Caitlin Evans 1

Radiation Safety Paper

Caitlin Evans
DOS 516 Fundamentals of Radiation Safety
University of Wisconsin La Crosse
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The field of radiation oncology is constantly changing. New technologies and new
treatment techniques are implemented to improve both the accuracy and efficiency of radiation
therapy delivery. Continuously improving quality assurance regimens check the accuracy of
radiation therapy delivery. However, mistakes can happen. In 2010, a series of radiation safety
articles published by the New York Times caused concern among both the public and radiation
oncology professionals.1 These articles highlighted grave errors that had occurred during
radiation treatment which led to deaths. That same year, radiation oncology medical
professionals convened to discuss the concerns that the New York Times had created. The
meeting intended to discover processes to improve workflow and radiation safety.
The meeting finalized a “hierarchy of effectiveness” for preventing errors in radiation
oncology.1 The most important step in preventing errors is to have a series of interlocks in place
which force the user to acknowledge the treatment delivery process. Other effective strategies for
preventing errors include computer automation, standardization of radiation therapy procedures,
employing checklists, enforcing policies and procedures, and requiring training and safety
education.
A series of recommendations were created by radiation oncology professionals during the
meeting.1 Recommendations for radiation therapists focused on radiation therapy delivery
workstations and workflow, greater operator control, an early warning system, a simplified
billing process, appropriate staffing levels, safety commitments, “time outs,” and patient safety
competencies. Radiation therapy workstations should be streamlined and ergonomically
supported to provide control to the user. Workstations should have a reduced number of monitors
and should present information in a tiered manner. Greater control over radiation therapy
delivery equipment was emphasized as it provided a better understanding of radiation therapy
delivery. An early warning system “alerts the operator to an unusual feature of the treatment plan
or a possible malfunction in the treatment device.”1 Early warning systems should be integrated
into radiation therapy delivery equipment to provide opportunities for double checks. A
commitment to safety is expected of the radiation therapy team, which includes a pledge under a
radiation safety covenant. “Time Outs” provide an opportunity for staff to speak up about safety
concerns. Lastly, patient safety competencies should be required of radiation therapy staff.
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One of the most significant recommendations that surfaced from the meeting was the idea
that error reporting systems should be enforced in radiation therapy.1 The meeting emphasized
the need for any member of the radiation therapy staff to anonymously report mistakes or
equipment failures into a computerized system. The adoption of error reporting systems by
radiation therapy departments has grown exponentially since 2010. Most radiation therapy
departments now have a medical event reporting process. An error reporting system alerts the
radiation therapy department to potentials for error and allows the department to analyze
methods for improvement.
In 2010, a study published by Mutic and Brame et al analyzed the effectiveness of a web-
based error reporting system in a radiation therapy department in comparison to a paper-based
one.2 The voluntary web-based error reporting system was designed to allow users the
opportunity to report events quickly and easily. An event was defined as a situation that could
have or resulted in a divergence from radiation therapy treatment delivery. The events were
analyzed by an improvement committee which used the data to restructure clinical processes.
The error reporting system was implemented in 2007 and continued for two years. The web-
based system was compared to a paper-based system over a span of seven years. Overall, it was
found that the web-based system resulted in a greater number of error reporting, superior error
communication, and greater recognition of clinical areas that needed safety enhancements. Web-
based electronic reporting systems in a radiation oncology setting provide important data
regarding clinical areas that could improve patient safety.
Physicists in each radiation oncology department are held to a higher standard regarding
patient safety. One of the most important methods for physicists to improve patient safety is to
employ a failure mode effects analysis (FMEA).1 FMEA is a technique used to pinpoint possible
sources of error and discover reasons the error occurred. It is recommended that all radiation
oncology departments employ the use of FEMA to reduce the number of errors and to improve
patient safety. Physicists are also responsible for employing specific user groups for people who
utilize radiation therapy delivery equipment. User groups should provide an opportunity for open
discussion regarding safety concerns related to the vendor’s equipment.
From the day a diagnosis is made to the last day of radiation therapy treatment, a
complex set of tasks are employed by a radiation oncology department to ensure patient safety.
Once a diagnosis is made a prescription for radiation therapy must be created, which is verified
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by the physics team. The prescription is used by the medical dosimetrists to create a treatment
plan. The treatment plan is checked by the physics team. Quality assurance checks are made on
the machine that is to deliver the radiation to ensure that the dose is within tolerance. After
quality assurance is completed the treatment plan is approved by the medical oncologist. The
treatment approved plan is then checked by the radiation therapists. A series of checklists are
completed by the physicists, dosimetrists, oncologists, and radiation therapists to ensure that
patient is receiving the correct dose, treatment technique, and patient setup for their diagnosis.

References

1. Hendee WR, Herman MG. (2011). Improving patient safety in radiation oncology. Med
Physics. 2010;38(1):78–82. https://doi.org/10.1118/1.3522875
2. Mutic S, Brame RS, Oddiraju S, et al. Event (error and near-miss) reporting and learning
system for process improvement in radiation oncology. Med Physics. 2010;37(9):5027–
5036. https://doi.org/10.1118/1.3471377