患者計(jì)劃質(zhì)量控制獨(dú)立計(jì)劃核對(duì)專家講座

1患者計(jì)劃質(zhì)量控制-獨(dú)立計(jì)劃查對(duì)中國(guó)醫(yī)學(xué)科學(xué)院腫瘤醫(yī)院放療科李明輝患者計(jì)劃質(zhì)量控制獨(dú)立計(jì)劃核對(duì)第1頁(yè)2獨(dú)立計(jì)劃查對(duì)背景計(jì)劃療前查對(duì)療中查對(duì)結(jié)束查對(duì)課程綱領(lǐng)患者計(jì)劃質(zhì)量控制獨(dú)立計(jì)劃核對(duì)第2頁(yè)3計(jì)劃設(shè)計(jì)步驟傳輸步驟治療實(shí)施步驟獨(dú)立計(jì)劃查對(duì)背景患者計(jì)劃質(zhì)量控制獨(dú)立計(jì)劃核對(duì)第3頁(yè)2024/12/54為何要獨(dú)立查對(duì)患者治療計(jì)劃?獨(dú)立查對(duì)(IndependentCheck)是一個(gè)有效質(zhì)控辦法,經(jīng)過獨(dú)立方查對(duì)一項(xiàng)工作中各項(xiàng)條件、參數(shù),易于發(fā)覺潛在錯(cuò)誤放射治療要求劑量準(zhǔn)確,才能確保療效,防止事故放射性事故和差錯(cuò)多發(fā)于計(jì)劃設(shè)計(jì)階段患者計(jì)劃質(zhì)量控制獨(dú)立計(jì)劃核對(duì)第4頁(yè)2024/12/55放射性事故和差錯(cuò)多發(fā)于計(jì)劃階段IAEASRSNo.17總結(jié)92例放療事故,其中26例發(fā)生于治療計(jì)劃階段WHORadiotherapyRiskProfile()分析發(fā)覺3125例放射性事故爰害者中,1702例(55%)事故原因?qū)儆谟?jì)劃設(shè)計(jì)階段4616例未造成確認(rèn)傷害事件中(near-missincidents),9%與計(jì)劃相關(guān),38%與信息傳輸相關(guān)患者計(jì)劃質(zhì)量控制獨(dú)立計(jì)劃核對(duì)第5頁(yè)2024/12/56闡述獨(dú)立查對(duì)工作技術(shù)匯報(bào)IAEATRS430.Commissioningandqualityassuranceofcomputerizedplanningsystemsforradiationtreatmentofcancer()AAPMTG53Report.Qualityassuranceforclinicalradiotherapytreatmentplanning(1998)…患者計(jì)劃質(zhì)量控制獨(dú)立計(jì)劃核對(duì)第6頁(yè)2024/12/57獨(dú)立查對(duì)在放療計(jì)劃QA體系位置計(jì)劃系統(tǒng)QA患者1計(jì)劃QA患者2計(jì)劃QA…試驗(yàn)驗(yàn)證獨(dú)立查對(duì)查房自查患者計(jì)劃質(zhì)量控制獨(dú)立計(jì)劃核對(duì)第7頁(yè)8獨(dú)立計(jì)劃查對(duì)背景計(jì)劃療前查對(duì)計(jì)劃療中查對(duì)計(jì)劃結(jié)束查對(duì)課程綱領(lǐng)患者計(jì)劃質(zhì)量控制獨(dú)立計(jì)劃核對(duì)第8頁(yè)2024/12/59計(jì)劃療前查對(duì)責(zé)任人主要是高年資物理師,同時(shí)還有高年資醫(yī)師和治療技師查對(duì)內(nèi)容操作計(jì)劃系統(tǒng)查對(duì)/評(píng)價(jià)計(jì)劃查對(duì)打印計(jì)劃匯報(bào)和傳輸?shù)絉&V系統(tǒng)計(jì)劃,查對(duì)MU/劑量第一次治療前在機(jī)器上查對(duì)計(jì)劃患者計(jì)劃質(zhì)量控制獨(dú)立計(jì)劃核對(duì)第9頁(yè)檢驗(yàn)項(xiàng)目:計(jì)劃?rùn)z驗(yàn)檢驗(yàn)項(xiàng)目:計(jì)劃?rùn)z驗(yàn)檢驗(yàn)項(xiàng)目:計(jì)劃?rùn)z驗(yàn)檢驗(yàn)項(xiàng)目:計(jì)劃?rùn)z驗(yàn)檢驗(yàn)項(xiàng)目:計(jì)劃?rùn)z驗(yàn)檢驗(yàn)項(xiàng)目:計(jì)劃?rùn)z驗(yàn)檢驗(yàn)項(xiàng)目:計(jì)劃?rùn)z驗(yàn)檢驗(yàn)項(xiàng)目:計(jì)劃?rùn)z驗(yàn)檢驗(yàn)項(xiàng)目:計(jì)劃?rùn)z驗(yàn)治療計(jì)劃獨(dú)立查對(duì)患者計(jì)劃質(zhì)量控制獨(dú)立計(jì)劃核對(duì)第10頁(yè)治療計(jì)劃獨(dú)立查對(duì)檢驗(yàn)項(xiàng)目:計(jì)劃?rùn)z驗(yàn)檢驗(yàn)項(xiàng)目:計(jì)劃?rùn)z驗(yàn)檢驗(yàn)項(xiàng)目:計(jì)劃?rùn)z驗(yàn)檢驗(yàn)項(xiàng)目:計(jì)劃?rùn)z驗(yàn)檢驗(yàn)項(xiàng)目:計(jì)劃?rùn)z驗(yàn)檢驗(yàn)項(xiàng)目:計(jì)劃?rùn)z驗(yàn)檢驗(yàn)項(xiàng)目:計(jì)劃?rùn)z驗(yàn)檢驗(yàn)項(xiàng)目:計(jì)劃?rùn)z驗(yàn)檢驗(yàn)項(xiàng)目:計(jì)劃?rùn)z驗(yàn)檢驗(yàn)項(xiàng)目:計(jì)劃?rùn)z驗(yàn)檢驗(yàn)項(xiàng)目:計(jì)劃?rùn)z驗(yàn)檢驗(yàn)項(xiàng)目:計(jì)劃?rùn)z驗(yàn)檢驗(yàn)項(xiàng)目:計(jì)劃?rùn)z驗(yàn)患者計(jì)劃質(zhì)量控制獨(dú)立計(jì)劃核對(duì)第11頁(yè)匯報(bào)單檢驗(yàn)患者計(jì)劃質(zhì)量控制獨(dú)立計(jì)劃核對(duì)第12頁(yè)患者計(jì)劃質(zhì)量控制獨(dú)立計(jì)劃核對(duì)第13頁(yè)患者計(jì)劃質(zhì)量控制獨(dú)立計(jì)劃核對(duì)第14頁(yè)等中心校位圖檢驗(yàn)患者計(jì)劃質(zhì)量控制獨(dú)立計(jì)劃核對(duì)第15頁(yè)劑量分布檢驗(yàn)患者計(jì)劃質(zhì)量控制獨(dú)立計(jì)劃核對(duì)第16頁(yè)DVH檢驗(yàn)患者計(jì)劃質(zhì)量控制獨(dú)立計(jì)劃核對(duì)第17頁(yè)統(tǒng)計(jì)驗(yàn)證（R&V）系統(tǒng)檢驗(yàn)患者計(jì)劃質(zhì)量控制獨(dú)立計(jì)劃核對(duì)第18頁(yè)射野參數(shù)檢驗(yàn)患者計(jì)劃質(zhì)量控制獨(dú)立計(jì)劃核對(duì)第19頁(yè)射野檢驗(yàn)后需重新署名確認(rèn)患者計(jì)劃質(zhì)量控制獨(dú)立計(jì)劃核對(duì)第20頁(yè)射野劑量跟蹤:依據(jù)每個(gè)野權(quán)重，取得其對(duì)單次劑量貢獻(xiàn)，并將其輸入系統(tǒng)。用于實(shí)時(shí)評(píng)定靶區(qū)累計(jì)劑量，監(jiān)測(cè)病人是否接收了預(yù)設(shè)劑量。射野劑量跟蹤檢驗(yàn)患者計(jì)劃質(zhì)量控制獨(dú)立計(jì)劃核對(duì)第21頁(yè)治療排程檢驗(yàn)患者計(jì)劃質(zhì)量控制獨(dú)立計(jì)劃核對(duì)第22頁(yè)圖像引導(dǎo)確認(rèn)2024/12/523患者計(jì)劃質(zhì)量控制獨(dú)立計(jì)劃核對(duì)第23頁(yè)MUCheck檢驗(yàn)計(jì)劃系統(tǒng)對(duì)MU計(jì)算正確性。允許偏差:CRT≤5%,IMRT≤10%MU獨(dú)立查對(duì)假如偏差非常大，考慮如:未作密度校正，額外使用擋塊，劑量歸一點(diǎn)選擇錯(cuò)誤或處于梯度區(qū)等原因造成?；颊哂?jì)劃質(zhì)量控制獨(dú)立計(jì)劃核對(duì)第24頁(yè)IMRTQA分析參數(shù):γ分析(DTA=3mm,%Diff=3%）AD模式,TH=10%經(jīng)過標(biāo)準(zhǔn):經(jīng)過率≥90%;IMRT驗(yàn)證檢驗(yàn)調(diào)強(qiáng)驗(yàn)證匯報(bào)單患者計(jì)劃質(zhì)量控制獨(dú)立計(jì)劃核對(duì)第25頁(yè)物理師檢驗(yàn)確認(rèn)在統(tǒng)計(jì)驗(yàn)證系統(tǒng)“計(jì)劃?rùn)z驗(yàn)”列表逐項(xiàng)確認(rèn)計(jì)劃?rùn)z驗(yàn)患者計(jì)劃質(zhì)量控制獨(dú)立計(jì)劃核對(duì)第26頁(yè)27獨(dú)立計(jì)劃查對(duì)背景計(jì)劃療前查對(duì)計(jì)劃療中查對(duì)計(jì)劃結(jié)束查對(duì)課程綱領(lǐng)患者計(jì)劃質(zhì)量控制獨(dú)立計(jì)劃核對(duì)第27頁(yè)檢驗(yàn)項(xiàng)目:療中查對(duì)檢驗(yàn)項(xiàng)目:療中查對(duì)檢驗(yàn)項(xiàng)目:療中查對(duì)檢驗(yàn)項(xiàng)目:療中查對(duì)檢驗(yàn)項(xiàng)目:療中查對(duì)檢驗(yàn)項(xiàng)目:療中查對(duì)檢驗(yàn)項(xiàng)目:療中查對(duì)檢驗(yàn)項(xiàng)目:療中查對(duì)檢驗(yàn)項(xiàng)目:療中查對(duì)檢驗(yàn)項(xiàng)目:療中查對(duì)檢驗(yàn)項(xiàng)目:療中查對(duì)治療計(jì)劃獨(dú)立查對(duì)患者計(jì)劃質(zhì)量控制獨(dú)立計(jì)劃核對(duì)第28頁(yè)首次治療前在機(jī)器上查對(duì)計(jì)劃主要性是防止錯(cuò)誤造成危害最終機(jī)會(huì)責(zé)任人設(shè)計(jì)計(jì)劃物理師、當(dāng)班技師和主管醫(yī)師查對(duì)內(nèi)容在患者擺位前,物理師和技師應(yīng)共同查對(duì)MLC或擋塊形成射野形狀。在患者擺位完成后,技師應(yīng)設(shè)置機(jī)器至每個(gè)照射野位置,檢驗(yàn)楔形板方向是否正確；床梁應(yīng)處于什么位置,才能防止射線照射床梁；應(yīng)拍攝正側(cè)位射野片或射野影像,將其與DRR比較來查對(duì)等中心位置患者計(jì)劃質(zhì)量控制獨(dú)立計(jì)劃核對(duì)第29頁(yè)檢驗(yàn)病人實(shí)際接收體表劑量與計(jì)劃系統(tǒng)計(jì)算一致性。允許偏差:≤10%

半導(dǎo)體劑量檢驗(yàn)可能造成誤差過大原因:擺位錯(cuò)誤，計(jì)算錯(cuò)誤（如誤加擋塊），計(jì)劃傳輸錯(cuò)誤等。半導(dǎo)體檢驗(yàn)僅用于3D-CRT和2D計(jì)劃病人治后第一次檢驗(yàn)患者計(jì)劃質(zhì)量控制獨(dú)立計(jì)劃核對(duì)第30頁(yè)檢驗(yàn)技師確認(rèn)計(jì)劃時(shí)僅修改治療床位置數(shù)據(jù)和射野驗(yàn)證片MU數(shù)據(jù)。檢驗(yàn)全部署名射野參數(shù)檢驗(yàn)檢驗(yàn)射野驗(yàn)證片曝光MU數(shù)據(jù)治后第一次檢驗(yàn)射野參數(shù)修改處會(huì)自動(dòng)高亮顯示患者計(jì)劃質(zhì)量控制獨(dú)立計(jì)劃核對(duì)第31頁(yè)檢驗(yàn)治療統(tǒng)計(jì)劑量跟蹤信息和統(tǒng)計(jì)驗(yàn)證系統(tǒng)相一致依據(jù)治療次數(shù)和單次劑量,檢驗(yàn)總劑量和預(yù)計(jì)相一致（預(yù)防個(gè)別射野漏照或重復(fù)照射而造成劑量改變）劑量跟蹤檢驗(yàn)周檢患者計(jì)劃質(zhì)量控制獨(dú)立計(jì)劃核對(duì)第32頁(yè)檢驗(yàn)治療參數(shù)是否被修改。檢驗(yàn)全部確認(rèn)署名射野參數(shù)修改檢驗(yàn)周檢患者計(jì)劃質(zhì)量控制獨(dú)立計(jì)劃核對(duì)第33頁(yè)檢驗(yàn)全部統(tǒng)計(jì)均已署名確認(rèn)。劑量跟蹤檢驗(yàn)簽字確認(rèn)結(jié)束查對(duì)患者計(jì)劃質(zhì)量控制獨(dú)立計(jì)劃核對(duì)第34頁(yè)物理師檢驗(yàn)確認(rèn)在統(tǒng)計(jì)驗(yàn)證系統(tǒng)列表逐項(xiàng)確認(rèn)結(jié)