1. Worth, Tammy


ASTRO responds to recent concerns.


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The American Society for Radiation Oncology (ASTRO) has announced a six-point plan aimed at improving the safety and quality of radiation therapy. The plan is in response to an initial safety notification issued by the Food and Drug Administration (FDA) in October 2009 after learning of 206 patients in California who'd received as much as eight times the proper dose of radiation during computed tomographic perfusion scanning. The FDA has since launched an investigation into the extent of imaging-related radiation errors, as well as a campaign, the Initiative to Reduce Unnecessary Radiation Exposure from Medical Imaging (for more, see

Figure. Dr. Hejal Pa... - Click to enlarge in new windowFigure. Dr. Hejal Patel prepares a cancer patient for radiotherapy at his clinic in Dothan, Alabama. Photo by Kevin Glackmeyer / Associated Press.

The goal of ASTRO's six-point plan is to provide oversight and staffing that meets the needs of today's sophisticated equipment, according to Anthony Zietman, ASTRO's president and a professor of radiology and oncology at Massachusetts General Hospital and Harvard Medical School in Boston.


ASTRO's first step is to create a database for reporting radiology errors. There is currently no single clearinghouse for this information. Some states don't require error reporting at all, Zietman said. Next is a call for an enhanced accreditation program. Only about 10% of hospitals are now accredited under a voluntary program, said Zietman, who would like to see accreditation become mandatory. Third is the expansion of education and training to include maintenance certification, much of which will encompass safety. The fourth goal is to improve patient advocacy, helping patients and families understand and ask providers about safety issues. Fifth is improving communication (the accurate transfer of information) between medical equipment. Finally, ASTRO supports the Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy Act of 2009, a reintroduction of a 2007 bill, which includes a call for national standards for training in the use of equipment and procedures related to radiation therapy and medical imaging.


Nurses working in radiology will receive safety training and help to improve patient safety, Zietman said. "If misadministrations occur, it will be incumbent on nurses and physicians to spot problems," he said. "Nurses are incredibly skilled at understanding what a patient's reaction should be."


Zietman also said that nurses are currently responsible for tracking safety measures in many areas, and they will likely play a large role in helping create new protocols. "The culture of safety in an ICU is nurse driven-nurses make sure physicians are scrubbing their hands and that they're using correct procedures," he said. "They're better attuned to a checklist culture than we are, and they're probably going to have to lead us. And that's fine with me."


Not everyone is convinced that the ASTRO plan is as potent as it could be. Writing on the Health Affairs blog on March 10 (, Peter Pronovost of the Johns Hopkins University School of Medicine and colleagues noted the wide variability in the effectiveness of the different methods used to improve safety. "Encouraging someone to be more careful . . . has the lowest probability" of success, he wrote, adding that the comparative effectiveness of "[c]hecklists and reminders [lies] somewhere in the middle." He and his coauthors call for changes in the design of equipment that will make such mistakes impossible, as well as the creation of "a public-private partnership to promote patient safety" modeled after the Commercial Aviation Safety Team, which has been so effective in improving the safety of air travel.


Tammy Worth