Effective Quality Assurance Program Research Articles

AAPM Medical Physics Practice Guideline 8.b: Linear accelerator performance tests.

The purpose of this guideline is to provide a list of critical performance tests to assist the Qualified Medical Physicist (QMP) in establishing and maintaining a safe and effective quality assurance (QA) program. The performance tests on a linear accelerator (linac) should be selected to fit the clinical patterns of use of the accelerator and care should be given to perform tests which are relevant to detecting errors related to the specific use of the accelerator. Current recommendations for linac QA were reviewed to determine any changes required to those tests highlighted by the original report as well as considering new components of the treatment process that have become common since its publication. Recommendations are made on the acquisition of reference data, routine establishment of machine isocenter, basing performance tests on clinical use of the linac, working with vendors to establish QA tests and performing tests after maintenance and upgrades. The recommended tests proposed in this guideline were chosen based on consensus of the guideline's committee after assessing necessary changes from the previous report. The tests are grouped together by class of test (e.g., dosimetry, mechanical, etc.) and clinical parameter tested. Implementation notes are included for each test so that the QMP can understand the overall goal of each test. This guideline will assist the QMP in developing a comprehensive QA program for linacs in the external beam radiation therapy setting. The committee sought to prioritize tests by their implication on quality and patient safety. The QMP is ultimately responsible for implementing appropriate tests. In the spirit of the report from American Association of Physicists in Medicine Task Group 100, individual institutions are encouraged to analyze the risks involved in their own clinical practice and determine which performance tests are relevant in their own radiotherapy clinics.

Comprehensive MR imaging QA of 0.35 T MR-Linac using a multi-purpose large FOV phantom: A single-institution experience.

Magnetic resonance-guided radiotherapy (MRgRT) is desired for the treatment of diseases in the abdominothoracic region, which has a broad imaging area and continuous motion. To ensure accurate treatment delivery, an effective image quality assurance (QA) program, with a phantom that covers the field of view (FOV) similar to a human torso, is required. However, routine image QA for a large FOV is not readily available at many MRgRT centers. In this work, we present the clinical experience of the large FOV MRgRT Insight phantom for periodic daily and monthly comprehensive magnetic resonance imaging (MRI)-QA and its feasibility compared to the existing institutional routine MRI-QA procedures in 0.35 T MRgRT. Three phantoms; ViewRay cylindrical water phantom, Fluke 76-907 uniformity and linearity phantom, and Modus QA large FOV MRgRT Insight phantom, were imaged on the 0.35 T MR-Linac. The measurements were made in MRI mode with the true fast imaging with steady-state free precession (TRUFI) sequence. The ViewRay cylindrical water phantom was imaged in a single-position setup whereas the Fluke phantom and Insight phantom were imaged in three different orientations: axial, sagittal, and coronal. Additionally, the phased array coil QA was performed using the horizontal base plate of the Insight phantom by placing the desired coil around the base section which was compared to an in-house built Polyurethane foam phantom for reference. The Insight phantom captured image artifacts across the entire planar field of view, up to 400mm, in a single image acquisition, which is beyond the FOV of the conventional phantoms. The geometric distortion test showed a similar distortion of 0.45±0.01 and 0.41±0.01mm near the isocenter, that is, within 300mm lengths for Fluke and Insight phantoms, respectively, but showed higher geometric distortion of 0.8±0.4mm in the peripheral region between 300 and 400mm of the imaging slice for the Insight phantom. The Insight phantom with multiple image quality features and its accompanying software utilized the modulation transform function (MTF) to evaluate the image spatial resolution. The average MTF values were 0.35±0.01, 0.35±0.01, and 0.34±0.03 for axial, coronal, and sagittal images, respectively. The plane alignment and spatial accuracy of the ViewRay water phantom were measured manually. The phased array coil test for both the Insight phantom and the Polyurethane foam phantoms ensured the proper functionality of each coil element. The multifunctional large FOV Insight phantom helps in tracking MR imaging quality of the system to a larger extent compared to the routine daily and monthly QA phantoms currently used in our institute. Also, the Insight phantom is found to be more feasible for routine QA with easy setup.

Patient-Specific Pre-Treatment VMAT Plan Verification Using Gamma Passing Rates

Continuous gantry motion, continuous beam modulation, and variable dose rate are used in volumetric modulated arc therapy (VMAT) to obtain highly conformal radiation therapy dose distributions. Several errors during daily radiation therapy treatment can be sources of uncertainties in dose delivery. These errors include monitor unit calculation errors and other human mistakes. Due to the uncertainties in the excessively modulated VMAT plan, the intended dose distribution is not delivered perfectly, leading to a mismatch between the measured and planned dose distributions. This necessitates an extensive and effective quality assurance (QA) program for both machine and patient. In this study, VMAT QA plan verification of 62 head and neck (HN) and 19 prostate cases was done using Octavius 4D setup with its associating VeriSoft gamma analysis software. The plans showed a maximum 3D gamma passing rate with 4 mm/3 % gamma acceptance criteria, i.e., 99.7 % for the HN cancer cases and 99.5 % for the prostate cancer cases. Local gamma analysis was also performed for both regions. Furthermore, 2D and volumetric gamma analyses were also carried out. Gamma analysis with respect to different axis was also carried out. It was known that the transversal axis showed the highest gamma passing rate in both HN and prostate cases, i.e., 99.17 % and 98.3 %, respectively. The transverse axis came to be a better fit for the planned dose distribution.

EVOLVING ACADEMIC CULTURE IN THE NEW NORMAL: DIRECTION TOWARDS QUALITY MANAGEMENT, EFFECTIVENESS OF POLICY IMPLEMENTATION, AND CURRICULUM ADAPTATION IN HIGHER EDUCATION INSTITUTIONS (HEIS)

The new normal poses a challenge to the academic culture, management, and existing policies of higher education institutions. The new normal calls for the creation and implementation of a “new normal educational policy” to ensure continued quality education despite lockdowns, community quarantine, and compliance with minimum health protocols. This study aimed to determine and analyse the factors affecting the higher education institutions’ culture, management, and policies. Specifically, it analysed the effect of total quality management and the institution’s culture on the quality assurance program. To test the hypothesis that the effectiveness of quality assurance program factors is significantly related to the level of implementation of total quality management and the level of the institution’s culture, an online survey was distributed to administrators, personnel, teachers, and students of the four (4) campuses of Laguna State Polytechnic University. The results presented that the Total Quality Management and institution’s culture is significantly related to the perception of the Quality Assurance Program effectiveness. The result shows that the schools have yet to reach a high level of quality assurance program. Relative to this, the educational institution’s Total Quality Management, as well as the school culture, must be improved in order to effect a positive change toward the creation of plans and initiatives for the implementation of an effective Quality Assurance Program.

Identifying risk characteristics using failure mode and effect analysis for risk management in online magnetic resonance-guided adaptive radiation therapy.

Online magnetic resonance-guided adaptive radiotherapy (MRgART) is a new technology of radiotherapy and requires a new quality control program in many aspects. This study aimed to gain a deeper understanding of risks in online MRgART through the application of failure mode and effect analysis (FMEA) for more enhanced and effective quality assurance (QA) programs. We present an FMEA conducted by a multidisciplinary team with more than two years of experience. A process map describing the whole process of online MRgART was developed and potential failure modes were identified. High-risk failure modes and their potential causes and corrective measures were also identified. Failure modes were classified into three categories, MRgRT, online ART, and conventional RT, to investigate their features. A comparison with previous studies was also conducted to gain a general perspective. In total, 153 failure modes and 49 high risks were identified. Among all failure modes, 51, 63, and 66 were related to MRgRT, online ART, and conventional RT, respectively. The hazardous processes were structure segmentation, treatment planning, and treatment beam delivery. Lists of failure modes identified in this study and previous studies were presented. Based on the results, characteristics and general aspects of the risks were discussed. Exploring the results of the FMEA enhanced our understanding of risk characteristics to improve QA program of online MRgART.

Implementing an Effective Quality Assurance Program to Improve Hospital Clinical Outcomes

Implementing an Effective Quality Assurance Program to Improve Hospital Clinical Outcomes

Overcoming Obstacles in Designing and Sustaining a High-Quality Cardiovascular Procedure Environment.

Accurate evaluation of the quality of invasive cardiology procedures requires appraisal of case selection, technical performance, and procedural and clinical outcomes. Regrettably, the medical care delivery system poses a number of obstacles to developing and sustaining a high-quality environment. The purposes of this viewpoint are to summarize the most common impediments, followed to summarize the most common impediments, followed by the optimal ways to design and sustain a quality assurance program to overcome these barriers. A 7-step program to create and implement an effective quality assurance program is outlined.

Chemical and Microbiological Hazards of Dried Fishes in Bangladesh: A Food Safety Concern

Food safety along with nutrition is an important issue in the present word. Only nutritionally safe food can ensure a healthy balanced diet to consumers. Dried fish is a popular processed fishery product not only in our country, but also in many countries of the world. It is a very good source of dietary protein, lipid and minerals necessary for a healthy body. The consumers of dried fish in national and international level are losing their interest to buy dried fish due to poor quality and safety of the products. Therefore, we reviewed the state of knowledge regarding the contamination level of dried fish by heavy metals, harmful pesticides, amount of lipid oxidation, and microbial quantity and quality from several districts in Bangladesh. The data reviewed in this article revealed that several dried fishes contaminated with excess amount of heavy metals (Pb, Cd, Cr etc.), pesticide residue (dichlorodiphenyltrichloroethane, heptachlor, endrin, aldrin, dieldrin), higher degree of lipid oxidation, excess amount of total plate count and presence of highly pathogenic E. coli, Salmonella sp. Vibrio sp. were found in few dried fish that may cause substantial human health hazard after consumption. The possible factors of these hazards are traditional drying, use of illegal pesticides with higher dose, lack of maintaining proper hygiene, sanitation, packaging, storage, distribution as well as water pollution. These findings will be helpful to develop an effective quality control and assurance program for producing safe dried fishery products for domestic consumption as well as earning foreign currency.

Medication Administration Errors: Perceptions of Jordanian Nurses.

Medication administration errors (MAEs) have short- and long-term implications on patients' health as well as on hospitals' accreditation and financial status. The purpose was to explore Jordanian nurses' perceptions about MAEs. A cross-sectional design was used with a convenience sample of 470 nurses. The most common types of MAEs were wrong time (32.6%) and wrong patient (30.5%). In addition, night shifts accounted for 42.9% of MAEs; the factor that contributed the most to MAEs was workload. Developing effective quality assurance programs in relation to medications and medication administration in all Jordanian health care settings is vital to ensure patient safety. Nursing educators in clinical and academic settings need to reinforce the importance of medication rights as well as medication calculation. A distraction-free zone should be created and reinforced in all medication rooms.

AAPM Medical Physics Practice Guideline 8.a.: Linear accelerator performance tests.

PurposeThe purpose of this guideline is to provide a list of critical performance tests in order to assist the Qualified Medical Physicist (QMP) in establishing and maintaining a safe and effective quality assurance (QA) program. The performance tests on a linear accelerator (linac) should be selected to fit the clinical patterns of use of the accelerator and care should be given to perform tests which are relevant to detecting errors related to the specific use of the accelerator.MethodsA risk assessment was performed on tests from current task group reports on linac QA to highlight those tests that are most effective at maintaining safety and quality for the patient. Recommendations are made on the acquisition of reference or baseline data, the establishment of machine isocenter on a routine basis, basing performance tests on clinical use of the linac, working with vendors to establish QA tests and performing tests after maintenance.ResultsThe recommended tests proposed in this guideline were chosen based on the results from the risk analysis and the consensus of the guideline's committee. The tests are grouped together by class of test (e.g., dosimetry, mechanical, etc.) and clinical parameter tested. Implementation notes are included for each test so that the QMP can understand the overall goal of each test.ConclusionThis guideline will assist the QMP in developing a comprehensive QA program for linacs in the external beam radiation therapy setting. The committee sought to prioritize tests by their implication on quality and patient safety. The QMP is ultimately responsible for implementing appropriate tests. In the spirit of the report from American Association of Physicists in Medicine Task Group 100, individual institutions are encouraged to analyze the risks involved in their own clinical practice and determine which performance tests are relevant in their own radiotherapy clinics.

Quality Control Measures over 30 Years in a Multicenter Clinical Study: Results from the Diabetes Control and Complications Trial / Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study.

Implementation of multicenter and/or longitudinal studies requires an effective quality assurance program to identify trends, data inconsistencies and process variability of results over time. The Diabetes Control and Complications Trial (DCCT) and the follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study represent over 30 years of data collection among a cohort of participants across 27 clinical centers. The quality assurance plan is overseen by the Data Coordinating Center and is implemented across the clinical centers and central reading units. Each central unit incorporates specific DCCT/EDIC quality monitoring activities into their routine quality assurance plan. The results are reviewed by a data quality assurance committee whose function is to identify variances in quality that may impact study results from the central units as well as within and across clinical centers, and to recommend implementation of corrective procedures when necessary. Over the 30-year period, changes to the methods, equipment, or clinical procedures have been required to keep procedures current and ensure continued collection of scientifically valid and clinically relevant results. Pilot testing to compare historic processes with contemporary alternatives is performed and comparability is validated prior to incorporation of new procedures into the study. Details of the quality assurance plan across and within the clinical and central reading units are described, and quality outcomes for core measures analyzed by the central reading units (e.g. biochemical samples, fundus photographs, ECGs) are presented.

ASCO research program quality assessment tool: Basics for a quality community-based research site.

97 Background: In 2008, ASCO published a statement to identify minimum standards and exemplary attributes of clinical trial sites. Recommendations were made to assist with the development and implementation of high-quality research programs. Based on feedback from an ASCO needs assessment survey, ASCO’s Community Research Forum (CRF) sought to develop a tool to help community-based research sites exceed the minimum standards of conducting clinical research, and to identify important components for an internal quality assurance program. Methods: A tool was developed to incorporate elements of ASCO publications on minimal standards and exemplary attributes of research sites. The tool was designed to assist community-based research sites with the development and implementation of an internal quality assurance program. A checklist was also developed to help sites easily conduct an assessment of their program. Community-based researchers provided feedback on the tool’s content and utilization. Feedback was incorporated and the tool was released for widespread use in March 2014. Results: The tool was very well received by reviewers. All reviewers indicated that the level of detail of the tool was sufficient; 94% indicated that it presented realistic expectations, in terms of resources required to implement; and 81% indicated that it would be valuable for conducting a quality assessment of their research program. As of July 2014, the tool was downloaded by over 150 practices from 8 different countries and early feedback continued to be favorable, particularly from small and/or new research programs. Conclusions: Many community-based research programs do not have the resources to support an effective quality assurance program and rely heavily on external audits. The ASCO Research Program Quality Assessment Tool provides self-directed continual process improvement to help community-based research sites create an internal quality assurance program and exceed minimum standards of conducting clinical research. The CRF will learn more from users of the tool about the quality of research programs and processes, and key quality metrics. The tool is available for download at www.asco.org/communityresearchforum.

Clinical Interpretation Standards and Quality Assurance for the Multicenter PET/CT Trial Rubidium-ARMI

Rubidium-ARMI ((82)Rb as an Alternative Radiopharmaceutical for Myocardial Imaging) is a multicenter trial to evaluate the accuracy, outcomes, and cost-effectiveness of low-dose (82)Rb perfusion imaging using 3-dimensional (3D) PET/CT technology. Standardized imaging protocols are essential to ensure consistent interpretation. Cardiac phantom qualifying scans were obtained at 7 recruiting centers. Low-dose (10 MBq/kg) rest and pharmacologic stress (82)Rb PET scans were obtained in 25 patients at each site. Summed stress scores, summed rest scores, and summed difference scores (SSS, SRS, and SDS [respectively] = SSS-SRS) were evaluated using 17-segment visual interpretation with a discretized color map. All scans were coread at the core lab (University of Ottawa Heart Institute) to assess agreement of scoring, clinical diagnosis, and image quality. Scoring differences greater than 3 underwent a third review to improve consensus. Scoring agreement was evaluated with intraclass correlation coefficient (ICC-r), concordance of clinical interpretation, and image quality using κ coefficient and percentage agreement. Patient (99m)Tc and (201)Tl SPECT scans (n = 25) from 2 centers were analyzed similarly for comparison to (82)Rb. Qualifying scores of SSS = 2, SDS = 2, were achieved uniformly at all imaging sites on 9 different 3D PET/CT scanners. Patient scores showed good agreement between core and recruiting sites: ICC-r = 0.92, 0.77 for SSS, SDS. Eighty-five and eighty-seven percent of SSS and SDS scores, respectively, had site-core differences of 3 or less. After consensus review, scoring agreement improved to ICC-r = 0.97, 0.96 for SSS, SDS (P < 0.05). The agreement of normal versus abnormal (SSS ≥ 4) and nonischemic versus ischemic (SDS ≥ 2) studies was excellent: ICC-r = 0.90 and 0.88. Overall interpretation showed excellent agreement, with a κ = 0.94. Image quality was perceived differently by the site versus core reviewers (90% vs. 76% good or better; P < 0.05). By comparison, scoring agreement of the SPECT scans was ICC-r = 0.82, 0.72 for SSS, SDS. Seventy-six and eighty-eight percent of SSS and SDS scores, respectively, had site-core differences of 3 or less. Consensus review again improved scoring agreement to ICC-r = 0.97, 0.90 for SSS, SDS (P < 0.05). (82)Rb myocardial perfusion imaging protocols were implemented with highly repeatable interpretation in centers using 3D PET/CT technology, through an effective standardization and quality assurance program. Site scoring of (82)Rb PET myocardial perfusion imaging scans was found to be in good agreement with core lab standards, suggesting that the data from these centers may be combined for analysis of the rubidium-ARMI endpoints.

Quality assurance and quality control in mammography: a review of available guidance worldwide

ObjectivesReview available guidance for quality assurance (QA) in mammography and discuss its contribution to harmonise practices worldwide.MethodsLiterature search was performed on different sources to identify guidance documents for QA in mammography available worldwide in international bodies, healthcare providers, professional/scientific associations. The guidance documents identified were reviewed and a selection was compared for type of guidance (clinical/technical), technology and proposed QA methodologies focusing on dose and image quality (IQ) performance assessment.ResultsFourteen protocols (targeted at conventional and digital mammography) were reviewed. All included recommendations for testing acquisition, processing and display systems associated with mammographic equipment. All guidance reviewed highlighted the importance of dose assessment and testing the Automatic Exposure Control (AEC) system. Recommended tests for assessment of IQ showed variations in the proposed methodologies. Recommended testing focused on assessment of low-contrast detection, spatial resolution and noise. QC of image display is recommended following the American Association of Physicists in Medicine guidelines.ConclusionsThe existing QA guidance for mammography is derived from key documents (American College of Radiology and European Union guidelines) and proposes similar tests despite the variations in detail and methodologies. Studies reported on QA data should provide detail on experimental technique to allow robust data comparison. Countries aiming to implement a mammography/QA program may select/prioritise the tests depending on available technology and resources.Main messages•An effective QA program should be practical to implement in a clinical setting.•QA should address the various stages of the imaging chain: acquisition, processing and display.•AEC system QC testing is simple to implement and provides information on equipment performance.

Innovative staffing in emergency departments: the role of midlevel providers

NPs and PAs are increasingly common in US and Canadian EDs. Emergency medicine is a unique specialty with a vast knowledge base performed in a high-risk environment; therefore, supervisory models and regulatory requirements developed for lower-risk settings (e.g., primary care) and more circumscribed practices (e.g., diabetes clinic) are unlikely to be sufficient for EDs. As innovative ED staffing models evolve, specific roles and scopes of practice for midlevel providers should be based on an objective analysis of existing care gaps and system needs, local provider availability, operational efficiency, cost-effectiveness, regulatory compliance, risk management, and quality of care. Although it is tempting to reduce cost by using PAs or NPs, de-emphasis of emergency physician involvement should proceed cautiously to avoid negatively impacting patient care. Variability in midlevel provider use and the relative paucity of evidence describing optimal provider roles, scopes of practice, and care outcomes in different patient populations highlight the need for a measured approach, appropriate supervisory models, effective quality assurance programs, and cost-effectiveness analyses looking at both clinical and economic outcomes of this important health system evolution.

SU‐C‐BRCD‐04: Development of An Efficient and Effective Patient Specific QA Program for IMPT

Purpose: Intensity modulated proton therapy (IMPT) patient specific quality assurance (QA) program based on measurement alone could be very time consuming due to highly modulated dose distributions of IMPT fields. In this work, we present our efforts for developing an efficient and effective patient specific QA program for IMPT. Methods: The improved QA program, based on a previously reported one for single field uniform dose (SFUD), consists of three components: measurements, independent dose calculation and analysis of patient specific treatment delivery log files. Measurements included two‐dimensional (2D) measurements for each field delivered at the planned gantry angles with electronic medical record (EMR) system in the QA mode and the accelerator control system (ACS) in the treatment mode and additional depths for each field with ACS in physics mode without using the EMR. Dose distributions in a water phantom for each field were calculated independently using a recently developed in‐ house pencil beam algorithm and compared with the results of TPS. The treatment log file for each field was analyzed in terms of deviations in delivered spot positions from their planned positions using various statistic analysis methods. Results: With the improved patient specific QA program, we are able to verify (1) the dose calculation of TPS, (2) integrity of the data transfer from TPS to EMR to ACS and (3) treatment delivery including dose delivered and spot positions. We estimated that the in‐room measurement time required for each complex IMPT patient like head and neck patients would be less than 2 h. Conclusions: We have developed an efficient and effective QA program for IMPT patients with the equipment and resources available in our clinic.

Assessment of patient doses during mammography practice at Kenyatta National Hospital

Background Breast cancer constitutes 21% of all cancer cases and ranks third according to cancer type in Kenya. Mammography therefore remains a powerful radiographic imaging technique for detecting and managing breast cancer. However, the active and radiosensitive glandular tissue calls for the need of an effective quality assurance program. Materials and Methods A questionnaire method was developed and used in recording the displayed patient dose, compressed breast thickness and exposure factors. The average glandular dose, device performance, and film quality grading were also carried out. Results There were 3264 films taken from 1252 women between 25 to 90 years old. The AGD per film was 2.14 (range 0.27-9.43) mGy for the cranio-caudal (CC) projection and 2.44 (range 0.20-10.12) mGy for the medio-lateral oblique (MLO) projection. In this study 17% of CC and 30% of MLO films recorded doses above the 3 mGy American College of Radiology using grid diagnostic reference level. Conclusion In view of the diagnostic dose finding of this study, the variation of mammography imaging techniques revealed the need for imaging guidelines, quality assurance and optimization of mammography practice in Kenya.

Medico-legal aspects and concerns in quality assurance in the United States

Quality assurance data - essential to successful efforts to improve the quality and efficiency of healthcare - is more important than ever in today's environment. Robust quality assurance activities are required to achieve the accreditation necessary to obtain Medicare reimbursement and for participation in the Accountable Care Organization shared savings programs proposed by the Centers for Medicare and Medicaid Services ("CMS"). The federal government and US states require reporting of quality assurance data to a variety of independent and governmental agencies. Commercial insurance carriers and innovative employers are developing new reimbursement models that require demonstrable achievement of quality performance standards based on quality performance data. Such data can consist of both aggregate performance information and individualized outcomes. This chapter reviews the potential vulnerabilities of quality assurance programs and data and the legal concerns related to disclosure of the information. Available legal protections and some effective strategies for protecting that information are also discussed. This information will enable providers to develop effective quality assurance programs structured to maximize opportunities to protect the confidentiality of the data.

Poster — Wed Eve—30: Routine QA and Re‐Commissioning of Linacs, TomoTherapy, and Treatment Planning Systems with MapCHECK™

Recent developments in radiation delivery and treatment planning systems require more complicated quality assurance (QA) procedures. There are various QA test tools and specialized equipment for performing linear accelerator (Linac) and treatment delivery QA tests. However in order to have an effective QA program and ensure execution of the program, QA procedures should be simple and yet tailored so that each procedure checks as many facets as possible, while keeping the operating cost reasonable. At our center we use a 2D detector array, MapCHECK™ from SUN NUCLEAR Corporation, not only for its intended filmless IMRT QA but also for routine Linac and TomoTherapy machine QA as well as QA and commissioning of radiation treatment planning system. Using MapCHECK™ has improved our QA program feasibility and accuracy and has brought us one step closer to a paperless QA program.

SU‐FF‐T‐472: Quality Assurance for MR Guided Focused Ultrasound as a Multi‐Modality Platform for Cancer Therapy

Purpose: The purpose of this work is to develop an effective and efficient quality assurance (QA) program for the application of MR guided focused ultrasound (MRgFUS) as a multi‐modality platform for cancer therapy. Materials and Method: An MRgFUS system has been installed in our institution, which consists of an InSightec ExAblate 2000 high‐intensity focused ultrasound (HIFU) system and a 1.5T GE MR scanner. This system has been FDA approved for the treatment of uterine fibroids clinically and is being investigated under local IRB approval for treating bone metastases, prostate and breast cancers and the enhancement of drug delivery for gene therapy and chemotherapy. In addition to the daily, monthly and annual calibration and commissioning measurements for the MRI unit special QA procedures were developed for the HIFU system including the mechanical motion of the couch and transducer, the safety system and patient panic buttons, the functionality of the temperature mapping and treatment software, the acoustic power output and the localization of the treatment focal spot. Results: The MRgFUS system has been operational since the fall of 2006. Successful experiments have been performed on in vitro bio‐samples and in vivo animal models for pre‐clinical studies and for drug enhancement experiments. Patients with bone metastases have been treated successfully using the MRgFUS system for pain relief with a pre‐treatment QA procedure. Patients tolerated the HIFU treatment well. No skin damage was observed after treatment. The pain scale was significantly reduced within 24 hours and further reduced at later follow‐ups. Conclusions: Comprehensive QA procedures have been developed for the safe and successful operation of the MRgFUS system as a multi‐modality platform for breast surgery, bone palliation, and prostate boost in combination with radiotherapy clinically and for drug delivery enhancement investigations for gene therapy and chemotherapy using animal models.