Artificial intelligence in medicine: mitigating risks and maximizing benefits via quality assurance, quality control, and acceptance testing.

The adoption of artificial intelligence (AI) tools in medicine poses challenges to existing clinical workflows. This commentary discusses the necessity of context-specific quality assurance (QA), emphasizing the need for robust QA measures with quality control (QC) procedures that encompass (1) acceptance testing (AT) before clinical use, (2) continuous QC monitoring, and (3) adequate user training. The discussion also covers essential components of AT and QA, illustrated with real-world examples. We also highlight what we see as the shared responsibility of manufacturers or vendors, regulators, healthcare systems, medical physicists, and clinicians to enact appropriate testing and oversight to ensure a safe and equitable transformation of medicine through AI.

Performance characteristics of the 5-ring GE Discovery MI PET/CT scanner using AAPM TG-126 report.

AIM: To report on the performance characteristics of the 5-ring GE Discovery MI PET/CT systems using the AAPM TG-126 report and compare these results to NEMA NU 2-2012 where applicable. MATERIALS AND METHODS: TG-126 testing was performed on two GE 5-Rings Discovery MI scanners. Tests performed included spatial resolution, PET/CT image-registration accuracy, sensitivity, count rate performance, accuracy of corrections, image contrast, scatter/attenuation correction, and image uniformity. All acquired data were analyzed using scanner console or free software tools as described by TG-126 and the results were then compared to published NEMA NU 2-2012 values. RESULTS: Both scanners gave similar resolution results for TG-126 and NEMA NU 2-2012 and were within manufacturer specifications. Image-registration accuracy between PET and CT using our clinical protocol showed excellent results with values ≤1 mm. Sensitivity using TG-126 was 19.43 cps/kBq while for NEMA the value was 20.73 cps/kBq. The peak noise-equivalent counting rate was 2174 kcps at 63.1 kBq/mL and is not comparable to NEMA NU 2-2012 due to differences in phantoms and methods used to measure and calculate this parameter. The accuracy of corrections for count losses for TG-126 were expressed in SUV values and found to be within 10% of the expected SUV measurement of 1. Image contrast and scatter/attenuation correction using the TG-126 method gave acceptable results. Image uniformity assessment resulted in values within the recommended ± 5% limits. CONCLUSION: These results show that the 5-ring GE Discovery MI PET/CT scanner testing using TG-126 is reproducible and has similar results to NEMA NU 2-2012 tests where applicable. We hope these results start to form the basis to compare PET/CT systems using TG-126.

Liking and Description of Pasta Sauces with Varying Mealworm Content.

Entomophagy is directly connected with culture, explaining why it is commonly rejected in Western countries. Due to increased meat consumption in recent years with its associated negative impacts on health and sustainability, the development of products based on alternative protein sources has become urgent. The larval form of Tenebrio molitor (mealworm) has the potential to substitute meat as it requires less resources and produces less emissions compared to other forms of meat production. Therefore, in this project we have aimed to develop pasta sauces with differing mealworm contents based on a common meat sauce and to test the acceptance with 91 consumers in Austria. Three sauces (100% mealworm, 50% mealworm and 50% meat, 100% meat) were developed and tested using a 9-point hedonic scale for acceptance, and the CATA (Check-All-That-Apply) method was integrated to also receive descriptive information. The analysis of the liking data revealed that the liking for the hybrid sauce with meat and mealworm content was comparable to the meat sauce (6.9 ± 1.8. vs. 6.5 ± 1.8, p > 0.05). Less liked was the sauce with the highest mealworm content (5.7 ± 1.8, p < 0.05). The CATA analysis demonstrated the strongest positive effects on the mean in terms of how much the products were liked for the attribute "fleshy" (0.8). On the other hand, the attributes "brownish" (-0.9) or "mushy" (-1.0) had the strongest negative effects on the mean of the liking of products. We have seen that meat cannot be substituted by mealworm immediately and completely. The results suggest a stepwise substitution and the further adaptation of products regarding the (negative and positive effecting) attributes to increase consumer acceptance.

A Bespoke Electronic Health Journal for Monitoring Response to Botulinum Toxin in Treatment of Cervical Dystonia: Open-Label Observational Study of User Experience.

BACKGROUND: The mainstay of treatment for cervical dystonia (CD) is regular botulinum toxin injections every 3-4 months. Clinical evaluation of response is dependent on the patient's recall of how well symptoms responded to the previous injection. A mobile health app could assist both patients and health care professionals to monitor treatment benefits and side effects to assist with the selection of muscle and toxin dose to be injected at the next visit. The DystoniaDiary is a bespoke electronic health journal for monitoring symptoms of CD and response to treatment. OBJECTIVE: The objective of this study was to assess the acceptability and utility of the DystoniaDiary in patients with CD treated with botulinum toxins as part of their usual care. METHODS: In this open-label, single-center, single-arm observational study, patients attending a botulinum toxin injection clinic were invited to download the DystoniaDiary app. Patients selected up to 3 of their most troublesome CD symptoms (from a predefined list) and were prompted every 3 days to rate the control of these symptoms on a scale from 0 (very badly) to 100 (very well). Dates of onset and wearing off of response to injected botulinum toxin and responses to the Cervical Dystonia Impact Profile (CDIP-58) questionnaire at baseline and week 6 were also recorded in the app. RESULTS: A total of 34 patients installed DystoniaDiary. Twenty-five patients (25/34, 74%) recorded data for ≥12 weeks and 21 patients (21/34, 62%) for ≥16 weeks. Median time between the first and last data input was 140 days with a median of 13 recordings per patient. User experience questionnaires at weeks 4 and 12 (20 respondents) indicated that the majority of respondents found the DystoniaDiary app easy to install and use, liked using it, would recommend it to others (19/20), and wished to continue using it (16/20). A smaller proportion indicated that the DystoniaDiary gave a greater sense of control in managing their CD (13/20). There was interindividual variation in patients' perceptions of control of their symptoms after botulinum toxin injection. Response to treatment was apparent in the symptom control scores for some patients, whereas the severity of other patients' symptoms did not appear to change after treatment. CONCLUSIONS: This observational study demonstrated that the DystoniaDiary app was perceived as useful and acceptable for a large proportion of this sample of patients with CD attending a botulinum toxin clinic. Patients with CD appear to be willing to regularly record symptom severity for at least the duration of a botulinum injection treatment cycle (12-16 weeks). This app may be useful in monitoring and optimizing individual patient responses to botulinum toxin injection.

Characterization and commissioning of a new collaborative multi-modality radiotherapy platform.

TaiChi, a new multi-modality radiotherapy platform that integrates a linear accelerator, a focusing gamma system, and a kV imaging system within an enclosed O-ring gantry, was introduced into clinical application. This work aims to assess the technological characteristics and commissioning results of the TaiChi platform. The acceptance testing and commissioning were performed following the manufacturer's customer acceptance tests (CAT) and several AAPM Task Group (TG) reports/guidelines. Regarding the linear accelerator (linac), all applicable validation measurements recommended by the MPPG 5.a (basic photon beam model validation, intensity-modulated radiotherapy (IMRT)/volumetric-modulated arc therapy (VMAT) validation, end-to-end(E2E) tests, and patient-specific quality assurance (QA)) were performed. For the focusing gamma system, the absorbed doses were measured using a PTW31014 ion chamber (IC) and PTW60016 diode detector. EBT3 films and a PTW60016 diode detector were employed to measure the relative output factors (ROFs). The E2E tests were performed using PTW31014 IC and EBT3 films. The coincidences between the imaging isocenter and the linac/gamma mechanical isocenter were investigated using EBT3 films. The image quality was evaluated regarding the contrast-to-noise ratio (CNR), spatial resolution, and uniformity. All tests included in the CAT met the manufacturer's specifications. All MPPG 5.a measurements complied with the tolerances. The confidence limits for IMRT/VMAT point dose and dose distribution measurements were achieved according to TG-119. The point dose differences were below 1.68% and gamma passing rates (3%/2 mm) were above 95.1% for the linac E2E tests. All plans of patient-specific QA had point dose differences below 1.79% and gamma passing rates above 96.1% using the 3%/2 mm criterion suggested by TG-218. For the focusing gamma system, the differences between the calculated and measured absorbed doses were below 1.86%. The ROFs calculated by the TPS were independently confirmed within 2% using EBT3 films and a PTW60016 detector. The point dose differences were below 2.57% and gamma passing rates were above 95.3% using the 2%/1 mm criterion for the E2E tests. The coincidences between the imaging isocenter and the linac/gamma mechanical isocenter were within 0.5 mm. The image quality parameters fully complied with the manufacturer's specifications regarding the CNR, spatial resolution, and uniformity. The multi-modality radiotherapy platform complies with the CAT and AAPM commissioning criteria. The commissioning results demonstrate that this platform performs well in mechanical and dosimetry accuracy.

Testing the acceptability of motorcycle-AEB system: Use of unanticipated interventions as a reliable surrogate of genuinely unexpected events.

OBJECTIVE: Active safety systems such as motorcycle autonomous emergency braking (MAEB) capable of ensuring effectiveness and safe rider-vehicle interaction present many potential benefits to reduce road fatalities but also many challenges. The whole development cycle of MAEB requires research through extensive field tests that reproduce unexpected interventions or real-life driving situation before the system can be available to the end-user. This study aims to better understand the rider's kinematic response required to control the stability of the rider-motorcycle system, as well as the extent of unexpectedness perceived by participants under different degrees of awareness of automatic braking (AB) activation. METHODS: We compared responses to AB in anticipated and (un)anticipated conditions and in a condition that was intended to be genuinely unexpected (Out of the Blue). Twenty men and women, wearing an inertial measurement unit on their upper-back, rode a scooter-type motorcycle with two front wheels simulating urban riding maneuvers on a closed test-track. Three automatic braking (AB) profiles were tested in different sessions, ranged from 3 to 5 m/s2 deceleration and 15 to 25 m/s3 braking-jerk. Differences between AB conditions were analyzed using linear mixed models. RESULTS: The unanticipated condition was perceived as fairly unexpected (rated between Quite Unexpected and Very Unexpected). Out of the Blue condition was on average close to the highest level of unexpectedness (Completely Unexpected). The exposure to unanticipated AB events resulted in upper-body response with larger peaks of pitch rate (0.20 to 0.77 rad/s higher) and acceleration (1.0 to 2.3 m/s2 higher) than those of anticipated. Participants showed less postural stability during unanticipated events taking longer both to start correcting the initial forward lean and to fully stabilize balance. Unanticipated and Out of the Blue conditions did not differ in either the amplitude of the kinematic variables or the time-to-peak pitch rate. CONCLUSIONS: The kinematic response of the rider's upper-body was found to be a reliable estimator of unexpectedness in AB. The findings suggest that unanticipated AB events while the rider engages in riding tasks can enable testing aimed at designing MAEB systems and assessing end-user acceptance in a reliable manner and within ethical safety limits.

Analysis of acceptance testing results of 60 extraoral dental X-ray equipment in Beijing, China / 中国辐射卫生

Objective To analyze the results of acceptance testing of 60 extraoral dental X-ray equipment in Beijing, China from 2021 to 2022, and understand the main types and performance parameters of newly installed extraoral dental X-ray machines in the clinical market of Beijing, as well as the level of installation and trial run of the whole machine by various manufacturers, and to summarize the problems found in acceptance testing for improving equipment testing. Methods Field acceptance testing and evaluation were carried out according to the Specification for Testing of Quality Control in Medical X-Ray Diagnostic Equipment (WS 76—2020). Results The overall qualified rate of 60 extraoral dental X-ray equipment was 98.33%. Under the same condition of the same tube voltage for one dental equipment, the maximum deviation of the tube voltage indicated by the two modes (panorama and skull) is 5.5%, and the maximum difference of the half-value layer of the useful beam is 1.22 mm Al. There is also a certain difference between the exposure time indicating deviation from the panorama and the skull, with a maximum difference of 75.51%. Conclusion Strengthening ex-factory quality control, installing, and debugging of equipment can basically guarantee the performance of newly installed equipment. In the testing process, it is critical to ensure the effective point of measurement of the dose detector located on the central axis of the primary beam.

A multi-institutional comparison of acceptance testing data for a 0.35 T MRI scanner.

Objective.To present and quantify the variability in the acceptance testing data for the imaging component of the 0.35 T magnetic resonance-linear accelerator (MR-linac).Approach.The current acceptance testing protocol by the MR-linac vendor was described along with the equipment and scanner parameters utilized throughout the process. TheBofield homogeneity, SNR/uniformity of the combined and individual receiver coils, American College of Radiology (ACR) image quality testing, and spatial integrity of the imaging data were collected from twelve different institutions. The variability in the results was accentuated and the ramifications of the results were discussed in the context of MR-guided radiation therapy.Main Results.TheBofield homogeneity was found to have a large gantry dependence with the median values being <4 ppm for all gantry angles. The SNR and uniformity were found to be well above the vendor-specified thresholds with a relatively small institutional-dependence. All institutions passed the ACR image uniformity tests. The largest institutional variability was noted to be for the slice positional accuracy test. The spatial fidelity was calculated to be <1.0 and <2.1 mm within a 100 and a 175 mm radius from the isocenter.Significance.The results from this study can be used to set the tolerances and formal guidelines for MR-linacs imaging quality assurance. Additionally, the multi-institutional data reported in this work will aid in future MR-linac acceptance and commissioning.

Best Practice Recommendations: User Acceptance Testing for Systems Designed to Collect Clinical Outcome Assessment Data Electronically.

Implementing clinical outcome assessments electronically in clinical studies requires the sponsor and electronic clinical outcome assessment (eCOA) provider to work closely together to implement study-specific requirements and ensure consensus-defined best practices are followed. One of the most important steps is for sponsors to conduct user acceptance testing (UAT) using an eCOA system developed by the eCOA provider. UAT provides the clinical study team including sponsor or designee an opportunity to evaluate actual software performance and ensure that the sponsor's intended requirements were communicated clearly and accurately translated into the system design, and that the system conforms to a sponsor-approved requirements document based on the study protocol. The components of an eCOA system, such as the study-specific application, customization features, study portal, and custom data transfers should be tested during UAT. While the provider will perform their own system validation, the sponsor or designee should also perform their due diligence by conducting UAT. A clear UAT plan including the necessary documentation may be requested by regulatory authorities depending on the country. This paper provides the electronic patient-reported outcome (ePRO) Consortium's and patient-reported outcome (PRO) Consortium's best practice recommendations for clinical study sponsors or their designee for conducting UAT with support from eCOA providers to ensure data quality and enhance operational efficiency of the eCOA system. Following these best practice recommendations and completing UAT in its entirety will support a high quality eCOA system and ensure more reliable and complete data are collected, which are essential to the success of the study.

A multi-institutional comparison of dosimetric data for a 0.35 T MR-linac.

Objective.A comparison of percent depth dose (PDD) curves, lateral beam profiles, output factors (OFs), multileaf collimator (MLC) leakage, and couch transmission factors was performed between ten institutes for a commercial 0.35 T MR-linac.Approach.The measured data was collected during acceptance testing of the MR-linac. The PDD curves were measured for the 3.32 × 3.32 cm2, 9.96 × 9.96 cm2, and 27.20 × 24.07 cm2field sizes. The lateral beam profiles were acquired for a 27.20 × 24.07 cm2field size using an ion chamber array and penumbra was defined as the distance between 80% of the maximum dose and 20% of the maximum dose after normalizing the profiles to the dose at the inflection points. The OFs were measured using solid-state dosimeters, whereas radiochromic films were utilized to measure radiation leakage through the MLC stacks. The relative couch transmission factors were measured for various gantry angles. The variation in the multi-institutional data was quantified using the percent standard deviation metric.Main results.Minimal variations (<1%) were found between the PDD data, except for the build-up region and the deeper regions of the PDD curve. The in-field region of the lateral beam profiles varied <1.5% between different institutions and a small variation (<0.7 mm) in penumbra was observed. A variation of <1% was observed in the OF data for field sizes above 1.66 × 1.66 cm2, whereas large variations were shown for small-field sizes. The average and maximum MLC leakage was calculated to be <0.3% and <0.6%, which was well below the international electrotechnical commission (IEC) leakage thresholds. The couch transmission was smallest for oblique beams and ranged from 0.83 to 0.87.Significance.The variation in the data was found to be relatively small and the different 0.35 T MR-linacs were concluded to have similar dosimetric characteristics.

On the MLC leaves alignment in the direction orthogonal to movement.

The main focus of the recommended spatial accuracy tests for the multi-leaf collimators (MLC) is calibration of the leaf position along the movement direction and overall alignment to the radiation isocenter. No explicit attention was typically paid to the alignment of the leaves from the opposing banks in the direction orthogonal to movement. This paper is a case study demonstrating that verification of such alignment at the time of acceptance testing is prudent. The original standard MLC (SMLC) on an MRIdian MRI-guided linac (ViewRay Inc., Mountain View, CA, USA) was upgraded to a high-speed MLC (HSMLC), which is supposed to be mechanically identical to the SMLC except for the higher drive screw pitch. The results of the end-to-end IMRT tests demonstrated unacceptable dosimetric results exemplified by an average and maximum ion chamber (IC) point dose error in the high-dose low-gradient region of 2.5 ± 1.4% and 4.6%, respectively. Before the upgrade, those values were 0.3 ± 0.7% and 0.9%, respectively. An exhaustive analysis of possible failure modes eventually zeroed in on the average misalignment of about 1 mm in the Y (along the couch) direction between the right and left upper MLC banks. The MLC was replaced, reducing the Y-direction misalignment to 0.4 mm. As a result, the average and maximum IC dose-errors became acceptable 1.0 ± 0.7% and 1.6%, respectively. Simple film and/or chamber array tests during acceptance testing can easily detect Y-direction misalignments between opposing leaves banks measuring a fraction of a mm at isocenter. Left undetected, such misalignment can cause nontrivial dosimetric consequences.

PET/CT acceptance testing and quality assurance: Executive summary of AAPM Task Group 126 Report.

PURPOSE: A Positron Emission Tomography/Computed Tomography quality assurance program is necessary to ensure that patients receive optimal imaging and care. We summarize the AAPM Task Group (TG) 126 report on acceptance and quality assurance (QA) testing of PET/CT systems. METHODS: TG 126 was charged with developing PET/CT acceptance testing and QA procedures. The TG aimed to develop procedures that would allow for standardized evaluation of existing short-axis cylindrical-bore PET/CT systems in the spirit of NEMA NU 2 standards without requiring specialized phantoms or proprietary software tools. RESULTS: We outline eight performance evaluations using common phantoms and freely available software whereby the clinical physicist monitors each PET/CT system by comparing periodic Follow-Up Measurements to Baseline Measurements acquired during acceptance testing. For each of the eight evaluations, we also summarize the expected testing time and materials necessary and the recommended pass/fail criteria. CONCLUSION: Our report provides a guideline for periodic evaluations of most clinical PET/CT systems that simplifies procedures and requirements outlined by other agencies and will facilitate performance comparisons across vendors, models, and institutions.

Sensory Profile of Rice-Based Snack (Nuroongji) Prepared from Rice with Different Levels of Milling Degree.

Nuroongji is a traditional rice-based snack that is widely consumed in Korea, but there is no reported comprehensive sensory characterization of this popular snack. The objective of this study was to conduct a sensory analysis of Nuroongji made with rice with different degrees of milling. Four different types of Nuroongji samples according to the degree of milling were prepared in the lab and subjected to physiochemical analysis. Descriptive sensory analysis was conducted by a trained panel (n = 8), and a consumer acceptance test was conducted using college students (n = 70). A sensory lexicon describing the flavor and texture characteristics of Nuroongji was developed: it included roasted brown rice, burnt, buckwheat, rice powder, glutinous rice power, and floral. The following texture attributes were evaluated in triplicate: hardness of particles, irregularity of particles, degree of coagulation, number of chews, and residual mouthfeel. Significant differences in flavor and mouthfeel attributes were observed between the Nuroongji samples according to the degree of milling (p < 0.05). Nuroongji made with white rice (N1) had a higher hardness value and less sweetness compared to other samples (p < 0.05). Texture- and mouthfeel-related attributes such as cohesiveness of the mass, irregularity of the surface, and astringency were identified as important characteristics that drive consumer acceptance of Nuroongji products. Findings from this study can provide Nuroongji product developers a valuable insight to extend their market by reformulating the product to be appealing to young consumers.

Beam modeling and beam model commissioning for Monte Carlo dose calculation-based radiation therapy treatment planning: Report of AAPM Task Group 157.

Dose calculation plays an important role in the accuracy of radiotherapy treatment planning and beam delivery. The Monte Carlo (MC) method is capable of achieving the highest accuracy in radiotherapy dose calculation and has been implemented in many commercial systems for radiotherapy treatment planning. The objective of this task group was to assist clinical physicists with the potentially complex task of acceptance testing and commissioning MC-based treatment planning systems (TPS) for photon and electron beam dose calculations. This report provides an overview on the general approach of clinical implementation and testing of MC-based TPS with a specific focus on models of clinical photon and electron beams. Different types of beam models are described including those that utilize MC simulation of the treatment head and those that rely on analytical methods and measurements. The trade-off between accuracy and efficiency in the various source-modeling approaches is discussed together with guidelines for acceptance testing of MC-based TPS from the clinical standpoint. Specific recommendations are given on methods and practical procedures to commission clinical beam models for MC-based TPS.

Performance evaluation of computed tomography systems: Summary of AAPM Task Group 233.

BACKGROUND: The rapid development and complexity of new x-ray computed tomography (CT) technologies and the need for evidence-based optimization of image quality with respect to radiation and contrast media dose call for an updated approach towards CT performance evaluation. AIMS: This report offers updated testing guidelines for testing CT systems with an enhanced focus on the operational performance including iterative reconstructions and automatic exposure control (AEC) techniques. MATERIALS AND METHODS: The report was developed based on a comprehensive review of best methods and practices in the scientific literature. The detailed methods include the assessment of 1) CT noise (magnitude, texture, nonuniformity, inhomogeneity), 2) resolution (task transfer function under varying conditions and its scalar reflections), 3) task-based performance (detectability, estimability), and 4) AEC performance (spatial, noise, and mA concordance of attenuation and exposure modulation). The methods include varying reconstruction and tube current modulation conditions, standardized testing protocols, and standardized quantities and metrology to facilitate tracking, benchmarking, and quantitative comparisons. RESULTS: The methods, implemented in cited publications, are robust to provide a representative reflection of CT system performance as used operationally in a clinical facility. The methods include recommendations for phantoms and phantom image analysis. DISCUSSION: In line with the current professional trajectory of the field toward quantitation and operational engagement, the stated methods offer quantitation that is more predictive of clinical performance than specification-based approaches. They can pave the way to approach performance testing of new CT systems not only in terms of acceptance testing (i.e., verifying a device meets predefined specifications), but also system commissioning (i.e., determining how the system can be used most effectively in clinical practice). CONCLUSION: We offer a set of common testing procedures that can be utilized towards the optimal clinical utilization of CT imaging devices, benchmarking across varying systems and times, and a basis to develop future performance-based criteria for CT imaging.

Discrimination of sensory attributes by trained assessors and consumers in semi-sweet hard dough biscuits and their drivers of liking and disliking.

Descriptive methods are traditionally performed with trained assessors to objectively analyze products, since consumers have long been considered incapable of performing such tests because they are influenced by hedonic evaluations. However, in the last decades, there have been alternative descriptive tests performed by consumers, due to other advantages, such as a rapid sensory profile assessment, reducing cost and time, and Check-all-that-apply (CATA) is an example. Thus, the objective of this work was to compare the performance of trained assessors (n = 15) and consumers using quantitative descriptive analysis (QDA) - traditional method and CATA - alternative method (n = 161 consumers, including acceptance test as well), for 5 samples of semi-sweet hard dough biscuit with different contents of specific ingredients: fructose (0.0 to 6.0%), vanilla aroma (0.0 to 1.2%) and water (9.0 to 13.8%). Results showed that the number of attributes in which trained assessors perceived significant differences was marginally higher (p < .1) than consumers. For smaller formulation differences, trained assessors perceived more (p < .01) attributes presenting significant differences (10) than consumers (2). The sample discrimination presented the same pattern, however trained assessors had greater discriminative power than consumers, i.e., they discriminated samples in more difference levels. The description of the samples was not similar between the methods. The QDA and CATA assessors used different attributes to describe the samples, which reflected in different drivers of liking and disliking if descriptive data come from trained assessors or from consumers. It is concluded that the choice of performing descriptive tests with trained assessors or consumers depends on the purpose of the study.

Summary of the AAPM task group 248 report: Interoperability assessment for the commissioning of medical imaging acquisition systems.

PURPOSE: We summarize the AAPM TG248 Task Group report on interoperability assessment for the commissioning of medical imaging acquisition systems in order to bring needed attention to the value and role of quality assurance testing throughout the imaging chain. METHODS: To guide the clinical physicist involved in commissioning of imaging systems, we describe a framework and tools for incorporating interoperability assessment into imaging equipment commissioning. RESULTS: While equipment commissioning may coincide with equipment acceptance testing, its scope may extend beyond validation of product or purchase specifications. Equipment commissioning is meant to provide assurance that a system is ready for clinical use, and system interoperability plays an essential role in the clinical use of an imaging system. CONCLUSION: The functionality of a diagnostic imaging system extends beyond the acquisition console and depends on interoperability with a host of other systems such as the Radiology Information System, a Picture Archive and Communication System, post-processing software, treatment planning software, and clinical viewers.

Using immersive technologies to explore the effects of congruent and incongruent contextual cues on context recall, product evaluation time, and preference and liking during consumer hedonic testing.

To explore how contextual information streams are processed and prioritized during consumer studies, we manipulated the congruency of visual, auditory and olfactory cues using immersive technologies and assessed the impact on context recall, evaluation time, and preference and liking for cold brewed coffee. Each consumer (n = 50) was exposed to two identical control conditions, a visually incongruent condition, an auditory incongruent condition, an olfactory incongruent condition, and an all-incongruent condition. The control condition simulated a coffeehouse environment complete with the sights, sounds and smells commonly experienced in that venue. A laboratory setting, construction noise, and laundry detergent represented the individual incongruent visual, auditory, and aroma streams, respectively. Results revealed that olfactory information had a lesser priority than visual or auditory information in the simulated environments when assessed by subject's ability to recall encountered information streams. Panelists also spent more time evaluating coffees in the first presented control condition compared to the incongruent conditions or the repeated control condition. Finally, although the averaged combined liking score for subjects' least to most preferred coffees was significantly lowered in the all-incongruent condition compared to the control condition, this decrease was not substantial. Understanding how the saliency of contextual information influences consumer behavior and attention can inform immersive testing methodologies.

Application of TG-100 risk analysis methods to the acceptance testing and commissioning process of a Halcyon linear accelerator.

PURPOSE: A new type of linear accelerator (linac) was recently introduced into the market by a major manufacturer. Our institution is one of the early users of this preassembled and preconfigured dual-layer multileaf collimator (MLC), ring-gantry linac - Halcyon™ (1st version). We performed a set of full acceptance testing and commissioning (ATC) measurements for three Halcyon machines and compared the measured data with the standard beam model provided by the manufacturer. The ATC measurements were performed following the guidelines given in different AAPM protocols as well as guidelines provided by the manufacturer. The purpose of the present work was to perform a risk assessment of the ATC process for this new type of linac and investigate whether the results obtained from this analysis could potentially be used as a guideline for improving the design features of this type of linac. METHODS: AAPM's TG100 risk assessment methodology was applied to the ATC process. The acceptance testing process relied heavily on the use of a manufacturer-supplied phantom and the automated analysis of electronic portal imaging device (EPID) images. For the commissioning process, a conventional measurement setup and process (e.g., use of water tank for scanning) was largely used. ATC was performed using guidelines recommended in various AAPM protocols (e.g., TG-106, TG-51) as well as guidelines provided by the manufacturer. Six medical physicists were involved in this study. Process maps, process steps, and failure modes (FMs) were generated for the ATC procedures. Failure modes and effects analysis (FMEA) were performed following the guidelines given in AAPM TG-100 protocol. The top 5 and top 10 highest-ranked FMs were identified for the acceptance and commissioning procedures, respectively. Quality control measures were suggested to mitigate these FMs. RESULTS: A total of 38 steps and 88 FMs were identified for the entire ATC process. Fourteen steps and 34 FMs arose from acceptance testing. The top 5 FMs that were identified could potentially be mitigated by the manufacturer. For commissioning, a total of 24 steps and 54 potential FMs were identified. The use of separate measurement tools that are not machine-integrated has been identified as a cause for the higher number of steps and FMs generated from the conventional ATC approach. More than half of the quality control measures recommended for both acceptance and commissioning could potentially be incorporated by the manufacturer in the design of the Halcyon machine. CONCLUSION: This paper presents the results of FMEA and quality control measures to mitigate the FMs for the ATC process for Halcyon machine. Unique FMs that result from the differences in the ATC guidelines provided by the vendor and current conventional protocols, and the challenges of performing the ATC due to the new linac features and ring-gantry design were highlighted for the first time. The FMs identified in the present work along with the suggested quality control measures, could potentially be used to improve the design features of future ring-gantry type of linacs that are likely to be preassembled, preconfigured, and heavily reliant on automation and image guidance.

Survey of the prevalence and methodology of quality assurance for B-mode ultrasound image quality among veterinary sonographers.

Image quality in B-mode ultrasound is important as it reflects the diagnostic accuracy and diagnostic information provided during clinical scanning. Quality assurance programs for B-mode ultrasound systems/components are comprised of initial quality acceptance testing and subsequent regularly scheduled quality control testing. The importance of quality assurance programs for B-mode ultrasound image quality using ultrasound phantoms is well documented in the human medical and medical physics literature. The purpose of this prospective, cross-sectional, survey study was to determine the prevalence and methodology of quality acceptance testing and quality control testing of image quality for ultrasound system/components among veterinary sonographers. An online electronic survey was sent to 1497 members of veterinary imaging organizations: the American College of Veterinary Radiology, the Veterinary Ultrasound Society, and the European Association of Veterinary Diagnostic Imaging, and a total of 167 responses were received. The results showed that the percentages of veterinary sonographers performing quality acceptance testing and quality control testing are 42% (64/151; 95% confidence interval 34-52%) and 26% (40/156: 95% confidence interval 19-33%) respectively. Of the respondents who claimed to have quality acceptance testing or quality control testing of image quality in place for their ultrasound system/components, 0% have performed quality acceptance testing or quality control testing correctly (quality acceptance testing 95% confidence interval: 0-6%, quality control testing 95% confidence interval: 0-11%). Further education and guidelines are recommended for veterinary sonographers in the area of quality acceptance testing and quality control testing for B-mode ultrasound equipment/components.