1

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

IAEA

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

IAEA

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

2

IAEA

Protection from risks

Safety Improvement Initiatives

City wallBastion

IAEA

Protection from risks

Safety Improvement Initiatives

IAEA

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

IAEA

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

3

IAEA

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

IAEA

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

IAEA

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)

4

IAEA

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)

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)

IAEA

From: W. Bogdanich, N.Y.Times, USA

Why Safety Reporting and Learning?

From: S. Derreumaux, IRSN, France

France 2004 USA 2009?

5

IAEA

From: W. Bogdanich, N.Y.Times, USA

Why Safety Reporting and Learning?

From: S. Derreumaux, IRSN, France

France 2004 USA 2009?

IAEA

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?

IAEA

Browse the process-steps to find safety information

SAFRON

IAEA

Safety information related to process step, from different sources

SAFRON

6

IAEA

SAFRON information-flow

SAFRON

Output

Local

info

Shared

info

Targeted

guidance

Incident

reports

Other

systems

PSA

Input

IAEA

• 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

IAEA

Safety Improvement Initiatives

A good city wall with properly built bastions can be effective

IAEA