Research Articles Base: Quality Assurance Essays

A GUIDE FOR IMPLEMENTING QUALITY ASSURANCE

A GUIDE FOR IMPLEMENTING QUALITY ASSURANCE SYSTEMS: A LESSON FROM THE CLOTHING INDUSTRY   Background of the Firm The firm is a major player in the clothing industry with strong market base n offering superior value for casual wear for both men and women. Although years of experience mark the firm as one of the leaders, competition is becoming more and more intensive with the entry of global manufacturers.  As the firm is only operating primarily in a certain region, it must rely on the skills and expertise of its designers in the aspect of innovation and effective publicity to the public as well as its merchandising information system to sustain competitiveness.  Further, corporate resources related in patter-making, launching studio, quality standards and outsourcing of raw materials must receive high priority.  With the vertical integration the firm enjoys, the key area of cost-effective product development and quality assurance are almost settled.    However, its competitive shield is currently infiltrated by major customer (i.e. distributor) demanding stricter quality standards through provision and adherence to integrated quality assurance system.  Although the firm adopts certain quality standards, it is isolated to a particular division and also fragmented in which other departments tend to lack quality checks (i.e. sales).  The firm follows the principles of transnational strategy where regional efficiency and local responsiveness are critical to success.  As a result, an integrated system is necessary not only to maintain the loyalty of the major customer but also to align every department towards a single and comprehensive quality path for stronger effort towards sustaining competitive edge.    A simple glimpse to the high-end Asian apparel industry is noteworthy caters its products/ services (see Figure 1).  Scale advantages is low because there are several niche market to exploit while the need for differentiation is the driving force of intense competition.  Capital requirement is high to remain competitive and be a leader because attracting the market requires advertising, R&D and customization costs.  Switching costs are also high because expensive products tend to reflect the status and lifestyle of the customer.  Access to distribution is very important as online shopping is not yet matured while government policy is low due to elimination of textile quotas within regional (i.e. ASEAN) and global (i.e. WTO) members where dumping is yet to be strictly policed.    Bargaining power of suppliers is low as Asia (i.e. China) is considered an efficient location for cheap materials and labor.  Bargaining power of customers is high because there is only limited high-end market in Asia unlike Europe or America.  Although imitated products are abundant, their impact to high-end customers is minimal.  Due to the entry of Western manufacturers, the industry will also have heightened intensity of competition.  This is aggravated by equally balanced competitors within the high-end sector, slow growth of high-end market, high fixed costs that players must recoup, high differentiation, high strategic stakes on Asian market and existence of high exit barriers from substantial investments to assure market loyalty, maintaining vertically-integrated operation and marketing costs.  In this view, the industry is attractive to potential and current players but the importance of continuous quality assurance is highlighted by the importance of being competitive and limited market base.   Assurance System of the Clothing Firm The methods of Deming are focused on minimizing variability from departing to quality standards.  His plan-do-check-act (PDCA) cycle put emphasis to systematic adaptation/ improvement of quality processes.  On the other hand,  suggested the creation of annual quality programs as separate strategy with corporate objectives (i.e. cost leadership) as they may have conflicting outcomes.  Coordination of aims is vital in yearly programs and he recommended a breakthrough key to solve bottleneck in quality improvements where corporate-wide effort is a crucial platform.  Third, Crosby believed that the cost of poor quality will be undermined by the substantial cost in rework due to defects.  To avoid this, top-down approach should be initiated to execute quality control policies.   concretises this finding by stating that visionary leaders are required to sustain quality improvements.  Finally, to complete quality integration model, Ishikawa posited quality circles that contain internal customers (i.e. manufacturing is a customer of raw material/ inspection section) to describe how quality satisfaction in the firm-level can be an effective guide in assuring that external customer’s perception of quality is addressed.     In obtaining an integrated assurance system, all productive processes must be considered and their functions well-defined.  Marketing, sales and research are responsible for collecting valuable information from the customers.  The engineering department must analyse the data gathered by the former and turn them to deliver product designs, details and any resource necessities.  The role of engineers is vital to the whole system because after products are conceptualized they will undergo mass production and changes in specifications in the post-design will result to substantial cost of change and adjustments.  Domino effect is the constraint attached to the product design.  To follow, purchasing division is expected to acquire materials consistent to the needs of the engineers in both effectiveness and efficiency dimensions.  After raw materials and production systems are in place, the human resources department will supply the production floor with skilled and motivated workers.    With these variables, top-level management is responsible to plan and execute policies to provide resources for the intended results.  Of course, they are thinking about the intervention of the assurance system.  Accountants and advisors can contribute in the realisation of this engagement, which is, aligning quality to overall corporate strategy (i.e. increase shareholder’s wealth).  When production of the products is completed, it is the role of packing, storing and shipping departments to assure that quality emphasized in the design, procurement, resource allocation and conversion phase are kept until products reached its users.  As ultimate safety net to the system, the firm must also provide after-sales support (i.e. warranties for quality) that can address the feedbacks, queries and problems of customers regarding the delivered product.  With the vertical structure of the firm, functional areas must collaborate on quality while corporate must serve as monitoring and apprehending mechanism to ensure compliance.   It is also important to discuss inherent features that the assurance system of the firm should establish.  Apparel quality is derived initially in the purchase of raw materials.  Therefore, the firm must adopt single-sourcing to maximize bargaining power in the aspect of timeliness and quality of textiles.  Partnering will be entered through long-run purchase contract.  In the finished product area, customer survey will be conducted regarding the performance of the assurance system on their opinion.  This will serve as an evaluation and which can also be applied to other stakeholders (e.g. employees, suppliers, government).  Although e-marketing has big potential for the firm, this is less useful for the Asian market that prefers personal shopping and actual observance to the product.  To provide customization, satisfaction and give impression that every customer is crucial to business success, other forms of media will be used to advertise the product.  In this regard, the firm can pursue human contact.  This is a strategic move as the firm has vertically-integrated structure that makes it relatively easy to affect specific processes according to customer needs.  There is flexibility and customer-centered approach to manufacturing is possible.   Benefits of the Assurance System Strategic quality development and maintenance are proved to be closely-inclined to above average profits.  When there quality is guaranteed, risks of poor quality will reduce, productivity will rise, competency will be generated and market base will expand.  In relation to indirect benefits, workplace will be more conducive to employees, production traffic will be prevented and monitoring will be applied at all levels.  The assurance system can aid in protecting the narrow market through serving the sophisticated needs of customers and also minimize cost of design and innovation by imposing quality assurance in the design and final product.  In addition, underdevelopment of internet capacities can be addressed by applying breakthrough solutions.  All function areas will have awareness of quality that isolation to traditional manufacturing-based concept will be eliminated.         With the policy of prevention (i.e. of costs) is better than cure (i.e. using contingencies), economies of scale through standardized store lay-out can be achieved.  The motif, ergonomics and position of model apparels in the store of high-end sellers are important to personal shopping experience of customers.  Further, zero-defects can stimulate customer loyalty and opportunities to potential and capable franchises.  When quality circles are existent, managers and employees can exchange views and deepen motivation of the workforce and building of possible creative/ innovative organization.  As each employee respects the quality of their contribution for the finished products, the wide acceptance and loyalty of end-users will be highly appreciated and also connect to human resource self-esteem on their job.  When there are several opinions about quality, the firm also encourages market duplication inside its functional areas.  This duplicate market reflects the opinions of the real market to the employees within the quality circles.    With the vertically-integrated structure of the firm, departmental framework of quality will be consolidated to single schema.  This would necessitate modification of job scope to insert the role of employees to product quality.  As a result, they will become more sensitive on their responsibilities because quality audits and evaluation will be corporate-wide and not simply on manufacturing division.  Work relations will also be loosened and each employee under different departments can relate more to one another.  Relation constraints or gaps will be minimized as the quality assurance applied to other technical workers is also existent to other rank-and-file employees.  Accountability and integrative approach in measuring performance (i.e. as it can affect the final products) will increase.  For example, sales team will have more confidence in telling the features, design and other advantages of using the product because there is close-relationship with the technical/ manufacturing team.  Irresponsible sales talk will also be prevented because sales team is more knowledgeable to the nature of the finished products as the fruit of close collaboration and related effort of the other units.   Supplier partnering is earlier considered as efficient way to acquire necessary raw materials.  However, as quality is integral part of corporate growth, acquisition of major suppliers can be considered in the latter stages of implementation.  When this happens, the need for flexible outsourcing partner will be reduced and the firm will have the control on purchasing policies.  In effect, just-in-time (JIT) production can be installed towards creation of a more responsive, cost-efficient and profitable business organization.  Further, although online distribution channel is less effective on the part of the market, database using the platform can expedite customer surveys useful for decision-making related to quality.  It will not displace store selling rather it will keep the historical complaints and other issues raised (i.e. positive feedbacks) regarding the products of the company.  As a result, the quality circle’s contribution to quality will be vividly guided and framed towards direct aspect of customer satisfaction.   Implementation of the System <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Employ a corporate-wide total quality management (TQM) practice – This will require briefing, survey, pilot tests, series of managerial evaluation, discussion groups, and actual design of how the system will flow and affect the nature of employee work.</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Eradicate scrutiny on the final products and enforce quality standards on unit processes – This former will avoid complacency on the part of the workforce who contribute to the final output (i.e. increase cooperation) while the latter will ensure that each contribution follows a specific quality benchmark.  This set-up will increase interests of employees in supporting the system and minimize subjective approach of how to arrive on it. </li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Create yearly quality plans – This will take evaluation and continuous improvement of the current setting depending on the mixture of the labor force and change in customer preferences or industry forces.  Managers and executives should prioritize the update also with quality standards.  </li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Create record (i.e. database) of past, current and future quality characteristics which is customer-oriented – This will aid in making the update of annual quality plans.  The admonition that customer-orientation is critical is important because customer is the king.</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Installing visionary leadership – Continuous update and adherence to quality can receive pressures to halt and only visionary leaders can undermine obstacles that can defeat the quality system.</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Improve and sustain system reputation in employee-, managerial- and company-level – When the system has substantial loopholes, it will not be trusted by the organization. </li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Assure elastic partner contracts and do business with strong bargaining power – Purchasing area is a major contributor to the value of the firm and must be a priority.</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Quantify both implied and precise quality drivers all through quality audits – This will maximize the evaluation process and prevent undermining not-so-obvious contributor to quality. </li>   Appendices Figure 1: Rating Industry Forces in Clothing Sector General Forces Specific Forces Rating                 Threat of new entrants Barriers to entry   ·   Economies of scale Medium ·   Product differentiation High ·   Capital requirements Medium ·   Switching costs High ·   Access to distribution channels High ·   Cost of disadvantages independent of scale High Governing policy Low  Expected Retaliation Medium Bargaining power of suppliers   Low Bargaining power of buyers   High Threat of substitute products   Medium     Intensity of rivalry among competitors         ·   Numerous or equally balanced competitors High ·   Slow industry growth High  ·   High fixed costs or high storage costs High   ·   Level of differentiation or switching costs High ·   High strategic stakes High ·   High exit barriers High   References Books Journals   Electronic Sources   Credit:ivythesis.typepad.com

A GUIDE FOR IMPLEMENTING QUALITY ASSURANCE

A GUIDE FOR IMPLEMENTING QUALITY ASSURANCE SYSTEMS: A LESSON FROM THE CLOTHING INDUSTRY Background of the Firm The firm is a major ...

ASSIGNMENT INSTRUCTION: A GUIDE FOR IMPLEMENTING QUALITY ASSURANCE SYSTEMS

Module No   ModuleTitle  Operations Systems     Aims:      The unit aims to:   1.       Identify the key decision areas of operations management and generic principles underpinning their theoretical role. 2.       Explore specific principles and approaches adopted within organisations in relation to generic theory. 3.       Develop a critical approach to the analysis of an operation management in an organisational context. 4.       To identify and evaluate the key roles of operations management in a range of different types of organisations .   Learning Outcomes:        On successful completion of this module a student will be able to:   1   Define their operation in operating system terminology. 2 Select and apply appropriate classification models to describe the overall design of the operation.     3 Critically evaluate contemporary issues for operations management 4 Analyse the service’s approach to operations management decision areas within the context of the overall design and relevant theoretical concepts. 5   Evaluate the efficiency and effectiveness of the service in operational terms.           Learning Process:   A mixture of lectures, group discussion and case studies. The methods will actively seek to make use of the experiences of the student group. Students will be provided with directed reading to support the learning programme. Initial lecture periods will be used to establish the theoretical framework allowing later sessions to be increasingly focused on exploration of concepts       Syllabus:   The syllabus includes a review of basic principles of Operations Management; Quality standards and quality issues; comprehensive overview of an understanding of factors important to efficient operating systems – Scheduling; Capacity; Location; etc. . Application of such principles in both public and commercial organisations.         Indicative Bibliography:       Core Text-Book: The following book is recommended for purchase:   The latest version of Slack et al Operations Management, Prentice Hall, UK   Scheme of Work:   Session: Date Topic: Pages to read[1]: Seminar: Week Week Commencing       1 2nd October Operations Management and its place in the organisations   Relevant Chapter of Core text book Seminar taken by Research module 2 9th October Operations as a System – Systems analysis   Relevant Chapter of Core text book Process Planning Game (exercise) 3 16th October Development of Operational Systems Relevant Chapter of Core text book What would you need to do to make this? (Exercise) 4 23rd October Japanisation   Relevant Chapter of Core text book Introduction to Beer Game 5 30th October Beer Game   Relevant Chapter of Core text book Beer Game   6 6th November Reading Week   Reading Oakland Quality Article – Total Quality Management 7 13th November Beer Game feedback   Relevant Chapter of Core text book   8 20th November Monitoring Performance   Relevant Chapter of Core text book   9 27th November TQM   Relevant Chapter of Core text book   10 4th December ISO 9000 series   Relevant Chapter of Core text book   11 11th December Quality Systems Relevant Chapter of Core text book   12 8th January Synthesis and feedback       Assignment.     The small company for which you work has been informed by a major customer that due to their recent application for ISO9000 certification unless you can provide evidence that you too have a robust quality assurance system in place they will no longer be able to trade with you.   Alarmed at the potential loss of revenue your MD has asked you to prepare a paper detailing and explaining the PROCESS(ES) your firm would have to go through in order to introduce an effective integrated assurance management system.   For the purposes of your report you should <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> <li class="MsoNormal" style="text-align: left; punctuation-wrap: hanging; text-autospace: ideograph-numeric ideograph-other"> Identify the nature of the business you work for (eg sector, nature of business) </li> <li class="MsoNormal" style="text-align: left; punctuation-wrap: hanging; text-autospace: ideograph-numeric ideograph-other"> Clearly identify and explain the benefits to be accrued from the introduction of an integrated assurance system </li> <li class="MsoNormal" style="text-align: left; punctuation-wrap: hanging; text-autospace: ideograph-numeric ideograph-other"> Devise and justify a system appropriate to the environment in which your type of business operates </li> <li class="MsoNormal" style="text-align: left; punctuation-wrap: hanging; text-autospace: ideograph-numeric ideograph-other"> Devise an appropriate plan to implement the system, explaining carefully the logic behind your project plan. </li> <li class="MsoNormal" style="text-align: left; punctuation-wrap: hanging; text-autospace: ideograph-numeric ideograph-other"> Ensure that your plans are supported by references to appropriate theory and case studies. </li> </ul>   The report must be NO MORE than 2500 words, not including diagrams, tables and references     Marking Guidelines   q       The marks that are awarded to answers will take account of the standard of written communication that each displays. In this regard, you should attempt to write your answer in a scholarly style, akin to that displayed in an academic journal. This will be assessed in terms of style, meaning, and the accuracy of spelling, grammar, punctuation and syntax. However, appropriate allowance will be made for those for whom English is not their first language. Answers that when taken as a whole, are illegible, inappropriate to the question asked, and/or whose meaning is insufficiently clear, will be awarded a fail mark. q       Answers must not exceed the maximum of 2500 words (excluding references and appendices) and must contain a declaration of the number of words that they contain (excluding any references and/or appendices). Any appendices should support the content of the answer and superfluous materials should be excluded. Answers that exceed the maximum word limit will be penalised two marks for every interval of 100 words that they exceed the limit by. Answers that fail to declare a word count will be penalised by ten marks. q       The marks that are awarded to answers will take account of the standard of referencing. For your purposes, the two acceptable forms of referencing written work are the British Standard System or the Harvard System. q       Formal inquiry proceedings will be instigated if there is any suspicion of misconduct or plagiarism in the preparation of answers. In this regard, you may be asked to produce the notes and working papers that you compiled in the preparation of your answer, and to discuss the books and other references that you cite. Academic misconduct includes instances of collaboration. Refer to the University’s regulations on assessment if you are unclear as to the meaning of these terms. A copy of these regulations is available from your School Office. q       Your answer will not be returned to you. You should ensure that you retain a copy of your answer for your own records.   Assessment Criteria   Mark General Criteria First (80 – 100) Exceptional scholarship for subject.  Outstanding ability to apply, in the right measure, the skills necessary to achieve highly sophisticated and fluent challenges to received wisdom. First (70 – 79) Knowledge and understanding is comprehensive both as to breadth and depth.  A mature ability to critically appreciate concepts and their inter-relationship is demonstrated.  Clear evidence of independent thought.  Presentation of work is fluent, focused and accurate. Upper Second (60 – 69) Knowledge base is up-to-date and relevant, but also may be broad or deep.  Higher order critical appreciation skills are displayed.  A significant ability to apply theory, concepts, ideas and their inter-relationship is illustrated Lower Second (50 – 59) Sound comprehension of topic.  Reasoning and argument are generally relevant but not necessarily extensive.  Awareness of concepts and critical appreciation are apparent, but the ability to conceptualise, and/or to apply theory is slightly limited. Third (40 – 49) Knowledge is adequate but limited and/or superficial.  In the most part, description/assertion rather than argument or logical reasoning is used.  Insufficient focus is evident in work presented. (30 – 39) Minimal awareness of subject area.  Communication of knowledge frequently inarticulate and/or irrelevant. (0 – 29) Poor grasp of topic concepts or of awareness of what concepts are.  Failure to apply relevant skills.  Work is inarticulate and/or incomprehensible.   Coursework Deadlines   The University requires students to adhere to submission deadlines for any form of assessment. A penalty will be applied in relation to unauthorised late submission of work.   Authorisation of the late submission of work requires written permission. The Head of Department with responsibility for the module, or his/her nominee, will be authorised to give permission for one extension period of between 1 and 10 working days where evidence of circumstances has been accepted and where submission within this timescale would be reasonable taking into account those circumstances.   The University operates a universal penalty scale for unauthorised late submission of any form of assessed work. Students who submit work within 10 working days after the published submission date without an authorised extension will obtain a maximum mark of 40% for that element of assessment.   All work submitted later than 10 working days after the published submission date will be awarded a mark of 0%.   Students who are unable to submit work within 10 working days after the submission date due to verifiable extenuating circumstances which are serious and exceptional, may submit a case for consideration in accordance with the University’s Extenuating Circumstances Procedure as detailed within Appendix 9 to the academic regulations which is available on the University web-site.         Credit:ivythesis.typepad.com

ASSIGNMENT INSTRUCTION: A GUIDE FOR IMPLEMENTING QUALITY ASSURANCE SYSTEMS

Module No ModuleTitle Operations Systems Aims: The unit aims to: 1. Identify the key decision areas...

QUALITY ASSURANCE IN BRACHYTHERAPY FOR PROSTATE CANCER

QUALITY ASSURANCE IN BRACHYTHERAPY FOR PROSTATE CANCER   The Prostate The prostate is a fibromuscular glandular organ that surrounds the prostatic urethra. It is about 1 ¼ inches (3 cm) long and lies between the neck of the bladder above and the urogenital diaphragm below. It is surrounded by a fibrous capsule. Outside the capsule is a fibrous sheath, which is part of the visceral layer of pelvic fascia. The numerous glands of the prostate are embedded in a mixture of smooth muscle and connective tissue, and their ducts open into the prostatic urethra. The prostate is incompletely divided into five lobes (2000). The function of the prostate is the production of a thin, milky, fluid containing citric acid and acid phospatase. It is added to the seminal fluid at the time of ejaculation. The prostatic secretion is alkaline and helps neutralize the acidity in the vagina. The prostate gland has a reputation as a health destroyer. Prostate cancer is the most common malignancy (2003), and is the third most prevalent cancer in men (2004). Prostate cancer is a vexing disease because the cure – removal of the prostate – often causes impotence or incontinence. In the past, the main alternative was a combination of hormone therapy to shrink the tumor and radiation treatments to kill cancer cells, which was often less effective and still caused considerable discomfort (1999). As a rule, prostatic cancer is a slow-growing, hidden condition, but it can also be a swift and deadly killer. The treatment of localized prostate cancer is highly controversial, with many treatment options. Treatment of prostate cancer can include surveillance, “watchful waiting,” radical prostatectomy, androgen hormone ablation, internal or external radiation, surgery, chemotherapy, or a combination of any of these modalities (2002;  2004). Treatment decisions should consider the patient’s age, medical history, tumor stage, and contributing family medical history. The risk/benefit ratio of each treatment option should be considered and discussed thoroughly with the patient and his significant other. The use of radioactive seeds in brachytherapy to provide radiation therapy is one of the three recommended treatment options for localized carcinoma of the prostate (1998). Brachytherapy, or the insertion of radioisotopes directly into the cancer-bearing organ, is gaining acceptance as a treatment, with survival outcomes similar to other treatments. This outpatient procedure has the advantage of patient convenience and cost effectiveness (2003).   Overview of Radiation Therapy Radiation therapy, or radio therapy, is a branch of radiology used to treat cancer. Radiation is the emission of electromagnetic waves or atomic particles that result from the disintegration of nuclei of unstable or radioactive elements. The treatment of malignant disease of radiation may be referred to as radiation therapy, brachytherapy, or radiotherapy. Ionizing radiation is used for this type of therapy, which involves the use of high-voltage radiation and other radioactive elements to injure or destroy cells. Like surgical resection and photodynamic therapy, radiation therapy is localized therapy that is applicable for a limited number of specific tumors (2004). A patient is exposed to ionizing radiation in doses to kill a malignancy. Malignant tissues are more sensitive than normal tissues to radiation exposure and can be treated if they have not spread throughout the body and are not surrounded by normal tissue that is especially sensitive to radiation, such as the spinal cord. Sophisticated physical and biological techniques are used for radiation therapy, often accompanied by computer analyses. A radiation therapist develops a treatment plan that permits the absorption of a fatal amount of radiation by all tumor cells but causes relatively minor damage to normal tissue. The usual mode of therapy is an external high-energy beam directed at the tumor site for a few minutes a day for 2 to 6 weeks, depending on the type of malignancy. X-rays, gamma rays, and such isotopes as cobalt-60 and iodine-31 are often used.             To further understand why quality assurance in radiotherapy is vital and why it is important in treatment delivery, a discussion on the effects of radiation on cells will first be provided.   Effects of Radiation on Cells             Cancer cells multiply out of normal body control; they are in a state of active, uncontrolled mitosis (the nuclear division of the cytoplasm and nucleus). Radiation affects the metabolic activity of the cells. Cells in an active state of mitosis are most susceptible. Over time, gamma rays and x-rays cause a cessation of cell growth and a regression of the tumor mass. Cells die and are replaced by fibrous tissue ( 2004). The sensitivity of a tumor to radiation varies. Some tumors can be destroyed by a small amount of radiation, whereas others require a large amount. The sensitivity of the tumor cells is determined by the sensitivity of the normal cells from which the tumor cells are derived. The effects of radiation therapy also depend to a large extent on tissue oxygenation. As a tumor grows, the periphery is well oxygenated but the central portion becomes necrotic and poorly oxygenated. The number of cells killed by radiation therapy is directly related to the amount of tissue and oxygen within the tumor. Therefore the hypoxic effect is a factor in determining therapeutic dosage of radiation. Radiation therefore cannot be limited solely to the area being treated. The danger of injuring normal surrounding tissue is a limiting factor in the dosage and selection of the most appropriate type of radiation therapy. A factor of dosage is the ratio of tumor tissue to the surrounding normal tissue. The penetration of radiation energy is calculated from the rate of decay or disintegration, known as half-life. Half-life is the time required for half of the radioactive material to disintegrate and to lose one half of its activity through decay.     Treatment Modality/Implantation of Radiation Source – Brachytherapy All radiation sources for implantation are prepared in the desired therapeutic dosages by personnel in the nuclear medicine department. Many types of sources are used to deliver maximum radiation to the primary tumor. It is important to remember that no single type is ideal for every tumor or anatomic site. Brachytherapy is on type of radiation therapy. The term brachytherapy comes from a Greek term meaning “short-range treatment.” Brachytherapy, or “seeding” the cancer directly with radioactive isotopes embedded in capsules the size of rice grains (1999). Tiny titanium cylinders that contain a radioactive isotope are implanted to deliver a dose of radiation from the inside out that kills cancer cells while sparing healthy tissue. Brachytherapy is performed fro many types of cancers including breast and prostate. It is useful for delivering higher cell-killing doses in shorter periods than conventional radiation treatments. The capsules are placed under ultrasound guidance (2004). Brachytherapy requires the implantation of radioactive iodine-125 or palladium-103 seeds directly into the prostate. They emit highly localized radiation energy to kill localized cancer cells without excessive harm to nearby healthy cells. Proper placement of these seeds is critical, and a preprocedural map of the prostate gland, using ultrasound or CT, is obtained. A grid is then placed over the perineum and ultrasonic or CT imaging used to deliver seeds to the prostate alone. These seeds remain in the body, but their radioactivity declines over a period of months (2004). It has only been over the past couple of years that seeding has become the treatment of choice for a growing number of doctors and their patients (1999).   Quality Assurance Systems in Place that Govern the Safe Delivery of Brachytherapy Preparation for brachytherapy typically includes bowel cleansing and administration of prophylactic antibiotics. An oral bowel stimulant such as magnesium citrate may be combined with a cleansing enema to prepare the bowel. The patient should be advised to maintain a clear liquid diet 12 to 24 hours preceding the study as directed. The patient should also be instructed that the procedure is likely to produce rectal pressure or mild discomfort when the ultrasound probe is placed, but pain is not associated with implantation of radioactive seeds ( 2004). The patient should be educated and informed that the implantation will cause inflammation of the prostate that is likely to provoke bothersome LUTS, including daytime voiding frequency, an increase in nocturia, and difficulty initiating a urinary stream. These manifestations are typically transient and subside as prostatic inflammation diminishes (2004). In general, the patient and the caregiver should be taught the principles of radiation safety before, during and following brachytherapy. This should be in consultation with the radiation oncologist and based on institutional policies. The cardinal factors of protection from radiation sources, regardless of implantation sites, are distance, time, and shielding. For both personnel and patients, the following principles of radiation safety also apply to handling all types of radioactive materials: <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> The intensity of radiation varies inversely with the square of the distance from it. Personnel should stay as far from the source as feasible.</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Radiation sources such as needles, seeds, capsules, and suspensions are prepared by the personnel in the nuclear medicine department. Personnel prepare these sources behind a lead screen, and their hands are protected by lead-lined gloves, if possible, or special forceps during handling. </li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Radiation sources are transported in a long-handled lead carrier so they are as close to the floor as and as far away from the body of the transporter as possible. The lead carrier should be stored away from personnel and patient traffic areas while it is in the operating room suite.</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> When radiation sources are delivered to the operating room, each needle, seed, or capsule as are the ones placed in the prostate, is counted by the surgeon with the radiation therapist. This number is recorded.</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Glutaraldehyde solution is poured into the lead carrier to completely submerge the radiation sources. When ready to use, the radiation source is transported in the lead carrier into the operating room. The needles, seeds, or capsules are removed from the lead container with sterile, long-handled instruments and are rinsed thoroughly with sterile water.</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> All radiation sources are handled with special long, ring-handled forceps from behind a lead protection shield. Radiation sources should never be touched with bare hands or gloves. Radiation sources are never handled with a crushing forceps because the seal of hollow containers can be broken. A groove-tipped forceps that is designed for this purpose is used.</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Radiation sources are handled as quickly as possible to limit the time that personnel are exposed to radiation.</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> All radiation sources are accounted for before and after use, and any loss is immediately reported. Nothing should be removed from the room. To locate a lost radiation source, a radiation therapist or nuclear medicine department technician is called to bring a Geiger counter. A Geiger counter has a radiation-sensitive gauge with an indicator that moves and a sound that increases when near radioactive substances.</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> A radiation documentation sheet is completed and put in the patient’s chart. The surgeon fills in the amount and exact time of insertion and the time the source is to be removed. Each health care professional who cares for the patient on the unit signs this sheet just before going off duty, thereby passing responsibility for checking the patient and radiation source to the health care professional who relieves.</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> The patient’s bed and door to the room are conspicuously labeled with a radiation-in-use card or symbol.</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> The radiation source is removed by the surgeon at the exact time indicated so the patient will not be overexposed.</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Radiation is neither seen nor felt. Therefore the rules are carefully observed. Exposure is monitored and minimized.</li> </ul>   Effects of Radiation Therapy on the Patient             The patient may be undergoing several treatment modalities and may experience the specific tissue and systemic effects of each. Health care professionals caring for the patient should understand how radiation affects the patient and how it affects the attainment of desired outcomes. The plan of care therefore should include consideration for the potential side effects of radiation therapy.             In one study, it was demonstrated that when brachytherapy is evaluated 6 months after treatment, bowel, bladder, and sexual functioning are affected. The impact of brachytherapy on quality of life of the patient appears to be tolerable. Although each of the participants in the study made several statements related to their post treatment physical functioning, the negative statements were qualified by minimizing the problem, or stating the possibility that other factors may be influencing the difficulty (2003). Acute urinary retention is also one of the most common complications following prostate brachytherapy, occurring in 1% to 22% of patients in various studies ( 2003). However, one study also demonstrated that reducing urethral dosage in patients undergoing brachytherapy for localized prostate cancer decreases the rate of post-implant urinary retention (2003)       Summary and Conclusion             The process of radiation therapy involves the use of rays that could be harmful to the body. Quality assurance is therefore vitally important in all aspects of radiation therapy to ensure that the treatments delivered are safe and effective. Brachytherapy for treatment of prostate cancer has been widely used and although found to have some side effects in the long run, are able to treat cancer patients well. Although some studies have shown negative effects as a result of brachytherapy, it is tolerable and is not without a remedy. A safe and effective brachytherapy could do wonders for the patient and its side effects are just minima compared to what harm could have been done if brachytherapy was not performed. The principles of radiation safety also apply to handling brachytherapy to ensure a safe and effective treatment.                       Credit:ivythesis.typepad.com

QUALITY ASSURANCE IN BRACHYTHERAPY FOR PROSTATE CANCER

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