As any seasoned pilot will tell you, pre-flight checklists are an essential link in the safety chain at all levels of aviation. Indeed, the idea of a pre-flight checklist was first introduced by management and engineers at Boeing Corporation in 1935 following a fatal crash of the prototype Boeing B-17 Wright Field in Dayton, Ohio. Both pilots in the aircraft were killed, and after investigation it was found that the pilots had forgotten to disengage the gust locks, devices which stop control surfaces moving in the wind while the plane is parked, prior to take-off. After this Boeing decided to have a set list of actions to be undertaken pre-flight, so that such a thing could never occur again. Thus, the pre-flight checklist was born and soon adopted by others throughout the aviation world.
While delivering radiation therapy is vastly different from flying airplanes, one can argue that it is just as technically complex and challenging, with just as many instruments, gadgets, and protocols that must be fine-tuned in working in sync to optimize operation. As with flying, delivering radiation requires a huge array of steps, each of which introduces the potential for error.
As a major component of our pre-emptive safety program in radiation oncology, the Department leadership initiated a series of “No Fly Rules” in October 2018 which were meant to institute a methodical system of checks in workflow, to enhance patient safety. This Department-wide initiative was instituted after a review of prior safety incidents. With the goal of ensuring that radiation therapy planning was never rushed and that corners were never cut, the specific rules were imposed that ensure that quality is optimized to the utmost. While compliance to the “No Fly Rules” remains a work in progress, notable improvements in performance have been observed suggesting that our patients benefit now more than ever.
