QA Flashcards
What is QA
All procedures that ensure consistency of the medical prescription and safe fulfilment of that prescription, as regards to the dose to the target volume, together with minimal dose to normal tissue, minimal exposure of personnel and adequate patient monitoring aimed at determining the end result of treatment
Who looks after QA at RT site
- Site manager
- Radiation onc
- Physicist
- Clinical lead
- Charge therapist and deputy charge
- Junior and senior RT
What should be checked in morning run up QA
Computer start up, program launch
Lights and CCTV
MLC launch and self check
Linac temperatures and pressures
Field light size
X Y jaw movements t
Graticule alignment
Couch shifts
Gantry rotation
Collimator rotation
Floor rotation
Laser alignment
SSD
Interlocks
Beam outputs
Imaging OBI, XVI warmup
Patient schedule
New starts
Equipment for patients
Types of error
Single patient error - wrong patient, position, site, equipment. Use 3Cs
Human interface complexity error - clutter, noise, make work area clean and reduce clutter
Systematic error — beam data error that goes unnoticed
Procedural error
ACDS
Australian clinical dosimetry service
Government funded auditing service
Uses a phantom to measure whether doses are of clinical standard
Reporting an incident
- Immediately after an incident has occurred/has been identified
- Stop and reflect on what has happened
- Record in a report or on a database
- Details recorded must include time, date and place, where it happened and who was involved
- Treatment details
- Include a descriptive narrative of exactly what happened
- Was it a single or multiple event
1-2pm is where people make most mistakes
Medical radiation incidents
Wrong patient
Wrong quantity of radiation
Performed on the wrong part of the body
ARPANSA objectives
- Protect the public, workers and the environment from radiation exposure
- Promote radiological and nuclear safety and security and emergency preparedness
- Promote the effective use of ionising radiation
- Ensure the effective and proportionate regulation and enforcement activities
ARIR
The Australian radiation incident register - database of radiation incident reports
ARIR objectives
- To highlight to radiation protection authorities and users
of ionising radiation and non-ionising radiation, specific
sources, causes or procedures which give rise to a potential
hazard - To act as a national focus for information on ionising
radiation incidents and accidents through appropriate
publications - To provide feedback and guidance to users of radiation on
preventing or limiting the consequences of radiation accidents - To provide useful data and reports to regulatory and
advisory bodies.
What is the Swiss model
Holes due to active failures leads to an incident
NPSA Incident categories
No harm, low, moderate, severe, death
Justifiable culture
Whereby a practitioner must justify their actions in the event and there can be repercussions for poor performance
QA incident reporting culture
Blame, no blame, justifiable culture
Requirements for incident investigation and reporting
Establishing what happened
Identifying failure
Deciding on remedial action to minimise chance of similar failure
Estimate likely radiation doses received by patients and staff
