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Rachelle Jacobs
DOS 516 – Fundamentals of Radiation Safety
Radiation Safety Paper

Radiation Safety Paper

Rachelle Jacobs
University of Wisconsin – La Crosse
DOS 516 - Fundamentals of Radiation Safety
December 10, 2023
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Rachelle Jacobs
DOS 516 – Fundamentals of Radiation Safety
Radiation Safety Paper

Radiation safety is an important issue, especially for people who work in radiation
therapy departments. The public’s reaction to radiation is often skeptical and fearful. In working
as a radiation therapist, I’ve noticed this to be especially true among older patients who
remember radiation disasters like Fukushima and Chernobyl. There have also been past incidents
in radiation therapy where patients have received incorrect doses, leading to serious harm or
death. Understandably, when some patients come in for treatment, they are nervous and worried
about treatment doses being delivered correctly. In general, radiation therapy is a very safe and
effective cancer treatment and radiation oncology departments are constantly working to improve
processes and safety for patients. There are numerous regulating bodies, monitoring mechanisms,
and quality assurance checks that are in place to improve safety.
One major factor that improves patient safety in radiation oncology is following
guidelines determined by regulatory agencies. Radiation therapy departments are required to do
this to become accredited. The International Atomic Energy Agency (IAEA) is an independent
organization that lists improving radiation safety as one of its mission statements.1 They have
found that many radiation errors have been the result of an insufficient number of staff or not
enough properly trained staff.1 Subsequently, the IAEA has developed recommendations for
staffing in radiation therapy departments that are internationally recognized. 1 They have also
developed programs for radiation safety education and training that are used by national
regulatory bodies.1 The Nuclear Regulatory Commission (NRC) is a national agency that
regulates radioactive materials in the United States.2 They require radiation therapy departments
to have a radiation safety committee and a licensed radiation safety officer.2 Any radiation
incidents that occur have to be reported to the NRC and the radiation safety officer has to do an
investigation.2 The radiation safety committee is also required to meet periodically to go over
any incidents and come up with ideas for process improvement.2
Incident reporting systems are another requirement of the NRC that help improve
radiation safety. These systems allow staff members to anonymously report errors or near
misses.3 The reports get reviewed by the radiation safety officer and radiation safety committee
so that the root cause can be determined and improvements can be made for the future.2 The
IAEA has developed an international reporting system to collect reports of radiation incidents
that put patients at risk.1,3 It’s advantageous to have national or international databases for
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Rachelle Jacobs
DOS 516 – Fundamentals of Radiation Safety
Radiation Safety Paper

incident reports so that clinics can learn from mistakes that happen at other places as well. 3
Documenting and analyzing these incidents helps to prevent them from happening again in the
future.1 At the hospital I work at, we use RO-ILS: Radiation Oncology Incident Learning
System, which is a national, web-based database that currently has over 825 facilities that
contribute to it.4 When hospitals are all able to communicate and learn from each other, it helps
increase patient safety.
Radiation therapy departments also have many checks and balances in place to prevent
errors before they happen. Our team of medical physicists perform quality assurance (QA)
checks on the treatment machines and on every patient plan before it is delivered. They follow
recommendations on calibrating the machines from organizations like the IAEA.1 The IAEA
does independent audits to verify that radiotherapy beams are calibrated correctly. 1 Quality
assurance tools are beginning to be incorporated directly into the treatment software and will
likely become more advanced in the future.5 For example, the linear accelerators that we work
with do not allow a therapist to turn the beam on if any treatment parameters (couch, gantry,
collimator, etc.) are not at their planned values. This would require a manual override by the
radiation therapist. There are also features in the software that will turn the beam off if it senses
any movement on the treatment table, like if a patient coughs, for instance. On the treatment
planning side, some suggestions for future development are software systems that will compare a
new plan with any previous plans for the same patient, compare proposed target volumes with a
directory of volumes for common diagnoses, and automatically highlight any under-dosed target
areas or hot-spots.5 These QA functions being built into the planning software would help
identify any inconsistencies between the proposed plan and their database of similar plans. 5 As
the technology continues to improve, our ability to increase safety for patients will also improve.
Finally, in my personal experience as a radiation therapist, there are many things that we
are trained to do to decrease the probability of a radiation error. One thing is that we always do a
timeout before starting a treatment. A timeout verifies the patient’s identity with two identifiers,
the treatment site, and dose. We also run QA on the machine every morning, which verifies that
radiation beam outputs are correct, imaging systems are accurate, and that safety interlocks are
working correctly. We always work in teams, so there are at least two sets of eyes on every x-ray
that we take and every time we set up for a treatment. If we don’t feel totally confident about
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Rachelle Jacobs
DOS 516 – Fundamentals of Radiation Safety
Radiation Safety Paper

something, we are encouraged to call a doctor to review it. This culture of safety is something
that should be standard in every clinic, so that no one is afraid of getting chastised when they ask
for help.5 While we are all human and errors are bound to happen, feeling comfortable enough to
have open communication and an honest dialogue about concerns and process improvements can
make a huge difference.
Radiation safety is a top concern for both healthcare workers who work in radiation
oncology as well as patients who are coming in for treatment. Radiation therapy departments
follow specific guidelines from regulatory agencies to become accredited. They also participate
in incident reporting systems which contribute to process improvement. Quality assurance
checks are routinely performed and there are built-in features to the treatment software that
prevent errors. Everyone on the team is trained to be mindful and looking for errors constantly.
With these factors in mind, as well as my personal experience working in radiation oncology, I
feel that radiation therapy is a very safe treatment option and I would feel more than comfortable
utilizing it myself if I needed to. I am confident that radiation safety is a top priority in the field
and that with every passing year, we are improving patient safety.
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Rachelle Jacobs
DOS 516 – Fundamentals of Radiation Safety
Radiation Safety Paper

References
1. Abdel-Wahab M, Rosenblatt E, Holmberg O, Meghzifene A. Safety in radiation
oncology: the role of international initiatives by the International Atomic Energy Agency.
Journal of the American College of Radiology. 2011;8(11):789–794.
https://doi.org/10.1016/j.jacr.2011.07.014
2. United States Nuclear Regulatory Commission. Regulation of Radioactive Materials.
NRC.gov. June 23, 2022. Accessed December 4, 2023.
https://www.nrc.gov/about-nrc/radiation/protects-you/reg-matls.html
3. Hendee WR, Herman MG. Improving patient safety in radiation oncology. Practical
Radiation Oncology. 2011;1(1):16–21. https://doi.org/10.1016/j.prro.2010.11.003
4. American Society for Radiation Oncology. RO-ILS: Radiation Oncology Incident
Learning System. ASTRO.org. Accessed December 4, 2023.
https://www.astro.org/Patient-Care-and-Research/Patient-Safety/RO-ILS
5. Marks LB, Jackson M, Xie L, et al. The challenge of maximizing safety in radiation
oncology. Practical Radiation Oncology. 2011;1(1):2–14.
https://doi.org/10.1016/j.prro.2010.10.001