When there’s a near-miss or safety incident (NMSI) with a patient undergoing radiation therapy, and the incident was related to the disease or treatment itself, the lapse often involves imaging. But it’s not imaging per se that raises any particular risk. It’s that NMSIs in radiotherapy are associated with case complexity, which imaging tends to add to, especially when it’s done daily or used to guide the treatment.

The Journal of Oncology Practice published the study behind the findings online June 26.

Gregory Judy, MD, and colleagues at the University of North Carolina reviewed NMSIs filed on 200 radiotherapy patients and compared these patients’ records with those from 200 similar radiotherapy patients who had no NMSI.

The team’s main interests were identifying common root causes of the incidents and determining how the causes related to incident severity.

They found the most common root cause to be documentation and scheduling errors, while the most severe incidents were related to technical mistakes in treatment delivery.

They also found the errors most likely to affect patients were the ones tracing to problems with communications.

As for the role complexity plays in tripping up radiotherapy safety, the authors report finding NMSIs associated with several treatment- and disease-specific factors, most prominent among them:

• daily imaging (odds ratio 7, P < .001);
• treatments involving the head and neck (odds ratio 5.2, P = .01);
• tumors staged as T2 (odds ratio 3.3, P = .004); and
• image-guided intensity-modulated radiotherapy (odds ratio 3, P = .009).

“Overall, our results suggest that complexity (e.g., head and neck, image-guided intensity-modulated radiotherapy, and daily imaging) might be a contributing factor for an NMSI,” the authors write. “This promotes an idea of developing a more dedicated and robust quality assurance system for complex [radiotherapy] cases and highlights the importance of a strong reporting system to support a safety culture.”