One of the fasting-growing radiation therapies for treating tiny brain and spinal chord tumors can pose safety hazards that have seriously harmed some patients, The New York Times reports.
The treatment is called stereotactic radiosurgery, or SRS, which often use linear accelerators to deliver targeted radiation to combat small tumors and other medical problems requiring great precision. The problems can arise when the jolt of radiation from the linear accelerators spills outside of a metal cone that is supposed to channel the beam, delivering excessive radiation outside the target area.
Fifty-year-old Marci Faber was one such victim. After seeking medical help to treat a disorder that causes severe facial pain, doctors at Evanston Hospital in Illinois performed SRS on her in March, 2009.
Unfortunately, the operators of the linear accelerator did not properly match the size of the radiation beam to the opening allowed it by four metal jaws near the point of the cone. As a result, the radiation beam was far too large for the cone, which caused it to spill out and irradiate healthy portions of Faber’s body.
Faber’s health declined steadily after the incident. Today the mother of three lives in a nursing home, unable to eat, walk or speak. Two other patients at Evanston received excessive doses of radiation about the same time, though the consequences were not as grave.
While there is some disagreement about the reasons for the mishaps at Evanston Hospital, the Times reports that a combination of user error, flawed design and lax regulation have caused scores of patients to receive radiation overdoses around the country. The FDA approved retrofitted linear accelerators with little review, taking the position that the devices were extensions of existing technology.
Still, SRS advocates say that with proper safeguards, the procedure is completely safe and a significant medical advance.
“Tens of thousands of patients have been treated with protocols properly followed and no mistakes were made,” said Dr. Frank J. Bova, a key figure in developing SRS. “It has changed many difficult procedures, ones with high surgical risk, into one-day outpatient procedures.”
Some point to the complexity of the linear accelerator, a versatile device that must be retrofitted with accessories like the metal cone to perform SRS, as a source of significant difficulty. Others say that more rigorous pre-operation checkups could ensure that the radiation beams are properly calibrated.
There is a much simpler device sometimes used for SRS, but the Gamma Knife, as it is called, has significant drawbacks for a hospital. At $3 million per unit, it is far more expensive and less versatile than the linear accelerator.
Despite the evident danger of misuse, the Times reports that there is no evidence of a state or federal investigation of the Faber case. Part of the reason might be that the FDA deals with linear accelerators, while the Gamma Knife, which uses a radioactive isotope, falls under the jurisdiction of the Nuclear Regulatory Commission, which has greater authority to crack down on radiation mishaps.
This is a very horrible thing. What her family has had to endure is unbelievable. Three daughters that have basically lost their mother and I have lost my friend. There is no excuse for things like this to happen. Peoples lives are at stake.
It is a terrible thing when medical treatments go awry. It is unfortunate that a few circumstances can also change the minds of many who benefit. Radiation therapy is a proven treatment. Used alone or in combination with other treatments, radiation therapy can ease pain, control the spread of cancer and, in many cases, cure patients of their disease. Nearly two-thirds of all U.S. patients diagnosed with cancer receive radiation therapy – more than 1 million patients per year. With each patient receiving an average course of 29 radiation therapy treatments, that means nearly 30 million treatments are delivered annually in the United States.
An entire team of medical professionals works to develop a customized treatment plan for each cancer patient. The radiation therapist is the team member who operates the equipment that delivers the prescribed, targeted dose of radiation to the patient. Registered radiation therapists are skilled specialists who have graduated from a rigorous educational program in radiation therapy and passed a national certification examination that demonstrates their knowledge of radiation biology and safety, patient anatomy and physiology, and patient care. They also must complete continuing education coursework to maintain their registration. The radiation therapist’s goal is to deliver an effective dose of radiation to the tumor while reducing damage to normal tissue that surrounds it.
Although radiation therapists are licensed in New York, 17 other states do not require individuals to hold a license in order to deliver radiation therapy. For over the last 10 years, the American Society of Radiologic Technology (ASRT) has lobbied for the U.S. Congress to pass the Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy bill (H.R. 3652). The CARE bill establishes minimum educational and certification standards for all health care workers who perform medical imaging examinations or who plan or deliver radiation therapy. The accuracy and quality of these procedures are directly related to the competency and qualifications of the personnel who provide them.
A few facts about the safety of radiation therapy:
During the time period 2001-2008, in New York alone, over 500,000 people recieved radiation treatment recieving 13.6 million treatments. During that time The New York Times identified 621 errors many of which were minor. This equates to a 0.0046% error rate. Therefore, radiation therapy is safe and effective 99.99% of the time.
Practices work continuously to strengthen the radiation oncology safety culture. There are sophisticated quality assurance tools that are used on the equipment, before and during treatment. There is also extensive training for treatments such as SBRT and SRS.
The best advocate there is for your treatment is you. Don’t be afraid to ask questions. Don’t leave until you are satisfied with the answers you are given. Above all, don’t deny yourself treatment because of a newspaper article. Radiation therapy is a proven and effective treatment and cure.