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RE: [cdn-nucl-l] Radiation Offers New Cures, and Ways to Do Harm
A couple of posts re. the NYT story, FYI.....
Letter to the New York Times January 25, 2010
Radiation therapy 99.99 percent safe and effective
No medical error is acceptable and the two instances reported in your
article on January 24, 2010, "The Radiation Boom - Radiation Offers New
Cures, and Ways to Do Harm" are devastating. We regret the suffering the
patients and families were forced to endure.
However, the numbers reported are exceptionally misleading. The story cites
621 radiation mistakes. During that time, we estimate half a million New
Yorkers received 13.6 million daily radiation therapy treatments, meaning
radiation errors occurred only .0046 percent of the time. We believe your
readers should see this context.
Even one error is too many and ASTRO continuously works to strengthen the
radiation oncology safety culture. We are at the forefront by providing
quality assurance tools, hands-on training for sophisticated treatments like
IMRT, guidelines on treatment use, new technology assessments and
accreditation. ASTRO leads an international coalition improving equipment
interconnectivity to prevent errors.
All treatments pose risks and patients should discuss them with their
doctors. Radiation therapy is a tool no different than a knife in the hands
of a surgeon. It should be used only by those with appropriate training and
Tim R. Williams, M.D.
Chairman, American Society for Radiation Oncology, the world's largest
radiation oncology society with 10,000 members, and a radiation oncologist
at Boca Raton Community Hospital in Boca Raton, Fla.
AAPM Statement on Quality Radiation Therapy
The American Association of Physicists in Medicine (AAPM) is a scientific
and professional organization composed of scientists (medical physicists)
whose clinical practice is dedicated to accuracy, safety and quality in
radiation oncology, medical imaging, image-guided medical procedures and
medical radiation safety. Articles published recently in the New York Times
have focused on rare events in radiation therapy that have resulted in
tragic consequences for patients. The AAPM and its members deeply regret
that these events have occurred, and we continue to work hard to reduce the
likelihood of similar events in the future.
Each year in the United States, hundreds of thousands of people with cancer
receive radiation therapy, amounting to tens of millions of radiation
therapy treatments. Clinical trials have conclusively demonstrated the
benefits of radiation therapy for curing cancer and for alleviating pain and
The medical team in radiation therapy includes radiation oncologists,
medical physicists, dosimetrists, radiation therapists and nurses, all
dedicated to working cooperatively to provide optimum care of the patient.
These individuals work within a system where quality measures are designed
to prevent errors and failures from affecting patients. Even with this
system in place, errors occasionally occur. As suggested in recent reports,
radiation treatment errors that could have adverse effects on patients occur
in a very small number of radiation treatments (1, 2). In most cases, these
effects do not lead to permanent injury. Consequences like those reported
recently in the press occur exceptionally rarely - although the AAPM and its
members agree that they should never occur.
Medical physicists are responsible for quality assurance and the technical
aspects of the complex technology used to treat patients with radiation. The
medical physicist's primary professional responsibility is to the patient's
safety and welfare. Qualified Medical Physicists have a unique combination
of education and training in physics principles, radiation physics
applications, the technologies of treatment delivery, dose planning and
measurement, radiobiological principles, human anatomy and oncology
principles, as well as safety analysis and quality control methods.
In the United States, medical physicists demonstrate competence in their
discipline by obtaining board certification. Certification is a rigorous,
multi-year process that requires considerable clinical experience under
supervision and passage of written and oral examinations. Medical
physicists follow detailed quality assurance and safety protocols
established to insure that cancer treatments with radiation are conducted
according to the prescription prepared by the physician for every treatment
of every patient. Medical physicists follow guidance from national standards
documents developed by the AAPM and in cooperation with other professional
societies. The AAPM has numerous committees dedicated to quality assurance
and safety in radiation therapy.
Education on Quality and Safety
The AAPM provides educational symposia and courses on the reduction and
prevention of errors in radiation therapy. The AAPM works with several other
professional societies, equipment manufacturers and regulatory agencies to
develop national guidance for quality assurance and safety (3). A national
summit is being organized by the AAPM to identify ways to enhance the safety
and effectiveness of using complex technologies to administer radiation to
humans for the treatment of cancer. Medical physicists, radiation
oncologists, dosimetrists, radiation therapists, manufacturer and vendor
representatives, and members of public interest groups will be invited to
Radiation therapy provides safe and effective treatment of cancer and other
diseases for hundreds of thousands of people each year. Very rare events
with tragic consequences serve as a poignant reminder that treatment is not
without risk. We remain committed to identifying and implementing
improvements in patient safety in order to enable us to continue to offer
high quality, safe and effective radiation treatments for every patient in
the fight against cancer.
AAPM Executive Committee
(1) The American Society for Radiation Oncology Letter to the New York
(2) Towards Safer Radiotherapy, British Institute of Radiology, 2008.
(3) AAPM has published a number of quality specific documents for the
technical aspects of radiation therapy at http://www.aapm.org/pubs/reports.
In addition AAPM has sponsored national quality assurance conferences, most
recently in 2007 ; Int. J. Radiation Oncology Biol. Phys., Vol. 71, No. 1,
Supplement, p. S1, 2008.