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Monday, February 8th 2010

The Dangers of Radiation

It’s been more than a hundred and ten years since Marie Currie and her colleagues discovered radium and coined the term radioactive. Currie’s groundbreaking work on ionizing radiation would cost her her life. Since then and great realizations have been made about the therapeutic and disastrous effects ionizing radiation promises.

We’ve gotten smarter, more sophisticated, more skilled at manipulating radiation to do the most benefit in medicine and minimize harm. Ionizing radiation has spurned two whole medical specialties. Doctors now describe themselves as radiologists or radiation oncologists. Whole technology has arisen to more precisely diagnose diseases with radiation and to treat them. Radiosurgery, the use of linacs like the Gamme Knife or Cyberknife to more precisely target pathological areas and spare the normal, has been a huge development.

Of course the more technically complicated medicine gets, the more places things can go wrong. Nowhere is medicine as technically savvy or complicated than in in some of the ways we deliver radiation to patients. And, while admittingly slightly alarmist, the New York Times had a recent expose reminding us of that.

At a VA treatment facility in Virginia,

56 patients were treated incorrectly for cancer of the prostate, head and neck, lung, breast and two other malignancies. Thirty-six had been overradiated and 20 more subjected to “errors in technique,” the hospital said.

The Radiological Physics Center sponsored by the National Cancer Institute,

reported in 2008 that among hospitals seeking admission into clinical trials, nearly 30 percent failed to accurately irradiate an object, called a phantom, that mimicked the human head and neck. The hospitals were all using I.M.R.T., which shapes and varies the intensity of radiation beams to more accurately attack the tumor, while sparing healthy tissue.

“This is a sobering statistic, especially considering that this is a sample of those institutions that felt confident enough in their I.M.R.T. planning and delivery process to apply for credentialing and presumably expected to pass,” said a task group investigating I.M.R.T. guidelines for the American Association of Physicists in Medicine.

Not to quote a comic book or a Sam Rami film but with great power comes great responsibility. To err is human, but we shouldn’t accept it. Every error in medicine is something precious lost to someone, something that should be unacceptable. And when we push the boundaries of technology the odds of mistakes only tick up. Like so much in medicine and life, but to the margins, radiation is a boon and a bust; technology promises to potentially deliver it in more effective and safer ways but only if healthcare knows how to use such technology, only if healthcare respects the power of what it’s dosing out and works to prevent errors.