Allison Roberts

DOS 516-501 Fundamentals of Radiation Safety

December 8, 2023

Safety in Radiation Oncology

Medical errors and mistreatments can happen in any area of healthcare, and radiation
oncology is no exception. The rapidly changing technologies, equipment, and software, and the
ability to create complex treatment plans also means that there is more room for errors.
However, radiation therapy has a low incidence rate compared to other areas of healthcare, and
the industry as a whole is committed to improving patient safety through incidence learning,
which is “a process through which employees and the organization as a whole seek to understand
any negative safety events that have taken place in order to prevent similar future events.” 1 So
although a treatment error can never be taken back, things like incident reporting and open dialog
about mistakes, allow for the radiation team to learn from those mistakes and take measures to
ensure they do not happen again.1
One of the first places to start learning about patient safety and making sure it is a priority
is by including it in the curriculum for students in radiation therapy programs. That way they are
aware of its importance before they even enter the field. The more that students are taught about
patient safety and can learn about some of the most critical errors that have been made in the
past, the more it will become second nature to them and they can apply that knowledge to real
world situations. “Education is a vital tool for shaping the future safety behavior of health care
professionals and protecting the safety of healthcare consumers.” 2 Educators in the field are
aware that patient safety should be an integral part of the curriculum and are finding new ways to
incorporate that concept into their teachings. Faculty members have achieved this by expanding
the patient safety content of the curriculum. “This expansion involved adding a patient safety
topic or module, including a new lecture or speaker, or increasing the number of learning
resources.”2 Those who are wary of their safety during radiation therapy procedures can feel
more assured by knowing that the importance of patient safety is taught to healthcare workers
from the very beginning.
Radiation oncology departments are always striving to facilitate an environment that
emphasizes patient safety and open communication in order to continually provide patients with
the optimum level of care. There are many ways that organizations create an environment that
ensures patient safety. One very important way is by having adequate staffing levels based on
the patient workload. A balanced schedule needs to be maintained because “an excessive
workload can lead to errors….conversely, light workloads can also be problematic since a certain
workload level is needed to maintain situational awareness.” 3 The public should also feel a
sense of comfort in knowing that at least two therapists are always present during treatments and
several sets of eyes will review a treatment plan before it is even implemented.
Physicians often participate in peer to peer reviews as a way to get feedback regarding
their proposed plan of care for patients. Peer reviews are done in several ways and one is by
holding weekly chart rounds which include all members of the radiation team. “Chart rounds are
an important interdisciplinary peer review procedure in RT. Treatment details such as
pathology, informed consent, treatment site, prescription, and dosimetry are reviewed.” 3 This is a
great way for everyone to be in agreement with a patient’s plan of care. Physicians may also
participate in tumor boards where they discuss their patients with other providers in order “to
determine the appropriate combination (and coordination) of therapies for each individual case.” 3
Another very important process that clinics use is the “time-out” which can be declared by any
member of the treatment team and effectively puts a pause on the treament. “Each member of
the treatment team should have the right and responsibility to speak out if he/she has concerns or
questions about the plan or course of treatment for a patient.”4 The team respects this time out
and does not proceed with treatment until the questions have been addressed.
So while the public may be worried about radiation exposure and their general safety
when receiving treatment for their cancer, radiation therapy departments take many steps to
ensure patient safety. Policies and procedures are constantly being reviewed and revised as
necessary. The implementation of incidence learning “has proven to reduce the number of errors
in many industries, including healthcare.”1 Mistakes are used as a learning opportunity and
procedures are put into place to prevent future occurrences of those errors. Patients should feel a
sense of security in knowing that their safety is everyone’s top priority. This includes not only
the care team (therapists, physicians, dosimetrists, etc) but also the vendors of the equipment and
software used, engineers, organization administrators, and regulators. 4 “Representatives of
equipment vendors and members of regulatory agencies must be willing to work with the
radiation therapy team to improve the safety of patients.”4 The radiation department realizes the
importance of patient safety and works diligently to provide the best possible care to their
patients.
References
1. Trad M, Romanofski D. Improving Patient Safety Through Incident Learning. Radiation
Therapist. 2017;26(2):163-180. Accessed December 8, 2023. https://search-ebscohost-
com.libweb.uwlax.edu/login.aspx?
direct=true&AuthType=ip,uid&db=rzh&AN=125099738&site=ehost-live&scope=site
2. Dodge B. Patient Safety Curriculum and Instruction in U.S. Radiation Therapy Programs.
Radiation Therapist. 2020;29(2):114-127. Accessed December 8, 2023. https://search-
ebscohost-com.libweb.uwlax.edu/login.aspx?
direct=true&AuthType=ip,uid&db=rzh&AN=146978254&site=ehost-live&scope=site
3. 1.Safety Is No Accident: A Framework for Quality Radiation Oncology Care. ASTRO;
2019. Accessed December 6, 2023.
https://www.astro.org/Patient-Care-and-Research/Patient-Safety/Safety-is-no-Accident/
SINA-Digital-Book
4. ‌Hendee WR, Herman MG. Improving patient safety in radiation oncology. Med Phys.
2011;38(1):78-82. doi:10.1118/1.3522875