It is known beyond a shadow of a doubt that x-rays are harmful.

If sufficiently intense, x-rays can cause hematologic, gastrointestinal, and central nervous system disorders; local tissue damage; cytogenetic impairment (which are considered as an early effect of radiation). Late effects of radiation on humans would include leukemia, bone cancer, lung cancer, thyroid cancer, breast cancer, genetic damage and shortening of life span.1 However, the benefits resulting from applications of x-rays are enormous and often outweigh potential risks. It is the job of the radiation oncology multidisciplinary team to perform high- quality radiation therapy procedures with minimal radiation exposure to patients healthy tissues. This attitude results in the highest benefit with the lowest risk to patients and radiation workers, and its a foundation of the practice of ALARA as low as reasonably achievable.1 In 1994 the ALARA document became a part of title 10f the Code of Federal Regulations (10CFR35.20) which is binding on all institutions as a NRC regulation. Therefore, it must be practiced as a matter of mandate of federal code. Given the complexity of a radiotherapy practice, patients safety depends largely on human performance and training. Therefore, to ensure general public safety, educated and trained professionals are an essential prerequisite for quality and safety in radiotherapy. All of the following individuals have responsibility for public protection and safety by virtue of tasks involving decisions, operation or manipulation of sources or equipment used in radiotherapy: radiation oncologists; qualified experts in radiotherapy physics - medical physicists and dosimetrists; other health professionals operating radiotherapy equipment or handling radioactive sources (radiotherapy technologists); the Radiation Safety Officer; staff for maintenance of radiotherapy equipment; staff performing special tasks (type tests, long term stability checks, etc.) Moreover, the evidence is required of education and training relevant to their duties in relation to protection and safety. Responsibility for the practice of radiotherapy requires accreditation by the professional body (like Nuclear Regulatory Commission, International Council on Radiation Protection, and Committee on Biologic effects of Ionizing Radiation) or an educational institution2. The main task of all of these

institutions and trained professionals is to ensure public that their general safety is not a worry. According to an article published by the University of Maryland Cancer Center, radiation therapy is by far one of the safest and most effective forms of cancer treatment.3 As noted in the article, radiation therapy actually has an extremely low rate of errors, due to the many checks currently in place to ensure patient safety. An estimated 35 million treatments were administered last year on equipment made by Varian Medical Systems alone, with about 70 instances of mistakes that affected or nearly affected patient care. Most of the errors were associated with the lack of quality assurance processes. To eliminate that problems, and consequently to ensure patient safety, most of cancer centers follow a comprehensive set of safety rules. These include: 1) machine-related QA checks, including a daily check of the beam output and monthly physics checks of all equipment; 2) secondary calculations to verify the accuracy of the radiation dose calculated by our treatment planning systems; 3) a review of all treatment plans by medical physicists; 4) quality assurance checks of Intensity Modulated Radiation Therapy (IMRT) plans prior to treatment; 5) review by the therapist staff to verify agreement between the radiation dose in the treatment plan and the treatment console; and 6) verification of the physician's written directive, the prescribed dose and the patient's identity. Even though in the past few years several cases of cancer patients over-exposure were recorded across the United States, general public has no reason to worry. The field of Radiation Oncology is strictly governed by many professional institutions (which ensure radiation safety practices) and employs educated and trained in radiation safety personnel. Moreover, comprehensive set of safety rules are rigorously utilized, to verify accuracy of the radiation dose.

References: 1) Joseph, Nicolas Jr., Phalem Jeffrey. CE Essentials, LLC. Cardinal Principles of Radiation Protection. 2006. Available at: http://www.ceessentials.net/article3.html. Accessed at: October 1, 2011. 2) International Atomic Energy Agency. Applying Radiation Safety Standards in Radiotherapy. 2006. available at:

http://www-pub.iaea.org/MTCD/publications/PDF/Pub1205_web.pdf. Accessed at: October 1, 2011. 3) University of Maryland Greenebaum Cancer Center. Radiation Therapy and Patient Safety. 2011. Available at: http://www.umgcc.org/news/rt_safety.htm. Accessed at: October 1, 2011.