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External quality assurance in Malaysia

Nawawi H, Lim HH, Zakiah I

Southeast Asian J. Trop. Med. Public Health, 1999;30 Suppl 3:39-45.
PMID: 10926257

An activity supportive of the MOH QA Programme, the National EQAS for clinical chemistry monitors for analytical performance in core routine biochemical testing by the pathology laboratories, with unsatisfactory performance scores serving to alert against deficiencies or problems and the scores in subsequent challenges providing the feedback of effectiveness of remedial actions taken. While unacceptable individual analyte performance score (variance index score, VIS) indicated problems in instruments, reagent and calibrators, or the use of inherently poorer methods, repeated occurrence of unsatisfactory OMRVIS was traceable to generally poor laboratory management of usually inadequately-equipment small laboratories. The outcome has been one of slow but gradual improvement in the overall performance of participating laboratories, with a move towards methods upgrading and standardization to achieve greater concordance of results. Presently, the programme is limited to 61 government and 4 private hospital laboratories in the country for 12 commonly assayed clinical biochemistry analytes. It is hoped that the NEQAS could be extended to the other private laboratories and that of academic institutions. However, this is dependent to a large extent on the manpower and financial support obtainable by the organizing body of the programme in the future. Belk and Sunderman, 1947 demonstrated that laboratories participating in an quality assessment scheme could rapidly and dramatically improve their analytical performance. In some countries, participation has become mandatory, and acceptable performance is a requirement in laboratory accreditation. The need and value of the NEQAP is, therefore, evident. While there may be limitations in the national programme. efforts are being made at improving the programme within the means and resources of the organising body. The goals of the NEQAP are not just to monitor performance but also to educate. On this, matters related to and supportive of these goals have also been pursued. The annual workshop/forum on quality controls had allowed exchange of information between representatives of participating laboratories and the organising body. Recently in the 1997 MOH Quality Improvement evaluation, Quality Control has been evaluated together with the other 17 such activities. The study on knowledge, attitude and practice has provided the necessary feedback and will be used for future planning in making efforts at increasing the effectiveness and benefits of the all QC activities including this NEQAP for clinical chemistry. In addition, there is a need to look into areas such as selection of methods and test systems, and improvement of continuing education, training as well as research in quality improvement as suggested by the Quality Improvement evaluation.

Matched MeSH terms: Quality Assurance, Health Care/methods; Quality Assurance, Health Care/organization & administration*
Fulltext POSSUM--a model for surgical outcome audit in quality care

Ng KJ, Yii MK

Med J Malaysia, 2003 Oct;58(4):516-21.
PMID: 15190626

Comparative surgical audit to monitor quality of care should be performed with a risk-adjusted scoring system rather than using crude morbidity and mortality rates. A validated and widely applied risk adjusted scoring system, P-POSSUM (Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality) methodology, was applied to a prospective series of predominantly general surgical patients at the Sarawak General Hospital, Kuching over a six months period. The patients were grouped into four risk groups. The observed mortality rates were not significantly different from predicted rates, showing that the quality of surgical care was at par with typical western series. The simplicity and advantages of this scoring system over other auditing tools are discussed. The P-POSSUM methodology could form the basis of local comparative surgical audit for assessment and maintenance of quality care.

Matched MeSH terms: Quality Assurance, Health Care*
Cytopathology in malaysia

Jayaram G, Yahya H

Diagn Cytopathol, 2002 Nov;27(5):322-4.
PMID: 12412003
Matched MeSH terms: Quality Assurance, Health Care*
Improving diabetes care in a public hospital medical clinic: report of a completed audit cycle

Tan F, Liew SF, Chan G, Toh V, Wong SY

J Eval Clin Pract, 2011 Feb;17(1):40-4.
PMID: 20807297 DOI: 10.1111/j.1365-2753.2010.01367.x

RATIONALE, AIMS AND OBJECTIVES: To evaluate the impact of clinical audit on diabetes care provided to type 2 diabetic patients attending our hospital general medical clinics.
METHODS: Performances on diabetes-related process measures and intermediate outcome measures were evaluated through structured review of outpatient medical records. The results were fed back to the doctors and measures were implemented to improve care. The performance indicators were re-evaluated 2 years later to complete the audit cycle.
RESULTS: Annual testing rates improved for HbA1c (68.4% vs. 87.4%; P < 0.001) and lipid profile (91.8% vs. 97%; P = 0.027). Enquiry on smoking improved from 45.9% to 82.3% (P < 0.001), eye screening rates from 68.9% to 78.8% (P = 0.020) and foot examinations from 22.4% to 64.1% (P < 0.001). Prescription rates for insulin increased from 17.3% to 31.8% (P = 0.001) and statin from 83.2% to 94.4% (P < 0.001). The use of aspirin (80.6% vs. 83.8%; P =0.402) and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (92.3% vs. 88.9%; P = 0.239) remained high in both cycles. More patients achieved targets for HbA1c < 7% (38% vs. 26%; P = 0.006), blood pressure < 130/80 mmHg (43% vs. 32%; P = 0.071) and low-density lipoprotein cholesterol < 2.6 mmol/L (71% vs. 52%; P <0.001).
CONCLUSION: Clinical audit is a useful tool in improving diabetes care.
Study site: Outpatient clinic, Sarawak General Hospital, Kuching, Sarawak, Malaysia

Matched MeSH terms: Quality Assurance, Health Care/methods*
"Edge-on" MOSkin detector for stereotactic beam measurement and verification

Jong WL, Ung NM, Vannyat A, Jamalludin Z, Rosenfeld A, Wong JH

Phys Med, 2017 Jan;33:127-135.
PMID: 28089106 DOI: 10.1016/j.ejmp.2016.12.020

Dosimetry in small radiation field is challenging and complicated because of dose volume averaging and beam perturbations in a detector. We evaluated the suitability of the "Edge-on" MOSkin (MOSFET) detector in small radiation field measurement. We also tested the feasibility for dosimetric verification in stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT). "Edge-on" MOSkin detector was calibrated and the reproducibility and linearity were determined. Lateral dose profiles and output factors were measured using the "Edge-on" MOSkin detector, ionization chamber, SRS diode and EBT2 film. Dosimetric verification was carried out on two SRS and five SRT plans. In dose profile measurements, the "Edge-on" MOSkin measurements concurred with EBT2 film measurements. It showed full width at half maximum of the dose profile with average difference of 0.11mm and penumbral width with difference of ±0.2mm for all SRS cones as compared to EBT2 film measurement. For output factor measurements, a 1.1% difference was observed between the "Edge-on" MOSkin detector and EBT2 film for 4mm SRS cone. The "Edge-on" MOSkin detector provided reproducible measurements for dose verification in real-time. The measured doses concurred with the calculated dose for SRS (within 1%) and SRT (within 3%). A set of output correction factors for the "Edge-on" MOSkin detector for small radiation fields were derived from EBT2 film measurement and presented. This study showed that the "Edge-on" MOSkin detector is a suitable tool for dose verification in small radiation field.

Matched MeSH terms: Quality Assurance, Health Care
Fulltext Quality assurance in mammography: College of Radiology Survey in Malaysia

Ho EL, Ng KH, Wong JH, Wang HB

Med J Malaysia, 2006 Jun;61(2):204-8.
PMID: 16898312

Malaysia's mammography QA practice was surveyed based on the Malaysian Ministry of Health and the American College of Radiology (ACR) requirements. Data on mammography unit, processor, image receptor, exposure factors, mean glandular dose (MGD), sensitometry, image quality and viewbox luminance were obtained. Mean developer temperature and cycle time were 34.1 +/- 1.8degreesC and 107.7 +/- 33.2 seconds. Mean base+fog level, speed index and contrast index were 0.20+/-0.01, 1.20+/-0.01 and 1.33+/-0.26 respectively. Eighty-six percent of the fifty centres passed the image quality test while 12.5% complied with ACR recommended viewbox luminance. Average MGD was 1.0+/-0.4 mGy. Malaysia is on the right track for QA but with room for total quality improvement.

Matched MeSH terms: Quality Assurance, Health Care*
Fulltext An audit of the quality of lateral cephalometric radiographs for orthodontic treatment

Mohd Zambri Mohamed Makhbul, Rashidah Burhanudin, Wan Nurazreena Wan Hassan

Malaysian Dental Journal, 2016;39(1):35-51.
MyJurnal

It is not uncommon for lateral cephalometric radiographs to be outsourced for orthodontic treatment, as not all orthodontic clinics in Malaysia have their own cephalometric radiograph machine. Since the quality of outsourced radiographs is not within the governance of the clinician, there is a need to monitor the quality of cephalometric radiographs received. Aim: To audit the quality of lateral cephalometric radiographs received at the Orthodontic Specialist Unit, Klinik Pergigian Cahaya Suria, Kuala Lumpur, Malaysia. Methodology: Lateral cephalometric records of patients with registration numbers up to 200 in 2015 were selected and assessed using a light box. The quality of good radiographs were based on 15 parameters: correct head position; presence of the scale; important structures centered on the film; patient’s name; date taken; patient’s identifier; label not obscuring radiograph; soft tissue visible; teeth in occlusion; good contrast; ‘A’ point identifiable; ‘B’ point identifiable; nasion identifiable; sella identifiable; incisors visible and their angulation measureable. Standard was set at 100%, as radiographs received should contain all parameters. Results: Five records were excluded (2 had no radiographs, 2 had digital radiographs, and 1 record could not be traced). 64.5% radiographs had all 15 parameters, 30.3%, 3.9% and 1.3% with 14, 13 and 12 parameters, respectively. Patient’s name, identifier, date taken, soft tissue visible, ‘B’ point identifiable, nasion identifiable were present in all radiographs (100%). Incisor visible and their angulation measurable were present in 99%; good contrast and ‘A’ point identifiable in 98%; presence of scale, important structures centred on films and sella identifiable in 97%, label not obscuring radiographs in 96%; correct head position in 86%; and teeth in occlusion in 88% of radiographs. Conclusion: There is a need to liaise with the radiology unit to improve the quality of radiographs taken.

Matched MeSH terms: Quality Assurance, Health Care
Fulltext A standardised model for stool banking for faecal microbiota transplantation: a consensus report from a multidisciplinary UEG working group

Keller JJ, Ooijevaar RE, Hvas CL, Terveer EM, Lieberknecht SC, Högenauer C, et al.

United European Gastroenterol J, 2021 Mar;9(2):229-247.
PMID: 33151137 DOI: 10.1177/2050640620967898

BACKGROUND: Faecal microbiota transplantation is an emerging therapeutic option, particularly for the treatment of recurrent Clostridioides difficile infection. Stool banks that organise recruitment and screening of faeces donors are being embedded within the regulatory frameworks described in the European Union Tissue and Cells Directive and the technical guide to the quality and safety of tissue and cells for human application, published by the European Council.
OBJECTIVE: Several European and international consensus statements concerning faecal microbiota transplantation have been issued. While these documents provide overall guidance, we aim to provide a detailed description of all processes that relate to the collection, handling and clinical application of human donor stool in this document.
METHODS: Collaborative subgroups of experts on stool banking drafted concepts for all domains pertaining to stool banking. During a working group meeting in the United European Gastroenterology Week 2019 in Barcelona, these concepts were discussed and finalised to be included in our overall guidance document about faecal microbiota transplantation.
RESULTS: A guidance document for all domains pertaining to stool banking was created. This document includes standard operating manuals for several processes involved with stool banking, such as handling of donor material, storage and donor screening.
CONCLUSION: The implementation of faecal microbiota transplantation by stool banks in concordance with our guidance document will enable quality assurance and guarantee the availability of donor faeces preparations for patients.

Matched MeSH terms: Quality Assurance, Health Care
Fulltext Audit of diabetes mellitus in general practice

Lee TW, Chan SC, Chua WT, Harbinder K, Khoo YL, Ow Yeang YL, et al.

Med J Malaysia, 2004 Aug;59(3):317-22.
PMID: 15727376 MyJurnal

An audit on diabetic management was done in seven Perak general practice (GP) clinics in December 2001. The results showed inadequacies in nine out of eleven criteria assessed. Remedial measures were implemented. A second audit in March 2003, at the completion of the audit cycle, showed improvements in all the criteria used. All clinics established a diabetic register compared to 28.6% in the first audit and 57.1% of the clinics set up a reminder mechanism compared to 0% in the first audit. In the process of care, recording of weight, height, blood pressure; feet examination, fundoscopy, blood sugar monitoring and urine for albumin improved at the end of the audit cycle. In the only outcome criteria, the blood sugar control improved from 21.8% to 31.3%.

Matched MeSH terms: Quality Assurance, Health Care
An evaluation framework for Health Information Systems: human, organization and technology-fit factors (HOT-fit)

Yusof MM, Kuljis J, Papazafeiropoulou A, Stergioulas LK

Int J Med Inform, 2008 Jun;77(6):386-98.
PMID: 17964851

The realization of Health Information Systems (HIS) requires rigorous evaluation that addresses technology, human and organization issues. Our review indicates that current evaluation methods evaluate different aspects of HIS and they can be improved upon. A new evaluation framework, human, organization and technology-fit (HOT-fit) was developed after having conducted a critical appraisal of the findings of existing HIS evaluation studies. HOT-fit builds on previous models of IS evaluation--in particular, the IS Success Model and the IT-Organization Fit Model. This paper introduces the new framework for HIS evaluation that incorporates comprehensive dimensions and measures of HIS and provides a technological, human and organizational fit.

Matched MeSH terms: Quality Assurance, Health Care/methods*; Quality Assurance, Health Care/organization & administration*
Cross-calibration, Least Significant Change and Quality Assurance in Multiple Dual-Energy X-ray Absorptiometry Scanner Environments: 2019 ISCD Official Position

Jankowski LG, Warner S, Gaither K, Lenchik L, Fan B, Lu Y, et al.

J Clin Densitom, 2019 09 07;22(4):472-483.
PMID: 31558404 DOI: 10.1016/j.jocd.2019.09.001

In preparation for the International Society for Clinical Densitometry Position Development Conference (PDC) 2019 in Kuala Lumpur, Malaysia, a cross-calibration and precision task force was assembled and tasked to review the literature, summarize the findings, and generate positions to answer 4 related questions provided by the PDC Steering Committee, which expand upon the current ISCD official positions on these subjects. (1) How should a provider with multiple dual-energy X-ray absorptiometry (DXA) scanners of the same make and model calculate least significant change (LSC)? (2) How should a provider with multiple DXA systems with the same manufacturer but different models calculate LSC? (3) How should a provider with multiple DXA systems from different manufacturers and models calculate LSC? (4) Are there specific phantom procedures that one can use to provide trustworthy in vitro cross calibration for same models, different models, and different makes? Based on task force deliberations and the resulting systematic literature reviews, 3 new positions were developed to address these more complex scenarios not addressed by current official positions on single scanner cross calibration and LSC. These new positions provide appropriate guidance to large multiple DXA scanner providers wishing to offer patients flexibility and convenience, and clearly define good clinical practice requirements to that end.

Matched MeSH terms: Quality Assurance, Health Care*
Fulltext Effect of Calcium Channel Blockers on Lower Urinary Tract Symptoms: A Systematic Review

Salman M, Khan AH, Syed Sulaiman SA, Khan JH, Hussain K, Shehzadi N

Biomed Res Int, 2017;2017:4269875.
PMID: 29124064 DOI: 10.1155/2017/4269875

Background: Numerous medications are known to be associated with the development of lower urinary tract symptoms (LUTS). One such medication group is calcium channel blockers (CCB).
Objective: To critically examine the literature regarding the involvement of CCB in manifestation of LUTS in humans.
Methods: A systematic literature search was conducted on PubMed, SciELO, Scopus, and OpenGrey databases to find all potentially relevant research studies before August 2016.
Results: Five studies met the inclusion criteria and were included in this review. Three out of five studies stated that CCB were involved in either precipitation or exacerbation of LUTS. As for the remaining two studies, one study found out that only the monotherapy of CCB was associated with increased prevalence of nocturia and voiding symptoms in young females, whereas the other study reported an inverse association of CCB with LUTS. The methodological quality of studies was considered high for four studies and low for one study.
Conclusion: Healthcare providers should make efforts for an earlier identification of the individuals at risk of LUTS prior to the commencement of CCB therapy. Moreover, patients should be counselled to notify their healthcare provider if they notice urinary symptoms after the initiation of CCB.

Matched MeSH terms: Quality Assurance, Health Care
Fulltext Quality in health care

Sahan AK

Med J Malaysia, 1986 Dec;41(4):284-6.
PMID: 3670148
Matched MeSH terms: Quality Assurance, Health Care
Fulltext Building capacity for evidence generation, synthesis and implementation to improve the care of mothers and babies in South East Asia: methods and design of the SEA-ORCHID Project using a logical framework approach

McDonald S, Turner T, Chamberlain C, Lumbiganon P, Thinkhamrop J, Festin MR, et al.

BMC Med Res Methodol, 2010;10:61.
PMID: 20594325 DOI: 10.1186/1471-2288-10-61

Rates of maternal and perinatal mortality remain high in developing countries despite the existence of effective interventions. Efforts to strengthen evidence-based approaches to improve health in these settings are partly hindered by restricted access to the best available evidence, limited training in evidence-based practice and concerns about the relevance of existing evidence. South East Asia--Optimising Reproductive and Child Health in Developing Countries (SEA-ORCHID) was a five-year project that aimed to determine whether a multifaceted intervention designed to strengthen the capacity for research synthesis, evidence-based care and knowledge implementation improved clinical practice and led to better health outcomes for mothers and babies. This paper describes the development and design of the SEA-ORCHID intervention plan using a logical framework approach.

Matched MeSH terms: Quality Assurance, Health Care*
Fulltext Optimising reproductive and child health outcomes by building evidence-based research and practice in South East Asia (SEA-ORCHID): study protocol

Henderson-Smart DJ, Lumbiganon P, Festin MR, Ho JJ, Mohammad H, McDonald SJ, et al.

BMC Med Res Methodol, 2007;7:43.
PMID: 17892586

Disorders related to pregnancy and childbirth are a major health issue in South East Asia. They represent one of the biggest health risk differentials between the developed and developing world. Our broad research question is: Can the health of mothers and babies in Thailand, Indonesia, the Philippines and Malaysia be improved by increasing the local capacity for the synthesis of research, implementation of effective interventions, and identification of gaps in knowledge needing further research?

Matched MeSH terms: Quality Assurance, Health Care*
Protecting children from violence and maltreatment: a qualitative comparative analysis assessing the implementation of U.N. CRC Article 19

Svevo-Cianci KA, Hart SN, Rubinson C

Child Abuse Negl, 2010 Jan;34(1):45-56.
PMID: 20060588 DOI: 10.1016/j.chiabu.2009.09.010

(1) To identify which United Nations Convention on the Rights of the Child (CRC) recommended child protection (CP) measures, such as policy, reporting systems, and services for child abuse and neglect (CAN) victims, individually or in combination, were most important in establishing a basic level of child protection in 42 countries; and (2) to assess whether these measures were necessary or sufficient to achieve basic child protection in developing and industrialized countries.

Matched MeSH terms: Quality Assurance, Health Care
Comparison of the effectiveness of trauma services provided by secondary and tertiary hospitals in Malaysia

Sethi D, Aljunid S, Saperi SB, Clemens F, Hardy P, Elbourne D, et al.

Ann Emerg Med, 2007 Jan;49(1):52-61, 61.e1.
PMID: 17084938

STUDY OBJECTIVE: The trauma services provided by 6 hospitals operating at 2 levels of care (4 secondary or district general hospitals and 2 tertiary care hospitals) in Malaysia are compared in terms of mortality and disability for direct admissions to emergency departments to test the hypothesis that care at a tertiary care hospital is better than at a district general hospital.
METHODS: All cases were recruited prospectively for 1 year. The hospitals were purposefully selected as typical for Malaysia. There are 3 primary outcome measures: death, musculoskeletal impairment, and disability at discharge. Adjustment was made for potential covariates and within-hospital clustering by using multivariable random-effects logistic regression analysis.
RESULTS: For direct admissions, logistic-regression-identified odds of dying were associated with older age (>55 years), odds ratio (OR) 1.9 (95% confidence interval [CI] 1.3 to 2.8); head injury, OR 2.7 (95% CI 1.9 to 3.9); arrival by means other than ambulance, OR 0.6 (95% CI 0.4 to 0.8); severe injuries (Injury Severity Score >15) at a district general hospital, OR 45.2 (95% CI 27.0 to 75.7); severe injuries at a tertiary care hospital, OR 11.2 (95% CI 7.3 to 17.3); and admission to a tertiary care hospital compared to a district general hospital if severely injured (Injury Severity Score >15), OR 0.2 (95% CI 0.1 to 0.4). Admission to a tertiary care hospital was associated with increased odds of disability (OR 1.9; 95% CI 1.5 to 2.3) and musculoskeletal impairment (OR 3.5; 95% CI 2.7 to 4.4) at discharge.
CONCLUSION: Care at a tertiary care hospital was associated with reduced mortality (by 83% in severe injuries), but with a higher likelihood of disability and impairment, which has implications for improving access to trauma services for the severely injured in Malaysia and other low- and middle-income settings.

Matched MeSH terms: Quality Assurance, Health Care*
Fulltext Quality in family practice

Rajakumar MK

Asia Pac Fam Med, 2002;1(2&3):74-8.

Quality programs are difficult to implement where social support for healthcare costs are inadequate and there is no institutional support for quality programs to guide and assist the doctor in pratice. ‘Quality’ is not the good intention to do better, but the process of measurement of behavioral change against set targets. For the majority of the doctors of this region who practice under great constraints, this article outlines some quality activities that are entirely within their personal initiative and responsibility, but should make a real difference to the quality of care provided.nd responsibility, but should make a real difference to the quality of care you provide.
Republished in: Republished in: Teng CL, Khoo EM, Ng CJ (editors). Family Medicine, Healthcare and Society: Essays by Dr M K Rajakumar, Second Edition. Kuala Lumpur: Academy of Family Physicians of Malaysia, 2019: 68-74

Matched MeSH terms: Quality Assurance, Health Care
Reducing maternal mortality: can we derive policy guidance from developing country experiences?

Liljestrand J, Pathmanathan I

J Public Health Policy, 2004;25(3-4):299-314.
PMID: 15683067 DOI: 10.1057/palgrave.jphp.3190030

Developing countries are floundering in their efforts to meet the Millennium Development Goal of reducing maternal mortality by 75% by 2015. Two issues are being debated. Is it doable within this time frame? And is it affordable? Malaysia and Sri Lanka have in the past 50 years repeatedly halved their maternal mortality ratio (MMR) every 7-10 years to reduce MMR from over 500 to below 50. Experience from four other developing countries--Bolivia, Yunan in China, Egypt, and Jamaica-confirms that each was able to halve MMR in less than 10 years beginning from levels of 200-300. Malaysia and Sri Lanka, invested modestly (but wisely)--less than 0.4% of GDP--on maternal health throughout the period of decline, although the large majority of women depended on publicly funded maternal health care. Analysis of their experience suggests that provision of access to and removal of barriers for the use of skilled birth attendance has been the key. This included professionalization of midwifery and phasing out of traditional birth attendants; monitoring births and maternal deaths and use of such information for high profile advocacy on the importance of reducing maternal death; and addressing critical gaps in the health system; and reducing disparities between different groups through special attention to the poor and disadvantaged populations.

Matched MeSH terms: Quality Assurance, Health Care/legislation & jurisprudence
The characteristics of Fuji IP Cassette Type PII and application for radiation oncology quality assurance tests and portal imaging

Soh HS, Ung NM, Ng KH

Australas Phys Eng Sci Med, 2008 Jun;31(2):146-50.
PMID: 18697706

The advancement of digital imaging has prompted more medical institutions to go filmless. The computed radiography (CR) system is becoming an important tool not only in diagnostic imaging, but also in radiation oncology. A new CR system that was specially designed for the use in radiation oncology, Fuji IP cassette type PII has been introduced to the market in the middle of year 2006. This project aimed to study some basic physical characteristics of this new type of cassette and explore its application for performing quality assurance (QA) tests and portal imaging in radiotherapy. All the images were read by FCR 5000 Plus reader. The image was found to reach its saturation value of 1023 (due to the image was stored in 10 bits data) by depending on the sensitivity value being adjusted. The uniformity test gave the result of 0.12%. The cassette was used to perform the QA tests which were previously performed using film. All the results met the specification as stated in AAPM Task Group 40. The comparison for the portal images of PortalVision contrast-detail phantom showed that the spatial resolution of the images obtained by CR system (Fujifilm Co., Ltd., Tokyo, Japan) were better than the EPID (Varian Medical Systems, Inc., Palo Alto, USA) and film system (Eastman Kodak Co., New York, USA). The IP cassette type PII was found to be suitable as an alternative QA test tool and portal imaging in radiotherapy.

Matched MeSH terms: Quality Assurance, Health Care*

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