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Radiation Therapy Hits No. 1 On The Wrong List

December 13, 2010
Written by: , Filed in: Medical Ethics, Practice Management
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Radiation therapy leads an early 2011 “top 10” list, but that’s not a good thing. ECRI Institute named “radiation overdose and other dose errors during radiation therapy” as No. 1 on its Top 10 Technology Hazards for 2011.

Not far behind at No. 4 comes “the high radiation dose of CT scans.”

ECRI Institute is a nonprofit organization that is, according to its Web site, “dedicated to bringing the discipline of applied scientific research to discover which medical procedures, devices, drugs, and processes are the best.” It says it intends its annual technology-hazards list to present “the potential sources of danger that we believe warrant the greatest attention to increase awareness and prevent risks.”

ECRI focused particularly on radiation-therapy errors because the consequences can be devastating but rarely manifest themselves immediately, meaning that a patient may be overdosed repeatedly before an error is discovered. “And by that time,” the ECRI report says, “the damage has already been done (and can’t be undone).”

Human error gets the most blame, but ECRI also cites “the pace of technological change.” Training and experience can have a hard time keeping up with increasingly complex technology, including software from multiple vendors.

“There is no simple fix to ensure safe and effective treatment,” ECRI says. It lays out an unglamorous, by-the-book set of steps: keeping everyone properly trained, following all required procedures, providing proper supervision, and taking necessary corrective actions even if they’re expensive.

As for radiation doses from CT scans, ECRI says, “The crux of the problem is that a delicate balance must be achieved between keeping doses low and maintaining adequate image quality.”

Here, ECRI sees rapid progress on dose-saving technology as a boon. “Unfortunately,” it adds, “the most advanced technologies are generally available only on the latest, and most expensive, CT systems.” Again, ECRI’s recommendations aren’t going to startle anyone: educate referring physicians to avoid unnecessary imaging, monitor radiation levels, keep staff trained, optimize and control X-ray protocols (and make sure the settings can’t be changed by unauthorized personnel), and employ whatever technological assistance you can afford.

Overall, ECRI says, “The objective of this article is to increase awareness of these hazards and to stimulate action within healthcare facilities to formulate programs that succeed in minimizing the dangers.”

Here’s the rest of the top 10: alarms being ignored, turned off, or incorrectly set; contamination from improperly cleaned endoscopes; data loss, system incompatibilities, and other IT problems; misconnected tubing; oversedation via PCA infusion pumps; needlesticks and other sharps injuries; surgical fires; and defibrillator failures.

Related seminar: Radiology Review

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