Ordering the RPS Technical QA Program

 

What Is Included?

 

Purchase of the Technical QA Program includes all items listed below under Basic Services.  A basic, paper-based version of the RPS medical error reduction program is included in the Basic Services.  Upgrading to MERP software is available at a reduced price.  Contract RPS for additional information about upgrading or purchasing MERP separately.

 

Basic Services

I.    Policies and Procedures (requirement of NRC, State, JCAHO, and ACR)

A.    Provide and implement an in-depth facility policies and procedures manual entitled “Technical Quality Assurance, Radiation Safety, and Quality Management Program” for technical staff/physicians.

B.    Provide and implement a facility policies and procedures manual entitled “Radiation Safety Program” for non-technical staff.

 

II.   Quality Management Program (requirement of some States)

A.    Establish and implement an accelerator based quality management program for meeting the regulatory requirements of Agreement States [1].

B.    Provide policies and procedures (included in Item I.).

 

III.  QA, QC, and Miscellaneous Forms (requirement of State, JCAHO, and ACR)

A.    Provide custom QA and QC forms for recording the performance of daily, weekly, and monthly, bi-annual, and annual equipment and machine tests, and clinical aspects:

1.     Linear Accelerator

2.     CT/Conventional Simulator

3.     Block Cutting Machine

4.     Film Processor

5.     Film Cassettes

6.     Barometer/Thermometer

7.     Chart Checks

8.     Quality Checklist (Chart)

B.    Provide custom radiation safety forms for checking/recording of required documentation:

1.     Declared Pregnant Woman

2.     Accelerator Door Interlock Bypass Approval

3.     Area Monitor Calibration

4.     Facility RSO/Physicist Requirements Checklist

 

IV.  Medical Error-Reduction Program (requirement of NRC, State, JCAHO, and ACR)

A.   Establish and implement the paper-based error reduction system for identifying, correcting, and tracking medical and regulatory errors (unintended deviations) in the following areas:

1.     Quality Assurance

2.     Radiation Safety

3.     Quality Management Program

4.     Regulatory

5.     Patient Treatment Process

B.    For paper-based system, provide forms and training for identifying, codifying, categorizing (based on safety and regulatory significance), recording, and correcting Unintended Deviations:

1.     Pre-Treatment Unintended Deviations Matrix

2.     Post-Treatment Unintended Deviations Matrix

3.     Significant Unintended Deviations Form (Level II or >)

4.     Pre-Treatment Quarterly Unintended Deviation Summary Form

5.     Post-Treatment Quarterly Unintended Deviation Summary Form

 

V.   QA/Compliance Record-Keeping System (requirement of NRC, State, JCAHO, and ACR)

A.    Establish record-keeping system and provide training for maintaining documents required for inspection/review by state and NRC regulations, and JCAHO/ACR standards.

B.    Provide each center with a set of 27 labeled notebooks with subdividers and master outline.

 

VI.  Training (requirement of NRC, State, JCAHO, and ACR)

A.    Provide ASRT approved training (14 hours of Category "A" CE) as described in Items I. - V. (excluding MERP software), including applicable state regulations:

1.     Initial classroom training (technical staff/physicians) - 7.0 hours

2.     Initial classroom training (non-technical staff) in radiation safety - 1.0 hour

3.     Hands-on workshops

a)     QA of Accelerator, CT/Conventional Simulator, Block Cutter and Film Processor - 4.5 Hours

b)     Record and Verify System in Radiotherapy (if installed) - 1.5 Hours

c)     CT/Conventional Simulation Process - 1.0 Hours

 

VII. Reasonable E-Mails and Phone Consultation [2]

 

Ordering Optional Services

What Is Included?

 

Individual modules can be purchased as part of the RPS QA Technical Program or separately.  Services can be tailored to the your specific institutions needs.

 I.    Optional modules [3]:

        A.     Dose Calculation Protocol:

                    1.    Photons: Isocentric (SAD)

                    2.    Photons: SSD Setup

                    3.    Electrons: Hand Calculation

                    4.    Protons and Electrons: Dose Change - Prescription

                    5.    Photons: Dose Change - SSD

                    6.    Photons: Gap Calculation

                    7.    Electrons: Cutout Measurements

                    8.    Photons and Electrons: Cord Dose Summary

                    9.    Photons and Electrons: Mantle Point Dose Summary

                   10.    Photons and Electrons: Diode Point Measurement Dosimetry

                   11.    Miscellaneous Forms for Clinical Processes:

                               (1)  Simulation Record

                               (2)  Mantle Simulation Worksheet

                               (3)  Dosimetry and Block Room Sign-In Sheets

                               (4)  Physics Check Fax Transmittal

        B.    IMRT QA Protocol

                    1.    Picket Fence Film QA

                    2.    Test Pattern Film QA

                    3.    Long-Term Stability of DMLC Output

                    4.    Stability of DMLC Output vs Gantry/Collimator Angles

        C.    Patient Chart Protocol

        D.    Diode Acceptance/Commissioning Protocol

        E.    Annual Calibration of Accelerator Protocol

                    1.    Tests follow AAPM TG-40 recommendations

                    2.    Tests follow AAPM Report No. 13

        F.     Acceptance/Commissioning of 3-D Treatment Planning Computer Protocol (Under Development)

        Note: Future Modules Under Development

 

II.   Feedback System (recommendation of JCAHO)

A.    Provide ongoing, unlimited feedback system (via e-mail or fax ) between RadPhysics Services LLC and the client radiation oncology center(s) for 12 months [4].  This system is comprised of written evaluations and recommendations from RadPhysics Services LLC for corrective actions of all Severity Level I - II errors/violations self-identified at each center.
B.    Provide Quarterly Medical Error Reduction Report on a quarterly frequency [5]:
1.     Detect tangible and measurable improvements in patient safety
2.     Identify violations of state and federal requirements, and ACR standards
3.     Analyze patterns and trends of errors and unintended deviations that occur at the radiation oncology center(s) with recommended corrective actions.

III.  Error Reduction/Compliance Audits (requirement of NRC, State, and JCAHO) [6]

A.    Perform quarterly and annual audits to identify deficiencies of internal policies and procedures, ACR standards, violations of state and NRC requirements, and systems-related medical errors.
1.     Deficiencies and/or violations will be documented, evaluated, and corrective actions suggested.
2.     Provide a report summarizing the results of the audit with recommendations.

 

IV.  Dosimetry (requirement of NRC and State) [7]

A.    Assist in establishing dosimetry system and services for monitoring of external radiation exposure (i.e., film badges, badge boards, controls).
B.    Review results of monthly badge readings on a quarterly frequency (as part of quarterly audits).

 

V.  RS and QI Committee Meetings (requirement of NRC, State, JCAHO, and ACR)

A.    If possible (when coordinated with quarterly audits), attend RS (Radiation Safety) and QI (Quality Improvement) Committee meetings on a quarterly frequency.
B.    Provide assistance and direction in committee discussions or, if unable to attend, review committee minutes with written feedback (via e-mail or fax).

VI.   Registration/License (requirement of State) [8]

A.    Prepare facility registration/licensing documents and procedures to the State or NRC for approval and issuance of new facility registration(s)/license(s):

1.     Linear Accelerator

2.     CT/Conventional Simulator

3.     Film Processor/Dark Room (if required)

4.     Radioactive Materials

B.    Provide facility applications for registration/licensure when periodically renewed by the State or NRC.
C.    Prepare amendments to the facility registration/license as deemed necessary under State and NRC regulations.

 

VII.     Annual, Radiation Safety Refresher Training (requirement of NRC, State, JCAHO, and ACR)

          A.   Technical staff/physicians - 2.0 hours

          B.    Non-Technical staff - 0.5 hours

 

VIII.  Emergencies (requirement of NRC and State) [9]

A.    Provide emergency response to radiation incidents, such as patient misadministrations or employee overexposures.
B.    Provide an investigation, analysis, and written report of such radiation incidents.
C.    Provide technical consultation regarding any state/federal escalated enforcement action.
D.    Prepare and submit all required documentation of the incident as required by state/federal regulations.
 

 

[1] The Nuclear Regulatory Commission (NRC) oversees the radiation control programs for all Agreement States.  Each Agreement State is required to adopt applicable NRC regulations for use at the state level.  Currently most Agreement States require facilities to establish a quality management program (QMP) for radioactive materials used for therapeutic applications (e.g., brachytherapy).  Some states (i.e., North Carolina, Mississippi, Ohio, etc.) currently require facilities to establish a QMP for the use of therapeutic radiation produced by machines.  Other states (i.e., Kentucky) are in the process of establishing such a requirement.

[2] A reasonable number of e-mails or phone calls is included free for the first year.

[3], [4], [5], [6], [7] When purchased in addition to the RPS Technical QA Program, discounts are provided (contact RPS for pricing).

[8], [9] Charges for these services are based on either a set project fee or hourly rate (contact RPS for pricing).