The main topic of this project is the problem of accidents in radiation therapy. This treatment modality can be effective with different types of cancer but can lead to diverse side effects due to high doses of radiation that are used to kill cancer cells. However, side effects, although usually not predictable, can be mitigated. Another challenge faced by radiation therapy specialists and patients is accidents that happen during this type of treatment.
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Accidents in radiation therapy are particularly dangerous because they cannot be foreseen, and thus there is a high risk of negative outcomes for patients. The themes discussed in this project in relation to radiation therapy accidents include types of these accidents, their causes, and opportunities for prevention of radiation therapy accidents, as well as reduction of their negative impact on patients.
Radiation therapy is a treatment approach that is usually applied in the treatment of metastatic diseases such as cancer. It applies high doses of radiation to affect cancer cells and reduce the size of tumors. Usually, treatment strategy depends on the patient’s condition. Radiation therapy is likely to be used by more tat a half of cancer patients at some stage of their treatment (Baeza 2012). However, exposure to high doses of radiation results in diverse side effects. Nevertheless, another problem with radiation therapy is accidents that are less frequent than side effects but are more dangerous. Some common accidents that are observed during this curative therapy are radiation overexposure, which results in overdose, malfunctioning of equipment or its design, etc.
Nevertheless, while there is extensive evidence base about the effectiveness of radiation therapy, the problem of accidents is almost not investigated. On the one hand, it can be explained by their rare incidence or poor reporting rate. On the other hand, the discovery of the major accidents and their causes can provide a background for developing prevention strategies and further reduction of accidents’ risk in radiation therapy. This project analyses accidents that happen during radiation therapy reveal their causes, and provides ideas for reducing and prevent these accidents.
Defining Radiation Therapy Accidents and Their Causes
The use of radiation for a medical purpose is the cause of a greater number of accidents and lethal outcomes than any other source. Thus, according to the study by Coeytaux et al. (2015), the medical sector and radiation therapy are responsible for 32 percent of radiation overexposure accidents compared to 27 percent reported by the industry sector. In the most general meaning, an accident is “an unfortunate incident that happens unexpectedly and unintentionally, typically resulting in damage or injury” (Oxford Living Dictionaries n.d.). If applied in the medical context, an accident or a situation that can lead to an accident are treated as an incident, which is any “happening that is not consistent with the routine operation of the hospital or the routine care of a particular patient” (Washington 2016, p. 37).
Generally, radiation therapy accidents are not frequent. The most common types of these accidents are related to the dose of radiation (such as radiation overexposure or massive overdoses) and the equipment used for the therapy (for example, failures in equipment design or design testing). Also, errors can be related to incorrect shaping of field that should be exposed to radiation, wrong use of beam modification devices such as shielding, wedge, and bolus, and the location of treatment that can be difficult to access (Asnaashari, Gholami, & Khosravi 2014). I agree with the researchers that the causes of errors can be diverse because they depend on many factors. Probably, the authors of this study faced such a pitfall as the lack of evidence for radiation therapy accidents’ research.
Radiation overexposure accidents are typically uncommon but are dangerous due to unpredictable severe long-term consequences. Earlier research examines the rate of incidents during external beam radiation therapy (Bissonnette & Medlam 2010).
The scholars come to a conclusion that the reported incidence rates are low and range from 1.5 to 8 cases per 100 procedures of radiation therapy (Bissonnette & Medlam 2010). While many of these incidents do not have a meaningful influence on the course of radiation therapy, there are cases of severe accidents that result in death. It should be taken into account that these severe incidents have happened in clinics that apply modern equipment as well as software operated by trained staff and certified in accordance with the existing procedures. Nevertheless, similar accidents can become more severe in the future. The problem is that cancer clinics that provide radiation therapy apply more hypofractionated regimes, which involve high doses per fraction (Bissonnette & Medlam 2010).
Consequently, overexposure becomes more probable, and safety measures during radiation therapy should become a primary concern of healthcare providers because clinical practice is adopting new technologies and practices that are more effective but demand more careful use. Thus, such technologies as intensity-modulated radiation therapy (IMRT) or image-guided radiation therapy (IGRT) can lead to better patient outcomes in case they are used appropriately or have a negative effect if not managed by professionals. I support the evidence provided by researchers because the study is based on a reliable sample.
The therapeutic dose of radiation is initially high. For example, the dose in postoperative cases is 5000 cGy compared to 10 cGy that are used during diagnostic procedures such as CAT scan. However, therapeutic doses, if properly calculated, can result in moderate adverse effects. For example, External Beam Radiation Therapy (EBRT) is mainly well tolerated in most patients (Swisher-McClure et al., 2013). Consequently, overdose in radiation therapy can lead to a lethal outcome. Thus, apart from the expected benefits of radiation therapy, the researchers conclude that this treatment method can cause life-threatening hazards. The only bias in the conclusion of the researchers can be related to the lack of reporting of radiation therapy accidents, which is a limitation of the majority of studies in this field.
One of the causes of radiation overdose during therapy can be inaccuracy or a mistake in calculations of an equivalent exposure for one minute. Such calibration errors can lead to significant overdoses for many patients until the mistake is revealed, which results in increased morbidity. It is a type of medication error caused by a human factor and can be explained by the lack of attention or experience of a healthcare professional performing these calculations. Another type of accident in radiation therapy is related to the technical aspect of this procedure.
According to the World Health Organization (2009), accidents such as equipment failures or operating errors can result in accidental exposures. For example, accidental exposure to an external beam can occur due to problems with the accelerator. There are some recorded cases of accidental exposures that happened because of accelerator software problems, incorrect repair of the accelerator, or accelerator interlock failure (Accident prevention in case of radiotherapy equipment malfunction 2018).
Prevention and Reduction of Negative Impact of Radiation Therapy Accidents
Radiation accidents are usually the result of the lack of alertness and awareness, inefficient procedures and ineffective checks, as well as the lack of qualified staff. Therefore, prevention of accidents in radiotherapy includes the use of diverse preventive actions, which are able to address the problem of safe use of technology and procedures. Baeza (2012) analyzes the errors in radiotherapy and defines them as “a non-conformance where there is an unintended divergence between a radiotherapy treatment delivered or a radiotherapy process followed and that defined as correct by local protocol” (p. 180).
The definition is wide, but it comprises a diversity of causes that can lead to accidents in radiation therapy and thus should be addressed to reduce their negative impact. In fact, an accident can be stimulated by a wide range of factors starting from the planning of treatment and ending with treatment delivery or technical aspects of radiation therapy organization (Baeza 2012). I agree with the evidence provided by the author because it reveals the need for different approaches to react to the problem of accidents in radiation therapy.
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The major recommendations for preventing accidents in radiation therapy are as follows. First of all, the personnel of a healthcare facility involved in the procedure has to be properly trained about the safety of critical procedures, be aware of the up-to-date peculiarities of therapy, and understand their responsibilities. Secondly, there is a need for a regular independent check of equipment used in radiation therapy as well as protocol exposure norms.
Thirdly, much attention should be given to beam calibration, which is regularly conducted by specially trained staff members. Another idea to make radiation therapy safer is to provide careful individual planning for every patient taking into account the patient’s condition, type of cancer, and the location of tumor or metastases (Mukherji 2018). Moreover, treatment plans should be verified before every procedure and corrected in case of necessity. Another option for reducing errors in radiation therapy is the use of electronic safety checklists, which are empowered by specialized software and can be used by all healthcare professionals involved in radiation therapy (Greenwalt et al., 2014).
It is vital to use appropriate and contemporary software because software-related errors can also lead to radiation therapy accidents. Thus, it is a demand for individuals responsible for software and hardware functioning to be attentive and report any problems with computers used to control radiation therapy. In addition, a risk factor of medication error can be reduced due to the use of electronic patient health records, which contain patient information as well as peculiarities of previous radiation therapy procedures and recommendations about future procedures. Many healthcare facilities already adopt electronic health records and use them meaningfully, but there is still much space for improvement for this tool in radiation oncology (Shen et al., 2012).
Finally, the most global approach to reducing the number of accidents in any field is the adoption of reporting algorithm because timely reporting enables the generalization of accidents and the following development of mitigating and preventive interventions. Ganesh (2014) suggests implementing an incidence reporting learning system in radiation therapy, which accumulates the received reports and allows summarizing data to use in research or clinical practice.
One of the important steps for making radiotherapy more secure through reducing the number of accidents is to conduct the analysis of risk factors as well as the cases that are already registered. Timely and effective analysis has the potential to reduce the incidence of radiation therapy accidents or eliminate them (Mazeron, Aguini & Deutsch 2013). The analysis of risks can be empowered by the data about errors registered during radiation therapy institutions.
The study by Asnaashari, Gholami, and Khosravi (2014) analyzes the experience of centers providing radiation therapy. The researchers conclude that about one-half of the detected radiation therapy accidents were related to treatment field errors. Moreover, they suggest that an effective national reporting system can be useful for detecting the existing errors and thus reducing the number of radiation therapy accidents.
Summary and Conclusions
To summarizing, it should be mentioned that radiation therapy is one of the effective modalities for cancer treatment and can be applied as an independent treatment or in combination with other approaches. However, a patient who takes radiation therapy is at risk of both adverse effects that are typical of this procedure as well as of radiation therapy accidents that are not frequent but dangerous. The most frequent accidents are radiation overdose and technical malfunction. These accidents can have some causes such as wrong calculation of radiation dosage, other types of medication errors caused by a human factor, or technical issues with software or hardware that support radiation therapy.
On the whole, it is evident that there is a need for a complex approach to addressing the problem of radiation therapy accidents. The incidence of such accidents can be reduced due to the involvement of well-trained professionals, a regular check of equipment and procedures, introduction of individual planning of radiation therapy together with the adoption of electronic health records in radiation therapy units. Also, it is necessary to use appropriate software and hardware in the organization of radiation therapy sessions. Finally, it is vital to report all the cases of errors and accidents related to radiation therapy to provide information necessary for the development of preventive strategies.
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