Task 7. Prevention of accidental exposures in radiotherapy

Background

Curative or palliative radiation therapy has three major concerns: efficacy, quality of life, and safety. From the point of view of radiation safety, radiotherapy very special because human beings are directly placed in a very intense radiation beam (external beam therapy), or radiation sources are placed in direct contact with tissue (brachytherapy), to deliver intentionally very high doses (20 Gy – 80 Gy), and overdosage, as well as underdosage, may have severe consequences. From the prescription to the delivery of a radiotherapy treatment, a team of professionals from a number of disciplines is involved in a large number of steps. In the case of external beam radiotherapy, a treatment is usually delivered with 20 to 40 fractions or sessions, each requiring a large number of machine and patient parameters to be set up by the radiotherapy technologist. Based on these considerations, the significant potential for mistakes leading to an accidental exposure becomes apparent and the consequences can be devastating, as shown in a number of reported cases. Special preventive measures are, therefore, required.

Courses were held in four regions, and three languages (English, Spanish and French). The approach adopted was to describe severe accidental exposures that have occurred in radiotherapy, summarize the consequences of these events, which were in some cases devastating; and provide recommendations on measures to prevent such events. The audience was multidisciplinary, consisting of professionals directly involved in radiotherapy, such as radiation oncologists, technologists, medical physicists as well as regulators.

Main activities

The national counterparts of the thematic area 3 (medical exposure) in collaboration with national radiotherapy clinics are expected to undertake the following actions:

Actions recommended:

A. Phase I. Pilot project: Review of current safety baseline in clinical practice

1. National radiotherapy centres to collaborate are identified with the input of national counterparts.
2. The national counterparts in collaboration with expert review the current status of procedural and technological safety barriers in place in the collaborating national radiotherapy clinics.
3. Participating national radiotherapy clinics report all potential incidents and actual incidents to IAEA for review, including information on where in the process these incidents have been discovered. The duration of this pilot phase is one year.
4. Expert reviews the reports in order to benchmark effectiveness of current safety barriers. Review looks at ratio of reported potential incidents to reported actual incidents, as well as overall level of reporting.

B. Phase II. Enhancing the safety barriers in clinical practice

1. The participating national radiotherapy centres receive technological safety barriers and support in the implementation of these, as well as support in implementing procedural safety barriers, through technical assistance from expert and IAEA technical officer.
2. Participating national radiotherapy clinics again report all potential incidents and actual incidents to IAEA for review, including information on where in the process these incidents have been discovered. The duration of this phase is one year.
3. Expert again reviews the reports in order to benchmark effectiveness of new safety barriers. Review looks at ratio of reported potential incidents to reported actual incidents, as well as overall level of reporting.

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