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Brittany Bird
Safety Essay
October 7, 2017
The Medical Dosimetrists Role in Safety
The evolution of radiation therapy has grown beyond measure in the last few decades.
New advancing technology and sophisticated treatment techniques have shown to be beneficial
to the patient and effective in precisely targeting tumor volumes. The emerging advancements
have vastly increased the complexity of the planning and treatment delivery process and affected
the department workload structure. Incidences have been publicized in media reports regarding
errors or near misses to patients as read about in the New York Times case, where a computer
error went undetected and the patients brainstem was irradiated at high doses.1 Along with the
intricate planning process, stories similar to this have focused attention to promote teamwork
within the radiation oncology field and to ensure adequate quality assurance (QA). A growing
dependence on relying on computer systems and interlock functions has caused for second-
checks to decrease.2 A medical dosimetrist is at the forefront of the treatment planning process
and can integrate several methods into their daily practice to reduce errors including good
communication skills, following as low as reasonably achievable (ALARA) methods, attending
safety or chart rounds, contouring clearly, and maintaining continuing education and training.
The American Society for Radiation Oncology (ASTRO) white paper entitled Safety is
No Accident: A framework for quality radiation oncology and care, was developed and
endorsed by several regulatory groups and medical professionals including radiation oncologists,
nurses, medical physicists, and medical dosimetrists.3 It discusses ways to improve quality and
safety in order to reduce the chance of medical errors. While human error is inevitable, there are
measures that can be taken to reduce the possibilities from errors arising. Several organizations
such as The World Health Organization (WHO), the International Atomic Energy Agency
(IAEA), and the International Commission on Radiological Protection (ICRP) have established
QA guidelines to reduce the likelihood of an accident from occurring.
It is important for each medical professional to collaborate with each other and to also
adhere to their individual roles and duties within their scope of practice. The medical dosimetrist
is a valuable team member that is on the forefront of the treatment planning process. A medical
dosimetrist meticulously designs complex plans on a computer system utilizing 3D conformal
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radiotherapy, intensity-modulated radiation therapy (IMRT), or volumetric-modulated radiation

therapy (VMAT) techniques. They maintain a balance between sparing healthy normal tissue
and achieving the prescription. They work in conjunction with a medical physicist and the
radiation oncologist to meet desired constraints and to develop the best treatment plan that is
advantageous to the patient. While designing treatment plans is their primary responsibility, they
also assist with simulation procedures, brachytherapy cases, take part in QA checks, and educate
students rotating throughout the facility.
There are several ways that a medical dosimetrist can incorporate safety into their daily
practice. During the development of the dosimetric treatment plan, the medical dosimetrist has
the obligation to address any findings or objectives that fail to meet constraints to the radiation
oncologist. It is important to follow ALARA to keep ionizing radiation doses to the patient low,
and this is especially important for those patients who have received previous radiation treatment
to the surrounding area of interest. Communication is the appropriate course of action in order to
deliver an effective treatment and provide quality patient care. Weekly chart rounds or tumor
boards is another avenue to discuss treatment plans, chart checks, patient issues, or any safety
concerns. The Joint Commission (TJC) requires QA meetings so that leadership can review
safety concerns and develop policies to improve operations.4 It is also vital to perform necessary
calculations correctly, and assistance can be given by the medical physicist. Contouring critical
structures and target volumes clearly is another essential process. Contours create dose tracking
not only to target volumes but also to OR; however, incorrect contours or variances within
contours can create inaccurate dose administration and tracking. Deviations within contours may
lead to over irradiation of normal tissue or cause under-dosing to portions of the target volume.
Aside from daily safety practices, the medical dosimetrist should participate in continuing
education. The American Association of Medical Dosimetrists (AAMD) offers live webinars,
regional and annual conferences, journal self-assessment modules, and ProKnow contouring
accuracy activities to satisfy continuing education requirements and to enhance knowledge.5
Safety is critical in the evolving field of radiation oncology and is pertinent for a medical
dosimetrist to stay ahead of the latest advances and integrate safety into their daily performance.
A safe culture in the healthcare environment can easily be accomplished by following the
recommended guidelines in the white paper provided by ASTRO and is crucial for patient safety.
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Resources have been made available to try and resolve the problem and the issue has received
significant attention to develop more methods to practice safety in the department.
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References
1. Bogdanich W. Radiation offers new cures, and ways to do harm. Health. January 2, 2016.
http://www.nytimes.com/2010/01/24/health/24radiation.html?_r=0. Accessed October 6, 2017.
2. Terezakis SA, Pronovost P, Harris K, et al. Safety strategies in an academic radiation oncology
department and recommendations for action. Joint Commission journal on quality and patient
safety / Joint Commission Resources. 2011;37(7):291-299. http://dx.doi.org/10.1016/S1553-
7250(11)37037-7
3. Zietman, A.L., Palta, J.R., Steinberg, M.L., et al. Safety is no accident: A framework for quality
radiation oncology and care. American Society for Radiation Oncology, Fairfax, VA; 2012.
www.astro.org/uploadedFiles/Main_Site/Clinical_Practice/Patient_Safety/Blue_Book/Safetyisno
Accident.pdf. Accessed on October 3, 2017.
4. American Association of Medical Dosimetrists. Scope of Practice of a Medical Dosimetrist,
2012. http://pubs.medicaldosimetry.org/pub/39731f93-2354-d714-5182-
a342d50fd925?_ga=2.124298636.700881204.1507477666-1151541143.1461615339. Accessed
on October 3, 2017.
5. American Association of Medical Dosimetrists. Continuing Education Overview for 2016-2017.
https://www.medicaldosimetry.org/education/education-overview/. Accessed October 5, 2017.