Landon Brown 1

Fundamentals of Radiation Safety

Radiation Safety Paper

Radiation is a commonly used, yet often misunderstood term. Many patients have
undergone some sort of procedure in their lifetime that involves radiation whether that was an x-
ray, CT scan, or cancer treatment. With the growing theme of distrust in our medical system
along with the few unfortunate accidents that have happened, it makes sense that the public is a
little weary of getting high doses of radiation to their body. Fortunately, the radiation oncology
field has prioritized patient safety over the last decade and there have been substantial
improvements in the quality and safety of care.
As the radiation oncology field continues to improve and develop their technology,
patients are getting more benefits now than ever from treatment. These advancements do not
come without a cost though, the treatments are continuing to get more and more complex which
is causing an increased focus on patient safety with the need for the entire department to be on
the same page. In 2010, the New York Times released an article highlighting detrimental errors
in radiation oncology that severely handicapped patients or even cost them their life.1 The title of
this article was “The Radiation Boom: Radiation Offers New Cures and Ways to Do Harm.”1
This article brought to light many issues in the field and kickstarted the much needed
conversation on ways to improve patient safety throughout radiation oncology.
Later in 2010 there was a meeting titled “Safety in Radiation Therapy: A Call to Action”,
put on by the Americans Association of Physicists in Medicine (AAPM) and the American
Society for Radiation Oncology (ASTRO).1 This meeting involved a multitude of different
professions in the radiation oncology department like radiation therapists, medical physicists,
radiation oncologists, dosimetrists, administrators, and many others.1 This meeting highlighted
likely causes of common errors such as the fact that the treatment planning and delivery
processes are becoming more and more automated which is causing staff to be less hands on,
therapists working in often cluttered and easily distracted environments, and insufficient quality
oversight in the calibration of machines.1 It was decided by the end of this meeting that although
mistakes are bound to happen due to human involvement, machine malfunctions, complex
procedures, and miscommunication, these errors can be greatly reduced with the involvement of
a multidisciplinary approach with a goal to catch these errors prior to it reaching the patient.1
One of the most important things to come out of this meeting was a national database being
 2

created to report events.1 This makes it much easier to track and fix common errors that occur.
They also chose to expand education and training programs involved with patient safety and
quality of care.1 Other recommendations included as treatment devices continue to become more
and more complex, control over the devices should be simplified and standardized as much as
possible.1 Staffing levels should be reevaluated and updated to ensure there is an adequate
number of staff now that treatments are more complex.1 Treatment teams should use checklist to
ensure patient safety by double checking patient identity, treatment site, etc.1 Periodical audits
should be conducted in which dosimetric computations are compared against dose measured in
phantoms to confirm that the treatment machine is delivering dose as intended. 1 Patient safety is
added as a competency by the American Board of Radiology.1 Lastly, the FDA safety data must
be well documented and deminstrated.1 This meeting began a lot of very important changes that
have shaped the way departments are run today.
One of the bigger advancements in radiation oncology over the last 20 years is the
improvements in quality management.2 As leaders in the department, radiation oncologists have
taken a big step up in implementing and promoting patient safety. In 2012, ASTRO proposed a
model that outlined specific task for radiation oncologists to use in a document they called
“Safety is No Accident, A Framework for Quality Radiation Oncology Care.”2 This document
specifically outlined nine steps of a radiation oncologist journey with a patient and had
suggestions on how to safely conduct their treatment from pre-consultation all the way to the
patient’s follow-up and even one step further into implementing new technology and continuing
education. The first step outlined is the pre-consultation which involves the oncologist being
involved in tumor boards with many different medical professionals in attendance.2 This
prevents oncologists from making unilateral decisions without consulting other medical
professionals.2 This ensures that all physicians can hear the patients’ case and choose the best
possible treatment method. The next step is the consultation, which allows the doctor to meet the
patient and explain what to expect moving forward. ASTRO suggests that doctors do not exceed
250 new consults/treatments per year.2 An overworked physician is much more likely to make
mistakes. Next is the treatment prescription being written clearly with evidence based researched
used and if it’s not being used for some reason then justification needs to be provided.2 Patient
simulation is the next step, and the doctor should be involved in this process or give the
therapists the freedom to do so if they are adequately trained.2 This protocol should be updated
 3

every six months to ensure the most up to date standards are being implemented.2 After that the
treatment planning process will begin. This should be conducted with a medical physicist and
there needs to be an intra-departmental peer review conducted on the plan.2 Once treatment
begins the physician should monitor the patients' symptoms minimum of once a week while
reviewing daily films ensuring treatment is going as planned.2 A follow-up should be conducted
at minimum until toxicities have resolved and follow-up diagnostic scans should be discussed.2
Beyond just patient care, oncologists should be involved in the selection and implementation of
all new technology while also completing their continued education requirements with a focus on
quality and patient safety.2 It is very clear that the oncologist is heavily involved in the patients’
care every step of the way and they constantly have multiple professionals reviewing and
consulting their work to ensure high quality care.
Patient safety has come a long way in the last few decades. In the early 2010’s oncology
departments and groups really put an emphasis on patient safety and the benefits have been clear.
Departments are more highly trained, properly staffed, and have put a greater emphasis on safety
as a whole. With the increased use of error reporting systems, clinics can learn from other sites'
mistakes and prevent them at their own. Moving forward, the radiation oncology field will
continue to have better technology, producing better results, while continuing to minimize costly
errors that were so common decades ago.

1. Hende WR, Herman MG, a. Improving patient safety in radiation oncology. Practical
Radiation Oncology. 2011;1(1):16-21. https://doi.org/10.1016/j.prro.2010.11.003
2. Calvo FA, Cherab BS, Zubizarreta E, et al. The role of the radiation oncologist in quality
and patient safety: A proposal of indicators and metrics. Critical Reviews in
Oncology/Hematology. 2020;154. https://doi.org/10.1016/j.critrevonc.2020.103045