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Teri Burrier
DOS 516 Fundamentals of Radiation Safety
Safety in Radiation Therapy
October 24, 2017
Safety in Radiation Therapy
Members of the general public may be unfamiliar with the safety protocols used in
radiation therapy. This can lead to worry about their general safety and the risks they may face
from exposure. The health care industry has come a long way in implementing practices to
improve the safety of all patients and provide a level of trust between patients and health care
providers. For example, in 1995 President Bill Clinton addressed issues of informed consent and
patient autonomy after details were released about government-funded radiation tests that were
secretly carried out on U.S. citizens between 1944-1974.1 These experiments, which included
actions like injecting patients with plutonium and feeding radioactive material to children, were
extremely unethical and did not provide proper informed consent.1 In addressing these issues,
President Clinton stated that informed consent means your doctor tells you the risk of the
treatment you are about to undergo.2 This was an important milestone for patient rights and is
still applicable in the standards we have today.
Due to events that have happened in the past, patients may be very cautious when it
comes to receiving radiation treatments because of the known effects radioactive materials can
have. If a patient is still concerned about excess radiation exposure or treatment errors even after
receiving proper informed consent, the departments safety practices should be discussed with
them in order to help alleviate their fears.
When a patient makes the decision to receive radiation therapy for their cancer diagnosis
the first step in treatment is to obtain a treatment planning CT scan. This is done to be able to
accurately identify the tumor volume and create an appropriate treatment plan. Once the images
are obtained, a dosimetrist pulls in the images and creates the treatment plan based on the
doctors prescription. Many advances have taken place in the field of radiation therapy over the
last few decades that help to improve accuracy and minimize the dose that normal structures
receive. One such advancement is the use of intensity modulated radiation therapy (IMRT).
With this type of treatment, dosimetrists are better able to conform the dose being delivered to
the specified treatment volume and in turn limit the dose to surrounding critical structures. Also,
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the use of multileaf collimators (MLCs) help to shape the field and block normal structures as
well as helping to decrease hot spots in a patients plan, which will lead to less skin reactions.
Once a plan is completed, the dosimetrist performs all necessary dose calculations, has
the physician review and sign the plan, and sends the final plan to the physics team so it can be
checked again before being sent to the therapists. When it reaches the therapist for its final
check before treatment, the plan has been looked at by four separate individuals in the
department and has been through multiple QA steps. This is done to ensure everything is correct
and ready for the patient to come in to start their treatments.
A patients first day consists of a verification simulation performed by a minimum of two
therapists. According to Odle and Rosier,3 it is best practice to staff at the level of two therapists
per machine at all times to reduce the chance of treatment errors by proving a double check on
patient setups and treatment delivery. During the verification simulation process, the therapists
will set up the patient, perform all necessary shifts from the CT marks, and film each beam angle
that is going to be treated. This is done to ensure that everything is setting up well prior to the
first treatment and that all fields and blocking look correct on the patients skin as well as in
relation to the internal anatomy visualized on the x-rays. The patients physician will come out
to the treatment machine on the first day to ensure that all fields look correct and that no
adjustments should be made. After this is complete the therapists give the patient their final
marks that will be used for set-up purposes each day and the patient is ready to receive their
radiation treatments.
The dose being delivered to patients is carefully monitored to ensure the dose prescribed
is what is actually being given. Dose output checks are done daily at Genesis Medical Center in
Davenport, IA. These output checks test all photon and electron beam energies used to ensure
that the output is within operating limits. Furthermore the imaging devices used such as CBCT
and KV/MV match are checked to ensure proper alignment of imaging systems, which will
ensure a correct adjustment is given during treatment when positioning the patient. Two
therapists perform these daily checks and the medical physics team reviews these results. In
addition to this, a backup counter is utilized for every patient on each field to record the dose
delivered should a treatment ever be interrupted and only a partial dose was given.
With all of these safety practices in place, as well as the advances in patient care, patients
in a radiation oncology department should be confident in the care they receive. As healthcare
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professionals it is important to ensure our patients feel safe and that we are always doing our best
to make safety our number one goal.
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References
1. Roberts BW. Patient-centered radiation safety. http://libweb.uwlax.edu:2066/ehost/pdfviewer/
pdfviewer?vid=4&sid=ab5e87a4-eb97-4785-8bf8-db581335e9ff%40sessionmgr101.
Accessed October 24, 2017.
2. Clinton WJ. Remarks on accepting the report of the advisory committee on human radiation
experiments. http://www.presidency.ucsb.edu/ws/?pid=50597. Accessed October 24, 2017.
3. Odle TG, Rosier N. Radiation Therapy Safety: The Critical Role of the Radiation Therapist.
ASRT White Paper. https://www.asrt.org/docs/default-source/publications/whitepapers/rt-
safety---the-critical-role-of-the-rad-therapist.pdf?sfvrsn=2. Accessed October 24, 2017.