The Canadian Organization of Medical Physicists (COMP), in close partnership with the Canadian Partnership for Quality Radiotherapy (CPQR) has developed a series of Technical Quality Control (TQC) guidelines for radiation treatment equipment. These guidelines outline the performance objectives that equipment should meet in order to ensure an acceptable level of radiation treatment quality. The TQC guidelines have been rigorously reviewed and field tested in a variety of Canadian radiation treatment facilities. The development process enables rapid review and update to keep the guidelines current with changes in technology (the most updated version of this guideline can be found on the CPQR website). This particular TQC details recommended quality control testing for medical linear accelerators and multileaf collimators.
Radiation therapy departments are faced with the challenge of tracking numerous quality control tests as well as monitoring service events affecting radiation therapy treatment units. Service events, in particular, pose a challenge since the clinic must be able to provide evidence to the regulatory body that both the service work and any required follow-up tests were recorded and authorized by the appropriate staff. This article presents an integrated approach to tracking quality control tests and service event logs using QATrack+. The newly developed version of this quality assurance software integrates quality control tracking with the service event log, allowing a direct link between a service event and any initiating routine tests or follow-up tests that are performed. This improves the ability of a licensee to ensure compliance with regulations and permits a simple platform from which to access all machine equipment tests and service events. Furthermore, this improves the ability of a department to assess the service record of equipment and to identify trends in failure modes.
Purpose: Historically many radiation medicine programs have maintained their Quality Control (QC) test results in paper records or Microsoft Excel worksheets. Both these approaches represent significant logistical challenges, and are not predisposed to data review and approval. It has been our group's aim to develop and implement web based software designed not just to record and store QC data in a centralized database, but to provide scheduling and data review tools to help manage a radiation therapy clinics Equipment Quality control program. Methods: The software was written in the Python programming language using the Django web framework. In order to promote collaboration and validation from other centres the code was made open source and is freely available to the public via an online source code repository. The code was written to provide a common user interface for data entry, formalize the review and approval process, and offer automated data trending and process control analysis of test results. Results: As of February 2014, our installation of QAtrack+ has 180 tests defined in its database and has collected ∼22 000 test results, all of which have been reviewed and approved by a physicist via QATrack+'s review tools. These results include records for quality control of Elekta accelerators, CT simulators, our brachytherapy programme, TomoTherapy and Cyberknife units. Currently at least 5 other centres are known to be running QAtrack+ clinically, forming the start of an international user community. Conclusion: QAtrack+ has proven to be an effective tool for collecting radiation therapy QC data, allowing for rapid review and trending of data for a wide variety of treatment units. As free and open source software, all source code, documentation and a bug tracker are available to the public at https://bitbucket.org/tohccmedphys/qatrackplus/.
The aim of this work was to apply failure modes and effect analysis (FMEA) to assess risk in two radiation planning and treatment processes; our on-call (out-of-clinical hours) process and our tomotherapy process. The motivation was provided by analysis of 2506 adverse incidents reported over a 5 year period, the on-call process for giving rise to a higher than expected number of incidents and our tomotherapy process for the reverse. For the on-call scenario, three separate processes were analysed: our current process, our current process incorporating a software upgrade eliminating several planning steps and a fully integrated process in which the patient is imaged, planned and treated on a single platform (TomoTherapy Hi Art, Accuray Incorporated, Sunnyvale, CA). After construction of a detailed process map for each case, a multidisciplinary group identified potential failure modes for each process step, the effects of each failure and existing controls. Risk probability numbers were determined from severity, frequency of occurrence and detectability scores assigned to each failure mode according to a standard scale. The results were analysed to identify and prioritise feasible and effective process improvements. For the on-call process, our current workflow was identified as incurring the highest risk of the three processes analysed, demonstrating quantitatively the value of the software upgrade and providing a clear rationale for the associated expense. In summary, we have found FMEA to be a feasible tool for assessing relative risk in a clinical process. However, operational and resource issues must be considered separately.
Purpose: Beam penumbra, symmetry, flatness and surface dose have been measured for the Equinox cobalt‐60 external beam therapy system using both source to surface distance (SSD) and source to axes distance (SAD) setups. Method and Materials: All data were measured using a 100 cm Equinox teletherapy unit manufactured by MDS Nordion. This newly designed unit features asymmetric jaw capability and has a source to diaphragm distance of 50 cm. The unit was installed with a 2.0 cm diameter C‐146 source. Beam data were measured using a Scanidtronix / Wellhofer Blue Phantom water tank equipped with a p‐type Silicon detector (PFD3G) or a CC13 ion chamber. OmniPro Accept software, version 6.2, was used to manipulate the data and to calculate penumbra, flatness and symmetry according to IEC 976 definitions. Surface dose measurements were independently confirmed with GafChromic film and MOSFETs. Results: Percent depth dose measurements were compared to BJR Supplement 25 data with good agreement for field sizes up to 12×12 cm and reasonable agreement for larger field sizes and depths. Relative surface dose measurements indicated that the IEC 60601‐2‐11 criteria of 90% for the maximum field size may be exceeded when an 80 cm SSD setup is used. Beam flatness, symmetry and penumbra parameters have changed little from previously manufactured units and are reported for square field sizes ranging from 1 cm to 40 cm. Conclusion: This investigation demonstrates that the beam characteristics of the Equinox unit do not differ significantly from previous units. In order to reduce surface dose to IEC stated levels; it is recommended that an electron filter be utilized on the 80 cm machine for field sizes exceeding 900 square cm. Conflict of Interest: MDS Nordion provided financial support for this project.
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