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

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

3. GOALS (Curative) Low complication rate

4. RADIATION FOR BENIGN DISEASE Keloid Heterotopic Bone

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

6. 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

7. 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”

8. 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

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