体部X-刀的质量保证与质量控制

目的　分析体部X -刀治疗过程的质量保证和质量控制。方法　采用标准电离剂量法和胶片剂量法对体部X -刀照射的剂量、摆位精度、靶点位置精度进行测量。结果　体部X -刀治疗最大误差为 3 % ,完全符合国家规定 5 %的标准。结论　QA和QC是保证体部X -刀治疗精度的极其重要的措施     

超声成像的质量保证

作者使用美国ＲＭ１４１３Ａ超声体模，对一批超声诊断设备进行了包括几何位置精度、空间分辨率、探测深度（系统灵敏度变化）、均匀度、影像显示与记录特性以及Ｍ型扫描计时准确性等多项性能参数的质量保证检测。本文报告检测方法与结果，对发现的典型故障作简要分析，并就有关的理论和技术性问题作初步探讨。所介绍的检测方法是一种定量化的、非侵入式新技术，对于保证超声诊断影像的质量有重要作用，适合于在我国医院Ｂ超室推广应用。     

Quality Assurance in the EORTC Randomized Trial 22922/10925 Investigating the Role of Irradiation of the Internal Mammary and Medial Supraclavicular Lymph Node Chain Works

BACKGROUND AND PURPOSE: A quality assurance (QA) program in conjunction with the EORTC trial investigating the role of adjuvant internal mammary and medial supraclavicular irradiation in stage I-III breast cancer is presented. The results of a dummy run procedure and of an individual case review are compared to each other. The effects of recommendations based on QA procedures on the protocol compliance are evaluated. MATERIAL AND METHODS: Prior to protocol activation all participating institutes were asked to produce treatment plans according to the guidelines of the protocol based on manual outlines of an average patient. Thereafter, they were asked to provide data on each of their first six randomized patients. RESULTS: The dummy run provided a lot of information on specific treatment techniques. In the individual case review, additional patient- and tumor-related data were collected, showing the use of anatomic information for treatment planning. A comparison between both procedures revealed that the individual case reports concurred more accurately with protocol guidelines than the dummy run. CONCLUSION: It was observed that the number of systematic protocol deviations was substantially decreased in trial patients compared to the dummy run case. Therefore, it is concluded that this extensive QA program had a positive effect on the consistency of all institutes participating in the trial.     

Radiologist Quality Assurance by Nonradiologists at Tumor Board

PurposeTo explore the use of nonradiologists as a method to efficiently reduce bias in the assessment of radiologist performance using a hepatobiliary tumor board as a case study.Materials and MethodsInstitutional review board approval was obtained for this HIPAA-compliant prospective quality assurance (QA) effort. Consecutive patients with CT or MR imaging reviewed at one hepatobiliary tumor board between February 2016 and October 2016 (n = 265) were included. All presentations were assigned prospective anonymous QA scores by an experienced nonradiologist hepatobiliary provider based on contemporaneous comparison of the imaging interpretation at a tumor board and the original interpretation(s): concordant, minor discordance, major discordance. Major discordance was defined as a discrepancy that may affect clinical management. Minor discordance was defined as a discrepancy unlikely to affect clinical management. All discordances and predicted management changes were retrospectively confirmed by the liver tumor program medical director. Logistic regression analyses were performed to determine what factors best predict discordant reporting.ResultsApproximately one-third (30% [79 of 265]) of reports were assigned a discordance, including 51 (19%) minor and 28 (11%) major discordances. The most common related to mass size (41% [32 of 79]), tumor stage and extent (24% [19 of 79]), and assigned LI-RADS v2014 score (22% [17 of 79]). One radiologist had 11.8-fold greater odds of discordance (P = .002). Nine other radiologists were similar (P = .10-.99). Radiologists presenting their own studies had 4.5-fold less odds of discordance (P = .006).ConclusionsQA conducted in line with tumor board workflow can enable efficient assessment of radiologist performance. Discordant interpretations are commonly (30%) reported by nonradiologist providers.     

放射科导管室质量保证与管理的研讨

目的：研究导管室在配合各种介入放射术中的质量监控与保证。方法：导管室严格区分清洁区与无菌区，有一套应急抢救设备。建立人员岗位责任制及患者术中安全保证措施；健全各种消毒灭菌制度与监控手段。每月进行检查并有相应的奖惩措施。结果：５３个月中手术间空气培养报告单８４张，除头２次外全部符合无菌要求。完成各种介入放射１９３８例，其中复杂操作如ＰＴＣＡ，ＲＦＡ及ＴＩＰＰＳＳ等７９２例，未出现配合失误与术后感染。术中发生室颤多例，心跳骤停３例，均抢救成功。结论：导管室质量保证要素为：（１）一套健全的规章制度；（２）严格的无菌技术及监控手段；（３）患者术中的安全保证措施。     

IMRT Quality Assurance Using a Second Treatment Planning System

We used a second treatment planning system (TPS) for independent verification of the dose calculated by our primary TPS in the context of patient-specific quality assurance (QA) for intensity-modulated radiation therapy (IMRT). QA plans for 24 patients treated with inverse planned dynamic IMRT were generated using the Nomos Corvus TPS. The plans were calculated on a computed tomography scan of our QA phantom that consists of three Solid Water slabs sandwiching radiochromic films, and an ion chamber that is inserted into the center slab of the phantom. For the independent verification, the dose was recalculated using the Varian Eclipse TPS using the multileaf collimator files and beam geometry from the original plan. The data was then compared in terms of absolute dose to the ion chamber volume as well as relative dose on isodoses calculated at the film plane. The calculation results were also compared with measurements performed for each case. When comparing ion chamber doses, the mean ratio was 0.999 (SD 0.010) for Eclipse vs. Corvus, 0.988 (SD 0.020) for the ionization chamber measurements vs. Corvus, and 0.989 (SD 0.017) for the ionization chamber measurements vs. Eclipse. For 2D doses with gamma histogram, the mean value of the percentage of pixels passing the criteria of 3%, 3 mm was 94.4 (SD 5.3) for Eclipse vs. Corvus, 85.1 (SD 10.6) for Corvus vs. film, and 93.7 (SD 4.1) for Eclipse vs. film; and for the criteria of 5%, 3 mm, 98.7 (SD 1.5) for Eclipse vs. Corvus, 93.0 (SD 7.8) for Corvus vs. film, and 98.0 (SD 1.9) for Eclipse vs. film. We feel that the use of the Eclipse TPS as an independent, accurate, robust, and time-efficient method for patient-specific IMRT QA is feasible in clinic.     

Quality Assurance Guidelines for Superior Vena Cava Stenting in Malignant Disease

Superior vena cava stenting for the treatment of malignant superior vena cava obstruction is now well established. It offers simple, rapid, and safe palliation of a distressing and potentially fatal complication of mediastinal malignant disease and compares very favorably with standard therapies such as chemotherapy and radiotherapy. The following are quality assurance guidelines for superior vena cava stenting.     

The ESTRO-EQUAL Quality Assurance Network for Photon and Electron Radiotherapy Beams in Germany

BACKGROUND: In 1998 an ESTRO Quality Assurance Network for radiotherapy (EQUAL) has been set up for 25 European countries for photon and electron beams in reference and non-reference conditions. MATERIAL AND METHODS: Measurements are done using LiF powder (DTL937-Philitech, France) that is processed with the PCL3 automatic reader (Fimel-PTW). The participating centers irradiate the TLDs with an absorbed dose of 2 Gy according to the clinical routine. RESULTS: Until September 2000 EQUAL has checked 135 photon beams (including the beams rechecked) from 51 radiotherapy centers in Germany out of 86 accepted centers. The results show that 2% of the beam outputs in reference conditions and 3% of the percentage depth doses are outside the tolerance level (deviation > +/- 5%). 6% of the beam output variations and of the wedge transmission factors show deviations > +/- 5%. The global analysis of results shows deviations > +/- 5% in at least one parameter for 18 beams out of the 135 beams checked. Five rechecked beams present one "real dosimetric" problem in one or more parameters, corresponding to 4% of the 114 beams for which the deviations cannot be attributed to set-up errors.--The EQUAL network has checked 89 electron beams in Germany. The results show that all beam outputs checked are within the tolerance level. The standard deviation for the beam output in reference conditions is 2.0% and 2.2% for the beam output for the others field sizes. The percentage of deviations > 3% and < or = 5% for the reference beam output is higher for electron beams than for photon beam checks. Therefore the electron beam calibration and the TPS algorithms should be improved to increase the accuracy of the patient dosimetry for radiotherapy. CONCLUSION: EQUAL program demonstrates a consistency in radiotherapy dosimetry for photon and electron beams resulting in a satisfying accuracy of the dosimetry in Germany.     

IMRT Quality Assurance Using a Second Treatment Planning System

We used a second treatment planning system (TPS) for independent verification of the dose calculated by our primary TPS in the context of patient-specific quality assurance (QA) for intensity-modulated radiation therapy (IMRT). QA plans for 24 patients treated with inverse planned dynamic IMRT were generated using the Nomos Corvus TPS. The plans were calculated on a computed tomography scan of our QA phantom that consists of three Solid Water slabs sandwiching radiochromic films, and an ion chamber that is inserted into the center slab of the phantom. For the independent verification, the dose was recalculated using the Varian Eclipse TPS using the multileaf collimator files and beam geometry from the original plan. The data was then compared in terms of absolute dose to the ion chamber volume as well as relative dose on isodoses calculated at the film plane. The calculation results were also compared with measurements performed for each case. When comparing ion chamber doses, the mean ratio was 0.999 (SD 0.010) for Eclipse vs. Corvus, 0.988 (SD 0.020) for the ionization chamber measurements vs. Corvus, and 0.989 (SD 0.017) for the ionization chamber measurements vs. Eclipse. For 2D doses with gamma histogram, the mean value of the percentage of pixels passing the criteria of 3%, 3 mm was 94.4 (SD 5.3) for Eclipse vs. Corvus, 85.1 (SD 10.6) for Corvus vs. film, and 93.7 (SD 4.1) for Eclipse vs. film; and for the criteria of 5%, 3 mm, 98.7 (SD 1.5) for Eclipse vs. Corvus, 93.0 (SD 7.8) for Corvus vs. film, and 98.0 (SD 1.9) for Eclipse vs. film. We feel that the use of the Eclipse TPS as an independent, accurate, robust, and time-efficient method for patient-specific IMRT QA is feasible in clinic.