In a society where the media has so much power and mostly everything stated is hardly

questioned, the perception that people have towards radiation therapy have been deeply
damaged. During the past years due to accidents and the bad coverture/interpretation from the
media, the public have created a sense of panic towards radiation therapy, to a stage that many
patients would let their condition progress rather than even considering radiotherapy. Shafiq et
al.1 establishes that radiation therapy is one of the major options in cancer management and that
at least 52% of patients should receive radiotherapy at least once during their treatment.
Furthermore, she states that 40% of the patients that are treated with radiation are cured of their
cancers.
Over exposure and the consequences that mistreatments and accidents could lead to are
definitively scary and even more terrifying for the general public that does not have the
knowledge of what is really happening or how it happens. Lets start by stating that even though
accidents and errors in radiation therapy could be lethal they are rare2 and when compared to
other medical situation like adverse drug reactions, radiotherapy errors are way lower than
hospital admissions for the last metioned.1(Pg.17) It is important that the general public understands
that radiation therapy involves a long and exhaustive process of prescribing, planning, designing
and passing many revision check points before the therapy is finally delivered. Therefore, it is
likely for a mistake to happen but it has the same probability for such mistake to be caught
before it could turn into an accident (before is delivered). Also when a mistake is to happen is not
only one persons fault, such error has to be missed by all the medical team members such as
radiation oncologists, medical physicists, medical dosimetrists, radiation therapists and nurses
among others.2(Pg.15)
Throughout the years, research has been done in the effort to point out in what steps of
the process most of the errors are made and how could they be fixed. Shafiq et al1 did a 30 years
retrospective investigation using the Radiation Oncology Safety Information System (ROSIS)
data base from US, Latin America, Europe and Asia, to target the most common radiation
therapy mistakes and propose possible solutions. She states that 55% of incidents where found
to be in the planning stage and the other 45% were due to errors that occurred during the
introduction of new systems and or equipment such as megavoltage machines (25%), errors in
treatment delivery (10%), information transfers (9%) or in multiple stages (1%). The purpose of
presenting this data is not to increase the panic, but rather to provide you with the preventive

measures that have been put in place to minimize and if possible avoid these errors. It is
important to reiterate that these statistics are not only from the US, therefore the requirements
(education, licensing, etc) may vary from country to country and even from state to state. As
the statistics shows, a high percentage of the errors seem to be made during the treatment
planning stage, introduction of new systems and in treatment delivery, to improve these
situations the following requirements have been put into place and have been strengthen:

Planning stage- During past years, formal education for dosimeters was not compulsory,
many received in-job training that allowed them to performed the task without
necessarily knowing the physics behind what was performed. Nowadays there are
regulatory institutions that, for many states in the US, required Dosimetrist to received
formal education plus clinical training from one accredited school and to get licensed in
order to work. Also they are required to complete courses of continued education during
the extent of their career. Once therapies are designed they are peer reviewed and QA by
medical physicists, oncologist, radiation therapists and other dosimetrist to assure that

there are no errors and that it is the best approach to the condition.
New systems/equipment- Advance technologies like IMRT have improved treatment of
a number of cancers by better compensating for irregular or concave tissues, along with
those close to or largely surrounded by normal tissue.2(Pg3) However, with the pros that
comes along with this new technology theres also cons like the usage of such high
technology equipment which could bring bias for errors. For this situation continued
education for radiation professionals have been put in place altogether with coaching

from the machines developers.

Treatment delivery- Mayo pointed out that in 2010, 17 states did not require a license to
deliver rad therapy.2(Pg2) Requirements for licensing and continued education have been
rapidly put into place. Also to improve safety while treatment is being delivered
accreditation programs recommend a minimum of two therapists per active linear
accelerator regardless of patient volume, and more therapist based on the annual number

of new patients at a facility2(Pg3)

While providing professionals with better training and knowledge errors are being reduced.
Holmberg and McClean1(Pg18) claim that following a multistep checkpoint system and following
the stablished requirement they have been able to detect and correct about 14 adverse events per
1000 treatment plans designed and delivered in their institution. Radiotherapy errors are possible

but they do not out weight the benefits that it delivers to a cancer patient. Furthermore, no patient
should be refusing treatment because of misinformation. I believe radiation information
programs should be put into place to target the general public possibly using the same basic
media (newspapers/ news channels) that are within most people reach and using a common lingo
to uncover all the taboos and wrong information that may have many scared.

References:
1. Shafiq J, Barton M, Noble D, Lemer C, Donaldson LJ. An international review of patient
safety measures in radiotherapy practice. Radiotherapy and Oncology.
2009;92(1):1521. doi:10.1016/j.radonc.2009.03.007.
2. Teresa O, Natasha R. Radiation Therapy Safety: the Critical Role of the
Radiation
Therapist.White Paper.