principles semester 2 (ALL EXAMS)

the target safely campaign which was created by ASTRO focuses on

improving safety and reducing errors

refers to the evaluation of work or performance by another individual (s) in the same field

peer reviews

best describes "automaticity" in the context of clinical practice

the ability to perform tasks without conscious thought due to extension repetition

transactional leaderships focus on supervision, organization, and group performance

true

transactional leaderships focuses on relationships between leaders and followers

false

transactional leaderships rewards for positive behaviors and punishment for negative behaviors

true

transactional leaderships is effective when operating within existing constraints

true

transactional leaderships seek rationale for why tasks need to be done

false

a therapist who feels disgust with everyone and everything may be experiencing the final level of burnout, where a therapist suffers from

decreased personal accomplishment

a department may institute daily "huddles" to achieve which objective

improve communication throughout the department

we complete a daily time-out prior to treatment delivery to identify correct patient and treatment site

true

we complete a daily time-out prior to treatment delivery to ensure treatment plan and prescription is being followed

true

we complete a daily time-out prior to treatment delivery to help prevent errors from occurring

true

we complete a daily time-out prior to treatment delivery to distribute the workload among therapists

false

what step in the plan-do-check-act improvement cycle is associated with performing the tests and documenting the outcome

do

which category of behavior is associated with taking shortcuts, deviating from the standard protocol, or performing other behaviors to complete the task quicker

expediting behavior

what is a quality improvement plan used for

departmental improvement

what is a reactive approach that involves reviewing radiation therapy processes and instituting remedial actions, if necessary

quality assessment

which organization is responsible for regulating the storage and disposal of radioactive material and sets regulations on exposure doses (occupational and general public)

NRC

what professional regulating agency created the accreditation program for excellence (APEx)

ASTRO

A QI team includes

All members of the radiation oncology team

what is the annual effective dose equivalent limit for a radiation worker

50 mSv

the lean improvement methodology focuses on improving processes by

emphasizing speed and efficiency

what regulating professional agencies are responsible for recommending quality control testing, frequency, and setting the tolerances for the testing

AAPM

risk analysis methods are a reactive approach, meaning it is utilized used once a failure has been identified

root cause analysis

operational techniques and activities used to fulfill requirements for quality

quality control

review of the radiation therapy process to ensure it is working appropriately and effectively - performed at a predefined time

quality audit

all planned or systematic actions necessary to ensure product or service will satisfy given requirements for quality

quality assurance

systems and processes used for decision making related to reliable functioning of continuous quality improvement, quality assurance and quality control

quality management

considered a secondary barrier in radiation therapy, designed to protect against scatter and leakage radiation

walls of waiting area adjacent to treatment room

according to the best practices identified for staffing radiation therapists, there should be at least _ registered radiation therapist(s) per treatment unit

2

necessary to calculate the primary barrier formula in radiation therapy: workload

true

necessary to calculate the primary barrier formula in radiation therapy: distance from isocenter to outside barrier

true

necessary to calculate the primary barrier formula in radiation therapy: fraction of time beam is aimed at barrier

true

necessary to calculate the primary barrier formula in radiation therapy: average patient age in treatment room

false

necessary to calculate the primary barrier formula in radiation therapy: acceptable weekly dose

true

component of quality management are considered to be product-oriented

quality control

classify as a medical event: administering treatment to the wrong patient

true

classify as a medical event: delivering a total dose that differs from the prescribed dose by 20%

true

classify as a medical event: delivering treatment with the incorrect treatment modality

true

classify as a medical event: an individual fractionated dose delivered that differs from the prescribed single fraction dose by 40%

false

classify as a medical event: treatment must be canceled due to a significant treatment fault

false

federal agency responsible for setting standards for employees in radiation therapy, including employee exposure to lead and cadmium

OSHA

the AAPM recommends that radiation therapy departments complete _ tests on equipment that directly impact treatment delivery on a day to day basis

daily

reasons in radiation therapy as to why errors occur: communication breakdown

true

reasons in radiation therapy as to why errors occur: multi-tasking

true

reasons in radiation therapy as to why errors occur: environmental factors

false

reasons in radiation therapy as to why errors occur: decreased staffing

true

examples of patient outcome assessed by the national cancer institute

patient survival rates, quality of life, and toxicities

monthly quality control procedures are more refined and are tests that have less impact on daily treamtent outcomes

true

examples of driving forces that impact the ability to promote improvement: organizational accoutability

true

examples of driving forces that impact the ability to promote improvement: low staffing levels

false

examples of driving forces that impact the ability to promote improvement: job related autonomy

true

examples of driving forces that impact the ability to promote improvement: positive feedback

true

examples of driving forces that impact the ability to promote improvement: lack of knowledge of improvement methods

false

in order to oversee organizational change to create a culture of safety within a department, leaders should identify staff members to guide the rest of the staff through implementation of change

true

in order to oversee organizational change to create a culture of safety within a department, leaders should maintain open communication as progress is made

true

in order to oversee organizational change to create a culture of safety within a department, leaders should focus on punishment or ridicule for making errors

false

in order to oversee organizational change to create a culture of safety within a department, leaders should develop systems to identify problems and explore solutions collaboratively

true

in order to oversee organizational change to create a culture of safety within a department, leaders should encourage staff to not only do their jobs but to improve the manner in which they do the job

true

the first level of employee burnout is depersonalization

false

the ultimate benefit of continuous quality improvement is to the

patient

example of a cause-and-effect visual and is also referred to as a fishbone diagram

ishikawa

Describe the improvement methodology, Six Sigma

statistically driven

light/radiation field coincidence is a monthly mechanical check

true

cross-hair centering is a monthly mechanical check

true

jaw symmetry is a monthly mechanical check

true

photon and electron output constancy is a monthly mechanical check

false

misalignment of the could cause the electron beam flatness to be out of tolerance

scattering foil

What is the tolerance for beam profile constancy

1%

the tolerance for photon and electron output constancy is for monthly checks and for daily checks

2%, 3%

photon beam flatness is defined as "the variation of dose relative to the CAX over the central ____% of the field size at a depth of 10cm"

80

Effective radiation therapy treatment requires accurate delivery of radiation. the standard is that radiation delivery must be accurate to within ± %

5

the star pattern quality control test is used to check the linear accelerator on an annual basis

radiation isocenter

which category of QC tests is done to evaluate the functionality of interlocks and monitors

safety

what is the testing category for beam flatness

dosimetry

what is the testing category for laser alignment

mechanical

what is the testing category for beam output

dosimetry

what is the testing category for door interlock

safety

causing out of tolerance errors: focal spot displacement, asymmetry of collimator jaws, displacement in the collimator or gantry rotation axis

multiple beam alignment

causing out of tolerance errors: mirror misalignment (possibly due to table collision), light bulb misalignment, setup error

light/radiation field coincidence

causing out of tolerance errors: misalignment or warping of the mylar, gantry flex or sag

cross hair centering

causing out of tolerance errors: warped distance- measuring rod, table sag, possible setup error

ODI

the tolerance for the annual linear accelerator output calibration test is ____% absolute

1

gantry/collimator angle indicators should be within ____, according to the AAPM TG142 quality assurance report

1 degree

linear accelerator acceptance testing involves the calibration of the machine and the collection of the beam's data

false

an increase in the room temperature can cause a(n) in the number of ionizations and an increase in room pressure can cause a(n) _ in ionizations, which can influence beam output constancy

decrease, increase

tolerance for the monthly symmetric light and radiation field coincidence test

2mm or 1% on a side

a(n) and _ are commonly used when performing the linear accelerator monthly or annual beam output constancy check

ion chamber, electrometer

monthly tolerance for localizing laser alignment for non-imrt treatment

2mm

accurately describe the collimator angle indicator check performed on a monthly basis: equipment involves the use of a spirit level

true

accurately describe the collimator angle indicator check performed on a monthly basis: equipment involves the use of a wiggler

false

accurately describe the collimator angle indicator check performed on a monthly basis: gantry should be in the lateral position

true

accurately describe the collimator angle indicator check performed on a monthly basis: tolerance is 1 degree

true

accurately describe the collimator angle indicator check performed on a monthly basis: tolerance is .5 degrees

false

accurately describe the collimator angle indicator check performed on a monthly basis: may be influenced by collimator belt misalignment

true

in addition to verifying imaging and treatment coordinate coincidence, it is recommended that monthly linear accelerator imaging QC include testing for image

quality

for brachytherapy treatments, the calculation point and dose check should be within _%

15

it is recommended by the AAPM that a qualitative test, commonly referred to as the "picket fence" test, be performed on the MLC on a ____ basis for all IMRT machines

weekly

annual testing performed on the respiratory gating system to verify the beam energy constancy is within _%

2