Patient-specific instrumentation in total ankle arthroplasty

The recent increase in the adoption of total ankle arthroplasty(TAA)reflects the improvements in implant designs and surgical techniques,including the use of preoperative navigation system and patient-specific instrumentation(PSI),such as custom-made cutting guides.Cutting guides are customized with respect to each patient's anatomy based on preoperative ankle computed tomography scans,and they drive the saw intra-operatively to improve the accuracy of bone resection and implant positioning.Despite some promising results,the main queries in the literature are whether PSI improves the reliability of achieving neutral ankle alignment and more accurate implant sizing,whether it is actually superior over standard techniques,and whether it is cost effective.Moreover,the advantages of PSI in clinical outcomes are still theoretical because the current literature does not allow to confirm its superiority.The purpose of this review article is therefore to assess the current literature on PSI in TAA with regard to current implants with PSI,templating and preoperative planning strategies,alignment and sizing,clinical outcomes,cost analysis,and comparison with standard techniques.

Application of 3D printed patient-specific instrumentation in distal tibial tuberosity-high tibial osteotomy

Objective:To observe the clinical efficacy and advantages of 3D printed patient-specific instrumentation(PSI)assisted distal tibial tuberosity-high tibial osteotomy in the treatment of medial compartment knee osteoarthritis.Methods:75 patients with medial compartment knee osteoarthritis were included in the study performed DTT-HTO in our hospital from August 2017 to August 2019.The patients were divided into the PSI group(n=39)and conventional group(n=36)According to whether PSI was used in surgery.The differences of lateral cortical fracture rate,time of intraoperative X-ray exposure,intraoperative blood loss,operative time,weight bearing line(WBL),Posterior tibial slope(PTS)and Caton-Deschamps index(CDI)were compared between the two groups.Visual analogue scale(VAS)scores and Hospital for Special Surgery(HSS)scores were recorded to evaluate knee pain and function before surgery and after surgery at 3 months and 12 months.Results:All 75 patients were followed up for more than 12 months,the ranged from 12-26(18.74±6.21)months.Three lateral cortical fractures in the conventional group and no fracture in PSI group.The lateral cortical fracture rate,time of intraoperative X-ray exposure,intraoperative blood loss,operative time in PSI group were lower than those in conventional group(p敿0.05).WBL in two groups were significantly improved after surgery(p敿0.05),and PTS,CDI were no statistically improved after surgery(p>0.05).While there was no statistically significant difference with WBL,PTS and CDI between two groups(p>0.05).At 1 months,3 months and 12 months after surgery;VAS and HSS scores in both groups were significantly improved compared with that before surgery(p0.05),and were no statistically significant difference between two groups.Conclusion:3D printed patient-specific instrumentation assisted DTT-HTO has significant clinical efficacy,and effectively standardized surgical procedures,meanwhile reduced the time of intraoperative X-ray exposure,intraoperative blood loss and risk of lateral cortical fracture.

Computerised tomography vs magnetic resonance imaging for modeling of patient-specific instrumentation in total knee arthroplasty

AIM: To summarise and compare currently available evidence regarding accuracy of pre-operative imaging, which is one of the key choices for surgeons contemplating patient-specific instrumentation(PSI) surgery.METHODS: The MEDLINE and EMBASE medical literature databases were searched, from January 1990 to December 2013, to identify relevant studies. The data from several clinical studies was assimilated to allow appreciation and comparison of the accuracy of each modality. The overall accuracy of each modality was calculated as proportion of outliers > 3% in the coronal plane of both computerised tomography(CT) or magnetic resonance imaging(MRI). RESULTS: Seven clinical studies matched our inclusion criteria for comparison and were included in our study for statistical analysis. Three of these reported series using MRI and four with CT. Overall percentage of outliers > 3% in patients with CT-based PSI systems was 12.5% vs 16.9% for MRI-based systems. These results were not statistically significant. CONCLUSION: Although many studies have been undertaken to determine the ideal pre-operative imaging modality, conclusions remain speculative in the absence of long term data. Ultimately, information regarding accuracy of CT and MRI will be the main determining factor. Increased accuracy of pre-operative imaging could result in longer-term savings, and reduced accumulated dose of radiation by eliminating the need for post-operative imaging and revision surgery.

Patient-specific instruments as a standard procedure in total knee arthroplasty: Logistics and postoperative radiological results in 70 patients

Serous Purpose: There is limited information in the literature surrounding the use of patient-specific instrumentation (PSI) by a large number of surgeons. This prospective observational study was therefore designed to evaluate the logistics of using PSI for total knee arthroplasty (TKA) in a multi-surgeon environment, as well as its accuracy in positioning components. Methods: Of 73 patients enrolled in this study, 3 were excluded after the surgeon decided intraoperatively to switch to conventional instrumentation. Results: Mean operative time was 77.6 minutes. The component size had to be changed in 19 patients and bone cuts corrected in 12. In 65 of the 70 cases (92.9%), mechanical alignment was within the optimal range from 3° varus to 3° valgus, with the remaining 5 cases considered outliers (7.1%). Mean overall mechanical alignment was 0.3° varus (standard deviation, ±2°). There was a distinct variance with regard to the position of the tibial component in the sagittal plane. Conclusions: PSI can be effectively incorporated in larger, multisurgeon practices. Although high accuracy was observed for overall mechanical alignment and component positioning in the frontal and sagittal planes, further attention must be paid to the tibial slope. We highly recommend the use of the extramedullary alignment rod to the proper position of the tibial block, as well as double-checking the slope before performing bone cuts.

Patient-Specific Instruments Based on Knee Joint Computed Tomography and Full-Length Lower Extremity Radiography in Total Knee Replacement

Background： Restoring good alignment after total knee replacement （TKR） is still a challenge globally, and the clinical efficiency of patient-specific instruments （PSIs） remains controversial. In this study, we aimed to explore the value and significance of three-dimensional printing PSls based on knee joint computed tomography （CT） and full-length lower extremity radiography in TKR. Methods： Between June 2013 and October 2014, 31 TKRs were performed using PSIs based on knee joint CT and full-length lower extremity radiography in 31 patients （5 males and 26 females; mean age： 67.6 ± 7.9 years, body mass index [BMI]： 27.4 ±3.5 kg/m2）. Thirty-one matched patients （4 males and 27 females; mean age： 67.4± 7.2 years; mean BM 1：28.1 ± 4.6 kg/m2） who underwent TKR using conventional instruments in the same period served as the control group. The mean follow-up period was 38 months （31-47 months）. Knee Society Score （KSS）, surgical time, and postoperative drainage volume were recorded. Coronal alignment was measured on full-length radiography. Results： Twenty-three （74.2%） and 20 （64.5%） patients showed good postoperative alignment in the PSI and control groups, respectively, without significant difference between the two groups （χ2 = 0.68, P = 0.409）. The mean surgical time was 81.48± 16.40 rain and 72.90 ± 18.10 min for the PSl and control groups, respectively, without significant difference between the two groups （t = 0.41, P = 0.055）. The postoperative drainage volume was 250.9 ± 148.8 ml in the PSI group, which was significantly less than that in the control group （602. 1± 230.6 ml, t = 6.83, P 〈 0.001）. No significant difference in the KSS at the final follow-up was found between the PSI and control groups （91.06 ± 3.26 vs. 90.19±3.84, t= 0.95, P=0.870）. Conclusions： The use of PSls based on knee joint CT and standing full-length lower extremity radiography in TKR resulted in acceptable alignment compared with the use of conventional instruments, although the marginal advantage was not statistically different. Surgical time and clinical results were also similar between the two groups, However, the PSI group had less postoperative drainage.

The CCD instrument background of the SMILE SXI

The ESA and CAS SMILE mission orbit is highly elliptical and will pass through multiple radiation environments.The Soft X-ray Imager(SXI)instrument aboard has a radiation shutter door designed to close when the surrounding radiation flux is high.The shutter door will close when passing below an altitude threshold to protect against trapped particles in the Earth’s Van Allen Belts.Therefore,two radiation environments can be approximated based on the shutter door position:open and closed.The instrument background for the CCDs(Charge-Coupled Devices)that form the focal plane array of the SXI were evaluated for the two environments.Due to the correlation of the space environment with the solar cycle,the solar minima and maxima,the background was also evaluated at these two extremes.The results demonstrated that the highest instrument background will occur during solar minima due to the main contributing source being Galactic Cosmic Rays(GCRs).It was also found that the open background was highest for solar minima and that the closed background was highest during solar maxima.This is due to the radiation shutter door acting as a scattering centre and the changes in the energy flux distribution of the GCRs between the two solar extremes.

Glaucoma surgery experiments using digital microscope-integrated optical coherence tomography and OCT-compatible instruments

There is a certain failure rate in traditional glaucoma surgery because of the lack of depth information in microscope images.In this work,we present a digital microscope-integrated optical coherence tomography(MIOCT)system and several custom-made OCT-compatible instruments for glaucoma surgery.Sixteen ophthalmologists were asked to perform trabeculectomy and canaloplasty on live porcine eyes using the system and instruments.After surgery,a subjective feedback survey about the user experience was taken.The experiment results showed that our system can help surgeons easily locate important tissue structures during surgery.The custom-made instruments also solved the shadowing problem in OCT imaging.Surgeons preferred to use the system in their future practice.

Implementation of Level-3 Autonomous Patient-Specific Quality Assurance with Automated Human Interactive Devices

Purpose: Patient-specific quality assurance (PSQA) requires manual operation of different workstations, which is time-consuming and error-prone. Therefore, developing automated solutions to improve efficiency and accuracy is a priority. The purpose of this study was to develop a general software interface with scripting on a human interactive device (HID) for improving the efficiency and accuracy of manual quality assurance (QA) procedures. Methods: As an initial application, we aimed to automate our PSQA workflow that involves Varian Eclipse treatment planning system, Elekta MOSAIQ oncology information system and PTW Verisoft application. A general platform, the AutoFrame interface with two imbedded subsystems—the AutoFlow and the PyFlow, was developed with a scripting language for automating human operations of aforementioned systems. The interface included three functional modules: GUI module, UDF script interpreter and TCP/IP communication module. All workstations in the PSQA process were connected, and most manual operations were automated by AutoFrame sequentially or in parallel. Results: More than 20 PSQA tasks were performed both manually and using the developed AutoFrame interface. On average, 175 (±12) manual operations of the PSQA procedure were eliminated and performed by the automated process. The time to complete a PSQA task was 8.23 (±0.78) minutes for the automated workflow, in comparison to 13.91 (±3.01) minutes needed for manual operations. Conclusion: We have developed the AutoFrame interface framework that successfully automated our PSQA procedure, and significantly reduced the time, human (control/clicking/typing) errors, and operators’ stress. Future work will focus on improving the system’s flexibility and stability and extending its operations to other QA procedures.

Exploring the Mysteries of the Universe, and Innovation Leading the Future——Astronomical Techniques and Instruments

Dear Readers:Astronomical Techniques and Instruments is a professional English journal of open access devoted to recent develop-ments,discoveries,and theories in astronomical techniques,methods,and instruments.It will serve as a platform for dis-course,learning,and information sharing for astronomic and astrophysics professionals worldwide.

Reform of Teaching Practice of Modern Instrumental Analysis in Biotechnology Programs

Through the online and offline practical reform of the Modern Instrumental Analysis course of biotechnology majors from teaching content,teaching method,teaching demonstration to teaching effect,the traditional single offline lecture is transformed into diversified and interactive modern teaching.The practical reform enriches and optimizes the course content,perfects and improves the course assessment system,and improves the teaching quality.It achieves the student-centered and application-oriented teaching goal,and also provides reference for further cultivating high-quality applied talents.

Surgical Management of Lumbar Spinal Canal Stenosis with Instrumentation at the Yaounde Central Hospital: Comparison of Unilateral versus Bilateral Pedicle Screw Fixation Combined with Transforaminal Lumbar Interbody Fusion

Introduction: The choice of adopting unilateral pedicle screw fixation or using bilateral pedicle screw fixation in lumbar spinal stenosis remains controversial. In our context, very few studies have been performed comparing the clinical effectiveness of unilateral versus bilateral fixation in the surgical management of lumbar spinal canal stenosis. Objective: Evaluate the impact on quality of life and clinical efficacy of unilateral spondylodesis compared to bilateral spondylodesis in the surgical management of lumbar spinal canal stenosis at the Yaounde Central Hospital. Methods: This was a retrospective descriptive cross-sectional study for a period of 4 years, from June 2015 to June 2019. It involved all patients operated for lumbar canal stenosis and who underwent spondylodesis or spinal fusion at the neurosurgery department of the Yaounde Central Hospital. Results: A total of 68 participants were recruited during our study period. 32 (47%) of the study population were in the 50 - 60 age group, with a mean age of 56.98 years ranging from 41 to 75 years. Females, housewives and farmers were the most affected. In our study, 72% of patients had unilateral spondylodesis and 28% had bilateral fusion. Preoperatively, 71% of patients had insurmountable pain, refractory to medical treatment. At 3 months postoperatively, 73.7% of patients with bilateral setup had moderate pain compared to 69% of those with unilateral setup. At 6 months postoperatively, 79% of patients with bilateral fusion had mild pain compared to 82% of patients with unilateral setup. At 1 year postoperatively, all patients had mild pain. Preoperatively, 66.2% of patients were unable to walk and 19.1% of patients were bedridden according to the Oswestry score. At 3 months postoperatively, 10.2% of patients with unilateral setup were unable to walk compared to 10.5% of patients with bilateral fixation, while 67.3% of patients with unilateral fixation had moderate disability compared to 52.6% of patients with bilateral fixation. At 6 months postoperatively, 51% of patients with unilateral setup had moderate disability compared to 47.4% of patients with bilateral fixation, while 42.9% of patients with unilateral fixation had mild disability compared to 42.1% of patients with bilateral fixation. At 1 year postoperatively, 81.6% of patients who underwent unilateral fixation had only mild disability compared to 73.7% of patients with bilateral fixation. Conclusion: The assessment of quality of life according to the set-up used shows similar results at 3 months, 6 months and 1 year, with no statistically significant differences. Single-sided pedicle screw fixation combined with transforaminal lumbar interbody fusion or mounting has the advantage of being faster, with less bleeding and is less expensive compared to bilateral fixation.

Development and validation of an instrument to assess knowledge,attitudes,and practices on digital health among nursing officers

Objective:Validation is an important aspect of an instrument,and it ensures the confidence of researchers to employ the instrument in their studies.This study was conducted to develop and validate an instrument to assess knowledge,attitudes,and practices(KAP) on digital health among nurses since digital health capacity is a major concern in health care that needs to be assessed.Methods:We conducted a methodological study to assess the content validity and reliability of the instrument.First,items were generated through a comprehensive literature review and by obtaining an expert opinion.Second,content and face validity were assessed by a panel of 7 experts.Both the item-level content validity index(I-CVI) and the scale-level content validity index(S-CVI) were established.Moreover,test–retest reliability and internal consistency of the instrument were assessed.Data were analyzed using SPSS version 25.Results:The initial pool consisted of 60 items and after obtaining content,face,and construct validity,51 items remained.Items with an I-CVI <0.78 were considered relevant.The S-CVI for relevancy,clarity,ambiguity,and simplicity were 0.93,0.91,0.94,and 0.92,respectively.Five subcomponents were constructed in each knowledge and attitudes domain,and the test–retest reliability test revealed that the instrument has good reliability,showing correlation coefficient values for the KAP domains and the total questionnaire of 0.76,0.98,0.99,and 0.99,respectively.The independent Cronbach's α for all items was 0.76,indicating good internal consistency.Conclusions:The present study established the acceptable validity and ensured the good reliability and internal consistency of the instrument,which can serve as an assessment tool of KAP on digital health among healthcare professionals.

Analysis Of Urban Planning Instruments in Comala,Colima,Mexico(1997-2009)from a Gender Perspective-A Secondary Publication

This work is carried out based on the analysis of urban planning instruments,taking the gender perspective as a foundation.It arises from the inclusion of women in the participation of urban development,through an analysis of the gender gaps that have marked the history of women,the inequalities serve as a basis for carrying out this study.It highlights the challenges we face today as a society in the process of building citizen participation,where we must all be recognized and have equal opportunities within the territory in which we live.This article analyzes the extent to which the Municipal Urban Development Programs of the Mexican municipality of Comala,Colima,Mexico,consider the recommendations on gender and urbanism,established since the 1990s by international entities and applied transversally to urban planning policies.Considerable differences are found between women and men in terms of empowerment and participation in urban territorial planning instruments,mainly in the oldest instrument(1997).Significant progress is observed in the most recent document and is currently in force in the municipality of Comala(2009).

Instrument Automation Control System Faults and Maintenance

This article explores the topic of fault diagnosis and maintenance strategies for instrument automation control systems,analyzing them through specific cases.The aim of this research is to improve the stability and reliability of the system by conducting a thorough investigation of faults and maintenance in instrument automation control systems.By doing so,this research hopes to provide a strong guarantee for the smooth progress of industrial production.

Design of Signal Lamp Filament Monitoring Alarm Instrument

To improve the reliability of the light emitting diode(LED)signal lamp filament current monitoring alarm instrument for metro systems,a new type of hot standby online monitoring apparatus was developed which is based on synchronous transmission data(STD)bus technology.In this system,a double hot standby mode can be achieved by adopting bus arbitration.In addition,to detect the effective value of alternating current which is from 0 to 200 mA in the signal lamp lighting circuit,a precision rectifier signal conditioning circuit and an isolated acquisition circuit were designed.This new type of alarm instrument has high detection accuracy and could meet the functional requirements for metro signal systems after comparing it with some industry products that were applied on the spot.

Indirect printing of hierarchical patient-specific scaffolds for meniscus tissue engineering

The complex meniscus tissue plays a critical role in the knee. The high susceptibility to injury has led to an intense pursuit for better tissue engineering regenerative strategies, where scaffolds play a major role. In this study, indirect printed hierarchical multilayered sca ffolds composed by a silk fibroin (SF) upper layer and an 80/20 (w/w) ratio of SF/ionic-doped β-tricalcium phosphate (TCP) bottom layer were developed. Furthermore, a comparative analysis between two types of sca ffolds pro- duced using di fferent SF concentrations, i.e., 8% (w/v) (Hi8) and 16% (w/v) (Hi16) was performed. In terms of architecture and morphology, the produced sca ffolds presented homogeneous porosity in both layers and no di fferences were observed when comparing both sca ffolds. A decrease in terms of mechanical performance of the sca ffolds was observed when SF concentration decreased from 16 to 8% (w/v). Hi16 revealed a static compressive modulus of 0.66 ± 0.05 MPa and dynamical mechanical properties ranging from 2.17 ± 0.25 to 3.19 ± 0.38 MPa. By its turn, Hi8 presented a compressive modulus of 0.27 ± 0.08 MPa and dynamical mechanical properties ranging from 1.03 ± 0.08 MPa to 1.56 ± 0.13 MPa. In vitro bioactivity studies showed formation of apatite crystals onto the surface of Hi8 and Hi16 bottom layers. Human meniscus cells (hMCs) and human primary osteoblasts were cultured separately onto the top layer (SF8 and SF16) and bottom layer (SF8/TCP and SF16/TCP) of the hierarchical sca ffolds Hi8 and Hi16, respectively. Both cell types showed good adhesion and proliferation as denoted by the live/dead staining, Alamar Blue assay and DNA quanti fication analysis. Subcutaneous implantation in mice revealed weak in flammation and sca ffold’s integrity. The hierarchical indirect printed SF sca ffolds can be promising candidate for meniscus TE sca ffolding applications due their suitable mechanical properties, good biological performance and possibility of being applied in a patient-speci fic approach.

Real-Time Patient-Specific ECG Arrhythmia Detection by Quantum Genetic Algorithm of Least Squares Twin SVM

The automatic detection of cardiac arrhythmias through remote monitoring is still a challenging task since electrocardiograms(ECGs)are easily contaminated by physiological artifacts and external noises,and these morphological characteristics show significant variations for different patients.A fast patient-specific arrhythmia diagnosis classifier scheme is proposed,in which a wavelet adaptive threshold denoising is combined with quantum genetic algorithm(QAG)based on least squares twin support vector machine(LSTSVM).The wavelet adaptive threshold denoising is employed for noise reduction,and then morphological features combined with the timing interval features are extracted to evaluate the classifier.For each patient,an individual and fast classifier will be trained by common and patient-specific training data.Following the recommendations of the Association for the Advancements of Medical Instrumentation(AAMI),experimental results over the MIT-BIH arrhythmia benchmark database demonstrated that our proposed method achieved the average detection accuracy of 98.22%,99.65%and 99.41%for the abnormal,ventricular ectopic beats(VEBs)and supra-VEBs(SVEBs),respectively.Besides the detection accuracy,sensitivity and specificity,our proposed method consumes the less CPU running time compared with the other representative state of the art methods.It can be ported to Android based embedded system,henceforth suitable for a wearable device.

A Systematic Approach for Making 3D-Printed Patient-Specific Implants for Craniomaxillofacial Reconstruction

Craniomaxillofacial reconstruction implants,which are extensively used in head and neck surgery,are conventionally made in standardized forms.During surgery,the implant must be bended manually to match the anatomy of the individual bones.The bending process is time-consuming,especially for inexperienced surgeons.Moreover,repetitive bending may induce undesirable internal stress concentration,resulting in fatigue under masticatory loading in v iv o and causing various complications such as implant fracture,screw loosening,and bone resorption.There have been reports on the use of patient-specific 3D-printed implants for craniomaxillofacial reconstruction,although few reports have considered implant quality.In this paper,we present a systematic approach for making 3D-printed patientspecific surgical implants for craniomaxillofacial reconstruction.The approach consists of three parts:First,an easy-to-use design module is developed using Solidworks®software,which helps surgeons to design the implants and the axillary fixtures for surgery.Design engineers can then carry out the detailed design and use finite-element modeling(FEM)to optimize the design.Second,the fabrication process is carried out in three steps:0 testing the quality of the powder;(2)setting up the appropriate process parameters and running the 3D printing process;and (3)conducting post-processing treatments(i.e.,heat and surface treatments)to ensure the quality and performance of the implant.Third,the operation begins after the final checking of the implant and sterilization.After the surgery,postoperative rehabilitation follow-up can be carried out using our patient tracking software.Following this systematic approach,we have successfully conducted a total of 41 surgical cases.3D-printed patient-specific implants have a number of advantages;in particular,their use reduces surgery time and shortens patient recovery time.Moreover,the presented approach helps to ensure implant quality.

Influence of Clip Locations on Intraaneurysmal Flow Dynamics in Patient-specific Anterior Communicating Aneurysm Models with Different Aneurysmal Angle

To improve aneurysm treatment,this study examined the influence of clip locations on hemodynamic factors in patient-specific anterior communicating artery(ACoA)aneurysms with different aneurysmal angle.We proposed a simplified classification of ACoA aneurysms using aneurysmal angle,defined by the angle of pivot of the aneurysmal dome and the virtual two-dimensional plane created by both proximal A2 segments of anterior cerebral artery(ACA).ACoA aneurysms with three different aneurysmal angles,which are 15°,80°and 120°,were analyzed in our study.In this work,we obtained hemodynamics before and after clipping surgery with three clip locations based on clinical clipping strategies in three ACoA aneurysms with different aneurysm angles.Results showed that local high pressure occurs at impingement region of the ACoA aneurysm before clipping and new impingement region close to the clipping location after clipping treatment.For clipping the aneurysm with aneurysmal angle 15°and a wide neck,wall shear stress(WSS)distribution is more uniform when the clipping angle of two clips close to 180°comparing with other two angles.In addition,for clipping the aneurysm with aneurysmal angle 80°and 120°,local high pressure appears on new impingement region and high WSS distributes around the clipping location when the clip plane is normal to the direction of inflow of aneurysm from the dominance of A1 segment of ACA.Hence,we should avoid the impingement of inflow from the A1 segment and choose a favorable clipping location for the fastness of clip.The results of our study could preoperatively give a useful information to the decision of surgical plan.

Patient-Specific QA of Spot-Scanning Proton Beams Using Radiochromic Film

Radiochromic film for spot-scanning QA provides high spatial resolution and efficiency gains from one-shot irradiation for multiple depths. However, calibration can be a tedious procedure which may limit widespread use. Moreover, since there may be an energy dependence, which manifests as a depth dependence, this may require additional measurements for each patient. We present a one-scan protocol to simplify the procedure. A calibration using an EBT3 film, exposed by a 6-level step-wedge plan on a Proteus&reg;PLUS proton system (IBA, Belgium), was performed at depths of 18, 20, 24 cm using Plastic Water&reg;(CIRS, Norfolk, VA). The calibration doses ranged from 65 - 250 cGy (RBE) (relative biological effectiveness) for proton energies of 170 - 200 MeV. A clinical prostate + nodes plan was used for validation. The planar doses at selected depths were measured with EBT3 films and analyzed using one-scan protocol (one-scan digitization of QA film and at least one film exposed to a known dose). The gamma passing rates, dose-difference maps, and profiles of 2D planar doses measured with EBT3 film and IBA MatriXX-PT, versus the RayStation TPS calculations were analyzed and compared. The EBT3 film measurement results matched well with the TPS calculation data with an average passing rate of ~95% for 2%/2 mm and slightly lower passing rates were obtained from an ion chamber array detector. We were able to demonstrate that the use of a proton step-wedge provided clinically acceptable results and minimized variations between film-scanner orientation, inter-scan, and scanning conditions. Furthermore, for relative dosimetry (calibration is not done at the time of experiment), it could be derived from no more than two films exposed to known doses (one could be zero) for rescaling the master calibration curve at each depth. The sensitivity of the calibration to depth variations has been explored. One-scan protocol results appear to be comparable to that of the ion chamber array detector. The use of a proton step-wedge for calibration of EBT3 film potentially increases efficiency in patient-specific QA of proton beams.