Gaba contends that the safety record of commercial aviation is
unmatched in healthcare even for elective care [1]. He quotes a figure for
US airline scheduled services (2000-9) of 0.17 fatal accidents per million
departures. Of course, this definition minimises the human impact and he
goes on to admit that many lives are at risk on each flight. With 30-300
passengers per plane, the risk is 5-50 deaths per million passenger trips.
This is low compared with many of the risks inherent in clinical practice
and daily life [2]. However, contrary to his assertion, this safety record
has been equalled in medicine. Radiotherapy is a potentially dangerous and
complex elective intervention whose risks have previously been highlighted
in the BMJ [3]. It carries a risk of death from erroneous delivery of 2-15
per million courses of treatment [4]. This has been achieved by standard
operating procedures, close attention to detail and a system of multiple
checks [5]. In addition, the UK has long had a compulsory system to report
doses "greater than intended" and now has a comprehensive voluntary
reporting system for near misses which emulates that of aviation. We seek
further reduction in errors and incidents and our approach has in part
been informed by that of the airline industry [5].
1. Gaba DM. Have we gone too far in translating ideas from aviation
to patient safety? BMJ 2011; 342:c7310
2. Munro AJ. Hidden danger, obvious opportunity: error and risk in
the management of cancer. British Journal of Radiology. 2007; 80: 955-66
3. Donaldson L. Reducing harm from radiotherapy. BMJ 2007; 334: 272.
4. Williams MV and Frew TL. How dangerous is radiotherapy? Int J
Radiat Oncol Biol Phys 2011 in press.
5. The Royal College of Radiologists, Society and College of
Radiographers, Institute of Physics and Engineering in Medicine, National
Patient Safety Agency, British Institute of Radiology (2008) Towards Safer
Radiotherapy. The Royal College of Radiologists, London. Available at: www.rcr.ac.uk/index.asp?PageID=149&PublicationID=281
Rapid Response:
Radiotherapy is as safe as flying
Gaba contends that the safety record of commercial aviation is
unmatched in healthcare even for elective care [1]. He quotes a figure for
US airline scheduled services (2000-9) of 0.17 fatal accidents per million
departures. Of course, this definition minimises the human impact and he
goes on to admit that many lives are at risk on each flight. With 30-300
passengers per plane, the risk is 5-50 deaths per million passenger trips.
This is low compared with many of the risks inherent in clinical practice
and daily life [2]. However, contrary to his assertion, this safety record
has been equalled in medicine. Radiotherapy is a potentially dangerous and
complex elective intervention whose risks have previously been highlighted
in the BMJ [3]. It carries a risk of death from erroneous delivery of 2-15
per million courses of treatment [4]. This has been achieved by standard
operating procedures, close attention to detail and a system of multiple
checks [5]. In addition, the UK has long had a compulsory system to report
doses "greater than intended" and now has a comprehensive voluntary
reporting system for near misses which emulates that of aviation. We seek
further reduction in errors and incidents and our approach has in part
been informed by that of the airline industry [5].
1. Gaba DM. Have we gone too far in translating ideas from aviation
to patient safety? BMJ 2011; 342:c7310
2. Munro AJ. Hidden danger, obvious opportunity: error and risk in
the management of cancer. British Journal of Radiology. 2007; 80: 955-66
3. Donaldson L. Reducing harm from radiotherapy. BMJ 2007; 334: 272.
4. Williams MV and Frew TL. How dangerous is radiotherapy? Int J
Radiat Oncol Biol Phys 2011 in press.
5. The Royal College of Radiologists, Society and College of
Radiographers, Institute of Physics and Engineering in Medicine, National
Patient Safety Agency, British Institute of Radiology (2008) Towards Safer
Radiotherapy. The Royal College of Radiologists, London. Available at:
www.rcr.ac.uk/index.asp?PageID=149&PublicationID=281
Competing interests: No competing interests