Towards Safer Radiotherapy

Chapter 4: Prerequisites for safe delivery
of radiotherapy
Patients undergoing radiotherapy expect the best possible care with the minimum risk of sideeffects
or complications. The balance between disease control and side-effects means that
treatment should only commence after a detailed consultation with the patient, leading to explicit
consent to treatment. 48–50
In addition, it is incumbent on organisations providing radiotherapy and on all the professional staff
involved in its delivery to ensure that this delicate balance is not adversely affected by errors and
untoward incidents in any part of the delivery process. This chapter addresses the prerequisites for
the safe delivery of service and reviews the recommendations that contribute to this overall
objective.
4.1 Radiotherapy services are complex and dynamic
24
Complexity arises from the wide range of conditions treated, technologies used and professional
expertise needed. This complexity is compounded by the fact that processes are dynamic,
continually changing in the light of research and the introduction of new technologies. Complexity
and change increases the probability of incidents and errors reinforcing the need to design delivery
systems which, as far as possible, ensure safety and efficacy.
Safe radiotherapy depends on:
• An adequately trained professional workforce practising together in a multidisciplinary
environment
• Robust operational and management systems which facilitate safe and effective practice
• Equipment which is designed with safety in mind and which is up to date and maintained to
high standards.
4.2 Workforce
4.2.1 The professional workforce directly involved in the delivery of radiotherapy includes, for
example, clinical oncologists, therapeutic radiographers, clinical scientists and clinical
technologists. Tasks should be assigned in relation to competency rather than professional
background, so as to maximise the benefits of skills mix. 51 More details of the training and
qualifications required can be found by referring to professional organisations and regulatory
bodies. 52–54
4.2.2 In addition to the achievement of core qualifications, competence to practise in a particular
centre depends on specialised training in local procedures and practices. There is
considerable diversity in operational practice and equipment throughout the UK and
internationally. This diversity is one of the drivers for local training.
4.2.3 Following initial attainment of competence, all professional staff need to maintain their skills
by lifelong learning through continuing professional development (CPD), which is a
requirement for the maintenance of registration in most regulatory frameworks.
Maintenance of competency is particularly important in radiotherapy due to the fast pace of
change as new techniques and equipment are introduced. Training should include safety
aspects, learning from radiotherapy incidents and quality assurance methodology. This
should form an essential part of CPD. The maintenance of up-to-date training records is
essential as is adequate funding for staff training.
Towards Safer Radiotherapy