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Evgenia Nigay
Safety Essay
October 8, 2017

The Medical Dosimetrists Role in Safety

Radiation oncology is a rapidly evolving and highly technological field. All the advances
allow for better patient care and improved treatment plans. However, as the technology becomes
more advanced and complex, there becomes more room for error. Safety checks and quality
assurance protocols are necessary at every level of patient care, from treatment planning to
treatment delivery. It is every radiation oncology team members responsibility including the
medical dosimetrist to ensure that the patients receive the highest quality, safest radiation
treatments. The two ways medical dosimetrists can incorporate safety into their daily practice is
to check the patient chart and planning directive and to review all the contours prior to beginning
the treatment planning.

Medical dosimetrists are professionals within the radiation oncology field who work
under the supervision of a radiation oncologist and a medical physicist to create plans for
radiation dose delivery.1 To work as a medical dosimetrist, one must be certified by the Medical
Dosimetrist Certification Board (MDCB) whose mission is to advance the profession and to
enhance the quality of patient care by establishing certification and continuing education
standards.2 Maintaining the certification and keeping up with the continuing education credits is
in itself a way to ensure safety in the field of radiation oncology.

After the simulation scan is complete, the physician contours the gross tumor volume
(GTV) and the expansion the planning target volume (PTV). The physician also decides on the
dose and fractionation schedule as well as what organs at risk (OR) to consider during the
planning process. All the information is written in the planning directive and submitted for the
medical dosimetrists to use as a document upon which to base the treatment plan. It is easy,
especially at a busier facility, to simply follow the directive when creating the plan. However,
medical dosimetrists should always review the planning directive to make sure the fractionation,
total dose and OR constraints make sense. One publication by JAMA Oncology suggests looking
for the 3 Ps in the patients chart to ensure that vital patient information is included on the
planning directive: whether the patient is pregnant, has a pacemaker or had previous radiation
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Evgenia Nigay
Safety Essay
October 8, 2017

treatment.3 Quickly reviewing the patients chart and the planning directive is a simple way to
ensure that no mistakes have been made by the physician and that no information have been
overlooked.

The physicians contour the GTV and the PTV. At most facilities it is the responsibility of
a medical dosimetrist to contour the OR. However, some facilities use radiation oncology
residents for this task. This leaves medical dosimetrist with more time to focus on generating the
optimal plans, especially at a busier facility. It should not mean, however, that medical
dosimetrists dont have to look over the contours. Regardless of who draws the OR contours, it
should be a habit to look over all the OR contours as well as the PTV contours after their
completion. Often when contouring the PTV the physicians are in a rush and may miss a slice or
draw a little pixel where it doesnt belong. Overlooking these errors may cause the optimization
to be off, resulting in the dose being delivered in the wrong regions or not being able to meet the
OR constraints. Simply double checking that all the contours make sense is an easy way to
ensure that the patients will be receiving the most accurate and safe treatments possible.

In the field of radiation oncology every team member has the responsibility of keeping
patient safety their number one priority. Medical dosimetrists are integral part of the team,
generating the high-quality treatment plans. In such rapidly evolving field as radiation oncology
its clear why safety is becoming more and more important and should be integrated in the daily
responsibilities in the evolving role of the medical dosimetrist.
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Evgenia Nigay
Safety Essay
October 8, 2017

References

1. Tripuraneni P, Kwiatkowski T, Mills MD, et al. The radiation oncology team. In: Safety
Is No Accident, A Framework for Quality Radiation Oncology and Care. ASTRO; 2012.
2. Scope of Practice. MDCB. https://mdcb.org/about-mdcb/about-dosimetry/scope-practice.
Accessed October 8, 2017.
3. Chera BS, Lukasz Mazur L, Buchanan I, et al. Improving patient safety in clinical
oncology: applying lessons from normal accident theory. JAMA Oncol. 2015;1(7):958-
964.