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Jenna Cimmiyotti
University of Wisconsin-La Crosse
DOS 516 – Fundamentals of Radiation Safety
October 28, 2020
Patient Safety in Radiation Oncology
Radiophobia is the fear of ionizing radiation. In today’s world, there is undoubtedly a
public fear of radiation whether that is diagnostic x-rays at the dentist office or therapeutic
radiation treatments to cure cancer. As early as the 1990’s, the public’s perception of radiation as
a safe and effective option in the treatment of cancer began to erode as details and statistics
regarding medical errors were publicized. In 2010, The New York Times printed a series of
articles highlighting the dangers of radiation and the fatal effects it had caused. Articles with
titles such as “Radiation Offers New Cures, and Ways to Do Harm” and “As Technology Surges,
Radiation Safeguards Lag” aroused negative attention towards the field.1
Members of the radiation oncology community quickly recognized the need to address
these safety concerns and in July 2010, a meeting was hosted by the American Association of
Physicists in Medicine (AAPM) and the American Society of Radiation Oncology (ASTRO)
entitled “Safety in Radiation Therapy: A Call to Action.” Radiation oncology personnel
including radiation oncologists, medical dosimetrists, radiation therapists, administrators, and
vendors were among the 400 attendees. Acknowledging that radiation oncology is a complex
therapy involving multiple health care professionals and increasingly complex equipment it was
determined a multidisciplinary team approach is needed. Human error is a variable that will
always exist.1
AAPM and ASTRO proposed “fault-tolerant” policies be developed, allowing for
problems to be identified and corrected before harm occurs. ASTRO’s Target Safely Campaign
proposed targets and priorities for the various stages of the radiation oncology
process.2 Proposed safety elements include therapist workstations are to be decluttered by
eliminating unnecessary monitors, keyboards and by utilizing a user-friendly interface. Attention
to limiting traffic through the workspace to limit distraction is stressed. Vendors are to be held
responsible for acting on concerns brought to their attention. Technology with improved warning
systems that alert the treatment team of unusual treatment parameters is key.1 From a managerial
standpoint, appropriate staffing levels should be employed and staff should feel empowered to
speak up if they question anything regarding patient safety. Furthermore, radiation therapists
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work in teams as they deliver treatment. More than one radiation therapist is involved in every
patient’s care so they can work together to check each other’s work and further promote safety.
Additionally, it was recommended that the billing process be streamlined so that the focus of the
radiation therapist was not consumed in billing but rather focused on patient care and patient
safety.1
An incident learning system (ILS) is essential in continual improvement in patient safety.
An ILS serves as a system to report actual or potential errors that occur. By recording incidences
that are classified as “near misses” or “good catches,” procedural changes or other necessary
steps can be made to avoid actual errors before they even occur.3 A quality assurance committee
oversees the ILS and reviews the submissions, facilitate process improvements and involve a
larger audience as necessary.3 Some of the international incident learning systems include: The
Radiotherapy Incident Reporting and Learning System from the Center for Assessment of
Radiological Sciences, Radiation Oncology Safety Information Systems (ROSIS), International
Atomic Energy Agency’s Safety in Radiation Oncology (SAFRON), and Radiation Oncology
Incident Learning System (RO-ILS).3
Tumor boards and chart rounds are other practices used in radiation oncology
departments as a means of peer review. Tumor boards involve a multidisciplinary approach,
whereas chart rounds typically include a peer review within the radiation oncology department
itself to review the treatment approach and decisions.2 Case analysis by a group of qualified
individuals can result in comprehensive and thorough review that aids in patient safety. Peer
reviews also occur in the form of chart checks by the medical physicist and radiation therapists
prior to the initial treatment, weekly throughout treatment, and following completion of the
treatment course.
Most often, the radiation therapists work directly with the patient daily. Therefore, they
play an important role in imparting a sense of confidence in a patient’s view of their treatment
experience. It is important to recognize the potential worries associated with diagnosis and
treatment uncertainties. They can then use their formal educational knowledge to educate and
answer the patient’s questions which often eases the patient’s fears. Good communication
between all members of the oncology radiation team and with the patient will help ensure a safe
treatment process and will give confidence to the patient and their families.
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The risk of radiation is real and is not to be underestimated. We, as radiation oncology
professionals, should hold patient safety in the highest regard and strive to maintain a culture
centered around patient safety. As William Mayo is famously quoted, "The best interest of the
patient is the only interest to be considered."
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References:
1. Hendee, W. R., & Herman, M. G. (2011). Improving patient safety in radiation oncology.
Medical physics, 38(1), 78–82. https://doi.org/10.1118/1.3522875
2. Marks LB, Adams RD, Pawlicki T, et al. Enhancing the role of case-oriented peer review
to improve quality and safety in radiation oncology: Executive summary. Pract Radiat
Oncol. 2013;3(3):149-156. doi:10.1016/j.prro.2012.11.010
3. Ganesh T. Incident reporting and learning in radiation oncology: Need of the hour. J Med
Phys. 2014;39(4):203-205. doi:10.4103/0971-6203.144481