Study on the established customized limits for the daily quality assurance procedure.

Since there are no corresponding specification limits for some new daily quality assurance (QA) items in the TG-142, it is a compromise that the specification limits used in the monthly or annual QA procedures are used for the daily QA procedure in work. But there is no basis for whether this is feasible. The purpose of this article is to analyze QA results using SPC to determine the tolerance limits at our institution, and to present the usefulness of the analysis method using SPC. The data of three groups daily QA processes performed with Daily QA3 in three years were analyzed using statistical process control (SPC). For calculating capability indices (Cp, Cpk, Cpm and Cpmk) of processes, the appropriate number of calculation points was analyzed firstly. Then, in calculating the capability indices for output, limits ±3% of the daily QA in the TG-142 were used as the specification limit, while for flatness and symmetry, an annual QA limits of ±1% was used. For putting forward measures to solve the problem, customized tolerance and action limits were established for each process. And the process control charts calculated using data measured by the five therapists and a medical physicist were compared. At least six to eight weeks of control daily check data points (i.e. 30-40 points) should be used for calculating the individuals and moving range (I-MR) control chart to ensure the stability of control lines. Process capability indices of output were all ≥1, some were up to 3-4. While for symmetry, some processes failed to meet the requirements that capability indices were < 1. For different processes of the same daily QA items, the calculated customized limits were quite different. The range of upper control line (UCL) and lower control line (LCL) was smaller for output and the CL was closer to the target value of 0 for flatness and symmetry in the I-MR control chart calculated using data measured by one staff. For different quality control processes without management by the SPC method at our institution, calculated tolerance and action limits of the same measurement item were quite different. And in most measurement items, the specification limits used in the monthly or annual QA procedures in the TG-142 are not suitable to the daily QA procedure. So the analysis method using SPC is useful and necessary.