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COURSE
SYLLABUS
1. Clinical need
Describes and illustrates the requirement for consistent performance of treatment equipment. Present clinical illustrations of the adverse effects of sub-optimal performance in terms of delivering the incorrect dose, missing the target and irradiating critical tissue in error.
2. Performance requirements and Standards IEC60976 / IEC60601
Review the origins of the British Standard in relation to IEC. Go on to describe the sections of the two documents, how they are set out, what they set out and why. To set out the published data and results which give an indication of the acceptable tolerances. Introduce the absolute accuracy which is required for dose and geometry and also the reproducibility of machine and treatment performance which is required in the context of a single fractionated regime and in the context of applying a technique throughout the life of a machine.
3. Meeting the specification: Design and Manufacture to Acceptance.
Describe how the standard and specification is seen by the manufacturer and how it is implemented into the machine design. The safety and the performance aspects and their impact on the design, construction and type testing of the accelerator will be of relevance.
4. Meeting the specification: Purchase, Acceptance and Responsibilities
Aspects of a document schedule which should relate to the standard and how evaluating its compliance should be done before purchase and installation. How deviations from the standard should be approached. Responsibilities for provision of safe and effective equipment.
5. Research, Innovation and Planning Future Developments
Present the manufacturers perspective in accommodating current standards and initiating standards to satisfy change in product design as well as new products.
6. Optical and Mechanical
To describe the optical and mechanical aspects of treatment machines which are critical to accurate and precise dose delivery. Review the methods of checking these and the associated equipment, discussing the advantages and disadvantages.
7. Radiation field
Review the aspects of the radiation field which require quality control and how they should be approached. Discuss the measurements and techniques available, the errors and differences encountered and their significance.
8. Dosimetry
Describe the aspects of machine control with respect to delivery of absolute dose. Review the aspects of machine control which relate to this e.g. arc therapy and motorised wedge control and describe the techniques and equipment which can be used to monitor them.
9. Afterloading machines/ DXR / SXR
Describe the essential requirements of mechanical and optical, radiation field and dosimetry and outline these with respect to the other machines. Illustrate with some examples and relate it also to PPM.
10. MLC, dynamic dose delivery and other advanced techniques.
The two advanced aspects of MLC and dynamic dose delivery are given a separate section. The novel difference between these devices and standard devices should be highlighted and then the methods of undertaking QC should be described. Stereo-tactic radiotherapy and radio-surgery is presented in the context of the special QC requirements which such facilities have.
11. Simulator and CT-simulation
Describe the essential requirements of mechanical and optical and radiation field alignment with respect to the treatment machines, dose prediction requirements and patient marking. Illustrate with examples and relate it to PPM.
12. Imaging verification systems
Discusses the need for portal imaging and the technologies available. The possible sources of reference images and their use in conjunction with portal imaging for quality control of treatment delivery. Quality control of portal imaging devices and the test tools required. The increasing use of multimodality imaging introduces a requirement for testing of fusion algorithms and routine quality control of the software packages used.
13. Maintaining the specification
Describe the need to schedule checks and develop techniques to rapidly obtain the information required by the standard. Give the example of an automated scheduling program which enables a user to systematically review and undertake the appropriate QC.
14. Reliability, maintenance and breakdown: The Manufacturer
Review the data available which have been used to calculate and predict the failure modes and rates on accelerators. Demonstrate how these data are considered and combined in order to calculate machine availability.
15. Planned /Practical maintenance and breakdown
Present machine problems in a Maintenance and Breakdown context. Illustrate the aspects that dictate the type of problems there are and what aspects in the service can be changed to minimise breakdowns and their effect. Describe the practical problems and logistics of implementing PPM and also the aspects which are important in minimising breakdown. Relate PPM, and Breakdown to QC.
16. Predictive Maintenance / Statistical Process Control (SPC)
Introduces Control Charts and Capability Studies, tools to monitor the performance of a machine and which together give almost complete performance information. Describes how to create and interpret them. Control Charts indicate whether a special cause of variation (non-random) becomes present and allows intervention without waiting for a tolerance to be breached. A Capability Study gives information about the mean and spread of a machine’s output, and an estimate of the proportion that will be out-of-tolerance based on the study sample. A Capability index is a single number that is generated in the study and allows the performance of different machines or processes to be compared.
17. Scheduling of Maintenance and QC
Present the clinical and financial need for extended working arrangements. Then examine the problems with expertise, staff numbers and QC to PPM scheduling in order to accommodate these machine operation needs.
18. Digital Portal Imaging and Computer Systems
Describe the essential requirements for these two aspects and how they relate to the satisfactory operation of the treatment machine. Illustrate with some examples and relate it also to PPM.
19. Quality Systems and Interdepartmental Audit
Demonstrate that the Quality System should be effective for the QC of the equipment. Discuss the basis of audit and its role in evaluating the effectiveness of the QC being used, and the overall performance of the treatment equipment.
20. Errors and tolerances in perspective
Present measurements in the context of uncertainty. Consider failure modes and their detection by measurement. Discuss detectable variations in the context of real treatment situations with examples.
21. Customer Confidence - the Radiographer
Discuss what aspects of machine maintenance and quality control provides confidence to the radiographers and how that is conveyed through communication and participation of staff and between staff. Present the radiographers perspective from delivering a radiation dose to patients, their safety concerns and concerns for effective therapy.