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Radiation Safety in Radiation Oncology: A Literature Review

Alexander Mckennell
In Partial Fulfillment of DOS 516-501
University of Wisconsin-La Crosse, Medical Dosimetry
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Why is radiation safety important? Radiation safety helps to ensure that patients, family
members and all medical staff are properly protected from radiation sources, specifically within a
radiation oncology department. Over the last five years as a radiation therapist, I have come
across countless situations where patients are concerned with their safety during treatment and
the effects that radiation has on their body. However, when used with proper training it can
safely and effectively treat cancer and other diseases. Research shows that successfully
implementing the ALARA (as low as reasonably achievable) principle, the appropriate precision
of radiation delivery to tumor volumes and proper patient involvement has significantly reduced
the harmful effects and portrayal of radiation.

The ALARA principle is widely utilized in radiation oncology to decrease the time that a
patient is exposed to radiation, as well as shielding areas that are not to be treated.1 Furthermore,
it protects the staff and family members through maximizing distance and increasing shielding of
the treatment room vaults.1 Linear accelerator vault rooms are designed to prevent radiation
leakage by having lead lined, thick concrete walls and maze formation hallways to reduce beam
and live radioactive source scatter. Therefore, this protects the radiation therapists, other
healthcare personnel and patients in the waiting areas from radiation exposure. A. Schiska
states,1 “ALARA is a cornerstone of the American Registry of Radiologic Technologists (ARRT)
Code of Ethics.” The equipment used in radiation oncology is designed to avoid any unnecessary
dose to other areas of the body. There are numerous quality assurance protocols that are followed
to guarantee that the machines are in perfect working condition. When these protocols do not
meet the requirements, patient treatment is not completed on the machine until it is deemed
acceptable under quality assurance regulations.

Evidence shows that using methods such as IGRT (image guided radiotherapy) and
IMRT (intensity modulated radiotherapy) have improved the precision of radiation delivery. A
general concern that is often expressed by patients is if the effects of radiation are systemic
resulting in harmful impacts to other regions of the body than what is being treated. Another
concern reported is the fear that they are radioactive when they finish their daily treatments. This
is a common misconception and is frequently explained that radiation therapy is designed to only
destroy cancer cells in the treated area with minimal normal tissue involvement. Precision is also
achieved by multi-leaf collimation which allows for the creation of a field that matches the shape
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of the tumor, again reducing dose to normal tissues within the area being treated. Patient
education and involvement is particularly important within radiation oncology and their
understanding of daily procedures, precautions, and protocols are crucial in optimizing safety.

Providing patient centered care includes educating and involving patients in their
treatment to create an additional safety barrier for reducing errors, raising awareness, and
encouraging participation. Pernet et al. states,2 “Patients should not be viewed as recipients of
medical decisions but should be considered as responsible for their treatment.” One common
practice used to include patients and reduce errors is the utilization of a time-out procedure
(TOP). The TOP includes asking the patient for their name, date of birth, area being treated, total
number of fractions and current fraction number prior to entering the treatment room.2 This helps
build a positive rapport and trust among the patient and radiation therapists, as well as
encourages participation in their treatment. Education is essential in providing optimal care while
also reducing patient anxiety and intrinsic errors.2 Pernet et al. states,2 “Language should be
adapted to the patients’ understanding, without being too technical. Information should also not
be given in a single session because too much information at once could lead to
misunderstandings.” Furthermore, due to the precision and accuracy required for treatment, it
must be emphasized that patients understand that movement should be limited during beam on
times as to avoid any discrepancies during daily treatment.

Radiation safety is of the utmost priority in the field of radiation oncology. Following the
guidelines of ALARA helps to reduce unnecessary dose to patients, staff and family members.
Specifically, by decreasing exposure times, increasing distance from radiation sources or areas of
potential radiation exposure, as well as increasing shielding around the treatment room vaults to
prevent radiation leakage to common areas within the radiation oncology clinic. Ensuring that
patients understand the benefits and risks of radiation is a vital component to a successful and
precise course of treatment. Explaining the different treatment modalities, such as IGRT and
IMRT, that assist in bringing the precision of treatment delivery down to the millimeter can aid
in putting patients minds at ease knowing that radiation is directed only at their tumor. Finally,
patient engagement throughout their course of treatment can help build a trustworthy and safe
relationship with the cancer care team.
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References

1. Schiska A. Teaching radiography students the ALARA principle. Radiologic Technology.

2021;93(2):228-231.
http://www.radiologictechnology.org/content/93/2/228.full.pdf+html. Published
December 2021. Accessed December 4th, 2022.

2. Pernet A, Mollo V, Bibault J-E, Giraud P. Evaluation of patients’ engagement in

radiation therapy safety. Cancer/Radiothérapie. 2016;20(8):765-767.
doi:10.1016/j.canrad.2016.02.010. Accessed December 4th, 2022.