The advancement of treatment options and technology continues to be a source of optimism in the successful fight against cancer. Radiotherapy is one of the cornerstones that led to this accomplishment.
Regardless of the desired strategy for accurate radiotherapy, there is a likelihood that unanticipated risks will emerge that can be managed or prevented by effective safety measures. Safety in healthcare practice has been an important concern for the healthcare sector. In the radiological (diagnostic and therapeutic) fields, organisations such as the International Atomic Energy Agency (IAEA) and the International Commission on Radiological Protection (ICRP), among others, have published guidelines, reports, and recommendations to ensure that safety is prioritised in practice. The 2019, 2022 and 2023 World Radiography Day theme, focused on the importance of safety in practice.
Why safety in Radiotherapy?
Radiotherapy treatment is a multi-stage process that uses various technologies and equipment to treat a variety of cancers. It necessitates a thorough understanding of medical physics and radiobiology. The complexity has rendered it vulnerable to a variety of incidents and errors. Radiotherapy consists of three stages: prescription, planning, and treatment delivery. The oncologist examines the patient during the prescription stage to define the tumour based on grade and stage. To accomplish this, the oncologist employs a variety of imaging modalities (CT, MRI, and PET) and laboratory tests. After the tumour is graded and staged, the oncologist prescribes a treatment pathway for the patient. Now comes the planning stage, in which the patient is simulated using computed tomography (CT), which is occasionally paired with magnetic resonance tomography (MRT), positron emission tomography (PET), or both at some point. The images obtained from these imaging modalities are used to contour the tumour (the targeted cancerous cell) and organs at risk (the normal cell tissues). Following successful contouring, the medical physicist develops plans based on the treatment prescription.
The delivery stage is the final stage, in which the prescribed dose is delivered to the targeted tumour, reducing the dose to normal cells to the tolerance level. The main criteria for a successful delivery stage are to ensure the dose is delivered accurately and precisely. This is accomplished by ensuring the patient is positioned similarly to the simulation and immobilised to reduce movement during treatment.
Every stage of the radiotherapy process has a likelihood of an incident or error, which could result in a poor treatment outcome or worsening side effects. There are two kinds of radiotherapy errors: random and systematic.
Random errors are intrafractional errors that occur during treatment delivery. Poor patient preparation, poor patient positioning or image matching, and patient movement during treatment are all possible examples. Systematic errors refer to interfractional errors that occur during simulation or treatment planning. Poor equipment calibration, incorrect treatment areas, and erroneous dose prescriptions are some examples. All these errors can be prevented or managed when approached tactically. If they fail to be managed properly, they will have an impact on the overall treatment outcome. Tactical approaches include incident learning and reporting systems, failure mode and effect analysis, quality assurance programs, and root cause analysis.
Who is responsible for ensuring safe radiotherapy?
To ensure safety in radiotherapy, everyone must establish a safe culture and have a clear mission. The main medical professionals who deliver radiation therapy are medical physicists (MP), radiation therapists (RT), and radiation oncologists (RO). Radiation therapy is prescribed, planned, and delivered to patients using a collaborative approach of these areas of expertise. Each of these personnel must have the necessary abilities and competence to enable effective treatment. They must collaborate and function as a team. The complexities of radiotherapy involve strong teamwork and communication because all information is required for decision making. Any of these experts may notice and report problems or errors during therapy (online review) or after treatment (offline review). According to reports, the majority of radiotherapy errors occur at the planning stage or are the result of poor equipment quality control.
It is impossible to overemphasize the significance of the impact that safety measures and approaches have in radiotherapy; hence, the objective of effective radiotherapy should be to place a priority on safety measures and quality control programs.
Author Birma Yohanna Musa, is an adept, and enthusiastic radiographer by profession. At present, also a student in the master’s programme in radiography at Tartu Healthcare College in Estonia.
References
American Society for Radiation Oncology (2019). Safety is no accident; A framework for quality radiation oncology care. https://www.astro.org/Patient-Care-and-Research/Patient-Safety/Safety-is-no-Accident. Accessed 07.03.2024.
Budanec, M., Mrčela, I., Gregov, M., Mlinarić, M., Matanić, A., & Fröbe, A. (2019). Safety considerations in radiotherapy. Acta clinica Croatica, 58(Suppl 2), 82–83.
European Commission, Directorate-General for Energy, (2015). General guidelines on risk management in external beam radiotherapy, Publications Office. https://data.europa.eu/doi/10.2833/667305
ISRRT (2021). Safety culture and general safety management guide for diagnostic imaging and Radiotherapy department. https://www.isrrt.org/proffesional-practice/safety-and-safety-culture/isrrt-safety-culture-and-general-safety-guide. Accessed 06.03.24
Oelofse, I., van Staden, J., Coetzee, N., & Steyn, J. (2021). Quality management in radiotherapy: A 9-year review of incident reporting within a multifacility organisation. South African Journal of Oncology, 5, 6 pages. https://doi.org/10.4102/sajo.v5i0.170