Robust Quality Assurance Research Articles

Quality assurance and quality control processes: summary of a metabolomics community questionnaire

The Metabolomics Society Data Quality Task Group (DQTG) developed a questionnaire regarding quality assurance (QA) and quality control (QC) to provide baseline information about current QA and QC practices applied in the international metabolomics community. The DQTG has a long-term goal of promoting robust QA and QC in the metabolomics community through increased awareness via communication, outreach and education, and through the promotion of best working practices. An assessment of current QA and QC practices will serve as a foundation for future activities and development of appropriate guidelines. QA was defined as the set of procedures that are performed in advance of analysis of samples and that are used to improve data quality. QC was defined as the set of activities that a laboratory does during or immediately after analysis that are applied to demonstrate the quality of project data. A questionnaire was developed that included 70 questions covering demographic information, QA approaches and QC approaches and allowed all respondents to answer a subset or all of the questions. The DQTG questionnaire received 97 individual responses from 84 institutions in all fields of metabolomics covering NMR, LC-MS, GC-MS, and other analytical technologies. There was a vast range of responses concerning the use of QA and QC approaches that indicated the limited availability of suitable training, lack of Standard Operating Procedures (SOPs) to review and make decisions on quality, and limited use of standard reference materials (SRMs) as QC materials. The DQTG QA/QC questionnaire has for the first time demonstrated that QA and QC usage is not uniform across metabolomics laboratories. Here we present recommendations on how to address the issues concerning QA and QC measurements and reporting in metabolomics.

The WHO AFRO external quality assessment programme (EQAP): Linking laboratory networks through EQA programmes.

External Quality Assessment (EQA) surveys performed by the World Health Organization Regional Office for Africa (WHO AFRO) revealed the need for the strengthening of public health microbiology laboratories, particularly for testing of epidemic-prone diseases in the African Region. These surveys revealed common issues such as supply chain management, skilled personnel, logistical support and overall lack of quality standards. For sustainable improvements to health systems as well as global health security, deficiencies identified need to be actively corrected through robust quality assurance programmes and implementation of laboratory quality management systems.Given all the pathogens of public health importance, an external quality assessment programme with a focus on vaccine-preventable diseases and emerging and re-emerging dangerous pathogens is important, and should not be stand-alone, but integrated within laboratory networks as seen in polio, measles, yellow fever and rubella.In 2015, WHO AFRO collaborated with the US Centers for Disease Control and Prevention, the London School of Hygiene & Tropical Medicine and partners in a series of consultations with countries and national and regional EQA providers for the development of quality assurance models to support HIV point-of-care testing and monitoring. These consultations revealed similar challenges as seen in the WHO AFRO surveys. WHO AFRO brought forth its experience in implementing quality standards for health programmes, and also opened discussions on how lessons learned through such established programmes can be utilised to supporting and strengthening the introduction of early infant diagnosis of HIV and viral load point-of-care testing.An optimised external quality assessment programme will impact the ability of countries to meet core capacities, providing improved quality management systems, improving the confidence of diagnostic network services in Africa, and including capacities to detect events of international public health importance.

Canadian Phase III Randomized Trial of Stereotactic Body Radiotherapy Versus Conventionally Hypofractionated Radiotherapy for Stage I, Medically Inoperable Non–Small-Cell Lung Cancer – Rationale and Protocol Design for the Ontario Clinical Oncology Group (OCOG)-LUSTRE Trial

We describe a Canadian phase III randomized controlled trial of stereotactic body radiotherapy (SBRT) versus conventionally hypofractionated radiotherapy (CRT) for the treatment of stage I medically inoperable non–small-cell lung cancer (OCOG-LUSTRE Trial).Eligible patients are randomized in a 2:1 fashion to either SBRT (48 Gy in 4 fractions for peripherally located lesions; 60 Gy in 8 fractions for centrally located lesions) or CRT (60 Gy in 15 fractions). The primary outcome of the study is 3-year local control, which we hypothesize will improve from 75% with CRT to 87.5% with SBRT. With 85% power to detect a difference of this magnitude (hazard ratio = 0.46), a 2-sided α = 0.05 and a 2:1 randomization, we require a sample size of 324 patients (216 SBRT, 108 CRT). Important secondary outcomes include overall survival, disease-free survival, toxicity, radiation-related treatment death, quality of life, and cost-effectiveness. A robust radiation therapy quality assurance program has been established to assure consistent and high quality SBRT and CRT delivery.Despite widespread interest and adoption of SBRT, there still remains a concern regarding long-term control and risks of toxicity (particularly in patients with centrally located lesions). The OCOG-LUSTRE study is the only randomized phase III trial testing SBRT in a medically inoperable population, and the results of this trial will attempt to prove that the benefits of SBRT outweigh the potential risks.

Timely stereotactic body radiotherapy (SBRT) for spine metastases using a rapidly deployable automated planning algorithm.

Purpose/objectivesThe complex planning and quality assurance required for spine SBRT are a barrier to implementation in time-sensitive or limited resource clinical situations. We developed and validated an automated inverse planning algorithm designed to streamline planning and allow rapid delivery of conformal single fraction spine SBRT using widely available technology.Materials/methodsThe Rapid Spine (RaSp) automated script successfully generated single fraction SBRT plans for fourteen complex spinal lesions previously treated at a single high-volume institution. Automated RaSp plans were limited to 5 beams with a total of 15 segments (allowing calculation-based verification) and optimized based on RTOG 0631 objectives. Standard single fraction (16 Gy) stereotactic IMRT plans were generated for the same set of complex spinal lesions and used for comparison. A conservative 2 mm posterior isocenter shift was used to simulate minor set-up error.ResultsAutomated plans were generated in under 5 min from target definition and had a mean dose to the PTV of 1663 cGy (SD 131.5), a dose to 90 % of PTV (D90) of 1358 cGy (SD 111.0), and a maximum point dose (Dmax) to the PTV of 2055 cGy (SD 195.2) on average. IMRT plans took longer to generate but yielded more favorable dose escalation with a mean dose to the PTV of 1891 cGy (SD 117.6), D90 of 1731 cGy (SD 126.5), and Dmax of 2218 cGy (SD 195.7). A 2 mm posterior shift resulted in a 20 % (SD 10.5 %) increase in cord dose for IMRT plans and a 10 % (SD 5.3 %) increase for RaSp plans. The 2 mm perturbation caused 3 cord dose violations for the IMRT plans and 1 violation for corresponding RaSp plans.ConclusionThe Rapid Spine plan method yields timely and dosimetrically reasonable SBRT plans which meet RTOG 0631 objectives and are suitable for rapid yet robust pretreatment quality assurance followed by expedited treatment delivery. RaSp plans reduce the tradeoff between rapid treatment and optimal dosimetry in urgent cases and limited resource situations.

Poster ‐ 09: A MATLAB‐based Program for Automated Quality Assurance of a Prostate Brachytherapy Ultrasound System

Purpose:A robust Quality Assurance (QA) program is essential for prostate brachytherapy ultrasound systems due to the importance of imaging accuracy during treatment and planning. Task Group 128 of the American Association of Physicists in Medicine has recommended a set of QA tests covering grayscale visibility, depth of penetration, axial and lateral resolution, distance measurement, area measurement, volume measurement, and template/electronic grid alignment. Making manual measurements on the ultrasound system can be slow and inaccurate, so a MATLAB program was developed for automation of the described tests.Methods:Test images were acquired using a BK Medical Flex Focus 400 ultrasound scanner and 8848 transducer with the CIRS Brachytherapy QA Phantom – Model 045A. For each test, the program automatically segments the inputted image(s), makes the appropriate measurements, and indicates if the test passed or failed. The program was tested by analyzing two sets of images, where the measurements from the first set were used as baseline values.Results:The program successfully analyzed the images for each test and determined if any action limits were exceeded. All tests passed – the measurements made by the program were consistent and met the requirements outlined by Task Group 128.Conclusions:The MATLAB program we have developed can be used for automated QA of an ultrasound system for prostate brachytherapy. The GUI provides a user‐friendly way to analyze images without the need for any manual measurement, potentially removing intra‐ and inter‐user variability for more consistent results.

A paediatrician's guide to clinical trials units.

A clinical trial is a research study that prospectively assigns health-related interventions to people (or groups) typically using randomisation to evaluate the effects on health outcomes. Well-designed, suitably powered, randomised, trials provide the most reliable evidence about the effectiveness (or not) of interventions and should underpin medical practice. Unfortunately, within paediatrics, many common interventions have not been subjected to such rigorous evaluation,1 ,2 leading to variation in both treatments3 ,4 and outcomes (http://www.rightcare.nhs.uk/index.php/atlas/children-and-young-adults/). Many more high-quality clinical trials are needed before paediatric care is robustly evidence based. Healthcare professionals are ideally placed to inform such trials, but one factor that limits their involvement is the complexity involved: the processes and requirements for trials of investigational medicinal products are illustrated on the clinical trials route map (http://www.ct-toolkit.ac.uk/routemap). There has been a significant investment in clinical trials research infrastructure over the last decade recognising this complexity. The UK Clinical Research Collaboration Registered Clinical Trials Units (CTU) Network is part of this infrastructure and oversees the registration of CTUs. Registered CTUs need to demonstrate track record, a multidisciplinary team, robust quality assurance systems, statistical input and secure information technology. CTUs exist to help healthcare professionals navigate this complex landscape and assist in developing clinical questions into well-designed studies. ### The history of CTUs The first UK unit to undertake clinical trials was the Tuberculosis Research Unit in 1948. Further specialist trials units were established in subsequent decades, followed by a more general …

POST-MISSION QUALITY ASSURANCE PROCEDURE FOR SURVEY-GRADE MOBILE MAPPING SYSTEMS

Mobile Mapping Systems (MMS) consist of terrestrial-based moving platforms that integrate a set of imaging sensors (typically digital cameras and laser scanners) and a Position and Orientation System (POS), designed to collect data of the surrounding environment. MMS can be classified as “mapping-grade” or “survey-grade” depending on the system’s attainable accuracy. Mapping-grade MMS produce geospatial data suitable for GIS applications (e.g., asset management) while survey-grade systems should satisfy high-accuracy applications such as engineering/design projects. The delivered accuracy of an MMS is dependent on several factors such as the accuracy of the system measurements and calibration parameters. It is critical, especially for survey-grade systems, to implement a robust Quality Assurance (QA) procedure to ensure the achievement of the expected accuracy. In this paper, a new post-mission QA procedure is presented. The presented method consists of a fully-automated self-calibration process that allows for the estimation of corrections to the system calibration parameters (e.g., boresight angles and lever-arm offsets relating the lidar sensor(s) to the IMU body frame) as well as corrections to the system measurements (e.g., post-processed trajectory position and orientation, scan angles and ranges). As for the system measurements, the major challenge for MMS is related to the trajectory determination in the presence of multipath signals and GNSS outages caused by buildings, underpasses and high vegetation. In the proposed self-calibration method, trajectory position errors are properly modelled while utilizing an efficient/meaningful trajectory segmentation technique. The validity of the proposed method is demonstrated using a dataset collected under unfavorable GNSS conditions.

POST-MISSION QUALITY ASSURANCE PROCEDURE FOR SURVEY-GRADE MOBILE MAPPING SYSTEMS

Abstract. Mobile Mapping Systems (MMS) consist of terrestrial-based moving platforms that integrate a set of imaging sensors (typically digital cameras and laser scanners) and a Position and Orientation System (POS), designed to collect data of the surrounding environment. MMS can be classified as “mapping-grade” or “survey-grade” depending on the system’s attainable accuracy. Mapping-grade MMS produce geospatial data suitable for GIS applications (e.g., asset management) while survey-grade systems should satisfy high-accuracy applications such as engineering/design projects. The delivered accuracy of an MMS is dependent on several factors such as the accuracy of the system measurements and calibration parameters. It is critical, especially for survey-grade systems, to implement a robust Quality Assurance (QA) procedure to ensure the achievement of the expected accuracy. In this paper, a new post-mission QA procedure is presented. The presented method consists of a fully-automated self-calibration process that allows for the estimation of corrections to the system calibration parameters (e.g., boresight angles and lever-arm offsets relating the lidar sensor(s) to the IMU body frame) as well as corrections to the system measurements (e.g., post-processed trajectory position and orientation, scan angles and ranges). As for the system measurements, the major challenge for MMS is related to the trajectory determination in the presence of multipath signals and GNSS outages caused by buildings, underpasses and high vegetation. In the proposed self-calibration method, trajectory position errors are properly modelled while utilizing an efficient/meaningful trajectory segmentation technique. The validity of the proposed method is demonstrated using a dataset collected under unfavorable GNSS conditions.

Using miRNA-mRNA Interaction Analysis to Link Biologically Relevant miRNAs to Stem Cell Identity Testing for Next-Generation Culturing Development.

Therapeutic benefit of stem cells has been demonstrated in multiple disease models and clinical trials. Robust quality assurance is imperative to make advancements in culturing procedures to enable large-scale cell manufacturing without hampering therapeutic potency. MicroRNAs (miRNAs or miRs) are shown to be master regulators of biological processes and are potentially ideal quality markers. We determined miRNA markers differentially expressed under nonclinical multipotent adult progenitor cell (MAPC) and mesenchymal stem cell (MSC) culturing conditions that regulate important stem cell features, such as proliferation and differentiation. These bone marrow-derived stem cell types were selected because they both exert therapeutic functions, but have different proliferative and regenerative capacities. To determine cell-specific marker miRNAs and assess their effects on stem cell qualities, a miRNA and mRNA profiling was performed on MAPCs and MSCs isolated from three shared donors. We applied an Ingenuity Pathway Analysis-based strategy that combined an integrated RNA profile analysis and a biological function analysis to determine the effects of miRNA-mRNA interactions on phenotype. This resulted in the identification of important miRNA markers linked to cell-cycle regulation and development, the most distinctive being MAPC marker miR-204-5p and MSC marker miR-335-5p, for which we provide in vitro validation of its function in differentiation and cell cycle regulation, respectively. Importantly, marker expression is maintained under xeno-free conditions and during bioreactor isolation and expansion of MAPC cultures. In conclusion, the identified biologically relevant miRNA markers can be used to monitor stem cell stability when implementing variations in culturing procedures. Human adult marrow stromal stem cells have shown great potential in addressing unmet health care needs. Quality assurance is imperative to make advancements in large-scale manufacturing procedures. MicroRNAs are master regulators of biological processes and potentially ideal quality markers. MicroRNA and mRNA profiling data of two human adult stem cell types were correlated to biological functions in silico. Doing this provided evidence that differentially expressed microRNAs are involved in regulating specific stem cell features. Furthermore, expression of a selected microRNA panel was maintained in next-generation culturing platforms, demonstrating the robustness of microRNA profiling in stem cell comparability testing.

Quality assurance and its impact on ovarian visualization rates in the multicenter United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS).

ABSTRACTObjectiveTo describe the quality assurance (QA) processes and their impact on visualization of postmenopausal ovaries in the ultrasound arm of a multicenter screening trial for ovarian cancer.MethodsIn the United Kingdom Collaborative Trial of Ovarian Cancer Screening, 50 639 women aged 50–74 years were randomized to the ultrasound arm and underwent annual transvaginal ultrasound (TVS) examinations. QA processes were developed during the course of the trial and included regular monitoring of the visualization rate (VR) of the right ovary. Non‐subjective factors identified previously as impacting on VR of the right ovary were included in a generalized estimating equation model for binary outcomes to enable comparison of observed vs adjusted VR between individual sonographers who had undertaken > 1000 scans during the trial and comparison between centers. Observed and adjusted VRs of sonographers and centers were ranked according to the highest VR. Analysis of annual VRs of sonographers and those of the included centers was undertaken.ResultsBetween June 2001 and December 2010, 48 230 of 50 639 women attended one of 13 centers for a total of 270 035 annual TVS scans. One or both ovaries were seen in 228 145 (84.5%) TVS scans. The right ovary was seen on 196 426 (72.7%) of the scans. For the 78 sonographers included in the model, the median difference between observed and adjusted VR was −0.7% (range, −7.9 to 5.9%) and the median change in VR rank after adjustment was 3 (range, 0–18). For the 13 centers, the median difference between observed and adjusted VR was −0.5% (range, −2.2 to 1%), with no change in ranking after adjustment. The median adjusted VR was 73% (interquartile range (IQR), 65–82%) for sonographers and 74.7% (IQR, 67.1–79.0%) for centers. Despite the increasing age of the women being scanned, there was a steady decrease in the number of sonographers with VR < 60% (21.4% in 2002 vs 2.0% in 2010) and an increase in sonographers with VR > 80% (14.3% in 2002 vs 40.8% in 2010). The median VR of the centers increased from 65.5% (range, 55.7–81.0%) in 2001 to 80.3% (range, 74.5–90.9%) in 2010.ConclusionsA robust QA program can improve visualization of postmenopausal ovaries and is an essential component of ultrasound‐based ovarian cancer screening trials. While VR should be adjusted for non‐subjective factors that impact on ovarian visualization, subjective factors are likely to be the largest contributors to differences in VR. © 2015 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd. on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

American College of Radiology (ACR) Radiation Oncology Practice Accreditation: A pattern of change

PurposeThe American College of Radiology (ACR) Radiation Oncology Practice Accreditation (ROPA) program has accredited more than 600 sites since 2006, including practices within academic, hospital-based, and freestanding settings. The purpose of this report is to evaluate and compare patterns of change in common deficiencies over time. Methods and materialsThe ACR database was queried to analyze the common deficiencies noted by the ACR ROPA program between 2012 and 2014. Deficiencies were ranked and compared to the top 10 items that were reported in 2006. ResultsBetween 2012 and 2014, 272 new applications and 306 renewals were received. Timely verification of port films, documentation of physician peer review, inclusion of essential elements of a treatment prescription, evidence of a final physicist chart review, documentation of weekly treatment visits, and inclusion of key elements of brachytherapy documentation all improved when compared with 2000-2005. Deficiencies ranked higher on the current review compared with the previous analysis included documentation of a robust quality assurance program, missing elements from the history and physical documentation, and documentation of follow-up visits. ConclusionsOur analysis of changes in patterns of deficiencies across radiation oncology practices reflects changes in our field such as the growing reliance on electronic records and imaging. Accreditation continues to play an integral role in establishing national standards and a nonpunitive, peer-reviewed method to evaluate a practice’s compliance with national quality guidelines.

Career learning in schools in Scotland past, present and future

Career education has never been statutory in Scotland but has nonetheless been subject to the ebb and flow of government policy. At times this has been helpful, generating funding, guidelines and advice. However, government engagement has also been characterised by short-termism and, often, wasteful repetition. In Scotland, by 20 IS, there will be a model that is underpinned by several new policy initiatives, one which locates learning about life and work within the curriculum, and one which provides more robust quality assurance arrangements. This could be the makings of a concerted national effort to improve career learning or yet another short-term initiative that eventually leaves us back where we started.

The Royal College of Psychiatrists' response.

Examinations have been a feature of medical training for centuries both in undergraduate and postgraduate education. The primary purpose of such examinations has been to define a minimum standard that the public and fellow professionals have confidence in. In recent years there has been a drive for examinations to also inform the learning process and to be conducted in a format that is evidence based. The current MRCPsych examination was introduced in 2008 within parameters laid out by the Postgraduate Medical Education and Training Board (PMETB; Principles for Assessment Systems). The requirements of PMETB were for all Colleges to use assessment formats that were supported by evidence in the literature as being a reliable assessment method. As a consequence, all Colleges developed written paper examinations that were based on the multiple-choice question (MCQ) format and clinical examinations in an Objective Structured Clinical Examination (OSCE) format. These two formats are regarded as the most reliable. The written papers moved away from short-answer and essay questions as there are concerns about the reliability of these formats. The current MRCPsych written papers have extremely good reliability (Chronbach's α consistently greater than 0.9) and the Clinical Assessment of Skills and Competencies (CASC) also has good reliability (Chronbach's α 0.75–0.85). The performance of the examination is closely monitored by the Royal College of Psychiatrists' Examinations Sub-Committee with robust quality assurance processes in place. The content and performance of each item is scrutinised pre- and post-examination. The College is also required to provide data and reports to the regulator (the General Medical Council, GMC) and any proposed changes to the examination require GMC's approval. Recent changes approved by the GMC include a reduction from three written papers to two (introduced from this year) and a change to the CASC marking scheme from the Hofstee method to borderline regression (from diet 2 this year). As part of the process to reduce the number of written papers, the written paper question banks have been fully reviewed and updated. The statement that MCQs are continuously recycled year after year is incorrect. New questions are constantly being developed and every examination paper has about 40% of new questions. All questions have been mapped to the examinations syllabus and new question writing is focused on areas of the question bank where the range of questions is limited. There is also a focus on developing a greater range of questions testing clinical management within Paper B. The MRCPsych examination is under continuous review and development by the Examinations Sub-Committee. An external review of the examinations was commissioned in 2014 and we are following up on recommendations for further enhancements to the MRCPsych. These are due to be published at the end of 2015. The curriculum, like the examination, is under constant review in a process that involves a wide community including lay people, trainees, medical managers, psychiatry experts and trainers. All changes have to be approved by the GMC and there is regular dialogue between the College and the GMC. A major revision of the core curriculum is being planned and will include the incorporation of the examination syllabus. While we understand that trainees may feel the MRCPsych is another hurdle, ultimately, the College is responsible for ensuring that quality and patient safety are at the forefront of its examination processes. We are satisfied that the current standard is appropriate for entry into higher training. While it is our ambition to drive up the standard, we are aware that a significant proportion of core trainees struggle to achieve the standards set by the examination. The College is keen to influence training and the learning experience of trainees. To this end we have introduced Trainees Online (TrOn; http://tron.rcpsych.ac.uk), a series of online learning modules for trainees that will eventually cover the whole MRCPsych examination syllabus. We have also been working with MRCPsych course organisers to improve the standard and consistency of courses. We hope that increased clarity about what trainees need to know will lead to higher examination pass rates as well as the acquisition of knowledge that will support clinical practice.

Daily QA of linear accelerators using only EPID and OBI.

As treatment delivery becomes more complex, there is a pressing need for robust quality assurance (QA) tools to improve efficiency and comprehensiveness while simultaneously maintaining high accuracy and sensitivity. This work aims to present the hardware and software tools developed for comprehensive QA of linear accelerator (LINAC) using only electronic portal imaging devices (EPIDs) and kV flat panel detectors. A daily QA phantom, which includes two orthogonally positioned phantoms for QA of MV-beams and kV onboard imaging (OBI) is suspended from the gantry accessory holder to test both geometric and dosimetric components of a LINAC and an OBI. The MV component consists of a 0.5 cm water-equivalent plastic sheet incorporating 11 circular steel plugs for transmission measurements through multiple thicknesses and one resolution plug for MV-image quality testing. The kV-phantom consists of a Leeds phantom (TOR-18 FG phantom supplied by Varian) for testing low and high contrast resolutions. In the developed process, the existing LINAC tools were used to automate daily acquisition of MV and kV images and software tools were developed for simultaneous analysis of these images. A method was developed to derive and evaluate traditional QA parameters from these images [output, flatness, symmetry, uniformity, TPR20/10, and positional accuracy of the jaws and multileaf collimators (MLCs)]. The EPID-based daily QA tools were validated by performing measurements on a detuned 6 MV beam to test its effectiveness in detecting errors in output, symmetry, energy, and MLC positions. The developed QA process was clinically commissioned, implemented, and evaluated on a Varian TrueBeam LINAC (Varian Medical System, Palo Alto, CA) over a period of three months. Machine output constancy measured with an EPID (as compared against a calibrated ion-chamber) is shown to be within ±0.5%. Beam symmetry and flatness deviations measured using an EPID and a 2D ion-chamber array agree within ±0.5% and ±1.2% for crossline and inline profiles, respectively. MLC position errors of 0.5 mm can be detected using a picket fence test. The field size and phantom positioning accuracy can be determined within 0.5 mm. The entire daily QA process takes ∼15 min to perform tests for 5 photon beams, MLC tests, and imaging checks. The exclusive use of EPID-based QA tools, including a QA phantom and simultaneous analysis software tools, has been demonstrated as a viable, efficient, and comprehensive process for daily evaluation of LINAC performance.

SU‐E‐J‐161: Quality Assurance of 4DCT Process Using ET Gating Phantom System

Purpose:To develop a robust quality assurance procedure for 4DCT process using ET gating phantom (ET‐GPS), to optimize 4DCT scan protocols, and to investigate practical solutions for patients who have difficulties to be scanned with 4DCT.Methods:ET‐GPS (BrainLab AB) in conjunction with the marker block is used to test the motion tracking of 4DCT imaging and Real‐time Position Management (RPM) system (Varian). Several standard sinusoidal motion profiles as respiratory simulation were used as reference. A maximal motion range of 2.5mm to 16.5mm for horizontal motion (HM) and 6.4mm to 38.0mm for vertical motion (VM), with breathing period time (T) of 3s, 5s, and 7s, were applied to ET‐GPS, respectively. 4DCT images were acquired by LightSpeed 16‐slice CT simulator (GE Medical System), using our general 4DCT chest imaging protocol (cine, 120kVp, 350mA, 0.8s) with scan thicknesses of 1.25mm and 2.5mm, respectively. Maximal motion ranges obtained from 4DCT imaging were analyzed and compared to the references. Furthermore, acquired trajectory profiles from RPM system were played back to the ETGPS, agreement between 2nd acquired trajectories and reference sinusoidal profiles were analyzed quantitatively.Results:Test results of maximal horizontal motion ranges from 4DCT image agree well with the physical measurement (&lt;3%) when the scan thickness is 1.25mm and with T = 5s or 7s. Motion range discrepancy is up to 13.5% for HM when 2.5mm thick is applied. The VM differences are less than 7%. ET‐GPS can reproduce the patient motion profiles very well.Conclusion and discussion:The developed method using ET‐GPS is a feasible and efficient way for quality assurance of 4DCT process. Imaging protocols can be further optimized when agreement is out of the expected. Further 4DCT QA procedure with different HU inserts and customized patient breathing profile will be investigated.

PWE-316 Incidence and management of iatrogenic perforations in the welsh bowel screening programme

Introduction Iatrogenic perforation is a rare but serious complication of colonoscopy. Reported incidence varies between 0.005% and 0.629%, and is mostly based on diagnostic and therapeutic rather than screening colonoscopies. The British Society of Gastroenterology (BSG) has set a target of no more than one perforation in every 1000 screening colonoscopies. Method All cases of iatrogenic perforations within the Bowel Screening Wales programme between January 2009 and December 2014 were identified. As part of a robust Quality Assurance programme, a policy of detailed root cause analysis was introduced in 2011; this was subsequently performed for all cases and outcomes recorded. Results 17,699 screening colonoscopies were performed within the specified time period, of which 10,688 proceeded to polypectomy (60.4%). There were 13 perforations (0.073%), of which 11 underwent root cause analysis. Of these, nine cases were following polypectomy, one was following negotiation around a splenic flexure malignant tumour and one was during a difficult colonoscopy in the context of multiple adhesions and diverticular disease. Almost all were managed with emergency surgery (n = 10). There was one fatality as a result of colonoscopy (0.006%). Conclusion Our perforation rate falls well below the BSG target and is lower than most of the previously published rates for therapeutic and diagnostic colonoscopies. Management of perforations tends to be less conservative than expected, and this was addressed with individual feedback, education and training. Bowel screening is a safe procedure with a low rate of perforation and a low risk of morbidity and mortality. Disclosure of interest None Declared.

Radiation-related injuries and their management: an update.

Ionizing radiation (in the form of X-rays) is used for the majority of procedures in interventional radiology. This review article aimed at promoting safer use of this tool through a better understanding of radiation dose and radiation effects, and by providing guidance for setting up a quality assurance program. To this end, the authors describe different radiation descriptive quantities and their individual strengths and challenges, as well as the biologic effects of ionizing radiation, including patient-related effects such as tissue reactions (previously known as deterministic effects) and stochastic effects. In this article, the clinical presentation, immediate management, and clinical follow-up of these injuries are also discussed. Tissue reactions are important primarily from the patients' perspective, whereas stochastic effects are most relevant for pediatric patients and from an occupational viewpoint. The factors affecting the likelihood of skin reaction (the most common tissue reaction) are described, and how this condition should be managed is discussed. Setting up a robust quality assurance program around radiation dose is imperative for effective monitoring and reduction of radiation exposure to patients and operators. Recommendations for the pre-, peri-, and postprocedure periods are given, including recommendations for follow-up of high-dose cases. Special conditions such as pregnancy and radiation recall are also discussed.

Developing Coordinated Communities of Autonomous Gliders for Sampling Coastal Ecosystems

AbstractUnderwater autonomous gliders have transitioned from exotic experimental systems to becoming a standard platform capable of collecting data over a critical range of spatial and temporal scales in the ocean. The data are proving to be extremely valuable for addressing a wide range of basic and applied research questions. This evolution has led to a growing international community of glider laboratories and offers the potential of increased opportunities to leverage efforts across this “young” growing community. To that end, we review the evolution of the glider communities and share our opinions of opportunities and hurdles. These communities grew from distributed research and/or education groups. It is crucial as systems continue to evolve that there is an effort to “harmonize” data products while preserving the diversity of approaches/science/experimentation. As the gliders have matured and new battery solutions provide additional energy, there is an increased focus on the integration of a wider range of sensors to be incorporated into gliders. Many of these new classes of sensors will be particularly effective for characterizing biological processes in the coastal ocean. As biological sensors generally provide proxy estimates of a parameter, developing robust quality control and assurance procedures is critical. These new sensors will be more power intensive, thus requiring the development of planning tools for increasing energy efficiency during missions. Given the significant growth in the highly distributed glider community, efforts are now focusing on the development mission planning tools to allow for efficient operation of glider fleets.

Quality assurance of assessment and moderation discourses involving sessional staff

Quality assurance is a major agenda in tertiary education. The casualisation of academic work, especially in teaching, is also a quality assurance issue. Casual or sessional staff members teach and assess more than 50% of all university courses in Australia, and yet the research in relation to the role sessional staff play in quality assurance of student assessment outcomes is scarce. Moderation processes are a pivotal part of robust quality assurance measures. Drawing upon previous work surrounding four discourses of moderation, this pilot project reports the results of research into the role and impact of sessional staff in moderation processes at tertiary level. Qualitative data were gathered through focus interviews. Results, in the form of various moderation discourses, indicate that sessional staff impact the formal quality assurance processes in numerous ways.

Can a systematic assessment moderation process assure the quality and integrity of assessment practice while supporting the professional development of casual academics?

There has been a threefold increase in the employment of casual academics in Australian universities within the last 20 years, to the extent that most teaching and marking is now undertaken by casual academics, also known as sessional staff. Yet, casualised teaching and assessment has been considered a risk to student engagement and success, and casual academics report a lack of professional development and increased feelings of marginalisation within the academy. Concurrently, the quality assurance of teaching and assessment in higher education has become a central focus of the government-funded regulatory organisation, the Tertiary Education Quality and Standards Agency (TEQSA). Situated within this context, we report on an assessment moderation process that could support casual academics’ contextualised professional development, generate a sense of connectedness and collegiality and fulfil the requirements of TEQSA. Such processes may ensure that workforce growth in the higher education system supports a robust quality assurance and regulatory framework.