The Therac 25 accidents

I found this post to be extremely interesting. Last year my wife required radiation treatment for a tumor on her optic nerve. There were about 25 treatments. One per day for about 6 weeks. These were done in a major hospital. The machine, obviously a lot newer and more advanced, was regularly "out of order". After reading this post, I am afraid of what the problems really were. Since the location of her tumor left no room for positioning error, we were very concerned. On several occasions things like inoperable intercoms and attendants not being 100% into their jobs, left us concerned. After reading this, I think our concern was justified. One major difference was that a form fitting mask for her head was made. Each treatment required her to wear the mask which was clamped to the table, thus keeping her head in the exact position. The table and equipment was obviously servo driven with extremely accurate positioning devices. Even with all this, our concern was about the "dependability " of the equipment.
After reading this post, my concern is with the regulatory agencies that we so depend on. Apparently too many things happened, too many people were hurt and killed before they stepped in. Hopefully these accidents and deaths have led to stricter monitoring of the machines and operators. As often as we try to make machines "foolproof" we can never make them "Damn fool proof". And as often as we see operators trying to outthink or outmanuever the controls we put in place, to think that just pushing some keys too quickly could be the possible cause of these people dying. Again, thanks for the article.
 
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