1

Aubrie Rice

Safety Essay

October 8, 2017

The Medical Dosimetrists Role in Patient Safety

The field of radiation oncology is rapidly developing in terms of new technologies and
techniques which offer many different opportunities to treat target volumes while better sparing
normal structures. Along with these advancements though, comes the need for a more structured
quality assurance program due to the complexity of the treatments that are now being performed.
A document sponsored by the American Society for Radiation Oncology (ASTRO) titled Safety
is No Accident outlines the measures that need to be taken by a radiation oncology facility in
order to ensure a safe environment in light of the advancements that have taken place in the field
in the last 20 years. These measures include requirements involving the structure, personnel, and
technical processes of the radiation oncology facility.1 Specifically, medical dosimetrists play
several key roles in maintaining a safe environment for the patients in the radiation oncology
department. These roles range from pursuing and maintaining certification, effective and clear
communication with physicians and physicists, maintaining adequate instruction in anatomy for
the implementation of contouring organs at risk and preforming image registrations, and
participating in peer review processes.

The first role that a medical dosimetrist plays in patient safety is through pursuing and
maintaining certification through the Medical Dosimetrists Certification Board (MDCB).1 The
MDCB promotes safe and competent medical care of all patients requiring medical dosimetry
services.2 This certification ensures the dosimetrists competence in practicing medical
dosimetry according to the Safety is No Accident document.1 The Certified Medical Dosimetrist
(CMD) credential that accompanies this certification implies several ethical standards in which
all CMDs must abide by. These principles include that the CMD promote the safety of their
patients by completing their dosimetry duties in a safe and skillful manner.2 Another way that a
medical dosimetrist promotes patient safety is by maintaining this certification. The medical
dosimetrist must complete 50 continued education credits every 5 years in order to maintain
CMD certification.2 By completing these credits, they are expanding their knowledge and
 2

understanding of the field which continues to play a role in the medical dosimetrists
professional efforts toward patient safety.

Effective and clear communication with the radiation oncology team is another way that
a medical dosimetrist works to maintain the safety of the patient. It is the duty of the dosimetrist
to design the radiation plan under the direction and supervision of the radiation oncologist and
medical physicist.3 Communication between these team members is essential to the safety of
each patient. The dosimetrist must converse with the physician regarding the location of the
target structure, the technique they recommend using, and the physicians radiation prescription.
The effective communication by the dosimetrist also includes proper charting of the radiation
treatment plan and cataloging of images used for target delineation.1

Maintaining adequate instruction in anatomy for the implementation of contouring organs

at risk and preforming image registrations is another way that the medical dosimetrist can
promote patient safety. The document Safety is No Accident notes that the challenge in the
medical dosimetrists role for preforming image registrations is an adequate instruction of
anatomy.1 For contouring specifically, a dosimetrists familiarity with the Radiation Therapy
Oncology Group (RTOG) guidelines for contouring is also essential. An article by Mccall et al5
examines the variation in thoracic contours between dosimetrists and the dosimetrist effects of
such variations. A variation of 86.5% of the prescription dose was noted when the target volume
was placed near the esophagus.5 Familiarity and adherence to the RTOG contouring guidelines
along with having adequate instruction in anatomy is imperative to promoting patient safety by
the medical dosimetrist.

Another way that the medial dosimetrist can integrate patient safety into their daily
practice is by advocating peer review at their institution. Having a plan peer reviewed by another
dosimetrist is an excellent way to ensure plan quality by reviewing beam selection, weighting,
energy, contours, etc.1 An article by Adams et al4 also notes the importance of peer review
between dosimetrists in a radiation oncology department. Twenty years ago, before the
introduction of the new technologies like IMRT that are utilized today, it could have taken a
dosimetrist 30 to 40 minutes to create a treatment plan. Today, the planning time could take up to
three hours. Since this is an unreasonable amount of time to be under direct supervision by the
 3

physician, peer review by another dosimetrist or medical physicist can minimize the opportunity
for errors and increase patient safety.4

In conclusion, the innovations in the field of radiation oncology and resulting increased
complexity of treatments have augmented the need for a focus on patient safety. Medical
dosimetrists play several roles in the promotion of patient safety in their daily duties. One of
these roles involves pursuing and maintaining certification through the MDCB who ensure the
competence of CMDs as well as implementing ethical principles that CMDs must abide by
which involve the promotion of patient safety and performance of dosimetry duties with safety
and skill.2 Effective and clear communication with physicians and physicists, maintaining
adequate education in human anatomy for the implementation of contouring organs at risk and
preforming image registrations are also two imperative roles of the medical dosimetrist in
ensuring the safety of patients. Lastly, promoting and participating in a peer review process can
help to ensure the best quality plan for each patient.
 4

References

1. Zietman AL, Palta JR, Steinberg ML, et al. Safety is No Accident: A Framework for
Quality Radiation Oncology and Care. ASTRO. 2012.
2. Ethical Standards. Medical Dosimetrists Certification Board. 15 August 2011. Available
at: https://mdcb.org/about-mdcb/ethical-standards. Accessed October 8, 2017.
3. Hartford AC, Galvin JM, Beyer DC, et al. American College of Radiology (ACR) and
American Society for Radiation Oncology (ASTRO) Practice Guideline for Intensity-
modulated Radiation Therapy (IMRT). Am J Clin Oncol. 2012;35(6):612-7.
http://dx.doi.org/10.1097/COC.0b013e31826e0515.
4. Adams RD, Marks LB, Pawlicki T, Hayman J, Church J. The new radiation therapy
clinical practice: the emerging role of clinical peer review for radiation therapists and
medical dosimetrists. Med Dosim. 2010;35(4):320-3.
http://dx.doi.org/10.1016/j.meddos.2010.09.002.
5. Mccall R, Maclennan G, Taylor M, et al. Anatomical contouring variability in thoracic
organs at risk. Med Dosim. 2016;41(4):344-350.
http://dx.doi.org/10.1016/j.meddos.2016.08.004