Radiation Safety Paper

Jose L. Olmos
DOS 516- Fundamentals of Radiation Safety
University of Wisconsin, La Crosse
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With news headlines such as this one: “Radiation Overdoses At Cedar-Sinai Prompt
Investigation1”, it is easy to understand why some people are fearful of receiving radiation when
it comes to their diagnostic imaging exams. This headline comes from a report of on an incident
that was reported on October 2009, “only after a patient complained in August about losing
some hair following a CT scan did Cedars-Sinai Medical Center realize more than 200
people had been exposed to excessive radiation from diagnostic tests performed there in the
last year and a half. 1” As it turns out the problem was summed up to being the result of
operator error as the “CT scanner operators at Cedars-Sinai failed to heed notices of jacked-
up radiation doses after technicians reprogrammed the machine and overrode standard
settings.1”
But CT scans are not the only area of concern as other imaging modalities have
shown an increase in use by ordering physicians. A study published by the New England
Journal of Medicine researching low energy radiation exposure during imaging procedures
in non-elderly adults, found that “approximately 70% of the study population underwent at
least one such procedure during the 3-year study period, resulting in mean effective doses that
almost doubled what would be expected from natural sources alone.2” This means that younger
populations are potentially receiving more and more doses or radiation over time. What is even
more alarming is that the National Council on Radiation Protection and Measurements recently
reported that “in the United States the per capita dose of radiation from medical imaging has
increased by a factor of nearly six since the early 1980s.2”
The findings don't mean the tests performed weren't worth the risk. “But the rise in
testing and the lack of evidence that some of the tests make a meaningful difference in
medical outcomes for patients heighten concerns. Some of the reasoning for the increase in
these studies is that it can predict future events, 3” acting as a kind of preventative
maintenance. This is also thanks in part to the constant improvements in medical imaging
technology, where less and less dose is needed to produce quality images. This feeds into
the notion because there is less dose, that makes it okay to order additional studies, but this
logic does not take into account the cumulative dose received by a patient. “The imaging
technology today is amazing, it's amazing how quickly it's advanced, yet we haven't
answered the fundamental question of whether we're actually helping people by [ordering
more studies]. 3”
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The reality is that the benefits of having a diagnostic image procedure done, far outweigh
the risks involved. “There is a risk that people who need a lifesaving or life-improving
imaging procedure might not get one because of radiation worries. 3” “Not only should
strategies for optimizing and ensuring appropriate use of these procedures in the general
population should be developed, but it is time to do a better job making sure tests are
appropriate and advising patients about the risks. 2-3” It starts with better information and
education for medical personnel, who can then pass this along to patients. In one study of U.S.
“health care providers using CT in patients with abdominal and flank pain, less than 50% of
radiologists and only 9% of emergency department physicians reported even being aware that CT
was associated with an increased risk of cancer.2” A better informed staff helps give patients the
most accurate, up-to-date information ensures that they are well informed to be able to make the
best decisions possible for their healthcare needs.
Now with regard to radiation therapy where the radiation beam energies and doses are
substantially higher, compared to those from diagnostic imaging procedures, there have been
some incidents in the past which raised some alarms. A study performed by Practical Radiation
Oncology to improve radiation treatments describes incidents as “any unwanted or unexpected
changes from normal behaviors that could potentially adversely affect people or equipment. 4”
“Non-minor incidents are classified as those that resulted in more than 5% deviation from a
prescribed dose or a near miss or unsafe condition that can lead to treatment error.4” The study
sought to see whether the system of safety checks they had implemented at their facility showed
any improvements in the number of incidents occurring. “Analysis of 2506 incident reports
generated over a 5-year period demonstrate a substantial decline in actual, nonminor incidents;
ie, those with a dose variation from that prescribed of greater than 5%. Only 49 incidents
(1.95%) had an impact on patients.4” It also showed that the “overall number of reported
incidents decreased over the course of the 5 years, as did the level of severity of the incidents,
despite a 20% increase in number of treatments and a 30% increase in staffing.4” More
impressive is that their “facility that delivers over 4,000 treatments a year and 2,506 reported
incidents over the course of 5 years, only 49 incidents had any impact on the patient.5”
These outcomes are thanks in part due to the nature of radiation therapy as a whole which
makes it so that it is highly regulated and must adhere to very strict practice standards.
“Problems [that arise] are best addressed through a multidisciplinary approach that includes
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members of treatment teams (radiation oncologists, physicists, dosimetrists, radiation therapists,

nurses) working with vendors, administrators, and regulators.5” At every treatment site, there is a
massive team of people involved in the treatment of a patient, double-checking everything before
a therapeutic dose is even administered to the patient. In researching ways to improve radiation
oncology, Hendee and Herman noted that:
although errors in radiation oncology can be reduced, they cannot be eliminated because
the treatment process is complex, hardware and software technology can malfunction,
communications can be misunderstood, and, especially, because humans are involved.
Therefore, treatment approaches must be fault-tolerant—i.e., they must be designed to
catch and correct errors before they can harm the patient.5
In my years working as a Radiologic Technologist, a Radiation Therapist, and now as a Medical
Dosimetry student, there is a mantra that I picked up along the way, and that is that no job is so
urgent that we cannot take the time to do things safely. The systems in place may not be perfect,
as nothing in life truly is, but it is this strive to perfection that makes me proud to be part of a
field that makes safety their top priority.
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References

1. Mertens M. Radiation Overdoses At Cedars-Sinai Prompt Investigation. NPR.

https://www.npr.org/sections/health-shots/2009/10/cedars_sinai_ge_found_to_be_be_1.html.
Published October 14, 2009.
2. Fazel R, Krumholz HM, Wang Y, et al. Exposure to Low-Dose Ionizing Radiation from
Medical Imaging Procedures. New England Journal of Medicine. 2009;361(9):849-857.
doi:https://doi.org/10.1056/nejmoa0901249
3. Hensley S. Heart Stress Tests Pump Up Radiation Dose. NPR. Published August 27, 2009.
Accessed December 7, 2023.
https://www.npr.org/sections/health-shots/2009/08/heart_stress_tests_pump_up_rad.html/
4. Clark BG, Brown RJ, Ploquin J, Dunscombe P. Patient safety improvements in radiation
treatment through 5 years of incident learning. Practical Radiation Oncology. 2013;3(3):157-
163. doi:https://doi.org/10.1016/j.prro.2012.08.001
5. Hendee WR, Herman MG. Improving patient safety in radiation oncology. Medical Physics.
2010;38(1):78-82. doi:https://doi.org/10.1118/1.3522875‌