The Safety of Radiation: Fact or Fiction?

The Safety of Radiation: Fact or Fiction?

Timothy T. Zehnder
University of Wisconsin – La Crosse
DOS 516-501 Radiation Safety
December 8, 2023
The Safety of Radiation: Fact or Fiction? 2

Radiation oncology is a very complex form of medicine that comes with inherent risks
due to the delivery of something that is permanent. Radiation cannot be taken back after it is
administered and there is no miracle drug that can combat the biological effects that it has on the
body. Many of the public have heard of at least one story of misadministration of radiation from
imaging studies or the actual treatment itself. Hearing about the misadministration of any form of
medicine can and should make people hesitant about the medical care that they are receiving but
it would, hopefully, also cause someone to become educated on the topic to understand how
much of a risk that it really is posing to them. The first step in determining how much danger a
procedure poses is to understand the incidence rates of a misadministration occurring and the
complexity of those errors.
Radiation therapy administration errors have been shown to occur every 1,500 per 1
million treatment courses with the majority of those errors occurring over a decade ago. 1 That is
an incidence rate of .15% and the rate of misadministration has been dropping as more
regulations and rules are put in place to reduce errors. It was also shown that only 1% of the
adverse events in radiation therapy resulted in the death of the patient.1 The majority of those
adverse events were seen in the early 1990’s and it is speculated that they were due to
inexperience with the rapidly changing and developing technology in the field of radiation
therapy.1 However, radiation therapy is not the only department in a hospital where radiation is
delivered to a patient. Most forms of medical imaging such as Computed Tomography (CT) and
Positron Emission Tomography (PET) deliver doses of radiation to patients. Utilization of
imaging modalities has been increasing in recent decades and accounting for the increasing dose
of radiation that patients are recieving.2 It is estimated that over three billion diagnostic imaging
studies are conducted on a yearly basis, globally, compared to the five million radiation therapy
treatments that are delivered.3 While the levels of radiation utilized in those procedures are
relatively safe, accidental overdoses of radiation can affect the genetic material in the cells of the
body as well as bodily systems such as the hematopoietic system, digestive system, skin, gonads,
central nervous system and eyes.3
It is because of the dangerous nature of radiation that so many regulations are put in place
to protect the patients from the possible harm of overuse and overdose. The most prominent
professional organization in radiation in the United States is the American Association of
Radiologic Technologists (ASRT) which represents over 140,000 imaging technologists and
The Safety of Radiation: Fact or Fiction? 3

radiation therapists.4 In response to the increasing worry about the dangers of radiation and the
increasing worry about misadministration of high levels of radiation, the ASRT has come out
with many appropriate responses. The paramount of those ASRT responses was to create a
standard of certification and education for radiation therapist to increase patient safety and
decrease errors.4 The ASRT also worked with the The Foundation’s Health Care Industry
Advisory Council (HCIAC) to publish guidelines for the roles and training of personnel in a
radiation therapy department known as the “White Paper”. The White Paper addresses key
departmental points that have the largest impact on patient safety such as workplace staffing,
workplace culture, skill assessment of staff and application training.4 Through the White Paper,
the ASRT has been able to set the minimum requirements that facilities must achieve to be able
to deliver safe and affective care to patients. The Nuclear Regulatory Commission (NRC) is
another organization that has created a set of federal regulations known as the Title 10 Code of
Federal Regulations (10 CFR) as a set of laws and procedures that must be followed in order to
utilize radioactive sources in the United States.5 These laws ensure that radioactive materials are
handled in the most regulated and safe manner possible in an effort to decrease errors and
increase overall patient safety. If the Title 10 CFR laws are not followed properly, facilities can
be stripped of their license allowing them to utilize radioactive material. This is a significant step
towards the overall safety of handling and delivery of radiation.
Along with federal laws and mandatory education levels for staffing, accreditation
agencies such as The Joint Commission (TJC) have been implementing rules and processes of
their own to ensure the safety of patients and staff in radiation oncology departments. The Joint
Commission (TJC) found that although the rate of misadministration of radiation is low, it still
needs to decrease when compared to the ultralow incidence rates of the “ultra safe” industries
such as aviation and nuclear power.6 According to independent research conducted by TJC, 6 the
most powerful methods of driving patient safety are the creation of a peer to peer review system
in the department, ensuring that the most experienced personnel are in charge of their safety
program and the creation of a safety reporting system. In a separate study, it was discovered that
in the case of peer to peer review prior to SBRT radiation therapy procedures, changes were
made to the treatment plan 23% of the time as a result of the review.7 This is an excellent
example of how something as simple as installing a peer to peer review process prior to
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treatment delivery can increase safety and decrease the chances of delivering a permanent form
of medicine incorrectly.
Radiation can be a very useful tool in medicine and has the ability to positively impact
many patients that are suffering from cancer. The permanent nature of the delivery of radiation
means that safety must be of paramount importance for any department that utilizes it. Federal
regulations, professional regulations and accreditation agencies have put rules in place that
ensure the safety of the staff that handle radiation in any setting as well as the patients that are
having radiation delivered to them for any procedure. Departmental policy and procedure is also
a driving force in patient safety and is something that should be explained to patients that are
coming in for treatment. I believe that if patients understood how much importance is placed on
safety in radiation oncology, it would put them more at ease about receiving radiation. All of the
data points to very low rates of misadministration of radiation and a continually dropping rates.
The risk of serious or fatal errors in radiation oncology are even lower and that is very solid
proof that our continued efforts are saving lives and making health care safer for everyone. The
general public should be able to see this data and have high confidence that their safety is of the
utmost concern in health care, both today and in the future, as continued efforts for assurance and
accuracy are made.
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References

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Safety Measures in radiotherapy practice. Radiotherapy and Oncology. 2009;92(1):15-21.
doi:10.1016/j.radonc.2009.03.007

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Intervention Journal. 2010;6(3). doi:10.2349/biij.6.3.e8

3. El-Feky A, El-Sallamy R, El-Sherbeni A, El-Mursi Hagras H. Safety measures among

workers occupationally exposed to ionizing radiation in Tanta University Hospitals. Tanta
Medical Journal. 2017;45(4):166. doi:10.4103/tmj.tmj_29_17

4. 1. Odle T, Rosier N. Radiation therapy safety: The critical role of the radiation therapist ...
2012. Accessed December 7, 2023.
https://www.asrt.org/docs/default-source/research/whitepapers/rt-safety---the-critical-role-of-
the-rad-therapist.pdf?sfvrsn=7ce57dd0_12.

5. Regulations (NRC, 10 CFR) | nrc.gov. NRC Regulations Title 10, Code of Federal
Regulations. November 13, 2023. Accessed November 28, 2023.

6. Terezakis SA, Pronovost P, Harris K, DeWeese T, Ford E. Safety strategies in an academic

radiation oncology department and recommendations for action. The Joint Commission
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7250(11)37037-7

7. Ford E, Dieterich S. Safety considerations in stereotactic body radiation therapy. Seminars in

Radiation Oncology. 2017;27(3):190-196. doi:10.1016/j.semradonc.2017.02.003