QA Guidelines Research Articles

Quality assurance of magnetic resonance imaging for a polymer gel dosimeter using a 3D-printed phantom

PurposeQuality assurance (QA) of magnetic resonance imaging (MRI) for gel dosimetry using an in-house phantom was established to ensure consistent dosimetric performance. MethodsA normoxic N-vinylpyrrolidone-based gel dosimeter sensitized with an inorganic salt was used. Each individual gel dosimeter, in addition to a specially designed image QA phantom, was imaged at three institutions with different MRI systems. ResultsBoth the gel dosimeter and QA phantom had linear dose–response curves at all institutions, with correlation coefficients = 1.00 and ≥ 0.99, respectively. Minor inter-institutional variations in the sensitivity (gel dosimeter, 0.096 ± 0.010 s−1Gy−1; QA phantom, 0.140 ± 0.003 s−1Gy−1) and offset value (gel dosimeter, 2.188 ± 0.222 s−1; QA phantom, 3.318 ± 0.081 s−1) were found. Dose uncertainties for the gel dosimeter ranged from 3.2% to 3.5% at 10 Gy and 1.7%–2.1% at 20 Gy, and these were comparable with the corresponding QA phantom uncertainties. Dose resolutions were 0.8–1.2 Gy for the gel dosimeter and 0.6–1.4 Gy for the QA phantom. Uniformity factors were ≥98% at all institutions. Spatial linearity had a geometric distortion ≤1.0%, Gamma passing rates of 95%–100% met recommended QA guidelines; strong correlations between the QA phantom and gel dosimeter were also obtained for each of these measures. ConclusionOur study demonstrates the viability of applying MRI acquisition parameters validated using a QA phantom to polymer gel dosimetry across diverse MRI systems. This approach enables robust QA measures, focusing on effective management of uniformity and dose uncertainty.

Application of the ESHO-QA guidelines for determining the performance of the LCA superficial hyperthermia heating system

Purpose This study aimed to assess the quality of the lucite cone applicator (LCA), the standard applicator for superficial hyperthermia at the Erasmus MC Cancer Institute, using the most recent quality assurance guidelines, thus verifying their feasibility. Materials and methods The assessment was conducted on each of the six LCAs available for clinical treatments. The temperature distribution was evaluated using an infrared camera across different layers of a fat-muscle mimicking phantom. The maximum temperature increase, thermal effective penetration depth (TEPD), and thermal effective field size (TEFS) were used as quality metrics. The experimental results were validated through comparison with simulated results, using a canonical phantom model and a realistic phantom model segmented from CT imaging. Results A maximum temperature increase above 6 °C at 2 cm depth in the fat-muscle phantom for all the experiments was found. A mean negative difference between simulated and experimental data was of 1.3 °C when using the canonical phantom model. This value decreased to a mean negative difference of 0.4 °C when using the realistic model. Simulated and measured TEPD showed good agreement for both in silico scenarios, while discrepancies were present for TEFS. Conclusions The LCAs passed all QA guidelines requirements for superficial hyperthermia delivery when used singularly or in an array configuration. A further characterization of parameters such as antenna efficiency and heat transfer coefficients would be beneficial for translating experimental results to simulated values. Implementing the QA guidelines was time-consuming and demanding, requiring careful preparation and correct setup of antenna elements.

PB.21. Is the technical quality of screening mammograms lower in Asian women who cannot understand the English language?

Good patient and radiographer communication is vital for good quality mammograms. Many Asian women 47 to 73 years old cannot understand English. The Radiographers QA Guidelines categorise mammographic images as Perfect, Good, Moderate and Inadequate (PGMI). The standards required are 75% PG, 97% PGM and <3% I (inadequate).

A national strategy for quality and safety in radiotherapy: A comprehensive quality improvement approach.

148 Background: Canada utilizes a public payer, private health care delivery model, delegated sub-nationally. Effective coordination of uniform access to safe, high quality care can be challenging in this and similar international models. Quality improvement in radiotherapy (RT) involves approximately 50% of all cancer patients who will require RT during their illness. The Canadian Partnership for Quality Radiotherapy (CPQR) is a national quality improvement approach employing pan-Canadian engagement of a multi-disciplinary group of physicians, allied health professionals, administrators and patients. The objectives are to create a national culture of safe, high quality RT delivery for all patients; develop and implement a comprehensive sustainable national program for safe, high quality RT. Methods: All CPQR QA products/programs are processed using standard methodology of review and validation through community consultation, and endorsed by national stakeholders. QA products are incorporated into national QA guidelines and indicators for RT programs, technical equipment and patient experiences; integrating these into a national accreditation program; developing a national RT incident reporting and learning system. Active dissemination strategies use bottom-up and top-down approaches. Results: The national RT programmatic QA guidelines and key quality indicators were released in 2011 and 2013, with 3849 downloads. Approximately 50% of Canadian RT centres indicated implementing CPQR guidelines and changing local QA practices. 9 equipment QA guidelines were developed and validated, 6 are in development. National monitoring and learning structures are being developed through an accreditation program and incident reporting repository to be operated by national organizations for sustainability. Knowledge exchange activities included 26 presentations and 10 national/international invited discussions. A national systematic evaluation process will be executed shortly. Conclusions: CPQR’s national RT QA development and implementation approach is a successful model that can be adopted in other areas of healthcare considering system improvement.

Peer review in radiotherapy (RT): A national quality improvement initiative.

221 Background: Peer review (PR) in Radiation Oncology has been shown to be effective in improving quality of treatment by detecting and correcting deficiencies in proposed treatment plans prior to treatment. PR is also effective in: guiding departmental treatment planning policies and processes; reducing variation in practice; providing a venue for multi-disciplinary communication, and increasing staff and trainee awareness of evolving treatment processes. The importance of PR is reflected in the inclusion of 3 PR-specific quality indicators in the Canadian Partnership for Quality Radiotherapy QA Guidelines for Radiation Oncology programs. Given this endorsement, we aim to enhance PR implementation across all Canadian cancer centres using a knowledge-translation and implementation framework. Methods: This project will facilitate increased uptake of PR in Canadian RT programs by implementing the top-down model used with success in Ontario. This model has several key components, including: a) engaging the leadership of provincial cancer agencies to promote PR at every Provincial cancer centre; b) providing modest financial support for the acquisition of the required hardware and/or staff time for coordinating PR activities; c) systematic collection of each centre’s baseline PR activities, perceived barriers and potential facilitators of PR at each centre; d) creation of a continuous quality improvement cycle by monitoring PR quality indicators over time; e) systematic knowledge and information sharing regarding effective PR processes. Results: Funding for this initiative was obtained from the Canadian Partnership against Cancer (CPAC) in April 2014. A steering committee consisting of stakeholders from across Canada has been struck and provincial launches, based on the tenets used in Ontario, have commenced in 7 of 13 provinces with others expressing interest. A national survey to obtain baseline data relating to PR activities, perceived barriers, and facilitators is underway and will be reported. Conclusions: Preliminary evidence suggests a “snowball effect” of increasing PR uptake across Canada. The implementation model could be applied in other jurisdictions interested in increasing PR in radiation oncology.

Quality assurance - A special issue.

Welcome to this Special Issue on Ultrasound Quality Assurance. For many working in the field of medical ultrasound, it seems that quality assurance is not so much a special issue, but more a Cinderella subject. As you can read over the page, in the Guest Editorial by the BMUS QA Working Party, quality assurance, at least as applied to performance monitoring of ultrasound imaging systems, is not practised universally or to the same level in all ultrasound departments. This may be because there is no explicit legal requirement to carry out such work or because there is no perceived risk incurred by not doing it. The BMUS QA Working Party has put together their recommended approach and methodologies for monitoring the performance of ultrasound imaging systems. These recommendations, which have been approved by BMUS Council, are directed at ultrasound system users and constitute minimum standards, which should be maintained in any department. The new BMUS QA Guidelines form the key article in this special issue and describe maintenance and testing protocols, which can be carried out by users with minimal training and no special equipment, such as test objects. Quality assurance tests based on the visual assessment of test object images are often criticised for being subjective, insensitive and not repeatable. Several articles in this special issue demonstrate that when quantitative methods are applied to such testing, subtle changes in imaging performance can be detected. In two articles by Dudley and Gibson, it is shown that automated analysis of test object images can detect small changes in performance due to transducer faults or changes in system settings. Quinn and Verma show that quantitative analysis of the in-air reverberation pattern from the transducer can detect changes in system sensitivity and reduce observer variability. A review article by Moran et al. describes the use of the Edinburgh Pipe Phantom. This quantitative method is used to derive figures of merit related to ultrasound beam quality, including the Resolution Integral. The system has been used to assess many ultrasound imaging systems and demonstrate differences in beams for different applications and show how beam quality has improved with developments in technology. The system can also demonstrate deterioration in the beam quality due to transducer damage. But there is more to monitoring the overall quality of an ultrasound imaging service than testing machine performance and the intention of this special issue is to include other elements that affect service quality. Perhaps one of the most variable components in the chain is the human one, one that can be difficult to assess and control. Cantin and Knapp describe a peer audit of the diagnostic quality of gynaecological ultrasound images produced within their department, using various outcome measures. Lower scores for diagnostic quality were associated with more difficult studies. In many medical professions, the training and competence of the workforce are controlled by statutory registration. However, in the UK, there is no statutory register of sonographers and the title of sonographer is not yet protected. As described by Thompson and Paterson in their review of the current status of sonographer registration in the UK, those working in sonography must rely on registration under an alternative title, but can join a voluntary register. But even the most competent scans, using the highest quality imaging system, will fail to help the patient if the results are not communicated effectively back to the referrer. Edwards et al. give us some guidance on what makes a good ultrasound report. The provision of high quality ultrasound imaging services is supported by good overall governance of equipment and people within a hospital trust. Verma and Peacock and Russell give us their respective views of how this is done in Sheffield and Manchester. And finally, Jacinta Browne contributes the third and final instalment of her series on getting started with research. Sadly, I have to report that Jacinta wishes to stand down as Deputy Editor of Ultrasound and I would like to thank her for her outstanding hard work and many great contributions to the journal over the last three years. I do hope that by the time this issue is delivered, one of our readers will have volunteered to take her place.

연구개발 품질보증 적용유형 분석 및 핵심 연구품질요소 도출

Purpose: This study aims to analyze general types of R&D Quality Assurance(R&D QA) and to identify key quality elements for R&D QA. R&D QA is defined as all the planned and systematic actions to verify whether R&D processes are conducted in a proper manner and the results of R&D fully satisfy customers' requirements. Methods: The existing R&D QA guidelines and the some cases were reviewed. From the review, three general types are analyzed and thirteen key quality elements are identified. Then, the survey on the eighteen domestic experts has been conducted for prioritization of the identified elements. Results: As the result of this study, three types for R&D QA based on quality elements, standard process, and final evaluation are analyzed. Related to the first type, thirteen quality elements, e.g., administrative plan, project plan, process management and so on, are identified and prioritized. Conclusion: This study contributes to develop the baseline for R&D QA including the types and the key quality elements. It may be helpful for the institute that has an interest adopting R&D QA.

SU-E-T-535: Analysis of Results from an Anthropomorphic Stereotactic Radiosurgery Phantom

Purpose: To analyze 634 irradiations of the stereotactic radiosurgery(SRS) anthropomorphic phantom. Method and Materials:The anthropomorphic SRS head phantom consists of a water‐fillable head shaped plastic shell that has been altered to accept imaging and dosimetry inserts. The water‐fillable imaging insert houses a 1.9 cm diameter nylon sphere that allows localization with either CT or MRI. The dosimetry insert houses TLD and radiochromic film. Institutions imaged, planned and treated the phantom. Plans were designed to deliver 30 Gy to the center of the target that was covered by an isodose line typically between 50% and 85%. The treated volume, assumed to be an ellipsoid defined by the prescription dose, was calculated from film profiles and compared to distances reported by the institution. Results: Between 2000 and 2010, 125 of the irradiations were performed with Gamma Knife and 509 were performed with linear accelerators. Most of these irradiations were performed as a method of independent verification of treatment delivery. Gamma Knife TLD and treatment volume results were on average 0.98±0.03 and 1.09±0.11, respectively. Linear acceleratorTLD and treatment volume results were on average 1.00±0.03 and 1.04±0.15, respectively. The percentage of institutions, using accelerators, meeting the QA guidelines for dose to the target, treated volume, ratio of measured treated volume to target volume and minimum dose to target were 93%, 90%, 80%, and 80%, respectively. For Gamma Knifes the corresponding percentages were 91%, 98%, 88%, and 49%. The percent of institutions meeting all four criteria were 54% and 39% for accelerators and Gamma Knife, respectively. Conclusion: Though most SRS phantom irradiations met several of the individual criteria, only 50% met all four. Failure to plan adequate target coverage and/or deliver adequate target coverage contributed to the low percentages for minimum dose to target compliance. Work was supported by PHS grants CA10953 and CA81647 awarded by the NCI, DHHS.

Quality assurance considerations in chemical analysis

AbstractQuality Assurance (QA) for an analytical laboratory is an essential tool to ensure good comparability of data. In order to achieve this purpose, processes are monitored and performance problems are systematically solved. A variety of texts exists such as Good Laboratory Practice and the Quality Assurance Systems ISO 9001 and ISO 17025. However, these international standards provide only general rules to install and maintain a quality system. It remains the responsibility of the laboratory to define appropriate procedures to ensure that proper quality is achieved. Adherence to QA guidelines, participation in inter‐laboratory studies, use of reference materials (RM) and certified reference materials (CRM) are all means of achieving good data quality for determinations. Copyright © 2009 John Wiley &amp; Sons, Ltd.

MO‐SAMS‐AUD B‐02: Stereotactic Body Radiation Therapy (SBRT) II: Physics and Dosimetry Considerations

SBRT of well defined extracranial targets in various anatomical locations demands special treatment planning considerations due to limitations of dose calculation algorithms in heterogeneous medium and small field dosimetry coupled with tumor/organ motion and multiple radiobiological constraints. Unlike conventional intracranial radiosurgery, SBRT treatment planning and delivery are confounded by reduced 3D physical space for beam placement due to possibility of treatment machine and patient collision as well as a multiplicity of surrounding serial and parallel architecture organs. Currently advanced treatment planning techniques with radiobiological considerations and precise image‐guided treatment delivery methods are practiced for SBRT delivery to a wide variety of tumor types.The physics and dosimetry presentation will include an overview of the available technology for SBRT with an emphasis on image guidance, Quality Assurance, and clinical implementation of SBRT. The presentation will also include site specific treatment planning techniques with considerations to accuracy of dose calculation algorithms, radiobiological issues, and physics reporting strategies.Educational Objectives:1. Understand the issues related to the clinical implementation and technical aspects of SBRT techniques and technology and become familiar with the preliminary reporting of AAPM Task Group 101.2. Understand the importance of QA procedures and guidelines and reporting requirements for SBRT.3. Understand the practical aspects of SBRT treatment planning for paraspinal, lung, liver, and abdominal tumors and recognize the critical issues related to each site.4. Understand the importance and limitations of dose calculation algorithms and heterogeneity correction methods for SBRT in various anatomical sites.

Developing Quality Assurance Processes for Image-Guided Adaptive Radiation Therapy

Quality assurance has long been implemented in radiation treatment as systematic actions necessary to provide adequate confidence that the radiation oncology service will satisfy the given requirements for quality care. The existing reports from the American Association of Physicists in Medicine Task Groups 40 and 53 have provided highly detailed QA guidelines for conventional radiotherapy and treatment planning. However, advanced treatment processes recently developed with emerging high technology have introduced new QA requirements that have not been addressed previously in the conventional QA program. Therefore, it is necessary to expand the existing QA guidelines to also include new considerations. Image-guided adaptive radiation therapy (IGART) is a closed-loop treatment process that is designed to include the individual treatment information, such as patient-specific anatomic variation and delivered dose assessed during the therapy course in treatment evaluation and planning optimization. Clinical implementation of IGART requires high levels of automation in image acquisition, registration, segmentation, treatment dose construction, and adaptive planning optimization, which brings new challenges to the conventional QA program. In this article, clinical QA procedures for IGART are outlined. The discussion focuses on the dynamic or four-dimensional aspects of the IGART process, avoiding overlap with conventional QA guidelines.

SU‐FF‐T‐200: Establishment of Japanese QA Booklet in Permanent Prostate Implant Brachytherapy

Purpose: I‐125 permanent implant brachytherapy for prostate cancer was approved in Japan in 2003, and is now offered by an increasing number of hospitals. Although existing QA guidelines (AAPM or ESTRO) in this therapy are well documented, many Japanese hospitals required more detail procedures, because of the shortage of medical physicists. In addition, it is important to supply reliability on clinical evidence in the future clinical trial in Japan. The purpose of this study is to establish new Japanese QA booklet which dedicates clinical practice. Materials and Methods: We first investigated several brachytherapy QA guidelines in western countries including AAPM reports or ESTRO booklet. Then we confirmed the procedures one by one by performing QA in our hospitals and made the resulting problems clear. After that, we determined QA items. To support QA, we developed the software for commissioning of brachytherapy treatment planning system (TPS). Results: The feature of this booklet is that (1) Much easier to understand by using many figures or examples. (2) For QA which requires expert knowledge including point dose calculation check in the commissioning of TPS, we developed software to support users. (3) The QA items were classified into two categories. Namely, category ‘Must’ indicates a recommendation that is necessary to be executed at least as a prevention of accidents, and category ‘Recommend’ indicates an advisory recommendation to keep quality of implant. (4) Items of acceptance testing and the detail procedures were described in detail to promote vendor acceptance test in the Japanese agencies. (5) Each sentence 2447_2was itemized so that users can easily read and understand. Conclusion: We established very practical Japanese QA booklet for permanent implant brachytherapy. This booklet can be helpful worldwide.This study was supported by a Grant‐in‐Aid for Cancer Research (17‐10) of Ministry of Health, Labor and Welfare.

MO‐D‐230C‐06: Totoku's Medical Display QA Solutions “i‐Model”

As PACS gains widespread use, the importance of quality assurance in medical image displays is rising and QA control methods are specified by guidelines and standards worldwide. In Japan, QA guidelines JESRA X‐0093−2005 kicked into full swing last August. The JESRA QA guidelines are based on the current AAPM‐TG18 and the expected IEC standards.In light of such trends in the market, TOTOKU developed a QA software that covers AAPM‐TG18 and the other major standards, QA Medivisor. This software makes acceptance and constancy testing easy and accurate.There is also a demand from medical personnel for a solution that quantitatively controls display quality. TOTOKU's i model displays satisfy such a need. The i‐model displays have a luminance sensor that is installed in front of the LCD panel. It controls the display's luminance, the key factors in determining display quality, and realizes quick and easy evaluation of the display's conformance to the DICOM GSDF. This conformance evaluation function can be used to supplement other standards and guidelines.Furthermore, TOTOKU's performance monitoring software PM Medivisor keeps a constant watch on operating status of all displays connected to the PACS network.This workshop focuses on the basic QA procedures and a demonstration of the DICOM GSDF conformance evaluation on the i‐model display.

Esho Quality Assurance Guidelines for Regional Hyperthermia

The Technical Committee and the Clinical Committee of the ESHO evaluated the experience of the institutes which are active in clinical regional hyperthermia using radiative equipment. Based on this evaluation, QA guidelines have been formulated. The focus of these guidelines lies on what must be done not on how it should be done. Subjects covered are: treatment planning, treatment, treatment documentation, requirements and characterization of equipment, safety aspects, hyperthermia staff requirements and instrumentation for quality assurance.

A one-year audit of 255 operable breast cancers

The publications 'Guidelines for Surgeons in the Management of Symptomatic Breast Disease' and 'QA Guidelines for Surgeons in Breast Cancer Screening' by the BASO Breast Specialty Group set standards for audit which were aimed at good, achievable practice. Data from 251 patients with operable breast cancers, under the age of 70 years and treated in 1994 at Nottingham City Hospital's Professorial Unit of Surgery, were audited according to 12 of the quality objectives and outcomes measures specified. The questions addressed included: waiting time for first appointment; number of attendances in diagnostic clinic; time for results to be given; pre-operative diagnosis; waiting time for surgery; localization biopsy reports; and number of therapeutic operations. Six outcome measures achieved the targets, four were close and required minimal action for correction, while two were not achieved. As a result of this audit corrective action has been taken with regard to the latter two quality objectives.

Quality assurance in clinical hyperthermia

Careful attention to quality assurance in all phases of hyperthermia treatment is essential to assure optimal safe and effective treatments. General guidelines have been established by the Hyperthermia Physics Center (HPC). However, equipment and treatment needs will vary among hyperthermia facilities. Therefore, these guidelines should serve as a baseline starting point for each facility in the establishment of their own QA guidelines.