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CSH076 > QA Tools And QI > Flashcards

QA Tools And QI Flashcards

1
Q

Traceability: Definition

A

Property of a measurement result which can be related to a reference through a documented unbroken chain of calibrations, each contributing to the measurement uncertainty

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2
Q

Examples of Traceability

A

Electrometer:
* Needs to have calibration certification prior to use within a department

  • Within Australia, ARPANSA can calibrate electrometers for radiotherapy dosimetry
  • Calibration is traceable to the Australian Standards of Voltages
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3
Q

Policies for Traceability

A
  • Equipment calibrations must be traceable to a reputable organisation such NATA

NATA = National Association of Testing Authorities, Australia
* Develop policies for traceability when performing tests or measurements

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4
Q

Inter-comparison: Definition

A

Systematic comparison of measurements, performance, or output between different machines, techniques, or facilities to ensure consistency and accuracy in treatment delivery

Help identify discrepancies, standardise practice and improve treatment accuracy

Process performed on simple equipment that cannot be calibrated

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5
Q

Inter-comparison: Example

A

Thermometer and Barometer

Up to 8% of the Australian Clinical Dosimetry Service (ACDS) recommendations stem from simple errors in thermometer and barometer calibrations
* Includes up to 4 degrees error in thermometer readings and up to 1% in barometer readings –> errors feed directly into beam output calibration

Mercury Thermometer can be utilised as a backup to confirm temperature shown on Digital Thermometer

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6
Q

Importance of Assessing Room Temperature

A

Overheating of the treatment machine –> leads to alternation of dose output

Physics utilise an electrometer to determine room temperature on a monthly basis

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7
Q

Phantom: Definition and Common Examples

A

These are physical objects, often designed to mimic human tissue –> used for calibration and testing

Common Examples:
1. Water Phantoms
2. Solid Water Phantoms
3. Anthropomorphic Phantoms

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8
Q

Dosimeters: Definition and Common Examples

A

Instruments used to measure radiation dose

Common Examples:
1. Ionisation Chambers
2. Diode Detectors
3. TLD’s

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9
Q

Ionisation Chamber: Definition and Use

A

Devices used to directly measure the ionisation of air or a liquid by radiation

Highly accurate and commonly used for reference dosimetry

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10
Q

Electrometers: Definition

A

Tool used to measure and verify the electrical charge produced by ionisation chambers and other detectors

Help to ensure accurate dose measurements

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11
Q

Portal Imaging Devices: Definition

A

Devices used to capture x-ray images of the patient’s treatment area before or during treatment to verify the alignment of the treatment beam

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12
Q

Quality Improvement: Definition

A

Quality Improvement is a systematic approach to enhancing the quality of products, services or processes within an organisation

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13
Q

Quality Indicator: Definition

A

Generally thought of as the most appropriate action for patient treatment given a certain disease and stage

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14
Q

Quality Measure: Definition

A

Quantitative description of the degree of adherence to a quality indicator

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15
Q

Action Limits: Description

A

Define the degree to which measured quantities in the clinic are allowed to vary without risking harm to the patient

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16
Q

Tolerance Levels: Definition

A

Define the boundary within which the process is considered operating normally

17
Q

Three Methodologies for QI in RT

A

Failure Mode and Effects Analysis (FMEA)

Incident Learning and Root Cause Analysis (IL-RCA)

Statistical Process Control (SPC)

18
Q

Failure Mode and Effects Analysis (FMEA)

A

Failure Modes and effects Analysis (FMEA)

Clinical Team develop a process map

Individual steps of the process map are analysed for ways in which the desired outcome of a step may not be achieved –> known as potential failure modes

For each potential failure mode, three components are assessed and assigned a numerical value from zero to ten:
Severity (possible outcome on a patient)
Occurrence (how likely it is that the failure pathway occurs)
Detectability (how likely is it that the failure pathway, once initiated, will not be intercepted)

Numerical values of the three parameters are multiplied together to calculate the risk priority number

By ranking potential failure modes according to risk priority numbers, FMEA’s enable the clinical team to understand where safety and quality issues could arise and their relative priority.

Originally developed by NASA

19
Q

Use of AI in the FMEA Process

A
  1. Data Analysis and Pattern Recognition
    * AI can analyse large datasets of historical failure data and identify patterns and trends that may not be immediately apparent to human analysts
    * This can help in the identification of potential failure modes and their associated effects
  2. Risk Assessment
    * AI can assist in the risk assessment phase of FMEA by calculating risk scores based on historical data, probabilities, and consequences
    * This can help prioritise which failure modes to focus on
  3. Recommendations
    * AI algorithms can generate recommendations for mitigating or preventing specific failure modes based on historical data and expert knowledge
    * Recommendations can help in the development of effective preventive and corrective actions
  4. Automating Documentation
    * AI can assist in generating documentation for the FMEA process, including failure mode descriptions, risk assessments, and recommended actions
    * Reduces the administrative burden on FMEA teams
  5. Real-time Monitoring
    * AI-driven sensors and monitoring systems can provide real-time data on equipment and processes
    * AI can analyse this data to detect abnormal conditions and potential failure modes in real-time, allowing for proactive maintenance and intervention
  6. Continuous Improvement
    * AI can help in continuously improve the FMEA process itself by analysing historical FMEA data and suggesting refinements to the criteria used for risk assessment
20
Q

Incident Learning: Definition

A

Identification of problems in the care delivery process and the subsequent investigation of those problems to uncover and address causal factors and latent conditions for error

21
Q

Root Cause Analysis (RCA)

A

Is a process analysis used to identify the underlying causes of system failures

Provides the information needed to solve problems and address these failures

22
Q

Comparison between FMEA and RCA

A

FMEA:
* Pro-active
* Deal with hypothetic failure
* Look forward in time
* Aimed at predicting the the adverse outcomes of various human and machine failures, and system states

RCA:
* A reactive process
* Takes places after the error/harm has been done
* Deal with actual failures
* Look backward in time

23
Q

Statistical Process Control (SPC): Definition

A

A method to measure and control variability in processes

Analytical decision making tool that employs statistics to measure and monitor a system process

Fundamental concept of SPC is to compare current statistics in a process with its previous corresponding statistic for a given period

24
Q

Statistical Process Control (SPC): Steps

A
  1. Define the Process
  2. Select Quality Characteristics
  3. Collect Data
  4. Create Control Charts (Graphical Tools)
  5. Determine Control Points
  6. Collect and Plot Control Charts
  7. Analyse and Interpret Control Chart
  8. Take Corrective Action
  9. Document and Communicate
25
Q

Statistical Process Control (SPC): Measurable Endpoints

A

Might include the following:

  • Physics-related quality measures (e.g., LINAC output)
  • Clinical practice measures (e.g., time from simulation to planning)
  • Patient-related measures (treatment breaks)
26
Q

SPC: Control Charts

A

Visually tracks data over time to monitor the stability of a process, helping to identify variations that may indicate issues

By plotting data points on a control chart, one can observe whether variations are within normal limits (indicating stable performance) or if they fall outside predefined control limits (suggesting potential problems requiring investigations)

Upper and lower control limits are set to accommodate for expected variability (these are distinct from action limits that are clinically acceptable)

27
Q

SPC: Control Charts - RT Specific Example

A
  1. Data Collection
    * Daily dose output measurements are taken with a QA device, and each day’s result is plotted on the control chart
  2. Setting Control Limits
    * Based on historical data, acceptable control limits (e.g., +/- 2%) are set around the baseline dose level
  3. Monitoring
    * By plotting daily dose values, physicists can quickly see if the Linac is performing within acceptable limits or if there are outliers
  4. Actionable Insights
    * If the dose output strays outside control limits, this signals a need for maintenance or recalibration, preventing potential inaccuracies in patient dose delivery.
28
Q

SPC: Patient-related Measure Example

A

Indicator/Process:
* Patient comfort during treatment

Measure
* Percent of patients with pain level scores <1

Process Target (%)
* 95

Action Limits (%)
-5

29
Q

SPC: Clinical Practice-related Measure Example

A

Indicator/Process
* Clinical Process Efficiency

Measure
* Time from simulation to first treatment

Process Target
* 5 working days

Action Limits
* +1 working days

Other machine parameters which can also be measured
* beam output
* beam energy
* couch travel time
* minimum percentage of open multi-leaf collimators (MLC) during treatment

30
Q

Can AI assist SPC for RT QA?

A

Patient Management System
Example: Mosaiq
* Generate care patterns and operational trends
* Use IQ scripts for data analysis

** IQ Scripts **
A set of software tools lets you modify your Elekta onoclogy information system (OIS) to match your clinic’s specific needs

No programming required

31
Q

Remote Monitoring and Data Management Systems: Definition

A

These systems allow for continuous monitoring of treatment delivery and dose verification remotely

32
Q

Survey Metre: Purpose

A

Can be used as a dose counter for brachytherapy

Hand-held ionising radiation measurement instruments are used to check personnel, equipment and the environment for radioactive contamination

CSH076 (11 decks)

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