Radiation Safety in Radiation Oncology

Jessica Ezelle
University of Wisconsin at La-Crosse

With recent incidences of overdosing patients that have led to some patients deaths, the
public seems to be worried about radiation exposure. However, there are numerous checks and
balances set in place to ensure that patient safety is the number one goal in radiation therapy.
The linear accelerators go through extensive testing and calibrations before the therapists
are ever released the machine to ensure their proper usage. Then they undergo daily, monthly and
yearly quality assurance measurements to ensure their output is as it should be. The same with
brachytherapy sources.1 They are calibrated at the beginning of their life span and undergo
testing often and before each use.
The linear accelerators also have many checks and balances within themselves so that if
one thing is not exactly right the machine will not beam on. All treatment parameters must be
met and all internal parts of the machine must be working properly for the linear accelerator to
produce beam.
There should be several quality management approaches set up within the radiation oncology
facility that all play a vital role in the radiation safety process. One of these is peer review, each
chart should undergo a peer review by one or more peers to ensure that the plan is appropriate for
the patient.2
Another quality management approach is physics initial and weekly chart checks are
recommended by several radiation governing agencies. Physics must first check the chart
initially before the patient begins treatment ensure accuracy of calculation, appropriateness of
charting data, and fulfillment of the physicians' written prescription.2 After that a chart review
must be conducted at least once a week to ensure dose calculations are correct and the
prescription is being followed as prescribed.
Audits are another quality management approach. These are independent evaluations that
can include commissioning data, beam outputs, and phantom testing. Both the ASTRO report
Safety Is No Accident and the ACR technical standards for external beam radiation therapy call
an audit to be performed at commissioning then annually after that.2
Staff training and competency is another. Continuing medical education on procedures
and safe operation of equipment is vital to the safety of the patients.2

Having clearly written policies and procedures about radiation safety, kept in an easily
accessible spot, is very important to keeping the staff informed on what to do in certain situations
should they arise.2
The last quality management approach is having an incident reporting system for logging
radiation incidences and near misses. The facility should allow for this in a blame-free
environment so that the staff feels safe to report the event2. With event reporting, sometimes
incidences are able to be accounted for and made up for so that they do not become a bigger
problem.
Another radiation safety role in radiation oncology is the advancement of treatment plans.
With the use of intensity-modulated radiation therapy (IMRT), this has the ability to conform
isodose distributions in a plan more precisely to the targets shape allowing for the reduction of
the dose to adjacent structures. IMRT plans require a quality assurance (QA) measurement on a
phantom to be performed, documented, verified and approved to be sure that the dose
distributions are correct.3 Along with very precise treatments image guided radiation therapy
(IGRT) may be performed to ensure accuracy in the alignment of the target radiation area.1
Also in radiation therapy, it has become a standard that at least two therapists be present
during treatment not matter how low the patient load may be. These therapists must review each
plan, set-up instructions, prescription, and pictures to ensure the information is consistent and
valid prior to treatment. All plans before a treatment is given are required to have an x-ray
verification of some type that must be reviewed and approved by the physician. Then weekly, if
not daily, x-ray verification x-rays are taken to ensure proper set-up is still being made.3 Also
therapists are responsible for making realistic schedules so that each patient has their own time
on the treatment table to avoid rushing through a treatment and allowing more room for error.1
All of these areas of radiation must work well together and communicate well to provide
the best care for our patients to ensure they get their proper treatment. Errors and overdoses
occur when there are flaws in the system and one area is not doing what they are supposed to do
and something gets missed.

References:
1. Dieterich, S., Ford, E., Pavord, D. and Zeng, J. (2016) Quality and Safety
Improvement in Radiation Oncology, in Practical Radiation Oncology
Physics. Philadelphia, PA: Elsevier, pp. 165178
2. Zietman A, Palta J, Steinberg M. Safety is No Accidnet. American Society
for Radiation Oncology; 2012.
https://www.astro.org/uploadedFiles/Main_Site/Clinical_Practice/Patient_Saf
ety/Blue_Book/SafetyisnoAccident.pdf. Accessed October 23, 2016.

3. Odle T, Rosier N. Radiation Therapy Safety: The Critical Role of the

Radiation Therapist. ASRT Education and Research Foundation. 2012.
https://www.asrt.org/docs/default-source/whitepapers/rt-safety---thecritical-role-of-the-rad-therapist.pdf?sfvrsn=2.