• The Journal of Korean Academic Society of Nursing Education
• /
• v.5 no.1
• /
• pp.133-141
• /
• 1999

Recently there are increasing concerns on quality improvement activities related to difficult economic situations, more competitive environment, health professional's emphasis on quality, and customer's needs in health care. The purpose of this study was to identify educational needs in the quality improvement for staff nurses. Study setting was an acute care hospital having more than 1000 bed in Seoul, Korea. The subjects were 40 staff nurses who participated in the first Quality Assurance(QA) inservice education. Data were collected by self-administered questionnaire which consisted of four parts : QA knowledge and attitude(ten items, by five Likert scale), contents of QA education(ten items, by setting the priority), evaluation of the program(structure, time allocation, place, educational method), and general characteristics of respondents (age, duration to work for hospitals etc.) The response rate was 85%(34/40), Most had positive perspective and attitude about QI/QA activities, but 9% had negative impression and knowledge about this activities. Also they'd like to know the plan of hospital-level QI/QA activities, QI/QA current practice, general hospital system, the role of QA specialist and so on. Consequently, for building the quality improvement activities that is customer-focused, coordinated, outcome-oriented, resource-efficient, collaborative in Korea, at first the education about philosophy, theory, and implementation process of QI/QA should be conducted, and then that on QI/QA terminology, quality indicators development, the analysis and presentation of quality-related data and so forth be followed.

• Quality Improvement in Health Care
• /
• v.3 no.1
• /
• pp.78-93
• /
• 1996

Background : The goal of this study was to establish the QA items and guidelines for preventing and improving of safety management. Therefore we investigated the nurses' recognition and knowledge of the safety and risk procedures and policies, and the agreement between the nurses beliefs on the degree of importance of those procedures and policies, with actual implementation in hospitals. Method : The subjects of this study were 201 nurses who participated in a program called continuing education for nurses, which held in December, 1993. Result: The results of this study were as follows: 1. Among 18 types of hospital risks, the items that scored highest or the need of closer attention in safety management was the needle stick, medication errors, falling, and bed sores. 2. In most questions of the 18 incidences, the nurses showed that the estimated result would have positive signs except for hospital infections, burns, and bed sores. 3. Even though the survey shows that incidences and types of occurences varies according to the person's age and the time of incident, they mostly occur between midnight to 6AM. Falls and bed sores can be seen more in the elderly. Medications errors, hospital infections and burns are frequently found between the ages of one through twenty. 4. There was a higher mean score for recognizing the importance of those items than the importance of implementing them. Conclusion : In summary, nurses did perceive the need of safety management but the hospital policy for proper safety management was not established. So we recommended that the hospital administration would undertake an early detection and proper management system for hospital precautions, based on QA items & guidelines presented in this study.

• Progress in Medical Physics
• /
• v.21 no.1
• /
• pp.99-112
• /
• 2010

In Republic of Korea, there are many Quality Assurance protocol for general radiation treatment machine such as linac. However, Quality Assurance protocol for radiosurgery treatment system is not ready perfectly. One of the radiation treatment machine for radiosurgery, novalis system needs to suitable Quality Assurance protocol for using it right way during radiation treatment and maintaining suitable accuracy for daily, weekly, monthly and annually periods. Therefore, in this article, we develop Quality Assurance protocol for novalis system. We collected and analysed domestic and foreign novalis Quality Assurance protocol. After that, we selected essential QA items and each tolerance range for developing proper QA protocol, and we made anatomical phantom for execution of selected QA items and evaluation of overall state of QA, and then, we use this measured value as a reference. Quality Assurance items are consisted of Mechanical accuracy QA part and Radiation delivery QA part. Mechanical accuracy QA part is comprised of radiation generation machine part, assistive devices part and multi-leaf collimator part. Radiation delivery QA part is divided into radiation isocenter accuracy and dosimetric evaluation. After that, developed novalis QA tables are made by using these QA items. These novalis QA tables would be used to good standard in order to maintain apt accuracy for radiosurgery in daily, weekly, monthly and annually periods.

• Progress in Medical Physics
• /
• v.13 no.3
• /
• pp.109-113
• /
• 2002

In recent years, the radiotherapy equipment has become much more sophisticated, and with the complication comes an increased set of quality assurance (QA) responsibilities. Today's computer controlled linear accelerator requiring QA of not only the radiation integrity, but also the mechanical accuracy of the linear accelerator. The existing QA sheets are adequate for acceptance testing and commissioning but those sheets are somewhat descriptive form for routine QA. establishing the QA sheets for a facility are more efficient if the sheets could estimate the long-term stability for the result of QA. We are going to develope new prototype of mechanical QA sheet to visualize and to verify long-term stability of mechanical QA for clinical linear accelerator. The items included in mechanical QA sheet were 1) gantry rotation, 2) collimator rotation, 3) couch rotation, 4) optical distance indicator (ODI), and 5) laser alignment. We compared new prototype sheet with conventional sheet for several hospitals in Korea for those items. The QA acceptance criteria in this study mainly followed published recommendations. The contents of test for mechanical QA are the following. Confirm that the digital and/or mechanical gantry angle readouts are correct. Verify that digital and/or mechanical readouts of collimator angle agree with the true angle, as determined with the protractor. Measure the light field using a graph paper and compare with the digital readouts. Confirm digital readout accuracy. Verify that the sagittal laser, the left and right lasers, and the ceiling laser intersect at the isocenter. In the design of new QA sheet, we emphasized the representation of the long-term stability of mechanical QA by using Excel program. By using the new prototype QA sheet, we simplified and visualized the mechanical QA process, and could estimate the long-term stability of mechanical error of linear accelerator.

• Proceedings of the KIEE Conference
• /
• 2002.07d
• /
• pp.2219-2221
• /
• 2002

This paper describes QA methodologies for developed TBN control system that will be applied to nuclear power plants. The details are the development of QA Manual, QA Procedures, Equipment Qualification Procedure, Commercial Grade Items Dedication, and Software Verification & Validation Plan.

• Korean Journal of Digital Imaging in Medicine
• /
• v.9 no.1
• /
• pp.53-65
• /
• 2007

PACS has been run at the Kyung Hee University Medical Center(KHMC) since 2001, and the installation and operation of PACS have contributed to automation and quantification of KHMC's medical environment During these five years our greatest concern is how to make our own guiding principle of diagnostic monitor QA which is adapted to international standards. In accordance with the terms of 'KHMC QA Guideline', 'AAPM TG18', 'SMPTE RP133', 'DICOM Part14', 'DIN V 6868-57', 'JESRA X-0093', 'JIS Z4752-2-5' and 'KCARE', concern about quality assurance of medical images are on the increase. With the investigation of acceptance testing and quality control of international standards for medical display devices, and data collection and analysis for recommended guideline, it is reported that acceptance testing(quality control), including geometrical distortion, display reflection, luminance response, luminance uniformity, display resolution, display noise, veiling glare and color chromaticity being adequate and effective to domestic hospital environments for medical display devices and assessment methods according to each performance. Accordingly, KHMC classified the checkpoint items by period, at the time of monitor setting, monthly, quarterly, half-yearly and annually. Periodic classification of checkpoint items for monitor QA makes a good guideline for image QA/QC and useful guideline for persistent good quality of monitor.

• Radiation Oncology Journal
• /
• v.20 no.1
• /
• pp.81-90
• /
• 2002

Purpose : To establish and verify the proper and the practical IMRT (Intensity--modulated radiation therapy) patient QA (Quality Assurance). Materials and Methods : An IMRT QA which consists of 3 steps and 16 items were designed and examined the validity of the program by applying to 9 patients, 12 IMRT cases of various sites. The three step OA program consists of RTP related QA, treatment information flow QA, and a treatment delivery QA procedure. The evaluation of organ constraints, the validity of the point dose, and the dose distribution are major issues in the RTP related QA procedure. The leaf sequence file generation, the evaluation of the MLC control file, the comparison of the dry run film, and the IMRT field simulate image were included in the treatment information flow procedure QA. The patient setup QA, the verification of the IMRT treatment fields to the patients, and the examination of the data in the Record & Verify system make up the treatment delivery QA procedure. Results : The point dose measurement results of 10 cases showed good agreement with the RTP calculation within $3\%$. One case showed more than a $3\%$ difference and the other case showed more than $5\%$, which was out side the tolerance level. We could not find any differences of more than 2 mm between the RTP leaf sequence and the dry run film. Film dosimetry and the dose distribution from the phantom plan showed the same tendency, but quantitative analysis was not possible because of the film dosimetry nature. No error had been found from the MLC control file and one mis-registration case was found before treatment. Conclusion : This study shows the usefulness and the necessity of the IMRT patient QA program. The whole procedure of this program should be peformed, especially by institutions that have just started to accumulate experience. But, the program is too complex and time consuming. Therefore, we propose practical and essential QA items for institutions in which the IMRT is performed as a routine procedure.

• Progress in Medical Physics
• /
• v.29 no.4
• /
• pp.123-136
• /
• 2018

The complex dose distribution and dose transfer characteristics of intensity-modulated radiotherapy increase the importance of precise beam data measurement and review in the acceptance inspection and preparation stages. In this study, we propose a process map for the introduction and installation of high-precision radiotherapy devices and present items and guidelines for risk management at the acceptance test procedure (ATP) and commissioning stages. Based on the ATP of the Varian and Elekta linear accelerators, the ATP items were checked step by step and compared with the quality assurance (QA) test items of the AAPM TG-142 described for the medical accelerator QA. Based on the commissioning procedure, dose quality control protocol, and mechanical quality control protocol presented at international conferences, step-by-step check items and commissioning guidelines were derived. The risk management items at each stage were (1) 21 ionization chamber performance test items and 9 electrometer, cable, and connector inspection items related to the dosimetry system; (2) 34 mechanical and dose-checking items during ATP, 22 multileaf collimator (MLC) items, and 36 imaging system items; and (3) 28 items in the measurement preparation stage and 32 items in the measurement stage after commissioning. Because the items presented in these guidelines are limited in terms of special treatment, items and practitioners can be modified to reflect the clinical needs of the institution. During the system installation, it is recommended that at least two clinically qualified medical physicists (CQMP) perform a double check in compliance with the two-person rule. We expect that this result will be useful as a radiation safety management tool that can prevent radiation accidents at each stage during the introduction of radiotherapy and the system installation process.

• Quality Improvement in Health Care
• /
• v.5 no.1
• /
• pp.76-91
• /
• 1998

Background : The purpose of this study was to understand general attitudes of physicians toward hospital quality improvement activities who have been members of QA committee in 32 Korean university hospitals. Methods : A postal survey about opinions of hospital quality improvement activities and desirable policy directions was sent to 328 QA committee member physicians. The questionnaires were composed of 48 items. In total 152 physicians responded to this survey(response rate: 49.3%). This study was carried out from January to February 1996. Results : Most physicians(97.5%) recognized the necessity of hospital QA activities. The most dominant supporting reason for quality activities was to improve clinical outcome. Two thirds of physicians regarded their own hospital activities for quality improvement as inactive. They considered that the obstacles were too little concern(33.6%), unclear objectives(28.9%), lack of human resources(14.3%), and insufficient education and training for quality improvement(10.1%). The most favoring policy among respondents was to give health care providers economic incentives. Provision of education and training for implementing quality improvement was the next to it. Physicians revealed their preferences for professional society, government, health insurance societies, consumer groups, hospital labor unions, and mass media in sequence as sponsoring agencies for hospital accreditation program. Conclusion : These study suggested that the concrete means for motivating physicians and promoting constructive partnership among related parties should be developed in order to activate current hospital quality activities in Korea.

• Progress in Medical Physics
• /
• v.14 no.1
• /
• pp.20-27
• /
• 2003

For the treatment of cancer using computer controlled linear accelerator, it is important to ensure that all equipments are operated properly. Therefore, many studies were performed and published on the safe use of radiotherapy machine controlled by computer logic and microprocessor These studies provided methods of preventing accident from software and hardware failure. In Korea, the use of computer controlled linear accelerator has increased over the past 10 years. However, there are no standard protocols for quality assurance (QA) of linear accelerator. In this study, three QA protocols from America, Japan, and Europe were collected and summarized. In addition, agreement and disagreement among the protocols were analyzed. In conclusion, the QA items included in the protocols were similar among the various QA protocols although there were differences in performance frequencies.