Radiation Therapy and Patient Safety

By William F. Regine, M.D.
Chief of Radiation Oncology

Editor’s Note: In response to an article in the New York Times on January 24, 2010, about radiation injuries to patients, Dr. William F. Regine provided the following comment. Dr. Regine is chief of radiation oncology at the University of Maryland Marlene and Stewart Greenebaum Cancer Center and professor and Isadore and Fannie Schneider Foxman chair of radiation oncology at the University of Maryland School of Medicine.

An article in the New York Times highlights several cases of radiation over-exposure in cancer patients in several New York hospitals in 2005. We are concerned that the article could make some patients fearful of receiving radiation therapy. This would be disastrous, since radiation therapy is by far one of the safest and most effective forms of cancer treatment.

We want to reassure all of our patients that their safety is our number one priority. In fact, our hospital has been recognized as one of the nation’s best hospitals for patient safety and quality of care for the past four years in a row by the Leapfrog Group, a national public assessment of hospital safety and quality performance. We strictly follow the highest standards of quality assurance in providing radiation therapy to patients.

Radiation therapy actually has an extremely low rate of errors, due to the many checks currently in place to ensure patient safety. As noted in the article, an estimated 35 million treatments were administered last year on equipment made by Varian Medical Systems alone, with about 70 instances of mistakes that affected or nearly affected patient care. While this is a very low rate, even assuming significant under-reporting, even one such mistake is too many.

The errors described in the article were associated with the lack of quality assurance processes. At our center, we strictly follow a comprehensive set of safety rules. These include: 1) machine-related QA checks, including a daily check of the beam output and monthly physics checks of all equipment; 2) secondary calculations to verify the accuracy of the radiation dose calculated by our treatment planning systems; 3) a review of all treatment plans by medical physicists; 4) quality assurance checks of Intensity Modulated Radiation Therapy (IMRT) plans prior to treatment; 5) review by the therapist staff to verify agreement between the radiation dose in the treatment plan and the treatment console; and 6) verification of the physician’s written directive, the prescribed dose and the patient’s identity.

Since 2005, when the events described in the New York Times article occurred, two national-level professional meetings have taken place to specifically address errors in radiation therapy. A member of our faculty in the Department of Radiation Oncology was selected to serve on a special task force launched by the American Association of Physicists in
Medicine (AAPM)
to study safety processes in radiation oncology. Both the AAPM and the American Society for Radiation Oncology (ASTRO) continuously work to strengthen training, quality assurance and safety in radiation oncology.

All treatments pose risks, and patients should discuss them with their doctors. Our staff is committed to the very highest standards in the delivery of radiation therapy to our patients. Please feel free to discuss your treatment plan and our quality assurance processes with your radiation oncologist or with any member of our staff.

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