Quality Assurance Program Research Articles

Elekta Unity MR-linac commissioning: mechanical and dosimetry tests

Abstract We report the commissioning results of Elekta Unity for the dosimetric performance and mechanical quality assurance (QA), and propose additional commissioning procedures. Mechanical tests included multi-leaf collimator (MLC) positional accuracy, radiation isocenter diameter at the center and off-center position, and coincidence between the magnetic resonance (MR) image center and radiation isocenter. Comparisons between the measurements and calculations of the simple irradiated field, intensity modulated radiation therapy (IMRT) commissioning, MLC output factor ratio, validation of independent dose calculation software and end-to-end testing were performed to evaluate dosimetric performance. The average values of the MLC positional accuracy for film- and imaging device-based analysis were −0.1 and 0.3 mm, respectively. The measured radiation isocenter size was 0.41 mm, and the off-center results were within 1 mm. The coincidence was −0.21, −1.19 and 0.49 mm along the x-, y- and z-axes, respectively. The calculated percent depth doses (PDD) and profiles agreed with the measurements. The results of independent dose calculation were within the action level recommended by American Associations of Physicist in Medicine. The gamma passing rate (GPR) for IMRT commissioning was 98.6 ± 0.9%, and end-to-end testing of adapted plans showed agreement within 2% between the measurement and calculation. We reported the results of mechanical and dosimetric performances of Elekta Unity, and proposed novel commissioning procedures. Our results should provide knowledge to the physics community for enhancing the QA programs.

Dosimetric validation of a GPU-based dose engine for a fast in silico patient-specific quality assurance program in light ion beam therapy.

With rapid evolutions of fast and sophisticated calculation techniques and delivery technologies, clinics are almost facing a daily patient-specific (PS) plan adaptation, which would make a conventional experimental quality assurance (QA) workflow unlikely to be routinely feasible. Therefore, in silico approaches are foreseen by means of second-check independent dose calculation systems possibly handling machine log-files. To validate the in-house developed GPU-dose engine, FRoG, for light ion beam therapy (protons and carbon ions) as a second-check independent calculation system and to integrate machine log-file analysis into the patient-specific quality assurance (PSQA) program. Spot sizes, depth-dose distributions, and absolute dose calibrations were configured into FRoG and a set of nine regular-shaped targets in combination with more than 170 clinical treatment fields were tested against pinpoint ionization chamber measurements. Both the treatment planning system DICOM RTplans and machine treatment log-files were used as input for the dose kernel in water, and a 3D local γ (1mm/2%) index was used as the main evaluation metric. Calculated configuration data matched experimental measurements with submillimetric agreement. For regular-shaped targets, the unsigned average relative difference between calculated and measured dose values was less than 2% for both protons and carbon ions. The mean γ passing rate (PR) was around 98% for both particle species. For clinical treatment beams, DICOM-based recalculations showed a γ-PR more than 99% for both particle species. The same level of agreement was preserved for protons when moving to log-file-based recalculations. A score of around 95% was registered for carbon ion beams, once excluding low-quality machine log-files. Unsigned average relative difference against acquired data was less than 2% also for real clinical beams. FRoG was proven as an accurate and reliable tool for PSQA in scanning light ion beam therapy. The proposed method allows for an extremely efficient workflow, without compromising the quality of the plan verification procedure.

Development and Implementation of Quality Assurance According to GMP Guidelines in Lebanese Pharmaceutical Companies

The quality of pharmaceuticals has always been a concern to the World Health Organization (WHO) from the beginning its inception. Good Manufacturing Practice (GMP) is an important part of a comprehensive system of quality assurance (QA) for both manufacturers and the government. In Lebanon, and since its application, many challenges faced the implementation of the QA program according to GMP guidelines. Yet, this program has been successfully implemented in the Lebanese pharmaceutical industry supported by the Lebanese Ministry of Public Health (MOPH), and the commitment of the national GMP committee, in addition to the involvement of the public and private pharmaceutical sectors. The main objective of this study is to evaluate the implementation of the QA program according to GMP guidelines by selected Lebanese pharmaceutical companies. A descriptive analytical study was conducted between August-November of 2018, using a questionnaire that was administered to the quality departments of 10 Lebanese pharmaceutical companies. Finding showed that all these companies were implementing the QA programs according to GMP guidelines (100%), where 60% of their quality managers are experienced in GMP guidelines for more than 6 years. Further, 50% of these companies were applying QA program according GMP guidelines since more than 6 years, and 80% of them are formulating their programs using all the quality tools of the international GMP standards. Moreover, 80% of them are establishing awareness toward the implementation of GMP guidelines through training by internal expertise and external consultants. On the other hand, the implementation cost was the most important challenge faced by 60% of these firms. Finally, all companies are profiting by an increase in efficacy and efficiency, better product quality, and decrease in defects due to the implementation of the GMP guidelines. All the Lebanese pharmaceutical companies are working toward developing their program to meet the international standards, yet, they still need governmental support to spread and compete around the world.

Accuracy of point-of-care HIV and CD4 field testing by lay healthcare workers in the Botswana Combination Prevention Project

Accurate HIV and CD4 testing are critical in program implementation, with HIV misdiagnosis having serious consequences at both the client and/or community level. We implemented a comprehensive training and Quality Assurance (QA) program to ensure accuracy of point-of-care HIV and CD4 count testing by lay counsellors during the Botswana Combination Prevention Project (BCPP). We compared the performance of field testing by lay counsellors to results from an accredited laboratory to ascertain accuracy of testing. All trained lay counsellors passed competency assessments and performed satisfactorily in proficiency testing panel evaluations in 2013, 2014, and 2015. There was excellent agreement (99.6 %) between field and laboratory-based HIV test results; of the 3002 samples tested, 960 and 2030 were concordantly positive and negative respectively, with 12 misclassifications (kappa score 0.99, p < 0.0001). Of the 149 HIV-positive samples enumerated for CD4 count in the field using PIMA at a threshold of ≤ 350 cells/µl; there was 86 % agreement with laboratory testing, with only 21 misclassified. The mean difference between field and lab CD4 testing was − 16.16 cells/µl (95 % CI −5.4 to 26.9). Overall, there was excellent agreement between field and laboratory results for both HIV rapid test and PIMA CD4 results. A standard training package to train lay counsellors to accurately perform HIV and CD4 point-of-care testing in field settings was feasible, with point-of-care results obtained by lay counsellors comparable to laboratory-based testing.

Review of Best Practices for an Environmental Laboratory

Key TakeawaysUtilities with environmental laboratories can monitor water and wastewater treatment plant processes and water quality from source, through distribution, and to the consumer's tap.“Best laboratory practices” are criteria intended to ensure that environmental laboratories produce reliable and defensible water quality data that comply with regulatory requirements.Accreditation and robust quality control and quality assurance, ethics, safety, and other laboratory program criteria support data integrity and protection of public health.

Diagnostic Proficiency Test Using Digital Cytopathology and the Comparative Assessment of the Whole Slide Images of Cytologic Samples for Quality Assurance Program in Korea

Diagnostic Proficiency Test Using Digital Cytopathology and the Comparative Assessment of the Whole Slide Images of Cytologic Samples for Quality Assurance Program in Korea

School Quality Assurance Guidelines: Status of Implementation in Private Secondary Schools in Sumbawanga Municipality, Tanzania

School Quality Assurance Guidelines (SQAGs) were adopted in Tanzania as a lens through which the quality standards in all aspects of school life would be monitored, assessed, evaluated and reported. This study sought to assess the implementation of school quality assurance guidelines in private secondary schools in Sumbawanga Municipality. It was underpinned by the Value-Added Theory by Neil Smelser (1962). The study was guided by two objectives: to describe the extent to which academic staff qualifications and teaching abilities in private secondary schools meet the school quality assurance guidelines, and to assess the quality of facilities and infrastructure in private secondary schools. The study employed convergent parallel design under mixed research approach method. Sample sizes of 94 participants were involved in the study including teachers, heads of schools, Municipal Education Officer, and School Quality Assurance Officers. Data was gathered through questionnaires, interview guides and observation checklists. Quantitative data was coded by using descriptive statistics with the support of Statistical Package for Social Science version 21. Qualitative data were organized into themes and analyzed thematically. The results show that to a large extent private secondary schools met the quality assurance guidelines due to quality of facilities and infrastructures. Also, it was revealed that private secondary schools faced challenges in the implementation of quality assurance guidelines such as shortage of funds, high taxes, inadequate number of teachers- to mention but a few. The study recommended that private secondary schools should be more committed in implementing quality assurance guidelines through developing quality assurance plans and programs and develop school generating income activities. Additionally, the study recommended for the government to provide support and subsides to private secondary schools to remedy the challenges and enhance the implementation of quality assurance guidelines.

Quality Assurance of Screening Colonoscopy in Austria and Europe

Die Vorsorgekoloskopie als effizientes Tool zur Reduktion von Kolorektalkarzinominzidenz und -mortalität ist nur dann effektiv, wenn sie unter hohen Qualitätsstandards durchgeführt wurde. Die European Society for Gastrointestinal Endoscopy gibt hierbei Key Performance Measures, wie die Adenomentdeckungsrate, die Zökumerreichsrate und die Rate an adäquater Vorbereitungsqualität, vor, auf die beim Screening geachtet werden sollten. Das „Qualitätszertifikat Darmkrebsvorsorge“, das als Qualitätssicherungsprogramm auf freiwilliger Basis von der Österreichischen Gesellschaft für Gastroenterologie und Hepatologie gemeinsam mit dem Dachverband der österreichischen Sozialversicherungsträger und der Österreichischen Krebshilfe für Endoskopiker:innen in ganz Österreich ins Leben gerufen wurde, überprüft diese Qualitätsparameter. Es wird ein Darmkrebsscreening auf höchsten Standards angestrebt, um somit die besten Outcomes für Patient:innen zu erzielen. Auch europaweit ist das Interesse an einer qualitätsgesicherten Vorsorgekoloskopie groß: Viele Länder, wie z. B. die Niederlande, Norwegen und das Vereinigte Königreich haben Programme, um die Qualität des Screenings zu überwachen und zu verbessern.

Comprehensive Evaluation of the NeoBase 2 Non-derivatized MSMS Assay and Exploration of Analytes With Significantly Different Concentrations Between Term and Preterm Neonates.

Despite the popularity of the NeoBase 2 Non-derivatized MSMS assay (PerkinElmer, Turku, Finland), there are no reports of its comprehensive evaluation, including the ability to distinguish transient tyrosinemia of the newborn (TTN) from tyrosinemia type 1 (TYR 1) using succinylacetone (SUAC). No newborn screening (NBS) cutoffs for preterm neonates in the Korean population have been suggested. We evaluated the NeoBase 2 assay and identified analytes requiring different cutoffs in preterm neonates. Residual NBS dried blood spot samples and proficiency testing (PT) materials of the Newborn Screening Quality Assurance Program and the Korean Association of External Quality Assessment Service were used. Precision, accuracy, limit of detection (LOD), lower limit of quantification (LLOQ), linearity, recovery, carryover, and performance of SUAC were evaluated. Cutoffs were determined, and analytes requiring different cutoffs in preterm neonates were investigated. Mean CVs for within-run and between-day precision were within 15%. Accuracy analysis indicated high agreement with in-house derivatized assay results and results of other PT participants. All analytes demonstrated acceptable LOD, LLOQ, and linearity. Recoveries were acceptable, except for SUAC. Carryover was negligible. Cutoffs were established for all analytes; Tyr, adenosine, and C20:0-lysophosphatidylcholine required different cutoffs in preterm neonates. Differential diagnosis of TYR 1 and TTN was successful with simultaneous Tyr and SUAC measurement. The NeoBase 2 assay demonstrated satisfactory performance. The additional analytes provide a wider diagnostic coverage, and the simultaneous measurement of Tyr and SUAC is efficient in excluding TYR 1. The new cutoffs for preterm neonates may decrease false-positive rates, without compromising diagnostic sensitivity.

Implementation of a Dedicated HDR Peer Review Program can Result in Improved Total Treatment Times for Gynecological Patients

<h3>Purpose/Objective(s)</h3> Total treatment times (TTT) >56 days(d) has demonstrated worse outcomes for cervical cancer patients¹. Each extra day of treatment beyond 6-8 weeks can result in a loss of 0.6% per day pelvic control². With appropriate quality assurance programs set in place, teams can achieve TTT success 85% of the time and 53d median time to complete¹. At UT Health SA from September 2016 to 2019 our non-cylinder HDR median TTT was 64d, with only 30% of patients completing </=56d. We hypothesized that creation of a dedicated brachytherapy (HDR) team could significantly improve total treatment times. <h3>Materials/Methods</h3> Starting 10/2019 we implemented an HDR peer review program. Every patient to receive HDR was reviewed before or at the initiation of EBRT as well as after subsequent imaging prior to HDR. Process mapping from start to end of therapy was put in place following the patient from initial review to completion of therapy (graph 1). Data were collected from both an electronic patient information management system and EPIC EMRs. TTT was calculated as the elapsed time between the first day of external beam and the last day of either external beam radiation (EBRT) or HDR, whichever is the latest. Nodal boost and patient attendance to scheduled activities was recorded as variables that could extend TTT. <h3>Results</h3> From 10/1/2019 to 12/1/2021 a total of 63 patients underwent EBRT and non-cylinder HDR. Non-cylinder HDR included 28 tandem and ovoid (39%), 11 utrecht (15%), 30 syed procedure (42%) and 2 combined (3%). The median TTT for patients post implementation of peer review was 53d versus 64d before. Forty-five patients (71%) finished TTT in </=56d compared to 30% before peer review. Eighteen patients (29%) completed TTT in > 56d versus 70% before peer review. Completion times falling outside of 56d by TTT (volume) include: 57d (3), 58 (3), 59 (4), 60(1), 62(1), 63(1), 64(1), 65(1), 67(1), 69(1), 71(1). Only 21% of patients exceeding TTT >56d had a nodal boost versus 55% in of those patients with TTT <=56d. Seventy-six percent of patients with TTT >56d missed an EBRT treatment, range 1 to 22d, average 5.8d. Thirty-nine percent of patients with TTT </=56d missed EBRT treatments, range 1-6d, average 2.2. <h3>Conclusion</h3> Establishing a dedicated HDR peer review program improved median TTT from 64d to 53d. The percentage of patients with TTT </=56d improved from 30% to 71%. Noncompliance with scheduled treatments was the single most significant factor in TTT exceeding 56d. In all cases of TTT >56d, subtracting scheduled but missed EBRT treatment days from TTT results in 92% of patients completing TTT </= 56d. Our data suggests that a dedicated HDR peer review process is beneficial towards achieving the 56d goal. We believe further investigation into interventions that could potentially reduce poor compliance with scheduled treatments is warranted.

The Dosimetric Effect of Variations in Bolus Placement Identified via Cherenkov Imaging

<h3>Purpose/Objective(s)</h3> The expanding use of Cherenkov imaging in radiation therapy (RT) clinics has presented the opportunity for a variety of applications. With the ability to visualize radiation dose on the surface of patients, Cherenkov imaging has emerged as a tool for detecting incidents in treatment delivery. With the use of transparent bolus, we can detect when a bolus has been misplaced during treatment setup. In this study, it is hypothesized that changes in treatment delivery due to bolus misplacement can be detected with Cherenkov imaging and verified with the treatment planning software (TPS). <h3>Materials/Methods</h3> Radiotherapy patients were imaged with a Cherenkov imaging system consisting of multiple time-gated, intensified CMOS cameras installed in the ceiling of two treatment bunkers at an academic center. All patients were treated according to their prescribed plan, and Cherenkov images were recorded for each fraction of their treatment. We investigated the dosimetric effect of misplaced bolus by mocking up the actual bolus positions for each case in the TPS. The dose distributions were then recalculated using an advanced dose calculation algorithm with 0.1 cm voxels, and compared to the original plan. <h3>Results</h3> Images from 622 patients were manually reviewed and a total of nine treatment incidents were detected. Two of these incidents involved variations in bolus placement from day to day during whole-breast RT, resulting in a lack of coverage for one or more beams during a single fraction of the patients' treatments. In Case 1, for a left breast treatment, the bolus did not cover the medial edge of the exit LPO field, resulting in a decrease in the minimum medial skin normalized dose in that area from 28.1% to 10.7% due to the lack of bolus backscatter into the skin. In Case 2, the lateral edge of a right breast RT treatment was left uncovered during the delivery of both the RPO and LAO fields, each contributing to a decrease in dose at the lateral edge. However, there was a slight increase in dose at the medial edge without the bolus due to a lack of beam attenuation at the lateral edge. Overall, the minimum normalized dose to the entire right breast decreased from 23.2% to 18.9%. <h3>Conclusion</h3> This first investigation into the effect of bolus misplacement detected via Cherenkov imaging demonstrated that these images can inform a mock-up of the actual treatment condition in the TPS for a dosimetric analysis. In comparison to the original plans with full bolus coverage, we confirmed that partial coverage results in a noticeable minimum dose reduction for relevant structures. This result validates that the lower Cherenkov emission seen from these fractions relative to the others can be at least partially attributed to the misaligned boluses, as Cherenkov intensity is proportional to dose. Ultimately, this method of treatment review is a valuable tool for radiation oncology quality assurance programs.

Contouring Variations and the Role of Deep Learning-Based Auto-Contouring in Breast Cancer Radiation Therapy: A Multi-Institutional Planning Study

<h3>Purpose/Objective(s)</h3> To quantify variations in target and organ-at-risk (OAR) contouring and to investigate whether intervention with deep learning-based auto-contour could improve the interobserver variations. <h3>Materials/Methods</h3> Two breast cancer cases (one with breast conservation surgery and the other with mastectomy with immediate implant-based reconstruction) were distributed with clinical information to multiple institutions that responded to participate in KROG 21-01 (1^st phase). Six months after the 1^st phase data was collected, auto-contour sets were generated for two cases using the deep-learning model that had previously been developed and verified, and the participants were asked to edit and submit the finalized auto-contours (2^nd phase). Consensus contour sets (i.e., ground truth) were generated and approved by members of KROG. Study endpoints were Dice similarity coefficient (DSC), 95% Hausdorff distance (HD), and added path length (APL). <h3>Results</h3> Thirty-one physicians from 31 institutions participated in this study. Statistically significant improvements (<i>p</i> <.05) in DSC, HD, or APL were observed in most target volumes (CTV_Ax_level II and III, CTV_IMN, and CTV_breast) and some OARs (heart, contralateral_breast, Lung_L and R, A_LAD, and thyroid) in the 2^nd phase compared to the 1^st phase. All OARs had a high level of agreement with less variability, except for A_LAD. Despite the high level of agreement in PTV (average interquartile range of DSC and HD; 0.08 and 7.90 mm, respectively), the lymph node CTVs had a considerable variance (the highest being CTV_Ax_level III). For each structure, areas with substantial contouring deviations were identified and shown using heatmaps. <h3>Conclusion</h3> Our findings demonstrated the potential of deep-learning based auto-contours in radiation therapy quality assurance programs for reducing the interobserver variations in multi-center studies.

Accuracy of determination of free light chains (Kappa and Lambda) in plasma and serum by Swedish laboratories as monitored by external quality assessment

BackgroundFree light chain (FLC) measurements are important in diagnosing monoclonal gammopathies. As FLC are heterogeneous, different reagents and instruments for measuring FLC concentrations may give diverging results that affect assessment of patients with monoclonal gammopathies. Here we investigated agreement between different FLC methods using data from the Swedish external quality assurance (EQA) programme. MethodsThe two main FLC assays, N Latex FLC (Siemens) and Serum Freelite (The Binding Site), using four nephelometric or turbidimetric instrument platforms, were compared. Results from 27 EQA rounds distributed to 11–16 Swedish hospital laboratories during 2015–2020 were investigated. ResultsThe kappa (κ) FLC measurements deviated significantly over time, but when only nephelometry was used, deviation from the mean was lower (median ranges: −5% to 13 %). The CV was significantly higher for the Freelite assay (mean CV = 8.7) than for the N latex assay (mean CV = 5.7) (p < 0.0001). The coefficient of determination between all combinations of reagents and instrument platforms used was generally good (r2 = 0.76–0.87), and the correlation slope acceptable (0.81–1.2). For lambda (λ) FLC measurements, no concordance between combinations of instruments and reagents is apparent, deviating between −40 % to + 48 % from the mean. The CV was significantly higher for the combination with nephelometry and the Freelite assay (CV mean = 13.9 %) than nephelometry and the N latex assay (CV mean = 9.9 %) (p <0.001). The coefficient of determination varied between combinations of reagents and instrument platforms (r2 = 0.59–0.89) and the slope ranged between 0.48 and 1.5. Significant differences between the two reagents used were sometimes noted. ConclusionsImprecision in λFLC affects the κFLC/λFLC ratio. This may be important in clinical assessment of patients, especially differentiating between monoclonal and polyclonal gammopathies.

Collaborating toward equity in Pennsylvania: The Age-Friendly Care, PA project.

To collaboratively implement the age-friendly health systems framework, known as the 4Ms: What Matters, Medication, Mentation, and Mobility, at The Primary Health Network (PHN), a federally qualified health center. Data were collected from PHN electronic medical records (EMRs) for individuals over age 65 from December 30, 2019 to December 24, 2021 and from Project ECHO© attendance and evaluation surveys. The telementoring educational program, Project ECHO©, was used to engage PHN health care professionals working in rural areas of Pennsylvania to incorporate the 4Ms into their practice starting with the annual wellness visit (AWV). Project ECHO© was launched at three primary care sites. After 18 months, it was then disseminated to an additional 18 sites creating pilot and comparison groups. Outcomes included codesigned patient process metrics using EMR data and project ECHO© participant data. EMR data were generated by system reports created by PHN's quality assurance program manager. Project ECHO© data were collected and managed using REDCap electronic data capture tools. Outcomes were aggregated, analyzed for trends over time, and compared between groups. All nine process outcomes increased from baseline to follow-up at the three initial sites, ranging from 4% to 43% g. At year two, the three initial sites had higher rates on AWVs (pilot 24%, comparison 12%; p < 0.0001), Advance Care Planning (New on file, pilot 8%, comparison 2%; Discussed with patient, pilot 18%, comparison 13%; Patient declined, pilot 0%, comparison 0%; p=0.0001), Dementia Screening (pilot 24%, comparison 12%; p < 0.0001), Fall Risk Management (pilot 43%, comparison 10%; p < 0.0001), and Mobility Goal (pilot 19%, comparison 9%; p < 0.0001); and lower rates on High-Risk Medication Elimination (pilot 54%, comparison, 63%, p < 0.02). Access to high-quality geriatric care for rural older adults can be improved by increasing health care professionals' knowledge of the 4Ms, beginning with its incorporation into the AWV.

Implementation of a telemedicine-based genetic counseling program in a large community oncology practice.

393 Background: Genetic testing is an integral part of cancer care. To optimally facilitate testing, genetic counselors (GC) provide interpretation and direction for treatments in certain applicable solid tumors. A telemedicine (TM) genetic counseling program was initiated in 2019 at Tennessee Oncology, a large community oncology practice spanning over 30 clinical sites throughout Tennessee and Georgia. Methods: Appropriate patients were identified and referred through the Electronic Medical Record (EMR) for genetic testing based on current National Comprehensive Cancer Network (NCCN) guidelines. All counseling sessions were scheduled over TM to the patient’s home to enhance convenience, broaden access, and decrease no-show rates. Physician education regarding result-dependent appropriate screening recommendations per NCCN for mutation positive patients were provided through email communication and dedicated GC notes in the EMR. Results: Between 2019 and 2021, GC referrals per year grew from 195 to 840. Of these referrals, 84.6% of patients completed GC consultations, all of which were facilitated through TM. Of completed consultations, 81.4% underwent testing. Average time from referral to GC consultation was 8-13 business days. The no-show rate was low (&lt; 7%). This program started at 1 clinic in 2019 and is now offered for patient care in 16 clinics across the state. Conclusions: Our program illustrates how remote GC programs are an effective choice for scaling genetics care across a large community oncology practice. Deep integration of TM-based genetic counseling within the EMR helps identify high-risk patients, improves test adoption, patient keep-rate and turn-around-time therefore helping to better patient outcomes. This quality assurance program is an important part of comprehensive cancer care that we can provide to our patients and their families.

Investigation of the Constancy of the Dosimetric Parameters of the Proton Therapy System

Purpose: Determination of fluctuation ranges of dosimetry parameters of the proton therapy system&#x0D; (PTS) to clarify the permissible limit deviations.&#x0D; Methods and materials: The basis for the quality assurance program (QA) of the PTS is the report of the&#x0D; American Association of Physicists in Medicine AAPM TG-224. According to this report, the QA program is a living, adaptive document that needs to be refined, corrected and optimized taking into account the features of the PTS being in use and the available dosimetry equipment. After setting-up&#x0D; checks within the framework of the daily QA program, it became possible to automatically collect data&#x0D; containing dosimetry parameters of the PTS for subsequent analysis. It was decided to investigate the&#x0D; stability over time of some dosimetry parameters of the PTS in order to determine the ranges of their&#x0D; fluctuations and, as a result, to clarify the permissible deviations of these parameters.&#x0D; Results: The stability of the parameters associated with the constancy of the proton beam energy selection was studied. As a result, the study showed that the values of the parameters associated with the&#x0D; constancy of the proton beam energy selection fluctuated within much smaller limits compared to&#x0D; those proposed in TG-224.&#x0D; Conclusion: The obtained result may allow us to reconsider the approach to proton therapy planning&#x0D; system in the FSBI FSCCRO of the FMBA of Russia, in particular, to the choice of PTV margins. The new&#x0D; refined tolerances for the maximum deviations of the analyzed parameters are proposed in this research work

Quality assurance programs to support tuberculosis diagnostic capacity amongst laboratories within Meru county, Kenya

Background: According to the Kenya Ministry of Health, Meru County had reported a tuberculosis (TB) notification rate of 158/100,000 population in 2015. Aforementioned reports indicates that the prevalence of TB that warrants early detection and diagnosis, hence the need to determine quality assurance programs to Support tuberculosis diagnostic capacity of Tuberculosis amongst laboratories within Meru County. Objective: To determine quality assurance programs to support tuberculosis diagnostic capacity amongst laboratories within Meru County, Kenya. Materials and Methods: This was a descriptive study survey which utilized quantitative techniques to establish the potential and capacity of laboratory personnel in TB diagnostic laboratories in selected medical centres. Data entry was done through use of Statistical Package for Social Sciences (SPSS). Frequency and percentages were calculated. Findings were presented in form of frequency distribution tables and bar graphs and analyzed using Chi square. Results: Majority of laboratory personnel had indicated that their laboratories were public laboratories (69.2%) followed by private owned laboratories (30.8%). There were significant differences in the diagnostic capacity of TB between public and private owned laboratories in relation to availability of the following resources: Safety cabinet [χ2 (1 df, N= 26) = 18.49, p=0.000&amp;lt;0.05], Centrifuge [χ2 (1 df, N= 26) = 10.64, p=0.000&amp;lt;0.05], Gene Xpert resources [χ2 (1 df, N= 26) = 18.49, p=0.000&amp;lt;0.05], Freezer/refrigerator [χ2 (1 df, N= 26) = 14.28, p=0.000&amp;lt;0.05], Incubator [χ2 (1 df, N= 26) = 18.49, p=0.000&amp;lt;0.05] and TB florescence microscopy [χ2 (1 df, N= 26) = 18.49, p=0.000&amp;lt;0.05]. Majority of the respondents had been using Centre of Disease Control and Prevention (CDC) as their quality assurance schemes (61.5%) followed by Central TB reference laboratories, Ministry of Health (26.9%) and (others please specify) who never participated in any quality assurance scheme (11.5%). majority of respondents had been sending their specimens for TB culture and sensitivity to research institution (KEMRI Centre for Respiratory Diseases) (69.2%), followed by those who indicated ‘Any other’ thus not sending any specimen for TB culture and sensitivity (26.9%) and to private or commercial laboratories (3.8%). None of the respondents had indicated sending their specimens for TB culture and sensitivity to either Central TB Reference laboratories Q/A (ministry of health) or a university (0.0%).

Impact of COVID-19 on quality checks of solid tumor molecular diagnostic testing-A surveillance by EQAS provider in India.

BackgroundMolecular tests in solid tumours for targeted therapies call for the need to ensure precision testing. To accomplish this participation in the External Quality Assessment Program (EQAS) is required. This evaluates the consistency of diagnostic testing procedures and offers guidance for improving quality. Outbreak of COVID-19 pandemic led to worldwide lockdown and disruption of healthcare services including participation in EQAS.The present study describes the extended scope of EQAS offered byMPQAP (Molecular Pathology Quality Assurance Program), the first proficiency test provider for solid tumor diagnostics in India. The study surveys the preparedness of molecular testing laboratories in routine diagnostics and participation for quality assessment scheme.MethodsA documented guideline for measures and precautions to be carried by testing laboratories in performing routine diagnostic tests during the lockdown period were charted and distributed to all MPQAP participant centres. A survey was conducted for MPQAP participants to check whether laboratories were involved in COVID-19 testing and to evaluate the impact of lockdown on the operations of diagnostics procedures. From the acquired response of the survey, 2 cycles out of initially proposed 11 cycles were executed with transformed approach using digital tools and image interpretation modules.FindingsOut of 25 solid tumour testing laboratories registered as participants, 15 consented to participate in survey. The summary of survey conveyed the impact of COVID-19onroutine operations of diagnostics tests such as shortcomings in inventory and human resource management. Thirteen participants showed active willingness and consented to participate in EQAS test scheme.InterpretationsThe survey findings and assessment of EQAS cycles endorsed the quality testing procedures carried by participating laboratories throughout the lockdown. It highlighted the utility of EQAS participation during pandemic along with emphasis on safety measures for continual improvement in quality of diagnostic services.

179 Today's Beef Quality Assurance Program: Rancher Involvement and the Future of Developing Sustainability Programs

Abstract To date the most successful rancher educational program has been the beef quality assurance (BQA) program. However, it is not understood why ranchers chose to become BQA certified. Without this knowledge it becomes increasingly difficult to build new rancher educational and sustainability focused programs. To gain insight on current BQA program involvement and application of BQA best management practices (BMP) we administered an online multi-state survey to cattle ranchers in collaboration with state Cattlemen’s Associations. In total, the survey consisted of 45 questions and was divided into 3 sections including: 1) rancher demographics, 2) BQA participation and current BQA BMP, and 3) willingness to join new rancher sustainability program. Of the survey participants (n=884) ranchers that were BQA certified at any time were less likely to administer injections in areas other than the neck compared with ranchers who were not certified (p&amp;lt; 0.05), demonstrating the effectiveness of the BQA program. More than 87% (n=542) of survey respondents listed “improving animal health and welfare” as one of their top three reasons for joining BQA, while only 22% (n=137) listed “animals fetching a higher price”. This result highlights that although financial incentive was a factor in program adoption, animal health and welfare was at the forefront of ranchers’ minds. The survey indicated that ranchers who were male, ranched for a greater number of years, grazed more total acres, and received a larger percent of income from ranching were more likely to be BQA certified (p&amp;lt; 0.05). Finally, those who were BQA members were more likely to state that joining a rancher sustainability program would be beneficial to their operation (p&amp;lt; 0.05). Overall, this survey provides insight into BQA program and BMP adoption and demonstrates that the BQA program could be a possible framework for creating a successful rancher sustainability program.

Hemodialysis facility star rating affects mortality in chronic hemodialysis patients: a longitudinal observational cohort study.

Many countries have their own hemodialysis (HD) quality assurance programs and star rating systems for HD facilities. However, the effects of HD quality assurance programs on patient mortality are not well understood. Therefore, in the present study, the effects of the Korean HD facility star rating on patient mortality in maintenance HD patients were evaluated. This longitudinal, observational cohort study included 35,271 patients receiving HD treatment from 741 facilities. The fivestar ratings of HD facilities were determined based on HD quality assessment data from 2015, which includes 12 quality measures in structural, procedural, and outcome domains. The patients were grouped into high (three to five stars) and low (one or two stars) groups based on HD facility star rating. Cox proportional hazards model was used to evaluate the effects of star rating on patient mortality during the mean follow-up duration of 3 years. The patient ratio between high and low HD facility star rating groups was 82.0% vs. 18.0%. The patients in the low star rating group showed lower single-pool Kt/V and higher calcium and phosphorus levels compared with subjects in the high star rating group. After adjusting for sociodemographic and clinical parameters, the HD facility star rating independently increased the mortality risk (hazard ratio, 1.11; 95% confidence interval, 1.04-1.18; p = 0.002). The HD facilities with low star rating showed higher patient mortality.