Lecture 1 Flashcards
What is the purpose of QA in RT? (4)
- reduces random and systematic errors in all steps of care improving dosimetric and geoetric accurey and precision
- increases the probability erros are recognised and rectified reduing their consequences for patients
- allows a reliable inter-comparision of results amount centres
- high level accuracy and consistency is achieved
What are the steps of care QA is involved in? (7)
- Diagnosis
- Consultation
- imagine/simulation
- treatment planning
- pre-treatment delivery
- treatment
- follow up
In QA what is the role of the RT?
- demonstrate a thorough knowledge of QA and procedure
- knowledge and application of procedures used in QA and follows department polices and procedures
Why are there so many different QA documents?
- as each Nation/state have their own standards and protocols
Why is it important to understand the national/state standards?
- as what RTs can do legally differs from one country to another e.g. in UK only physicts do QA but in AUS RTs can do daily QA
What is the benefit and downfall of mutli-disciplinary QA?
- repsonsibilites shared decreases workload for each individual
- clear responsibilities and training need to be provided and any overlaps must be clarrified
What is the rationale for stringent QA?
- address the errors that can be controlled so that the errors that can’t be controlled
matter less
Define quality assurance
- ioverall process which is supported by QC activities.
- activities that impose specific quality on a process, such as evaluation of operating performance of a device and comparing it to a desired goal
Define quality system management
- is the management of
a QA program
Define quality control
- mechanism and procedures by which one can assure quality
- these include all the activities that demonstrate a level of quality achieved by the output of a process
QA is concerned with operational techniques and activities used to … (2)
- check that quality requirements are met.
2. adjust and correct performance if the requirements are found not to have been met
Define QA in the context of RT
- is all procedures that
ensure consistency of the medical prescription and safe
fulfillment of that radiotherapy related prescription
What are some examples of medical procedures that need QA? (4)
- dose to the target volume
- Minimal dose to normal tissue.
- Adequate patient monitoring aimed at determining the optimum end result of the treatment.
- Minimal exposure of personnel
What is the general structure of equipment QA programme? (4)
- Acceptance Testing and Commissioning
- Routine QC checks
- Additional QC checks
- Planned preventative maintenance (PM) program
What is acceptance testing?
- Acceptance of equipment is the
process in which the supplier demonstrates the
baseline performance of the equipment to the
satisfaction of the customer
What is comissioning?
- Commissioning is the process of
preparing the equipment for clinical service - usually done by physics
When is QC first done?
- begins immediaey after comissioning
Why is risk management important?
- It plays a vital role in supporting and
informing decision making in providing a
safe and secure environment for patients,
staff and the public
What is the reasoning behind risk management?
- We must be proactive in reducing
identified risk to an acceptable level with
preventative measures rather than reactive
remedies
When does preventative maintenance occur?
- after commissioning and before regular QC tests
What are the QC program specifications (8)?
- parameteres tested
- specific equipment to be used
- geometry of test
- frequency of tests
- staff group or individual performing tess responsible for standards
- expected results
- tolerance and action levels
- actions required when the tolernaces are exceeded
Who is the main regulatory body for QA?
- ARPANSA
What are the services of ARPANSA?
- monitoring
- testing and calibration
- training
- hire radiaiton meters
Who conducts dosimetry audits?
- the australian clinical dosimetry service
What is Australina Clinical Dosimtry Service?
- a national independent dosimetry auditing program, providing quality assurance for radiation oncology facilities and patients
- team consists of 2 MP and 2 RT
Define Quality audit
- is a systematic and independent test to determine if quality activities and results comply and if these are implemented effectively
What is the rationale for quality audits?
- evaluate the need for improvmenet or corrective action is those standards are not met
What are the characteristics of a quality audit?
- should be regular and form part of a quality feedback loop to improve quality
- voluntary or regulatory
- procedural or practical
What is the scope of a quality audit?
- check documentation
- check meausurements
- assess infrastructure
What is an example of an international quality audit?
- IAEA/WHO TLD audit
- small TL dosimeters (0.5x2.5cm) are distributed by mail to participants for irradiation and upon their return, they are read in the IAEA dosimetry laboratory
- criteria TLD results within 5%
What is a level 1 ACDS audit?
- occurs every two years
- mail out
- independent measurements of Linac output under reference conditions
What is a level 1B ACDS audit?
- new linac
- upon request
- ACDS staff perform onsite measurements using own dosimetry equipment
- audit photon and electron dose output, FFF beams and small field beams
What is a level 2 ACDS audit?
- once every 4 years
- diagnostic test of the TPS performance
- mail out audit
- independent measurments of linac output under reference conditions
What is an example of a level 2 ACDS audit?
- C-shaped target volume adapted to a horseshoe
- test 5 beam types to test the intended dose
What is the pass criteria for a level 2 ACDS audit?
- 3DCRT = 5%
- IMRT/FFF = 3%, 3mm
What is a level 3 ACDS audit?
- to detemine absorbed dose to water delivered to selected points within n anthropomorphic phantom
- this is an end-to-end audit where the phantom undergoes all steps within the radiotherapy treatment chain
What are 3 level 3 ACDS audits from 3DCRT?
- chair test = 3.3%
- c-shape test = 3.3-5%
- complex case = 5%
What is the monthly TPS QA check?
- checksums on beam data and executable files
What is the rationale for checksum QA?
- the program cannot be modified by the operator therefor it should be verified that it has not been corrupted by any virus or wrong operations
- the beam data can be modified
What are forms of peer review and who attends each meeting?
- physician lead case oriented (RO, RT, physics)
- tumour board (multiple physicians and people from diverse disciplines)
- chart rounds (members of treatment team)
- morbidity and mortality
What are the steps for a PRAT peer review?
- patient selectio
- preliminary scoring of each case
- peer review meeting to discuss all cases and feed back to RO
- subsequent re-audit of al cases where a change in management was discussed
