External Quality Assessment Program for SARS-COV-2 Molecular Detection in Pakistan.

INTRODUCTION: Amid coronavirus disease 2019 (COVID-19) pandemic, accurate detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is critical for diagnosis management and breaking down transmission chains. We designed a national external quality assessment panel (EQAP) for SARS-CoV-2 molecular detection comprising working laboratories nationwide. METHODS: A molecular diagnostic EQA panel that consists of five samples for SARS CoV-2 testing was distributed to 141 public and private sector laboratories across country. These samples contain different concentrations of SARS-CoV-2 to evaluate the sensitivity of commercial kits available. RESULTS: Sensitivity among public and private sector laboratories was variable, particularly lower SARS-CoV-2 concentrations significantly increased the risk of false-negative tests, whereas Ct values of accurately tested SARS-CoV-2 specimens increased as concentration decreased. These findings highlighted that performance of used commercial kits was not significantly correlated to various extraction or PCR methods. CONCLUSION: This study highlights the need for a national external quality assessment panel (EQAP) in the country to improve the quality of the healthcare system while ensuring the accuracy and reliability of results. Furthermore, EQAPs can help laboratories meet accreditation and regulatory requirements. However, continued participation in EQAP is recommended for quality enhancement of laboratories.

Implementation and evaluation of a system for assessment of the quality of long-term management of patients at a geriatric hospital.

BACKGROUND: The increasing aging population presents a significant challenge, accompanied by a shortage of professional caregivers, adding to the therapeutic burden. Clinical decision support systems, utilizing computerized clinical guidelines, can improve healthcare quality, reduce expenses, save time, and boost caregiver efficiency. OBJECTIVES: 1) Develop and evaluate an automated quality assessment (QA) system for retrospective longitudinal care quality analysis, focusing on clinical staff adherence to evidence-based guidelines (GLs). 2) Assess the system's technical feasibility and functional capability for senior nurse use in geriatric pressure-ulcer management. METHODS: A computational QA system using our Quality Assessment Temporal Patterns (QATP) methodology was designed and implemented. Our methodology transforms the GL's procedural-knowledge into declarative-knowledge temporal-abstraction patterns representing the expected execution trace in the patient's data for correct therapy application. Fuzzy temporal logic allows for partial compliance, reflecting individual and grouped action performance considering their values and temporal aspects. The system was tested using a pressure ulcer treatment GL and data from 100 geriatric patients' Electronic Medical Records (EMR). After technical evaluation for accuracy and feasibility, an extensive functional evaluation was conducted by an experienced nurse, comparing QA scores with and without system support, and versus automated system scores. Time efficiency was also measured. RESULTS: QA scores from the geriatric nurse, with and without system's support, did not significantly differ from those provided by the automated system (p < 0.05), demonstrating the effectiveness and reliability of both manual and automated methods. The system-supported manual QA process reduced scoring time by approximately two-thirds, from an average of 17.3 min per patient manually to about 5.9 min with the system's assistance, highlighting the system's efficiency potential in clinical practice. CONCLUSION: The QA system based on QATP, produces scores consistent with an experienced nurse's assessment for complex care over extended periods. It enables quick and accurate quality care evaluation for multiple patients after brief training. Such automated QA systems may empower nursing staff, enabling them to manage more patients, accurately and consistently, while reducing costs due to saved time and effort, and enhanced compliance with evidence-based guidelines.

A prospective study on the effect of tumor shrinkage on exit fluence gamma pass rate in high precision radiotherapy and influence of phantom setup error in patient-specific quality assurance.

PURPOSE: Objective parameters for decision on adaptive radiotherapy depend on patient, tumor and treatment related factors. Present study reports geometric uncertainties occurring during high precision radiotherapy, beam fluence analysis and serial exit dose measurement as a patient-specific tool for adaptive radiotherapy. MATERIALS AND METHODS: Serial exit dose fluence of 24 patients (at baseline and mid-treatment) undergoing IMRT/VMAT treatment were measured. Baseline and midtreatment exit dose evaluation was done using gafchromic films in predefined region of interest. Difference of volume of GTV at baseline (from simulation CT scan) and midtreatment CBCT scan was calculated (ΔGTV). RESULTS: Population based systematic errors (mm) were 4.15, 2.26, 0.88 and random errors (mm) were 2.56, 3.69, and 2.03 in mediolateral (ML), craniocaudal (CC) and anteroposterior (AP) directions respectively. Gamma pass rate reduced with incremental shift. For a 5 mm shift, maximum deviation was found in anteroposterior axis (22.16 ± 7.50) and lowest in mediolateral axis (12.85 ± 4.95). On serial measurement of exit dose fluence, tumor shrinkage significantly influenced gamma pass rate. The mean gamma pass rate was significantly different between groups with 50% shrinkage of tumor volume (86.36 vs 96.24, P = 0.008, on multivariate analysis P = 0.026). CONCLUSION: Rapid fall of gamma pass rate was observed for set up error of ≥3 mm. Serial measurement of exit dose fluence by radiochromic film is a feasible method of exit dose comparison in IMRT/VMAT, where EPID dosimetry is not available with linear accelerator configuration. Our study suggests that there is a significant difference between gamma pass rates of baseline and mid treatment exit dose fluence with greater than 50% tumor shrinkage.

An operator-independent quality assurance system for automatically generated structure sets.

Objective. This study describes geometry-based and intensity-based tools for quality assurance (QA) of automatically generated structures for online adaptive radiotherapy, and designs an operator-independent traffic light system that identifies erroneous structure sets.Approach.A cohort of eight head and neck (HN) patients with daily CBCTs was selected for test development. Radiotherapy contours were propagated from planning computed tomography (CT) to daily cone beam CT (CBCT) using deformable image registration. These propagated structures were visually verified for acceptability. For each CBCT, several error scenarios were used to generate what were judged unacceptable structures. Ten additional HN patients with daily CBCTs and different error scenarios were selected for validation. A suite of tests based on image intensity, intensity gradient, and structure geometry was developed using acceptable and unacceptable HN planning structures. Combinations of one test applied to one structure, referred to as structure-test combinations, were selected for inclusion in the QA system based on their discriminatory power. A traffic light system was used to aggregate the structure-test combinations, and the system was evaluated on all fractions of the ten validation HN patients.Results.The QA system distinguished between acceptable and unacceptable fractions with high accuracy, labeling 294/324 acceptable fractions as green or yellow and 19/20 unacceptable fractions as yellow or red.Significance.This study demonstrates a system to supplement manual review of radiotherapy planning structures. Automated QA is performed by aggregating results from multiple intensity- and geometry-based tests.

Proton Beam Range and Charge Verification Using Multilayer Faraday Collector.

PURPOSE: A daily quality assurance (QA) check in proton therapy is ensuring that the range of each proton beam energy in water is accurate to 1 mm. This is important for ensuring that the tumor is adequately irradiated while minimizing damage to surrounding healthy tissue. It is also important to verify the total charge collected against the beam model. This work proposes a time-efficient method for verifying the range and total charge of proton beams at different energies using a multilayer Faraday collector (MLFC). METHODS: We used an MLFC-128-250 MeV comprising 128 layers of thin copper foils separated by thin insulating KaptonTM layers. Protons passing through the collector induce a charge on the metallic foils, which is integrated and measured by a multichannel electrometer. The charge deposition on the foils provides information about the beam range. RESULTS: Our results show that the proton beam range obtained using MLFC correlates closely with the range obtained from commissioning water tank measurements for all proton energies. Upon applying a range calibration factor, the maximum deviation is 0.4 g/cm2. The MLFC range showed no dependence on the number of monitor units and the source-to-surface distance. Range measurements collected over multiple weeks exhibited stability. The total charge collected agrees closely with the theoretical charge from the treatment planning system beam model for low- and mid-range energies. CONCLUSIONS: We have calibrated and commissioned the use of the MLFC to easily verify range and total charge of proton beams. This tool will improve the workflow efficiency of the proton QA.

Multi-granularity prior networks for uncertainty-informed patient-specific quality assurance.

Deep Learning Automated Patient-Specific Quality Assurance (PSQA) aims to reduce clinical resource requirements. It is vital to ensure the safety and effectiveness of radiation therapy by predicting the dose difference metric (Gamma passing rate) and its distribution. However, current research overlooks uncertainty quantification in model predictions, limiting their trustworthiness in real clinical environments. This paper proposes a Multi-granularity Uncertainty Quantification (MGUQ) framework. A Bayesian framework that quantifies uncertainties at multiple granularities for multi-task PSQA, specifically Gamma Passing Rate (GPR) prediction and Dose Difference Prediction (DDP), integrates visualization-based interactive components. Using Bayesian theory, we derive a comprehensive multi-granularity loss function that comprises granularity-specific loss and coherence loss components. Additionally, we proposed Multi-granularity Prior Networks, a dual-stream network architecture, to infer the distributions of DDP (modeled as t-distributions) and GPR (modeled as Gaussian distributions) under specific statistical assumptions. Comprehensive evaluations are conducted on a dataset from ''Peeking Union Medical College Hospital'', and results show that our proposed method achieves a minimum MAE loss of 0.864 with a 2%/3 mm criterion and realizes the uncertainty visualization of dose difference. Further, it also achieves 100% Clinical Accuracy (CA) with a workload of 67.2%. Experiments demonstrate that the proposed framework can enhance the trustworthiness of deep learning applications in PSQA.

A method for empirically validating FMEA RPN scores in a radiation oncology clinic using physics QC data.

In failure modes and effects analysis (FMEA), the components of the risk priority number (RPN) for a failure mode (FM) are often chosen by consensus. We describe an empirical method for estimating the occurrence (O) and detectability (D) components of a RPN. The method requires for a given FM that its associated quality control measure be performed twice as is the case when a FM is checked for in an initial physics check and again during a weekly physics check. If instances of the FM caught by these checks are recorded, O and D can be computed. Incorporation of the remaining RPN component, Severity, is discussed. This method can be used as part of quality management design ahead of an anticipated FMEA or afterwards to validate consensus values.

A novel EPID-based MLC QA method with log files achieving submillimeter accuracy.

The purpose of this study is to develop an electronic portal imaging device-based multi-leaf collimator calibration procedure using log files. Picket fence fields with 2-14 mm nominal strip widths were performed and normalized by open field. Normalized pixel intensity profiles along the direction of leaf motion for each leaf pair were taken. Three independent algorithms and an integration method derived from them were developed according to the valley value, valley area, full-width half-maximum (FWHM) of the profile, and the abutment width of the leaf pairs obtained from the log files. Three data processing schemes (Scheme A, Scheme B, and Scheme C) were performed based on different data processing methods. To test the usefulness and robustness of the algorithm, the known leaf position errors along the direction of perpendicular leaf motion via the treatment planning system were introduced in the picket fence field with nominal 5, 8, and 11 mm. Algorithm tests were performed every 2 weeks over 4 months. According to the log files, about 17.628% and 1.060% of the leaves had position errors beyond ± 0.1 and ± 0.2 mm, respectively. The absolute position errors of the algorithm tests for different data schemes were 0.062 ± 0.067 (Scheme A), 0.041 ± 0.045 (Scheme B), and 0.037 ± 0.043 (Scheme C). The absolute position errors of the algorithms developed by Scheme C were 0.054 ± 0.063 (valley depth method), 0.040 ± 0.038 (valley area method), 0.031 ± 0.031 (FWHM method), and 0.021 ± 0.024 (integrated method). For the efficiency and robustness test of the algorithm, the absolute position errors of the integration method of Scheme C were 0.020 ± 0.024 (5 mm), 0.024 ± 0.026 (8 mm), and 0.018 ± 0.024 (11 mm). Different data processing schemes could affect the accuracy of the developed algorithms. The integration method could integrate the benefits of each algorithm, which improved the level of robustness and accuracy of the algorithm. The integration method can perform multi-leaf collimator (MLC) quality assurance with an accuracy of 0.1 mm. This method is simple, effective, robust, quantitative, and can detect a wide range of MLC leaf position errors.

Developing a quality and safety assessment framework for Iran's military hospitals.

BACKGROUND: The first crucial step towards military hospitals performance improvement is to develop a local and scientific tool to assess quality and safety based on the context and aims of military hospitals. This study introduces a Quality and Safety Assessment Framework (Q&SAF) for Iran's military hospitals. METHODS: This is a literature review which continued with a qualitative study. The Q&SAF for Iran's military hospitals was developed initially, through a review of the WHO's framework for hospital performance, literature review (other related framework), review of military hospital-related local documents, consultations with a national and sub-national expert. Finally, the Delphi technique used to finalize the framework. RESULTS: Based on the literature review results; 13 hospital Q&SAF were identified. After reviewing literature review results and expert opinions; Iran's military hospitals Q&SAF was developed with 58 indictors in five dimensions including clinical effectiveness, safety, efficiency, patient-centeredness, and Responsive Management (Command and Control). The efficiency dimension had the highest number of indictors (19 indictors), whereas the patient-centered dimension had the lowest number of indices (4 indictors). CONCLUSION: Regarding the comprehensiveness of the developed assessment framework due to its focus on the majority of quality dimensions and important components of the hospital's performance, it can be used as a useful tool for assessing and continuously improving the quality of hospitals, particularly military hospitals.

DAHEAN: A Danish nationwide study ensuring quality assurance through real-world data for suspected hereditary anemia patients.

BACKGROUND: Hereditary anemias are a group of genetic diseases prevalent worldwide and pose a significant health burden on patients and societies. The clinical phenotype of hereditary anemias varies from compensated hemolysis to life-threatening anemia. They can be roughly categorized into three broad categories: hemoglobinopathies, membranopathies, and enzymopathies. Traditional therapeutic approaches like blood transfusions, iron chelation, and splenectomy are witnessing a paradigm shift with the advent of targeted treatments. However, access to these treatments remains limited due to lacking or imprecise diagnoses. The primary objective of the study is to establish accurate diagnoses for patients with hereditary anemias, enabling optimal management. As a secondary objective, the study aims to enhance our diagnostic capabilities. RESULTS: The DAHEAN study is a nationwide cohort study that collects advanced phenotypic and genotypic data from patients suspected of having hereditary anemias from all pediatric and hematological departments in Denmark. The study deliberates monthly by a multidisciplinary anemia board involving experts from across Denmark. So far, fifty-seven patients have been thoroughly evaluated, and several have been given diagnoses not before seen in Denmark. CONCLUSIONS: The DAHEAN study and infrastructure harness recent advancements in diagnostic tools to offer precise diagnoses and improved management strategies for patients with hereditary anemias.

Paediatric patient referrals from Greenland to the National University Hospital, Rigshospitalet, Denmark.

INTRODUCTION: Greenlandic patients may be referred to Denmark for specialised diagnostics and treatment. The main collaborator for these activities is the National University Hospital, Rigshospitalet, Copenhagen. We aimed to investigate the referral pattern of Greenlandic paediatric patients to Rigshospitalet. METHODS: This was an observational quality assurance project comprising all Greenlandic patients below 18 years who received healthcare services at Rigshospitalet in the 2017-2021 period. This period was chosen to obtain the most updated, available and coherent data possible. Unique patients and disease courses were stratified by paediatric subspecialities and procedures. RESULTS: During the five-year period, a total of 310 unique patients were referred to Rigshospitalet, resulting in a total of 676 disease courses and yielding an average 62 annual referrals of paediatric Greenlandic patients. This represents around 0.5% of all Greenlandic children. Age groups were distributed as 28% aged 0-1 years, 23% 2-4 years, 13% 5-9 years, 21% 10-14 years and 16% 15-17 years. During the study period, the number of disease courses increased by 89% with most patients being managed as outpatients. The subspecialities with most referrals were ophthalmology (17%), oto-rhino-laryngology (16%) and cardiovascular diseases (10%). CONCLUSIONS: Approximately 0.5% of Greenlandic children were referred annually to Rigshospitalet with a marked increase being observed during the five-year study period. We observed a shift towards an increasing proportion of outpatient treatments at Rigshospitalet. FUNDING: None. TRIAL REGISTRATION: Not relevant.

[Staff hebdomadaire qualité et gestion des risques en gériatrie: un outil d'appropriation de la démarche qualité pour le management des unités]. / Staff hebdomadaire qualité et gestion des risques en gériatrie : un outil d'appropriation de la démarche qualité pour le management des unités.

The quality approach has become essential in geriatric hospital services, but also in the medico-social sector. This process is continuous and shared by all those in charge of the care units, to facilitate unit management and support caregivers in this approach. The weekly structured quality staff meeting is a relevant tool to facilitate the understanding and appropriation of this approach by the medical and nursing managers of the care units.

Design, construction, and dosimetry of 3D printed heterogeneous phantoms for synchrotron brain cancer radiation therapy quality assurance.

Objective.This study aims to design, manufacture, and test 3D printed quality assurance (QA) dosimetry phantoms for synchrotron brain cancer radiation therapy at the Australian synchrotron.Approach.Fabricated 3D printed phantoms from simple slab phantoms, a preclinical rat phantom, and an anthropomorphic head phantom were fabricated and characterized. Attenuation measurements of various polymers, ceramics and metals were acquired using synchrotron monochromatic micro-computed tomography (CT) imaging. Polylactic acid plus, VeroClear, Durable resin, and tricalcium phosphate were used in constructing the phantoms. Furthermore, 3D printed bone equivalent materials were compared relative to ICRU bone and hemihydrate plaster. Homogeneous and heterogeneous rat phantoms were designed and fabricated using tissue-equivalent materials. Geometric accuracy, CT imaging, and consistency were considered. Moreover, synchrotron broad-beam x-rays were delivered using a 3 Tesla superconducting multipole wiggler field for four sets of synchrotron radiation beam qualities. Dose measurements were acquired using a PinPoint ionization chamber and compared relative to a water phantom and a RMI457 Solid Water phantom. Experimental depth doses were compared relative to calculated doses using a Geant4 Monte Carlo simulation.Main results.Polylactic acid (PLA+) shows to have a good match with the attenuation coefficient of ICRU water, while both tricalcium phosphate and hydroxyapatite have good attenuation similarity with ICRU bone cortical. PLA+ material can be used as substitute to RMI457 slabs for reference dosimetry with a maximum difference of 1.84%. Percent depth dose measurement also shows that PLA+ has the best match with water and RMI457 within ±2.2% and ±1.6%, respectively. Overall, PLA+ phantoms match with RMI457 phantoms within ±3%.Significance and conclusion.The fabricated phantoms are excellent tissue equivalent equipment for synchrotron radiation dosimetry QA measurement. Both the rat and the anthropomorphic head phantoms are useful in synchrotron brain cancer radiotherapy dosimetry, experiments, and future clinical translation of synchrotron radiotherapy and imaging.

Applying the British Association of Oral and Maxillofacial Surgeons quality outcomes metrics to a regional Australian oncology and reconstructive service: benchmarking the data to audit clinical outcomes in emerging, regional, and small-volume centres.

The traditional model of centralisation of care, whilst having many advantages, also requires adaptation and upscaling to meet the requirements of both regional areas and the increasing urban sprawl. However, to ensure comparable outcomes with current major centres, this transition, when required, must be delivered in a safe and effective manner. Our project, which utilised the British Association of Oral and Maxillofacial Surgeons (BAOMS) recently published outcome data from the Quality and Outcomes in Oral and Maxillofacial Surgery (QOMS) project to benchmark data prospectively collected from a small-volume, emerging centre in Northern Queensland, was the first of its kind in terms of validation studies. As expected, the small volume of our centre impacted the ability to derive powerful statistical models and comparators, an intrinsic limitation for small-volume centres whilst they are developing services. However, during this evolution project, the use of comparison metrics allowed for the detection of alert and alarm levels, which are invaluable to ensure patient safety and quality of outcome.Our paper demonstrated that, irrespective of size or volume, the utilisation of quality assurance metrics (national or international) provides for the safe and transparent upscaling of head and neck services in emerging, regional, and small-volume centres.

HDR brachytherapy afterloader quality assurance optimization using monolithic silicon strip detectors.

BACKGROUND: There currently exists no widespread high dose-rate (HDR) brachytherapy afterloader quality assurance (QA) tool for simultaneously assessing the afterloader's positional, temporal, transit velocity and air kerma strength accuracy. PURPOSE: The purpose of this study was to develop a precise and rigorous technique for performing daily QA of HDR brachytherapy afterloaders, incorporating QA of: dwell position accuracy, dwell time accuracy, transit velocity consistency and relative air kerma strength (AKS) of an Ir-192 source. METHOD: A Sharp ProGuide 240 mm catheter (Elekta Brachytherapy, Veenendaal, The Netherlands) was fixed 5 mm above a 256 channel epitaxial diode array 'dose magnifying glass' (DMG256) (Centre for Medical and Radiation Physics, University of Wollongong). Three dwell positions, each of 5.0 s dwell times, were spaced 13.0 mm apart along the array with the Flexitron HDR afterloader (Elekta Brachytherapy, Veenendaal, The Netherlands). The DMG256 was connected to a data acquisition system (DAQ) and a computer via USB2.0 link for live readout and post-processing. The outputted data files were analyzed using a Python script to provide positional and temporal localization of the Ir-192 source by tracking the centroid of the detected response. Measurements were repeated on a weekly basis, for a period of 5 weeks to determine the consistency of the measured parameters over an extended period. RESULTS: Using the DMG256 for relative AKS measurements resulted in measured values within 0.6%-3.0% of the expected activity over a 7-week period. The sub-millisecond temporal accuracy of the device allowed for measurements of the transit velocity with an average of (10.88 ± 1.01) cm/s for 13 mm steps. The dwell position localization for 1, 2, 3, 5, and 10 mm steps had an accuracy between 0.1 and 0.3 mm (3σ), with a fixed temporal accuracy of 10 ms. CONCLUSION: The DMG256 silicon strip detector allows for clinics to perform rigorous daily QA of HDR afterloader dwell position and dwell time accuracy with greater precision than the current standard methodology using closed circuit television and a stopwatch. Additionally, DMG256 unlocks the ability to perform measurements of transit velocity/time and relative AKS, which are not possible using current standard techniques.

[The CARE (CArdiovasculaR prEvention) Score - an instrument for recording the quality of care of cardiovascular risk patients in the GP practice]. / CARE-(CArdiovasculaR prEvention) Score ­ ein Instrument zur Erfassung der Versorgungsqualität von kardiovaskulären Risikopatient/-innen in der Hausarztpraxis.

INTRODUCTION: There is potential for improvement in the care of cardiovascular diseases in Switzerland, particularly when it comes to achieving target values defined in guidelines. Adherence scores such as the SGED score for diabetic care established in Switzerland can help to reduce the evidence-performance gap. The CARE score presented here is an adherence score that validly reflects the quality of care for patients with a cardiovascular risk using process and outcome indicators.

[Considering the Professionalism of Pharmacists from a Viewpoint of "Regulatory Science"].

Regulatory science underpins scientific regulations, including reflection papers, guidelines, and administrative notices, and is closely related to the quality assurance (QA) of pharmaceuticals, foods, and chemicals in our living environment. Historically, QA has been considered the basis of pharmaceutical science. Therefore, the Pharmaceutical and Medical Device Law specifies that pharmacists, as marketing directors of pharmaceutical products, are responsible for their QA. Furthermore, a pharmacist is responsible for the QA of foods and environmental chemicals by several laws; for example, as a food sanitation supervisor or an environmental sanitation training officer. This suggests that the professional expertise of pharmacists is expected in medical care where pharmaceuticals are used and in other fields associated with QA. Thus, I consider that the professionalism of a pharmacist is guided by spiritual concepts with a pragmatic attitude and conformance to these expectations.

A comprehensive pre-clinical treatment quality assurance program using unique spot patterns for proton pencil beam scanning FLASH radiotherapy.

BACKGROUND: Quality assurance (QA) for ultra-high dose rate (UHDR) irradiation is a crucial aspect in the emerging field of FLASH radiotherapy (FLASH-RT). This innovative treatment approach delivers radiation at UHDR, demanding careful adoption of QA protocols and procedures. A comprehensive understanding of beam properties and dosimetry consistency is vital to ensure the safe and effective delivery of FLASH-RT. PURPOSE: To develop a comprehensive pre-treatment QA program for cyclotron-based proton pencil beam scanning (PBS) FLASH-RT. Establish appropriate tolerances for QA items based on this study's outcomes and TG-224 recommendations. METHODS: A 250 MeV proton spot pattern was designed and implemented using UHDR with a 215nA nozzle beam current. The QA pattern that covers a central uniform field area, various spot spacings, spot delivery modes and scanning directions, and enabling the assessment of absolute, relative and temporal dosimetry QA parameters. A strip ionization chamber array (SICA) and an Advanced Markus chamber were utilized in conjunction with a 2 cm polyethylene slab and a range (R80) verification wedge. The data have been monitored for over 3 months. RESULTS: The relative dosimetries were compliant with TG-224. The variations of temporal dosimetry for scanning speed, spot dwell time, and spot transition time were within ± 1 mm/ms, ± 0.2 ms, and ± 0.2 ms, respectively. While the beam-to-beam absolute output on the same day reached up to 2.14%, the day-to-day variation was as high as 9.69%. High correlation between the absolute dose and dose rate fluctuations were identified. The dose rate of the central 5 × 5 cm2 field exhibited variations within 5% of the baseline value (155 Gy/s) during an experimental session. CONCLUSIONS: A comprehensive QA program for FLASH-RT was developed and effectively assesses the performance of a UHDR delivery system. Establishing tolerances to unify standards and offering direction for future advancements in the evolving FLASH-RT field.

Quality assurance for next-generation sequencing diagnostics of rare neurological diseases in the European Reference Network.

In the past decade, next-generation sequencing (NGS) has revolutionised genetic diagnostics for rare neurological disorders (RND). However, the lack of standardised technical, interpretative, and reporting standards poses a challenge for ensuring consistent and high-quality diagnostics globally. To address this, the European Reference Network for Rare Neurological Diseases (ERN-RND) collaborated with the European Molecular Genetics Quality Network (EMQN) to establish an external quality assessment scheme for NGS-based diagnostics in RNDs. The scheme, initiated in 2021 with a pilot involving 29 labs and followed by a second round in 2022 with 42 labs, aimed to evaluate the performance of laboratories in genetic testing for RNDs. Each participating lab analysed genetic data from three hypothetical cases, assessing genotyping, interpretation, and clerical accuracy. Despite a majority of labs using exome or genome sequencing, there was considerable variability in gene content, sequencing quality, adherence to standards, and clinical guidance provision. Results showed that while most labs provided correct molecular diagnoses, there was significant variability in reporting technical quality, adherence to interpretation standards, reporting strategies, and clinical commentary. Notably, some labs returned results with the potential for adverse medical outcomes. This underscores the need for further harmonisation, guideline development, and external quality assessment in the evolving landscape of genomic diagnostics for RNDs. Overall, the experience with the scheme highlighted the generally good quality of participating labs but emphasised the imperative for ongoing improvement in data analysis, interpretation, and reporting to enhance patient safety.