• Quality Improvement in Health Care
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• v.6 no.1_2
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• pp.136-149
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• 1999

Background : Although a number of studies are related to QA improvement, there are few studies applied various method of QA tools. This study reviewed the availability of general quality assurance(QA) tools according to ten steps in performing quality improvement activities at emergency room of a tertiary teaching hospital which has more than 1,000 beds. Methods : All patients in emergency room from 15th Oct. 1997 to 5th Sep. 1998 were surveyed. The survey data based on the patient's records of emergency room were evaluated according to length of stay, and we tried to identify problems with management of emergency room. To solve the problems, our team applied general QA tools(brainstorming, flow chart, nominal group technique, benchmarking, cause-and-effect diagram, run chart, control chart) to quality improvement activities and discussed the availability of the tools. Results : After the activities such as changes of staffing, the establishment of local area network and chest pain clinic, application of triage and so on, the percentage of patient who had stayed more than six hours was reduced from 56.0% to 46.8%. The mean number of patients per day in emergency room was increased from 49 to 62. But the reporting time for laboratory test was not changed after these activities. Conclusion : Each QA tool has unique benefit and limitation, but we can implement and evaluate the quality improvement activities more scientifically and systematically by applying these tools to practice according to QA ten steps.

• Journal of the Korea Safety Management & Science
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• v.17 no.1
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• pp.119-124
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• 2015

According as radiation therapy technique develops, standardization of radiation therapy has been complicated by the plan QA(Quality Assurance). However, plan QA tools are two type, OADT (opposite accumulation dose tool) and 3DADT (3 dimensional accumulation dose tool). OADT is not applied to evaluation of beam path. Therefore tolerance error of beam path will establish measurement value at OADT. Plan is six beam path, five irradiation field at each beam path. And beam path error is 0 degree, 0.2 degree, 0.4 degree, 0.6 degree, 0.6 degree, 0.8 degree. Plan QA accomplishes at OADT, 3DADT. The more path error increases, the more plan QA error increases. Tolerance error of OADT path is 0.357 using tolerance error of conventional plan QA. Henceforth plan QA using OADT will include beam path error. In addition, It will increase reliability through precise and various plan technique.

• Journal of the Korean Society of Radiology
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• v.16 no.5
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• pp.513-518
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• 2022

Electron beam quality assurance (QA) should be done regularly for accurate radiation therapy. However, QA tools used in clinical practice are designed mainly for X-rays. So, a dosimeter for electron beam QA is required. Therefore, in this study, the electron beam detection performance was measured by using a thorium bromide material as an electron beam sensor. In addition, it was evaluated whether it could be applied with an electron beam QA dosimeter. Reproducibility, linearity, and dose rate dependence were evaluated at 6 MeV and 9 MeV energies. As a result of reproducibility, it showed a maximum output change of 0.92% at 6 MeV and 1.15% at 9 MeV. The linearity result evaluation and determination coefficient were presented as 0.9998. As a result of dose rate dependence evaluation, relative standard deviation 0.51% at 6 MeV and relative standard deviation 1.07% at 9 MeV were presented. The manufactured TlBr sensor shows the ability to detect radiation that meets the criteria for evaluation of reproducibility, linearity, and dose rate dependence. These results mean that the TlBr dosimeter is applicable as an electron beam QA dosimeter.

• The Journal of Korean Society for Radiation Therapy
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• v.29 no.2
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• pp.65-73
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• 2017

Purpose: Machine Performance Check (MPC) is a self-checking software based on the Electronic Portal Imaging Device (EPID) to measure daily beam outputs without external installation. The purpose of this study is to verify the usefulness of MPC by comparing and correlating daily beam output of QA Beamchecker PLUS. Materials and Methods: Linear accelerator (Truebeam 2.5) was used to measure 10 energies which are composed of photon beams(6, 10, 15 MV and 6, 10 MV-FFF) and electron beams(6, 9, 12, 16 and 20 MeV). A total of 80 cycles of data was obtained by measuring beam output measurement before treatment over five months period. The Pearson correlation coefficient was used to evaluate the consistency of the beam output between the MPC and the QA Beamchecker PLUS. In this study, if the Pearson correlation coefficient is; (1) 0.8 or higher, the correlation is very strong (2) between 0.6 and 0.79, the correlation is strong (3) between 0.4 and 0.59, the correlation is moderate (4) between 0.2 and 0.39, the correlation is weak (5) lower than 0.2, the correlation is very weak. Results: Output variations observed between MPC and QA Beamchecker PLUS were within 2 % for photons and electrons. The beam outputs variations of MPC were $0.29{\pm}0.26%$ and $0.30{\pm}0.26%$ for photon and electron beams, respectively. QA Beamchecker PLUS beam outputs were $0.31{\pm}0.24%$ and $0.33{\pm}0.24%$ for photon and electron beams, respectively. The Pearson correlation coefficient between MPC and QA Beamchecker PLUS indicated that photon beams were very strong at 15 MV, and strong at 6 MV, 10 MV, 6 MV-FFF and 10 MV-FFF. For electron beams, the Pearson correlation coefficient were strong at 16 MeV and 20 MeV, moderate at 9 MeV and 12 MeV, and very weak at 6 MeV. Conclusion: MPC showed significantly strong correlation with QA Beamchecker PLUS when testing with photon beams and high-energy electron beams in the evaluation of daily beam output, but the correlation when testing with low-energy electron beams (6 MeV) appeared to be low. However, MPC and QA Beamchecker PLUS are considered to be suitable for checking daily beam output, as they performed within 2 % of beam output consistency during the observation. MPC which can perform faster than the conventional daily beam output measurement tool, is considered to be an effective method for users.

• Journal of radiological science and technology
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• v.38 no.1
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• pp.7-15
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• 2015

A ultrasonic probe is very important in medical ultrasonic image, but the frequency of probe defects are often. Therefore practical tools for probe based ultrasonic QA should be developed. Advanced research on the effects of the probe defects on the quality of ultrasonic images is required. This study has investigated the effects of the defects in the probe elements influence Doppler images in the medical ultrasonic scanners. Especially the defects in a set of adjacent elements(SAE) electrically disconnected influence Doppler images were tested. The results show Doppler brightness and velocity became rapidly reduced as the defected elements is located centrally, as the defected elements is activated. The more the defected elements increased, the more Doppler brightness and velocity increased. As a set of the element disconnected moved, it appeared Doppler velocity starting to decrease and then was followed by brightness. The strength is not consistent with the velocity in the number and location of the defected elements. The defects in the probe elements influence Doppler velocity when the defected elements got out of the elements activated at Doppler mode.

• The Journal of Korean Society for Radiation Therapy
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• v.11 no.1
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• pp.16-21
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• 1999

Purpose : The aim of this study is to conform the possibility of the liquid type EPID as a QC tools to clinical indication and of replacement of the film dosimetry. Aditional aim is to describe a procedure for the use of a EPID as a physics calibration tool in the measurements of radiation beam parameters which are typically carried out with film. Method & Materials : In this study we used the Clinac 2100c/d with EPID. This system contains 65536 liquid-filled ion chambers arranged in a $256{\times}256$ matrix and the imaging area is $32.5{\times}32.5cm$ with liquid layer thickness of 1mm. The EPID was tested for different field sizes under typical clinical conditions and pixel values were calibrated against dose by producing images using various thickness of lead attenuators(lead step wedge) using 6 & 10MV x-ray. We placed various thickness of lead on the table of linear accelerator and set the portal vision an SDD of 100cm. To acquire portal image we change the field size and energy, and we recorded the average pixel value in a $3{\times}3$ pixel region of interest(ROI) at field center was recorded. The pixel values were also measured for different field sizes in order to evaluate the dependence of pixel value on x-ray energy spectrum and various scatter components. Result : The EPID, as a whole, was useful as a QA tool and dosimetry device. In mechanical check, cross-hair centering was well matched and the error was less than ?2mm and light/radiation field coincidence was less than 1mm also. In portal dosimetry the wider the field size the the higher the pixel value and as the lead thickness increase, the pixel value was exponentially decreased. Conclusions : The EPID was very suitable for QA tools and it can be used to measure exit dose during patients treatment with reasonable accuracy. But when indicate the EPID to clincal study deep consideration required

• Journal of KIISE:Computing Practices and Letters
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• v.16 no.5
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• pp.581-585
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• 2010

As developers and testers today we all suffer from increasing project complexity, the risks of late defect discovery, repetitive manual processes, and the risk of release delays. In this paper, we introduce an effective framework for automated testing to help solve such problems. Those that are new to testing do not need to delve into complex automation tools or test scripts. This framework helps automate the distribution, execution and results analysis of test cases. It also aids communication among the various stakeholders, using tables for representing tests and for reporting the results of automatically checking those tests. This paper describes the practices and benefits of using the proposed framework.

• Progress in Medical Physics
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• v.15 no.2
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• pp.63-69
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• 2004

HDR brachytherapy administers a large dose of radiation in a short time compare with LDR, and its optimization for treatment is related to several complex factors, such as physical, radiation and optimization algorithms, so there is a need for these to be verified for accurate dose delivery. In our approach, a previous study concerning the phantom for dose verification has been modified, and a new pelvic phantom fabricated for the purpose of localization, including a structure enabling the use of a CT or MRI system. In addition, a comparison study was performed to verify an orthogonal method that is commonly used for brachytherapy localization by comparing target coordinates from a CT system. Since the developed phantom was designed to simulate the clinical setups of cervix cancer, it included an air-filled bladder and a rectum structure shaped sphere and cylinder An N-shaped localizer was used to obtain precision coordinates from both CT and films. Moreover, the IDL 5.5 software program for Windows was used to perform coordinates analysis based on an orthogonal algorithm. The film results showed differences within 1.0 mm of the selected target points compare with the CT coordinates. For these results, a Plato planning system (Nucletron, Netherlands) could be independently verified using this phantom and software. Furthermore, the new phantom and software will be efficient and powerful qualify assurance (QA) tools in the field of brachytherapy QA.

• Quality Improvement in Health Care
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• v.4 no.2
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• pp.260-278
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• 1997

Background : Quality of professional nursing care is the most essential factor for survival and growth of nursing profession. Then, nursing professionals have responsibility for the evaluation of quality of professional nursing care. The purpose of this study was to develope an evaluation tool of nursing care for patients received gastrointestinal surgery with general anesthesia. This study was a primary work for the developement of a computer program for the evaluation of nursing care. Methods : This study was done through some consecutive steps. They were (1) Developement of items for the tool (2) Developement of an evaluation tool of nursing care quality for the G-I surgery patient (3) Test of reliability and validity of the tool. Two groups of experts and expert pannels who had much experience of the QA and the care of G-I surgery patients participated for developement of the items. 85 nursing records were used for the test of reliability and validity of the developed tool. The evaluation tools were developed with two types of scoring, norm-referenced tool and criterion-referenced tool. Results The system of items for tool was evaluation area evaluation item-indicator. There were 7evaluation areas which contained 32evaluation items which contained 7lindicators. Evaluation areas 1, 2, 3, 4 were for the evaluation of process and 5, 6, 7 were for the evaluation of outcome of nursing care for G-I surgery patient. For the test of interrator reliability, correlation coefficients of each scores of items and intragroup correlation coefficients were calculated. The average correlation coefficients between two rators were 0.65, 0.54 and the intragroup correlation coefficient were 0.99 and 1.00 by the types of scoring. The Cronbach alpha coefficients of the tools were 0.54 and 0.46 by the types of scoring. The average content validity index of the items was 0.95 from 4 pairs of experts. Because there were significant differences between some scores of quality of nursing care of 3 general hospitals regardless of the types of scoring, the tools could be thought to have some construct validity. And also, there were significant correlations between some scores of quality of nursing care and admission days and admission days after surgery regardless of the types of scoring, the tools could be thought to have predictive validity. Conclusion In this study, the evaluation tool of nursing care was developed for the very specified group of patient, G-I surgery patient. And the items were developed and tested by the experts of nursing practice. Because of these reasons, it was supposed that the tool could be used effectively in nursing pratice. And the procedures for the development and the test of the evaluation tool of nursing care in this study were supposed to be used for the developement of other tools.

• Radiation Oncology Journal
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• v.18 no.4
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• pp.337-344
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• 2000

Purpose :To design and test test CT simulator phantom for geometrical test. Materials and Methods : The PMMA phantom was designed as a cylinder which is 20 cm in diameter and 24 cm in length, along with a 25$\times25\times31cm^{3}$ rectangular parallelepiped. Radio-opaque wires of which diameter is 0.8 mm are attached on the other surface of the phantom as a spiral. The rectangular phantom was made of four 24$\times24\times0.5 cm^{3}$ square plates and each plate had a 24$\times24 cm^{2}$, 12$\times12cm^{2}$, 6$\times6 cm$^{2}$ square line. The squares were placed to face the cylinder at angles 0 $^{\circ}$ , 15 $^{\circ}$ , 30 $^{\circ}$ ,respectively. The rectangular phantom made it possible to measure the field size, couch angle, the collimator angle, the isocenter shift and the SSD, the measurements of the gantry angle from the cylindrical part. A virtual simulation software, AcOSim, offered various conditions to perform virtual simulations and these results were used to perform the geometrical Quality assurance of CT simulator. Results : A 0.3$\~$0.5 mm difference was found on the 24 cm field size which was created with the DRR measurements obtained by scanning of the rectangular phantom. The isocenter shift, the collimator rotation, the couch rotation, and the gantry rotation test showed 0.5$\~$1 mm, 0.5$\~$l$^{\circ}$ 0.5$\~$ 1$^{\circ}$ , and 0.5-1 $^{\circ}$ differences, respectively. We could not find any significant differences between the results from the two scanning methods. Conclusion :The geometrical test phantom developed in the study showed less than 1 mm (or 1 $^{\circ}$ ) differences. The phantom could be used as a routine geometrical QC/QA tools, since the differences are within clinically acceptable ranges.