Assurance Task Research Articles

Developing an automatic treatment record review system for quality assurance of patient treatment delivery in radiation therapy

Background and purposeTreatment record contains most of information related to treatment plan delivery in radiation therapy. Reviewing treatment record is an important quality assurance (QA) task for safety and quality of patient treatments. This task is usually performed by senior medical physicists. However, it is time-consuming, tedious, and error-prone. To assist this process, a treatment record review system (TRRS) is developed to automatically review items related to treatment delivery record.MethodsThe treatment record is firstly extracted from oncology information system (OIS). Based on the daily patient treatment information, the original plan from the treatment planning system is identified. Then the original plan and the delivered plan are correlated. Eight review categories (parameter consistency, treatment completeness, treatment progression, image guidance, override, treatment couch, documentation, and treatment mode) are created. Tailored rules are designed for various review items to automate the review process. As a result, for each daily treatment record, a reviewed flag (pass, failure, warning, and N/A) is assigned by the TRRS. Finally, this system is evaluated by 6 months patient treatment records collected in our institute and compared to the manual process on the same data.ResultsTRRS processed a total of 76,651 treatment fractions from 4230 patients with an average of 574 treatments per day. The percentage of the detected anomalies among the total records was 0.76%. The average processing time was 3.9 s and 282 s per treatment record for the automatic and manual processes, respectively. Comparing with the manual process, the time efficiency of TRRS is improved by a factor of 72. The average numbers of anomalies detected by the automatic and manual processes are 21 and 13 per day, respectively. TRRS detects 61.5% more anomalies than those of the manual process.ConclusionTRRS is not only efficient in processing a large amount of treatment records on a daily basis but also effective in finding more anomalies than those of physics weekly check. The application of the TRRS could significantly reduce the workload of the review physicists and let them focus on more important works related to patient safety.

Seeing the Trees: How a Concrete versus Abstract Mindset Improves Performance on Low-Level Assurance Tasks

ABSTRACT Prior research shows that individuals benefit from abstract construals when performing broader high-level assurance tasks. We extend this research by studying the effects of different construal mindsets on skepticism and performance in a low-level assurance task setting. Using a sample of 195 online participants, we find that individuals benefit from concrete (versus abstract) mindsets when performing low-level assurance tasks because concrete construals better allow them to focus on detailed evidence that may contradict client assertions. Specifically, we show that assurance providers who utilize a concrete (abstract) construal mindset when performing a low-level task display better (worse) skeptical judgments and actions. Taken together with findings from past research, our results support the notion that assurance providers should utilize the construal mindset that best matches the characteristics of the task at hand. Exploratory analysis suggests that client retention incentives may moderate the relationship between skeptical judgment and skeptical action in our context. Data Availability: Data are available from the authors upon request.

Toward Understanding Deep Learning Framework Bugs

DL frameworks are the basis of constructing all DL programs and models, and thus their bugs could lead to the unexpected behaviors of any DL program or model relying on them. Such a wide effect demonstrates the necessity and importance of guaranteeing DL frameworks’ quality. Understanding the characteristics of DL framework bugs is a fundamental step for this quality assurance task, facilitating designing effective bug detection and debugging approaches. Hence, in this work, we conduct the most large-scale study on 1,000 bugs from four popular and diverse DL frameworks (i.e., TensorFlow, PyTorch, MXNet, and DL4J). By analyzing the root causes and symptoms of DL framework bugs associated with five components decomposed from DL frameworks, as well as measuring test coverage achieved by three state-of-the-art testing techniques, we obtain 12 major findings for the comprehensive understanding of DL framework bugs and the current status of existing DL framework testing practice, and then provide a series of actionable guidelines for better DL framework bug detection and debugging. Finally, based on the guidelines, we design and implement a prototype DL-framework testing tool, called TenFuzz , which is evaluated to be effective and finds three unknown bugs on the latest TensorFlow framework in a preliminary study, indicating the significance of our guidelines.

Pose Estimation and Damage Characterization of Turbine Blades during Inspection Cycles and Component-Protective Disassembly Processes.

Inspection in confined spaces and difficult-to-access machines is a challenging quality assurance task and particularly difficult to quantify and automate. Using the example of aero engine inspection, an approach for the high-precision inspection of movable turbine blades in confined spaces will be demonstrated. To assess the condition and damages of turbine blades, a borescopic inspection approach in which the pose of the turbine blades is estimated on the basis of measured point clouds is presented. By means of a feature extraction approach, film-cooling holes are identified and used to pre-align the measured point clouds to a reference geometry. Based on the segmented features of the measurement and reference geometry a RANSAC-based feature matching is applied, and a multi-stage registration process is performed. Subsequently, an initial damage assessment of the turbine blades is derived, and engine disassembly decisions can be assisted by metric geometry deviations. During engine disassembly, the blade root is exposed to high disassembly forces, which can damage the blade root and is crucial for possible repair. To check for dismantling damage, a fast inspection of the blade root is executed using the borescopic sensor.

Degradation in photovoltaic encapsulant transmittance: Results of the second PVQAT TG5 artificial weathering study

AbstractThe optical degradation of encapsulants from ultraviolet (UV) radiation has historically resulted in a significant loss in performance throughout the life of a photovoltaic (PV) module. International Electrotechnical Commission (IEC) test methods have recently been developed to screen for PV encapsulants prone to loss in optical performance. The present study was performed to benchmark polymeric packaging materials relative to IEC 62788‐1‐4 (covering the measurement of optical transmittance) and IEC 62788‐1‐7 (on the durability of transmittance), provide feedback toward improvement of the methods, and develop insight regarding optical degradation. Contemporary materials were examined, including poly(ethylene‐co‐vinyl acetate) (EVA), thermoplastic polyolefin (TPO), polyolefin elastomer (POE), and polyvinyl butyral (PVB) encapsulants; a poly(ethene‐co‐tetrafluoroethene)/poly(ethylene terephthalate) (ETFE/PET) transparent backsheet; and a polystyrene (PS) working reference material. The use of silica‐, specialty‐, and rolled‐glass was also compared in laminated coupons. Specimen size was separately examined from 2.5 to 12.5 cm. Weathering was performed with a xenon source, using IEC TS 62788‐7‐2 methods A2, A3, A4, and A5 (chamber temperature of 55°C, 65°C, 75°C, or 85°C), respectively. Characterizations were made using a UV–visible–near‐infrared (UV–VIS–NIR) spectrophotometer (transmittance and reflectance, with and without an integrating sphere), a UV–VIS fluorescence spectrophotometer, a camera, and an optical microscope. Performance was analyzed, including solar weighted transmittance, yellowness index, UV cut‐off wavelength, and haze (scattering). Separate Arrhenius analyses were performed to assess retention of transmittance and changes in yellowness index. The activation energy for both characteristics was found to range from 15–80 kJ·mol−1, with an average of 48 kJ·mol−1, similar to the average of 45 kJ·mol−1 identified in the previous international PV Quality Assurance Task Force (PVQAT) Task Group 5 (TG5) study of more traditional encapsulants. The separate degradation modes of discoloration and scattering were distinguished in the encapsulants using a comprehensive spectral characterization. Based on these results, the IEC 62788‐1‐7 pass/fail criteria of 5% change in transmittance was confirmed to identify a known bad encapsulant.

Multidisciplinary Consensus and Evaluation of Gynecological High-Dose-Rate (HDR) Brachytherapy

To improve the consistency and quality of gynecological HDR brachytherapy through multidisciplinary evaluation of implants and treatment plans.A quality assurance (QA) task force initiated in 2020 consisting of radiation oncologists, physicists, and radiation therapists reviewed applicator implant and treatment plan quality convened monthly for 48 gynecology patients undergoing high-dose-rate (HDR) brachytherapy. Each implant was scored based on the location and symmetry of applicators (tandem and ovoids/ring), interstitial needle location (if applicable), and packing quality as previously described (PMID: 22193645, 29705049). Treatment plans were evaluated based on contouring quality and dosimetry (target dose and OAR doses). Each quality measure was scored from 0 (inadequate) to 1 (excellent) to and a mean score for implant and treatment plan was calculated for each patient. The assigned scores represent a consensus among task force members who provided feedback according to their areas of expertise. Individual measures, implant types and mean scores were analyzed at the mid-year-mark.QA evaluation proved more beneficial for implant placement compared to treatment planning. Mean implant scores increased by 15% with significant improvements in needle positions (P = 0.02) and nonsignificant increases in packing scores (P = 0.09). In contrast, mean treatment plan scores remained unchanged throughout the year (P = 0.56). No differences were noted in the scores assigned for dosimetry, contouring, OAR doses or target doses after the mid-year mark.The QA initiative enabled the interprofessional team to share knowledge and resources to facilitate immediate mid-course changes in implant and planning strategy. The feedback generated encouraged members to alter practices and expand their understanding of treatment goals and limitations. Specific criteria for the scoring of individual quality measures should be developed to improve objectivity. The utility of HDR QA should be correlated with tumor control, recurrence, and OAR toxicity to bolster patient safety and treatment outcomes. QA sessions require quantifiable measures such as team member satisfaction and ongoing assessment due to the multidisciplinary nature of the process.C.Y. Mollings Puentes: Independent Contractor; UWorld. T. Banks: Develop/vet educational website content; AAPM.B.A. Hrycushko: None. X. Jia: None. C.R. Nwachukwu: Scientific Advisory board; Boston Scientific. K.V. Albuquerque: Research Grant; Astra Zeneca. Honoraria; ACR, ARRT. Travel Expenses; ACR, ARRT, ASCO.

Recommendations for a More Organized and Effective Approach to the Early Detection of Pancreatic Cancer From the PRECEDE (Pancreatic Cancer Early Detection) Consortium

Recommendations for a More Organized and Effective Approach to the Early Detection of Pancreatic Cancer From the PRECEDE (Pancreatic Cancer Early Detection) Consortium

Feasibility study of range verification based on proton-induced acoustic signals and recurrent neural network

Range verification in proton therapy is a critical quality assurance task. We studied the feasibility of online range verification based on proton-induced acoustic signals, using a bidirectional long-short-term-memory recurrent neural network and various signal processing techniques. Dose distribution of 1D pencil proton beams inside a CT image-based phantom was analytically calculated. The propagation of acoustic signal inside the phantom was modeled using the k-Wave toolbox. For signal processing, five methods were investigated: down-sampling (DS), DS + HT (Hilbert transform), Wavelet decomposition (Wavedec db1, db4 and db20). The performances were quantitatively evaluated in terms of mean absolute error, mean relative error (MRE) and the Bragg peak localization error (). In addition, the study analyzed the impact of noise levels, the number of sensors, as well as the location of sensors. For the noiseless case (32 sensors), the Wavedec db1 method demonstrates the best performance: is less than one pixel and the dose accuracy over the region adjacent to the Bragg peak (MRE50) is ∼3.04%. With the presence of noise, the Wavedec db1 method demonstrates the best noise immunity, achieving less than 1 mm and an MRE50 of ∼12%. The proposed machine learning framework may become a useful tool allowing for online range verification in proton therapy.

Трансформація моделі ризику аудиту в умовах перевірки інтегрованої звітності

The article describes the features of risk of integrated reporting audit identification and assessment. It is determined that the audit risk model should take into account the circumstances affecting the generation, evaluation and application of integrated reporting data in relation to the transformation of information users’ requests, modification of the reporting interpretation of relevant data, and the extension of the audit scope as an assurance task. In this regard, the purpose of the study is to formalize methodological approaches to audit risk modeling in the context of integrated reporting audit tasks. The financial and non-financial data that could be disclosed in the integrated reporting are characterized. It is established that the circumstances of the formation of information to be identified by the auditor to assess the audit risk are determined by users’ requests, organizational and methodological approaches to its processing, availability of appropriate technical facilities and personnel. It is defined that the audit risk is the auditor's ability expected to express an inappropriate opinion on the audit results, which will include the misplacement or incorrect accounting of the deviations existing in the information or their incorrect identification. The article substantiates the model of the integrated reporting audit risk assessment, and the model provides the identification and determination of the level of such elements as: information risk, the risk of information preparing, the risk of information evaluation and the risk of changes in the influence of factors due to determination of preliminary assessment. The main advantage of the proposed audit risk assessment model is the definition of its elements, based on the main aspects of formulating and evaluating the information contained in the integrated reporting. In doing so, these aspects should be examined during the audit of the historical, forecast and hypothetical information contained in the integrated reporting.

Трансформація очікувань користувачів результатів аудиту інтегрованої звітності

One of the prerequisites for using an integrated report is to obtain a sufficient level of confidence in it, in particular, based on the audit report. In this regard, the expectations of users of the audit results are broadened by including additional quantitative and qualitative parameters that are taken into account when information evaluation criteria are formulating. Thus, there is a need to clarify the approach to identifying and assessing users' expectations about results of the data audit contained in the integrated reporting of entities, which affected on the purpose of the study. It is determined that the interest of the users of information disclosed in integrated reporting may affect the nature of interest in the results of its audit. The classification of the expectations of the users of the results on the basis of their formalization and the consequences of the integrated reporting audit are substantiated. It is established that the meaningful characteristics of the expectations of the audit results of the users are determined by the presence of the audit report, the identification of its purpose, the individual parameters of the presented information, the compliance of the reporting data with predefined criteria and the availability of information regarding additional circumstances. The findings of the study allow to solve a number of problems related to the identification and detail of the audit objectives of the integrated reporting, the clarification of its subject area, and, as a consequence, the improvement of measures aimed at achieving the audit objective as an assurance task. Among the areas for further research, it is proposed to identify the development of methodological approaches to improve the integrated reporting audit activities based on the recognition of the priority of users' expectations of its results.

Evaluation of Patients Record and its Implications in the Management of Trauma Patients.

Introduction:A medical record audit is a type of quality assurance task which involves formal reviews and assessments of medical records to identify where a medical organization stands in relation to compliance and standards. A study was carried out with the objective to document the audit of the medical records in a tertiary care trauma center and suggest the corrective measures and preventive measures in case of lacunae.Methodology:A retrospective study was conducted in an apex trauma care facility of New Delhi. All the admissions on disaster bed from October 1, 2015, to December 31, 2015, were evaluated. A list of 106 admissions were made using the online software at the trauma center. The files were taken from the medical record departments and compared using a checklist prepared in accordance with the guidelines laid down by the Joint Commission International.Results:A total of 106 admissions on disaster bed from October 1, 2015, to December 31, 2015, were evaluated. The average length of stay for the disaster beds was 11.7 days and the mortality rate was 9.5%. Signature of the patient and doctor and name of the witness were missing in more than 50% of the cases of consent. Discharge summary in which the investigation details, signature of the doctor, and contact number in case of an emergency were not documented. In the miscellaneous records, transfer (61%) and referral (42%) were not documented properly.Conclusion:The average length of stay for the disaster beds was 11.7 days. Maximum admissions were under the neurosurgery department. The filing and assembling of records were poor. Signature of the patient and doctor and name of the witness were missing in more than 50% of the consent forms. There was no anesthesia consent form used. The doctor daily records were poor, while the nursing records were well maintained. It is recommended to have a periodic weekly auditing to minimize chances of deficiency/misplacing of records. Periodic training sessions and workshops should be organized.

Audit subject formalization in sustainable development

In the context of sustainable development, user's requests for information about the activities of business entities are expanded. As a result, the information forms in reports based on data that are grounded on a non-economic nature but are capable of influencing the activities of economic entities. This has led to the interest of information contained in non-financial reporting forms users in obtaining of assurance in its high-quality parameters. Therefore, there was a necessity to revise approaches to formalizing the subject matter of the audit, taking into account changes in the volume and content of the data to be independently audited. That’s why, the purpose of the study, the results of which are outlined in the paper, is to develop proposals for identifying and evaluating the conditions and circumstances that influence the identification of the subject of the audit and to determine the nature of such impact in the context of audit tasks.It is established that the content of information to be audited in terms of sustainable development, has changed due to the inclusion of reporting forms data relating to impact on the economic agents of environmental, social and other socially significant circumstances and the existence of the request for information not only historical but prospective nature too. On this basis, a methodological approach to formalize the subject matter of the audit as an assurance task was developed.However, the results of the study indicate that the general properties of the subject of audit in conditions of sustainable development remain mostly unchanged. These properties offer the opportunity to attribute identification, definition of critical values of the parameters of the audit subject, and – the auditor's ability to receive appropriate audit evidence.The results of the study will help to clarify the purpose and objectives of audit in the context of providing users with information about the activities of business entities, as well as to satisfy user's requests for a sufficient level of confidence in it.

Trust but verify: Is there a role for active surveillance in monitoring adverse events in Zimbabwe's large-scale male circumcision program?

IntroductionEnsuring quality service provision is fundamental to ZAZIC’s voluntary medical male circumcision (MC) program in Zimbabwe. From October, 2014 to September, 2017, ZAZIC conducted 205,847 MCs. Passive surveillance recorded a combined moderate and severe adverse event (AE) rate of 0.3%; reported adherence to follow-up was 95%, suggesting program safety. Despite encouraging passive surveillance data, verification of data quality and accuracy would increase confidence in AE identification.MethodsFrom May to August, 2017, ZAZIC implemented a focused quality assurance (QA) study on AE ascertainment and documentation at 6 purposively-selected, high-volume MC sites. ZAZIC Gold-Standard (GS) clinicians prospectively observed 100 post-MC follow-ups per site in tandem with facility-based MC providers to confirm and characterize AEs, providing mentoring in AE management when needed. GS clinicians also retrospectively reviewed site-based, routine MC data, comparing recorded to reported AEs, and held brief qualitative interviews with site leadership on AE-related issues.ResultsObserved AE rates varied from 1–8%, potentially translating to thousands of unidentified AEs if observed AE rates were applied to previous MC performance. Most observed AEs were infections among younger clients. Retrospective review found discrepancies in AE documentation and reporting. Interviews suggest human resource and transport issues challenge MC follow-up visit attendance. Post-operative self-care appears to produce generally good results for adults; however, younger clients and guardians need additional attention to ensure quality care. There was no evidence of missed severe AEs resulting in permanent impairment or morbidity.ConclusionsAlthough results cannot be generalized, active surveillance suggests that AEs may be higher and follow-up lower than reported. In response, ZAZIC’s Quality Assurance Task Force will replicate this QA study in other sites; increase training in AE identification, management, and documentation for clinical and data teams; and improve post-operative counseling for younger clients. Additional nurses and vehicles, especially in rural health clinics, could be beneficial.

Methodology paper: a novel phantom setup for commissioning of scanned ion beam delivery and TPS

BackgroundCommissioning of treatment planning systems (TPS) and beam delivery for scanned light ion beams is an important quality assurance task. This requires measurement of large sets of high quality dosimetric data in anthropomorphic phantoms to benchmark the TPS and dose delivery under realistic conditions.MethodA novel measurement setup is described, which allows for an efficient collection of a large set of accurate dose data in complex phantom geometries. This setup allows dose measurements based on a set of 24 small volume ionization chambers calibrated in dose to water and mounted in a holder, which can be freely positioned in a water phantom with various phantoms mounted in front of the water tank. The phantoms can be scanned in a CT and a CT-based treatment planning can be performed for a direct benchmark of the dose calculation algorithm in various situations.ResultsThe system has been used for acceptance testing in scanned light ion beam therapy at Heidelberg Ion Beam Therapy Center for scanned proton and carbon ion beams. It demonstrated to be useful to collect large amounts of high quality data for comparison with the TPS calculation using various phantom geometries.ConclusionThe setup is an efficient tool for commissioning and verification of treatment planning systems. It is especially suited for dynamic beam delivery, as many data points can be obtained during a single plan delivery, but can be adapted also for other dynamic therapies, like rotational IMRT.

Exploring the audit capabilities expectation-performance gap of newly employed first-year trainee accountants in Gauteng: Audit managers at large firms’ perceptions

The objective of this paper is to determine the relative size of the expectation-performance gap of technical auditing and assurance knowledge of newly employed first-year trainee accountants. In a study dealing with the expectation-performance gap in accounting education it was reported that according to practitioners, graduates were not able to demonstrate the expected practical accounting knowledge. This gives rise to the question: is the gap really as big as practitioners would like academic institutions to believe? As the relative extent of the gap will be determined in this study, the findings could assist audit and assurance academics in understanding accounting practitioners’ expectations of and concerns about newly employed first-year trainee accountants, which as a result could be addressed in their education practices. In addition, training at training offices at audit firms could be customised to focus on the areas in which the newly employed first-year trainee accountants are lacking.A questionnaire was used to determine audit managers’ perceptions regarding their expectations and their perceptions regarding the actual levels of capability demonstrated by newly employed first-year trainee accountants when performing technical audit and assurance tasks, after which the relative size of the expectation-performance gap was determined. The findings indicate that audit managers do not expect newly employed first-year trainee accountants to be capable of performing any of the identified technical audit and assurance tasks without, or with only limited supervision. However, despite this rather low expectation, it was evident that newly employed first-year trainee accountants do not meet audit managers’ expectations. The technical audit and assurance task with the largest expectation-performance gap was the ability of newly employed first-year trainee accountants to consider and document the need to use computer-assisted audit techniques to gather audit evidence, with an expectation-performance gap of 28.9%.

Abnormal Pap Tracking in Resident Clinics – What Is Our Standard and Can We Do Better? [6O

INTRODUCTION: Screening tests are only as valuable as the quality of the system in which they are performed. To reduce cancer rates, tracking patients' care after pap testing is fundamental. Electronic health records (EHR) have made reporting of abnormal test results more efficient and reliable, but how are they being used? We investigated current protocols for tracking abnormal cytology results in Obstetrics & Gynecology resident clinics to better understand how future physicians are trained in this important quality assurance task. METHODS: A brief survey designed using REDCap, a secure, web-based application, was sent out to all 249 Obstetrics & Gynecology residency programs within the FRIEDA database. RESULTS: Of the 249 residency programs, 54 (22%) responded, 51 (94%) perform colposcopy, and 47 (87%) programs provide treatment. Twenty-five (46%) of respondents have a tracking system for abnormal results with 21 (45%) of the 47 programs providing treatment, tracking post-treatment follow-up care. Follow-up is confirmed by chart review in 18 (72%) of the 25 programs who perform tracking, while 6 (24%) use EHR reports or disease management capability. CONCLUSION: The majority of residency programs perform colposcopy and treatment, yet less than 50% of the programs track abnormal results to assure appropriate patient follow-up. The majority of programs who perform tracking do so by the time consuming method of chart review, with only 6 programs (11%) leveraging the efficiency and reliability of their EHR to assist with this quality assurance task. Resident clinics and clinical practices of all types might consider this an area for future quality improvement.

Invisible Play and Invisible Game: Video Game Testers or The Unsung Heroes of Knowledge Working

In this paper, I examine video game testing as a lens through which exploring broader aspects of digital economy such as the intersection of different kind productive practices—working, labouring, playing and gaming—as well as the tendency to conceal the labour associated with them. Drawing on Lund’s (2014) distinction between the creative aspects of “work-playing” and the constraining/instrumental aspects of “game-labouring”, I claim that video game testing is buried under several layers of invisibility. Ideologically, the “playful”, “carnivalesque”, quasi-subversive facets of this job are rejected because of their resistance to be easily subsumed by the logic of capitalism. Practically, a fetishist process of hiding human relations behind relations among things (elements in the video game environment) reaches its paradoxical apex in the quality assurance task of this profession: the more the game tester succeeds in debugging games higher is the fetishization of his/her activity.

A wide variation of the quality of colonoscopy reporting system in the real clinical practice in southeastern area of Korea.

Background/AimsEstablishment of a colonoscopy reporting system is a prerequisite to determining and improving quality. This study aimed to investigate colonoscopists' opinions and the actual situation of a colonoscopy reporting system in a clinical practice in southeastern area of Korea and to assess the factors predictive of an inadequate reporting system.MethodsPhysicians who performed colonoscopies in the Daegu-Gyeongbuk province of Korea and were registered with the Korean Society of Gastrointestinal Endoscopy (KSGE) were interviewed via mail about colonoscopy reporting systems using a standardized questionnaire.ResultsOf 181 endoscopists invited to participate, 125 responded to the questionnaires (response rate, 69%). Most responders were internists (105/125, 84%) and worked in primary clinics (88/125, 70.4%). Seventy-one specialists (56.8%) held board certifications for endoscopy from the KSGE. A median of 20 colonoscopies (interquartile range, 10–47) was performed per month. Although 88.8% of responders agreed that a colonoscopy reporting system is necessary, only 18.4% (23/125) had achieved the optimal reporting system level recommended by the Quality Assurance Task Group of the National Colorectal Cancer Roundtable. One-third of endoscopists replied that they did not use a reporting document for the main reasons of "too busy" and "inconvenience." Non-endoscopy specialists and primary care centers were independent predictive factors for failure to use a colonoscopy reporting system.ConclusionsThe quality of colonoscopy reporting systems varies widely and is considerably suboptimal in actual clinical practice settings in southeastern Korea, indicating considerable room for quality improvements in this field.

P-292 The Polyp Manager: a new tool to report polyps during colonoscopy in a complete and time-efficient way. A pilot study

Introduction: According to the CO-RADS report of the Quality Assurance Task Group of the American National Colorectal Cancer Roundtable, standardized documentation of colon polyps should include the following 7 items: location, size, morphology, method of removal, completeness of removal and retrieval and if the specimen is provided to the pathologist. In The Netherlands, a description of the mucosal aspect and packaging of each individual polyp in separate containers are considered additional quality items. Since a report is usually made after the colonoscopy it can be difficult to recall all relevant data, especially when there are many polyps to be described. Previous studies have shown that reporting of polyps is often incomplete. The Polyp Manager (PM, Olympus, Zoeterwoude, The Netherlands) is a new touchscreen operated software application that allows the endoscopist to describe polyps real-time during the colonoscopy. PM generates a uniform and complete list of all polyp characteristics that serves as input for both the colonoscopy report and pathology request. In this pilot study PM was not yet connected to a digital reporting system. We compared the PM with conventional reporting (CR) with respect to completeness of polyp documentation and potential time benefit. Methods: In two Dutch hospitals, all patients planned for a regular colonoscopy were included and randomly assigned to either PM or CR. Excluded were national screening colonoscopies, incomplete colonoscopies, patients with no polyps found and with previous colon surgery. Endoscopists measured the total duration of the colonoscopy plus the time needed to report polyps and to create a pathology request. The sum of the latter two in both groups was considered as the potential time benefit once PM would be integrated in the reporting system, provided that using PM would not prolong the colonoscopy. To evaluate completeness of polyp description, the PM-group was compared with an equally sized historical CR-group (CRH) including all patients that had colonoscopy in the month before starting the prospective study. Each of the eight polyp descriptors mentioned above (Dutch criteria) were scored for each polyp. Results: 144 colonoscopies (78 PM, 66 CR) were included prospectively with patients comparable for age, sex and number of polyps (both PM and CV 2.0 ± 2.0, p > 0.05)‡ . Duration of colonoscopy was equal in PM and CR (25:42 ± 16:20 vs 24:00 ± 16:40 minutes, p > 0.05)‡ suggesting that operating PM does not extend the procedure. Time to report polyps and provide a pathology request was 2:23 ± 3:03‡ minutes in the entire group (PM plus CR). Historical CR-reports (78 CRH) were comparable for age, sex and number of polyps with PM (CRH 2.0 ± 2.0, p > 0.05)‡. The incomplete documentation of the following items did significantly improve by using the PM: location (96% vs 82%, p = 0.01), size (95% vs 89%, p = 0.03), aspect (71% vs 36%, p < 0.001) and completeness of removal (61% vs 37%, p < 0.001). (‡= median ± interquartile range) Conclusion: This pilot study suggests that PM improves the completeness of reporting polyp characteristics and may reduce the total procedure time once PM is a fully integrated part of the reporting system. Conformational studies in such a setting are expected shortly.

Importance of Determining Indication for Colonoscopy: Implications for Practice and Policy

Colorectal cancer (CRC) is the second leading cause of cancer-related death in the United States1. Colonoscopy plays a central role in the CRC screening process and can be performed for several indications, ranging from screening to surveillance to diagnostic work-up (Supplemental Table 1)2. In this commentary, we discuss the importance of accurately determining indication for colonoscopy in clinical care, healthcare quality reporting, research, and policy. Colonoscopy indication plays a central role in characterizing adenoma detection rates (ADR), overuse and underuse of CRC screening and surveillance, and the comparative effectiveness of different CRC screening strategies. Accordingly, documentation of procedural indication is one of the key recommendations for colonoscopy reporting from the Quality Assurance Task Force of the National Colorectal Cancer Roundtable (NCCRT)3. However, several challenges and inconsistencies make determination of colonoscopy indication difficult. For example, there are several varying perspectives of indication and data sources, each potentially yielding a different answer. We review several published algorithms to determine indication to highlight these issues and propose suggestions for future research in this area.