GOALS OF RADIATION (Palliative) To Relieve Symptoms 5 – 12 treatments No long-term complications

GOALS OF RADIATION (Curative) Alternative Only Breast, Head & Neck, Prostate Only Advanced Cervix or Brain Adjuvant Rectum or Uterus

GOALS (Curative) Low complication rate

RADIATION FOR BENIGN DISEASE Keloid Heterotopic Bone

RADIATION EQUIPMENT Linear Accelerator Tomotherapy Gamma Knife Cyber Knife Protons Seeds / Needles for prostate and gynecologic cancers

ERRORS (1) New Jersey:36 over-radiated – complications 20 substandard – failure to cure Louisiana: 38 overdoses – new accelerator Texas: Colostomy & Ureterostomy – physics error Pennsylvania:Prostate Seeds

ERRORS (2) California: CT Scans (diagnostic) – errors displayed on computerscreens New York:Tongue Cancer –brain injury (death) “computer problem” Brooklyn:Breast Cancer–death–“computer / accelerator problem”

QUALITY ASSURANCE Multiple Physicians Multiple Dosimetrists Multiple Physicists Daily Chart Rounds At least 2 Therapists per accelerator Diodes or TLD Phantoms for Tomo or IMRT

AVOIDANCE OF ERRORS Impeccable Quality Assurance Insomnia Physician and Staff > Equipment