Quality in Management Part 3

what should the legal document contain

name and linked demographic information, prescription, physician signature on computer plan

what is included in the prescription

total dose, daily dose, energy, portals, point of calculation, beam modifying device

what parts of the prescription can be determined by dosimetrists and approved by physician

energy, portals, beam modifying devices

what will the treatment record include

date of each tx, tx number, elapsed dates, initial of treating therapist, MU settings, daily tumor doses, accumulated dose, detailed setup instructions

what are potential outcome of errors

under and over dose, unnecessary dose, improper time/dose relationship, increased risk of complications, legal liability

what does the NRC set standards for

treatment and radioactive sources

when was specific action of the NRC required for a medical event and dose errors greater than

+-10% of total prescription

what tolerance of a course of treatment to result in effective treatment for a need for accuracy of

+-5% for all aspects of a course of tx

if the treatment prescription is unclear, what do you need to do

clarify before beginning a course of tx

when should charts be checked

initiation of treatment and weekly

when must the therapist verify the prescription

before putting patient on the table

when should obtaining consent for a patients treatment be done

before beginning of the procedure

what do you do if you find an error on a chart

single ling through it, correct data, initials, and date you changed it

what is the principle of a spot check of the treatment room

enhance safety, prepare for emergencies, and prepare for daily routine

what are some examples of spot check of the tx room

tx supplies, emergency supplies, linen, gloves, room temp, immobilization supplies

what can be some issues with custom blocks

rough edges

how much beam should blocks attenuate

95%

what are some treatment accessory issues examples

indexing wedges, bolus material is not the same thickness, accurate labeling of immobilization devices

what increases as hinge angle decreases

dose in overlapping areas

what is the hinge angle formula

180 - (2x wedge)

what is the wedge angle formula

(180 - hinge) / 2

what is the result of the therapist inserting a physical wedge in the wrong orientation

hot/cold spots in the wrong places; wrong dose to target volume

if the therapist fails to insert physical wedge into port calculated for wedge, what is the result

overdose

if dosimetry fails to include a wedge factor in a mu calculation, but wedge is used in tx, what is the result

underdose

what kind of contact with pts is mandatory during tx

audible and visual

what should you do if you do not have visual contact on the pt

do not treat

what kind of machines uses direct visualization

simulator and orthovoltage

how do you test the audible system

have a person within the room and have a two way convo from room and console

what should be checked daily and operational to treat

audible and visual devices

what is always appropriate to have a system of double checks in place

verbal call out of parameters bt therapist and rotation of therapist in duties

all safety features are _ or _

pass or fail

what does a failure require

unit be taken out of service until failures are corrected

when should over ride/dead man switch be tested

weekly

when should the emergency off switch be tested

monthly

when should the collision ring be teste

daily

when should the limit switches be tested

quarterly

when should the motor reversal be tested

quarterly

what is the motor reversal

prevents gantry from continuing in one direction after being rapidly changed via a switch

when should the back up timer/counter be checked

daily

when should the radiation off switch at console be tested

daily

when should the door interlock be tested

daily

where is the emergency hand control/pendant located

in the drive stand

what is an example of an uncontrolled area and who is it occupied by

waiting room; anyone

an uncontrolled area should not receiving more dose than _

1mSv/year

what is the public dose limit

1mSV

what is an example of the controlled area and who is it occupied by

vault or console; staff or pts

what is the permissible dose for an controlled area

50mSv/year

if you are a worker but also a pt, does getting dose as a pt contribute to your annual 50mSv/year

no

what is a radiation area

area where radiation levels external to body could result in someone receiving dose in one hour at 30cm from source

what dose can someone receive greater than in a radiation area

greater than .005rem

.005 rem = _ mSv

.05

.005rem = _ mrem

5

what is a high radiation area

area where radiation levels external to body could result in receiving greater than .02rem in one hour at 30cm from source

how much higher dose is from high radiation area than radiation areas

20x

what are area radiation monitoring devices

provide protection as well as visual indication of potential overdose of radiation to patient

what are two categories of area radiation monitoring devices

lights activated by electricity and lights activated by presence of radiation

when do the area radiation monitoring devices need to be checked

daily

when are area surveys for HDR required

at the end of all HDR procedures

what do you do if a machine parameter failed to pass the spot check

notify the engineer or physicist, do spot checks after repairs are completed, proceed with treatment when given authorization

when can errors occur with a mechanical readout SSD/SAD device

dropped or damaged or used incorrectly

when can errors occur with a optical readout SSD/SAD device

distorted readout due to device being struck, improper bulb replacement, loosening

what is another word for an optical ssd/sad readout device

ODI or rangefinder

which sad/ssd readout device is more accurate

mechanical

what in used in QC testing to assure the ODI is accurate

mechanical devices

what can inaccurate readouts of ssd/sad lead to

over/under doses

when should sad/ssd readout devices be checked, and what is the tolerance

daily, 2mm

what is SF6 gas coolant pressure

prevents arcing from happening

what are 3 examples of errors that could occur in the absence or failure of quality assurance efforts

under/overdose, death, not treated right

who is the person with ultimate responsibility for the quality management program

medical director

what process will take the longest, commissioning or acceptance testing

commissioning