Navigation Links
Combination of existing safety checks could greatly reduce radiotherapy errors

A combination of several well-known safety procedures could greatly reduce patient-harming errors in the use of radiation to treat cancer, according to a new study led by Johns Hopkins researchers.

Radiation oncologists use more than a dozen quality assurance (QA) checks to prevent radiotherapy errors, but until now, the Hopkins researchers say, no one has systematically evaluated their effectiveness. Working with researchers at Washington University in St. Louis, the Hopkins team gathered data on about 4,000 "near miss" events that occurred during 2008-2010 at the two institutions. They then narrowed the data set to 290 events in which errors occurred that if they had not been caught in time could have allowed serious harm to patients. For each commonly used QA check, they determined the percentage of these potential patient-harming incidents that could have been prevented.

The group's key finding was that a combination of approximately six common QA measures would have prevented more than 90 percent of the potential incidents.

"While clinicians in this field may be familiar with these quality assurance procedures, they may not have appreciated how effective they are in combination," says Eric Ford, Ph.D., D.A.B.R., assistant professor of Radiation Oncology and Molecular Radiation Sciences at Johns Hopkins, who will present the group's findings on August 3 at the joint American Association of Physicists in Medicine (AAPM) and Canadian Organization of Medical Physicists annual meeting, held July 31 to August 4, 2011 in Vancouver, Canada.

At a separate symposium at the meeting, also on August 3, Ford and his colleagues will make related recommendations for the standardization of radiotherapy accident investigation procedures.

Ionizing radiation such as gamma radiation or proton beam radiation has long been a staple in cancer treatment, because it can efficiently create cell-killing DNA breaks within tumors. The goal is to use it in ways that maximize the dose delivered to a tumor, while keeping healthy tissue around the tumor as protected as possible by sharply focusing the radiation treatment area.

Unfortunately, the multistep complexity of radiation therapy, and the numerous precision measurements its use entails, can sometimes lead to mistakes, with patients getting too little radiation where it's needed, or too much where it isn't.

One QA check, a piece of hardware called an Electronic Portal Imaging Device (EPID), is built in to many radiotherapy-delivery machines, and can provide a real-time X-raylike image of the radiation coming through a patient. But Ford says less than one percent of radiotherapy clinics use EPID because the software and training needed to operate are mostly absent.

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.


Contact: Vanessa Wasta
Johns Hopkins Medical Institutions

Related medicine news :

1. Hypnosis/local anesthesia combination during surgery helps patients, reduces hospital stays
2. Combination antibody therapy shows promise in metastatic melanoma
3. Combination therapy shows promise for rare, deadly cancer caused by asbestos
4. Less toxic combination of erlotinib and bevacizumab is effective non-small cell lung cancer patients
5. Model developed to improve combination vaccine accessibility worldwide
6. Gene combinations are found to be related to hip osteoporosis in postmenopausal women
7. Smoking in combination with immunosuppression poses greater risk for transplant-related carcinoma
8. Combination overcomes breast cancer resistance to herceptin
9. New combination therapy for solid tumors?
10. Certain Drug Combinations May Beat Back Aggressive Breast Cancer
11. Drug combination shows promise for newly diagnosed blood cancer patients, study finds
Post Your Comments:
(Date:6/26/2016)... ... , ... Brent Kasmer, a legally blind and certified personal trainer is helping to develop a ... fitness app plans to fix the two major problems leading the fitness industry today:, ... type program , They don’t eliminate all the reasons people quit their exercise ...
(Date:6/25/2016)... Viejo, California (PRWEB) , ... June 25, 2016 , ... ... to fit their specific project," said Christina Austin - CEO of Pixel Film Studios. ... fully customizable and all within Final Cut Pro X . Simply select a ...
(Date:6/25/2016)... Canada (PRWEB) , ... June 25, 2016 , ... Conventional ... pursuit of success. In terms of the latter, setting the bar too high can ... risk more than just slow progress toward their goal. , Research from ...
(Date:6/24/2016)... ... 2016 , ... The Pulmonary Hypertension Association (PHA) learned during ... two significant new grants to support its work to advance research and patient ... recognizing patients, medical professionals and scientists for their work in fighting pulmonary hypertension ...
(Date:6/24/2016)... Plano, TX (PRWEB) , ... June 24, 2016 , ... ... taking part in Genome magazine’s Code Talker Award, an essay contest in which patients ... for an award to be presented at the 2016 National Society of Genetic Counselors ...
Breaking Medicine News(10 mins):
(Date:6/23/2016)... , June 23, 2016 ... CAPR ), a biotechnology company focused on the ... announced that patient enrollment in its ongoing randomized ... has exceeded 50% of its 24-patient target. Capricor ... the third quarter of 2016, and to report ...
(Date:6/23/2016)... INDIANAPOLIS , June 23, 2016 If ... Leaders Scholarship is any indication, the future is in ... at by the Diabetes Scholars Foundation ... the way of academic and community service excellence. ... since 2012, and continues to advocate for people with ...
(Date:6/23/2016)... 23, 2016 The vast majority of dialysis ... facility.  Treatments are usually 3 times a week, with ... including travel time, equipment preparation and wait time.  This ... grueling for patients who are elderly and frail.  Many ... and rehabilitation centers for some duration of time. ...
Breaking Medicine Technology: