Safety Steps in Radiation Therapy

Ryan Pohl
University of Wisconsin- La Crosse
DOS 516: Fundamentals of Radiation Safety
October 25, 2016

Modern society has seen radiation progress from an academic curiosity to an effective
means of medical treatment. However, the general populations perception of radiation has
failed to evolve with it. This evolution is hindered by a misunderstanding, and ultimately, a fear
of radiation. Public fear of radiation can largely by attributed to seeing graphic images of
radiation injuries following nuclear disasters and the exaggeration of radiation mutations in
science fiction films. A study conducted under the guidance of the University of Vermont
Research Protections Office in 2015 reported that only eight percent of the general public have
confidence of their knowledge of ionizing radiation. Health professionals that use radiation need
to make public education a top priority to reduce the stigma associated with radiation. If the
public is made aware of established radiation safety measures, it would help alleviate concern
they have with its use in medicine. This is an important step in decreasing patients reluctance to
use radiation therapy as a treatment modality.
Radiation therapy plays a key role in cancer treatment; it is a requirement for
approximately half of all cancer patients at some point during their illness. There are a number
of practices used in radiation therapy to ensure patient safety. The National Council on
Radiation Protection and Measurements advocates the principle that doses should be kept as
low as reasonably possible (ALARA). A concerted effort is made by the entire therapy
department to ensure radiation exposure is minimal. It starts with the oncologist prescribing a
dose necessary to treat the cancer effectively without being lethal to the patient. They also use
diagnostic studies and known patterns of tumor spread to make appropriate treatment margins;
enough to treat affected volumes while sparing healthy tissue. A dosimetrist is then responsible
for designing a treatment plan that avoids critical structures (organs at risk) as much as possible.
The therapists only deliver an amount of radiation necessary to complete the treatment
successfully. For instance, during CT simulation they set scan parameters to acquire the area of
interest without scanning unnecessary normal tissue. When using image-guided radiation
therapy (IGRT), they will subject the patient to the minimal amount of dose required to line the
patient up correctly. In this instance, a lower quality image will suffice so the higher dose
produced by a diagnostic quality image is not required. Radiation departments exercise the
principle of ALARA by being mindful of patient exposure and following basic safety practices.

When discussing radiation safety with patients, it is important to be as transparent as

possible. Mistakes have been made, but they have helped mold many regulations and protocols
used today. As a result, the quality assurance (QA) program in every radiation department is
expected to meet national and international standards. They are reviewed on a regular basis in
order to incorporate recommendations of new protocols. QA programs act as risk management
systems for radiation departments. Their purpose is to identify possible sources of failure,
analyze the frequency of these errors, take corrective action to minimize such failure, and
monitor the outcome of each action. QA programs are broadly separated into two categories,
equipment QA and patient QA.
Equipment QA are the necessary tests performed on linear accelerators, conventional
simulators, CT simulators, HDR units, and treatment planning systems. When a department
acquires new equipment, it is put through acceptance testing and commissioning to establish a
baseline. Mechanical, dosimetry, and safety QA checks are done on to ensure certain parameters
are within a tolerance of specifications set when the equipment was installed. For example, a
daily check is performed on localizing lasers to make sure they do not move more than 2 mm
away from their expected position. If that tolerance level is exceeded, there is already a
procedure in place that determines what action needs to be taken next. This is one of many QA
procedures that affords a high degree of accuracy in radiation therapy. Patient QA are the
procedures used to certify that patients receive their correct and specific treatment. The physicist
does a chart check (usually before the 3rd fraction or delivery of 20% of total dose) to review the
prescription, treatment plan, and dose calculations. If an error is detected after a few fractions,
an alteration to field parameters or dose delivery can be used to give the intended dose.
Subsequent chart checks are conducted on a weekly basis. Portal images are used to verify field
placement and in vivo dosimetry (diodes, TLDs, or MOSFETs) confirm the patient is receiving
the correct dose. All of these QA procedures are in place to meet the International Commissions
on Radiation Units and Measurements (ICRU) standard of 5% dose delivery accuracy.
Fear of radiation treatment is a natural reaction for cancer patients. The best way to
reduce patient anxiety is to explain established safety procedures and show how effective they
have been. Radiation is not something patients need to be afraid of, but the inherit dangers

associated with radiation need to be acknowledged. Fortunately, modern society has the
technology to harness the power of radiation and procedures set forth to do so in a safe manner.

References
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