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IAEAInternational Atomic Energy Agency
Global Safety Improvement Initiatives
Ola Holmberg, PhD
Head, Radiation Protection of Patients Unit
Radiation Safety and Monitoring Section
NSRW
International Atomic Energy Agency - IAEA
Vienna, Austria
Session: Improving Patient Safety in Radiotherapy
IAEA
1. Starting point: Radiotherapy has significant global importance
• An estimated 5.1 million courses of radiotherapy treatment were
administered annually between 1997 and 2007 (up from an estimated
4.3 million in 1988)*
• 50-60% of cancer patients could benefit from radiation therapy
• The fraction of cancer patients treated is increasing, where RT is available
* UNSCEAR 2008 Report
Background
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2. Safety in radiotherapy is crucial
• Over the last three decades, at least 3000 patients have been
affected by radiotherapy incidents and accidents
• Radiation accidents involving medical uses have accounted for more
acute radiation deaths than any other source, including Chernobyl
• These accidents do not only affect patients directly (e.g. harm and
death), but might also undermine the public’s confidence in the
treatment
• Preventable medical errors overall also cost countries billions of
dollars each year
Background
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Department of Nuclear Safety and Security
Department of Nuclear Sciences and Applications
Department of
Safeguards
Department of
Nuclear Energy
Department of
Management
Department of Technical
Cooperation
Director General
Division of Radiation,
Transport and Waste Safety
Division of
Human Health
Radiation Safety and Monitoring
Section
Radiation Protection of Patients Unit
Background
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Protection from risks
Safety Improvement Initiatives
City wallBastion
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Protection from risks
Safety Improvement Initiatives
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Educated and
trained staff
Appropriate
staffing levels
Adequate safety
infrastructureEffective quality
assurance
Equipment
designed for safety
Direct safety
learning in RT
Protection from risks
Safety Improvement Initiatives
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Safety Improvement Initiatives
• Regional and inter-regional training courses in RT
• Country projects in RT including scientific visits,
fellowships and national courses
• Development of syllabi for training and education
of RT professionals
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Safety Improvement Initiatives
• Development of recommendations for staffing
levels of radiation therapy centres
• New evidence-based guidance document being
developed for staffing based on procedures
done, not only patient numbers
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Safety Improvement Initiatives
• Development of standards on radiation safety and
assistance to Member States to implement these
standards
• Development of guidance at different levels:
National, hospital, individual health professional
and also international calibration protocols
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Safety Improvement Initiatives
• Postal TLD audits (IAEA/WHO network) to verify
the calibration of radiotherapy beams
• Comprehensive clinical audits (QUATRO)
• Guidance on Quality Control and commissioning
of equipmentIAEA
Safety Improvement Initiatives
• Pushing for compliance with relevant International
Standards i.e. IEC/ISO or equivalent national
• Planning and procurement of radiotherapy
equipment for developing countries
• Sponsoring the “Integrating the Healthcare
Enterprise in Radiation Oncology” (IHE-RO)
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Safety Improvement Initiatives
• Dedicated website (rpop.iaea.org) for global
knowledge exchange on radiation protection of
patients (>10,000,000 hits per year)
• Training material and books on radiotherapy safety
• Safety reporting and learning system – SAFRON
(Safety in Radiation Oncology) IAEA
Why Safety Reporting and Learning?
From: S. Derreumaux, IRSN, France
France 2007 (1-year period)
From: W. Bogdanich, N.Y.Times, USA
USA 2009 (5-year period)
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Why Safety Reporting and Learning?
From: S. Derreumaux, IRSN, France
France 2007 (1-year period)
From: W. Bogdanich, N.Y.Times, USA
USA 2009 (5-year period)
IAEA
From: W. Bogdanich, N.Y.Times, USA
Why Safety Reporting and Learning?
From: S. Derreumaux, IRSN, France
France 2004 USA 2009?
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From: W. Bogdanich, N.Y.Times, USA
Why Safety Reporting and Learning?
From: S. Derreumaux, IRSN, France
France 2004 USA 2009?
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Accidents and incidents still tend to “repeat themselves” – i.e. we need to
be better at learning from previous events
Why Safety Reporting and Learning?
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Browse the process-steps to find safety information
SAFRON
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Safety information related to process step, from different sources
SAFRON
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SAFRON information-flow
SAFRON
Output
Local
info
Shared
info
Targeted
guidance
Incident
reports
Other
systems
PSA
Input
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• Prototype ready
• Next: run pilot with limited number of clinics
• Next: populate system with historical data, events from collaborating systems,
prospective data etc., and continue to build links
• Funding and manpower available
• Positive issues in relation to the system:
• IAEA has global reach
• IAEA has well-established record in safety activities
• IAEA is seen as independent
• IAEA is well-placed to target guidance to all relevant stakeholders
• Opportunity to place system on much visited web-site (rpop.iaea.org)
• System developed in parallel with “radiological imaging system” SAFRAD
SAFRON
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Safety Improvement Initiatives
A good city wall with properly built bastions can be effective
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