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Pat Sheil
Dos 516: Radiation Safety
October 25, 2016
Radiation Safety
In the field of radiation therapy, it is a normal occurrence to have a patient come
to their first day of treatment feeling nervous and apprehensive. The entire process is
overwhelming for a patient who has little to no knowledge of radiation. They are
suddenly diagnosed with cancer, overcome by information from multiple medical
professionals, have to go through scans and tests, instill trust in new faces they just met,
and finally enter the radiation vault where they are met with a daunting linear accelerator
which will provide their treatment. Radiation can be especially frightening to many,
because it is something the eye cannot see and carries with it very lethal potential. Just by
doing background research online, a patient may become uneasy while reading articles
about past cases of overdose, possible side effects, and risks. While radiation is viewed as
a disconcerting situation, it is important to understand the standards and protocols
implemented to ensure patient safety and protection.
Shortly after the discovery of x-rays by Wilhelm Roentgen in 1895, the world
realized the potential harm that came with it.1 Adverse effects on the human body such as
dermatitis, hair loss, anemia and even death became acknowledged and investigated.
Radiation protection efforts became established as a result of the mistakes and ignorance
of radiation effects by radiation pioneers. Today, we are not free from errors but many
programs and organizations have implemented safety guidelines to minimize them. The
American Association of Physicists in Medicine (AAPM) and the American Society of
Radiation Oncology (ASTRO) are two organizations that sponsored a meeting called
Safety in Radiation Therapy: A Call to Action in response to medical errors that were
put into the limelight by the New York Times in 2010.2
The meeting consisted of 400 attendees, including physicians, dosimetrists,
radiation therapists, oncologists, equipment vendors, regulators, and hospital
administrators. The intent of the meeting was for medical professionals to collaborate and
identify causes of mistakes and equipment failures and develop an approach to address

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the causes and make radiation therapy safer. The discussions yielded several
recommendations. A few of the recommendations were therapists workstations should be
free from clutter, recommended staffing levels should be developed, therapists should be
free from unwarranted distractions, and error reporting systems should be developed.2
The recommendations from the meeting have been implemented in many institutions. For
example, the standard for many hospitals requires at least two radiation therapists per
treatment unit. According to the American Society of Radiologic Technologists (ASRT),
having two therapists per machine is the best practice. Having two therapists allows one
therapist to monitor the patient and the other to focus on the control panel.3 Two
therapists are beneficial in the event of an emergency and can provide a second set of
eyes to double check patient identification, treatment plans, and any inconsistencies.
While errors in radiation oncology will occur due to the complexity of diseases,
sophistication of new ever-evolving technology, and the involvement of humans who are
not flawless; the errors can be minimized by quality assurance (QA). One of the biggest
fears seen in patients is the accuracy of the treatment delivered. Quality assurance
programs are done daily, monthly, and annually to ensure deviation from the baseline
values are within set tolerance levels.4 Examples of some QA checks include
functionality of safety interlocks, x-ray/electron output constancy (+/-3%), treatment
couch position indicators (1 degree) and localization of lasers (+/-2mm).4 Correct
calibration and commissioning by the physicist is of the utmost importance because the
patients plan is created from mathematical computer calculations based off of specific
baseline numbers. Any deviation could lead to overdose, under dose, or complete miss of
target. Proper quality assurance checks and calibration of the machines prevents errors
and gives patients confidence that they will receive the prescribed treatment correctly.
Radiation oncology has made great strides in patient safety and quality over the
years. Many organizations have implemented quality policies and procedures in radiation
therapy departments to ensure the safety of each patient. Radiation workers are constantly
going to training seminars to enhance their skills and stay up to date. New technological
advances have improved the accuracy of treatments, while new research has helped those
working in the field become more knowledgeable and cognizant of patients concerns.

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Radiation can be overwhelming to a patient at first but the benefits of the treatment
outweigh the concerns.

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References:
1. Cherry, Simon, Physics in Nuclear Medicine, Elsevier, 4th Edition,
2012. Chapter 1
2. Hendee W, Herman M. Improving Patient Safety in Radiation Oncology. Medical
Physics. January 2011. http://dx.doi.org/10.1118/1.3522875. Accessed October 25, 2016
3.Odle T, Rosier N. Radiation Therapy Safety: The Critical Role of the Radiation
Therapist. ASRT. https://www.asrt.org/docs/default-source/whitepapers/rt-safety---thecritical-role-of-the-rad-therapist.pdf?sfvrsn=2. Accessed October 25, 2016
4. Washington, Charles M. and Leaver, Dennis T. The Principles and
Practice of Radiation Therapy. 4th ed. St. Louis, MO: Mosby Year Book
Inc.