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How safe is radiotherapy practice in India: perceptions and practical experiences among the workers of radiotherapy facilities in North East, India?

Published online by Cambridge University Press:  24 July 2018

Dewan Thokchom Singh
Dewan Thokchom Singh*
Affiliation:
Atomic Energy Regulatory Board, Mumbai, India Tata Institute of Social Sciences, Mumbai, India, V.N. Purav Marg, Deonar, Mumbai, Maharashtra 400088
*
Author for correspondence: Dewan Thokchom Singh, School of Habitat Studies, Tata Institute of Social Sciences, V.N. Purav Marg, Deonar, Mumbai, Maharashtra 400088, India. Tel: +91 22 25990674. E-mail: tdsaerb@gmail.com
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Abstract

Purpose

The aim of this study was to understand how the regulatory requirements for functioning radiotherapy practices in India to control risk were conceptualised, perceived and applied accordingly in the radiotherapy facilities. It further examined how the social factors influenced the decision-making process for implementing regulatory requirements in the radiotherapy facilities.

Material and method

This study was carried out in nine radiotherapy facilities located in the northeastern Indian states of Manipur, Assam, Meghalaya, Tripura and Mizoram. The study adopted both the semi-structured and in-depth questionnaire, developed on the basis of multidisciplinary fields.

Result

The study found that the facilities in the northeastern regions were commissioned in line with the regulatory requirements. The facilities had adequate structural shielding rooms to protect workers, patients and the public from the risk of ionising radiation. However, in the operational phase of the facilities, majority of the facilities had the improper management of existing resources and non-implementation of regulatory requirements on time. It was observed that workers in some facilities continued the practice, despite the failure of specific safety functions, or not meeting regulatory requirements. Such practices led to the suspension of patient treatment in three of the facilities by the regulator. The existence of a varying nature of risk perceptions among oncologists, medical physicists, radiological safety officers, radiotherapy technologists in the facilities were observed and these influenced the decision-making process of the facilities on the implementation of regulatory requirements.

Conclusion

The study found that the facilities needed to explore various means, including to narrow the gap that existed in respects of perceived risk (within the facilities), communication to enhance work coordination and mutual trust among workers. The adoption of the institutional policy for conducting an internal audit of working practices, encouragement of workers to participate in continuing education programs would enhance effective utilisation of already existing infrastructure/equipment and work procedures including quality assurance programs.

Keywords

radiation safetyradiotherapyregulatorrisk perceptionworker
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 17 , Issue 4 , December 2018 , pp. 427 - 435
Copyright
© Cambridge University Press 2018 

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References

1. International Atomic Energy Agency. Safety Glossary: Terminology Used in Nuclear Safety and Radiation Protection, 2007 edition. Vienna: International Atomic Energy Agency, 2007.Google Scholar
2. Atomic Energy Regulatory Board. Glossary of Terms for Nuclear and Radiation Safety, Guide No. AERB/SG/GLO. Mumbai: Atomic Energy Regulatory Board, 2005.Google Scholar
3. Atomic Energy Act 1962. http://dae.nic.in/?q=node/153. Accessed on 12th May 2017.Google Scholar
4. Atomic Energy (Radiation Protection) Rules 2004. Published in the Gazette of India: 11 September 2004] Part –II, Section 3, Sub-Section (i). http://dae.nic.in/writereaddata/RPR2004.pdf. Accessed on 12th May 2017.Google Scholar
5. Atomic Energy Regulatory Board. Surveillance Procedures for Medical Application of Radiation 1989. Mumbai: Atomic Energy Regulatory Board, 2005.Google Scholar
6. Atomic Energy Regulatory Board. Safety Code on Radiation Therapy Sources, Equipment, and Installations, AERB/RF-MED/SC-1 (Rev.1). Mumbai: Atomic Energy Regulatory Board, 2011.Google Scholar
7. Atomic Energy Regulatory Board. Safety Code on Safe Transport of Radioactive Material, AERB/NRF-TS/SC-1 (Rev.1). Mumbai: Atomic Energy Regulatory Board, 2016.Google Scholar
8. Atomic Energy Regulatory Board. Testing and Classification of Sealed Radioactive Sources, AERB/SS/3 (Rev.1). Mumbai: Atomic Energy Regulatory Board, 2001.Google Scholar
9. Atomic Energy Regulatory Board. Safety Guide on Security of Radioactive Sources in Radiation Facilities, AERB/RF-RS/SG-1. Mumbai: Atomic Energy Regulatory Board, 2011.Google Scholar
10. Atomic Energy Regulatory Board. Safety Guide on Security of Radioactive Material During Transport, AERB/NRF-TS/SG-10. Mumbai: Atomic Energy Regulatory Board, 2008.Google Scholar
11. World Health Organisation. Radiotherapy risk profile. http://www.who.int/patientsafety/activities/technical/radiotherapy_risk_profile.pdf. Accessed on 21st May 2017.Google Scholar
12. Chang, D W, Cheetham, L, te Marvelde, L et al. Risk factors for radiotherapy incidents and impact of an online electronic reporting system. Radiother Oncol 2014; 112 (2): 199–204.Google Scholar
13. International Atomic Energy Agency. Lessons Learned From Accidental Exposures in Radiotherapy, Safety Reports Series No. 17. Vienna: International Atomic Energy Agency, 2000.Google Scholar
14. International Commission on Radiological Protection. Prevention of Accidents to Patients Undergoing Radiation Therapy. ICRP Publication 86. Annals of ICRP 30(3). Oxford: Pergamon Press, 2000.Google Scholar
15. Ortiz, P, Oresegun, M, Wheatley, J. Lessons from major radiation accidents. Proceedings of the 10th International Congress of the International Radiation Protection Association, 14th–19th May, Hiroshima 2000. http://www.irpa.net/irpa10/cdrom/00140.pdf. Accessed on 15th May 2017.Google Scholar
16. Stavem, P, Brøgger, A, Devik, F et al. Lethal acute gamma radiation accident at Kjeller, Norway: Report of a case. Acta Radiol Oncol 1985; 24 (1): 61–63.Google Scholar
17. International Atomic Energy Agency (IAEA). Lessons Learned from the Response to Radiation Emergencies (1945–2000). Vienna: International Atomic Energy Agency (IAEA), 2012.Google Scholar
18. Nénot, J C. Radiation accidents over the last 60 years. J Radiol Prot 2009; 29 (3): 301.Google Scholar
19. Covello, V T, Slovic, P, Von Winterfeldt, D. Risk Communication: A Review of the Literature. Risk Abstracts 1986; 3 (4): 172–182.Google Scholar
20. Mary, D. Risk Acceptability According to the Social Sciences. New York: Russell Sage Foundation, 1986.Google Scholar
21. Freudenburg, W R. Perceived risk, real risk: social science and the art of probabilistic risk assessment. Science 1988; 242 (4875): 44–49.Google Scholar
22. Gregory, R, Mendelsohn, R. Perceived risk, dread, and benefits. Risk Anal 1993; 13 (3): 259–264.Google Scholar
23. Hoos, I. Risk Assessment in Social Perspective. Perceptions of Risk. Washington: National Council on Radiation Protection and Measurement, 1980.Google Scholar
24. Hughes, P, Ferrett, E. Introduction to International Health and Safety at Work. London: Routledge, 2010.Google Scholar
25. Mazur, A. Does public perception of risk explain the social response to potential hazard. Q J Ideol 1987; 11 (2): 41–45.Google Scholar
26. Kasperson, R E, Renn, O, Slovic, P et al. The social amplification of risk: a conceptual framework. Risk Anal 1988; 8 (2): 177–187.Google Scholar
27. Renn, O, Burns, W J, Kasperson, J X, Kasperson, R E, Slovic, P. The social amplification of risk: theoretical foundations and empirical applications. J Soc Issues 1992; 48 (4): 137–160.Google Scholar
28. Slovic, P, Fischhoff, B, Lichtenstein, S. Why study risk perception. Risk Anal 1982; 2: 83–93.Google Scholar
29. Slovic, P. The Perception of Risk. London: Routledge, 2016.Google Scholar
30. Singh, T D, Jayaraman, T, Sharma, B A. Assessment of radiological protection systems among diagnostic radiology facilities in North East India. J Radiol Prot 2016; 37 (1): 68.Google Scholar
31. Stenzel, P L. Acceptable risk?: Making decisions in a toxic environment by Lee Clarke. DePaul Law Rev 2014; 40 (4): 1165.Google Scholar
32. Barke, R P, Jenkins‐Smith, H C. Politics and scientific expertise: scientists, risk perception, and nuclear waste policy. Risk Anal 1993; 13 (4): 425–439.Google Scholar
33. Johnson, B B. Advancing understanding of knowledge’s role in lay risk perception. Risk 1993; 4: 189.Google Scholar
34. Tversky, A, Kahneman, D. Judgment under uncertainty: Heuristics and biases. Science. 1974; 185 (4157): 1124–1131.Google Scholar
35. Finucane, M L, Alhakami, A, Slovic, P, Johnson, S M. The affect heuristic in judgments of risks and benefits. J Behav Decis Mak 2000; 13 (1): 1–17.Google Scholar
36. Kumar, R V, Bhasker, S. Is the fast-paced technological advancement in radiation treatment equipment good for Indian scenario?. J Cancer Policy 2015; 4: 26–30.Google Scholar
37. Dikshit, K R, Dikshit, J K. North-east India: land, people and economy. Dordrecht, The Netherlands: Springer, 2014.Google Scholar
38. Shimray, U A. Socio-political unrest in the region called North-East India. Econ Polit Wkly 2004; 39 (42): 4637–4643.Google Scholar
39. Atomic Energy Regulatory Board. Regulatory Inspection and Enforcement in Radiation Facilities, Manual NO. AERB/RF/SM/G-3. Mumbai: Atomic Energy Regulatory Board.Google Scholar
40. International Atomic Energy Agency. Applying Radiation Safety Standards in Radiotherapy, Safety Reports Series No. 38. Vienna: International Atomic Energy Agency, 2006.Google Scholar
41. International Atomic Energy Agency. Inspection of Radiation Sources and Regulatory Enforcement (Supplement to IAEA Safety Standards Series No. GS-G-1.5). Vienna: International Atomic Energy Agency (IAEA), 2007.Google Scholar
42. Cha, Y J. An analysis of nuclear risk perception: with focus on developing effective policy alternatives. Int Rev Public Admin 2004; 8 (2): 33–47.Google Scholar
43. World Health Organization (WHO). Quality Assurance in Radiotherapy. Geneva: WHO, 1988.Google Scholar
44. Novotny, J. Accidents in Radiotherapy: Lack of Quality Assurance?. Vienna: International Atomic Energy Agency (IAEA), 1997. http://www.iaea.org/inis/collection/NCLCollectionStore/_Public/29/029/29029219.pdf. Accessed on 10th May 2017Google Scholar
45. Yeung, T K, Bortolotto, K, Cosby, S, Hoar, M, Lederer, E. Quality assurance in radiotherapy: evaluation of errors and incidents recorded over a 10 year period. Radiother Oncol 2005; 74 (3): 283–291.Google Scholar
46. Diefenbach, T. Hierarchy and Organisation: Toward a General Theory of Hierarchical Social Systems. New York, NY: Routledge, 2013.Google Scholar
47. Stoddart, M C. Ideology, hegemony, discourse: a critical review of theories of knowledge and power. Social Thought Res 2007; 28: 191–225.Google Scholar