Quality Assurance Standards Research Articles

Simulation of consequences of using nonideal detectors during beam data commissioning measurements.

Beam data commissioning is a core task of radiotherapy physicists. Despite multiple detectors available, a feasible measurement program compromises between detector properties and time constraints. Therefore, it is important to understand how nonideal measurement data propagates into patient dose calculation. We simulated the effects of realistic errors, due to beam commissioning with presumably nonoptimal detectors, on the resulting patient dose distributions. Additionally, the detectability of such beam commissioning errors during patient plan quality assurance (QA) was evaluated. A clinically used beam model was re-commissioned introducing changes to depth dose curves, output factors, profiles or combinations of those. Seventeen altered beam models with incremental changes of the modelling parameters were created to analyze dose changes on simplified anatomical phantoms. Additionally, fourteen altered models incorporate changes in the order of signal differences reported for typically used detectors. Eighteen treatment plans of different types were recalculated on patient CT data sets using the altered beam models. For the majority of clinical plans, dose distributions in the target volume recalculated on the patient computed tomography data were similar between the original and the modified beam models, yielding global 2%/2mm gamma pass rates above 98.9%. Larger changes were observed for certain combinations of beam modelling errors and anatomical sites, most extreme for output factor changes in a small target volume plan with a pass rate of 80.6%. Modelling an enlarged penumbra as if measured with a 0.125cm3 ion chamber had the largest effect on the dose distribution (average pass rate of 96.5%, lowest 85.4%). On different QA phantom geometries, dose distributions between calculations with modified and unmodified models typically changed too little to be detected in actual measurements. While the simulated errors during beam modelling had little effect on most plans, in some cases changes were considerable. High-quality penumbra and small field output factor should be a main focus of commissioning measurements. Detecting modelling issues using standard patient QA phantoms is unlikely. Verification of a beam model should be performed especially for plans with high modulation and in different depths or geometries representing the variety of situations expected clinically.

Patient Satisfaction measurement with Quality of Service in a Public Hospital from Rural West Bengal

For measuring healthcare performance, an imperative indicator is patient satisfaction with quality of service. Perception of poor quality by clients leads to some patients altogether bypassing the public hospitals for an alternative provider services. The main objective of this study is to investigate patient satisfaction with quality of services in a public hospital from rural West Bengal. The study is a cross-sectional descriptive design employing quantitative primary data collection methods. Data are collected from 150 inpatients by simple random sampling technique using validated questionnaire of National Quality Assurance Standards operational guidelines for quality assurance of public health facilities. Quantitative data were analyzed using IBM SPSS software Version 28. The results indicated patient satisfaction at 42 % for “good” quality of services. Facility was short to meet patients’ expectation for overall cleanliness. Quality of the service needs to be improved in the admission counter, provision of prescribed drugs and diagnostic tests. Quality of service was also significantly affected by the quality and timeliness of supply of food. In conclusion, patient satisfaction needs to be improved at the facility level in delivering quality of care by improving responsiveness, technical assistance and training along with investment for up gradation of the facility.

Nilai Nutrisi dan Rendemen Ekstrak Metanol Pelet Katuk Depolarisasi sebagai Parameter Standar Mutu Produksi

Standardization of the quality of the depolarized katuk pellet production process as a feed additive is very important to maintain product quality. The production process requires dry katuk leaves (DKK) as raw materials which are then processed into depolarized katuk leaves (DKD), and continues in the pelleting process to become depolarized katuk pellets (PKD). Quality standard can be done by measuring the parameters of nutritional value and also the yield of methanol extract. Nutritional values were obtained from the results of proximate analysis, namely the percentage of dry matter, ash content, crude protein, crude fiber, crude fat, beta-N, calcium, phosphorus, and gross energy (Cal/g). Mean while, the yield of methanol extract was obtained by maceration using methanol solvent. This study aims to evaluate the nutritional value and yield of crude methanol extract of katuk leaves (DKK, DKD, PKD) which can be used as a quality assurance standard for the depolarized katuk pellet production process. In general, the nutritional value of DKD and PKD had the same value as that of DKK, except for calcium which was quite high (P<0.05) in DKD and PKD, and the percentage of crude fiber was lower (P<0.05) in PKD compared to DKK and DKD. The percentage of crude fat in pellets (PKD) was higher (P<0.05) when compared to DKK and DKD. The yield of methanol extract was very high (P<0.05) in DKK, compared to DKD and PKD. The nutritional parameters and the yield of the katuk leaf extract can be used as quality assurance standards for the depolarized katuk pellet production process.
 
 Keywords: depolarization, katuk, methanol, nutrition, pellet

Evaluation of Dhofar University Performance according to Quality Assurance and Academic Accreditation Criteria of Islamic Universities Federation

Objectives: The aim of this research is to evaluate the performance of Dhofar University in Sultanate of Oman based on two criteria: quality assurance and academic accreditation of Islamic Universities Federation. Methods: This research is categorized under quantitative approach by using descriptive statistics analysis. 236 participants of academics and Employee were selected randomly from population of university which included 423 lecturers and employees. Data was analyzed by using the Statistical Package for Social Sciences (SPSS-25). Results: The results indicated that criteria used in Dhofar University was congruent with Islamic Universities Federation criteria with an average (3.81 of 5) and a standard deviation (0.63) which is relatively high. The first criteria were the "Education Resources and Facilities Standard" with an average of 4.06, then the "Teaching and Learning Standard" with an average of 4.01, and finally the "International Standard" with an average of 3.56 respectively. The results also revealed that there are no significant differences between the responses of participants in the extent of quality assurance application standards and academic accreditation at Dhofar University, based on gender and years of experience. Conclusions: Finally, researcher presented a set of recommendations including adoption of the model (quality assurance standards and academic accreditation of Islamic Universities Federation) as long as there is an appropriate ground for the application at Dhofar University, with the initiation of forming a team to undertake this work, in addition to possibility of applying the module in other universities.

Implementing Internal Quality Assurance Systems in the In-Service Teacher Education Programmes in Zimbabwean Universities: The Quality Discourse

The emerging discourses in the Zimbabwean teacher education system have been on the capacity of in–service teachers to be transformative through their preparation at university. The call, then, has been on universities to improve their quality assurance and its effective implementation for quality programmes and learning outcomes. There have been growing indications and expectations that university in–service teacher graduates should lead in transforming the educational and economic systems of nations presenting a strong explanation for effective quality assurance structures in universities. In this article, the researchers contended that without robust quality assurance systems at Zimbabwean universities’ teacher education programmes, the nation may not achieve the desired educational vision. The paper reports, analyses practices and lessons learnt on the implementation of internal quality assurance systems on in-service teacher education programmes at one state university in Zimbabwe. Underpinned by the sociocultural theory, the qualitative case study used semi–structured interviews and open–ended questionnaires. One quality assurance directorate, four departmental quality assurance lecturers drawn from each of the four School of Education departments and twelve final years in-service students were purposefully sampled. The results indicated that the university had weak internal quality assurance management structures failing to continuously monitor and evaluate in-service programmes and their implementation. The study recommended that the institution reconstitutes the quality assurance body by bringing together all stakeholders including in-service students to a dialogue table to discuss how quality assurance standards and practices can be designed, implemented and evaluated. Keywords: Implementation, internal quality assurance, university, teacher education, in-service

Point-of-Care Ultrasound Transmission for Remote Interpretation in Austere Environments

Point-of-care ultrasound (POCUS) is used in wilderness medicine and could potentially be the only imaging modality available. Cellular and data coverage is often lacking in remote areas, limiting image transmission. This study evaluates the viability of transmitting POCUS images from austere environments using slow-scan television (SSTV) image transmission methods over very-high-frequency (VHF) hand-held radio units for remote interpretation. Fifteen deidentified POCUS images were selected and encoded into an SSTV audio stream by a smartphone and transmitted over a VHF radio. A second radio and smartphone 1 to 5 mi away received and decoded the signals back into images. The original images and transmitted images were randomized into a survey graded by emergency medicine physicians using a standardized ultrasound quality assurance scoring scale (1-5 points). The difference in mean scores between the original image and transmitted image showed a 3.9% decrease in transmitted image scores, with P <0.05 on a paired t test; however, this is not likely a clinically significant decrease. Comparing transmitted images using different SSTV encodings and distances ranging up to 5 mi, 100% of survey respondents determined the images to be clinically usable. This dropped to 75% when significant artifacts were introduced. Slow-scan television image transmission is a viable option for transmitting ultrasound images in remote areas where more modern forms of communication are unavailable or not practical. Slow-scan television may have potential as another data transmission option in the wilderness, such as electrocardiogram tracings.

Stages and Standards of Quality Assurance Planning with Character Strengthening Religious Stackholders at Madrasah Aliyah Plus Az-Zikra Bogor.

Stages and Standards of Quality Assurance Planning with Character Strengthening Religious Stackholders at Madrasah Aliyah Plus Az-Zikra Bogor.

Application of Conditional Generative Adversarial Networks to Efficiently Generate Photon Phase Space in Medical Linear Accelerators of Different Primary Beam Parameters

Successful application of external photon beam therapy in oncology requires that the dose delivered by a medical linear accelerator and distributed within the patient’s body is accurately calculated. Monte Carlo simulation is currently the most accurate method for this purpose but is computationally too extensive for routine clinical application. A very elaborate and time-consuming part of such Monte Carlo simulation is generation of the full set (phase space) of ionizing radiation components (mainly photons) to be subsequently used in simulating dose delivery to the patient. We propose a method of generating phase spaces in medical linear accelerators through learning, by artificial intelligence models, the joint multidimensional probability density distribution of the photon properties (their location in space, energy, and momentum). The models are conditioned with respect to the parameters of the primary electron beam (unique to each medical accelerator), which, through Bremsstrahlung, generates the therapeutical beam of ionizing radiation. Two variants of conditional generative adversarial networks are chosen, trained, and compared. We also present the second-best type of deep learning architecture that we studied: a variational autoencoder. Differences between dose distributions obtained in a water phantom, in a test phantom, and in real patients using generative-adversarial-network-based and Monte-Carlo-based phase spaces are very close to each other, as indicated by the values of standard quality assurance tools of radiotherapy. Particle generation with generative adversarial networks is three orders of magnitude faster than with Monte Carlo. The proposed GAN model, together with our earlier machine-learning-based method of tuning the primary electron beam of an MC simulator, delivers a complete solution to the problem of tuning a Monte Carlo simulator against a physical medical accelerator.

Studi Penjaminan Mutu (Quality Assurance) Internal Dalam Pelayanan Kefarmasian

Pharmaceutical services in hospitals aim to improve the quality of pharmaceutical services, protect patients from irrational drug use to maintain patient safety, and ensure legal certainty for pharmacists. Quality Assurance (QA) is used in measuring service quality, whereas QA in IFRS aims to provide assurance of product quality and the quality of pharmaceutical services provided to patients. This research employs descriptive research with a cross-sectional method, and primary date are obtained from questionnaires with the framework of QA standard indicators in pharmaceutical services at the primary Installastion of Mother and Child Hospital Kasih Fatimah Kotamobagu, with five respondents. The results indicate that internal quality assurance in pharmaceutical services at the Fatimah Kotamobagu Mother and Child Hospital Kasih Fatimah Kotamobagu Pharmacy Installation was in accordance with quality assurance standards, especially in the aspects of organizational structure, quality measures, and safety assurance, as well as drug distribution with an overall value in the criteria, are (75%), moderately appropriate are (15%) and not appropriate are (10%).

Towards the improvement of breast cancer management based on EUSOMA quality indicators: Insights from a 15-year institutional experience.

e13662 Background: Breast cancer (BC) is the most common female malignancy and the leading cause of cancer-related deaths among women worldwide. Quality indicators (QIs) are evidence-based measures in healthcare used to track and improve patient care. In 2010, the European Society of Breast Cancer Specialists (EUSOMA) identified several quality indicators that could be adopted by breast cancer dedicated institutions. These QIs allow standardized clinical performance and quality assurance for BC care. We assessed the compliance of EUSOMA QIs published in 2017 by the Hospital de los Valles (HDLV), an Ecuadorian private institution, as a tool to assess BC management. This is the first project in Ecuador and South America that evaluates breast cancer quality indicators. The importance of this project is to create a foundation to identify areas for the improvement of breast cancer care in Ecuador. Methods: Women between 20 and 80 years of age with a histopathological diagnosis of BC and surgically treated at HDLV between 2007 and 2022 were included and analyzed in compliance with the updated EUSOMA QIs (2017). Exclusion criteria: male patients, breast cancer cases diagnosed by core biopsy only and without surgical excision, previous chemotherapy exposure. The number of cases meeting each criteria for EUSOMA QIs is expressed as percentages. Results: 137 women with breast cancer were included for analysis. Based on available information and resources, we were able to assess 14 out of the 34 QIs proposed by EUSOMA. Six indicators reached the minimum standard suggested by EUSOMA: 3 out of 7 QIs for diagnosis, 2 out of 3 for surgical and locoregional treatment, and 1 out of 4 for surgical and quality of life. Standards in triple diagnosis, waiting time, and surgical approaches were accomplished, while standards for surgical over-treatment and simultaneous reconstructive surgery did not meet standards. Conclusions: The lack of data about treatment, follow-up, and low access to standardized procedures limited the number of QIs assessed. This study marks a milestone towards continuous BC care improvement and indicates the need for local QIs and their regional implementation.

Quality in colonoscopy: time to ensure national standards are implemented?

BackgroundHigh-quality colonoscopy is crucial to ensure complete mucosal visualisation and to maximise detection of pathology. Previous audits showing variable quality have prompted national and international colonoscopy improvement programmes, including the...

Lobster Position Estimation Using YOLOv7 for Potential Guidance of FANUC Robotic Arm in American Lobster Processing

The American lobster (Homarus americanus) is the most valuable seafood on Canada’s Atlantic coast, generating over CAD 800 million in export revenue alone for New Brunswick. However, labor shortages plague the lobster industry, and lobsters must be processed quickly to maintain food safety and quality assurance standards. This paper proposes a lobster estimation orientation approach using a convolutional neural network model, with the aim of guiding the FANUC LR Mate 200 iD robotic arm for lobster manipulation. To validate this technique, four state-of-the-art object detection algorithms were evaluated on an American lobster images dataset: YOLOv7, YOLOv7-tiny, YOLOV4, and YOLOv3. In comparison to other versions, YOLOv7 demonstrated a superior performance with an F1-score of 95.2%, a mean average precision (mAP) of 95.3%, a recall rate of 95.1%, and 111 frames per second (fps). Object detection models were deployed on the NVIDIA Jetson Xavier NX, with YOLOv7-tiny achieving the highest fps rate of 25.6 on this platform. Due to its outstanding performance, YOLOv7 was selected for developing lobster orientation estimation. This approach has the potential to improve efficiency in lobster processing and address the challenges faced by the industry, including labor shortages and compliance with food safety and quality standards.

Automatic and standardized quality assurance of digital mammography and tomosynthesis with deep convolutional neural networks

ObjectivesThe aim of this study was to develop and validate a commercially available AI platform for the automatic determination of image quality in mammography and tomosynthesis considering a standardized set of features.Materials and methodsIn this retrospective study, 11,733 mammograms and synthetic 2D reconstructions from tomosynthesis of 4200 patients from two institutions were analyzed by assessing the presence of seven features which impact image quality in regard to breast positioning. Deep learning was applied to train five dCNN models on features detecting the presence of anatomical landmarks and three dCNN models for localization features. The validity of models was assessed by the calculation of the mean squared error in a test dataset and was compared to the reading by experienced radiologists.ResultsAccuracies of the dCNN models ranged between 93.0% for the nipple visualization and 98.5% for the depiction of the pectoralis muscle in the CC view. Calculations based on regression models allow for precise measurements of distances and angles of breast positioning on mammograms and synthetic 2D reconstructions from tomosynthesis. All models showed almost perfect agreement compared to human reading with Cohen’s kappa scores above 0.9.ConclusionsAn AI-based quality assessment system using a dCNN allows for precise, consistent and observer-independent rating of digital mammography and synthetic 2D reconstructions from tomosynthesis. Automation and standardization of quality assessment enable real-time feedback to technicians and radiologists that shall reduce a number of inadequate examinations according to PGMI (Perfect, Good, Moderate, Inadequate) criteria, reduce a number of recalls and provide a dependable training platform for inexperienced technicians.

Evaluating the performance of kindergarten teachers according to quality assurance standards in the Kurdistan Region / Iraq

Evaluating the performance of kindergarten teachers according to quality assurance standards in the Kurdistan Region / Iraq

IMRT QA result prediction via MLC transmission decomposition.

Quality assurance measurement of IMRT/VMAT treatment plans is resource intensive, and other more efficient methods to achieve the same confidence are desirable. We aimed to analyze treatment plans in the context of the treatment planning systems that created them, in order to predict which ones will fail a standard quality assurance measurement. To do so, we sought to create a tool external to the treatment planning system that could analyze a set of MLC positions and provide information that could be used to calculate various evaluation metrics. The tool was created in Python to read in DICOM plan files and determine the beam fluence fraction incident on each of seven different zones, each classified based on the RayStation MLC model. The fractions, termed grid point fractions, were validated by analyzing simple test plans. The average grid point fractions, over all control points for 46 plans were then computed. These values were then compared with gamma analysis pass percentages and median dose differences to determine if any significant correlations existed. Significant correlation was found between the grid point fraction metrics and median dose differences, but not with gamma analysis pass percentages. Correlations were positive or negative, suggesting differing model parameter value sensitivities, as well as potential insight into the treatment planning system dose model. By decomposing MLC control points into different transmission zones, it is possible to create a metric that predicts whether the analyzed plan will pass a quality assurance measurement from a dose calculation accuracy standpoint. The tool and metrics developed in this work have potential applications in comparing clinical beam models or identifying their weak points. Implementing the tool within a treatment planning system would also provide more potential plan optimization parameters.

Three-dimensional printing accuracy analysis for medical applications across a wide variety of printers.

Three-dimensional (3D) printing has had a significant impact on patient care. However, there is a lack of standardization in quality assurance (QA) to ensure printing accuracy and precision given multiple printing technologies, variability across vendors, and inter-printer reliability issues. We investigated printing accuracy on a diverse selection of 3D printers commonly used in the medical field. A specially designed 3D printing QA phantom was periodically printed on 16 printers used in our practice, covering five distinct printing technologies and eight different vendors. Longitudinal data were acquired over six months by printing the QA phantom monthly on each printer. Qualitative assessment and quantitative measurements were obtained for each printed phantom. Accuracy and precision were assessed by comparing quantitative measurements with reference values of the phantom. Data were then compared among printer models, vendors, and printing technologies; longitudinal trends were also analyzed. Differences in 3D printing accuracy across printers were observed. Material jetting and vat photopolymerization printers were found to be the most accurate. Printers using the same 3D printing technology but from different vendors also showed differences in accuracy, most notably between vat photopolymerization printers from two different vendors. Furthermore, differences in accuracy were found between printers from the same vendor using the same printing technology, but different models/generations. These results show how factors such as printing technology, vendor, and printer model can impact 3D printing accuracy, which should be appropriately considered in practice to avoid potential medical or surgical errors.

Quality of Artificial Intelligence Driven Procurement Decision Making and Transactional Data Structure

Purpose: Current data driven decision making development calls for the quality assurance based on quality data structure. The paper analyses transactional data structure used in public procurement in Slovakia and the effect of data structure enhancement on prediction performance as crucial part of artificial intelligence (AI) quality assurance standard. We examine the significance of data structure enhancement and attributes transformation for prediction modelling. Methodology/Approach: The research is based on mutli-step model using stacked ensemble machine learning (ML) algorithm and simulating input space of 211 attributes transformed and aggregated according to different perspectives assessed by r2, mean absolute error (MAE) or mean square error (MSE). Findings: The results show that different performance of variable categories to prediction power. The most significant predictors were in category related to sectoral product classifications and in category related to variables aggregated for supplier, what underline the significance of structured information of all suppliers and negotiation participants in public tenders. Research Limitation/Implication: Methodology is based on big data with high complexity. Due to limited computing power, no subjects’ IDs were used as inputs. The complexity behind data and processes call for more complex simulations of all variables and their mutual interaction and interdependencies. Originality/Value of paper: The paper contributes to data science in transactional data domain and assessed the significance of different variables categories with respect to their specific added value to prediction power.

Use of Thermoluminescence Dosimetry for QA in High-Dose-Rate Skin Surface Brachytherapy with Custom-Flap Applicator

Surface brachytherapy (BT) lacks standard quality assurance (QA) protocols. Commercially available treatment planning systems (TPSs) are based on a dose calculation formalism that assumes the patient is made of water, resulting in potential deviations between planned and delivered doses. Here, a method for treatment plan verification for skin surface BT is reported. Chips of thermoluminescent dosimeters (TLDs) were used for dose point measurements. High-dose-rate treatments were simulated and delivered through a custom-flap applicator provided with four fixed catheters to guide the Iridium-192 (Ir-192) source by way of a remote afterloading system. A flat water-equivalent phantom was used to simulate patient skin. Elekta TPS Oncentra Brachy was used for planning. TLDs were calibrated to Ir-192 through an indirect method of linear interpolation between calibration factors (CFs) measured for 250 kV X-rays, Cesium-137, and Cobalt-60. Subsequently, plans were designed and delivered to test the reproducibility of the irradiation set-up and to make comparisons between planned and delivered dose. The obtained CF for Ir-192 was (4.96 ± 0.25) μC/Gy. Deviations between measured and TPS calculated doses for multi-catheter treatment configuration ranged from -8.4% to 13.3% with an average of 0.6%. TLDs could be included in clinical practice for QA in skin BT with a customized flap applicator.

Advancement and benefits associated with ISO 9000 series

ISO 9000 is a set of internationally recognized standards for quality assurance and management. Published by the International Organization for Standardization, it aims to encourage the production of goods and services that meet a globally-acceptable level of quality. ISO 9000 is a quality management standard that presents guidelines intended to increase business efficiency and customer satisfaction. The goal of ISO 9000 is to embed a quality management system within an organization, increasing productivity, reducing unnecessary costs, and ensuring quality of processes and products.ISO 9000 was first published in 1987 by the International Organization for Standardization (ISO). It was based on the BS 5750 series of standards from BSI that were proposed to ISO in 1979.. ISO 9000 is defined as a set of international standards on quality management and quality assurance developed to help companies effectively document the quality system elements needed to maintain an efficient quality system. They are not specific to any one industry and can be applied to organizations of any size. They are issued by certification/registration bodies (also called Registrars or CB's), which are independent of ISO. CB's need to be accredited by an IAF member to be internationally recognized. ISO 9001 supports you to increase the control of your business processes. The more you control your business, the more your consistency rises. Increased consistency means your customers are getting the same good service or same good products every time they are making business with you. ISO 9000 aims to improve quality and facilitate business objectives.

Exploring the themes for Quality Assurance at Secondary Level in Punjab: A Document Analysis

Quality assurance (Q.A.) in education is the process of ensuring that educational programs and services meet established standards and expectations. This study aimed to explore themes for quality assurance in secondary schools at the Punjab level to enhance and evaluate the quality assurance process. In order to support in-depth realities, the exploration study is grounded in the interpretivism research paradigm. Data were collected by using the document analysis technique on quality assurance standards documents implemented in different countries around the world; In-depth qualitative analysis was performed with the use of NVivo 12 software. The study's various themes have been confirmed via the use of numerous methods, including Coding Nodes, Word Trees, Word Tag Clouds, and Treemaps. Documents from eleven countries were selected to achieve the study’s objective; the most updated and relative themes were extracted and presented diagrammatically and in tabular form. A total of twelve themes were found through a thematic analysis process. Twelve themes were explored and named 1)assessment;2)community involvement; 3)curriculum; 4)early childhood education;5)school environments; 6)school ethos and value;.7)Facilities for schools;8)H)school administration and management, 9)school quality management and improvement. 10)School Mission, Vision, and Objectives ,11)Teacher Standards,12)Student Standards This research study is applicable at the secondary school level in the quality assurance process. The research finding highlighted the most relevant themes/factors used in quality assurance process; to enhance or evaluate the quality assurance practices. The outcome of this research study bridges the gap in the existing literature by offering empirical knowledge on the school quality assurance process at the secondary school level. This is the first research done in an Asian setting to focus specifically on quality assurance and its associated themes and processes. This study may eventually improve educational standards and student performance.