Mumbai: The first radiation death in Indiain Delhi`s Mayapuri area was a wake up call not only in thearea of handling and disposing of such hazardous material butalso in the misadministration of radiation treatment(radiotherapy) in some hospitals in the country, experts said.This kind of misadministration could lead to eitheroverdose or underdose to patients and hamper the treatmentprocess, sometimes leading to their death, experts from BhabhaAtomic Research Centre (BARC) and Atomic Energy RegulatoryBoard (AERB) said here.
The botched up radiotherapy in several hospitals in USAand Canada during 1974 to 1992 affected 466 patients; four ofthem died. In one instance, a radiation source of highactivity remained inside a patient for four days as it gotaccidentally detached. The patient got exposed to over 889times the prescribed dose. Ninety four other individuals gotexposed inadvertently.There is phenomenal increase in the number of medicalaccelerators, Cobalt-60 units and remotely operated afterloading equipment in India. The AERB, the agency enforcingradiation safety in India, issues licences to hospitals onlyif they satisfy prescribed conditions including availabilityof qualified personnel, Parthasarathy said.The Board has published relevant safety codes on thesubject. The hospitals owning and operating radiationequipment shall satisfy the provisions in the codes.Rule 26 in the Atomic Energy (Radiation Protection)Rules 2004 (RPR2004) aptly addresses the issues (available atwww.aerb.gov.in)."Though the licensees carrying out radiation therapyusing accelerators and Cobalt-60 units and remote afterloading equipment are required to investigate and submitwritten reports on accidental exposures, AERB has not receivedany so far," Parthasarthy said.BARC had started a postal dose quality audit programmein 1976, with nine hospitals using cobalt-60 machines. Now thescientists in the Radiation Standards Section, BARC, sendcapsules containing specially prepared thermo-luminescentpowder to the participating hospitals. As per instruction, themedical physicist in the hospital exposes them to a specificdose under specified conditions before returning them to BARC."BARC scientists estimate the dose accurately," he said.Most hospitals deliver accurate doses to patients. AERB andBARC have asked hospitals showing unacceptable errors tostop treatment of patients till the issues are resolved. Theservice covered over 250 hospitals in India."Occasionally, BARC scientists have noticed seriouserrors like during 2007-2008 eight beams showed serious errorsranging from -13.2 per cent to 72.8 per cent, due tocalculation errors or mistaken irradiation of capsules. Apositive deviation leads to under-dosing and inadequatetreatment," Parthasarthy said.It is appalling to note that several hospitals do notparticipate in this virtually free service which provides anindependent verification of radiation dose. During February2006, BARC invited 100 hospitals to the audit programme butonly 33 turned up, he said."Cancer patients or their relatives may ask the hospitalwhether they have joined the dose audit programme of BARC.This may force the hospitals to join the scheme. Duringinspections, AERB officials must ask the hospitals to show therecords of BARC dose audit programmes," Parthasarathy andscientists from health physics division of BARC said.Replying to a query as to how and why India should beconcerned and take preventive steps towards a safer radiationtreatment, Parthasarathy said, "This year, The New York Times(January 24, 26, 27 issues) described several instances ofbungled radiotherapy in USA and lessons should be learnt fromthat."Radiotherapy is a popularly used mode for cancertreatment. About 60 per cent of cancer patients may requiresome form of radiation treatment. The recent humongous errorsin radiotherapy in USA led to gruesome consequences, he said.Dose audit programme covering all hospitals must bemade mandatory, the expert said. PTI
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