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Patient Safety in Radiation Therapy

Travis Kilmer

DOS 516 - Fundamentals of Radiation Safety

Radiation, for a mass of the population, has a negative connotation associated with it.
When it comes to movies, media, and other sources of misleading information, the benefits of
radiation can be shadowed and even ignored by the fear of physical defects, mutation, cancer,
and other health risks. Freudenberg and Beyer write, “In addition, patients’ decisions against
undergoing an imaging procedure are frequently based on partial and sometimes incorrect
information.”2 A specific example of this misinformation combined with preconceived ideas of
radiation, showed that 60% of women that were informed about the benefits and risks of a
mammogram overestimated the radiation in the procedure. 3

With advancements in technology within the medical field, particularly radiation

oncology, risks and protocols are continuously examined to study the effects of radiation
exposure to both patients and those working in this field. When looking at radiologic screening,
newer multidetector CT scans increase the radiation dose to patients by 30% to 50% when
compared to an older version, the single-slice CT scanner. 1 This shows the importance of having
up-to-date standards to protect the patient and others.

The collection of misinformation and preconceived notions of radiation, along with the
dangers of an increasing advancement in technology within the field, can give the impression of
chaos and instill worry in patients in regards to the field of radiotherapy. This is why protocol
and protective measures are established so that medical errors are less frequent, therefore,
providing safe and effective care.

One of the ways that patient safety is managed and medical errors are reduced is by
implementing programs like RCA and FMEA. RCA, or root cause analysis, looks at “the most
reasonable causes from the myriad of competing causes” to expose the underlying agent of an
adverse event. 4 This obviously only takes place once the harm has been established. 4 FMEA, or
failure mode and effects analysis, is used to predict the outcomes of adverse events due to system
states and failures by humans and machines. 4 With each of these programs working together, we
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can see that with FMEA looking ahead and RCA looking at the past, medical errors and patient
safety are currently being accounted for to improve quality care now and for the future. 4

Along with analytical programs like FMEA and RCA, the American Society for
Radiation Oncology (ASTRO) is committed to reduce medical errors and improve safety when
using radiation to treat cancer. 5 ASTRO has worked with others in creating a central database for
errors involving computed tomography scanners and linear accelerators.5 Other steps ASTRO
has taken include the Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging
and Radiation Therapy (CARE) Act. The CARE Act promotes “updated regulations specifying
the education and credentialing requirements for persons who perform medical imaging
examinations and who plan and deliver radiation therapy treatments.”6 With these minimum
standards put in place, there will be a reduced amount of complications and more patients will be
treated correctly and safely.

Finally, not only do analytical programs and different committees have a share the in the
process of minimalizing the amount of medical errors and improving patient safety, but the entire
radiotherapy team does too. While also making sure proper protocol and procedure is being
followed throughout the patient’s treatment process, the team also conducts meetings to discuss
each treatment plan. 8 The purpose of these meetings is multifunctional by enhancing
communication, efficiency, education, and professional relationships. 7 By having oncologists,
dosimetrists, radiation therapists, etc. involved all at once, there can be a greater sense of
understanding and comprehension of everyone’s role in providing the best possible care for the
patient, therefore, reducing medical errors and increasing patient safety. 7, 8

Many people are susceptible to misinterpretations of radiation and worry about their
safety. With reports deaths and consequences of medical errors due to the treatment of radiation,
it can be easy to exaggerate the risks and overshadow the benefits. Everyone should be reassured
of the benefits of radiation and the safety of having it as a treatment option. Through continuous
adaptations being made to safety measures, this ensures the safety of the patient and those in the
radiation oncology department. By the use of FMEA and RCA, predictions and analysis of
adverse events are able to be addressed. With committees such as ASTRO, updated regulations
can keep up with the increasing advancement in technology and the people using it. Lastly, by
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having the radiation team discuss the overall treatment plan, there is a lower chance of medical
errors and a greater chance of increasing the patient’s safety.
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References:

1. Berlin L. Medicolegal and ethical issues in radiologic screening. Seminars in

Roentgenology. 2003;38(1):77-86. doi:10.1016/s0037-198x(03)00012-9.
2. Freudenberg LS, Beyer T. Subjective Perception of Radiation Risk. Journal of Nuclear
Medicine. 2011;52(Supplement_2). doi:10.2967/jnumed.110.085720.
3. Hollada J, Speier W, Oshiro T, et al. Patients’ Perceptions of Radiation Exposure
Associated With Mammography. American Journal of Roentgenology. 2015;205(1):215-
221. doi:10.2214/ajr.14.13650.
4. Senders JW. FMEA and RCA: the mantras* of modern risk management. Quality and
Safety in Health Care. 2004;13(4):249-250. doi:10.1136/qshc.2004.010868.
5. Hampton T. Radiation Oncology Organization, FDA Announce Radiation Safety
Initiatives. Jama. 2010;303(13):1239-1240. doi:10.1001/jama.2010.340.
6. Care FAQs. https://www.aapm.org/government_affairs/documents/CAREFAQs.pdf.
Accessed October 15, 2018.
7. Devitt B, Philip J, Mclachlan S-A. Team Dynamics, Decision Making, and Attitudes
Toward Multidisciplinary Cancer Meetings: Health Professionals Perspectives. Journal
of Oncology Practice. 2010;6(6). doi:10.1200/jop.2010.000023.
8. Duggar WN, Bhandari R, Yang CC, Vijayakumar S. Group consensus peer review in
radiation oncology: commitment to quality. Radiation Oncology. 2018;13(1).
doi:10.1186/s13014-018-1006-1.