Original article
Safety in Radiation Oncology: The Role of International Initiatives by the International Atomic Energy Agency

https://doi.org/10.1016/j.jacr.2011.07.014Get rights and content

The International Atomic Energy Agency (IAEA) has a wide range of initiatives that address the issue of safety. Quality assurance initiatives and comprehensive audits of radiotherapy services, such as the Quality Assurance Team for Radiation Oncology, are available through the IAEA. Furthermore, the experience of the IAEA in thermoluminescence dosimetric audits has been transferred to the national level in various countries and has contributed to improvements in the quality and safety of radiotherapy. The IAEA is also involved in the development of a safety reporting and analysis system (Safety in Radiation Oncology). In addition, IAEA publications describe and analyze factors contributing to safety-related incidents around the world. The lack of sufficient trained, qualified staff members is addressed through IAEA programs. Initiatives include national, regional, and interregional technical cooperation projects, educational workshops, and fellowship training for radiation oncology professionals, as well as technical assistance in developing and initiating local radiation therapy, safety education, and training programs. The agency is also active in developing staffing guidelines and encourages advanced planning at a national level, aided by information collection systems such as the Directory of Radiotherapy Centers and technical cooperation project personnel planning, to prevent shortages of staff. The IAEA also promotes the safe procurement of equipment for radiation therapy centers within a comprehensive technical cooperation program that includes clinical, medical physics, and radiation safety aspects and review of local infrastructure (room layout, shielding, utilities, and radiation safety), the availability of qualified staff members (radiation oncologists, medical physicists, and radiation technologists and therapists), as well as relevant imaging, treatment planning, dosimetry, and quality control items. The IAEA has taken the lead in developing a comprehensive program that addresses all of these areas of concern and is actively contributing to the national and international efforts to make radiation therapy safer in all settings, including resource-limited settings.

Section snippets

Personnel-Related Initiatives

Insufficient numbers of radiotherapy professionals and a lack of adequate training of existing staff members have been found to be among the main causative factors behind radiotherapy incidents and accidents [3, 4, 5]. Several IAEA programs help rectify these problems in its member states.

Radiation Safety Education and Training

A program for education and training in radiation safety for radiation protection officers, regulators, and radiation therapy staff members has been developed, and supporting publications are available [18]. In addition, publications containing information important to safety in radiotherapy (http://www.iaea.org) and standardized training materials on various topics such as the prevention of accidental exposure in radiotherapy are also available at the Web site of the IAEA's Radiation

QA

Most severe accidental exposures have occurred in radiation therapy departments in which QA programs either were not in place or were not fully implemented or monitored [22]. Effective implementation of a radiotherapy QA program requires the support, training, and commitment of every staff member [23, 24]. Training becomes particularly critical when introducing new equipment technology or changing procedures.

Example of Implementation of IAEA Initiatives in a Single Country

The country we describe is on a continent that has scarce radiation oncology facilities. The only available facilities are concentrated mainly in countries in the northern and southern areas of the continent. This limited the technical expertise and support available in radiation oncology and radiation physics in the area. However, the need for radiation oncology services was evident, with 10,000 new cancer patients annually in a population of approximately 12 million. Young patients with

Discussion

Patient safety in radiation therapy can be influenced by many factors. The human error component of these errors can be due to one or more contributing factors. First is the situation in which the professionals involved were not certified or did not have updated training. This can be addressed by training, education, and national certification and benchmarking. An appropriate system of education and training (in the country or abroad) and a process of certification must be in place. In

Conclusions

A comprehensive program that addresses all of these areas of concern, including reporting, analysis, and learning from incidents, is possible and is available through the IAEA. Such programs contribute to the national and international efforts to make radiation therapy safer in all settings, including resource-limited settings. Advance government and professional association planning to prevent shortages of staff members with key roles in safety is encouraged and made possible through

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