{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T06:06:41Z","timestamp":1767852401622,"version":"3.49.0"},"reference-count":26,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2014,3,6]],"date-time":"2014-03-06T00:00:00Z","timestamp":1394064000000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2014,3]]},"abstract":"<jats:p>Emergency\u2010off systems (EOS) are essential to the safe operation of medical accelerators and other high\u2010risk equipment. To assure reliable functioning, some states require weekly tests; others permit monthly, tri\u2010monthly or even six\u2010monthly tests, while some do not specify test intervals. We investigate the relative safety of the various test schedules by computing the fraction of time during which a nonfunctional state of the EOS may remain undetected. Special attention is given to the effect of flexibility (i.e., to regulations that specify the number of tests that have to be done in any given time interval, but allow a range within the interval during which a test can be done). Compared to strict test intervals, a schedule that provides flexibility increases risk only marginally. Performing tests on any arbitrary day of the week when weekly tests are required increases the time span during which a nonfunctionality goes undetected by only 17%, compared to an exact one\u2010week schedule. The same ratio applies for monthly tests. For a three\u2010month schedule, the relative risk increases by only 2% if tests are done on an arbitrarily chosen day during each due\u2010month, compared to tests done on an exact three\u2010month schedule. The most irregular time intervals possible in a three\u2010calendar month schedule increase the relative risk by 11%. For the six\u2010month and the 12\u2010month schedule the ratio of risks is even smaller. The relative risk is virtually independent of the mean time between failures of the EOS, but the absolute risk decreases in proportion the mean time between failures. Adherence to strict, resource\u2010intensive test intervals provides little extra safety compared to flexible intervals that require the same number of tests per year. Regulations should be changed to provide the practicality offered by flexible test schedules. Any additional increase in patient safety could be achieved by strict regulations concerning reliability of emergency\u2010stop (e\u2010stop) systems.<\/jats:p><jats:p>PACS numbers: 87.55.N\u2010, 87.55.Qr, 87.56.bd<\/jats:p>","DOI":"10.1120\/jacmp.v15i2.4583","type":"journal-article","created":{"date-parts":[[2017,2,27]],"date-time":"2017-02-27T23:25:53Z","timestamp":1488237953000},"page":"327-336","source":"Crossref","is-referenced-by-count":1,"title":["Patient safety considerations concerning the scheduling of emergency\u2010off system tests"],"prefix":"10.1002","volume":"15","author":[{"given":"Ivan A.","family":"Brezovich","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology The University of Alabama at Birmingham  Birmingham AL USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard A.","family":"Popple","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Alabama at Birmingham  Birmingham AL USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2014,3,6]]},"reference":[{"key":"e_1_2_5_2_1","unstructured":"New York.NY City Health Code. Article 175 \u2013 Radiation Control. \u00a7175.64(g)(9)(vi) and \u00a7175.64(g)(9)(vii)(F)."},{"key":"e_1_2_5_3_1","unstructured":"Florida Administrative Code.Florida Department of Health. Control of Radiation Hazards: Operating procedures. Chapter 64E\u20135.808 (3)."},{"key":"e_1_2_5_4_1","unstructured":"State of Georgia.Radiation Safety Requirements for Particle Accelerators. Rules and Regulations 290\u20105\u201022.05(9)(c)."},{"key":"e_1_2_5_5_1","unstructured":"Illinois Administrative Code.Emergency Management Agency. Title 32 Chapter II Subchapter b Part 360.120 g) 1) D)."},{"key":"e_1_2_5_6_1","unstructured":"Alabama Administrative Code.Radiation Control Chapter 420\u20103\u201026\u2010.09\u2010(7)(a)."},{"key":"e_1_2_5_7_1","unstructured":"Mississippi Department of Health. Title 15 Part 21 Subpart 78 Chapter 1 Code Ann. \u00a745\u201014\u201011 Rule 1.9.10.3."},{"key":"e_1_2_5_8_1","unstructured":"Administrative Rules of Montana.Radiation Control Rule 37.14.1426(3)."},{"key":"e_1_2_5_9_1","unstructured":"Oregon AdministrativeRule 333\u2010109\u20100015(6)."},{"key":"e_1_2_5_10_1","unstructured":"State of Rhode Island.Rules and regulations for the control of Radiation R23\u20101.3\u2010RAD Part D.36(c)."},{"key":"e_1_2_5_11_1","unstructured":"Texas AdministrativeCode 25 \u00a7289.229(f)(3)(A)(viii)."},{"key":"e_1_2_5_12_1","unstructured":"The North Carolina Radiation Protection Commission 15A NCAC 11.0908 (c)."},{"key":"e_1_2_5_13_1","unstructured":"State of South Carolina.Rules and Regulations for Radiation Control Title C Part III Radiation Safety Requirements for Particle Accelerators RHC 3.4.8."},{"key":"e_1_2_5_14_1","unstructured":"Colorado Department of Public Health and Environment.Radiation Control Part 24 \u2013 Particle Accelerators and Therapeutic Radiation Machines in the Healing Arts Periodic Quality Assurance Checks 24.8.20.7."},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.597316"},{"key":"e_1_2_5_16_1","unstructured":"Missouri Code of State Regulations. Chapter 10 Title 19 CSR 20\u201010.180:Requirements for radiation therapy installations."},{"key":"e_1_2_5_17_1","volume-title":"#24. Physical aspects of quality assurance in radiation therapy","author":"Radiation Therapy Committee Task Group","year":"1984"},{"key":"e_1_2_5_18_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.3190392"},{"key":"e_1_2_5_19_1","unstructured":"Conference of Radiation Control Program Directors Suggested State Regulations for Control of Radiation Part I Sec. I.10 c 1991. Available from:http:\/\/www.crcpd.org\/SSRCRs\/ipart91.PDF"},{"key":"e_1_2_5_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2007.03.010"},{"key":"e_1_2_5_21_1","volume-title":"IEEE Guide for general principles of reliability analysis of nuclear power generating station safety systems","author":"ANSI\/IEEE","year":"1987"},{"key":"e_1_2_5_22_1","unstructured":"New York.NY City Heatlh Code Article 175 Radiation Control \u00a7175.64(g)(5)(i)(I)."},{"key":"e_1_2_5_23_1","unstructured":"Mississippi Department of Health. Title 15 Part 21 Subpart 78 Chapter 1 Code Ann. \u00a745\u201014\u201011 Rule 1.9.8.4."},{"key":"e_1_2_5_24_1","unstructured":"Administrative Rules of Montana.Radiation Control Rule 37.14.1418(5)."},{"key":"e_1_2_5_25_1","unstructured":"Oregon AdministrativeRule 333\u2010109\u20100030(4)."},{"key":"e_1_2_5_26_1","unstructured":"State of Rhode Island.Rules and regulations for the control of Radiation R23\u20101.3\u2010RAD Part D.34(e)."},{"key":"e_1_2_5_27_1","unstructured":"The North Carolina Radiation Protection Commission. 15A NCAC 11.0906 (e)."}],"container-title":["Journal of Applied Clinical Medical Physics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1120%2Fjacmp.v15i2.4583","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1120%2Fjacmp.v15i2.4583","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1120\/jacmp.v15i2.4583","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1120\/jacmp.v15i2.4583","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/pdf\/10.1120\/jacmp.v15i2.4583","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,10]],"date-time":"2023-09-10T18:32:36Z","timestamp":1694370756000},"score":1,"resource":{"primary":{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/10.1120\/jacmp.v15i2.4583"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,3]]},"references-count":26,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2014,3]]}},"alternative-id":["10.1120\/jacmp.v15i2.4583"],"URL":"https:\/\/doi.org\/10.1120\/jacmp.v15i2.4583","archive":["Portico"],"relation":{},"ISSN":["1526-9914","1526-9914"],"issn-type":[{"value":"1526-9914","type":"print"},{"value":"1526-9914","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,3]]}}}