Ch 19 Quality Improvement in Rad Onc

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RadTherapy
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206840
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Ch 19 Quality Improvement in Rad Onc
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2013-03-12 22:09:14
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pages 363-375
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  1. "An approach to the continuous study and improvement of the processes of health services to meet the needs of patients and others
    • QI
    • Quality Improvement
  2. Synonyms for QI
    • CQI....continuous quality improvement
    • TQM...total quality management
  3. a non profit organization dedicated to improving the quality of care in health care settings
    • TJC  the Joint Commission Office
    • formerly JCAHO
    • Joint Commission on the Accreditation of Healthcare Organization
  4. Focuses on performance measurement
    -based on the comparison of processes with outcomes to quality indicators, the measurable dimension of quality that defines what is to be monitored
    Quality assurance (aka quality assessment, quality improvement by the TJC)
  5. stresses the control and assessment of performance, providing standards of measurement
    quality control
  6. Involves the systematic collection of and review of quality assurance data
    quality assessment
  7. integrates quality assurance, quality control and assessment into a complex system wide improvement program revolving around the healthcare organization's mission and goals
    CQI Plan
  8. eliminates duplication of quality assurance and and quality improvement efforts but still provides assurance that services are of high quality
    CQI Plan
  9. QI in rad onc, involves ongoing activities encompassing administrative, clinical, physical and technical aspects of processes in rad one
    ACR American College of Radiology and the AAPM  American Association of Physicists in Medicine
  10. What is an integral part of the QI plan in the ACR AND AAPM?
    a peer review and audit mechanism
  11. Responsible for oversight of patient care, established in 1917
    American College of Surgeons  (ACS)
  12. Established Hospital Standardization Program which developed the concept of "minimum standards" in 1919
    ACS
  13. The Joint Commission on Accreditation of Hospitals  (JCOAH)was formed through the efforts of what 5 establishments?
    • ACP American College of Physicians
    • ACS  American College of Surgeons
    • AHA  American Hospital Association
    • AMA  American Medical Association
    • CMA  Canadian Medical Association
  14. Which Commission , was created in 1974
    "to ensure adequate protection oof the public health and safety, the common defense and security, and the environment in the use of radioactive materials in the US."
    Nuclear Regulatory Commission
  15. Commission which managed nations atomic energy program 1954-1974
    Atomic Energy Commission
  16. What did the Atomic Energy commission divide into in 1974
    Energy Research and Development and the National Regulatory Commission.
  17. What is the NRC's scope of responsibility?
    • -regulation of commercial nuclear power reactors 
    • -nonpower research, test, and training reactors
    • -fuel cycle facilities
    • -medical, academic and industrial uses of nuclear materials
    • -transport, storage, and disposal of materials and waste
  18. Use of radioisotopes in brachytherapy and cobalt for external treatment falls under which Agency?
    National Regulatory Commission
  19. The federal agency, established in 1970, to assist NRC whose mission is" to protect human health and safeguard the natural environment -air,land and water- upon which life depends"
    Environmental Protection Agency EPA
  20. Involved in the regulation of the disposal, the storage, and handling of nuclear waste materials as it relates to the enviromental issues
    EPA
  21. Regulates the transportation of hazardous materials
    Department of transportation  DOT
  22. Responsible for overseeing the national safety program for transporting hazardous materials by air, rail, highway and water
    Office of Hazardous Matrials
  23. "To ensure safe and healthful working conditions for working men and women"
    -developed in 1970
    Occupational Health and Safety Act (OSHA)
  24. "to save lives and prevent injuries and protect the health of America's workers"
    -Developed in 1970
    OSHA
  25. Mid 1980's,________ mandated a policy on bloodborne pathogens stating an exposure control plan must be in place for all industries in which workers may come in contact with blood or other infectious materials
    OSHA
  26. ______ set standards fir exposure to lead and cadmium, which would apply to mold rooms in Rad Onc facilities, where Cerrobend (Lipowitz metal)
    OSHA
  27. What is Lipowitz alloy?
    Cerrobend
  28. What provides the basis for the NRC to relinquish portions of its regulatory authority to licensing and regulating;
    by-product materials (radioisotopes),
    source materials (uranium, thorium)
    certain quantities of nuclear materials
     the the individual states...
    Section 274B of the Atomic Energy Act of 1954
  29. When was the first agreement state established?
    1962
  30. How many agreement are there?
    34
  31. In the agreements, what does the NRC provide assistance for?
    • -reviewing agreement request
    • -conducting training courses and workshops
    • -evaluating technical licensing and inspection issues
  32. A professional organization for the medical physicists, a forerunner in the development of minimum standards to guide medical physicists in the development of a quality assurance program as it relates to treatment planning and delivery
    AAPM

    American Association of Physicists in Medicine
  33. Which professional association developed practice standards for radiation therapists
    ASRT

    American Society for Radiologic Technologists
  34. What are the three sections the practice standards for the ASRT
    • Clinical performance- activities related to the patient care and delivery of  procedures and treatments
    • Quality performance_-activities of practitioner in the technical areas of equipment safety and TQM (total quality management)
    • Professional Performance- defines activities in the areas of education, interpersonal relationships, personal and professional assessment and ethical behavior
  35. What is Quality as defined  in reference to Rad Onc?
    the totality of features ad characteristics if a radiation therapy process that bear on its ability to satisfy stated or implied needs of the patients
  36. "All those planned or systemic actions necessary to provide adequate confidence that a product or service will satisfy given requirements for quality"
    Quality Assurance
  37. The term used to refer to the planned or systemic actions to ensure an RT facility consistently delivers high quality care in the treatment of patients leading to the best outcomes with the least side effects
    Quality Assurance (also referred to as quality assessment, quality improvement by TJC)
  38. A review of all aspects of radiation therapy, routinely and continuously measured, results analyzed and corrective measures taken to ensure quality patient care is
    a quality audit
  39. Defined as " the operational techniques and activities used to fulfill the requirements for quality"
    Quality Control
  40. The term typically used to refer to those procedures and techniques used to monitor or test and maintain the components of RT quality improvement program
    Quality Control
  41. Who requires measurement of patient outcomes including  morbidity, mortality, recurrence of disease, and survival rates , patient satisfaction and quality of life
    TJC
  42. who provides a continuous evaluation of performance as part of the accreditation process to help healthcare organizations measure and improve their quality of care through the use of common ______   _______.
    quality indicators
  43. What is the IM System?
    Joint Commissions Indicator Measurement System
  44. What are measured as Quality Indicators?
    • morbidity
    • mortality
    • disease recurrence
    • survival rates
    • patient satisfaction
    • quality of life
  45. Because emphasis of quality is now an ongoing evaluations the program is often refferred to as
    • CQI  or TQM
    • Continuous Quality Improvement
    • TOTAL QUALITY MANAGEMENT
  46. Who is responsible for improvement quality?
    Rad Onc Team
  47. What is a pictorial representation of the steps necessary in a process
    flow chart
  48. A simplistic and easy to implement, improvement methodology, consisting of A system wide set of methods and tools for improving a process by emphasizing speed and efficiency
    The Lean Technique
  49. A process improvement method focusing on precision and accuracy, with the elimination of defects in the process
    Six Sigma
  50. What is the tolerance for QA Tolerance of Simulators?
    • Everything is +/- 2 for daily monthly or annually Except
    • GANTRY/COLLIMATOR ANGLE INDICATORS which is  1 DEGREE
  51. TOLERANCES FOR THE CT SIMULATOR
    DAILY, MONTHLY SEMI ANNUALLY AND ANNUALLY CHECKS WITHIN 2MM

    EXCEPT TABLE VERTICAL AND LONGITUDINAL MOTION WHICH IS 1MM
  52. What is the QA tolerance for gantry /collimator angle indicators?
    1 degree
  53. Which QA of Medical Accelerators tolerance is 3%
    • Dosimetry
    • Daily
    • xray and electron output constancy
    •  
    • Monthly
    • Electron Beam flatness constancy
    • xray and electron symmetry
  54. Which QA are 1 degree?
    Gantry/collimator angle indicator

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