Quality Improvement In Radiation Oncology

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electron central axis dosimeter

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parameter constancy (PDD) 2 mm @therapeutic depth

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MA-cross hair centering

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2 mm diameter

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QA-cross hair centering

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2 mm diameter

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treatment couch positions indicators

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2 mm/ 1 degree

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latches wedges, block tray

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functional

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field light intensity

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functional

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monitor chamber linearity

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1%

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arc mode

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manufacturers specifications

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check of source positioning

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3 mm

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CO-cross hair centering

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1 mm

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CO- light/radiation field coincidence

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3 mm

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time linearity and error

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1%

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beam uniformity vs gantry angle

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3%

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fluoroscopic image quality

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baseline

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film processor sensitometry

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baseline

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emergency/collision avoidance

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functional

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RULE: Safety

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functional

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RULE: Mechanical

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2 mm

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RULE: Mechanical Checks

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iso- 2 mm diameter
no iso- 2 mm

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RULE: Dosemetry Daily

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3%

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RULE: Dosemetry Monthly/Annually

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2%

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RULE: QA Sim

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2 mm

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RULE: Radiographic checks

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baseline

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RULE: Image Performance Eval CT Sim

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manufactor specifications

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RULE: Begins CT or kVp

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5HU

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RULE: X or Y

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1 mm

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gantry/collimator angle indicators

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1 degree

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RULE: Daily

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2 mm

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RULE: Starts w/ Orientations

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"over" something

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CT number accuracy for water

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0-5 HU

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RULE: Tolerances for CT Sim: Monthly

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2 mm (over)

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Spacing of lateral wall lasers with respect to lateral gantry lasers

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2 mm and scan plane

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Table vertical and longitudinal motion

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1 mm over the range of the table

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RULE: Tolerances for CT Sim :
Semi-annually and Annually

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1 mm

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Generator test

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Manufactors Specifications

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Radiation profile width

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Manufactors Specification

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Focuses on improving the process through precision and accuracy with the elimination of defects in the process

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Six Sigma Process improvement method

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Systemwide set of methods and tools for improving a process by emphasizing speed and efficiency.

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lean

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Those activities considered to be of the most importance in providing healthcare services

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aspect of care

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Pictorial representation of the steps necessary in a process

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flow chart

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Systematic quality analysis and review of patient care data

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quality assessment

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Measurement tool used to evaluate an organizations performance

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quality indicator

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the operational techniques and activities used to fulfill requirements for quality

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quality control (QC)

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Review of the radiation therapy process that is routinely and continuously measured, the results analyzed, and corrective action taken as required to ensure quality patient care

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quality audit

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all those planned or systematic actions necessary to provide adequate confidence that a product or service will satisfy given requirements for quality "ongoing"

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quality-assurance (QA)

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"ongoing" Professional performance standard that define activities in the areas of education, interpersonal relationships, personal and professional self-assessment, and ethical behavior

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total quality management (TQM)

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Integrates quality assurance, quality control, and assessment into a complex systemwide improvement program revolving around health cares mission and goals

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continuous quality improvement (CQI)

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"ongoing" Continuous study and improvement of health care services through the systematic evaluation of processes to meet the needs of patients and others

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quality improvement (QI)

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Audit mechanism. Evaluation by heath care professionals with the same credentials in which standards of practice are applied to evaluate professional performance and processes

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peer review

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An independent non-for-profit organization dedicated to improving quality of care in organized health care settings. Accrediting body for health care organization. Stresses: quality control, standards of measurements, quality assessment, systematic collection, and quality assurance data

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The Joint Commision (TJC)
(JCAHO) Joint Commission on the Accreditation of Healthcare Organizations

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Mission is to foster the professional growth of radiologic technologies by expanding knowledge through education, research and analysis

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ASRT American Society of Radiologic Technologies

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Administrative regulatory agency requiring employers to ensure the safety of workers

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OSHA Occupational Safety and Health Administration

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ACR

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American College of Radiology

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AAPM

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American Association of Physicists in Medicine

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QI in radiation oncology involves ongoing activities involving (4)

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administrative
clinical
physical
technical

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NRC

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U.S. Nuclear Regulatory Commission

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Mission to ensure protection of public health and safety in the use of radioactive materials

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Nuclear Regulatory Commission

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Involved in regulations of disposal, storage, and handling of nuclear waste as it relates to environmental protection issues.

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EPA

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Responsible for the manufacturers responsible regarding radiation-producing electronic products and facilities

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FFDCA Federal Food, Drug and Cosmetic Act

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To ensure safe and healthful working conditions for OSHA to save lives, prevent injuries, and protect the health of americas workers

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Occupational Safety and Health Act of 1970

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Provides a basis for the NRC to relinquish to the states portions of its regulatory authority relating to licensing and regulating by-product material, source materials, and nuclear materials

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Section 274b of the Atomic Energy Act of 1954

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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

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quality (in rad onc)