Radiation Therapy Safety: the Critical Role of the Radiation Therapist ASRT Education and Research Foundationeducation I and Research Foundation White Paper

WHITE PAPER WHITE PAPER Radiation Therapy Safety: TheRadiation Critical Therapy Role of Safety: the Radiation the Critical Therapist Role of the Radiation TherapistTeresa G Odle, BA, ELS, and Natasha Rosier, MHA, MBA, R.T.(R)(T) for the ASRT Education and Research Foundation Health Care Industry Advisory Council Subcommittee on Patient Safety and Quality in Radiation Therapy Author Sample, B.S.R.T., R.T.(R)(M)(QM) ©2012 ASRT Education and Research Foundation. All rights reserved. Published by the American Society of Radiologic Technologists, 15000 Central Ave. SE, Albuquerque, NM 87123-3909. Reprinting all or part of this document is prohibited without advance written permission of the ASRT. Send reprint requests to the ASRT Education and Research Foundation. ® ASRT Radiation Therapy Safety: the Critical Role of the Radiation Therapist ASRT Education and Research FoundationEducation i and Research Foundation WHITE PAPER Radiation Therapy Safety: the Critical Role of the Radiation Therapist Teresa G Odle, BA, ELS, and Natasha Rosier, MHA, MBA, R.T.(R)(T), for the ASRT Education and Research Foundation Health Care Industry Advisory Council Subcommittee on Patient Safety and Quality in Radiation Therapy early 1.6 million people in the United States and radiation therapists. The organization provides edu- were diagnosed with cancer in 2011 and about cational opportunities to members, promotes the radio- two-thirds of these patients likely received logic science profession and monitors legislation affecting radiation therapy treatments during their ill- the profession. In addition, ASRT establishes standards of Nnesses.1,2 Most radiation treatments occur without inci- practice and develops education criteria for medical imag- dent and contribute to the comfort or cure of cancer ing and radiation therapy professionals.7 patients.3 Still, advances in technology that provide The ASRT Education and Research Foundation, more sophisticated, promising and accurate techniques the philanthropic arm of the ASRT, accepts donations for targeting malignancies come with a price: complex from individuals and organizations to fund research technology that requires extensive training, continuing and scholarships. The Foundation supports and education and attention from the radiation therapists empowers professionals in medical imaging and radia- who deliver the radiation. tion therapy professions to pursue opportunities that The consequences of a single error are enormous, improve patient care. One method to accomplish this as outlined by feature articles in The New York Times goal is through partnering with the industry to improve beginning in 2010.4,5 These and other reports, such as medical imaging technologist and radiation therapist the ECRI Institute (formerly Emergency Care Research education, job performance and patient care. The Institute) naming of radiation therapy errors as the Foundation’s Health Care Industry Advisory Council number one hazard in health care,6 have focused pub- (HCIAC) includes representatives of important compa- lic, professional and regulatory attention on radiation nies in the radiology and radiation oncology industries oncology processes, equipment and delivery of care. who work together in a noncompetitive environment Professional organizations, vendors and providers are to advance patient care.8 Members meet annually, and responding to address the challenges faced by ensuring occasionally form subcommittees to discuss significant that all of the tools for learning and improving process- issues in the radiologic sciences. The Subcommittee on es are in place to prevent, detect and correct radiation Patient Safety and Quality in Radiation Therapy met therapy-related errors. November 14, 2011, in Albuquerque, N.M. Committee members in attendance are listed in Appendix A. Background The American Society of Radiologic Technologists Committee Purpose (ASRT) is a professional membership organization repre- HCIAC member organizations recognize the impor- senting more than 144,000 medical imaging technologists tance of working together for the good of the patient. Radiation Therapy Safety: the Critical Role of the Radiation Therapist 1 WHITE PAPER Patient care and safety remain at the forefront of radia- member of the ASRT Board of Directors and administra- tion therapist ethics and practice standards, and safe and tive director of radiation therapy services at the University effective design, manufacture and operation of radiation of Texas, MD Anderson Cancer Center in Houston. oncology equipment remain constant goals for HCIAC Hayden emphasized that establishing national member organizations. However, events such as media education and certification standards for technical reports brought these matters to the surface beginning personnel who perform radiation therapy procedures in January 2010. The Subcommittee on Patient Safety was the best way to ensure quality and safety of the and Quality in Radiation Therapy met in light of these procedures. She mentioned that the solution lies in the events, but also because of numerous challenges regard- Consistency, Accuracy, Responsibility and Excellence ing radiation oncology care and commitment to the role in Medical Imaging and Radiation Therapy (CARE) of the radiation therapist in patient care. bill before the House. Hayden and the ASRT also called There has been a heightened perception of medical for establishment of consistent and mandatory methods safety among professionals and the public over the past of reporting medical radiation errors.11 Other organiza- decade, with mixed perception regarding patient safety tions, such as the American Association of Physicists in in radiation therapy.9 When The New York Times fea- Medicine (AAPM), the American Society for Radiation tured stories of serious radiation overdoses,5 the errors Oncology (ASTRO) and the Medical Imaging and raised fears in the public — and in patients slated to Technology Alliance (MITA) have made statements, receive radiation therapy. In addition, the complexity of published white papers or developed initiatives to the technology used to deliver radiation treatments has address safety in radiation therapy.9,12,13 increased exponentially in recent years. This is good news for patients, but only if personnel who maintain Scope of White Paper and operate the equipment and plan the treatments This White Paper also is a response — as commis- remain up-to-date on the advances and the skills neces- sioned by the ASRT Foundation and the HCIAC — on sary to work within the technological environments the behalf of the radiation therapy profession and the indus- new modalities and machines require. try’s equipment vendors, particularly representatives These and other factors brought together the sub- of the companies’ education services. The goal of the committee of concerned radiation therapists, managers document is to provide background on the radiation and representatives of radiation therapy equipment ven- therapist’s role in safe treatment delivery, an overview of dors to discuss the issue in detail and consider coopera- the challenges faced by therapists in delivery of care and tive and workable solutions focusing primarily on the challenges faced by vendors and sites in appropriately areas they represent: the role of the radiation therapist training providers on use of clinical equipment. The and the support provided to therapists and other radia- paper also outlines best practice scenarios and recom- tion oncology staff from equipment vendors. mendations for radiation therapists, their leadership and industry. The committee’s evaluation and recommenda- Industry Response tions are categorized according to: skills assessment, Several professional organizations responded imme- applications training and support, workplace culture diately to the articles in The New York Times, including and workplace staffing. the ASRT. In a letter to the newspaper’s editor, then- This document is the direct result of collaborative dis- president Diane Mayo, R.T.(R)(CT), reminded readers cussions of the radiation therapists represented from prac- that although radiation therapy errors are tragic, they are tice and industry who serve on the HCIAC Subcommittee rare. She also pointed out that in 2010, 17 states did not re- on Patient Safety and Quality in Radiation Therapy and quire a license to deliver radiation therapy.10 Many organ- has been reviewed and accepted by its members. izations also were asked to testify before the U.S. House of Representatives Energy and Commerce Committee’s Workplace Staffing Subcommittee on Health. ASRT was among these, and Radiation helps treat cancer and select other diseases was represented by Sandra Hayden, MA, R.T.(T), a by destroying cells. When radiation damages cancer Radiation Therapy Safety: the Critical Role of the Radiation Therapist 2 WHITE PAPER cells’ DNA, it affects the cells’ ability to continue repro- facilities to set and enforce minimum qualifications for ducing. By nature, cancer cells divide rapidly, which radiation therapists and medical dosimetrists.17 makes them particularly susceptible to radiation.14 Despite lack of regulation, accreditation programs Delivering ionizing radiation to patients to target spe- for radiation oncology recommend that radiation cific cells requires unparalleled accuracy. Too little radi- therapists have ARRT certification.18 Still, the CARE ation can allow cancerous cells to regrow, but too much bill (H.R. 2104) remains stalled in the U.S.

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