The U.S. Nuclear Regulatory Commission (NRC) oversees medical uses of nuclear material through licensing, inspection, and enforcement programs. An article published in Practical Radiation Oncology1 describes a review of brachytherapy errors reported by licensees to the NRC.
The article classified and evaluated the types and numbers of reported brachytherapy errors over a 2-year period of time. The modalities of treatment delivery included Gamma Knife, therapeutic radiopharmaceuticals, and high-dose and low-dose-rate rate brachytherapy. The types and causes of errors are presented.
The article states human error as the primary causative factor. The types of mistakes showing highest frequency involved wrong dose.2
The article concludes by stating a large number of errors are related to older, well established processes and technologies. Newer technologies were also associated with errors.3
1,2,3Richardson S. A 2-year review of recent Nuclear Regulatory Commission events: What errors occur in the modern brachytherapy era? Article in press:Prac Radiat Oncol. 2011
Source: http://www.practicalradonc.org
