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Jacquelyn Palermino

Dos 516 Radiation Safety

October 24, 2017

Radiation Safety

Radiation safety plays a significant role in the field of radiation oncology. As a healthcare
professional who works with radiation, it is our responsibility to follow radiation safety policies
and procedures. These procedures follow as low as reasonably achievable (ALARA) principles
as well as making sure the correct dose is delivered to the correct patient. Following these
policies and procedures help to protect patients along with healthcare professionals who work
with medical imaging and radiation therapy equipment. When a patient is diagnosed with cancer,
they are not aware of what happens behind the scenes in preparation for their radiation
treatments. Some patients may lean on family members for support, while others may research
what radiation is and how it will affect them. The information presented through media can be
beneficial to a patient, but it can also cause fear and misperceptions on radiation therapy.

In the United States, there are approximately 400 million radiologic procedures
performed every year. According to Koth and Smith1, more than 90% of radiation exposure from
unnatural sources comes from medical imaging. Over the years, the rise of advanced imaging
modalities, such as computed tomography (CT) and positron emission tomography (PET), have
led to an increase of radiation dose. As a result, radiation dose has increased by nearly 6 times
since the early 1980s because of advancements in diagnostic imaging and the emphasis of high
quality images.

Today, many Americans receive far more radiation than ever before, especially the ones
undergoing radiation therapy. Radiation is known to save countless lives, but it also has serious
risks and potential dangers that need to be considered. Although rare, most radiation treatment
accidents may occur when safety policies and procedures are violated, resulting in overexposure.
In 2005, a hospital in Florida revealed that 77 brain cancer patients received 50 percent more
radiation than what was prescribed due to a linear accelerator incorrectly programmed for nearly
a year.2 Another incident of overexposure happened in New York in 2005. A patient received
treatment for a cancerous tumor on the base of his tongue. The patients treatment was delivered
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improperly due to the multi-leaf collimators being left open instead of taking the shape of the
field the doctor initially prescribed. The patient received seven times his prescribed dose and
suffered from deafness, blindness, dysphagia, dyspnea, and eventually death because of radiation
overdose.3

Radiation safety began in the early 1900s and led to the concepts of time, distance and
shielding. Twenty years later, procedures for protection personnel were recommended. These
procedures focused on maximizing distance, limiting occupational time, and requiring mandatory
time off to reduce overall dose.1 Today, any organization that uses radiologic technology must
establish a radiation safety program. A radiation safety committee consisting of a radiation safety
officer (RSO), a nursing professional, and a departmental manager are responsible for meeting to
discuss policies and corrective actions to stop unsafe operations in their department. Koth and
Smith1 state, A radiation safety program should confirm proper supervision and training of
individuals working with radiation, oversee safe use and control of radioactive materials, limit
controlled and uncontrolled areas, provide occupational exposure monitoring, provide
appropriate radiation safety equipment, provide ongoing training and ensure proper radiation
safety practices and confirm proper licensing of radiologic technologists. According to Fencl4,
radiation safety for patients and health care professionals can be obtained by providing guidance
on how to achieve ALARA and the development of proper procedures and policies focusing on
specific safety aspects. Some of the aspects may include who can operate radiologic technology
or diagnostic imaging equipment, protective measures for patients and staff, requirements for the
use of radiation monitoring devices, educational and competency requirements for personnel,
patient education, and quality improvement initiatives. The guidelines from a radiation safety
program allow staff to understand the standards and protocols implemented and to ensure patient
safety and protection.

In radiation therapy departments, there are many quality assurance tests that are used to
ensure proper machine function as well as proper dose delivery to the patients. McDermott5
explains that equipment quality assurance consists of tests that are performed on the equipment
or software, whereas patient quality assurance consists of tests, checks, or measurements
performed to make sure that a specific patient receives the correct treatment prescribed. When a
linear accelerator is initially installed, it must go through a series of tests to verify that the new
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piece of equipment and software meet the specifications provided by the manufacturer. Next, the
process of commissioning begins which provides all the procedures necessary to put the machine
into clinical use. These procedures involve a radiation survey of all contiguous occupiable areas,
absolute calibration of all radiation beams using the AAPM TG-51 protocol, and depth dose data
and beam profile measurements for every beam energy. These are just some of the measurements
that need to be made to establish a baseline performance of the linear accelerator. Once the
machine is accepted and commissioned, equipment quality assurance procedures are maintained
on a daily, monthly, and annual basis to make sure the machine is operating properly.

Patient QA involves procedures that are designed to ensure that each individual patient
receives the specific treatment prescribed for them. The whole radiation oncology department
works together to make sure there are no errors in a patients treatment. Once planning is
completed by the dosimetrist and physician, there are numerous checks that take place to verify
the patient is receiving the appropriate treatment. For example, a physics chart check is
performed by a medical physicist to review a patients chart making sure that the plan matches
the prescription. A physicist reviews the prescription, noting that it is dated and signed by the
physician. The beam arrangement, modality, and energy prescribed along with the dose per
fraction and total dose are also checked. Another example of patient QA is the use of in vivo
dosimetry. This type of QA can be used to verify the dose the patient receives. Diodes, TLDS,
OSLDs, and MOSFETS are all examples of dosimeters that can be used to verify that the correct
dose is being delivered to the target. Portal imaging and cone beam CT (CBCT) are other ways
to assure correct targeting and verification that the isocenter is in the correct location.5

There are many policies and procedures a radiation oncology department must follow to
provide safe and accurate treatments to their patients. The chance for errors can be reduced by
obtaining the proper education, implementing a radiation safety program, and performing the
required quality assurance checks. Radiation safety is an important role in radiation oncology
and should not be overlooked. The whole radiation oncology team must work together to make
sure every patient receives the best and most accurate treatment the facility can provide.
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REFERENCES
1. Koth J, Hess Smith M. Radiation Safety Compliance. Radiologic Technology. 2006;87
(5):511-524.
http://www.radiologictechnology.org/content/87/5/511.full.pdf+html?sid=61e97b3f-913f-
4941-9744-a9de60d73182. Accessed October 21, 2017.

2. Watson D. Radiation Safety. AORN Journal. 2010;92(2):233-235.

doi:10.1016/j.aorn.2010.04.012. Accessed October 21, 2017.

3. Bogdanich W. Radiation offers new cures, and ways to do harm. The New York Times.
January 23, 2010. http://www.nytimes.com/2010/01/24/health/24radiation.html. Accessed
October 21, 2017.

4. Fencl J. Guideline Implementation: Radiation Safety. AORN Journal.2015;102(6):629-639.

doi:10.1016/j.aorn.2015.10.010. Accessed October 22, 2017.

5. McDermott PN, Orton CG. The Physics & Technology of Radiation Therapy. Madison,
WI:Medical Physics Publishing; 2010. Chapter 18.