Is pin-point radiation therapy everything it is cracked up to be?

Stereotactic radiotherapy ("SRS") has become one of the fastest growing radiation therapies.  Stereotactic radiation is a technological innovation designed to target tiny tumors while minimizing the damage to surrounding tissues. Because the radiation is concentrated and intense, accuracy is particularly important. 

Stereotactic radiotherapy appeals to patients because it can be performed on an out-patient basis in a single day. As a result, the use of small beam treatments has soared, as they are used on many different parts of the body in addition to the brain and spine.

Standard radiation therapy often involves dozens of treatments at low doses, so an incorrect treatment may not cause harm to the patient.  However, with stereotactic radiotherapy, there is usually only a single potent dose requiring pin-point precision.

In the last five years, the manufacturer of the linear accelerators that are used for stereotactic radiotherapy have caused a numbers of radiation overdoses, according to a New York Times article.  Some mistakes were caused by operator error.  In Missouri, 76 patients were over-radiated because the physician did not realize that the smaller radiation beam used in radiosurgery had to be calibrated differently than the larger beam used in tradiational radiation therapy.  The overdoses continued for five years because the hospital did not realize that its radiation therapy equipment had been set up incorrectly.

Linear accelerators, which generate radiation without using radioactive material, are overseen by the Food and Drug Administration.  Since there is no requirement that all mistakes involving linear accelerators be reported to a central database, it cannot be determined how often errors with linear accelerators occur.  Without a requirement that accidents and near-misses be reported, hospitals cannot learn from their mistakes.

Earlier this year, the American Society of Radiation Oncology called for the establishment of a central database for reporting of errors involving linear accelerators.  Nothing has happened.

As in other areas of medical mistakes, the reporting of errors with stereotactic radiotherapy should be transparent and mandatory.  Until this happens, the mistakes of over-radiation will continue and physicians and hospitals will not learn from their mistakes.