Risks of IMRT - or - Never stop questioning

This post is based on an article in the NY Times that was recommended to me as something to read before my radiation treatments start.  It's a long read, but an important one for anyone considering radiation treatments.  It's titled "A lifesaving Tool Turned Deadly".  Check it out, but be prepared. It's pretty graphic.  Or if not, read on...

Because I'll talk about it a bit more.  Reading it caused me to call my doctor and ask for a consult before we initiate the IMRT plan that we've been working on.  Up until now I have been reading some of the information on the web about IMRT (intensity modulated radiation therapy) and have been fairly impressed with the ability to get some pretty precise margins around various tissues.  And it's all computer controlled.  So cool!  But at the same time not! 

As the NY Times article brought back to the front of my mind, one needs to maintain a level of detachment with regards to their treatment so that each stage can be assessed and questioned clearly and adequately. Instead, I allowed myself to be lulled into gear-headed awe with the technology... which is not to say I shouldn't have been impressed.  But I should not have let go of the questioning.  And really, the mistakes discussed in the Times article are part and parcel of my job from day to day.  Many of them boil down to human/machine interaction issues.

The Times article identified 621 radiation mistakes (in NY state) during 8 year period. Not a lot, when you consider how many radiation treatments were given over the same period (the number escapes me now) but given the severity of some of the mistakes, that doesn't matter.  In a sidebar on the article a small chart categorizes the errors and relevant factors found.  there were about two factors per mistake. Here are the top 7 factor categories:

1. Quality assurance flawed (355)
2. Data entry or calculation errors by personnel (252)
   
3. Misidentification of patient or treatment location (174)
4. Blocks, wedges or collimators misused (133)
5. Patient's physical setup wrong (96)
6. Treatment plan flawed (77)
7. Hardware malfunction (60)

(source: NY Times, 1/24/2010)

I promise, from now on, I will not give my CT technician a hard time about checking my identity and treatment every time (she gives me a test).  That ranked #3 in NY as a factor in the radiation mistakes.

I've been sitting on this post for a couple of days while digesting some of the NY Times article.  I have more on this, but it's time this was done.