1
Q
What is the purpose of QA in RT? (4)
A
- 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
2
Q
What are the steps of care QA is involved in? (7)
A
- Diagnosis
- Consultation
- imagine/simulation
- treatment planning
- pre-treatment delivery
- treatment
- follow up
3
Q
In QA what is the role of the RT?
A
- demonstrate a thorough knowledge of QA and procedure
- knowledge and application of procedures used in QA and follows department polices and procedures
4
Q
Why are there so many different QA documents?
A
- as each Nation/state have their own standards and protocols
5
Q
Why is it important to understand the national/state standards?
A
- 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
6
Q
What is the benefit and downfall of mutli-disciplinary QA?
A
- repsonsibilites shared decreases workload for each individual
- clear responsibilities and training need to be provided and any overlaps must be clarrified
7
Q
What is the rationale for stringent QA?
A
- address the errors that can be controlled so that the errors that can’t be controlled
matter less
8
Q
Define quality assurance
A
- 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
9
Q
Define quality system management
A
- is the management of
a QA program
10
Q
Define quality control
A
- 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
11
Q
QA is concerned with operational techniques and activities used to … (2)
A
- check that quality requirements are met.
2. adjust and correct performance if the requirements are found not to have been met
12
Q
Define QA in the context of RT
A
- is all procedures that
ensure consistency of the medical prescription and safe
fulfillment of that radiotherapy related prescription
13
Q
What are some examples of medical procedures that need QA? (4)
A
- 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
14
Q
What is the general structure of equipment QA programme? (4)
A
- Acceptance Testing and Commissioning
- Routine QC checks
- Additional QC checks
- Planned preventative maintenance (PM) program
15
Q
What is acceptance testing?
A
- Acceptance of equipment is the
process in which the supplier demonstrates the
baseline performance of the equipment to the
satisfaction of the customer
16
Q
What is comissioning?
A
- Commissioning is the process of
preparing the equipment for clinical service - usually done by physics
17
Q
When is QC first done?
A
- begins immediaey after comissioning
18
Q
Why is risk management important?
A
- It plays a vital role in supporting and
informing decision making in providing a
safe and secure environment for patients,
staff and the public
19
Q
What is the reasoning behind risk management?
A
- We must be proactive in reducing
identified risk to an acceptable level with
preventative measures rather than reactive
remedies
20
Q
When does preventative maintenance occur?
A
- after commissioning and before regular QC tests
21
Q
What are the QC program specifications (8)?
A
- 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
22
Q
Who is the main regulatory body for QA?
A
- ARPANSA
23
Q
What are the services of ARPANSA?
A
- monitoring
- testing and calibration
- training
- hire radiaiton meters
24
Q
Who conducts dosimetry audits?
A
- the australian clinical dosimetry service
25
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
26
Define Quality audit
- is a systematic and independent test to determine if quality activities and results comply and if these are implemented effectively
27
What is the rationale for quality audits?
- evaluate the need for improvmenet or corrective action is those standards are not met
28
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
29
What is the scope of a quality audit?
- check documentation
- check meausurements
- assess infrastructure
30
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%
31
What is a level 1 ACDS audit?
- occurs every two years
- mail out
- independent measurements of Linac output under reference conditions
32
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
33
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
34
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
35
What is the pass criteria for a level 2 ACDS audit?
- 3DCRT = 5%
| - IMRT/FFF = 3%, 3mm
36
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
37
What are 3 level 3 ACDS audits from 3DCRT?
- chair test = 3.3%
- c-shape test = 3.3-5%
- complex case = 5%
38
What is the monthly TPS QA check?
- checksums on beam data and executable files
39
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
40
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
41
What are the steps for a PRAT peer review?
1. patient selectio
2. preliminary scoring of each case
3. peer review meeting to discuss all cases and feed back to RO
4. subsequent re-audit of al cases where a change in management was discussed
Quality Assurance
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