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June 24, 2017

However, Ford says, their research showed that another key to safety turned out to be a humble checklist of relatively low-tech measures, "assuming it's used consistently correctly, which it often isn't," adds Ford. The checklist includes reviews of patient charts before treatment by both physicians and radiation-physicists, who calculate the right dose of radiation.

Use of film-based radiation-dose measurements as an alternative to EPID and a mandatory "timeout" by the radiation therapist before radiation is turned on to double-check that the written treatment plan and doses match what's on the radiation delivery machines were also on the list of the most effective QA procedures.

A common QA measure known as pretreatment IMRT (intensity modulated radiation therapy), in which clinical staff do a "test run" of the radiotherapy device at its programmed strength with no patient present, ranked very low on the list - because it would have prevented almost none of the potential incidents studied. "This is important to know, because pre-treatment IMRT often consumes a lot of staff time," says Ford.

Ford and his Johns Hopkins colleague Stephanie Terezakis, M.D., a pediatric radiation oncologist and a contributor to the QA evaluation study, also are members of the AAPM Working Group on the Prevention of Errors. At the Vancouver meeting, in a symposium on August 3, the group will make recommendations for a national radiotherapy incident reporting system. The group is developing a way to have treatment errors and near-misses reported and sent to a central group for evaluation and dissemination to clinics, says Ford. "It could work in ways similar to how air and train accidents are reported to the National Transportation Safety Board," he noted.

Source: Johns Hopkins Medical Institutions