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Brendan Gallagher
Radiation Safety Paper
October 21, 2015
Radiation therapy plays a crucial role in the treatment of cancer. According to the
National Cancer Institute, it is estimated that 50% of cancer patients receive radiation during the
course of their treatment.2 Radiation therapy treatments are mostly safe and effective, but if
treatment errors do occur they can have major consequences. The public has become more
aware of the harmful effects of radiation due to events such as Chernobyl. The potential harmful
effects of radiation tend to be in the spotlight, unlike the medical benefits of it. This makes the
jobs in radiology oncology departments more difficult.
When I was working in x-ray and CT departments, I would often get asked by patients if
the exam is worth doing because of the radiation exposure. Patients that had a lot of x-rays in
their past would often ask questions about what might happen to them because of the radiation.
It seemed as if they had researched what radiation exposure can do to the human body. It is
always important to comfort the patients and explain to them why the benefits outweigh the
risks. In the x-ray department I would compare the x-rays to cigarettes or lottery tickets. If you
smoke one cigarette then the risk of getting cancer from it is very low or if you only buy one
lottery ticket your chances of winning are very low. However, the more you smoke or the more
tickets you buy then your chances increase. Thats not something youre able to say in radiation
therapy, but if you comfort the patient and explain why procedures are being done it will help
them feel less anxious. This is crucial in radiation therapy since theyre in a large room by
themselves, sometimes with the moulds or masks. It is important to let patients know that the
doctor wouldnt order procedures if they werent needed.
Technological advances have helped minimize errors within radiation oncology
departments. Radiation therapists use a computer to ensure a patients identity by asking for two
forms of identification. This was standardized by the Joint Commission to eliminate the risk of
patients being overdosed because their treatment plan wasnt correct because of their anatomy or

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what they properly needed.1 Another advancement has been Record and Verify systems (R&Vs).
Record and Verify systems reduce the risks of errors since a patients information is in the system
stating the way their treatment needs to be performed. This has helped reduce treatment delivery
errors. A very important advancement has been the use of imaged guided radiation therapy
(IGRT). For patients with intensity modulated radiation therapy (IMRT) treatments and other
types of treatments with tight margins, images are taken daily prior to treatment to ensure that the
patient is properly aligned. If the patient is misaligned, therapists can make millimeter
adjustments to ensure the treatment is as accurate as possible. Errors are also reduced by the
radiation physicist performing Quality Assurance tests on the equipment. These might be
performed monthly, quarterly, or annually depending on the test. Each test is properly performed
to make sure theyre within their specific ranges of errors. Hospitals do their best to make sure
patients are treated properly and are not harmed. Quality control measures can uncover certain
specific errors such as machine dose mis-calibration or misalignments of the patient in the
radiation treatment beam.2 However, they are less effective at uncovering less common errors
that can occur anywhere along the treatment planning and delivery process.
A possible source of error in radiation oncology departments could be improper staffing.
Hiring licensed radiation therapists typically eliminates this error. The therapists are certified by
the American Registry of Radiologic Technologist (ARRT). This demonstrates that the
employees have been adequately trained. These certified staff members have the correct
education to recognize any errors if theyre made. The same thing can be said for the radiation
physicist who does the quality control testing, the dosimetrist who creates the plan, and the
doctor. All the steps to minimize errors are carefully taken by oncology departments to make
sure the patient is treated correctly and not harmed.
We can explain all of these precautions to our patients, yet we will still have some that
are worried. Many people do not realize that we receive radiation daily, even without x-rays,
CTs, or radiation therapy. In one year the average American receives approximately 600
millirems of radiation.3 Half of that is due to natural/background radiation from radon in the air,

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cosmic rays, or even from food. The other half is from man-made radiation such as x-rays or
industrial sources. We even receive radiation while flying in an airplane. Radiation is a part of
our everyday life, and these small doses we receive have not shown that they cause us harm.3
Medical procedures do have the capability of producing high enough dosages to create a range of
injuries, but those are typically due to errors created by machines or staff members. With
modern technology and highly trained staff members these errors are becoming less common
each day.

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References
1. Errors in Radiation Therapy. Pennsylvania Patient Safety Advisory [online]. 2009; 6(3): 8792. Available at:
http://patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2009/Sep6%283%29/Pa
ges/87.aspx. Accessed October 21, 2015.
2. Terezakis SA, Pronovost P, Harris K, DeWeese T, Ford E. Safety Strategies in an Academic
Radiation Oncology Department and Recommendations for Action. Joint Commission journal
on quality and patient safety / Joint Commission Resources. 2011;37(7):291-299.
3. United States Nuclear Regulatory Commission. Radiation Protection.
http://www.nrc.gov/about-nrc/radiation/around-us/doses-daily-lives.html. Accessed October 20,
2015.