Jaminan Kualitas

Penggunaan Kamera
Gamma SPECT
Definisi Jaminan Kualitas
(Quality assurance)
Quality Assurance terfokus pada pemberian
jaminan/keyakinan bahwa persyaratan mutu akan
dipenuhi (ISO 9000:2000 (QMS-Fundamentals and
Vocabulary).
Quality Assurance adalah suatu proses pengukuran mutu,
menganalisis kekurangan yang telah ditemukan lalu
membuat rencana atau kegiatan untuk meningkatkan
mutu diikuti dengan penilaian apakah sudah mengalami
peningkatan atau belum. QA menggunakan standar
pengukuran dalam melakukan setiap kegiatannya. (
palmer, H, 1983 )
 Quality assurance (QA) is a way of preventing
mistakes or failure in products.
 QA is a process-focussed concept. It is a
systematic process implemented within a quality
system
QA in nuclear medicine
QA in nuclear medicine should cover all aspects of clinical
practice. Specifically,:
 QC is necessary in the submission of requests for
procedures;
 the preparation and dispensing of radiopharmaceuticals;
 the protection of patients, staff and the general public
against radiation hazards and accidents caused by faulty
equipment;
 the scheduling of patients;
 the setting-up, use and maintenance of electronic
instruments;
 the methodology of the actual procedures;
 the analysis and interpretation of data;
 the reporting of results and, finally, the keeping of records

IAEA-TECDOC-
602. Vienna: IAEA; 1991.
 QA (Jaminan mutu) dalam kedokteran nuklir
mengacu pada semua aspek dalam
servis/pelayanan kedokeran nuklir.

Penjadwalan Preventive
Pasien Maintenance

Proteksi radiasi
Preparasi Radiofarmaka Pasien, Pekerja,

Dispensing

Quality Control
QA dan Masyarakat
Umum
Perawatan
Instrumen
Dokumentasi Standar Prosedur

Faktor Lain
Parameters that can affect the proper
functioning of the instrument are:

 »» Availability of space (sufficient space for the

instrument, for the clinical practice and for QC
and maintenance procedures)
 »» Electrical power supplies (which must follow
instrument specifications regarding voltage and
frequency)
 »» Temperature, humidity and air pollution (stable
temperature and slow temperature gradients, low
humidity and clear air)
 »» Background radiation levels (location of the hot
cell, the storage and movement of radioactive
materials, and the movement of patients)
Maintenance of instruments is
divided into two categories

 »» Preventive maintenance: a fundamental,

routine and planned maintenance activity to
keep equipment in operating status and to avoid
unplanned maintenance activity.
 »» Corrective maintenance: a set of activities to
detect and rectify a defect so that the
equipment is returned to its normal state.
Documentations
Record keeping may include (depending on the equipment):
 »» Instrument condition (physical, mechanical and
electronic)
 »» All calibration records
 »» QC results
 »» Instrument maintenance records

The record keeping can be used to:

 »» Monitor compliance with QC procedures
 »» Educate employees
 »» Help prevent instrument breakdowns
 »» Evaluate service personnel
 »» Help ensure reliable patient results
Example of a
flowchart for a QC
programme
Definisi QC

 Quality Control (kendali mutu) adalah kegiatan

yang dilakukan sebagai upaya dalam
pengendalian mutu.
 QC adalah teknik atau aktivitas operasional yang
digunakan untuk memenuhi persyaratan kualitas.
 Tujuan: memberikan kepuasan kepada kepada
pelanggan dengan cara memeriksa hasil produsi,
memonitor, dan meninai produk yang bermutu.
Quality assurance versus
quality control
QC Kedokteran Nuklir
 Instrument QC
1. Diagnostic Imaging Equipment:
- Gamma Cameras
- PET/CT Scanner
2. Non Imaging Systems
- Dose calibrator
- Survey Meters
- Gamma Probe
- Cyclotron

 Non Instrument QC
- Radiofarmaka oleh radiofarmasis
 Instrumen QC
 Tc99m point source (syringe 1-2
ml volume 0.1- 0.5 ml, 400-800
uCi)
 Planar Flood source Co-57
 4 quadrant bar phantom
 Jaszczak phantom OK

 COR holder phantom

X

4 quadrant bar
Planar Source 57-Co phantom
Daily QC Gamma
Camera
 Daily QC adalah pengecekan yang dilakukan setiap hari
untuk menyatakan kesiapan alat kamera gamma
(Mandatory)
DAILY QC gamma camera:
 energy window
 Visual Inspection
 Background level dan kontamisi
 uniformity
 Daily QC gamma camera

Energy Window
 Daily operational checks of energy
window settings should be performed to 20%
confirm that all preset pulse height
analyser energy windows are properly
centred around the energy photopeaks
of the radionuclides to be used with the
scintillation camera for clinical imaging
purposes, thus suggesting correct energy
calibration of the system
- Tc99m 140 Kev
- Co57 122 Kev
- Symmetric Energy Window 20%
asymmetric high image

Asymmetric low image

symmetric energy window

Daily QC gamma camera

 Visual Inspection: melihat

kondisi fisik, lekukan, retakan,
noda, oli mekanik
 Background level dan
kontamisi: pengecekan ini
dilakukan untuk mengevaluasi
adanya paparan tambahan
atau kontaminasi pada
detector atau pada tempat
lain yang mempengaruhi
uptake pada detector.
DAILY QC gamma
camera

Uniformity
 Uniformity  kemampuan gamma camera dalam
menghasilkan sebuah gambaran yang seragam saat
terpapar sumber yang homogen
Intrinsic (point Source)
Extrinsic (Planar source)
Daily QC gamma camera

Uniformity
Persiapan
 Tc99m point source, 400-800 uCi (Intrinsic)
 10-15 mCi of 57-Co (Extrinsic)
 Plastik penutup detector
 Uptake > 10 Million Counts -/5+ min (Intrinsic)
 Uptake > 10 Million Counts 10-20 min (Extrinsic)
Intrinsic dan Extrinsic
Uniformity
Tc99m Point
Source

Planar Source
> 5x FOV
57-Co

Gamma
Camera

> 10 Million Counts

10-20 min.
Gamma
Camera

> 10 Million Counts, -/+ 5 min.

- >10 million counts
- Paek 140 Kev (Tc99m), 122 Kev (Co-57) 20% Symmetric energy
window
- Useful field of view (UFOV)  area of detector used for imaging
- Central field of view (CFOV) is 70% of the UFOV.
- Integral Uniformity
Contoh Uniformity dengan variasi energy window widht

20%
WEEKLY QC Gamma
camera
Spatial Resolution dan Linearity
• Spatial resolution  Kemampuan gamma
camera untuk membedakan dua objek yang
berdekatan
• Linearity check  untuk mengecek pola garis
pada bar pattern, melihat ada tidaknya
gelombang pada bar pattern.
Intrinsic (point Source)
Extrinsic (Planar source)

Planar Source 57-Co

WEEKLY QC Gamma
camera
Spatial Resolution dan Linearity
Persiapan
 Tc99m point source, 400-800 uCi (Intrinsic)
 10-15 mCi of 57-Co (Extrinsic)
 4 quadrant bar phantom
 Plastik penutup detector
 Uptake > 10 Million Counts -/5+ min (Intrinsic)
 Uptake > 10 Million Counts 10-20 min (Extrinsic)
WEEKLY QC Gamma
camera
Point Source
400-800 uCi

Planar Source
10-15 mCi of 57- 4 quadrant bar
Co phantom

Gamma > 10 Million Counts Gamma

Camera 10-20 min. Camera
 WEEKLY QC Gamma
camera
Spatial Resolution dan Linearity

wavy
Monthly QC gamma
camera
Center Of Rotation (COR)
 Digunakan untuk mengoreksi gambar
 Harus mengikuti rekomendasi pabrik terkait aktivitas
dan penempatan sumber saat calibrasi. Wajib
mengikuti manual alat!
 Dilakukan setiap bulan atau sesuai petunjuk
pabrikan.
Center Of Rotation (COR)
- Syringe 1 cc, aktivitas 400-800 uCi
- Volume kurang dari 0.1 cc
 Monthly | QC gamma
camera
Center Of Rotation (COR)

X Error range: < 4.5 mm

Y Error range: < 4.5 mm
Mean + 2 mm
QC SPECT (Jaszczak
phantom)

SPECT
Material

 Jaszczak phantom
 10 to 20 mCi Tc99m
 Plastik
 Syringe
 Gloves
 Fiksasi
 aquades
Preparation

 Isi phantom 2/3 volume dengan aquades

 Masukan tc99m 10-20mCi
 Goyang phantom hingga merata
 Isi hingga penuh
 Pastikan tidak ada gelembung udara
Positioning
Posisikan detector papa posisi 180derajat
Pastikan phantom sejajar, dan berada dipertengahan kolimator
Atur ketinggian meja hingga phantom pada pertengahan collimator
Fiksasi phantom
Atur kolimator sedekat mungkin dengan phantom
Putar detector, cek putaran detector
Acquisition

 Series Name: XXXXX test

 Activity (mCi) : 10 mCi
 Matrix Size: 128 x128 (default)
 Radius of Rotation
 Orbit: Step and Shoot or Continuous (Step and
Shoot is the default)
 Orbit Shape: Circular or Non-Circular (Circular is
recommended)
 Acquisition Zoom: 1.45 (default)
 Time/View:
Processing
SPECT Phantom Analysis