 Fundamentals of Radiation Safety

Radiation therapy has been very beneficial in the treatment of cancer, but often times
patients still express concern regarding treatment. These concerns stem from old practices, old
technology, and stories of errors or mistreatments of other patients. Many efforts are set in place
to protect both patients and workers. According to Koth and Smith1, the National Regulatory
Commission (NRC) sets standards to ensure that radiation exposure is “as low as reasonably
achievable”, also known as ALARA. The NRC also describes procedure for any errors that may
occur. The NRC requires a radiation safety committee at each site headed by a radiation safety
officer. The radiation safety committee is responsible for upholding regulations and making sure
patients and personnel are safe through the use of proper training, dose monitoring, safety
measures, and safety equipment. Other regulatory committees also play a part in keeping the
public safe. For example, when it comes to shipping radioactive equipment, the NRC and
Department of Transportation sets safety guidelines. The Joint Commission sets guidelines for
quality assurance, imaging protocols, and safety1.

Patients should understand that the delivery of radiation is not something that is ever
taken lightly and that there is protocol set in place to keep everyone safe. To begin, the use of
imaging is an important step in determining that radiation is delivered accurately every time.
Therapists also keep in mind the principle of ALARA when imaging and patients should be told
that all images taken are completely necessary and the therapist is eliminating possible exposure
whenever possible. For example, during simulation, CT machines are programmed with
protocols depending on what is being imaged from a head and neck to pelvis. Three principles
are used when it comes to minimizing radiation exposure. These are time, distance, and
shielding. Limiting the time that the beam is on and making sure that time displays are accurate.
Distance from the treatment room and lead shielding also helps to reduce radiation exposure
ensuring that the workers receive no dose. To keep records of exposure, therapists and other
personnel are required to wear film badges to check for dose. To help maintain safety and lower
risk of radiation, immobilization and position devices are used to keep the patient from moving
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and delivering dose to wrong areas. Overall, radiation is highly regulated, and personnel are
highly trained to keep people safe1.

Not only does the radiation oncology department utilize radiation safety officers, NRC or
agreement state regulations but actions to eliminate errors have also been taken. According to
Herman and Hendi2, in a meeting in 2010 between members of various radiation oncology
groups, extra precautions were drafted to ensure that safety of patients was the number one
priority. These precautions were steps that radiation oncology departments should take to ensure
human error is minimized and that radiation treatments are as accurate as possible2.

One of the biggest steps that a department can take and was proven to be the fastest and
most effective way to improve safety is to make sure that the machines have proper interlocks
and should also provide alerts of malfunctions such as if table parameters are out of tolerance.
Simpler steps include creating a clutter free work area to help eliminate distractions. Examples of
this should be minimizing the number of monitors and keyboards used to treat patients is to
create a simple process. Traffic near the treatment console should also be limited so other staff is
not distracting the therapists who should be focused on the patient. Examples of this could be a
possible sign that alerts people to not disturb or talk to the driver who should not take their eyes
off the monitors. Radiation therapists also have control of terminating the treatment if necessary
and have the knowledge of when to do so. The billing process should also be simple so therapists
can focus on treating the patient and not working on other tasks. Checklists should be utilized in
the department to double check procedure so errors are minimized. If errors do happen a proper
reporting system should be in place because procedures can be adjusted to account for these
errors and possibly other sites can re-evaluate their own system to catch errors before they
happen. Time outs should be able to be called by any therapist at any time without any question.
An example of a time out is before a treatment is delivered, therapists will stop, reread patients
name, what they are treating on the patient, fraction, and dose. Another therapist will also
compare this to the dose prescription given by the oncologist. Audits should also be performed to
make sure machines are accurate and safe. An example of an audit is comparing dosimetric
computations to actual measurements in a phantom. Accreditation is another priority when it
comes to steps departments should take to ensure safety. Accreditation ensures that safety
procedures are upheld to a certain standard and the same across all different radiation facilities.
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Overall, therapists, oncologists, and dosimetrists should all have patient safety in mind because
these steps are only effective if everyone has the same goal in mind2.

In conclusion, many patients are often nervous when it comes to their first treatment.
However, with proper education, training, and procedure, safety is upheld. It is important that all
regulations are followed, although some may seem unnecessary, it helps to eliminate any
potential errors.

References

1. Herman M, Hendee W. Improving patient safety in radiation oncology. Medical Physics.

2010;2011;38:78-82.
2. Koth J, Smith MH. Radiation Safety Compliance. Radiologic technology. 2016;87:511.