"Furthermore, these data are derived mostly from academic centers, not community hospitals where the majority of the procedures in the US are performed," Dr. Stone notes, so the true rate of inadequately performed procedures could be higher.

Bad publicity


Evidence of botched brachytherapy procedures is not quietly lingering in the pages of medical journals; it has begun to make headlines. Last week the University of Pennsylvania admitted in January a man undergoing brachytherapy to treat prostate cancer had seeds that missed the prostate.

The error hearkened back to similar bad news Penn received last summer, when the New York Times uncovered a troubled Penn-administered brachytherapy program at the Philadelphia Veterans Administration hospital. According to the Times, over a six-year period a doctor there bungled 92 out of 116 brachytherapy procedures.

And on Thursday, the U.S. Nuclear Regulatory Commission, which found around eight violations during their initial investigation of the hospital, including the VA's failure to properly train personnel to identify and report problems, announced a proposed $227,500 fine against the VA, the second largest the agency has ever proposed for a medical error.

Lack of training

Echoing the NRC findings, Dr. Stone believes the problem is one of lack of training. "There are no certifications for any of the new procedures out there," he notes.

In learning how to use a new technique, such as prostate brachytherapy, most doctors attend a seminar, then go back to their hospital and begin to practice it after only one or two supervised procedures, Dr. Stone says.

"When I was in med school, the axiom for learning was 'See one, do one, teach one,'" he notes. "You see a procedure, you do one, then you can teach one." But now Dr. Stone believes that model is outdated. "Today, procedures are so complicated that no longer fits," he argues. And when doctors stick with this traditional method Dr. Stone believes patients "suffer the learning curve of the physicians."

Currently, for prostate brachytherapy, the field is only regulated by hospital bylaws, which Dr. Stone believes are inadequate. "Unfortunately, the hospitals are not really equipped to understand what is necessary to make physicians proficient," Dr. Stone argues.

What Dr. Stone believes works is rigorous hands-on training. And over the last 15 years, Dr. Stone says he has trained around 1,500 physicians world-wide in prostate brachytherapy, including around 10 percent of all doctors in the U.S. who perform that procedure. Dr. Stone and his colleagues have published on the success of this training methodology.

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