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Ensuring the Safe Use of Advanced Radiotherapy in Eastern Europe and Central Asia

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Early and honest reporting on incidents and near misses is key to improving safety in radiotherapy. This is one of the messages participants took home this week from a workshop on risk assessment in advanced radiotherapy techniques organized by the IAEA in Vienna for radiotherapy professionals from Eastern Europe and Central Asia.

“While historically there has been a reluctance to report mistakes, we need to know about past mistakes in order to learn from them and make sure we avoid them when treating patients in the future,” said Tatul Saghetelyan, Head of the Department of Radiotherapy at the Ministry of Health in Armenia.

Like Armenia, more and more countries in the region are adopting advanced radiotherapy technology to treat their cancer patients. The technology involves targeting tumours accurately and the possibility of using higher radiation doses with the aid of image guidance. Such precise treatments can increase the chances of cure, but with them comes a greater need to ensure the treatments are performed safely.

“Delivering higher doses to smaller fields can increase the potential for error. The smaller you go, the higher your chances of missing the target,” said Mary Coffey, expert from the European Society for Radiotherapy and Oncology (ESTRO). “This is why we are giving so much focus to safety. Following the right safety procedures, we decrease the possibility of any unwanted side effects, while increasing the chances to cure.”

The workshop brought together senior radiation oncologists, medical physicists and radiation therapy technologists from 22 countries in the region, where hospitals are rapidly adopting advanced radiotherapy technologies. International experts from the three key professions moderated the discussions.

The different specialists agreed that while there are guidelines and regulations in place for treatment machines, there is much work to be done in developing and establishing institutional procedures and guidelines for the people who operate them. Documenting all procedures, assigning clear roles and having protocols in place were among the recommendations made to enhance safety in the field.

“As machines do not do the job on their own, there is a need for well-trained and responsible professionals,” said Jenia Vassileva, a radiation protection specialist at the IAEA. “If you’re going for advanced radiotherapy, you’re going to have to consider all the other aspects: infrastructure, training, staffing, quality assurance, as well as safety procedures. These are required by international standards and national regulations, but more actions are still needed to fully implement them in clinical practice.”

One of the workshop’s aims, Vassileva added, is for senior specialists to learn how to perform risk analysis and convey the importance of having the right safety barriers in place once they return home. “This will help improve patient safety while delivering radiotherapy services,” she said. Turkish medical leaders, for example, will encourage the establishment of a Committee for Quality and Safety, said Yavuz Anacak, President of the Turkish Society for Radiation Oncology.

“Building a strong safety culture needs commitment from the very top,” said Anacak, who like other senior workshop participants will spread the concepts learned to members of their national radiotherapy community.

One of the hardest practices to instil, beyond standard procedures, is creating a culture that allows space for professionals at any level to report on mistakes. “We know when big accidents occur, but we hardly hear about the smaller incidents, the near misses,” Anacak said. “We cannot work towards improving safety in the long term if we’re only looking at the tip of the iceberg.”

IAEA experts presented the SAFRON tool, a database of radiotherapy incidents and near misses based on voluntary reporting. They also shared the results of various IAEA quality audits which are key to improving quality and safety in the field.

The workshop also emphasised the need to move beyond hierarchical interactions among radiation oncologists, medical physicists and radiation therapy technologists.

“When it comes to safety, it shouldn’t really matter if you’re a junior oncologist or a senior radiation therapy technologist,” said Carl Rowbottom, Head of Medical Physics at the Clatterbridge Cancer Centre in Liverpool, United Kingdom. “Anybody should feel free to ask questions to improve the quality of the treatment.”

The workshop is the first in a series of four to be held until 2021 to increase safety in radiotherapy in the region and is being implemented under the IAEA’s programme for technical cooperation.

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