Quality Assurance Steps Research Articles

SU-FF-T-252: HDR Endorectal Brachytherapy: Quality Assurance

Purpose: Fractionated high‐dose rate endorectal brachytherapy has been developed in our institution as a pre‐operative down‐staging modality. Since the treatment is fractionated (26 Gy/4) it is essential to reproduce the treatment planningdose distribution on a daily basis. In this paper we present the Quality Assurance (QA) steps developed to ensure patient based daily dose reproducibility. Method and Materials: The applicator used has a cylindrical symmetry. In addition to the applicator auto‐radiographs used for the catheter physical length determination, there are two additional steps that have to be performed in order to reproduce a treatment planningdose distribution on a daily basis. Another correction has to be performed on a daily basis for rotation of the catheter channels. For this purpose, we use uniquely coded “dummy” source inserts that show themselves on a daily radiograph. The applicator is rotated and radiograph repeated until perfect alignment is achieved. Results: Since the applicator might not be placed to the same depth inside the rectal lumen, there is a shift along the catheter axis that has to be performed on a daily basis. The amount of shift is determined by comparison of a daily radiograph and treatment planningDRR.Conclusions: Reproduction of the treatment planningdose distribution on a daily basis is crucial for the success of the fractionated 3D based brachytherapy treatments. Due to the cylindrical symmetry, two types of adjustments are necessary: applicator rotation and dose distribution shift along the applicator axis.

Video methods in the quantification of children's exposures

In 1994, Stanford University's Exposure Research Group (ERG) conducted its first pilot study to collect micro-level activity time series (MLATS) data for young children. The pilot study involved videotaping four children of farm workers in the Salinas Valley of California and converting their videotaped activities to valuable text files of contact behavior using video-translation techniques. These MLATS are especially useful for describing intermittent dermal (i.e., second-by-second account of surfaces and objects contacted) and non-dietary ingestion (second-by-second account of objects or hands placed in the mouth) contact behavior. Second-by-second records of children contact behavior are amenable to quantitative and statistical analysis and allow for more accurate model estimates of human exposure and dose to environmental contaminants. Activity patterns data for modeling inhalation exposure (i.e., accounts of microenvironments visited) can also be extracted from the MLATS data. Since the pilot study, ERG has collected an immense MLATS data set for 92 children using more developed and refined videotaping and video-translation methodologies. This paper describes all aspects required for the collection of MLATS including: subject recruitment techniques, videotaping and video-translation processes, and potential data analysis. This paper also describes the quality assurance steps employed for these new MLATS projects, including: training, data management, and the application of interobserver and intraobserver agreement during video translation. The discussion of these issues and ERG's experiences in dealing with them can assist other groups in the conduct of research that employs these more quantitative techniques.

The nuclear tRNA aminoacylation-dependent pathway may be the principal route used to export tRNA from the nucleus in Saccharomyces cerevisiae

Nuclear tRNA export in Saccharomyces cerevisiae has been proposed to involve three pathways, designated Los1p-dependent, Los1p-independent nuclear aminoacylation-dependent, and Los1p- and nuclear aminoacylation-independent. Here, a comprehensive biochemical analysis was performed to identify tRNAs exported by the aminoacylation-dependent and -independent pathways of S. cerevisiae. Interestingly, the major tRNA species of at least 19 families were found in the aminoacylated form in the nucleus. tRNAs known to be exported by the export receptor Los1p were also aminoacylated in the nucleus of both wild-type and mutant Los1p strains. FISH (fluorescence in situ hybridization) analyses showed that tRNA(Tyr) co-localizes with the U18 small nucleolar RNA in the nucleolus of a tyrosyl-tRNA synthetase mutant strain defective in nuclear tRNA(Tyr) export because of a block in nuclear tRNA(Tyr) aminoacylation. tRNA(Tyr) was also found in the nucleolus of a utp8 mutant strain defective in nuclear tRNA export but not nuclear tRNA aminoacylation. These results strongly suggest that the nuclear aminoacylation-dependent pathway is principally responsible for tRNA export in S. cerevisiae and that Los1p is an export receptor of this pathway. It is also likely that in mammalian cells tRNAs are mainly exported from the nucleus by the nuclear aminoacylation-dependent pathway. In addition, the data are consistent with the idea that nuclear aminoacylation is used as a quality control mechanism for ensuring nuclear export of only mature and functional tRNAs, and that this quality assurance step occurs in the nucleolus.

Implementation of IMRT in the radiotherapy department.

This paper describes the implementation of intensity modulated radiotherapy (IMRT) in a radiotherapy department. When preparing to set-up an IMRT programme, it is important to review departmental protocols with regard to immobilization, CT planning, treatment planning and verification. Any additional quality assurance steps also need to be fully understood. A new IMRT programme is most likely to be successful if it builds on established clinical experience with three-dimensional conformal radiotherapy (CRT). Training of radiographers, clinicians and physicists is critical, and both team-work and communication are vital to ensure a smooth transition from 3DCRT to IMRT delivery in the clinic.

What Is Palliative Care in Germany? Results from a Representative Survey

The recent development of palliative care inpatient units in Germany has been impressive. As a first step for quality assurance, a core documentation form was developed in 1996. The core documentation form consisted of 4 pages with 35 items documenting physical and psychosocial symptoms at the time of admission, diagnostic and therapeutic procedures before and during inpatient treatment, and outcome of physical and psychosocial dimensions. Checklists were used for most items and free text entries could be added. Of the 65 palliative inpatient units in Germany, 44 participated in the second phase of the evaluation of the core documentation in 2000. Eight units were affiliated with anesthesiology departments, 31 with internal medicine, two with radiotherapy, 1 with a surgical department, and 2 units were not affiliated with a department of the hospital. A total of 1087 patients were assessed in the 44 units during a period of up to 3 months. There was a high variability between units in all checklist items of the core documentation. Compared to units affiliated with internal medicine departments, units affiliated with anesthesiology departments performed less chemotherapy, but more immunotherapy; gave fewer infusions and blood transfusions but more skin and wound care, and more lymphatic drainage and massage; and documented psychosocial interventions more frequently for patients as well as for relatives. In one-third of the patients, a consent for omission of therapeutic options was documented. Inpatient treatment ended with the death of the patient in 45.3% of patients and with discharge in 51.6% (not documented 3.1%). The efficacy of inpatient treatment was rated very high by the staff. In conclusion, we found large variation in the documentation pertaining to palliative care patients at the time of admission, as well as for inpatient treatment, among palliative care units in Germany. This was related to the affiliation of the units at least to some degree, but also to differences in interests and documentation discipline. We suggest that training procedures for documentation should be included in crossectional surveys, as the results may not be comparable otherwise. However, common documentation instruments may be the first step towards an interdisciplinary discussion on aims and methods in palliative care.

Emission inventory development and processing for the Seasonal Model for Regional Air Quality (SMRAQ) project

This paper describes the experiences and insights gained from inventory preparation and emissions processing for the Seasonal Model for Regional Air Quality (SMRAQ) project. The emission inventory was derived from the 1990 and 1995 Ozone Transport Assessment Group (OTAG) inventories. Here we outline the emissions processing strategy used for the May‐to‐September simulation, summarize the inventory characteristics and corrections made on the OTAG inventories, and describe the quality assurance steps taken as part of the processing. We then provide spatial maps and daily total time series charts of the hourly, gridded emissions of nitrogen oxides (NOx), reactive organic gases (ROG), and carbon monoxide (CO). Large peaks from electric utility point sources and urban mobile sources characterize the NOx emissions, and the NOx emissions in nonpeak regions are primarily mobile‐source emissions. ROG emissions are dominated by biogenic isoprene production in the southern United States, and they have a strong seasonal variability. CO emissions are characterized by less variability, with area and mobile sources dominating the inventory. We compare ratios of season‐average nonmethane organic gases to NOx between the emission inventory and the Photochemical Assessment Monitoring Stations (PAMS) data, and these comparisons show poor correlation between the inventory and ambient ratios.

Subsecond multislice spiral CT as an alternative to electron beam computerized tomography

X-ray computed tomography (CT) has exhibited rapid technological advances in recent years which has made it a potential alternative to electron beam computed tomography (EBCT). In addition to the development of spiral CT, rotation times in the subsecond range and the development of multislice detectors were decisive steps. These technical developments will be sketched briefly; the necessary adaptation of image reconstruction and evaluation will be explained. Particular emphasis will be placed on the necessary steps of quality assurance and calibration in quantitative procedures, as for example coronary calcium measurements. The exposure for typical CT examinations of the heart are in the order of half to five times the natural exposure per year. With synchronous recording of the ECG, the complete heart can be imaged continuously with thin slices and high spatial resolution in less than 30 s. In spite of the very short validation phase up to now, we consider multislice spiral CT an alternative to EBCT.

The Measurement of Adult Literacy in Theory and in Practice

The International Adult Literacy Survey (IALS) was designed as a vehicle to directly measure the functional literacy skills of adults across different countries. This survey was conducted as a household-based survey whereby a random sample of adults in participating countries was selected and administered a literacy skill assessment. The IALS theoretical framework was founded upon a solid base of research and statistical theory. Proven statistical methods such as Item Response Theory and Plausible Values Methodology were used in the development and analysis of the literacy test. Likewise, from the practical viewpoint, the IALS has been successfully administered in the household-survey setting. Several quality assurance steps have shown to be effective in this regard. Finally, the resultant national literacy skill profiles have provided useful literacy indicators at both government and individual levels.

Selenium speciation in human milk with special respect to quality control.

Selenium- (SE) organo compounds of pooled human milk (7th-14th d after delivery) were separated by centrifugation and subsequent size-exclusion chromatography (SEC) as described in ref. (1). The SEC fractions were used for Se determinations by electrothermal vaporization inductively coupled plasma mass spectrometry (ETV-ICP-MS) in parallel to identification procedures of the organic ligands by two different capillary zone electrophoresis (CZE) methods. Further, the combination of isotachophoresis- (ITP) CZE with ETV-ICP-MS was used for final identifications. Mass balances were carried out at each analytical step for quality assurance. Reinjection experiments were performed to check the stability of Se-organo compounds during the analytical procedure. These quality-control experiments showed that no species transformations took place during the analytical procedure, and the Se species were native in human milk. The identification and quantification of organic ligands were clear and resulted in values of 2 (+/- 0.2) mg/L GSH/GSeH, 2 (+/- 0.22) mg/L cystamine/Se-cystamine, 4 (+/- 0.4) mg/L cystine/ Se-cystine, and 1 (+/- 0.18) mg/L methionine/Se-methionine. Unfortunately, a differentiation between sulfur (S) and Se analogs was not possible with the applied CE methods. The Se values per organic ligand were determined as 2.5 (+/- 0.23) mg/L associated with GSH (as GSeH), 3.1 (+/- 0.31) mg/L associated with cystamine (as Se-cystamine), 5.2 (+/- 0.4) mg/L associated with cystine (as Se-cystine), and 1 (+/- 0.1) mg/L associated with methionine (as Se-methionine).

Results of a Validation Study in Germany on Two in Vitro Alternatives to the Draize Eye Irritation Test, the HET-CAM Test and the 3T3 NRU Cytotoxicity Test

Results of a Validation Study in Germany on Two in Vitro Alternatives to the Draize Eye Irritation Test, the HET-CAM Test and the 3T3 NRU Cytotoxicity Test

Contribution of standard programming languages to software quality

The paper examines the contribution that a standard programming language can make to the quality of the software written in that language. By means of an example, we show that there is a substantial difference in languages and their implementations in the assurance provided of the correctness of the resulting program. Demonstrating that a program is correct with respect to the semantics of the language is a useful step in quality assurance.

Sensory Gas Chromatography for Evaluation of Taste and Odor Events in Drinking Water

A sensory gas chromatography (sensory GC) procedure with appropriate quality assurance steps was developed to evaluate ng/l concentrations of odorous chemicals in drinking water. Closed loop stripping analysis was used to concentrate the chemicals in the water samples. Sensory GC analysis was completed by smelling the effluent at the exit port of an on-column injector capillary GC system. An identical and parallel GC flame ionization detector system was used to monitor the sensory gas chromatograms. The sensory GC analysis is important because it can detect some of the individual components of the odor that a sensory panel determines on a water sample. The relationship between sensory panel response and the sensory GC procedure were investigated near threshold odor concentration levels and the data shows that sensory GC does not always correlate with sensory panel evaluations. This can be caused by the concentrations differences of the chemicals in the mixture and synergistic and antagonistic effects. Two taste and odor events reported at the Baxter Water Treatment Plant of the city of Philadelphia on the Delaware river were investigated. The events were first a metallic aftertaste accompanied by a burnt rubber odor and second a cucumber odor in the drinking water. The cases studied illustrate the use of FPA, sensory GC and GC/MS to understand the chemical nature of the odors present in the samples.

First Steps in Quality Assurance in Preventive Health Care

The study of health and lifestyles was undertaken by Dumfries and Galloway Health Board, by means of a postal questionnaire. The results showed a change to a healthier way of life generally, although this can be widely different between socioeconomic groups.

Quality assurance in a nuclear medicine department.

This article reviews the general principles of quality assurance (QA) in an imaging department, with emphasis on nuclear medicine. The various steps taken during the development of the QA program reflect the response of the QA committee as it came to a better understanding of the components of QA. Accrediting and regulatory bodies have had important roles in providing guidance. Quality control of instrumentation and radiopharmaceuticals opened the gateway to monitoring in high-volume, high-risk areas; however, QA expanded this concept into better generic and clinical monitoring. Encouragement of the use of quality of care referral forms resulted in greater participation by all members of the department. Examples of physicians' QA activities include double reading of images and sending of code cards. Experience with other forms of physician QA activities is also included. The QA committee provides a forum for five steps of QA: identify problems, assess the causes, implement action to prevent them, monitor effects of the actions, and document these activities. These steps should lead to improvement in the standards of patient care.