It's hard not to be shaken by recent reports of medical errors involving CAT scans and radiation therapy. Last month, The Inquirer reported that the Philadelphia VA Medical Center had acknowledged that its prostate cancer program violated federal radiation rules and is facing more than 30 claims of treatment mistakes. And the New York Times recently published a series of articles detailing the gruesome outcomes of medical radiation errors.
While we can assume that the intent of these and other media reports is to call attention to safety lapses, it would be tragic if they led patients to fear needed diagnostic testing and radiation therapy. Along with surgery and chemotherapy, radiation is one of three proven pillars of effective cancer treatment.
Radiation therapy is safe and effective more than 99.99 percent of the time. The Times, for example, identified 621 radiation errors in New York over eight years. Since more than 500,000 New Yorkers received treatment in more than 13.6 million radiation sessions during that period, the errors occurred in only 0.0046 percent of cases.f
This is not to say that mistakes are not an issue. Radiation oncology has evolved into a highly technical specialty that is radically different - and better - than it was even 10 years ago. For example, intensity-modulated radiation therapy (IMRT) with linear accelerators delivers more precise treatment, while reducing side effects. But it is an extremely sophisticated, powerful tool that must be used only by skilled medical professionals.
While there are strict state and federal quality-assurance regulations in place for hospitals and physicians, some go above and beyond those standards with extra personnel and stringent procedures to ensure safety. The key for patients is to select an institution with multiple checks and balances in place to assure that the proper radiation is delivered as prescribed.
When choosing a radiation-therapy team, patients should ask questions about safety, including:
What does the institution do to make sure patients receive proper treatment?
How does it ensure that the lowest possible CAT scan dose is delivered?
Before administering IMRT, does the team radiate a test "phantom"?
How are implanted brachytherapy seeds monitored to ensure proper placement and delivery of therapy?
Do multiple radiation therapists attend the machines so that no one is treating the patient alone?
Are there full-time engineers and IT staff on site to assure that the equipment is functioning correctly every day?
In the case of a radiation oncology department, as with other areas of medicine, years of experience, patient volume, and the size of the department are also relevant.
The American Society for Radiation Oncology has a useful Web site (www.rtanswers.org) that offers information and guidance for patients, as do the National Cancer Institute (www.cancer.gov) and the National Comprehensive Cancer Network (www.nccn.org).
Going through diagnostic tests and cancer treatment is stressful enough without worrying about worst-case scenarios. The vast majority of patients receive accurate diagnostics and radiation therapy that shrinks tumors and prevents recurrence with few side effects. However, it will serve everyone well if patients play a greater role in driving safety. By asking informed questions, they can ensure that health-care institutions use state-of-the-art safety protocols as well as state-of-the-art technology.
Dr. Eric M. Horwitz is chairman of the radiation oncology department at Fox Chase Cancer Center and president of the American Brachytherapy Society.