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当前的外照射放射治疗质量保证指南:它能否应对新兴图像引导技术的挑战?

Current external beam radiation therapy quality assurance guidance: does it meet the challenges of emerging image-guided technologies?

作者信息

Palta Jatinder R, Liu Chihray, Li Jonathan G

机构信息

Department of Radiation Oncology, University of Florida, Gainesville, FL, USA.

出版信息

Int J Radiat Oncol Biol Phys. 2008;71(1 Suppl):S13-7. doi: 10.1016/j.ijrobp.2007.06.084.

Abstract

The traditional prescriptive quality assurance (QA) programs that attempt to ensure the safety and reliability of traditional external beam radiation therapy are limited in their applicability to such advanced radiation therapy techniques as three-dimensional conformal radiation therapy, intensity-modulated radiation therapy, inverse treatment planning, stereotactic radiosurgery/radiotherapy, and image-guided radiation therapy. The conventional QA paradigm, illustrated by the American Association of Physicists in Medicine Radiation Therapy Committee Task Group 40 (TG-40) report, consists of developing a consensus menu of tests and device performance specifications from a generic process model that is assumed to apply to all clinical applications of the device. The complexity, variation in practice patterns, and level of automation of high-technology radiotherapy renders this "one-size-fits-all" prescriptive QA paradigm ineffective or cost prohibitive if the high-probability error pathways of all possible clinical applications of the device are to be covered. The current approaches to developing comprehensive prescriptive QA protocols can be prohibitively time consuming and cost ineffective and may sometimes fail to adequately safeguard patients. It therefore is important to evaluate more formal error mitigation and process analysis methods of industrial engineering to more optimally focus available QA resources on process components that have a significant likelihood of compromising patient safety or treatment outcomes.

摘要

传统的规范性质量保证(QA)程序旨在确保传统外照射放疗的安全性和可靠性,但其在适用于三维适形放疗、调强放疗、逆向治疗计划、立体定向放射外科/放疗以及图像引导放疗等先进放疗技术方面存在局限性。以美国医学物理师协会放射治疗委员会任务组40(TG - 40)报告为例的传统QA范式,包括从一个假定适用于设备所有临床应用的通用过程模型中制定一套共识性的测试和设备性能规范清单。高科技放疗的复杂性、实践模式的差异以及自动化程度,使得这种“一刀切”的规范性QA范式在想要涵盖设备所有可能临床应用的高概率误差路径时变得无效或成本过高。当前制定全面规范性QA协议的方法可能极其耗时且成本效益低下,有时还可能无法充分保障患者安全。因此,评估工业工程中更正式的错误缓解和过程分析方法,以便更优化地将可用的QA资源集中于那些极有可能危及患者安全或治疗结果的过程组件上,这一点很重要。

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