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Without organ shielding) had been lower than those planned. It is well known that underdosage can only be clinically noted after months or years (a decrease in the tumour control rate and therefore an increase in tumour recurrence), in contrast to overdosage. 3. DISCOVERY OF IRREGULARITIES According to the information obtained during the expert review in July 1996, the radiation oncologist at the Calderón Guardia Hospital had noticed that there were unusually severe effects in some of the patients treated with the Alcyon II unit at the San Juan de Dios Hospital, and followed up on the observation.
Patient No. 5 Gy each). This treatment is calculated to be biologically equivalent to about 31 fractions of 2 Gy each, with a total dose to the bowel of about 62 Gy. 5. CARDIOVASCULAR SYSTEM Radiation induced changes in the heart have been reported in patients treated for Hodgkin’s disease. Cardiomyopathy rarely occurs with standard fractionation schemes and doses of less than 40 Gy. Above this level, up to half of the patients will experience pericarditis. Patients show a more than 50% incidence of complications when the dose exceeds 60 Gy (standard fractionation).
As an example of the extent of psychological effects, 5 years after the Chernobyl accident, over 80% of the persons surveyed reported fatigue, even in villages with essentially no radioactive contamination. 57 Part III CONCLUSIONS AND RECOMMENDATIONS 6. 1. GENERAL CONSIDERATIONS This accident has confirmed a number of lessons that were well known from previous incidents, and also yielded specific lessons. Lessons of a more general character can be summarized as follows: (1) Investigation of radiation accidents generally reveals faults that should have been corrected; (2) Radiation accidents with severe and even fatal consequences do occur in medical facilities; (3) Human error is the most common cause of radiation accidents; (4) A properly operating machine does not guarantee good radiotherapy treatment; adequate ancillary equipment, education and training, staffing and management are essential; (5) Radiation accidents can have major short and long term psychosocial consequences; (6) Accepted radiotherapy protocols have very little margin for error, since both normal and malignant cells are killed; significant overdoses (errors much larger than 10%) will result in an unacceptable incidence of severe consequences; (7) Doses administered in fewer than the normal number of treatments with higher doses per treatment result in an excessive number of early and, particularly, late complications; (8) When radiation therapy sources are replaced, calibration should be done by appropriately trained persons, and independently checked; (9) Regulations should cover the training and competence required to deal with potentially hazardous radiation sources; (10) Specific training should be given after an individual working in a radiotherapy unit has received a thorough basic education and should not consist of simply attending occasional short courses; (11) When there is high incidence/severity of acute effects during radiotherapy treatment, the treatment should be stopped and the source calibration checked immediately; (12) In radiotherapy accidents, the tumour dose may not be the parameter of primary interest; often the biologically equivalent 2 Gy/fraction dose (the dose that would be biologically equivalent had it been delivered in fractions of 2 Gy) to sensitive structures such as the spinal cord, heart and intestine is more important; 61 (13) Early and reliable information and communication are crucial for good management of radiation accidents; (14) Radiotherapy records should be uniform, clear, consistent and complete.
Accidental Overexposure of Radiotherapy Patients in San Jose, Costa Rica by International Atomic Energy Agency