“Many facilities that don’t participate in clinical trials don’t feel the need seek out external validation tests,” he says. “It is possible that the pass rate for those facilities could be even lower than the 70 percent pass rate that we see for all facilities that are currently taking these tests.”

Cues from the airline industry


In discussions about patient safety, experts often draw parallels between radiation therapy and the airline industry. Both realms depend on the balance of human skill and technology, a relationship that has grown more complex over the years.

“Decades ago, the cockpit was much simpler and many more things were done manually, and maybe you had a better feel for what was happening,” says Burmeister. “In this day and age of the autopilot, so many things are done with computers, and in some cases, even without your active participation, that it becomes difficult to keep up with everything that’s going on.”

Checklists or mandatory pauses in the process are safety precautions radiation therapists plan to borrow from pilots. The idea of using checklists in medicine was made popular by Dr. Atul Gawande’s book the “Checklist Manifesto,” which promotes the concept of using checklists in the operating room to prevent mistakes. Gawande also advocates empowering all individuals to call a timeout when they feel something is off, a practice that’s gaining ground in radiotherapy.

“That’s becoming pretty widely accepted,” says Hendee. “Everyone on the team has the ability to call a timeout and no one can override that.”

As with other safety enhancing initiatives, OEMs are on board and investing in evaluating the efficacy of the proposed solution. Varian Medical Systems is working as a part of a Clinical Council on Patient Safety to investigate the validity of checklists and timeouts in radiotherapy.

“What we see as our role is to do what we can in our software to support the documentation of such checklists and potentially to automate some of these enforced pauses,” says Varian’s Donohoe. “We fully support the efforts that are being discussed with respect to reporting, standardization and accreditation of the users of the technology.”

Next steps

Several recommendations were discussed at the AAPM and ASTRO safety meeting but how will they reach radiotherapy teams in treatment centers worldwide?

“This is all on my shoulders,” says Hendee. “I have agreed to draft the white paper that comes out of this meeting with these recommendations.”

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