The document discusses recommendations for preventing accidental radiation exposures to patients undergoing radiation therapy. It provides case histories of 8 major accidental exposures that occurred due to equipment errors, miscommunications, unverified procedure changes, and lack of quality assurance programs. Clinical consequences of over and under exposures are described. Recommendations include implementing comprehensive quality assurance programs involving organization, training, acceptance testing, equipment monitoring, communication policies, and patient identification verification. Specific recommendations are provided for external beam therapy and brachytherapy quality controls.
Introduction
Time dose & fractionation
Therapeutic index
Four R’s Of Radiobiology
Radiation response
Survival Curves Of Early & Late Responding Cells
Various fractionation schedules
Clinical trials of altered fractionation
Introduction
Time dose & fractionation
Therapeutic index
Four R’s Of Radiobiology
Radiation response
Survival Curves Of Early & Late Responding Cells
Various fractionation schedules
Clinical trials of altered fractionation
Ionizing radiation makes invasive cardiology procedures such as coronary angiography, percutaneous coronary intervention (PCI), and electrophysiologic diagnostics and therapeutics possible .
Radiation risks can be thought of as deterministic (effects after exceeding certain threshold, e.g., skin burns) or stochastic (a risk of an outcome is proportional to the dose received, e.g., malignancy or teratogenicity) .
Reducing the radiation exposure in the cardiac catheterization laboratory is important, especially as procedures are becoming more complex .
View the clinical evidence from the Angel Catheter Pivotal Study. This investigation was concluded in December 2015. The primary objective of this clinical trial was to evaluate the safety and effectiveness of the Angel® Catheter in subjects at high risk of PE and with recognized contraindications to standard pharmacological therapy.
The Angel Catheter received 510(k) Clearance in July 2016.
Email sbrewer@bio2medical.com to request a meeting to review the study results and device.
BSS_M KMZ Presentation - A Gamechanger in Medical Diagnostics Vikki Choudhry
BSS Materiel Limited and KMZ Holdings LLC presentation on Zeptronic Diagnostics - A Gamechanger in Medical Diagnostics
System and Method for Diagnostic Analysis of Human Body Systems, Organs and Cells.
An approach for radiation dose reduction in computerized tomographyIJECEIAES
Minimization of radiation dose plays an important role in human wellbeing. Excess of radiation dose leads to cancer. Radiation greatly affects young children less than 10 years of age as their life span is longer. Radiation can be reduced by hardware and/or by software techniques. Hardware methods deal with variation of parameters such as tube voltage, tube current, exposure time, focal distance and filter type. Software techniques include image processing methods. The originally acquired X-ray images may be contaminated with noise due to the fact of instability in the case of sensors, electrical power or X-ray source, that is responsible for the degradation of the image attributes. An enhanced image denoising algorithm has been proposed which decreases Gaussian noise combined with salt and pepper noise that retains most information particulars.
Survey of emf emitted by lab equipments in pharmacy labs of southeast univers...eSAT Journals
Abstract The aim of this survey is to investigate whether the Electromagnetic Fields (EMF) emitted by various lab equipments affects the students. There is a standard threshold value recommended by WHO for both electric and magnetic fields. Electro-Magnetic Fields commonly known as Non Ionizing Radiation is emitted from high power transmission lines, computer monitor/video display unit, radio waves of different frequencies (extremely low frequency to microwaves), telecommunication, satellite, radar etc. which causes health hazards to living system and environment. The WHO/ International Agency for Research in Cancer (IARC) has classified radio frequency electromagnetic field as possibly carcinogenic to humans. There has been no such study performed in Bangladesh. The data were collected from various labs of department of pharmacy at Southeast University in Dhaka, Bangladesh. These labs are Pharmaceutical, Cosmetology and Biopharmaceutical Lab, Pharmacology Lab, Organic Pharmacy and Pharmacognosy Lab, Inorganic Pharmacy Lab and Microbiology Research Lab. Both threshold values of Electric and Magnetic fields were measured for various electronic equipments. Also the maximum value of the magnetic field results showed that in many cases the magnetic field radiated from the different sources are greater than the threshold limit which are the main point of our findings. As a result of the long time efforts of world scientist community WHO formed ICNIRP in 1969. Key Words: EMF, NIR, DNA, EMC, AML and ICNIRP
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
17 marzo 2014: Trattamenti ipofrazionati ed ipofrazionati-accelerati: nuove possibilità di prevenzione e trattamento della tossicità acuta e tardiva
EVOLUTION IN CARDIAC RESYNCHRONIZATION THERAPY
Moving towards Leadless pacing mainly in cases with difficult coronary sinus anatomy, where placing the LV lead is difficult.
Similar to Phy icrp 86 rt accidents prevention (20)
Management of acute lymphoblatic leukemia with light on etiology, clinical features, diagnosis and different aspects of management including chemotherapy and radiation therapy
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Colonic and anorectal physiology with surgical implications
Phy icrp 86 rt accidents prevention
1. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Prevention of AccidentalPrevention of Accidental
Exposures to PatientsExposures to Patients
Undergoing Radiation TherapyUndergoing Radiation Therapy
2. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
International Commission
on Radiological Protection
Information abstracted from
ICRP Publication 86
Available at www.icrp.org
Task Group: P. Ortiz, P. Andreo, J-M. Cosset, A. Dutreix,
T. Landberg, L.V. Pinillos, W. Yin, P.J.Biggs
3. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Use and disclaimer
This is a PowerPoint file
It may be downloaded free of charge
It is intended for teaching and not for
commercial purposes
This slide set is intended to be used with
the complete text provided in ICRP
Publication 86
4. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Contents
Case histories of major accidental
exposure in radiotherapy
Clinical consequences of accidental
exposures
Recommendations for prevention
5. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Case Histories of
Major Accidental Exposures
of Patients in Radiotherapy
Case Histories ofCase Histories of
Major Accidental ExposuresMajor Accidental Exposures
of Patients in Radiotherapyof Patients in Radiotherapy
6. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Case 1: Use of an incorrect decay
curve for 60Co (USA, 1974-76)
Initial calibration of a 6060
CoCo beam was correct, but ..
A decay curve for 6060
CoCo was drawn: by mistake, the slope was
steeper than the real decay and the curve underestimated the
dose rate
Treatment times based on it were longer than appropriate, thus
leading to overdoses, which increased with time reaching up
to 50% when the error was discovered
There were no beam measurements in 22 months and total
of 426 patients affected
Of the 183 patients who survived one year 34% had severe
complications
7. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Case 2: Incomplete understanding & testing
of a treatment planning system (TPS)
(UK, 1982-90)
In a hospital, most of the treatments were with a SSD of
100 cm
For treatments treatments with SSD different from
standard (100 cm), corrections for distance were usually
done by the technologists
When a TPS was acquired, technologists continued to
apply manual distance correction, without realising that
the TPS algorithm already accounted for distance
8. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Cont’d: Incomplete understanding and testing
of a treatment planning system
(UK, 1982-1990)
As a result, distance correction was applied twice,
leading to underdosage (up to 30%)
The procedure was not written, and therefore, it was
not modified when new TPS was used
Problem remained undiscovered during eight years
and affected 1,045 patients
492 patients who developed local recurrence
probably due to the underexposure
9. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Case 3: Untested change of procedure
for data entry into TPS (Panama, 2000)
A TPS allowed entry of four shielding blocks for
isodose calculations, one block at a time
Need for five shielding blocks led to deviation from
standard procedure for block data entry: several blocks
were entered in one step
Instructions for users had some ambiguity with respect
to shielding block data entry
TPS computer calculated treatment time, which was
double the normal one (leading to 100% overdose)
10. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Cont’d: Untested change of procedure
for data entry into TPS (Panama, 2000)
There was no written procedure for the use of
TPS, and therefore, a change of procedure was
neither written nor tested for validity
Computer output was not checked for
treatment time with manual calculations
The error affected 28 patients;
One year after the event, at least five had died
from the overexposure
11. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Case 3: Patient treated with overdose
Ulceration
and
necrosis
Colonoscopy of a
patient treated with
overdoses of 100%
Necrotic tissue
Telangiectasia
12. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Case 4: Accelerator software problems
(USA & Canada, 1985-87)
Software from an older accelerator design was
used for a new, substantially different, design
Software flaws were later identified in the
software used to enter treatment parameters,
such as type of radiation and energy
Six accidental exposures occurred in different
hospitals and three patients died from
overexposure
13. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Case 5: Reuse of outdated computer file
for 60Co treatments (USA, 1987-88)
After source change, TPS computer files were
updated…
Except a computer file, which was no longer in
use (this was intended for brain treatments
with trimmer bars)
The computer file was not removed although
no longer in use
14. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Cont’d: Reuse of outdated computer
file for 60Co treatments (USA, 1987-88)
A new radiation oncologist decided to treat
with trimmer bars and took the file
corresponding to the prior 6060
CoCo source
There was no double or manual check for
dose calculation
33 patients received 75% higher
overexposure
15. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Case 6: Incorrect accelerator repair &
communication problems (Spain, 1990)
Accelerator fault followed by an attempt to
repair it
Electron beam was restored but electron
energy was misadjusted
Accelerator delivered 36 MeV electrons,
regardless of energy selected
Treatments resumed without notifying
physicists for beam checks
16. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Cont’d: Incorrect accelerator repair &
communication problems (Spain, 1990)
There was a discrepancy between energy displayed and
energy selected, which was attributed to a faulty
indicator, instead of investigating the reason for the
discrepancy
A total of 27 patients were affected with massive
overdoses and by distorted dose distribution due to
wrong electron energy
At least 15 of these patients died from the accidental
overexposure and two more died with overexposure as
major contributor
17. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Case 7: Malfunction of HDR
brachytherapy equipment (USA, 1992)
HDR brachytherapy source detached from the driving
mechanism while still inside the patient
While the console display indicated that the source was
in retracted to the shielded position, an external
radiation monitor was indicating that there was radiation
Staff failed to investigate the discrepancy with available
portable monitor
The source remained in the patient for several days and
the patient died from overexposure
18. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Case 8: Beam miscalibration of 60Co
(Costa Rica, 1996)
Radioactive source of a teletherapy unit was
exchanged
During beam calibration, reading of the timer was
confused, leading to underestimation of the dose rate
Subsequent treatment times were calculated with the
wrong dose rate and were about 60% longer than
required
115 patients were affected; two years after the event,
at least 17 patients had died from the overexposure
19. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Case 8: Beam miscalibration of 60Co
(Costa Rica, 1996)
Failure to perform
independent
calibration
Failure to notice that
treatment times were
too long for a new
source with higher
activity
Child affected by overdoses to brain and spinal cord and lost his
ability to speak and walk
20. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Clinical ConsequencesClinical ConsequencesClinical Consequences
21. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Side effects and complications
in radiotherapy
Side effects are usually minor and transient
e.g : xerostomia and localised subcutaneous fibrosis
Relatively high frequency acceptable to achieve cure
Complications are more severe and long lasting
e.g : radiation myelitis
Expected only at very low frequency
22. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Impact of accidental
underexposure
Accidental underdosage may jeopardise tumour
control probability
They are difficult to discover, may only be
detected after relatively long time and, therefore,
may involve a large number of patients
23. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Impact of overdoses on early
(or acute) complications
Usually observed in tissues with rapid cell
turnover (skin, mucosa, bone marrow …)
Overexposure may increase the frequency
and severity (up to necrosis)
24. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Early (acute) complications
Determinant factors for acute
complications are:
1) total delivered dose
2) total duration (protraction)
3) size and location of irradiated volume
Little correlation of early complications
with fraction size and dose rate (except if
the latter is very high)
25. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Late complications
Mainly observed in tissues with slowly
proliferating cells (arteriolar narrowing which
occurs with a time delay)
Can also become manifest in rapidly proliferating
cells (in addition to and after acute effects)
Manifest more than six months after irradiation
and even much later
Usually irreversible and often slowly progressive
26. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Example of late complications due
to an accidental overexposure…
Extensive fibrosis of
the left groin with
limitation of hip
motion as a result of
accidental
overexposure
27. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Impact of overexposure on late
complications (cont’d)
Determinant factors:
1) total delivered dose
2) fraction size and dose rate
In the case of accidental exposure,
increased fraction size may amplify the
effects (as occurred in some accidents)
28. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Late complications (cont’d)
In serial organs (spinal cord,
intestine, large arteries), a
lesion of small volume
irradiated above threshold
may cause major incapacity,
for example paralysis
In organs arranged in
parallel (e.g. lung and liver),
severity is related to the
tissue volume irradiated
above threshold
Organs with serial arrangement
(example spinal cord)
Organs with parallel arrangement
(example, liver)
29. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Example of late complication on
organ with serial arrangement
(spinal cord)
Young woman who
became quadri-
plegic as a result of
accidental over-
exposure to the
spinal cord
30. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Clinical detection of accidental
medical exposure
Careful clinical follow-up may lead to detect
accidental overdose through early enhanced
reactions
Experienced radiation oncologists can detect
overdoses of 10 % during regular weekly
consultations
Some overdoses may cause late severe
effects without abnormal early effects
31. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Clinical detection of accidental
medical exposure (cont’d)
In the case of unusual reactions in a single
patient, other patients treated in the same
period may need to be recalled
32. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Recommendations forRecommendations for
PreventionPrevention
33. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
List of Recommendations for
prevention
Overall preventive measure: a Quality
Assurance Programme, involving
– Organisation
– Education and training
– Acceptance testing and commissioning
– Follow-up of equipment faults
– Communication
– Patient identification and patient charts
– Specific recommendations for teletherapy
– Specific recommendations for brachytherapy
34. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Quality Assurance Programme
for Radiation Therapy (QART)
Quality assurance programmes have evolved
from equipment verifications to include the
entire process, from the prescription to delivery
and post treatment follow-up
Major accidental exposures occurred in the
absence of written procedures and checks
(QART); either because a QART did not exist or
it was not fully implemented (checks omitted)
35. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Organisation
Comprehensive QA is crucial in prevention and
involve clinical, physical and safety
components:
Its implementation requires
– complex multi-professional team work
– clear allocation of functions and responsibilities
– functions and responsibilities understood
– number of qualified staff, commensurate to workload
36. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Education and training
The most important component of QA is qualified
personnel, including radiation oncologists, medical
physicists, technologists and maintenance engineers
Comprehensive education together with specific
training on
– procedures and responsibilities
– everyone’s role in the QART programme
– lessons from typical accidents with a description of methods
for prevention
– additional training when new equipment and techniques are
being introduced
37. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Acceptance testing & commissioning
Errors in these phases may affect many patients
Acceptance testing:
Should include test of safety interlocks, verification of equipment
specifications, as well as understanding and testing TPS
Commissioning:
Should includes measuring and entering all basic data for future treatments
into computer
Systematic acceptance and commissioning, including
a cross check and independent verification, form a
major part of accident prevention
38. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Follow-up on equipment faults
Experience has shown that some equipment
faults are difficult to isolate and to correct
If an equipment fault or malfunction has not
been fully understood and corrected, there is a
need for
– communication and follow-up with manufacturer
– dissemination of information and experience to other
maintenance engineers
39. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Communication and repairs
Need for a written communication policy,
including:
– Reporting of unusual equipment behaviour
– Notification to the physicist and clearance by
before resuming treatments (because of possible
need for control checks after repairs)
– Reporting of unusual patient reactions
40. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Patient identification and patient chart
Effective patient identification procedures
and treatment charts (consideration of
photographs for identification …)
Double check of chart data at the beginning
of treatment, before changes in the course
of treatment (for example, a new field) and
once a week at least
41. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Specific items for external beam therapy
Calibration
– Provisions for initial beam calibration and follow-up
calibrations
– Independent verification of the calibration
– Following an accepted protocol
– Participation in dose quality audits
Treatment planning
– Include TPS in the programme of acceptance testing
commissioning and quality assurance
– Cross-checks and manual verification
Adequate in-vivo dosimetry would prevent most
accidental exposures
42. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Specific items for brachytherapy
Provisions for checking source activity and
source identification before use
Dose calculation and treatment planning
Provisions for dose calculation and cross-checks
Source positioning and source removal
Provisions to verify source position
Provisions to ensure that sources do not remain in the patient
(including monitoring patients and clothes)
43. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Summary
Radiotherapy has unique features from the point of
view of the potential for accidental exposure
Consequences of accidental exposure can be very
severe and affect many patients
Careful clinical follow up may detect overdoses from
about 10%
A quality assurance programme is the key element in
prevention of accidental exposure
44. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————
Web sites for additional information
on radiation sources and effects
European Commission (radiological protection pages):
europa.eu.int/comm/environment/radprot
International Atomic Energy Agency:
www.iaea.org
International Commission on Radiological Protection:
www.icrp.org
United Nations Scientific Committee on the Effects of
Atomic Radiation:
www.unscear.org
World Health Organization:
www.who.int