How to prevent radiation mistakes in cancer patients

Recent media stories have reported isolated cases of cancer patients who were injured by incorrect doses from intensity-modulated radiation therapy (IMRT).

Despite such reports, IMRT remains one the most powerful cancer treatments, and extensive safety measures can ensure patients receive the proper doses, said radiation oncologist Dr Kevin Albuquerque of Loyola University Health System.

IMRT uses computer-controlled linear accelerators to deliver precise radiation doses to a tumour or areas within a tumour. It focuses high doses within the tumour while minimising the dose to surrounding normal tissue.

Albuquerque said these are among the measures a hospital can take to prevent the type of radiation injuries that were the subject of a recent New York Times series on radiation injuries:

- A team of physicians, therapists and physicists does several levels of checking before treating a patient. For example, the team does a trial run on a 'phantom patient' with radiation detectors. This ensures the machine is delivering the proper dose of radiation.

- Accreditation by the American College of Radiology assesses the qualifications of personnel, policies and procedures, equipment specifications, quality assurance activities, patient safety and quality of patient care.

- State inspections ensure the hospital meets state regulations on radiation use.

- A comprehensive quality assurance program includes tests on equipment and software on a daily, weekly, monthly and annual basis.

- Treatment plans are created by board-certified dosimetrists and reviewed by physicians, physicists and therapists before and during the course of treatment. (A dosimetrist is a key member of the radiation oncology team who specialises in the use of computers for radiation treatment planning.) Weekly physics checks are performed to ensure the treatment plan is being implemented as intended, and all patient charts are reviewed.

Radiation therapy can cure certain head and neck cancers, lymphomas, cervical cancer, anal cancer and cancer of the vocal cords, thus avoiding surgery.

'It's one of the most powerful weapons against cancer we have,' Albuquerque said.