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QA 2020 > Midterm > Flashcards

Midterm Flashcards

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1
Q

How does the Institute Of Medicine (IOM) define healthcare quality?

A

the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge

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2
Q

How does the Institute Of Medicine (IOM) define outcomes?

A

the anticipated benefits or results from a planned implementation of a process

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3
Q

Define each of the 4 concepts in the Plan-Do-Check (Study)-Act Model

A

Plan: Members of the team agree on a project and an intervention for change
Do: Tests of change are carried out, and outcomes are documented.
Check (Study): Data are analyzed to assess whether the change was successful and what actions may be necessary for the next improvement cycle.
Act: Changes are made to the intervention; when a desired outcome is reached, the actions are disseminated

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4
Q

Define Six Sigma

A

Six Sigma is a statistically driven improvement process. Sigma refers to the number of standard deviations a process is from average performance. If a process is within six standard deviations of the average performance, then it is said to be in Six Sigma. At this point, the process results in approximately 3.4 errors per million opportunities, or it is 99.99996% error-free.

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5
Q

The framework of Six Sigma includes DMAIC. What do each of these letters stand for?

A

Define: Define the project, goals, and other parameters
Measure: Use tools to determine quality, identify variation, validate measuring process, and collect data
Analyze: Identify underlying causes for an issue, testing statistical significance from the population sampled
Improve: Solutions are implemented to improve a process so it will be efficient, economical, and safe
Control: Systems are in place to ensure improvements are sustained

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6
Q

What does a regulatory agency do?

A

establishes mandates with authorization from Congress to write regulations that explain the technical, operational, and legal details necessary to implement laws.

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7
Q

What do the letters in NRC stand for?

A

Nuclear Regulatory Commission

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8
Q

What is the NRC’s mission?

A

Its mission is to ensure the safe use of radioactive materials for beneficial civilian purposes while protecting people and the environment.

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9
Q

What do the EPA’s radiation protection programs involve?

A

The EPA’s radiation protection programs involve regulation of the emergency response and storage, handling, and disposal of radioactive materials.

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10
Q

Which agency monitors and regulates the transportation of hazardous materials?

A

The transportation of hazardous materials is monitored and regulated through the Department of Transportation (DOT).

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11
Q

List the devices regulated by the Center for Devices of Radiological Health?

A
  • Diagnostic x-ray imaging devices
  • Microwave ovens
  • Industrial x-ray systems
  • X-ray or electron generators
  • Television receivers and monitors
  • Cellular phones
  • Sunlamps
  • Entertainment lasers
  • Ultrasound imaging devices
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12
Q

What does the FDA regulate?

A

This agency regulates the manufacture and use of devices that generate isotopes.

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13
Q

Who monitors the operation of equipment or devices regulated by the FDA?

A

The operation of the actual equipment or device is monitored by the State.

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14
Q

What do the letters in SMDA stand for? What does the SMDA require?

A

Safe Medical Devices Act
It requires medical facilities to report to the FDA any medical device that has caused death or injury of a patient or employee.

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15
Q

What do the letters in OSHA stand for? Why was OSHA created?

A

Occupational Safety and Health Administration
OSHA was created to ensure safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, and education.

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16
Q

Describe the policy that OSHA mandated in the mid 1980s.

A

a policy on bloodborne pathogens that stated that an exposure control plan must be in place for all industries in which workers may come in contact with blood and other infectious materials.

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17
Q

In what way is OSHA connected to radiation therapists’ mold (i.e. block making) rooms?

A

OSHA standards apply to mold rooms.

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18
Q

What does it mean to be an agreement state? (Hint: Atomic Energy Act of 1954)

A

In “agreement states,” the NRC has relinquished portions of its regulatory authority specific to licensing and regulating byproduct materials (radioisotopes), source materials (uranium and thorium), and certain quantities of special nuclear materials.

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19
Q

What do the letters TJC stand for? What is TJC?

A

The Joint Commission TJC is a nonprofit organization that accredits and certifies more than 20,000 healthcare organizations in the United States.

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20
Q

Without TJC accreditation, an institute may not receive what 3 things?

A

Without TJC accreditation, an institution may not receive reimbursement from CMS, have a physician residency program, or receive malpractice insurance.

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21
Q

What was designed to accredit independent oncology centers?

A

the American College of Radiation Oncology-Practice Accreditation Program (ACRO-PAP) program

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22
Q

What do the letters ACR stand for? What does the ACR devote its resources to?

A

The American College of Radiology devotes its resources to making imaging accessible to those who need it in a safe and effective manner. They also collaborate with the CMS and the Physician Quality Reporting System by encouraging physicians to submit outcome information.

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23
Q

What do the letters AAPM stand for? Who is the AAPM for?

A

The American Association of Physicists in Medicine is for medical physicists.

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24
Q

Which organization developed practice standards for radiation therapists in 1995?

A

American Society of Radiologic Technologists (ASRT)

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25
Define the following terms according to the definitions developed by the ISO
a. Quality: the totality of features and characteristics of a radiation therapy process that bear on its ability to satisfy stated or implied needs of the patient. b. Quality Assurance: all those planned or systematic actions necessary to provide adequate confidence that a product or service will satisfy given requirements for quality c. Quality Control: the operational techniques and activities used to fulfill requirements for quality d. Quality Assessment: the systematic collection of data and quality improvement (QI) that encompasses the activities directed to improve the quality of a system by reducing error or variation in that system e. Continuous Quality Improvement: CQI’s principle is that room for improvement exists in every process, every time. CQI emphasizes the view of healthcare as a process, with focus on the system as a whole and not the actions of an individual. It is synonymous with TQM and Quality Assessment. f. Total Quality Management: TQM is a customer-centered approach that is driven by data and long-term strategies for improvement. It is synonymous with CQI and Quality Assessment.
26
All aspects of a QA program can be checked with use of a
quality audit
27
For accreditation, measurement of patient outcomes is now required by which organization?
The Joint Commission
28
TJC’s Agenda for Change includes a set of 6 standardized core measurements. List them
measurements of morbidity, mortality, recurrence of disease, survival rates, patient satisfaction, and quality of life
29
What do the letters in SEER stand for? What does SEER do?
Surveillance, Epidemiology and End Results provides clinicians with population data stratified by age, gender, race, year of diagnosis, and geographic areas.
30
Who is part of the radiation oncology quality improvement team?
radiation oncologists, medial physicists, radiation therapists, medical dosimetrists, nurses, engineers, and other support staff
31
Who is commonly responsible for the establishment and continuation of a quality improvement program?
the medical director of the radiation oncology center
32
What is a quality improvement plan?
A quality improvement plan is an official statement that declares specific quality practices and resources used to conduct the activities that provide patient care.
33
What is the indicator measurement system?
This system provides a continuous evaluation of performance to help healthcare organizations measure and improve their quality of care through the use of common quality indicators.
34
What are quality indicators?
Quality indicators are tools used to measure a department’s performance of functions, processes, and outcomes over time.
35
According to the Inter-Society Council for Radiation Oncology Blue Book, what does structure include?
Structure includes the staff, equipment, and facility.
36
According to the Inter-Society Council for Radiation Oncology Blue Book, what does process cover?
Process covers the pre- and post-treatment evaluations and the actual treatment application.
37
According to the Inter-Society Council for Radiation Oncology Blue Book, how is outcome documented?
Outcome is documented by the frequency of accomplishing stated objectives, usually tumor control, and by the frequency and seriousness of treatment-induced sequelae.
38
What is sequelae?
Sequelae is defined as an aftereffect of a disease, condition, or injury; a secondary result.
39
What book, published in 2012, provides a blue print for contemporary radiation oncology facilities in terms of structure, process, and personnel requirements?
Safety Is No Accident: A Framework for Quality Radiation Oncology and Care
40
Who has the overall responsibility for the conduct of the entire radiation treatment process?
The radiation oncologist
41
Calibration of radiation generators or sources is the exclusive responsibility of whom?
The medical physicist
42
Next to calibration and quality assurance of radiation equipment, what is the physicist’s role?
Treatment planning
43
What are the 5 categories that describe the roles and responsibilities of physicists?
Equipment (Teletherapy, Brachytherapy, Simulator); Treatment Planning (Teletherapy and Brachytherapy); Dosimetry; Radiation Protection; Academic / Administrative
44
The final treatment plan is approved by the
radiation oncologist after discussing the plan with the physicist.
45
Who controls the use of all reactor-produced materials (by product materials) in the U.S.?
The U.S. Nuclear Regulatory Commission (USNRC)
46
Who regulates the use of naturally occurring radioactive materials (e.g. radium) and x-ray machines?
individual states
47
New NRC regulations go through the usual ---------- and ------- hearing process as is customary for the enactment of any federal regulation.
public, congressional
48
Who has the responsibility of implementing the radiation protection program?
Radiation safety officer (RSO)
49
What must each medical institution licensee establish to oversee the use of byproduct material?
A radiation safety committee
50
What is a written directive?
A prescription
51
If, because of the emergent nature of the patient’s condition, a delay in order to provide a written directive would jeopardize the patient’s health, what is acceptable?
An oral directive
52
A written directive must be prepared within (what length of time?) of the oral directive.
48 hours
53
What is teletherapy?
External beam radiation therapy
54
For teletherapy, what must the written directive contain?
The patient or human research subject’s name, the total dose, dose per fraction, number of fractions, and treatment site
55
What term has replaced the formerly used terms of “misadministration” and “recordable event?”
medical event
56
What is byproduct material?
Radioactive material produced by a nuclear reactor; a radioisotope
57
Is an event that results from patient intervention considered a “medical event?”
No
58
What is the definition of “effective dose equivalent?”
The sum of the weighted dose equivalents for individual tissues or organs
59
What is a “leaking sealed source?”
The USNRC defines “sealed source” as “Any radioactive material or byproduct encased in a capsule designed to prevent leakage or escape of the material” Consequently, a leaking sealed source would be defined as a radioactive material or byproduct whose material is escaping the capsule in which it is encased.
60
When must a licensee report a medical event?
the administration of byproduct material or radiation from byproduct material that results in: 1. A dose that differs from the prescribed dose by more than 5 rem effective dose equivalent, 50 rem to an organ or tissue, or 50 rem shallow dose equivalent to the skin; anda. The total dose delivered differs from the prescribed dose by 20% or more or falls outside the prescribed dosage range.b. The fractionated dose delivered differs from the prescribed dose, for a single fraction, by 50% or more.2. A dose that exceeds 5 rem effective dose equivalent, 50 rem to an organ or tissue, or 50 rem shallow dose equivalent to the skin from any of the following:a. An administration of a wrong radioactive drug containing byproduct material.b. An administration of a radioactive drug containing byproduct material by the wrong route of administration.c. An administration of a dose or dosage to the wrong individual.d. An administration of a dose or dosage delivered by the wrong mode of treatment.e. A leaking sealed source.3. A dose to the skin or an organ or tissue other than the treatment site that exceeds the dose defined in the written directive by 50 rem or 50% (or more). This excludes seeds, in the case of permanent implants, that migrated outside the correct treatment site.a. A licensee shall report any event resulting from intervention of a patient or a human research subject in which the administration of byproduct material or radiation from byproduct material results or will result in unintended permanent functional damage to an organ or a physiological system, as determined by a physician.b. A licensee shall notify by phone the NRC Operations Center no later than the next calendar day after discovery of the medical event.c. The licensee shall subject a written report to the appropriate NRC Regional Office within 15 days after discovery of the medical event.
61
How many Sieverts are in 5 rem?
0.05 Sv
62
How many Sieverts are in 50 rem?
0.5 Sv
63
The licensee authorized to use radiopharmaceuticals must possess a dose calibrator to measure activity administered to each patient. The calibrator must be checked for constancy of response, accuracy of calibration, linearity, and source geometry dependence. How long must the records of these checks be retained?
3 years
64
The licensee must possess calibrated survey instruments. When must calibration of the survey meter be done?
a. Before the first use b. Annually c. Following repair
65
How long must records of each survey instrument calibration be retained?
For 3 years
66
Must the licensee leak test the source before its first use?
Yes, unless the licensee has a leak test certificate from the supplier.
67
How often must subsequent leak tests be performed?
At intervals not to exceed 6 months.
68
If the leakage test reveals the presence of 0.005 microcurie or more of removable contamination, what must happen?
The source must be withdrawn from use and appropriately stored.
69
How often must the licensee conduct a physical inventory of all sources in possession and measure ambient dose rates?
quarterly
70
How long must records of the surveys referred to in question 35 be maintained?
3 years
71
When can a patient who is administered a radiopharmaceutical be released from medical care?
Until either: a. the measured dose rate at a distance of 1 m from the patient is less than 5 mrem/hour, or b. the activity remaining in the patent is less than 30 microcurie.
72
When can a patient who is administered a permanent brachytherapy implant be released from medical care?
Until the measured dose at a distance of 1 m from the patient is less than 5 mrem/hour.
73
When can a patient with a temporary implant be released from medical care?
Until: a. all sources have been removed, and b. the patient is surveyed with a radiation detector to confirm that all sources have been removed.
74
How long must the licensee retain records of surveys referred to in questions 37, 38, and 39?
3 years
75
A licensee shall provide radiation safety instructions to all personnel caring for the patient undergoing implant therapy. How long must these instruction records be retained?
3 years
76
Can a licensee house a patient receiving implant therapy in the same room as a patient who is not receiving radiation therapy?
No, unless an exception is justified by the NRC
77
In the case of patients receiving brachytherapy, what must the sign posted on the patient’s door read?
“Radioactive Materials”
78
Can individuals under the age of 18 visit a patient receiving brachytherapy?
Only on a patient-by-patient basis with the approval of the authorized user and the Radiation Safety Officer (RSO)
79
If a patient receiving brachytherapy dies or has a medical emergency, who must be notified immediately?
The RSO
80
In the case of a teletheraphy unit that contains a sealed source of cobalt-60 or cesium-137, what must be posted at the console?
Safety instructions that inform the operator of procedures to follow before turning the beam on, and an emergency procedure to follow in case of source movement failure
81
What safety precautions are specific to the teletherapy room door?
a. Door interlocks that prevent the beam from turning on when the door is open, and b. Prevents the beam from turning back on after a door interlock interruption without closing the door and resetting the beam on at the console
82
Are radiation therapists permitted to treat patients without a permanent radiation monitor?
No, a permanent radiation monitor must continuously monitor beam status.
83
Are radiation therapists permitted to treat patients without equipment that allows for continuous observation of the teletherapy room from the console?
No, the teletherapy room must have equipment that allows for continuous observation of the patient from the teletherapy unit console during irradiation.
84
A licensee shall perform full calibration measurements on the teletherapy unit if spot check measurements indicate that the output differs more than ------% from the output obtained at the last full calibration, corrected for radioactive decay.
5%
85
Does a licensee need to perform full calibration measurements on the teletherapy unit after the source is replacement? How about after the teletherapy unit is relocated? How about after the teletherapy unit is repaired?
Yes to all 3 questions.
86
How often does a licensee need to perform full calibration measurements on the teletherapy unit?
At intervals not exceeding 1 year
87
Does a licensee need to retain a record of each calibration for the duration of the teletherapy unit?
Yes
88
In the case of malfunction of a safety mechanism, what must be done?
The licensee shall lock the control console in the off position and not use the unit until necessary repairs have been made.
89
n the case of a teletheraphy unit that contains a sealed source of cobalt-60 or cesium-137, what must be done a) before medical use, b) after each installation of a teletherapy source, and c) after making any change for which an amendment is required?
The licensee shall perform a radiation survey of the facility.
90
What must the survey referred to in question 55 verify?
a. That the leakage from the source head with the beam in the off position doesn’t exceed 2 mrem/hour on average & 10 mremn/hour maximum, both measured at a distance 1 m from the source b. That dose rates outside the room in the restricted and unrestricted areas don’t exceed the limits specified by the NRC
91
In rem, what is the maximum permissible whole-body exposure for individuals in the restricted area per calendar quarter?
1.25 rem
92
In the unrestricted area, radiation levels must not exceed _____ mrem in any 1 hour, _____ mrem in any 1 week, and _____ in any 1 year.
In the unrestricted area, radiation levels must not exceed 2 mrem in any 1 hour, 100 mrem in any 1 week, and 0 .5 rem in any 1 year.
93
In the case of a teletheraphy unit that contains a sealed source of cobalt-60 or cesium-137, a licensee shall have the teletherapy unit fully inspected and serviced at a minimum of once every ______ years.
5 years

QA 2020 (1 decks)

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