Radiation Oncology is often a modality utilized as part of a multi-disciplinary approach for the treatment of cancer.

Radiation administered for cancer treatment can be remarkably successful; however, health risks can be associated with radiation if it is not properly controlled. Having complete knowledge of the possible damage radiation can cause should be known and accounted for. Ensuring patient safety in a radiation oncology department plays an equally pivotal role in the quality of care, as the actual treatment itself. Healthcare professionals must manage day-to-day procedures in a way that makes certain the health and safety of patients are maintained. A comprehensive role is essential to ensure patient safety. Cooperation from all groups of staff, including radiation device manufacturers, physicians, physicists to therapists, must work together to promote quality assurance (QA) throughout all aspects of the radiation process. Adequate QA is required for machine calibration, patient diagnosis to medical prescription, and finally for treatment delivery. To ensure safety of patients, there are several organizations that oversee and regulate safety practices in radiation oncology departments. There have been increasing efforts to introduce improved protective measures to keep the public safe. To name a few are the Nuclear Regulatory Commission (NRC), which is a sub-agency of the Department of Energy (DOE), The Joint Commission (TJC), Occupational Safety and Health Administration (OSHA) and the World Health Organization (WHO). The NRC holds weight of federal law with regard to radiation regulations. They manage radioactive materials, along with the byproducts of those materials, and require quality management to include a radiation safety committee to maintain the safety of these materials within a department. This committee must meet quarterly at a minimum, and include a radiation safety officer (RSO). The RSO is responsible for implementing a safety program to enforce regulations and ensure the entire staff is properly trained in safety procedures. They are required to hold up-to-date policies, and keep records. Departments implement safety protocols for all treatment processes. This includes proper functioning equipment, immobilization during simulation, dose calculation in planning, daily setup in the treatment room and treatment verification before delivery. A quality system has been defined as the organizational structure, responsibilities, procedures, processes and resources for implementing quality

assurance.[1] Radiation Oncology departments maintain a safe environment beginning with QA of equipment. American Association of Physicists in Medicine (AAPM) provides many guidelines for physicists to accurately calibrate radiation treatment modalities. Accuracy and reliability in dose delivery is achieved, through the establishment of quality assurance programs for every aspect of design and delivery of radiation.[1] It has been reported[1]; in general, carelessness is not the main cause of accidents. In the last 30 years, the treatment planning stage was the cause of 55% of extensively reported accidents in radiation therapy that caused substantial harm to patients, and 45% were related to equipment errors. To improve safety in these areas, medical physicists follow AAPM Task Group guidelines to ensure proper commissioning and maintenance of equipment. Treatment dose accuracy is verified through independent monitor unit software and then double-checked by another colleague, in addition to physician signature, before being transferred to the treatment console for delivery. Most departments require a checklist to be completed while therapists re-check the treatment plan as part of an additional safety precaution. Therapists confirm the treatment plan matches the written prescription, and verify no changes were introduced when the plan was transferred via careful review of the record and verify system. The patients identity is double-checked and image guidance is used to confirm the plan properly corresponds with the treatment machine before any radiation is delivered. The therapists verify patient setups before each treatment is administered. It is extremely unfortunate that radiation incidences have occurred causing severe injuries or even death. The publics inquiries about the safety of the field are justified; however, the benefits to numerous individuals on a daily basis with the use of radiation in medicine far outweigh the devastations. Many safety protocols are in effect, as well as constant efforts to improve upon safety. Michael G. Herman on behalf of AAPM, made a statement last year regarding the incidences that were reported in the New York Times.[2] AAPM believes that patient safety in the use of medical radiation will be increased through: consistent education and certification of medical team members, whose qualifications are recognized nationally, and who follow consensus practice guidelines that meet established nation accrediting standards. Undeniably, education is the key to creating an environment incorporating patient safety into its

culture. Knowledgeable individuals with adequate communication skills are needed to raise awareness of the importance of safety practices and procedures. The CARE bill, also known as Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy, is another way to impose efficient regulations and standardize patient safety. This bill is an important piece of legislation for improved quality of patient care and safety measures. Many organizations and health care professionals support the CARE bill because they recognize the importance of education and certification standards in regards to safety advancements. Patient safety is a leading priority in radiation oncology. Even though the percentage error in our industry is much smaller than others, we must continue to work on all levels from manufacturers, legislators to the radiation oncology team to improve patient care.

REFERENCES:

1.

Boadu, M., Rehani, MM. Unintended exposure in radiotherapy: Identification of

prominent causes. Radiotherapy and Oncol. 2009;93(3).

2.

Statement of Michael G. Herman, Ph.D., FAAPM, FACMP On Behalf of the

American Association of Physicists in Medicine (AAPM) Before the Subcommittee on Health of the House Committee on Energy and Commerce. [News release]. February 26, 2010. http://www.aapm.org/publicgeneral/StatementBeforeCongress.asp. Accessed October 3, 2011