Clinical application of a GPU-accelerated monte carlo dose verification for cyberknife M6 with Iris collimator.

PURPOSE: To apply an independent GPU-accelerated Monte Carlo (MC) dose verification for CyberKnife M6 with Iris collimator and evaluate the dose calculation accuracy of RayTracing (TPS-RT) algorithm and Monte Carlo (TPS-MC) algorithm in the Precision treatment planning system (TPS). METHODS: GPU-accelerated MC algorithm (ArcherQA-CK) was integrated into a commercial dose verification system, ArcherQA, to implement the patient-specific quality assurance in the CyberKnife M6 system. 30 clinical cases (10 cases in head, and 10 cases in chest, and 10 cases in abdomen) were collected in this study. For each case, three different dose calculation methods (TPS-MC, TPS-RT and ArcherQA-CK) were implemented based on the same treatment plan and compared with each other. For evaluation, the 3D global gamma analysis and dose parameters of the target volume and organs at risk (OARs) were analyzed comparatively. RESULTS: For gamma pass rates at the criterion of 2%/2 mm, the results were over 98.0% for TPS-MC vs.TPS-RT, TPS-MC vs. ArcherQA-CK and TPS-RT vs. ArcherQA-CK in head cases, 84.9% for TPS-MC vs.TPS-RT, 98.0% for TPS-MC vs. ArcherQA-CK and 83.3% for TPS-RT vs. ArcherQA-CK in chest cases, 98.2% for TPS-MC vs.TPS-RT, 99.4% for TPS-MC vs. ArcherQA-CK and 94.5% for TPS-RT vs. ArcherQA-CK in abdomen cases. For dose parameters of planning target volume (PTV) in chest cases, the deviations of TPS-RT vs. TPS-MC and ArcherQA-CK vs. TPS-MC had significant difference (P < 0.01), and the deviations of TPS-RT vs. TPS-MC and TPS-RT vs. ArcherQA-CK were similar (P > 0.05). ArcherQA-CK had less calculation time compared with TPS-MC (1.66 min vs. 65.11 min). CONCLUSIONS: Our proposed MC dose engine (ArcherQA-CK) has a high degree of consistency with the Precision TPS-MC algorithm, which can quickly identify the calculation errors of TPS-RT algorithm for some chest cases. ArcherQA-CK can provide accurate patient-specific quality assurance in clinical practice.

Metabolomics 2023 workshop report: moving toward consensus on best QA/QC practices in LC-MS-based untargeted metabolomics.

INTRODUCTION: During the Metabolomics 2023 conference, the Metabolomics Quality Assurance and Quality Control Consortium (mQACC) presented a QA/QC workshop for LC-MS-based untargeted metabolomics. OBJECTIVES: The Best Practices Working Group disseminated recent findings from community forums and discussed aspects to include in a living guidance document. METHODS: Presentations focused on reference materials, data quality review, metabolite identification/annotation and quality assurance. RESULTS: Live polling results and follow-up discussions offered a broad international perspective on QA/QC practices. CONCLUSIONS: Community input gathered from this workshop series is being used to shape the living guidance document, a continually evolving QA/QC best practices resource for metabolomics researchers.

Performance evaluation of facility locations using integrated DEA-based techniques.

Facility location, particularly in the context of international investments by global enterprises, stands out as a paramount concern within the purview of top management's strategic decision-making process. The selection of a suitable location plays a pivotal role in determining the ultimate achievement of organizational objectives. The process of selecting an appropriate location requires the comprehensive analysis of a substantial volume of data, encompassing diverse tangible and intangible evaluation criteria that may exhibit inherent conflicts. This paper addresses the challenge of determining the best location for a manufacturing facility by employing alternative performance measures within the framework of the data envelopment analysis (DEA) model. In a performance evaluation process, not only positive but also negative aspects should be determined. This paper, therefore, proposes a double-frontier DEA-AR model, which is an integrated approach that incorporates the efficient frontier, anti-efficient frontier, and assurance region weight restrictions, with the aim of increasing the discrimination ability of the DEA method. An efficient frontier evaluates the information of each location from a positive viewpoint, while the worst side is evaluated by an anti-efficient frontier. The technique of weight restrictions, which allows incorporating expert opinion into the assessment, is also applied with both frontiers to restrict the regions of weights to some specific area. The prescribed approach is illustrated by a numerical example of selecting the best location among ten different countries under consideration of 22 selection criteria obtained from PEST analysis. The results show that the proposed alternative performance measures significantly improve discrimination capability, enabling the ranking of candidates based on their suitability for the optimal location.

Evaluation and improvement of the safety of 3D-printed template assisted intracavitary/interstitial brachytherapy for cervical cancer using repeat FMEA.

BACKGROUND AND PURPOSE: 3D-printed templates are used in intracavitary/interstitial brachytherapy (3DP-IC/IS) for locally advanced cervical cancer (LACC). We applied failure mode and effects analysis (FMEA) twice in one year to improve 3DP-IC/IS safety. MATERIALS AND METHODS: A risk assessment group was established. We created a process map for 3DP-IC/IS procedures, identifying potential failure modes (FMs) and evaluating occurrence (O), detectability (D), severity (S), and risk priority number (RPN = O*D*S). High RPN values identified high-risk FMs, and quality control (QC) methods were determined by root cause analysis. A second FMEA was performed a year later. RESULTS: The 3DP-IC/IS process included 10 main steps, 48 subprocesses, and 54 FMs. Initial RPN values ranged from 4.50 to 171.00 (median 50.50; average 52.18). Ten high-risk FMs were identified: (1) unreasonable needle track design (171.00/85.50), (2) noncoplanar needle label identification failure (126.00/64.00), (3) template model reconstruction failure (121.50/62.50), (4) improper gauze filling (112.00/60.25), (5) poor needle position (112.00/52.50). QC interventions lowered all high-risk RPN values during the second assessment. CONCLUSIONS: A feasible 3DP-IC/IS process was proposed. Staff training, automatic needle path planning, insertion guidance diagrams, template checking, system commissioning, and template design improvements effectively enhanced process safety.

Development and integration of a clinical dashboard within a dental school setting.

PURPOSE: To describe the development and integration of an electronic health record-driven, student dashboard that displays real-time data relative to the students' patient management and clinic experiences at the University of Illinois Chicago, College of Dentistry. MATERIALS AND METHODS: Following development and implementation of the student dashboard, various objective metrics were evaluated to identify any improvements in the clinical patient management. A cross-sectional retrospective chart review was completed of the electronic health record (axiUm, Exan, Coquitlam, BC, Canada) from January 2019 to April 2022 evaluating four performance metrics: student lockouts, note/code violations, overdue active patients, and overdue recall patients. Descriptive statistics were analyzed. The Kolmogorov-Smirnov test was applied to assess the normal distribution of data. Data were analyzed by the Kruskal-Wallis tests for potential differences between pre-dashboard and post-dashboard implementation years with the mean overdue active/recall patient to student ratio variables. Mann-Whitney U-tests for between-groups comparisons with Bonferroni correction for multiple comparisons were performed (α = 0.05). Descriptive statistics were performed to analyze the student utilization frequency of the dashboard. RESULTS: Post-implementation analysis indicated a slight decrease in the number of lockouts and note/code violation; and a statistically significant decrease in overdue active patients post-dashboard (P < 0.001). On average, students accessed their dashboards 3.3 times a week. CONCLUSIONS: Implementation of a student dashboard through the electronic health record platform within an academic dental practice has the potential to assist students with patient management and is utilized regularly by the students.

Transforming experimental radiology: Design and implementation of an innovative ePACS image storage system for AI imaging research environments.

INTRODUCTION AND PURPOSE: We present the needs, design, development, implementation, and accessibility of a crafted experimental PACS (ePACS) system to securely store images, ensuring efficiency and ease of use for AI processing, specifically tailored for research scenarios, including phantoms, animal and human studies and quality assurance (QA) exams. The ePACS system plays a crucial role in any medical imaging departments that handle non-care profile studies, such as protocol adjustments and dummy runs. By effectively segregating non-care profile studies from the healthcare assistance, the ePACS usefully prevents errors both in clinical practice and storage security. METHODS AND RESULTS: The developed ePACS system considers the best practices for management, maintenance, access, long-term storage and backups, regulatory audits, and economic aspects. Moreover, key aspects of the ePACS system include the design of data flows with a focus on incorporating data security and privacy, access control and levels based on user profiles, internal data management policies, standardized architecture, infrastructure and application monitorization and traceability, and periodic backup policies. A new tool called DicomStudiesQA has been developed to standardize the analysis of DICOM studies. The tool automatically identifies, extracts, and renames series using a consistent nomenclature. It also detects corrupted images and merges separated dynamic series that were initially split, allowing for streamlined post-processing. DISCUSSION AND CONCLUSIONS: The developed ePACS system encompasses a successful implementation, both in hospital and research environments, showcasing its transformative nature and the challenging yet crucial transfer of knowledge to industry. This underscores the practicality and real-world applicability of our innovative approach, highlighting the significant impact it has on the field of experimental radiology.

A nonparametric measure of contrast in x-ray images.

Objective We propose a nonparametric figure of merit, the contrast equivalent distance CED, to measure contrast directly from clinical images. Approach A relative brightness distance δ is calculated by making use of the order statistic of the pixel values. By multiplying δ with the grey value range R, the mean brightness distance MBD is obtained. From the MBD, the CED and the distance-to- noise ratio DNR can be derived. The latter is the ratio of the MBD and a previously suggested nonparametric measure τ for the noise. Since the order statistic is independent of the spatial arrangement of the pixel values, the measures can be obtained directly from clinical images. We apply the new measures to mammography images of an anthropomorphic phantom and of a phantom with a step wedge as well as to CT images of a head phantom. Main results For low-noise images of a step wedge, the MBD is equivalent to the conventional grey value distance. While this measure permits the evaluation of clinical images, it is sensitive to noise. Therefore, noise has to be quantified at the same time. When the ratio σ/τ of the noise standard deviation σ to τ is available, validity limits for the CED as a measure of contrast can be established. The new figures of merit can be calculated for entire images as well as on regions of interest (ROI) with an edge length not smaller than 32 px. Significance The new figures of merit are suited to quantify the quality of clinical images without relying on the assumption of a linear, shift-invariant system. They can be used for any kind of greyscale image, provided the ratio σ/τ can be estimated. This will hopefully help to achieve the optimisation of image quality vs dose required by radioprotection laws.

Systematic review on the implementation of metrological assurance systems for medical devices in Latin America.

Background: Metrology plays a crucial role in small healthcare service businesses to ensure the quality of products and services. While legal metrology in healthcare exists in some regions, it lacks harmonization. In other countries, there is limited presence of metrology in medical and biomedical engineering. We aimed to evaluate the implementation of metrological assurance systems for medical devices in Latin America. Methods: A systematic review was conducted following PRISMA 2020 guidelines and registered with PROSPERO (CRD42022359284). Searches were performed across 13 databases from October 30th to November 3rd, 2022. The search equation was "(((quality assurance) AND (metrology)) AND (medical devices))." A total of 7,789 documents were identified, of which only 16 met the inclusion criteria. Results: The majority of studies (75%) were conducted in Colombia, with a significant portion being undergraduate theses. The primary normative references used in the analyzed studies were ISO 10012 and ISO 17025, with the majority (68.75%) relying on national legislation for their approach. One study in Colombia referenced eight standards, and one in Brazil analyzed user involvement in medical device management. Among the included studies, 56.25% were conducted in healthcare institutions, mainly clinics. Most studies provided implementation guidelines, with ISO 10012 being prominent, alongside ISO 17025, which implicitly addresses ISO 9001 elements. Global bias was low across all studies. Conclusion: Our results underscore the importance of metrological assurance in managing medical devices in Latin America. The utilization of international standards and national legislation illustrates the diverse approaches adopted by different institutions. Future research should focus on optimizing metrological practices to enhance quality and safety in healthcare.

The Performance of ChatGPT-4 and Gemini Ultra 1.0 for Quality Assurance Review in Emergency Medical Services Chest Pain Calls.

OBJECTIVES: This study assesses the feasibility, inter-rater reliability, and accuracy of using OpenAI's ChatGPT-4 and Google's Gemini Ultra large language models (LLMs), for Emergency Medical Services (EMS) quality assurance. The implementation of these LLMs for EMS quality assurance has the potential to significantly reduce the workload on medical directors and quality assurance staff by automating aspects of the processing and review of patient care reports. This offers the potential for more efficient and accurate and identification of areas requiring improvement, thereby potentially enhancing patient care outcomesMETHODS: Two expert human reviewers, ChatGPT GPT-4, and Gemini Ultra assessed and rated 150 consecutively sampled and anonymized prehospital records from 2 large urban EMS agencies for adherence to 2020 National Association of State EMS metrics for cardiac care. We evaluated the accuracy of scoring, inter-rater reliability, and review efficiency. The inter-rater reliability for the dichotomous outcome of each EMS metric was measured using the kappa statistic.RESULTS: Human reviewers showed high interrater reliability, with 91.2% agreement and a kappa coefficient, 0.782 (0.654-0.910). ChatGPT-4 achieved substantial agreement with human reviewers in EKG documentation and aspirin administration (76.2% agreement, kappa coefficient, 0.401 (0.334-0.468), but performance varied across other metrics. Gemini Ultra's evaluation was discontinued due to poor performance. No significant differences were observed in median review times: 01:28 minutes (IQR 1:12 - 1:51 min) per human chart review, 01:24 minutes (IQR 01:09 - 01:53 min) per ChatGPT-4 chart review (p = 0.46), and 01:50 minutes (IQR 01:10-03:34 min) per Gemini Ultra review (p = 0.06).CONCLUSIONS: Large language models demonstrate potential in supporting quality assurance by effectively and objectively extracting data elements. However, their accuracy in interpreting non-standardized and time-sensitive details remains inferior to human evaluators. Our findings suggest that current LLMs may best offer supplemental support to the human review processes, but their value remains limited. Enhancements in LLM training and integration are recommended for improved and more reliable performance in the quality assurance processes.

Novel strategies for the determination of plastic additives derived from agricultural plastics in soil using ultrahigh-performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS).

Certain agricultural plastics, i.e., mulching films, are generally considered as potent sources of micro- and nanoplastics (MNPs), due to their direct application on soil and waste mishandling. During the synthesis and fabrication of such agricultural plastics, it is necessary to use chemicals, the so-called plastic additives (PAs), improving the physicochemical properties of the final polymeric product. However, since PAs are loosely bound on the polymer matrix, they can potentially leach into the soil environment with unidentified effects. Clearly, to monitor the fate of PAs in the terrestrial ecosystem, it is necessary to develop accurate, sensitive and robust analytical methods. To this end, a comprehensive analytical strategy was developed for monitoring 16 PAs with diverse physicochemical properties (partition coefficient; -3 < logP<19) in soil samples using ultra-high-performance liquid chromatography coupled to tandem mass spectrometry (UHPLC-MS/MS). For this purpose, two different extraction procedures were developed, namely, a single step ultrasound-assisted extraction (UAE) using ethyl acetate or an aqueous solution of methanol and a binary extraction, combining Quick, Easy, Cheap, Effective, Rugged and Safe (QuEChERS) and UAE principles with n-hexane as the extractant. Interestingly, within the sample preparation investigation, we identified in-lab contamination sources of PAs, e.g., centrifuge tubes or microfilters. Such consumables are made of plastic contaminating the procedural blanks and omitting their use was necessary to acquire satisfactory analytical performance. In detail, method validation was performed for 16 compounds achieving recoveries mainly in the range 70-120 %, repeatability (expressed as relative standard deviation, RSD %) < 20 % and limits of quantification (LOQs) ranging between 0.2 and 20 ng/g dry weight (dw). Importantly, the presented strategies are added to the very limited available for PA determination in soil, a topical issue with a significant and rather understudied impact on agriculture.

Nursing Home Star Ratings and End-Of-Life Care Quality: Lessons Learned From the Veterans Health Administration.

OBJECTIVES: More than 25% of deaths among older adults occur in nursing homes. Thus, assessments of nursing home quality, including the widely used 5-star rating systems, should reflect quality of end-of-life (EOL) care. Our objective was to examine the associations between Veterans Affairs (VA) nursing home star ratings and quality of EOL care as measured by the VA's Bereaved Family Survey (BFS). DESIGN: National, retrospective observational study. SETTING AND PARTICIPANTS: VA nursing homes, known as Community Living Centers (CLCs). All veterans who died in a CLC from October 2018 to September 2019 whose next of kin completed a BFS. METHODS: Using linked VA data sources, we examined the BFS-Performance Measure (BFS-PM) (ie, the % of BFS respondents who provided an "excellent" overall rating) by the Overall Star Rating and domain star ratings (unannounced survey, staffing, and quality) for the 133 CLCs in our sample. Logistic and linear regression was used to examine the associations between CLC Overall Star Rating and individual-level BFS outcomes. Outcomes included the BFS-PM (primary), the 3 BFS factor scores of Respectful Care and Communication, Emotional and Spiritual Support, and Death Benefits, and 2 symptom management items. RESULTS: Differences in the BFS-PM by CLC star rating were small to none and not statistically significant across all star rating domains. The relationship between a higher CLC Overall Star Rating and odds of an "excellent" BFS global rating was not statistically significant. Similarly, no significant associations were observed between a higher CLC Overall Star Rating and scores on the BFS factor scores and symptom management items. CONCLUSIONS AND IMPLICATIONS: Our findings suggest that the current CLC star rating system is not sufficient to assess the quality of EOL care. BFS scores, or a comparative EOL quality of care measure, should be integrated into CLC quality rating systems.

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.

Quality assurance and other challenges in paediatric radiotherapy: Accurate delivery of craniospinal radiotherapy.

INTRODUCTION: Cranio-spinal radiotherapy (CSI) is used to treat central nervous system malignancies in paediatric, adolescent/young adult (AYA), and adult patients. Its delivery in the paediatric/AYA population is particularly challenging across different age groups. This study aims to assess the setup variations and dosimetric impact of CSI in paediatric and AYA patients. METHODS: This retrospective analysis included, 10 paediatric and AYA patients (aged 4-25) who underwent volumetric modulated arc therapy (VMAT) CSI between 2016 and 2022. Patient characteristics, diagnoses, prescribed CSI doses, and fractionation details were assessed. CT simulation and treatment planning followed standard protocols with setup errors were quantified by comparing daily treatment setup images with the planned position. The study evaluated the dosimetric impact on target volumes and organs at risk (OARs). RESULTS: The setup errors were identified, ranging from 0.5 to 6.2 mm in different directions, especially in the cranio-caudal direction. Despite these variations, there was minimal impact observed on the coverage of clinical target volumes (CTV) and doses to OARs (<1% relative change). CONCLUSION: Ensuring precise setup in paediatric and AYA patients undergoing CSI is essential to maintain adequate CTV coverage. Although occasional substantial setup variations occurred during treatment, they had a limited impact on CTV coverage and OAR doses when infrequent. Appropriate planning target volume (PTV) margins can effectively compensate for occasional shifts. However, systematic errors could compromise treatment quality if undetected. Regular off-line review of patient set-up trends is recommended.

Novel Optical Methodology Unveils the Impact of a Polymeric Pour-Point Depressant on the Phase Morphology of Waxy Crude Oils.

Crude oil, also known as petroleum, plays a crucial role in global economies, politics, and technological advancements due to its widespread applications in industrial organic chemistry. Despite environmental concerns, the dwindling supply of easily accessible oil reservoirs necessitates the exploration of unconventional resources, such as heavy and extra-heavy oils. These oils, characterized by high viscosity and complex composition, pose challenges in extraction, transportation, and refinement. With decreasing temperatures, heavy oils undergo phase changes, with transitions from Newtonian to non-Newtonian fluid behavior, leading to difficulties in transportation. Alternative methods, such as the use of polymeric pour-point depressants, help mitigate flowability issues by preventing wax precipitation. Understanding the properties of waxy crude oil, such as the wax appearance temperature (WAT), is crucial for effective mitigation strategies. The objective of this research is to determine the WATs of different types of waxy crude oils through a comparative analysis using advanced techniques such as cross-polar microscopy (CPM), standard rheology, and differential scanning calorimetry (DSC). Disparities in WAT identified through different analytical methods highlight the potential of microscopy to enhance our understanding of complex fluid dynamics in real time in order to proactively identify and address crystallization issues in oilfields.

Yet another dose algorithm (YODA) for independent computations of dose and dose changes due to anatomical changes.

Objective:To assess the viability of a physics-based, deterministic and adjoint-capable algorithm for performing treatment planning system independent dose calculations and for computing dosimetric differences caused by anatomical changes. Approach:A semi-numerical approach is employed to solve two partial differential equations for the proton phase-space density which determines the deposited dose. Lateral hetereogeneities are accounted for by an optimized (Gaussian) beam splitting scheme. Adjoint theory is applied to approximate the change in the deposited dose caused by a new underlying patient anatomy. Main results:The quality of the dose engine was benchmarked through three-dimensional gamma index comparisons against Monte Carlo simulations done in TOPAS. The worst passing rate for the gamma index with (1 mm, 1 %, 10 % dose cut-off) criteria is 94.55 %. The effect of delivering treatment plans on repeat CTs was also tested. For a non-robustly optimized plan the adjoint component was accurate to 5.7 % while for a robustly optimized plan it was accurate to 4.8 %. Significance:YODA is capable of accurate dose computations in both single and multi spot irradiations when compared to TOPAS. Moreover, it is able to compute dosimetric differences due to anatomical changes with small to moderate errors thereby facilitating its use for patient-specific quality assurance in online adaptive proton therapy.

Chemical Composition of Fat Bloom on Chocolate Products Determined by Combining NMR and HPLC-MS.

To reduce unwanted fat bloom in the manufacturing and storage of chocolates, detailed knowledge of the chemical composition and molecular mobility of the oils and fats contained is required. Although the formation of fat bloom on chocolate products has been studied for many decades with regard to its prevention and reduction, questions on the molecular level still remain to be answered. Chocolate products with nut-based fillings are especially prone to undesirable fat bloom. The chemical composition of fat bloom is thought to be dominated by the triacylglycerides of the chocolate matrix, which migrate to the chocolate's surface and recrystallize there. Migration of oils from the fillings into the chocolate as driving force for fat bloom formation is an additional factor in the discussion. In this work, the migration was studied and confirmed by MRI, while the chemical composition of the fat bloom was measured by NMR spectroscopy and HPLC-MS, revealing the most important triacylglycerides in the fat bloom. The combination of HPLC-MS with NMR spectroscopy at 800 MHz allows for detailed chemical structure determination. A rapid routine was developed combining the two modalities, which was then applied to investigate the aging, the impact of chocolate composition, and the influence of hazelnut fillings processing parameters, such as the degree of roasting and grinding of the nuts or the mixing time, on fat bloom formation.

Multi-centre digital radiography reject analysis for different clinical room use types: The establishment of local reject reference levels for public hospital departments.

INTRODUCTION: Reject analysis in digital radiography helps guide the training of staff to reduce patient radiation dose and improve department efficiency. The purpose of this study was to perform a multi-centre, vendor agnostic reject analysis across different room usage types, and to provide benchmarks for comparison. METHODS: Retrospective reject and exposure log data were collected via USB from fixed general X-ray systems across multiple Australian sites, for collation and analysis. The overall reject rate, local reject reference level, absolute and relative reject rates for body part categories, reject rates by room usage types and the reject rate for each reason of rejection were calculated. RESULTS: Data were collected from 44 X-ray systems, across 11 hospitals. A total of 2,031,713 acquired images and 172,495 rejected images were included. The median reject rate was 9.1%. The local reject reference level (LRRL), set as the 75th percentile of all reject rates, was 10.6%. Median reject rates by room type were emergency (7.4%), inpatients + outpatients (9.6%), outpatients (9.2%), and hybrid (10.1%). The highest absolute reject rates by body part were chest (2.1%) and knee (1.4%). The highest relative rates by body part were knee (18.1%) and pelvis (17.2%). The most frequent reasons for image rejection were patient positioning (76%) and patient motion (7.5%). CONCLUSIONS: The results compare well with previously published data. The range of reject rates highlights the need to analyse typical reject rates in different ways. With analysis feedback to participating sites and the implementation of standardised reject reasons, future analysis should monitor whether reject rates reduce.

Longitudinal evaluation of an electronic audit and feedback system for patient safety in a large tertiary hospital setting.

Objective: This study sought to assess the impact of a novel electronic audit and feedback (e-A&F) system on patient outcomes. Methods: The e-A&F intervention was implemented in a tertiary hospital and involved near real-time feedback via web-based dashboards. We used a segmented regression analysis of interrupted time series. We modelled the pre-post change in outcomes for the (1) announcement of this priority list, and (2) implementation of the e-A&F intervention to have affected patient outcomes. Results: Across the study period there were 222,792 episodes of inpatient care, of which 13,904 episodes were found to contain one or more HACs, a risk of 6.24%. From the point of the first intervention until the end of the study the overall risk of a HAC reduced from 8.57% to 4.12% - a 51.93% reduction. Of this reduction the proportion attributed to each of these interventions was found to be 29.99% for the announcement of the priority list and 21.93% for the implementation of the e-A&F intervention. Discussion: Our findings lend evidence to a mechanism that the announcement of a measurement framework, at a national level, can lead to local strategies, such as e-A&F, that lead to significant continued improvements over time.

Quality Assurance in Radiotherapy (RT)-Specific Trials: Indian Scenario.

AIMS: There is evidence that proper radiotherapy trial quality assurance (RTTQA) translates into improved outcomes for patients. However, the practice of RTTQA is heterogeneous and implemented in a diverse manner across trials. In this paper, we review the RTTQA report for randomised trials (RCT) conducted in India and present our experience with RTTQA for various clinical trials and highlight the key achievements and challenges. MATERIALS AND METHODS: Search was performed using the keywords and the variations thereof for "radiotherapy" and author affiliations from India, its states and major metropolitan cities. Pubmed search filters were used to restrict results to RCT published in the past 5 years (2019-2024). Reporting of RTTQA procedures from publications and protocols was documented along with the protocol-specified dosimetric goals. We also evaluated a few clinical trials performed in the Department of Radiation Oncology at Tata Medical Center. The different RTTQA procedures and results for four representative clinical trials have been described. RESULTS: A formal RTTQA process was reported by only one out of 24 randomised controlled trials and formal dosimetric goals were pre-specified by 9 of 13 trials where IMRT was used as treatment. RTTQA requirements were tailored for each clinical trial at Tata Medical Center. For the HYPORT trial, the RTTQA process focused on ensuring the matchline doses were homogenous. HYPORT B trial commissioned the use of a simultaneous integrated boost technique which emphasised conformal avoidance of dose spillage to contralateral breast and lung. HYPORT Adjuvant and PROPARA trials are multicentre clinical trials. While HYPORT Adjuvant focussed on ensuring that the dose delivery met the predefined constraints, segmentation of the target volume was important for the PROPARA trial. CONCLUSION: We demonstrate different RTTQA procedures required for representative clinical trials and highlight key challenges encountered.