Entwicklungen auf dem Weg zur Computertomographie-gestu tzten adaptiven Brachytherapie

Computed tomography (CT) represents a tremendous cornerstone of modern brachytherapy. The three-dimensional visualization of applicators in-situ enabled with this modality has been established as important foundation for precise and anatomically adapted treatment planning. In recent years, particularly imaging-based adaptive workflows have gained rising importance. This refers, on the one hand, to an individualization of implantations based on intraoperative imaging. On the other hand, imaging-based quality assurance (QA) during the treatment course, which allows for therapy adaptions by detecting variations of applicator locations with respect to patient anatomy, finds increasing clinical application as well. The focus of the present doctoral thesis was on the introduction, QA, and utilization of various CT techniques for adaptive brachytherapy. In particular, a novel, mobile cone-beam CT system for imaging directly on the ward was fully clinically implemented worldwide first. Its imaging performance was profoundly characterized, forming the basis for the subsequent clinical usage. In this respect, an evaluation of the device’s suitability for imaging-based adaptive workflows for gynecologic and breast brachytherapy was conducted. For breast patients, an image quality sufficient for treatment QA was achieved, whereas substantial limitations were observed for gynecologic patients. Furthermore, a QA procedure for ensuring the system’s performance stability in clinical operation was developed, concomitant with an assessment of its long-term stability. The latter revealed a reasonable stability of image quality over time, whereas hardware features as lasers still require significant improvements. Moreover, this thesis advanced the developments of new CT techniques. New approaches for imaging laterally extended field of views were described and validated for the first time. With these methods an image quality comparable to conventional scanning techniques was achieved. In addition, the comprehensive QA of a novel algorithm for four-dimensional CT (4DCT) was conducted, which showed a substantial reduction of artifacts and a high imaging fidelity compared to previous 4DCT approaches. These investigations formed the basis for the future utilization of these scanning techniques for adaptive brachytherapy. In further studies, the clinical benefits of CT imaging for adaptive breast and prostate brachytherapy were elaborated. For breast patients, an extensive CT-based analysis of implant variations during the treatment course and a first-time quantification of underlying causes was performed. Based on this, a decision-tree for detecting the necessity for therapy adaptions was established. A new treatment workflow, for which an enhanced stability of the catheter arrangement was obtained, was introduced. For prostate brachytherapy, the displacements of implanted seeds were comprehensively assessed, whereby potential measures for improving implant stability were identified as well. It was observed that seed displacements may mainly originate from implantation uncertainties, and adaptive interventions by utilizing CT were suggested to conceivably increase treatment quality further. In summary, new CT technologies were introduced and the use as well as benefits of CT for brachytherapy of various entities were described. The clinical advantages of establishing CT-based adaptive brachytherapy workflows were comprehensively presented.Die Computertomographie (CT) bildet einen immensen Grundpfeiler der modernen Brachytherapie. Die hiermit ermöglichte dreidimensionale Darstellung von Applikatoren in-situ für eine präzise, anatomisch angepasste Bestrahlungsplanung hat sich als wichtige Grundlage entsprechender Behandlungen etabliert. In den letzten Jahren haben zudem bildgebungsbasierte adaptive Workflows erheblich an Bedeutung gewonnen. Dies betrifft zum einen die Individualisierung von Implantationen mittels intraoperativer Bildgebung. Zum anderen finden auch bildgebungsbasierte Qualitätssicherungen (QS) während des Behandlungsverlaufs, welche durch die Detektion von Veränderungen der Applikatorlage in Relation zur Patientenanatomie Therapieanpassungen erlauben, vermehrt klinischen Einsatz. Der Fokus dieser Doktorarbeit lag auf der Einführung, der QS und dem Einsatz verschiedener CT-Techniken für die adaptive Brachytherapie. Insbesondere wurde ein neues, mobiles Kegelstrahl-CT-System für die Bildgebung direkt auf der Station weltweit erstmalig vollständig klinisch implementiert. Dessen Bildgebungsperformanz wurde umfangreich charakterisiert, wodurch die Basis für die anschließende klinische Verwendung gelegt wurde. Hierbei erfolgte eine Evaluation der entsprechenden Eignung für bildgestützte adaptive Workflows für die gynäkologische und Brust-Brachytherapie. Für Brust-Patientinnen wurde eine für die QS der Behandlung ausreichende Bildqualität erzielt, wohingegen deutliche Limitationen in dieser Hinsicht für gynäkologische Patienten beobachtet wurden. Zudem wurde eine QS-Prozedur zur Gewährleistung der Performanzstabilität des Systems im klinischen Betrieb entwickelt, einhergehend mit einer Bewertung seiner Langzeitstabilität. Dabei zeigte sich hinsichtlich der Bildqualität eine befriedigende Stabilität über den zeitlichen Verlauf, jedoch erfordern Hardware-Bausteine wie etwa Laser noch immer erhebliche Verbesserungen. Des Weiteren beschäftigte sich die Arbeit mit der Entwicklung neuer CT-Techniken. So wurden neue Ansätze zur Bildgebung eines lateral vergrößerten Scanfelds erstmals beschrieben und validiert. Dabei wurde eine zu konventionellen Scantechniken vergleichbare Bildqualität erzielt. Außerdem wurde die umfassende QS eines neuartigen Algorithmus für die vierdimensionale CT (4DCT) durchgeführt, welcher eine deutliche Reduktion von Artefakten und ein hohes Maß an Abbildungstreue im Vergleich zu vorherigen 4DCT Ansätzen ermöglichte. Diese Untersuchungen bildeten die Basis für den zukünftigen Einsatz dieser Scantechniken in der adaptiven Brachytherapie. Anschließend wurde der klinische Nutzen der CT Bildgebung für die adaptive Brust- und Prostata-Brachytherapie herausgearbeitet. Für Brust-Patientinnen erfolgte eine extensive CT-basierte Analyse von Implantatveränderungen während des Behandlungsverlaufs mit einer erstmaligen Quantifizierung der zugrundeliegenden Ursachen. Darauf basierend wurde ein Entscheidungsbaum zur Detektion der Notwendigkeit für Therapieanpassungen etabliert. Zudem wurde ein neuer Behandlungsworkflow eingeführt, für den eine verbesserte Stabilität des Katheterarrangements nachgewiesen wurde. Für die Prostata-Brachytherapie erfolgte eine umfangreiche Bewertung der Verschiebungen implantierter Seeds, wodurch ebenso potentielle Maßnahmen zur Verbesserung der Implantatstabilität identifiziert wurden. Es wurde beobachtet, dass Seed-Verschiebungen vor allem in Implantationsunsicherheiten begründet zu sein scheinen und adaptive Interventionen mittels CT die Behandlungsqualität unter Umständen weiter steigern könnten. Zusammenfassend wurden somit neue CT-Technologien eingeführt sowie der Einsatz und die Notwendigkeit der CT für die Brachytherapie verschiedener Entitäten beschrieben. Der klinische Nutzen der Etablierung CT-basierter adaptiver Brachytherapie-Workflows wurde umfassend dargelegt

Developing an integrated concept for sewage sludge treatment and disposal from municipal wastewater treatment systems in (peri-)urban areas in Vietnam

The study took place in Vietnam at Hanoi University of Science in the framework of the DAAD (German Academic Exchange Service) – “An advancement of the German-Vietnamese University partnerships”. The research has been supported by the program: “Wastewater and Solid Waste Management in Provincial Centers” and belongs to its technical component. The present diploma thesis elaborates the current situation of sewage sludge management in Vietnam and is dealing with sludge characteristics from both domestic sewage treatment facilities and septic tanks. During the research, different treatment components and treatment facilities have been analyzed to carry out a comprehensive survey of sewage sludge types. In this thesis, a guideline (draft) was developed as a main result, which can be helpful to bridge the legislative gap for sewage sludge re-use in Vietnam. In conclusion, an integrated concept has been developed, which recommends the application of selected proceeding elements to treat sewage sludge and the further utilization of re-useable materials in agriculture in a controlled and environmentally-safe manner.:Abbreviations .......................................................................................................................... 4 List of Figures ......................................................................................................................... 5 List of Tables .......................................................................................................................... 6 Acknowledgement .................................................................................................................. 7 Abstract .................................................................................................................................. 8 1 Introduction ................................................................................................................... 10 2 Legal framework for sewage sludge management in Vietnam ................................. 13 2.1 Background ........................................................................................................... 13 2.2 Institutional framework .......................................................................................... 13 2.3 Legal framework.................................................................................................... 15 2.4 Standards .............................................................................................................. 18 2.4.1 Technical standards ...................................................................................... 18 2.4.2 National standards ........................................................................................ 19 2.5 Current situation .................................................................................................... 20 3 Theoretical basis for the concept ................................................................................ 22 3.1 Sewage sludge ...................................................................................................... 23 3.1.1 Sewage sludge types .................................................................................... 27 3.1.2 Quantity .......................................................................................................... 30 3.1.3 Sludge volume ............................................................................................... 30 3.1.4 Sludge composition ....................................................................................... 34 4 Municipal wastewater treatment plants ...................................................................... 47 4.1 DEWATS ............................................................................................................... 47 4.2 Waste water management program .................................................................... 48 4.2.1 Results of sludge analysis ............................................................................ 50 4.3 Learned outcomes ................................................................................................ 54 5 Sludge treatment and disposal options ...................................................................... 56 5.1 Goals of sludge treatment .................................................................................... 56 5.2 Processing elements ............................................................................................ 58 5.2.1 Pre-treatment ................................................................................................. 59 5.2.2 Transportation................................................................................................ 60 5.2.3 Stabilization.................................................................................................... 60 5.2.4 Disinfection .................................................................................................... 65 5.2.5 Removal of water .......................................................................................... 65 5.2.6 Drying ............................................................................................................. 70 5.2.7 Agricultural uses and landscape measures ................................................ 70 5.2.8 Biological re-uses .......................................................................................... 71 5.2.9 Thermal disposal (energy recovery) ............................................................ 74 5.2.10 Land-filling ...................................................................................................... 76 6 Sewage sludge management concept ....................................................................... 78 6.1 Avoidance .............................................................................................................. 79 6.2 Treatment .............................................................................................................. 79 6.2.1 Proposed treatment concept ........................................................................ 81 6.3 Re-use or Disposal ............................................................................................... 84 6.3.1 Small-scale concept ...................................................................................... 85 6.3.2 Medium- and large-scale concept ................................................................ 85 6.4 Conclusion ............................................................................................................. 86 7 Guideline (draft) ............................................................................................................ 88 7.1 Formulation of a guidance document .................................................................. 88 8 Conclusion .................................................................................................................... 89 9 References .................................................................................................................... 92 10 Appendices ................................................................................................................ 97 a) Calculation of sludge amount .................................................................................. 97 b) Guideline (draft) ........................................................................................................ 99 Declaration .......................................................................................................................... 106Die Diplomarbeit wurde im Rahmen des Deutsch-Vietnamesischem Auslandsaustauschprogramms an der „Hanoi University of Science“ verfasst. Dieses Vorhaben wurde unterstützt von dem DAAD (Deutschen Akademischen Austausch Dienst), und ist im technischem Bereich des Programms “Wastewater and Solid Waste Management in Provincial Centers“ einzugliedern. Die vorstehende Diplomarbeit beschäftigt sich mit dem aktuellen Klärschlammmanagement in Vietnam und liefert dabei detaillierte Resultate zu verschiedenen Klarschlammtypen aus kommunalen Abwasserbehandlungsanlagen. Bei den Untersuchungen wurden verschiedene Abwasser- und Klärschlammbehandlungsanlagen untersucht, um einen Überblick zu den gebräuchlichen Behandlungsmethoden in Vietnam zu erarbeiten. Zusätzlich wurden die institutionellen und rechtlichen Rahmenbedingungen überprüft. Der Entwurf einer Verordnung zur Verwertung von Klärschlamm in der Landwirtschaft wurde vorgelegt, um eine bestehende rechtliche Lücke in Vietnam zu schließen. Mit dieser Arbeit wurde ein integriertes Konzept entwickelt, welches mittels verschiedene verfahrenstechnische Elemente den Klärschlamm behandelt und darauffolgend das verwertbare Material in ausgewählten landwirtschaftlichen Flächen in einer kontrollierten und umweltschonenden Weise verwertet.:Abbreviations .......................................................................................................................... 4 List of Figures ......................................................................................................................... 5 List of Tables .......................................................................................................................... 6 Acknowledgement .................................................................................................................. 7 Abstract .................................................................................................................................. 8 1 Introduction ................................................................................................................... 10 2 Legal framework for sewage sludge management in Vietnam ................................. 13 2.1 Background ........................................................................................................... 13 2.2 Institutional framework .......................................................................................... 13 2.3 Legal framework.................................................................................................... 15 2.4 Standards .............................................................................................................. 18 2.4.1 Technical standards ...................................................................................... 18 2.4.2 National standards ........................................................................................ 19 2.5 Current situation .................................................................................................... 20 3 Theoretical basis for the concept ................................................................................ 22 3.1 Sewage sludge ...................................................................................................... 23 3.1.1 Sewage sludge types .................................................................................... 27 3.1.2 Quantity .......................................................................................................... 30 3.1.3 Sludge volume ............................................................................................... 30 3.1.4 Sludge composition ....................................................................................... 34 4 Municipal wastewater treatment plants ...................................................................... 47 4.1 DEWATS ............................................................................................................... 47 4.2 Waste water management program .................................................................... 48 4.2.1 Results of sludge analysis ............................................................................ 50 4.3 Learned outcomes ................................................................................................ 54 5 Sludge treatment and disposal options ...................................................................... 56 5.1 Goals of sludge treatment .................................................................................... 56 5.2 Processing elements ............................................................................................ 58 5.2.1 Pre-treatment ................................................................................................. 59 5.2.2 Transportation................................................................................................ 60 5.2.3 Stabilization.................................................................................................... 60 5.2.4 Disinfection .................................................................................................... 65 5.2.5 Removal of water .......................................................................................... 65 5.2.6 Drying ............................................................................................................. 70 5.2.7 Agricultural uses and landscape measures ................................................ 70 5.2.8 Biological re-uses .......................................................................................... 71 5.2.9 Thermal disposal (energy recovery) ............................................................ 74 5.2.10 Land-filling ...................................................................................................... 76 6 Sewage sludge management concept ....................................................................... 78 6.1 Avoidance .............................................................................................................. 79 6.2 Treatment .............................................................................................................. 79 6.2.1 Proposed treatment concept ........................................................................ 81 6.3 Re-use or Disposal ............................................................................................... 84 6.3.1 Small-scale concept ...................................................................................... 85 6.3.2 Medium- and large-scale concept ................................................................ 85 6.4 Conclusion ............................................................................................................. 86 7 Guideline (draft) ............................................................................................................ 88 7.1 Formulation of a guidance document .................................................................. 88 8 Conclusion .................................................................................................................... 89 9 References .................................................................................................................... 92 10 Appendices ................................................................................................................ 97 a) Calculation of sludge amount .................................................................................. 97 b) Guideline (draft) ........................................................................................................ 99 Declaration .......................................................................................................................... 10

Analyse von Gerichtsfällen im Rahmen von Tierseuchen in der Bundesrepublik Deutschland

Die Dissertation befaßt sich mit Gerichtsfällen, in denen Tierseuchen eine Rolle spielen. In jedem dieser Fälle wurde die Aufgabe und Beteiligung des Tierarztes analysiert

Intellectual property and intangible assets: Alternative valuation and financing approaches for the knowledge economy in Luxembourg

With the disappearance of the bank secrecy and loss of e-commerce tax in year 2015, Luxembourg will be confronted to an existential challenge. Therefore, Luxembourgish economy has to reinvent itself and develop new key drivers boosting country's economic growth. Well known for the strong fund industry, Luxembourg needs alternative burst of growth to ensure long-term sustainability. An option could be innovation that arises from a knowledge-based economy. Intellectual property (IP) and intellectual capital (IC) driven companies like Amazon, SES or Netflix have market advantages, create jobs and drive innovation through the use and dissemination of new technology. However, a major problem for innovative companies, whose main enterprise value comprises identifiable or unidentifiable intangible assets, remains the funding. Specifically for Luxembourg, the funding solutions for those companies are very restricted. The trigger according to the funding problem for innovative companies consists in the absence of collaterals. At the lunch period, many OIP and IC driven companies have only small capital resources and their business value persist largely of intangibles. According to this initial situation, banks would today refuse the funding of this innovative business. During the last years, the main focus of the Luxembourgish government was the promotion of Luxembourg as an innovation hub such as the launch of Luxinnovation or the Cluster Initiative. Apart from the state aid program, they missed to consider IP and IC as an economic good that needs long-term support in order to create prospective values. Faced to the previously mentioned capital outflows due to the abandon of the bank secrecy, business of providing fund and consultancy to such innovative business could be a chance for Luxembourgish economy, thus refining their market and serving a very promising niche market. Identifiable or unidentifiable intangible possess and create a huge value and often outperform the value of tangible assets. Therefore an alternative valuation and funding approach in Luxembourg has to be developed. This master thesis deals with the problematic of determining a realistic value of company's intangibles that would give companies not only the access to alternative funding forms, but also to the classical bank loan

Optimizing epigenetic therapies of hematological malignancies : identification of novel epigenetic biomarkers and mechanistic study of 5-aza-2\u27-deoxycytidine

Glutathione S-transferase P (GSTP) 1 and prostaglandin-endoperoxide synthase (PTGS) 2 genes are commonly silenced by promoter hypermethylation in various cancers. However, these epimutations remain poorly investigated in leukemia and lymphoma. We hypothesized that DNA methylation-induced GSTP1 and PTGS2 silencing may be involved in hematological malignancies. Our results demonstrated that methylation- associated silencing of GSTP1 and PTGS2 was found in various leukemia and lymphoma cell lines. A correlation was found between GSTP1 chromatin structure and GSTP1 transcriptional state. Interestingly, PTGS2 hypermethylation was observed in many samples from patient with hematological malignancies presenting reduced PTGS2 expression levels. By extending our study to other epigenetically regulated genes, we observed differential proliferation, cell death and DNA demethylation responses of blood cancer cell lines to the DNA demethylating agent 5-aza-2"-deoxycytidine. In conclusion, we identified DNA methylation signatures that could be promising clinical biomarkers in hematological malignancies. Finally, our study provides critical data for a better understanding of the mechanism of action and effects of 5-aza-2"-deoxycytidine that could provide guidance to predict sensitivity and response for a therapeutic use of this compound against hematological malignancies and potentially other cancers.In Krebszellen liegen die Gene Glutathion-S-transferase P1 (GSTP1) und Prostaglandinsynthase-2 (PTGS2) häufig methyliert vor, jedoch wurden diese Epimutationen in Blutkrebszellen noch kaum untersucht. Wir vermuteten allerdings, dass fehlerhafte Methylierungen eine wichtige Rolle beim Ausschalten dieser Gene in Leukämie- und Lymphomzellen spielen könnte. Unsere Ergebnisse bestätigten diese Annahme und zeigten, dass die Genexpression von GSTP1 und PTGS2 durch die Hypermethylierung der DNA unterdrückt wird. Weiterhin konnte ein Zusammenhang zwischen der GSTP1 Genexpression und Chromatinstruktur hergestellt werden. Interessanterweise konnte die Methylierung des PTGS2 Gens auch in Zellen von Blutkrebspatienten nachgewiesen werden. Die Analyse weiterer epigenetisch regulierter Gene und die Untersuchung der Zellteilung, des Zelltods und der DNA Demethylierung in Blutkrebszellen, welche mit der demethylierenden Substanz 5-Aza-2’-Deoxycytidin behandelt wurden, zeigte dass jede Zelle unterschiedlich auf den Verlust der Methylierung reagiert. Schlussfolgernd sind die Methylierungsmuster der hier beschriebenen Gene vielversprechende Blutkrebsmarker. Weiterhin ermöglichen die Ergebnisse dieser Studie einen Einblick in die Wirkungsweise von 5-Aza-2’-Deoxycytidin in Blutkrebszellen. Diese Erkenntnisse könnten nicht nur eine wichtige Rolle für die Diagnose sondern auch für die Behandlung von Blutkrebs oder anderen Krebsarten mit dieser demethylierenden Substanz spielen

QAMaster: A new software framework for phantom-based computed tomography quality assurance

The regular evaluation of imaging performance of computed tomography (CT) scanners is essential for CT quality assurance. For automation of this process, the software QAMaster was developed at the Universitätsklinikum Erlangen, which provides based on CT scans of the CatPhan® 504 (The Phantom Laboratory, Salem, USA) automated image quality analysis and documentation by evaluating CT number accuracy, spatial linearity, uniformity, contrast-noise-ratio, spatial resolution, noise, and slice thickness. Dose assessment is supported by calculations of the weighted computed tomography dose index (CTDIw) and weighted cone beam dose index (CBDIw). QAMaster was tested with CatPhan® 504 scans and compared to manual evaluations of these scans, whereby high consistency of the respective results was observed. The CT numbers, spatial linearity, uniformity, contrast-noise-ratio, noise, and slice thickness deviated by only (0.13 ± 0.25) HU, (0.02 ± 0.05) mm, (−0.01 ± 0.03)%, 0.8 ± 1.8, (0.131 ± 0.05) HU, and (0.004 ± 0.005) mm between both evaluations, respectively. The QAMaster results for spatial resolution did not differ significantly (p = 0.34) from the CatPhan® 504 based manual resolution assessment. Dose computations were fully consistent between QAMaster and manual calculations. Thus, QAMaster proved to be a comprehensive and functional software for performing an automated CT quality assurance routine. QAMaster will be open-source after its release

Messung, Bewertung und Einflussfaktoren der Trübung in der Wassersäule – Schlussfolgerungen für einen die Sedimentakkumulation optimierenden Küstenschutz auf Hallig Langeneß

Online First, geplanter Druck 202

Technical evaluation of the cone‐beam computed tomography imaging performance of a novel, mobile, gantry‐based X‐ray system for brachytherapy

Abstract Purpose A novel, mobile cone‐beam computed tomography (CBCT) system for image‐guided adaptive brachytherapy was recently deployed at our hospital as worldwide first site. Prior to the device's clinical operation, a profound characterization of its imaging performance was conducted. This was essential to optimize both the imaging workflow and image quality for achieving the best possible clinical outcomes. We present the results of our investigations. Methods The novel CBCT‐system features a ring gantry with 121 cm clearance as well as a 43.2 × 43.2 cm2 flat‐panel detector, and is controlled via a tablet‐personal computer (PC). For evaluating its imaging performance, the geometric reproducibility as well as imaging fidelity, computed tomography (CT)‐number accuracy, uniformity, contrast‐noise‐ratio (CNR), noise characteristics, and spatial resolution as fundamental image quality parameters were assessed. As dose metric the weighted cone‐beam dose index (CBDIw) was measured. Image quality was evaluated using standard quality assurance (QA) as well as anthropomorphic upper torso and breast phantoms. Both in‐house and manufacturer protocols for abdomen, pelvis, and breast imaging were examined. Results Using the in‐house protocols, the QA phantom scans showed altogether a high image quality, with high CT‐number accuracy (R2 > 0.97) and uniformity (<12 Hounsfield Unit (HU) cupping), reasonable noise and imaging fidelity, and good CNR at bone–tissue transitions of up to 28:1. Spatial resolution was strongly limited by geometric instabilities of the device. The breast phantom scans fulfilled clinical requirements, whereas the abdomen and pelvis scans showed severe artifacts, particularly at air/bone–tissue transitions. Conclusion With the novel CBCT‐system, achieving a high image quality appears possible in principle. However, adaptations of the standard protocols, performance enhancements in image reconstruction referring to artifact reductions, as well as the extinction of geometric instabilities are imperative

Quality assurance and long-term stability of a novel 3-in-1 X-ray system for brachytherapy

Purpose A novel, mobile 3-in-1 X-ray system featuring radiography, fluoroscopy, and cone-beam computed tomography (CBCT) has been launched for brachytherapy recently. Currently, there is no quality assurance (QA) procedure explicitly applicable to this system equipped with innovative technologies such as dynamic jaws and motorized lasers. We developed a dedicated QA procedure and, based on its performance for a duration of 6 months, provide an assessment of the device's stability over time. Methods With the developed QA procedure, we assessed the system's planar and CBCT-imaging performance by investigating geometric accuracy, CT-number stability, contrast-noise-ratio, uniformity, spatial resolution, low-contrast detectability, dynamic range, and X-ray exposure using dedicated phantoms. Furthermore, we evaluated geometric stability by using the flexmap-approach and investigated the device's laser- and jaw-positioning accuracy with an in-house test phantom. CBCT- and planar-imaging protocols for pelvis, breast, and abdomen imaging were examined. Results Planar- and CBCT-imaging performances were widely stable with a geometric accuracy ≤1 mm, CT-number stability of up to 46 HU, and uniformity variations of up to 48 HU over time. For planar imaging, low-contrast detectability and dynamic range exceeded current recommendations. Although geometric stability was considered tolerable, partly substantial positioning inaccuracies of up to more than 120 mm and −13 mm were obtained for lasers and jaws, respectively. X-ray exposure showed small variations of ≤0.56 μGy and ≤0.76 mGy for planar- and CBCT-imaging, respectively. The conductance of the QA procedure allowed a smooth evaluation of the system's overall performance. Conclusion We developed a QA workflow for a novel 3-in-1 X-ray system allowing to assess the device's imaging and hardware performance. The system showed in general a reasonable imaging performance and stability over time, whereas improvements regarding laser and jaw accuracy are strictly required