Evaluation of the Impact of Refined Quality Control Management Model on the Qualified Rate of Disinfection and Sterilization of Surgical Instruments in the Sterilization Supply Center

Objective:To evaluate the application value of a refined quality control management model for a sterilization supply center.Methods:A retrospective analysis was conducted on the work situation of the sterilization supply center from January 2021 to January 2023.The work situation before January 31,2022,was classified as the control group;a routine quality control management model was implemented,and the work situation after January 31,2022,was classified as the observation group.The quality of medical device management and department satisfaction between the two groups were compared.Results:The timely recovery and supply rate,classification and cleaning pass rate,disinfection pass rate,packaging pass rate,sterilization pass rate,and department satisfaction score in the observation group were all higher than those of the control group(P<0.05).Conclusion:Implementing a refined quality control management model in the sterilization supply center can improve the quality management level of medical devices and department satisfaction and is worthy of promotion.

Assessment of Monitor Units and Gamma Pass Rate for 6 MV and Flattening Filter Free (FFF) Beams in Volumetric Modulated Arc Therapy (VMAT)

Background: In linear accelerators, the treatment field’s uniform intensity is achieved by including a flattening filter in the beam. However, to produce more conformal dose distributions, contemporary radiotherapy practice now frequently uses fluence and aperture modifying techniques, such as volumetric modulated arc therapy. In these circumstances, the flattening filter in the beam manufacturing process is no longer required. It is therefore necessary to compare the monitor units of 6 MV and flattening filter free plans and how it influences the gamma pass rates to determine which is best for treating cervical cancer with pelvic lymph node metastasis. Methods: VMAT plans for fifteen patients with cervical cancer with pathological pelvic lymph node metastasis were included in this study. Each patient had two VMAT plans using conventional 6 MV beam with flattening filter and one with flattening filter free beam (FFF). The VMAT plans were made using two arcs, and then recalculated to give the planned dose distribution to the detectors in a Delta4 phantom. The VMAT plans were irradiated on the Delta4 phantom using an Elekta linear accelerator (6 MV). Results: The mean monitor unit for the 6 MV plans was 506.3 MU and a standard deviation of 48.6 while that of the FFF plans had a mean MU of 701.5 with a standard deviation of 87.6. The total monitor units (MUs) for the FFF plans were significantly greater than the 6 MV plans (p = 6.1 × 10-5). Conclusion: Flattening filter free (FFF) plans require more numbers of monitor units in comparison to conventional 6 MV filtered beams for external radiation of cervical cancer with pelvic lymph nodes involvement.

器械清洗预处理与清洗消毒合格率的关系研究

目的探讨复用医疗器械清洗前预处理对清洗效果的影响。方法选取2019年12月我院消毒供应室回收的1600件止血钳,根据使用时间先后随机分为对照组和实验组,每组800件。对照组按照常规流程清洗,实验组使用含酶保湿剂预处理后清洗,比较两种方法的清洗效果。结果使用含酶保湿剂预处理后器械清洗效果显著提高,实验组器械表面蛋白残留阳性率(3.8%)显著低于对照组(11.3%),差异有统计学意义(p<0.05);实验组器械表面隐血合格率显著高于对照组,差异有统计学意义(p<0.05);但器械表面细菌菌落数无明显改变(p>0.05)。在此基础上,进一步对两组器械进行常规消毒灭菌后,发现使用含酶保湿剂预处理的实验组蛋白残留阳性率率(0.3%)低于对照组(1.8%),实验组器械表面隐血合格率(98.9%)显著高于对照组(93.6%),但两组均未见细菌残留。结论对复用医疗器械进行合理的预处理能够有效提高器械清洗合格率,预处理需要长效保湿及酶剂的协同作用,方能有效提高预处理效率。含酶保湿剂不具备杀菌作用,需要进一步加强复用器械清洗后的消毒、灭菌措施,以提高细菌菌落合格率,保证器械消毒灭菌效果。

A preliminary study of a new high-resolution detector matrix applied to three-dimensional dose verification in intensity-modulated radiotherapy

Objective:To test the basic dosimetry characteristics of a new high-resolution matrix and to perform a preliminary study on the three-dimensional(3D)dose verification of intensity-modulated treatment(IMRT).Methods:The dosimetry characteristics of the new matrix were investigated,including repeatability,dose-rate response,and dose linearity.Twenty cases of nasopharyngeal carcinoma(NPC)and 20 cases with lung cancer were randomly selected for IMRT plans,and the novel matrix was employed for 3D dose verification.The measured results were evaluated using the gamma passing rate(GPR)and dose volume histogram(DVH).The action limit(AL)and tolerance limit(TL)of the target volume and each organ at risk(OAR)were calculated with reference to the American Association of Physicists in Medicine(AAPM)TG218 report.Results:The matrix performed well for all dosimetry characteristic tests,with a deviation of<1%.The average GPRs of the body were(99.32±0.32)%,(98.36±0.59)%,and(96.27±1.20)%for NPC,and(99.17±0.74)%,(98.09±1.33)%,and(95.83±2.22)%for lung cancer at the gamma standards of 3%/3 mm,3%/2 mm,and 2%/2 mm.The average GPRs difference between the head-neck and thorax-abdomen plans were<1%for the same gamma standard.For both the target volumes and OARs,the average GPRs were>90%under the relatively strict standard of 2%/2 mm.The DVH showed that the measurement results of D_(98) and D_(95) for the target volumes were slightly lower and D_(2) were higher than those of treatment planning system(TPS)(P<0.01).In addition,with the same standard,there may be significant differences in the values of AL and TL between different structures for target volumes and OARs,especially small-volume OARs such as the chiasma and optic nerve-L.Conclusions:The new matrix showed good dosimetry characteristics and can be effectively applied to the treatment planning dose verification of the head-neck and lung cancer.Further research is needed to establish how to analyze the GPR and DVH of the target volume and OARs,and to determine more precise dose verification standards combined with the parameters of AL and TL to better guide 3D dose verification in clinic.