Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Combination of existing safety checks could greatly reduce radiotherapy errors

03.08.2011
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.

Other experts who contributed to the QA-check effectiveness study are Kendra Harris, M.D., a radiation oncology resident at Johns Hopkins; Annette Souranis, a therapist in the radiation oncology department, and Sasa Mutic, Ph.D., associate professor of radiation oncology at Washington University School of Medicine in St. Louis, Missouri.

The study was funded with a pilot research grant from Elekta Inc.

Abstract Title/Number: WE-C-214-5-- A Quantification of the Effectiveness of Standard QA Measures at Preventing Errors in Radiation Therapy and the Promise of in Vivo EPID-Based Portal Dosimetry

Abstract Link: http://www.aapm.org/meetings/amos2/pdf/59-16302-92754-297.pdf

Vanessa Wasta | EurekAlert!
Further information:
http://www.jhmi.edu

More articles from Health and Medicine:

nachricht Investigators may unlock mystery of how staph cells dodge the body's immune system
22.09.2017 | Cedars-Sinai Medical Center

nachricht Monitoring the heart's mitochondria to predict cardiac arrest?
21.09.2017 | Boston Children's Hospital

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: The pyrenoid is a carbon-fixing liquid droplet

Plants and algae use the enzyme Rubisco to fix carbon dioxide, removing it from the atmosphere and converting it into biomass. Algae have figured out a way to increase the efficiency of carbon fixation. They gather most of their Rubisco into a ball-shaped microcompartment called the pyrenoid, which they flood with a high local concentration of carbon dioxide. A team of scientists at Princeton University, the Carnegie Institution for Science, Stanford University and the Max Plank Institute of Biochemistry have unravelled the mysteries of how the pyrenoid is assembled. These insights can help to engineer crops that remove more carbon dioxide from the atmosphere while producing more food.

A warming planet

Im Focus: Highly precise wiring in the Cerebral Cortex

Our brains house extremely complex neuronal circuits, whose detailed structures are still largely unknown. This is especially true for the so-called cerebral cortex of mammals, where among other things vision, thoughts or spatial orientation are being computed. Here the rules by which nerve cells are connected to each other are only partly understood. A team of scientists around Moritz Helmstaedter at the Frankfiurt Max Planck Institute for Brain Research and Helene Schmidt (Humboldt University in Berlin) have now discovered a surprisingly precise nerve cell connectivity pattern in the part of the cerebral cortex that is responsible for orienting the individual animal or human in space.

The researchers report online in Nature (Schmidt et al., 2017. Axonal synapse sorting in medial entorhinal cortex, DOI: 10.1038/nature24005) that synapses in...

Im Focus: Tiny lasers from a gallery of whispers

New technique promises tunable laser devices

Whispering gallery mode (WGM) resonators are used to make tiny micro-lasers, sensors, switches, routers and other devices. These tiny structures rely on a...

Im Focus: Ultrafast snapshots of relaxing electrons in solids

Using ultrafast flashes of laser and x-ray radiation, scientists at the Max Planck Institute of Quantum Optics (Garching, Germany) took snapshots of the briefest electron motion inside a solid material to date. The electron motion lasted only 750 billionths of the billionth of a second before it fainted, setting a new record of human capability to capture ultrafast processes inside solids!

When x-rays shine onto solid materials or large molecules, an electron is pushed away from its original place near the nucleus of the atom, leaving a hole...

Im Focus: Quantum Sensors Decipher Magnetic Ordering in a New Semiconducting Material

For the first time, physicists have successfully imaged spiral magnetic ordering in a multiferroic material. These materials are considered highly promising candidates for future data storage media. The researchers were able to prove their findings using unique quantum sensors that were developed at Basel University and that can analyze electromagnetic fields on the nanometer scale. The results – obtained by scientists from the University of Basel’s Department of Physics, the Swiss Nanoscience Institute, the University of Montpellier and several laboratories from University Paris-Saclay – were recently published in the journal Nature.

Multiferroics are materials that simultaneously react to electric and magnetic fields. These two properties are rarely found together, and their combined...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

“Lasers in Composites Symposium” in Aachen – from Science to Application

19.09.2017 | Event News

I-ESA 2018 – Call for Papers

12.09.2017 | Event News

EMBO at Basel Life, a new conference on current and emerging life science research

06.09.2017 | Event News

 
Latest News

Rainbow colors reveal cell history: Uncovering β-cell heterogeneity

22.09.2017 | Life Sciences

Penn first in world to treat patient with new radiation technology

22.09.2017 | Medical Engineering

Calculating quietness

22.09.2017 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>