title: Does a too risk-averse approach to the implementation of new radiotherapy technologies delay their clinical use?
abstract: Radiotherapy is a generally safe treatment modality in practice; nevertheless, recent well-reported accidents also confirm its potential risks. However, this may obstruct or delay the introduction of new technologies and treatment strategies/techniques into clinical practice. Risks must be addressed and judged in a realistic context: risks must be assessed realistically. Introducing new technology may introduce new possibilities of errors. However, delaying the introduction of such new technology therefore means that patients are denied the potentially better treatment opportunities. Despite the difficulty in quantitatively assessing the risks on both sides of the possible choice of actions, including the "lost opportunity", the best estimates should be included in the overall risk-benefit and cost-benefit analysis. Radiotherapy requires a sufficiently high level of support for the safety, precision and accuracy required: radiotherapy development and implementation is exciting. However, it has been anxious with a constant awareness of the consequences of mistakes or misunderstandings. Recent history can be used to show that for introduction of advanced radiotherapy, the risk-averse medical physicist can act as an electrical fuse in a complex circuit. The lack of sufficient medical physics resource or expertise can short out this fuse and leave systems unsafe. Future technological developments will continue to present further safety and risk challenges. The important evolution of radiotherapy brings different management opinions and strategies. Advanced radiotherapy technologies can and should be safely implemented in as timely a manner as possible for the patient groups where clinical benefit is indicated.
authors.affiliation: 1 Physics Department, Institut Sainte Catherine, Avignon, France.
authors.forename: R
authors.initials: R
authors.lastname: Garcia
authors.affiliation: 2 Medical Physics, Skandionkliniken, Uppsala, Sweden.
authors.forename: H
authors.initials: H
authors.lastname: Nyström
authors.affiliation: 3 Medical Physics, San Raffaele Institute, Milano, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Fiorino
authors.affiliation: 4 Institute of Medical Physics, School of Physics, University of Sydney, Sydney, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Thwaites
mesh_terms: D003362:Cost-Benefit Analysis; D006801:Humans; D011878:Radiotherapy / Q000009:adverse effects*; D018570:Risk Assessment; D013679:Technology, Radiologic / Q000191:economics / Q000639:trends